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Relationships with the medical staff and aspects of satisfaction with care expressed by parents of children with cancer.

Seventy-four parents of children with cancer were asked to characterize the behavior of medical staff members with whom they interacted. Seven empirically distinct dimensions of staff behavior relevant to their relationships with parents were identified, including information transmission, clarity and honesty of communication, acceptance of parental efficacy, resolution of conflicts, personal contact with parents, empathy with the child, and staff competence. With respect to their experiences with the treatment of their child, parents also were asked to indicate their satisfaction with the medical staff in terms of changes in their respect and/or anger for the medical staff, changes in feelings about doctors, support received from doctors and nurses, and stress resulting from tense relations with the staff. The seven dimensions of parent-staff relationships were used as predictors in a series of multiple regressions employing these satisfaction measures as criteria. The overall quality of the parent-staff relationship was best predicted by positive personal contact. The strongest predictor of whether or not parents felt increased anger was staff empathy with child. Increased respect for the medical staff was predicted by a combination of information transmission and perception of staff competence. Experience of support by parents was best predicted by information transmission and staff acceptance of parental efficacy in treatment and decision making. This complex pattern supports the usefulness of disaggregating measures of staff behavior and parent satisfaction when examining the relations between medical consumers and service providers.

Adolescent↗

Relationship of client participation to psychotherapy.

Dimensions of client participation in psychotherapy were assessed to investigate whether participation is unidimensional or multidimensional, stable over therapy, and/or related to measures of psychotherapy outcome. Participation dimensions included compliance with scheduling (lateness, rescheduling, no-show) and with homework assignments (completion of a daily diary and relaxation home-practice), reported acceptance of the credibility of therapy rationale, satisfaction with global and specific aspects of therapy, expectation of personal improvement in anxiety symptomatology, self-rated engagement in therapy activities, and reported judgments about therapist characteristics and relationship qualities. Outcome measures included assessor ratings, daily client self-report of anxiety severity, and questionnaire measures. Subjects were 30 clients participating in a 12-session generalized anxiety disorder comparative treatment study in which they receive progressive relaxation training plus either cognitive therapy or nondirective therapy. Across clients in both treatment groups, behavioral compliance measures were poorly intercorrelated and unrelated to the other participation measures. Canonical correlation of participation variables with change on pre-post outcome measures showed a significant relationship between some participation variables representing satisfaction with specific aspects of therapy and the therapeutic relationship and improvement in daily level of subjective anxiety.

Anxiety Disorders↗

A psychoeducational approach to methadone maintenance treatment: a survey of client reactions.

STAR, a methadone clinic in Portland, Oregon employs a psychoeducational approach in an attempt to provide coherent, comprehensive treatment in meeting diverse client needs. Two hundred and thirty-eight STAR clients completed a 133 item survey as part of an evaluative review of the efficacy of the psychoeducational model. Clients were asked about their perceived treatment needs and expectations, drug use, criminality, mental and physical health, social and economic stability, and their sense of self-worth and life satisfaction. Respondents reported that receiving methadone was the most useful and best liked aspect of treatment, followed by individual counseling, and education and skill classes. Clients indicated low rates of criminal behavior and drug use, but acknowledged high rates of psychological symptoms including depression, anxiety, and irritability, and rated as very important the need to reduce drug use and to improve health, to achieve a sense of life satisfaction, to enhance feelings about self and relationships, especially those with their children. A majority of the respondents had less than adequate income, and a substantial minority had less than a high school education. Longer time in treatment at STAR was associated with reduced heroin and cocaine use and improvements in social, economic and legal realms. The discussion focuses on implications for methadone treatment in general and possible modifications of the STAR program.

Activities of Daily Living↗

[Psychological education as a group process for parents of adolescents with eating disorders].

Psychoeducation is a well-established component of cognitive-behavioral therapy in adult patients with eating disorders. This paper describes a group model of psychoeducation that has been offered by our department for the past two years to parents of adolescent patients with anorexia and bulimia nervosa. According to their own reports, parents appreciate this means of support to help them cope with their child's illness.

