Family planning needs and behavior of Mexican American women: a study of health care professionals and their clientele

"A random sample of Mexican American women and a sample of family planning health care professionals, both from two major southwestern cities in the United States, were compared in terms of their reports of birth control methods used, problems in obtaining family planning services, and values involved in making fertility-related decisions, within the Mexican American population.... While there were points of agreement between the two samples, discrepancies were found in reports of problems in obtaining family planning services, fertility-related values, and in the acceptability of female sterilization as a birth control method. It was concluded that family planning professionals in these service areas tend to stereotype Mexican American women, and may not yet realize that the family planning attitudes and behavior of these women are probably changing in significant ways." (SUMMARY IN SPA)     

Factors contributing to the utilization of mental health services in a rural setting

The purpose of this study was to examine if age, attitudes toward help-seeking, education, and sex were related to previous or intended future mental health utilization in a rural population. Data were collected via a mail survey from 438 adults. Regression analyses suggested that positive attitudes toward help-seeking, being female, and being younger were significantly related to both previous and intended future mental health service utilization. In addition, prior mental health use was significantly related to whether one would seek out mental health services in the future, Implications for mental health practitioners in rural settings are addressed, and limitations of the study discussed.     

Addressing Urgent Community Mental Health Needs in Rwanda: Culturally Sensitive Training Interventions

Rwandan leaders in the health and educational sectors have begun to discuss the necessity for establishing culturally appropriate community-based mental health counselling services in Rwanda, especially trauma counselling. The need for a community psychology approach is anchored in the lingering effects of the genocide and the continuing post-traumatic stress symptoms suffered by many in the population. Capacity building in an effort like this would require the design of multi-level counselling curricula that are sensitive to the social structures within Rwandan culture. These curricular endeavours call for the development of a National Counselling Centre to serve as a structural mechanism for organizing community-based counselling initiatives. We consider the community health services needs in Rwanda here, along with associated challenges and strategies for effective mental health services in a country with a recent history of genocide. A community psychology approach to mental health would benefit Rwandan society by making trauma counselling and recovery services available and accessible to citizens throughout the country.     

A Genetic Counseling Intervention to Facilitate Family Communication About Inherited Conditions

This paper describes the development and implementation of the first intervention to facilitate family communication of genetic information based on a genetic counseling model of practice. The intervention is telephone-based and therefore designed to complement face-to-face genetic counseling consultations. It was developed by firstly reviewing the literature and a model of genetic counseling practice, leading to definition of seven core principles underpinning the intervention. A counseling framework based on these principles was developed through iterative role playing and review, tested for consistency with good practice and piloted on ten study participants. It was found to be feasible to implement and consistent with good genetic counseling practice. Implementation included training of the genetic counselors who would deliver the intervention as part of a randomized controlled trial. Noteworthy deviations from good genetic counseling practice were observed, with unexpected additional insights into the ‘black box’ of genetic counseling that may have wider implications and would benefit from further investigation. The intervention is currently being evaluated in a randomized controlled trial, to assess its impact on the number of family members attending genetic services.     

Barriers between mental health services and Mexican Americans: An examination of a paradox

The paradox of underutilization of mental health services by Mexican Americans is critically examined. It is argued that Mexican Americans live under high levels of psychological and environmental stress that would ordinarily lead to mental health problems and an increased utilization of mental health services. A number of barriers to the use of mental health services by Mexican Americans are examined. Included among these barriers are such factors as the relationship between social class and treatment offered, stereotypes concerning Mexican American folk psychiatry, limitations imposed by language differences, and the effects of stereotypes between Anglo Americans and Mexican Americans. Paradoxical findings in some studies which show a positive perception of mental health services by Mexican Americans are seen to further underscore the need for more research on the Mexican American's position. Stereotypes and generalizations about Spanish-speaking and bilingual Mexican American's approaches to psychotherapy are challenged in the light of recent empirical findings. Recommendations for future research directions and for improving the delivery of mental health services are presented.     

A cascade of disparities: health and health care access for people with intellectual disabilities

People with ID represent approximately 2% of the population and, as a group, experience poorer health than the general population. This article presents recent conceptualizations that begin to disentangle health from disability, summarizes the literature from 1999 to 2005 in terms of the cascade of disparities, reviews intervention issues and promising practices, and provides recommendations for future action and research. The reconceptualization of health and disability examines health disparity in terms of the determinants of health (genetic, social circumstances, environment, individual behaviors, health care access) and types of health conditions (associated, comorbid, secondary). The literature is summarized in terms of a cascade of disparities experienced by people with ID, including a higher prevalence of adverse conditions, inadequate attention to care needs, inadequate focus on health promotion, and inadequate access to quality health care services. Promising practices are reviewed from the perspective of persons with ID, providers of care and services, and policies that influence systems of care. Recommendations across multiple countries and organizations are synthesized as guidelines to direct future action. They call for promoting principles of early identification, inclusion, and self-determination of people with ID; reducing the occurrence and impact of associated, comorbid, and secondary conditions; empowering caregivers and family members; promoting healthy behaviors in people with ID; and ensuring equitable access to quality health care by people with ID. Their broadscale implementations would begin to reduce the health disparity experienced by people with ID.     

从细节着手围手术期人文关怀

人文关怀不是能一蹴而就的工作,而是需要从细节着手贯穿始终的系统工程。作为麻醉医生,与患者的接触通常仅限于围手术期。除了为患者提供高质量的麻醉外,还必须注意围手术期的各种细节问题。只有把术前、术中、术后各个阶段的各种"小事"做好了,才能充分体现对患者的人文关怀。这既有利于患者的健康,也有利于建立良好的医患关系。     

Psychological testing for Hispanic Americans

The need for culturally responsive mental health services for Hispanic Americans has never been greater. This population will soon become the largest of all U.S. ethnic minority groups, and recent epidemiologic studies suggest that Hispanics have rates of mental health need that are similar to those found in the general population. Developing culturally relevant mental health services, including diagnostic and assessment procedures, for this population is essential. A synthesis of extant literature pertaining to psychological testing for Hispanics is presented. It is limited to the adult literature and discusses issues related to personality, neuropsychological, and intellectual assessment. The importance of language as it influences the assessment process has also been discussed. Based on clinical and research experiences and the results of the literature review, a set of general guidelines is proposed for those working with this population.     

Call to Action: Family Therapy and Rural Mental Health

Rural communities experience considerable disparities in mental health. Research about this topic is limited, however, especially in the family therapy field. What is known comes primarily from work in other disciplines, which points to three primary barriers that prevent rural communities from accessing high quality mental health care: availability, accessibility, and acceptability of services. A search for papers published over the past 20 years in family journals yielded only 18 articles. A review of these articles in presented here, alongside a call for family clinicians and researchers to advance further contributions. Specific directions for such research are discussed, including telehealth technology, collaboration with existing structures and institutions in rural communities, and the need for more precise definitions and measures of rurality. Family clinicians and researchers are uniquely positioned to conceptualize systemic challenges that rural communities face, and would be advised to join other disciplines in developing innovative methods to address them.     

A narrative review: arguments for a collaborative approach in mental health between traditional healers and clinicians regarding spiritual beliefs

This review explores the possibility of a more collaborative approach between mental health clinicians and traditional healers, from a clinical psychology perspective, for clients with spiritual beliefs. Spiritual beliefs are incorporated into the identity and functioning of clients within a cultural context and prevalence rates reveal this is not uncommon. It is argued that working collaboratively would address many access difficulties to mental health services and support is generated through a number of studies and case reports in the United Kingdom, worldwide and across cultures. This approach appears to be in accordance with current theories of acculturation. The problems in the current system when working non-collaboratively are also explored. Counter arguments and pragmatic difficulties of collaboration have been discussed. Research in the United Kingdom is limited and it is suggested that more research is needed in the field. Pragmatic solutions are suggested to stimulate discussion.     

