Empowering individuals with early dementia and their carers: an exploratory study in the Chinese context

This article discusses an early dementia program developed for sufferers and family carers in a Chinese context. Instead of replicating formats of similar programs developed in Western countries, this program considered cultural issues and caring values that are unique to Chinese people. Its main objective was to empower sufferers and carers through educational activities and support programs. Observations and interviews were used for program evaluation. The program creates a "win-win" situation in which both parties experienced pleasurable feelings and developed a close relationship. It also highlights the values of "meaningful occupation" in dementia care. Furthermore, the program broadens our understanding of needs and concerns of sufferers and carers at early stages, which are deemed important to develop continuous dementia programs along the disease course.     

Predictors of cancellation in an oregon involuntary commitment program

The problem of attrition from mental health care programs before such services begin is poorly understood. The present research has identified several variables which predict first appointment cancellations for Oregon involuntary committment petitioners in behalf of potential clients. The value of such variables is discussed in terms of petitioner attrition from involuntary commitment programs, mental health needs of those petitioning for the involuntary commitment of allegedly mentally ill persons, increased mental health program efficiency, and economic benefits for underbudgeted and understaffed mental health care programs. Recommendations to improve community mental health programs in general, and involuntary commitment programs in particular are presented.     

Principles for the training of “new professionals” in mental health

Experience with two of the recent programs for training mature women in new professions for mental health service has led the authors to develop a series of hypotheses concerning such new training programs. These hypotheses are presented as guidelines or principles of planning and training for developing new programs in nontraditional mental health roles.A clinical psychologist, was at the time this paper was written with the Department of Psychology at the University of MarylandThis work was supported by a grant from the National Institute of Mental Health, MH 8322.     

A reexamination of the reported decline in partial hospitalization

This study examines recent trends in the organization of partial-hospitalization services in the United States. Contrary to two recent reports describing declining support for partial hospitalization, data from the National Institute of Mental Health's Inventory of Mental Health Organizations reveal that the number of "partial-care" providers increased by 20% between 1984 and 1988, with increases occurring among privately and publicly funded programs. However, there has been a 56% decline in the average length of stay, with both privately and publicly funded programs showing proportional shifts to more acute care. An increase in the number of long-stay "day care" programs may be attributable to educational and rehabilitation programs that report as partial-care providers. Future study is proposed to create a better typology of partial-hospitalization programs.     

Psychiatric resident conceptualizations of mood and affect within the mental status examination

OBJECTIVE: To explore the ways in which psychiatry residents conceptualize the terms "mood" and "affect," a 14-item questionnaire was sent to residency programs in New York. METHOD: The questions consisted of possible definitions of mood and affect; all questions required a "true" or "false" response. Residents (N=99) were asked how they viewed mood and affect from a temporal perspective (i.e., sustained versus momentary) and in terms of an objective-subjective (or external-internal) dichotomy. RESULTS: There were inconsistencies in the temporal view of mood (said to be sustained by 60.6% and momentary by 50.5%) and affect ("pervasive" by 26.3% and "momentary" by 66.3%). Residents overwhelmingly defined mood as being subjective and internal and affect as being objective and external. CONCLUSIONS: If mood and affect are to be viewed from both perspectives, psychiatrists must infer the enduring internal emotional tone (mood) of a patient over an entire interview.     

Recruit, screen, and hire: staff selection and the decision-making process

This article focuses on the role of the clinician-manager in staff selection. The duties of the clinician-manager in a mental health center include those tasks described as "recruit, screen, and hire" but little or no guidance on the steps involved in this sequence of events is available. The "how" of hiring is transmitted by word of mouth, by following another's example, or by trial and error. This article examines the component parts of staff selection from the assimilation of procedures, rules, and regulation of the public authority under which a particular mental health center operates, to the compilation of a "short list" of those to be screened and finally the risk taking and decision-making process by the clinician-manager who makes the choice. Some speculation on the emotional impact it has on the clinician-manager is examined. The impact of personal value judgments of the selector are considered. Recommendations are made for the inclusion of training in staff selection by academic programs for mental health administrators.     

Contracting between public and private providers: A survey of mental health services in California

This paper reports on a public authority's decision to make or buy mental health services. Data come from key informant interviews with California county contract or program managers. The questionnaire measures the extent of contracting and the importance of factors that are hypothesized to affect the relative costs of contracting. The percent of contracting by programs ranges from zero to 100, averaging 41%. Sixty-two percent of rural programs perceive little or no competition for public mental health contracts, and contract significantly less than urban programs. The extent of contracting is related to economic and public organizational factors.     

