Examining the Impact of Policy on Collaboration in Systems of Care

Since Jane Knitzer’s 1982 report on Unclaimed Children, many states and localities have been developing systems of care to more effectively serve children with serious emotional disturbance. We report on the methods and outcomes of a two-phase study designed to determine the relationship between the mechanisms that have been used to establish systems of care and their resulting levels of collaboration. A national survey of state mental health authorities revealed that, allowing for multiple approaches, 82% of respondents with systems of care used legislation, 15% used inducements, 41% used capacity building and 44% used other means of system change (e.g., blended funding). Cluster analysis was used to select 10 sites for visits. Multiple methods of collecting data at these sites were used including the administration of a scale on collaboration. Data were obtained from 302 respondents. Difference in beliefs about collaboration and collaborative behaviors were found, indicating that level of collaboration may be an important variable to consider in studies of outcomes of systems of care for children and families.     

Clinician Perspectives of Diagnosis and Perceived Client Change in “Real World” Psychotherapy for Youth Emotional and Behavioral Disorders

We investigated the extent to which clinician-assigned diagnoses of emotional and behavioral disorders and clinicians’ perceptions of client change are consistent with structured measures of youth clinical functioning and parent/family characteristics within the context of usual care or “real world” psychotherapy. A total of 54 therapists from two publicly-funded youth outpatient mental health clinics and 128 youths and parents from the therapists’ combined caseloads were included in the study. Clinician-assigned diagnosis and youth and family demographics were collected at the initial visit, clinician-reported perceived client change was collected at 6-month follow-up, and structured measures of youth clinical functioning and parent/family characteristics were collected at both time points. Results indicate some overlap between clinician-assigned diagnosis, clinician-reported perceived client change, and structured measures of youth clinical functioning and parent/family characteristics after controlling for demographic factors. Results are discussed in terms of implications for the implementation of evidence-based practices in real world community settings.     

An Overview of Primary Care Family Psychology

This paper describes the application of family psychology to the primary care setting—in service, education and training, and scholarship. Primary care family psychology integrates family systems with biopsychosocial theory, yielding an approach that is uniquely suited to the generalist demands of primary care. This approach attends especially to the effects of relationships on health and healthcare, using the family as a potential resource to the patient just as the healthcare team is a resource to the clinician. Training opportunities in primary care family psychology are growing. The University of Rochester School of Medicine and Dentistry fellowship is described as an example, with core primary care family psychology training in four different clinical sites: Family Medicine, Internal Medicine, Pediatrics, and Obstetrics/Gynecology. Susan H. McDaniel is Professor of Psychiatry & Family Medicine, Director of Family Programs & the Wynne Center for Family Research in Psychiatry, and Associate Chair of Family Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York. Dr McDaniel also directs the Primary Care Family Psychology Fellowship. Picter LeRoux is Associate Professor of Psychiatry & Pediatrics, and Director of the Family Therapy Training Program in Psychiatry, University of Rochester School Medicine and Dentistry, Rochester, New York. Dr. LeRoux also heads the Pediatric Track of the Primary Care Family Psychology Fellowship.     

Recognition and Social Justice: A Roman Catholic View of Christian Bioethics of Long-Term Care and Community Service

Contemporary Christian ethics encounters the challenge to communicategenuinely Christian normative orientations within the scientificdebate in such a way as to render these orientations comprehensible,and to maintain or enhance their plausibility even for non-Christians.This essay, therefore, proceeds from a biblical motif, takesup certain themes from the Christian tradition (in particularthe idea of social justice), and connects both with a compellingcontemporary approach to ethics by secular moral philosophy,i.e. with Axel Honneth's reception of Hegel, as based on Hegel'stheory of recognition. As a first step, elements of an ethicsof recognition are developed on the basis of an anthropologicalrecourse to the conditions of intersubjective encounters. Theseconditions are then brought to bear on the idea of social justice,as developed in the social-Catholic tradition, and as systematicallyexplored in the Pastoral Letter of the United States Conferenceof Catholic Bishops, Economic Justice For All (1986). Proceedingfrom this basis, aspects of a Christian ethics of communityservice with regard to long-term care can be defined.     

