Succeeding in Rural Mental Health Practice: Being Sensitive to Culture by Fitting in and Collaborating

Sustainable solutions to the access to mental health care problems are complex and must address both the availability of mental health care resources and the acceptability of those resources to consumers. The purpose of this study was to determine how to address the acceptability problem by learning from medical and mental health care providers what mental health therapists need to know to be successful in providing care in rural communities. Using a qualitative design, focus groups were conducted in three rural communities (<2,500) with medical and mental health care providers practicing in these communities. Data were analyzed using inductive qualitative methods. Results indicate that in addition to sound clinical skill, mental health therapists should (A) be sensitive to the culture of the rural community in which they are working and (B) practice in a way that accommodates to the care culture of the community. The latter includes spending time with patients commensurate with what is expected by other providers, engaging in generalist practice, and collaborating with local providers in patient care. An important implication of these results is that mental health care must be acceptable to both the residents of the community and the gatekeepers to health care.     

Acceptance, avoidance, and ambiguity: conflicting social values about childhood disability

Advances in medical technology now permit children who need ventilator assistance to live at home rather than in hospitals or institutions. What does this ventilator-dependent life mean to children and their families? The impetus for this essay comes from a study of the moral experience of 12 Canadian families--parents, ventilator-dependent child, and well siblings. These families express great love for their children, take on enormous responsibilities for care, live with uncertainty, and attempt to create "normal" home environments. Nevertheless, they experience social isolation, sometimes even from their extended families and health care providers. Their lives are constrained in many ways. The challenges faced by parents of technology-dependent children raise questions of justice within society and within families.     

Family Forms and Member Well-Being: A Research Agenda for the Decade of Behavior

Few institutions have changed as much in the past quarter-century as have American families. What are the factors affecting change? What are the conditions under which different family forms might best serve the interests of their members? What further changes are required? In this paper societal inequalities manifested within and between two family forms, heterosexual marriage and single-parent families, are reviewed, and a research agenda to assess the conditions under which these different family forms might best serve the interests of their members is posed.     

Managed Care, Catholic Vision, and the Claims of Justice

There are numerous challenges posed to Roman Catholic healthcare institutions by recent developments in health care delivery.Some are practical, involving the acceptable limits of accommodationto and collaboration with secular networks of health care delivery.Others, quite often implicated in the first set, are explicitlytheological. What does it mean to be a distinctively Roman Catholichealth care institution? What are the nature and the scope ofRoman Catholic institutional identity? More broadly, what isthe moral relevance of themes in Roman Catholic social teachingto the provision of health care? This issue of Christian Bioethicsaddresses these questions with a spirited exchange among itsauthors. They offer noticeably different perspectives on thegeneral cogency of Roman Catholic social teaching and differentstrategic recommendations for Roman Catholic institutions tomaintain, or recover, their distinctive presence in health caredelivery.     

Commentary: Why Do Research on Spirituality and Health, and What Do the Results Mean?

I address two related questions in this article. First, why conduct research on religion/spirituality (R/S) and health? Second, what are the dangers of misinterpreting or misapplying the results from such research? If relationships are found, so what? What is the practical value or clinical relevance of such information? Why should investigators spend time and scarce financial resources to explore such connections? What might health care professionals do differently as a result? How would people live their lives differently in light of such information? Questions like these need solid answers for the field to continue to move forward. Related to the "So what?" question is the issue of how results from research in this area are translated into popular understanding and application. After discussing why conducting research on religion and health is important, I identify a recently published research report that focuses on the relationship between R/S and self-control, an article that received considerable media press coverage. I present the results reported by the authors of this study and then examine a column written about the study that appeared in the New York Times. Finally, I explore what the findings mean, how the media portrayed the findings, and problems that might result depending on how people applied those findings.     

Comparing pluralities

What does it mean to compare sets of objects along a scale, for example by saying “the men are taller than the women”? We explore comparison of pluralities in two experiments, eliciting comparison judgments while varying the properties of the members of each set. We find that a plurality is judged as “bigger” when the mean size of its members is larger than the mean size of the competing plurality. These results are incompatible with previous accounts, in which plural comparison is inferred from many instances of singular comparison between the members of the sets (Matushansky &; Ruys, 2006). Our results suggest the need for a type of predication that ascribes properties to plural entities, not just individuals, based on aggregate statistics of their members. More generally, these results support the idea that sets and their properties are actively represented as single units.     

Social Psychological Correlates of Teachers' Language Attitudes1

In this paper, we examine social psychological correlates of teachers' linguistic diversity attitudes. We surveyed 191 regular-classroom teachers in 3 states (Arizona, Utah, and Virginia) to determine the relative effects of psychological insecurity, political ideology, cognitive sophistication, and educational level on language attitudes. Region of the country was included as a contextual variable. We tested the effects of education and cognitive sophistication on tolerance of language minority groups. Psychological insecurity measures and political conservatism were associated with negative language attitudes. Cognitive sophistication but not education was related to positive language attitudes. Teachers from Arizona had more positive language attitudes than did their counterparts in Utah and Virginia. We discuss the implications of our research for inservice and teacher-education programs directed toward constructive attitude change around language diversity issues.     

