Biomedical subjects
Publications and source records attributed to J F Wilder.
A psychiatrist offers internists thoughtful advice for appraising the changes that confront them and coping with the stress those changes bring. Physicians do well to follow the advice they give their own patients.
The authors surveyed women and men psychiatric chief residents who were near the end of their residency training. The findings documented the active participation of women in leadership roles as psychiatric residents in education, administration, and clinical care. Men and women reported remarkably similar job descriptions, opportunities, and difficulties. Women were less likely than men to participate in research activities during the chief residency or to accept full-time faculty positions after training.
Outpatient clinics gradually accumulate patients with longstanding disabilities. The traditional treatment approach is to see such patients in brief, intermittent, individual visits. Staff generally dislikes treating such patients and patients may, in part, maintain their symptoms in order to maintain ties with a nurturing institution. The experience with an alternative approach, weekly group meetings using a number of helping modalities, is described. Although no panacea, the approach appears to provide a reasonably effective, efficient, and enjoyable way of helping chronically disabled patients.
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Using an intrument called SNAPOR--Services Needed, Available, Planned, Offered, and Rendered--the authors investigated the mental health service needs of 643 clients in six community mental health centers and the adequacy with which they were met. The centers' intake workers completed the first part of the instrument, immediately after the initial interview, to identify which of 13 services clients needed and to estimate the availability of the services. Follow-up eight weeks later indicated which of the needed services had been offered and which were actually given. Individual sessions and medication were the needs most often identified. The percentages of needed services that were ultimately provided ranged from lows of 3 to 10 per cent, for various kinds of rehabilitation, to a high of 84 per cent, for 24-hour hospitalization.
An attempt was made to identify some of the major variables, such as age, sex, ethnicity, and diagnosis, that might be determinants of compliance with psychiatrists' recommendations to enter outpatient treatment after emergency room visits. In general, it was found that older Puerto Rican and white women, usually those diagnosed as having some kind of depression, had the highest rate of compliance. Black patients, as well as all patients diagnosed as schizophrenic, had the lowest probability of outpatient follow-up. A telephone survey of those patients who did not go for outpatient treatment within six months after referral was conducted to elicit their reasons for not going. Several hypotheses were developed concerning reasons for lack of compliance with recommendations for outpatient follow-up, and a number of suggestions were made about possible methods for increasing the compliance rate.
The functioning of Overing House, a halfway house established in organizational context produced a number of changes: The tenants became more representative of Overing's neighboring community; the availability of a network of services under one administrative structure improved the continuity of comprehensive care; a more productive relationship was established between house parents and therapists. Significant different in outcome between the two groups (precenter and center) was suggested by data related to course of employment, independent living, and reduction in long-term hospitalization.
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The job expectations of 35 incoming chief residents were tested by questionnaire when they attended a weekend workshop on leadership and were reexamined after they has had six months' experience on their jobs. Such personal qualities as a sense of humor and persistence and such administrative skills as the ability to exercise authority and set objectives significantly increased in importance six months after these residents began work. The authors recommend educational programs in administration for chief residents.
The authors describe a program that is directed at assuring effective treatment and referral for alcoholic and addicted patients in a general hospital; the program was developed to assure maximal utlization of available addiction treatment facilities without adding to the hospital staff. Drawing on systems theory, the authors review both a pragmatic and a conceptual basis for psychiatric intervention with paraprofessional support to provide consultation to the general medical staff who treat alcoholic and addicted patients. They stress the feasibility of altering the nature of the hospital system to achieve more effective treatment for these patients.
In making his case for a flexible, long-term sheltered workshop, the author presents seven propositions that he supports with reviews of outcome studies in psychiatric treatment and rehabilitation. He submits that it is unrealistic to expect a lasting cure for many psychiatric patients; that despite rehospitilizations, many patients spend most of their lives in the community, where their vocational performance is poor; that total vocational rehabilitation is an unrealistic goal for many of the patients but that in our culture employment is essential to self-respect; and that hospital patients can and will work in hospital workshops and in community workshops after discharge. In addition, he describes a work-for-pay program affiliated with a psychiatric day hospital.
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A study has been reported on 5 years of experience in a community mental health center with a career escalation training program for indigenous workers in a ghetto community. More than one-half entered the program during the 5-year period and about one-third had either achieved a degree or were still active in the Program at the time of this study. Although it is too early to assess the full impact of the program on career advancement, the authors believe that at least a master's degree is required for true upward and lateral mobility. The most striking finding was the high retention rate in the mental health field of those workers who entered the program in contrast to those who didn't. A number of suggestions have been made to improve the effectiveness of a career escalation training program. It is too early to tell whether the long term benefits for individuals, the Center, and the mental health field at large justify the cost and the continuation of such educational release time programs.
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