Field Of Community Mental Health Research Articles

Multiple stakeholders' perspectives on patient and public involvement in community mental health services research: A qualitative analysis.

BackgroundPatient and public involvement (PPI) has become essential in health research. However, little is known about multiple stakeholders' perspectives on the implementation of PPI in community mental health research settings. The present study aimed to qualitatively analyse multiple stakeholders' views on PPI, including potential concerns, barriers and approaches.MethodsThis study involved conducting focus group interviews and collecting qualitative data from 37 participants in multiple stakeholder groups (patients = 6, caregivers = 5, service providers = 7, government staff = 5 and researchers = 14) in the community mental health field. The data were qualitatively analysed using a data‐driven approach that derived domains, themes and subthemes related to perspectives on PPI and to specific challenges and approaches for implementing PPI.ResultsThe qualitative analysis identified four domains. The ‘Positive views and expectations regarding PPI’ domain consisted of themes related to supportive views of PPI in a mental health service research setting and improvements in the quality of research and service. The ‘General concerns about PPI’ domain included themes concerning the need for non‐PPI research and tokenism, excessive expectations concerning social changes and use of evidence from PPI research, and heavy burdens resulting from PPI. The ‘Specific issues regarding the implementation of PPI’ domain consisted of four themes, including academic systems, selection methods (e.g., representativeness and conflict of interest issues), relationship building, and ambiguous PPI criteria. In particular, all stakeholder groups expressed concerns about relational equality during PPI implementation in Japan. The ‘Approaches to PPI implementation’ domain included themes such as facilitating mutual understanding, creating a tolerant atmosphere, establishing PPI support systems (e.g., training, ethics and human resource matching) and empowering patient organizations.ConclusionThe study replicated most of the barriers and approaches to PPI reported by qualitative research in Western counties. However, utilization of evidence produced by PPI research and partnership in the PPI process may be particularly serious issues in Japan. Future PPI studies should carefully address solutions that fit each culture.Patient or Public ContributionA patient‐researcher was involved in all stages of this project, from development of the research topic and the protocol to manuscript preparation.

Building organizational readiness: initial field testing of an expert-informed typology of implementation strategies

BackgroundOrganizational readiness is a known barrier to implementing evidence-based practices (EBPs) in community mental health services. A robust methodology for enhancing organizational readiness for implementation (ORI) has the potential to improve implementation outcomes of EBPs and ensure better services for people with a psychiatric disability. Prior work established a framework of implementation strategies targeting ORI enhancement by asking a group of implementation experts from various fields to categorize strategies from the “Expert Recommendations for Implementing Change” (ERIC) Project into three readiness stages, consistent with the pre-action stages of the Transtheoretical Model of behavioral change: Pre-contemplation, Contemplation, and Preparation. The current study provides initial confirmation and refinement to this expert-driven typology based on community mental health field experiences.MethodsWe conducted in-depth interviews with stakeholders involved in a recent EBP implementation project. Participants included staff (n=9) from four community mental health agencies and the implementation team who facilitated the project (n=3). Their pre-implementation experiences were compared with the experts’ typology to identify consistencies and discrepancies.ResultsThe participants’ experiences were congruent with two thirds of the strategies identified by the experts for specific ORI stages. The refinements included 12 strategies used in additional stages beyond the experts’ classification, four strategies from the ERIC list that were not included in the ORI typology, and five new strategies.ConclusionsThis study provides initial confirmation and refinements to the previously published ORI typology. The results offer guidance as to how ORI could be enhanced in the community mental health field.

Consensus development of priority outcome domains for community mental health cares by multiple stakeholders: Protocol for an online Delphi study in Japan.

