Provider Perspectives on Disaster Mental Health Services in Oklahoma City

Abstract

Seven years after the bombing of the Murrah Federal Building in Oklahoma City, 34 individuals affiliated with various organizations were interviewed about their experiences in providing disaster mental health services to victims and the community. Their perspectives elucidated the importance of preparedness, training and education, local control, interagency cooperation, and psychosocial support for providers. Significant conflicts emerged among providers about credentials, referrals, the quality of services provided, and the appropriateness, in this context, of basing services solely on a crisis counseling model. The lack of ongoing needs assessment or evaluation data further fueled the debates. On the basis of the findings, the authors outline several recommendations for planning mental health responses to future terrorist attacks.     

国外心理健康服务及其启示

在回顾了美国、瑞典等国家心理健康服务概况的基础上提出了以下启示：1．中国心理健康服务体系应以构建和谐社会理论为基础;2．在心理服务的教育与培训中,应当尽量兼顾普及知识与提高专业化水平两个目标;3．政府应当大力支持社区心理健康服务以及包含各种社区可用资源的综合性社区服务;4．中国心理健康服务必须从本国文化与国情出发,因此还需要更多这方面的文献总结与实际诃查工作;5．心理健康服务应当全面而有区别地实施予心理健康水平不同的人群。     

Community Mental Health in Emergencies and Mass Disasters

Summary

Mass disasters are widespread and intensive, affecting individuals, families, communities, society, and culture. Mental health services must play a crucial role in order to meet non-routine challenges that put basic professional issues to the test both in theory and in practice. In the Tel Aviv Model, responsible planning is based on a broad system of mediators and activities during normal times, supplemented by intervention personnel and techniques set in motion during emergencies. This operation is coordinated with municipal and governmental support systems, which must be aware of the importance of comprehensive and flexible emergency systems for treating the population.     

The Mental Health Needs of Youth with Emotional and Behavioral Disabilities Placed in Special Education Programs in Urban Schools

We describe the psychosocial characteristics of youth with an average age of 11.8 years served in special education due to emotional disturbances in urban communities (N = 158). Data were also collected describing service utilization, academic functioning, and family characteristics. Ten schools in three mid-size urban cities participated. Results from the administration of standardized assessments revealed that the majority of students scored in the clinical range on the parent version of the Child Behavior Checklist and the Columbia Impairment Scale, indicating significant levels of emotional and behavioral impairment. Further, behavior problems began at an early age with 80% of the youth using outpatient services beginning at the average age of 7.5 years and 29% of the youth using inpatient services beginning at an average age of 8.4 years of age. Most of the youths' school careers (67%) have been in a special education setting. The most common services currently being supplied by school personnel was individual counseling and this was provided for 63% of the students while child-serving agency personnel were providing individual counseling for 17% of the youth. Implications for the development of multi-agency collaborative services are presented.     

心理健康培训对医护人员心理健康服务的影响

为探讨医护人员心理健康培训现状以及对心理健康服务的影响,采用《医护人员心理健康教育培训问卷》与《心理健康服务行为量表》对664名医护人员进行问卷调查。结果发现,分别有91.6%、65.2%的医护人员学习过心理健康相关课程或接受过相关培训,70.3%通过科普宣传途径学习心理健康知识;心理健康教育和培训正向预测心理健康服务,能够增加8.5%解释变异量。因此,医护人员接受心理健康教育与培训的内容和途径较为单一,对医护人员加强心理健康相关教育培训,可以增加其心理健康服务。     

Mapping Men's Mental Health

The central theme of this paper is that men are at one and the same time both damaged and damage-doing. The process of being damaged through the agency of masculinity predisposes men to exploit, dominate and abuse—not only as boys, as partners and fathers, but as priests, teachers, therapists, lawyers, nurses, psychologists and psychiatrists. Mental health services need to see both aspects of this male equation: a focus on male abuse alone leads to punishment, containment and, very likely, the continuation of abuse; a focus on male damagedness alone preserves the ideology of male unaccountability. However, evidence reviewed here suggests that most traditional psychiatric services fail to acknowledge the impact of inequalities on men's mental health as comprehensively as they fail to acknowledge the impact of these inequalities on the mental health of women. This is a significant problem, and we suggest ways that a gendered analysis of masculinity can be used to help address this deficit. This analysis is used to develop a map of men's mental health that not only accommodates traditional categories of mental health difficulty, but other important consequences of the close association between masculinity and sexuality inequality, especially the use of violence and the capacity to do harm. This analytical framework also invites consideration of the invisibility of male distress, the disallowing and desensitizing of ‘vulnerability, and their submersion in a kind of psychology of entitlement. Finally, we consider the implications of this mapping exercise for mental health services and for working with men.     

