Showing papers on "Psychological intervention published in 1981"

Counseling Psychology: Career Interventions, Research, and Theory

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Childhood mental disorders in primary health care: results of observations in four developing countries. A report from the WHO collaborative Study on Strategies for Extending Mental Health Care.

Abstract: To ascertain the frequency of mental disorders in Sudan, Philippines, India, and Columbia, 925 children attending primary health care facilities were studied. Rates of between 12% and 29% were found in the four study areas. The range of mental disorders diagnosed was similar to the encountered in industrialized countries. The research procedure involved a two-stage screening in which a ten-item "reporting questionnaire" constituted the first stage. The study has shown that mental disorders are common among children attending primary health care facilities in four developing countries and that accompanying adults (usually the mothers) readily recognize and report common psychologic and behavioral symptoms when these are solicited by means of a simple set of questions. Despite this, the primary health workers themselves recognized only between 10% and 22% of the cases of mental disorder. The result have been used to design appropriate brief training courses in childhood mental disorders for primary health workers in the countries participating in the study.

Sociology of mental disorder

Abstract: 1. The Problem of Mental Disorder. 2. Types of Mental Disorders. 3. Mental Disorder: Concepts of Causes and Cures. 4. Mental Disorder as Deviant Behavior. 5. Mental Disorder: Social Epidemiology. 6. Mental Disorder: Social Class. 7. Mental Disorder: Age, Gender, and Marital Status. 8. Mental Disorder: Urban versus Rural Living and Migration. 9. Mental Disorder: Race. 10. Help-Seeking Behavior and the Prepatient Experience. 11. Acting Mentally Disordered: The Example of Schizophrenia, Anxiety, and Depression. 12. The Mental Hospital Patient. 13. Residing in the Community. 14. Community Care and Public Policy. 15. Mental Disorder and the Law. 16. Mental Disorder and Public Policy in Selected Countries. References. Index.

Intervention strategies to improve compliance with medical regimens by ambulatory hemodialysis patients

Abstract: This research examined the relative efficacies of three intervention strategies designed to increase compliance to medical regimens in a group of ambulatory hemodialysis patients. The interventions examined included behavioral contracting (with or without the involvement of a family member or friend) and weekly telephone contacts with patients. Compliance was assessed with regard to following dietary restrictions and limiting fluid intake. Data were collected from 116 patients drawn from two outpatient clinics. Within clinics, patients were randomly assigned either to an intervention program or to a control group. The study employed a pretest-posttest control group design. Patients were interviewed before the intervention programs began (T1), after a 6-week intervention period (T2), and 3 months after completion of the intervention period (T3). Results showed that the interventions achieved substantial reductions in patients' serum potassium levels and in weight gains between dialysis treatments between T1 and T2. In general, however, these program effects tapered off to preintervention levels between T2 and T3. The findings thus indicate a need for long-term intervention programs.

Toward a methodology of withdrawal designs for the assessment of response maintenance

Abstract: Single-case experimental designs have advanced considerably in the evaluation of functional relationships between interventions and behavior change. The systematic investigation of response maintenance once intervention effects have been demonstrated has, however, received relatively little attention. The lack of research on maintenance may stem in part from the paucity of design options that systematically evaluate factors that contribute to maintenance. The present paper discusses three design options potentially useful for the investigation of response maintenance. These include: (a) the sequential-withdrawal, (b) the partial-withdrawal, and (c) the partial-sequential withdrawal designs. Each design is illustrated and potential limitations are discussed.

A Test of Interventions to Increase Adherence to Hypertensive Medical Regimens

Abstract: Low rates of adherence to hypertensive therapy limit patients' securing the full benefits of treatment. While some factors related to adherence have been identified research on the effectiveness of interventions to increase adherence levels is sparse. The present study was designed to assess the impact of a series of different interventions on a group of some 400 patients, all under the care of private physicians in a small community. A factorial design was employed to deliver four, sequential educational interventions, about four months apart, to randomly selected sub-groups. Interviews before and after each intervention provided information concerning self-reported adherence, health status, health beliefs, and personal characteristics. Pertinent medical records and pharmacy data were also obtained. The first intervention - printed material - did not significantly affect adherence. The second and fourth interventions - nurse telephone calls and social support - each increased medication taking and the third intervention - self-monitoring - led to better weight control. There was no cumulative impact of the interventions and different aspects of regimens were not significantly related to one another.

