Family-centered intensive case management: A step toward understanding individualized care

New York State's initial attempt at individualizing services occurred within the context of an experiment. We randomly assigned children 5–12 years old who were referred for out-of-home placement in treatment foster care to either treatment foster care, Family-Based Treatment (n=15), or to Family-Centered Intensive Case Management (FCICM) (n=27). FCICM used teams of case managers and parent advocates to provide in-home services. Flexible service dollars, respite care, and behavior management skills training were available to assist teams in individualizing care. Preliminary outcomes indicate that children in FCICM are doing as well or better than children assigned to FBT in their functioning and symptom reduction. Parents of children in FCICM have made gains, although not at a statistically significant level, in behavior management skills and family strengths that allow them to provide care for their children at home.     

Laying mother to rest: Working with grief-related nightmares through exposure therapy and imagery

Cognitive behavioural therapy of unresolved grief is usually presented as a fairly rapid approach for reducing psychological problems. The present case study shows how behavioural cognitive and symbolic approaches can be integrated to foster griefwork at several levels. The counselling adopted a behavioural exposure technique specifically for eliminating a significant anxiety-provoking obstacle to mourning, namely the experience of recurrent death-related nightmares that surfaced every time the bereavement was recalled in depth. The client was also encouraged to explore the symbolic meaning of the dream images and in drawings modified these images in ways that helped to alleviate her feelings of long-standing guilt. Drawing as well as verbal representation could also be regarded as an effective form of exposure therapy, helping the client to stay with the anxiety-provoking death-related images. The client once relatively free of nightmares could mourn the loss of the mother more deeply in subsequent less directive counselling sessions.     

Teacher ratings of children's problem and competence behaviors: Normative and parametric characteristics

Teacher-rated adjustment differences among young elementary school children from (a) a recent sample and a 1974 cohort, and (b) urban/suburban, male/female, and grade-level subgroups were examined. A problem behavior checklist (Classroom Adjustment Rating Scale) and a school competence measure (Health Resources Inventory) for 974 children from 5 urban and 5 suburban schools were completed by 101 first- to fourth-grade teachers. Children from the more current cohort were rated as significantly more maladjusted than those from the earlier sample on 8 of 10 adjustment variables. In the recent sample, girls and suburban children evidenced a greater number of school competencies and fewer problem behaviors than boys and urban children, respectively. The implications of these findings for the future use of the teacher rating scales are discussed.     

Spiritual issues in mental health care

Religious and spiritual issues in mental health are explored in the context of four conceptual models: the medical, the nursing, the humanistic, and the pastoral. This is done by looking at each model in terms of content, diagnostic focus, language and treatment goals, and primary qualities in the health provider.The models are illustrated by case studies gathered from a multidisciplinary setting. The discovery that each model can incorporate the religious and spiritual dimension in mental health care, but that each model does this in distinctive ways, is a key point.     

Gay women,men, and families in rural settings: Toward the development of helping communities

The urban biases of empirical research on gay men, women, and families have resulted in minimal knowledge about gay people in rural settings. The diversity of lives of rural gay women and men and the variety of patterns of meeting the challenges of rural living are described. Processes of help-seeking and help-giving are discussed and the need for a helping community of family, friends, and caring others is affirmed. Collaboration between rural gay people and rural community psychologists is suggested to promote the development of helping communities for gay people and thereby initiate a process of change in rural settings.     

Differential impact of parenting sick infants

Parenting a newborn infant has been identified as a significant stressor, and parenting a sick infant evokes an even greater stress. This study evaluated the differential impact of parenting infants with interrupted infantile apnea vs. extremely low birth weight infants. These infants were compared to normal infants on the Bayley Scales of Infant Assessment and the Parenting Stress Index when the infants were 6 months old. Significant effects on the mental index revealed that the low birthweight infants performed more poorly than did the other groups. A stepwise multiple discriminant analysis on the Parenting Stress Index suggested that child adaptability, maternal restrictions, isolation, and health were significant stressors. Mothers of apneic infants were affected most severely by their child's illness. The lower educational level of these mothers may have influenced these findings.     

Neuroticism and depressive symptoms among spouse caregivers: do health behaviors mediate this relationship?

This study examined the mediating role of health behaviors in the relationship between neuroticism and depressive symptoms among spouse caregivers. Path analysis was used to test a model of the caregiver stress process among 233 caregivers of people with dementia. Results indicate that neuroticism has a significant direct effect on depressive symptoms and also indirectly influences depressive symptoms through health behaviors and perceived stress. When individual health behaviors were examined in the path model, only physical activity served a significant mediating role. These findings suggest that neuroticism may lead to depressive symptoms among caregivers partly through declines in physical activity.