The Program Environment Scale: Assessing Client Perceptions of Community-Based Programs for the Severely Mentally Ill

The Program Environment Scale (PES) was developed for use with clients of community-based programs for the severely mentally ill. It is intended to fill the gap in available tools for assessing clients' perceptions of program functioning as it affects their quality of life in a program. Formal pretests were conducted with 121 clients at 12 randomly selected programs near Washington, DC. The final field test used a revised form (29 domains; 129 items) with 221 clients in 22 programs selected randomly throughout the U.S., including Clubhouse, day treatment, psychosocial rehabilitation, and social club programs. Twenty-three subscales met at least five of eight psychometric criteria for internal consistency and discriminant validity. A 24th subscale was retained because of its substantive importance. Successful subscales cover program atmosphere and interactions (program cares about me, energy level, friendliness, openness, staff-client and client-client respect, reasonable rules, availability of positive physical contact, protection from bad touch, staff investment in their jobs, and confidentiality), client empowerment/staff-client equality (program and treatment empowerment, egalitarian space use), and service components (support for paid work, work importance, emergency access, family activities, housing, public benefits, community activities, medications, substance abuse, and continuity). Subscale validity is indicated by associations of specific service offerings with scores on scales measuring client perceptions of those services, and by an ability to differentiate among program models (i.e., Clubhouses, day treatment programs, and psychosocial rehabilitation programs look different from each other). Subscale scores were not influenced by client characteristics (gender, race, age, diagnosis, number of hospitalizations, length of time in program). The final scale has 97 items and takes about 25 minutes to complete. The PES succeeds in measuring different aspects of programs as clients perceive them. In the programs we visited, directors felt the PES covers the important things they want to know about how clients perceive their program. The PES should become a useful tool both for researchers interested in how client responses to programs may influence their therapeutic outcomes, and for practitioners interested in improving their clients' program experiences and/or increasing convergence of staff and client views of their program.     

Methylphenidate Does Not Modify the Impact of Response Frequency or Stimulus Sequence on Performance and Event-Related Potentials of Children with Attention Deficit Hyperactivity Disorder

Twenty-six children with attention deficit/hyperactivity disorder (ADHD) participated in a double-blind trial consisting of 2 consecutive weeks each of placebo and methylphenidate (M = 26.92 mg/day = 0.78 mg/kg/day). As expected, stimulant therapy resulted in moderate weight loss, increased somatic complaints, and teacher and parent reports of reduced inattentiveness, aggression, and oppositionality. In both phases of the trial, patients were tested in a choice reaction time task assessing two aspects of the task that presumably affect response selection: response frequency (ratio of targets/nontargets = 25/75 vs. 50/50) and stimulus sequence (alternations vs. repetitions). Both manipulations yielded expected results on performance and event-related potentials (ERPs). Stimulant treatment increased accuracy and speed among younger children and curtailed variability of reaction time for the sample as a whole. However, methylphenidate did not affect ERPs. In combination, the results imply that the enhancement of performance by methylphenidate does not involve the demands of response selection examined in this study.     

“Nothing About Me, Without Me”: Participatory Action Research with Self-Help/Mutual Aid Organizations for Psychiatric Consumer/Survivors

Participatory action research with self-help/mutual aid organizations for psychiatric consumer/survivors is reviewed. We begin by tracing the origins of and defining both participatory action research and self-help/mutual aid. In so doing, the degree of correspondence between the assumptions/values of participatory action research and those of self-help/mutual aid for psychiatric consumer/survivors is examined. We argue that participatory action research and self-help/mutual aid share four values in common: (a) empowerment, (b) supportive relationships, (c) social change, and (d) learning as an ongoing process. Next, selected examples of participatory action research with psychiatric consumer/survivor-controlled self-help/mutual aid organizations which illustrate these shared values are provided. We conclude with recommendations of how the key values can be promoted in both the methodological and substantive aspects of future participatory action research with self-help/mutual aid organizations for psychiatric consumer/survivors.     

