The Heart of the Matter: An Essay about the Effects of Managed Care on Family Therapy with Children*

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.     

Assessment of methods for measuring social support

A rapidly expanding literature documents the effects of social support on physical and psychological well-being. Although definitions vary, most include both tangible components (e.g., financial assistance and physical aid) and intangible components (e.g., encouragement and guidance). Social support has been implicated in the mediation of stressful life events, recovery from illness, and increased program adherence. There are many inconsistent findings in the literature, however, and it is difficult to resolve discrepancies because measures of social support vary widely from study to study. To guide in the selection of measurement methods for research and applied work, 23 techniques for assessing social support are reviewed and evaluated. Criteria for favorable evaluation included reliability coefficients greater than .8 and documentation of validity. Correlations between various social support and criterion measures are simulated in order to demonstrate the consequences of choosing a measure with low reliability. Scale developers reported reliability data for 19 of the reviewed measures. Internal consistency coefficients ranged from .31 to .98. Test-retest coefficients ranged from .22 to .96. At least some validity documentation was available for 13 of the scales. Discriminant validity evidence, however, is almost universally absent. Despite psychometric weaknesses and variability among the scales, researchers have several instruments available to them.     

Studies of psychosocial influences on coronary artery atherogenesis in cynomolgus monkeys

The cynomolgus macaque provides a suitable primate model for studying how psychosocial factors contribute to coronary artery atherogenesis. Important interactions with diet, sex, and behaviorally elicited cardiovascular reactivity are described.     

Visual Elaboration Scale as a measure of imagery

We studied the correlation of one measure of imagery ability, the Visual Elaboration Scale, with two others, absorption of image and effort required to form a mental image. Significant correlations were obtained between the Visual Elaboration Scale and the other scales, with the exception of Absorption for women.