A brief history of primary prevention in the twentieth century: 1908 to 1980.

While primary prevention is a much talked about and debated topic in contemporary psychology, it has a considerable history. This paper critically traces primary prevention, philosophy and practice, in the 20th century. Beginning with the mental hygiene movement (1908-1960), the paper progresses to examine the child guidance movement (1920-1955), the eugenics movement (1860-1955), the initial era of federal involvement (1930s, 1940s) as well as significant research, events, and legislation in the decades between 1950 and 1980. The paper concludes with a synopsis of the major themes revealed by the review and suggestions for future efforts in prevention.

The training of paraprofessionals as behavior modifiers: a review.

Paraprofessionals are increasingly being employed in the mental health field. While much interest has focused on their roles and functioning, little systematic attention has been devoted to an examination of training practices. Because a particularly compatible relationship may exist between paraprofessionals and the behavioral model of intervention, this review focuses on the training and use of paraprofessionals as behavior modifiers. Paraprofessional populations reviewed include psychiatric aides and nurses, college students, inpatients, and community and indigenous workers. The review concludes that a strong case can be made for the administrative feasibility of training and utilizing diverse groups of paraprofessionals as behavior modifiers. The lack of consistent, solid outcome evidence prohibits a conclusion relative to the effectiveness of these paraprofessionals at this point in time. Numerous researchable questions concerning the effectiveness of various forms of training with paraprofessionals, optimal length of training for various purposes, training resistances, etc., are unanswered. Beyond this, a serious lack of communication of the basic process of training is revealed, and the perhpas questionable roles paraprofessionals are being trained for is discussed.

Assessing a CMHC's impact: resident and gatekeeper awareness of center services.

One accessible measure of the impact a community mental health center has on the community it serves is the awareness levels of both residents and gatekeeper groups regarding the center's existence and services. This broad-based study was conducted with university students at no cost to the center and included 436 residents and 175 gatekeepers. The results indicated that awareness levels for community residents and gatekeeper groups were 34% and 53%, respectively, but varied dramatically as a function of how the awareness questions were phrased. The overall awareness findings generally supported those of other studies and were discussed in light of potential normative levels, methods for conducting surveys of this nature, response rates, and the increasing need to justify existence given the diminishing funding situation.

A comparison of community attitudes toward CMHC services and clients with those of mental hospitals.

Community residents (n = 403) in the East Catchment area of Tucson, Arizona, were interviewed to assess attitudes toward community mental health center (CMHC) services and patients as well as mental hospital services and patients. These residents reported significantly more positive attitudes toward CMHC services than mental hospital services; however, there were no differences in reported attitudes towards CMHC and mental hospital patients. Results are discussed in terms of shifts in community residents' attitudes towards mental health services in general and community-based services in particular. Implications of community attitudes for support of CMHC programs in a time of increasing financial cutbacks are also explored.

Clients' treatment expectations at a community mental health center.

Clients' expectations about mental health care, particularly differences in these expectations as a function of social class, and the relationship of discrepancies between expectations and perceptions to treatment outcome, is examined in this study with 317 Caucasian clients. In contrast to the majority of studies, no differences in treatment expectations relating to clients' social class, sex, or marital status were found. Nor were discrepancies related to course or outcome of therapy. Discussion focuses around explanation and interpretation of these findings. Particularly relevant is the need to determine the extent to which nonusers in the community share the attitudes and expectations of clients.

Client evaluation of community mental health services: relation to demographic and treatment variables.

Community mental health center (CMHC) outpatient clients' satisfaction and perceived problem improvement were assessed by telephoning 108 clients, representing 40% of clients discharged during the period under investigation. The CMHC's services were perceived positively, and most clients were satisfied with their therapy experience, found it helpful, and felt more able to handle future problems. Data on reasons for termination, expected future behavior, and extratherapeutic factors were also gathered. Of particular interest were the findings that satisfaction and improvement were unrelated to client age, sex, marital status, or social class, but significantly more positive outcome responses were found for those clients who terminated therapy with a mutual client--therapist decision as compared to those who terminated unilaterally.

Predicting client improvement from and satisfaction with community mental health center services.

The present study assesses client improvement from and satisfaction with CMHC services, and attempts to examine the presence of positive bias from responders. Results based on questionnaires mailed to 1,000 former clients indicated both high consumer satisfaction and reported improvement attributable to treatment. Responders and nonresponders did not differ on demographic or treatment variables related to post-treatment improvement. A multiple regression analysis was computed and yielded an estimated index of improvement for responders. No differences obtained on this measure between responders and nonresponders, thereby not supporting the presence of a positive bias in this sample. confidence in therapist, satisfaction with the therapeutic relationship, and number of individual sessions were the most positive improvement correlates, with lack of contact and increasing age most negatively related to improvement. Discussion focuses on the implications for generalization of results based on responders' data.

Developing a rural mental health service from a base in an academic clinical psychology program.

The development of a Community Mental Health Service for a multiethnic rural area by an academic psychology department clinical program was carried out for the purpose of providing relevant training for grauate students through realistic service functions. The population served was largely lower socioeconomic, and the available resources very limited. The Community Psychology course was used to assist the planning and negotiating for the clinic. Services provided during the first year are summarized. The graduate students' not-too-happy view of the program is presented. The problems and issues raised by this experience, for both training and service, are discussed.