Concordance Between Parent Reports of Children's Mental Health Services and Service Records: The Services Assessment for Children and Adolescents (SACA)

The concordance between parent reports of children's mental health services and medical and administrative service records were assessed in a field test of the Services Assessment for Children and Adolescents (SACA) interview instrument. Service use reports from primary caregivers, usually mothers, for their child's emotional or behavioral problems were compared against inpatient, outpatient, and school records in St. Louis, one of the pilot sites for the Multi-Site Study of Service Use, Need, Outcomes and Costs in Child and Adolescent Populations (UNOCCAP). A global any use service variable, comprised of inpatient, outpatient, and school reports, yielded an overall service use concordance kappa of .76 between parent reports and records. Parent reports of inpatient hospitalization services using the SACA yielded the highest agreement with medical records, with kappa statistics of 1.00 for use of any inpatient hospital care and for medication use. Parent reports of specific inpatient services concurred with medical records more moderately, yielding kappas from .50 to .66. Reports of any outpatient mental health services yielded variable rates of agreement, with kappas ranging from .67 for any use of outpatient care, to .66 for medication use, to negligible kappas for specific treatments. Parent reports of school services were weakly related to records for most services, except for moderate agreement (.48) on placement in special classrooms for emotional or behavioral problems. Family burden or impact discriminated more powerfully than other variables between respondents who concurred with records and those who did not.     

Physician-Assisted Suicide in the United States: Confronting Legal and Medical Reasoning – Part Two

In the United States, judicialrulings that unrealistically addressed the complexityof cases and demonstrated limited understanding ofprinciples, helped to create a legal quagmire whichlegislatures had to confront. Moreover, thelegislative response was often slow and inadequate interms of both the scope and clarity of the laws. However, since the 1970s, progress has been made onmany fronts, particularly in regard to advancedirectives dealing with end-of-life decisions. Thedebate over physician-assisted suicide has spawned arepetition of moral and legal arguments. Thoseagainst legalization have failed to make a realisticappraisal of the dilemmas facing patients and theirfamilies in an age of technological medicine deliveredin the context of the marketplace. The underlyingproblem is a system in dire need of reform that willno longer treat health care as a commodity of themarketplace and provide universal health care. Terminal care as an integral part of health care willsubstantially benefit from such reforms because amajor obstacle to comprehensive palliative care is thecondition of the present system.     

学校心理咨询若干倾向性问题的思考

本文针对当前学校心理咨询中普遍存在的重视"调适性心理咨询",忽视"发展性心理咨询";重视心理异常中"心理障碍"的矫治,忽视"一般心理问题"的调控和重视成人心理异常表现模式的套用,忽视学生心理异常表现的年龄特征等倾向,提出并论述了学校心理咨询"咨询类型"的侧重点在于发展性心理咨询,"调适矫正"的着眼点在于心理异常中"一般心理问题"的调控,"分析判别"的出发点在于以学生各年龄阶段心理异常特有表现为依据的观点,为进一步强化学校心理咨询的科学性,顺利进行心理健康教育,以提高学生心理素质提供了理论依据.     

Development of the Lurian Approach: A Cultural Neurolinguistic Perspective

This article presents a discussion of the principle of extracortical organization of higher mental functions and its significance for the development of contemporary neuropsychology. The role of external factors (stimulus-mediator, symbol) in establishing functional connections between various brain systems is, in principle, universal. However, inasmuch as differing mediators and means, or significantly different details within them (direction of writing, orientation by maps or by the behavior of sea birds, etc.) may and in fact do develop in different cultures, neuropsychological analysis must take into account cross-cultural differences. Diagnostic tools must also be adapted to differing cultural contexts. The efficacy of this principle for the analysis of bilingual aphasia and of mental organization of speech, including the effect of acquisition of literacy in native language, is demonstrated. The importance of this principle for the development of new directions in applied neuropsychology is also discussed.     