BackgroundTreatment goals for mental illness have expanded from hospital discharge and improved functioning to employment, living alone, and personal realization. These changes in treatment goals have also influenced mental health research. Recent studies have addressed the development of core outcome sets focusing on clinical aspects of mental illness such as depression and anxiety. However, a well‐developed framework of essential outcomes for people with mental illness (service users) who live in the community is lacking. In addition, recent worldwide trends suggest more patient and public involvement and the importance of considering multiple stakeholders’ views in the area of mental health research. Purpose of this study is to explore consensus on high‐priority outcome domains among multiple stakeholders in community mental healthcare fields in Japan.MethodsA three‐step approach to developing an outcome list will be used. First, we developed a long list of outcomes for community mental health through a literature review, focus group interviews with key stakeholders, and online questionnaire surveys of service users and caregivers. Second, the long list was checked and revised in a pilot study. Third, the long list will be shortened to the outcome list through the Delphi methodology with participation from multiple stakeholders.DiscussionIdentifying important common outcome domains through collaboration with multiple stakeholders appears to contribute to the development of evidence for community mental health research in Japan. In addition, the study process itself may help promote patient and public involvement in education, practice, and research in the field of community mental health.

Ready to roll: Strategies and actions to enhance organizational readiness for implementation in community mental health.

Organizational readiness for implementation (ORI) is a barrier to disseminating recovery-oriented evidence-based practices for people with severe mental illnesses. However, there is a knowledge gap regarding implementation strategies and specific actions related to those strategies that may enhance ORI across organizations. The Transtheoretical Model (TTM) is a well-established stage-based model used to support organizational change. In TTM, the first three stages-Pre-contemplation, Contemplation, and Preparation-represent the pre-implementation phase, during which ORI should be developed. This study explored ORI enhancement strategies reported as useful by different stakeholders in the field of community mental health (CMH) and tested the applicability of the TTM readiness stages as an organizing framework to direct ORI development. The study included the following two phases: (1) a qualitative exploration of ORI enhancement actions reported by various stakeholders in the CMH field (N = 16) based on their experience in successful implementation projects and (2) a consolidation process performed by the research team to create coherent groups of actions and their overarching implementation strategies per readiness stage. A comprehensive list of strategies and related actions was created. The strategies and actions correspond with each of the first three stages of the TTM. Stakeholders differed in their methods of facilitating engagement across the organization and in their level of involvement in developing ORI. This study is a first step in conceptualizing a systematic process for developing ORI using the TTM as a theoretical framework. Future studies should test the transferability and effectiveness of this repository to other implementation efforts, expend the lists per stage, and further explore differences between stakeholders' role in ORI development. Interventions that were proven effective in supporting the recovery of people with mental illnesses are not sufficiently available in the field of community mental health. One barrier to getting those interventions implemented is the lack of willingness and preparedness of organizations to change their practice, also referred to as organizational readiness for implementation (ORI). Little is known about how to enhance ORI to increase the availability of interventions. This study explored actions used to enhance ORI by people in different roles who successfully implemented new recovery-oriented interventions in community mental health settings. The actions were organized into three stages of readiness development based on the Transtheoretical Model (TTM) of behavioral change. Differences were found between administrators, consultants, supervisors, and providers in the type and number of strategies they described. The results show the applicability of the TTM as an organizing framework for ORI development and provide sets of strategies and specific actions to support different readiness needs across the organization.

Community mental healthcare: new developments and innovative strategies.

The aim of this scoping review was to identify and map the available evidence on recent innovations in community mental healthcare across the globe. This review highlights the different innovative approaches and strategies being currently used in the field of community mental health. Key approaches found in the reviewed studies include collaborative care with the inclusion of peer workers, growing use of e-health and telepsychiatry, improved reforms on national mental health policies and de-institutionalization, modification of outreach models and mental health promotion in the community. The studies reviewed here suggest that continued innovation and implementation of new models and strategies have the potential to reduce the burden of disease and increase the quality of life for patients with mental health issues. Growing body of evidence shows that integrative care is the new standard of care for people with mental illnesses, with necessity of continuity of care from emergency department to community mental health services. Social determinants of rehabilitation and recovery, and peers support remain a new main topic of research in area of treatment of people with severe mental illnesses. E-health tools are becoming prevalent in the processes of promotion, prevention and treatment in mental healthcare.

