Case management: the current best practices and the next generation of innovation.

Eight published literature reviews of case management were evaluated to determine areas of consensus regarding outcomes associated with full service, broker, and hybrid models. Full service was recommended for "best practice" status and the effectiveness of the broker model was seriously questioned. Research evaluating para-professional and peer assisted models of case management, a potential method for improving outcomes, was also reviewed. One promising peer-assisted model was identified and described. Although the use of paraprofessionals and peers in case management holds promise, much more research is needed before the effectiveness of this approach can be confidently determined.

Facial nerve paresis involving passenger airbag deployment: a case report.

The case of a 32-yr-old woman who developed transient facial nerve paresis following deployment of the passenger airbag is presented. Although a wide range of injuries including fatalities have occurred, this case represents a unique type of injury following passenger airbag deployment.

The effect of exercise on normal mood.

Research has shown that aerobic exercise is effective in alleviating depression. However, the contention that aerobic exercise similarly has an enduring beneficial psychological effect on the mood of normal, non-depressed individuals has not been verified. Research examining the effects of exercise on normal mood has yielded inconsistent findings, due in part to methodological shortcomings. The present study attempted to rectify these methodological difficulties and evaluated the effect of 13 weeks of aerobic exercise on the mood of normal, non-depressed men and women. Groups intended to be non-aerobic and waiting list controls were included in the design, as were a stratified random sampling procedure, measurement of physical fitness, and a seven-day pre/post-program assessment period for both positive and negative mood. Results indicated that, although subjects demonstrated significant improvement in physical fitness, there were no significant changes in either positive or negative mood. Thus, in contrast to effects with clinical depressives, exercise does not appear to have any long-term beneficial effect on the mood of non-depressed individuals selected from a normal, i.e. non-clinical, population.

The peer-managed small group versus the rehabilitation model of treatment of chronic patients.

The Fairweather small-group model, developed some 20 years ago, has been proven to be an effective form of treatment for chronic patients who have spent long years in institutions. However, there have been no recent evaluations of how small-group programs work compared with contemporary rehabilitation programs and how effective they are with the "new chronic patient" recently described in the literature. In a study of such patients at the Florida Mental Health Institute in 1977, the authors compared matched patients in a small-group program and a rehabilitation therapy program on measures of self-concept, perception of kind and degree of help received, and recidivism rate. They found that patients in the small-group program spent significantly less time in treatment. Moreover, the small-group program was effective in reducing recidivism over an 18-month period and was less expensive than the rehabilitation therapy program.

Time-limited residential treatment: issues and evaluation.

The trends toward deinstitutionalization and community care have increased the need for short-term residential programs, and the literature supports their effectiveness as an alternative to longer-term care. The authors describe an innovative short-term residential treatment program at Florida Mental Health Institute. Called the Early Intervention Project and limited to nine weeks, it uses a combination of behavioral and psycho-educational techniques for building skills in younger patients who have not received extensive prior treatment. It includes training modules in assertiveness, communication, problem-solving, managing anxiety and depression, medication, relaxation, and nutrition, and also incorporates a peer-managed token economy. A series of research studies have demonstrated the program's effectiveness in changing patient behavior.

Peer managed token economies: evaluation and description.

Evaluated peer Managed Token Economy Programs (TEP) to determine their effectiveness in influencing patients' behaviors on the treatment unit and psychosocial adjustment as rated by treatment staff. Two experiments were conducted with adult patients (N = 56) in a residential treatment program. The first study indicated that patients' ward behaviors were maintained at a satisfactory level by either a special peer managed or staff managed TEP. An identical program that operated with non-contingent reinforcement, however, was shown to result in dramatic decrements in patients' ward behavior. The second experiment compared two peer managed token economy programs, one that operated with a group incentive and one with an individual incentive orientation. Results indicated that both of these programs effectively maintained patients' daily ward performance, reduced psychological problems, increased social adequacy, and enhanced community adjustment potential. The relative advantages and potential uses of peer managed programs were discussed.

Personality, demographic, and intellectual variables associated with readiness for discharge from psychiatric treatment.

This study examined the relationship between staff rated discharge readiness and patient personality, demographic, and intellectual variables. Chi square and t test analyses were performed on data of 88 male and female adult patients of a short-term residential psychiatric treatment program. Patient diagnosis, trait anxiety level, marital status, age, and abstract intelligence scores assessed at admission were found to be significantly associated with staff ratings of patients' readiness for discharge following six weeks of treatment. Findings were discussed in terms of prior process and outcome literature and implications for future research.

Relaxation therapy, desensitization, and the treatment of anxiety-based disorders.

Evaluated systematic desensitization and relaxation training for the treatment of snake phobia and test anxiety as representatives of two classes of anxiety-based disorders. Treatment outcomes were assessed by examining situational and dispositional components of anxiety as related to these disorders and by behavioral measures of performance in relevant anxiety-provoking situations. Analyses of variance revealed that more pervasive anxiety reductions occurred for the more focalized animal phobia and that there was little difference in the effectiveness of desensitization and relaxation training. The generalizability of research findings based on the treatment of animal phobias was questioned, and the possible role of nonspecific factors in determining success was considered.

The effects of stress on state and trait anxiety in emotionally disturbed, normal, and delinquent children.

The effects of stress on trait and state anxiety of emotionally disturbed, normal, and delinquent children were assessed using the State-Trait Anxiety Inventory for Children (STAIC). This scale measures both transitory feelings of apprehension and tension that vary over time as a function of situational stress (A-State) and individual differences in the disposition to experience such anxiety states (A-Trait). Results indicated that A-State increased as a function of stress, whereas A-Trait was relatively stable and impervious to the temporary effects of stress. Use of the STAIC with normal and deviant populations was supported.