Factors associated with respite care use by families with a child with disabilities

This paper reviews the literature on respite care utilization, describes a respite care program in Arkansas, and reports on a study of utilization initiated by the Arkansas Division of Mental Health Services (DMHS). Among the 89 families qualifying for respite services, 70 consented to participate, and 66 were surveyed in a phone interview. Users (n=54) and non-users (n=12) were compared relative to a variety of staff, child, geographic, and budget differences. Also, respite use was examined relative, to the aforementioned variables based on level of use, (i.e., none, low, moderate, high). There were no differences in use according to age, the number of family members, family income, or needs of the child. A larger percentage of non-use and low use of respite care was evident among those families receiving Tax Equity Fiscal Responsibility Act (TEFRA) benefits. There were no significant differences between races related to perceived barriers to care. Differences in expectations/experiences with respite care among rural and urban groups were limited with rural respondents expressing, concern about travel/distance issues. Overall, the program as a whole received positive ratings by parents, and no clear factors were found to be related to non-use in the small sample (n=12) who did not take advantage of respite services.     

The readability of educational materials written for parents of children with attention-deficit hyperactivity disorder

Health-care providers are relying increasingly on printed materials to educate patients and their families about varous aspects of their health or mental health conditions. For the target audience to be able to read and understand health brochures, they should be written at or about the 8th-grade level and incorporate variables that facilitate comprehension. The purpose of this study was to analyze brochures related to Attention-Deficit Hyperactivity Disorder to determine (a) if they were written at a level appropriate for the target audience, and (b) the extent to which they incorporated variables identified in the research literature as facilitating comprehension. The results showed that the brochures were written at a reading level beyond that of the target audience. Further, although the brochures incorporated a large number of variables which facilitate comprehension, many were not used to the extent necessary to ensure that readers would be able to understand the brochures. These results clearly indicated the need for health care materials to be written in such a way that they can be read and understood by the target audience.     

Crisis for community mental health: The use of groups in the struggle for survival

The task of community mental health is to provide quality services to clients despite funding cutbacks. This paper describes the recent evolution in conceptualization and service delivery in one center. The outcomes are a philosophy that is customer oriented, and treatment that draws upon brief techniques, in group and long term contexts.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.     

Psychological Distress and Help Seeking in Rural America

The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.     

American Political Culture in Comparative Perspective

In order to formulate a comparative model of political cultures, a theory that integrates psychological, sociological and economic variables is developed. Within societies dominant political cultural themes stress particular patterns of right and obligation. These patterns simultaneously undergird social solidarity and justify an unequal distribution of rewards. Differences among political cultures exist vertically on an historical dimension of increasing moral comprehensiveness and horizontally on a dimension of moral content. Internal tensions deriving from technological development and from social discourse about the moral adequacy of norms stimulate change. A case study of American political culture, with its contrasting emphases on egalitarianism and individualism, assesses the theoretical claims.     

CONTINGENT OBSERVATION: AN EFFECTIVE AND ACCEPTABLE PROCEDURE FOR REDUCING DISRUPTIVE BEHAVIOR OF YOUNG CHILDREN IN A GROUP SETTING1

Since a major task of childhood is learning to get along in a group without disrupting other children's activities, caregivers need explicit guidelines for gentle but effective procedures for dealing with disruptive behaviors in child-care settings. In a day-care center for normal 1- and 2-yr-old children, an effort was made to develop a procedure that appeared sufficiently humane and educational to be acceptable to parents and daycare workers, and yet effective in reducing disruptive play behaviors. Caregivers used the occasion of disruptive behavior to instruct the child in appropriate alternatives, then had the child sit on the periphery and observe the appropriate social behavior of the other children, “sit and watch”, for a brief period before inviting him or her to rejoin the play activities. The effectiveness of this procedure was compared with a method commonly recommended for use with young children: instructing the child, then distracting or redirecting the child to an alternative toy or activity. Contingent observation, combining instruction with a brief timeout (from being a participant in an activity to becoming an observer of the activity), proved considerably more effective in maintaining low levels of disruptions and was considered by caregivers and parents to be an appropriate and socially acceptable method of dealing with young children's disruptive behaviors. Therefore, contingent observation can be recommended for general use in day-care programs for young children.     

Modifying food purchases in supermarkets with modeling, feedback, and goal-setting procedures

We compared several procedures designed to modify consumer food purchases with the objectives of reducing fat and increasing carbohydrate content, and reducing dollar expenditures on food. Participants were 126 volunteer community households which, after a 7-week baseline period, were randomly assigned to video-modeling, video-modeling-feedback, video-lecture, video-lecture-feedback, participant-modeling, video-modeling-discussion, and control conditions. The main dependent measure was a weekly record of food purchases, convertible to percentages of nutrients and dollar expenditures. Results indicated that modeling-feedback and participant-modeling procedures were most effective (e.g., 6% reduction of total fat consumption, 19% dollar savings). Strategies to refine and automate modeling and feedback in supermarkets that may benefit consumers, corporations, and government are discussed.     

Infant state in relation to its environmental context

Two neonatal intensive care units (NICU) were observed every 15 minutes for at least 72 consecutive hours. Although infants on both NICUs were exposed to considerable amounts of stimulation, there were differences between the units for each environmental measure in the amount of stimulation and/or the pattern of circadian periodicity. The two NICUs also differed in the amount of time infants spent in various states and in the pattern of state periodicity. In general, the diurnal rhythms of the infant states were associated with the diurnal rhythms of different environmental events; furthermore, the patterns of association were not the same on the two NICUs. The results point to potential problems in depicting a “typical” NICU. More importantly, they suggest that the environmental of NICUs has a recognizable influence on aspects of their inhabitants' behavior and that the nature of influence is different from NICU to NICU. The effects are potentially significant for physical, social, and cognitive development.