A Snapshot of Social Support Networks Among Parental Caregivers of Adults with Autism

This study provided a description of types and dimensions of informal and formal social support among aging parental caregivers of adult children diagnosed with autism spectrum disorder (ASD). Parents participated in a web-based survey regarding use of and satisfaction with social support services for parents or their adult children. Results indicated that many parents participated in autism support groups (27.5%), with psychiatric services (48.8%), counseling (40.6%), and financial assistance (39.7%) the most commonly used formal social supports. Emotional support (88.8%) and informational support (67.5%) were the most common informal social supports used. Professionals who are working with parental caregivers and their adult children diagnosed with ASD should be aware of available social support services to help them find needed services.

Mental Health Trainee Facilitation of Sibling Support Groups: Understanding its Influence on Views and Skills of Family-Centered Care

OBJECTIVES

Prior research suggests family-centered interventions are among the least taught yet most needed skills for practicing psychiatry. In this study, we evaluated whether having mental health trainees lead a sibling support group could serve as a method to promote family-centered care among trainees.

METHODS

All trainees in psychiatry, psychology, and social work were invited to participate as sibling support group facilitators. Both facilitator and non-facilitator trainees were then surveyed using a questionnaire inquiring about exposure to family-centered care, comfort level in providing family-centered care, attitudes regarding the importance of family-centered care, and desire to provide family-centered care in the future. A second survey was administered to the facilitator trainees to assess their perceptions of the sibling group leader experience.

RESULTS

Facilitator trainees reported increased engagement in family-centered activities during training (p < 0.05), expressed greater confidence in their family-centered care skills (p < 0.05), and reported stronger intentions to practice in a family-centered way (p < 0.05). Facilitator trainees were overwhelmingly positive about their experience with the sibling support program and reported it strengthened their commitment to addressing the needs of siblings as a part of family-centered care.

CONCLUSIONS

Facilitating a sibling support group may be an effective way for mental health trainees to gain skills and confidence in delivering family-centered care. Mental health training programs aiming to imbue trainees with the importance of family-centered care may consider creating opportunities for trainees to facilitate sibling support groups.

When a parent dies - a systematic review of the effects of support programs for parentally bereaved children and their caregivers

BACKGROUND

The death of a parent is a highly stressful life event for bereaved children. Several studies have shown an increased risk of mental ill-health and psychosocial problems among affected children. The aims of this study were to systematically review studies about effective support interventions for parentally bereaved children and to identify gaps in the research.

METHODS

The review's inclusion criteria were comparative studies with samples of parentally bereaved children. The focus of these studies were assessments of the effects on children of a bereavement support intervention. The intervention was directed towards children 0-18 years; but it could also target the children's remaining parent/caregiver. The study included an outcome measure that dealt with effects of the intervention on children. The following electronic databases were searched up to and including November 2015: PubMed, PsycINFO, Cinahl, PILOTS, ProQuest Sociology (Sociological Abstracts and Social Services Abstracts). The included studies were analysed and summarized based on the following categories: type of intervention, reference and grade of evidence, study population, evaluation design, measure, outcome variable and findings as effect size within and between groups.

RESULTS

One thousand, seven hundred and-six abstracts were examined. Following the selection process, 17 studies were included. The included studies consisted of 15 randomized controlled studies, while one study employed a quasi-experimental and one study a pre-post-test design. Thirteen studies provided strong evidence with regards to the quality of the studies due to the grade criteria; three studies provided fairly strong evidence and one study provided weaker evidence. The included studies were published between 1985 and 2015, with the majority published 2000 onwards. The studies were published within several disciplines such as psychology, social work, medicine and psychiatry, which illustrates that support for bereaved children is relevant for different professions. The interventions were based on various forms of support: group interventions for the children, family interventions, guidance for parents and camp activities for children. In fourteen studies, the interventions were directed at both children and their remaining parents. These studies revealed that when parents are supported, they can demonstrate an enhanced capacity to support their children. In three studies, the interventions were primarily directed at the bereaved children. The results showed positive between group effects both for children and caregivers in several areas, namely large effects for children's traumatic grief and parent's feelings of being supported; medium effects for parental warmth, positive parenting, parent's mental health, grief discussions in the family, and children's health. There were small effects on several outcomes, for example children's post-traumatic stress disorder (PTSD) symptoms, anxiety, depression, self-esteem and behaviour problems. There were studies that did not show effects on some measures, namely depression, present grief, and for the subgroup boys on anxiety, depression, internalizing and externalizing.

