published_or_final_version / Psychology / Master / Master of Philosophy

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This study explored the experiences of street-involved youth who have received mental health services for symptoms of methamphetamine-induced psychosis. Specifically, the study investigated what factors were perceived by participants to promote and hinder access to mental health services. The researcher interviewed nine street youth at Covenant House, a Vancouver agency serving street-involved youth. Interview data and the researcher's field notes were coded and analyzed within a grounded theory paradigm. Youth discussed formal and informal sources of help and routes to both. Two distinct perspectives to treatment were identified: an addictions perspective and a concurrent disorders perspective. Respondents outlined the typical pathway into methamphetamine use and described barriers and supports for accessing services while undergoing drug-induced psychosis. Significant factors that encouraged access to services were positive relationships with helpers, strong peer supports, and the use of involuntary services when necessary. Identified barriers included fear of being stigmatized, lack of problem awareness, and systemic barriers. The current research proposed a model of access to mental health services that positions outreach and frontline workers as key figures to mediating street youth's access to appropriate services.

There are four main components in this thesis: a literature review of program evaluation, a description and discussion of the current status of program evaluation in the crisis intervention literature, results and discussion of the formative evaluation which is the primary element of the thesis, and a report on the use of the Goal Attainment Follow-up Guide (GAFG) (Kiresuk & Sherman, 1968) and the Brief Derogatis Psychiatric Rating Scale (B-DPRS) (Derogatis, 1978) for community-based mobile crisis intervention programs. The data for the evaluation were gathered using both quantative and qualitative methods. There were 150 participants in the study: 89 females and 61 males. The mean age was 35. The GAFG was completed by 81 of the participants; 33 of the participants were administred the B-DPRS. There were three major findings in this evaluation. the participants contacted significantly more community agencies and spent less time in hospital after using the crisis program and the GAFG and B-DPRS were found to be unsuitable as outcome instruments for a community-based mobile crisis program. / xv, 208 leaves : ill. ; 28 cm.

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This research examined the effects of supervisor and subordinate biological sex and race on supervisory referrals to an EAP. The study tested Bayer and Gerstein's (1988a) similarity hypothesis from their Bystander-Equity Model of EAP Helping Behaviors. Four specific hypotheses were generated: 1) Female supervisors will more likely refer female subordinates than male subordinates to EAPs; 2) Male supervisors will refer equal numbers of female and male subordinates to EAPs; 3) Supervisors will refer more troubled workers of their own race than troubled workers of another race; and 4) Caucasian male supervisors will be the most likely to refer persons who are different from themselves (in terms of sex and race) to EAPs.Supervisors employed by a large southwestern County government who made referrals to their "inhouse" EAP were participants in this study. The sample included 146 supervisors who made 188 EAP referrals.A log-linear analysis that controlled for the sex and racial composition of the supervisors' subordinates was used to test the hypotheses. The independent variables were race (Caucasian, African American, & Hispanic) and sex (male & female) of the supervisors and their subordinates. The dependent variable was whether the subordinate was referred to the EAP or not. None of the hypotheses received support. Too few ethnic supervisors referred to the EAP to adequately test the race hypotheses (Hypotheses 3 & 4). Male and female supervisors were equally likely to refer male and female subordinates to the EAP.While none of the hypotheses received support, there were some interesting significant trends involving the employees' race and supervisors' sex. Hispanic subordinates were most likely to be referred to their EAP, and African-American subordinates were least likely to be referred. While Caucasian male supervisors followed this pattern, Caucasian female supervisors demonstrated an even stronger bias in this regard. Implications of these findings were discussed. / Department of Counseling Psychology and Guidance Services

The purpose of this study was to assess the sources of referrals of children with psychological instabilities and the types of problems referred for treatment to the Five County Mental Health Clinic in Warsaw, Indiana.The research was planned to answer two questions: (1) Will the distribution of referral sources be the same for five comparable counties? (2) Will a similar occurrence of delinquent and neurotic behavior be recognized and referred for treatment ineach county?The research was based on the records of 461 children representing all the referrals made to the Clinic in 1973 and 1974. The chi-square test was used to measure factual data quantitatively and to determine significant differences in observed and expected occurrences.The findings show that similar professional groups in comparable counties varied significantly in their utilization of clinic services. No epidemiological studies were done to account for these differences in the sources of referrals from one county to another. It is hypothesized that a difference in knowledge of available services and necessary procedure for establishing contactwith the clinic, a need for specific mental health information to aid in the detection of childhood maladjustments, and stigma attached to psychiatric help are responsible factors.Secondly, the research revealed that unique county characteristics did not influence reasons for referrals to the clinic significantly. For example, one might have expected Kosciusko County, which received national attention as a source of a wild marijuana crop, to show more referrals for drug abuse. This assumption was not supported.Additional examination of the findings also pointed out the need for creating an awareness of the importance of earlier detection and treatment of emotional instabilities. Clinical experience indicates that prognosis is more favorable the earlier a psychiatric problem is treated. This data, however, showed that about one-half of the referred children were in their teens before professional assistance was explored.Finally, the groups of caregivers such as physicians, guidance counselors, ministers, courts, and social welfare agencies who referred few children were isolated in this study. Strengthening appropriate communication channels with these professionals and agencies could increase the effectiveness of the consultative services provided by the clinic and more adequately fulfill regional needs.Since a caregivers's decision to make a referral is a high subjective one and may be threatening to this individual in terms of reflecting his professional competency, the consultative services provided by the clinic are of vital importance.

