Provider contact with families of adults with severe mental illness: taking a closer look

This exploratory study examined the frequency and nature of providers' contact with families of persons with severe mental illness. Fifty-nine providers in six community mental health programs completed a self-administered survey. A subsample of 8 providers also completed two in-depth interviews. Although most providers had some family contact, the contact was restricted to a small percent of their caseloads. The nature of contact that providers have with families is generally limited by their professional role. Best practice guidelines for the treatment of mental illness and agency administrators responsible for instituting these guidelines will need to clarify the types of providers who are expected to implement various aspects of family involvement.     

The current status of EHDI programs in the United States

The importance of identifying congenital hearing loss during the first few months of life has been recognized for almost 60 years. Unfortunately, until more effective newborn hearing screening equipment and procedures were developed in the late 1980s, it was not practical to implement programs for identifying hearing loss during the first few months of life. This paper reviews the activities implemented by the federal government in the last 15 years to promote more effective Early Hearing Detection and Intervention (EHDI) programs, and summarizes legislation passed by states related to universal newborn hearing screening. In surveys conducted in 1998 and 2001, State EHDI Coordinators were asked to rate the degree to which various issues were obstacles to implementing effective EHDI programs. The most serious obstacles are the shortage of qualified pediatric audiologists, inadequate reimbursement for screening and diagnosis, and lack of knowledge among primary health care providers about EHDI issues. Opposition to EHDI programs by hospital administrators was rated substantially lower in 2001 than in 1998. State EHDI Coordinators were also surveyed about how well their EHDI program is addressing issues related to screening, diagnosis, early intervention, linkages to medical home providers, tracking and data management, and family support programs. Although substantial progress has been made, many gaps remain with current EHDI programs.     

School-Based Substance Abuse Prevention Programs

Substance abuse has been identified as a significant problem among adolescents. Personal and social coping skills training programs implemented in school settings have shown evidence of effectiveness as a primary prevention approach. Early intervention programs for students most at risk are also needed, however, few have been adequately evaluated. Special services providers possess training and skills that are well suited for planning and implementing school-based programs that address the substance abuse issue.     

Treatment approaches and offending behavior programs: Some critical issues

This paper discusses what is known about effective methods of program delivery in offender rehabilitation programs and how this impacts on the integrity of correctional programs. Drawing on literature from both psychotherapy and adult education, it is concluded that collaborative and client-centred approaches are likely to be associated with the highest levels of effectiveness, and that there is a need to support these methods of delivery through the development of practice guidelines that can be used by both program providers and supervisors.     

Innovation in HIV prevention: organizational and intervention characteristics affecting program adoption

A multiple case study design was used to explore the organizational characteristics of community-based organizations that provide HIV prevention programs and the criteria these organizations employ when judging the merits of externally-developed HIV prevention programs. In-depth interviews were conducted with organizational representatives of 38 randomly-selected HIV prevention providers throughout Illinois. Results indicated that there were three main types of adopting organizations: adopters of entire programs, adopters of program components and practices, and adopters of common ideas. These three types of organizations were distinguished by their level of organizational commitment to HIV prevention, organizational resources, and level of organizational maturity. Narrative data from the interviews are used to describe the dimensions that underlie the organizations' program adoption criteria. The criteria of merit used by these organizations to evaluate prevention programs provide partial empirical support for existing theories of technology transfer. Implications for designing and disseminating HIV prevention programs are discussed.     

Reflective Capacity: An Antidote to Structural Racism Cultivated Through Mental Health Consultation

Effecting a paradigm shift from “reproductive health” to “reproductive justice” within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant-Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use-of-self in patient–provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well-being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.     

