Alcohol and Other Drug Problems in Older Adults

SUMMARY

While there is considerable awareness and knowledge on the part of the health and human service community on the problems of the misuse and abuse of alcohol and other drugs in the general population, this unfortunately often does not extend to older adults, those who are 60+. Problems with alcohol and other drugs in older persons is in itself not a sudden crisis or new problem. However, as with any health problem affecting a specific demographic group, when the problem is not recognized and appropriately dealt with the repercussions pose greater risks for the individuals with the problem as well as for the larger community. This is particularly true in regard to older adults where natural physical changes and increased age related health risks can only be exacerbated by the misuse and abuse of substances.     

Community Building with Technology

Abstract

This article describes the creation and development of community technology initiatives in Lowell, Massachusetts, a historically poor and ethnically diverse mid-size city. In the past two years, many organizations have joined in community-wide efforts to share information and resources electronically and to launch new electronic technology projects. Recent initiatives include a comprehensive computerized public database of area-wide health and human service programs, a centralized multi-purpose community Web site, and a new inter-agency community technology collaborative. This article reviews these activities and describes general lessons learned in electronic community building that may apply to other communities.     

Doctoral Education in Clinical-Community Psychology

SUMMARY

This paper provides an overview of doctoral clinical-community psychology programs and highlights some possible future directions in training. Clinical-community doctoral programs were categorized as: (1) formally labeled clinical-community programs, (2) clinical programs with a formal community track, or (3) clinical programs with an informal community emphasis. Many graduates from these programs obtain a basic understanding and appreciation of community psychology through required or elective courses, and through contact with students and faculty involved in community research and action. Those students who focus their research and electives around community psychology obtain a thorough and in-depth training experience in community research and action. Changes precipitated by managed care will challenge current ways that psychological services are provided allowing for more community based, innovative, and preventive approaches for which community psychology training would be particularly useful. Greater flexibility in APA accreditation guidelines provide opportunities for greater flexibility within clinical-community programs. Doctoral programs in clinical-community psychology are positioned to lead the development of a public health and human service approach to doctoral training through the integration of community and clinical psychology.     

Urban planning and mental health

Abstract

Both the product and the process of city planning have been shown to have an influence on mental health. This paper presents a model of the process through which community design characteristics influence mental health. The model emphasizes the importance of local social interaction and physical stimulation, as well as adjustment mechanisms used to dampen stress resulting from undesirable levels of interaction and stimulation. The research on the relationship between four community design characteristics and social interaction, stimulation and mental health is then reviewed. An argument for the importance of citizen participation is also presented, stressing the influence of participation on both sense of control and the development of social support. Commonly employed participation techniques, however, differ in their ability to affect support and control. Neighborhood council programs are identified as having the greatest potential for influencing sense of control and social support. Finally the obstacles to improving community design and specific recommendations for the prevention of environmentally induced mental health problems are presented.     

The Influence of Sexual Orientation on Health Behaviors in Women

SUMMARY

Lesbians may be at risk for poorer health outcomes than heterosexual women because of differential health behaviors and risk factors for disease. Difficulty recruiting representative lesbian populations and a lack of simple, accurate measures of sexual orientation have hindered research about the differential health risks and outcomes faced by lesbian and heterosexual women. The purpose of this article was to (1) examine the relationship between self-chosen sexual orientation labels and other sexual orientation measures and (2) compare the health related behaviors of women of diverse sexual orientations based on simple sexual orientation measures. The participants in this study were women aged 18 to 74 recruited via public announcements in mainstream and minority communities to participate in a randomized trial of breast cancer risk counseling strategies. Sexual orientation, relevant health behaviors and other outcomes related to breast cancer risk and screening were measured. No single measure of sexual behavior or desire appears to accurately measure lesbian sexual orientation. Lesbians were found to participate in mammography and Pap testing at significantly lower levels than bisexuals and heterosexuals. These data add to the growing body of knowledge on lesbian health and point to areas of community action and future research.     

Promoting Methodological Pluralism,Theoretical Diversity and Interdisciplinarity Through a Multi-Leveled Violence Prevention Initiative in South Africa

SUMMARY

Violence prevention within low-income, under-resourced communities presents significant challenges to community development researcher-practitioners seeking to maximize partnerships, resource utilization and overall program effectiveness. This article highlights a South African research and service delivery organization's efforts to develop a violence prevention matrix, premised upon an adaptation of the public health approach and the infusion of a critical, community development praxis. It presents preliminary outcomes of a multi-level pilot application of this matrix in a low-income neighborhood in South Africa, specifically focusing on evaluating its capacity to foster methodological pluralism, theoretical diversity and interdisciplinarity, together with promoting community empowerment and coalition-building strategies.     

