Wrapping community-based mental health services around children with a severe behavioral disorder: An evaluation of project wraparound

During the past two decades there has been a significant increase in community-based mental health and educational services for children and youth with serious emotional and behavioral problems and their families. However, in the vast majority of programs there are no reliable longitudinal data on the adjustment of the children that are served. Project Wraparound was a community-based individualized treatment program which served children and youth with severely maladjusted behavior and their families by providing intensive home and school-based services. The purpose of this paper is to provide a longitudinal analysis of client and family adjustment data. Data on client adjustment within the home and characteristics of the home environment were obtained at intervals of 3 months, 6 months, and 1 year. Data on client adjustment in school was obtained at four points over a period of 2 years. The results from 19 cases indicate that substantial change occurred on measures of the home environment and client adjustment in the home with no significant change in adjustment in the school. Implications of the findings are discussed.     

Adolescents' perceptions of outpatient mental health services

Thirty-three adolescents from three mental health service settings were interviewed regarding their perceptions of the purpose, goals, expectations, frustrations and benefits of mental health experiences. They provided satisfaction ratings and importance rankings of seven domains of satisfaction: (a) Convenient/Accessible, (b) Meeting Needs, (c) Staff Competence, (d) Personal Relationship with Staff, (e) Effectiveness of Treatment, (f) Comfort/Appropriateness of Center, and (g) Costs and Paperwork. In addition, participants completed the Client Satisfaction Questionnaire (CSQ-8). Results indicated that, in general, the adolescents were very satisfied with the services they received. Gender, race/ethnicity and treatment site were not related to satisfaction scores, nor was the adolescent's perceived choice in seeking services. Some significant gender differences were found both in terms of the rankings of satisfaction domains, as well as in the adolescents' perceptions of their reasons for initiating counseling and the perceived goals and benefits of counseling. Additional differences in perceptions of services were found for treatment site and race/ethnicity. In general, adolescents were able to generate informative, sophisticated responses to questions regarding their perceptions of mental health services, and demonstrated that they are capable of evaluating services they receive.     

Wraparound care in vermont: Program development,implementation, and evaluation of a statewide system of individualized services

Over the past decade, there has been a dramatic shift in the provision of mental health services to children, adolescents, and their families. This shift has been marked by a movement away from restrictive treatment options toward the development of comprehensive community-based systems of care designed to keep the most challenging children in their homes, schools, and communities. Based on a model of intensive case management referred to as Wraparound Care, Vermont's statewide approach emphasizes aggressive outreach, use of the least restrictive treatment options, and care that is flexible, unconditional, and child- and family-centered. We chart the development of Vermont's Wraparound Care Initiative and present residential, educational, and behavioral outcome data for a cohort of 40 youth receiving Wraparound Care over a 12-month period. The results showed that after 12-months, youth who had been previously removed from their homes or were at imminent risk of such removal, were residing in significantly less restrictive community-based living arrangements and exhibiting significantly fewer problem behaviors than at intake. These results are discussed in light of recent national studies and previous studies on similar cohorts of Vermont youth receiving Wraparound Care.     

Nurse psychologists: A unique group within health psychology

Since the mid-1980s commonalities between nursing and psychology have been explored, with subsequent establishment of a Nursing and Health Psychology Committee within the American Psychological Association's Division 38. A survey was undertaken to study this little-known, unique cadre of individuals with dual preparation in both nursing and psychology. Participants were queried regarding their educational preparations in both disciplines, current employment, theoretical and/or research interests, and current projects. Results of the survey provide information about the characteristics of this group. Dual preparation appears to offer certain advantages for the practice of health psychology.     

Psychological aspects of scuba diving injuries: Suggestions for short-term treatment from a psychodynamic perspective

Dive medicine is described as an area of practice in which psychologists may choose to expand their clinical service and research activities. The author argues that most research studying risk behavior and sports take into account biological, behavioral or cognitive approaches, while ignoring unconscious conflict in risk-taking and injury management. The present paper uses a psychodynamically-oriented, interview-based approach to studying psychological reactions to decompression sickness in three experienced scuba divers. Brief interventions and their outcomes are described.     

SEPARATE AND COMBINED EFFECTS OF METHYLPHENIDATE AND A BEHAVIORAL INTERVENTION ON DISRUPTIVE BEHAVIOR IN CHILDREN WITH MENTAL RETARDATION

We investigated the separate and combined effects of a behavioral intervention and methylphenidate (Ritalin®) on disruptive behavior and task engagement in 3 children with severe to profound mental retardation. The behavioral intervention involved differential reinforcement of appropriate behavior and guided compliance. All 3 children demonstrated decreased disruptive behavior and improved task engagement in response to the behavioral intervention. Two of the 3 children demonstrated similar improvement in response to methylphenidate. Although both interventions were highly effective for these 2 participants, the relative efficacy of the interventions varied between the 2 children. There was no evidence of an additive or synergistic effect of the two interventions, but the high efficacy of each intervention alone limited our ability to detect such effects.     

Sober adolescence–Predictor of psychosocial maladjustment in young adulthood?

We have explored how age at first intoxication with alcohol relates to mental health, social integration and adjustment to the adult role. The data stem from a longitudinal representative study of 2000 Norwegians. The sample was assessed at ages 19–22, 21–24 and 25–28. Among females, only early intoxication was related to young adult symptoms of poor mental health. A U-shaped association between intoxication debut and psychological problems was revealed among males, implying that both early and late beginners had more such problems than those who had followed the mainstream. These associations persisted without change over time. However, males who remained abstainers in adulthood were psychologically healthy, but they showed indications of a delayed entry into the adult role. Male late beginners were also somewhat reluctant to adopt adult role-behaviors. Thus, getting drunk for the first time in mid-adolescence seems to be an ingredient in the normal developmental process in young males.     

The factor structure of the Maslach Burnout Inventory in two Swedish human service organizations

The Maslach Burnout Inventory, MBI, is a well established measure of burnout. Its validity outside the USA is, however, uncertain. The aim of the present study was therefore to apply the MBI on personnel in two Swedish human service organizations, comparing factor solutions and scoring norms to the original results. The population consisted of 5730 employees in the Social Insurance Organization (SIO) and the Individual and Family Care section (IFC) of the social welfare agencies. Principal components analysis, principal axes and alpha factor analyses were performed, all with varimax rotation. The suggested three factor solution showed to be remarkably stable irrespective of type of analysis. Score levels were somewhat lower on two subscales in the Swedish population. The conclusion is that the psychometric properties of the MBI seem to be very satisfactory and stable, at least in comparison between Sweden and USA. It is suggested that the dimensionality of MBI is rather invariant, but that the score levels covary with national, cultural, or professional contexts within the human services.