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.     

A COMPARISON OF PEER-DIRECTED AND TEACHER-DIRECTED EMPLOYMENT INTERVIEW TRAINING FOR MENTALLY RETARDED ADULTS

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.     

Processing resources and age differences in working memory

This study investigated the performance of young and old subjects on a modified version of the working memory task developed by Baddeley and Hitch (1974). Subjects were required to verify a set of sentences of varying complexity while they repeated aloud zero, two, or four words. The older subjects took longer to verify the sentences, especially when the sentences were grammatically complex, but the effect of concurrent memory load on verification latency was the same in both groups. These results cast doubt on the notion that there is an age-related decline in one general pool of processing resources. They also suggest that older people have greater difficulty with the active processing aspects, rather than with the passive holding aspects, of working memory tasks.     

Maternal depression and its relationship to life stress,perceptions of child behavior problems,parenting behaviors,and child conduct problems

This study examined the relationship of reported maternal depression to prior and current life stressors, and to mother perceptions of child adjustment, parenting behaviors, and child conduct problems. Forty-six depressed mothers and 49 nondepressed mothers and their clinic-referred children (aged 3-8 years) participated. Depressed mothers were more critical than nondepressed mothers, but the behavior of children of depressed and nondepressed mothers showed no significant differences. Depressed mothers were more likely to have experience child abuse, spouse abuse, or more negative life events than nondepressed mothers. Maternal reports of stress related to mother characteristics and to negative life events were the most potent variables discriminating depressed from nondepressed mother families.     

Responses to the Challenger tragedy: Subtle and significant gender differences

Within two weeks of the explosion of the space shuttle Challenger, 188 subjects rated and ranked questionnaire items, and completed open-ended questions reporting their responses to and concerns arising from the accident. Analysis of open-ended responses showed females focused more on communal, person-centered aspects of the tragedy than did males. Analysis of ratings showed females viewed person-oriented issues as more important than did males. However, males and females did not differ in rankings assigned the items nor in ratings of the importance of the technological issues. Claims about sex differences in moral orientation are discussed in light of the results of this study.     

Developmental versus sensory deficit effects on perceptual processing in the reading disabled

Thirty children and 5 adults participated in two experiments designed to compare visual processing in normal and reading disabled children. The children were aged 8, 10, and 12 years. In Experiment 1, subjects were asked to detect the temporal order of two briefly presented stimuli. In Experiment 2, subjects sorted cards containing bracket stimuli that did or did not produce perceptual grouping effects. Poor readers required more time to make accurate temporal order judgments and showed stronger perceptual grouping effects. For both good and poor readers, the amount of time necessary to make a correct temporal order judgment decreased, and perceptual grouping effects became weaker with age. However, the magnitude of the difference between the groups did not lessen with age. These results suggest that there are visual processing differences between good and poor readers that do not appear to correct by age 12.