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Biomedical subjects

H P Lefley

Publications and source records attributed to H P Lefley.

17 recordsLinked to original sources
PubMed1992

Expressed emotion: conceptual, clinical, and social policy issues.

Research on schizophrenia has suggested an association between relapse of patients and high expressed emotion (EE), defined as criticism, hostility, or emotional overinvolvement of at least one family member. In international studies, however, the majority of families of persons with schizophrenia demonstrate low expressed emotion. These families are described as empathic, calm, and respectful by EE researchers, who also reject the idea of family schizophrenogenesis. The author discusses expressed emotion as a construct, its validity and stability over time, and the direction of the relationship between relatives' expressed emotion and patients' symptoms and behavior. She reviews studies indicating significant differences in levels of expressed emotion across cultures, examines the social policy implications of programming based on the construct, and suggests research on EE analogues in clinical and rehabilitative environments.

Emotions↗
PubMed1991

Public-academic linkages for culturally sensitive community mental health.

This paper traces the sixteen year history of a unique community mental health center which has combined academic and service provider roles in delivery of culturally appropriate care. Initially an arm of a department of psychiatry and derived from an anthropological research project, the center model was based on seven teams serving discrete ethnic communities, with subsequent development of a network of neighborhood-based "mini-clinics" as well as centralized aftercare facilities. The team staff-social scientists, clinicians, and paraprofessionals all of matching ethnicity to the populations served-became a core of "culture brokers" with a service, teaching, and research role at the interface of the university, medical center, and community. Subsequently the university was funded for a cross-cultural training institute for mental health professionals. Center staff extended training in culturally appropriate care to 174 mental health professionals from 97 facilities throughout the nation, as well as other spinoffs improving cultural expertise of staff in public sector agencies. Data on effectiveness of services and training are given and significant findings are discussed. The description includes the impact of historical shifts in funding, the effects of external events on community mental health center structure, and the current state of cross-cultural training and public-academic linkages in this particular program.

Aftercare↗
PubMed1990

Culture and chronic mental illness.

The relationship of culture to chronic mental illness is reviewed in a cross-national and cross-ethnic perspective. The author critically examines the argument, based on differential prognosis for serious mental illness in developing and industrial countries, that chronicity is a cultural artifact. Key questions include whether cultural beliefs and practices that minimize social stigma, self-devaluation, and patients' assumption of the sick role are linked to better prognosis. World view, religion, alternative healing resources, values of interdependence, extended kinship structure, family support, and professionals' willingness to work collaboratively with families are viewed as cultural strengths that may help to mediate the course of mental illness. Issues that are relevant to treatment of long-term psychiatric disability in ethnic patients in the United States include interethnic differences in the distribution of cases and service utilization patterns, diagnostic and medication issues, and development of culturally relevant treatment modalities.

Attitude to Health↗
PubMed1988

Training professionals to work with families of chronic patients.

This paper describes a multidisciplinary (psychiatry, psychology, social work) training program which prepares clinicians to work in a collaborative relationship with families of the chronically mentally ill. Content includes an overview of traditional approaches to family roles in major mental illnesses, research findings on family burden, typology of professional-family interactions, and treatment and outcome issues related to older conceptual models of family-patient relationships. The training model includes a didactic component on relevant research and theory, incorporating social policy and cross-cultural issues and emphasizing the actual experiences of patients and families within a framework of coping and adaptation. Training in patient and family education, problem management, supportive counseling, and resource knowledge is accompanied by practicum experiences involving longitudinal work with chronic patients and families. Special features in psychiatric residency training are highlighted.

Chronic Disease↗
PubMed1988

Linked changes in mental, health service delivery and psychiatric education.

In sociocultural perspective, this paper traces the impact of deinstitutionalization and the community mental health movement on the mental health service delivery system and subsequent effects on psychiatric training. Examples are given of changes at the national, state, and local levels. The current need is for new initiatives to interest residents in public sector psychiatry and in work with the chronic patient. Issues discussed include new conceptions of the parameters and roles of psychiatric treatment, involvement of families and other support groups in patient care, comprehension and applications of cultural values, and new functions of the state hospital in the continuum of care as locus of specialized services and of professional training and research.

Community Mental Health Services↗
PubMed1987

Impact of mental illness in families of mental health professionals.

Family burden and coping strategies were investigated in 84 experienced mental health professionals with family members suffering from chronic major mental illnesses. The sample was nationally recruited from ads in professional journals. Personal reactions of respondents involved cognitive and attitudinal changes in conceptions of psychotic disorders and guarded relations with colleagues with respect to self-disclosure and case involvement. Financial and emotional burdens were substantial, with ongoing stressful life events, aversive patient behaviors, and poor treatment histories. In rating family coping strategies, mental health professionals showed a high degree of concordance with nonprofessional family members in assigning priority to education on symptoms, medications, and patient management techniques. Involvement with self-help groups and physical separation from patients were rated higher than individual or family therapy as aids in coping for families of the mentally ill.

Adaptation, Psychological↗
PubMed1987

Aging parents as caregivers of mentally ill adult children: an emerging social problem.

More than one-third of long-term mentally ill adults live with their families, most with aging parents, a situation that accentuates the need for residential alternatives to home care for deinstitutionalized patients who will out-live their caregivers. The role of parenting mentally disabled adults may also impose undue stress on elderly persons. Objective and subjective parental burden, including fears for the patient's future, are increased by the mental health system's failure to offer education, support, training in problem solving, and a collaborative role in discharge planning to family members. Social policy implications of considering families as primary caregivers include the danger that government will be relieved of responsibility for care of the mentally ill, the creation of a potentially at-risk population among aging parents and other family members affected by the stresses of caregiving, and the reduction of the patient's potential for independent living.

Activities of Daily Living↗
PubMed1979

Environmental interventions and therapeutic outcome.

An eveluation study to determine whether intensive environmental interventions for individual patients help their psychotherapeutic progress was conducted at a community mental health center serving a multi-ethnic, inner-city catchment area with multiple social stressors. Using the Kiresuk-Sherman goal attainment scaling method for therapeutic and environmental goals, researchers analyzed outcome levels of a random sample of 150 patients. Ninety-two of those patients received both psychotherapeutic and environmental interventions, 37 received only psychotherapy, and 21 received only environmental interventions. Evaluation indicated that environmental goal attainment effectively predicted therapeutic outcome among high-, moderate-, and low-success groups.

Community Mental Health Centers↗
PubMed1975

Differential self-concept in American Indian children as a function of language and examiner.

The hypothesis that minority self-concept may vary as a function of implicit ethnic and nonethnic evaluative criteria was investigated by testing 40 Mikasuki Seminole Indian children in their native language (Mikasuki) with Indian examiners and in English with Anglo examiners. Two reservation groups, matched for age and sex, received four administration of a personal (Piers-Harris) and an Indian self-concept scale, in a repeated measures counterbalanced design, varying language and order. Significant tes-retest correlations indicated response stability across languages and time. Results, homogeneous for all subgroups, showed significantly higher personal self-concept in Mikasuki, significantly higher Indian self-concept in English. It was suggested that minority testing may involve culturally patterned and context-bound response tendencies.

Adolescent↗