New trends for a new millennium.

Six new trends leading us into the new millennium are described. They include psychotherapy integration, specialization, managing care, the expanding scope of practice, cultural diversity, and psychotherapy without walls. We are entering an age of greater public access to psychotherapeutic interventions, and more control of our professional field. Changes will be revolutionary.

Patient care monitoring review at a psychiatric hospital for adolescents.

Patient care monitoring review (PCMR) allows a mental health facility's professional staff to collectively address difficult cases. The Devereux Center, a psychiatric hospital in Kennesaw, Georgia, conducted a study examining its PCMR system's effectiveness in individual cases. The study also looked at PCMR cases in aggregate to identify problematic trends in patient care. Findings showed that the hospital's PCMR system was generally effective: Few patient cases were referred to PCMR more than once for the same or similar reasons, and most recommendations made by the PCMR committee were followed by the hospital's direct care staff. Aggregate analysis of PCMR cases identified several patient groups whose needs could be better met through more individualized and specialized forms of care. As a result of the study, several improvements were made in both the hospital's structure of care and the PCMR system.

Psychological impact of the development of a presymptomatic test for Huntington's disease.

For the first time, a genetic probe can provide individuals at risk for Huntington's disease (HD) with diagnostic information regarding this progressive genetic disorder before symptoms are exhibited. This article investigates the effects of such a technology on the at-risk HD population. At-risk HD individuals were informed about the genetic probe, and their level of anxiety was assessed. A group conference format was an effective means of providing information regarding the HD probe to a large number of at-risk families. Findings from the measure of anxiety demonstrate that the at-risk HD population is no different from a normative population or from an at-risk HD population unfamiliar with the new technology.

Client-therapist cooperation in the treatment of compulsive handwashing behavior.

While success rates with obsessive-compulsive disorders have improved greatly, debate continues regarding the effective components of behavioral intervention. The present study uses techniques of a jointly designed behavioral contract, active modeling and response discrimination and delay to treat compulsive handwashing. The number of handwashings and time spent at each washing was reduced and the time between handwashings was increased. Obsessive-compulsive clients may respond more successfully to techniques that emphasize self-control, self-definition of appropriateness and client participation in treatment planning.

Length of intervention and client assessed outcome.

The assumption that therapy becomes increasingly effective with an increase in the number of sessions is reported commonly by therapists. However, in this study, single session (N = 47) and multiple session (N = 54) clients both expressed satisfaction with the therapeutic intervention and felt that they had been helped or that their problem had been solved. About half of the women attributed their success to the therapy regardless of the number of sessions, while the percentage of men shifted from less than 20% for single session clients to nearly 80% for multiple session clients. Cultural differences and degree of commitment may account for these differences.

A state-wide assessment of training needs of community mental health administrators.

In order to construct a trainee-designed continuing education (CE) program for administrators, a training needs assessment of all community mental health agencies in Illinois was conducted using a framework of pertinent organization, task, and individual variables. Mental health administrators were, indeed, interested in CE. Areas of interest included leadership, clinical services, planning and evaluation, supplemental services, accountability and accreditation. Funding source was the key variable in relation to training priorities. However, other variables such as comprehensiveness, caseload, serving all ages, and years of experience were also related to training interests. There were contrasts in organization, task, and administrator variables but not in training preferences in relation to geographic location. Implications of administrator/agency descriptive data for the planning of CE are discussed.

Self-designed continuing education for supervisors in community mental health.

This paper describes a continuing education program designed to meet the needs and interests of supervisors working in community mental health centers. As initial group of supervisors was recruited as consultants to design all aspects of their educational experience. The group used a modified nominal group technique to develop the curriculum. Subsequently 28 trainees in three separate groups participated in the training program; they represented 20 agencies and included directors, training coordinators, supervisory staff, and direct service workers. Methods employed were satisfaction measures, content retention measures, and interviews to evaluate program impact. Participants reported that they increased their knowledge and were satisfied with training, but that the program was only modestly effective in contributing to changes in their job and agency functioning. Training was most effective with agency directors, employees of private agencies, and workers with fewer years at a given work site.

A statewide assessment of mental health governing board training needs.

