Patricia Bricklin

Parameters of managed mental health care: Legal, ethical, and professional guidelines.

Presentation des principaux parametres des systemes «commerciaux» de sante mentale (Managed Mental health care): orientations legales, ethiques et professionnelles

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed cares competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making.

Health Care Reform and Psychological Practice in Schools

National policy calls for the placement of comprehensive, customer-oriented, and accessible health and social services programs for Americas children and youth. Schools have been targeted as the ideal location for such services. Numerous models of school-based and school-linked programs have been initiated. The role of psychology in these emerging models and programs is highly variable; however, it is an essential service that increasingly is being recognized as necessary in order for schools to address complex and diverse student and staff health needs. In this article, models for the delivery of school health services are profiled. Implications for practitioners who currently work in schools and for psychologists who are not currently working in schools but who are interested in maximizing psychologys contribution to school health services are offered.

Being Ethical: More Than Obeying the Law and Avoiding Harm

In this article, I provide the reader with a model for considering ethical dilemmas that arise in the settings in which assessors practice. The overarching set of principles necessary to consider to make an effective ethical decision are presented as well as a series of steps through which the assessor should proceed in considering a situation. The role of ethics codes in decision making is also described.

THE CONCEPT OF “SELF AS LEARNER”: ITS CRITICAL ROLE IN THE DIAGNOSIS AND TREATMENT OF CHILDREN WITH READING DISABILITIES

The development of self‐esteem in children is traced, with special emphasis on the evolution of a sense of “self as learner.” The particular influences of the family and the school as children develop their perception of competence to perform learning tasks are examined. The insidious interactive role that a negative self‐image contributes to a reading disability at different ages is highlighted and an ecological, learning therapeutic approach to intervention is developed Case examples are used.

The Changing School Scene

The author who attempts to write a book with multiple purposes for readers of different backgrounds and levels of sophistication has taken on a difficult, i f not impossible, assignment. This book i s intended to be useful to practicing psychologists, especially those who work with children and families in schools, clinics, and in the community. It i s written, also, for educators and special education staff, parents, community and government leaders. The author also wants the book to be useful to undergraduate and graduate students in psychology and in education. I t s stated purpose is: “ . . . to explore the innovative, experimental, and compensatory programs in the public schools with special attention to the changes in schools in deprived areas and the challenges these present to psychologists serving the schools” (p. xiv). In i t s 13 chapters, the book attempts to cover the development of the specialty of school psychology and some of i t s present dilemmas, especially those related to problems of the distribution of power in public schools. It includes sections on the nature-nurture controversy and the nature of school learning. A review of most of the major compensatory and experimental education programs of the 1960s i s presented along with descriptions of a number of research programs in which the author has been involved. Sections on the use of paraprofessions and trends in multilevel training including paraprofessions are presented. There are chapters which give useful information & Sons, 1974,314pp. about working with mentally retarded, brain damaged, emotionally disturbed, and gifted children. Behavior modification principles and methods with emphasis on their use in the classroom are also presented. There are detailed appendices in this short book devoted to background and technical information about the author’s research studies, cited in the text. School psychologists need all the help they can get, as do all specialists and educators working in urban schools. Unfortunately, the book i s less useful than the author and the reviewer would have liked. Some of the sections and chapters, by themselves, ‘are good essays dealing with topics of interest to many speciali s t s and educators. Especially useful are an excellent, but too brief, overview of the development of school psychology to mid-century; a review, program by program, of most of the compensatory and experimental education programs of the 1960s and sections, here and there, which reflect the author’s varied and extensive background with children, schools, and community agencies. However, the pieces o f the book are not integrated into a cohesive whole. The impression i s given that the author brought together a number of different ideas about which she was thinking and tried to find an integrating theme in order to put them al l in one book. In some areas there are glaring omissions. Especially noteworthy i s omission of the extensive work of Emory L. Cowen and his associates over the past 18 years on early detection and prevention of educational and socioemotional problems using nonprofessional child aides. This book can be recommended as a sup-

Eidetic Parents Test Analysis, by Akhter Ahsen, Ph.D. New York: Brandon House, 1972. 255 pp.

Eidetic Parents Test Analysis. by Akhter Ahsen, Ph.D. New York: Brandon House, 1972. 255 pp.

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1 7.50. Sometimes i t i s possible to diagnose and help children whose language facility i s weak by a judicious use of imagery. In our own practices we have found i t possible to utilize Rorschachbased imagery with a wide assortment of learning disabled children. They are asked to role play, that is, to assume and speak for, the imagined characteristics of their own image creations. This brings to light aspects of their personalities otherwise hard to reach, and perhaps more significantly, involves them in their own therapy. (The description of this technique with a learning disabled child will appear in the Journal of Personality Assessment.) Akhter Ahsen has produced a technique which (with minor editing to adapt the stimulus situations and the instructions to the particular child) could be used similarly. “Eidetic” comes from the German “Eidetisch,” meaning “clear visual image.” Traditionally, the term has been used in connection with people, usually children, whose visual recall i s so complete it could almost be called “perfect.” Ahsen aims for this clarity with his patients, but there i s no way to tell i f he achieves it. Briefly, he asks them to visualize a number of standard situations. They are then asked to report on the inner experiences which follow these instructions. Observable behavior also is recorded by the examiner. An extremely lengthy first chapter i s written by A.T. Dolen, M.D., who maps out Ahsen’s main points and theoretical rationales. In trying to differentiate an “eidetic” from “an ordinary image” he points out that the latter does not manifest a perceptual quality, as does an eidetic. Additionally, an eidetic i s more accurate in its reproduction of detail. An eidetic i s assumed to show a greater degree of coherence in terms of the background against which i t i s seen. A memory image i s reported to be two-dimensional in nature, lacking any clear background. (No real evidence i s offered to support any of these assertions.) Ahsen believes that very specific traumata are “stored” in the central nervous system, “in the form of eidetics . . . (p. 18).” There are three aspects to an eidetic: an image, a related somatic state, and the meaning attached to the image. If an emotionally upsetting event i s not brought to a resolution, this structure can break down. A situation comes about in which you may have stored in isolation either the image, the somatic state, or the “meaning.” This set-up determines how symptoms are manifested, e.g., psychosomatic, phobic, obsessional, etc. Reuniting the eidetic i s part of the therapeutic process. The test consists of 30 situations which the subject i s requested to image. During the first exposure, the patient i s not pushed, nor i s the resulting material explored. These are the situa-

Research in Infant Assessment, edited by Natalie W. Paul. White Plains, NY: March of Dimes Birth Defects Foundation. 1989. 168 pp.

ing Disabilities. The purpose was to explore work in progress aimed at identifying, from infancy, children who might later have learning or behavioral problems. The result is a collection of articles by an esteemed group of researchers and represents a wide spectrum of approaches. There are 10 papers, each of which summarizes a different approach. The first, by Molfese and Holcomb, reviews the literature related to the prediction of learning disorders from the assessment of &dquo;reproductive and caretaking variables:’ They present a theoretical basis for this perspective and discuss approaches that have been used. Fifteen stud-

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Gerald Leisman is a professor in the Department of Health Science at Brooklyn College and coordinator of the Clinical Neurophysiology Laboratory in the Department of Neurosciences at the Veterans’ Administration Hospital in East Orange, New Jersey. Basic Visual Processes and Learning Disability. Gerald Leisman (end.). Springfield: Charles C Thomas, 1976, 439 pp. Price: