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During the past ten or so years, a new group of people-helpers has emerged. These are the human services workers, and they have made a considerable impact on the drug and alcohol abuse scenes, on clinics, universities, hospitals and schools. They are the paraprofessionals and they come into existence as a result of an increasing lack of available professional helpers. In spite of the great need, most professionals showed a minimum interest in and concern for the addict, the alcoholic, the mental patient, the compulsive gambler, the compulsive obese person, the run-away, and other individuals in need of help. The coming into existence of lay helpers has answered this need, but it has also provided the two groups many mutual challenges. These challenges are of paramount importance and must be met on both sides.

The address discusses the issues that confront the independent practitioner today. Issues of inflation, peer review, declining patient populations, increased office expenses and the evolving of HMO, PPO facilities. In order to survive, the practitioner needs to be aware of the development of free standing clinics, the ownership and administration of hospitals by corporations, as well as the future increased fragmentation of the health delivery system. Some of the answers lie in understanding marketing techniques, developing appropriate advertising approaches recognizing and responding to "new" evolving patient populations, e.g., the retireds, single parent families, chemical abusers, that may exist in your area as well as developing our own HMO settings.

The dictionary defines the verb " to burn out ." It means " to fail, wear out, or become exhausted by making excessive demands on energy, strength, or resources." That definition clarifies for many the concept of the particular type of burn-out personally experienced by more and more workers in the world of helping institutions. As an occupational hazard, burn-out has become an especially critical condition suffered by the child care professional as well as, to a significant degree, the individual who works in the direct-service components of an agency. It can truly be said that both are in the " f ron t lines" of crisis intervention in the child care institution. Burn-out among professional child care workers is similar to that among professionals working in alternative institutions, as I have discussed elsewhere (Freudenberger, 1975b). Briefly described, burnout includes such symptoms as cynicism and negativism and a tendency to be inflexible and almost rigid in thinking, which often leads to a closed mind about change or innovation. The worker may begin to discuss the client in intellectual and jargon terms and thereby distance himself from any emotional involvement. Along with this, a form of paranoia may set in whereby the worker feels that his peers and administration are out to make life more difficult. Another sign is that the worker takes on a superior "know-it-all" att i tude that borders on the condescending. He hardly communicates with others and tends to become a loner or withdrawn. On the other hand, he may go to the other extreme and hardly do any work be

In the widespread confusion of our times and with much of the emphasis on the increased "disrelatedness"* within our families, two major factors are being overlooked as various attempts are being made to understand what is going wrong. These factors are the importance of the presence within the home of a "legitimate" authority figure and the need to reassess the values by which we live today. I believe that it is only through an honest, direct confrontation with what we as parents are doing and are failing to do that we shall be able to deal effectively with what we see happening to a large segment of our society. What do we mean by a "legitimate" authority? We mean a person who, by

In terms of personal qualities, a competent free clinic counselor ought to be able to manifest a degree of warmth and humor, feel comfortable with people, and have a facility and liking for people. The chapter also discusses techniques of staff training, the need for common objectives, the use of role playing, films, tapes, and video-tape equipment, the possibility of using two-counselor teams both for training and for the possibility of one's substituting for the other in case of absence. Techniques and “how to” in terms of crisis counseling for individual and group work are presented. The crisis intervention approach is demonstrated, as well as means of assessing strengths and weaknesses in those who seek help. Issues of the dynamics of the counseling staff are discussed, the subtle dependency relationships that are established, the problems of transference and mutual need that may be acted upon through counseling. Finally, the author presents the issues of community education and prevention work, as part of a counselor's task.

Eight antifungal agents were examined for effects on lipid biosynthesis and membrane integrity in Candida albicans. Lipids were labeled in vivo or in vitro with [14C]acetate and analyzed by thin-layer and gas chromatography. Membrane integrity was measured by a recently developed [14C]aminoisobutyric acid radiolabel release assay. The imidazole antifungal agents miconazole, econazole, clotrimazole, and ketoconazole, at concentrations inhibiting ergosterol biosynthesis (0.1 microM), decreased the ratio of unsaturated to saturated fatty acids in vivo but not in vitro. Similarly, naftifine, tolnaftate, and the azasterol A25822B, at concentrations inhibiting ergosterol biosynthesis (10, 100, and 1 microM, respectively), decreased the ratio of unsaturated to saturated fatty acids in vivo only. This suggests that the effect on fatty acids observed with ergosterol biosynthesis inhibitors may be secondary to the effect on ergosterol. With imidazoles, oleic acid antagonized inhibition of cell growth but not inhibition of ergosterol. This suggests that, with the C-14 demethylase inhibitors, decreased unsaturated fatty acids, rather than decreased ergosterol, are responsible for growth inhibition. Cerulenin, previously reported to be a potent inhibitor of both fatty acid and ergosterol biosynthesis, was found in the present study to inhibit the former (at 5 microM) but not the latter (up to 100 microM). Of the antifungal agents tested, econazole and miconazole (at 100 microM) produced complete release of [14C]aminoisobutyric acid, which is consistent with membrane damage.

The authors have been able to follow up on a number of residents over the years. Most of them have frequently referred to the helpfulness of the seminars during their reentry phase. Some have sought out private counseling once they felt problems cropping up. While there is no abundance of jobs awaiting the adolescent graduate, they must be prepared to the best of their, and the TC's, ability to confront the world. TCs need to provide them with the ability and skills to cope with the many realities they will be called on to face. A serious review of the adolescent TC process is called for, with greater emphasis on teaching, training and role modeling. TCs need to evolve more skill-training seminars in conjunction with community agencies and resources. Further training of TC staff is needed to strengthen their vulnerabilities and understand their own relationships with adolescent clients. Too many have lost touch with what it was like to be a frightened young adult. Unless more serious attention is paid to adolescent reentry candidates, TCs will find themselves being criticized for turning out incomplete graduates: graduates whose lifestyles have been behaviorally modified, but whose impoverished value systems have not been attended to. One without the other is programming clients for eventual recidivism and TCs for failure.