President Kennedy enacted a major change to our health care state by deinstitutionalizing those with mental illness. However, those with mental health care issues must navigate a complex system of care. There are a few effective models of integrated care (such as the ACT).
“Design” a system, intervention, or preventative endeavor that meets the spirit of a community psychology system or program and better meets the needs of our citizens with mental health problems. Submit a paper on the designed health care system (or intervention or prevention endeavor). In the paper, address which principles of Community Psychology (refer back to Ch. 1) are incorporated into this program. More specifically, please address the following points in your paper:
Explain the current mental health system
Design and describe a better system that will address the needs of those with mental health care concerns (make sure that I can understand what you are proposing by being specific)
Describe which Principle(s) of Community Psychology (CP; from Ch. 1) are represented in your program or system, and specifically comment on how and why your program meets the spirit of a CP program
AT LEAST ONE BIG PARAGRAPH PER QUESTION THANK YOU
PLEASE BE CLEAR ON THE ANSWERS AND ANSWER SPECIFICALLY I WILL BE ATTACHING THE BOOK WITH THE INFORMATION THAT YOU NEED. PLEASE FOLLOW GUIDELINES
ALSO THIS IS ANOTHER RESOURCE:
video covers The Mental Health System and the effects of deinstitutionalization.
2
Fifth Edition
COMMUNITY PSYCHOLOGY
John Moritsugu
Pacific Lutheran University
Elizabeth Vera
Loyola University Chicago
Frank Y. Wong
Emory University
Karen Grover Duffy
State University of New York, Geneseo
Part I
Chapter 1
Chapter 2
CONTENTS
Introductory Concepts
INTRODUCTION: HISTORICAL BACKGROUND
Historical Background
Social Movements
Swampscott
What Is Community Psychology?
Fundamental Principles
A Respect for Diversity
The Importance of Context and Environment
Empowerment
The Ecological Perspective/Multiple Levels of Intervention
▶ CASE IN POINT 1.1 Clinical Psychology, Community Psychology: What’s the
Difference?
Other Central Concepts
Prevention Rather than Therapy
▶ CASE IN POINT 1.2 Does Primary Prevention Work?
Social Justice
Emphasis on Strengths and Competencies
Social Change and Action Research
Interdisciplinary Perspectives
▶ CASE IN POINT 1.3 Social Psychology, Community Psychology, and Homelessness
▶ CASE IN POINT 1.4 The Importance of Place
A Psychological Sense of Community
Training in Community Psychology
Plan of the Text
Summary
SCIENTIFIC RESEARCH METHODS
5
Chapter 3
The Essence of Scientific Research
Why Do Scientific Research?
What Is Scientific Research?
The Fidelity of Scientific Research
▶ CASE IN POINT 2.1 A Theory of Substance Abuse and HIV/STDs that Incorporates the
Principles of Community Psychology
Traditional Scientific Research Methods
Population and Sampling
Correlational Research
■ BOX 2.1 Research across Time
Experimental Research
Quasi-experimental Research
Alternative Research Methods Used in Community Psychology
Ethnography
▶ CASE IN POINT 2.2 Case Study of a Consumer-Run Agency
Geographic Information Systems
Epidemiology
Needs Assessment and Program Evaluation
▶ CASE IN POINT 2.3 Needs Assessment of a Hmong Community
Participatory Action Research
Cautions and Considerations Regarding Community Research
The Politics of Science and the Science of Politics
Ethics: Cultural Relativism or Universal Human Rights?
The Continuum of Research: The Value of Multiple Measures
▶ CASE IN POINT 2.4 HIV Intervention Testing and the Use of Placebos
The Importance of Cultural Sensitivity
Community Researchers as Consultants
Summary
STRESS AND RESILIENCE
The Stress Model and the Definition of Community Psychology
Stress
6
Part II
Chapter 4
Stressor Events
Stress as a Process
Stress Reaction
▶ CASE IN POINT 3.1 Contemporary Racism
Coping
Social Support
▶ CASE IN POINT 3.2 Mexican American College Student Acculturation Stress, Social
Support, and Coping
Resilience
At-Risk to Resilient
The Kauai Longitudinal Studies
A Useful Model
The Fourth Wave
Summary
Social Change and Intervention
THE IMPORTANCE OF SOCIAL CHANGE
Reasons for Social Change
Diverse Populations
Social Justice: A Moral Imperative for Social Change
The Perception of Declining or Scarce Resources
▶ CASE IN POINT 4.1 Funding Dilemmas for Nonprofit Organizations
Accountability
Knowledge-Based and Technological Change
Community Conflict
Dissatisfaction with Traditional Services
Desire for Diversity of Solutions
▶ CASE IN POINT 4.2 Community Conflict: Adversity Turns to Opportunity
Types of Social Change
Spontaneous or Unplanned Social Change
Planned Social Change
7
Chapter 5
▶ CASE IN POINT 4.3 Working with an Indigenous People Experiencing Change
Issues Related to Planned Change
Difficulties Bringing About Change
Summary
COMMUNITY INTERVENTION STRATEGIES
Creating Planned Change
Citizen Participation
▶ CASE IN POINT 5.1 The Community Development Society
Community Participation and Prevention
Who Participates?
Advantages and Disadvantages of Citizen Participation
Networking/Collaboration
▶ CASE IN POINT 5.2 Online Networks for Ethnic Minority Issues
Issues Related to Networks
Advantages and Disadvantages of Networks
Consultation
Issues Related to Consultants
Advantages and Disadvantages of Consultants
Community Education and Information Dissemination
Information Dissemination
Community Education
Issues Related to Information Dissemination
Issues Related to Community Education
▶ CASE IN POINT 5.3 The Choices Program
Public Policy
▶ CASE IN POINT 5.4 Rape Crisis Centers: A National Examination
Issues Related to the Use of Public Policy
Advantages and Disadvantages of Public Policy Changes
A Skill Set for Practice
Summary
8
Part III
Chapter 6
Chapter 7
Community Psychology Applied to Various Settings
THE MENTAL HEALTH SYSTEM
Epidemiological Estimates of Mental Illness
Models of Mental Health and Mental Disorder
The Medical Model
The Psychoanalytic Model
The Behavioral Model: The Social-Learning Approach
The Humanistic Model
▶ CASE IN POINT 6.1 Mental Health Care Professionals
The Evolution of the Mental Health System
Brief History of Mental Health Care
▶ CASE IN POINT 6.2 Rosenhan’s Classic Study of Hospital Patients’ Stigmatization
Deinstitutionalization
The Social Context to Deinstitutionalization
Early Alternatives to Institutionalization
Measuring “Success” of Deinstitutionalized Persons
Beyond Deinstitutionalization
“Model” Programs for Individuals with Mental Disorders
Intensive Case Management
Wraparound
▶ CASE IN POINT 6.3 Wraparound Milwaukee
Early Childhood Experiences and Prevention
The Battle Continues: Where Do We Go from Here?
Summary
SOCIAL AND HUMAN SERVICES IN THE COMMUNITY
Historical Notes about Social Welfare in Western Society
▶ CASE IN POINT 7.1 Poverty in America
▶ CASE IN POINT 7.2 The Grameen Bank
Specific Social Issues and Social Services
Child Maltreatment
9
Chapter 8
Chapter 9
Intimate Partner Violence
Teen Pregnancy
The Elderly
Homelessness
▶ CASE IN POINT 7.3 How Do Cultures Differ on the Issue of Homelessness?
Summary
SCHOOLS, CHILDREN, AND THE COMMUNITY
The Early Childhood Environment
Child Care
Enrichment Education and Early Intervention
Self-Care Children
The Public Schools
Desegregation, Ethnicity, and Prejudice in the Schools
The Schools and Adolescents
▶ CASE IN POINT 8.1 Dual-Language Immersion Programs
▶ CASE IN POINT 8.2 Children of Divorce
Summary
LAW, CRIME, AND THE COMMUNITY
The Traditional Justice System
Introduction
Crime and Criminals
▶ CASE IN POINT 9.1 Neighborhood Youth Services
Jails and Prisons
Victims and Fear of Being Victimized
Enforcement Agencies
Addressing Justice System Issues
Primary Prevention
▶ CASE IN POINT 9.2 Working with At-Risk Youth
Secondary Prevention
▶ CASE IN POINT 9.3 Huikahi: The Restorative Circle
10
Chapter 10
Chapter 11
Summary
THE HEALTHCARE SYSTEM
The American Healthcare System
National Health Indicators
Observations on the System
Community Psychology and the Healthcare System
Prevention over Remediation
Shifting Focus from Individuals to Groups, Neighborhoods, and Systems
Building Systems
Increasing Accessibility
▶ CASE IN POINT 10.1 Teen Pregnancy Prevention
Social Support and Health
Summary
COMMUNITY HEALTH AND PREVENTIVE MEDICINE
Tobacco
Extent of the Problem
Antitobacco Efforts
Community-Based Approaches
Alcohol
Extent of the Problem
Alcohol Safety Laws
A Community Psychology Approach
Illicit Drugs
Extent of the Problem
Possible Solutions and Challenges
▶ CASE IN POINT 11.1 Prescription Drug Misuse: Risk Factors for Problem Users
Sexually Transmitted Diseases
Extent of the Problem
Possible Solutions and Challenges
HIV and AIDS
11
Chapter 12
Overview
Extent of the Problem
Complexities and Controversies
Possible Solutions: Community-Based Approaches
▶ CASE IN POINT 11.2 Evaluation and Implementation of STD/HIV Community
Intervention Program in Lima, Peru
▶ CASE IN POINT 11.3 The Bilingual Peer Advocate (BPA) Program
Obesity
Scope of the Problem
Community Prevention Efforts
Summary
COMMUNITY/ORGANIZATIONAL PSYCHOLOGY
What Do Organizational and Community Psychology Share?
Organizational Psychology, Organizational Behavior
Ecology and Systems Orientation
Distinctions
Everyday Organizational Issues
Stress
Stress Reduction
Burnout
Organizational Culture
Organizational Citizenship Behaviors
Work and Self-Concept
Dealing with a Diverse Workforce
Other Ecological Conditions
▶ CASE IN POINT 12.1 Consulting on Diversity
Traditional Techniques for Managing People
Compensation Packages
Rules and Regulations
Overview of Organizational Change
12
Part IV
Chapter 13
Reasons for Change
Issues Related to Organizational Change
Changing Organizational Elements
Leadership
Reorganization
Quality of Work Life Programs
Team Building
▶ CASE IN POINT 12.2 Managing Change
Summary
Where to from Here?
THE FUTURE OF COMMUNITY PSYCHOLOGY
The Establishment of Institutional Markers
Growing Beyond National Boundaries
A Useful Paradigm
Commentaries
Answering the Present and Future Needs of Society
Appreciation of Differences and the Search for Compassion
Sustainability and Environmental Concerns
Disparities in Opportunity for Health, Education, and Economic Success
Aging and End of Life
Summary
Final Reflections
Bibliography
Name Index
Subject Index
13
PREFACE
14
•
•
•
•
•
•
•
NEW TO THIS EDITION
Heightened readability: Many chapters have been re-written with the student
reader in mind.
Updated literature reviews: You will find references to new terminology,
innovative ways of studying the community, new studies of the community as well
as new areas of study.
Consideration of healthcare disparities: What are these discrepancies in our care?
What is being done to understand and to address them?
New materials on obesity prevention: Is obesity on the rise? What are
community-based solutions to preventing obesity in children?
Added section on interpersonal violence: Theories that attempt to explain
violence in intimate relationships are presented along with community
interventions, aimed to prevent this problem.
Addition of healthy aging considerations: What helps adults enter later stages of
life in healthy ways? In what ways are the elderly vulnerable to abuse and
exploitation?
New considerations of bilingual education and the community: In what ways
are schools attempting to integrate immigrants into the community? Methods that
view immigrant communities as assets are discussed.
Community psychology grows from an optimism regarding human nature and a search for
truth and meaning in the world. It believes in our basic need for each other and our
biologically grounded ability to feel compassion and to desire to help. As community
psychologists, we are motivated to improve the conditions for the whole, ameliorating the
negative and promoting the positive (Cowen, 2000; Shinn & Toohey, 2003).
There is an appreciation for our individual differences and the diversity of our
backgrounds, and at the same time for the commonalities that bind us together. We are
able to indulge our curiosity about the world and its complexities.
Driven by questions about ourselves, and the collective entities in which we find
ourselves, we derive an understanding that is both complex and nuanced. Simple answers
may be easiest, but at the basis to the nature of things, we sense complexity, interactions,
and a richness of factors that influence the natural social ecologies we study and in which
we work. We believe the answers are to be found both in the empirical data that describe
our human and social conditions and in the expression of our values and our spirit (Kelly,
2006).
The direction of our answers is toward the transactional nature of our world. We
influence each other for better or worse. And so community theory is driven not just by the
individual and his or her personality, but also by the influences of context (Trickett, 2009).
It is a humble position to take with regard to our world and our influence in that world.
We have tried to succinctly capture the basic principles, themes, and practices in
community psychology. The rest is exposition on the various systems in which these
15
principles, themes and practices can be applied. In the interdisciplinary spirit of community
psychology (Rappaport, 1977), the programs and research in these content areas are
gathered from a variety of sources within community psychology, outside community
psychology but within the discipline (counseling, clinical, educational and school
psychology), and finally outside of psychology itself. Among the works cited, you, the
reader, might find social work, public health, education, public policy, criminology/police
sciences, sociology, and urban planning. This is reflective of where community
psychologists are at work.
The text is divided into four parts. The first provides the historical, theoretical, and
research framework for the field. Called to action, we are guided by principles of
empowerment, ecology, appreciation of diversity, stress, and resilience. The second section
looks at social change and how community psychologists might help in that change. The
third section examines the variety of systems in which community psychology principles
could be applied. The fourth and final section explores community psychology at present
and into the future. What has been accomplished and what are potential areas to grow in?
And what bits of wisdom might those who have worked in the field provide?
At the beginning of each chapter are quotes from others who pose a challenge or
reflection, which may play out a theme within that chapter. Also at the beginning is an
opening story or stories, providing an example of what is going on in the chapter. Each
chapter is outlined so that students can expect what they are about to read and formulate
questions related to the topics listed. Within the chapters are Case in Point examples of
how the theory and research are being applied in the community.
Key concepts have been highlighted by boldface in all chapters. And finally, each
chapter concludes with a summary. Students are advised to read this summary after they
first peruse the outline and chapter so as to direct their attention to important issues in each
chapter and to better organize their studying.
We hope that you find both information and a way of thinking about your
psychological world emerging from this text. Community psychology is a body of
knowledge, a theoretical framework, and a practice of psychology that relates to building a
better world. Topics include fellowship and caring, compassion, support, coping, and
succeeding against the odds.
Community psychology is also a way of conceptualizing the world and ourselves in it.
You will see how thinking contextually, transactionally, systemically, and ecologically might
shift your construction of problems and solutions.
Our thanks to Kristin Landon, who helped on the final editing, and all at Allyn &
Bacon who facilitated in the completion of this project. Thanks also to the Pearson
reviewers Edison Trickett, Peter Wollheim, and Rebecca Francis.
JM & EV
As one of the coauthors on this text, I thank the original authors, Karen Duffy and Frank
Wong, for their original invitation to join them in this work. I also welcome Elizabeth
Vera, the newest coauthor. She brings a wealth of expertise in prevention, social justice, and
16
counseling, as well as work with diverse populations. Besides her research and practice
acumen, she is a clear and effective writer. I could not have done the book without her.
I continue to thank my wife and fellow psychologist, Jane Harmon Jacobs, whose
positive attitude and support helped in the good times and the hard times, and my son,
Michael Moritsugu, who provided informed and very real help in the completion of the
text.
We are the product of our own intellectual and emotional communities. Among my
early advisors and teachers were Ralph Barocas and Emory Cowen from my graduate school
days at the University of Rochester. I thank them for their support and challenges during
my time in the snow country of upstate New York and throughout my career.
Among the many colleagues I found in graduate school, three in particular have
remained helpful in continuing to engage me in discussions about the field of community
psychology. I thank Leonard Jason, David Glenwick, and Robert Felner for their fellowship
and connection over the years. Their rich and enlightening research and writing in the field
speak for themselves.
JM
I thank my family and colleagues for their support in my professional endeavors, which laid
the groundwork for my contributions to the text. I am also indebted to the communities
with whom I have collaborated over the years in efforts to promote the positive and
ameliorate the negative.
EV
17
■
■
■
■
Introduction: Historical Background
HISTORICAL BACKGROUND
Social Movements
Swampscott
WHAT IS COMMUNITY PSYCHOLOGY?
FUNDAMENTAL PRINCIPLES
A Respect for Diversity
The Importance of Context and Environment
Empowerment
The Ecological Perspective/Multiple Levels of Intervention
CASE IN POINT 1.1 Clinical Psychology, Community Psychology: What’s the
Difference?
OTHER CENTRAL CONCEPTS
Prevention Rather Than Therapy
CASE IN POINT 1.2 Does Primary Prevention Work?
Social Justice
Emphasis on Strengths and Competencies
Social Change and Action Research
Interdisciplinary Perspectives
CASE IN POINT 1.3 Social Psychology, Community Psychology, and
Homelessness
CASE IN POINT 1.4 The Importance of Place
A Psychological Sense of Community
Training in Community Psychology
PLAN OF THE TEXT
SUMMARY
Until justice rolls down like waters, and righteousness like a mighty stream.
—Martin Luther King, quoting Amos 5:24
Be the change that you wish to see in the world.
—M. Gandhi
My dog Zeke is a big, friendly Lab–golden retriever–Malamute mix. Weighing in at a little
over 100 pounds, he can be intimidating when you first see him. Those who come to know
him find a puppy-like enthusiasm and an eagerness to please those he knows.
One day, Zeke got out of the backyard. He scared off the mail delivery person and
18
roamed the streets around our home for an afternoon. On returning home and checking
our phone messages, we found that we had received a call from one of our neighbors. They
had found Zeke about a block away and got him back to their house. There he stayed until
we came to retrieve him. We thanked the neighbor, who had seen Zeke walking with us
every day for years. The neighbor, my wife, and I had stopped and talked many times.
During those talks, Zeke had loved receiving some extra attention. Little did we know all
this would lead to Zeke’s rescue on the day he left home.
As an example of community psychology, we wanted to start with something to which
we all could relate. Community psychology is about everyday events that happen in all of
our lives. It is about the relationships we have with those around us, and how those
relationships can help in times of trouble and can enhance our lives in so many other ways.
It is also about understanding that our lives include what is around us, both literally and
figuratively.
But community psychology is more than a way to comprehend this world.
Community psychology is also about action to change it in positive ways. The next story
addresses this action component.
We start with two young women named Rebecca and Trisha, both freshmen at a large
university. The two women went to the same high school, made similar grades in their
classes, and stayed out of trouble. On entering college, Rebecca attended a pre–freshman
semester educational program on alcohol and drug abuse, which introduced her to a small
group of students who were also entering school. They met an upperclassman mentor, who
helped them with the mysteries of a new school and continued to meet with them over the
semester to answer any other questions. Trisha did not receive an invitation and so did not
go to this program. Because it was a large school, the two did not have many opportunities
to meet during the academic year. At the end of their first year, Rebecca and Trisha ran
into each other and compared stories about their classes and their life. As it turns out,
Rebecca had a good time and for the most part stayed out of trouble and made good
grades. Trisha, on the other hand, had problems with her drinking buddies and found that
classes were unexpectedly demanding. Her grades were lower than Rebecca’s even though
she had taken a similar set of freshman classes. Was the pre-freshman program that Rebecca
took helpful? What did it suggest for future work on drug and alcohol use on campuses? A
community psychologist would argue that the difference in experiences was not about the
‘character’ of the two women, but about how well they were prepared for the demands of
freshman life and what supports they had during their year. And what were those
preparations and supports that seemed to bring better navigation of the first year in college?
By the end of this chapter, you will be aware of many of the principles by which the
two stories might be better understood. By the end of the text, you will be familiar with the
concepts and the research related to these and other community psychology topics and how
they may be applied to a variety of systems within the community. These topics range from
neighborliness to the concerns and crises that we face in each of our life transitions. The
skills, knowledge, and support that we are provided by our social networks and the systems
and contexts in which these all happen are important to our navigating our life. A
19
community psychology provides direction in how to build a better sense of community,
how to contend with stresses in our life, and how to partner with those in search of a better
community. The interventions are usually alternatives to the traditional, individual-person,
problem-focused methods that are typically thought of when people talk about psychology.
And the target of these interventions may be at the systems or policy level as well as at the
personal. But first let us start with what Kelly (2006) would term an ‘ecological’
understanding of our topic—that is, one that takes into account both the history and the
multiple interacting events that help to determine the direction of a community.
We first look at the historical developments leading up to the conception of community
psychology. We then see a definition of community psychology, the fundamental principles
identified with the field, and other central concepts. We learn of a variety of programs in
community psychology. And finally, a cognitive map for the rest of the text is provided.
But first, back to the past.
