Psychology Implies Paternalism? Bounded Rationality may Reduce the Rationale to Regulate Risk-Taking

Behavioral economists increasingly argue that violations of rationality axioms provide a new rationale for paternalism – to “de-bias” individuals who exhibit errors, biases and other allegedly pathological psychological regularities associated with Tversky and Kahneman’s (in Science 185:1124–1131, 1974) heuristics-and-biases program. The argument is flawed, however, in neglecting to distinguish aggregate from individual rationality. The aggregate consequences of departures from normative decision-making axioms may be Pareto-inferior or superior. Without a well-specified theory of aggregation, individual-level biases do not necessarily imply losses in efficiency. This paper considers the problem of using a social-welfare function to decide whether to regulate risk-taking behavior in a population whose individual-level behavior may or may not be consistent with expected utility maximization. According to the social-welfare objective, unregulated aggregate risk distributions resulting from non-maximizing behavior are often more acceptable (i.e., lead to a weaker rationale for paternalism) than population distributions generated by behavior that conforms to the standard axioms. Thus, psychological theories that depart from axiomatic decision-making norms do not necessarily strengthen the case for paternalism, and conformity with such norms is generally not an appropriate policy-making objective in itself.     

Medicaid Home and Community-Based Services: How Consumer Access Is Restricted by State Policies

State Medicaid programs have expanded home and community-based services (HCBS). This article compares trends and variations in state policies for Medicaid HCBS programs in 2005 and 2010. State limitations on financial eligibility criteria and service benefits have remained stable. Although the use of consumer direction, independent providers, and family care providers has increased, some states do not have these options. The increased adoption of state cost control policies have led to large increases in persons on waiver wait lists. Access could be improved by standardizing and liberalizing state HCBS policies, but state fiscal concerns are barriers to rebalancing between HCBS and institutional services.     

Model free audit methodology for bias evaluation of tumour progression in oncology

Many oncology studies incorporate a blinded independent central review (BICR) to make an assessment of the integrity of the primary endpoint, progression free survival. Recently, it has been suggested that, in order to assess the potential for bias amongst investigators, a BICR amongst only a sample of patients could be performed; if evidence of bias is detected, according to a predefined threshold, the BICR is then assessed in all patients, otherwise, it is concluded that the sample was sufficient to rule out meaningful levels of bias. In this paper, we present an approach that adapts a method originally created for defining futility bounds in group sequential designs. The hazard ratio ratio, the ratio of the hazard ratio (HR) for the treatment effect estimated from the BICR to the corresponding HR for the investigator assessments, is used as the metric to define bias. The approach is simple to implement and ensures a high probability that a substantial true bias will be detected. In the absence of bias, there is a high probability of accepting the accuracy of local evaluations based on the sample, in which case an expensive BICR of all patients is avoided. The properties of the approach are demonstrated by retrospective application to a completed Phase III trial in colorectal cancer. The same approach could easily be adapted for other disease settings, and for test statistics other than the hazard ratio. Copyright © 2015 John Wiley & Sons, Ltd.     

The Cost of High Unemployment

In response to R. A. B. Leaper's challenge in the last issue of this journal we present a report which we have just prepared for the BBC North-East. We believe that a better understanding of the costs of high unemployment to the country is needed to inform decisions on how much we can afford to pay to tackle the problem. In the final section of the paper we show how this evidence can be of value in costing policy options.
The last detailed costings of unemployment were published in 1982 for the financial year 1981/82. In February 1982 it appears that a political decision was taken not to publish the latest Treasury estimate updating their 1981 calculations. Since then numerous parliamentary questions on the subject have received very limited answers disputing the validity of the whole exercise.     

Relational Aggression in Middle Childhood: Predictors and Adolescent Outcomes

This study examined gender differences in the level and developmental course of relational aggression in middle childhood, as well as early predictors and outcomes of relational aggression, after controlling for concurrent physical aggression. Relational (RAgg) and Physical aggression (PAgg) scores for 558 boys and 545 girls at the ages of eight to 11 in the NICHD Study of Early Child Care and Youth Development (SECCYD) were created by combining the highest rating for each item across mother and teacher reports. Longitudinal analyses were conducted using latent curve models of RAgg with PAgg as a time‐varying covariate, with all parameters allowed to vary by gender. Boys and girls had different growth parameters of RAgg. Girls' RAgg intercept was higher, and the slope was not different from zero; boys' RAgg intercept was lower, and the slope declined. Mother–child conflict in early childhood predicted RAgg intercept for both boys and girls, but maternal harsh control and sensitivity were also uniquely predictive for girls whereas center care was uniquely predictive for boys. RAgg intercept predicted adolescent self‐reports of depression for girls and delinquency and risk‐taking for both boys and girls; the magnitude of the association with risk taking was significantly greater for boys.     

A cumulative ecological–transactional risk model of child maltreatment and behavioral outcomes: Reconceptualizing early maltreatment report as risk factor

The current analysis was designed to critically examine the tendency to focus on child maltreatment as a unique risk factor and test the resulting assumption of a direct causal relationship between early maltreatment and later behavioral problems. The variation seen in behavioral outcomes among children reported for maltreatment early in life led us to hypothesize that the cumulative level of risk facing children and their families can, at least in part, account for that variation in outcome. Participants were 242 mothers of predominantly at-risk newborn infants who were interviewed shortly after giving birth. The State Central Registry of Maltreatment was then reviewed over each child's first four years of life to assess for early maltreatment. Following the neonatal interviews, mothers completed the Child Behavior Checklist when their children were 4, 6, 8, 10 and 12 years-of-age. Although early maltreatment report does appear to be important to early child functioning, the cumulative level of risk more strongly predicts long-term clinical behavioral difficulty. High-risk children who were not reported for maltreatment by age 4 demonstrate greater behavioral problem trajectories than did low-risk children with a maltreatment report. Maltreatment itself may be best conceptualized as an important, but not singularly so, risk factor for later behavioral problems. In focusing directly on reported maltreatment, our child protective systems may be paying too little attention to what else is going wrong in the lives of children and targeting intervention efforts in the wrong direction. When it comes to early maltreatment our child protective policy and practice need to broaden their lenses to include greater emphasis on overall family functioning, stress and well-being. Early maltreatment, it seems, may be a symptom of more profound problems in the early environments of our most vulnerable children, rather than the problem itself.     

Social work in mental health services: A survey of the field

Abstract

A survey of social workers employed in mental health services was conducted in Victoria in mid-1997. Approximately 300 social workers were identified as working in the sector. About half were employed in adult clinical services, 23% in psychiatric disability services, 12.4% in Child and Adolescent Mental Health Services, and the rest in a range of other services. More than 90% worked in a community based service or team. The number of entry-level (SW I) positions in clinical services was found to have declined over the last ten years from 61 to 14, resulting in a lack of opportunities for social workers to gain experience in base grade positions, and difficulty in recruiting to SW II positions. Major issues of concern reported by social workers included: the lack of accommodation and other community resources for consumers; diminished opportunities for professional development, supervision, and discipline-specific training; lack of professional recognition; increasing workloads; and organisational emphasis on throughput rather than quality.