This paper describes a statewide survey assessment of the training needs of governing board members and presents a demographic profile of governing board presidents. Presidents of the 55 governing boards in a consortium of state-funded, community-based mental health agencies were mailed questionnaires. They were asked to respond in terms of board rather than individual priorities. Forty-four questionnaires were returned representing 80% of the sample and 57% of all governing boards in the state. Seventy-one percent of the respondents were male and 55% were executives or managers. Their mean age was 45. Of the 10 needs assessment items, the two highest rated pertained to the financing of centers and knowledge of mental health legislation. Three areas of need emerged from a factor analysis: a board mandate factor, a board organization factor, and a planning and evaluation factor. The perceived training needs of the Chicago Metropolitan Area and Downstate Illinois were similar. The issue of effective citizen involvement vis-à-vis valid representation and appropriate training was discussed.

Primary presenting problem and mental health service delivery.

This study describes the variety of problems reported by clients seeking the services of a large urban community mental health center and explores the extent to which these problems are related to three sets of variables: client demographic characteristics, system entry, and system response. A 10% random sample totaling 273 case files was examined. The most frequently reported problem area was interpersonal followed by drug/alcohol abuse and cognitive disturbance. Clients' presenting problem was significantly related to all three sets of variables. Implications for planning service delivery are discussed with emphasis on identifying both unique and shared center responses to presenting problems, client characteristics, and system entry factors.

Are dropouts, dropouts?

In this study, the perceptions of unilateral terminators, "dropouts," of their visit to a community mental health center were examined. A telephone survey was conducted to assess client satisfaction, impressions of the setting and therapist, helpfulness of the visit, expectations of and reported services received, and source and degree of problem(s) solution. Forty-seven respondents participated in the survey. Seventy percent were satisfied with the service they received. Satisfaction was related to favorable perceptions of the setting, the therapist, helpfulness of the visit, and whether improvement was due to contact with the center. Almost 80% of the respondents reported their problems had improved. Expectations of services to be rendered were generally met. Meeting of expectations was related to client satisfaction and perceived helpfulness but not to problem solution. Center impact was related to client satisfaction, mode of entry, meeting of clients' expectations, and number of services received. The study suggests that unilateral client termination is not a failure of the client or the intervention system. Clients can benefit from one session, use alternative sources of assistance, or be affected by environmental changes.

Fundamental role characteristics of the community psychologist.

The purpose of this paper is to examine four fundamental characteristics of the community psychologist's role. Understanding the nature of these characteristics is important to the development of community psychology. They are marginality, complexity, informality, and evolvement. Marginality is a consequence of the separateness of the change agent from the host system. This separateness promotes access and mobility, which facilitates the process of change. Complexity is inherent in encountering problems, learning requisite skills, and making ideological and ethical judgments. Informality is a characteristic necessitated by limited knowledge and the threatening effects of introducing change. Evolvement describes the constant emergence of community psychology, its progression from the crude to the sophisticated, and the importance of its historical roots to its future. Implications of these characteristics for the training of community psychologists are also discussed.

Knowledge assessment of mental health advisory boards.

Informed citizen advisory boards are vital to the operation of community mental health programs. In order to provide relevant educational experiences, a continuing education program conducted a survey of the self-judged level of knowledge of a sample of board members in a large city. The sample consisted of 57 respondents representing 16 of 19 city mental health centers and the three federally funded community health centers located in the city. The results indicated areas of strength and weakness. Also, knowledge assessments differeed in relation to years of experience on advisory boards. Several suggestions are made about designing curricula for mental advisory boards.

Demographic data and mental health planning.

The use of readily available demographic data in mental health planning is discussed and illustrated. Four indices are identified as important in setting priorities for mental health services: social class, family organization, population mobility, and population heterogeneity.

Day hospital in the context of a community mental health program.

The paper focuses on the role of the day hospital within the framework of total care delivery in community mental health programs and stresses its unique position in the continuity of care cycle. The day hospital lies midway in the service continuum between inpatient and outpatient services and can provide a bridge between community and intramural resources. As such it can serve as a "center for change' where inputs from the entire network of services merge to test solutions for care delivery problems. Experiences with a specific day are used to illustrate relevant issues for those currently engaged in planning or implementing day hospital services.