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The Democrats gained control of Congress in 2007, and the debates about the CHAMP Act’s comparative effectiveness provisions had occurred against the party’s mobilization to win the White House. With the prospect of a Democratic president came the chance of comprehensive health care reform. In late2007 and early 2008 the US economy began its slide into the Great Recession and was in free-fall when Barack Obama was elected president in November 2008. Within 3 weeks the new administration was presenting its plans for fiscal stimulus. Many pieces of ready-to-go legislation were amalgamated to form the February 2009 American Recovery and Reinvestment Act, among them $1.1 billion for comparative effectiveness research. A cliff-hanger battle for health reform culminated in the March 2010 Affordable Care Act, one provision of which was a federal mandate for comparative effectiveness research modelled on a proposal of Senators Max Baucus (D-MT) and Kent Conrad (D-ND).

From a nearly imperceptible start, federal policy on comparative effectiveness research gained substantial momentum over its eight-year odyssey and got several legislative toeholds. The story starts in May 2002 with a short bill introduced into the US House of Representatives by Representative Thomas Allen (D-Maine). This bill focused solely on prescription drugs and would have authorized the appropriation of $25 million for comparative effectiveness research to the Agency for Healthcare Research and Quality. It died in committee. The next year Representative Allen and a Republican co-sponsor JoAnn Emerson (R-Missouri) introduced a more ambitious bill that encompassed all treatments, not just drugs. By means of a circuitous path involving Senate Majority Leader Bill Frist (R-Tennessee) many elements of the 2003 Allen-Emerson bill became law as part of the 2003 Medicare Modernization Act passed by the Republican-held Congress and signed by Republican President George W. Bush.

This chapter interprets questions contained in the Phase I Supplementary protocols of the Peer Arena Retrospect (PAR) protocols, namely, PAR-Su-SEP (Student Educational Perspective) protocol, PAR-Su-PEP (Parent Educational Perspective) and PAR-Su-TEP (Teacher Educational Perspective) protocols, PAR-Su-FP (Friendship Preferences) protocol, PAR-Su-GU (What Do You Have to Give Up) protocol, PAR-Su-FO (What Do Friends Offer You) protocol, PAR-Su-R (Recuperation) protocol, PAR-Su-KF (Keeping Friends) protocol, PAR-Su-AC (Awareness of Comparisons) protocol, PAR-Su-CA (Comparative Act) protocol. Future-Focused Supplementary protocols are also described, including PAR-Su-FFD (Fantasies and Future Dreams) protocol, PAR-Su-DA (Defensive Actions Reflection) protocol, PAR-Su-F (Future) protocol, and PAR-Su-EI (Emotional Income and Deprivation) protocol. Embedded in the Supplementary protocols are questions that elicit the information sought or lead up to eliciting qualitative information such as emotional reactions to comparative acts with age-mates. Some are asked again in order to compare the adolescents' consistency, as well as their disassociation or just plain avoidance.

This chapter presents two case studies that illustrate the structure and process of Peer Arena Lens (PAL) group therapy. Both cases involve teenage girls, one from a middle-class Latino family and the other from a white middle-class family. The first girl had adopted a False Facade defensive glitch and donned a mask of maturity. The marijuana found in her room was the first crack in her defensive glitch. The second case presents information on an unusual home environment, the effects of scarcity of peers for comparative acts, the impact of puberty, use of protocols, and PAL therapy interactional dynamics. This chapter considers the diagnosis done on the two girls and evaluates the impact of PAL group therapy on them.

This chapter presents the Phase II protocols used with adolescents identified as having turned off Peer Arena comparative acts, thus aborting their development. These protocols assist in identifying defensive glitches and begins with the Defensive Glitch (PAR-DG) protocol; the protocols that follow it ask questions to elicit special aspects about their interactions with peers in order to fill out gaps from PAR-DG findings. This chapter describes the design and approach of the Phase II protocols and highlights the importance of detecting defensive flights as soon as possible in addressing the adolescent's fear and work. It also discusses supplementary protocols for suspected defensive glitches, namely: PAR-SuII-CC (Continuity and Change) protocol, PAR-SuII-AS (Antisocial) protocol, and PAR-SuII-ASCR (Antisocial Cognitive Rationale) protocol.

This chapter describes Peer Arena Lens (PAL) group therapy with adolescents. PAL group therapy is designed to assist troubled adolescents in working through their need for a defensive glitch and to prepare them to return to the Peer Arena to complete the adolescent psychological task of developing successfully into maturity. Therapy groups are assembled in such a way as to replicate the adolescent's home Peer Arena as much as possible. The overall goal of PAL group therapy is to strengthen adolescents' return to their natural Peer Arena, so that they are ready to deal constructively with peer interaction. To accomplish this goal, they will learn to use comparative acts constructively, cope with the findings, and sustain ups and downs without resorting to defensive glitches. The Peer Arena Retrospective (PAR) protocols are designed for use in PAL group therapy. This chapter considers the structure of PAL group therapy as well as the admission and application process, finishing process, leaving process, group discharge criteria and group discharge process, and group therapy design features.