On‐site pharmacy services now prominent in community mental health facilities

A concept that was largely foreign to the community mental health field a generation ago, on‐site pharmacy services have become an integral component of many facilities' array of services for patients. The nation's largest provider of pharmacy and related services for behavioral health patients announced in December the opening of its 500th facility, capping a two‐decade period of steady growth.

Qualitative Exploration of Trauma Experience and Posttraumatic Support of Community Mental Health Professionals

Background: The study purpose was to describe experience of violence and trauma, needs for support of community mental health professionals (CMHP). Methods: This study had a qualitative descriptive design and qualitative content analysis was used. For data collection, focus group interviews were carried out with 18 CMHP in 3 groups. Results: Data analysis has been extracted in to 5 domains (safety, stress, coping, support, protection), 9 categories (primary trauma, secondary trauma, negative emotion, burnout, workload, ineffective response, trust and understanding, foundation for protection and empowerment) and 14 subcategories. Conclusions: From the findings, we could know it more clearly that the community mental health field is relatively high in the risk of violence, suicide case and death of the subjects. However, the pre- post-response measures for the protection of CMHP who has been violently traumatized were very insufficient. Therefore, it is necessary to prepare psychological emotional support system along with preventive and post-response measures for safety at the individual and institutional level. At the same time, it is important to create a supportive environment at the peer and organizational level. As a results we proposed that rapid preparation of the materialization of emotional support system for CMHP, mandatory application of two-person-one intervention principle, preparation of guidelines for emergency response, improvement of physical environment for safety, improvement of understanding on mental health work of institutional officials and also supervision ability of mental health senior staffs, strengthening education and supervision system for enhancement CMHP’s capacity are necessary.

Who is driving change, and where is it taking us? Interview with an expert.

In addition to providing critical behavioral health services for those with mental health issues and substance use disorders, some Community Mental Health Centers (CMHCs) in the United States have begun integrating primary care services, referred to as "reverse integration". Representing the interests of CMHCs across the United States, the National Council for Behavioral Health (NCBH) represents over 3,000 member organizations delivering mental health and/or addictions treatment and services to roughly 10 million patients and families. This article reflects a recent wide-ranging conversation with Linda Rosenberg, the president and CEO of NCBH. Trained as a social worker, Rosenberg was senior deputy commissioner of the New York State Office of Mental Health prior to joining the NCBH and is a dynamic and high-energy strategist and thought leader in the field of community mental health and integrated care. We discussed issues impacting payment for integrated care, including private equity investment, capitated payment, and the role of risk, and how these market dynamics impact vulnerable populations. For the sake of brevity, we summarize our conversation with Ms. Rosenberg and offer her perspective to integrated care practitioners and researchers who largely operate outside of this world of business built on calculated risks and rewards. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effectiveness of a Decision-Training Aid on Referral Prioritization Capacity

In the community mental health field, occupational therapy students lack the capacity to prioritize referrals effectively. The purpose of this study was to test the effectiveness of a clinical decision-training aid on referral prioritization capacity. A double-blind, parallel-group, randomized controlled trial was conducted using a judgment analysis approach. Each participant used the World Wide Web to prioritize referral sets at baseline, immediate posttest, and 2-wk follow-up. The intervention group was provided with training after baseline testing; control group was purely given instructions to continue with the task. One hundred sixty-five students were randomly allocated to intervention (n = 87) or control (n = 81). Intervention. Written and graphical descriptions were given of an expert consensus standard explaining how referral information should be used to prioritize referrals. Participants' prioritization ratings were correlated with the experts' ratings of the same referrals at each stage of testing, as well as to examine the effect on mean group scores, regression weights, and the lens model indices. At baseline, no differences were found between control and intervention on rating capacity or demographic characteristics. Comparison of the difference in mean correlation baseline scores of the control and intervention group compared with immediate posttest showed a statistically significant result that was maintained at 2-wk follow-up. The effect size was classified as large. At immediate posttest and follow-up, the intervention group improved rating capacity, whereas the control group's capacity remained poor. The results of this study indicate that the decision-training aid has a positive effect on referral prioritization capacity. This freely available, Web-based decision-training aid will be a valuable adjunct to the education of these novice health professionals internationally.