Reproductive Genetic Counseling to Asian-Pacific and Latin American Immigrants

Latin and Asian-Pacific immigrants are the fastest growing new-comer groups in the U.S. contributing to 85% of immigration totals. New immigrants experience multiple barriers to accessing genetic counseling resulting from cultural, linguistic, financial, and educational factors as well as having unique perceptions on health, illness, reproduction, and life as a whole. In addition, new immigrants lack familiarity with Western medical practices as well as genetic risk and available interventions. We provided perinatal genetic services to 2430 clients, mostly new immigrants of Latin and Asian-Pacific descent over a period of 6 years. Counseling aides sharing the clients' cultural backgrounds were employed. A study assessing the efficacy of cross-cultural education regarding advanced maternal age risk and amniocentesis was implemented and linked to a database containing demographic and clinical information. Practical observations relating to cultural beliefs in the two groups relevant to perinatal genetic counseling were made.     

Parental Perceptions of Child Development Among Low-Income Mexican American Families

Parents' perceptions of child development are influenced by complex interactions among cultural, social, and economic factors. Insights into how parents from culturally diverse societies perceive the development of their children might explain why different cultural groups foster or value the development of different skills in their children. In this study, we explored the perceptions of child development among low income Mexican American parents. A series of ethnographic interviews were conducted with eight Mexican American families who had preschool children. Qualitative data analyses yielded three main themes that were important to these parents: family attitudes and values, changes, and adaptations. For these parents, the development of social attributes in children, that will enable them to function within their own cultural group, was as important as the development of cognitive or motor skills. Service providers, such as school and mental health personnel, should take into account cultural differences in parents' perceptions of the importance of various developmental milestones for their children when suggesting interventions typically used by parents in the dominant culture.     

Association Between Employment and Sexual Risk-Taking Behaviors Among Public High School Adolescents

We examined the relationship between adolescent after school and weekend employment and sexual intercourse behavior in a cross-sectional sample of public high school students in South Carolina. The CDC Youth Risk Behavior Survey was used to secure usable data from 4,800 subjects. Thirty-nine percent of the sample worked at a job for pay during the academic year of the study. The majority of all race/gender groups reported having sexual intercourse in their lifetime and during the past 3 months prior, with the exception of Caucasian females. For Caucasian males employment ranging from 1-5 to 31+ hours per week was associated with sexual risk-taking. Caucasian female employment was associated with sexual risk-taking at 16-20 and 21-25 hours of work per week. For African American males, the relationship between employment and sexual risk-taking was evidenced at the 1-5 and 26-30 hours of work per week levels. Similar trends were determined for Caucasians (males and females) regarding sexual intercourse in the past 3 months prior and working for pay during the academic year. Youth working above 10 hours per week during high school may have an increased risk for unintended pregnancy and sexually transmitted infections, including HIV.     

Behavioral Family Interventions for Improving Child-rearing: A Review of the Literature for Clinicians and Policy Makers

This paper reviews evidence that behavioral family interventions are effective at improving child-rearing in distressed families and families with children exhibiting disruptive behavior. Essential therapeutic strategies offered within a collaborative therapeutic process are identified. Exemplary materials for parents and clinicians are identified. Differences between behavioral family interventions and two popular press parenting approaches are highlighted, including the lack of empirical support for these widely used programs and the advice they offer which runs counter to behavioral approaches. Recommendations are offered for combining behavioral family interventions with other empirically supported approaches, promoting more widespread use of empirically supported treatments, such as behavioral family interventions, and the need for a public health perspective on family functioning, involving collaboration among clinicians, policy makers, and researchers.     

GENERATING HYPOTHESES ABOUT THE FUNCTION OF STUDENT PROBLEM BEHAVIOR BY OBSERVING TEACHER BEHAVIOR

We examined whether, as predicted by research on child effects, we could generate hypotheses about the function of student problem behavior by observing the amount of attention teachers provided to students. In the first phase of the study, we observed the amount of attention teachers distributed among small groups of students who exhibited problem behavior in individual or small-group instructional settings (problem behavior presumably maintained by attention or escape). Based on the amount of attention each student received, we generated hypotheses about the function of his or her problem behavior. In the second phase of the study, we determined the accuracy of these predictions by conducting a brief functional assessment with each student. Results confirmed that, for 14 of the 15 students, we were able to generate accurate hypotheses about the function of their problem behavior. These results suggest the potential efficacy of using the amount of attention teachers distribute among groups of students to generate empirically based hypotheses about the function of student problem behavior maintained by attention and/or escape. These results also illustrate the efficiency of this procedure; by observing teacher behavior, we were able to generate hypotheses about the function of problem behavior for several students at one time.