Suicide and Suicidal Attempts in the United States: Costs and Policy Implications

The national cost of suicides and suicide attempts in the United States in 2013 was $58.4 billion based on reported numbers alone. Lost productivity (termed indirect costs) represents most (97.1%) of this cost. Adjustment for under‐reporting increased the total cost to $93.5 billion or $298 per capita, 2.1–2.8 times that of previous studies. Previous research suggests that improved continuity of care would likely reduce the number of subsequent suicidal attempts following a previous nonfatal attempt. We estimate a highly favorable benefit–cost ratio of 6 to 1 for investments in additional medical, counseling, and linkage services for such patients.     

A modest/immodest proposal: Reciprocal foster families

In this article we describe the concept of reciprocal foster families a strength-based approach to helping families in poverty. This approach focuses on the resources that all families have to offer each other. The goal of reciprocal foster families approach is to restrict the role of professionals and develop trust in the intuitive wisdom of natural networks of people and families as they help each other succeed in times of difficulty.     

A validity study of existential/dialectical marital questionnaire [EDMQ]: A psychometric questionnaire for assessing marital interaction

This paper reports the successful development of a psychometric questionnaire for analyzing marital functioning and interaction based on an existential/dialectical model originally presented by Charny as the basis for a clinical model for rating couples,Existential/Dialectical Marital Profile [EDMP]. The clinical model and psychometric questionnaire address five main areas of functioning in marriage: family management, companionship, relationship and communication, attraction and sexuality, and parenting; as well as five main dimensions of marital relationship: competence, commitment, respect, power, and closeness.Presented at the Conference of the International Family Therapy Association, Amsterdam, May, 1993. This study was completed as a master's thesis by Shlomit Asineli in collaboration with and under the supervision of Professor Israel Charny at the Bob Shapell School of Social Work, Tel Aviv University.     

Alcoholism treatment and marriage and family therapists: An empirical study

This article reports on results of a mail questionnaire study conducted among 257 members of the American Association for Marriage and Family Therapy (132 respondents, response rate of 51%) on their attitudes toward alcoholism issues (acceptance of alcoholism as a disease, treatment philosophies used with clients and/or families, and acceptance and use of Alcoholics Anonymous as a resource). Results indicated that 69% of respondents (as compared with 42% formerly) considered alcoholism a disease after MFT education. A combination of individual, family therapy, and AA (81.1%); family therapy (66.7%); and AA only (60.6%) were most often used. Controlled use of alcohol by clients in treatment was believed to be unethical by 43.2%, legal by 39.4% and ineffective by 54.5%.     

A qualitative understanding of reflective-teams II: Therapists' perspectives

A research team developed and asked questions to a reflective-team about their clinical practice. The purpose of the questions was to better understand reflective-team members' experiences, beliefs, and aspirations. A participant/observation methodology was used in formulating the questions to the therapists. Therapists stated that reflective-teams were valuable in resolving impasses, developing multiple perspectives on clients' problems, and encouraging interaction among team members, but were problematic if clients were unaccustomed to team practice or if there were physically too many people in the interviewing room. Therapists believed that reflective-teams as a team practice was not practical in typical practice settings.     

Medicaid: A potential source of revenue for special education

Currently, over 4.3 million children are receiving special services within the nation's schools because of physical, developmental, and educational disabilities. It is estimated that twice this number would benefit from special education services. Public Law 94–142, the Education for the Handicapped Act, offered the first real opportunity for many children with disabilities to receive special health and educational services. Public schools have become a primary setting for provision of services to these children, however, many states have encountered difficulty in procuring funding. One federally mandated source of revenue is the Medicaid program. In the fall of 1991, all state Medicaid and special education programs were asked to provide information concerning current or planned use of Medicaid funds for special education services. Responses were received from 36 states. Only 19 states reported using Medicaid funding in any capacity, and of these, only four required schools to bill Medicaid for services rendered. The majority of these programs are in the pilot stages of development. Special education services covered by Medicaid vary widely, as do reimbursement mechanisms. All 19 states allow Medicaid coverage for speech, physical, and occupational therapy. Only about half of those states provide allowances for diagnostic evaluation and assessment, while coverage for psychological services is provided by three-fourths of those states, and EPSDT screens by half of the states. Only two programs had been evaluated formally at the state and/or federal level. Medicaid remains a largely untapped source of revenue that could be used to help fund services for disabled children.     

Manufacturing multiple meanings of addiction: Time-limited realities

This article explores how clinicians, patients, and addiction as a youthful science manufacture meaning. Explanations of addictive behavior and addictive disease are viewed as constructs, ideologies, or ways of making meaning. This analysis considers the controversy—over whether addiction qualifies as a disease—to be primarily a matter of epistemology and social perception. Since there is no widespread agreement about what isease means in general, it is not possible to determine whether or not addiction is a disease in particular. The discussion also envisions how treatment for addicted clients might be reformulated as a transactional process utilizing the range of relevant theoretical models as time-limited reframes of addictive reality instead of dichotomizing addiction as either a disease or not.The authors extend thanks to Michelle Bowdler, Nancy Costikyan, Blase Gambino, Teri Loughead, Janet Mann, Peter Monius, Arthur Robbins, and Mitchell Young for their helpful assistance, suggestions, and comments on earlier drafts of this article.     

Ideologies,Idols (and Graven Images?): Rejoinder to Gurman and Kniskern

Three major issues raised in Gurman and Kniskern's commentary are discussed. These are (a) the suitability of established research design criteria for studying the outcome of family therapy; (b) the impact of therapist relationship factors on therapy outcome; and (c) the place of concrete or objective change measures in psychotherapy outcome research. Areas of agreement and disagreement with Gurman and Kniskern's observations are identified.     

Immigration: going home or going to pieces

Immigration may constitute a family crisis. Because of its lengthy duration, this crisis may be an unrecognized factor in the problem which brings patients into therapy. The immigration crisis may bring an individual into renewed contact with past unresolved emotional issues. It also affects the structure, hierarchies, and values of the family as a system. The therapist who relates only to presenting symptoms and ignores the context of the immigration crisis may lose credibility with patients and miss important therapeutic opportunities. Case studies are given to illustrate the statement.