Vertical integration in medical settings: A brief introduction to its potential effects on professional psychology

Vertical integration in medical settings typically involves the merging of independent physicians, physician groups, and hospitals to render an organized health care network. Such systems are considered to be vertical, as they may allow for a seamless continuation of services throughout the range of needs a patient may require. Mergers often result in the redefining of professional services offered in the acquired facility or across the network. As such, mergers have the potential of adversely impacting psychological practices. Professional psychology needs to take a proactive stance in this changing health care landscape. Research regarding empirically validated treatments and effects of psychological interventions on overall health-care costs needs to be properly disseminated to health care administrators to assure their knowledge of the utility of psychological services in the medical setting. Training psychologists to assume leadership positions in health-care institutions, gaining representation on hospital staff boards, and linking psychologists and physicians through collaborative training, to provide improved care, may allow for psychology to influence health care delivery.     

Filial maturity of middle-aged adult children in the context of parent care: Model and measures

There is a growing recognition of the usefulness of Blenkner's (1965) concept of filial maturity for theory and practice in the domain of adult development. This concept refers to a dynamic state of continuous successful coping with the normative task of parent care in middle-aged adult children. The objectives of the present study were (a) to begin construction of psychometrically sound filial maturity measures; (b) to test a comprehensive model of filial maturity; and (c) to explore gender differences and the role of adult child, elderly parent, and context variables as predictors of filial maturity. Subjects were 298 middle-aged adults. The Louvain Filial Maturity Scale (LFMS-A) contains sevena priori scales probing for Filial Love, Filial Obligation, Filial Helpfulness, Filial Help, Filial Autonomy, Parental Consideration, and Family Solidarity and Help. A LISREL analysis yielded a model in which Filial Love and Filial Autonomy occupied central positions and a considerable percentage of the variance in Filial Helpfulness and Help was explained by the other filial maturity dimensions. Gender differences emerged on the Filial Obligation, Filial Help, and Filial Autonomy subscales, with women scoring higher on the first two scales and men scoring higher on the last. A set of adult child, aged parent, and context variables explained a noticeable percentage of the variance in the scores on the subscales in both men and women.     

Psychological science in the public arena: Three cases of dubious influence

Psychological science has a great deal to contribute to social welfare in all societies, because the world's most pressing social problems are behavioral in nature—violence, hunger, drug abuse, environmental pollution, low worker productivity, poor educational outcomes, and so forth. Thus, psychological research can inform public policies to improve approaches to these important social problems. The relationship of psychological science to public policy is often troubled, however, by misunderstandings about the role of science in the policy making process. Many scientists fear that their research results will be "misused" by others whose values differ from those of scientists. Thus, psychologists are reluctant to publish research results that can be used to support policies contrary to their own values and hesitate to ask research questions that can generate politically incorrect results. In this article, I argue that psychological science has a primary responsibility to ask dangerous questions and to report results honestly, without fear of their use; that research is not translated directly into public policies; and that psychological science should not be perverted either by fear of political consequences or by compromising truth in a quest for power. Three research examples are given to illustrate the different faces of temptation to pervert psychological science in a misguided hope that scientists' own values will be reflected in public policies.     

Predicting infant attachment classification from multiple, contemporaneous measures of maternal care

This investigation was designed to test whether stylistic differences in maternal caregiving were associated with both secure and insecure mother-infant attachment classifications in a low-income sample. Multiple measures of maternal interactive behavior and care were collected from a sample of 95 urban, low-income mothers and their 12-month-old infants. Contemporaneous relations to attachment were found only at the broad level of composite scores of caregiving. Scores derived from different measures were aggregated to create composites reflecting three caregiver styles—sensitive, controlling, and unresponsive. Mothers of infants with secure attachment classifications showed greater sensitivity and less controlling behavior than mothers of infants with resistant and avoidant attachments, respectively. Mothers of infants with resistant attachments appeared less responsive to their infants' signals than those of infants with avoidant attachments. Group differences were significant, but modest. These results contribute to the growing body of studies relating parental care with infant attachment patterns and indirectly support the more recent conceptual work on intergenerational transmission of attachment. They also raise methodological issues that need to be considered in future work on caregiving and infant-mother attachment.     