CONCLUSIONS

The results indicate that relatively brief interventions can prevent children from developing more severe problems after the loss of a parent, such as traumatic grief and mental health problems. Studies have shown positive effects for both children's and remaining caregiver's health. Further research is required including how best to support younger bereaved children. There is also a need for more empirically rigorous effect studies in this area.

How do recovery definitions distinguish recovering individuals? Five typologies

BACKGROUND

Six percent of American adults say they are "in recovery" from an alcohol or drug problem yet only a scant emergent literature has begun to ask how they define "recovery" or explored whether there is heterogeneity among their definitions.

METHODS

Secondary analysis of the "What is Recovery?" online survey employed latent class analysis (LCA) to identify typologies of study participants based on their actual endorsement of 39 recovery elements and to compare the composition of these typologies in terms of distinguishing personal characteristics.

RESULTS

A five-class solution provided the best fit and conceptual representation for the recovery definitions. Classes were labeled 12-step traditionalist (n=4912); 12-step enthusiast (n=2014); secular (n=980); self-reliant (n=1040); and atypical (n=382) based on patterns of endorsement of the recovery elements. Abstinence, spiritual, and social interaction elements differentiated the classes most (as did age and recovery duration but to a lesser extent). Although levels and patterns of endorsement to the elements varied by class, a rank-ordering of the top 10 elements indicated that four elements were endorsed by all five classes: being honest with myself, handling negative feelings without using, being able to enjoy life, and process of growth and development.

CONCLUSIONS

The results of the LCA demonstrate the diversity of meanings, and varying degrees of identification with, specific elements of recovery. As others have found, multiple constituents are invested in how recovery is defined and this has ramifications for professional, personal, and cultural processes related to how strategies to promote recovery are implemented.

Psychosocial approaches to alcohol use disorders since 1940: a review

OBJECTIVE

A review of psychosocial approaches to alcohol use disorders (AUDs) was performed to identify and contextualize trends in major treatment approaches and special populations and provide possible future directions for alcohol research.

METHOD

The PsycINFO database was searched for peer-reviewed articles relevant to psychosocial approaches to AUDs for each decade since the 1940s, resulting in approximately 4,246 articles for review. Topics were included if they made up at least 4% of the relevant articles for any one decade. Nine treatment and seven special population topics were identified for the current review.

RESULTS

Psychoanalytic/psychodynamic and aversion therapies were major topics in the 1940s and 1950s, but few articles have been published recently. Other topics have shown consistent representation in the literature, including criminal justice and military populations, self-help groups, group therapies, couples and family therapies, behavioral treatments and cognitive-behavioral therapy, and complementary/ alternative treatments. The majority of the specific population topics and two newer treatment approaches have appeared more recently in significant proportions, including adolescents, college students, women, ethnic minorities, and dually diagnosed populations; newer treatments include brief interventions and motivational interviewing approaches.

CONCLUSIONS

The number of articles on psychosocial approaches to AUDs has been increasing since the 1940s. There have been recent surges in alcohol research on specific populations, an increase in the integration of alcohol treatment with primary care, and a continued emphasis on empirically supported and cost-effective treatments for AUDs; these trends likely will continue into the future.

[The characteristics of and social support for pathological gamblers among "pachinko" or "slot" users in Japan]

AIM

In Japan, there are one to two million people suspected of being pathological gamblers according to the definition in DSM-IV-TR. Almost all of them use "pachinko" or "slot," which are gambling stores, throughout Japan, that number 12,000 in total. However, the characteristics and ratio of pathological "pachinko" and "slot" gamblers have not been investigated. The author aimed to determine the characteristics, ratio, and social support available for these users.

