The Client Cultural Competence Inventory: An Instrument for Assessing Cultural Competence in Behavioral Managed Care Organizations

The rapid growth in Behavioral Managed Care Organizations has led to increasing concern about the future availability of culturally competent mental health services for ethnic minorities. Prior efforts to assess cultural competence of mental health services have focused exclusively on agency providers and individual mental health professionals rather than on clients' perceptions of care. We introduce the Client Cultural Competence Inventory, which has several advantages over other cultural competence measures including its (a) lower susceptibility to social desirability bias, (b) ability to assess attitudes concerning a broader range of therapists, providers and plans, and (c) focus on clients rather than the psychiatric community as the central force in determining cultural competence. Preliminary psychometric analyses of the inventory are presented from data gathered in a group of parents with children who are severely emotionally disturbed.     

The Future of Psychology in Academic Health Care Centers

A promising opportunity exists to continue psychology's move beyond its traditional mental health emphasis into a general health care discipline. Abundant empirical evidence supports that psychologists treat a wide array of physical disorders as well as psychological components of medical problems. The immediate issues confronting psychology's full emergence into the health care world are discussed and recommendations are offered to assure the success of this initiative. Office of the Senior Vice President and Provost     

An Investigation of Psychology Staffing in Australian Metropolitan Acute Public Hospitals

Psychology is one component of the multidisciplinary services provided to patients in acute public hospitals, with research demonstrating that psychological intervention significantly enhances clinical outcomes for patients across a range of health issues. Despite the increasingly important role that psychologists play in Australian hospitals, there remains a lack of information available about staff levels, discipline structures, and clinical activity for psychological services within acute hospital settings. The most recent Australian data about hospital‐based psychology services was collected 20 years ago. The current study provides updated information from a survey of 15 Australian metropolitan, acute public hospitals: presenting and critically reviewing staffing configurations and models of service delivery. Results suggest that: (a) hospitals employ a highly skilled workforce at a rate of 0.16 full‐time equivalent psychology staff for every 10 hospital beds; (b) psychologists have a viable career pathway within the hospital‐based health sector; (c) role diversity is common, with the primary focus varying as a function of position level; (d) neuropsychology staffing requires urgent attention to address significant delays in access to services; and (e) public hospitals actively contribute to current and future workforce development through supervision, research, and training. The implications of these results for the future of psychological services in Australian healthcare are discussed.     

Physician-Assisted Suicide in the United States: Confronting Legal and Medical Reasoning – Part Two

In the United States, judicialrulings that unrealistically addressed the complexityof cases and demonstrated limited understanding ofprinciples, helped to create a legal quagmire whichlegislatures had to confront. Moreover, thelegislative response was often slow and inadequate interms of both the scope and clarity of the laws. However, since the 1970s, progress has been made onmany fronts, particularly in regard to advancedirectives dealing with end-of-life decisions. Thedebate over physician-assisted suicide has spawned arepetition of moral and legal arguments. Thoseagainst legalization have failed to make a realisticappraisal of the dilemmas facing patients and theirfamilies in an age of technological medicine deliveredin the context of the marketplace. The underlyingproblem is a system in dire need of reform that willno longer treat health care as a commodity of themarketplace and provide universal health care. Terminal care as an integral part of health care willsubstantially benefit from such reforms because amajor obstacle to comprehensive palliative care is thecondition of the present system.     

Decreasing Neuroleptic Doses in Older Adults with Schizophrenia

This prospective study of 27 older adults, residing in long-term care facilities, examined the effects of reducing neuroleptic medications to the point of controlling symptoms and reducing side effects. Schizophrenia is a challenging health care condition that leads to delusions, hallucinations, disorganized speech, and a host of other symptoms. Unfortunately, medications control many of the symptoms but cause unwanted side effects unless monitored closely and regulated to each person's needs. This study addresses six research questions related to the reduction of neuroleptic medications. Study findings related to neuroleptic medication dose reduction were encouraging. Additionally, the findings strongly suggest that health care providers working with older adults with the diagnosis of schizophrenia would benefit from planned educational programs about behavior, observations, and medications.     

A Longitudinal Analysis of Family Empowerment and Client Outcomes

We examined the relationship between family empowerment, parent satisfaction, and mental health outcome across time. Based on the Vanderbilt Family Empowerment Project Model, increased empowerment should lead to positive changes in client outcomes. Data consisted of the Family Empowerment Scale (FES), which was used to assess the caregiver's perception of empowerment, Child and Adolescent Functional Assessment Scale (CAFAS), which measures the degree of disruption in the youth's current functioning, Client Satisfaction Questionnaire (CSQ), and demographic information gathered from families receiving services from a county mental health service system at intake and discharge. The results showed that the CAFAS and CSQ were related to empowerment at intake and discharge. Results also indicated significant increases in the knowledge subscale of the FES and the CAFAS and moderate increases in the advocacy subscale of the FES and the CSQ. We discuss the implications of these findings for systems of care, such as stronger parent-professional relationships.     

Mental Health and Dangerousness: Characteristics and Outcomes of Children and Adolescents in Residential Placements

Violence has been identified as a significant risk behavior among children and adolescents. Dangerousness is a factor in psychiatric hospitalizations and out-of-community placements. However, there is only a small amount of research that has investigated the mental health co-morbidities and treatment outcomes of violent children and adolescents. A random sample of children and adolescents in residential placements through the State of Florida's child welfare system were studied. Cases were classified into three levels of dangerousness. Results indicated that dangerousness was associated with much elevated mental health co-morbidity. Also, cases who were dangerous at the time of admission had less developed peer and moral/spiritual strengths than did other cases. Although dangerous cases had worse dispositional outcomes, there was strong evidence that these cases derived the most clinical benefit from residential treatment.     

初中生心理健康与气质、父母教养方式的关系

本研究从心理健康出发,采用《中学生心理健康量表》、《艾森克人格问卷》(儿童版)、《父母教养方式评定量表》对329名初中学生进行测量,探求初中生心理健康与气质、父母教养方式的关系。研究结果发现,初中生的心理健康与气质、家庭教养方式三者间存在交互作用,气质和家庭教养方式对心理健康有影响,气质是某些父母教养方式因子与心理健康的中介因素;并且气质特点与某些父母教养方式对初中生心理健康有较强的预测效应。     

Determinants of Children's Primary Health Care Use

We review factors that influence children's use of primary health care services. Predictors of pediatric health care use include child health status, child mental health, parent and family functioning, demographic characteristics, and access to health care services. Health services research is marked by inconsistencies due to varying approaches to measurement, population sampling, and analysis, and models that do not incorporate situational factors. We present recommendations for practicing clinicians and discuss suggestions for future research to help identify additional factors that may influence a parent's decision to seek help from pediatric physicians. Health care use is determined by multiple factors, and complex models will lead to improved strategies for maximizing health status and establishing optimal pediatric care.