Complex Caring Trajectories in Community Mental Health: Contingencies, Divisions of Labor and Care Coordination

The concept of 'trajectory' refers to the unfolding of individual service users' health and illness experiences, the organization of health and social care work surrounding them and the impact this work has on people involved. Using qualitative data from a study completed in two sites in Wales we first reveal the complex character of trajectories encountered in the community mental health field. We show how these can be shaped by features peculiar to mental ill-health per se, and by features with organizational origins. We then use our data to lay bare true divisions of labor. Mental health professionals featured prominently in our study. We also reveal relatively invisible contributions made by professionals on the periphery, support workers, unpaid lay carers and service users. In examining the significance of our findings we identify particular lessons for mental health practitioners, managers and policymakers sharing concerns for the coordination of care.

Training Novices to Make Expert, Occupationally Focused, Community Mental Health Referral Decisions

Introduction: Currently, British health policy requires services to be prioritised according to an individual's level of need. This is particularly necessary for community mental health services, where referral demand far exceeds service availability. Purpose: The purpose of this study was to use expert occupational therapists' referral prioritisation policies, derived from judgement analysis, to train novices in the skill of referral prioritisation. Method: The therapists' policies chosen were those that supported the occupationally focused practice advocated by the profession. Thirty-seven pre-registration students were asked to prioritise a set of referrals, before and after being trained with graphical and descriptive representations of these experts' policies. Findings: Pre-training, the students overvalued the client's history of violence and undervalued the reason for referral and the client's diagnosis, as compared with the experts. Post-training, the students' policies were better matched to those of the experts. The effect of training was demonstrated through several measures: more accurate prioritisation scores when matched with expert ratings on the same referrals, improved consistency on repeat referrals and higher group agreement. Conclusion: Decision training may be useful in promoting the type of service that aims to target clients' occupational needs in the field of community mental health.

