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

Timothy J.DowdRachel A.Askew Emory University专业人员是决策者，定期诊断、评估和治疗客户的问题。少数几项研究考察了由多个专业群体治疗的单一客户群体，经常发现基于提供者的专业从属关系的决策差异，但对这些差异几乎没有提供任何解释。根据组织社会学和文化社会学交叉点的理论文献，职业从属关系可能通过塑造临床医生看待客户的机构透镜来影响临床决策。本研究以来自不同心理健康专业的临床实习生为研究对象，考察专业社会化过程如何影响决策，并提出以下问题：1)专业心理健康实习生对诊断和治疗建议的判断差异有多大？2)专业从属关系是否有助于解释实习生临床决策的一些差异？3)大学培训是通过什么机制塑造临床实习生对其工作的看法和对客户的决定？这项混合方法的案例研究将侧重于参加三个培训计划的高级临床实习生-佐治亚州最顶尖的精神病学、临床心理学和临床社会工作专业培训计划。为了评估临床决策中的差异数量和来源，受训者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。这项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化和临床决策。为了探索大学经历塑造专业人士对其工作的看法和关于客户的决定的机制，联合PI将对来自三所专业学校的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种潜在的合理化趋势(例如，管理式行为护理的普及)，这项研究衡量了心理健康实习生在与客户打交道时实际上可互换的程度，这是一个对心理健康护理消费者至关重要的问题，也是对医学和组织社会学做出贡献的一个问题。通过研究大学培训影响有争议司法管辖区专业人士日常决策的机制，这项研究试图阐明个人是如何理解周围环境并制定行动蓝图的，这些问题是文化和认知社会学以及职业社会学的核心问题。最后，确定有助于影响精神卫生专业人员临床决策的因素，对于缩小目前向美国人提供的精神卫生服务质量方面存在的差距将是重要的。

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.