Military psychology in the age of managed care: The Wilford Hall model

Military medicine is currently being overhauled through Tricare, a comprehensive, managed care program designed to reduce costs and increase clients' access to health care. This article presents reforms initiated by the psychologists at Wilford Hall Medical Center, the largest military hospital in the world, in response to Tricare. These reforms have resulted in adult, outpatient services that are immediately accessible, effective, and cost efficient. The Wilford Hall approach to psychological services is offered as model that can be used in other outpatient settings. Additionally, potential limitations of this approach to psychological care are presented.     

农村留守儿童心理健康水平变迁的横断历史研究

研究选取2004年至2017年中采用MHT量表的90篇文献,进行了横断历史元分析,探究留守儿童心理健康状况随年代的变化趋势.结果表明:(1)学习焦虑、过敏倾向与年代呈正相关,其余因子均与年代呈负相关,年代对各因子变异的解释率在14％～23％之间;(2)对人焦虑、身体症状、恐怖倾向、冲动倾向平均下降范围在0.06～0.7...     

Relationship between maternal aggression and maternal care in the rat

Aggression among female rats is almost entirely confined to the period of late pregnancy and lactation. Behaviorally it is similar to the aggression of males including piloerection and lateral attacks, but it differs in its function. Unlike male aggression which serves to establish a social hierarchy and a territory, i. e., is competitive, maternal aggression is protective, i. e., it serves to prevent predation of the mother's offspring. In this respect it is closely related temporally and causally to maternal care; if the offspring are removed maternal aggression wanes almost immediately–its function no longer exists! Studies on aggression by mothers, among rats, from the author's laboratory are reviewed and comparisons made with maternal care. As noted, maternal aggression and maternal care are closely related during the cycle of maternal behavior and they share a similar hormonal basis and possibly the effect of uterine stimulation, but maternal care requires prolactin and the decline of progesterone while maternal aggression appears independent of pituitary hormones and does not require a decline in progesterone. Maternal aggression like maternal care appears to be organized into a hormonal phase, during pregnancy, parturition, and for about a week postpartum and a nonhormonal phase thereafter. Bilateral radiofrequency lesions of the lateral midbrain peripeduncular nucleus (PPN) produce deficits in maternal aggression if made on lactation day 7 (L7), but not earlier, without producing significant deficits in maternal behavior. Experiments showed that the PPN does not mediate hormonally stimulated maternal aggression; it appears to mediate only nonhormonally stimulated maternal aggression. Studies on the role of pregnancy hormones on long-term retention of maternal aggression and the role of olfaction in maternal aggression are also reviewed. © 1994 Wiley-Liss, Inc.     

Decreasing Neuroleptic Doses in Older Adults with Schizophrenia

This prospective study of 27 older adults, residing in long-term care facilities, examined the effects of reducing neuroleptic medications to the point of controlling symptoms and reducing side effects. Schizophrenia is a challenging health care condition that leads to delusions, hallucinations, disorganized speech, and a host of other symptoms. Unfortunately, medications control many of the symptoms but cause unwanted side effects unless monitored closely and regulated to each person's needs. This study addresses six research questions related to the reduction of neuroleptic medications. Study findings related to neuroleptic medication dose reduction were encouraging. Additionally, the findings strongly suggest that health care providers working with older adults with the diagnosis of schizophrenia would benefit from planned educational programs about behavior, observations, and medications.     

Mental Health and Dangerousness: Characteristics and Outcomes of Children and Adolescents in Residential Placements

Violence has been identified as a significant risk behavior among children and adolescents. Dangerousness is a factor in psychiatric hospitalizations and out-of-community placements. However, there is only a small amount of research that has investigated the mental health co-morbidities and treatment outcomes of violent children and adolescents. A random sample of children and adolescents in residential placements through the State of Florida's child welfare system were studied. Cases were classified into three levels of dangerousness. Results indicated that dangerousness was associated with much elevated mental health co-morbidity. Also, cases who were dangerous at the time of admission had less developed peer and moral/spiritual strengths than did other cases. Although dangerous cases had worse dispositional outcomes, there was strong evidence that these cases derived the most clinical benefit from residential treatment.     

A Longitudinal Analysis of Family Empowerment and Client Outcomes

We examined the relationship between family empowerment, parent satisfaction, and mental health outcome across time. Based on the Vanderbilt Family Empowerment Project Model, increased empowerment should lead to positive changes in client outcomes. Data consisted of the Family Empowerment Scale (FES), which was used to assess the caregiver's perception of empowerment, Child and Adolescent Functional Assessment Scale (CAFAS), which measures the degree of disruption in the youth's current functioning, Client Satisfaction Questionnaire (CSQ), and demographic information gathered from families receiving services from a county mental health service system at intake and discharge. The results showed that the CAFAS and CSQ were related to empowerment at intake and discharge. Results also indicated significant increases in the knowledge subscale of the FES and the CAFAS and moderate increases in the advocacy subscale of the FES and the CSQ. We discuss the implications of these findings for systems of care, such as stronger parent-professional relationships.     

Possession and Medicine in South Central India

Possession is a powerful and surprisingly prevalent belief system in many parts of the developing world. In India it is common for many reasons—isolation, illiteracy, polyglotism, lack of an adequate medical infrastructure, a need for hope. Possession, and the practice of exorcism, is more than just an explanatory system based on superstition and folk lore. It is also an important social structure and force that allows the integration of the sick into the community of the well, and facilitates a first albeit tentative step from the local community to the medical community. In many parts of India, health care delivery as well as social organization is through the practice of possession. Thus, the role and power of possession needs to be appreciated if one seeks to affect health care delivery in India, and further possession should be appreciated if one seeks to better understand how some of its forces might in fact be curative.     

Family Therapy in India: A New Profession in an Ancient Land?

This paper examines the need for family therapy in India and its evolution as an integrated academic discipline and widespread form of clinical practice. Included is a discussion of the numerous factors placing Indian families at risk today, both common and more serious child, marital, and family difficulties, the current status of mental health services and minimal emphasis on family-based treatment, and the potential benefits of family therapy to such a radically diverse and rapidly changing society. Targets of and settings for family therapy training are highlighted, and a brief outline of a training-the-trainer approach is provided.     

Continued Evolution of Family Therapy: The Last Twenty Years

There have been numerous accounts of the history and major trends and issues in family therapy during the field's first three decades in the literature (see for example: Broderick & Shrader, 1981; Framo, 1972; Guerin, 1976; Kaslow, 1973, 1977, 1980; Nichols, 1986, 1999 for some varied depictions, written from each respective author's unique lens). Viewed as a set, packaged with different, yet interrelated contents, they offer a multihued portrait of the emerging field during its infancy, childhood, and adolescence. Now it is time to move on and look at the adulthood era as it has unfolded.