METHODS

The author administered an internet survey for users of "pachinko" or "slot." Two hundred and fifty users visited "pachinko" or "slot" stores more than twice a week, and 250 users visited once a week or once a month. The Japanese version of the South Oaks Gambling Screen was administered, and gamblers were asked about their awareness of pathological gambling and the condition of their social support.

RESULTS

The author observed that 70.2% of "pachinko" or "slot" users were suspected pathological gamblers and 28.6% of "pachinko" or "slot" users were severe gamblers. A total of 39.3% of them were aware of their pathological gambling, and 6.5% of users who had awareness of pathological gambling had social support. However, most of their social support consisted of family and friends, and almost none of them attended psychiatric clinics, community health centers, or self-help groups like gamblers anonymous.

CONCLUSION

Almost all "pachinko" or "slot" users were suspected of being pathological or severe gamblers. However, they did not approach psychiatric facilities or self-help groups. The author strongly recommends the need for educational programs in junior or high school to prevent future pathological gambling, and create awareness of the dangers of pathological gambling through TV commercials and "pachinko" or "slot" stores. Pathological gambling is a disease that afflicts many people; hence, psychiatric and social welfare professionals should continue to stress the dangers of and offer prevention programs for "pachinko" or "slot" gambling.

[SOS children: from the beginning to this day S. Godinas et M. Gérard]

Child abuse is a major and critical public health concern. We aim to present the "Abused Children Intervention Program" of the National Office for Childcare, and to delineate the current situation, using our recent experience at the Saint-Pierre's Teaching Hospital in Brussels. The SOS Children teams focus on children protection while providing support for abusing parents. We will notice how a preventive initiative aimed at reducing child abuse can give lead to a specialized structure dealing with abuse situations.

"The impatient patient"

Modern Healthcare Systems that have embraced ICT and Internet technologies (referred to as Health 1.0) are evolving towards self management but from a clinical knowledge perspective. In contrast, from a user experience perspective, and using the latest web 2.0 technologies, the developing healthcare social networking communities (referred to as Health 2.0) are evolving towards becoming online medical portals. The growing Grand Challenge for healthcare is therefore: how will health care services (Health 1.0) work together with user-generated health care (Health 2.0) in a consumer market place delivering self management services for a healthier lifestyle and medical compliance. What is foreseen is that the self care information tool of the future will be a combination between the patient's observation record and the Internet, with the doctor and the patient positioned together at the intersection but not having to pay attention to the technology. This article deals with various aspects related to this Grand Challenge like the paradigm shift towards a needs-led and consumer-oriented healthcare, the role, supply and quality of information and the changing doctor-patient relationship.

I hear, I listen and I care: a qualitative investigation into the function of a self-harm message board

This paper reports on the findings of a qualitative inquiry into the interactions on a nonprofessional self-harm message board. Individuals using the message board were very positive about the message board and appeared to feel that their needs for support, venting, and validation were being met. However, we found that negative harmful behaviors mentioned in messages posted on the board were either not acknowledged, or were legitimized and normalized by those who responded to the messages. We suggest that this process of minimizing the seriousness and/or normalizing the behaviors may actually be encouraging the maintenance of such behaviors and therefore conclude that caution should be exercised when using nonprofessional self-harm message boards.

Expanding community through ARV provision in Thailand

Anti-retrovirals (ARVs) have altered the complexion of HIV/AIDS management in Thailand. In 2005, ARVs were included within a subsidised health scheme making provision widespread. Increased access has been brought about through the legal and political advocacy of the Thai Network for People Living with HIV/AIDS (TNP+) who now play a central role in expanded ARV provision. HIV-infected volunteers help the state deliver comprehensive services and assist with follow-up and adherence programs. Alongside improvements in drug provision, a focus on pharmaceutical treatment has left other issues, such as community support of orphans and the social responses to living with HIV, less central within community responses. As they take on new responsibilities, people living with HIV/AIDS (PLHA) groups move from activities focused on reversing local stigma to constitute a new social movement that is increasingly prominent in Thai civil society. Networks of PLHA confront new social and political challenges as they also seek to broaden access to marginalised groups who remain excluded from these services. Many ethnic minority groups without full Thai citizenship have been denied access to subsidised health services including ARVs. As part of a broadening advocacy profile, the PLHA movement is now engaging in a politics of difference defined not simply by presence or absence of HIV but also by wider issues of national identity and belonging.

