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Conflicts in the multiple mandates—legislative, community and professional—under which the West Philadelphia Community Mental Health Consortium operates serve to obstruct its progress toward the goals of a Community Mental Health Center. The first paper explains the structure of the Consortium and the setting in which it operates. The two papers that follow discuss the impact of the conflicts on research and evaluation services, and the implications for race relations—a critically pervasive issue at the Consortium.

While acknowledging the importance of primary prevention, mental health agencies continue to devote their major resources to diagnosis, treatment, and rehabilitation efforts. This paper attempts a comprehensive understanding of the multiple and related barriers to the design and implementation of preventative programs. Barriers are discussed under the categories of definitional problems, systemic complexity, difficulties of demonstration, and lack of constituent demands.

The new behavior technologies raise obvious ethical and legal questions, particularly when employed in institutional contexts. This paper offers a conceptual framework for the discussion of legal interventions designed to prevent Orwellian abuses of the new technologies, without preventing legitimate therapeutic applications.

Clinicians and administrators have emphasized crisis intervention as a means of extending services and reducing costs. This paper asserts that ghetto children, because of their multiple deprivations, complex problems, and family structures, are particularly unsuitable for short-term contacts. Modalities other than crisis intervention are indicated as alternatives to long-term child treatment.

With the Supreme Court recognition of abortion as a matter between a woman and her physician, the commitment of the medical profession to the highest standards of total patient care requires greater consideration of the psychological component in the abortion experience than has heretofore been provided. This paper suggests providing social work service—individual, family, or group—in all obstetric-gynecologic facilities.

This paper describes a program of group therapy aimed at grappling with the core problem of most blacks in this society—loss of self-identification and lack of projection of a productively healthy existence. The black experience is seen as being akin to that of a control group in a laboratory experiment; implications of decontrolling a control group in the even more rigidly defined setting of a therapeutic community are explored.

This paper traces the development of psychiatry in the People's Republic of China—with special reference to the social aspects of treatment and prevention—and delineates the salient features of the Chinese approach. Implications of this approach for mental health workers in other countries are discussed.

This paper describes and evaluates a two-year parent education program designed to involve whole families. The program begins when the child is a year old, and includes in-home training of the mother, plus several weekend sessions for the entire family. In its second year, mother and child participate in a nursery school setting, and father is involved in evening meetings. Bilingual training is emphasized. Significant achievements on the part of both program children and program mothers, as compared to controls, are reported on a number of measures.

Barriers of culture and language have tended to keep poor Spanish-speaking people from using community mental health center treatment facilities. This paper describes a program of brief group therapy, conducted in Spanish by a bilingual social work assistant, that helped patients with their presenting problems and helped prepare them to accept referral to the longer term treatment facilities of the center.

This paper describes a black therapy group in a predominantly white hospital. It focuses on the beginnings of the group process, examines group development over thirty weeks, and offers case material regarding differences and similarities between the all-black group experience and the white or integrated group. Leadership roles are addressed in an attempt to clarify the role of co-leaders of a black group operating in a white hospital.

How does the stereotype image of the Negro affect the Negro child's identity? How does it emerge in treatment? This paper describes the effects of the distorted self-concept in several Negro children in an otherwise white treatment center. It describes staff reactions, peer relationships, specific problems in psychotherapy, and the methods used to deal with the emerging problems that are related to race.

This paper, and the one that follows, are drawn from a special Plenary Session on “Values and Economics in the Delivery of Human Services” at the 49th annual meeting of the American Orthopsychiatric Association. This, the session's keynote address, examines the problems that pollution poses to the nation's economy, and foresees an era of diminished growth necessitating a redistribution of wealth and a new approach to the funding of human services. A concerted Crusade by professionals on behalf of human welfare is called for, to replace the current competition for available funds.

This paper examines the validity of the premise that there is only one effective learning environment for the very young child—an intrafamily environment characterized by minimal disruption of primary social relationships. New evidence pointing to (1) the importance of the first three years for priming cognitive development and (2) the inability of many parents to provide the child with the priming ingredients suggests that alternative models involving home supplementation should be considered. If such supplementation is to have maximum effectiveness, careful thought should be given to the advisability of beginning it during the very earliest years of life during which time the child is maximally receptive.

This paper compares the progress of 25 retarded children who attended an experimental summer camp based on principles of behavior modification, with a matched group of 15 retarded children who did not attend camp. The campers showed significantly greater progress than did controls in predetermined target areas, suggesting that a camping experience may have beneficial effects, and that a program of behavior modification may provide even further benefits.

Of the many institutions in our society that have changed their perspective on the father's participation in the family, psychiatric clinics have been among the most prominent. Currently, an attempt is being made to involve more fathers in various treatment procedures. This paper deals with the writer's experience in working with a group of fathers, each of whom refused to participate in a one-to-one treatment relationship. While described as passive, weak, and poor treatment candidates they all responded positively to a Fathers' Guidance Group. Feeling that their pathology would not be intensively explored, they could discuss their conflicts and frequently resolve them within a sympathetic male group.

The Board of Directors of the American Orthopsychiatry Association has established early child care programs as an area of top priority during the current year, with special emphasis on day care. In keeping with this commitment, the Association has authorized and endorsed this statement on early childhood services. The four papers and one book review that follow cover a range of conceptual and practical approaches to the provision of day care.

