Youth Living with HIV as Peer Leaders

Community-based service providers often hire youth living with HIV (YLH) as peer leaders for delivering HIV education to uninfected adolescents. Life narratives were collected from 44 YLH during a hypotheses-generating two-year ethnographic study. About 30% of the youth were employed as peer educators. While 60% of the 44 youth had a lower-class background, only 23% of the peer leaders were lower class. One-fifth of the sample were female, but more than one-half of the peer leaders were female. After identifying and categorizing difficulties experienced by the peer leaders, a frequency count of each theme was conducted. Issues about professional boundaries were evident in 38.5% of the youth's narratives, indicating conflicts in their roles as peer leaders; 23% of the youth engaged in substance use and sexual behaviors that placed themselves and uninfected youth in their peer educator programs at risk; and 8% of the youth reported relapse while peer leaders. The observations suggest reconsideration or restructuring of existing peer-education models that employ YLH.     

Ecological Factors Impacting Provider Attitudes Towards Human Service Delivery Reform

Although reform efforts are substantially altering the structural operations and guiding ideological framework of the human service delivery system, little empirical work has been done to systematically examine these transformations. This study examines providers' attitudes regarding two reform elements that are being widely implemented: an increased emphasis on inter-agency collaboration and a shift from a medical model service delivery philosophy, that focuses on client deficits, to one that emphasizes consumer strengths. Through survey data collected from 186 providers from 32 human service agencies in one county, the relationship between providers' perceptions of contextual support for human service delivery reform and providers' attitudes towards these initiatives is explored. The findings from this study support the importance of attending to the ecology in which we initiate system reform efforts. For both reform elements, working within contexts that are perceived as providing ideological and functional support for change was associated with positive provider attitudes towards those changes. Staffs' perceptions of the external environment played the most critical role in shaping staff attitudes. Interestingly, unique aspects of providers' work environments were related to positive attitudes towards the two different reforms. The implications of these findings for the success of human service delivery reform are discussed.     

国外学校心理学的发展及其启示

本文首先考察了国外学校心理学的发展历史和现状,并对国外学校心理学的发展趋势作出了预测。接着从我国中小学生及大学生的心理健康现状及我回学校心理服务现状两方面分析了建立我国学校心理学的条件。最后,对如何建立建设我国学校心理学提出了建议。     

Prehension in children and adults: The effects of object size

Studies of visually goal-directed arm movements in adults have shown that various task constraints such as intention, context, and object properties affect different kinematic characteristics of the movement components (Jeannerod, 1984; MacKenzie et al., 1987; Marteniuk et al., 1987, 1990; Paulignan et al., 1991; Soechting, 1984). The purpose of the present study was to compare the effects of varying object size on the kinematics of reaching and grasping in both children and adults. Five children aged 9–10 years and five adults aged 18–24 years reached for and grasped three different sized cubes. Results revealed that object size had the same effect on the planning and control of reaching and grasping movements in children as in adults. Unlike adults, however, children in this age range spent more time in deceleration and reached peak aperture much later in the movement trajectory. The results were interpreted as immature integration of the visual and proprioceptive systems in 9–10 year olds. The implications of these findings for further examining developmental trends in prehension are discussed.PsycINFO classification: 2330     

Parent Satisfaction with Case Managed Systems of Care for Children and Youth with Severe Emotional Disturbance

Case management has emerged as an integral component of current efforts to reform the delivery of mental health services to children and youth with Severe Emotional Disturbance (SED). We examined parental satisfaction with one program's case management system for SED children. In order to validly address parental satisfaction, the program first turned to a group of its parents to develop a satisfaction measure, the Family Satisfaction Survey (FSS). Of the 51 parents who returned an FSS, 74% of the parents were generally satisfied while 26% indicated that they were dissatisfied with their families' case management services. Multivariate regression analyses were employed to examine the role played by client, service, and outcome variables in predicting parental satisfaction. After controlling for child diagnoses, severity of impairment, and levels of psychosocial stress, parent satisfaction with case management services was best predicted by the frequency of monthly contact and fewer days is a psychiatric hospital proportional to length of service. Our results suggest that parent satisfaction is based not only on what case managers do but on how this service impacts SED children's ability to remain at home and in their communities.     

