The influence of individual,marital, and family therapy on high utilizers of health care

Research has shown that people reduce their use of health care after individual, marital, and family therapy, which is known as the "offset effect." However, little research has been done to learn if high utilizers of health care reduce health care usage after therapy. Medical records of research participants (n = 65) from a health maintenance organization (HMO) were randomly selected and examined for 6 months before, during, and after therapy. Persons who received individual, marital, or family therapy all reduced their health care use after therapy, with the largest reductions coming from those participants who had some form of conjoint therapy.     

The influence of marital and family therapy on health care utilization in a health-maintenance organization

Research has shown that people reduce their use of health care after individual psychotherapy. However, little research has been done to learn if marital and family therapy has a similar effect. Subjects (n = 292) from a health-maintenance organization were randomly selected according to the type of therapy they had received. Subjects' medical records were examined for 6 months before, during, and after therapy. Those who received marital and family therapy significantly reduced their use of health care services by 21.5%. These results show an "offset effect" for marriage and family therapy.     

Global healthy backpack initiatives

Schoolbag use by children is a global common concern.. Children carry school books and other amenities in their school bags. Global evidence indicates that daily load carried by school children may have negative health implications. Backpack as a school bag model, is the healthiest way of load carriage for school children. Several initiatives have been launched world over to minimize unhealthy consequences resulting from schoolbags. Based on a situation analysis, Sri Lanka implemented a national healthy schoolbag campaign by joint efforts of Ministries of Health and Education. Actions were contemplated on; strategies for bag weight reduction, introduction of an ergonomically modeled schoolbag and bag behaviour change. New strategies were introduced with awareness campaigns to policy makers, bag manufacturers, parents, teachers and children. Four million schoolchildren benefitted. In 2000, the backpack strategy of "Pack it Light, Wear it Right" was started as a public health initiative in the United States by the American Occupational Therapy Association (AOTA). Over the last eleven years, thousands of occupational therapy practitioners and students participated in educational programs and outreach activities. In 2004, modeled after the success AOTA initiative, the Icelandic Occupational Therapy Association launched a national backpack awareness initiative. This article shares examples of practices that could be implemented in any context to the promote health of children.     

Organizational Change as a Paradigm Shift*

Organizational change may be considered as analogous to scientific change. Kuhn's analysis of scientific activities as paradigm guided is applied to an organizational framework to suggest that organizational activities may be understood in the same fashion. This perspective is briefly applied to the current controversy in health care. Research attention is directed toward the use of knowledge in organizational activities and in health care in particular.     

Measurement for a human science

This paper argues a number of points about measurement in the sociology of mental health: (1) measurement is critical, (2) measures should represent and assess elements of human experience, taking measure of life as people feel it, sense it, and understand it, and (3) social scientists should create a human science, producing information for the people it studies so that they can better understand and control their own lives. We argue that a human science is best achieved with the use of indexes, not diagnoses, to measure mental health. We present a brief history of diagnostic instruments and detail how a diagnosis is made. We show how use of diagnoses to measure mental health discounts much human suffering. They dichotomize the true range of feelings and emotions into crude either/or distinctions that do not reflect the reality of people's lives, and they often exclude suffering such as that due to loss or illness that does not meet medical model preconceptions about mental disorder. Using diagnoses to measure mental health presents a reified image of hidden disease knowable and manageable only by trained professionals--beyond the capacity of the suffering individuals to understand and control.     

Approaching ADHD as a chronic condition: implications for long-term adherence

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic conditions of childhood. Although evidence-based treatments for ADHD, including stimulant medication and behavior modification, have long been established, and guidelines for care of ADHD in primary care settings have been developed, adherence to long-term therapy is poor among youth with ADHD. This article proposes use of the Chronic Care Model for Child Health, the purpose of which is to develop informed, activated patients who will interact with a prepared, proactive health care team. Six "pillars" make up the model: decision support, delivery system design, clinical information systems, family and self-management support, community resources and policies, and health care organizations. Each of these is discussed, and an individual example is described. Adopting the Chronic Care Model for Child Health has the potential to improve the quality of care for ADHD.     

