THE EFFICACY AND EFFECTIVENESS OF MARITAL AND FAMILY THERAPY: A PERSPECTIVE FROM META-ANALYSIS

This article reviews the major findings from a multiproject meta-analysis of the effects of marital and family therapy (MFT). Across 163 randomized trials, MFT demonstrates moderate, statistically significant, and often clinically significant effects. No orientation is yet demonstrably superior to any other, nor is MFT superior to individual therapy. Cost effectiveness information is scant in these 163 studies, but supportive. Randomized experiments yield very different answers from nonrandomized experimental studies of the effects of MFT, calling into question whether we should mix the two in reviews. We have also found several new differences in the ways that marital therapy (MT) and family therapy (FT) studies are conducted, making them harder to compare. Finally, important questions still exist about whether any psychotherapy, including MFT, yet has sufficient information about how well research generalizes to everyday clinical practice.     

Scheduling Updates of Probabilistic Risk Assessments: The Arkansas Nuclear One-Unit 1 Experience

This paper presents the results of a study that identified how often a probabilistic risk assessment (PRA)should be updated to accommodate the changes that take place at nuclear power plants. Based on a 7-year analysis of design and procedural changes at one plant, we consider 5 years to be the maximum interval for updating PRAs. This conclusion is preliminary because it is based on the review of changes that occurred at a single plant, and it addresses only PRAs that involve a Level 1 analysis (i.e., a PRA including calculation of core damage frequency only). Nevertheless, this conclusion indicates that maintaining a useful PRA requires periodic updating efforts. However, the need for this periodic update stems only partly from the number of changes that can be expected to take place at nuclear power plants–changes that individually have only a moderate to minor impact on the PRA, but whose combined impact is substantial and necessitates a PRA update. Additionally, a comparison of two generations of PRAs performed about 5 years apart indicates that PRAs must be periodically updated to reflect the evolution of PRA methods. The most desirable updating interval depends on these two technical considerations as well as the cost of updating the PRA. (Cost considerations, however, were beyond the scope of this study.)     

The Approved Social Worker -- Reflections on Origins

Correspondence to Pauline M. Prior, Department of Social Policy and Social Work, University of York, Heslington, York YO1 5DD. Summary The aim of this paper is to examine the role of social workersunder current mental health law, in order to see if the adventof the Approved Social Worker (ASW) represents any more thanthe re-appearance of old concepts in a new guise. It is arguedthat it is impossible for the ASW to be anything more than anupdated version of the Relieving Officer of the last century,in view of the fact that the Mental Health Act 1983 does notprovide a clear mandate for an effective professional advocateon behalf of mentally ill people.     

The analysis of incomplete data using stochastic covariates

In the development of many diseases there are often associated random variables which continuously reflect the progress of a subject towards the final expression of the disease (failure). At any given time these processes, which we call stochastic covariates, may provide information about the current hazard and the remaining time to failure. Likewise, in situations when the specific times of key prior events are not known, such as the time of onset of an occult tumour or the time of infection with HIV-1, it may be possible to identify a stochastic covariate which reveals, indirectly, when the event of interest occurred. The analysis of carcinogenicity trials which involve occult tumours is usually based on the time of death or sacrifice and an indicator of tumour presence for each animal in the experiment. However, the size of an occult tumour observed at the endpoint represents data concerning tumour development which may convey additional information concerning both the tumour incidence rate and the rate of death to which tumour-bearing animals are subject. We develop a stochastic model for tumour growth and suggest different ways in which the effect of this growth on the hazard of failure might be modelled. Using a combined model for tumour growth and additive competing risks of death, we show that if this tumour size information is used, assumptions concerning tumour lethality, the context of observation or multiple sacrifice times are no longer necessary in order to estimate the tumour incidence rate. Parametric estimation based on the method of maximum likelihood is outlined and is applied to simulated data from the combined model. The results of this limited study confirm that use of the stochastic covariate tumour size results in more precise estimation of the incidence rate for occult tumours.     

Robustness of testing the equality of two slopes in simple linear structural relationships

The usual test of the equality of two slopes in a simple structural relation-ship is the test formed from the normal approximation using the Fisher information matrix, assuming two explanatory variables are independent. This paper examines the robustness if the explanatory variables are, in fact, dependent. A more efficient estimator is derived for a matched pair situation.     

Comparison of three estimators of the number of species

We consider estimation of the number of cells in a multinomial distribution. This is one version of the species problem: there are many applications, such as the estimation of the number of unobserved species of animals; estimation of vocabulary size, etc. We describe the results of a simulation comparison of three principal frequent-ist' procedures for estimating the number of cells (or species). The first procedure postulates a functional form for the cell probabilities; the second procedure approxi mates the distribution of the probabilities by a parametric probability density function; and the third procedure is based on an estimate of the sample coverage, i.e. the sum of the probabilities of the observed cells. Among the procedures studied, we find that the third (non-parametric) method is globally preferable; the second (functional parametric) method cannot be recommended; and that, when based on the inverse Gaussian density, the first method is competitive in some cases with the third method. We also discuss Sichel's recent generalized inverse Gaussian-based procedure which, with some refine ment, promises to perform at least as well as the non-parametric method in all cases.     

Benefits of preventive dentistry in children: Cost factors and public policy

Dental caries in children is now recognized as a preventable disease. The use of fluoride and sealants has produced a major reduction in caries prevalence among school aged children in the United States and other countries. A portion of the child population who are educationally and socioeconomically disadvantaged are not fully receiving these benefits. Public policy, insurance and medicaid groups must be made aware of these preventative measures and strategies developed to implement them.     

The Effects of ROTC Program Participation on Socioeconomic Status and Life Satisfaction*

Using mail survey data based on a stratified systematic sample [N = 686] of 1983–1988 graduates of a medium-sized state university, this research evaluates whether ROTC program participation constitutes an independent source of human capital in civilian labor markets by comparing postgraduate earnings (annual income), prestige and authority, and life satisfaction of ROTC program participants with those of nonparticipants. The results revealed no statistically significant ROTC program participation effects, independent of subsequent military status. ROTC program participation paid off in terms of occupational prestige and authority for those on active duty, but not for those in national guard or reserve units. Neither ROTC participation nor current military status affected income or life satisfaction levels.     

A solution of the externality problem using strategic matching

This paper develops a Coase-like solution of the problem of inducing Pareto optimal behavior in the presence of reciprocal externalities. In place of Coasean direct compensation between the parties to an externality problem, actors strategically match each other's externality-producing activity, and thus induce counterparts to internalize the external benefits or costs of their actions. The analysis suggests a general framework for analyzing social interactions in the presence of reciprocal externalities. As an application of the theory, a solution of the duopoly problem is noted.We are indebted to L. Danziger, D. Samet, participants in faculty seminars at Bar-Ilan and New York Universities and at the University of Maryland, and two anonymous referees for helpful comments and discussions. All remaining errors are our own.