Richard M. Yarvis

Test-Taking and the Stability of Adjustment Scales

Nonpatient responses to five major adjustment scales were examined at three time-points, two weeks apart. There was no evidence for a systematic increase in adjustment scores due to completing the instruments. Internal consistency coefficients and test-retest stability coefficients for the five adjustment scales show them to have utility for assessing patient groups. Only the SCL-90 showed promise for allowing reliable assessment of individual change over time. All five scales significantly discriminate patient groups from groups of nonpatients. Further research is needed to clarify present results, to determine the clinical significance of various magnitude changes on the scales, and to develop more specific measures of adjustment and symptomatology.

Impulsiveness, impulsive aggression, personality disorder, and spousal violence.

Impulsiveness has become a key concept in thinking about the determinants of violence and aggression. In this study of spouse abusers, the relationship between impulsiveness, impulsive aggression, and physical violence is confirmed. Impulsiveness and impulsive aggression have significant correlations with physical aggression. Impulsiveness and impulsive aggression are also correlated with measures of Borderline Personality Disorder and Antisocial Personality Disorder. In addition, the measures of Borderline and Antisocial Personality Disorder (PD) are significantly correlated with physical aggression. The violent and non-violent groups differed on impulsive aggression and on Borderline Personality Disorder. A partial replication of Tweed and Dutton’s findings (1998) revealed sub-groups of high- and low-violence men. The high-violence group was very different from the low-violent and the non-violent groups. The high-violence group had higher pathology scores on all clinical scales, except Mania, of the Personality Assessment Inventory. These findings have implications for violence prediction and for treatment of violent men.

Stressful life events and community mental health center patients.

This paper reports on the occurrence of stressful life events prior to treatment and at a follow-up timepoint in a general sample of community mental health center patients. Life events scores from the patients, at both timepoints, are compared with scores from a nonpatient sample drawn from the community. Results indicate that patients before entering treatment tend to experience more events (particularly undesirable ones that could be confounded with psychological condition) than nonpatients. The result is no longer true at the follow-up time point. Findings regarding life events and patienthood are basically the same whether all events are used (i.e., the change score) or undesirable events alone. If, however, only events judged to be unconfounded with psychological condition are considered, we find no difference between patients and nonpatients at either timepoint. Implications of the studys results for the direction-of-effect issue with respect to the stress-psychological disorder relationship are discussed.

Deinstitutionalization—The Sacramento story

Abstract Sacramento Countys approach to deinstitutionalization was to devise a system of care for those persons in need of ongoing support so as to enable them to develop their own resources and achieve their potential. Community based treatment programs enhance the persons independence because they permit the development of supportive relationships with family and friends. Provision of a continuum of services and a variety of residential options creates a maximum flexibility toward meeting the needs a person may have at any given time. The success of our programs has been directly related to our ability to apply the principles of good community mental health planning. It is important, however, to remember that changes in human services are not accomplished simply by scientific fact. They also depend upon the economy and the political scene. New and innovative human service programs are easier to adopt in times of inflation and easy money when liberal politics hold sway. They suffer during periods of economic depression and conservative politics. An example of this is the early 20th century health center movement. It grew out of the effort of those who operated settlement houses and was based on the principles of: (1) district location or accessibility, (2) preventive goals rather than direct care, (3) community participation, and (4) bureaucratic organization rather than solo practice. It was surprisingly similar to the Community Mental Health movement. It held promise and was achieving support, but came to an early demise with the shift to conservative politics and economic depression that followed World War I. Those of us committed to community-based treatment of the mentally ill need to be able to demonstrate that we have more than optimism and hope to offer and that deinstitutionalization of the chronically mentally ill can be accomplished.

Let's quit stalling and do program evaluation

Five issues have been identified as major impediments to program evaluation. Examination of these issues shows many of them to be resolved in the process of conducting evaluations. It is asserted that only by implementing evaluations will the field move foreward. At the present time much energy is wasted discussing or arguing the five issues and the ideal approach to making program evaluations. Examples are provided from ongoing evaluations that show how the issues are resolved.Five issues have been identified as major impediments to program evaluation. Examination of these issues shows many of them to be resolved in the process of conducting evaluations. It is asserted that only by implementing evaluations will the field move foreward. At the present time much energy is wasted discussing or arguing the five issues and the ideal approach to making program evaluations. Examples are provided from ongoing evaluations that show how the issues are resolved.

Secondary prevention: Serendipitous therapeutic effects for parents of child patients

Documentation of results of treatment in the community mental health centers is necessary in order to maintain the continuation of funding. Short-term treatment of children in such a setting was examined along with its effects on one parent in the family. The sample consisted of 241 children and 222 parents. An adaptation of the National Center of Health Statistics General Well-Being Scale was used in order to assess change in children and parents. There were significant increases in general well-being in both groups. The parents, as well as the children, benefited from therapy, regardless of whether or not they, themselves, received any treatment. Therefore, therapeutic intervention in one family member has been shown to have an effect on at least one other family member.

Child therapy outcome in a community mental health center

Studies by the Davis Child Therapy Effectiveness Project reveal that brief therapy is the norm. A retrospective outcome study in one mental health center shows a large proportion of adjustment reactions. Outcome ratings from therapists, parents and patients show fairly high levels of outcome and significant improvement in rated impairment. The children who were more impaired at intake were found to have the most visits and numbers of visits were unrelated to success in treatment. Examples are provided illustrating the use of parent responses to modify center practices.