Making the Parents as Partners Principle a Reality: The Role of the Alliance

We explore the dimensions of the Parents as Partners principle, the widely touted, but somewhat elusive construct in the literature on treating children with serious mental illness, whose poorly defined boundaries, lack of empirical grounding, and overemphasis on instrumental dimensions attenuates its usefulness as a guide for practice and research. Four major barriers to the realization of this principle are outlined, all of which may impede actualizing partnership in practice and may also inhibit the early formation of a positive clinician/parent alliance, a neglected, though key dimension of true partnership practice. The alliance, which has a long clinical and research history in psychotherapy and behavioral research, and more recently, in a variety of community-based interventions, is a precursor to active client partnership with helpers and to treatment participation, as well as therapeutic in its own right. After reviewing relevant alliance research, we close with a beginning research agenda to incorporate the alliance as an integral component of future conceptualization and research about the Parents as Partners principle.     

The Program Environment Scale: Assessing Client Perceptions of Community-Based Programs for the Severely Mentally Ill

The Program Environment Scale (PES) was developed for use with clients of community-based programs for the severely mentally ill. It is intended to fill the gap in available tools for assessing clients' perceptions of program functioning as it affects their quality of life in a program. Formal pretests were conducted with 121 clients at 12 randomly selected programs near Washington, DC. The final field test used a revised form (29 domains; 129 items) with 221 clients in 22 programs selected randomly throughout the U.S., including Clubhouse, day treatment, psychosocial rehabilitation, and social club programs. Twenty-three subscales met at least five of eight psychometric criteria for internal consistency and discriminant validity. A 24th subscale was retained because of its substantive importance. Successful subscales cover program atmosphere and interactions (program cares about me, energy level, friendliness, openness, staff-client and client-client respect, reasonable rules, availability of positive physical contact, protection from bad touch, staff investment in their jobs, and confidentiality), client empowerment/staff-client equality (program and treatment empowerment, egalitarian space use), and service components (support for paid work, work importance, emergency access, family activities, housing, public benefits, community activities, medications, substance abuse, and continuity). Subscale validity is indicated by associations of specific service offerings with scores on scales measuring client perceptions of those services, and by an ability to differentiate among program models (i.e., Clubhouses, day treatment programs, and psychosocial rehabilitation programs look different from each other). Subscale scores were not influenced by client characteristics (gender, race, age, diagnosis, number of hospitalizations, length of time in program). The final scale has 97 items and takes about 25 minutes to complete. The PES succeeds in measuring different aspects of programs as clients perceive them. In the programs we visited, directors felt the PES covers the important things they want to know about how clients perceive their program. The PES should become a useful tool both for researchers interested in how client responses to programs may influence their therapeutic outcomes, and for practitioners interested in improving their clients' program experiences and/or increasing convergence of staff and client views of their program.     

Family-expressed emotion,childhood-onset depression,and childhood-onset schizophrenia spectrum disorders: Is expressed emotion a nonspecific correlate of child psychopathology or a specific risk factor for depression?

Expressed emotion (EE) was examined, using the brief Five Minute Speech Sample measure, in families of (1) children with depressive disorders, (2) children with schizophrenia spectrum disorders, and (3) normal controls screened for the absence of psychiatric disorder. Consistent with the hypothesis of some specificity in the association between EE and the form of child disorder, rates of EE were significantly higher among families of depressed children compared to families of normal controls and families of children with schizophrenia spectrum disorders. Within the depressed group, the presence of a comorbid disruptive behavior disorder was associated with high levels of critical EE, underscoring the need to attend to comorbid patterns and subtypes of EE in future research.This research was supported by a grant from the John D. and Catherine T. MacArthur Foundation as part of their Network on Risk and Protective Factors in the Major Mental Disorders. The authors wish to express their appreciation to Sybil Zaden and Ana Magana-Amato for their assistance coding the FMSS-EE data, to Gwen Gordon for her assistance with data analysis, and to the families participating in the project.     

Leadership Style and Leader Title

In a 2 by 4 design, leadership style (authoritarian versus democratic) was varied against form of address (Mr., Ms., Miss, Mrs.) in a simulated small group case study. Subjects (374 college and high school students) read the case study and then rated their reactions to the leaderson behavioral differential factors of "subordination" and "friendship." These ratings indicate significant effects due to leader style (i.e., greater subordination and stronger friendship attraction to democratic rather than authoritarian leaders). Leader title produced no significantmain effects although authoritarian leaders using the title Ms. evoked higher subordination (p <.001) than other authoritarian leaders.     

THE MODIFICATION OF LEISURE BEHAVIOR IN A HALF-WAY HOUSE FOR RETARDED WOMEN1

A multi-element baseline design combined with a multiple-baseline design, was used to investigate the effect of availability of materials, prizes for participation, and instruction on the leisure behavior of 14 mentally retarded women in a half-way house. A leisure program was conducted on weekday evenings, during which residents could choose to participate in any of six activities offered: puzzles, card games, clay, painting, weaving, and rug making. It was found that instruction in weaving and rug making significantly increased the percentage of residents participating in these activities, and that following instruction, prizes were not necessary to maintain high levels of participation. In contrast, prizes were more effective than mere availability of materials in maintaining participation in the other activities.     

TEMPORAL AND CLIMATIC VARIABLES IN NATURALISTIC OBSERVATION1

Home-observation data on 5- to 7-yr-old boys collected over 2 yr were examined for systematic variations in rates of desirable and undesirable behaviors associated with several temporal and climatic variables. Significant effects associated with time of day, day of the week, precipitation, and temperature were found. No significant effects on the naturalistic observation data were found for environmental factors associated with lunar phase. It was noted that the correlational nature of the findings did not obviate the necessity for control of the influence of temporal and climatic variables. Several methodological strategies for such control were discussed.     

Oral behavioral patterns in facial pain, headache and non-headache populations

Patterns of oral behavior have been suggested as factors leading to head and facial pain. The present study evaluated the frequency with which certain oral habits were self-reported by five groups of Ss: Facial Pain. Tension Headache, Migraine Headache, Combined Migraine and Tension Headache and No Pain. Four oral behavior patterns were found to be significantly different among groups. These were diurnal bruxism. thrusting the jaw forward, cupping the chin in the hand and resting the hand on the side of the face. When Ss were reclassified into those reporting no facial pain, temporomandibular joint (TMJ) pain, or a combination of TMJ and jaw muscle pain, the variables of diurnal bruxism and resting the hand on the side of the face were found to predict significantly both pain groups. However, the resting the hand factor was negatively weighted for the TMJ Pain group only. One other factor, nocturnal bruxism. was found to be self-reported at a significantly higher frequency in the Combined Facial Pain group compared to the No Facial Pain and TMJ Pain groups. Discussion focuses on the implications of the present findings on research in the facial pain and headache areas.     

Touch by Intrusive and Withdrawn Mothers with Depressive Symptoms

Interaction behaviours of 88 adolescent mothers with depressive symptoms and their 3-month-old infants were videotaped and coded for different types of touch. The ‘depressed’ mothers were classified as intrusive, withdrawm or good by one observer and another observer coded rough tickling, poking, tugging and pulling as negative touch behaviours and gentle stroking and rubbing as positive touch behaviours. The mothers with depressive symptoms were more likely to touch their infants in a negative way and more likely to be classified as intrusive.