20
HISTORICAL BACKGROUND
Shakespeare wrote, ‘What is past is prologue.’ Why gain a historical perspective? Because
the past provides the beginning to the present and defines meanings in the present. Think
of when someone says ‘Hi’ to you. If there is a history of friendship, you react to this act of
friendship positively. If you have no history of friendship, then you wonder what this
gesture means and might react with more suspicion. In a similar way, knowing something
of people’s developmental and familial backgrounds tells us something about what they are
like and what moves them in the present. The history of social and mental health
movements provides insight into the state of psychology. These details provide us with
information on the spirit of the times (zeitgeist) and the spirit of the place (ortgeist) that
brought forth a community psychology ‘perspective’ (Rappaport, 1977) and ‘orientation’
(Heller & Monahan, 1977).
These historical considerations have been a part of community psychology definitions
ever since such definitions began to be offered (Cowen, 1973; Heller & Monahan, 1977;
Rappaport, 1977). They also can be found in the most recent text descriptions (Kloos et al.,
2011; Nelson & Prilleltensky, 2010). A community psychology that values the importance
of understanding ‘context’ would appreciate the need for historical background in all things
(Trickett, 2009). This understanding will help explain why things are the way they are, and
what forces are at work to keep them that way or to change them. We also gain clues on
how change has occurred and how change can be facilitated.
So what is the story? We will divide it into a story of mental health treatment in the
United States and a story of the social movements leading up to the founding of the U.S.
community psychology field.
In colonial times, the United States was not without social problems. However, given
the close-knit, agrarian communities that existed in those times, needy individuals were
usually cared for without special places to house them (Rappaport, 1977). As cities grew
and became industrialized, people who were mentally ill, indigent, and otherwise powerless
were more and more likely to be institutionalized. These early institutions were often dank,
crowded places where treatment ranged from restraint to cruel punishment.
In the 1700s France, Philip Pinel initiated reforms in mental institutions, removing
the restraints placed on asylum inmates. Reforms in America have been attributed to
Dorothea Dix in the late 1800s. Her career in nursing and education eventually led her to
accept an invitation to teach women in jails. She noted that the conditions were abysmal
and many of the women were, in fact, mentally ill. Despite her efforts at reform, mental
institutions, especially public ones, continued in a warehouse mentality with respect to
their charges. These institutions grew as the lower class, the powerless, and less privileged
members of society were conveniently swept into them (Rappaport, 1977). Waves of early
immigrants entering the United States were often mistakenly diagnosed as mentally
incompetent and placed in the overpopulated mental ‘hospitals.’
In the late 1800s, Sigmund Freud developed an interest in mental illness and its
21
treatment. You may already be familiar with the method of therapy he devised, called
psychoanalysis. Freud’s basic premise was that emotional disturbance was due to
intrapsychic forces within the individual caused by past experiences. These disturbances
could be treated by individual therapy and by attention to the unconscious. Freud gave us a
legacy of intervention aimed at the individual (rather than the societal) level. Likewise, he
conferred on the profession the strong tendency to divest individuals of the power to heal
themselves; the physician, or expert, knew more about psychic healing than did the patient.
Freud also oriented professional healers to examine an individual’s past rather than current
circumstances as the cause of disturbance, and to view anxiety and underlying disturbance
as endemic to everyday life. Freud certainly concentrated on an individual’s weaknesses
rather than strengths. This perspective dominated American psychiatry well into the 20th
century. Variations of this approach persist to the present day.
In 1946, Congress passed the National Mental Health Act. This gave the U.S. Public
Health Service broad authority to combat mental illness and promote mental health.
Psychology had proved useful in dealing with mental illness in World War II. After the
war, recognition of the potential contributions of a clinical psychology gave impetus to
further support for its development. In 1949, the National Institute of Mental Health
(NIMH) was established. This organization made available significant federal funding for
research and training in mental health issues (Pickren, 2005; Schneider, 2005).
At the time, clinical psychologists were battling with psychiatrists to expand their
domain from testing, which had been their primary thrust, to psychotherapy (Walsh,
1987). Today, clinical psychology is the field within psychology that deals with the
diagnosis, measurement, and treatment of mental illness. It differs from psychiatry in that
psychiatrists have a medical degree. Clinical psychologists hold doctorates in psychology.
These are either a PhD, which is considered a research degree, or a PsyD, which is a
‘practitioner–scholar’ degree focused on assessment and psychological interventions.
(Today, the practicing ‘psychologist,’ who does therapy, includes a range of specialties. For
example, counseling psychologists, who also hold PhD or PsyD degrees, have traditionally
focused on issues of personal adjustment related to normal life development. They too are
found among the professional practitioners of psychology.) The struggle between the fields
of psychiatry and psychology continues today, as some psychologists seek the right to
prescribe medications and obtain practice privileges at the hospitals that do not already
recognize them (Sammons, Gorny, Zinner, & Allen, 2000). New models of ‘integrated
care’ have been growing, where physicians and psychologists work together at the same
‘primary care’ site (McGrath & Sammons, 2011).
Another aspect of the history of mental health is related to the aftermath of the two
world wars. Formerly healthy veterans returned home as psychiatric casualties (Clipp &
Elder, 1996; Rappaport, 1977; Strother, 1987). The experience of war itself had changed
the soldiers and brought on a mental illness.
In 1945, the Veterans Administration sought assistance from the American
Psychological Association (APA) to expand training in clinical psychology. These efforts
culminated in a 1949 conference in Boulder, Colorado. Attendees at this conference
22
approved a model for the training of clinical psychologists (Donn, Routh, & Lunt, 2000;
Shakow, 2002). The model emphasized education in science and the practice of testing and
therapy, a ‘scientist–practitioner’ model.
The 1950s brought significant change to the treatment of mental illness. One of the
most influential developments was the discovery of pharmacologic agents that could be
used to treat psychosis and other forms of mental illness. Various antipsychotics,
tranquilizers, antidepressants, and other medications were able to change a patient’s display
of symptoms. Many of the more active symptoms were suppressed, and the patient became
more tractable and docile. The use of these medications proliferated despite major side
effects. It was suggested that with appropriate medication, patients would not require the
very expensive institutional care they had been receiving, and they could move on to
learning how to cope with and adjust to their home communities, to which they might
return. Assuming adequate resources, the decision to release patients back into their
communities seemed more humane. There was also a financial argument for
deinstitutionalization, because the costs of hospitalization were high. There was potential
for savings in the care and management of psychiatric patients. The focus for dealing with
the mentally ill shifted from the hospital to the community. Unfortunately, what was
forgotten was the need for adequate resources to achieve this transition.
In 1952, Hans Eysenck, Sr., a renowned British scientist, published a study critical of
psychotherapy (Eysenck, 1952, 1961). Reviewing the literature on psychotherapy, Eysenck
found that receiving no treatment worked as well as receiving treatment. The mere passage
of time was as effective in helping people deal with their problems. Other mental health
professionals leveled criticisms at psychological practices, such as psychological testing
(Meehl, 1954, 1960) and the whole concept of mental illness (Elvin, 2000; Szasz, 1961).
(A further review of these issues and controversies can be found.) If intervention was not
useful, as Eysenck claimed, what would happen to mentally ill individuals? Would they be
left to suffer because the helping professions could give them little hope? This was the
dilemma facing psychology.
In the 1950s and 1960s, Erich Lindemann’s efforts in social psychiatry had brought
about a focus on the value of crisis intervention. His work with survivors of the Cocoanut
Grove fire in Boston demonstrated the importance of providing psychological and social
support to people coping with life tragedies. With adequate help provided in a timely
manner, most individuals could learn to deal with their crises. At the same time, the
expression of grief was seen as a natural reaction and not pathological. This emphasis on
early intervention and social support proved important to people’s ability to adapt.
Parallel to these developments, Kurt Lewin and the National Training Laboratories
were studying group processes, leadership skills for facilitating change, and other ways in
which social psychology could be applied to everyday life (www.ntl.org/inner.asp?
id=178&category=2). There was a growing understanding of the social environment and
social interactions and how they contributed to group and individual abilities to deal with
problems and come to healthy solutions.
As a result, the 1960s brought a move to deinstitutionalize the mentally ill, releasing
23
them back into their communities. Many questioned the effectiveness of traditional
psychotherapy. Studies found that early intervention in crises was helpful. And psychology
grew increasingly aware of the importance of social environments. Parallel to these
developments, social movements were developing in the larger community.
Social Movements
At about the same time as Freud’s death (1930s), President Franklin D. Roosevelt
proclaimed his New Deal. Heeding the lessons of the Great Depression of the 1920s and
1930s, he experimented with a wide variety of government regulatory reforms,
infrastructure improvements, and employment programs. These efforts eventually included
the development of the Social Security system, unemployment and disability benefits, and a
variety of government-sponsored work relief programs, including ones linked to the
building of highways, dams, and other aspects of the nation’s economic infrastructure. One
great example of this was the Tennessee Valley Authority, which provided a system of
electricity generation, industry development, and flood control to parts of Tennessee,
Alabama, Mississippi, Kentucky, Virginia, Georgia, and North Carolina. This approach
greatly strengthened the concept of government as an active participant in fostering and
maintaining individuals’ economic opportunities and well-being (Hiltzik, 2011). Although
the role of government in fostering well-being is debated to this day, newer conceptions of
the role of government still include an active concern for equal opportunity, strategic
thinking, and the need for cooperation and trust (Liu & Hanauer, 2011).
There were other social trends as well. Although women had earlier worked in many
capacities, the need for labor during World War II allowed them to move into less
traditional work settings. ‘Rosie the Riveter’ was the iconic woman of the time, working in
a skilled blue-collar position, doing dangerous, heavy work that had previously been
reserved for men in industrial America. After the war, it was difficult to argue that women
could not work outside the home, because they had contributed so much to American war
production. This was approximately 20 years after women had gained voting rights at the
national level, with the passage of the 19th Amendment to the Constitution (passing
Congress in 1919 and taking until 1920 for the required number of states to ratify it).
Throughout the 1950s, 1960s, and 1970s, women—once disenfranchised as a group and
with limited legal privileges—continued to seek their full rights as members of their
communities.
In another area of social change, the U.S. Supreme Court in 1954 handed down their
decision in Brown v. Board of Education of Topeka, Kansas. This decision overturned an
earlier ruling that racial groups could be segregated into ‘separate but equal’ facilities. In
reality, the segregated facilities were not equivalent. School systems that had placed Blacks
into schools away from Whites were found to be in violation of the U.S. Constitution. This
change in the law was a part of a larger movement by Blacks to seek justice and their civil
rights. Notably, psychologists Kenneth and Mamie Phipps Clark provided psychological
research demonstrating the negative outcomes of segregated schools (Clark, 1989; Clark &
24
Clark, 1947; Keppel, 2002). This was the first time that psychological research was used in
a Supreme Court decision (Benjamin & Crouse, 2002). The Brown v. Board of Education
decision required sweeping changes nationally and encouraged civil rights activists.
Among these activists were a tired and defiant Rosa Parks refusing to give up her bus
seat to a White passenger as the existing rules of racial privilege required; nine Black
students seeking entry into a school in Little Rock, Arkansas; other Blacks seeking the right
to eat at a segregated lunch counter; and students and religious leaders around the South
risking physical abuse and death to register Blacks to vote. The civil rights movement of the
1950s carried over to the 1960s. People of color, women, and other underprivileged
members of society continued to seek justice. The Voting Rights Act of 1965 helped to
enforce the 15th Amendment to the Constitution, guaranteeing citizens the right to vote
(www.ourdocuments.gov/doc.php?flash=true&doc&100&page=transcript).
In the 1960s, the ‘baby boomers’ also came of age. Born in the mid-1940s and into
the 1960s, these children of the World War II veterans entered the adult voting population
in the United States in large numbers, shifting the opinions and politics of that time.
Presaging these changing attitudes, in 1960, John F. Kennedy was elected president of the
United States (www.whitehouse.gov/about/presidents/johnfkennedy). Considered by some
too young and too inexperienced to be president, Kennedy embodied the optimism and
empowerment of an America that had won a world war and had opened educational and
occupational opportunities to the generation of World War II veterans and their families
(Brokaw, 1998). His first inaugural address challenged the nation to service, saying, ‘Ask
not what your country can do for you—ask what you can do for your country.’ During his
tenure, the Peace Corps was created, sending Americans overseas to help developing nations
to modernize. Psychologists were also encouraged to ‘do something to participate in society’
(Walsh, 1987, p. 524). These social trends, along with the increasing moral outrage over
the Vietnam War, fueled excitement over citizen involvement in social reform and
generated an understanding of the interdependence of social movements (Kelly, 1990).
One of President Kennedy’s sisters had special needs. This may have fueled his
personal interest in mental health issues. Elected with the promise of social change, he
endorsed public policies based on reasoning that social conditions, in particular poverty,
were responsible for negative psychological states (Heller, Price, Reinharz, Riger, &
Wandersman, 1984). Findings of those times supported the notion that psychotherapy was
reserved for a privileged few, and institutionalization was the treatment of choice for those
outside the upper class (Hollingshead & Redlich, 1958). In answer to these findings,
Kennedy proposed mental health services for communities and secured the passage of the
Community Mental Health Centers Act of 1963. The centers were to provide outpatient,
emergency, and educational services, recognizing the need for immediate, local
interventions in the form of prevention, crisis services, and community support.
Kennedy was assassinated at the end of 1963, but the funding of community mental
health continued into the next administration. In his 1964 State of the Union address,
President Lyndon B. Johnson prescribed a program to move the country toward a ‘Great
Society’ with a plan for a ‘War on Poverty.’
25
President Johnson wanted to find ways to empower people who were less fortunate
and to help them become productive citizens. Programs such as Head Start (addressed in
Chapter 8) and other federally funded early childhood enhancement programs for the
disadvantaged were a part of these efforts. Although much has changed in our delivery of
social and human services since the 1960s, many of the prototypes for today’s programs
were developed during this time.
Multiple forces in mental health and in the social movements of the time converged in
the mid-1960s. Dissatisfaction with the effectiveness of traditional individual
psychotherapy (Eysenck, 1952), the limitation on the number of people who could be
treated (Hollingshead & Redlich, 1958), and the growing number of mentally ill
individuals returning into the communities combined to raise serious questions regarding
the status quo in mental health. In turn, a recognition of diversity within our population,
the appreciation of the strengths within our communities, and a willingness to seek
systemic solutions to problems directed psychologists to focus on new possibilities in
interventions. Thus we have the basis for what happened at the Swampscott Conference.
Swampscott
In May 1965, a conference in Swampscott, Massachusetts (on the outskirts of Boston), was
convened to examine how psychology might best plan for the delivery of psychological
services to American communities. Under the leadership of Don Klein, this training
conference was organized and supported by the National Institute of Mental Health
(NIMH; Kelly, 2005). Conference participants, including clinical psychologists concerned
with the inadequacies of traditional psychotherapy and oriented to social and political
change, agreed to move beyond therapy to prevention and the inclusion of an ecological
perspective in their work (Bennett et al., 1966). The birth of community psychology in the
United States is attributed to these attendees and their work (Heller et al., 1984; Hersch,
1969; Rappaport, 1977). Appreciating the influence of social settings on the individual, the
framers of the conference proceedings proposed a ‘revolution’ in the theories of and the
interventions for a community’s mental health (Bennett et al., 1966).
26
1.
2.
3.
WHAT IS COMMUNITY PSYCHOLOGY?
Community psychology focuses on the social settings, systems, and institutions that
influence groups and organizations and the individuals within them. The goal of
community psychology is to optimize the well-being of communities and individuals with
innovative and alternate interventions designed in collaboration with affected community
members and with other related disciplines inside and outside of psychology. Klein (1987)
recalled the adoption of the term community psychology for the 1963 Swamp-scott grant
proposal to NIMH. Klein credited William Rhodes, a consultant in child mental health,
for writing of a ‘community psychology.’ Just as there were communities that placed people
at risk of pathology, community psychology was interested in how communities and the
systems within them helped to bring health to community members.
Iscoe (1987) later tried to capture the dual nature of community psychology by
drawing a distinction between a ‘community psychology’ and a ‘community psychologist.’
He stated that the field of community psychology studied communities and the factors that
made them healthy or at risk. In turn, a community psychologist used these factors to
intervene for the betterment of the community and the individuals within it. In the 1980s,
the then Division of Community Psychology (Division 27 of the APA): was renamed the
Society for Community Research and Action so as to better emphasize the dual nature of
the field.
The earliest textbook (Rappaport, 1977) defined community psychology as
an attempt to find other alternatives for dealing with deviance from societal-based
norms … [avoiding] labeling differences as necessarily negative or as requiring social
control … [and attempting] to support every person’s right to be different without
risk of suffering material and psychological sanctions … The defining aspects of this
[community] perspective are: cultural relativity, diversity, and ecology, [or rather]
the fit between person and environment … [The] concerns [of a community
psychology reside in] human resource development, politics, and science … to the
advantage of the larger community and its many sub-communities. (pp. 1, 2, 4–5;
boldface ours)
Table 1.1 Four Broad Principles Guiding Community Research and Action
Community research and action requires explicit attention to and respect for
diversity among peoples and settings.
Human competencies and problems are best understood by viewing people within
their social, cultural, economic, geographic, and historical contexts.
Community research and action is an active collaboration among researchers,
practitioners, and community members that uses multiple methodologies. Such
research and action must be undertaken to serve those community members
27
4.
directly concerned, and should be guided by their needs and preferences, as well as
by their active participation.
Change strategies are needed at multiple levels to foster settings that promote
competence and well-being.
Source: From www.scra27.org/about.html.
This emphasis on an alternative to an old, culture-blind, individual-focused
perspective was restated more recently in Kloos and colleagues (2011), who provide two
ways in which community psychology is distinctive. It ‘offers a different way of thinking
about human behavior … [with a] focus on the community contexts of behavior; and it
[expands] the topics for psychological study and intervention’ (p. 3).
Both Kofkin Rudkin (2003) and Kagan, Burton, Ducket, Lawthom, and Siddiquee
(2011) have noted that continual reconsiderations of the definition of community
psychology accommodate a flexible and dynamic conceptualization of a field that is
sensitive to the continual input of science and theory as well as considerations of the details
of time and place.
Community psychology is born out of dissatisfaction with the limitations of the
traditional psychotherapy approaches. The ‘radical’ theory- and research-based position it
took was that individuals were best understood within the contexts in which they were
embedded, that these contexts demanded an appreciation of the cultural and ethnic
diversity of backgrounds, and that the individual and the context provided both
opportunities and problems for health and well-being. Studying communities would yield a
better understanding of this position and would provide new approaches to programming
toward the health of those communities and the individuals within them.
At the beginning of the 21st century, the Society for Community Research and Action
(Division 27 of the APA) surveyed its membership. From those results, a divisional task
force compiled four basic principles for community psychology (see Table 1.1). These
principles may be summarized as a respect for diversity, a recognition of the power of
context, an appreciation of a community’s right to empowerment, and an understanding of
the complexity of ecologically relevant interventions. The following exploration of these
four fundamental principles provides us with a good example of community psychology in
application.
28
FUNDAMENTAL PRINCIPLES
‘Principles’ are (1) the theoretical assumptions on which a concept (i.e., community
psychology) is built, or (2) the values that influence and motivate action in the field. The
framers of these principles hoped to portray what were commonly agreed-on fundamentals
of a community psychology, but they also noted that these were aspirations.
TABLE 1.2 The ADDRESSING Framework for Diversity
A ge,
D evelopmental and acquired D isabilities,
R eligion,
E thnicity,
S ocioeconomic status,
S exual orientation,
I ndigenous heritage,
N ational origin,
G ender.
Source: Adapted from material in Hays, P. A. (2008). Addressing cultural complexities in practice:
Assessment, diagnosis, and therapy (2nd ed.). Washington, DC: American Psychological Association.
A Respect for Diversity
At one time, psychology was in search of universal principles that would transcend culture
or ethnicity. However, the group sampled to establish these universals tended to be White,
middle-class college students. The irony in this did not escape psychologists in the 1960s or
today (Gutherie, 2003; Pedersen, 2008; Rappaport, 1977; Trimble, 2001). Recognizing
and respecting differences in people and their cultural and ancestral heritage is important to
a community psychology. Trickett, Watts, and Birman (1994) and Hays (2008) have noted
that diversity extends beyond culture, ethnicity, and race and includes considerations of
gender, disability, sexual orientation, and those who have been marginalized and oppressed.
Hays (2008) included 10 categories in her system for noting diversity (Table 1.2), the
ADDRESSING system. Okazaki and Saw (2011) would add to this list an 11th category,
that of Immigrant Status.
Rappaport (1977) called for the acceptance of ‘the value of diversity and the right of
people to choose their own goals and life styles’ (p. 3). If diversity is respected, how might
that affect our thinking? Certainly, different would not mean inferior (lower) or deficient
(lacking). Early models of abnormality that assumed such positions would have to be
discarded, and new models that appreciated the contribution of social and cultural factors
29
would have to be incorporated into our conceptions of health and pathology (Sue, Sue,
Sue, & Sue, 2013). The assumptions of merit and achievement would also need to be
reconsidered, along with resource distribution and the criteria for allocations. From a belief
in the diversity of people also comes a recognition of the distinctive styles of living,
worldviews, and social arrangements that are not part of the perceived mainstream or
established traditional society but that more accurately characterize our society’s diversity.