Adaptation, Psychological↗

[Bibliotherapy as a self-help program for parents of children with externalizing problem behavior].

OBJECTIVES: Externalizing problem behaviour is one of the most frequent and most stable behavioural disorders of childhood and adolescence. The development of applicable alternatives to expensive and restrictedly available treatments becomes increasingly necessary. This pilot study tested bibliotherapy in the form of a manual-assisted self-help programme under minimum contact conditions for parents of children with externalizing problem behaviour. METHOD: A total of 21 children, aged 6 to 15 years and diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) and/or an Oppositional Defiant Disorder, were recruited from an outpatient population. The bibliotherapy lasted 10 weeks and consisted of working through a self-help book for parents (Wackelpeter und Trotzkopf). Initial clinical interviews and pre- and post-treatment evaluations were included, as well as short weekly telephone contacts (approx. 20 min. per contact) with the parents. RESULTS: The children's externalizing behaviour was significantly reduced during the intervention. The parenting skills were strengthened. The satisfaction of the parents with the program was high. Fewer than 20% of the parents indicated a need for an additional intensive behavioural outpatient treatment at the end of the intervention. CONCLUSIONS: Bibliotherapy may be an applicable and effective treatment alternative for children with disruptive behaviour disorders, at least in families with the resources necessary for this kind of intervention. The results have to be replicated within randomized control group trials.

Adolescent↗

Adolescents' perceptions of a health survey using multimedia computer-assisted self-administered interview.

OBJECTIVE: To ascertain young people's perceptions of an adolescent health survey when administered by multimedia computer assisted self-administered Interview (M-CASI) through analysis of (1) questionnaire item responses and (2) focus group interviews. METHODOLOGY SETTING: Auckland, New Zealand, 1999. STUDY TYPE: Pilot testing of a 488-item branching questionnaire delivered using a youth-oriented and user-friendly M-CASI interface in a variety of settings using both desktop and laptop computers. Post pilot focus groups of participants identifying their perceptions and experiences of the survey. SAMPLE: 110 school students aged 12 to 18 years. RESULTS: The mean number of questions answered by participants was 316 with the median time to completion being 48 minutes. On average 65% of the total number of questions were seen and of these 1.5% were deliberately not answered. A high level of acceptability and enjoyment of M-CASI was found in the analysis of focus group responses and agreed with the item responses relating to M-CASI within the questionnaire itself. Participants identified privacy and confidentiality as being particularly important for the honesty of their responses. The passive matrix screens of the computers were popular as they could only be viewed from in front. CONCLUSIONS: M-CASI is an acceptable instrument for the administration of a youth health survey. Laptop computers with passive matrix screens are able to enhance perceptions of privacy and confidentiality, which may improve honesty of responses. IMPLICATIONS: M-CASI is now feasible and offers advantages in health surveying.

Adolescent↗

Mental health promotion for vulnerable African American youth.

Fifty-six African American youth between 10-14 years of age participated in a community-based 14-week expressive arts program designed for youth at risk of involvement with the juvenile justice system. Positive and statistically significant findings for pre-post changes in self-control, protective factors, and resilience were found. Difficulty in engaging parents and the strong racial biases of the community appear to have influenced the lack of improvement in self-esteem scores.

Adaptation, Psychological↗

Group anxiety management: effectiveness, perceived helpfulness and follow-up.

An evaluation was conducted on out-patient cognitive-behavioural anxiety management groups. Twenty-nine clients assessed before and after the group and at three-month follow-up showed significant improvement on self-report measures. A further follow-up on 21 clients, conducted by an independent assessor at an average of 11 months, showed greater improvement with time. Clients also rated how helpful they had found non-specific therapeutic factors, and specific anxiety management techniques. 'Universality' was the most helpful non-specific factor, and 'the explanation of anxiety' was the most helpful technique.

Adult↗

On systems analysis in autism intervention programs.