Stopping life-sustaining medical treatment: psychiatric considerations in the termination of renal dialysis.

Abstract: Data are presented regarding the decision by medical staff and by patients to discontinue renal dialysis. Some relevant issues regarding the patients are discussed, including their mental competence, underlying motivation and psychiatric state. Also some of the medical factors involved in the decision to stop treatment are considered. Emphasis is placed on the importance of the patients's sense of active participation and involvement in his treatment. Mention is made of the importance of interventions to decrease the psychological morbidity in survivors of patients who stop dialysis.

Dementia in the elderly: an analysis of medical responsibility.

Abstract: Chronic dementia syndromes are often assumed to be untreatable, and thus patients with these disorders are neglected and their condition worsens. Many interventions, however, can improve t...

Linking Research and Practice in Patient Education for Hypertension Patient Responses to Four Educational Interventions

Abstract: Data from a longitudinal study of 432 hypertensive patients under the care of private practitioners are used to answer two questions: How do patients react to educational interventions, and how are their responses related to changes in their adherence behaviors? The four educational interventions, introduced sequentially and tested in a factorial design, were written messages, nurse's phone call, self-monitoring and social support. Patients' reactions to the interventions were assessed, using data from questions asked at post-intervention interviews and information recorded during the interventions. Cognitive, attitudinal and behavioral data are examined. Findings indicate that respondents were cognizant of the interventions and viewed them positively; also, some predictions about intervention features were supported. However, actions which respondents attributed to the interventions were not found to be related to increased adherence, according to the test used in this study.

Psychology of Disability

Abstract: Part 1 The disability experience: the person - reactions to disablement the world - people with disabilities in a handicapping world living independently loving pairing working playing transcending. Part 2 Interventions: legislation - the long arm of the law evaluating individual differences psychogogic approaches peer counselling and related services psychotherapeutic approaches looking ahead.

Unintended consequences of requiring a license to help.

Abstract: Current proposals for licensure, accreditation, and third-party reimbursement may have several unintended consequences. Until now discussion has focused on the effects of the proposed regulations on the development of psychology as a profession. Recent proposals, however, may have unexpected adverse consequences on three other areas as well: the education of professionals within psychology, the delivery of psychological and other helping services, and the self-definition of the consumer of psychological services. Any changes in licensure, accreditation, and reimbursement require compromises of our concerns for the profession, for the consumer, and for our own livelihood. Unless we consider the unintended consequences of current proposals, we may undermine the unity of our profession and the public's trust in psychology. All interventions have consequences, and one of the things we should learn to keep in the forefront of our consciousness is that the most important consequences of any intervention almost always turn out to be those consequences that were not intended. (Marcus, 1978, p. 66) For the past several years, psychologists have been debating the effects of licensing, credentialing, and implementation of national health insurance on the development of psychology as a profession (Albee, 1977a; Cummings, 1977; Gross, 1978; Koocher, 19791 Matarazzo, 1977). The discussion has emphasized defining what a psychologist is and determining what training is necessary to produce an individual competent to practice psychology. Two dominant themes have emerged from the discussion: ensuring psychology's place within the third-party reimbursement system and excluding other professions (e.g., social work and marriage and family counseling) from such a system. This article examines important unintended consequences of current efforts to regulate the , practice and training of psychologists. Specifically, we review how present proposals for regulation may influence the development of psychology as a profession. Then we examine how these may Vol. 36, No. 1, 13-21 Copyright 1981 by the American Psychological Association, Inc. 0003-066X/81/3601-0013$00.75 create adverse consequences for the education of professionals, the delivery of professional psychological and other helping services, and the consumers of these services. Within this framework, we show how third-party reimbursement influences psychologists in their efforts to define prac-

The Measurement of Outcome in Social Care of the Elderly

Abstract: This article is concerned with the problem of measuring the outcome of interventions of Local Authority Social Services Departments in the care of the elderly. The focus is upon the intended consequences of such interventions which are more or less explicit within the social welfare paradigm appropriate to such agencies. Seven dimensions upon which the effectiveness of care provision may be assessed are identified, and pertinent literature of measurement relating to these dimensions is examined. It is argued that outcome measurement is as yet at an early stage of development and that the development of a consensus among researchers about the methods of assessment is an important goal towards which the paper is a contribution.