Moreover, a recognition of these distinctions keeps diverse populations from being
compared with perceived mainstream cultural standards and then being labeled as
‘deficient’ or ‘deviant’ (Snowden, 1987). Such a recognition of diversity increases our
ability to design interventions that are culturally appropriate and thus more effective (e.g.,
Dumas, Rollock, Prinz, Hops, & Blechman, 1999; Marin, 1993).
Sue (1977), early in the community mental health movement, pointed out the
differential treatment and outcomes for ethnic minority group clients in the system. He
called for provision of responsive services to these populations. These demands for more
cultural competency in treatments, emphasizing the importance of understanding
relationships and context in our interventions, have continued over several decades (Sue,
2003). Sue believes these variables of cultural capacity to be just as important, if not more
important, than specific treatment techniques. Padilla, Ruiz, and Alvarez (1975) also called
attention to the barriers of geography, class, language, and culture that led to a lack of
Spanish-speaking and -surnamed populations in mental health systems. The
recommendations of barrio-(neighborhood) and family-focused services have been models
for what community-based services should be. In particular, the emphasis continues to be
on respect for cultural context in devising treatments. When interventions fail, it is not
necessarily the fault of the client or patient. The system and its assumptions can also be at
fault and must be examined. Bernal and Sáez-Santiago (2006) described a framework
(Table 1.3) for deriving what Pederson (1997) called a ‘culturally centered’ community
intervention. The APA has adopted Guidelines on Multicultural Education, Training,
Research, Practice and Organizational Change for Psychologists (APA, 2003) in recognition of
the importance of diversity in psychology.
TABLE 1.3 Framework for Culturally Centered Interventions
Language (Native language
skills)
A carrier of culture and meaning
Personal relationships Especially as might be influenced by similarities or
differences in ethnicity and race
Metaphors The ways in which meaning and concepts are
conveyed
Cultural knowledge Traditions, customs, and values
Theoretical model for
intervention
The psychological bases for action
30
Intervention goals Need for agreement as to what is to be
accomplished
Intervention methods Culturally sensitive and respectful of the community
Consideration of context The historic, social, political, and economic setting
are seen as important to the person, the setting, and
the intervention
Source: Adapted from material in Bernal, G., & Sáez-Santiago, E. (2006). Culturally centered psychosocial
interventions. Journal of Community Psychology, 34, 121–132.
In terms of research, the recognition of diversity within populations has slowly but
steadily been rising. In early issues of community psychology journals, about 11% of the
articles addressed ethnic minority populations (Loo, Fong, & Iwamasa, 1988). Martin,
Lounsbury, and Davidson (2004) found this rate to more than double in the time period
from 1993 to 1998, with approximately 25% of the articles in the American Journal of
Community Psychology addressing diversity issues.
The study of ethnic minority groups is really the practice of good science (Sue & Sue,
2003). Given our understanding of population (the people in whom we are interested) and
sample (a subset of those people), accurate sampling requires recognition of who is the
population. The cultural variations in ethnic groups make them different ‘populations’ for
study. Considerations of culture and community are integral to one another (Kral et al.,
2011; O’Donnell, 2006). O’Donnell proposed the term cultural–community psychology
because all communities were best understood within their specific cultural contexts.
Building on the work of Trickett (1996), who described the importance of both culture
and context in understanding and working in diverse communities, O’Donnell commented
that all community phenomena and interventions should be preceded by the phrase ‘it
depends.’
Given the emphasis on diversity and the appreciation of cultural and ethnic factors, it
is not surprising that 23% of the membership of the Society for Community Action and
Research self-identifies as ethnic minority (Toro, 2005). In comparison, approximately 6%
of the APA membership self-identifies as ethnic minority.
Notably, certain marginalized groups continue to be ignored or underserved — for
example, homosexuals, individuals with disabilities, and women (Bond, Hill, Mulvey, &
Terenzio, 2000). Bond and Harrell (2006) caution that there is little work on the subtleties,
contradictions, and dilemmas that arise from working with the many diversities that exist
within our communities. Along with the obvious issues of competing ethnic groups, there
are the intersections of gender and ethnicity, the combinations of sexual orientation and
class, or all of these considerations together creating practical challenges to the practice of
community psychology. Although diversity has a history of recognition within the field, its
implications are still being worked out and understood.
The appreciation of diversity has been important to community psychologists’ work in
various groups and communities. However, research has found that community is created
31
most easily within homogeneous populations. This tension between diversity and
homogeneity is an area that community psychology must better address (Townley, Kloos,
Green, & Franco, 2011).
Of note is Toro’s (2005) comment on how the field has become so diverse. This
diversity extends to the many theories, approaches to problems, issues addressed, and
populations served. Although some may call this a lack of focus, Toro believes it to be an
indication of health and vitality as the field expands its boundaries and takes on new
challenges.
You will see numerous studies on specific ethnic groups in this text. There are also
growing numbers of studies focusing on other aspects of diversity. We will not reference
one particular chapter that deals with this topic. That is because diversity is integral to any
of the considerations within the field. This is very different from what was found in the
1960s. Community psychology was one of the areas in psychology that championed the
need for inclusion of diversity in the mainstream of the discipline.
The Importance of Context and Environment
Our behaviors are governed by the expectations and demands of given situations. For
example, students’ behavior in lecture classes is different from their behavior at a dance.
Even the levels of our voices are governed by where we happen to be. At a ball game or
sports event, we are louder. At a funeral, or in a church or temple, we are quieter. Raising
our children, we may tell them to use their ‘inside’ voices, or allow them to use their
‘outside’ voices when the occasion permits it.
Kurt Lewin (1936) formulated that behavior is a function of the interaction between
the person and the environment [B = f(P × E)]. A social–gestalt psychologist, Lewin
intended to capture the importance of both the individual and his or her context. To
consider the individual alone would provide an incomplete and weak description of the
factors influencing behavior. It would be like a figure without a ground. Therefore, any
study of behavior must include an understanding of the personal dispositions and of the
situation in which the person finds him- or herself.
Roger Barker (1965), one of Lewin’s students, studied the power of ‘behavior
settings’ in guiding the activities of a setting’s inhabitants. People in a given setting acted in
prescribed ways. Violation of these environmentally signaled patterns was punished. As a
result, these patterns persisted over time. Barker observed and analyzed the social and
psychological nature of these settings. For example, in a dining room, we dined. We did
not play football there, or so we were told. If we were to go up to a person and rub his
shoulder instead of shaking his hand, we would get curious looks. If we were to get into an
elevator and face inward instead of outward, people would become nervous. These behavior
settings held a powerful influence on what we did.
One aspect of the setting that Barker studied was the number of people it took to
maintain that setting. To run a grocery store requires a certain number of people—for
example, the checkout clerk, the stocker, and the people to make and accept deliveries. We
32
have all been at a checkout area when there were not enough checkout clerks. There is a
demand on people to work harder, and everyone feels that there are not enough people to
do what needs to be done. If there are more customers, there might be a call for more
checkers to come to their stands. The number of people required is flexible, and the store
has made provision to have more or less as the needs change.
Each setting has an optimal level of staffing. When there are too many staff members,
it is likely that the setting will be more selective about who is allowed to perform the tasks.
There will be competition to fill those positions. Barker (1965) called this a case of
overmanning, or rather, too many people for the situation. Newcomers are less likely to be
welcome, because they would add to the competitive pool. On the other hand, if there are
not enough people to complete a task, there is more environmental demand to use every
available individual and to recruit more. With a lot of work to be done and not enough
personnel to do, there will be less competition for positions. As we might guess, new
members will be welcome. This is a case of undermanning, or insufficient personnel to
accomplish the required tasks. In this case, the social environment is more open and
positively inclined to newcomers.
It might be noted that in economically difficult times, where there is competition for
scarce jobs, the attitude toward newcomers and immigrants is usually negative. When there
is a need for more workers, there is more willingness to take in new people. Often these
positive or negative attitudes toward newcomers can be manipulated by perceptions of
overmanning or undermanning. For example, attitudes toward new workers can be made
more negative by instilling a belief that there are too many people, even though newcomers
might be performing tasks that others would not do.
Barker’s and Lewin’s works have underscored the importance of environmental factors
in behavioral tendencies. Regularities of behavior are not determined solely by personality
and genetics. Behaviors are also the result of environmental signals and pressures on the
individual. Different environments bring different behaviors. Change the environment,
change the behavior.
Behavioral community psychology reinforces the importance of context from a
learning theory perspective. Discriminative stimulus and setting control are contextual
terms. In behavioral terminology, the ‘context’ can be construed as the discriminative
stimuli within a setting that, as individuals or groups have learned, signal the display of
certain behaviors leading to consequences that are desirable or undesirable. The expectation
of reinforcement or punishment for the behaviors is the basis of the community learning.
Certain behaviors are reinforced in a given setting, increasing the probability of those
behaviors in those settings; if other behaviors are punished in that setting, the probability of
those behaviors decreases (Figure 1.1). A ‘No Smoking’ sign usually suppresses smoking
behavior. People drinking usually increases the likelihood of others drinking in that setting.
When picking up dog waste on a walk through certain urban neighborhoods was
reinforced, people picked up their dog waste in those neighborhoods (Jason & Zolik,
1980). This is a Skinnerian explanation of setting control (Skinner, 1974).
Beyond this strict behavioral interpretation of context, Mischel (1968) argued for the
33
importance of setting as well as personality in determining behaviors. That is, certain
behavioral tendencies might appear stronger in particular settings and weaker in others. For
example, we might not see friendly behaviors in one setting (final exams), but in another
setting, friendliness overflows (parties). Behavioral community programs have been a part
of the community psychology tradition for many years, contributing to the understanding
of context and the power of learning theory in devising interventions (Bogat & Jason,
1997, 2000; Fawcett, 1990; Glenwick & Jason, 1980). The emphasis on clear goals, the
importance of settings, and the impact of consequences can be seen in community
psychology today.
FIGURE 1.1 Setting Control and behavior
The conceptualization of context is more typically in terms of process and systems
(Seidman & Tseng, 2011; Tseng & Seidman, 2007). Here, consideration is given to
“resources,” “the organization of resources,” and “the social processes” within a given
environment. Resources are defined as material, personal, or social “assets” that can be of
help to an individual or group (http://oxforddictionaries.com/definition/resource).
Examples of resources include personnel, expertise, supplies, and money. The organization
of resources addresses who has the resources, how they are distributed, and how within the
system they are accumulated and managed. Finally, the social processes are the interactions
(back and forth) and the transactions (exchanges) between and among the members of a
system. For example, in a particular organization we might consider the amount of money
in the system (its resources), the rules governing how and when it is distributed
(organization of resources), and the discussions around these issues (processes). Although
psychologists typically focus on the processes within a system (who talks to whom, how
people communicate with each other, the clarity of communications), the context can be
changed just as dramatically by alternations in resources (more or less money) or the
organization of resources (who has it, how it is decided who gets it).
As we have described, context can be as simple as the stimulus controls in a setting, or
as complex as the consideration of means, rules, and participatory patterns of a given
setting; context can also dictate behavior patterns and influence motivation for accepting
new or rejecting old members. An example of using contextual frameworks for
understanding events is our portrayal of the historical events within mental health and
social movements leading up to the Swampscott Conference. The social, political, and
historical events leading up to Swampscott helped to define the “spirit” of the times
34
(zeitgeist) and of the place (ortgeist) that led the founders of community psychology to
bring change (Kelly, 2006).
No matter what the theoretical framework, the importance of context or setting is an
essential part of a community psychology (Trickett, 2009). A person does not act except in
ways that are determined by his or her setting. In turn, those actions are best understood
when viewed in the framework of context.
Empowerment
Empowerment is another basic concept of community psychology. It is a value, a
process, and an outcome (Zimmerman, 2000). As a value, empowerment is seen to be
good. It assumes that individuals and communities have strengths, competencies, and
resources and are by nature nonpathological. As a process, empowerment is a way in which
individuals and communities feel that they have some say in and control over the events in
their lives, the structures that shape their lives, and the policies that regulate those
structures. Community psychology emphasizes the value of the democratic process. As an
outcome of democracy, people can feel empowered. In psychological terms, a feeling of
efficacy is the belief that one has power over one’s destiny. It is the opposite of helplessness.
It is what Bandura (2000, 2006) has called agency (being an actor within one’s world, and
not merely a passive observer), self-efficacy (a belief that one can make a difference), and
collective efficacy (a belief of a group or community that together they can bring about
change). Beyond these cognitive components, empowerment includes action on one’s own
behalf.
Empowerment is viewed as a process: the mechanism by which people, organizations,
and communities gain mastery over their lives. (Rappaport, 1984, p. 3)
At the community level, of analysis, empowerment may refer to collective action
to improve the quality of life in a community and to the connections among
community organizations and agencies. (Zimmerman, 2000, p. 44)
Empowerment is a construct that links individual strength and competencies,
natural helping systems, and proactive behaviors to social policy and social changes.
Empowerment theory, research, and intervention link individual well-being with the
larger social and political environment. (Perkins & Zimmerman, 1995, p. 569)
Perkins and associates (2007) note that empowering individuals through learning and
participation opportunities eventually leads to higher level organizational and community
transformations.
There are many ways to feel empowered within a work setting (Foster-Fishman,
Salem, Chibnall, Legler, & Yapchai, 1998). Job autonomy (control over and influence on
the details of the work setting), gaining job-relevant knowledge, feeling trusted and
respected in the organization, freedom to be creative on the job, and participation in
decision making were examples found through interviews and observations at a given work
35
site. Studies of empowering organizations found that inspiring leadership, power role
opportunities, a socially supportive environment, and group belief in the power of its
members all contributed to feelings of empowerment in community organizations (Maton,
2008; Wilke & Speer, 2011).
And yet, empowerment processes are not simply giving initiative and control over to
people. We are reminded that attempts at youth empowerment have come in a variety of
forms with differential success. Reviewing relevant youth programs, Wong, Zimmerman,
and Parker (2010) noted that empowerment attempts took forms ranging from total
control by youth to total control by adults, and included a shared-control model involving
both youth and adults in decision making and action as the middle ground. Empowerment
was found to be a transactional process, with both adult and youth contributing to the
outcomes (Cargo, Grams, Ottoson, Ward, & Green, 2004). Adults contribute by creating a
welcoming and enabling setting. Youth contribute through engaging with others in positive
and constructive change. Actions by both adults and youth are required. Together, their
contributions build on each other’s behaviors and produce an empowering and productive
environment.
As an example of empowerment outcomes, Zeldin (2004) found that youth increase
in their sense of agency and in their knowledge and skills when they participate in
community decision-making activities. This reminds us that agency, or the feeling that a
person can influence a situation, is linked to self-efficacy, a cognitive attitude that has been
shown to result in better persistence, effort, and final success in dealing with problem
situations (Bandura, 1989, 2006). Empowerment situations may lead to feelings of self- or
collective group efficacy.
Maton and Brodsky (2011) make the distinction among psychological
empowerment, where individuals gain a sense of mastery; social empowerment, where
individuals rise in status; and civic empowerment, where there is a gain in rights and
privileges. Although related to each other, these forms of empowerment are different. Such
distinctions need to be considered in examining both processes and outcomes.
The concept of empowerment has not gone without criticism. Empowerment often
leads to individualism and therefore competition and conflict (Riger, 1993). Empowerment
is traditionally masculine, involving power and control, rather than the more traditionally
feminine values and goals of communion and cooperation. Riger (1993) challenged
community psychologists to develop an empowerment concept that incorporates both
empowerment and community. We will see a variety of attempts at empowerment in our
exploration of community applications throughout the text. It is interesting to note to what
end? With what results?
The Ecological Perspective/Multiple Levels of Intervention
In the developmental literature, Urie Bronfenbrenner (1977) described four layers of
ecological systems that influence the life of a child. At the center of the schema is the
individual, and in ever-growing circles lie the various systems that interact with and
36
influence him or her. The “immediate system” contains the person and is composed of the
particular physical features, activities, and roles of that person. This is called the
microsystem. Examples of microsystems include a playroom, a home, a backyard, the street
in front of the house, or a classroom. Microsystems could include the school or one’s
family. These microsystems directly influence the individual, and the individual can
directly influence the system.
At the next level out is the mesosystem, which holds the microsystems and where the
microsystems interact with each other. Examples of this would be places where one
microsystem (school) and another microsystem (family) come together. A mesosystem is a
“system of microsystems” (Bronfenbrenner, 1977, p. 515). Note that the child/individual is
an active member within the mesosystem. Research has shown the advantages of clear and
demonstrated linkages between the school and the family for the child’s school adaptation
and academic performance, and this has led to direct calls for better collaboration between
schools and communities (Adelman & Taylor, 2003, 2007; Warren, 2005). In turn, there
are also findings that schools seen as a part of their community are more likely to be
supported and less likely to be the target of vandalism. Children who feel connected to
family, school, and neighborhood may feel the responsibilities of membership and the
supportiveness of their holistically integrated social and psychological environment. The
“system” then can lead to feelings of connection or disconnection among the microsystems;
to the collection of social, material, and political resources; or to the alienation of the
various components from each other.
The next circle out is the exosystem, an extension of the mesosystem that does not
immediately contain the child or individual. The exosystem influences the mesosystem.
Examples would be government agencies that influence the meso- and microsystems
(school boards, city councils, or state legislatures, which influence the schools and families
but do not have them as members) or work situations for family members (who in turn
populate the micro- and mesosystems).
At the furthest level outward is the macrosystem, which does not contain specific
settings. The macrosystem contains the laws, culture, values, or religious beliefs that govern
or direct the lower systems. Being in the southwestern United States brings certain cultural
and legal assumptions that may differ markedly from those in Vancouver, Canada;
Barcelona, Spain; Auckland, New Zealand; or Hong Kong, China. Bronfenbrenner (1977)
proposed that any conceptualization of a child’s development needed a comprehensive
examination of all these systems to provide an adequate understanding of the processes that
influenced the child. Interventions to address this progress should have a comprehensive
and conceptual basis addressing multiple levels. Anything less provides an artificial
perspective on what really happens in the life of an individual or a group of individuals.
Graphic descriptions of Bronfenbrenner’s ecological model showed circles embedded in
larger circles. This described the nature of the systems embedded in larger systems.
Kelly (2006) saw the ecological model as an alternative to the reductionistic attempts
to describing phenomena. If the world was complex and dynamic, it required concepts and
processes that captured those qualities. Among the ecological principles were
37
interdependence, cycling of resources, adaptive capacity, and succession.
With interdependence, the elements of an ecosystem are seen to be related to each
other. Changing one element affects all elements in some way. Kelly (1980) described a
baseball game as a good example of interdependence. Billy Martin, the onetime manager of
the New York Yankees, said that every pitch in every game was different (Angell, 1980).
Each pitch required calculations of factors such as weather, wind, time of day, ballpark,
personnel, positioning, order at bat, pitcher, and number of pitches. You can see the shifts
in the infield and outfield, types of signals given, types of swings attempted, and other
changes in strategy and tactics. Everything is interdependent. To the uninformed or
uninvolved, baseball can seem a quiet, leisurely sport with which one can be intermittently
engaged. To those who know, its complexity is never-ending and a source of continuing
fascination. Action in the community requires a similar calculation of various interacting
parts. Resources, players, activities, traditions, values, history, and culture are some of the
interdependent elements of community psychology.
The second principle of Kelly’s ecological model is the cycling of resources. This
follows the first law of thermodynamics, which states that the amount of energy in a system
remains constant: If there is an expenditure of energy in one area, it is the result of transfer
of energy from another area. In the ecological model, for resources to be dedicated to one
area, they must come from another area. Therefore, the community must choose where to
attend and where to expend its energy or resources. To provide more funds for education,
some roads may not be repaired; to provide more funds for roads, schools may have to get
by with less money. This becomes especially apparent in economically lean times.
The third ecological principle deals with adaptive capacity to a given environment.
Those who are better able to deal with their environment are more likely to survive, and
those who can deal with a broader range of environments should find more settings in
which it is possible to live. What matters is not just adaptation to one environment, but
also the adaptive range that enables the organism to survive across more situations. One
might figure that the argument for flexibility and openness to social and cultural variation
would allow a person to do well in more social and physical situations. Community
cultures allowing us to learn and to live and to change our living situations across a wide
array of settings allow for more successful adjustment to change. If our weather changes,
how open are we to changing what we do? One of the authors went from Hawaii to upstate
New York. When winter came, it got cold. One day, the winter skies cleared. In Hawaii,
clear skies meant warm weather. Blue skies in upstate New York in the middle of winter
meant the exact opposite. It was colder. Much colder. Make that mistake once, and the
person who lives to talk of it again learns very quickly, or risks death. A community that
notes warming or cooling, changes in economic opportunities, or shifts in demographics
needs to adapt to deal with these changes, or it will fail. Those who do this better survive
and thrive.
Kelly’s final ecological point is that of succession. One thing follows another in a
fairly predictable manner. Consider the queen of England and who will succeed her when
she is gone. Which of the princes or princesses comes next? And after him or her, who else?
38
1.
2.
3.
4.