A 3-year study of addiction mutual-help group participation following intensive outpatient treatment

BACKGROUND

Addiction-focused mutual-help group participation is associated with better substance use disorder (SUD) treatment outcomes. However, little has been documented regarding which types of mutual-help organizations patients attend, what levels of participation may be beneficial, and which patients, in particular, are more or less likely to participate. Furthermore, much of the evidence supporting the use of these organizations comes from studies examining participation and outcomes concurrently, raising doubts about cause-effect connections, and little is known about influences that may moderate the degree of any general benefit.

METHOD

Alcohol-dependent outpatients (N=227; 27% female; M age=42) enrolled in a randomized-controlled telephone case monitoring trial were assessed at treatment intake and at 1, 2, and 3 years postdischarge. Lagged-panel, hierarchical linear models tested whether mutual-help group participation in the first and second year following treatment predicted subsequent outcomes and whether these effects were moderated by gender, concurrent axis I diagnosis, religious preference, and prior mutual-help experience. Robust regression curve analysis was used to examine dose-response relationships between mutual-help and outcomes.

RESULTS

Mutual-help participation was associated with both greater abstinence and fewer drinks per drinking day and this relationship was not found to be influenced by gender, Axis I diagnosis, religious preference, or prior mutual-help participation. Mutual-help participants attended predominantly Alcoholics Anonymous and tended to be Caucasian, be more educated, have prior mutual-help experience, and have more severe alcohol involvement. Dose-response curve analyses suggested that even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity.

CONCLUSIONS

Use of mutual-help groups following intensive outpatient SUD treatment appears to be beneficial for many different types of patients and even modest levels of participation may be helpful. Future emphasis should be placed on ways to engage individuals with these cost-effective resources over time and to gather and disseminate evidence regarding additional mutual-help organizations.

[Influence of psychological therapy on duration of survival in patients with metastatic cancer]

The work of A. J. Cunningham has created new perspectives for extension of survival through psychological intervention in patients with advanced cancer. Therapeutic techniques exploiting unique subjective psychic and social experiences may be particularly helpful at the time when life of the patient is threatened by an incurable disease. Psychological therapy should be based on an individual plan for living with cancer. Novel qualitative research and therapeutic methods need to be developed.

Group Psychotherapy and Related Helping Groups Today: An Overview

Following an historical summary of the broader group helping field, the article differentiates among clinical group psychotherapy, "therapeutic" groups, human relations and training groups, as well as mutual-help and self-help groups. Twelve major theoretical models of group interventions are delineated, followed by an account of the current status of group treatment theory, practice and research. The role of group interventions in the fields of physical, sexual and substance abuse, chronic illness, and trauma--as in the aftermath of the September 11, 2001 terrorist attacks--are highlighted. A glimpse at the future of group treatments considers the obstacles and prospects occasioned by the managed care "revolution" in mental health.

[An activating state and active citizen groups in the German health care system]

This paper discusses the question, to what extent concepts of an enabling state are realised in the German health policy and wether they meet active citizens with corresponding competencies. The analysis is based on a review of the literature referring to the promotion and development of the self-help movement and citizen participation in the German health care system. The results show, that since 1999 the following enabling health policy measures were adopted: the promotion of independent patient advisory services and shared decision-making, the enactment of participation rules in the rehabilitation system and the compulsory subsidy for self-help groups, self-help organisations and clearing houses for self-help. The active engagement of the citizens both as co-producers of health on the individual level and as participants in processes of communication and decision-making on the system level is still restricted to a small part of the population. An enabling health policy and a broad citizen participation are still in the beginning, but they have the potential to strengthen each other and to realise synergetic effects. Even though some corresponding institutions were already established and attitudes of the health care professionals start to alter, the question wether the health policy will change from a welfare producing state to an enabling state cannot be answered completely yet.

