John Monahan

Bio: John Monahan is an academic researcher from University of Virginia. The author has contributed to research in topics: Poison control & Risk assessment. The author has an hindex of 72, co-authored 313 publications receiving 21833 citations. Previous affiliations of John Monahan include University of California, San Francisco & City University of New York.

Mandated Community Treatment: The Potential Role of Violence Risk Assessment

Abstract: This chapter summarises a new conceptual framework for understanding outpatient commitment and other forms of "mandated community treatment". People with a disability, such as a serious mental disorder, may qualify under federal or state laws in the United States to receive certain social welfare benefits. Each of the forms of leverage is described: money, housing, avoidance of jail, and avoidance of hospitalisation. The chapter argues that what policy makers and practitioners need in order to make informed decisions about mandated community treatment is an evidence base that includes answers to central, cross-cutting empirical questions, and a thorough airing of legal, moral, and political questions as well. The use of actuarial approaches to improve the prediction of violence, the MacArthur Risk Assessment Study assessed a large sample of male and female acute civil patients at several facilities on a wide variety of variables believed to be related to the occurrence of violence.

Burnout in Pediatric Nephrology Fellows and Faculty: Lessons From the Sustainable Pediatric Nephrology Workforce Project (SUPERPOWER)

Abstract: Physician well-being is an important contributor to both job satisfaction and patient outcomes. Rates of burnout among physicians vary by specialty, ranging from 35 to 70%. Among pediatric residents, longitudinal data demonstrates consistent rates of burnout around 50-60%, although little is known about burnout among pediatric subspecialty fellows. Specifically, the degree of burnout among pediatric nephrologists remains unknown, as does the impact faculty burnout may have on trainee burnout. We sought to evaluate prevalence and predictors of burnout among US pediatric nephrology fellows and faculty, and assess for interactions between groups. In this multi-center pilot survey of all United States pediatric nephrology training programs from February to April 2020, burnout was assessed through abbreviated Maslach Burnout Inventory and predictors were explored through survey items devoted to demographic, personal characteristics, and job and career satisfaction questions. A total of 30/34 available fellows and 86/102 faculty from 11 institutions completed the survey (overall response rate 85%). The prevalence of burnout was 13% among fellows and 16% among faculty. Demographic (age, gender, year of training, faculty rank, marital status) and program factors (fellowship size, faculty size, current block/rotation, vacation or weekend off timing) were not significantly associated with burnout. Faculty and fellows with burnout reported significantly lower quality of life (5.3 vs. 7.9, p < 0.05), higher perceived stress (2.4 vs. 1.4, p < 0.05) and lower satisfaction with career choice (66 vs. 22%) and work life balance (28 vs. 0%), compared to those without burnout (p < 0.05 for all). Other important factors positively associated with burnout included lower institutional support for wellness programs and lower satisfaction with both colleague and faculty support. Larger studies are needed to explore if burnout is truly less prevalent among pediatric nephrology fellows and faculty compared to pediatric residents and graduate physicians. A larger sample size is also necessary to determine whether any interactions exist between the faculty and trainee roles in the developments of burnout. Future studies should also explore how to promote well-being through addressing key factors such as overall learning/working environment, stress reduction, and building personal resilience.

Police and the Mentally Disordered

Abstract: Nowhere are the controversies that can arise when police deal with mentally disordered persons more tragically evident than in a recent New York City case of Mrs. Eleanor Bumpurs (Raab, 1985). Mrs. Bumpurs was a 67-year-old mentally disordered black woman who lived alone in a public housing project in the Bronx. Her rent was $89 a month and she had not paid it for 5 months. A New York City marshall went to the apartment to evict Mrs. Bumpurs for failing to pay her rent, but she refused to let him in and made threats through the locked door. The next day, October 29, 1984, the Emergency Service Unit of the New York City Police Department was notified of the threats. Six Emergency Service Unit officers went to Mrs. Bumpurs’ apartment to evict her. They punched out the lock and went into the apartment carrying plastic shields designed to protect them against blows and knife thrusts and also carrying a “restraining bar,” which is a U-shaped bar attached to a long handle that is used to pin a person against a wall.