They have it all worked out. This person follows, and when they are gone, the next in line
follows, and so on and so on. A similar type of consideration is made with the president of
the United States. If he or she is incapacitated while in office, the vice president takes
charge, and if the person who is vice president is unable to do the job, the Speaker of the
House is next in line. Of course, the president can also be succeeded after an election: The
process of moving from one president to the next is laid out in predictable fashion, from
the elections in November to the inauguration in January. All of this is to say that with
time, changes occur. These changes follow a predictable sequence, just as the queen of
England will not always be queen, or the president remain the president. With the passage
of time, there will be someone new. Settings and organizations change as well. Just as a
college student moves from freshman to senior, and spring follows winter, a decline in one
industry leads to opportunity for new industries, and particular groups of people decrease
and other groups increase in an area. Succession requires the community psychologist to
pay attention to these changes. We can see these ecological principles summarized in Table
1.4.
TABLE 1.4 Ecological Principles
Interdependence—Elements of the environment influence each other.
Adaptation—An organism must be able to change as the environment changes.
Cycling of resources—Resources are exchanged in a system, such as money for
goods.
Succession—Change occurs; nothing is static.
Source: Adapted from material in Kelly, J. (2006). Becoming ecological. New York, NY: Oxford University Press.
The ecological model also calls attention to person–environment fit. Does the person
have the characteristics to succeed, given the environmental expectations and demands?
Will someone who is short do well in a place where all the important objects are placed
seven feet off the floor? Or (and one author has observed this) can a tall person live
comfortably in a basement apartment with six-foot ceilings? This person–environment fit
works in psychological terms as well, being quiet when appropriate and loud when
appropriate. The person–environment fit concept is well embedded in community
psychology (Pargament, 1986; Trickett, 2009). Early on, Rappaport (1977) explained that
the ecological perspective required an examination of the relationship between persons and
their environments (both social and physical). The establishment of the optimal match
between the person and the setting should result in successful adaptation of the individual
to his or her setting.
Moos measured person–environment fit by assessing a person’s perception of the
environment and that person’s desired environment according to Social Climate Scales
(Moos, 1973, 2003). The discrepancies between the real and the ideal could be compared.
39
Where there were few differences (good fit), we would expect the person to be happier. In
contrast to this, most psychological evaluations focus on the person alone. The assumption
is that people are the most important contributors to their own well-being. This purely
trait-type focus has been critiqued by social–behavioral personality theorists Mischel (1968,
2004) and Bandura (2001), where the person and what he or she carries within them is the
sole determinant of success or failure. The more recent social–behaviorist personality
theories are interactionist or transactionalist.
Labeling the person who does not fit the setting as a “misfit” and blaming the
problems on the individual alone is not helpful or realistic. Rather, the ecological
perspective recognizes that with people and environments, the influence is mutual.
Individuals change the settings in which they find themselves, and in turn, settings
influence the individuals in them (Bandura,1978, 2001; Kelly, 1968, 2006; Kuo, Sullivan,
Coley, & Brunson, 1998; Peterson, 1998; Seidman, 1990). If something is awry with the
individual or the environment, both can be examined and perhaps both changed. A study of
the person–environment fit of urban Mexican American families in the southwestern
United States yielded several findings supporting the importance of setting and families.
Economically distressed families did better in low-income neighborhoods, and successful,
acculturated families did less well in a nonmatching neighborhood. Although single-parent
families were generally at risk and dual-parent families generally more adaptive to settings,
the match of neighborhoods influenced adjustment capabilities (Roosa et al., 2009).
Given the ecological framework, community psychology research and action must
consider more than the individual. It must include the environment that contains the
individual. That environment, or context, needs to be expanded to include the variety of
situations that influence behaviors. The more completely the ecology can be understood,
the more effectively the interventions can be devised and implemented. Communities are
complex and reciprocal systems by nature and must be dealt with as such. A more recent
description of ecological thinking included (1) thinking interdependently (as before); (2)
understanding the cultural contexts (macrosystemically); (3) ensuring the development of
trust between the researcher and the community; and (4) realizing that the researcher is
transformed in the discovery process, just like the communities he or she studies or
intervenes in (Kelly, 2010).
We think systemically, ecologically, and with appreciation for the differences we bring
to our social milieu. Beyond the principles outlined here, several concepts have high
currency within the field. We examine them next. Note that the differences between
clinical and community psychology are elaborated in Case in Point 1.1.
CASE IN POINT 1.1
Clinical Psychology, Community Psychology: What’s the
Difference?
Clinical psychology and community psychology both grow out of the same motivation to
40
help other individuals using the science of psychology. Clinical psychology’s orientation has
traditionally been on the individual and the internal variables that influence their lives.
Among those internal variables are emotions, cognitions, neural structures, and behavioral
tendencies. Clinicians tend to speak of personality and what has influenced personal
qualities. Given the assumption that a clinician is called into service when there is an
identified personal problem, clinical skills include testing and assessment, diagnosis, and
psychotherapy (Plante, 2011). Essentially, a clinician is trained to deal with
psychopathology.
Among the clinical psychologist’s work settings may be a hospital, a health clinic, a
group or private practice office, a university, or a research setting. You may note the
medical nature of most of these sites. American clinical psychology traces its origins back to
the late 1800s. Lightner Witmer is credited by many as the father of American clinical
psychology. His work in the first part of the 20th century focused on schoolchildren and
their treatment, learning, and behavioral problems in the psychological clinic.
In contrast to clinical psychology, community psychology is oriented to groups of
people and the external social and physical environments’ effects on those groups—that is,
communities.
External variables include consideration of social support, peer and familial
environments, neighborhoods, and formal and informal social systems that may influence
individuals or groups. There is interest in social ecology and public policy. The orientation
is toward prevention of problems and promotion of wellness. Skill sets include community
research skills; the ability to understand community problems from a holistic perspective;
skills in relating to community members in a meaningful and respectful manner; attention
to the existing norms, system maintenance, and change; appreciation for the many ways in
which context/environment influences behaviors; being able to assemble and focus
resources toward the solution of a community problem; and training that enables thinking
outside the established normative world. A review of three community psychology texts
support these descriptions. Among the earliest of texts on community psychology,
Rappaport (1977) dedicated many of his chapters to social interventions and systems
interventions. A few years ago, Kofkin Rudkin’s (2003) book included chapters titled
“Beyond the Individual,” “Embracing Social Change,” “Prevention,” “Empowerment,” and
“Stress.” Kloos et al. (2011) had chapters entitled “Community Practice,” “Community
Research,” “Understanding Individuals within Environments,” “Understanding Diversity,”
“Stress and Coping,” “Prevention and Promotion,” and “Social Change.” None of these
community texts had sections on psychopathology, assessment, or psychotherapy.
Community psychologists might be working for urban planners, government offices,
departments of public health, community centers, schools, or private program evaluation
agencies, as well as universities and research centers. They are not usually found in medical
settings doing therapy but might work there examining delivery systems and community
accessibility programs.
There are clear differences between clinical and community psychology topics.
Common interests include providing effective interventions for the human good and
41
understanding phenomena from a psychological perspective. Many community
psychologists were trained as clinical psychologists. The Swampscott Conference attendees
were clinicians. Clinical psychology has taken on the themes of pathology prevention and
health promotion in a significant way. The discussion of the limitations of traditional one-
on-one clinical psychology has continued among clinicians (Kazden, 2010). The questions
remain the same. How can we more efficiently and more effectively bring psychological and
physical health to larger segments of the population? Community psychology argues that its
approach brings new perspectives to help answer this question.
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OTHER CENTRAL CONCEPTS
Besides the principles that have been identified as foundational to a community
psychology, several concepts are central to the field. Among them are the ideas of
prevention, a strength focus, social change and action research, a sense of community, and
an interdisciplinary perspective.
Prevention Rather than Therapy
The Swampscott Conference’s focus on prevention rather than treatment was inspired by
public health (Heller et al., 1984; Kelly, 2005) and work in child and social psychiatry
(Caplan, 1964). In very basic terms, prevention is understood to be “doing something now
to prevent (or forestall) something unpleasant or undesirable from happening in the future”
(Albee & Ryan, 1998, p. 441). What one specifically does may be determined by what one
is specifically trying to prevent, of course, but the underlying premise remains.
The main argument for prevention is that traditional psychological interventions often
came too late in the illness development process; they were usually provided long after the
individual already had developed a problem. Emory Cowen (1980) stated,
We became increasingly, indeed alarmingly, aware of (a) the frustration and pessimism
of trying to undo psychological damage once it had passed a certain critical point;
[and] (b) the costly, time-consuming, culture-bound nature of mental health’s basic
approaches, and their unavailability to, and effectiveness with, large segments of
society in great need. (p. 259)
Such concerns continue to this day (Vera & Polanin, 2012).
On the other hand, prevention might counter any trauma before it begins, thus saving
the individual and perhaps the whole community from developing a problem. In this
regard, as stated earlier, community psychology takes a proactive rather than reactive role.
For example, community psychologists believe it is possible that sex education before
adolescence, teamed with new social policy, can reduce the teenage pregnancy rate. Kirby
(2007) provides clear research-based guidelines on pregnancy prevention programs. In the
following chapters, you will read about a variety of techniques in prevention: education,
altering the environment, development of alternate interventions, and public policy
changes.
Community psychologists recognize that there are distinctions among levels of
preventive intervention. Primary prevention attempts to prevent a problem from ever
occurring (Heller, Wyman, & Allen, 2000). Levine (1998) likened primary prevention to
an inoculation. Just as a vaccination protects against a targeted disease, primary preventive
strategies can help an individual fend off problems altogether. Primary prevention refers
most generally to activities that can be undertaken with a healthy population to maintain or
enhance its physical and emotional health (Bloom & Hodges, 1988)—in other words,
43
•
•
•
•
•
•
•
•
“keeping healthy people healthy” (Scileppi, Teed, & Torres, 2000, p. 58). Which
preventive strategies are best (or whether they are equally efficacious) is part of the current
debate in community psychology (Albee, 1998).
Cowen (1996) argued that the following criteria must be met for a program to be
considered truly primary preventive:
The program must be mass- or group-oriented.
It must occur before the maladjustment.
It must be intentional in the sense of having a primary focus on strengthening
adjustment of the as yet unaffected.
Levine (1998, 1999) added further characteristics. Primary prevention interventions
should do the following:
Evaluate and promote synergistic effects and consider how to modify countervailing
forces.
Be structured to affect complex social structures, including redundant messages. They
should be continued over time.
Examine institutional and societal issues, not just individual factors.
Recognize that whatever the program, it is just one part of a much larger cultural
effort.
Acknowledge that because high-risk behaviors tend to co-occur, several behaviors
should be targeted.
Later, once there are some signs of problems beginning to arise (e.g., risk factors
emerge or are identified), secondary prevention attempts to prevent a problem at the
earliest possible moment before it becomes a severe or persistent problem. In other words,
at-risk individuals are identified and an intervention is offered because of their increased
likelihood of developing the problem. This is different from primary prevention, which
would be targeted at all individuals, regardless of whether they were at risk. For example,
students at a particular high school whose parents are substance abusers or addicts might be
helped by secondary preventive efforts directed at keeping the students from becoming
habitual users.
Tertiary prevention attempts to reduce the severity of an established problem and
prevent it from having lasting negative effects on the individual. It is seen as similar to
therapy, in that it attempts to help the affected person to avoid relapses (Heller et al.,
2000). An example of tertiary prevention would be designing a program to help
hospitalized persons with mental disorders return to the community as soon as possible and
keep their symptoms under control (Scileppi, Teed, & Torres, 2000) or a program that
helps teen mothers reduce the likelihood of having more children during their adolescence.
Many argue that this is not really a form of prevention, in that it is conceptually different
from primary prevention and the methods used may vary dramatically from those for
primary prevention. Whereas psychoeducation, or teaching skills or information about a
particular problem, might be effective for individuals who are not involved in risky
44
activities, it is likely to be ineffective for those already exhibiting a particular problem.
A second method for defining prevention is provided by Mrazek and Haggerty’s
(1994) Institute of Medicine (IOM) report. They describe three types of prevention based
on the target populations involved. The first is a universal prevention program, which
addresses the general public. Here the effort is to help the total population, as is the case
with most primary prevention efforts. The second is a selective program, aimed at those
considered at risk for future development of problems, as is the case with most secondary
prevention efforts. These risk factors may be biological, social, or psychological. Last, there
are indicated prevention programs for those who are starting to show symptoms of a
disorder. This category is not analogous to tertiary prevention, however. The IOM
definitions of prevention are clear that once a problem has already manifested, the
intervention is no longer considered prevention; thus, relapse prevention would be
considered treatment in this model. The definitions also make a distinction between illness
prevention programs and health promotion programs. The authors point to the difference
between programs that focus on the avoidance of symptoms and programs that focus on
the development of personal potential and sense of well-being. The first type of program is
successful when a phenomenon does not appear (e.g., a symptom), and the second type of
program is successful when a phenomenon (e.g., a new skill set) does appear. Cowen
(2000), Romano and Hage (2000), and Weissberg, Kumpfer, and Seligman (2003) argue
for a synthesis of the prevention and promotion components. They point out that
promotion of well-being does have a positive effect on the prevention of disorder. Romano
and Hage (2000), for example, broadened the definition of prevention to include the
following: (1) stopping a problem behavior from ever occurring; (2) delaying the onset of a
problem behavior; (3) reducing the impact of a problem behavior; (4) strengthening
knowledge, attitudes, and behaviors that promote emotional and physical well-being; and
(5) promoting institutional, community, and government policies that further physical,
social, and emotional well-being. This more inclusive definition of prevention emulates the
evolution that has occurred within the field in conceptualizing the different facets of
prevention.
A review of the literature (see Case in Point 1.2) examining the efficacy of primary
prevention programs has come to the conclusion that primary prevention works. These
reviews also highlight an important differentiation in the prevention literature, namely the
difference between person-centered and environmental-centered prevention efforts. Person-
centered interventions are those that work directly with individuals who may be at risk for
developing disorders and typify many prevention strategies (e.g., skill building,
psychoeducation) (Conyne, 2004). Environment-centered interventions work indirectly to
benefit individuals by affecting the systems in which those individuals reside.
Metaphorically, this process involves enriching the soil so that plants will thrive. The
systems targeted in environment-centered interventions may be familial, community, or
organizational. Based on Bronfenbrenner’s Ecological Systems Theory (Bronfenbrenner,
1979), which you just read about, environment-centered interventions might be aimed at
the participants’ microsystem, which includes peers, school, family, child care, and
45
neighborhood; the mesosystem, which contains the relationships among entities in the
microsystem; the exosystem, which includes places of business and industry, federal and
state governments, social media, health and social services agencies, school organizations,
and extended family members; or last, the macrosystem, which includes cultural values,
attitudes and ideologies, and dominant belief systems. Although community psychologists
have a preference for environment-centered prevention over person-centered, you will read
about both types of prevention in forthcoming chapters.
CASE IN POINT 1.2
Does Primary Prevention Work?
Community psychologists respect prevention efforts, especially those aimed at primary
prevention. Can one demonstrate, however, that primary prevention works? As mentioned
previously, it is complicated to show that a problem that does not (yet) exist has been
successfully affected by a prevention program. Primary prevention programs, however, have
been around a long time. Some have been individually evaluated, but not until the 1990s
did researchers set out to determine whether, overall, primary prevention works.
Fortunately, several major statistical reviews of the literature, called meta-analyses, have
been performed in the past 20 years. Each set of researchers came to the same conclusion:
Primary prevention does work! It is helpful to understand why the converging conclusions
of these studies are rather astonishing.
In the early 1990s, at the request of the U.S. Congress, the Institute of Medicine
(Mrazek & Haggerty, 1994) performed a statistical review of the mental health literature.
Using “reduction of new cases of mental disorder” (p. 9) as its definition of primary
prevention, the Institute of Medicine gathered 1,900 journal citations on primary
prevention of mental health problems. Overall, the institute found that primary prevention,
as previously defined, does work. A quote from the final report divulges their conclusions:
“With regard to preventive intervention research … the past decade has brought
encouraging progress. At present there are many intervention programs that rest on sound
conceptual and empirical foundations, and a substantial number are rigorously designed
and evaluated” (p. 215).
Durlak and Wells (1997) completed a statistical review of the literature on primary
prevention of mental health disorders. In this instance, the researchers examined programs
only for children and adolescents. Using 177 programs designed to prevent behavioral and
social problems, such as depressive reaction to parental divorce, they, too, found empirical
support for primary prevention. For example, the average participant in primary prevention
programs surpassed the performance of between 59% and 82% of children in control
groups, depending on the study. In their journal article, Durlak and Wells summarize their
findings supporting the notion that primary prevention, at least of mental disorders, is
effective: “Outcome data indicate that most categories of primary prevention programs for
most categories of primary prevention programs for children and adolescents produce
significant effects. These findings provide empirical support for further research and
46
practice in primary prevention” (p. 142).
Psychologist Emory Cowen (1997a) compared both of these statistical literature
reviews and concluded that although there was amazingly little overlap in the citations each
set of researchers used, the concept of primary prevention is sound. One other point he
made is that each meta-analysis used a different definition of primary prevention. Recall that
the Institute of Medicine’s study definition was “reduction of new cases of mental
disorder.” Durlak and Wells defined primary prevention as reducing potential for mental
health problems (like the Institute of Medicine) as well as increasing the competencies (or
well-being) of the prevention program participants. After his comparison, Cowen
concluded that research on primary prevention programs is both positive and encouraging
for the future.
In 2010 and 2011, Durlak and his colleagues updated the literature on whether
programs that increase specific competencies for children and adolescents work. One study
(Durlak, Weissberg, & Pachan, 2010) looked at the success of after-school programs that
seek to promote personal and social skills in children and adolescents. Results from 75
reports evaluating 69 different programs (the majority conducted after 2000) were included
in the meta-analysis. In general, after-school programs yielded positive effects on
participants compared to control groups. Furthermore, the researchers found that programs
that contained all the following characteristics were more effective than those that did not:
Sequenced: Does the program use a connected and coordinated set of activities to achieve
their objectives relative to skill development? Active: Does the program use active forms of
learning to help youth learn new skills? Focused: Does the program have at least one
component devoted to developing personal or social skills? Explicit: Does the program
target specific personal or social skills? After-school programs that had these characteristics
were associated with significant increases in participants’ positive feelings and attitudes
about themselves and their school (child self-perceptions [effect size =.37] and school
bonding [effect size =.25]) and their positive social behaviors (.29). In addition, problem
behaviors were significantly reduced (effect size =.30). Finally, there was significant
improvement in students’ performance on achievement tests (.20) and in their school
grades (.22). In 2011, Durlak, Weissberg, Dymnicki, Taylor, and Schellinger conducted a
meta-analysis of 213 school-based, universal social and emotional learning (SEL) programs
involving 270,034 kindergarten through high school students. Compared to controls, SEL
participants demonstrated significantly improved social and emotional skills, attitudes,
behavior, and academic performance that reflected an 11-percentile-point gain in
achievement. Thus, these more recent studies suggest that policy makers, educators, and the
public can contribute to healthy development of children by supporting the incorporation
of evidence-based SEL programming into standard educational practice and the availability
of after-school programs as a mechanism for prevention.
Throughout this text, you will also read about the uses of preventive programs in
various settings in which psychologists work, whether they are industrial settings, law
47
enforcement agencies, mental health agencies, or sports programs in communities. It is
incumbent on psychologists, no matter where they work, to be knowledgeable about
appropriate interventions and prevention techniques (Price, Cowen, Lorion, & Ramos-
McKay, 1988). As Felner (2000b) cautions, the true preventive program is one that is
intentional with regard to its theoretical basis, its understanding of causal pathways, and the
purposeful planning and execution of programs to intercept those pathways to gainful ends.
Social Justice
Another core value of community psychology is the goal of social justice. Social justice is a
value or aspiration that is best understood in contrast to social injustice. Examples of social
injustice abound within our society and around the world. Inequality in educational
opportunities, racial disparities in many categories of health and well-being, discrimination
experienced by members of particular ethnic, gender, or religious groups, and the
homophobia to which gay, lesbian, and bisexual individuals as exposed are examples of
social injustices that you will read more about in this text. Although society has developed
many laws intended to protect people from being harmed by injustices, it is unfortunately
true that we do not yet live in a world of legitimate “equal opportunities” for all to reach
their potential. In other words, the playing field in our society is not yet level.
So how then is social justice to be defined? On the one hand, it could be argued that
when resources are all equally distributed and all citizens experience a level playing field of
opportunity, social justice has been achieved. This was the philosophy behind communism.
However, others have argued that true social justice is not merely examining how resources
are ultimately distributed, but rather creating equitable processes to determine the
allocation of resources (Vera & Speight, 2003). In a definition of social justice that focuses
on process versus outcome, some groups may temporarily have more resources than others,
but it will be because the group as a whole has decided that this should happen, perhaps for
a particular reason.
Various definitions of social justice are found in theology, political science, and
education, but for our purposes, the overall goal of social justice is “full and equal
participation of all groups in a society that is mutually shaped to meet their needs. Social
justice includes a vision of society in which the distribution of resources is equitable and
all members are physically and psychologically safe and secure” (Bell, 1997, p. 3). Note that
in this definition, the word equitable is used instead of equal when talking about resources.
