Doctoral Dissertation Research: Professional Affiliation, Training, and Decision-making.

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SES-0827921Timothy J. DowdRachel A. Askew Emory UniversityProfessionals are decision makers, routinely diagnosing, evaluating, and treating their clients' problems. Those few studies that examine a single client population treated by multiple professional groups often find differences in decision making based on a provider's professional affiliation but offer little explanation for these differences. According to theoretical literature at the intersection of organizational and cultural sociology, professional affiliation may influence clinical decision making by shaping the institutional lenses through which clinicians view their clients. This study focuses on clinical trainees from different mental health professions in order to examine how professional socialization processes may shape decision making, and asks: 1) To what degree do professional mental health trainees' judgments about diagnosis and recommendations for treatment vary? 2) Does professional affiliation help explain some of the variability in trainees' clinical decisions? 3) What are the mechanisms through which university training shapes clinical trainees' views of their work and decisions regarding their clients? This mixed-methods case study will focus on advanced clinical trainees enrolled in three training programs - the top professional training programs in psychiatry, clinical psychology, and clinical social work in Georgia. In order to assess the amount and source of variation in clinical decisions, trainees will be asked to evaluate an identical written case study of a patient manifesting symptoms of anxiety and depression. The study will measure students' case conceptualizations and clinical decisions regarding the case study via a self-administered survey. In order to explore the mechanisms through which university experiences shape professionals' views of their work and decisions regarding clients, the co-PI will conduct in-depth qualitative interviews with a subset of students from each of the three professional schools. Broader Impacts: In the face of several potentially rationalizing trends affecting the mental health arena (e.g., the spread of managed behavioral care), this study gauges the degree to which mental health trainees are actually interchangeable in their dealings with clients, a question critical for consumers of mental health care and one that contributes to medical and organizational sociology. By examining the mechanisms through which university training affects professionals' everyday decision making in a contested jurisdiction, this study seeks to shed light on how individuals come to understand their surroundings and create blueprints for action, questions central to the sociology of culture and cognition and the sociology of professions. Finally, identifying factors that help shape mental health professionals' clinical decisions will be important for narrowing the gaps that exist in the quality of mental health services currently provided to Americans.