Family support in the home. Programs, policy, and social change.

The need for a coordinated national policy on family support in the home is discussed. First, the history of home visiting programs is reviewed. Then, recommendations for practice, training, and research in family support programs are presented. A discussion of the impact of new federal initiatives on family support programs and research demonstration efforts follows.     

Psychologists' role in family-centered approach to practice, training, and research with young children

Family-centered, community-based, coordinated care for children with special needs is presented as the best practice model for providing services to children and families. Psychologists must learn to play an active role in this frame-work that both integrates psychology with other health and education disciplines and uses the broad spectrum of psychological knowledge about families, development, community organization, and intervention strategies. Key principles of family-centered child psychology affect practice research and training. The psychologist becomes part of a team created to support families as the primary care-givers of their children. Training programs must reorganize the types of experiences both in the classroom and the field to train new psychologists within this model. As mandates for family-centered care affect policies at the state and federal levels, research will remain a critical factor in understanding the effects of these policy shifts on child and family functioning and the delivery of services.     

Innovations in Family Support: What Are We Learning?

As family support programs develop across the United States through grassroots efforts by families, state demonstration projects, and local initiatives, new opportunities have become available to examine the experiences of families with service delivery systems. In this study, the research team examined key principles of innovative family support and their effects on families with children at high risk for out-of-home placements. The research team used a multi-case study design with indepth participant observation and semi-structured interviews with a purposeful sample of families. The findings on agency implementation and the families' perspectives are described, together with implications for agency change in family support. The findings point to the need for a re-examination of the emerging approaches to family support innovations, including in the context of national policy reform and the agency-based, service delivery system.     

National leadership for children and youth with serious emotional disturbance: Progress and prospects

Despite the federal mandate to identify and provide appropriate educational and related services to children and youth with serious emotional disturbance (SED), the national profile portrays exceptionally low rates of identification; unacceptably low rates of school completion; high rates of placement in segregated environments; evidence that economic and demographic factors substantially affect identification, placement, and school completion; and a mixed, although mostly discouraging picture of outcomes after leaving the educational system. Recent national leadership, comprised of strategic planning, research, and demonstration initiatives has attained considerable momentum and is intended to improve outcomes for children with SED. Significant changes are anticipated as a result of the upcoming reauthorization of the statute governing special education and related services. These changes reflect a 20 year perspective regarding the benefits and shortcomings of current eligibility criteria and discretionary initiatives for improving outcomes for children with disabilities. The manner in which these changes may affect prospects for better serving children with SED is discussed.     

Moving from Principles to Practice: Recommended Policy Changes to Promote Family-Centered Care

This paper emphasizes the value of family-centered care. Discussion highlights family-centered philosophies (e.g., Systems of Care [SOCs]) and practice models (i.e., wraparound) and identifies discrepancies between conceptualizations and actual practice. Data from multiple sources detail issues in fidelity to family-centered values and needs and risks experienced by siblings of children with severe emotional disturbance and their caregivers. This discussion provides a springboard for policy recommendations to strengthen family support programming and enhance family-centered care, from modifying funding streams such that systems extend their reach beyond children with full-blown, diagnosable problems (those meeting standards of "medical necessity), to supporting prevention and early intervention initiatives that address families as targets for intervention. Recommendations include ensuring that communities with SOC funding address the needs of families; broadening Medicaid rules and definitions; expanding the range of reimbursable activities and services; and increasing funding for evaluating family-centered care models and family support programming.     

Sponsored research in the counseling psychology literature

Elliott and Shewchuk (1996) assert that counseling psychology should have considerable potential to influence national healthcare and public policy. A mechanism for realizing this potential entails being responsive to national, state and private funding initiatives for reaearch and other programmatic activities. To examine the extent to which counseling psychology resarch reflects an involvement in these initiatives, we studied the rate of sponsored research in three journals traditionally associated with mainstream counseling psychology research. We compared this rate with that observed in oher applied and theoretically oriented psychological journals. In comparison with the research published in the other outlets, results indicated that the mainstream counseling psychology literature has a disproportionately low level of sponsorship from national and federal sources. The scant representation of federally-funded research in the counseling psychology literature may effectively preclude full participation in addressing and setting national funding priorities and other health care and public policies germane to the field. Several issues are raised and discussed in light of these findings.     

What policymakers need and must demand from research regarding the employment rate of persons with disabilities

Enabling persons with disabilities to prepare for and engage in gainful employment has become a priority concern in U.S. society. As a result, federal and state policymakers are adopting employment-related initiatives designed to enhance the employment rate of persons with disabilities. Policymakers need credible evidence in order to assess and reform these initiatives. This recognized need, however, begs the question of what constitutes 'credible evidence.' Of particular concern in the disability policy arena is the debate over the types of conclusion about employment rates that can and cannot be drawn from analyses of national survey data sets. This article connects standard research methodology concepts with the complexities of evaluating disability policy to help stakeholders appreciate the issues involved in this debate. This appreciation can help policymakers (1) recognize unwarranted cause-and-effect conclusions based solely on existing national survey data and (2) demand better data and stronger research designs to complement the potential over-reliance on correlational studies using problematic survey data to estimate policy impacts. To this end, the article concludes with a practical framework with a checklist for assessing the adequacy of research regarding the employment rate of persons with disabilities.     