Innovative Community Services for Rape Victims: An Application of Multiple Case Study Methodology

A qualitative multiple case study design was used to examine communities across the United States that have developed coordinated community-based programs to assist rape victims. Previous studies have suggested that coordinated community programs help victims obtain needed resources and services. This study provided a follow-up examination of how and why these programs are helpful to rape victims. In-depth interviews were conducted with rape victim advocates, rape crisis center directors, police officers, prosecutors, doctors, nurses, and rape survivors from 22 communities with coordinated programs. A comparison sample of 22 communities with fewer coordinated programs was also obtained. Results indicated that the high coordination communities had three types of programs to address sexual assault: coordinated service programs, interagency training programs, and community-level reform groups. Although not all of these programs directly address service delivery for rape victims, they help create a community culture that is more responsive to victims' needs. The research team and participants developed an explanatory model of why these program are effective in addressing rape victims' needs. This model hypothesizes that coordinated programs reflect an understanding of the multiple contexts of service delivery and embody that knowledge in services that are consistent with victims' needs. Narrative data from the interviews with service providers and rape survivors are used to develop and support this model.     

School-Based Intervention Strategies for the Treatment of Depression in Children and Adolescents

Depression in children and adolescents is a major problem of which special service providers need to be aware. In recent years, a number of advances have been realized in the identification of depression in youngsters via self-report depression scales. There have also been advances in the development of cognitive-behavioral intervention strategies for the amelioration of depressive symptomatology in children and adolescents. This article describes components of treatment programs that have demonstrated efficacy in the treatment programs that have demonstrated efficacy in the treatment of depressed youngsters. Specific components described include: self-monitoring, activity scheduling, cognitive restructuring, attribution retraining, self-evaluation training, self-reinforcement training, and relaxation training. Results of several group treatment studies that have utilized the components delineated are presented. Recommendations as well as cautions are put forth for special service providers in the use of these therapeutic techniques with depressed children and adolescents.     

Treating Transgender Individuals in Inpatient and Residential Mental Health Settings

This article describes the need for specific guidelines regarding how to manage inpatient and residential mental health programming with respect to transgender individuals. The article discusses what is known about transgender mental health and how it is related to sociopolitical factors, how inpatient and residential programs can address the impact of sociopolitical factors on transgender individuals and send a welcoming message to prospective consumers, how programs can attend to policies and procedures in ways that create the best milieu for an inpatient or residential unit that provides care for one or more transgender individuals, and how providers and interdisciplinary teams can meet the unique clinical needs of transgender individuals. These guidelines are designed to assist providers in creating a safe environment that affords quality inpatient and residential mental health care to transgender individuals.     

‘On-the ground’ strategy matrix for fostering quality participation experiences among persons with disabilities in community-based exercise programs

ObjectiveThe purposes of this paper are to (1) document the generation and refinement of a quality participation strategy list to ensure resonance and applicability within community-based exercise programs (CBEPs) for persons with physical and intellectual disabilities, and (2) identify theoretical links between strategies and the quality participation constructs.MethodsTo address purpose one, a list of strategies to foster quality participation among members was extracted from qualitative interviews with providers from nine CBEPs serving persons with physical disabilities. Next, providers from CBEPs serving persons with physical (n = 9) and intellectual disabilities (n = 6) were asked to identify the strategies used, and examples of their implementation, within their programs. Additional strategies noted by providers and in recent published syntheses were added to the preliminary list. A re-categorization and revision process was conducted. To address purpose two, 22 researchers with expertise in physical and/or intellectual disability, physical activity, participation and/or health behaviour change theory completed a closed-sort task to theoretically link each strategy to the constructs of quality participation.ResultsThe final list of 85 strategies is presented in a matrix. Each strategy has explicit examples and proposed theoretical links to the constructs of quality participation.ConclusionsThe strategy matrix offers a theoretically-meaningful representation of how quality participation-enhancing strategies can be practically implemented “on-the-ground” in CBEPs for persons with disabilities.     

