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about whether their reliance on particular cues is appropriate or inappropriate – information which is much harder to obtain when cues and criterion are on different dimensions. The results also suggest that all forms of feedback could be effective in MCPL, provided information is presented in a form that allows people to understand the relation between the cues and the outcome.

All reported work is part of the programme of the ESRC Centre for Economic Learning and Social Evolution (ELSE).

Monitoring and aiding clinical decision making under the new Dutch Youth Care Act: Call for suggestions

Huub Pijnenburg Nijmegen University Praktikon - centre for research and development in youth care E-mail: h.pijnenburg@acsw.kun.nl

As a result of the impending new Dutch Youth Care Act (which will most likely come into effect in 2003) a fundamental legal and logistical restructuring of youth care is currently under way in the Netherlands. In the old care structure, separate organisations within essentially independent health, legal and welfare systems sequentially assessed a client’s needs in relation to the services that they themselves provided. This amounted to a form of supply side economics: treatment decisions were often not so much the result of diagnostic decision making per se, but rather the result of a matching process. Diagnosticians (employed by organisations for care provision) matched a client’s needs against their employer’s fixed set of treatment options. This probably exacerbated the identified problems with clinical decision making whereby there was a lack of attention to clients’ desires, limited and confirmatory diagnoses, and a lack of relationship between clinical needs and treatment regime. Within such a structure, we found handheld Bayesian based decision aids and diagnostic expert systems to have limited impact on improving clinical decision making. Presumably judgment analysis and feedback of task information would not have faired better. The new system is an attempt to change youth care’s supply side economics into a form of ‘demand/need side’ economics. Its ambitious objectives are: to make youth care more client- oriented, to make diagnostic decision making more explicit and rational, to provide care as close to the client’s home as possible, to change the dominant role of care providers, and to break down barriers between care providers within the health, welfare and legal subsystems. Clients now gain access to

care via a single

‘front door’: the local/regional Youth

Care

Bureau.

Here

each

client’s

needs

are

assessed and treatment decisions are made, based on the findings and conclusions of independent YCB diagnosticians (mostly operating in multidisciplinary teams). Next, treatment is provided accordingly (based on standardised protocols) by an allocated care centre. No longer can care providers turn down clients. As a result we anticipate the quality of clinical decision making to improve. At the same time it is clear that this new set-up is by no means a panacea. Yes, self-interest of care centres will be avoided and diagnostic decision making should be improved, avoiding hypothesis confirmation et cetera. But unless specific measures are put into place, outcome feedback from this two tier system may be just as elusive as it was in the old system. It is clear that for Dutch youth care important times lies ahead. That is why at the moment we are rethinking our R&D priorities at Praktikon and formulating a project agenda for the coming years. We welcome contributions from fellow decision researchers in this process. At the first Clinical Judgement Analysis Meeting, staged earlier this year at Leeds University Business School by Clare Harries, the main recommendation from the audience was that we focus not on analysing individuals’ models of decision making, but instead that we should focus on task analysis based on multiple methods including focus groups. In the context of youth care in the Netherlands, as in many clinical contexts, the change of practice and role necessitated by changing circumstances means that there will now be no expert practitioners. As in many other clinical contexts, analysis of the task, and of the multi-faceted environment is therefore of primary importance. My question to the readers of this Newsletter, is: do you agree with this recommendation? What do you believe are key questions we should address? What are suitable and effective research approaches and tools, that will help us realise our ambition to monitor and support this reorganisation and development process, and come up with results that will be relevant to practitioners and researchers alike? Please mail any comments or suggestions you care to make to: h.pijnenburg@acsw.kun.nl

The importance the task environment in processing threatening stimuli

Manuel-Miguel Ramos Álvarez E-mail: mramos@ujaen.es

Two years ago I entered a research group interested in finding out about cognitive biases and emotional disorders. This group was given a grant for investigating within this field. The research I am going to talk about is connected to this context. A

Newsletter 2002 page 21 of 28

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