Robert F. Hill

Family Preservation and Family Support Programs: Child Maltreatment Outcomes across Client Risk Levels and Program Types.

OBJECTIVES This study evaluated client-level outcomes among an entire statewide group of Family Preservation and Family Support (FPFS) programs funded under PL 103-66. METHOD A total of 1,601 clients (primarily low income, moderate to high risk with no current involvement in the child protection system) were assessed and followed over time for future child maltreatment events reported to Child Protective Services. The study compared program completers with program dropouts, compared recipients of more lengthy full-service programs with recipients of one-time services, and examined the effects of program duration, intensity, service site (center-based vs. home based) and service model/content. Effects were modeled using survival analysis and variable-exposure Poisson hierarchical models, controlling for initial client risk levels and removing failure events because of surveillance bias. Changes in lifestyle, economic and risk factors were also examined. RESULTS A total of 198 (12.2%) participants had at least one defined failure event over a median follow-up period of 1.6 years. Controlling for risk and receipt of outside services, program completers did not differ from program dropouts or from recipients of one-time services, and there was no relationship between program intensity or duration and outcomes. Program types designed to help families meet basic concrete needs and programs using mentoring approaches were found to be more effective than parenting and child development oriented programming, and center-based services were found to be more effective than home-based services, especially among higher risk parents. CONCLUSIONS The findings did not support the effectiveness of these services in preventing future maltreatment cases, and raised questions about a number of common family support assumptions regarding the superiority of home-visiting based and parent training services. A number of possible reasons for this are explored.

ADOLESCENCE AND OLD AGE, PART II: MEDICALIZATION AND MEDICAL SPECIALISTS

In this second of a two‐part series of articles, we describe adolescence and old age as medicalized, culture‐bound syndromes in the American health care delivery system. Each of these pathological age groupings is characterized by its own distinctive, but surprisingly overlapping, diagnostic mix, medical specialists, and professional evolutionary milestones during the past half century.

PA and MD—Some parallels with clinical psychology and psychiatry☆

This paper compares the physicians associate (PA)--primary care physician (MD) relationship with that of the clinical psychologist (Ph.D.)--psychiatrist (MD) relationship. It explores the manifest and latent, explicit and implicit, instrumental and expressive, and conscious and unconscious issues which affect the division of labor within each of these professional pairs. The greater historical depth of the psychologist--psychiatrist relationship is explored to offer a perspective on the direction in which the professional identity of the PA is moving, and likewise that of the PA--MD relationship. In both cases, it is argued that the basis for the homeostasis of role complementarity is overdetermined by unconscious issues which role partners bring to the relationship.