Reducing the Risk for Preschool Expulsion: Mental Health Consultation for Young Children with Challenging Behaviors

Increasing numbers of young children are being expelled from child care settings because of their problem behavior. Access to mental health consultation is related to lower rates of expulsion, but additional data are needed to document the pathways through which mental health consultation reduces the risk of expulsion. We report on outcomes from a 4-year project designed to reduce the number of children expelled for problem behavior in a large suburban county in Maryland. Two master’s-level professionals provided behavioral consultation to child care providers who identified nearly 200 children at imminent risk for expulsion. Child care providers rated children’s social skills and problem behaviors at referral and discharge using the Preschool Kindergarten Behavior Scales and the Brief Infant Toddler Social Emotional Assessment. Statistically significant increases in social skills and reductions in problem behaviors were seen for children who received individualized consultation. More than three-quarters of the children who were at risk for expulsion were able to be maintained in their current child care placement; of those that changed placements, only half (n = 13) were removed involuntarily. These findings provide additional support for mental health consultation as a promising strategy to reduce the risk for expulsion for young children with problem behaviors.     

Ecological Networks and Community Attachment and Support Among Recently Resettled Refugees

Interventions aimed at enhancing mental health are increasingly centered around promoting community attachment and support. However, few have examined and tested the specific ecological factors that give rise to these key community processes. Drawing from insights from the ecological network perspective, we tested whether spatial and social overlap in routine activity settings (e.g., work, school, childcare) with fellow ethnic community members is associated with individuals’ attachment to their ethnic communities and access to social resources embedded in their communities. Data on routine activity locations drawn from the Refugee Well‐Being Project (based in a city in the Southwestern United States) were used to reconstruct the ecological networks of recently resettled refugee communities, which were two‐mode networks that comprise individuals and their routine activity locations. Results indicated that respondents’ community attachment and support increased with their ecological network extensity—which taps the extent to which respondents share routine activity locations with other community members. Our study highlights a key ecological process that potentially enhances individuals’ ethnic community attachment that extends beyond residential neighborhoods.     

社区卫生服务首诊制与医师多点执业

阐述了社区卫生服务首诊制的概念及其对规范医疗卫生次序的重要作用, 深入分析了限制社区卫生服务首诊制发展的主要因素。从正反两个方面分析了医师多点执业对首诊制的影响:医师多点执业能提高社区卫生人力资源的质量, 增强民众对社区卫生机构的信任度;但是医师多点执业也会造成医院和社区卫生机构管理上的问题, 医生自身也需要时间适应自身角色的转变。鼓励大医院办社区卫生服务机构, 增加社区医疗机构的政府补偿, 吸引医师到基层多点执业, 增强社区卫生服务首诊的能力。     

Understanding How Participation in a Consumer-Run Organization Relates to Recovery

The goal of this study was to examine how different types of participation in a consumer-run organization (CRO) are related to recovery. More specifically, this study uses structural equation modeling to examine the relative impact of empowering and socially supportive participation experiences on progress towards recovery among 250 CRO members from 20 CROs. An empowering participation experience refers to involvement in leadership roles and contribution to organizational functioning. A socially supportive participation experience refers to social involvement in mutually supportive friendships with intimacy and sharing. Results indicate that both types of participation are associated with recovery, although a socially supportive participation experience maintains a stronger relationship with recovery than an empowering participation experience. Findings are consistent with the idea that CROs should encourage both types of participation. Drawing from over ten years of experience supporting CROs, the discussion section explores several strategies CROs can use to foster empowering and socially supportive participation experiences.     

The Professional Status of Bioethics Consultation

Theoretical Medicine and Bioethics - Is bioethics consultation a profession? Withfew exceptions, the arguments andcounterarguments about whether healthcareethics consultation is a profession...     

Systems of Care: New Partnerships for Community Psychology

For almost two decades, the federal government has supported the development of integrated models of mental health service delivery for children and families, known as systems of care (SOCs), that strive to be child-centered, family-focused, community-based, and culturally competent. These efforts align well with the values and principles (e.g., empowerment, collaboration, strengths emphasis, focus on macro-level social/system change) central to community psychology (CP; Kloos et al. in Community psychology, Cengage Learning, Belmont, 2012). Despite the convergence of many core values, CPs have historically been underrepresented in key roles in SOC initiatives. However, this has changed in recent years, with increasing examples of community psychology skills and principles applied to the development, implementation, and evaluation of SOCs. Because successful and sustainable implementation of SOCs requires community and system-level change, and SOCs are increasingly being urged to adopt a stronger "public health" orientation (Miles et al. in A public health approach to children's mental health: a conceptual framework, Georgetown University Center for Child and Human Development, National Technical Assistance Center for Children's Mental Health, Washington, DC, 2010), there is great potential for CPs to play important roles in SOCs. This paper discusses opportunities and roles for CPs in SOCs in applied research and evaluation, community practice, and training.     