The Fort McDowell Yavapai

Abstract

Faced with the loss of their homeland due to a proposed dam, a small American Indian community initially seemed powerless to prevent their relocation. This threat was associated with substantial detrimental impacts on the physical, psychological, and economic functioning of the community and its members. While the proposed dam initially was stopped in 1976, it was resurrected by local political and public pressure following two years of devastating floods affecting a nearby metropolitan area. A federally funded and highly visible study was then commissioned to investigate the impacts of and alternatives to the proposed dam. An independent investigation collected data assessing the psychological impact on the Yavapai community caused by the threat of relocation. As a result of the visibility and attention the Yavapai gained from this study, their role as a politically active pressure group, and their shrewd use of the leverage they gained, the tribal community succeeded in eliminating the proposed dam and the accompanying threat of relocation. The present case illustrates both the process of empowerment as well as the efficacy of a large and thorough scientific study of alternatives for finding a viable option for such divergent interest groups. The political and mental health ramifications of these realities are discussed.     

Breaking Fresh Ground

ABSTRACT

In the present paper, the author introduces her roles and duties at her current job. The author then describes how she got into community psychology and primary prevention and how her graduate school and previous work experiences have influenced her current work. Focusing on primary prevention, the author delineates how the two community psychology concepts -primary prevention and action research -can be applied to the promotion of adolescent mental health in the Korean society. The author then adds advice for foreign students who are considering studying community psychology in the U.S.     

Implementing a Violence Intervention for Inner-City Adolescents

SUMMARY

Violence is a growing public health problem that disproportionately affects African American adolescents. There is a pressing need for more attention to be directed to the development of theoretically-based, research-validated, culturally sensitive preventive interventions and programs. This article focuses on the steps involved in the development, implementation, and evaluation of a culturally-specific program designed to reduce the prevalence of violent behaviors and related injuries and deaths among urban, African American teens. The project's success was heavily dependent upon the commitment and cooperation of the community organizations that participated in the field research. Although numerous unexpected challenges were encountered, the preliminary findings indicate that it is possible to effectively implement preventive interventions in urban communities with modest funding.     

On Becoming a Community Psychologist

Abstract

Recounts the author's professional life history in the context of his personal life story. Reflects on the ways in which history and autobiography combine to create life pathways that are experienced as individually chosen, yet historically determined. Recounts the author's family life, neighborhood experiences, early education in the Philadelphia public schools, and the impact of post-World War II government programs including the GI Bill and the establishment of United States Public Health Service fellowships. Considers the influence of African American writers and the civil rights movement, as well as women returning to school, the culture of medical schools and the influence of mentors in the formation of a professional identity. Recounts the discovery of the community mental health movement and the search for a social justice agenda that led to Community Psychology. Ultimately, the author views himself as an “insider/outsider,” whose personal and professional identity crosses traditional boundaries and welcomes paradoxical, narrative and qualitative approaches to research and practice.     

Effectiveness of a Cancer Education Program for Women Attending Rural Public Health Departments in North Carolina

SUMMARY

The Western North Carolina Cancer Awareness Program (CAP) was a four-year program, funded by the National Cancer Institute, to increase education and support services for the prevention and early detection of breast, cervical, and skin cancer among women receiving care in six rural county public health departments. Three health departments were selected as intervention units, and the remaining three health departments served as comparison units. Women age 20 and older were randomly selected in each health department. Women in the intervention group received a comprehensive health education program that included easy-to-read printed materials and telephone counseling dealing with breast, cervical, and skin cancer. Theoretical guidelines for development of the intervention program included the PRECEDE Model and the Health Belief Model. Overall, the results indicated that personalized education, which includes the combination of readable printed materials and telephone contact, can be effective in increasing some early detection behaviors for breast and skin cancer among women who attend public health departments. The value of telephone counseling as a comparatively inexpensive approach to individualizing health education has significant implications for the development of similar cancer education programs for underserved populations.     

The mental health association and prevention

Summary

The history of the Mental Health Association's involvement in prevention is described. From its inception in 1909 the Association has played a key role in advocating for prevention. It contributed to the Child Guidance Center movement, the community mental health center movement, and helped focus the 1978 President's Commission on Mental Health on prevention. In recent years, it has served as the catalyst for the formation of a coalition of national organizations with an interest in prevention.     

A Research Revolution in Women's Health

SUMMARY

Women's health research initiatives are emerging with evidence that there are unique diagnosis and intervention factors that provide a window into the specific health needs of women. The evidence of the need for this gender-specific research is being spurred by the establishment of The Office of Research on Women's Health by the National Institutes of Health (NIH). A review of some of the more current and salient research findings that apply to women's health and the health needs of women in different lifestyles, at different stages of the life cycle is discussed. Also considered are women's roles in the health service delivery system and where they fit into the provision of services within the context of women's styles of accessing and using health care. Self-help and other support programs will be described as they apply specifically to women and a case will be made for providing comprehensive, multi-systemic women's health services in one facility at the community level through an overview of some of the more current and successful models.     