Casting a cold but hopeful eye

Complex systems, rooted in age-old beliefs, and buttressed by powerful interest groups, are notoriously difficult to change. And yet, in a span of only two or three decades, from the early 1960s through the 1980s, the system for “caring” for people with serious mental illness appeared to have been virtually demolished. In the US, the resident population of state mental hospitals plunged from over 500,000 in the 1950s to about one-tenth that figure 50 years later. This transformation, which continues in the US to this day, as in other parts of the world, was the result of a “perfect storm” of independent forces working at a broad range of societal levels. At the highest levels: a) a civil rights movement swept American society, fueled by international conflicts with the totalitarian fascism and communism; b) visionary policy experts, hoping to transform the lives of people with serious mental illness, sought institutional reform; and c) government budgeters, facing increased wages for hospital workers, sought to shave stretched budgets by reducing costly hospital care. At intermediate levels, mental health system managers responsible for designing regional care systems, local facility directors, and clinical managers within such facilities sought to create new programs, train new kinds of professionals, and restructure care so that it would support fuller lives closer to communities where people reside. Finally, clinicians, working directly with clients (and at the same time, trying to preserve their jobs), and clients and their families tried to pilot their way to a new kind of interaction that would allow a freer more dignified life. Thornicroft et al draw on years of practice transforming and being transformed by public mental health systems to sketch their experiences at the intermediate level of this long chain. They center their presentation around “ten key challenges”. The word “challenge” has achieved a remarkable ambiguity in common English parlance, reflecting alternatively an opportunity for triumphant victory and a euphemism for unavoidable failure, with many shades in between. True to both meanings, Thornicroft et al describe the rich possibilities that emerge when people learn from each other, observe how each other adapts to new circumstances, bond in mutual support, and even party in celebration to create “learning communities”. On the darker side, they depict challenges posed by staff anxieties about change and loss of familiar job routines, rigid opposition from threatened interests, reluctant neighbors, and heartless budget cutters at upper levels of government. Their meditation reads as if its authors have briefly come up for air during a battering struggle, to tell us that the road is very rough in places but that mutual support and mutual learning sometimes present unexpected opportunities for success and succor. For all of us, it depicts the bittersweet balance of a social movement between notable progress in the face of great obstacles, and failure to accomplish its overarching goal of allowing people with serious mental illness to experience the same range of opportunities as other members of their communities. The focus on experience is wisely differentiated from that on ethics and on evidence, drawing attention to the murky middle ground of tactics, strategies and policies intended to move things forward through small negotiations, successful persuasions and studied alliances. These “moves” may inspire hope, but typically achieve only partial success. Charles Lindbloom 1 famously described the implementation of public policy as “muddling through”, and Grob and Goldman 2 applaud the quiet successes of small incremental changes. It is remarkable and dispiriting that the very persistence of the field of community mental health is in part attributable to the fact that the huge strides that have been made in basic brain science in recent years have not yielded useful knowledge about the causes of serious mental illness, much less led to its cure. Medical scientific progress has been slow and benefits from the perspective of the clinician or consumer are close to nil. And so the task remains to muddle through, doing the best we can in times which promise no swift biomedical breakthrough. Nevertheless, from year to year, decade to decade, systems seem to get stronger, clinicians are more expert at working in the free setting of the community. Peer support, recovery and other innovations have emerged from clients themselves, and along with practical interventions such as supported employment or assertive community treatment, continue, one can hope, to make things a little bit better. By focusing on these challenges, Thornicroft et al offer a realistic but hopeful vision of what is to be done in the grey world of community mental health. Their counsel echoes that of W.B. Yeats: “Cast a cold eye, on life, on death, Horseman, pass by!”.

Psychology in the Community

SUMMARY I review my 30 years in the community mental health field, emphasizing the personal and historical context that shaped this career. I especially highlight the origins of the values that guided significant career decisions, including family, neighborhood, religious and educational influences. The core guiding value was the belief that public service is both a privilege and an obligation, and that righting social injustice through such service is a noble calling. I trace the evolution of my thoughts and actions reflecting this value, from an early desire to “help children,” through preparation to become a child psychologist, and ultimately to practice in a public community mental health setting and a career dedicated first to primary prevention and then to broader safety net services for those in need. I highlight a corresponding intellectual evolution as well, a progressive change in identity from “clinical psychologist in the community” to community psychologist.

Educating Tomorrow’s Practitioners: Influences on Community Mental Health Occupational Therapy Education

The World Health Organization has identified mental health problems, mental illnesses, and the promotion of mental health as major issues currently facing the global population. This paper identifies several influences in the field of community mental health and explores how influences such as changing demographics, increasing diversity, a recovery paradigm, and workplace mental health issues are influencing the education of occupational therapy students. The authors present examples from the occupational therapy Masters Curriculum of the University of Toronto, Ontario, Canada to stimulate discussion on how internationally recognized frameworks, such as mental health promotion and the International Classification of Functioning can be incorporated in occupational therapy education to prepare students for practice in dynamic, shifting, and new practice environments.