Hmong Mental Health Needs Assessment: A Community-Based Partnership in a Small Mid-Western Community

The overall goal of this assessment was to verify the mental health needs of Hmong living in a mid-west community in order clarify the format, content, and feasibility of providing mental health services for Hmong in the future. Using a Community-Based Participatory Research (CBPR) model, we held four focus groups with 36 men, women, adolescents and professionals, all of Hmong descent, as well as interviewed 28 individual medical, mental health, education, and social service providers in the Eau Claire community. Our Hmong sample was frequently unclear about what “mental” health meant, indicating a low level of mental health literacy. Results confirmed that there are significant mental health needs in this refugee and immigrant population. Participants described problems consistent with depression, post-traumatic stress disorder (PTSD), anxiety disorders, somatoform disorders, and severe social stress and acculturation difficulties in every generation. Elder people and male adolescents were described as the most disaffected and in need of immediate services. It will be critical to address mental health literacy before designing future interventions. Treatment suggestions were provided with the intention of removing barriers and incorporating culturally sensitive methodologies, while continuing to work closely with our local mental health providers and Hmong leadership.     

Meeting the advocacy needs of people who have been abused by health and social care practitioners

The Prevention of Professional Abuse Network (POPAN) is the first national organization within the UK to address the problem of the abuse of clients and patients by health and social care providers. POPAN has a small staff group of eight people and a larger network of advisers, supporters and allies; its activities include campaigning, training, consultancy, and the provision of information, advice and advocacy. Jennie Williams is a clinical psychologist and trustee of POPAN, she has supported the development of the organization since the early 1990s; Jo Nash was the main person involved in the development and provision of the advocacy service between September 1997 to January 2000. This is the edited version of a taped and transcribed interview that took place in 1999. Jo Nash is uniquely placed to provide information of significance to anyone using or providing health and social care services. Her work as an advocate has given her a very particular insight into the challenges faced by those seeking redress for professional abuse, and she has first hand experience of providing advocacy to people who are vulnerable and reluctant to trust anyone offering help. In this interview Jo Nash directs attention to the considerable limitations in current complaints systems, practices and procedures, and offers comment on the implications for change. Her work with POPAN provides continual reminders of the importance of prevention, and she identifies a number of ways in which action can be taken to prevent health and social care practitioners abusing their patients and clients. Copyright © 2001 John Wiley & Sons, Ltd.     

The Effect of Professional Partnership on the Development of a Mutual-help Organization

The effects of partnership between Schizophrenics Anonymous (SA, a mutual-help organization) and the Mental Health Association in Michigan (MHAM, a professionally staffed advocacy organization) on SA's growth and development were explored. Following the initiation of a formal partnership, SA groups were more available throughout the state, more likely to be associated with formal mental health settings, and less likely to have leaders who had been participants in other SA groups. Groups with consumer leaders had significantly greater longevity than groups with professional leaders. Changes in the organizational structure and process of SA were also identified. SA leaders reported that SA moved from a collective to a more bureaucratic structure. As a result, there was greater consistency, administrative capacity, and response capacity. This enhanced capacity came with costs reported by SA leaders. The leadership role of SA members became less defined. SA members expressed concerns about the more hierarchical structure of SA's organization, decreased consumer control, increased professional involvement in SA, and an excessive focus on group development as opposed to group maintenance. Mental Health Association in Michigan staff reported that MHAM was also impacted by the partnership, both with regard to internal functioning and external perception. Implications for effective partnerships between mutual-help and professional organizations are discussed.     

The Influence of a Community-Based Service-Learning Experience on the Development of Occupational Therapy Students' Feelings of Civic Responsibility

This qualitative study examined the influence of service-learning on the development of Students' feelings of civic responsibility while involved with a community-based organization. Occupational therapy students involved in a semester-long service-learning experience maintained weekly reflective journals. Six such reflective journals were randomly selected for analysis. Findings revealed that while engaged in service-learning the six participants voiced themes of increased self-awareness, awareness of homeless individuals as persons, awareness of social issues, and professional self-efficacy. These developing competencies are associated with the skills required for health care professionals to participate in civic engagement and client advocacy.     

