Internal Climate of State Hospitals: a Multisystem Multimethod Analysis

When I began my doctoral studies in the Fall of 1988 I had just assumed duties as superintendent of a state hospital in Oklahoma. Very few people think state hospitals are of any value to society. Judges commit people to state hospitals sometimes as an alternative to jail. At the same time judges commit patients indefinitely, federal and state authorities implement policy to reduce inpatient beds, and advocacy groups may file law suits to support the right to refuse treatment. These mixed messages can make the work in these facilities frustrating.This research project focused on the attitudes and behaviors of staff and patients within the social group in five wards two state hospitals in Oklahoma. These wards were selected to represent two different but typical programs of service to adults with serious and debilitating mental illness. The wards were similar in size, staffing,and other ward characteristics. The objectives of the research was to identify and evaluate relationships between selected climate and work group variables, and make practical recommendations for administrators to consider as they go about the day to day work of manag1ng change. For this field study, the type of research used was descriptive, correlational, causalcomparative.Five wards with specific program characteristics were selected to narrow the focus of the multisystem, multimethod approach, and to efficiently manage a large number of variables. One thing that administrators know is that every patient, employee and work group is slightly different from another. In the day to day work environment it is difficult to know how these differences may shape the organization. Although we may think that something is this or that way from our experience, carefully collected and analyzed information may provide surprising insights to help us be more effective leaders. I hope that this study will contribute to our knowledge of state hospitals so that wecan improve both the quality of care and the quality of life.Home Economic

Evidence-Based Guidance for Culturally Sensitive Assessment and Interventions for Perinatal Depression in Black American Women

Purpose: This article provides a review of published evidence-based guidance about culturally sensitive assessment and treatment intervention strategies addressing perinatal depression in black American women. Culturally sensitive approaches focus more on the woman’s environment than on her race and thus may improve access to treatment for perinatal depression by increasing health literacy. Methods: The authors abstracted evidence-based guidance from articles published between November 2005 and September 2011, including only articles specifically analyzing a discrete sample of black American women during pregnancy or within 6 months postpartum. They also examined research on unique cultural characteristics of black American women. To obtain relevant studies, the authors searched for research literature indexed in PubMed, using key terms associated with 2 systematic reviews of prevalence and risk factors for perinatal depression and additional keywords as used in the articles found. They abstracted the focus, design and methods, population, and results for each article in a table; discussed the findings; and suggested assessment and intervention strategies based on the studies’ results. Findings: Sixteen articles from 13 journals provide compelling evidence of culture-based risk factors for perinatal depression for black American women and information to guide culturally sensitive assessments and interventions. The literature provides a rich compendium of relevant and useful implications for clinical practice in assessing and addressing depression among pregnant black American women. Conclusions: Primary care providers may want to incorporate culturally sensitive screening questions to early identify and facilitate treatment interventions for depressive symptoms in their pregnant black American patients

Cost-Effective Osteopathic Manipulative Medicine: A Literature Review of Cost-Effectiveness Analyses for Osteopathic Manipulative Treatment

Despite the value that osteopathic manipulative medicine (OMM) may offer to healthcare consumers in a managed care, evidence-based healthcare system, very little research has been published on the cost-effectiveness of osteopathic manipulative treatment compared with outer treatment modalities. The authors searched MEDLINE and OSTMED for English-language articles published between January 1966 and June 2002 using the key terms cost-effectiveness, osteopathic medicine, workers\u27 compensation, hospital length of stay, healthcare providers, and manipulative medicine. The authors then extended their search by reviewing the reference lists provided in the articles initially identified as relevant by these databases. The purpose, methods, findings, and conclusions of each study were evaluated for how the cost-effectiveness of OMM was analyzed. The authors conclude that the osteopathic medical profession needs to conduct and publish research that is consistent with current practices in the conventional medical literature