Examining the Content of Mental Health Intake Assessments From a Biopsychosocial Perspective

Psychotherapists’ approach to intake assessment has a major impact on mental health case conceptualization and treatment. Despite the importance of this issue, very little is known about the actual intake assessment practices of therapists providing mental health care in the community. This appears to be the first study that has investigated which aspects of biological, psychological, and sociocultural functioning are documented by therapists in their client intake assessments, how thoroughly these issues are assessed, and how well the information collected is then integrated into the assessment findings and case conceptualization. The examination of 163 client files from 3 mental health clinics found that therapists were regularly collecting client information regarding a wide range of biopsychosocial issues, though not in a detailed or comprehensive manner. There was also little evidence that the information was being integrated in a manner designed to maximize treatment effectiveness. These findings have major implications for training and practice in mental health assessment

The Evolution of Codification: A Principal-Agent Theory of the International Law Commission\u27s Influence

The International Law Commission has a mandate from the U.N. General Assembly to codify and progressively develop international law. For most of the ILC’s history, the lion’s share of its work took the form of draft articles adopted by the General Assembly as the basis for multilateral conventions. The ILC’s activities received their principal legal effect during this period through the United Nations treaty-making process, rather than directly on the basis of the ILC’s analysis of what customary international law does or should require. In recent decades, however, the ILC has turned to other outputs—such as principles, conclusions and draft articles that it does not recommend be turned into treaties. Significantly, the Commission often claims that these outputs reflect customary international law. In this chapter, we argue that increasing political gridlock in the General Assembly has led the Commission to modify the form of the work products it produces. We make three specific contributions to the literature. First, using principal-agent theory we argue that the ILC chooses the work product that maximizes its influence in shaping the evolution of custom. Our core claim is that, as gridlock has limited the General Assembly’s ability either to adopt treaties or decisively reject non-treaty outputs, the Commission has had both the incentive and the discretion to choose other outputs that do not require General Assembly approval. Second, we provide empirical support for this claim. Drawing upon a new data set that codes all ILC outputs since 1947, we show that the Commission began to favor non-treaty outputs beginning in the early 1990s. This followed a decade when ILC treaty recommendations were not adopted by the UNGA or, if adopted, did not garner sufficient ratifications for the treaties to enter into force. Third, we argue that the shift away from draft treaties increases the salience of the methodology that the ILC uses to prepare non-treaty outputs. Methodology functions as a de facto substitute for the political blessing that flows from the General Assembly’s adoption of draft treaty articles. Adherence to methodology increases the likelihood that a wider audience—government officials, international judges, national courts and non-state actors—will accept the ILC’s non-treaty work products as valid statements of custom. We thus expect the Commission to select a methodological approach that it expects will be supported by the audience(s) it hopes to persuade

Are small rural banks vulnerable to local economic downturns?

A potentially troubling characteristic of the U.S. banking industry is the geographic concentration of many banks’ offices and operations. Historically, banking laws have prevented U.S. banks from branching into other counties and states. A potential adverse consequence of these regulations was to leave banks—especially small rural banks—vulnerable to local economic downturns. If geographic concentration of bank offices leaves banks vulnerable to local economic downturns, we should observe a significant correlation between bank performance and the local economy. Looking at Eighth District banks, however, we find little connection between the dispersion of a bank’s offices and its ability to insulate itself from localized economic shocks. County-level economic data are weakly correlated with bank performance. Two policy implications follow from this finding. First, a priori, little justification exists for imposing more stringent regulatory requirements on banks with geographically concentrated operations than on other banks. Second, county-level labor and income data do not appear to be systematically useful in the bank supervision process.Rural areas ; Banks and banking ; Economic conditions - United States