Plural self-awareness

It has been claimed in the literature that collective intentionality and group attitudes presuppose some “sense of ‘us’” among the participants (other labels sometimes used are “sense of community,” “communal awareness,” “shared point of view,” or “we-perspective”). While this seems plausible enough on an intuitive level, little attention has been paid so far to the question of what the nature and role of this mysterious “sense of ‘us’” might be. This paper states (and argues for) the following five claims: (1) it is neither the case that the sense in question has the community (or “us”) in its content or as its object nor does the attitude in question presuppose a preexistent community (or “us”) as its subject. (2) The “sense of ‘us’” is plural pre-reflective self-awareness. (3) Plural pre-reflective self-awareness plays the same role in the constitution of a common mind that singular pre-reflective self-awareness plays in the individual mind. (4) The most important conceptions of plural subjects, collective persons, or group agents in the current literature fail to recognize the nature and role of plural self-awareness, and therefore fall short in important respects. (5) In spite of the striking similarities between the plural and the singular mind, there are important differences to consider. The authority of the singular first person point of view has no equivalent in the plural case.     

Who is my neighbor? A communitarian analysis of access to health care for immigrants

Immigrants lacking health insurance access the health care system through the emergency departments of non-profit hospitals. Because these persons lack health insurance, continued care can pose challenges to those institutions. I analyze the values of our health care institutions, utilizing a Walzerian approach that describes its appropriate sphere of justice. This particular sphere is dominated by a caring response to need. I suggest that the logic of this sphere would be best preserved by providing increased access to health insurance to this population. This access would marry the rights of these members of our community to access care to our responsibility to contribute to financing of the system. I close with some considerations on what it means to be a member of the community.     

The Future of the Church as a Primary Health Place

ABSTRACT

There is a critical need for change in America's Health System, and religious organizations can facilitate not only the redefining of what health is but also the shaping of what the primary health services of the future should look like, function as, and be. The vision presented here is that the local parish or some extension of it be seen by the average citizen as a primary health place. The model proposed is that faith based living in community become the core health concept, defining what it means to be human and healthy become the core teaching, and that healing such that no illness need dominate become the goal. Within that context, health information, education, prayer, care, and support for most chronic illness, lifestyle change, and end of life concerns would begin at one's community of faith and only within that context to specially trained persons. This health system will compliment the sophisticated and complex acute medical care system that now exists.     

Empowerment praxis in community coalitions

Community coalitions address a wide variety of community problems, espousing a community development processes that promotes individual and collective self-determination. They offer a promising venue for the study of empowerment of individuals and organizations. This study utilizes data from members of 35 community coalitions organized for the prevention of alcohol and other drug problems to address the following questions: What individual characteristics are related to the psychological empowerment of coalition members? What organizational characteristics are related to the collective empowering of members? What organization characteristics are related to a coalition being organizationally empowered to succeed in achieving its objectives? At the individual level, psychological empowerment was most strongly related to individuals' participation levels, sense of community, and perceptions of a positive organizational climate. At the group level, the strongest predictors of collective empowering (our operationalization of the empowering organization) were net benefits of participation, commitment, and positive organization climate. Psychological empowerment and positive organizational climate were the two predictors of organizational effectiveness (the empowered organization). Implications and limitations of these findings are discussed.     

Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers

Enhancing the public health impact of evidence-based practices (EBPs) in usual care settings is a key priority of the National Institute of Mental Health. Longitudinal data from community mental health providers (N = 268) participating in a series of state-sponsored workshops in modular approaches to EBPs for youth are presented. EBP workshop attendance for youth anxiety resulted in increased knowledge for EBPs for anxiety (and not other conditions) and EBP workshop attendance for youth disruptive behaviors resulted in increased knowledge for EBPs for disruptive behaviors (and not other conditions). Providers' tendencies toward incorrectly classifying non-EBP therapies as evidence-based increased over time, suggesting that providers over-generalize the EBP label as a result of attending these types of workshops. Regarding EBP attitudes, most measures of attitudes improved when providers attended a workshop. Additionally, an overly inclusive view of what constitutes an EBP at intake was related to significant decreases in openness to trying EBPs over time, whereas more positive attitudes at intake was related to achieving a more refined view of what constitutes an EBP over the course of attending trainings. Study limitations and implications for implementation of EBPs in usual care settings are discussed.     