Although intervention technology has grown substantially during the past quarter century, the design of intervention systems has not grown apace. This paper examines organizational arrangements that enhance and diminish treatment effectiveness and argues that defining, measuring, and manipulating systemic antecedent and consequent variables are as important as assessment and intervention on an individual client's behalf.

Autistic Disorder↗

Evaluating the effectiveness of student assistance programs in Pennsylvania.

This article presents data from an evaluation of the Pennsylvania Student Assistance Program (SAP). Focusing on both program process and effectiveness, the evaluation was conducted to determine the overall efficacy of SAPs in Pennsylvania and, more specifically, how SAP is currently being implemented. Five data collection strategies were employed: statewide surveys of SAP team members and county administrators, focus groups, site visits, and the Pennsylvania Department of Education SAP Database. A total of 1204 individual team members from 154 school buildings completed the team member survey. Fifty-three county administrators completed the county administrator survey. Focus groups were comprised of SAP coordinators, school board personnel and community agency staff. Site visits were conducted at five schools. The findings of the evaluation indicate that SAP in Pennsylvania is being implemented as designed. Recommended is the development of benchmarks and indicators that focus on the best SAP practices and the extent to which various indicators of the effectiveness of SAP are occurring at appropriate levels.

Adolescent↗

Retirement communities gain higher acceptance.

Retirement community gains in acceptance could indicate a bright future for the industry, according to the latest Generations research. The first ever on-line international survey of seniors and the first dial group studies of seniors show Boomers, Silent Generation seniors, and GI Generation seniors alike have become more positive in their evaluation of retirement communities as an option for the future.

Adult↗

[Behavior therapy in use--assessment of 633 cases of treatment].

633 written case-reports of behavior therapies were statistically evaluated. The case-reports, provided by 180 behavior therapists, were presented to the Deutsche Gesellschaft für Verhaltenstherapie in concurrence with their behavior therapy training closing criteria. Data concerning therapists and institutional settings were taken into consideration as well as data about patients, their disorders, specific treatments, lengths of therapy and outcomes. Results were discussed in the light of psychiatric-epidemiological and psychotherapy research as well as the general trends in theory and practice of psychotherapy.

Adolescent↗

A political economic theory of the dental care market.

A theory of the dental care market is introduced which proposes that the vertically integrated (local/state/national) structure of the profession services as an organizational vehicle both for intra-professional debate and for developing provider-oriented dental care policy. We suggest that a special relationship exists between professionalism and professional regulation. Such regulation has functioned simultaneously to limit competition and to foster a prized consumption commodity for providers: professionalism and professional esteem. The organized pursuit of this commodity inherently dampens competition. Professionalism itself plays a crucial role in: 1) securing for organized dentistry a form of state regulation in which the providers themselves are the principal decision-makers; and 2) influencing provider and consumer market behavior in several significant respects, the net result being the formation of maintenance of a type of "leadership cartel" in the local market. Thus, a political-economic theory of the dental care market formally acknowledges professionalism as valued by established dentists and recent graduates as a central determining influence. Traditional models of pure competition and monopoly emerge as special, extreme cases of the general theory. Hypotheses are offered regarding consumer and provider behavior, market dynamics, and health policy and regulation.

Dental Health Services↗

Effectiveness of post card appointment reminders.

OBJECTIVE: This study measures the effectiveness of post card appointment reminders in a residency-based family practice center. METHODS: Outcomes of 1,380 consecutive appointments before institution of reminders were compared with 1,303 appointments afterward. Then, 140 patients were informally surveyed in follow-up. RESULTS: Before reminders, overall office no-show rate was 13.0%, cancellations were 19.4%, and arrivals were 67.6%. No-shows correlated with length of time from scheduling date to appointment date, seeing a resident rather than faculty, and patient payment classification (p < 0.0001). Post card reminders did not significantly improve arrivals by patients or change no-shows to cancellations. The reminders were well received by patients. CONCLUSIONS: Post card appointment reminders were simple to institute and appreciated by patients but had little effect on improving appointment-keeping behavior.

Appointments and Schedules↗