A Randomized Trial of a Mental Health Consumer-Managed Alternative to Civil Commitment for Acute Psychiatric Crisis

This experiment compared the effectiveness of an unlocked, mental health consumer-managed, crisis residential program (CRP) to a locked, inpatient psychiatric facility (LIPF) for adults civilly committed for severe psychiatric problems. Following screening and informed consent, participants (n = 393) were randomized to the CRP or the LIPF and interviewed at baseline and at 30-day, 6-month, and 1-year post admission. Outcomes were costs, level of functioning, psychiatric symptoms, self-esteem, enrichment, and service satisfaction. Treatment outcomes were compared using hierarchical linear models. Participants in the CRP experienced significantly greater improvement on interviewer-rated and self-reported psychopathology than did participants in the LIPF condition; service satisfaction was dramatically higher in the CRP condition. CRP-style facilities are a viable alternative to psychiatric hospitalization for many individuals facing civil commitment.     

Towards an integrated identity in counselling psychology: Graduate,professional and academic experiences

The paper is a reflective summary of my identity as a counselling psychologist. It discusses personal life, work and training experiences. The reason I would like to publish such a work is to encourage students in Greece, where the field of Counselling Psychology is less developed, to consider this kind of specialization, as well as to continuously enhance their professional identity, assimilating both practice and research opportunities, throughout their career paths. The paper focuses on three major influences in my development and training in the field: (a) graduate experiences as a doctoral student, writing a thesis on women's professional development, (b) work experiences in a career center of a large academic institution, and (c) academic and instructional experiences in a School of Psychology, where I teach and supervise research of both undergraduate and graduate students. The above influences delineate three separate, yet integrating identities: the identity of a feminist, the identity of a practitioner, and the identity of a researcher and instructor in the academia–that is, the identity of a scientist. My intention is to show how these three identities have been well integrated all these years, improving continuously my level of work in each and every dimension.     

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were self-referred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.     

"病中辨证"是证发展的必然

在疾病的发展过程中,一般存在着病和证的两种演变,相对于病而言,证有着更高层次的组织方式,有自身发展规律,反映的是机体整体状态.这种对证的诠释有利于中西医理论间的接轨,使证研究更容易被现代医学理论所接受,是中医进一步发展的要求,病证二者并不矛盾,而是互补,共同提供了对疾病的完整认识.     

The Effects of Capitation on Outpatient Mental Health Episodes of Children

We analyzed the effects of the Colorado Medicaid Capitation Program on the duration and services of over 21,000 outpatient mental health episodes for young children. The study spanned a three year period before and after capitation was implemented, and compared episodes of outpatient care for children from 14 capitated Community Mental Health Centers (CMHCs) with those from three CMHCs that remained fee-for-service. Proportional hazards regressions revealed that capitation resulted in an increase in outpatient episode duration, over and above similar effects for the comparison fee-for-service episodes. The hypothesis that there were longer capitated episodes for children who were hospitalized was not supported. Children with behavioral and anxiety disorders had longer capitated episodes. Service intensity decreased over time in the managed care sites. Changes in case mix may have had an impact on changes in episode duration and service intensity. That outpatient episode duration increased over time while costs were lowered in the capitated agencies indicates some effects of capitation in changing patterns of care.     

Early identification of mental health problems in schools: The status of instrumentation

When embedded within a continuum of mental health services including both prevention and treatment, school-based mental health identification programs can promote improved academic and mental health functioning among students. This article describes the scientific status of assessment instrumentation that may be used for early mental health identification in schools. Currently available instruments are described in terms of their ability to accurately detect youth with mental health problems. Implications for selecting mental health screening and assessment instruments and integrating them into schools are discussed. Finally, a range of approaches to early identification in schools as well as some of the broader ethical and practical issues related to the integration of these strategies into a school-wide continuum of services are presented.     

工作倦怠和工作投入的整合

工作投入是近期组织心理学家引入的一个新概念,这是一种重视员工职业发展的积极心理学视角的工作追求,它与传统职业健康心理学工作倦怠的整合研究,越来越引起人们的关注。积极心理学研究取向推动了整合研究的实施;能量和认同量表为整合研究提供了测量工具;员工健康的积极和消极双过程模型是整合研究的主要模型;整合研究具有重要的理论和实践价值,更有利于提高员工的身心健康。今后的整合研究应当在研究方法上增加访谈研究、个案研究和追踪研究;在研究内容上多研究积极心理因素;在研究范围上加强跨文化的比较研究;在整合途径上进一步对现有的整合模型进行改进和创新。     

Gender differences in the pricing of professional services: Implications for income and customer relationships

This study extends our understanding of the effects of gender on both pricing behavior and owner income by examining both relationships in an experimental simulation involving owners of veterinary practices. Consistent with prior research, women owners are found to employ “compassionate pricing” more than men, even when the same services are offered. The process by which gender influences price, however is found to depend in part on one’s relationship orientation. Specifically, women are found to have a higher relationship orientation than men and relationship orientation is found to directly bias women’s transactional pricing towards more compassionate pricing. The relationship between role orientation, pricing, and income, however, is rather complex. While lower prices have a negative relationship with owner income, relationship orientation is found to have a positive direct influence on income. As a result, the influence of relationship orientation on income is found to be both negative, due to lower prices, and positive, due possibly to the resulting customer loyalty.     

Improving access to psychological therapy: Initial evaluation of two UK demonstration sites

Recently the UK Government announced an unprecedented, large-scale initiative for Improving Access to Psychological Therapies (IAPT) for depression and anxiety disorders. Prior to this development, the Department of Health established two pilot projects that aimed to collect valuable information to inform the national roll-out. Doncaster and Newham received additional funds to rapidly increase the availability of CBT-related interventions and to deploy them in new clinical services, operating on stepped-care principles, when appropriate. This article reports an evaluation of the new services (termed ‘demonstration sites’) during their first thirteen months of operation. A session-by-session outcome monitoring system achieved unusually high levels of pre to post-treatment data completeness. Large numbers of patients were treated, with low-intensity interventions (such as guided self-help) being particularly helpful for achieving high throughput. Clinical outcomes were broadly in line with expectation. 55-56% of patients who had attended at least twice (including the assessment interview) were classified as recovered when they left the services and 5% had improved their employment status. Treatment gains were largely maintained at 10 month follow-up. Opening the services to self-referral appeared to facilitate access for some groups that tend to be underrepresented in general practice referrals. Outcomes were comparable for the different ethnic groups who access the services. Issues for the further development of IAPT are discussed.     

Collaborative Helping: A Practice Framework for Family-Centered Services

This article offers a framework for collaborative family-centered practice that can reinvigorate our work with families who have not responded to more traditional approaches. Collaborative Helping is grounded in family-centered principles that include: striving for cultural curiosity, believing in resourcefulness, working in partnership, and making our work more accountable to the clients we serve. The article introduces collaborative inquiry as an organizing metaphor for clinical practice and offers a five-step practice framework with clinical illustrations and sample questions. The framework draws from appreciative inquiry, motivational interviewing, the signs of safety approach to child protection work, and solution-focused and narrative therapies.