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The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*
Ellen Pulleyblank Coffey Ph.d. Mary E. Olson Ph.d. Phebe Sessions Ph.d. 《Family process》2001,40(4):385-399
This essay is based on a pilot study that examined the effects of managed care on the treatment of children and families, with special attention to community mental health. We embarked on the pilot study to test the accuracy and generalizability of our impression that family therapy and other systemic practices have been marginalized in ordinary clinics and agencies, and to understand the reasons why. We interviewed managed care providers, researchers, family therapy trainers, and clinicians in the Northeast. Our findings led to seven themes that support our impression that, even though there is a consensus about the need for coordinated family-based services, there is a disconnection between state policies, contractual requirements and what is actually occurring at the implementation level. This study suggests that our knowledge of human systems may be in danger of being disqualified and lost, with damaging consequences for the care of children. Yet, as systemic thinkers and practitioners, it is our belief that ethical and effective treatment need not be at odds with care that is cost-efficient. The direction of our future research will be to study whether the involvement of all stakeholders at all levels of planning and training leads to systemic family-based practices that consistently save costs and provide high-quality care. 相似文献
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Patrick J. Schloss Christine Santoro Constance Ellen Wood Mary Jo Bedner 《Journal of applied behavior analysis》1988,21(1):97-102
Interview skills deficits may limit employment prospects of mentally retarded adults. Although numerous papers highlight the importance of interview skills, few have validated effective strategies for use with mentally retarded persons. Further, there has been a lack of research contrasting rival interview skills training strategies. The present study was conducted with two mentally retarded young adults. It contrasted peer-directed instruction, in which both participants were equally deficient in the target skills, with teacher-directed instruction. Results of the investigation indicated that instruction, rehearsal, and feedback may be effective strategies regardless of who provides instruction. Comparisons of teacher-directed and peer-directed instruction indicated little or no difference in the effectiveness of the two procedures. However, the peer-directed procedure involved considerably less staff time than did the teacher-directed procedure. 相似文献
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Ellen J. Frank 《Sex roles》1988,19(1-2):107-118
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Ellen Wright Clayton 《Kennedy Institute of Ethics journal》1992,2(4):347-359
The Tennessee Supreme Court's decision in Davis v. Davis, a case that raises the question of how to allocate frozen embryos in the event of divorce, addresses many of the legal issues posed by in vitro fertilization. The decision considers the interests of the progenitors as well as of the children who may result. For example, the court held that gamete providers' discretion regarding the disposition of embryos can be limited only when their decisions would harm the children who might be born. The court also made clear that efforts to seek genetic parenthood are protected only when accompanied by a desire to raise the resulting children, a conclusion that also affects other reproductive technologies. In addition to elaborating an analytic framework, the court set guidelines for resolving disputes when the couples had made no prior agreements, including holding that while the embryos are ex-utero the desire to avoid genetic parenthood almost always trumps the wish to become a parent. The well-reasoned analysis in Davis v. Davis should help shape legal and ethical discussion regarding the use of in vitro fertilization for many years to come. 相似文献
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An organizational field study involving 95 civil service employees examined the ways these individuals coped with the stressful events of their daily living. Lazarus' cognitive-phenomenological analysis of psychological stress provided the theoretical framework. Subjects indicated on Lazarus' Ways of Coping Checklist those coping thoughts and actions used in the specific encounter described as stressful. As hypothesized, individuals experiencing higher diastolic blood pressure were more likely to cope using strategies characterized by wishful thinking, avoidance, and minimization of threat than were individuals exhibiting lower blood pressure. Implications from both an individual and organizational perspective are discussed. 相似文献
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Ellen Greenberger Wendy A. Goldberg Sharon Hamill Robin O'Neil Constance K. Payne 《American journal of community psychology》1989,17(6):755-783
Examined the joint and unique contributions of informal social support in the workplace and formal, family-responsive benefits and policies provided by employers to the job-related attitudes and personal well-being of employed parents with a young child. Eighty married men, 169 married women, and 72 single women with a preschool child completed a survey concerning social support from co-workers and supervisor, utilization of family-responsive benefits and policies, readiness to leave the employer for additional benefits, job satisfaction, organizational commitment, role strain, and health symptoms. Among the findings: (a) Fathers and mothers expressed equal levels of job satisfaction and organizational commitment, but mothers reported more role strain and health symptoms; (b) nearly 48% of married women's organizational commitment was accounted for by measures of support in the workplace; (c) informal social support at work was significantly more important to men's well-being than that of women; and (d) formal, family-responsive policies appeared more consequential for the prediction of women's role strain, perhaps because of women's greater responsibility for adjusting work life to meet the demands of family roles. 相似文献
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