Primary health care for women: What is it and who provides it?

Recent federal policy has highlighted historically underrecognized women's health issues. Women comprise the majority of the population, especially the elderly. Women's health care needs, utilization patterns, and outcomes vary from those of men, and often among each other. Primary health care services for women are multidisciplinary and emphasize prevention, education, and early intervention as well as treatment. Psychologists and other primary health care providers can collaborate to provide their services in a cost-effective manner that optimizes quality of care and comprehensive health care.     

New directions for the education of clinical psychologists: The primary care setting,the VA's PRIME program,and the in-depth generalist model

As part of this special issue on psychology in primary care settings, we describe the Department of Veterans Affairs' (VA's) new approach to education for practice in the primary care setting and we concurrently address some general issues related to the education of clinical psychologists for practice in this setting. In this article we argue that the primary care psychologist, in parallel with the generalist in medicine, must have a strong generic background in clinical psychology in order to gain the broad range of clinical skills necessary to function effectively as an in-depth generalist (IDG) who is capable of addressing the variety of psychological issues that emerge in the primary care setting. The IDG model of professional practice, which we believe is best suited for primary care/managed care settings, requires extensive training in generic clinical skills and increased time devoted to its implementation at both the predoctoral and the postdoctoral levels.     

The detection and management of mental health disorders in pediatric primary care

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.     

Social integration and social support in a life crisis: Effects of macrosocial change in east Germany

This process evaluation study examined what variables moderate and mediate treatment effects on days in stable housing and client satisfaction for homeless mentally ill clients. In general, demographic characteristics did not moderate either outcome variable. Housing contacts, entitlement contacts, mental health contacts, and supportive services were significant mediators of the treatment effect on days in stable housing. Program contacts, mental health contacts, and supportive services were significant mediators of client satisfaction. The authors thank the National Institute of Mental Health for their financial support (MH43248, MH42357) for this project, Dorothy Gano for word processing and editorial assistance, and Gitry Heydebrand, Melissa Dannelet, Betty Tempelhoff, Ruth Smith, and Laeeq Ahmad for assisting in the interviews of clients. We are also appreciative of the cooperation given to us by the staffs of Malcolm Bliss Mental Health Center, St. Patrick's Center, the Community Advocacy and Support Alliance Program, and the St. Louisemergency shelters. Finally, we thank all of the participants in this study; we hope that their homelessness has now ended. (The conclusions presented in this paper are the sole responsibility of the authors and do not necessarily reflect official National Institute for Mental Health policy.)     

The total workload of male and female white collar workers as related to age, occupational level, and number of children

A questionnaire assessing various aspects of paid as well as unpaid forms of productive activity was mailed to stratified samples of male and female white collar workers, approximately matched for educational and occupational level. Data from 501 men and 679 women employed full time revealed traditional gender differences in terms of main responsibility for household duties, child care etc. In keeping with this, women reported higher levels of work overload, stress and conflict than men, which increased significantly with the number of children at home. The various stress indices reached a peak between the ages of 35 and 39. Men reported more autonomy in their paid work whereas women reported more control at home. Men and women at the upper managerial levels reported more control over their total work situation and less conflict between demands.     

A spanish translation and validation of the daily stress inventory and a comparison of the level of stress experienced by three culturally distinct hispanic groups

Two studies were conducted, the first to establish a valid Spanish version of the Daily Stress Inventory (DSI). A second study was conducted using the bilingual version of the DSI to assess differences in the level of stress experienced by three selected Hispanic groups: (a) very Hispanic/Hispanic-oriented bicultural, (b) true bicultural, and (c) Anglo-oriented bicultural/very Anglicized as determined by the adapted version of the Acculturation Rating Scale for Mexican Americans (ARSMA). It was expected that stress levels would be highest for the least acculturated group. The results of the first study indicate that the Bilingual DSI scores are highly correlated with the scores of the original DSI when both instruments are responded to simultaneously by fully bilingual individuals. In Study 2, the initial data analyses showed no difference in the level of stress reported by Hispanics at different levels of acculturation as measured by the ARSMA. When a median-split method was employed, differences in the DSI I/E measures between the two groups were significant, suggesting that acculturation level may be related to stress level.     

Circular definitions,circular explanations,and infinite regresses

This paper discusses some of the ways in which circular definitions and circular explanations entail or fail to entail infinite regresses. And since not all infinite regresses are vicious, a few criteria of viciousness are examined in order to determine when the entailment of a regress refutes a circular definition or a circular explanation.I would like to thank Professors Robert Tully, Howard Sobel, and Derek Allen for their constructive comments.     

Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

‘community psychology and politics’ by David Smail

Demystification, eschewing roles that disempower others and enhancing accessibility to the tools of knowledge, are consistent with the aims of community and applied social psychology. Although a focus on psychological empowerment can be a distraction from the need for actual power, it can also enhance it. Psychologists who avoid victim blaming and individual causal attribution biases can contribute to the discourse about social change. This requires both a reinterpretation of the known facts, and a reframing of social analysis. Social scientists and professionals are today's theologians and priests. Our power lies in our legitimation as interpreters of social reality. Teaching the psychology of empowerment, participative decision making and informed consent can influence the powerful as well as the powerless.     

The effects of maternal employment and non-maternal infant care on development at two and four years

Differences in maternal employment during children's first year of life and children's entry into non-maternal care before the age of 1 year failed to predict differences in cognitive and socioemotional development at 2 and 4 years of age, after family background variables were controlled. Two samples were studied: a population sample of 1100 Bermudian children and a smaller subsample of children most of whom were determined to be at risk for developmental problems. To assess the effects of maternal employment, we compared infants with mothers who worked 20 or more hours a week to infants with mothers who worked less than 20 hours a week. To assess the effects of entry into non-maternal care before the age of one, we compared infants who were placed in regular non-maternal care before the age of one versus infants who did not experience regular non-maternal care before the age of one. The results revealed that family background variables frequently predicted many child outcome measures in both the total sample and the smaller research sample. After controlling for family characteristics, no differences were found between children whose mothers worked 20 or more hours a week when they were infants and children with mothers who worked less than 20 hours a week in either sample. In addition, age of entry into non. maternal care before the age of one did not significantly predict any child outcome measures.