The President’s New Freedom Commission: Capitalizing on Opportunities to Advance School-Based Mental Health Services

The report from President George W. Bush’s New Freedom Commission on Mental Health (NFC), Achieving the Promise: Transforming Mental Health Care in America(2003), proposes goals and recommendations for improving mental health services. This report has significant implications for the delivery of mental health services through the schools. A focused discussion of the potential opportunities and challenges of implementing NFC recommendations related to school-based mental health is presented. Strategies for addressing five key areas at the intersection of school mental health and the Commission’s recommendations include: stigma reduction, suicide prevention, expansion and improvement of school mental health, and screening and treatment of co-occurring mental health and substance abuse disorders.     

The Impact of Economic Globalisation on Health

The analysis of the impact of economic globalisation on health depends on how it is defined and should consider how it shapes both health and health policies. I first discuss the ways in which economic globalisation can and has been defined and then why it is important to analyse its impact both in terms of health and health policies. I then explore the ways in which economic globalisation influences health and health policies and how this relates to equity, social justice, and the role of values and social rights in societies. Finally, I argue that the process of economic globalisation provides a common challenge for all health systems across the globe and requires a broader debate on values, accountability, and policy approaches.     

Attention-Affect Check List: A self-report measure of acute mental stress

Given a hint from Lang, Bradley, and Cutbert's (1997) defense cascade, two cognitive processes, instead of passive versus active behavioral coping, which seem to have differential effects on the provocation of vascular- versus cardiac-dominant reaction pattern during mental stress were advocated: attention (Attent) versus unpleasant affect (UnplAff). Based on this notion the Attention-Affect Check List (AACL) was developed as a self-report measure. In addition, items on uncontrollability (Uncontr) were prepared for the purpose of checking whether heightened Attent and UnplAff are accompanied by alterations in Uncontr. Two hundred and eighty-four students underwent two kinds of mental stress, which seemed to specifically heighten Attent and UnplAff. Four factors with four items each were extracted from the AACL item pool: concentrated and allocated Attent, UnplAff, and pleasant affect. Also, one factor with four items was extracted from the Uncontr item pool. For both the mental stresses, each scale, although very brief, had quite reasonable alpha reliability. Accountability of each scale for the total variance was reasonably high. Some problems are discussed in relation to the validity of AACL.     

Work values among the unemployed: changes over time and some gender differences

Work involvement (psychological identification with work in general) has generally been considered as a stable, dispositional characteristic, although some studies of unemployment have contradicted this view. Using longitudinal data from a Swedish representative sample (n= 888), this study examines employment status change (e.g. from work to unemployment) and work values development in a 15-month time period. Furthermore, the relationship between employment status change and well-being is explored, with a special focus on the roles played by work values and gender differences. Results indicated that work values are fairly stable over 15 months. As expected, the long-term unemployed (mostly active job seekers) had higher measures of work involvement after 15 months. Further, no gender difference was found with regard to work involvement but females were more likely to agree that there is an entitlement to work. Becoming unemployed was associated with negative health effects, but only among unemployed men.     

Spirituality Predicts Health and Cardiovascular Responses to Stress in Young Adult Women

The primary focus of this study was to investigate the roles of spirituality and religiosity in self-reported physical health, and to determine whether there is an association between an individuals spirituality and cardiovascular responses to two stressors. Fifty-two females participated in both a betrayal interview and a structured interview, during which blood pressure and heart rate were monitored. Spirituality, as assessed by the Spiritual Well-being Scale, was associated with perceived stress, subjective well-being, and medication use. The Existential Well-being subscale predicted fewer physical health symptoms and was associated with lower mean heart rate and decreased heart rate reactivity. The Religious Well-being subscale was associated with reduced systolic blood pressure reactivity in response to the structured interview. These findings suggest that spirituality may have a salutary effect on health, even in a fairly young sample. While previous studies have predominantly reported that religion, as well as spirituality, have a health protective effect, this study did not find strong support for that conclusion. Religiosity in this age group may still be undergoing developmental maturity, which may explain the lack of relationships to health.