Pilot study of the influence of self-coding on empathy within an introductory motivational interviewing training

Background: Motivational interviewing (MI) is a framework for addressing behavior change that is often used by healthcare professionals. Expression of empathy during MI is associated with positive client outcomes, while absence of empathy may produce iatrogenic effects. Although training in MI is linked to increased therapeutic empathy in learners, no research has investigated individual training components' contribution to this increase. The objective of this study was to test whether a self-coding MI exercise using smartphones completed at hour 6 of an 8-h MI training was superior in engendering empathy to training as usual (watching an MI expert perform in a video clip for the same duration at the same point in the training). Methods: This was a pilot study at two sites using randomization and control groups with 1:1 allocation. Allocation was achieved via computerized assignment (site 1, United Kingdom) or facedown playing card distribution (site 2, United States). Participants were 58 students attending a university class at one of two universities, of which an 8-h segment was dedicated to a standardized MI training. Fifty-five students consented to participate and were randomized. The intervention was an MI self-coding exercise using smartphone recording and a standardized scoring sheet. Students were encouraged to reflect on areas of potential improvement based on their self-coding results. The main outcome measure was score on the Helpful Responses Questionnaire, a measure of therapeutic empathy, collected prior to and immediately following the 8-h training. Questionnaire coding was completed by 2 blinded external reviewers and assessed for interrater reliability, and students were assigned averaged empathy scores from 6 to 30. Analyses were conducted via repeated-measures ANOVA using the general linear model. Results: Fifty-five students were randomized, and 2 were subsequently excluded from analysis at site 2 due to incomplete questionnaires. The study itself was feasible, and overall therapeutic empathy increased significantly and substantially among students. However, the intervention was not superior to the control condition in this study. Conclusions: Replacing a single passive learning exercise with an active learning exercise in an MI training did not result in a substantive boost to therapeutic empathy. However, consistently with prior research, this study identified significant overall increases in empathy following introductory MI training. A much larger study examining the impact of selected exercises and approaches would likely be useful and informative

The economics of managerialism and the drive for value for money in policing: best value performance indicators vs. efficiency rankings

The UK has recently proposed to develop a set of criteria whereby the economic analysis of police force efficiency is to be made standard. This follows a strategy of aiming for improvement through managerialism and Best Value Performance Indicators (BVPIs), similar to those implemented by US police forces after the Government Performance and Results Act 1993. In this paper we attempt to put this recent development of efficiency targeting into a UK historical/evolutionary context and discuss the economic methodologies and techniques behind creating best practice police reference sets. In addition, we present results from three techniques that have been advanced as tools to rank forces in the UK media and academic literature, and show how simple BVPI averaging can bias efficiency ranking of police forces

Economies of scale in UK building societies: a re-appraisal using an entry/exit model

This study advances an entry/exit model to analyse the scale efficiency of UK building societies. We find that there are considerable divergences across building societies in levels of scale efficiency and also in technological change during the sample period 1992-1997. The paper also finds that scale economies and technological change estimates are dependent on whether the econometrician balances a panel data set or utilises the entry/exit model based on Dionne et al’s (1998) specification. In general, scale economies in UK building societies are found to be more significant and more pervasive than in previous studies

The Economics modelling of policing and the measurement of efficiency

A recent report (Public Service Productivity Panel (PSP) (2000)) has developed a set of criteria whereby the economic analysis of police force efficiency is to be made standard. An aim of the government’s drive for efficiency rankings is to enable the Home Office to determine a ‘best practice’ reference set of forces, and thereby allow differential funding of police forces. This paper attempts to put this recent development into a historical/evolutionary context and discusses: the economic methodologies behind creating best practice reference sets; the techniques proposed by the PSP (2000) report; and how best to estimate the production of police forces

Police efficiency in offences cleared: an analysis of English 'basic command units'

The job of policing covers a wide range of activities including, traditional crime detection and punishment, and the non-traditional aspects such as community meetings. However, the major focus of policing is on crime detection and prevention. This paper specifically considers these functions with respect to Basic Command Units (BCUs) or ‘precincts’, and determines their relative efficiency in this key area using DEA and the little used stochastic distance frontier. Relative Efficiency is measured in the context of a ‘pure production approach’ relating the incidence of various crimes (inputs) to the corresponding clear offences (outputs). This type of efficiency ranking can also help in further analysing best practice in order to reduce crime and the fear of crime in many police forces. The powerful non-linearity established in this relationship has important implications for police resourcing and funding as highlighted by Houpis et al (2001

The use of 'performance radars' as a predictor of police force efficiency: an analysis of UK home office policy

