Psychotherapy dropouts: differences by modality, license, and DSM-IV diagnosis

Dropouts are frequent in mental health care. Several client factors have been identified as dropout predictors, including ethnic minority status, race, low SES, and more severe symptoms. Research on therapist and process variables is less common, and findings are inconsistent. This study used administrative data for 434,317 patients from CIGNA Behavioral Health (CIGNA) to examine dropout rates by profession of provider, therapy modality, and DSM-IV diagnosis. Results indicate that among the providers, MFTs have the lowest dropout rates in the CIGNA network. Of the therapy modalities, individual therapy is associated with lower dropout rates than family therapy. Mood and anxiety disorders have lower dropout rates than other diagnosis categories, while schizophrenia, psychotic, and substance use disorders have the highest dropout rates.     

The Vital Statistics Method of Estimating Net Migration By Age Cohorts

The focus of this paper is the development and testing of a method of estimating deaths which occur during a decade to aging birth and death cohorts, so that it may be possible to estimate net migration by the vital statistics (VS) method for age cohorts. Until now the VS method has been used only in making estimates of total net migration.The results obtained by using the VS method for age cohorts show that (1) the average census survival rate (CSR) method generally yields algebraically lower estimates of net migration than does the VS method; but (2) there are some striking exceptions which are apparently associated with errors in census enumeration by age, sex, and color. Comparisons between the average CSR and the VS methods are shown, by age, for both the North Carolina and the coterminous United States populations.A cursory examination of these comparisons suggests that the exclusive use of the VS method in estimating net migration for age cohorts may lead to substantial error. Finally, the magnitude of these errors in estimating net migration, as well as in census enumeration, can be roughly approximated if it is assumed that the use of the CSR method yields reasonably accurate estimates of net migration.     

Effect of census errors on the measurement of net migration

This paper traces the history of the use of vital statistics, survival rates, and ratios in the estimation of net migration from one decade to another. Net migration studies by Hart (1921); Baker (1933) ; Hamilton (1934); Thornthwaite (1934); Lively and Taeuber (1939) ; Henderson (1943); Hamilton and Henderson (1943); Hamilton (1951); Siegel and Hamilton (1952); Lee and Bowles (1954); Price (1955); Lee, Miller, and others (1957); Hamilton (1959); Zachariah (1962); Tarver (1962); Shryock (1964); Eldridge (1965); Hamilton (1965); and the United States Census Bureau are cited as the principal users of various residual methods of estimating net migration. All these demographers have either implicitly or explicitly recognized that errors in census enumeration and in the registration of births and deaths have been reflected in errors of estimated net migration.The underlying characteristic of all the methods used by these demographers has been the estimation of net migration as a residual obtained by subtracting natural increase in an area during a decade from the population change during the same decade. This method has been most generally stated in the classic formula {fx394-1} This formula has been used both with total populations and with aging cohorts. The principal variations of the basic formula have involved the use of life table and census survival ratios as a means of measuring natural increase (B - D), or of estimating "expected" populations assuming no migration. The main points of controversy have involved life table v. censm survival ratios, assumptions regarding the similarity in national and state census enumeration errors, and ways and means of estimating the errors involved in estimates of migration and of migration rates by the various methods.Daniel O. Price (1955) and Zachariah (1962) made important mathematical contributions and attempted to evaluate the errors involved in the me of census survival rates. Eldridge (1965) discovered that, in the United States between 1950 and 1960, the use of the census survival rate method usually gave much lower estimates of net migration than did the classic vital statistic method. Hamilton (1965), using some suggestions by Hope T. Eldridge, developed a mathematical theory or explanation of not only why the CSR estimates were usually lower than the VS estimates but also why the CSR estimates would usually give closer estimates on the true net migration than would the EVS method, which itself is subject to errors of census enumeration and of underregistration of births and deaths. The author also discusses the effect of improvement in census enumeration between 1950 and 1960 on estimates of net migration and derives a generalized formula which takes the timing of migration into consideration.The author acknowledges with sincere appreciation important constructive suggestions made by Dr. Hope T. Eldridge, Population Studies Center, University of Pennsylvania, and the authors of the many papers used as original material. This paper is a revision of a paper read before the annual meeting ot the Population Association of America, Hotel Roosevelt, New York, New York, April 29-30, 1966. Contribution from the Departments of Sociology and Experimental Statistics, North Carolina Agricultural Experiment Station, North Carolina State University. Published with the approval of the Director of Research as Paper No. 2227 of the Journal series.     