Caring for the caregivers

National Family Caregivers month is a reminder of the invaluable contributions of family caregivers--contributions that are too often unrecognized when addressing the costs of health care. Unpaid caregivers spend a substantial percentage of each week "helping out," often with older relatives, which requires major changes in their work patterns. It is clear that these caregivers may need help balancing their work and caregiving responsibilities, and it is tempting to want to help them by "taking over" some of the seemingly overwhelming tasks they face daily. Yet, it is also important to recognize the ways in which these tasks may enrich caregivers' own quality of life. Through listening to caregivers, nurses and other health care professionals can better understand the embedded values, goals, joys, and disappointments that connect their lives with those for whom they care.     

The healing power of dogs: Cocoa's story

Animals bring a sense of "at homeness" and even normalcy to people who are hospitalized or live in health care facilities. Illnesses, separation from family, fear, loneliness, and even depression may be lessened for those who receive a therapy dog visit by providing a welcome change in routine and something to look forward to. Individuals are often more active and responsive during and after a visit. Just stroking and petting a dog requires the use of hands and arms, as well as the motions of stretching and turning. Dogs are also unconcerned with age or physical ability; they accept people as they are. This alone causes many to reach out and interact with dogs. Animals provide a focus for conversation and a common interest. As Cocoa's human partner can attest, a pet also makes it easier for strangers to talk. Cocoa is known by so many people at the facilities she visits that residents' family members often stop to talk with "Cocoa's mom" when they meet her in the community, asking questions about how Cocoa is doing. When Cocoa is no longer able to perform her services, many in her community will mourn. Cocoa's story, as well as the limited research literature, supports the positive physical and psychological effects of animals, but continued research on the effect of therapy animals on health outcomes is needed. As advocates for clients, nurses are in key positions to facilitate the inclusion of animals in clients' care. Although not for everyone, including those who react negatively to animals or who are allergic, pet therapy offers important possibilities for providing holistic care that extends not only to clients, but also to family members and staff, and to the pets themselves.     

Disabling Ideology in Health and Welfare - the case of occupational therapy

In this paper it is argued, on the basis of an analysis of data from interviews with practitioners, that the rhetoric of partnership and the 'holistic' approach employed by Occupational Therapists is to be understood as an ideology which serves the occupation's professionalising project. It functions to distinguish Occupational Therapy from other health and welfare specialisms, to perpetuate the notion that disability is an individual problem to which professional intervention can provide the solution, and to ascribe responsibility for any perceived failure in therapy to the client rather than the practitioner.     

Intergenerational Wellness Programming in Occupational Therapy

Abstract

An intergenerational Wellness program was implemented by occupational therapy students at Laboure House located in Chicago, Illinois, in the fall of 2001 as part of a grant funded by the National Service Corporation in conjunction with the Association for Gerontology in Higher Education. Program goals include: (a) developing students' skills in evaluation and Wellness programming by participating in an intergenerational service learning project, (b) providing occupation-based Wellness programming for the residents, and (c) promoting Wellness for the residents by encouraging them to find meaning in their lives through a variety of wellness/health promotion activities. Outcome measures used to assess change in the residents included the COPM (Canadian Occupational Performance Measure) (Law, Baptiste, Carswell, McColl, Polatajko, & Pollock, 1998) and the SF-36 (Ware, 1992). Tools used to assess students' performance included internship assessment forms and qualitative data from students' reflective journals. Preliminary results indicate improvement in awareness of Wellness and health promotion activities by the residents as well as a positive learning experience for students.     

Occupational therapy practitioner role in the implementation of worksite accomodations

Injured workers have the right to return to their job if they are able to perform their duties, according to the American with Disabilities Act, 1990. Occupational therapy practitioners employed in work hardening programs, or working as private consultants, have a significant role in assisting employees, employers and human resource personnel in determining "reasonable accommodations" to enable a qualified employee with a physical or mental disability to access the work force. This article discusses the application of accommodations in two case studies.     

Mental Illness,Social Construction,and Managed Care

Abstract

Managed care is creating a social reality that affects the lives of millions. Mental health coverage under health care plans is a function of how mental illness and its proper treatment are defined. These definitions are shaped by social actors competitively seeking to satisfy their particular interests. This paper examines the influence of privatized managed behavioral health care on these evolving social definitions, as evidenced in published works, written reports, and legal actions. It is written from the perspective of social workers as providers of services and advocates for social justice. Options for social work responses to managed behavioral health care are explored.     