Over the last 20 years, governments around the world have implemented strategies and targets to ensure that public services are efficient in the management of resources. In the UK this common agenda has led to the recent ‘Police Reform Act 2002’ in which consideration was given on how police forces can show ‘Value for Money’ based on government strategic policy targets. This paper discusses the ‘Performance Radar’ technique proposed by the Home Office in the United Kingdom as a new public policy objective in order to assess police force performance. We show, utilising an innovative nonparametric modelling strategy, that environmental factors and revenues can have significant effects on whether a police force is deemed to be efficient. Further, the results presents evidence that survey data should not be utilised as a basis to assess police performance

The measure of English and Welsh police force efficiency: a comparison of distance function models

Since the Labour government came to power in 1997, it has introduced a regime whereby public services are accountable in respect of best value performance indicators (BVPIs). A recent Public Services Productivity Panel (PSP) (2000) report has developed a set of criteria whereby the economic analysis of police force efficiency by the Home Office is to be made standard. In this paper we utilise an innovative distance function strategy in contrast to the standard efficiency techniques (Data Envelopment Analysis and Stochastic cost Frontier Analysis) advocated in PSP (2000). We present results from four different distance function models; Data Envelopment Analysis; Free Disposal Hull; Super- Efficiency; and Stochastic Frontier Analysis; in order to assess police force efficiency during the sample period 1996 – 1999

English and Welsh Police Force Efficiency: Demonstration Project Peer Review Results

The recent report by the Public Service Productivity Panel (PSPP) (2000), proposed that non-parametric (DEA) and parametric (SFA) modelling techniques be utilised as an aid to allow efficiency bandings of police forces. To determine whether these techniques could be utilised, a data set approved by the Home Office Steering Committee was compiled, and a report commissioned to present the results of the Demonstration Project (DP). This paper presents abridged results from a Peer Review report on the DP showing that the given data set could indeed produce efficiency bandings and hence facilitate future discussions concerning differential payments of funds to English and Welsh police forces. Due to the sensitivity of the results, the police force names have been changed

An Economic evaluation of inputs and outputs in policing: problems in efficiency and measurement

The new Labour government has recently instigated an initiative to establish whether English and Welsh police forces should be ranked into groups based on an efficiency measure. The estimation techniques proposed in the Public Service Productivity Panel (2000) report in order to rank the efficiency of forces are Data Envelopment Analysis (DEA) and Stochastic Frontier Analysis (SFA). These procedures allow for multiple input/output configurations in a cost or production model in order to obtain efficiency scores. In order to produce comparative efficiency measures, however, it is essential that the services provided by police forces (the outputs or outcomes) be related to the resources (inputs) utilised by the forces in delivering these outputs (outcomes). A particular problem, however, is that policing includes many inputs and outputs (outcomes) that could potentially be utilised in an efficiency model using DEA and SFA. Hence, this paper considers the problems associated with measuring relative police force efficiency given that a vast number of potential indicators must be reduced to a handful to allow feasible estimation. In addition, it discusses the input and output variables utilised in the first 'official' analysis of English and Welsh police force efficiency (Demonstration Project (Home Office (2001))

Indirect evidence for stimulation of nitric oxide release by tumour necrosis factor-α in human veins in vivo

Objectives: The detrimental haemodynamic changes observed in septicaemia are generalised vasodilation, arterial hypotension, and hyporesponsiveness to vasopressor compounds, all of which could be explained by the release of an endogenous vasodilator. Experimental and clinical evidence suggests that tumour necrosis factor-α (TNF) induces the expression of vascular nitric oxide (NO) synthase within hours and that NO released from smooth muscle cells could be involved in the pathogenesis of septic shock. The aim of this study was to investigate the role of NO in the vascular effects of TNF. Methods: Using the dorsal hand vein compliance technique, the effect of the NO synthase inhibitor L-NG-monomethyl-arginine (L-NMMA) on α1-adrenergic responsiveness (phenylephrine 1.25-8000 ng/min) was studied after prolonged local venous infusion of TNF (8.7 μg in 5 h) in 9 volunteers and in 6 volunteers without previous cytokine exposure. Results: Mean (±s.e.) maximum phenylephrine constriction (Emax) was 73 ± 6% and log dose-rates exerting 50% of Emax (log ED50) were 3.2 ± 0.09 (geometric mean: 1535 ng/min). Local co-administration of L-NMMA at a dose sufficiently high to block NO formation (3.4 μmol/min) increased venous sensitivity to phenylephrine threefold (log ED50 2.8 ± 0.1, P < 0.015; geometric mean: 574 ng/min) whereas Emax was similar (73 ± 5%). In the controls the phenylephrine dose-response relationship remained unaffected by simultaneous administration of L-NMMA. Conclusions: As no basal release of NO occurs in hand veins without previous exposure to TNF these results provide direct evidence for induction of NO formation in the human vasculature and consecutive resistance to α-adrenergic venoconstriction. NO might, therefore, be a key mediator of haemodynamic impairment in humans under conditions with known elevations of circulating TNF, such as a septic shoc