Toward Comprehensive Behavioral Family Intervention An Algorithm for Matching Families and Interventions

Abstract: A comprehensive behavioral family intervention would serve a heterogeneous family population and would be comprised of public and replicable decision-making rules and intervention techniques. Current family behavior and priorities, rather than crude surrogates such as socioeconomic status, would generate matching decisions. As a step towards a comprehensive behavioral family intervention, this paper presents an algorithm to solve the problem of matching families and behavioral child-related interventions. The algorithm reveals that the needs of some families might not be met by the three prevalent child-related interventions: contingency management, contingency contracting, and problem-solving training. Sample interventions that might meet these needs are briefly described: parent self-control training, parent self-sufficiency training, and marital problem-solving training.

Management of priority mental disorders in the community.

Abstract: As a part of designing a suitable model for mental health care delivery in rural India, a study of detection and management of priority mental disorders was carried out in 120 villages around rural mental health centre, Sakalwara in Bangalore District. During three and a half year period, the team attempted to manage 51 schizophrenics, 30 acute psychotics, 27 M. D. P. and 268 epileptics in the community with minimum number of drugs. The experiences and outcome of this attempt is presented and discussed here.

Promoting breastfeeding: a national responsibility.

Abstract: Discusses the rationale behind national scale programs to support breastfeeding; assesses the elements needed for successful supply and demand interventions; and examines the national strategies of Jamaica Papua New Guinea and Nicaragua where breastfeeding programs appear likely to succeed. Governments can promote the health economic psychosocial and contraceptive benefits of breastfeeding in the areas of medical training public education community mobilization and national legislation. Supply and demand policies which influence the opportunity and motivation for individual women to breastfeed are tools available to national policymakers and health workers. Demand interventions are educational but supply interventions are usually regulatory require political commitment and a regulatory infrastructure and must be well organized and monitored to be successful. Very few countries have adopted supply interventions since they are more politically risky and can affect powerful economic interests. Demand interventions involving education have been more common while a few countries have legislated marketing regulations for sale of infant formula. Review of national efforts to promote breastfeeding suggests the need to combine both supply and demand interventions.

Current therapeutic options in the management of typical anxiety.

Abstract: Anxiety is a frequent symptom seen in a variety of clinical settings. Recognizing that therapeutic interventions (including drugs) can be costly and may involve potential risks, treatment of anxiety should proceed with some care. As outlined in Table 3, the first step is to establish a diagnosis, determining whether the anxiety is secondary to primary medical or psychiatric disorders. The remaining significant anxiety states fall into acute situational disturbances (best treated with benzodiazepines on a short-term basis) and the primary anxiety disorders. In each case, counseling or psychotherapy may be appropriate. Treatment of primary anxiety disorders is probably best accomplished by a combination of behavior interventions and, when necessary, temporary use of psychotropic drugs. The specific behavior intervention varies with the disorder (Table 6) and ranges from systematic desensitization or immersion techniques (for phobias) to thought stopping or aversion relief (for obsessive-compulsive behavior) to paradoxical intention (for panic disorders). Temporary use of tricyclic antidepressants or MAO inhibitors (probably equally effective) should be considered in the major anxiety disorders when panic attacks become frequent or subjective anxiety levels become intolerably high. Treatment of situational anxiety usually rests with counseling. When functioning is impaired, benzodiazepines can be most helpful as antianxiety agents or as hypnotics (e.g., flurazepam) for periods not to exceed 2-3 weeks.

Social Networks: A Link between Psychiatric Epidemiology and Community Mental Health.

Abstract: This paper examines the concept of social network as a mediating construct linking psychiatric epidemiology and community mental health. A selective review of studies investigating the structural and interactional features of the social networks of psychiatrically impaired persons is presented and the implications of their results are discussed. It is concluded that social networks provide a unifying framework potentially capable of linking empirical research with clinical practice.

