Consumer evaluation of community treatment

Development of community programs for offenders requires innovation in program design and evaluation. The Complex Offender Project (COP) provided intensive community treatment, and its clients' opinions were used as a component of its evaluation. Treated clients perceived the same needs for services as did other offenders, but more of them reported receiving the services. Compared to probation, COP was perceived to be more helpful in resolving problems, more continuously helpful, and of helping more to learn useful skills and achieve meaningful goals. The Complex Offender Project provides a model for program development, and the techniques of consumer evaluation are recommended as a means of evaluating such programs.     

Risk Assessment of Virus in Drinking Water

The reevaluation of drinking water treatment practices in a desire to minimize the formation of disinfection byproducts while assuring minimum levels of public health protection against infectious organisms has caused it to become necessary to consider the problem of estimation of risks posed from exposure to low levels of microorganisms, such as virus or protozoans, found in treated drinking water. This paper outlines a methodology based on risk assessment principles to approach the problem. The methodology is validated by comparison with results obtained in a prospective epidemiological study. It is feasible to produce both point and interval estimates of infection, illness and perhaps mortality by this methodology. Areas of uncertainty which require future data are indicated.     

The multiple service needs of drug dependent mothers

Maternal drug use has been the subject of much political discussion. Increases in the foster care population are reported to be a result of drug use by mothers. However, there is little information about the characteristics and service needs of drug using mothers. This study obtained data on drug dependent mothers referred to a child welfare agency, and suggests the need for coordinated treatment.     

The downside of managed mental health care

This article provides and analysis of the diffuculties caused by an attempt to combine professional and corporate cultural values in managed mental health care. It encourages the reader to think critically about the ethical, administrative, clinical, and practical issues which invevitably arise when these two cultures collide. It further suggests that although utilization review claims to provide cost-containment and consumer protection, in actuality is exists to protect profit, for the managed care company by providing disincentives for seeking and accessing necessary treatment. Finally, there is an exploration of the manner in which managed care companies manipulate virous segments of the healthcare system against one another in order to maximize profit. An alternative model is suggested.     

Psychotherapy Quality Assessment

Abstract

In the first section of this paper, Dr. Whitaker argues that there are both practical and heuristic reasons for developing a systematic method for assessing the quality of psychotherapy in a university mental health service. He maintains that, though the task of psychotherapy quality assessment is a complex undertaking, it is possible to take steps toward its accomplishment in a responsible way while still keeping the task within manageable proportions.

In the second section, Dr. Sarnat describes one in a series of efforts at quality assessment at the Mental Health Division of the University of Massachusetts Health Services. She describes the development of a new method of recordkeeping and record review, and the results of a review of three different samples of records. She concludes that the method is feasible, useful, and meaningful for quality assessment in that setting, although the method is admittedly limited in what it can measure.

In the final section, Dr. Arnstein comments on the above, adding a note of caution about both the feasibility and the wisdom of embarking on a program of quality assessment of psychotherapy. He elaborates some of the difficulties that may prevent one from arriving at a valid assessment.     

Letter to the Editor

Competency-based assessment required by the Council on Social Work Education was an impetus for the development of a practice evaluation design for use by clinical practice students in their field practicum. The standards-based comparison design was developed by the author as an alternative to single-system design. Student exemplars illustrate the application of this model.     

Assessment of the Familial Relationships of Young Adult Children of Separated Parents

The aim of this work was the psychometric study of six scales designed to assess the familial relationships of young adult children of separated parents. The analyzed constructs are interparental conflict, loyalty conflict, coalition, parentification, children's perceptions of the parent–child relationships, and young adult perception of the separation–individuation process. Internal consistency and factorial validity was studied through a sample of 535 Spanish young adults from disrupted and nondisrupted families who were between 20 and 30 years old. The confirmatory factor analyses showed a certain acceptability of the original structures of all scales, with Bentler–Bonett Nonnormed Fit Index, Bentler–Bonett Normed Fit Index, and comparative fit indexes above .90 in all cases, and root mean square error of approximation below .05 in the multifactorial scales and slightly higher in the unifactorial ones. The internal consistency values were between .89 and .94 in the unifactorial scales, and between .70 and .92 in the multifactorial ones. The estimations found for the factor saturation supported the acceptability of the original structures. It is concluded that all the scales within this set present acceptable properties, in terms of dimensionality and internal consistency. The limitations are pointed out.     

The Seven Pillars of Quality Care in a Statewide Pediatric Sexual Assault Nurse Examiner Program

This article describes a systematic approach used by a statewide pediatric sexual assault nurse examiner program to ensure the quality of forensic medical examinations it provides in child sexual abuse investigations. Seven strategies for enhancing quality are described: (a) hiring experienced professionals, (b) effective training, (c) comprehensive protocols, (d) ample support for pediatric sexual assault nurses, (e) management oversight, (f) a clinical coordinator to provide ongoing training and technical assistance, and (g) a quality assurance process in which expert child abuse pediatricians review each statewide pediatric sexual assault nurse examination. To show the evolution of quality care over time, the program's experience from 2004 to 2010 is reviewed, and quality assurance data are analyzed.     

The development of synchronous text-based instant messaging as an online interviewing tool

The article reports the development of a synchronous text-based online interviewing tool with a continuity of private discussion that is not achieved in open-ended questionnaires, email interviews and online discussion boards. The participants were women who had undergone a surgical or natural menopause, who in a pilot interview highlighted the potential sensitivity of this subject and inspired the implementation of this method. The overall feedback was positive with the main advantages centred on feelings of anonymity, convenience and a more comfortable interview environment. Disadvantages included lack of body language and technical issues with computers. This technique ensures a degree of confidentiality while still obtaining depth of enquiry, where other qualitative methods potentially risk invading a participant’s privacy. It can be offered both alongside other interviewing techniques to allow participant choice and on its own when exploring sensitive and personal topics or when extra participant anonymity is appropriate.