The effect of a psychosocial group intervention on loneliness and social support for Japanese women with primary breast cancer

PURPOSE/OBJECTIVES

To examine the effects of a psychosocial group intervention on loneliness and social support in Japanese women with breast cancer.

DESIGN

Secondary analysis of a randomized, controlled trial.

SETTING

A breast cancer outpatient area of a National Cancer Center hospital in Japan.

SAMPLE

50 women who were less than 65 years old, were diagnosed with primary breast cancer, and had undergone surgery within 4-18 months of the start of the study.

METHODS

Data were collected as part of a trial of an intervention. The investigators conducted a six-week group intervention consisting of health education, coping skills training, stress management, and psychological support. Subjects completed the revised University of California, Los Angeles, Loneliness Scale and a social support questionnaire at baseline, six weeks, and six months.

MAIN RESEARCH VARIABLES

Loneliness, number of confidants, satisfaction with confidants, and satisfaction with mutual aid.

FINDINGS

Fifty (33%) of the 151 invited patients participated and were randomized to either experimental (n = 25) or control (n = 25) groups, and 23 (92%) in each group completed the study. The experimental group had significantly lower scores than the control group for loneliness and significantly higher scores for the number of confidants, satisfaction with confidants, and satisfaction with mutual aid over the six-month study period.

CONCLUSIONS

This intervention is beneficial for Japanese patients with breast cancer experiencing loneliness and inadequate social support.

IMPLICATIONS FOR NURSING

The program can be used as an effective support for Japanese patients with cancer to manage their psychosocial concerns associated with illness.

Examining mechanisms of action in 12-step treatment: the role of 12-step cognitions

OBJECTIVE

Twelve-step treatment appears to be modestly effective in treating alcohol and cocaine dependence, but little is known about its mechanisms of action. The primary aim of this study was to examine the hypothesized mechanism of action of 12-step cognitions. In addition, the psychometric properties of a measure used to assess 12-step cognitions were tested.

METHOD

The psychometric properties of a measure to assess 12-step cognitions were examined in a sample of individuals (N = 370, 61% male) seeking inpatient (n = 118) or outpatient (n = 252) 12-step-oriented community treatment. Additional analyses of data from the inpatient sample examined changes in cognitions from entry to discharge and 12-month follow-up. The univariate and multivariate relationship of cognitions at discharge, and substance use outcomes across the 12-month follow-up were also examined in the inpatient sample.

RESULTS

The measure of 12-step cognitions demonstrated good internal consistency. Findings supported some, but not all, of the hypothesized active ingredients of 12-step treatment. Cognitive processes common to many treatment-approaches significantly mediated outcomes, whereas processes unique to the 12-step approach (e.g., spirituality) did not. Overall, some 12-step cognitions at discharge were good predictors of outcome, explaining as much variance in outcome as illness severity factors (e.g., dependence severity).

CONCLUSIONS

Results provided greater support for 12-step treatment theory than those reported in prior studies. At the same time, findings suggest that diverse treatment approaches may operate through a common set of active ingredients.

Psychiatric comorbidity, continuing care and mutual help as predictors of five-year remission from substance use disorders

OBJECTIVE

In a cohort of 2,595 male patients in VA intensive treatment programs for substance use disorders (SUD), we tested whether psychiatric comorbidity, outpatient care and mutual help group attendance during the first two follow-up years predicted remission status at Year 5, controlling for covariates.

METHOD

Logistic regression modeling of longitudinal data was used to test the hypotheses.

RESULTS

Dual diagnosis patients were less likely to be in remission at Year 5 than SUD-only patients. Outpatient care was at best only weakly related to Year 5 remission status. By contrast, mutual help involvement substantially improved the chances of substance use remission at Year 5 for both SUD-only and dual diagnosis patients. Mutual help involvement did not, however, offset the poorer prognosis for dual diagnosis patients.

