Relationship of interpersonal behaviors and health-related control appraisals to patient satisfaction and compliance in a university health center

OBJECTIVE: The authors' aim was to evaluate patient-provider relationships in a college health center. PARTICIPANTS: Eighty student patients and their health-care providers. METHODS: Patients completed a measure of perceived health competence before a consultation and measures of provider participatory behavior and interpersonal behavior before and after the consultation. They evaluated their satisfaction with care and compliance after the consultation and again 2 weeks later. Providers completed measures of their participatory behavior and patients' interpersonal behavior after the consultation. RESULTS: Patients preferred to be well informed and to have their preferences taken into account, and generally felt competent at managing their own health affairs. They indicated they obtained the high level of participation they desired. Patients desired and actually experienced friendly and submissive providers. Degree of match between patients' desired and actual level of involvement in their care was associated with greater satisfaction. A greater match between the extent to which they desired the provider to be affiliative and the provider's actual affiliative behavior was associated with more satisfaction. No variables were predictive of patient compliance. CONCLUSION: The authors discuss results in terms of the influence of situational factors characteristic of a college health center.     

Temporal Relationships Among Depressive Symptoms,Risky Behavior Engagement,Perceived Control,and Gender in a Sample of Adolescents

The goals of the study were to examine whether (a) risky behaviors precede depressive symptoms or, conversely, depressive symptoms predict risky behavior engagement; (b) gender moderates the relationship between risky behavior engagement and depressive symptoms; and (c) perceived control strengthens the association between risky behavior engagement and depressive symptoms. At Time 1, 118 adolescents completed self‐report measures assessing perceived control, risky behavior engagement, and depressive symptoms. Follow‐up assessments occurred every 6 weeks (Times 2–5), and participants completed measures assessing risky behavior engagement and depressive symptoms. Results indicated that neither risky behavior engagement nor depressive symptoms emerged as main effects for the sample as a whole. When examining the relationship between depressive symptoms and risky behavior engagement as a function of gender, boys', but not girls', risky behavior engagement predicted higher levels of depressive symptoms. Irrespective of whether we examined boys or girls, depressive symptoms did not predict risky behavior engagement. With regards to the role of cognitive vulnerability, adolescents with lower levels of perceived control reported higher levels of depressive symptoms following risky behavior engagement. These findings suggest that both gender and cognitive vulnerability factors may potentiate the relationship between risky behavior engagement and subsequent depressive symptoms.     

Incapsulating hands: on the (in)dependence of young adults in the UNHCR’s Maratane Refugee Camp

Drawing on research with a small group of young women and men in Maratane Refugee Camp, Mozambique, this paper argues that youth envisage themselves as incapsulated in the camp’s physical and ideological boundaries. It shows that the United Nations’ (UN) mandate of finding durable solutions to international problems is difficult to achieve when young people envisage themselves as reliant or dependent on the UN. It argues that greater attention needs to be given to the mentoring of young people within the UN system, so that they are equipped with viable and realistic life expectations and skills.     

HIV and PTSD: A Confirmatory Factor Analysis of the PCL Screening Instrument

ABSTRACT

The findings are reported from a confirmatory factor analysis (CFA) of the posttraumatic screening checklist (PCL) created by Weathers et al. (1993) Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A. and Keane, T. M. 1993. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility, Presented at Annual Meeting of the International Society for Traumatic Stress Studies, San Antonio, TX. [Google Scholar]. One hundred and eighty-six individuals receiving either preventive HIV information or ongoing HIV counseling from community-based AIDS organizations in the New York City area completed the PCL checklist. To identify a model relevant to screening posttraumatic stress disorder (PTSD) within the HIV/AIDS community, six CFAs were conducted. Results indicated that the PTSD scale should include attention to four general areas: a) reexperiencing the traumatic event; b) avoidance of anything associated with the traumatic event; c) a sense of numbing; and d) a hyperarousal state. The CFA produced a more concise model of 12 items, relevant to the HIV community. Future research suggests that the relationships between different components of trauma exposure and different manifestations of PTSD should be examined further.     

