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How do psychologists adapt over time to a new managed care program? Reactions of Iowan psychologists to a managed mental health care program for Medicaid recipients were examined. The program was generally perceived negatively, although perceptions improved over time. Psychologists in private practice decreased the proportion of Medicaid patients they treated. Psychologists who continued to treat Medicaid patients reported decreased levels of job autonomy and satisfaction. A new managed care program presents psychologists with difficult ethical decisions, in which the quality of care provided to clients must be weighed against the negative aspects of participating in a managed care program.

The literature indicates that the quality of affective relationships between youth and parents is associated with lower levels of a range of problem behaviors during childhood, early and late adolescence. While the protective effect of parental monitoring on substance use in the high school and post high school years has been demonstrated, there is a knowledge gap concerning effects of parent-child affective quality (PCAQ) during the same periods. We tested a conceptual theoretical model to examine the effects of PCAQ on substance use following high school. The sample was from a RCT that assessed adolescents in rural Iowa from the seventh grade through two years after high school (N=456). We specified direct effects of PCAQ in 12th grade on drunkenness, smoking and illicit drug use during the two years immediately following high school graduation. We also specified the effects of early substance use initiation (alcohol, tobacco and marijuana use reported at baseline) on later use. The direct effect of PCAQ in 12th grade on substance use was significant for all substances during at least one of the two years past graduation (ypg). Results were: drunkenness 1 ypg, β=-.126, p<.05; smoking 1 ypg, β=-.119, p<.05; 2 ypg, β=-.146, p<.05; illicit drug use 2 ypg, β=-.165, p<.05. Some significant indirect effects of PCAQ at baseline, via PCAQ at 12th grade, were found. Results also indicated significant direct effects of early initiation on two of the three substances, albeit with a different pattern of effects over time for each substance by years post high school. Importantly, while early initiation remains the strongest predictor of long-term tobacco and illicit drug use, results show how PCAQ might reduce its harmful effects.