A Comparative Study on Work Satisfaction of PMHNPs in the Hospital and Community

Purpose: The purpose of this study is to evaluate and compare the degrees of work satisfaction of PMHNPs (psychiatric mental health nurse practitioners) working in hospitals, public health centers and community mental health centers. Methods: Data was collected by questionnaire from 173 PMHNPs employed in hospitals and 182 PMHNPs employed in public health centers and community mental health centers. Data was analyzed using 'The Index of Work Satisfaction' developed by Slavitt (1976) et al and modified by Kim(1998). Results: The findings were as follows ; According to the characteristics of subjects, the differences of job satisfaction are significant for age (p=0.0209), degree of education (p=0.0003), income (p=0.0323) and motivation (p=0.0005). In the case of over 10 years* psychiatric career, PMHNPs working in hospitals are more satisfied than PMHNPs working in public health centers and community mental health centers(t=2.34, p=0.0414). PMHNPs working in hospitals shows significant difference in psychiatric career. The mean score of work satisfaction of PMHNPs is 2.75±0.44. Statistically significant differences in scores between PMHNPs working in hospitals and PMHNPs working in public health centers and community mental health centers were detected in two of the subcategories; ’nurse-doctor relationships* and 'interaction'. As a result of an additional analysis considering inhomogeneity of subjects, nurse-doctor relationship is significantly different between groups for motivation(F=6.34, p=0.0123), and interaction is significantly different between groups for age(F=4.41, p=0.0364), psychiatric career(F=4.2l, p=0.0410), income(F=5.19, p=0.0234) and motivation(F=l 1.26, p=0.0009). Conclusion: There are no differences of Work satisfaction between two groups. However, we found that PMHNPs working in community are less satisfied with particularly 'interaction* than PMHNPs working in hospitals. As a result, to improve the quality of mental health care through the management of efficient human resources in the field of community mental health, we should be more concerned about seeking various policies to facilitate effective cooperation systems and supportive interaction among the members of mental health team.

Exploratory Study of the Way Specialist Practitioners Demonstrate Risk Assessment in the Field of Community Mental Health

Exploratory Study of the Way Specialist Practitioners Demonstrate Risk Assessment in the Field of Community Mental Health

Burnout in community mental health nurses: findings from the all-Wales stress study.

Stress and its outcomes are significant problems for mental health workers. Questionnaires were sent to 614 community mental health nurses (CMHNs) in Wales. Three hundred and one responded (49%). Of these, 283 completed the Maslach Burnout Inventory (MBI) (Maslach et al. 1996). Half of those who responded indicated that they were emotionally overextended and exhausted by their work. One quarter of respondents were found to possess negative attitudes towards their clients, and approximately one in seven experienced little or no sense of satisfaction with their work. Working in an urban environment and lacking a supportive line manager were indicators for higher emotional exhaustion. CMHNs were significantly more likely to have negative attitudes towards their clients if they: were male; worked with an elderly care caseload; lacked job security; and had an unsupportive line manager. However, CMHNs who had worked longer within the field of community mental health were more likely to have positive attitudes towards their clients. Those CMHNs who had not completed a specialist postqualifying education course and those who did not hold a supervisory or management position were found to have a lowered sense of personal satisfaction in their work. Those CMHNs who reported that they drank alcohol were more satisfied with their sense of personal accomplishments achieved in their work.

An explanation of the coping strategies used by Community Psychiatric Nurses in Wales

Abstract Six hundred and fourteen Community Psychiatric Nurses (CPNs) were surveyed to estimate the extent to which they used various coping strategies in order to reduce occupation‐related stress. A questionnaire booklet, which included a number of validated measures and the Psychnurse methods of coping questionnaire, were used. ‘Having a stable home life that was separate from work’ and ‘knowing that my life outside of work is healthy, enjoyable and worthwhile’ were methods used most in order to cope with work‐based stress. ‘Through having team supervision’ and ‘by having confidential one to one supervision’ were the methods used the least. The mean overall coping scores were significantly higher for females and those who felt that they had job security. Those people who scored higher on the coping test instrument were significantly more likely to be older and have worked within the field of community mental health for longer. The current drive towards clinical supervision promoted through policy initiatives, appears not to be supported by these findings. The implications for CPN services and for further study are highlighted.