Latino Family Participation in Youth Mental Health Services: Treatment Retention,Engagement, and Response

Although researchers have identified a multitude of factors that contribute to family participation in mental health services, few studies have examined them specifically for Latino youth and their families in the U.S., a population that continues to experience significant disparities related to the availability, accessibility, and quality of mental health services. Latino youth and their families are at greater risk of dropping out of treatment prematurely and demonstrating poor treatment engagement, both of which have subsequent negative effects on treatment response outcomes. In order to help to guide efforts to improve the accessibility and quality of mental health services for Latino youth and their families, the current paper integrates modern conceptualization of family participation in youth mental health services and provides a summary of contextual factors within an ecological framework (Bronfenbrenner in The ecology of human development: experiments by nature and design, Harvard University Press, Cambridge, 1979). The current review aims to integrate empirical research on the impact of various contextual factors across multiple levels (i.e., culture, community, mental health system, family, parent/caregiver, and child/adolescent) on Latino family participation in youth mental health services, including treatment retention, engagement, and response. Clinical implications will be discussed, and an integrated, conceptual model will be presented. Not only does this model help to demonstrate the way in which existing literature is conceptually linked, but it also helps to highlight factors and underlying processes that health care providers, administrators, and policy makers must consider in working to improve mental health services for Latino youth and their families living in the U.S.     

Important Elements of Aftercare Services for Youth Departing Group Homes

Aftercare services have been suggested to improve the outcomes of youth who depart group homes. The purpose of this study was to collect views from social service agency leaders about the aftercare supports they believed were most important for youth departing group homes. This project used a survey method and gathered views from 38 agency leaders who were 28–66 years of age, with an average of 21 years of experience working with residential care programs in 23 states across the United States. Participants ranked seven support domains (i.e., family, education, mental health, relationships, physical health, safety, and independent living) and rated 56 specific aftercare supports based on importance for youth who were departing group homes and returning to their homes/schools prior to high school graduation. Results suggested family, safety, and mental health supports were the most important domains of support for aftercare. Specific aftercare items that were rated critically important included support for self-harm/suicidal thoughts, accessing mental health services, coping with trauma, and managing medication for behavior/mental health. Tables are provided for the complete list of 56 specific support ratings. The findings are summarized and limitations are discussed. Also included are the implications the findings could have regarding future research on the design of aftercare services.     

The Amish: Perceptions of genetic disorders and services

Previous studies of the closed Amish population have proven to be valuable in the field of genetics, however they have not explored the Amish parents' opinions and attitudes concerning genetic conditions and services. This exploration is necessary in order to provide culturally sensitive health care to a population at an increased risk for certain genetic conditions. The purpose of the present study was to examine the Amish population's general knowledge of genetic disorders, services, and the terminology used in describing inherited conditions, as well as their attitudes toward medical care and ethical and reproductive issues. Information was obtained from 17 Amish families, 12 who had an incidence of a genetic condition and five who had one or more children with other special health care needs, during personal interviews conducted in their homes in Lancaster, Pennsylvania. Results of the interviews showed that the birth of an affected child did not deter subsequent reproduction, that the majority of the parents were never offered genetic counseling or prenatal testing, and that the parents are interested in understanding the cause of their children's problems and recurrence risks.     

Determinants of Children's Primary Health Care Use

We review factors that influence children's use of primary health care services. Predictors of pediatric health care use include child health status, child mental health, parent and family functioning, demographic characteristics, and access to health care services. Health services research is marked by inconsistencies due to varying approaches to measurement, population sampling, and analysis, and models that do not incorporate situational factors. We present recommendations for practicing clinicians and discuss suggestions for future research to help identify additional factors that may influence a parent's decision to seek help from pediatric physicians. Health care use is determined by multiple factors, and complex models will lead to improved strategies for maximizing health status and establishing optimal pediatric care.     