Teenage Childbearing,Reproductive Justice,and Infant Mental Health

Reproductive justice advocates emphasize the rights of women to choose to have children, to decide the conditions under which they give birth, and to parent their children with support, safety, and dignity. This article examines what a reproductive justice perspective contributes to infant mental health work with teenage mothers and their families. It explores the historical framing of teenage pregnancy in which young mothers are the cause of a variety of social problems and in which the primary policy and practice approach is pregnancy prevention. The article offers alternative framings of teenage childbearing, based on reproductive justice principles, which focus on social conditions surrounding teenage parenthood and the meaning of motherhood in the lives of young women. These alternative frames shift the practice agenda to eradicating unjust social conditions and providing supports for young women in their roles as parents. The article then describes ways in which two infant mental health programs have incorporated reproductive justice principles into their work with young families: Chicago's community doula model and Florida's Young Parents Project for court-involved teenage parents. Finally, the article extracts a set of principles deriving from a reproductive justice perspective that are relevant to infant mental health work with young families.     

Gaps and Barriers in Services for Children in State Mental Health Plans

Significant gaps exist in children’s mental healthcare, and barriers prevent access to existing services. Current federal initiatives call for state governmental agencies to recognize and resolve deficits in their systems of care. Previous work has acknowledged some of the problems in meeting the mental health needs of children within a system of care. This current project sought to discriminate between gaps (e.g., non-existent services) and barriers (e.g., problems that prevent access to existing services) within state mental health care plans. Because acknowledging barriers and gaps in mental health services is a step towards systems improvement, the present project describes how state governments recognize the limits of their children’s mental health care systems. We analyzed state mental health plans submitted to the federal government in applications for block grant funds. Results illustrate that a varied number of gaps and barriers are acknowledged in state plans. Overall, 90% of state plans discussed barriers and 84% of state plans discussed service gaps. The gap most frequently recognized was lack of providers (74%), while lack of funding (52%) was the most common barrier. This project points to some recognition of system limits in the states and reflects potential efforts to create policies for system improvement for children and families.     

Family Policy Initiatives in Latin America: The Case of Colombia and Ecuador

Family policy initiatives in Colombia and Ecuador have targeted primarily families living in poverty. This paper discusses some of the major policy initiatives oriented to improve the living conditions of economically disadvantaged families in both countries. We argue that, even though governments recognize the importance of family policies, existing policies and programs for families living in poverty do not directly focus on family issues. They represent more implicit than explicit family policies. We analyze some of the issues that may hinder the development, implementation, and evaluation of family policies in Colombia and Ecuador. Such issues stem from political and economic instability, legislation, changing family demographics, as well as coordination among agencies that develop, implement, and evaluate policies. We discuss challenges related to family policies in both countries and recommendations to improve existing policy initiatives.     

Collaboration,Partnership, Policy,and Practice in Career Development

This article discusses the importance of collaboration among professional organizations, governmental entities, and counselors in behalf of career development. Examples of possible international and national collaborative initiatives and policy emphases are described.     

Theoretical, Developmental & Cultural Orientations of School-Based Prevention Programs for Preschoolers

Schools are the primary environment in which to conduct prevention programs for school-age children. Educators, policy makers, and psychologist argue that prevention efforts should begin as early as possible to maximize their effectiveness. Surprisingly, there are relatively few school-based prevention programs targeted for preschoolers. Given the evidence supporting earlier rather than later prevention efforts and the fact that many children in the United States attend preschool programs, more research on the feasibility and effectiveness of prevention programs administered in preschool environments is warranted. In this article, we review the existing literature on school-based prevention programs targeted for preschool children. We examine whether school-based prevention programs are theory driven, developmentally appropriate, culturally sensitive, and aimed specifically at symptom reduction or behavior promotion. Based on the findings of this review, our aim is to identify gaps in the prevention research literature regarding programs for preschoolers and propose research to address such gaps to create more effective school-based prevention programs for young children.     

Behavioral Telehealth: Emerging Practice,Research, and Policy Opportunities

Behavioral telehealth, the use of electronic and communication technologies to provide and support behavioral health care when distance separates the participants, has the potential to address the nationally significant problems of access, cost, and distribution of behavioral health care and providers. Using examples of developing behavioral clinical practice, research, and policy opportunities, this article outlines the promise of this field while discussing the barriers to the development of behavioral telehealth networks, including the lack of clinical protocols, solid evaluative research, payment for telehealth/telemedicine services, uniform state licensure, and uniform privacy/confidentiality policy. It is argued that behavioral practitioners, researchers, and advocates must actively participate in this rapidly developing field, and these professionals are ideally suited to supply ongoing federal and state policy initiatives with much needed empirical clinical data and evaluative research that will help to generate sound policy.     