Implementation and Dissemination of Military Informed and Evidence-Based Interventions for Community Dwelling Military Families

Community dwelling military families from the National Guard and Reserve contend with deployment-related stressors in relative isolation, living in communities where mental health providers may have little knowledge of military culture. When they are community residents, active duty service members and families tend to live in close proximity to their military installations. This article will focus primarily on the challenges to quality mental health care for reserve component (RC) families. Where studies of RC families are absent, those of active component (AC) families will be highlighted as relevant. Upon completion of a deployment, reintegration for RC families is complicated by high rates of symptomatology, low service utilization, and greater barriers to care relative to AC families. A paucity of providers skilled in evidence-based treatments (EBTs) limits community mental health capacity to serve RC military families. Several emergent programs illustrate the potential for better serving community dwelling military families. Approaches include behavioral health homes, EBTs and treatment components, structured resiliency and parent training, military informed schools, outreach methods, and technology-based coping, and psychoeducation. Methods from implementation science to improve clinical skill acquisition and spread and sustainability of EBTs may advance access to and quality of mental health treatment and are reviewed herein. Recommendations related to research methods, military knowledge and treatment competencies, and transition to a public health model of service delivery are discussed.     

How to justify enforcing a Ulysses contract when Ulysses is competent to refuse

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as "mental health advance directives." How can health care providers justify enforcing such contracts over an agent's current, competent refusal? I argue that providers respect an agent's autonomy not retrospectively--by reference to his or her past wishes-and not merely synchronically--so that the agent gets what he or she wants right now-but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers' actions over time. Mental health directives accomplish this, so they are a way of respecting the agent's autonomy even when providers override the agent's current competent refusal.     

Placing Community Psychology in the Context of the Social, Health and Educational Sciences: Directions for Interdisciplinary Research and Action

Building on Maton, Perkins and Saegert’s framework on inter-disciplinary work related to community psychology, this article addresses two questions about community psychology in the context of the social, health and educational sciences: (1) What can community psychology learn from other disciplines? and (2) What can community psychology uniquely contribute to other disciplines?     

Is the Same‐sex Marriage Debate Really Just about Marriage?

In What is Marriage? One Man and One Woman: A Defense, Sherif Girgis, Ryan Anderson and Robert George defend the ‘conjugal marriage’ while claiming to make no moral judgments about homosexuality. My contention in this article is that the argument of What is Marriage is not sufficiently different from the arguments of classical new natural law theorists (NNLT), and, therefore, What is Marriage does not remain neutral on the question of whether homosexuality is moral. First, I give an overview of some classical NNLT arguments on the nature of marriage and their sexual ethic. Next, I present What is Marriage's account of conjugal marriage as a comprehensive union of two people, focusing on what makes a genuinely bodily union. I then move to the central contention of this article. By drawing on its understanding of genuinely bodily union and its account of the harm of same‐sex marriage, I argue that What is Marriage is committed to the view that same‐sex sexual unions cannot be good, since on its account of things there can be no shared sexual goods in a same‐sex sexual ‘union’.     

On the Logic of Classes as Many

The notion of a "class as many" was central to Bertrand Russell's early form of logicism in his 1903 Principles of Mathematics. There is no empty class in this sense, and the singleton of an urelement (or atom in our reconstruction) is identical with that urelement. Also, classes with more than one member are merely pluralities — or what are sometimes called "plural objects" — and cannot as such be themselves members of classes. Russell did not formally develop this notion of a class but used it only informally. In what follows, we give a formal, logical reconstruction of the logic of classes as many as pluralities (or plural objects) within a fragment of the framework of conceptual realism. We also take groups to be classes as many with two or more members and show how groups provide a semantics for plural quantifier phrases.     

Community Coalition Building—Contemporary Practice and Research: Introduction

Over the last 20 years, coalition building has become a prominent intervention employed in communities across America. Coalitions provide community psychologists and those in related fields with a chance to work with whole communities and to better understand how to create community change. As we reflect on the past two decades of community coalition building, there are many questions to be answered about this phenomenon. Why has there been such an upsurge in community coalition building activity? What is the impact of this activity? What have we as students of community learned? What are the questions that we need to be asking to improve the effectiveness of coalition building efforts and their evaluation? This set of articles will review the state of the art of community coalition building in both practice and research. The structure of the articles reflects a collaborative process, with multiple contributors from different disciplines, using a variety of formats. Because this is an evolving phenomenon where the questions asked are as important as the lessons learned, many of the major sections include dialogues with community experts from across the country and from multiple fields, including community psychology, public health, political science, public administration, and grassroots organizing.     

Community coalition building--contemporary practice and research: introduction.

Over the last 20 years, coalition building has become a prominent intervention employed in communities across America. Coalitions provide community psychologists and those in related fields with a chance to work with whole communities and to better understand how to create community change. As we reflect on the past two decades of community coalition building, there are many questions to be answered about this phenomenon. Why has there been such an upsurge in community coalition building activity? What is the impact of this activity? What have we as students of community learned? What are the questions that we need to be asking to improve the effectiveness of coalition building efforts and their evaluation? This set of articles will review the state of the art of community coalition building in both practice and research. The structure of the articles reflects a collaborative process, with multiple contributors from different disciplines, using a variety of formats. Because this is an evolving phenomenon where the questions asked are as important as the lessons learned, many of the major sections include dialogues with community experts from across the country and from multiple fields, including community psychology, public health, political science, public administration, and grassroots organizing.