Resources should be fairly distributed, but perhaps not equally. This allows for the
possibility that in some situations, we may want some groups to have greater access to a set
of resources, in the case of affirmative action, for example. A community may decide that it
wants to encourage more women to have careers within science or technology fields, so it
may decide that creating college scholarships for women who have such interests is an
equitable distribution of resources. The point is that if the society as a whole decides that
this is a good policy (i.e., until there are more women in the fields of science and
technology), it would be considered a socially just decision.
48
So how do community psychologists contribute to this goal? Vera and Speight (2003)
argued that psychologists can make the most meaningful contributions to social justice by
attending to the societal processes through which injustices result. For example, in Young’s
(1990) conceptualization of social justice, social structures and processes are evaluated to
elucidate practices of domination, privilege, and oppression. Thus, inequities are not solved
by merely redistributing wealth or resources. Rather, the processes that facilitated unequal
outcomes to begin with must be scrutinized and transformed. Typically, marginalization
(i.e., exclusion) is the main process by which social injustice is maintained. Young argued
that in the United States, a large proportion of the population is expelled from full
participation in social and political life, including people of color, the elderly, the disabled,
women, gay men, lesbians, bisexuals, transgendered people, and people who are
involuntarily out of work. Thus, issues of social justice are important for the statistical
majority of the population, not just minority groups. Such a conceptualization of justice,
then, is logically related to issues of multiculturalism and diversity.
Many community psychologists have contributed to the discussion of social justice
within the field of psychology. Prilleltensky (1997) argued that human diversity cannot
flourish without notions of justice and equality. Several other prominent community
psychologists have articulated the connections among social justice, underserved
populations, and the overall profession of psychology in recent years (Albee, 2000; Martin-
Baró, 1994; Nelson & Prilleltensky, 2010; Ramirez, 1999). Martin-Baró (1994) discussed a
form of psychology called liberation psychology that is specifically concerned with fighting
injustice. He noted that liberation psychology focuses “not on what has been done [to
people] but what needs to be done” (p. 6). This is relevant for action-oriented community
psychologists, who may seek to transform the world, not just understand the world. Efforts
to engage in such transformations are described throughout this text.
Emphasis on Strengths and Competencies
Closely related to the idea of empowerment (see Principles) and prevention is the notion of
competence and strength. The field of clinical psychology has historically focused on
individuals’ weaknesses and problems. Freud planted the seed of pathology focus that was
cultivated by later clinicians.
TABLE 1.5 Jahoda’s Positive Mental Health Attributes
Positive and realistic sense of self
Orientation to growth and development
Integrated and coherent self
Grounded in reality
Autonomous and independent
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Successful adaption to the environment (in love, relationships, and
problem solving in general)
Source: Adapted from material in Jahoda, M. (1958). Current concepts of positive mental health.
New York, NY: Basic Books.
Marie Jahoda (1958) directed a turn in focus toward mental health following a review
of clinical research. She highlighted the advantages of examining our strengths. In
particular, she pointed out that the absence of mental illness did not make one mentally
healthy. Health was defined by the presence of positive attributes—such as a healthy sense
of self—and an orientation to growth and development (Table 1.5). Soon after, Robert
White (1959) wrote on the importance of competence, by which he meant a sense of
mastery when interacting with the environment. Jahoda’s and White’s ideas offered a
conceptual change for psychologists concerned with how clinical psychology was mired in
its focus on negative behavior.
Ryan (1971) claimed that our usual response to problems was to “blame the victim.”
It might be blatant, such as claims of laziness, lack of intelligence, incorrect priorities, or
“asking for it.” It could also be more subtle, such as claims of inferior cultural
opportunities, lack of adequate mentoring, or the need for more services. These all place the
individual victim in a place of inferiority. What if the individual’s problem was not seen as
the result of “deprivation, deficits, or weakness”? What if these populations had strengths
and had the resources to make the break from their confines? Ryan argued that the cause of
many problems is the lack of power.
These historic challenges to the pathology-focused fields of psychiatry and psychology
have more recently been joined by the Positive Psychology movement (Seligman, 2007;
Seligman & Csikszentmihalyi, 2000). Positive psychology primarily focuses on the
strengths of the individual (Seligman & Csikszentmihalyi, 2000). The parallels with
community psychology’s shift to a wellness focus (Cowen, 1994) are apparent but not
clearly described (Schueller, 2009). Positive Psychology’s research has been on the
individual and thus has lacked consideration of positive environments. Those in
community psychology have studied the necessary components of a high-functioning
environment (Moos, 2003). Three environmental factors working together led to well-
being and productivity: strong social ties, emphases on personal growth, and a clear
structure. And as Keyes (2007) pointed out, “mental flourishing” has been a better
indicator of well-being than has the absence of mental illness.
A strength and competence focus was embraced from the very first days of the
Swampscott Conference (Bennett et al., 1966). This orientation had linkages to
empowerment and to ecological principles. The focus on positives in communities and in
their members shifted research and interventions toward the ways in which people were
successful. These strengths can be commonly found, can be readily mobilized, and are both
effective and appealing to the community (Masten, 2009). We will see examples of the
research that contributed to these conclusions in Chapter 3 when we look at Stress and
Resilience.
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1.
2.
3.
4.
Social Change and Action Research
Community psychology has called for social change from its beginnings (Bennett et al.,
1966; Hill, Bond, Mulvey, & Terenzio, 2000; Rappaport, 1977; Seidman, 1988) and
continues to incorporate it within its operational frameworks (Revenson et al., 2002; Tseng
& Seidman, 2007). Social change may be defined as efforts to shift community values and
attitudes and expectations as well as “opportunity structures” to help in the realization of
the inherent strengths of all within a population. The promise of community psychology is
that of social change (Prilleltensky, 2008, 2009).
Research grounded in theory and directed toward resolving social problems is called
action research. In community psychology, much action research is participatory, where
affected individuals are not merely “subjects” in a study but participate in shaping the
research agenda (Nelson, Ochocka, Griffin, & Lord, 1998; Rappaport, 2000). An active
partnership between researcher and participants is the norm (Hill et al., 2000; Nelson,
Prilleltensky, & McGillivary, 2001). Ryerson Espino and Trickett (2008) presented a
framework for ecological inquiry, which incorporated input from those under study into
the process.
Chapter 2 describes and discusses how action research is conducted. At this point, it is
important to remember that social problems are difficult to resolve, and research in
community settings is complex. For instance, if one wanted to change a human services
agency so that it better addresses community needs, one would probably have to research
the whole agency and the people involved, including clients and staff, as well as all of their
interrelationships and processes within the agency. A special issue of the American
Community Psychologist presented articles reviewing the state of the science-practice
synthesis reached in community action research. Although community psychology has
successfully influenced a variety of fields within the larger psychology discipline, there
continue to be creative tensions between the search for empirical validation and the need to
be relevant to the context. Linney (2005) pointed to four themes arising from the science-
practice issue:
Effective strategies to bridge science and practice, so as to strengthen the capacity to
do both within the community
Changing who determines what is important, that is, giving the community power in
determining what is important and useful, the direction of the decision making
changing from a science directing practice, to a model where the community is a full
partner in decision making
A broadening of the definition of good science beyond the “narrow” laboratory-based
experimental designs
Dealing with the difficulty of implementing the values and ideals given the
contingencies under which many psychologists work—for example, publish or perish,
the valuing of true experimental designs, and the devaluing of quasior
nonexperimental designs
As you will see in this text, community psychology sees social change and action
51
research as an integral part of its conceptual and intervention framework.
Interdisciplinary Perspectives
Community psychologists believe social change can be better understood and facilitated
through collaboration with other disciplines (Kelly, 2010). Multidisciplinary perspectives
are a means of gaining more sweeping, more thorough, and better reasoned thinking on
change processes (Maton, 2000; Strother, 1987). Community psychologists have long
enjoyed intellectual and research exchanges with colleagues in other academic disciplines,
such as political science, anthropology, and sociology, as well as other areas of psychology,
such as social psychology (Altman, 1987; Jason, Hess, Felner, & Moritsugu, 1987a). There
are renewed calls for interdisciplinary efforts (Kelly, 2010; Linney, 1990; Wardlaw, 2000)
with other community professionals, such as substance-abuse counselors, law enforcement
personnel, school psychologists, and human services professionals.
Kelly (1990) believed that collaboration with others gives new awareness of how other
disciplines experience a phenomenon. A benefit of consultation with others such as
historians, economists, environmentalists, biologists, sociologists, anthropologists, and
policy scientists is that perspectives can be expanded and new perspectives adopted. Kelly
believed that such an interdisciplinary perspective helped to keep alive the excitement about
discovery in the field (Kelly, 2010). In that same article he acknowledged the influence of
philosophy, anthropology, social psychiatry, and poetry on his work.
Stokols (2006) described three factors necessary to have strong transdisciplinary
research among researchers: (1) a sense of common goals and good leadership to help deal
with conflicts that can arise; (2) proactive arrangement of contextual supports for the
collaboration (institutional support, prior collaborative experience, proximity of
collaborators, electronic linkage capabilities); and (3) “preparation, practice and
refinement” of the collaborative effort. Stokols cautioned that work between researchers
and the community increases the potential for misunderstanding. Participation of both
researchers and community members in all phases of project development is helpful in
these circumstances, deemphasizing status differences and establishing clear goals and
outcome expectations.
Case in Point 1.3 demonstrates integration of social and community psychology
theories, and Case in Point 1.4 provides us with an example of anthropological concepts
and methodology contributing to a community psychology intervention.
CASE IN POINT 1.3
Social Psychology, Community Psychology, and
Homelessness
You have learned in this chapter that community psychologists have issued a call for
collaboration with other disciplines both within and outside of psychology. In response to
that, we agree that community psychologists and social psychologists have much to learn
52
from each other (Serrano-Garcia, Lopez, & Rivera-Medena, 1987). In some countries,
community psychology evolved from social psychological roots. This was the case in New
Zealand and Australia (Fisher, Gridley, Thomas, & Bishop, 2008).
Social psychologists study social phenomena as they affect an individual. They may
have the answer as to why the media, the public, and other psychologists blame a person’s
homelessness on the person. Social psychologists have developed an explanation using
attribution theory, which explains how people infer causes of or make attributions about
others’ behaviors (Kelly, 1973). Research on attribution has demonstrated that people are
likely to place explanatory emphasis on the characteristics of the individual or use trait
explanations for another’s shortcomings (Jones & Nisbett, 1971). That is, when explaining
the behavior of others—especially others’ problems—people are less likely to attend to the
situation and more likely to blame the person for what is happening.
Does this theory apply to homelessness? Can this theory explain why the media and
the public often blame the victim, the homeless person, for his or her problem? Victim
blaming (Ryan, 1971) is a phrase that describes the tendency to attribute the cause of an
individual’s problems to that individual rather than to the situation the person is in. In
other words, the victim is blamed for what happened to him or her. Social psychologists
believe that blaming the victim is a means of self-defense (e.g., if a bad thing can happen to
her by chance, then it can happen to me; on the other hand, if the person was to blame for
what happened, then it won’t happen to me because I am not that way). In the case of the
homeless, did their personalities create their homeless situations? Did something in their
environment contribute to it? The average person who blames the victim would blame
homeless people for contributing to their homelessness.
Shinn, a prominent community psychologist, reviewed research on homelessness and
conducted a monumental and well-designed study on the issue (Shinn & Gillespie, 1993).
She concluded that person-centered explanations of homelessness, although popular, are
not as valid as situational and structural explanations of homelessness. Specifically, Shinn
suggested that the researched explanations for homelessness are twofold—that is,
personcentered and environmental. She reviewed the literature on each and concluded that
person-centered or deficit explanations for homelessness were less appropriate than
environmental or situational explanations.
Shinn found studies suggesting that structural problems offer some of the most
plausible explanations of homelessness. For example, Rossi (1989) found that between
1969 and 1987, the number of single adults (some with children) with incomes under
$4,000 a year increased from 3.1 to 7.2 million. Similarly, Leonard, Dolbeare, and Lazere
(1989) found that for the 5.4 million low-income renters, there were only 2.1 million units
of affordable housing, according to the U.S. Department of Housing and Urban
Development standards. Poverty and lack of affordable housing seem to be far better
explanations for today’s phenomenon of homelessness than personcentered explanations.
Solarz and Bogat (1990) would add to these environmental explanations of homelessness
the lack of social support by friends and family of the homeless.
What is important about Shinn’s review is not so much that it illustrates that the
53
public and the media may indeed suffer from fundamental attribution error—the
tendency to blame the person and not the situation —but rather that Shinn offers these
data so community psychologists can act on them. Public policy makers need to understand
that situations and structural problems produce homelessness. Psychologists and
community leaders need to be convinced that temporary solutions, such as soup kitchens,
are merely bandages on the gaping wound of the homeless. Furthermore, shelter managers
and others have to understand that moving the homeless from one shelter to another does
little for them. Families and children, not just the stereotypical old alcoholic men, are part
of today’s homeless (Rossi, 1990). Being in different shelters and therefore different school
systems has negative effects on children’s academic performance and self-esteem (Rafferty
& Shinn, 1991); homeless children lose their childhoods to homelessness (Landers, 1989).
Something must be done about the permanent housing situation in this country. On
this point, both community and social psychologists would agree.
CASE IN POINT 1.4
The Importance of Place
Anthropological methodologies were used in a study of communities recovering from a
forest fire in British Columbia, Canada (Cox & Perry, 2011). Case studies presented
ethnographic data, using intensive and longitudinal interviews, observations, and
documents in natural settings aimed at understanding the “meanings” of a group’s or
culture’s behaviors. A participant–observer approach was used, where the data collector
became an active engaged member of the group being studied (Genzuk, 2003). The role of
social capital (a sociological concept), which related to a sense of place in the land, seemed
to mediate the communities’ ability to adjust to the changes brought about by the fire.
Social capital is defined as those supports, assets, or resources that come to a group or an
individual as the result of social position within a system. The studies’ findings illustrated a
process of disorientation and a search for reorientation in individuals and in their
communities. The assumptions as to home and its meanings were reexamined and either
reinforced or discarded. The assumptions of social capital also had to be reexamined and
adjusted. Identity and sense of place as defined socially and physically were challenged and
required rebuilding. The research noted that rebuilding efforts were focused on material
and individual-oriented goals—the survival of the person and restoration of their property.
Ignored in the restoration efforts were the community’s own social capital, that is, natural
residential resource networks. As well, there was little attention to recovery of members’
“sense of place” in their world. Recommendations were made for attention to these details
at the policy level and in direct interventions.
A Psychological Sense of Community
Early discussions of community psychology noted the seeming contradiction in the terms
54
community and psychology . Community was associated with groups and psychology with
individual experience. Proposing a possible answer to those unfamiliar with the field,
Sarason (1974) suggested the study of a “psychological sense of community” (PSC). PSC
has become one of the most popular concepts to emerge from community psychology: it is
an individual’s perception of group membership.
If environments and individuals are well matched, a community with a sense of spirit
and a sense of “we-ness” can be created. Research has demonstrated that a sense of
community, or what is sometimes called community spirit or sense of belonging in the
community, is positively related to a subjective sense of well-being (Davidson & Cotter,
1991).
In an optimal community, members probably will be more open to changes that will
further improve their community. On the other hand, social disintegration of a community
or neighborhood often results in high fear of crime and vandalism (Ross & Jang, 2000), as
well as declines in children’s mental health (Caspi, Taylor, Moffitt, & Plomin, 2000) and
increases in school problems (Hadley-Ives, Stiffman, Elze, Johnson, & Dore, 2000),
loneliness (Prezza, Amici, Tiziana, & Tedeschi, 2001), and myriad other problems.
Community disorder may intensify both the benefits of personal resources (such as
connections to neighbors) and the detrimental effects of personal risk factors (Cutrona,
Russell, Hessling, Brown, & Murry, 2000).
Interestingly, research has demonstrated that happiness and the sense of satisfaction
with one’s community are not found exclusively in the suburbs. People living in the
suburbs are no more likely to express satisfaction with their neighborhoods than people
living in the city (Adams, 1992) or small towns (Prezza et al., 2001). Many laypeople and
psychologists believe that residents of the inner city are at risk for myriad problems.
However, research has found that some very resilient individuals are located in the most
stressful parts of our cities (Work, Cowen, Parker, & Wyman, 1990).
Community has traditionally meant a locality or place such as a neighborhood. It has
also come to mean a relational interaction or social ties that draw people together (Heller,
1989b). To these definitions could be added the one of community as a collective political
power. Brodsky (2009) also notes that we have multiple communities to which we may
have allegiance.
If those are the definitions for community, what is the sense of community? Sense of
community is the feeling of the relationship an individual holds for his or her community
(Heller et al., 1984) or the personal knowledge that one has about belonging to a collective
of others (Newbrough & Chavis, 1986). More specifically, it is
the perception of similarity to others, an acknowledged interdependence with others, a
willingness to maintain this interdependence by giving to or doing for others what one
expects from them, the feeling that one is part of a larger dependable and stable
structure. (Sarason, 1974, p. 157)
If people sense community in their neighborhood, they feel that they belong to or fit
55
1.
2.
3.
4.
into the neighborhood. Community members sense that they can influence what happens
in the community, share the values of the neighborhood, and feel emotionally connected to
it (Heller et al., 1984).
A sense of community is specifically thought to include four elements: membership,
influence, integration, and a sense of emotional connection (McMillan & Chavis, 1986):
Membership means that people experience feelings of belonging in their community.
Influence signifies that people feel they can make a difference in their community.
Integration, or fulfillment of needs, suggests that members of the community believe
that their needs will be met by resources available in the community.
Emotional connection implies that community members have and will share history,
time, places, and experiences.
Although there have been a variety of criticisms and alternatives to this
conceptualization of psychological sense of community (Long & Perkins, 2003; Tartaglia,
2006), the operational definition of this sense by McMillan and Chavis (1986) remains the
definitive model for this concept. Long and Perkins (2003) found a three-factor structure
for their data: social connections, mutual concerns, and community values. Tartaglia
(2006), using an Italian sample, produced a three-factor measure that included attachment
to place, needs fulfillment and influence, and social bonds. In its newest evolution,
Peterson, Speer, and McMillan (2008) have produced an eight-item Brief Sense of
Community Scale, which produces all four of the McMillan and Chavis (1986) elements
with significant statistical validity.
A scale developed by Buckner (1988) measured neighborhood cohesion or fellowship.
Wilkinson (2007) found validation of Buckner’s conceptualization of neighborhood
cohesion, and a three-factor structure to his data, taken from a Canadian sample. In
Wilkinson’s study, “cohesion” was based on a psychological sense of community,
neighboring (visiting others and being visited), and attraction for the community (“I like
being here.”).
Among the many groups whose psychological sense of community has been studied
are Australian Aboriginals (Bishop, Colquhoun, & Johnson, 2006), Native American youth
(Kenyon & Carter, 2011), Afghan women (Brodsky, 2009), German naval cadets
(Wombacher, Tagg, Bürgi, & MacBryde, 2010), gay men (Proescholdbell, Roosa, &
Nemeroff, 2006), churches (Miers & Fisher, 2002), university classrooms (Yasuda, 2009),
and the seriously mentally ill (Townley & Kloos, 2011). As Peterson and colleagues (2008)
said, sense of community is a “key theoretical construct” of community psychology.
A related but separate concept to sense of community is that of neighborhoods. These
are defined as local communities that are bounded together spatially, where residents feel a
sense of social cohesion and interaction, a sense of homogeneity (or sameness), as well as
place identity (Coulton, Korbin, & Su, 1996). Research has demonstrated the utility of
conceptualizing “sense of community” separately from “neighborhoods” (Prezza et al.,
2001), but they can be related. Although neighborhoods are primarily based on geographic
boundaries, they are best defined by their inhabitants and do not necessarily conform to
56
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political or formal maps. They are psychologically defined. One can see from the
description found in Table 1.6 that the questions relate to individual’s perceptions.
Training in Community Psychology
There are established training programs for those interested in studying community
psychology. Students are trained to conduct research and to intervene from a set of
community psychology theories and values. Just as the practice of community psychology is
varied, so are the perspectives provided. See the accompanying four tables of graduate
training programs (Tables 1.7 through 1.10). One might note that programs can be
selected from around the world. The doctoral programs include both community
psychology and clinical–community specialties. There is also a category of interdisciplinary
doctoral programs, which include areas such as public health, family studies, and applied
social psychology.
TABLE 1.6
The Brief Sense of Community Scale by Peterson, Speer, and Hughey (2006) seeks
information on:
Relationships/Social Connection —I talk to others; I know others here
Mutual Concerns —We want the same things
Bonding/Community Values —It feels like a community to me; I like it here
Source: From Peterson, N. A., Speer, P., & Hughey, J. (2006). Measuring sense of community: A methodological
interpretation of a factor structure debate. Journal of Community Psychology, 34, 453–469.