CONCLUSIONS

Because mutual help groups specifically targeted to individuals with comorbid substance use and psychiatric disorders are currently rare, further research is recommended to investigate whether they are more effective than standard SUD mutual help groups in facilitating the recovery of persons with dual diagnoses.

Mother-to-mother support for women breastfeeding in unusual circumstances: a new method for an old model

Support is critical for breastfeeding success. Mother-to-mother support via groups such as La Leche League and the Australian Breastfeeding Association, formerly Nursing Mothers' Association of Australia, is helpful to mothers in average circumstances. However, for women who are in more unusual circumstances, this support may be inadequate on its own. With the advent of the Internet, this problem has been decreased through the formation of Internet breastfeeding support groups. An Internet mailing list for women wishing to breastfeed their adopted children was used to investigate how Internet groups may provide breastfeeding support. Members of the mailing list were surveyed on issues relevant to breastfeeding support. It was identified that the mailing list overcame the problems of geographical isolation, lack of appropriate information and support and a sense of feeling alone. It is concluded that Internet breastfeeding support groups can provide mother-to-mother support to those breastfeeding in unusual circumstances. Those assisting women to breastfeed may refer women to these groups, use the groups as a resource in educating themselves or offer their knowledge and experience to such groups as a resource.

[Counseling concepts and services of health-associated self-help initiatives]

Self-help groups formed increased since the beginning of the eighties; in the field of health especially chronically ill persons met to cope with their daily illness-related problems. As these self-help-initiatives developed into suppliers of services this study should provide information about the special quality of counselling concepts and other services. A telephone interview with 224 self-help initiatives revealed a high proportion of counselling activity (75%). Based on the concept of Grounded Theory a qualitative analysis shows that the perspectives "service provision" and "social support" examined separately so far can only be understood in their combination. Especially community narratives proved to be connecting structural elements on which counselling concepts are based. These community narratives were reconstructed from narrative patterns of stories, mottos, rituals and others. Further essential structural elements are the principle of mutuality, the collective search for a panacea, processes of empowerment and the reference to everday life and environment. The principle of self-help and empowerment is highly valued by the patients. To incorporate this principle in the health care system a closer cooperation of these two systems should be strived for. Therefore it is necessairy to develop a theory of self-help specific counselling in combination with results from salutogenesis research.

The online patient meeting

Studies have shown the importance of social support for health, and the value of patient support groups. Today we are seeing a further development of the idea of the patient meeting: online discussions on the internet and other computer networks. This paper reports on the online activities of patients with amyotrophic lateral sclerosis. The paper explores key questions in the evaluation of online patient meetings, such as the ability of patients to discuss their problems frankly, the availability and accuracy of advice, the spread and control of rumours.

Self-help/mutual-aid clearinghouses and groups in Canada: recent developments

This paper reports on recent developments in the self-help movement in Canada based on the findings of a country-wide survey of self-help clearinghouses and interviews with key informants. Among the outcomes of this survey are an estimate of the number of self-help groups in various communities in Canada as well as a presentation of current trends in the growth of these entities. The author also explores recent fiscal and policy trends in the Canadian context and discusses their impact on the development of self-help groups and clearinghouses in the country.

Research on mutual aid and social support: progress and future directions

Signs of progress in the study of mutual aid and social support include a greater emphasis on the collection of empirical data to evaluate program effects and to comprehend relations between professional and informal sources of aid, as well as a clearer delineation of concepts and creative integration of practices associated with mutual aid. Several directions for future research on support interventions are addressed, including the nature and timing of outcome measures, analyses of the optimal fit of participants to different intervention formats, and the need for research designs that yield information about the necessary and cost-effective components of support interventions.

