RAND Corporation

About: RAND Corporation is a nonprofit organization based out in Santa Monica, California, United States. It is known for research contribution in the topics: Health care & Population. The organization has 9602 authors who have published 18570 publications receiving 744658 citations.

Many Objective Robust Decision Making for Complex Environmental Systems Undergoing Change

Abstract: This paper introduces many objective robust decision making (MORDM). MORDM combines concepts and methods from many objective evolutionary optimization and robust decision making (RDM), along with extensive use of interactive visual analytics, to facilitate the management of complex environmental systems. Many objective evolutionary search is used to generate alternatives for complex planning problems, enabling the discovery of the key tradeoffs among planning objectives. RDM then determines the robustness of planning alternatives to deeply uncertain future conditions and facilitates decision makers' selection of promising candidate solutions. MORDM tests each solution under the ensemble of future extreme states of the world (SOW). Interactive visual analytics are used to explore whether solutions of interest are robust to a wide range of plausible future conditions (i.e., assessment of their Pareto satisficing behavior in alternative SOW). Scenario discovery methods that use statistical data mining algorithms are then used to identify what assumptions and system conditions strongly influence the cost-effectiveness, efficiency, and reliability of the robust alternatives. The framework is demonstrated using a case study that examines a single city's water supply in the Lower Rio Grande Valley (LRGV) in Texas, USA. Results suggest that including robustness as a decision criterion can dramatically change the formulation of complex environmental management problems as well as the negotiated selection of candidate alternatives to implement. MORDM also allows decision makers to characterize the most important vulnerabilities for their systems, which should be the focus of ex post monitoring and identification of triggers for adaptive management.

Evidence-Based Mental Health Programs in Schools: Barriers and Facilitators of Successful Implementation

Abstract: Although schools can improve children’s access to mental health services, not all school-based providers are able to successfully deliver evidence-based practices. Indeed, even when school clinicians are trained in evidence-based practices (EBP), the training does not necessarily result in the implementation of those practices. This study explores factors that influence implementation of a particular EBP, Cognitive Behavioral Intervention for Trauma in Schools (CBITS). Semi-structured telephone interviews with 35 site administrators and clinicians from across the United States were conducted 6–18 months after receiving CBITS training to discuss implementation experiences. The implementation experiences of participants differed, but all reported similar barriers to implementation. Sites that successfully overcame such barriers differed from their unsuccessful counterparts by having greater organizational structure for delivering school services, a social network of other clinicians implementing CBITS, and administrative support for implementation. This study suggests that EBP implementation can be facilitated by having the necessary support from school leadership and peers.

Impact of pain on depression treatment response in primary care.

Abstract: Objective Pain commonly coexists with depression, but its impact on treatment outcomes has not been well studied. Therefore, we prospectively evaluated the impact of comorbid pain on depression treatment response and health-related quality of life. Methods We analyzed data from the ARTIST study, a randomized controlled trial with naturalistic follow-up conducted in 37 primary care clinics. Participants were 573 clinically depressed patients randomized to one of three selective serotonin reuptake inhibitor (SSRI) antidepressants: fluoxetine, paroxetine, or sertraline. Depression as assessed by the Symptom Checklist-20 (SCL-20) was the primary outcome. Secondary outcomes included pain and health-related quality of life. Results Pain was reported by more than two thirds of depressed patients at baseline, with the severity of pain mild in 25% of patients, moderate in 30%, and severe in 14%. After 3 months of antidepressant therapy, 24% of patients had a poor depression treatment response (ie, SCL-20 >1.3). Multivariate odds ratios for poor treatment response were 1.5 (95% confidence interval, 0.8-3.2) for mild pain, 2.0 (1.1-4.0) for moderate pain, and 4.1 (1.9-8.8) for severe pain compared with those without pain. Increasing pain severity also had an adverse impact on outcomes in multiple domains of health-related quality of life. Conclusions Pain is present in two thirds of depressed primary care patients begun on antidepressant therapy, and the severity of pain is a strong predictor of poor depression and health-related quality of life outcomes at 3 months. Better recognition, assessment, and treatment of comorbid pain may enhance outcomes of depression therapy.