Observations of two experienced teachers of disturbed children suggest the possibility of developing a coding system for differentiating between teaching styles. This paper presents pilot efforts, and poses questions about philosophies of teaching in therapeutic nursery schools which may help to refine training methods in this relatively new field.

Working with disorganized families of the low socioeconomic population requires adaptations of family therapy techniques which take the specific characteristics of those families into account. This paper discusses changing family subgroupings and shifting observational sets to help family members learn to experience their feelings more clearly and begin to see how they can change their ways of behaving.

This paper describes the use of psychotherapeutic consultation in pediatrics practice. Techniques of family interviewing were employed for short-term intervention. Three family meetings were done for families with preschool children whose symptoms had no organic basis and did not respond to usual pediatric advice.

This paper describes a method for grouping prime or target symptoms into social-behavioral, affectual-intrapsychic, and organic-cognitive classes, and thence into clinical diagnoses, which was used to assess clinical change in 85 children treated in a university-based inpatient psychiatric center.

In complex therapeutic settings the extent of confidentiality must be defined for each relationship. This paper discusses certain conditions leading to a break in confidentiality and makes recommendations for: specific focus on confidentiality in training programs; a tribunal to assist therapists confronted with difficult decisions; and regularly featured discussions in journals.

In the midst of a serious military action in Asia pursued by their government a number of American students steadfastly protest various aspects of their nation's foreign policy. This paper gives a psychiatrist's observation of some of those students and discusses the general problem of social protest and psychopathology.

Book reviewed in this article: Drawing upon the work of Piaget, this paper asserts that it is the multiple experiences of cognitive disequilibrium in the course of vitally meaningful encounters with the environment that necessitates the child's accommodation to that environment. When home environment functions at a lower level of conceptualization than that required in school, the child will be at a cognitive disadvantage. Suggestions for educational programs and policy are presented.

Ethical issues in group therapy with family members are reviewed. The central focus is concentrated on (1) effects of this form of therapy on family solidarity and intrafamily relationships and (2) the special features in the doctor-patient relationship. The paper also touches on relevant counter-transference factors masked by some ethical objections.

Family-centered treatment is based on the premise that the child's illness is, in part, a result of impaired family relationships. Treatment of the child is made more effective if the family is given help. This paper describes family-centered treatment as part of an institutional program, beginning with the child's referral to the institution, continuing through his stay at the institution and after his discharge.

The meeting of parent and ward staff in a child psychiatric inpatient or day care unit is an anxiety arousing experience. The anxiety created if handled untherapeutically leads to increased parental symptomatology (iatrogenic); if handled therapeutically it allows for the resolution of major child-parent conflicts. This paper describes some aspects of the training of the ward staff in this area.

In direct opposition to the popular mythology depicting the aging male homosexual as despairing and desolate, this paper proposes that homosexuality may be functional in adjusting to the aging process. Homosexuals commonly experience a “life crisis” early in their development and are therefore less affected by the trauma of role loss that occurs for most men in later life.

When some 200 drug addicts, accompanied by community representatives, staged a walk-in at Lincoln Hospital, a confrontation with the Establishment was forced. Based on retrospective accounts from staff, community, addicts, and administrators, this paper examines the factors leading to confrontation, and assesses the results. The value of this technique in achieving health care delivery is considered.

The use of human beings as subjects for experimentation by scientific investigators raises a multitude of complex and delicate issues. A number of principles have been encoded by medical groups, but there are significant differences between social science experiments and medical ones. The codes, the differences, and some tentative modifications are discussed in this paper.

A confluence of historical, social and political forces has resulted in the emergence of increased pressure for community control over human resources, particularly in urban areas. This paper explores a comprehensive mental health center's shift from institutional to consumer regulation, and the impact of that transition upon the delivery of services.

Current conceptual models for the delivery of mental health services lead us to lose sight of certain aspects of our ultimate goal while emphasizing others. As with all conceptual models, they tend to pass unquestioned. This paper reexamines the unstated premises of three such models.

The pressure of the waiting list and the lack of resources have produced a state of emergency for the child guidance clinic. We have seen the development of 57 varieties of the traditional model without developing any clarity on why each previous model was not workable. To resolve underlying problems, this paper presents a “model” of a child mental health center.

In considering the use of the Work Camp as an instrument in the treatment of delinquency, close attention must be given to the diagnosis of individual work campers, procedures for organizing the environment, and direct therapeutic techniques. These papers outline in detail the latest thinking of specialists from the several mental health disciplines regarding the types of delinquents most amenable to “Work Camp treatment,” the activities and administrative devices most likely to create a rehabilitative climate, the role of individual counseling in the Work Camp, “work” itself as a therapeutic medium, and possible extensions of the Work Camp idea into new settings.

More and more, workers in the mental health field are coming to the realization that the mental health of the individual is deeply rooted in his society's willingness to give him a sense of personal worth and dignity. The promotion of these human rights throughout the world was mandated in the United Nations Charter over twenty years ago. How the task has fared is discussed in this paper.

The purpose of this paper is, first, to outline a point of view concerning the role of interdisciplinary research projects in (a) isolating clinical factors contributing to underachievement and emotional disorders and (b) interpreting these findings into an instructional frame of reference; and, second, to concretize this viewpoint by reporting the clinical findings and instructional program resulting from a two-and-a-half-year interdisciplinary pilot study and demonstration involving forty hyperactive, underachieving, emotionally disturbed children.