TABLE 1.7 Doctoral Programs in Community Psychology
DePaul University, Department of Psychology—Chicago, IL
Edith Cowan University, School of Psychology and Social Science—Joondalup,
Australia
Georgia State University, Department of Psychology—Atlanta, GA
Instituto Superior de PsicologiaAplicada, (ISPA), Department of Psychology—
Lisbon, Portugal
Michigan State University, Department of Psychology—East Lansing, MI
National-Louis University, Department of Psychology—Chicago, IL
Pacifica Graduate Institute, Department of Psychology—Carpinteria, CA
Portland State University, Department of Psychology—Portland, OR
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University of Hawaii, Department of Psychology—Honolulu, HI
University of Illinois at Chicago, Department of Psychology—Chicago, IL
Universitá Laval, Department of Psychology—Quábec City, Canada
University of Maryland, Baltimore County, Department of Psychology—Baltimore,
MD
University of Quebec, Department of Psychology—Montreal, Canada
University of Virginia, Department of Psychology—Charlottesville, VA
University of Waikato, School of Arts and Social Sciences—Hamilton, New Zealand
Wichita State University, Department of Psychology—Wichita, KS
Wilfrid Laurier University, Department of Psychology—Waterloo, Canada
Source: From www.scra27.org/resources/educationc/academicpr.
TABLE 1.8 Doctoral Programs in Clinical–Community Psychology
Arizona State University, Department of Psychology—Tempe, AZ
Bowling Green State University, Department of Psychology—Bowling Green, OH
California School of Professional Psychology, School of Professional Psychology—
Los Angeles, CA
DePaul University, Department of Psychology—Chicago, IL
George Washington University, Department of Psychology—Washington, DC
Georgia State University, Department of Psychology—Atlanta, GA
Michigan State University, Department of Psychology—East Lansing, MI
Rutgers University, Graduate School of Applied & Professional Psychology—
Piscataway, NJ
University of Alaska, Department of Psychology—Anchorage or Fairbanks, AK
University of Illinois, Champaign-Urbana, Department of Psychology—Urbana-
Champaign, IL
University of La Verne, Department of Psychology—La Verne, CA
University of Maryland, Baltimore County, Department of Psychology—Baltimore,
MD
University of South Carolina, Department of Psychology—Columbia, SC
Wayne State University, Department of Psychology—Detroit, MI
Wichita State University, Department of Psychology—Wichita, KS
58
TABLE 1.9 Doctoral Programs in Interdisciplinary Community and Prevention
Programs
Clemson University, “International Family and Community Studies,” Institute on
Family and Neighborhood Life—Clemson, SC
Georgetown University, “Psychology and Public Policy,” Department of Psychology
—Washington, DC
North Carolina State University, “Psychology in the Public Interest,” Department of
Psychology—Raleigh, NC
Penn State University, “Human Developmental and Family Studies,” Dept. of
Human Development and Family Studies—University Park, PA
University of California—Santa Cruz, “Social Psychology with a Social Justice
Focus,” Department of Psychology—Santa Cruz, CA
University of Guelph, Ontario, “Applied Social Psychology,” Department of
Psychology—Ontario, Canada
University of Kansas, “Applied Behavioral Science,” KU Workgroup for Community
and Health Development—Lawrence, KS
University of Michigan, “Health Behavior and Health Education,” Department of
Health Behavior and Health Education—Ann Arbor, MI
University of North Carolina, Charlotte, “Community Health Psychology,”
Department of Psychology—Charlotte, NC
University of North Carolina, Greensboro, “Community Health,” Department of
Psychology—Greensboro, NC
University of Wisconsin–Madison, “Human Development and Family Studies,”
School of Human Ecology—Madison, WI
Vanderbilt University, “Community Research and Action,” Department of Human
and Organizational Development—Nashville, TN
Source: From www.scra27.org/resources/educationc/academicpr.
Clinical–community programs train in both the traditional clinical skills of testing
and therapy, and the community-oriented skills of preventive community interventions.
Freestanding community psychology programs emphasize ecological and systems
orientations to assessment and interventions. Courses at the graduate level might include
program evaluation, social action research, applied social psychology, consultation, grant
writing, and community field work.
59
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O’Donnell and Ferrari (2000) collected essays on community psychologist
employment from around the world. They found that the training of community
psychologists had prepared them for a diverse set of opportunities. Although university
positions were among the jobs mentioned, individuals found many other types of work: for
example, as consultants, evaluators, grant writers, directors of people’s centers, researchers,
and policy makers.
TABLE 1.10 Master’s Programs in Community Psychology
The Adler School of Professional Psychology—Vancouver, Canada
The American University in Cairo, Psychology Unit—Cairo, Egypt
Antioch University, Department of Psychology—Los Angeles, CA
University of Brighton, School of Applied Social Science—Brighton, UK
Central Connecticut State University, Department of Psychology—New Britain, CA
Edith Cowan University, School of Psychology and Social Science—Joondalup,
Australia
Manchester Metropolitan University, Faculty of Health, Psychology, and Social Care
—Manchester, England
University of Massachusetts Lowell, Psychology Department—Lowell, MA
Metropolitan State University, College of Professional Studies—St. Paul, MN
University of New Haven, Department of Psychology and Sociology—West Haven,
CT
Pacifica Graduate Institute, Department of Psychology—Carpinteria, CA
Penn State Harrisburg, School of Behavioral Sciences and Education—Harrisburg,
PA
Portland State University, Psychology Department—Portland, OR
The Sage Colleges, Department of Psychology—Albany, NY
Instituto Superior de Psicologia Aplicada, Department of Psychology—Lisbon,
Portugal
The University of the Incarnate Word, Psychology Department—San Antonio, TX
Victoria University of Technology, School of Psychology—Melbourne, Australia
University of Waikato, School of Arts and Social Sciences—Hamilton, New Zealand
Wilfrid Laurier University, Department of Psychology—Waterloo, Ontario, Canada
Source: From www.scra27.org/resources/educationc/academicpr.
60
PLAN OF THE TEXT
Now that you are on your way to understanding community psychology, you probably
would like to know what the rest of your journey through this text will be like. The
remainder of Part I, which is the introductory portion of the text, introduces you to
research processes (Chapter 2) and the stress and resilience models (Chapter 3) from which
work in community settings takes direction. Researchers in community psychology employ
some of the venerated methods used by other psychologists as well as techniques that are
fairly unique and innovative. You then explore the stress and resilience models for
understanding adaptation and adjustment to the social environment.
Part II consists of two chapters on social change (Chapter 4) and interventions
(Chapter 5). The first chapter outlines some of the reasons for social change. The second
chapter describes some strategies for community interventions.
Part III (Chapters 6–12) examines systems to which community psychology can be
applied. From mental health settings and issues, community psychologists have easily
moved into social and human services, school systems, criminal justice, health care, and
organizational settings.
Part IV, the final chapter of the text, looks ahead at what the future holds for the field
of community psychology.
Summary
Community psychology evolved from social science attempts to understand the human
condition and effectively improve it. Lewin’s and Lindeman’s legacies have been apparent
in the themes of social change and community research. With a belief in the power of
diversity, an understanding of the influence of context on individual actions, a realization
of the advantages of a multilayered ecological perspective on behavior patterns and how
they can be effectively changed, and a conviction that empowered individuals can be
healthier individuals, community psychology addresses the prevention of pathology and the
promotion of health. Embedded in these principles is the assumption that we all seek and
need community. Without it, we are alone and alienated. With it, we are grounded and
secure. The area has grown from a set of ideas to an organized and developing approach to
psychological research and interventions. For those interested in pursuing graduate studies
in this area, there are a variety of options available. Finally, the text organization is outlined
to provide a cognitive map of what is to come.
61
■
■
■
■
Scientific Research Methods
THE ESSENCE OF SCIENTIFIC RESEARCH
Why Do Scientific Research?
What Is Scientific Research?
The Fidelity of Scientific Research
CASE IN POINT 2.1 A Theory of Substance Abuse and HIV/STDs that
Incorporates the Principles of Community Psychology
TRADITIONAL SCIENTIFIC RESEARCH METHODS
Population and Sampling
Correlational Research
■ BOX 2.1 Research across Time
Experimental Research
Quasi-experimental Research
ALTERNATIVE RESEARCH METHODS USED IN COMMUNITY
PSYCHOLOGY
Ethnography
CASE IN POINT 2.2 Case Study of a Consumer-Run Agency
Geographic Information Systems
Epidemiology
Needs Assessment and Program Evaluation
CASE IN POINT 2.3 Needs Assessment of a Hmong Community
Participatory Action Research
CAUTIONS AND CONSIDERATIONS REGARDING COMMUNITY
RESEARCH
The Politics of Science and the Science of Politics
Ethics: Cultural Relativism or Universal Human Rights?
The Continuum of Research: The Value of Multiple Measures
CASE IN POINT 2.4 HIV Intervention Testing and the Use of Placebos
The Importance of Cultural Sensitivity
Community Researchers as Consultants
SUMMARY
The essential point in science is not a complicated mathematical formalism or a ritualized
experimentation. Rather the heart of science is a kind of shrewd honesty that springs from really
wanting to know what is going on!
—Saul-Paul Sirag
The connection between cause and effect has no beginning and can have no end.
62
—Leo Tolstoy, War and Peace
It’s tough to make predictions, especially about the future.
—Yogi Berra
Larry liked to take a walk around his neighborhood every evening. The sidewalk was busy
with foot traffic, even late at night. The one great annoyance was having to navigate
through dog waste that littered the block. Larry sometimes wondered how much of this was
deposited every day around his block, and whether there was anything he could do to
decrease the amount left on the street. When he brought up the topic in a conversation at
work, he found that some research on the problem had been done many years earlier. The
research found that wherever dog litter was allowed, the dogs’ owners would leave a good
deal of it behind. Looking further, Larry also found that a fairly simple program of
modeling and prompting could greatly reduce this problem.
Arun and his family had planned on buying a house for several years. When the time
came to decide on neighborhoods to explore, he asked questions not only about
transportation options, but about the schools as well. What were they like? What were their
strengths and weaknesses? What programs were available to his children? How successful
were the schools in educating beyond the basics of mathematics, reading, and writing? Did
graduates go on to higher education? Where? For Arun, who saw his home as more than a
building to house a family, these seemed reasonable questions to ask. The neighborhood
and the community could be measured by the success of its institutions. How was the
community doing in terms of educating its children? Arun wanted to know so he could
make an informed choice as to what his neighborhood would be like. He was asking for
data he believed answered some basic questions about the social environment into which he
was bringing his family.
63
THE ESSENCE OF SCIENTIFIC RESEARCH
Why Do Scientific Research?
Science is for the curious. We seek information about our world and make decisions on
how to act based on that information. We have come to assume that our experiences in life
help us determine what is true and real. This assumption, that experience is our window on
reality, is called empiricism. The tradition of examining the world around us for evidence of
what to believe goes back to the Greek philosophers, to the astronomers of the Middle East,
and later to the observational studies of the Renaissance. We have come to accept this
tradition as the science on which our modern world is built. How do we understand what
is around us? We observe it, note its regularities and patterns, test its possibilities, and
determine the likelihood that particular events predict or cause other events. Among our
questions might be: What makes a community? What about a community makes it a
healthy and happy one?
A major intervention strategy in the field of community psychology is to create or
engage in some form of social change so that individuals and communities can benefit. To
distinguish effective from less effective changes, psychologists need a way to understand and
assess these changes. Scientific research provides that mechanism; thus, it has been an
essential part of community psychology from its conception and throughout its
development (Anderson et al., 1966; Lorion, 1983; Price, 1983; Tolan, Keys, Chertak, &
Jason, 1990).
For example, how can researchers be sure that decreases in a risky behavior such as
unprotected sex are solely due to people’s participation in some form of prevention
program? Although we might find that the men and women who enroll in such programs
are less likely to engage in unprotected sex than are those who do not, further analysis
might indicate that those with spouses who are willing to use condoms are the ones who
benefit from the programs. That is, for many, enrollment in a prevention program is not
sufficient to reduce unprotected sex unless they can go back to a home environment or
community with some support (the ecological perspective). The validity of the program’s
effectiveness needs to be closely examined to determine what makes it work.
Price (1983) pointed to areas in which the community psychologist would need to do
research. First, problems or areas of concern must be identified and described. Second, the
factors related to these problems and concerns must be articulated. Based on this
articulation, possible interventions or solutions can be constructed and tested. Once a
program has been found to be effective, it must still be determined whether the
intervention can be successfully implemented in particular community contexts. If the
implementation succeeds, then the issue of successfully launching the program on a broader
scale needs to be studied. If the program is successful, the researcher is left to reexamine the
community status and see what other needs may exist. The research cycle provides guidance
from identification of community problems to community-wide dissemination of answers.
64
This process is an integral part of community psychology.
The notion that a research process should inform our actions seems both reasonable
and practical. If we can know and predict our world, we are at a clear advantage in what we
do. The most recent concerns within community psychology are over the best ways to
capture data; no voices speak against the advantages of empirical research as a valuable
guide to the field (Aber, Maton, & Seidman, 2011; Jason & Glenwick, 2012; Jason, Keys,
Suarez-Balcazar, Taylor, & Davis, 2004). If anything, the focus is on how to gather better
—that is, more ecologically meaningful—data.
What Is Scientific Research?
On a daily basis, people observe and make attributions about many things. For example,
you might have some hunches as to why men do or do not use condoms or why people
abuse alcohol and drugs. Scientists see research as the way to go beyond hunches. In other
words, when scientists conduct research, by using a set of related assumptions and activities,
they effectively come to understand the world around them. Figure 2.1 depicts the process
of scientific research.
Theory and theory-based research are an integral part of all scientific disciplines
(Kuhn, 1962/1996), and the field of community psychology is no exception. The early
applied social psychologist Kurt Lewin once said, “There is nothing more practical than a
good theory.” We agree. Why is theory so powerful? That is because theory directs our
research and helps us to avoid some common pitfalls in the conducting of scientific
inquiries.
THEORY. At one time or another, you probably have heard people use the terms theory,
model, and paradigm. The words are often used interchangeably, but they are not quite
synonymous. A theory is a systematic attempt to explain observable or measurable events
relating to an issue such as homelessness or alcoholism. More exactly, a theory is a “set of
interrelated constructs (concepts), definitions, and propositions that present a systematic
view of phenomena by specifying relations among variables, with the purpose of explaining
or predicting the phenomena” (Kerlinger, 1973, p. 9). The goal of a theory is to allow
researchers to describe, predict, and control for why and how a variable or variables relate
to observable or measurable events pertaining to an issue.
65
FIGURE 2.1 The Process of Scientific Research
Bear in mind that social science theories serve best as guideposts for studying
observable or measurable events. In other words, description and prediction of as well as
controls for these events are based on suggested rules rather than absolute laws like those
found in the physical sciences (Kuhn, 1962/1996).
MODELS AND PARADIGMS. Models and paradigms influence research in that they
provide a framework for our studies. In a formal science, preconceptions and assumptions
resulting from earlier work help to guide current work. Thus, science does not start from
the beginning, with no idea of how to proceed and no “understanding” of the world.
Rather, previous work helps to formulate the questions and the manner in which they are
answered. We might liken it to a child exploring the world. The experiences of the child’s
ancestors, social group, and others influential in the child’s world serve as guides in this
process of discovery.
A model is a working blueprint of how a theory works. A paradigm is a smaller
component from within the model that guides researchers to conceptualize specific event
sequences. Figure 2.2 depicts these relationships. (In his classic but controversial essay on
science and scientific revolutions, Kuhn, 1962/1996, uses the term paradigm with two
meanings. The first is to describe a set or collection of ideas, values, and theories that are
commonly agreed on in a sociological way to guide the direction and conduction of
scientific inquiry. The second sense is as the “concrete puzzle solution” to a given problem.
We use the term paradigm in our description of the progression from theory to model to
paradigm. In this case, we intend the paradigm to be the “concrete puzzle solution.”
However, when we speak of “paradigm shifts” in psychology, paradigm is used in the first
sense of the word—that is, the sociologically based collective and group-oriented definition
of the term. Initial reactions to Kuhn criticized his mixing of definitions, which was
confusing. He tried to clarify and correct this in an apologetic postscript in the later edition
of his book.)
A theory may develop more than one model. These models guide researchers’
understanding of the various observable events. In the case of undeveloped theories,
observable events can be explained by more than one theory. Of course, this can be
66
FIGURE 2.2
confusing.
The Relationships among Theories, Models, and Paradigms
FALSIFIABILITY. According to Popper (1957/1990), the hallmark of a science is
continuous testing of the proposition or theory at hand. The testing assumes that it is
always possible that the proposition or theory being tested is false. This falsifiability calls for
a reliance on observable events to help support or reject any given concept.
EXAMPLE. For decades, researchers investigating alcoholism or alcohol abuse
conceptualized excessive drinking as a consequence of a genetic predisposition, using the
medical explanation of alcoholism as a disease (the theoretical perspective). This theory
helped shape the development of various models about alcohol abuse, all of which
described individual tendencies totally out of the control of the individual.
In recent years, some researchers have begun to challenge the genetic disease theory of
alcoholism. Instead, they argue that some aspects of excessive alcohol use (the observable or
measurable event) may be a consequence of something in the environment, such as stress
from losing one’s home, a difficult life on the streets, prolonged unemployment, or some
traumatic life event. Thus, a new theory emerges—the distress or disorder theory of
alcoholism. This sociological paradigm shift or refocusing of thinking or conceptualizing
from genetics to environment leads to the development of new models. One model
specifies that socioeconomic status might influence alcoholism. Another suggests that social
stress plays a role. In other words, this theory allows for the prediction and description of
differential alcohol use for individuals with different environments. On the other hand, the
first theory—the disease theory—offers prediction and description of individual differences
based on genetics.
67
SCIENTIFIC REVOLUTIONS. This example illustrates the dynamic nature of scientific
theories. Kuhn (1962/1996) argued that major scientific development is not linear, or a
step-by-step accumulation of facts. Such is the case with the development of community
psychology as an alternative theory concerning the development of mental health and
mental illness. Within a scientific discipline, a crisis may cause a shift in thinking; such a
sociological paradigm shift may shape the development of a new theory. Recall that just
such a crisis (discouragement with traditional methods of conceptualizing and treating
mental illness) gave birth to the field of community psychology. We should expect the
development of new theories and models, as well as new methods for studying human
phenomena in the psychological realm.
You will read about many of the current theories, models, and paradigms in the field
of community psychology in other chapters of this book. You will also be introduced to the
research related to each theory; through research, one makes judgments about theories.
Case in Point 2.1 introduces an integrated theory of drug abuse.
The Fidelity of Scientific Research
Reliability, internal validity, and external validity are the three sets of related issues that
speak to the fidelity of research. We now examine each of these in more detail.
Reliability refers to the extent to which measurable features of a theory are
trustworthy or dependable. When two observers rate or describe what they saw or heard,
will they agree? If so, we tend to believe their description. This is called inter-rater or
observer reliability. When a question is asked two times, does it get the same or a similar
answer? If it does, then we trust that the answer will remain consistent. If the question is
asked twice within the same set of questions, we call that internal reliability. If the question
is asked twice at two separate occasions across time, we call that test–retest reliability.
Internal validity refers to the degree to which we believe the results of a study truly
describe what happens in a given set of research circumstances—that in an experiment, the
independent variable is indeed responsible for any observed changes in a dependent variable
(Campbell & Stanley, 1963). In other words, research is said to have high internal validity
when confounding effects are at a minimum. Confounding effects are extraneous variables
that influence the dependent variable and invalidate the conclusions drawn from the
research. For example, using Wong and Bouey’s (2001) theory of drug abuse, pregnancy
status (an individual characteristic) is said to have high internal validity if it is related to the
number of days of sobriety (the results) of women participating in primary and secondary
substance-abuse prevention or treatment programs. On the other hand, pregnancy status
might not be related to sobriety because some other factor (e.g., brain size or the presence
of friends who use drugs) is related instead. Researchers would then acknowledge that
pregnancy status is not internally valid.
CASE IN POINT 2.1
68
A Theory of Substance Abuse and HIV/STDs that
Incorporates the Principles of Community Psychology
There are more than 40 theories for studying drug abuse (see Lettieri, Sayers, & Pearson,
1984). Some of these theories are person centered, such as the medical or genetic theory of
alcoholism; other theories are environmental, such as the stress or disorder theory.
On the basis of 24 studies, Flay and Petraitis (1991) identified a number of
determinants of drug abuse. They concluded that the determinants are some combination
of the following: the social environment; social bonding of the individual to the family,
peers, and community organizations such as schools; social learning and learning from
others; intrapsychic factors such as self-esteem; and the individual’s own knowledge of,
attitudes toward, and behaviors related to alcohol and drugs. Flay and Petraitis argued that
most theories about substance abuse address only one of these domains. For the field to
advance, an effort needs to be made to integrate more of these domains into one coherent
theory. Community psychologists would heartily agree.
Responding to this challenge, Wong and Bouey (2001) proposed an integrated theory
for studying substance abuse as well as human immunodeficiency virus (HIV) and sexually
transmitted diseases (STDs) among American Indian/Alaska Natives (AI/ANs). This
population was singled out because, compared to other racial/ ethnic groups in the United
States, many AI/ANs have a more serious substance abuse problem (National Household
Survey on Drug Abuse, 1999, in Substance Abuse and Mental Health Services
Administration, 2000; Improving HIV Surveillance, 2013), which places them at risk for
STDs, including HIV.
