Wraparound care in vermont: Program development,implementation, and evaluation of a statewide system of individualized services

Over the past decade, there has been a dramatic shift in the provision of mental health services to children, adolescents, and their families. This shift has been marked by a movement away from restrictive treatment options toward the development of comprehensive community-based systems of care designed to keep the most challenging children in their homes, schools, and communities. Based on a model of intensive case management referred to as Wraparound Care, Vermont's statewide approach emphasizes aggressive outreach, use of the least restrictive treatment options, and care that is flexible, unconditional, and child- and family-centered. We chart the development of Vermont's Wraparound Care Initiative and present residential, educational, and behavioral outcome data for a cohort of 40 youth receiving Wraparound Care over a 12-month period. The results showed that after 12-months, youth who had been previously removed from their homes or were at imminent risk of such removal, were residing in significantly less restrictive community-based living arrangements and exhibiting significantly fewer problem behaviors than at intake. These results are discussed in light of recent national studies and previous studies on similar cohorts of Vermont youth receiving Wraparound Care.     

儒家文化对当前中国心理健康服务实践的影响

心理健康服务是以心理学的理论和方法为主导来维护与促进人们心理健康的活动。它与个人的心理因素和社会文化因素有必然联系, 中国心理健康服务植根于中国文化的土壤之中, 它本身就是文化的产物。而儒家文化作为中国社会的主流文化, 它在中国心理健康服务过程中具有表征、构建、指导、唤起功能; 对心理健康服务者和被服务者的人格、应对方式以及服务态度和行为产生直接和间接影响。中国心理健康服务模式与儒家文化传统的关系问题实际上涉及的是心理健康服务与文化的普遍性与特殊性问题。构建适合中国文化土壤的心理健康服务体系需要研究儒家文化传统对心理健康服务模式的观念、理论及实践操作层面的作用和影响。     

青少年的人格特征与互联网信息服务使用的关系

互联网上的信息服务为青少年的个性化学习提供了可能,如何使青少年健康地进行网上冲浪,使他们在冲浪的过程中增强自律意识,就需要我们深入地了解互联网信息服务在哪些方面能够满足青少年的需要。该研究通过对339名中学生进行问卷调查,对青少年的人格特征、社会支持与互联网信息服务之间的关系进行了探讨,结果表明:(1)开放性、客观社会支持和对社会支持的利用对互联网信息服务的使用偏好有直接而显著的影响。(2)宜人性和外向性通过社会支持的三个方面间接地对互联网信息服务的使用偏好产生影响。(3)客观社会支持会影响主观社会支持,主观社会支持对社会支持的利用水平也有影响。     

医学遗传服务与遗传学研究的伦理问题

遗传工程的分子技术于本世纪７０年代问世。这一技术的创新使人类与医学遗传学突飞猛进,由此导致遗传医学的飞速发展。与此同步,医学伦理学兴起,临床医学遗传服务与遗传学研究的伦理问题日益成为人文科学关注的核心。世界卫生组织（ＷＨＯ）于１９９７年发布的《医学遗传学与遗传服务伦理问题的建议国际准则》。探讨我国医学伦理学发展的策略和面临的挑战,祈盼适合我国国情的中华医学遗传服务与遗传学研究的伦理准则早日问世。     

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.     

Ethnic variations in the initial phase of mental health treatment: a study of Sami and non-Sami clients and therapists in northern Norway

Several studies indicate that mental health and mental health service vary with ethnicity. Ethnically linked social differences affect these results. We examined the multiethnic population in northern Norway where social inequalities between the Sami and the non-Sami population are not prominent. Clients (N=347) and therapists (N=32) in outpatient treatments reported demographics, ethnicity and the therapeutic alliance. Clients also reported pretreatment psychosocial status, service utilization and the type of help requested. Therapist recorded clinical and diagnostic assessments and treatment plans. The Sami and non-Sami client groups were similar in demographics and pretreatment psychosocial characteristics. However, the therapists prescribed more sessions and more socially focused interventions when clients were Sami. Verbal therapy was more often used by the non-Sami therapists. Alliance ratings were positively correlated only between Sami therapists and their clients, and Sami therapists rated the largest initial clinical improvement. Clinics located in the high Sami density areas offered their clients more therapy sessions, than in clinics in the high non-Sami density areas. Ethnic similarity between client and therapist were associated with more frequent use of medication and less frequent use of verbal therapy.     

Examining the Role of Social Network Intervention as an Integral Component of Community-Based,Family-Focused Practice

Social network intervention aimed at bolstering the informal supports of high risk families is recognized as a common element of community-based, family-focused practice models, such as intensive family preservation services (IFPS), multisystemic therapy (MST), and the wraparound process. The empirical research basis for these practice models is examined, with an eye toward discerning the extent to which network intervention is identified as a critical component of comprehensive service. Results reveal that few studies make clear the degree to which treatment adhered to a focus on natural network enhancement or the development of informal resources. Those that did, suggest that relatively few families received this form of ecologically-oriented intervention. Consequently, this body of practice research offers insufficient evidence of the benefits or limitations associated with network facilitation with multi-need families. Explanations for these findings are explored and directions for future research are recommended.     

Mental Health and Other Service Use by Youth in Therapeutic Foster Care and Group Homes

Little is known about what additional services youth receive while they reside in out-of-home treatment settings. However, such information may be crucial for explaining effectiveness and variation in outcomes for youth in such settings. Our research examines patterns of multi-sector service use for youth in two settings—Therapeutic Foster Care and group homes. Data come from in-person interviews with Treatment Foster Parents and Group Home Staff for a NC state-wide sample of youth with psychiatric disorders and aggressive behavior. Findings indicated high rates of service use by youth in both settings. Analyses indicated significant differences in service types used by youth in each setting, yet similar volume of service use between settings. Clinical and demographic factors did not significantly influence types of services received. Differences in service patterns between the two groups indicated that youth in TFC were more likely to receive community-based, individualized services while youth in group homes were more likely to receive more restrictive services.     

<Emphasis Type="Italic">Commentary</Emphasis>: Implementing Empirically Supported Treatments in the Schools: What Are We Asking?

The research reported in this special issue addresses important areas for the continued development of empirically supported school-based treatments. Although advances in the development and evaluation of treatment services have occurred, there is little public demand for the widespread dissemination of these treatments. In this commentary, the authors draw data from historical examples, related research, and personal experience to demonstrate the need to create a societal mandate for change. They present specific implications for future areas of research and the type of public education and marketing campaign that will be needed to create a demand for empirically supported school-based treatments.     

Religion, Spirituality, and Health Service Use by Older Hospitalized Patients

Background: Religious and spiritual beliefs and practices are common among medical inpatients, and may impact length of hospital stay (LOS) and other health services (HSU) during hospitalization. Methods: 812 consecutively admitted patients age 50 or over to Duke University Medical Center were assessed. Measures of religiousness and spirituality included religious TV/radio (RTV), self-rated religiousness (SRR), observer-rated spirituality (ORS), and daily spiritual experiences (DSE). The primary outcome was LOS. Results: RTV and SRR predicted longer LOS, whereas ORS and DSE predicted shorter LOS (p 0.05). Effects of RTV onLOS were stronger among women, but explained by worse health status. The effects of DSE on LOS were stronger among non-whites. Among those reporting high DSE, diagnostic tests and total procedures also tended to be less common. Conclusions: Religious activities, attitudes, and spiritual experiences are weak predictors of LOS and HSU during hospitalization. Whether the prediction is positive or negative depends on the religious or spiritual characteristic.