Saving the Political Consensus in Favor of Free Trade

2016 was the year that the political consensus in favor of liberalized international trade collapsed. Today, across the world, voters\u27 belief that international trade agreements lead to economic inequality threatens to derail ratification of the next generation of trade agreements and undo the substantial gains made under existing arrangements. The United States elected Donald Trump president on a platform of rolling back or renegotiating trade agreements. President Trump has moved to fulfill that promise immediately upon taking office by unsigning the Trans-Pacific Partnership ( TPP), the most recent major effort to liberalize global trading rules, and initiating efforts to renegotiate the North American Free Trade Agreement ( NAFTA\u27). The United Kingdom voted to pull out of the European Union, one of the world\u27s largest and most important free trade zones. Europe\u27s top trade negotiator declared European trade policy close to death after Germany and France held up ratification of a free trade agreement with Canada. \In the face of this onslaught, trade\u27s defenders have run out of ideas. They point out that trade makes nations wealthier; that trade plays a minor role in creating economic inequality when compared with technological innovation; and that domestic policies unconnected to trade rules can more efficiently address economic inequality, and can do so without the need for international obligations that might be construed as limiting national sovereignty in matters of social policy. These views are right as a matter of economics. But politicians make trade rules, not economists. Right or wrong, voters\u27 belief that liberalizing trade leads to economic inequality creates a political constraint on trade liberalization. This Essay proposes a way to save the political consensus in favor of free trade. In order to preserve and extend the international trade regime and the extraordinary gains it has produced since the end of World War II, the next generation of preferential trade agreements should include international obligations binding on developed countries to address domestic economic inequality. In other words, trade agreements must include obligations to redistribute the gains from trade within countries. This approach differs dramatically from that taken in existing trade agreements. Since NAFTA, trade agreements have tried to protect those who stand to lose from free tradeprincipally labor interests-by including labor provisions in trade agreements. However, these provisions are outward looking. They seek to raise labor and environmental standards in developing countries (e.g., Mexico) in order to limit the loss of jobs in developed countries (e.g., the United States). Critics of trade agreements have bought into this orientation. They argue, for example, for removing investor-state dispute settlement ( ISDS ) from trade agreements. But removing ISDS does little to help those suffering economically in developed countries, and it hurts developed countries\u27 businesses when they operate overseas. The removal of ISDS thus would be a major concession to critics of trade agreements, and yet not one that advances the core objective of ensuring that trade agreements improve economic equality. To be sure, governments do have domestic programs to help those negatively impacted by liberalized trade rules. Trade adjustment assistance ( TAA ) programs offer financial assistance to those who lose their jobs due to international trade. But recent studies in the United States suggest that TAA is ineffective. Moreover, unlike trade agreements, which are in force indefinitely, TAA expires every few years unless Congress reauthorizes it-a fight each time. To put it bluntly, these approaches have failed. They have failed to staunch the loss of jobs, and they have failed to persuade voters in developed countries that international trade is not a primary cause of economic inequality. An Economic Development Chapter in future preferential trade agreements would commit developed countries to addressing their own economic inequality problems at home. An Economic Development Chapter would create international obligations for member states to establish fiscal programs, such as education and infrastructure spending, designed to boost economic opportunity for those left behind by growing inequality. These spending obligations would be indexed, so that they would rise and fall with the economic losses attributable to trade agreements. If such losses do not occur or taper off, nations\u27 spending commitments would naturally sunset. These obligations would be enforced through reporting and monitoring requirements, similar to human rights treaties, and dispute settlement provisions that could lead to a loss of market access, the norm in trade agreements. Tying measures designed to address economic inequality directly into trade agreements would create political coalitions in favor of continuing efforts to liberalize trade. Those who do not benefit from trade agreements could still support them as a way to obtain greater domestic benefits. President Trump, for instance, has made infrastructure spending a major domestic priority and might be willing to support trade agreements in exchange. And those who benefit most from the liberalized trade rules could support redistribution as the price of further globalization. Trade agreements would create a commitment device allowing those who gain from trade to commit in advance to provide those who do not with a share of the spoils

The Political Economy of WTO Exceptions

In a bid to save the planet from rising temperatures, the European Union is introducing a carbon border adjustment mechanism-essentially a levy on imports from countries with weak climate rules. The United States, Canada, and Japan are all openly mulling similar proposals. The Biden Administration is adopting new Buy American rules, while countries around the world debate new supply chain regulations to address public health issues arising from COVID-19 and shortages in critical components like computer chips. These public policy initiatives-addressing the central environmental, public health, and economic issues of the day-all likely violate World Trade Organization (WTO) rules governing international trade, as well as regional free trade agreements. This inconsistency poses a political problem domestically and a diplomatic problem internationally, to say nothing of potential consequences authorized by the WTO. To ward off these consequences, governments will seek to justify their measures under a series of exceptions to trade obligations first drafted in 1947. Although governments have invoked these exceptions with increasing frequency in recent years, they have never been tested in the manner that they will be in the coming years. Indeed, a provision in the 2021 Infrastructure and Investment Act-the first major legislative piece of the Biden Administration\u27s economic agenda-contains a provision directing the government to invoke these exceptions to justify measures to manufacture personal protective equipment (PPE) in the United States. This Article seeks to make sense of the exceptions and their role in the legal, political, and diplomatic proceedings that determine the fate of public policies that restrict trade. It distills three paradigms through which to view legal exceptions in international trade agreements. Under the Policy Space Paradigm, governments have the right to violate international obligations so long as the violation is necessary to pursue a public policy goal permitted by an exception. Under the Safety Valve Paradigm, exceptions excuse violations that are undeterrable, such as those motivated by overwhelming domestic political pressure. Both of these approaches, which are dominant in international legal practice, permit governments to invoke international legal exceptions only to the extent that the government acts with a single, permissible objective. In so doing, both paradigms rest on faulty assumptions about how domestic policymaking works. I therefore introduce the Channeling Paradigm, which rests on the observation that international trade policies are the result of bargaining between domestic interest groups. Exceptions in trade agreements influence that bargaining process and the resulting domestic coalitions. Industries seeking economic protection will often ally themselves with groups pursuing non-trade public policy goals, such as environmental protection or public health. Both groups benefit. The domestic industry obtains protection from foreign competition by lending its political support to a public policy goal. Public policy advocates obtain important political support for policies that provide public goods that governments often undersupply, such as measures to protect public health, fight climate change, and address economic inequality. Counterintuitively, then, the domestic political bargaining that legal exceptions encourage serves the public interest by channeling protectionist pressure into the promotion of public goods. The Channeling Paradigm has implications for dispute resolution under international trade agreements, as well as the drafting of new agreements. In short, existing tests for the application of trade agreements\u27 public policy exceptions unduly constrain domestic politics. This Article argues that trade tribunals and treaty negotiations should adopt a Predominant Motive test when interpreting and drafting exceptions clauses. Under this approach, a trade restrictive policy would benefit from an exception if the primary objective of the measure is a permitted goal under the exception. So long as it does not become the predominant purpose of the challenged policy, economic protection would not be fatal to invoking an exception. The WTO compatibility of a wide range of critical government policies that have mixed motives-including President Biden\u27s Buy American requirements that seek to address economic inequality within the United States; efforts to reshore critical U.S. supply chains with the goal of ensuring the United States has access to the components it needs to be a global leader in manufacturing; the European Union\u27s efforts to impose a carbon tariff in aid of its efforts to combat climate change; and public health restrictions on trade in medical supplies and the COVID-19 vaccine-all depend on a more flexible approach to international legal exceptions

