Health care and the poor: psychological implications of restrictive policies

Medicaid proposals increasingly focus on cost-saving strategies that restrict clients' control over where and when they may receive services. This study used a field experiment in an urban welfare office to examine the possible effects of two aspects of restrictive policies: the loss of choice of providers and adverse patient mix (i.e., when the majority of a provider's clients are Medicaid beneficiaries). Results indicate that health care presented within the context of not having a choice is derogated and that choice and patient mix combine to influence intentions to seek care. Persons who did not choose the health plan in a simulated choice, who had fewer choices than expected, and who did not accept restricted choice also had negative perceptions.     

Trafficking women: Gendered impacts of Canadian immigration policies

Women and men are subject to different forms of human trafficking; sexual exploitation is more common for women than for men, and the purposes of trafficking follow gender roles. This article argues that Canadian immigration policies have differential and discriminatory impacts according to gender. We define human trafficking before critiquing two Canadian immigration programs that leave women vulnerable to exploitation. Interviews, questionnaires, and a review of official documents were employed in exploring the government's response to this phenomenon. Our findings suggest that given the nature of the international trafficking and exploitation of women in Canada, the government's focus on border control is ineffective in protecting trafficked women's human rights and the rights of migrants generally.     

Family coping strategies and the rural Appalachian working poor

Naturalistic research methods were used in this study to collect the voices, ideas, and opinions of rural, working poor, Appalachian families from Southeast Ohio about the stress of poverty in family life and family coping in the face of poverty. This data should be of interest to the professional family therapist who practices with the working poor.     

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)     

Psychotherapy, classism, and the poor: conspicuous by their absence

Four decades of research have delineated the need for improved psychotherapeutic opportunities for poor clients, yet psychotherapists remain contradictory in their stance regarding service to the poor. Despite periodic calls within the field to address the needs of poor people, evidence from the psychotherapeutic literature suggests that the poor are still largely absent from consideration. What barriers prevent psychotherapists from enacting their professional principles more consistently on behalf of poor clients? The author suggests that unexamined classist assumptions constitute a significant obstacle for practitioners and presents the experience of confronting her own classism to illustrate the operation of these attitudinal barriers.     

Family planning for inner-city adolescent males: pilot study

The results of a pilot family planning program (FPP) in a pediatric practice are reported for 66 inner-city male adolescents. The FPP was designed to eliminate registration barriers to the procurement of contraceptives by adolescent males, and to prompt the community neighborhood health center (CNHC) providers to initiate discussion of birth control with their male adolescent patients. Utilization data show that males were more likely to receive contraceptives if the provider first raised the topic of birth control to them. Unstructured follow-up interviews with 27 adolescent male FPP users identified a desire for anonymity/confidentiality and embarrassment or discomfort as the key reasons for not seeking contraceptives from the CNHC. If health care providers are sensitive to male adolescents' feelings about birth control, community health centers potentially could serve as a cost-effective source of contraceptives for sexually active male adolescents.     

Biomedical research and mining of the poor: The need for their exclusion

Almost all ethical guidelines and legislative policies concerning biomedical research involving human subjects contain provisions about relevance of research for the participating populations, informed consent, adequate care for research induced injuries and several other safeguards but the poor continue to suffer. Globalization has further aggravated poor people’s vulnerability by exposing them to international markets. Since the developing countries are abode of higher population of the poor they have become the unholy mines of this human ore for researchers. In this paper I examine various dimensions of poverty and analyze the international ethical responses in the area of biomedical research involving human subjects in order to determine their adequacy to protect the poor against exploitation and misuse and conclude that in view of the poor’s inherent and extreme vulnerability and the failure of ethical pronouncements to protect them from misuse and exploitation, they should be excluded from being enrolled as research subjects This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

Family planning and maternal health care in Egypt

The Government of Egypt is introducing policies to reduce the mortality of women of reproductive age. However, family planning and maternal-child health care programs are unlikely to have the desired impact without corresponding improvements in the status of Egyptian women. Women's status in the areas of education, health, poverty, employment, the family, government, and the community is a crucial determinant of their willingness and ability to accept a smaller family size ideal and become contraceptive users. At present, only 6% of Egyptian women are a part of the work force and 60% are illiterate. In a society in which women are valued on the basis of the number of children they produce for their husbands, those practice birth control risk abandonment and isolation. The powerlessness and insecurity that lead Egyptian women to have an average of at least 5 children impeded national development and thus delay creation of the socioeconomic conditions that could liberate women from their domestic role. Equal opportunities in education and employment would represent a first step toward improving women's status by giving them a source of income and increased independence. Also needed are modifications in archaic marriage, divorce, and custody laws.     