The Self-Help Clearinghouse of Metropolitan Toronto: reflections on seven years of survival and beyond

In May of 1987, Health and Welfare Canada awarded the Self-Help Clearinghouse of Metropolitan Toronto a three-year demonstration grant. Today, the Toronto Clearinghouse remains the only free-standing self-help resource of its kind in Canada and is a registered charitable organization whose mandate is to facilitate the growth and development of self-help/mutual-aid groups, networks, and resources. This paper describes the unique Toronto Clearinghouse model which from its earliest beginnings has been a partnership between the self-help community and interested and supportive professionals. The success of this model stems from its strong grassroots origins, respect for a community empowerment approach, and focused goals and objectives. Using information gleaned from the archival history of the Toronto Clearinghouse and through a series of interviews with past and current members of the Clearinghouse board of directors, program staff, and local self-help group members, the paper explains the "roller coaster ride" which has characterized the history of the Clearinghouse to date. Finally, the paper illustrates that while the achievement of financial stability has been an ongoing challenge in the face of variable community and political support, the Toronto Clearinghouse is, today, a strong centre of self-help activity and promotion, involved in a unique exercise to determine the role that self-help can play as a strategic component of an overall health and social services system-and with every reason to be optimistic about its future.

[Mutual aid as a complement to professional intervention]

This paper aims to illustrate and emphasize the relevance of Frank Riessman's futurist new paradigm for human services which proposes a restructuring that enables those who ordinarily receive help to function as providers of help. Some of the best known mutual-aid programs are briefly presented, followed by a more detailed description of pilot projects which have used the mutual-aid principle with multi-problematic clientele. Most of these pilot projects took place in the province of Québec and aimed at bridging the gap between public services and local communities by linking with informal support systems. Two specific modalities of mutual aid are discussed: pairings between clients and pairings between clients and natural helpers. The integration of mutual-aid strategies within clinical practice is not easy because of the important changes it requires of the professional both at the practical and the organizational level.

Educational group support for patients with gynaecological cancer and their families

Prior to the start of a psychosocial project for patients with gynaecological cancer and their families, a questionnaire was mailed to evaluate their potential interest in an educational and supportive group. Another aim was to rank the most important issues. Group I consisted of patients with a newly diagnosed cancer and group II comprised patients who had been in clinical remission for 2-5 years; 173 questionnaires were sent. The response rate was 80%. The rates of interest in the proposed group sessions were 63% and 65% from patients and relatives in group I, and 52% and 36% from those in group II (P < 0.05). Younger individuals, couples and people with a higher formal education were generally more interested in participating (P < 0.05). The highest-ranked issues (mean 3.9-3.7 on a four-point scale) were cancer and cancer treatment, living with a cancer diagnosis, side-effects of treatment, cancer pain and psychological reactions to cancer. Among patients in group I, the interest in questions related to sexual activity was moderate (mean 2.8); the corresponding figure was significantly higher in group II (P < 0.05). Interest in supportive and educational groups was significantly higher than in comparable studies. Since relaxation programmes and issues concerning problems with relationships have been generally regarded as the most crucial topics in supportive programmes, the preference for specifically cancer-related issues was surprising. The study underlines the importance of specifically ascertaining which issues an intended group considers to be important.

[Status of health policy and possible support to self-help groups]

Self-help groups strengthen an individual's sense of autonomy and self-determination, and help to recover from diseases and other health-related problems. Participants mutually support each other within the group to promote a healthier approach to socio-psychological issues; they also conduct activities outside the group, especially counselling services for peers dealing with similar problems. In recent years, the number of groups throughout Germany rosen to approximately 60,000. The groups are mainly supported by self-help clearinghouses which have sprung up in many regions of western and eastern Germany over the last few years. This paper provides an overview of the development of self-help groups as well as the current state of support and funding in this area. Furthermore, it describes in detail the work performed by clearinghouses and the possibilities for cooperation with these new "liaison institutions".

[Promoting self-help by a public health office--the example of the Unna district]

In the district of Unna support of self-help movement has been enjoying high priority for many years, giving a new orientation to the public health service towards a modern and more customer-friendly public service. Since January 1990 a self-help clearinghouse has been established by the section of health promotion supervised by the public health office. By now, three centres have been opened. The scheme of organisation, staffing and facilities, contents and working procedure, results and experiences are presented. It is quite obvious that support of the self-help movement should be one of the major tasks of public health service in the years to come.

