George H. Wolkon

Physical attacks on psychiatric residents by patients.

Thirty-one psychiatric residents at Los Angeles County-University of Southern California Medical Center were interviewed to ascertain whether they had been attacked by patients, and if so, under what conditions. Forty-eight per cent reported having been attacked, and most believed an incident frustrating to the patient triggered the attack. Personality characteristics of the residents were related to their being attacked, in that residents who scored high on an interview scale that measured a residents level of irritability were more likely to be attacked. Implications of the findings are briefly discussed.

Characteristics of clients and continuity of care into the community.

Two-thirds of the patients referred from psychiatric hospitals to a posthospital social rehabilitation center did not follow through on the referral. Patients who participated in the rehabilitation service were more dependent in several areas of functioning than were those who did not participate. Implications of these findings are discussed in terms of the continuity of care into the community.

Monitoring Program Implementation in Community Mental Health Settings

Evaluations that monitor program implementation provide an empirical description of a programs setvices, the population seived, and a method for assessing whether the program as delivered matches the conceptual model on which it is based. This article presents the Daily Contact Log (DCL), an instrument that has been used to monitor the longitudinal form and content of services delivered in several community mental health care programs for persons with chronic mental illness. The instrument is described and directions for its use are detailed. The psychometric properties of the instrument are discussed, as is its evolution in multisite applications in various mental health care settings. The usefulness of the DCL for programmatic and research purposes is outlined, as are some secondary benefits to staff who use the instrument. While the viability and versatility of the DCL as an instrument for measuring important aspects of program implementation are stressed, its appropriateness for quality assurance analyses is also suggested.

Crisis theory, the application for treatment, and dependency

Abstract The application for treatment was defined as a crisis—a period of psychological disequilibrium and high anxiety—in that it is an application for a major role change affecting the core self. Crisis theory predicts that the closer the intervention is to the crisis, the greater the success of the intervention. Specifically, it was predicted that the shorter the delay between the clients application for treatment and the first scheduled interview, the more successful the intervention in terms of the interviews actually taking place and the likelihood of the clients improving at the termination of therapy. Using the first definition of success, the prediction was confirmed in three different types of treatment agencies. With improvement as the definition of success, the prediction was given encouraging support in two types of agencies. An argument was made that a necessary but not sufficient condition for a successful crisis intervention is that a clients dependency and affiliative needs be satisfied. Research directions for understanding dependency and affiliation in relation to crisis interventions and the intake process were indicated.

Evaluation of a social rehabilitation program for recently released psychiatric patients

A modified control group experimental design was used to evaluate the effects of a social rehabilitative program for recently released psychiatric patients. Persons involved in the rehabilitation program were rehospitalized less often than those who were not involved. Persons optimally involved in the program functioned more adequately in the community as rated by themselves and the professional staff than did those less involved in the program. Methodological and conceptual issues concerning evaluative research, service programs, and their interface are discussed.

Effecting a continuum of care: An exploitation of the crisis of psychiatric hospital release

This paper describes the relative effects of certain structural techniques; that is, the type, timing, and frequency of the receiving agencys contact with the potential client, in implementing a continuum of care from the psychiatric hospital to a professionally recommended community-based rehabilitation center. The differential success of these techniques range from zero to 52%. The findings concerned with the timing of interventions are interpreted in terms of crisis theory and the findings concerned with the type and frequency of contacts lead to greater specification within the theory. It was suggested that in order for a crisis intervention to be effective, the intervention must, as a necessary condition, satisfy the dependency and affiliative needs of the client. Implications for interventions at other points on the continuum of care are suggested and specific recommendations made.

Professionals' views on the need for psychiatric aftercare services

Psychiatrists and social workers in state-supported hospitals were interviewed concerning their views on the needs of recently released patients for aftercare services. These mental health professionals thought that 95 per cent of the released patients should be receiving more than two and one-half separate services, but that only 77 per cent of the expatients were receiving slightly more than one service. Thus, in terms of number of services, only one-third of the need is being met. Differential needs for specific services are also reported.The findings were interpreted as meaning that new and already existing aftercare facilities might not be used as fully nor as appropriately as originally anticipated unless there is a strengthening of referral procedures and the effecting of a more efficient organization for psychiatric rehabilitation both in the community and in the hospital. Suggested changes are discussed.

Drug use, attitudes, and behaviors of youth in an urban free clinic

A questionnaire regarding drug use, attitudes, and behaviors was completed by youths attending a free clinic on randomly selected evenings. Compared to a sample of suburban high school youths, the clinic youths were heavier drug users and were more antiestablishment in their attitudes and behaviors. The clinic youth as a whole tended to have antiestablishment attitudes but within the sample drug use was, with specific exceptions, not related to such attitudes. Youths whose first drug was not marijuana tended to be relatively heavy users, as compared to youths who started with marijuana. Data regarding reasons for use are reported. A brief discussion focuses on societys influence on the implications with the phenomena of drug use and free clinics.

Therapists' physiological activation and patient difficulty.

The differential effects of an easy and difficult-to-interview patient on therapist self-reported behavioral arousal and physiological activation were observed. Eighteen experienced white male psychiatrists each interviewed two patient simulators believing they were real patients. Each actress was programed to act the part of a difficult-to-interview patient and an easy-to-interview patient. Each randomly played either part as assigned and the order of patient and role was counterbalanced. Differences in patient roles were validated by the participating therapists and independent raters. Fifteen-minute rest periods with soft music preceded each therapy session such that a complete experimental session consisted of rest 1, therapy 1, rest 2, and therapy 2. Self-reported arousal was assessed during each of the four periods by Thayers factors from the Nowlis Mood Adjective List. Physiological activation was measured by electromyogram, heart rate, blood pressure (systolic and diastolic), and skin conductance. Therapist self-reported behavioral arousal and measured physiological activation during therapy were significantly greater than during rest. The difficulty of the patient did not appear to affect either behavioral or physiological activation level of the therapists. Several explanations for this are explored.

The “Hang-Loose” Ethic and Drug use Revisited

All the students in four elective classes in one high school re-ponded to a questionnaire concerning drug use, selected attitudes, and selected behaviors. There were few differences between drug users and nonusers in terms of the attitudes and behaviors measured. However, there were striking differences between the high school sample and youth who frequented a free clinic. The “hang-loose” ethic was much more apparent at the clinic. Implications are briefly discussed.