Psychomotor disturbances in psychiatric patients as a possible basis for new attempts at differential diagnosis and therapy

Parts I-III of this series used psychometric assessment of motor performance in psychiatric patients and indicated a "psychotic-motor syndrome" (PMS) in schizophrenic and affective psychoses, which was not found in "neurotic"/reactive or healthy persons. Part IV yielded signs of concomitant brain dysfunction in these patients, demonstrated by EEG mapping as well as other (SPECT/PET) neuroimaging methods. Apart from this "basic science" interest into the pathophysiology of endogenous psychoses we engaged in the development of motor training programs using the PMS as "target" syndrome. We hypothesized, that motor training would not only improve disturbed motor behaviour, but ameliorate other symptoms of psychopathology also. These assumptions were supported in the first two independent studies involving n = 45 and n = 31 ICD-9 mono- and/or bipolar endogenous depressed patients, respectively (the studies on schizophrenic patients being reported finally as part VI of this series, along with the final version of our modified motor test battery). Examples of the motor training programs are provided in this paper, although the final version of the complete programs will be published separately for space reasons and for better availability for routine clinical use.     

Brief reports: the fidelity of supported employment implementation in Canada and the United States

Supported employment has been documented in the United States as an evidence-based practice that helps people with severe mental illness obtain and maintain employment. The evidence is strongest for the programs that follow the individual placement and support model. This brief report examines the degree to which supported employment programs in British Columbia, Canada, are similar to those in the United States. Data from the Quality of Supported Employment Implementation Scale were compiled in 2003 for ten supported employment programs from vocational agencies in British Columbia and were compared with data from 106 supported employment programs and 38 non-supported employment programs in the United States. Overall, the Canadian supported employment programs that followed the individual placement and support model had the highest fidelity.     

Different strokes for different folks: why overweight men do not seek weight loss treatment

Despite health risks associated with male-pattern obesity, few men utilize weight management programs. Strikingly missing from the literature are studies that ask, "Why?" Seventy-two overweight males were surveyed regarding what might motivate them to seek treatment, and which treatment characteristics might appeal to them. Respondents indicated that health problems and the desire to improve appearance are primary motivators. In contrast to the programs most widely available, respondents preferred individualized, athletics-based programs that allow autonomy in food selection. It was concluded that both a modified program and marketing approach are needed if the clinical community is to help overweight men.     

Cost-financed mental health facility. II. Utilization profile of a labor union program.

Specific data are presened concerning the utilization profile of a cost-financed mental health facility. The utilization is enhanced by a mental health education campaign, but total utilization remains within manageable limits (13 per 1000). The visit rate is 8.5 units per patient and remains well within the plan's dollar limits. Comparison between utilizers and the population from which they are drawn shows disproportionate numbers of males in contrast to other outpatient insurance studies. This may be a unique feature of work-related programs. "Acting out" disorders are more common among these workers than in other psychiatric programs in the same geographic area.     

Quality of institutional and community human service programs in Canada and the United States.

This methodological and substantive study was based on Wolfensberger and Thomas' (1983) Program Analysis of Service Systems' Implementation of Normalization Goals (PASSING), a program evaluation method used by teams of trained raters to assess the quality of human service programs. PASSING is based on Social Role Valorization, an internationally influential theoretical and philosophical approach to structuring human services, particularly services for persons with handicaps or other potentially devaluing conditions. The data for this study were derived from a sample of 213 programs evaluated with PASSING during 1983-88 in Canada (45%), the United States (51%), and the United Kingdom (4%). The programs served mainly mentally retarded persons (40%), subgroups of clients with "mixed" (different) impairments and conditions (38%), or psychiatrically impaired persons (6%). The results showed that PASSING has adequate internal consistency and interrater reliability and yields data suitable for statistical treatment with interval-level, parametric procedures. The average level of quality of services in the sample on the total PASSING scale and its five subscales (Program Relevance, Intensity, Integrativeness, Image Projection, and Felicity) was only modest, however. Community group residences (n = 77) were of significantly better quality than community vocational programs (n = 56), and both were superior to institutional residences (n = 20). Also, Canadian programs (n = 76) were of significantly better quality than U.S. programs (n = 77). An outstanding vocational program that was not part of the study sample was used to illustrate concrete ways in which the quality of many human service programs could be greatly improved, typically at little cost.     

Housing First Impact on Costs and Associated Cost Offsets: A Review of the Literature

Objective:

Housing First (HF) programs for people who are chronically or episodically homeless, combining rapid access to permanent housing with community-based, integrated treatment, rehabilitation and support services, are rapidly expanding in North America and Europe. Overall costs of services use by homeless people can be considerable, suggesting the potential for significant cost offsets with HF programs. Our purpose was to provide an updated literature review, from 2007 to the present, focusing specifically on the cost offsets of HF programs.

Method:

A systematic review was performed on MEDLINE and PsycINFO as well as Google and the Homeless Hub for grey literature. Study characteristics and key findings were extracted from identified studies. Where available, impact on service cost associated with HF (increase or decrease) and net impact on overall costs, taking into account the cost of HF intervention, were noted.

Results:

Twelve published studies (4 randomized studies and 8 quasi-experimental) and 22 unpublished studies were retained. Shelter and emergency department costs decreased with HF, while impacts on hospitalization and justice costs are more ambiguous. Studies using a pre–post design reported a net decrease in overall costs with HF. In contrast, experimental studies reported a net increase in overall costs with HF.