[The public health office and its partners: perspectives on cooperation between public health offices and self-help organizations]

Besides the three existing health sector entities in Germany: hospitals, established doctors and public health departments, a fourth area has developed, consisting of self-help organisations with their self-help groups. Today self-help organisations have a very extensive knowledge about special diseases and handicaps. Combined with the psychological and social assistance which they afford, their knowledge helps the affected persons considerably. Nevertheless, this practical experience cannot replace the professionals' know-how. Within the local "Gemeinschaftsaufgabe Gesundheitsförderung" (common task of health promotion) the co-operation between laymen and professionals may be particularly supported by the Public Health Offices.

A well-deserved break: respite programs offered by California's statewide system of Caregiver Resource Centers

This article describes the range of respite care options that are helping families of cognitively impaired adults under the auspices of California's statewide system of Caregiver Resource Centers. Types of respite provided include in-home care, adult day care and other group care programs, and overnight respite options outside the home, ranging from short-term care of the patient in a facility to weekend retreats designed for caregivers. The hallmarks of the program are flexibility, choice, and consumer control.

[Significance of support groups in the integrated management of chronically ill patients]

Support groups in terminal and chronic illnesses originated out of the families refusal to accept the pervasive hopelessness associated with these types of diagnosis. The creation of support networks aimed at providing a friendly atmosphere where participants could share their daily burdens. Unlike group therapy or other forms of psychotherapy, support groups do not focus their efforts on carrying out substantial personality changes in its members. Professionally led support groups also differ from lay organizations in that its main thrust lies in health education and management strategies in the home. The primary caretaker is given special priority inasmuch as he she are the ones involved in the daily care of these patients. The present article outlines a revision of the conceptual framework in the field of support groups. Their format, main characteristics and research aims are discussed within the context of a multidimensional approach to patient care.

Perceived costs and benefits of membership in a self-help group: comparisons of members and nonmembers of the Alliance for the Mentally Ill

We assess the utility of looking at the costs/barriers and benefits/incentives of belonging to an Alliance for the Mentally Ill (AMI) self-help group. Support for bimotivational factors of costs and benefits was found. Comparisons were made between members vs. nonmembers and between more active vs. less active members. Implications for theory and application are discussed.

The mental health consumers' self-help movement in Japan

Mental health services in Japan are centered on medical treatment, and medical organizations are regarded as the supreme authority. In recent years, however, some resources other than traditional medical treatment have been created. This chapter talks about one of those new resources, consumer self-help.

[Public health and citizen involvement--guidelines and general practice in Herne]

Health problems cannot be solved only by expanding medical and other systems of service. Limitations of these services are not only set by costs, but also by the disease patterns themselves. The traditional role of the patient must be redefined. It is necessary to develop personal health-coping strategies outside medical care, and for the citizen to participate in improving conditions of health in general. The public health system has the specific duty of initiating and establishing these new approaches to health promotion and coping with disease. A model for these new municipal health policies is presented with reference to medical practice in the city of Herne in the Ruhr area of Germany.

Networking consumers' participation in a community mental health service: mutual support groups, 'citizenship' and coping strategies

Consumers' and family members' involvement was indispensable to create social support networks promoted by the comprehensive mental health services resulting from the closure and subsequent complete reconversion of the mental hospital in Trieste. Despite long term consumers' disabilities and the families' heavy burden the individuals' positive skills and resources can be, and indeed are, 'valorized'. Mutual help groups, social clubs and solidarity initiatives in the community were the outcome of the individual consumer's active daily involvement in the service therapeutic programmes and of stimulation of social and communication skills. The service considers these forms of supported self-organisation of consumers and family members as new instruments for further deinstitutionalisation and demedicalisation of therapeutic and rehabilitative practices, for the overcoming of social isolation and learning of coping strategies from the mutual experience.