Part I. Work hardening for warriors: Occupational therapy for combat stress casualties

Combat stress is an occupational hazard of the military. Soldiers who become job-ineffective due to combat stress are termed "battle-fatigued." Occupational therapy, in the form of work hardening, is an important part of the management of these soldiers. Occupational therapists possess specialized knowledge and skills which make them uniquely qualified for this role. These assets include knowledge of neuromuscular and psychosocial aspects of occupational performance; the ability to do task analyses; the ability to assess occupational performance deficits; the ability to synthesize appropriate therapeutic occupations to rehabilitate functional deficits and match these to the needs of dysfunctional soldiers. These same resources serve occupational therapists equally well in civilian work hardening settings. This paper reviews the management of combat stress casualties, describes the Army units which minimize the impact of combat stress reactions, and delineates the Army occupational therapists' roles of soldier, mental health practitioner, and work hardening coordinator.     

Occupational mobility among immigrants: the impact of migration on economic success in Australia

"By analyzing national survey data collected among immigrants to Australia, this article examines immigrant occupational mobility. For immigrants, the results show economic disadvantages are caused by the act of migration itself rather than by economic experiences in their new country. Occupational status is depressed at the beginning of the immigrants' Australian working career, and this in turn diminishes occupational status throughout the working lives of the immigrants and accounts for the economic disadvantages they face."     

Dying patients' thoughts of ending their lives: a pilot study of rural New Mexico

Forty-nine hospice patients in rural New Mexico were directly interviewed concerning their thoughts about ending their lives. Thirty-one patients (63%) did not have thoughts of ending their lives, whereas 18 patients (37%) reported having suicidal thoughts. There were no differences between patients with and without thoughts of suicide related to gender; ethnicity; age; education; disease; religion; importance of religion; location of hospice agency; remaining financial, family, or spiritual issues; satisfaction with hospice care; sum of hospice personnel seen; or sum of medical equipment used. There were significant differences between patients with and without thoughts of suicide related to the number of household members (p = .02); the symptoms of trouble sleeping (p = .04) and nervousness (p =.03); and Medicare insurance coverage for hospice care (p =.01). No other symptom, including pain and hopelessness, was significant. Seven (39%) of the 18 patients who thought of ending their lives told someone about these thoughts. There were no variable differences between patients who did and did not tell someone about these thoughts.     

Explanatory models for disability: perspectives of health providers working in Malawi

Health providers’ understanding of disability determines how disabled people are treated, and hence it is imperative to address conceptualisations of disability, as this will contribute to better opportunities and realisation of human rights for disabled people. This article will use data from a qualitative study exploring conceptualisations of disability by 22 health service providers from the total health care system in Malawi, including the professional sector (e.g. medical doctors and nurses) and the folk sector (healers and indigenous practices). We will discuss how these perceptions influence the lives of disabled people, using the case of a health service user with physical and speech impairment as an example. Our data show that health providers largely conceptualise disability according to the medical model for disability, contributing to the exclusion of disabled people. The bio-psycho-social model for disability, largely absent as an explanatory model for disability among our informants, is the most inclusive and rights based.     

Family Experiences of Caring for Relatives Who Have Received Electroconvulsive Therapy (ECT)

The research literature on family members’ experiences of the use of electroconvulsive therapy (ECT) is limited. This article explores the perspectives of family members whose relatives had received ECT. Drawing on a social constructionist perspective, this qualitative study collected data using in-depth interviews with nine families in South Australia, to examine how family members constructed the supports and challenges they experienced. The research found that families experienced a range of social and service system barriers, including social stigma and isolation, and limited support from health professionals. They had to negotiate caring expectations within a social context that stigmatised both mental illness and ECT. A need for ECT-specific mental health support groups was identified.

IMPLICATIONS

• Social workers’ roles in Australian hospitals could be further expanded to accommodate supporting families whose relatives have received ECT, referring families to community support, and advocating for specialist support post-ECT treatment.

• Social workers can further articulate their unique contribution to community care post-ECT treatment and advocate for supporting families.

• Increased focus on ongoing and preventative care for supporting families is a potential growth area for social workers in mental health.