Most substance abuse and HIV prevention and intervention programs have enlisted
psychosocial models of individual behavior. These models, however, tend to isolate
individuals and assume that they all follow regular and rational decision-making processes
(e.g., DiClemente & Peterson, 1994; Leviton, 1989; Valdiserri, West, Moore, Darrow, &
Hin-man, 1992), a position consistent with the reasoning of the dominant medical model
in health-related programs (Singer et al., 1990). Although individuals are undeniably the
key component of such programs, individual behavior occurs in a complex social and
cultural context, and analysis that removes that behavior from its broader setting ignores
essential determinants (Auerbach, Wypijewska, & Brodie, 1994). Individuals may, in fact,
behave rationally, but they do so within the confines of their own sociocultural milieus.
Attempting to address this breadth of factors leads to the recognition that responses to
typical knowledge, attitude, and behavior measures are constructions by individual actors
situated within the interplay of political, economic, social, and cultural realms (Bouey et al.,
1997; Nemoto et al., 1998; see Figure 2.3). These forces create opportunities and obstacles
for individuals and define the parameters within which they function (Connors &
McGrath, 1997). Bouey and others (1997) and Nemoto and others (1998) asserted that it
is also necessary to recognize that although these domains are frequently isolated as
conceptually distinct entities, they have multiple dimensions and they overlap each other. If
we are to understand and address solutions to drug–HIV risks, we must perceive clients as
69
participants in these systemic contexts. Also, these contexts are dynamic. They and their
constituent elements evolve rapidly within themselves and within their encompassing
milieus. Thus, historical processes are of great significance in helping us to understand the
choices made by individuals. In brief, it is useful to understand substance use/ abuse, sexual
risk practices, and HIV/ STDs among AI/ANs as outputs of a process that involves or moves
through at least five domains. This research can help in deriving preventive models for
dealing with particular problems (Figure 2.3).
Within this theoretical setting, all populations are subject to factors associated with
the distribution of power and resources (Connors & McGrath, 1997). This applies to all
individuals in the larger scale of political-economic systems, as well as to those same persons
in smaller-scale personal relationships (Connors & McGrath, 1997). Marginalized inner-
city populations provide the extreme examples of these relationships. Unemployment,
homelessness, substandard nutrition, violence, substance abuse, lack of health care access,
stress, class, race, gender relations, family, community organizations, support networks, sex-
partner networks, and culture among other features of inner-city life contribute to this
imbalance (Connors & McGrath, 1997; Singer, 1994a; Singer et al., 1990; Weeks, Schen-
sul, Williams, Singer, & Grier, 1995).
As a consequence of these extremes, inner-city conditions represent one example of
international manifestation of acquired immunodeficiency syndrome (AIDS) as a disease of
poverty, wherein AIDS is just one of a host of community problems (Singer & Weeks,
1996). These circumstances also exhibit tremendous structural variability, supporting the
notion that the AIDS pandemic is more adequately described as thousands of separate
epidemics (Mann, Tarantola, & Netter, 1992). Exploratory models need to address
individuals and communities through these unique circumstances, and these models have
to possess the capacity to adjust to each “micro-epidemic and its particular route(s) of
transmission, sub-population at risk, and socio-behavioral context” (Singer & Weeks, 1996,
p. 490; also see Singer, 1994b).
70
FIGURE 2.3 A Conceptual Model of HIV/STD Prevention
Inner-city populations also constitute one class of “hidden populations” (Lambert,
1990; Watters & Biernacki, 1989), groups that are out of the mainstream and little known
to those outside their boundaries. These communities are a particular challenge for research
and program development, because they can be hard to define, difficult to understand, and
especially complex. The first step toward project goals is to engage the communities in the
process, opening a dialogue to define their needs and priorities (Waller-stein & Bernstein,
1998; Weeks, Singer, Grier, Hunte-Marrow, & Haughton, 1991). Through this form of
participation, for example, we can learn how people assign meaning to their encompassing
networks and communities, how they perceive risk and vulnerability, how they behave in
particular ways, and how they are most likely to respond to prevention and intervention
efforts. These models also must reflect the “micro-epidemics” and must use cultural
information in a culturally competent manner (Singer & Borrero, 1984; Trotter, 1995;
Weeks, 1990).
Although it is clear that context has a tremendous influence on each individual,
context alone does not account for all relevant aspects of the model. Individuals themselves
play an important role, not only in the perpetuation of risky behaviors but also in
constructing the parameters of those behaviors as well as their resolutions. Various
psychosocial learning and behavior theories apply to these circumstances, and although
their specific labels and categories might differ, they share the same basic components. For
example, the health belief model (e.g., Becker, 1974; Becker & Maiman, 1980; Janz &
Becker, 1984) and the theory of planned behavior (e.g., Ajzen, 1985, 1991; Ajzen &
Fishbein, 1980) both incorporate aspects of an individual perspective, of a societal or
71
normative perspective, of an individual’s desire to behave in a particular manner, and of an
individual’s actual behavior. Versions of both models also integrate self-efficacy (Bandura,
1986, 1994) or “perceived control” (Ajzen, 1985; also see Jemmott & Jemmott, 1994) as
key elements, and both identify nonspecific external factors as having some influence on
any segment of the central, “individual” section of the model.
These learning/behavior models have been successfully used for decades and continue
to be instrumental in contemporary efforts to describe, explain, and alter health-related
behaviors. Wong and Bouey (2001) incorporated the theory of planned behavior into a
more inclusive political–economic model with the intent of obtaining an improved
understanding of substance use/abuse, sexual risk practices, and HIV/STDs (see Figure
2.3). The theory of planned behavior holds that HIV/STD infections are determined by
behavior, which in turn is predicted by intentions. The latter are a product of individual
attitudes and subjective norms, both results of more inclusive individual perceptions of
social group expectations and of behavioral consequences. This particular model has been
selected because it has a long history of development and because it has been used
successfully in prevention and intervention efforts related to general health, sexual risk
behaviors, and substance abuse. For interventions focusing on individuals, this model
directs attention to specific attitudinal and normative components that are salient to certain
behaviors. Simultaneously, with the expanded scope of our political–economic model, one
can isolate contextual and structural factors that predict beliefs/attitudes and norms related
to behaviors. Individuals integrate these inputs, in addition to those they carry with their
personal histories, and construct their perceptions of behavior and norms. Attitudes and
subjective norms are derived from these exchanges, ultimately defining intentions with
commensurate behavioral correlates. This framework is directly applicable to substance
use/abuse, sexual risk practices, and HIV/STDs, facilitating the identification of linkages
surrounding and coupling those behaviors.
External validity refers to the generalizability of results from one study to other
settings and outside the laboratory. Can we generalize the findings to people living in the
real world? Do the results apply to larger community settings? Sue (1999) argues that the
consideration of external validity is not given a high enough priority in research where
diverse populations are not represented by diverse study samples. Where diversity matters
in the variables under investigation, the study’s methodology should account for it. Many
psychology studies are done with first-year college students. They are not representative of
the population of the United States, much less the population of the world. Using Wong
and Bouey’s (2001) work on drug abuse as an example, one may find that women in New
York City (urban dwelling) who enroll in substance-abuse prevention or treatment
programs are less likely to abuse drugs during pregnancy compared to those in Long Island
(suburban or rural dwelling), who may not follow the same pattern. Until these results are
replicated with similar samples in other cities and settings, the study results must be
interpreted as applicable only to New York City women.
72
A number of factors may also influence the fidelity of research. Most studies hoping to
generalize their results to a given population assume a representative sample from that
population. The classic manner to achieve representativeness is through random sampling,
where all potential participants have an equal chance of being selected for a study. A biased
sample occurs when those selected for a study are somehow disproportionally weighted so
that the sample is not representative of the population. If we were interested in the opinions
of both males and females at a school and got mostly males in our sample, we could not
honestly say the study was fair.
A consequence of biased sampling is diffusion of treatment, meaning that it is
difficult to draw definitive conclusions about the respective efficiency and effectiveness of a
program because the program is not pure. The effects of one treatment have spilled over
into the other. Participants in such programs are also likely to have other problems (e.g.,
homelessness) in addition to substance abuse, which make them likely to drop out of the
study. This is known as experimental mortality. Enrollment in such programs is no
guarantee that participants’ subsequent abstinence or recovery is solely due to components
of the programs. Possibly certain client characteristics (e.g., less physical tolerance of the
drug) can naturally lead to abstinence or recovery over time. In other words, the desirable
outcome is due to some form of maturation. Certain historical events might also influence
results (e.g., a terrorist attack influencing people’s attitudes toward the right to privacy).
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TRADITIONAL SCIENTIFIC RESEARCH METHODS
There are traditional group research strategies that are used by all psychologists, including
community psychologists. The usual first step in devising a study is to conduct a review of
the scientific literature. The researcher then draws what appears to be the logical conclusion
from reading the past work. A statement of what might be expected from a study is called a
hypothesis. (More formally, it is a tentative assumption made to draw out and test its
logical or empirical consequences—a definition adapted from the Merriam–Webster Online
Dictionary.) The researcher chooses which of two research designs to use in the study to
examine the hypothesis, the correlational or the experimental design. The design is the
systematic plan to test this hypothesis.
Researchers use these designs to guide what kinds of data are gathered from groups of
people, and how data gathering is carried out. Assumptions are made regarding what these
group data represent. This takes us into definitions of population and sampling.
We now look at these definitions, explore the two traditional research designs, and
then look at a third category called the quasi-experimental design, which attempts to gain
the explanatory advantages of the experimental design while dealing with the situational
limitations that such a design sometimes presents to the researcher (see Table 2.1). We
follow the descriptions of these designs with an exploration of other research methods likely
to be used by community psychologists.
TABLE 2.1 Characteristics of Three Scientific Research Designs
Correlation Quasi-experimental Experimental
Type of question
Are the variables of
interest related to
each other?
Does an
independent variable
that the researcher
does not completely
control affect the
dependent variable
or the research
result?
Is there a
relationship between
ndependent and
dependent variables
that addresses the
cause?
When used
Researcher is unable
to manipulate an
independent
variable. Sometimes
used in explanatory
research.
Researcher wants to
assess the impact of
real-life intervention
in the community or
elsewhere.
Researcher has
control over the
independent variable
and can minimize
the number of
confounding
variables in the
research.
Ability to
74
Advantages
Convenience of data
collection. May
avoid certain ethical
and/or practical
problems.
Provides some
information about
cause–effect
relationships.
Permits assessment
of more real-world
interventions.
demonstrate cause–
effect relationship.
Permits control over
confounding
variables and the
ruling out of
alternative
explanations.
Disadvantages
Cannot establish a
cause–effect
relationship.
Lack of control over
confounding
variable. Strong
causal inference
cannot be made.
Some questions
cannot be studied
experimentally for
either practical or
ethical reasons. May
lead to artificial
procedures.
Source: Adapted from Wong, Blakely, & Worsham (1991). Copyright 1991 by Guilford Press. Used with permission.
Population and Sampling
Social research attempts to understand human behavior. A population is defined as the
group of people that the research is attempting to understand. If we want to know how
people in New Zealand think and behave, the population is “all the people in New
Zealand.” If we are interested in males in Seattle, the population is “all the males in
Seattle.” Psychology’s ambition is to understand all human beings, in which case the
population is all human beings. That is the ambition—but getting data on an entire
population is difficult. We therefore use a sample of those in whom we are interested.
A sample is a subset of the population that is supposed to represent that population. A
random sample is a sample in which every member of a population has an equal chance of
being selected. In contrast, a convenience sample is chosen for no other reason than it is
available. College students represent a convenience sample, because the students are readily
available to participate in research conducted in psychology departments at colleges and
universities. A stratified sample tries to match the known characteristics of the population;
for example, if we know that 40% of the population is male, we would try to get a sample
that is 40% male. A purposive sample is one chosen for a specific reason. In a test of drug
use among pregnant women, only pregnant women would be chosen to be assessed; they
represent a purposive sample. Random samples are the revered form of sampling in
psychology.
Correlational Research
Correlational methods include a class of designs (e.g., surveys) and measurement
procedures, as well as techniques (e.g., self-report), that allow one to examine the
75
associations or relationships between two or more variables in their natural environments.
In other words, correlational methods do not contain active manipulations of the variables
under study; rather, they are usually descriptive. For example, using Wong and Bouey’s
(2001) theory of drug abuse, one might want to investigate the relationship between the
number of months a woman has been pregnant and the severity of her substance abuse;
these variables are not manipulated. The fact that one has no control over them means that
the distinction of independent from dependent variables may be arbitrary, albeit dictated
by a theory.
Causation cannot be determined from correlational studies, because intervening or
other unstudied variables could have produced the effects noted. Associations can be
spurious (false while giving the appearance of being correct) when intervening or
confounding variables are responsible for the relationships. In experimental research,
intervening variables are controlled for by randomly assigning participants to groups,
holding conditions constant, and manipulating the independent variable. In correlational
research, the methodology seldom if ever achieves these conditions.
In its simple form, the associations between two or more variables are quantified using
a statistic known as the Pearson correlation coefficient, which ranges from +1.00 to −1.00.
The sign (+ or −) indicates the direction of the association. For example, if the sign is
positive (+), both variables move in the same direction, or as one gets smaller, so does the
other. A positive correlation can also mean that as one variable increases, so does the other.
A negative or inverse correlation means that the variables move in opposite directions. For
example, as one variable increases, the other decreases. The number (e.g., .35) indicates the
magnitude or intensity of the relationship, with 1.00 being the largest correlation and .00
indicating little or no relationship.
Using Wong and Bouey’s (2001) research of drug abuse in pregnant women, a
Pearson correlation coefficient of −.80 between the number of months pregnant and
substance abuse means that women who are at more advanced stages of pregnancy are less
likely to abuse drugs (a strong negative association). However, one cannot conclude that
advanced stages of pregnancy cause decreases in substance abuse. Also, this association may
be artificial when there is reason to suspect that pregnant women’s perceived support from
their spouses later in pregnancy is largely responsible for decreases in substance abuse,
rather than the pregnancy itself. You can find a further description of the issues related to
research comparing data collected at two points in time in Box 2.1.
BOX 2.1
Research across Time
Lorion (1990) emphasized the importance of the time dimension in analyzing human
behavior. Developmentally we know that with the passage of time, things change, children
grow and mature, and interventions may take hold with seemingly small changes leading to
significant differences. While correlations do NOT show cause and effect, they do
demonstrate predictability. A correlation across time suggests that an event at time 1 is
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related to an event at time 2—i.e., if a positive correlation—then event 1 occurs, event 2 is
likely to occur. While not demonstrating cause and effect, it does help predict.
Experimental Research
The experimental design is considered by many to be the “gold standard” for research.
Experiments include a class of designs (e.g., between-groups designs where no two groups
receive the same treatment) and measurement procedures that allow one to manipulate
independent variables and observe the resulting effects on dependent variables. An
independent variable is the condition that is varied between groups (e.g., people in one
group receive a treatment; people in the other do not). The dependent variable is what the
scientist measures to see the effects of the independent variable (e.g., doing better in terms
of number of positive social contacts). A common design is the pretest−posttest control
group design (Campbell & Stanley, 1963; Cook, Shadish, & Campbell, 2002), which
involves assessing a dependent variable before and after an experimental manipulation
(treatment) in one group (the experimental group) and before and after a no-manipulation
condition in the control group. That is, one group of participants is exposed to an
independent variable, and another group is not.
In addition to this manipulation of the independent variable, in a true experimental
design, assignment to the experimental or control group is random —participants have an
equal chance of being assigned to either the experimental or the control group. If
assignment is random, the two groups, experimental and control, can be assumed to be
similar to each other, or rather, equivalent. If there are any differences between the groups
at the end of the process, it can be assumed that the independent variable is what brought
about the change, because the only difference between the groups is the independent
variable’s presence or absence.
If the experimental manipulation is functioning as predicted by a theory, the
dependent variable should be observable as a change from premanipulation to
postmanipulation scores within the experimental but not the control group. In other
words, the pretest−posttest observations of participants in the control group should remain
relatively constant over time, unless some natural maturation occurs or the initial pretest
sensitizes all participants to the nature of the assessment being conducted.
Quasi-experimental Research
For practical and ethical reasons, many variables studied in the field of community
psychology (e.g., school climate or minors being exposed to alcohol or cigarettes) cannot be
experimentally manipulated. Similarly, subjects cannot always be randomly assigned to
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groups. For example, if a participant is pregnant, it is not possible to randomly assign her to
the nonpregnant group. In studies of pregnancy, one would probably end up using intact
groups. Thus, a compromise is the use of the quasi-experimental design, which
approximates experimental conditions and random assignment but is not quite able to get
all of the necessary conditions for a true experimental design (Campbell & Stanley, 1963;
Cook et al., 2002). A common quasi-experimental design is the nonequivalent pretest
−posttest control design, which involves comparing a group before and after some
experimental manipulation or treatment with another group that has not been exposed to
the manipulation. As mentioned earlier, this design differs from the pretest−posttest design
previously discussed in that participants are not randomly assigned to experimental or
control conditions.
The quasi-experimental design allows for more natural or realistic research, where
initial differences between experimental and comparison groups may not be balanced. For
example, using Wong and Bouey’s (2001) research, pregnant women who voluntarily
participate in primary and secondary prevention or treatment programs may be more
educated than those in the comparison group, which may include more women who are
high school dropouts. Thus, differences already exist between the two groups before the
study begins. Care must be taken in drawing conclusions about differences found between
the two groups—because they may differ at the outset, other explanations for the
differences found in the study cannot be ruled out. Although there may be statistical
methods to bring treated and untreated groups to greater equivalency, quasi-experimental
design results are always viewed with caution.
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ALTERNATIVE RESEARCH METHODS USED IN COMMUNITY
PSYCHOLOGY
The reason to do research is to better understand the world in which we live. Although
traditional designs and methods continue to hold sway over the field of psychology, there
are alternatives that have gained increasing currency. Users of these alternatives hope to
gain a better sense of reality and to recognize and overcome the limitations of traditional
methods. Although we recognize the power of traditional research designs in our discovery
process, there are other ways to gain knowledge about our world. In some cases, these
methods come from other disciplines such as anthropology or public health, and in others,
there have been evolutions in our understanding of what that reality might be
(philosophical or statistical models). We now examine several research methodologies used
by community psychologists but not by laboratory-based psychologists.
Ethnography
Have you ever tried to tell a story and found that you could not because of the constraints
placed on you in its telling? Because of the urgency of the issues in the field of community
psychology, diverse methods or approaches are often employed. One such research method
is ethnography, which refers to a broad class of designs and measurement procedures where
one speaks directly with participants of the study. The primary purpose of ethnography is
to allow one to gain an understanding of how people view their own experiences. The effort
is to see the world from their perspective.
Ethnography allows an individual study participant to describe his or her own
experiences without having to translate them into the words of the researchers. In other
words, the informants or participants use their own language to describe their own
experiences. An ethnographic interviewer probably also explains why he or she is asking
particular questions so the informants understand more fully. Similarly, in contrast to the
more traditional scientific methodological efforts to remain objective or neutral, in
ethnography the value systems of the researcher may influence social interactions between
the researcher and the informants, and this is acknowledged. As much as possible, the
researcher should take a stance of ignorance about the experiences of the informants and
should be open to learning about the personal reality of those being studied.
As our models of social reality and research become more sophisticated and are
affected by the postmodernist philosophies of the world (which challenge the assumption of
objectivity and emphasize the importance of interpretation), a greater appreciation of this
type of research has come to the field of community psychology (Bond & Mulvey, 2000;
Campbell & Wasco, 2000; Campbell, Gregory, Patterson, & Bybee, 2012; Riger, 1990;
Speer et al., 1992; Tebbs, 2012; Trickett, 2009). Ethnography is perhaps most informative
when research questions asked do not have a strong theoretical framework and so leave the
researcher open to the discovery process. Thus, qualitative information that is likely to be
gathered from ethnographic studies can inform the researcher about future directions of
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study (Campbell, 1974). Qualitative information is acknowledged to be more subjective
and anecdotal. Its strength is that the ideas and themes emerge from the participant. An
examination of articles in the American Journal of Community Psychology found an increase
in qualitative data−based articles from 4% between the years 1981 and 1983 to 17%
between 2001 and 2003 (Luke, 2005). Qualitative data are typically seen in contrast to
quantitative data, which are by definition numeric, are considered objective, and typically
are the kind of data found in traditional research methodologies and designs.
The use of a combination of qualitative and quantitative techniques (mixed method)
for studying community phenomena has the potential to strengthen community research,
according to Cauce (1990). Others have since reinforced the value of such a hybrid
methodology (Campbell et al., 2012; Tebbs, 2012). The qualitative information may
inform the direction in which the quantitative study might go and then later inform the
meaning of those quantitative data (Banyard & Miller, 1998). The mixed-method
approach is a way to both empower and transform those being studied and, in a manner of
speaking, is an intervention in itself (Stein & Mankowski, 2004). The qualitative methods
require more awareness of the relationship between researcher and participant and the
potential impact of one on the other (Brodsky et al., 2004). The qualitative data assume a
more interactive role between the researcher and participants. Qualitative studies are
increasingly accepted as a model of research, especially as a part of mixed-method research
(Marchel & Owens, 2007). Case in Point 2.2 is an example of a mixed-method study.
