Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Mental health program evaluation: Where you start?

Seduced by the elegance, sophistication and jargon characteristic of new developments in applied research, practicing evaluators are in danger of becoming distracted from achievement of their evaluative goal: that of providing timely, reliable and useful data to program management to facilitate rational data-based decision-making. To avoid such seduction, the author advocates adaptation of simple, inexpensive and efficient evaluative methods tailored to organizational needs and presentation of findings in language readily understood by constituent groups. Likewise, insistance by evaluators upon maintenance of a strict role boundary — that is, limiting role functioning exclusively to those tasks considered evaluation — may be dysfunctional. Rather than detract from accomplishment of his goals, the author maintains that such participation allows development of skills, insights and staff relationships which enhance the evaluator's effective functioning within the organizational context and contribute to organizational acceptance and use of his evaluative results.     

Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

Planning for permanency planning in foster care

The perceived severity of the problem of “drift” in the foster care system has encouraged agencies nationwide to accept permanency planning, but perhaps with limited attention to the planning process. This article examines the phenomenon of permanency planning from a planning perspective by focusing on: (a) definition of the permanency planning problem, (b) understanding of issues relevant to permanency planning (caseworker, program and systemic), (c) appreciation of the operational context (political, economic and social factors), and (d) evaluation of available options and possible consequences in developing or improving a permanency planning program. Permanency planning is not a simple, ready-made program applicable to any situation; it involves coordinated efforts by workers, service systems, and society in general, and requires time, commitment and resources. Successful planning for permanency planning can permit more children to grow up in homes providing continuity and stability.     

Ethical dilemmas in evaluating programs with family court related clients

Two ethical dilemmas are discussed; breaching client confidentiality in order to intervene in the client's illegal behavior, and defining the role of evaluator as expert witness. The evaluation context concerns a combined program development and evaluation project with clients involved in family court proceedings for child abuse or neglect. Different perspectives, approaches, and experiences in resolving each dilemma are reviewed. The conclusion argues that approaches to ethical dilemmas in evaluation projects must go beyond techniques to disguise data, to include an assessment of the values and value commitments connected to the different roles an evaluator must perform.     

Commodity prices and the world distribution of income

Some advocates of a new international economic order recommend raising prices of commodities exported by developing countries as a means of reducing the inequality of world income distribution. A simulation model using commodity trade data and income distribution data for 68 industrial and developing countries examines this policy alternative. Initial data compilation reveals that internal inequality is as important as international: The world income share of the poorest 40% of people would be twice as high in the absence of intracountry inequality. Calculations using actual price experience in the “great inflation” of 1972–1975 show that despite the large relative price changes for some commodities (especially oil), these changes left the world size distribution of income virtually unchanged. Separate policy simulations show that even a quadrupling of the price of ali “equalizing” commodities (those mainly exported by LDCs) would leave the size distribution of world income practically unaltered (even under optimistic assumptions about intracountry distributional incidence), although some individual LDCs would gain. Increasing commodity prices therefore appears to be an ineffective means of increasing international equity, quite apart from questions about the feasibility of cartels or commodity agreements.     

The efficacy of early intervention programs for children with organic impairment: A quantitative review

The results of studies examining the effectiveness of early intervention for infants and children with organic impairment and developmental delay were reviewed using recently developed quantitative methods that treat the literature review process as a unique type of scientific inquiry. Thirty-eight studies meeting certain predetermined criteria were included in the review. The 38 studies contained a total of 118 statistical hypothesis tests that evaluated the effectiveness of early intervention. An analysis of these tests based on the calculation of effect sizes revealed that subjects receiving early intervention performed better on a wide range of dependent measures than subjects not receiving intervention. The outcomes were found to be related to several design and study characteristics. Larger effect sizes were associated with preexperimental designs, and also with studies in which the internal validity was rated as poor. Several other design variables such as how subjects were assigned to conditions and how the dependent measure was recorded were related to study outcome as measured by effect size. The conclusion was made that an accurate interpretation of the early intervention research literature cannot be made without consideration of specific design variables and study characteristics.     

流浪青少年犯罪的社会回归浅析

流浪青少年罪犯,作为我国犯罪团体中最为特殊的群体,在我国的犯罪中所占的比例越来越高,也越来越引起全社会的关注。本文在分析流浪青少年犯罪成因的基础上,对流浪青少年的社会回归,特别是社区矫正方法做了积极的探讨。