The Prophylactic Mastectomy Dilemma: A Support Group for Women at High Genetic Risk for Breast Cancer

The goal of this pilot study was to test the usefulness of a six session psychoeducational support group for women at high genetic risk for breast cancer who were considering prophylactic mastectomy. The themes of the group sessions included overestimation of and anxiety about risk; desire for hard data; the emotional impact of watching a mother die of breast cancer; concerns about spouse reactions; self- and body image; the decision-making process; and confusion over whom to trust in decision making. Both the participants and the multidisciplinary leaders concluded that as a supplement to individual counseling, a support group is a beneficial and cost-effective treatment modality. Recommendations for the optimal format for such a group are described.     

Functional Status, Receipt of Help, and Perceived Health

We model the effects of disability, functional limitation, and receipt of help on perceived health. This analysis specifies a model with two dimensions of disability and three dimensions of functional limitation, including upper body disability, lower body disability, basic activities of daily living (ADLs), household ADLs, and advanced ADLs. The latent variables of receiving help are modeled for each of the ADLs as intervening between limitations and perceived health. The results show that instrumental social support in the form of receiving help for ADLs has no substantive independent effect on perceived health. In addition, receiving instrumental social support shows a pattern of task-specific responses to individual measures of need. Implications for both caregiver and care recipient are discussed.     

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     

Relative Value Units: Using the New “Currency” for Measuring Clinical Productivity in a Productivity/Incentive Plan

This paper presents an overview of a productivity/incentive plan for faculty in an academic medicine center's department of behavioral medicine and psychiatry. The model utilizes the Resource-Based Relative Value Scale (RBRVS) for its measurement of clinical productivity. The paper provides an introduction to RBRVS terminology and how the RBRVS system was developed. The productivity/incentive plan developed for the Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, is described. The advantages and limitations of utilizing Relative Value Units (RVUs) in a productivity model are discussed. The paper may provide helpful insights to those charged with developing productivity/incentive plans at other academic health science centers.     

“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.     

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.     

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.     

Importance of Human Needs During Retrospective Peacetime and the Persian Gulf War: Mideastern Employees

This study examined the importance of needs during the retrospective peacetime in 1990 and the Persian Gulf War in 1991 using a sample of 378 employees in the Middle East. Results of factor analyses identified three levels of needs during peacetime and wartime. Factor structures of needs did change from peacetime to wartime and were different. The patterns of needs identified in this study were different from needs theories developed in the U.S. Results were discussed in light of cultural differences, available resources in the environment, and the Persian Gulf War.