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

埃默里大学专业人士是决策者，他们例行地诊断、评估和治疗客户的问题。那些为数不多的研究，检查了由多个专业团体治疗的单一客户群体，往往发现基于提供者的专业关系的决策差异，但对这些差异几乎没有解释。根据组织社会学和文化社会学交叉的理论文献，专业隶属关系可能通过塑造临床医生看待客户的制度镜头来影响临床决策。本研究以不同心理健康专业的临床实习生为研究对象，探讨专业社会化过程对决策的影响，并探讨：1)专业心理健康实习生对诊断和治疗建议的判断在多大程度上存在差异？2)专业归属是否有助于解释实习生临床决策的一些变异性？3)大学培训通过什么机制塑造临床实习生对工作的看法和对客户的决定？这个混合方法的案例研究将集中在三个培训项目的高级临床受训者——格鲁吉亚精神病学、临床心理学和临床社会工作的顶级专业培训项目。为了评估临床决策变化的数量和来源，学员将被要求评估一名表现出焦虑和抑郁症状的患者的相同书面案例研究。该研究将通过自我管理的调查来衡量学生对案例研究的概念和临床决策。为了探索大学经历如何影响专业人士对他们的工作和客户决策的看法，联合调查委员会将对三所专业学校的一部分学生进行深入的定性访谈。更广泛的影响：面对影响心理健康领域的几个潜在合理化趋势（例如，管理行为护理的传播），本研究衡量了心理健康学员在与客户打交道时实际可互换的程度，这是一个对心理健康护理消费者至关重要的问题，也是一个对医学和组织社会学有贡献的问题。通过研究大学培训在有争议的司法管辖范围内影响专业人员日常决策的机制，本研究试图揭示个人如何理解周围环境并制定行动蓝图，以及文化和认知社会学以及职业社会学的核心问题。最后，确定有助于形成心理健康专业人员临床决策的因素对于缩小目前向美国人提供的心理健康服务质量存在的差距非常重要。

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.