Parent-School and Community Partnerships in Children's Mental Health: Networking Challenges, Dilemmas, and Solutions

Inter-agency collaboration, service coordination, and the creation of successful partnerships among parents, teachers, and human services professionals continues to be a challenge for the development of responsive community-based systems of care for at-risk youth and their families. We explore how one inner-city neighborhood struggles to create successful community partnerships through traditional networking strategies. Our findings identify networking strategies that appear to work and those that do not. Recommendations for improving communication are provided.     

Applying a Theory of Change Approach to Interagency Planning in Child Mental Health

This paper describes the use of a theory of change approach to community-based cross-agency service planning for children with serious emotional disturbance and their families. Public agency planners in Contra Costa County, California used the theory of change approach to organize service planning for a population of youth who had been arrested and involved with juvenile probation. The theory of change process described in this paper links community outcomes with planned activities with the assumptions or principles that underlie the community planning efforts. When complete, a theory of change logic model can serve as a guide for implementation, ensuring that community plans for service delivery remain true to their intent. The theory of change development process includes twelve stages and is based on a step-by-step approach. Theory of change logic models establish a context for articulating a community's shared beliefs and prompt local stakeholders to establish logical connections between the population to be served, expected results, and strategies intended to achieve those results.     

Twenty Years Post‐genocide: The Creation of Mental Health Competence among Rwandan Survivors Through Community‐based Healing Workshops

Twenty years after the genocide, many Rwandans still suffer from the psychological wounds of the past. The country's mental health agenda is based on individualised and psychiatric approaches that help some but cannot be provided on a large scale. Further, many reconciliation initiatives have been based on public testimonies, which have been shown to be potentially re‐traumatising, leading to calls for small‐scale community‐based approaches to healing, which constitute a middle way between individualised and public approaches. Drawing on the concept of ‘mental health competence’ (Campbell and Burgess, 2012), this study evaluates one such approach: the Life Wounds Healing workshops offered by the African Institute for Integral Psychology. Twenty‐one semi‐structured interviews were conducted with former workshop participants, staff members and the institute's founder to investigate their views on how these workshops can help genocide survivors. The results suggest that the workshops succeed in creating mental health competence by establishing a safe social space for people to open up, increasing people's critical understandings of the processes of pain — and potential for healing — that informs behaviour change, generating bonding social capital and offering participants' income‐generating possibilities. Copyright © 2015 John Wiley & Sons, Ltd.     

Evidence for Relationships Between Hope,Resilience, and Mental Health Among Youth

Predictive modeling was used to evaluate the associations between hope, resilience, happiness, and mental health in 449 middle and high school students. Model results indicated large effect sizes for middle school (R² = .28) and high school (R² = .36) participants, with hope and resilience tending to predict self‐reported mental health symptoms. These findings and their application to counseling practice are explained.     

Psychological Impact of Terrorism on Children and Families in the United States

Summary

This article reviews the literature on the psychological impact of terrorism on children and families in the United States. It includes studies of the 1993 World Trade Center bombing in New York City and the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City, as well as the September 11 attacks. These studies explore the impact of various forms and degrees of exposure to terrorism on children across the development spectrum and on the relationships between parental and child reactions. The article concludes with a framework for future research on children's adaptation following mass trauma.     

The Effects of Capitation on Outpatient Mental Health Episodes of Children

We analyzed the effects of the Colorado Medicaid Capitation Program on the duration and services of over 21,000 outpatient mental health episodes for young children. The study spanned a three year period before and after capitation was implemented, and compared episodes of outpatient care for children from 14 capitated Community Mental Health Centers (CMHCs) with those from three CMHCs that remained fee-for-service. Proportional hazards regressions revealed that capitation resulted in an increase in outpatient episode duration, over and above similar effects for the comparison fee-for-service episodes. The hypothesis that there were longer capitated episodes for children who were hospitalized was not supported. Children with behavioral and anxiety disorders had longer capitated episodes. Service intensity decreased over time in the managed care sites. Changes in case mix may have had an impact on changes in episode duration and service intensity. That outpatient episode duration increased over time while costs were lowered in the capitated agencies indicates some effects of capitation in changing patterns of care.     