The Role of Professional Training Experiences and Manualized Programs in ABA Providers’ Use of Parent Training With Children With Autism

Parent training, in which providers teach parents intervention strategies to promote their children’s skill acquisition and/or behavior management, is considered a best practice in the treatment for children with autism spectrum disorder (ASD) and yet is underutilized in community settings. The present study examined the role of training experiences and manual use in promoting the use of parent training by community providers who serve children with ASD. Applied behavior analysis (ABA) providers (N = 1,089) from across the United States completed self-report questionnaires online. The total number of professional training experiences related to parent training significantly predicted the extensiveness of providers’ use of parent training. Receiving supervision in parent training, being trained in a specific parent training approach, taking a course related to parent training, and participating in self-guided learning (e.g., webinar) were unique predictors of parent training extensiveness. While only 15% of ABA providers used manualized parent training programs, using a manual was also a unique predictor of parent training extensiveness. Parallel multiple mediator analyses demonstrated that family-, provider-, and organization-level barriers all partially mediated the relationship between number of training experiences and parent training extensiveness; only provider- and organization-level barriers mediated the relationship between manual use and parent training extensiveness. Recommendations for training and supporting providers at the pre-service and in-service levels are discussed as a means of increasing access to parent training for children with ASD in community settings.     

Couple relationship education in Australia

In Australia, the strengthening of marriage through relationship education has received strong governmental policy support and some modest financial support. Couple relationship education services are offered by a variety of community-based, church-affiliated, and church-based providers. There is a strong emphasis on providing programs that are developed locally in response to perceived couple needs and government policies. Available evaluations show that most couples who attend education value the service, but relationship education providers need to do a better job reaching out to couples at high risk for future relationship problems, and more research is needed on the effects of education on long-term marital outcomes. There is significant scope for building on current initiatives to incorporate evidence-based approaches and to expand the program reach to more couples.     

Direct Social Support for Young High Risk Children: Relations with Behavioral and Emotional Outcomes across Time

This study is unique in addressing developmental correlates of direct social support for young children in a high risk sample, in contrast to previous studies addressing social support for caregivers. Participants were drawn from a prospective, longitudinal study of at-risk children. Social support was rated from maternal interviews throughout early childhood. Support from the mother was assessed from mother-child observations. Outcomes included internalizing and externalizing behavior problems measured from first through tenth grades. The most common support providers were biological fathers, followed by grandparents and other providers. Using multilevel modeling, higher quantity, higher quality, and lower disruption of support predicted lower starting levels of behavior problems, controlling for support from the mother. Disruption was associated with change in slope. Gender differences were found for externalizing behavior intercepts. Social support provides a promotive factor for young high risk children. Implications include involving children's social support providers in prevention and intervention programs.     

Infant day care: A social and psychological perspective on mental health implications

A review of infant group daycare programs abroad and in the USA leads to the conclusion that the degree of industrial and technological development is a major determinant of infant daycare practices. In the USA a culture gap exists between the middle class providers and the predominantly poor and non-caucasion recipients of the service. Difficulties in implementing programs, especially in transmitting child development information to parents stem from these basically different orientations. Some suggestions are made that may lead to more effective communication and collaboration between families using daycare personnel.     

Use of Quality Management Methods in the Transition from Efficacious Prevention Programs to Effective Prevention Services

This paper applies concepts and methods developed in management to translate efficacious prevention programs into effective prevention services. The paper describes Quality Function Deployment (QFD) as a method for structured planning and development that connects the needs and wants of the consumer with the design of the product or service. The paper describes basic tools used in quality management, and discusses how they might be applied to prepare a prevention program for implementation by community agencies. Prevention programs are conceptualized as having multiple consumers (i.e., stakeholders), including the participants who receive the service, the service providers, the organizations that deliver the program, and the researchers who evaluate the programs. As an illustration of one step in the application of QFD to translate efficacious prevention programs into effective prevention services, analysis of the needs and preferences of Family Courts for the implementation of an the New Beginnings Program is presented.     