Conclusions:

While our review casts doubt on whether HF programs can be expected to pay for themselves, the certainty of significant cost offsets, combined with their benefits for participants, means that they represent a more efficient allocation of resources than traditional services.     

Self-help and guided self-help treatments for bulimia nervosa and binge eating disorder

This article reviews the use of self-help and guided self-help treatments for bulimia nervosa (BN) and binge eating disorder (BED). Available data suggest that self-help and guided self-help treatments based on empirically-supported cognitive behavioral therapies (CBT) have efficacy for binge eating problems. Emerging findings from initial studies suggest that the magnitude of the differences in outcomes between certain guided-self-help CBT programs and therapist-led CBT may not be substantial, although further research is clearly indicated. Initial data suggest that self-help and guided self-help CBT programs may not only demonstrate "efficacy" but also "effectiveness"-i.e., utility in "real-world" primary care or community settings. Implications for clinical practice and for future research are discussed.     

An application of long-term frequency analysis in measuring drug-specific alterations in the EEG of the cat.

A method is described for the quantitative measurement of "drug-specific" effects on the EEG of the cat. These effects are dose-related and are independent of the normal sources of EEG variation associated with the sleep-waking cycle. Drug-induced changes are expressed as characteristic alterations in frequency spectra and the time courses of these effects are followed for 5 h following administration of the test compounds. Atropine sulfate (0.5 and 2.0 mg/kg) and physostigmine salicylate (0.05 and 0.20 mg/kg) were administered to three unanesthetized and unrestrained cats and a broad-band frequency analysis was performed on the spontaneous brain electrical activity recorded from the prepyriform cortex, ventral hippocampus, lateral geniculate nucleus and the midbrain reticular formation. The resulting data were used as input to discriminant and canonical statistical analysis programs employed to abstract "drug-specific" patterns of frequency change. It was found that both atropine and physostigmine produce alterations in EEG frequency spectra which are clearly distinct from those patterns associated with the sleep-waking cycle and thus neither compound results in what has been characterized as an "EEG-behavioral dissociation".     

Delinquents and nondelinquents in depressed areas: Some guidelines for community preventive action

Attention is directed to the reasons why all children from unwholesome homes do not become delinquent and why there are children from good families who do become delinquent. With these findings as a basis, foci of communitywide preventive programs that would take into realistic account the needs of special groups of delinquents and non-delinquents are suggested.This paper is adapted from an address delivered at the 17th Annual Meeting of Big Brothers of America, May 1965, and its data stem from current research which is focused on the development of etiological types among delinquents. The study is supported by a grant from the National Institute of Mental Health, MH-07286.     

The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.     

Research on day treatment programs for preschoolers with disruptive behavior disorders

OBJECTIVE: This review examined the literature on psychosocial treatments for preschoolers with disruptive behavior disorders to delineate ways in which interventions developed in research settings can be used to enhance existing clinical preschool day treatment programs. METHODS: A PsycINFO search was performed by using the keywords "day treatment," "behavior problems," "disruptive behavior disorder," and "oppositional defiant disorder" to find articles published between 1974 and 2004 on randomized controlled trials of psychosocial interventions for preschoolers (ages two to five years). No randomized controlled trials of multimodal day treatment programs were found. Therefore, studies on multimodal day treatment were selected on the basis of whether they presented quantitative outcome data. RESULTS AND CONCLUSIONS: Little research was available on the effectiveness of day treatment programs, despite the programs' prevalence as a treatment modality for disruptive preschoolers. In contrast, many interventions in the disruptive behavior disorder research have not made their way into clinical practice. Preschool day treatment programs may be enhanced by improving access to care, emphasizing social problem-solving skills, and using strategies to engage families in treatment. Research studies on existing day treatment programs are needed to clarify the role of these programs in child psychiatry clinics and to shed light on optimal methods of service delivery.     

Child neglect and maltreatment, "early aid" and the contribution of early intervention

Child neglect and maltreatment is--following the death of Kevin in Bremen - a major theme in german society. The improvement of prevention has a professional as well as a political dimension. In both fields, the possible contribution of early intervention services is hardly recognized. The experience of these services concerning the development of children in high risk constellations, and their diagnostic, intervention and networking techniques are a major Plus of early intervention programs and should be integrated in "early aid"--initiatives which are actually brought up.     

Comprehensive drug programs: the Dade County example.

The authors present data from a survey of four methadone maintenance programs, five outpatient clinics, six nonresidential facilities, and nine therapeutic communities affiliated with the Dade County Comprehensive Drug Program. The treatment population included more blacks but fewer Latins than the general county population. Primary drugs of abuse were narcotics in methadone clinics and "softer" drugs in outpatient and nonresidential facilities. Most patients were either self- or court referrals. Direct per patient costs, which were lowest in the outpatient clinics, averaged $1,041. The authors suggest that their data may aid other comprehensive drug treatment programs in establishing guidelines.