Reducing Adverse Childhood Experiences (ACE) by Building Community Capacity: A Summary of Washington Family Policy Council Research Findings

Community capacity for organization and collaboration has been shown to be a powerful tool for improving the health and well-being of communities. Since 1994 the Washington State Family Policy Council has supported the development of community capacity in 42 community public health and safety networks. Community networks bring local communities together to restructure natural supports and local resources to meet the needs of families and children, and increase cross-system coordination and flexible funding streams to improve local services and policy. In this study, researchers sought to demonstrate the strong impact of the community networks' capacity to interrupt health and social problems. Findings suggest that community networks reduce health and safety problems for the entire community population. Further, community networks with high community capacity reduced adverse childhood experiences (ACE) in young adults ages 18-34.     

Individual differences in safe behavior: A safety practitioner's viewpoint

SUMMARY

This paper focuses on the school as a setting for community-based prevention of factors that place learners at risk such as poverty, violence, substance abuse, learning difficulties and HIV/AIDS. It examines the development of school-based structures aimed at addressing these issues. The health promoting and inclusive schools approaches are explored as strategies to address these and other barriers to learning.

Reference is made to innovative practice at a school in a disadvantaged community outside of Cape Town. The case study reveals how school-based teams could be utilized to mobilize school communities in generating solutions to the difficulties that they encounter.     

Chapter 9: The Use of Law for Prevention in the Public Interest

Summary

One of the most important functions of law and the legal system is to prevent harm by regulating conduct prospectively. Almost all law—whether in the form of a statute enacted by a legislative body or a judgment decreed by a court—is designed, at least in part, to avoid some socially undesirable future state of affairs. This chapter explores some of the more significant ways in which lawmaking (both legislative and judicial) may be regarded as a form of prevention and the legal system may be used for prevention in the public interest. Although the chapter focuses on litigation and legislation of particular interest to those in the fields of mental health and mental retardation, the legal processes and principles described extend to many other areas of law with implications for promoting health and preventing harm.     

Reactions to collective stress: Correlates of active citizen participation at love canal

Abstract

Events at Love Canal, beginning in the spring of 1978, are described as an environmental crisis leading to acute collective stress. As the crisis unfolded, Love Canal residents’ perceptions of the situation, and the actions they took, were monitored through interviews with a sample of 58 families in fall, 1978. Of these, 39 were reinterviewed in spring, 1979. Among interviewed families, 24 (41%) had at least one “activist” member, someone who became personally involved in a community organization formed to help resolve the crisis. This study compares the social characteristics of “activist families” with “non‐activist families,” their Love Canal‐related problems, sources of help, and general views of the impacts on their personal lives, and on interpersonal relations. Activists relied on government and crisis‐related organizations for help, while non‐activists had more family support. Neither group utilized the mental health services provided by the community's “crisis center.” Activists felt better about themselves, and had a stronger feeling of personal efficacy in affecting government decisions. They perceived that the crisis had brought about positive personal changes, and changes in relations with others. The major implication for intervention is that several different approaches to assisting members of a community in crisis must be undertaken.     

Performance of Breast Self-Exam

SUMMARY

Breast cancer is a significant health threat for women and is currently the second-leading cause of cancer-related deaths in women. When breast cancer is diagnosed early in the disease process, the probability of survival is quite high, but when diagnosis is made at a later stage, mortality increases dramatically. Thus, early detection is crucial, and monthly breast self-exam (BSE) is recommended for all women over the age of 20. Despite this recommendation, adherence to BSE guidelines is quite low. The current study investigated the role of perceived susceptibility to breast cancer as it relates to the performance of BSE among a sample of community women. As hypothesized, a significant interaction between perceived susceptibility and age was found such that perceived susceptibility was significantly positively related to BSE performance for older women but was not related to BSE performance among younger women. Although there are certainly other variables associated with BSE performance, the implications of this particular finding for the design of interventions to increase BSE performance are discussed.     

School Violence Interventions in the Safe Schools/Healthy Students Initiative

Abstract

The Safe Schools/Healthy Students Initiative was designed to encourage collaboration among school districts and local community service providers in the provision of behavioral health prevention and early intervention efforts. These efforts would address the physical safety of students as well as provide mental health, violence prevention, and social skills services. One local SS/HS Initiative brought together community and school collaborators in an ambitious agenda that included 14 distinct programs that addressed the needs of over 110,000 students in a large school district. The purpose of the current paper is to report the results of the evaluation of two of the programs designed to reduce violent and disruptive behavior in schools. The programs include a school-based anger management program and a community-based, alternative-to-suspension program. Working in cooperation with program staff and the school district, quasi-experimental designs were used to measure change over time for students. The two studies demonstrate the application of multiple methodologies in evaluating the effectiveness of prevention and early intervention efforts with the aim of providing data to support program improvement and sustainability.