THE THERAPEUTIC ALLIANCE IN HOME‐BASED FAMILY THERAPY: IS IT PREDICTIVE OF OUTCOME?

This study examined the association between the therapeutic alliance in family therapy and changes in symptom distress, interpersonal relationships, and family coping. The participants (N = 81) were members of low socioeconomic status families referred to a university clinic for in-home family therapy. Participants completed the Outcome Questionnaire, Family Crisis Oriented Personal Evaluation, and the Family Therapy Alliance questionnaires. Regression analyses revealed that the therapeutic alliance explained 19% of the variance in symptom distress changes for mother, 55% for fathers, and 39% for adolescents. The implications of these findings for practicing and researching family therapy are presented.     

Are Some Risk Comparisons More Effective Under Conflict?: A Replication and Extension of Roth et al.

Despite many claims for and against the use of risk comparisons in risk communication, few empirical studies have explored their effect. Only one study, published by Roth et al. in this journal in 1990, has tested the 1988 predictions by Covello et al. as to the public's relative preferences for 14 kinds of risk comparisons as they might be used by a factory manager to explain risks of his ethylene oxide plant. That study found no correlations between the Covello predictions and seven different measures of "acceptability" of Covello's examples of each type of comparison. However, two critics of the Roth study, as well as its own authors, suggested that a scenario involving local risks, a conflict-ridden situation, and a plant manager unknown to the townspeople might better evoke Covello-like preferences than the distant, calm, friends-involving scenario used by Roth. The research reported here replicated the Roth study using the same scenario, risk comparison examples, and evaluation measures, and added a second scenario intended to replicate the conditions suggested by critics. Over 200 New Jersey residents answered the study questionnaire. The replication scenario reproduced Roth's results, and the conflict scenario also evoked no rankings correlated with Covello's predictions. Furthermore, neither agreement nor disagreement with five statements representing "conflict"--respondents' reports that the industrial-plant scenario made them angry, they lived near industry, they were concerned about industrial risks, people in their home town were angry about industrial pollution, and they worried "frequently" about long-term effects of pollution--correlated with Covello's predictions. Over half of all ratings ascribed to the comparisons in aggregate were positive, and most detailed comments offered by respondents also were positive, despite many criticisms and suggestions for their improvement. The wide variability in individuals' rankings also undermines the notion of any single ranking of preferred comparisons. These findings have implications for use of risk comparisons, but also reveal the inaccuracy of the field's assumptions about public reaction to industrial risk information, including risk comparison.     

Do Reports on Drinking Water Quality Affect Customers' Concerns? Experiments in Report Content

The Safe Drinking Water Act Amendments of 1996 required U.S. utilities to report on drinking water quality to their customers annually, beginning in fall 1999, on the assumption that such reports would alert them to quality problems and perhaps mobilize pressure for improvement. A random sample of New Jersey customers read alternative versions of a water quality report, in an experiment on reactions to water quality information under U.S. Environmental Protection Agency (USEPA) rules. Experiment design was 2 x 3 + 1: two versions each--one with, one without, a violation of a health standard--of a report that was (1) Qualitative (without water quality numbers, thus not meeting USEPA rules); (2) Basic, with minimal information meeting the rules; or (3) Extended, adding reading aids and utility performance information; plus a control instrument without any hypothetical report. Results of ANOVA suggest the reports will have less effect than hoped or feared. These manipulations were successful: people reading the Qualitative versions were less likely to say that the report gave the amounts of substances found in the water, and those reading Violation versions were more likely to report a violation of a health standard. The main differences in responses to the report involved the judged adequacy of the information, and to a lesser extent responses on a Concern scale (constructed from measures of concern, judged risk, clean-up intentions, distrust of utility information, and doubt that the utility was doing all it could to improve water quality). Overall judgments of water quality and utility performance did not change, either relative to the controls or in before versus after responses. Qualitative reports performed worse than others, confirming the decision to have utilities report actual contaminant levels. Extended reports did only slightly better than the Basic versions on these measures. Many respondents had trouble identifying the presence or absence of substance amounts or violations, despite their seeming obviousness (e.g., in a "bottom line" summary on the front page of each report), suggesting many were not processing this information carefully. However, the pattern of responses for those who accurately identified the presence or absence of substance amounts or violations did not differ substantially from that for the group as a whole. Generic risk beliefs (serious local environmental problems; lack of control over risks to one's health) dominated demographic variables, attitudes toward utility water quality or trustworthiness, and the content and format of water quality reports in influencing concern about drinking water quality. Previous empirical and theoretical evidence for lack of change in public risk attitudes due to one-time or infrequent communications--e.g., role of personal experience, perseverance of prior trust or distrust--seems to be confirmed for annual water quality reports.     

Communicating Worst-Case Scenarios: Neighbors'' Views of Industrial Accident Management

The prospect of industrial accidents motivated the U.S. Congress to require in the Clean Air Act of 1990 that manufacturing facilities develop Risk Management Plans (RMP) to submit to the U.S. Environmental Protection Agency (USEPA) by July 1999. Industry worried that the requirement to communicate to the public a "worst-case scenario" would arouse unnecessary and counterproductive fears among industry neighbors. We report here the results of focus groups and surveys with such neighbors, focusing particularly upon their reactions to messages about a hypothetical worst-case scenario and management of these risks by industry, government, and other parties. Our findings confirmed our hypotheses that citizens would be skeptical of the competence and trustworthiness of these managers and that this stance would color their views of industrial-facility accident risks. People with job ties to industry or who saw industrial benefits to the community as exceeding its risks had more positive views of industrial risks, but still expressed great concern about the risk and doubt about accident management. Notwithstanding these reactions, overall respondents welcomed this and other related information, which they wanted their local industries to supply. Respondents were not more reassured by additional text describing management of accidents by government and industry. However, respondents did react very positively to the concept of community oversight to review plant safety. Claims about the firm's moral obligation or financial self-interest in preventing accidents were also received positively. Further research on innovative communication and management of accident risks is warranted by these results, even before recent terrorist attacks made this topic more salient.     

Illinois's child welfare research agenda: an approach to building consensus for practice-based research

This article presents a consensus-building initiative to develop a statewide research agenda that responds to the needs of Illinois's child welfare community. Researchers conducted this process through a university-community partnership to engage those interested in child welfare services. The process and findings resulted in a living document that will guide child welfare research throughout the state. Findings of the inquiry suggest that the development of best practice models may be one of the most important contributions research can make to practice.     

More harm than good? Diagnostic codes for child and adult abuse

This study sought to understand the reasons for the lack of use of ICD diagnostic codes for child and adult abuse. New Jersey professionals were recruited to participate in three focus groups on child abuse, adult or primarily woman abuse, and elder abuse. Participants included health care providers, advocates from the community, and representatives of state agencies and the insurance industry. Concerns about coding abuse included further jeopardizing victims/patients, diagnostic uncertainty, and lack of resources. Members of the child abuse group were somewhat more receptive to coding abuse. Reasons to code, such as for documentation and reimbursement were discussed and rebutted. Most participants concluded that use of the abuse codes should be judicious because they have the potential to do more harm than good. More research is needed on the implications of coding for victims/patients along with medical education in the identification of abuse in general and coding abuse in particular.