The Law and Politics of Socially Inclusive Trade

American ambivalence toward international institutions is nothing new. In his farewell address, George Washington famously warned against foreign entanglements. After World War I, the U.S. Senate rejected the Treaty of Versailles, leaving the United States outside the formal post-war order it helped establish and neutering the new League of Nations. Throughout the late twentieth century, the United States refused to ratify multilateral agreements ranging from the Vienna Convention on the Law of Treaties, to the UN Convention on the Law of the Sea, to a host of human rights agreements. Nor did the dawn of the twenty-first century change the United States’ attitude. In 2001, President George W. Bush began his administration by “unsigning” the Rome Statute of the International Criminal Court and the Kyoto Protocol on the UN Framework Convention on Climate Change. These agreements run the gamut from treaties on peace and security to the environment, and from human rights to the law of the sea. But one area -—international trade-— has fared better than others in insulating itself from the United States’ hesitation toward international institutions. Even while he warned against foreign entanglements, Washington also counseled his successors to “establish[,] with powers so disposed, . . . conventional rules of intercourse, the best that present circumstances and mutual opinion will permit . . . .” This embrace of commerce and the international institutions that support it has been relatively consistent throughout American history. Even in the face of significant domestic political resistance to new trade agreements, such as opposition to NAFTA in the early 1990\u27s and the Seattle riots at the WTO Ministerial in 1998, key government institutions have by and large supported international trade institutions, even when they have been leery of other institutions. No longer. The 2016 presidential election sent Donald Trump to the White House on a platform of renegotiating trade agreements that he argued had poorly served American interests, especially those of the blue-collar workers so central to politics in the states that delivered the presidency to Trump. Since taking office, the Trump administration has embarked on an aggressive campaign to use trade policy to rebuild American manufacturing capacity. It has imposed tariffs on steel and aluminum imports in an effort to expand productive capacity and jobs in those sectors. It has renegotiated NAFTA to include provisions it hopes will return more of the automotive supply chain to the United States. And it has taken on China over its industrial policy that has led to the loss of U.S. jobs. These actions, unfortunately, have done little so far to meaningfully address the very real underlying concern. Neither U.S. trade policy nor international trade agreements do enough to ensure that trade liberalization supports important social values, such as an equitable distribution of wealth and environmental protection, which market transactions often undervalue. Given the Trump administration’s failure to make good on the demand for a socially inclusive trade policy, it falls to others to find a way forward. Into that void steps Professor Gregory Shaffer with his innovative and illuminating article, Retooling Trade Agreements for Social Inclusion. Professor Shaffer’s article is what scholarship should be-—well versed in theory and of immediate practical significance. Professor Shaffer’s article is a rich work on the relationship between the international trading system and issues of broader social policy. In this essay, I want to build upon two points Professor Shaffer makes. In Part I, I discuss the history of U.S. trade policy and how the separation of trade policy into what Professor Shaffer calls a “two-step model”—the first, a foreign policy issue aimed at maximizing the benefits of liberalized trade, and the second, a domes- tic policy issue aimed at combating distributional problems resulting there- from—has proven unsustainable because domestic politicians have failed to address the social inequalities caused by free trade. Part II responds to critics who argue that the crisis he identifies does not exist. In Part III, I discuss the substantial promise, but also peril, of a key component of Professor Shaffer’s proposed solution to this crisis: revising trade remedies laws to permit countries to impose social dumping duties