Supervision in Community Mental Health: Understanding Intensity of EBT Focus

The goal of the present study was to examine clinician, supervisor, and organizational factors that are associated with the intensity of evidence-based treatment (EBT) focus in workplace-based clinical supervision of a specific EBT, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Supervisors (n = 56) and clinicians (n = 207) from mental health organizations across Washington State completed online self-report questionnaires. Multilevel modeling (MLM) analyses were used to examine the relative influence of nested clinician and supervisor factors on the intensity of EBT focus in supervision. We found that 33% of the variance in clinician report of EBT supervision intensity clustered at the supervisor level and implementation climate was the only significant factor associated with EBT supervision intensity. While individual clinician and supervisor factors may play a role in EBT coverage in supervision, our results suggest that an implementation climate that supports EBT may be the most critical factor for improving intensity of EBT coverage. Thus, implementation efforts that address the extent to which EBTs are expected, rewarded, and supported within an organization may be needed to support greater coverage of EBT during workplace-based supervision.     

目前国内常用心理健康量表的回顾与反思

对国内近10多年来常被用于评鉴心理健康的7大类量表的分析结果表明,我国常用心理健康评估工具具有逐年增加、从单纯引进转向创造性地自编、自编量表的内容从学习与人格向多领域延伸、自编量表的方法从不完全到完全的特点。已编制出一些信效度较高的量表,但是仍存在一些问题。存在的主要问题是量表的信效度较低、自编量表有低水平重复现象、测量积极心理的量表少。     

城市低龄老年人的需要满足状况、社会支持和心理健康的关系研究

采用城市低龄老年人社会支持问卷、老年人心理健康问卷、城市低龄老年人需要问卷对738名城市低龄老年人进行施测,考察需要社会支持、需要满足状况对城市低龄老年人的心理健康关系机制。结果表明：城市低龄老年人的需要满足状况和社会支持同时影响其心理健康。具体而言,人际需要满足状况和亲情需要满足状况分别对关爱支持和心理健康起到了部分中介效应,人际需要满足状况、亲情需要满足状况认知需要满足状况和价值需要满足状况分别对指导支持和心理健康起到了部分中介效应。     

Adolescent Satisfaction with School-Based Mental Health Services

Examining adolescents' satisfaction with mental health services is an important program evaluation activity. Their perceptions of whether services were beneficial and resulted in improved functioning are indices of treatment quality. Assessment of adolescent satisfaction with school-based mental health programs has been limited. In our study, adolescents receiving services from a School Mental Health Program (SMHP) completed satisfaction surveys. Participants were predominantly minority youth residing in an urban area. Results indicated that students were highly satisfied with their mental health services. Students valued the therapeutic relationship, catharsis associated with therapy, and skills they learned during therapy. Several factors influenced satisfaction ratings including clinician training and availability.     

<菜根谭>的心理卫生思想剖析

该文着重从人际交往、个性、环境以及自我修养等方面分析了《莱根谭》中所蕴含的心理卫生思想。     

Representations of Mental Health Among Middle‐Aged Urban Chinese Men

Little is understood by the ideas that urban Chinese population holds about mental health. Insufficient research and recognition of mental illnesses, and a dearth of social resources for mental health support and promotion limit understandings of how daily life stresses restrict the quality of life of China's urban population. Drawing on in‐depth interviews with 15 middle‐age urban men, we map out men's accounts of how they battle to cope with the demands of everyday social, political, and familial pressures. The study reveals that the representations of mental health are shaped by notions of control over emotions, adherence to Confucian philosophy, familial obligations, and the need to demonstrate social obedience and conformity. Data also suggest that the participants represent stable family support along with healthy social interactions as important enabling factors of positive mental health, whereas pressures of modernity are regarded as significant disruptive factors in mental health. The theory of social representations guides the process as well as analytic interpretations of this research. Copyright © 2015 John Wiley & Sons, Ltd.