I was five years beyond graduating with a Ph.D. (Experimental Psychology) and was in awe of being one of the Fellows at the Center, interacting with psychologists I held in very high regard (Lee Cronbach, Gardner Lindsey, Henry Riecken, Roger Shepard, and Phil Zimbardo). The informal discussions with colleagues at lunch were quite stimulating and led to a career change.
Expressing the focus of my interest in clinical decision making to colleagues. One day at lunch, I commented that it was relatively easy to envision how to model and measure the factors leading to clinicians’ decision, about the type and intensity of a clinical disorder (e.g., depression or anxiety), following the leads of Egon Brunswik, SS Stevens and Kahnemann/Tversky. But I could not envision how to model and measure the decisions made about therapeutic interventions (treatment).
A critical scholarly intervention. Two hours later when returning from volleyball and a run along the cow paths of the Ranch, Robert Jenson and Ed Mansfield stopped me at the door to my study and handed me a book on “Managerial Accounting,” telling me that this would help me figure out how to measure the intensity of therapeutic efforts linked with the judgments about the type and intensity of a clinical disorder. My response was “What was this Capitalistic stuff?”
Impact of intervention. When told to read this “stuff” by these two notable scholars, I decided to lock myself in my study, and after three days of grinding my way through the “stuff” I had an insight on why they handed me this text. I came to recognize that when a clinician identified a person as having a severe disorder they would call upon one or more experienced (and costly) professionals to work with the person and possibly to make use of resources that would have higher costs to employ. I then conceived of the idea of feeding back to clinicians (or to clinical managers or to policy folks) the changes in measures of functioning and the related treatment costs. This would permit folks to evaluate the cost effectiveness of an intervention program for a group of persons to achieve the ability to function in the community to guide future treatment or policy decisions.
A shift in career direction. Again, while at lunch on the patio, Albert (Mickey) Stunkard, then chair of Psychiatry at U of Penn, so liked these notions that he became my “rabbi,” recruiting me to come to Pennsylvania and finding me a position with PA Office of MH and Eastern PA Psychiatric Institute to continue working this. This resulted in what became known as “Client Oriented Cost Outcome Methods,” employed in evaluating MH programs and policies. NIMH published the program instruction manual (co-authored with Dale Carter) employed to implement these methods (now in its third printing). The impact of these methods was noted several decades later when a staff member of the US Senate Financial Committee told me he always followed my work, because he knew how to use the results of our work in formulating funding policies with regard to community mental health and psychotherapy. Thus, these methods derived from the lunch time discussions at CASBS obviously became the corner stone of my career until I retired in 2010. I am sure that many other Fellows at the Center have had similar experiences in the evolution of their careers.
Sincerely,
Frederick (Fred) L. Newman, Ph.D.
Professor Emeritus, Health Policy & Management
Robert Stempel College of Public Health & Social Work
Florida International University
Adjunct Professor of Psychology in Psychiatry
University of Missouri Kansas City Medical School
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