Childhood Victimization,Cognitive Schemas,and Unwanted Consensual Sex Among College Students

Objective: Unwanted consensual sex (UCS)—freely consenting to sex that is neither wanted nor desired—is largely excluded from campus programming and the literature on sexual behavior. The present study expands on previous research to examine the relation between childhood victimization experiences and UCS.

Methods: Data were gathered using an online survey of college students.

Results: In the past year, 43% percent of 587 college students who engaged in sexual activity also engaged in UCS at least once. Childhood victimization was modestly related to frequency of UCS. The relation between childhood victimization and UCS was mediated by disconnection/rejection schemas (e.g., beliefs that one’s needs will not be met by others).

Conclusions: Results suggest that altering cognitive schemas through evidence-based psychotherapy may interrupt the relation between childhood victimization and engagement in UCS.     

Preference for same-race health care providers and perceptions of interpersonal discrimination in health care

This article examines black Americans' preference for black health care providers. Using data from a national survey, we assess how blacks 'perceptions of discrimination are related to preference for same-race health care providers. Overall, the belief that discrimination is frequent in different-race doctor-patient dyads is associated with greater preference for a same-race provider However; the belief that discrimination occurs regardless of a doctor's race reduces preference for a same-race provider Finally, general perceptions of discrimination are distinct from concerns about personally being treated unfairly, and low personal concern about unfair treatment reduces preference for a same-race provider among those who believe that interpersonal discrimination occurs frequently. These results suggest a complex picture of how perceptions of discrimination influence preferred race of health care provider among blacks in the United States.     

Critical context and international intrafirm best-practice transfers

The sharing and transfer of knowledge and best practices across the organization have long been recognized as a critical driver of a firm's capabilities and performance. In fact, Gupta and Govindarajan (1991) maintained that MNCs exist primarily because of their superior ability to transfer knowledge internally relative to the ability of markets. This paper examines factors that influence the success of intrafirm, cross-border knowledge transfers. We investigate the critical context similarity between best-practice source and recipient units and the impact of critical context similarity on transfer eventfulness. We argue that best practices are embedded within a set of 5 central contextual elements, which are critical to the firm's ability to utilize them. A model is developed and tested that explains the impact of context in enabling or inhibiting best-practice transfers. Our findings suggest that critical context dissimilarity inhibits best-practice transfers. The impact of congruence among the source and recipient units along the dimensions of culture, strategy, decision-making, environment and technology affects the eventfulness of the transfer in terms of time, budget and satisfaction. Additionally, the effect of the fit between the practice characteristics, and the transfer mechanisms employed, is examined.     

Above and Below the Water: Social/Ecological Transformation in Northwest Newfoundland

Marine fisheries and fishing societies develop around the resources provided by a particular ecosystem. As they exploit these resources, fisheries transform the ecosystem, which pushes fishery and society to adapt in turn. This process is illustrated by fisheries, ecological and social data tracking dramatic changes on Newfoundland's Northern Peninsula and its adjacent marine ecosystem, the northern Gulf of St. Lawrence. There a longstanding fishery for cod and other groundfish collapsed in the 1990s, and was replaced by fisheries targeting invertebrates. The new invertebrate fisheries have different socioeconomic characteristics than the former groundfish fisheries. The shift in target species reflects deep ecological changes that were underway at least a decade before official recognition of the crisis. Our analysis of biological data reveals that the main ecological changes occurred during the glory years of the 1980s, when Newfoundland's domestic fisheries were at their peak. Overfishing and interactions with adverse climatic conditions drove the changes. As the ecosystem transformed, human population declined due to outmigration, and social indicators show signs of distress. Accounts by outport residents paint a generational picture of social change.