Effectiveness of School-Based Mental Health Services for Children: A 10-Year Research Review

A review of the literature from 1985 to 1995 on school-based mental health services for children was conducted using a computerized data-base search. Of the 5,046 references initially identified, 228 were program evaluations. Three inclusion criteria were applied to those studies: use of random assignment to the intervention; inclusion of a control group; and use of standardized outcome measures. Only 16 studies met these criteria. Three types of interventions were found to have empirical support for their effectiveness, although some of the evidence was mixed: cognitive-behavioral therapy, social skills training, and teacher consultation. The studies are discussed with reference to the sample, targeted problem, implementation, and types of outcomes assessed, using a comprehensive model of outcome domains, called the SFCES model. Future studies of school-based mental health services should (a) investigate the effectiveness of these interventions with a wider range of children's psychiatric disorders; (b) broaden the range of outcomes to include variables related to service placements and family perspectives; (c) examine the combined effectiveness of these empirically-validated interventions; and (d) evaluate the impact of these services when linked to home-based interventions.     

Positive and negative self-related goals and subjective well-being: A prospective study

To examine whether having self-related personal goals, or rather whether positive or negative appraisal of them, is associated with subjective well-being, 311 students were asked to complete the Personal Project Analysis (PPA) and revised Beck Depression Inventory, first at the beginning of their studies, and then 2 years later. After 3 years they were asked about the use of mental health services. Two groups of students were identified: (1) those with positive self-projects and (2) those with negative self-projects. The results showed that both positive and negative self-related projects showed stability across a 2-year period, but only negative ones were prospectively predicted by earlier depressive symptomatology. Although neither positive nor negative projects predicted depressive symptomatology, both predicted the use of mental health services.     

Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

Termination of Mental Health Services for Children

In this paper, we examine the termination of children's mental health services. Analyses were based on the 901 families in the Fort Bragg Evaluation Project who participated at Wave 1 and Wave 2 six months later. The project compared a full continuum of care provided at a demonstration site with traditional care at two comparison sites. The results showed that in most cases families and providers were partners in decisions to terminate treatment. About half of the clients self-terminated or were terminated solely at the discretion of the provider. Providers tended to play a more dominant role in terminating restrictive services; families played a more central role in terminating outpatient care. Regardless of initial psychopathology, children in single-headed households, whose parents were dissatisfied with services, did not expect their child to cooperate with treatment and did not expect treatment to help their child, were more likely to terminate care than others. While the Demonstration site had significantly fewer terminations, the sites did not differ with regard to the reasons for termination, who participated in termination decisions, or the factors that affected the likelihood to terminate care. Of most interest, mental health outcomes among children who had terminated all care did not vary by reasons for termination or by who participated in the termination decision.     

The Future of Psychology in Departments of Psychiatry

Health care reform has put increasing pressure on faculty of medical schools to become self-supporting. Opportunities for clinical revenue will decrease, but psychologists who are able to generate research funding will become increasingly competitive, albeit as mercenaries, i.e., capable of paying their own way plus generating a profit to support departmental operations and educational programs. Changes in the health care system signal an end to psychiatry's paternalistic relationship to psychology and present opportunities for psychology proactively to influence its future role in health care. Research, political action, and revised scientific mission, models, and roles represent important strategies in the redefining of psychology as a basic science and major profession in health care.     

Flexibility of Labor, Well-Being, and Stress

After a short introduction into the changing nature of our society and organizations, we outline two kinds of flexibility of labor: qualitative flexibility, that is the degree to which people who work in or for a certain organization can and do perform different tasks, and quantitative flexibility, that is, varying the quantity of personnel and their working hours. Then, the different ways in which we organize our work and organizations are dealt with in terms of quantitative and qualitative flexibility. Next, we survey these ways of organizing on the degree to which they moderate the positive individual outcomes, or individual goals, of work. It can be concluded that quantitatively flexible work, besides some minor positive consequences, may have serious negative consequences for one's well-being, health, and personal development, while qualitative flexibility may have many more advantages, though it may lead to a devastating task overload. Last, we explore some ways to alleviate these negative effects.     

The use of the occupational stress indicator (OSI) in factory workers in China

The purpose of the study was to investigate occupational stress among Chinese factory workers (N=342), from three cities of South East China, using the shortened version of the Occupational Stress Indicator (OSI)-2. The results showed that the reliabilities and predictive validity of the OSI-2 subscales and other subscales used for the study were reasonably high. Quite a high percentage of workers perceived high work pressure. The main sources of stress were intrinsic to the job; and the coping strategies that were most frequently used to tackle stress were “control” methods. In addition, “satisfaction on environmental condition” seemed to be a common predictor for job satisfaction, and mental and physical well-being. The logical relationships between job satisfaction, mental well-being and physical well-being in Chinese workers have provided support to the findings obtained in Western countries.     

On the dynamics of dying

This study is concerned with dynamic processes that underly the rapid, degenerative changes associated with the “dying” stage of the multicellular organism's life cycle. The interaction between negative and positive feedback cycles is discussed: negative feedback cycles underly the superstability characteristic of health and illness. When negative feedback cycles fade in the dying phase of life, positive feedback cycles, previously held in check by the negative feedback cycles to which they had been coupled, rise explosively, driving physiologic variables from their normal values towards extremes. This results in the rapid downturn that we associate with dying—an accelerating disintegration terminating in death. A medical case history is analyzed.     

ACADEMIC EFFECTS OF PROVIDING PEER SUPPORT IN GENERAL EDUCATION CLASSROOMS ON STUDENTS WITHOUT DISABILITIES

We studied the academic effects on peers without disabilities of serving as peer supports for students with disabilities in general education classrooms. Three peers were studied using a range of indicators, including academic engagement, coursework performance, and social validity assessments. Peers assisting a student with disabilities via curricular adaptation, assignment completion, and social facilitation constituted the multicomponent independent variable. We used withdrawal or multiple baseline designs to demonstrate positive benefits for peers for all measures used. In addition, follow-up data for 2 peers indicated that the positive changes associated with serving as a peer support were maintained for up to 2 months. Our results are discussed in relation to the possible academic and social effects of providing peer supports in general education classrooms for students with and without disabilities.     

Primary health care for women: What is it and who provides it?

Recent federal policy has highlighted historically underrecognized women's health issues. Women comprise the majority of the population, especially the elderly. Women's health care needs, utilization patterns, and outcomes vary from those of men, and often among each other. Primary health care services for women are multidisciplinary and emphasize prevention, education, and early intervention as well as treatment. Psychologists and other primary health care providers can collaborate to provide their services in a cost-effective manner that optimizes quality of care and comprehensive health care.