Community Psychology Chapter 16

Perspectives & History What is Community Psychology? This is an approach to mental health that deals with how environmental forces create & alleviate problems. Focus on prevention of problems rather than cure Table 16-1 Principles of Community Psychology (refer to for common questions about this field).

Community Psychology Model Direct attention to the fit between environment & person (good or not good). Emphasize the creation of alternatives through identifying and developing the resources & strengths of community and people (focus on actions directed toward the competencies of the person). Community Psychologists believe that differences between the community are desirable-promote diversity. 3 Concerns defining Community Psychologists: 1)Human resource development 2)Political activity 3)Science

Chronology & Catalyzing Events 1955-Joint Commission on Mental Health & Illness formed. - encouraged development of community mental health concepts & reduction of mental hospitals. - based on belief that psychological distress & development of mental d/o’s were influenced by adverse environmental conditions. President Kennedy “Bold new approach” 1963-Kennedy Bill funded construction of mental health centers.

- Aim: promote the early detection of mental health problems, treat acute disorders, & establish a comprehensive delivery system of services that would prevent “warehousing” of the severe mentally ill. -APA endorsed the desirability of community residents & helped focus attention on community approaches & participation. - Conference 1965 regarded as “official” birth of community psychology. Shortly after conference, Division of Community Psychology organized within APA.

The Community Mental Health Journal & American Journal of Community Psychology began publication. 3 Factors reduced population of mental hospitals: the advent of psychotropic medications, more liberal discharge philosophy, better treatment in mental hospital. Therapy was pushed beyond the reach of the poor and disadvantaged.

Key Concepts- Concept of Community Mental Health Ecological levels of analysis 1955 Joint Commission of Mental Health & Illness: 1) better research into mental health phenomenon 2) broadened who can provide services 3) Mental health services provided in community 4) awareness that mental illness can stem from social problems 5) Federal Government should support recommendations financially

1963 Federal funds provided to help construction & staffing of mental health centers To qualify for these funds CMHC has to provide: 1) inpatient care 2) outpatient care 3) partial hospitalization 4) round the clock emergency service 5) consultation services Others hoped that diagnostic services, rehab services, research, training & evaluation would be included

Early detection & work with community agencies Must remedy individual deficits Reach those who need services & those who are excluded from services Advocacy of social action programs to improve housing, employment, crisis intervention and group therapy.

Concept of prevention Preventative activities will be more efficient & effective than individual tx administered at time of onset of disease or problem. Table 16-2- overview of JOBS program

Primary Prevention Correcting negative conditions before significant problems emerge as a consequence of these conditions. The application of this model necessitates a degree of social change. Secondary Prevention Detecting and correcting problems early. This involves screening large numbers of people, including people who are not seeking help &that do not appear to be at risk.

Tertiary Prevention: Reducing the duration & negative effects of problems after they have occurred. This prevention model often involves rehabilitation. Universal Preventative Interventions: Target’s entire population, interventions may be costly. Selective Preventative Interventions Target subgroups or individuals that have a higher-than-average risk of developing a d/o Indicated Preventative Interventions: Targets high risk individuals for developing the d/o

Empowerment Providing individuals with the sense that they are in control of their own destiny, or enhancing existing feelings of control. Examples include reducing child and spouse abuse, eradicating exploitation of women, migrant workers & elderly, decreasing bias against disabled & mentally ill. Prevention interventions must be collaborative & delivered in a way that avoids paternalistic style that characterizes some traditional therapist-client interventions.

Social intervention concepts Community psychologists seek to restructure roles & social organizations. When the environment is changed it allows people to exert power to make their own decisions.

Methods of intervention and change Consultation: The act by which a person who provides the services to others enlists the help of an expert for the purpose of improving these services. Types of Mental Health Consultation 1) Client-centered case consultation 2) Consultee-centered case consultation 3) Program-centered administrative consultation 4) Consultee-centered administrative consultation

Techniques & Phases: 1) Entry or preparatory phase 2) Beginning or warm-up phase 3) Alternative action phase 4) Termination

Community alternatives to hospitalization Community Lodge: akin to a halfway house where formerly chronic, hospitalized patients can learn independent living skills. Mendota Program: attempt to help “undischargable” patients find jobs, learn trades and shopping skills Day Hospitals

Intervention in early childhood Head Start Program: mid-1960’s President Johnson created Office of Economic Opportunity. This program targets disadvantaged children. Prepares preschool children for elementary school

Self-help 8 Primary functions of self-help groups: 1. Provide emotional support to members 2. Provide role models 3. Provide ways of understanding members 4. Provide important & relevant information 5. Provide new ideas about how to cope with existing problems 6.give members opportunity to help other members 7. Provide social companionship 8. Give members increased sense of mastery & control over their problems.

Paraprofessionals Person with no formal clinical training who have been trained to assist professional mental health workers. The use of these people has been growing in the community and the results of meta-analysis show that paraprofessionals can be as effective as professionals.

Questions of effectiveness Many prevention programs have been shown to be effective and cost efficient, and the consultation appears to be effective as well.

Values, power, and civil rights It is hoped that the individual practitioner & the community-oriented advocate will each carefully examine the potential for both harm and good that is inherent in their positions.

The training of community psychologists Multidisciplinary orientation, community psychology has not identified theoretical framework. Should have solid background in sociology, nursing, social work, public health, epidemiology, medicine, or clinical/community psychology. Training in the design of interventions Practicum or internship training in prevention.

The age of managed care Emphasis on prevention of mental health problems & initial reports indicating the cost-effectiveness of prevention, community psychology is likely to play a primary role in designing and implementing interventions that will be recommended and financially supported by managed care companies.

The future of prevention Future looks bright! Need for more community psychologists and prevention field specialists to be trained in the future. Likely that more interventions & programs designed and implemented by community psychologists will be recommended & financially supported by managed care companies in the future.