Concept mapping in mental health: uses and adaptations

Concept mapping is a structured method for translating complex qualitative data into a pictorial form that displays the interrelationships among ideas. Over the past ten years, this methodology has been applied to numerous program planning and program evaluation issues in a variety of disciplines. The ability to adapt concept mapping methodology to meet specialized needs and to accommodate external constraints has been demonstrated during this period. This paper describes the use of concept mapping in the field of community mental health. Investigators have used concept mapping for purposes ranging from mental health needs assessment to studying program models and theory. Adaptations to the methodology have been applied to the ways in which the qualitative data are generated, structured, represented, and interpreted. Examples from the mental health literature are presented to illustrate these purposes and adaptations. The contributions and value of concept mapping to the mental health field are discussed.

Time-limited group treatment of children.

SALVATORE LOMONACO, M.D.,* SAUL SCHEIDLINGER, Ph.D.** SETH ARONSON, Psy.*** While the mushrooming recent use of short-term treatment modalities for adults, related, in part at least, to the cost-cutting efforts of the country's managed health care system, is relatively well-known,l the parallel growing practice of time-limited groups for children, has so far not been appropriately covered in child psychotherapy's textbooks. This is especially regrettable since the journal literature suggests a current predominance of these abbreviated child-group approaches in clinical work. Time-limited group treatment will be viewed in this paper as encompassing 8 to 25 sessions over the course of six months. Fewer are intervention, while more are long-term psychotherapy. Historical Precedents The beginnings of clinical psychotherapy groups for children were understandably anchored in the then prevailing broader psychodynamic model of open-ended, and long-term reconstructive interventions.23 These approaches were preceded and accompanied, however, by less intensive psychoeducational kinds of shorter-term group modalities, especially diagnostic groups,4 as well as groups associated with therapeutic camping.5 In the 1950s and 1960s, in tandem with these developments, pediatric hospital wards had employed short-term groups for their child patients.6 Characteristically, ever changing in line with the flux of medical admissions, these groups emphasized cathartic expressions of fears, corrections of anxieties and of distortions, provision of factual information, and, above all, companionship and mutual support.7,8 At about the same time, psychoeducational groups for so-called children-at-risk, made their appearance. Conceptualized within the context of primary prevention, Churchill9 used discussion groups for siblings of hospitalized psychiatric patients aimed at modifying the strains and stresses inherent in such situations. Anthony10 similarly relied on the abbreviated group medium to help children of psychotic parents. Besides offering factual information about the illness, the group sessions were designed to help these children cope with the irrational conduct of their elders, as well as to achieve a degree of distance and of objectivity from the psychotic elements in their lives. In the field of community mental health, time-limited children's groups also emerged during the 1960s as part of the War on Poverty, within the context of crisis intervention. Located in clinics, in schools, and in youth-serving organizations, children-of-divorce groups addressed themselves to offer the millions of affected youths ongoing support through shared information and emotional expression. The sense of a peer communality, coupled with the disavowal of blame for the parental discord, were expected to prevent the emergence of personality pathology.11,12 Through the impetus from related community mental health programs, inner-city schools also developed special groupings for children with learning disabilities and behavioral problems. Self-esteem-enhancing activities, together with the release of feelings, were expected to lead to improvements in children's attitudes and behavior.13 While all of the time-limited group-intervention modalities discussed so far fall into the general category of psychoeducation, the following sparser approaches were more strictly clinical in character. They, thus, entailed specially trained group therapists who worked in clinical settings, with child-patients in small, carefully planned groups to effect repair of diagnosed dysfunctions.14 In the inpatient context, the literature of the 1970s carried only three references that pertained to short-term groups. The first, by Abramson, Hoffman and Johns,lf dealt with an open-ended play group for severely impulsive, hospitalized, elementary school-aged children. The twiceweekly sessions emphasized verbal interventions in response to the content of the play, to group interactions, and to emotional ideations. …