Prevention of depression with primary care patients: A randomized controlled trial

The prevention of major depression is an important research goal which deserves increased attention. Depressive symptoms and disorders are particularly common in primary care patients and have a negative impact on functioning and well-being comparable with other major chronic medical conditions. The San Francisco Depression Prevention Research project conducted a randomized, controlled, prevention trial to demonstrate the feasibility of implementing such research in a public sector setting serving low-income, predominantly minority individuals: 150 primary care patients free from depression or other major mental disorders were randomized to an experimental cognitive-behavioral intervention or to a control condition. The experimental intervention group reported a significantly greater reduction in depressive levels. Decline in depressive levels was significantly mediated by decline in the frequency of negative conditions. Group differences in the number of new episodes (incidence) of major depression did not reach significance during the 1-year trial. We conclude that depression prevention trials in public sector primary care settings are feasbile, and that depressive symptoms can be reduced even in low-income, minority populations. To conduct randomized prevention trials that can test effects on incidence with sufficient statistical power, subgroups at greater imminent risk have to be identified.     

Listening to a different voice: A feminist critique of Gilligan

A critical examination of Carol Gilligan's study of psychological theory and women's development, this essay begins by exploring her concerns about malebiased developmental theorizing. I consider in detail Gilligan's criticisms of Sigmund Freud and her own empirical studies of moral development, as they relate to the work of L. Kohlberg. After defending Freud to some degree, I propose various (less theoretical but intuitively plausible) alternative interpretations of her data-interviews with males and females about hypothetical ethical dilemmas and with females about actual abortion decisions. I contend that Gilligan is too willing to concede the adequacy of Kohlberg's categories for fathoming the moral reasoning of males and that she may, in consequence, exaggerate differences between males and females. Noting the ironic similarities between Gilligan's claims and Schopenhauer's misogyny, I suggest that there may be something undesirably self-limiting about the different course of development she sketches. To move toward a morally preferable, feminism-compatible version of an ethic of care, I recommend that it be extended — by the imagination — beyond the here and now and that it not be restricted to existing webs of personal relationships.     

Health and adaptedness

The purpose of this paper is to give an explication of the concept of health which does not rely on the concept of disease. The explication is informed by a view of the human individual as an acting subject and it therefore places the abilities of agents in the centre. Abilities may be qualified in different ways. The qualification essential for understanding the dimension of health and illness relates abilities to environmental circumstances and high-ranking projects in the life plan. For this purpose generalized adaptedness is introduced as the overarching construction. The dimension of health and illness is characterized in terms of the adequacy of the repertoire for generalized adaptedness. Some immediate consequences concerning the notion of care are noted.     

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.     

Affordances in the home environment for motor development: Validity and reliability for the use in daycare setting

The range of stimuli provided by physical space, toys and care practices contributes to the motor, cognitive and social development of children. However, assessing the quality of child education environments is a challenge, and can be considered a health promotion initiative. This study investigated the validity of the criterion, content, construct and reliability of the Affordances in the Home Environment for Motor Development – Infant Scale (AHEMD-IS), version 3–18 months, for the use in daycare settings. Content validation was conducted with the participation of seven motor development and health care experts; and, face validity by 20 specialists in health and education. The results indicate the suitability of the adapted AHEMD-IS, evidencing its validity for the daycare setting a potential tool to assess the opportunities that the collective context offers to child development.     

Les métamorphoses du système de santé

The normative framework intervened in recent years to renovate and establish a coherent framework to the hospital system questions the bipartite division between private medicine and public medicine. The state supervision, consolidated by the Law of 26 January 2016 on the modernization of the health system, blurs the boundaries and involves renewing the qualification of our health system.