Mental Health Needs Assessment of a Major Urban University

Abstract

A questionnaire surveying mental health needs was administered in class to 1,412 Virginia Commonwealth University (VCU) students, and a service utilization questionnaire was administered to 154 students applying for mental health services at four campus-based agencies. The nature of the specific problems of concern to students tended to remain stable over the course of a semester. Study habits and grades was the most frequently cited problem area on the needs survey, though help was sought most frequently for physically oriented concerns. Students lacking important sources of social support reported the most difficulties. Students who sought help had more problems and higher levels of concern than those not seeking help. A comparison of the two data sources indicated a slight but significant tendency for agencies to deal with the greatest areas of need at the severity levels indicated in the needs survey.     

Disclosure of Student Status to Clients

A survey was sent to 163 MSW programs in the United States and Canada that asked directors of fieldwork to respond to questions related to their school’s policies on disclosure of student status in the field. With a response rate of 66.3% (N = 108), most of the schools (68.5%, n = 74) reported policies requiring disclosure and most directors supported this position. The authors review the ethical and legal reasons in favor of disclosure. They strongly suggest that a pro-disclosure policy be written and adopted by social work programs and the discipline’s professional organizations.     

Time and Timelessness in the Psychoanalysis of an Adult With Severe Childhood Trauma

This article is an exploration of the phenomenological experiences of temporality in the psychoanalytic treatment of a patient who suffered severe dissociation. The writer tracked exchanges with an adult analysand who repeatedly suffered childhood attachment losses and sexual and physical traumata. During treatment sessions the patient enacted dissociated alter personality states each with distinct memories. Loewald (1980) contrasted the experience of time as eternity to the fragmented temporality of trauma. Tracking his experience during key sessions, the writer/analyst infers that by repeatedly going back and forth between experiences of sequential time and timelessness, the analyst helped the patient link previously dissociated experiences. This in turn allowed the patient to realize increased coherence and stability of identity and affectivity. The case material is used to consider how multiple temporalities are represented by the patient and the implications of temporality for understanding trauma and deep dissociation.     

Organizational change: The role of climate and job satisfaction in child welfare workers' perception of readiness for change

BackgroundWhen organizations embark on deliberate efforts to increase effectiveness through organizational-level changes, those that demonstrate greater readiness for change tend to have better outcomes. In contrast, when the organization is not ready, a change effort may result in resistance, conflict and, eventually, failure. However, studies addressing how agency climate and job satisfaction influence workers' perception of the organization's readiness for change in child welfare or human service organizations are scarce.MethodsData for this study was obtained from a sample of 356 direct care and clinical child welfare workers employed at eight not-for-profit child welfare agencies under contract to provide a variety of services in a large northeastern state. Workers were surveyed on their agency's readiness for change, organizational climate, and job satisfaction. The Spector Job Satisfaction Survey measured nine subscales and Parker Organizational Climate survey measured four primary domains: role, job, supervision, and organizational dimensions. A confirmatory factor analysis was conducted on nine questions derived from the Organizational Readiness for Change survey that measured workers' perceptions of organizational readiness for change. Structural Equation Modeling (SEM) was utilized to determine climate and satisfaction influences on voluntary child welfare workers' readiness for change.ResultsThe results of SEM confirmed that the exogenous independent indicators of role ambiguity, supervisor goal emphasis, organizational innovation, satisfaction with communication, and the number of years in current position were predictive of workers' perception of readiness for change with significant positive coefficients.ImplicationsThis study highlights the importance of certain organizational climate and job satisfaction factors that child welfare workers' identify for the success of agency change efforts. Workers perceive that organizations may have a higher level of readiness to implement successful change initiatives when: (1) workers feel their role is clear, supervisors articulate change goals, and job performance is held to a high standard and is measurable; (2) agency leaders establish organizational communication that is explicate, and they encourage workers to develop ideas and try new ways of doing the job; and (3) the greater the number of years workers are in their current position, the more likely change initiatives are perceived to be successful. Most importantly, this study suggests that not all organizational climate or job satisfaction factors are recognized by workers as supporting change equally.