Postdoctoral education and training for clinical service providers in health psychology

It was recommended by the 1983 National Working Conference on Education and Training in Health Psychology (Stone, 1983) that 2 years of postdoctoral education and training be mandated for future licensed health service providers in health psychology. The background for requiring this postdoctoral training, a model for education, criteria for developing programs, issues of funding, and a rationale for accepting this mandate are presented. Highlighted are the stable and consistent growth of health psychology, the need to expand the period of clinical training to meet the many advances in the field, and the challenges that exist for the fully trained clinical health service provider.     

A meta‐analysis of home visiting programs: Moderators of improvements in maternal behavior

A meta‐analysis of home visiting programs for at‐risk families (K = 35, N = 6,453) examined differences in the effects of programs on maternal behavior. On average, programs with more frequent visitation had higher success rates. The frequency of home visits explained significant variance of effect sizes among studies in the United States, with two visits per month predicting a small, substantive effect. Intensive programs or programs with at least three visits per month were more than twice as effective as were less intensive programs. Home visiting programs using nurses or mental health professionals as providers were not significantly more effective than were programs using paraprofessionals. In general, programs showed a positive effect on maternal behavior, but programs with frequent home visits were more successful.     

The family practices of service providers for young handicapped children

A survey was distributed to service providers in Connecticut working with newborn to 6-year-old handicapped children to examine the degree to which service activities currently focus on the family. Most service-provision goals elicited by the survey were child-focused clinical goals, but family-focused goals were frequently cited However, 30% reported spending no time with families during a typical week. Published programs or curricula were rarely used. The providers felt they were successfully achieving goals set for families but that they encountered some problems, including a lack of time to work with families. Comparisons were made between those working with children from birth to 3 years of age and those working with children 3 to 6 years of age. Suggestions concerning the implementation of the family-focused agenda were made.     

Philanthropy: A Method for Teaching Counselors to Be Social Advocates in the Age of Modern Behavioral Health Care

Graduate counseling programs are proficient in training direct service providers but less able to teach the business of sustaining a community agency's services. Modern philanthropy emphasizes social advocacy by investing in change that benefits the local community and respects the diverse cultural experiences of potential clients and stakeholders. Teaching philanthropy in an introductory graduate counseling course provides one avenue to prepare future counselors to both understand the importance of and be actively involved in sustaining a community counseling agency's mission.     

Training Methods for Delivering Difficult News in Genetic Counseling and Genetics Residency Training Programs

Genetic counselors and clinical geneticists are often in the position of delivering difficult news (DDN) to patients and families. Many studies show that healthcare providers require major improvement in the skills needed in DDN in a manner that is satisfactory to their patients. The purpose of this study was to assess the amount and methodology of DDN training received by genetic counselors and medical genetics residents in their training programs, such as observations of DDN or attending didactic lectures. To our knowledge, there is no previous assessment or study of DDN training in genetic counselor and medical genetics residency programs; therefore, we aim to both assess and compare the training in DDN received by genetic counselors and by genetics residents and determine whether there is a desire for recommendations on DDN training. We invited genetic counseling (GC) and genetics residency program directors to participate in an online survey designed to assess coursework, clinical experiences, and directors’ attitudes toward teaching DDN. Response rate was 85% (28/33) for GC program directors and 26% (14/53) for genetics residency program directors. One hundred percent of GC and genetics residency directors who responded to the survey agreed that it is important for genetic counselors and medical geneticists to be able to deliver difficult news effectively and that training programs should formally teach students how to deliver difficult news. Six of the eight common teaching methods are used by at least 75% of GC programs while two of eight are used by at least 75% of genetics residency programs. Seventy-nine percent of GC and 93% of genetics residency program directors agree that there should be recommendations on how to teach students to deliver this news. Our results show that techniques for DDN are integrated more fully into GC program curricula than genetics residency curricula. Directors of both types of programs desire recommendations and more standardized education for training students to deliver difficult news.