Integrating systems of care in California for youth with severe emotional disturbance III: Answers that lead to questions about out-of-home placements and the AB377 evaluation project

This paper is the third in a series of reports on preliminary empirical findings from replications of an integrated system of care for youth suffering from serious emotional disturbance. The development of the innovative system of care was pioneered in Ventura County, California, and the replications in three other California counties were legislatively enabled through California legislation (Assembly Bill 377). This report presents results on the expenditure and utilization of foster homes, residential placements made through special education programs, and state hospitals. Evaluation results indicate that foster home and state hospital utilization and expenditures are lower for the counties replicating the innovative system of care than for the state of California as a whole. Expenditures for special education residential placements are either at the state rate or lower in one county. The cumulative evidence supports the conclusion that the replication counties are utilizing restrictive levels of care at lower rates than would be expected, given state-wide patterns. The results, in conjunction with prior findings, are discussed in the context of questions about the possible fates of youth who no longer live in publicly funded residential facilities.     

进化心理学的过去和现在

进化心理学这个术语是90年代出现的,它从社会生物学演化而来,声势逐渐壮大。但它的思想起源却可以向前追溯一个多世纪。进化心理学否定了标准社会科学模式,注重对平常问题的研究。解释取向的进化心理学是比较成功的,它作为一种思想方法,已经渗透进心理学之外的许多领域,成就突出的是经济学领域。对进化心理学的批评主要集中在它非经验主义的方法上,但它仍然有巨大潜力。     

A Recursive Frame Qualitative Analysis of MFT Progress Note Tipping Points

Medically oriented psychotherapists typically record progress notes by articulating client symptoms, diagnoses, functional status, progress, and adherence to treatment plans. This orientation can challenge marriage and family therapists working from discursive or post-modern perspectives. Although there are discursive therapy friendly treatment planning guides, no published research on such practice exists. To address this gap the researchers conducted a recursive frame qualitative analysis of 206 de-identified progress notes from 30 completed cases seen by MFT master’s students learning discursive approaches to therapy in a university-based training clinic. Researchers found students noted problem to solution-focused discourse tipping or turning points in 20 cases with positive outcomes and no comparable shifts in 10 cases with negative or unclear outcomes.     

One Mind or Two? How Psychiatrists and Psychologists Reconcile Faith and Science

Utilizing qualitative interviews, this study showed how, to what extent, and why psychiatrists and psychologists of Judeo-Christian religious orientations or nonaffiliated believers in Michigan were willing or reluctant to integrate religious paradigms in their mental health practices. Most of the study participants were found to believe that medical-scientific and religious paradigms are equally important and may coexist or even be integrated in psychotherapeutic practice. However, actual attempts to integrate them usually reflected the practitioners’ personal religious backgrounds and initiatives and/or were client driven. Yet these integration initiatives were found to face powerful institutional impediments such as politico-cultural norms of separation of religion from secular institutions and professional norms.     

进化心理学视角下的智力研究

进化心理学和差异心理学是心理学的两个分支。进化心理学认为智力是一种进化的适应。差异心理学中智力是个体差异变量。本文试图整合二者的观点。认为智力既是进化的适应,也是个体差异变量。这将启示进化心理学家去研究更广范围的心理特质,允许智力研究和差异心理学运用进化心理学的理论和概念。本文还介绍了与智力进化相关的热带草原法则和Kanazawa的Savanna—IQ互动假说。     

职业化院长与专业化院长比较研究

专家型院长和职业化院长,谁入主中国的医院管理,一直是倍受关注的焦点议题,尽管职业化院长具有诸多优点,却难以占据医院管理的主要市场。分析二类院长的特点及专业化普遍存在的原因,并阐述国内外现状和趋势,探讨职业化推进的诸多障碍及原因,最后提出推行职业化的建议。     

Disability and participation: It's about us but still without us!

Participation is often espoused as a strategy to promote inclusion, social justice and equality. Exactly how to facilitate participation in practice is often not explicated, nor are the challenges or issues highlighted. By drawing on interview data, the first aim of this paper is to identify the key barriers to participation in an organizational planning activity as experienced by 12 disabled and non‐disabled staff and board members in a small community‐based disability advocacy organization. The second aim is to draw upon Jim Ife's principles of participation to further analyse the factors that hinder and enable participation in organizations. Reported barriers to participation were categorized at individual, interpersonal and organizational levels of analysis, and included a lack of skills and competence, interpersonal conflicts, poor resourcing and ad hoc processes. The importance of understanding the dynamic interplay of individual and structural factors, valuing different forms of participation and having participatory structures and processes embedded in organizational settings are all highlighted. This study illustrates that, even in an organization that is specifically attuned to meeting the needs of disabled people, there is still considerable exclusion and institutional discrimination. Strategies to promote participation within an organizational context may include providing sufficient time for reflection and support, and opportunities for board members to learn how to take part in constructive planning activities and to develop their strengths. Copyright © 2010 John Wiley & Sons, Ltd.     

Aging,Spirituality, and Time: A Qualitative Study

We examined the concepts of aging, time, spirituality, and future care needs in four randomly selected informants from a group of 54 never-married childless older women. Using data from the Generativity and Lifestyles of Older Women (GLOW) study, we questioned how women’s perceptions of these concepts came together in current older age. We employed cultural theory, (our theoretical framework), ethnography, (our methodological framework), and phenomenology, (our philosophical foundation) to produce a portrait of each woman interviewed. Through a three-session interview process, we elicited the women’s life stories, reasons for childlessness, and topics that emerged as significant to the women, including aging, a sense of time remaining, and spirituality. A key finding was that the context of each woman’s life, both biographical and historical, transpired as a foundation for these concepts. That is, a woman’s “place in time” shaped their experiences of aging, as well as her reasons for childlessness and perceptions of finitude.     

Conflict of interest as seen from a researcher's perspective

The continuous growth of the pharmaceutical industry is expected to require a considerable output of new drugs, with speedy development and approval processes. This profit-driven expansion of the drug market may broaden the already established erosion of the role of academia in favor of commercial clinical research organizations. Less and less control on the clinical trial design, its conduct and the resulting publication[s] is the likely consequence. Academic medicine and governments should find means to sustain the development of independent clinical research. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

Recent theoretical convergences in psychoanalysis and their epistemological importance

In this paper, the author starts by examining the recent occurrence of an increasing receptivity and critical exchange between different schools of psychoanalytical thought. Among its consequences have been convergences in the understanding of countertransference, especially through the hypotheses of projective identification and countertransferential enactment. The prevalence of these hypotheses points towards the fact that the community of analysts is bringing about an informal and convergent clinical research conducted by a wide and heterogeneous range of its members. The importance and epistemological relevance of this kind of 'informal clinical research' for the construction of psychoanalytical knowledge is emphasised. This process in psychoanalysis is compared with the evolution of knowledge in other scientific areas, highlighting their similarities and their differences. The author shows how Freud's 'mystic writing-pad'model can be expanded to represent the object of psychoanalytical investigation and to bring a better understanding of the reason why the hypotheses of projective identification and countertransferential enactment occupy such a central position in psychoanalysis. In addition, consideration is given to how this kind of research can help in the difficult task of finding criteria for the evaluation of different psychoanalytical concepts. Finally, the author demonstrates how, using this approach, some of the important divergences in contemporary psychoanalysis can be viewed from a new perspective.