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.     

对“四一三”医保模式破解双向转诊困境的思考

双向转诊困境成为制约社区卫生服务和医疗保障体系发展的关键问题。引入“四一三”医保模式，分析了该模式破解双向转诊困境的可能性，有助于优化城市卫生资源配置、调整医疗机构利益分配格局，有助于双向转诊制度的建立，有助于医疗信息的交流，以及风险分析。建议鼓励包括“四一三”医保模式在内的各种保障制度的发展。     

The influence of the Chinese sport system and Chinese cultural characteristics on Olympic sport psychology services

ObjectivesThe purpose of this study was to investigate the influence of sociocultural factors on Chinese Olympic sport psychology services.Design and methodsFifteen sport psychology consultants (SPCs), who served Chinese national teams for the 2008 Beijing Olympic Games, participated in this study after the Olympics. Semi-structured interviews were conducted within three months of the closing of the Olympics, followed by a hybrid approach to inductive and deductive thematic analyses.ResultsTwo general dimensions of sociocultural influence on Chinese Olympic sport psychology services were identified: (a) the Whole-Nation System and (b) Chinese cultural characteristics. They consisted of eight higher order themes, which comprised 26 lower order themes. This study revealed that Chinese sport psychology services were enhanced by recognizing the features of the Whole-Nation System (e.g., resource centralization and top-down management) and the successful blending of these features with Chinese cultural characteristics (e.g., holistic thinking style, keeping face and interpersonal order) into the psychological service.ConclusionsSociocultural factors had a marked influence on Chinese Olympic sport psychology services, which enabled Chinese SPCs to provide a culturally competent service (e.g., prioritizing collective interests, respecting the authority of administrative officials and coaches, and keeping face with others) for the Beijing Olympic Games.     

The Impact of Protective Factors on Posttraumatic Growth for College Student Survivors of Childhood Maltreatment

Many college students experience traumatic life events in childhood, yet demonstrate personal growth following these experiences. Deriving benefit in the face of adversity has been termed “posttraumatic growth.” The relationship between posttraumatic growth and childhood experiences of abuse and neglect was investigated in a sample of 501 college students. The primary focus was on what protective factors moderated the relationship between childhood experiences of abuse and neglect and later posttraumatic growth. It was found that although the protective factors of acceptance, positive reframing, and emotional support all significantly predicted scores on the Posttraumatic Growth Inventory, only the factor of prosocial adults and the overall number of social and emotional resources experienced moderated the relationship between childhood maltreatment and posttraumatic growth. These findings have implications for designing effective interventions that foster growth in college students who report a history of childhood maltreatment.     

Trauma-Informed Knowledge and Practices in School Psychology: A Pilot Study and Review

Growing acknowledgement that adverse childhood experiences are widespread and can threaten healthy development has led to advocacy for schools to systematically incorporate trauma-sensitive practices and policies. While the background and training of school psychologists would seem to make them the ideal professionals to lead such work, little is known regarding their preparedness to engage in these school-based practices. The current pilot study examines the experiences, education and training, confidence and competence, current and desired roles, and perceived barriers and supports of school psychology trainers, trainees, and practitioners to engage in trauma-informed practices within schools. Results indicated that high majorities reported scant knowledge or competencies across domains of professional practice considered essential to trauma-informed care delivery. Findings and implications are discussed.     

The Test of Time in School-Based Mentoring: The Role of Relationship Duration and Re-Matching on Academic Outcomes

The influence of match length and re-matching on the effectiveness of school-based mentoring was studied in the context of a national, randomized study of 1,139 youth in Big Brothers Big Sisters programs. The sample included youth in grades four through nine from diverse racial and ethnic backgrounds. At the end of the year, youth in intact relationships showed significant academic improvement, while youth in matches that terminated prematurely showed no impact. Those who were re-matched after terminations showed negative impacts. Youth, mentor, and program characteristics associated with having an intact match were examined. Youth with high levels of baseline stress and those matched with college student mentors were likely to be in matches that terminated prematurely, while rejection-sensitive youth and mentors who had previous mentoring experience were more likely to be in intact relationships. Implications for research and practice are discussed.     

Perceptions of Family Environment and Wraparound Processes: Associations with Age and Implications for Serving Transitioning Youth in Systems of Care

Addressing the unique needs of youth transitioning to adulthood has long been viewed as a priority in implementation of systems of care (SOCs) and wraparound. Developmental research and "practice-based evidence" suggest that there are differences between transitioning youth and their younger peers in family environment and wraparound team processes. Although these differences are thought to have significant implications for wraparound practice, few studies have examined them empirically. The present research involves two studies examining differences across several age cohorts (i.e., 10–12, 13, 14, 15, 16–17 year-olds) ranging from early adolescent to transitioning youth in: (1) caregiver perceptions of role-related strain and family environment quality, and (2) facilitator, caregiver, and youth perceptions of wraparound processes. In Study #1, older age was associated with higher levels of caregiver strain. In Study #2, age was associated with differences between youth and other team members' perceptions of wraparound processes, such that older youth perceived teams as less cohesive than others on their teams. These findings suggest that transitioning youth and their families merit special consideration in wraparound implementation and underscore the importance of considering the perceptions of transitioning youth in system change and practice improvement efforts (192 words).     

新疆农村医疗救助制度实施效果评价

为评价新疆农村医疗救助制度实施效果,利用2008年和2012年两次横断面调查资料,分析医疗救助对象和非医疗救助对象的卫生服务需要、利用及费用变化.救助对象的两周患病率由2008年的181.34‰下降到2012年的87.81‰,2008年两周患病率救助对象高于非救助对象.救助对象两周就诊率由2008年的110.92‰下降至2012年的46.93‰,2012年两周就诊率救助对象高于非救助对象.年住院率救助对象均高于非救助对象.新疆农村医疗救助制度提高了贫困人口对卫生服务的利用,应将医疗救助制度与新农合紧密结合,持续资助贫困家庭参合.     

‘The experiencing of experience’: a Pragmatic reassessment of Rogerian Phenomenology

This paper draws on a study that asked twenty family users about their first session of family therapy. Analyses of the interviews indicated that families entered therapy with a pre-existent knowledge about therapy, which did not always chime with those of professionals and which positioned speakers in ways which governed their expectations and perceptions of therapy. This paper, therefore, is concerned with the acquisition and deployment of knowledge: specifically, the knowledge involved in being a user of family therapy. Three key discourses were identified through this analysis: medical, counselling and consumerist. We aim to illustrate how these discourses served as a resource for members of the family in constructing therapists, therapy and themselves in relation to their experience. The examination of the rhetorical, ideological and practical effects of the positions chosen and the objects constructed, in terms of how speakers wanted to present themselves, with what enhanced or diminished status as patients, shows users actively engaging with the power of therapeutic institutions. Users’ accounts suggest that while most speakers felt anxious about the prospect of therapy, there were clear differences in overall satisfaction/dissatisfaction with the experience according to the synchrony between speakers’ construction of the therapist, and themselves as client/patients. Those who seemed to take a traditional view of therapy within a medical discourse valued therapists who offered diagnosis and a cure; those who sought and experienced a counselling relationship with the therapist found their experience to be constructive in terms of enhanced self-knowledge. We believe that the research findings discussed in this paper have implications for family therapists in accommodating to parental and child positions to maximise the effectiveness of therapy and so minimise drop-out.