Family planning of Portuguese immigrants and integration in Belgium

A substantial immigration of Portuguese and other foreign nationals to Belgium due to a favorable immigration policy guides this investigation to focus on this group in order to study the influence of the acculturation experience on birth-control practices. Choosing a sample of 100 married women within a group of 998 Portuguese immigrants in an urban municipality in Brussels, the study sets out specifically to investigate whether these immigrants adopt attitude patterns of the receiving social group or if they preserve the customs of their original community. The hypothesis held by the study was that the better the woman's integration into Belgian society, the larger her knowledge and acceptance of contraceptives would be. The study found that the majority of interviewed immigrants remained poorly integrated into the Belgian society, and that the transition from a traditional to an industrial society had not included great changes in attitudinal behavior which would facilitate social and cultural integration into the new society. In terms of attitudes toward contraception, negative behavior was observed to be linked not to levels of acculturation, but rather to lack of information. Though the majority of respondents expressed desires for controlled fecundity even when still in Portugal, those who came to Belgium with no previous knowledge or desires admitted to having felt the need for contraceptive practice. The crucial factor in acceptance of modern contraceptive practices is singled out as one of communication. Access to information about contraception is readily available in the Belgian society. The information actually obtained by the women, however, depended on their access to informational channels, the circumstances through which they got in touch with such sources, and their problems with a language barrier when relying on the media through which contraceptive knowledge was made available.     

Reflections on special-care babies and their early experience

In this paper the author presents some ideas about rapprochement and reciprocity, and considers them in relation to the experience of special-care babies and their mothers. Psychoanalytic infant-observation is discussed in the context of the relationship between psychoanalysis and developmental psychology and its value as a method of research is explored. Observational research has contributed to the understanding of early mother-infant relationships, and in particular has highlighted the importance of reciprocity and fit. The crucial importance of this in relation to premature babies' early relationships is illustrated by the presentation of extracts from the observations of three mother-child pairs during their stay in a special-care baby unit.     

Family social support during the predeparture period: The experience of British migrants

This study explored the stress, wellbeing and social support of predeparture British migrants to New Zealand. The main research questions addressed the relationship between family support and psychological outcomes, differences in migration desire between couples, and the impact of extended family support. A survey recruited 95 participants from online forums for migrants to New Zealand and results indicated that support from immediate family was related to better wellbeing and lower stress. Migrants who considered themselves the driving force behind the move reported significantly more stress and less family support than migrants who had partners who were equally enthusiastic about the move abroad. Sojourners perceived more support from extended family than did migrants who intended to leave permanently. The most difficult parts of the migration process were leaving loved ones, logistical demands, and uncertainty. The most positive parts of the process were adventure and becoming closer as a family. Overall, migration stress and coping began well before departure from the country of origin.     

Students' perspectives on their high school experience

This study explored students' levels of belonging and engagement in high school by obtaining their perspectives on the instruction, teachers, friends, and activities in their school. We interviewed 33 students from seven comprehensive high schools in Richmond, Virginia. Students indicated that they were more engaged when the instructional program included authentic learning experiences, teachers who provided challenging activities and showed interest in student learning, and a school day that supported interpersonal relationships with peers and adults. It was concluded that, to promote belonging and engagement, school personnel should attend to the quality of student learning and relationships.     

Incidence and impacts of psychotherapists' feelings toward their clients: A review of the empirical literature

The empirical literature examining the incidence and impacts of psychotherapists' feelings of fear, anger, and attraction toward clients is reviewed, including: (a) studies reporting the incidence of psychotherapists' feelings toward their clients; (b) studies investigating the measurable impact of psychotherapists' feelings on clients, psychotherapists, and the therapeutic process; and (c) examinations of the psychotherapist-factors that affect either the incidence or impact of psychotherapists' feelings toward their clients. Fear, anger, and attraction toward clients are common experiences for psychotherapists. Many psychotherapists report that they are confused, ashamed, and stressed by these feelings. These feelings, although occasionally an important therapeutic resource, were often reported to have a direct and negative impact on the therapeutic processes or cause behaviors that were destructive. Most psychotherapists feel that they were inadequately trained to acknowledge and successfully manage these common and stressful experiences. Recommendations for research and training are provided.