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.     

Marriage Guidance Training and the Trainee's Own Marriage: A Prospective Study

Twenty trainees and 18 partners took part in a study of the effects of a marriage guidance training programme on their own marriage. Changes were assessed in two ways: retrospectively ('perceived' changes as assessed following training) and prospectively (changes calculated by comparing scores obtained before training and those obtained after training). For most dimensions there was little correspondence between 'perceived' change and 'calculated' change. This has important methodological implications, which are discussed. The 'calculated' change indicated poorer marital adjustment following training. The trainees' scores suggested that they had become less 'abasing' and less 'nurturant' towards their partners; also that they had more disagreements about 'philosophy of life' and 'dealing with in-laws'. Their comments suggested that a number of the trainees had become more analytical of their own marriages, and that training had heightened their awareness of their own needs and individuality.     

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.     

Supernatural beliefs,natural kinds,and conceptual structure

This article presents cross-cultural evidence in support of the notion that adults' natural kind concepts are theory based but may be informed by knowledge/belief systems other than the biological. Three groups of subjects from western Nigeria--rural, urban, and elite--participated in the study. Subjects heard stories describing alterations of appearance; that is, one natural kind was made to resemble another in both ritual and nonritual contexts. Subjects then were required to judge the identity of the altered item and to give an explanation for the category judgment. It was predicted that subjects would make more nonpreservation-of-identity category judgments supported by supernatural explanations in the ritual contexts and that subjects' use of supernatural explanations would reflect the extent of their engagement with the supernatural. The first prediction was borne out; the second prediction was only partially supported. Discussion of the results emphasizes the importance of exploring the role of sociocultural factors in conceptual structure.     

Impairment of spontaneous alternation performance by an NMDA antagonist: attenuation with non-NMDA treatments.

N-Methyl-D-aspartate (NMDA) receptor antagonists disrupt learning on a variety of tasks. Previous findings indicate that glucose, naloxone, and physostigmine ameliorate learning deficits produced by several treatments. The present experiment examines whether these agents also reverse the amnestic effects of NMDA receptor blockade. Mice were tested for spontaneous alternation performance in a Y-maze. The animals received either saline or the NMDA antagonist, NPC 12626 (35 mg/kg, IP), 50 min prior to testing and received an additional injection of saline, glucose, naloxone, or physostigmine 30 min prior to testing. NPC 12626 significantly decreased alternation scores. Glucose (250 mg/kg), physostigmine (0.01 mg/kg), and naloxone (1 mg/kg) reversed the effects of NPC 12626. Thus, impairments of learning after NMDA receptor blockade share with other amnestic conditions the susceptibility to attenuation by glucose, naloxone, and physostigmine.     

The Personal and Social Worries of Adolescents in Northern Ireland: Results of a Survey

The aim of this study was to ascertain the self-perceived social and personal concerns of adolescents attending educational institutions in Northern Ireland. 446 questionnaires from 15-18-year-old students at ten institutions were analysed in order to determine the frequency with which respondents reported worrying about the following broad areas: school, choosing a job, finding a job, home, starting work, opposite-sex relationships, personal issues, and relating to others. The effects of variables such as gender, age and nature of educational institution attended were also examined. The results indicated that most frequent worry was reported about finding and choosing employment, personal issues and opposite-sex relationships. Gender, age and religious affiliation of school attended exerted major effects. Implications for those involved in working with adolescents within educational contexts are discussed.