Community health nurses' knowledge of, attitudes toward, and involvement with adolescent contraceptive services

A national sample of community health nurses were surveyed to assess their knowledge of, attitudes toward, and involvement with reproductive health services. Results indicated that slightly more than half of the nurses provided or administered contraceptive services to adolescents, although 73% worked in settings where contraceptive services were provided to adolescents. However, only 3.6% indicated that adolescents were their primary client population. The majority (64.3%) stated that they felt as prepared to work with adolescents as they did with adult clients. While 98% were aware that most adolescents are sexually active before seeking family planning services, a minority correctly answered questions about pregnancy and contraception among adolescents. Ninety-five percent agreed that contraceptives should be available to adolescents, and 90% agreed that parental consent should not be required for adolescents seeking contraceptive services. Yet only 21.5% were aware of the implications of the Adolescent Family Life Act.     

Use of Services Prior to and Following Intensive Family Preservation Services

A goal of short-term intensive family preservation services (IFPS) is to facilitate access to other services. However, service use following IFPS has rarely been studied. I describe the types of aftercare services that IFPS therapists recommended and use of these services in the two months following IFPS termination. Since families were using services that were not on the recommended aftercare plans, use of these services is also described. Primary caregivers of families who received family preservation through either child welfare or mental health were interviewed at two months after family preservation for the purpose of ascertaining service use. Different types of services were recommended and used based on whether families received IFPS through child welfare or mental health. However, there were also differences in the presenting problems and demographics between families in child welfare and mental health. Future research should include an independent assessment of need in order to determine the relationship between need and the types of services recommended and used. Even though families used services prior to IFPS, the findings indicated that IFPS facilitated use of new services. More research is needed on the process of how therapists decide what services to recommend and what they do to help families access services. It is also important to examine whether use of less restrictive services helps prevent out-of-home placements and the relationship between informal support and use of formal services.     

Aptitudes and Self-Perceptions Relating to the Employability of the Emotionally Disabled

Since diagnosis or standard psychological tests are poor predictors of successful vocational rehabilitation of emotionally disabled individuals, it is suggested that information regarding aptitudes and the individual's self-perceptions be included in the process of assessing employability. Minimum aptitudes for selected occupations in 19 worker trait groups are cited from the GATB manual as a starting point in considering occupations with the restricted mental health population often referred for services. Important self-perceptions in assessing employability with this group include locus of control, realistic appraisal of limitations, values relevant to vocational choices, and self-conceptualization of skills.     

Quality control and the practice of clinical psychology

Because of current health care reforms, quality control, accountability, and cost-effectiveness have become important issues in the practice of clinical psychology. It is imperative that practicing clinicians begin to evaluate their services to assess whether they demonstrate high quality and cost-effectiveness, as well as a continued commitment to qualify improvement. Deming's (1986) approach to quality control is discussed as a useful strategy for improving effectiveness in the practice of clinical psychology. This approach emphasizes the process of identification of the client population, improvements through incremental processes, and evaluation of outcomes. Organizational Behavior Management (OBM) techniques are also reviewed as useful ways in which to supplement and improve on Deming's approach to quality control. Science and quality control are discussed as being inherently coherent. The scientist—practitioner model dictates that services provided to clients should be rigorously evaluated. Various procedures for evaluating the quality of services provided in clinical practice are discussed.     

Difficulties Experienced by Women in Prison

This article assembles data that identify some problems experienced by women incarcerated in prisons in the United States. Inequalities in occupational and educational programs offered in women's prisons in comparison with those offered in prisons for men are discussed. The impact of inadequate health and mental health services on the lives of these women is explored, and separation problems encountered by the woman prisoner and her family are examined. Some recommendations for change are suggested.