Developing community alternatives to group home placement for SED special education students in the Ventura County System of Care

Interagency planning and resource development were used to improve available services for severely emotionally disturbed special education students who were in or at-risk of being placed in residential care. Augmented local school-based and regional day treatment services were financed by a Ventura County Social Services Agency trust fund and delivered cooperatively by the County Mental Health Agency and local education agencies. Revenues generated by the new service positions were planned to restore the trust fund. Outcomes following service implementation included: (a) an average reduction of 3.5 youths in the expected number of youths in group home placement per month; (b) a total reduction of $290,011 in the expected annual cost of placement; and (c) generation of $281,238 in Medi-Cal revenue by the school-based and day treatment components of the system of care. The implications of these outcomes are discussed in terms of existing trends in numbers of identified seriously emotionally disturbed students and their service needs and the processes that were involved in planning and implementing the service augmentation.     

The role of somatosensory stimulation in social phobia—An analysis of hand coordination in patients and therapeutic dyads during psychodynamic psychotherapy

In the psychotherapeutic treatment of social phobia, the hand movement behaviour exhibited during the interaction provides information about the success of the therapy. In particular, the degree of mutual somatosensory stimulation of the hands (hands moving on each other, as a unit, apart) appears to be relevant regarding the patient's mental state. To test this hypothesis, the present study investigates hand coordination in the course of psychotherapy in patients with and without symptom improvement and in the corresponding therapeutic dyads. Forty-two videos of patient–therapist dyads consisting of 21 patients (n = 11 non-improved; n = 10 improved; according to Liebowitz Social Anxiety Scale self-assessment) from the Social Phobia Research Network project were investigated in early psychotherapy sessions and in pre-last sessions. Hand movements of four randomised video sequences per dyad were analysed with NEUROGES^®-ELAN. Patients with non-improved symptoms displayed shorter act apart coordination and more act on each other coordination than patients with improved symptoms. Patients displayed more act apart and act on each other and less act as a unit coordination than therapists. In therapeutic dyads, act on each other coordination in early sessions, as well as short act apart coordination, was significantly related to non-improvement. Patients with non-improved symptoms are characterised by more hand coordination associated with a high degree of somatosensory stimulation serving self-regulation (act on each other), as well as short complex gestural expressions (act apart). Thus, hand coordination constitutes a progression and outcome parameter informing on somatosensory stimulation.     

Postpartum depression: Proposal for prevention through an integrated care and support network

Social science research and clinical literature concur with our experience as providers of psychoeducational and clinical services: Postpartum depression results from the interplay of a multitude of individual and contextual factors. In light of the extensive literature on postpartum depression, it is surprising that models for prevention have not been established. We propose a model for prevention through integrated care and support, in which a wide range of existing services are used. This model is similar to comprehensive prevention models proposed by advocates of integrated service systems, such as community mental health and family support. The article includes illustrative case material.     

Predictors of Placement Outcomes in Treatment Foster Care: Implications for Foster Parent Selection and Service Delivery

Treatment foster care (TFC) is a normalizing environment in which to treat those children whose particular needs are not addressed in traditional foster care and for whom an institutional setting is a restrictive and unnecessary alternative. However, when the foster care placements of these emotionally and behaviorally disturbed children fail, as they often do, the children are shifted from one home to another without the opportunity to experience permanence or emotional attachment, resulting in poor adjustment to foster care. Placement stability, which depends in part upon effective matching of foster children with potential foster families, is critical for achieving positive outcomes in TFC. Yet, there is a dearth of information to guide placement agencies in making decisions about matching foster children with families. Moreover, once a successful match has been made, it is equally vital that service delivery be of high quality so that permanence is maintained. We review research on the predictors of positive outcomes in foster care, focusing on studies involving emotionally or behaviorally disturbed children, and provide recommendations for selecting foster parents and for ensuring high quality foster care services and placement stability.     

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.