Prediction of Criminal Behavior: Recent Developments in Research and Policy in the United States

Abstract: The great American philosopher and psychologist William James once remarked that we should not attempt to write biographies in advance. Yet much of American law — and perhaps the law of other countries as well — is concerned with doing just that: predicting who will commit a violent or criminal act, and then intervening to prevent the predicted harm.

Heuristics and Biases: The Psychology of Intuitive Judgment

Abstract: A review is presented of the book “Heuristics and Biases: The Psychology of Intuitive Judgment,” edited by Thomas Gilovich, Dale Griffin, and Daniel Kahneman.

Individual differences in reasoning: Implications for the rationality debate?

Abstract: Much research in the last two decades has demon- strated that human responses deviate from the performance deemed normative according to various models of decision mak- ing and rational judgment (e.g., the basic axioms of utility theory). This gap between the normative and the descriptive can be inter- preted as indicating systematic irrationalities in human cognition. However, four alternative interpretations preserve the assumption that human behavior and cognition is largely rational. These posit that the gap is due to (1) performance errors, (2) computational limitations, (3) the wrong norm being applied by the experi- menter, and (4) a different construal of the task by the subject. In the debates about the viability of these alternative explanations, attention has been focused too narrowly on the modal response. In a series of experiments involving most of the classic tasks in the heuristics and biases literature, we have examined the implica- tions of individual differences in performance for each of the four explanations of the normative/descriptive gap. Performance er- rors are a minor factor in the gap; computational limitations un- derlie non-normative responding on several tasks, particularly those that involve some type of cognitive decontextualization. Un- expected patterns of covariance can suggest when the wrong norm is being applied to a task or when an alternative construal of the task should be considered appropriate.

Peer relations and later personal adjustment: Are low-accepted children at risk?

Abstract: In this review, we examine the oft-made claim that peer-relationship difficulties in childhood predict serious adjustment problems in later life. The article begins with a framework for conceptualizing and assessing children's peer difficulties and with a discussion of conceptual and methodological issues in longitudinal risk research. Following this, three indexes of problematic peer relationships (acceptance, aggressiveness, and shyness/withdrawal) are evaluated as predictors of three later outcomes (dropping out of school, criminality, and psychcpathology). The relation between peer difficulties and later maladjustment is examined in terms of both the consistency and strength of prediction. A review and analysis of the literature indicates general support for the hypothesis that children with poor peer adjustment are at risk for later life difficulties. Support is clearest for the outcomes of dropping out and criminality. It is also clearest for low acceptance and aggressiveness as predictors, whereas a link between shyness/withdrawal and later maladjustment has not yet been adequately tested. The article concludes with a critical discussion of the implicit models that have guided past research in this area and a set of recommendations for the next generation of research on the risk

Risk As Analysis and Risk As Feelings: Some Thoughts About Affect, Reason, Risk, and Rationality

Abstract: Modern theories in cognitive psychology and neuroscience indicate that there are two fundamental ways in which human beings comprehend risk. The analytic system uses algorithms and normative rules, such as probability calculus, formal logic, and risk assessment. It is relatively slow, effortful, and requires conscious control. The experiential system is intuitive, fast, mostly automatic, and not very accessible to conscious awareness. The experiential system enabled human beings to survive during their long period of evolution and remains today the most natural and most common way to respond to risk. It relies on images and associations, linked by experience to emotion and affect (a feeling that something is good or bad). This system represents risk as a feeling that tells us whether it's safe to walk down this dark street or drink this strange-smelling water. Proponents of formal risk analysis tend to view affective responses to risk as irrational. Current wisdom disputes this view. The rational and the experiential systems operate in parallel and each seems to depend on the other for guidance. Studies have demonstrated that analytic reasoning cannot be effective unless it is guided by emotion and affect. Rational decision making requires proper integration of both modes of thought. Both systems have their advantages, biases, and limitations. Now that we are beginning to understand the complex interplay between emotion and reason that is essential to rational behavior, the challenge before us is to think creatively about what this means for managing risk. On the one hand, how do we apply reason to temper the strong emotions engendered by some risk events? On the other hand, how do we infuse needed "doses of feeling" into circumstances where lack of experience may otherwise leave us too "coldly rational"? This article addresses these important questions.