Social work practice in community mental health

Abstract: Reprinted from SOCIAL WORK, Vol. 26, No. 1, January 1981 ocial work practice in community mental health Steven P. Segal and Jim Baumohl The authors analyze social work's role in community mental health and describe practice models that enable practitioners to contribute to the improvement of an individ- ual’s mental status while main- taining a view of the person in the environment and a commitment to the improvement of social life. Steven P. Sega], Ph.D., is Associate Professor and Director, and Jim Baumohl, MSW, is Field Research Specialist, Mental Health and Social ' Welfare Research Group, School of Social Welfare, University of Califor- nia, Berkeley. DURING the past twenty years, the mental health field has become in- creasingly cognizant of the interaction between social life and mental status —a relationship that is the basis of traditional social work practice. So- cial work is committed to improving the interaction among individuals, among institutions, and between people and institutions to enhance the general quality of life. However, in mental health, the major concern (the “depen- dent variable” in research jargon) is mental status. This article is concerned with social work’s role in community A mental health: the activities that enable the social worker to contribute to the improvement of an individual’s mental status while maintaining a commitment to viewing the person in the environ- ment and to improving the overall quality of social life. ‘ BOUNDARIES As a profession, social work is con- cerned with all spheres of interaction between people and their envi- ronments. Social workers practice in the realm of formal organizations of care and control; are concerned with the social, psychological, and jural di- mensions of the family; and have be- come increasingly interested in the everyday support systems that function among friends and acquaintances. All these concerns have been identified, in one way or another, with the treatment of mental disorders or the promotion of mental health. To the consternation of many traditional mental health professionals, the field of community mental health has become so elastic that it now in- cludes almost all kinds of ameliorative activity. This expanded purview de- rives from the association of a myriad of social factors with the development of mental disorders and from the con- comitant tendency to equate social well-being with mental well-being. For instance, the relationship between so- cial class and mental illness and the relationship between social stress and mental illness clearly indicate that poor people are at the greatest risk of devel- oping mental disorders. Because of these relationships, it is tempting to conclude that full employ- ment, better housing for the poor, na- tional health insurance, and an array of poverty programs might be the best means to reduce mental disorders in a society. Unfortunately, there is little evidence to support this conclusion. Such policies and programs are laud- able in their own right, but their impact on the mental status of the individual is subject to question.‘ The equation of social well-being and mental well-being is like the Calvinist equation of wealth . with salvation: both are nice, but not necessarily related. I What does it mean, then, to “con- tribute to the improvement of individ- ual mental status” while “maintaining a commitment to improving the overall quality of social lifeq? The answer de- pends largely on how a mental health “problem” and a mental health “ser- vice” are construed. INAPPROPRIATE LABELS As one moves farther from the traditional concerns of mental health (with psychoses, for example), the re- liability of the assessment of mental status becomes poorer and the risk of ' inappropriately labeling “problems of livingq as “mental disordersq becomes greater. Similarly, when one ap- proaches human problems whose re- lationship to discernible mental dis- orders is ambiguous or distant, the definition of a “mental health service” becomes problematic. Current empirical understanding does not permit a more elegant solution in either case. Mental disorders are variously defined and diagnosed either in narrow or broad terms. And a mental health service is often what Congress, ' the National Institute of Mental Health, state legislatures, or local citizens’ ad- visory boards are willing to pay for. The clinical risks associated with in- appropriate labels make it incumbent on mental health practitioners to be specific and judicious in the use of labels. Further, the treatment of indi- viduals in mental health settings, as op- posed to social service or “genen'cq settings, may discourage potential clients who “know” that only “crazy peopleq (or members of any devalued 16 0037-8046/81/2601/0016 $0.50 © I981, National Association of Social Workers, Inc.

Human factors engineering in computerized mental health care delivery

Abstract: There has been strong clinical resistance to the use of automation in mental health. At least part of the resistance may be due to the researcher’s failure to understand the psychological factors involved in the human-computer relationship. This paper reviews human factors research as it may be related to computerized systems in mental health. Human factors considerations are specifically applied to: design and implementation of computer systems, patient-computer interaction, mental health staff-computer interaction, and computer output.