Introducing humanistic group counselling for somatisation in a primary care practice: Preliminary findings

Can group counselling help patients who present with symptoms that cannot be explained medically? Preliminary results of working with one such group are reported. Six patients in a primary care practice were offered weekly sessions for half a year. The findings suggest that the patients attended all group sessions. The patients reported experiences known to be related to group counselling, and when the group ended, patient reports show that the severity of their problems was reduced significantly (p<.001). Furthermore, during the six months after the group ended patients significantly (p<.025) reduced their visits to their general practitioners. These results seem to call for wider use of humanistic group counselling with somatising patients and further research into the impact of such form of counselling.     

Counselling with a profoundly deaf client and the impact of a therapist's dream: A case study

This case study explores the experience of one client participating in a project evaluating the use of dreams in short‐term counselling within the National Health Service. The client received 24 sessions of counselling and completed a post‐counselling semi‐structured questionnaire. This was followed by a semi‐structured interview, which confirmed the internal coherence within the participant's narrative and allowed a more detailed exploration of her experiences, supported by process notes. Supervision challenged the therapist's preconceptions and held her in her uncertainty until the work was aided by a dream that the therapist had of the client.     

Withholding Hydration and Nutrition in Newborns

In the twenty-first century, decisions to withhold or withdraw life-supporting measures commonly precede death in the neonatal intensive care unit without major ethical controversy. However, caregivers often feel much greater turmoil with regard to stopping medical hydration and nutrition than they do when considering discontinuation of mechanical ventilation or circulatory support. Nevertheless, forgoing medical fluids and food represents a morally acceptable option as part of a carefully developed palliative care plan considering the infant’s prognosis and the burdens of continued treatment. Decisions to stop any form of life support should focus on the clinical circumstances, not the means used to sustain life.     

Patients taking the lead. A naturalistic investigation of a patient led approach to treatment in primary care

In an earlier paper (Carey, T. A. (2005). Can patients specify treatment parameters? A preliminary investigation. Clinical Psychology and Psychotherapy, 12, 326–335) an approach to treatment delivery was examined in which the duration and frequency of the appointments was scheduled by patients. Results of this approach were encouraging but the generalizability of the results was constrained because only one clinician trialed the approach and no standardized assessment measures were used. In the present study there are two clinicians involved and the Depression Anxiety Stress Scale (DASS) was used. The approach was introduced at one GP practice and monitored over a six-month period. Results suggest that this approach might be an effective way of promoting patient access to, and involvement in, service delivery as well as reducing waiting times.     

幽门螺杆菌cagA基因多态性对临床结局的影响:东亚菌株和西方菌株

CagA蛋白是幽门螺杆菌最重要的毒力因子之一.目前已证实cagA基因存在东亚及西方两种亚型.幽门螺杆菌产生CagA蛋白,注入胃上皮细胞后在其羧基端EPIYA重复序列区进行酪氨酸磷酸化,进而与SHP-2酪氨酸磷酸化酶相互作用,参与上皮细胞的信号传导,导致细胞骨架结构的重排,引起细胞表面形状的改变和细胞动力的增强,造成细胞异常的增殖和运动,在胃癌的发生中起了主要作用.cagA基因的羧基端EPIYA重复序列被认为是区分东亚型和西方型菌株的分子标记,东亚型CagA与SHP-2亲和力大于西方型,最终影响着不同CagA+菌株感染的临床表现.     

总结经验 推进新一轮卫生改革

着眼于实现为人人提供保健服务目标的医疗改革,要求卫生服务与医药购销制度的改革必须适应广覆盖、低成本的医疗保险制度;确保公共卫生、社区卫生与合作医疗在整个保健服务体系中的主体地位,在基本卫生保健服务机构与大医院之间建立合作、互补、互制的关系;坚定地对大医院实行调整和管理;构建医药分开的管理与流通体制;政府主导作用到位,投入方向合理,以顺利推进新一轮医疗改革。