While it is well known that multicultural issues have garnered recent prevalence in the field of counseling, the concerns faced by Native Americans continue to be under researched (Garrett & Pinchette, 2000). Although there are now several multicultural competency measures that are continuously undergoing validation research (see review by Constantine & Ladany, 2001; Ponterotto, Reiger, Barrett, & Sparks, 1994;) these instruments fail to consider specific counseling competencies when providing psychological services to Native American clients, their families, and communities. The purpose of this study was to identify the multicultural competencies a mental health professional should possess when working with Native American clients. These competencies were identified via the Delphi technique and qualitative methods were utilized to analyze the data. A panel of three expert checkers was used to reduce researcher bias when summarizing and interpreting each Delphi Round. Nominations for a panel of experts were solicited from the APA Monitor, counseling and psychology list serves (both national and local), anthropology list serves, personal contacts, and via nominations, self or other. Invitation letters were sent to those who expressed interest in the project and a final panel of thirteen experts agreed to participate in the project. Over the course of two years, only one panelist dropped out of the project. Three Delphi Rounds were completed and the results yielded numerous areas for consideration when assessing a mental health professional's competency when working with Native American clients. These included an understanding of heterogeneity amongst and between Native Americans, understanding historical and socio-political factors that influence the counseling process, and a demonstration of core counseling competencies necessary for any successful therapeutic course of treatment. The panel's consensus was that construction of a scale measuring counseling competencies with Native American clients was not feasible. Instead, several areas for further investigation were offered as well as more qualitative forms of investigation in the area of assessing counseling competencies when helping Native American clients. Theoretical, empirical, and applied implications are offered in an effort to further define the meaning of cultural competencies when assisting Native American mental health clients. / Department of Counseling Psychology and Guidance Services

Clinicians are often required to make judgments regarding clients on the basis of relatively limited information. These judgments can have a substantial effect on the client's own self-perception and on the perceptions of others about the client. This study was designed to investigate the effect of demographic information on clinical judgments.A preliminary study was utilized to determine which demographic variables to vary in the demographic combination presented in the case study. A cluster analysis found that undergraduates reported differences in their perceptions of demographic combinations based on the age and socioeconomic status which was included. As only one part of the demographic combination was to be varied, age was selected.In the main study, graduate student clinicians were presented a case study. The gender, race and socioeconomic status of the client presented in the case study remained constant while the age of the client was varied. Half of the students received a case study where the demographic information represented a 74 year old and half received a case study where the demographic information represented a 35 year old. It was hypothesized that graduate student clinicians' ratings would vary based on the age of the client presented.In addition, it was hypothesized that placing demographic information at the beginning of the case study would result in different ratings than when demographic information was placed at the end of the case study. Half of those presented with the 74 year old client demographic information received that information early in the case study and half received that information near the end of the case study. The same manipulation was made for those presented with the demographic information representative of the 35 year old client.It was also hypothesized that those without demographic information would rate clients differently than those with demographic information. None of the hypotheses were supported; however, an effect for the time of rating was found. Later ratings were found to be more lenient than earlier ratings. Clinical implications and suggestions for future research are discussed. / Department of Counseling Psychology and Guidance Services

This study explored the experiences of street-involved youth who have received mental health services for symptoms of methamphetamine-induced psychosis. Specifically, the study investigated what factors were perceived by participants to promote and hinder access to mental health services. The researcher interviewed nine street youth at Covenant House, a Vancouver agency serving street-involved youth. Interview data and the researcher's field notes were coded and analyzed within a grounded theory paradigm. Youth discussed formal and informal sources of help and routes to both. Two distinct perspectives to treatment were identified: an addictions perspective and a concurrent disorders perspective. Respondents outlined the typical pathway into methamphetamine use and described barriers and supports for accessing services while undergoing drug-induced psychosis. Significant factors that encouraged access to services were positive relationships with helpers, strong peer supports, and the use of involuntary services when necessary. Identified barriers included fear of being stigmatized, lack of problem awareness, and systemic barriers. The current research proposed a model of access to mental health services that positions outreach and frontline workers as key figures to mediating street youth's access to appropriate services.