区域卫生规划与卫生资源配置

区域卫生规划与卫生资源配置的关系密不可分,同时也是解决医疗保健供需平衡的重大举措和主要手段。首先提出了区域卫生规划的现实意义和基本理论,并分析了建立区域卫生规划对解决以上问题怎样产生积极的影响。     

Citizenship and Community Mental Health Care

Citizenship is an approach to supporting the social inclusion and participation in society of people with mental illnesses. It is receiving greater attention in community mental health discourse and literature in parallel with increased awareness of social determinants of health and concern over the continued marginalization of persons with mental illness in the United States. In this article, we review the definition and principles of our citizenship framework with attention to social participation and access to resources as well as rights and responsibilities that society confers on its members. We then discuss our citizenship research at both individual and social‐environmental levels, including previous, current, and planned efforts. We also discuss the role of community psychology and psychologists in advancing citizenship and other themes relevant to a citizenship perspective on mental health care and persons with mental illness.     

城市居民社区组织意识研究综述

社区组织意识是社区成员与社区组织在共同生活中形成的的精神联结,体现为对社区组织的认知、情感和行为意愿。文章对社区组织意识概念、状况和影响因素进行了论述,并提出社区组织意识研究存在的不足,及对未来研究的展望。     

Individual and Community Resilience Factors Among Lesbian,Gay, Bisexual,Queer and Questioning Youth and Adults in Israel

Drawing on resilience theories, this study examined the individual and community factors of Israeli lesbians, gays, bisexuals, queers, and questioning (LGBQs) that contribute to positive mental health and the degree to which individual and community protective factors mitigate the adverse effect of risk factors for poor mental health. Differences in resilience factors between LGBQ youth and adults were explored. Data were collected on 890 LGBQ youth and adults. Findings emphasize the role of community‐level resilience factors in the lives of LGBQs, and that these support systems differ slightly between the two age groups. Among youth, family support was both a strong predictor for well‐being and a protective factor for mental distress. Although family support was found as a resilience factor among adults as well, other community‐level factors (friends’ support, LGBT connectedness and having steady partner) were found as protective factors for poorer mental health. These findings suggest for efforts on fostering familial support for LGBQ youth and a multi‐level system that offers support at the familial, peer, relationship and community levels for both LGBQ youth and adults.     

Contextualizing Acculturation: Gender, Family, and Community Reception Influences on Asian Immigrant Mental Health

This article investigates differences in the mental health among male and female immigrants from an ecological perspective, testing the influences of both individual acculturation domains and social contexts. Data from the first nationally representative psychiatric survey of immigrant Asians in the US is used (N = 1,583). These data demonstrate the importance of understanding acculturation domains (e.g., individual differences in English proficiency, ethnic identity, and time in the US), within the social contexts of family, community, and neighborhood. Results demonstrate that among immigrant Asian women, the association between family conflict and mental health problems is stronger for those with higher ethnic identity; among immigrant Asian men, community reception (e.g., everyday discrimination) was more highly associated with increases in mental health symptoms among those with poor English fluency. Findings suggest that both individual domains of acculturation and social context measures contribute to immigrant mental health, and that it is important to consider these relationships within the context of gender.     

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention

American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre‐existing interview data from 15 self‐identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community's knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.     

Mental Health Literacy and Peer-to-Peer Counseling Referrals Among Community College Students

Mental health literacy (MHL) has utility for promoting peer-to-peer referrals to mental health support services among university students. However, there is a gap in the extant literature about the potential usefulness of MHL for supporting the mental health of community college students, a population facing a number of mental health conditions. The authors examined the construct validity and the utility of 3 dimensions of MHL as predictors of peer-to-peer referrals to the counseling center among community college students. Results of confirmatory factor analyses supported the dimensionality of the instrumentation and a hierarchical logistic regression analysis revealed that MHL was a significant positive predictor of peer-to-peer referrals to the counseling center. Implications for counseling practice and future research are discussed.     

论社区卫生服务机构与城市大中型医院的协调发展

对当前社区卫生服务机构与城市大中型医院协调发展中存在的问题及原因进行了分析,在功能定位、制度层面、筹资及服务提供机制、社区卫生服务机构自我建设以及综合配套改革等方面提出改进建议,并对社区卫生与医院协调发展的现有模式进行了探讨,以期构建科学合理、切实维护群众健康的城市卫生服务体系。