With the growing complexity of treatment decisions made at presentation to a psychiatric emergency room (PER) and the increasing influence of managed care on the decision-making process, it is increasingly important to establish a new and more sophisticated research agenda for studying PER decision making. The main goal of this paper is to propose a comprehensive conceptual model of the PER decision-making process that will facilitate active pursuit of such a research agenda. The proposed model presents both traditional and emerging elements of the PER decision-making process (i.e., determinants, mediating mechanisms, and outcomes) and explicates the nature of the relationships among them at different levels of analysis. The model's theoretical and empirical implications for future research are discussed and suggestions are made as to the research designs and methods needed to pursue this agenda.

In the spirit of evidence-based decision making, research findings are increasingly being used to inform practice guidelines and policy making. Whether research informs the process accurately and appropriately depends on due quality of the design. This article examines the assumptions underpinning the randomized trial in relation to its application to evaluating socially complex interventions. Because the properties of the randomized trial are not independent of the characteristics of the interventions being studied, researchers need to be more attentive to selection bias, unmeasured contextual variables and uncontrolled interaction effects that arise because the environment interacts with the intervention. It is recommended that evaluations of socially complex interventions be modified by adding a complex contextual evaluation and using multiple sites.

Issues related to correctional health care are receiving increasing attention across the country. Researchers at Rutgers University conducted a study that explored the state of inmate health in New Jersey jails, and the health care response within the jails and at the time of release. Of the 21 jails in New Jersey, 17 participated in the study. There are three principal findings. First, many inmates have complicated health problems, which often are not being addressed in the community. Second, there is wide variation among jails in their response to inmates' health and behavioral problems. Third, there is remarkably little coordination between correctional health care staff and "outside" providers. Detailed evidence and recommendations appear in the report.