Spirituality and religion in psychiatry: the impact of policy

ABSTRACT

Research and debate on the importance of spirituality and religion in psychiatry has led to a number of national and international policy initiatives, intended to clarify the boundaries of good practice and improve the way in which such matters are managed for the benefit of patients. Significant amongst these is the 2015 position statement of the World Psychiatric Association, the only such policy statement to date which has been internationally agreed. Preliminary evidence available suggests that this is having good effect in generating professional debate and further national policy initiatives in different countries. There is a need for further research on such policy initiatives to confirm whether or not they have the intended impact upon clinical practice and whether or not this in turn is beneficial for patients.     

Canada’s Same-Sex Marriage Law: Exception to or Exemplar of Canada’s Family Policy?

Family policy in Canada is primarily concerned with assisting parents raise their children. This fairly singular approach to family policy is ironic given that Canada does not have a nationally-coordinated family policy. The development of a national family policy has been hampered by Canada’s decentralized governmental structure (i.e., federal and provincial, as well as territorial, governments) and other factors such as diverse geography and different traditions (e.g., a tradition of common law in English Canada, and civil law in Quebec). A recent addition to Canada’s family policy is Bill C-38, The Civil Marriage Act (2005), the law legalizing same-sex marriage. To put Canada’s same-sex marriage law into context, this article presents some preliminary statistics about same-sex marriage in Canada, and considers whether same-sex marriage legislation is a good example of Canadian family policy, or an exception to the rule that Canadian family policy focuses primarily on helping parents socialize their children.     

National evaluation of US newborn screening system components

Newborn screening has existed as a state-based public health service since the early 1960s. Every state and most territorial jurisdictions have comprehensive newborn screening programs in place, but in the United States a national newborn screening policy does not exist. This results in different administrative infrastructures, screening requirements, laboratory and follow-up services, medical management approaches, and related activities across the country. Federal initiatives and support have contributed to limited evaluations of various aspects of individual newborn screening programs at the national level, but funding is an issue. The national evaluation strategies have taken various forms, all with the intent of improving the screening system through review of actions taken and suggestions for future improvements. While participation in the national evaluation effort for newborn screening laboratory practices includes all US programs, and this has aided in improving quality and harmonizing protocols, other national evaluation activities have been only moderately successful. National data reporting of quality indicators for various program elements must be comprehensive and timely, and the elements must be universally accepted in order to meet the evaluation and improvement needs of the national newborn screening system. A comprehensive real time national evaluation activity will likely require additional resources and enforcement incentives. Limited federal actions through grant incentives and selected reporting requirements provide a possible means of stimulating programs to participate in national harmonization efforts.     

Education of Foreign Children in Japan: Local Versus National Initiatives

Immigration has long been a controversial subject in Japan, with the country’s historic aversion to foreign populations well noted. This article seeks to discuss recent developments in Japanese immigration policy, looking specifically at how both local governments and the national government address education issues for foreign children. Examining the specific case of Kawasaki City’s foreign student educational policies in detail, this article compares local initiatives to national policy developments, arguing that Kawasaki has been a pioneer in many cases and that the national government has ultimately adopted similar resolutions. The national government, for its part, has been slow to take up issues addressing immigrants, trailing more progressive cities like Kawasaki, but has slowly been making efforts to improve foreign student education. In the broader sense, this article argues two additional points: that largely ethnically homogenous countries like Japan are no longer able to completely ignore their immigrant populations and that highly centralized states are moving slowly toward empowering their local governments.     

The effectiveness of early head start for 3-year-old children and their parents: lessons for policy and programs

Early Head Start, a federal program begun in 1995 for low-income pregnant women and families with infants and toddlers, was evaluated through a randomized trial of 3,001 families in 17 programs. Interviews with primary caregivers, child assessments, and observations of parent-child interactions were completed when children were 3 years old. Caregivers were diverse in race-ethnicity, language, and other characteristics. Regression-adjusted impact analyses showed that 3-year-old program children performed better than did control children in cognitive and language development, displayed higher emotional engagement of the parent and sustained attention with play objects, and were lower in aggressive behavior. Compared with controls, Early Head Start parents were more emotionally supportive, provided more language and learning stimulation, read to their children more, and spanked less. The strongest and most numerous impacts were for programs that offered a mix of home-visiting and center-based services and that fully implemented the performance standards early.     

Improving Medicare coverage of psychological services for older Americans

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology.     

Primary health care for women: What is it and who provides it?

Recent federal policy has highlighted historically underrecognized women's health issues. Women comprise the majority of the population, especially the elderly. Women's health care needs, utilization patterns, and outcomes vary from those of men, and often among each other. Primary health care services for women are multidisciplinary and emphasize prevention, education, and early intervention as well as treatment. Psychologists and other primary health care providers can collaborate to provide their services in a cost-effective manner that optimizes quality of care and comprehensive health care.