From a feminist psychology perspective, qualitative data allow for capturing richer and
more meaningful descriptions of social phenomena (Brodsky et al., 2004; Campbell &
Wasco, 2000; Campbell et al., 2012; Hill et al., 2000). Again, we note that the quest is for
a better apprehension of social reality and therefore a better understanding of that reality.
Participant observation is a special type of ethnographic technique. Although the
researcher often assumes the role of an observer, the usual assumption is that the
observations are made with detached neutrality. In participant observation, the researcher is
actively engaged in the dynamics within the setting. There are assumed to be ongoing
dialogues between the researcher and the participants. For example, a researcher who is
interested in the study of teenage gangs often needs to “hang out” with the gangs for a
period of time. Also, the researcher needs to acquire the language used by the gangs to
facilitate his or her investigation of the gangs’ social network characteristics as well as to
establish trust. Meanwhile, the constant social interactions between the researcher and gang
members may affect their perceptions of and relationships with each other. They may
become friends. A consequence can be role ambiguity, where it becomes unclear to gang
members what role the researcher is adopting. Is the researcher a member of the gang, a
researcher, or both? In the meantime, the researcher may live the details and nuances of
gang life, yielding a richer and more informed set of data. The ethical dilemmas of
informed participation and blurring of boundaries have been raised in regard to this
methodology in particular (Gone, 2006; Trimble & Fisher, 2006). Is the researcher really a
part of the group (gang)? What of informed consent? What are the responsibilities for
crediting those under study for what is discovered? What are the gains to be made from the
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research, and how can that be acknowledged? These are questions that could be raised
about much of our community research, a point that will be addressed again in our
consideration of participatory action research later in this chapter.
CASE IN POINT 2.2
Case Study of a Consumer-Run Agency
Felton (2005) studied a consumer-run agency working on mental health services. She
wanted to find the characteristics of that work community. Using a variety of methods,
including participant observations, ad hoc interviews, behavioral observations, and the
standardized Work Environment Scale (Moos, 1994), she spent two years on site,
interacting for periods of time and then retreating to analyze the data.
A content analysis of her qualitative interview data yielded a variety of staff-generated
themes: pride in the agency, an understanding and compassionate place, and the feeling
that it was family. The quantitative scale measures verified these general themes, yielding
comparatively high scores (two standard deviations higher) on worker involvement, task
orientation, and cohesion. The scale suggested high “relationship” orientation. There was
also a very high score on clarity of work mission. These scores triangulated well with the
qualitative data. The agency under study seems to be doing well in providing a service
setting with which workers feel engaged and to which they are committed.
The idea behind triangulation is a referent to anthropological terminology, which
likens social sciences efforts to obtain an understanding of phenomena to geological
mapping. To locate a site, one takes two readings from different perspectives/sites, focusing
on the site to be defined. The two sites triangulate with the one point under examination,
yielding a better understanding of the one point. It is a kind of social geometry. In a similar
way, the qualitative data, the interviews, yield one “siting” on the social phenomena being
examined. The quantitative data, the scale scores, yield the second “siting” on what the
agency is really like. The ensuing picture is more comprehensive, sensitive to personal
nuance, and yet also more verifiable, given the two sets of data.
Geographic Information Systems
“The three most important things in real estate are: location, location, and location.”
“Everything is related to everything else, but near things are more related than distant
things.” This is the first law of geography (Tobler, 1970, p. 236). Computers provide us
with myriad ways to collect and illustrate data on neighborhoods. Following the logic of the
importance of place within our lives, researchers are able to combine and map community
data so as to capture social phenomena and their location. Starting with a map of a
specified area, structural features such as roads, property lines, and government boundaries
as well as social (income, marital status, size of family) and psychological data (happiness,
well-being, mental health, mental illness) can be loaded onto the analyses. The data may be
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from archival sources (school, police, county records, U.S. Census), may come from other
research data sources, or may be generated by the researchers themselves through surveys
(Morton, Peterson, Speer, Reid, & Hughey, 2012).
Epidemiology
Dr. John Snow’s Ghost Map (Johnson, 2007) of 1854 London showed a pattern of cholera
deaths within a district. Using that pattern, Dr. Snow convinced officials that the patrons
of particular water sources were at high risk of dying. The wells were closed, and the
epidemic stopped. This was before germ theory, or any knowledge of the cause of cholera.
This is an example of epidemiology, a research methodology used by those in public
health. The research entails “the study of the occurrence and distribution of diseases and
other health-related conditions in populations” (Kelsey, Thompson, & Evans, 1986, p. 3).
This includes a broad class of designs (e.g., prospective or “futuristic” studies and
retrospective or “historical” studies) and measurement procedures and techniques (e.g.,
records, random telephone samples, or neighborhood surveys).
There are two measures of the rate of illness in the community: prevalence and
incidence. The prevalence of a disease or health-related condition is the total number of
people within a given population who have the disorder. Incidence refers to the number of
people within a given population who have acquired the condition within a specific time
period such as a week, a month, or a year.
Incidence rates can be established using a prospective design or investigation of new
cases. Here, all new cases for the given time frame are counted, yielding a rate of onset for
the disease. Rising incidence rates tell us that the problem is increasing. Declining incidence
rates suggest that the problem is lessening. We might think about flu season, when the cases
of flu rise. Epidemiologists continue to measure the rate of onset to see when the flu season
is over.
Prevalence rates can be established using a retrospective design or looking back at all
known cases. In this design, we would count all old cases and all new cases. In the case of
depression, we would count all old cases, take away all cases that have been cured, and then
add all the new cases. This tells us the total number of cases in the population at a
particular time.
Prevalence rate is a more inclusive measure than incidence rate and is easier to
calculate. However, prevalence rates have the disadvantage that they are difficult to
interpret, because they must take into account both the incidence and the duration of a
disorder.
Depending on the objectives of the epidemiological investigation, measurement
procedures as well as techniques used in the design can range from household interviews to
random telephone dialing. Others include the use of archived data such as birth certificates,
death certificates, census records, or other previously collected data.
Needs Assessment and Program Evaluation
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Needs assessment refers to a set of methods to determine whether a program or
intervention can be of use to a given population. Needs assessment could also examine
where prevention programs or other interventions might decrease the risk of a problem.
Needs assessments can be conducted via examination of existing sources of data on
problems and resources within a community. To these data could be added interviews,
surveys, and other observational or descriptive information. Each of these methodologies
brings advantages and disadvantages. People may be reluctant to provide information in a
face-to-face interview, but willing to disclose what they know on an anonymous survey. On
the other hand, during an interview, the interviewer (or the informant, for that matter) can
change the direction of the interview and thus reveal information not discovered on written
surveys. Case in Point 2.3 provides an example of needs assessment leading to a community
program.
When the needs or problems have been identified, and a program has then been
developed or refined to address needs related to a particular issue, the program’s
effectiveness or efficiency should be evaluated. This process is called program evaluation.
Program evaluation refers to a broad class of designs, methodologies, and measurement
procedures and techniques that allow one to examine “social programs … and the policies
that spawn and justify them, [and] aim to improve the welfare of individuals, organizations,
and society” (Shadish, Cook, & Leviton, 1991, p. 19).
CASE IN POINT 2.3
Needs Assessment of a Hmong Community
The Hmong are an ethnic hill tribe group in Laos. During the Vietnam War, they sided
with the United States against the communist Pathet Lao. When America retreated from
Southeast Asia, the Hmong suffered for their earlier alliance, and in time refugees were
rescued and resettled in America. Wisconsin has one of the largest Hmong refugee
communities in the United States.
The Hmong have low levels of education and high levels of teen suicide and drug
abuse (Secrist, 2006). They also have unusually high rates of disability (Pfeifer, 2005). In an
earlier Wisconsin-based report, the Hmong who were interviewed stated that their greatest
barriers to service were language and literacy (Wisconsin Department of Health, 2001).
Concerned providers in the Eau Claire, Wisconsin, area met and discussed how to
better address this population. Among their first actions was to engage the Hmong
community in assessing their needs. To this end, individual interviews of “key
informants”—that is, those within the community who should know its needs—were
conducted. Also, several group interviews were conducted with specific groups from the
Hmong community: professionals, men, women, and youth. The groups were identified
and invited to discuss their community’s needs. Interview con-tent was coded for topics.
Following this, group meetings were held to present the findings for identified themes.
Attendees were asked to provide feedback on what was found. Results yielded needs related
to the following (Collier, Munger, & Moua, 2012):
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Intergenerational communication difficulties
Marital discord
Domestic violence
Child abuse
Lack of mental health knowledge
The stigma of mental illness
Problems of elders
It is beyond the scope of this chapter to extensively discuss the processes involved in
evaluating a typical social program. We do note that besides needs assessment, there are
generally two kinds of evaluations: process and outcome. Process evaluation examines what a
program is doing. Are things going as planned, with interventions occurring in a timely
fashion? What are the day-to-day operations like? Where are the problems of
implementation and execution? A good process evaluation should report on what a
program is doing well and what it is not doing well. The adjustments to the process can
then be made based on the process evaluation findings.
An outcome evaluation, on the other hand, looks at the effects of a program. At the end
of the intervention, what has been accomplished? Does the program do what it intended to
do? Most program evaluations look at immediate outcomes, but community programs may
require extended outcome evaluations. Many treatment evaluations now look at outcomes
one to two years after the conclusion of the intervention. This tries to answer the question
of whether the outcomes endure beyond the period of intensive attention or if the natural
contingencies within the environment are sufficient to sustain the benefits that
accumulated.
A good evaluation usually consists of four related components: (1) the goals, (2) the
objectives, (3) the activities, and (4) the milestones. The goal refers to the aim of the
evaluation. A good evaluation is likely to be driven by theory. That is, the concept of a goal
addresses the question, What does the evaluation hope to achieve? (or why should an
evaluation be conducted?). The construct of an objective refers to the plan. That is,
objectives address the question, How does one go about achieving the goal? The concept of
activity refers to the specific task; that is, activity addresses the question, What does the plan
consists of? Milestone refers to the outcome; that is, does the evaluation achieve its
intended goal?
Using Wong and Bouey’s (2001) study of drug abuse, one might want to investigate
the differential effectiveness of mainstream versus native-focused prevention and treatment
programs for American Indian/Alaska Native adults (the goal). Therefore, one reviews
records and interviews clients and staff of the two types of programs (the objective or
design). Given the voluminous records and possible number of informants or interviewees,
only a randomized stratified sample will be used (the activity, including analysis). It might
be reasonable to hypothesize that a higher enrollment rate will be observed in the native-
focused programs than in programs in the mainstream because of culturally competent
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1.
2.
3.
4.
5.
6.
7.
8.
services. However, the two types of programs may not differ in dropout rates, because, as
you know by now, intervention outcomes are often contingent on a host of factors other
than program type (the milestones).
This example certainly is a very simplistic picture of program evaluation. Although
program evaluation may seem more objective, role ambiguity is still possible. Role
ambiguity is most likely to occur with internal evaluation. That is, an evaluator who is also
on the staff of the agency not only assumes the role of evaluator but also is someone
interested in using data derived from the evaluation for future program development or
refinement. To guard against this problem, agencies usually establish an advisory panel so
that program development or refinement is executed by the group rather than a single,
internal evaluator. Another solution is to employ an external evaluator, such as a
community consultant. Social dynamics are crucial in evaluating any social program.
People do not like to be judged, especially when there may be negative consequences. Many
not-for-profit social programs are sensitive to funding issues and public scrutiny. If these
programs are shown to be less than effective, they are likely to be eliminated. If they are
effective but less efficient (i.e., more expensive to maintain), they may still be eliminated.
The potential for bias in favor of maintaining the program is obvious.
The tensions between program evaluators and the programs they evaluate often exist
when only “objective” assessment or feedback is used with no active or direct engagement
of program staff. Wandersman and colleagues (1998) argued that
there has been a growing discussion of new and evolving roles for evaluators…. Unlike
traditional evaluation approaches, empowerment evaluators collaborate with
community members … to determine program goals and implementation strategies,
serve as facilitators … not outside experts … in ongoing program improvement. (p. 4)
Ultimately, it is about program accountability. To that end, eight questions (along
with the corresponding strategies for addressing them) serve as guides for program
accountability:
Are there needs for the program? (needs assessment)
What is the scientific knowledge or best practices basis for the program? (consult
scientific literature and promising practice programs)
How do new program(s) integrate with existing programs? (feedback on
comprehensiveness and fit of program)
How can the program best be implemented? (planning)
How effective is that implementation? (process evaluation)
How effective is the program? (outcome and impact evaluation)
How can the program be improved? (lessons learned)
How can effective programs be institutionalized? (replication or spin-off)
Fetterman (2005) emphasized that empowerment evaluation went beyond regular
evaluations in that one of the goals of empowerment evaluation was to center the control
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with those being evaluated. This was more than working together, where feeling
empowered is a possible side effect. If the empowerment evaluation worked as it should,
one of the main effects was that control of the work was with the organization and people
under study. The evaluator served as a facilitator who helped influence the process but did
not control it. Among the principles of this form of evaluation are community ownership,
inclusion, democratic participation, community knowledge, organizational learning, and
social justice.
Program evaluation can be seen as a form of intervention (Kaufman, Ross, Quan,
O’Reilly, & Crusto, 2004; Patton, 1997). Evaluation is not a passive process, because the
evaluator helps the organization define and objectify the goals and direction of the program
under scrutiny. Beyond the definition of tasks, the evaluator defines which data are
important, which are attended to, who is given a voice (administrators, staff, clients,
community), and how that voice will be heard (surveys, interviews, focus groups, numeric
methods, or personal testimony). The evaluator engages in interpretation, weighting, and
summation of the data. This is a great deal of power and can have a significant effect on the
direction and functioning of the targeted system.
Kaufman and colleagues (2006) presented an excellent example of the evaluation
process and its potential for community change. They worked to increase the likelihood
that evaluation findings would be used by developing a clear logic and strategy for the
program need; having all relevant parties actively engaged in the process of planning,
implementation, and evaluation; using a variety of both qualitative and quantitative data
from a variety of sources so all felt they were being respected and heard; working to be as
scientifically rigorous as possible in the generation of data; working to increase the
community’s ability to do its own evaluations; and being sure to share findings with all
involved once they had the opportunity to comment on first drafts (which increased the
ownership of the data and made for no surprises). Among their efforts to have the
evaluation accepted by the community was a conscious decision to become regulars within
the community, or as Kelly (2006) called it, “showing up” in the neighborhoods. The
evaluators were also open and willing to provide help when needed, even when it was above
and beyond what was contracted. One gets the impression the evaluators became a part of
the community. Thus, the comments were not from a distant and uninvolved team who
examined things without knowing in detail whom and what they were examining. The
evaluation in turn helped in bringing about a variety of changes within the community and
the service systems it served.
We move now to a type of research that closely resembles the process described here.
Whereas the focus of Kaufman and colleagues was evaluation, their goals were community
change. The incorporation of community participants in the research and intervention
planning process is made even more explicit in participatory research.
Participatory Action Research
If you want to know something about a community, ask someone who is a part of that
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community. If you want them to be forthcoming, it helps if they feel that they have a say in
the research and if they understand that what they say can ultimately affect them. The
participatory action research (PAR) methodology takes these points into account. It is
much like the empowerment evaluation described earlier in that PAR seeks a partnership
with those it is studying, but its basic intention is to do research. The action research
tradition (Lewin, 1946) has always incorporated including the targets of any study in the
research process. Participatory action research is a continuation of this tradition. In this
model, the studied community helps to define the areas to study, the methods for studying,
and the use of the study results. Kidd and Kral (2005) define participatory research as a
sharing of power with the participants themselves, and emphasize that it is an attitudinal
change more than it is a specific methodology. It can include both qualitative-anecdotal
and quantitative-numeric data. Participant research
involves the development of human relationships and friendships with participants as
opposed to the supposedly objective disinterest of traditional paradigms. It can be a
genuine connection, an ‘authentic participation’ that is motivational, contributes to
personal growth and reduces the barriers between peoples. (p. 192)
Jason, Keys, and associates (2004) elaborate at length on the participatory research
tradition and its place within community psychology. The partnership between researcher
and participants creates a structure of respect, and the research process can be considered
the intervention. Rather than doing research with strangers, it is like working with people
you come to know, as they come to know you. As opposed to an imposed set of theories
and hypotheses, there is partnership in discerning the important aspects of community to
research and how to research it.
We are reminded that the PAR is a process that has to deal with the community’s own
power structures (Dworski-Riggs & Langhout, 2010; Greenwood, Whyte, & Harkavy,
1993). Power is differentially distributed and determined by structural forces. In working
within a given community, it is wise to first come to understand that setting’s power
structure. As well, we are cautioned that participation may not be the way in which
participants in the setting believe they will become empowered (Dworski-Riggs Ȧ
Langhout, 2010; Foster-Fishman, Salem, Chibnall, Legler, & Yapchai, 1998).
Kelly and colleagues (2004) provided an example of a 10-year relationship with an
African American community on Chicago’s South Side in which community leadership was
both studied and developed. The Developing Communities Project (DCP) wanted to take
a community organization approach to preventing substance abuse. In close collaboration
with the DCP, researchers and community developed relationships and group mechanisms
to define and describe African American church-based organizing and leadership.
Admitting to the lack of relevant literature on the topic, the researchers built on
information from the citizen-leader panelists. The reliance on community knowledge and
feedback in devising appropriate data-gathering procedures was an integral part of the
process. Clearly, the development of personal relationships (common interests in jazz) and
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community-based metaphors (such as “Leadership as making a soup; there being many
ingredients needed in its making”) was essential to the project. Data were collected and
reported to the community and then refined so as to be more useful (the use of oral history
videotapes to communicate the findings).
There is a further cautionary tale to go with PAR. In reviewing the experiences of
researchers and community self-help groups in the PAR process, Isenberg, Loomis,
Humphreys, and Maton (2004) offer several reservations concerning the assumptions
involved in this methodology. Among them, they propose that PAR does not necessarily
make for better science, but rather is a decision that should be based on social justice
considerations. They do note that this can lead to better response rates and more
meaningful questions as the result of collaboration (Klaw & Humphreys, 2006), but that is
not the reason to adopt the process. They further suggest that “collaboration necessarily
includes conflicts, not all of which can be easily resolved” (Isenberg et al., 2004, p. 126).
Although participatory research is acknowledged to be complex and time-consuming,
as well as less respected in certain mainstream academic settings, nonetheless its potential
for contributing to our understanding of meanings within the communities we study seems
great (Kidd & Kral, 2005). As well, a second powerful recommendation for its use is the
potential for participatory research to empower the communities it studies (Kelly et al.,
2004; Jason et al., 2003). Research on the effects of PAR has begun to demonstrate the
effects of this methodology on its community participants, ranging from increased sense of
control to developing a change agent identity (Foster-Fishman, Nowell, Deacon, Nievar, &
McCann, 2005).
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CAUTIONS AND CONSIDERATIONS REGARDING COMMUNITY
RESEARCH
Research in the field of community psychology is often conducted with a sense of urgency
not often seen in other areas of psychology. The community concerns are immediate and
ongoing. Delay has real-life consequences for the populations involved. (See Case in Point
2.4 for an example of this.) And yet, there are cautions related to doing the research and
considerations with regard to the manner in which it is conducted. The following are some
of the issues.
The Politics of Science and the Science of Politics
Most of us assume that social policies and programs are based on a reasoned scientific
knowledge of social phenomena and human behaviors. That is, a systematic and vigorous
examination of an issue using scientific principles will result in programs producing the
most desirable outcome(s) or impact(s). However, as found in real-world community
projects, there are systems that must be negotiated and power issues with which to contend.
This has been discussed at length for work in neighborhoods (Kelly, 2006), in school
systems (Foster-Fishman et al., 2005), and at the highest federal policy levels (Jason, 2012).
A review of these articles reminds us that systems can be difficult to access and influence
and that there are lessons to be learned in the politics of science. In particular, we should be
aware of the existing power structure and those affected by change (stakeholders); look to
potential allies and coalitions; remember that “experts” within a community can be very
helpful; and understand and be willing to use the natural shifts of power and structures
(Foster-Fishman, Nowell, & Yang, 2007; Jason, 2012; Kelly, 2006).
Ethics: Cultural Relativism or Universal Human Rights?
A major principle of scientific research is that the well-being of research participants must
be ensured (American Psychological Association, 1985). Taking part in research should not
endanger people in any physical, psychological, or social way. All participants must be
informed about the purpose of the research as much as possible (without jeopardizing the
integrity of the research), and use of deception must be minimized. It is ethically
undesirable to do otherwise (see Christensen, 1988). In most research institutions and
universities, approval from an institutional review board must first be secured,
demonstrating that all ethical guidelines (e.g., participants must be fully debriefed about the
purpose of the study) have been met before research can be initiated.
These general principles seem straightforward and objective (i.e., research is neutral).
However, these principles were created over several decades. Historically, the lack of such
guidelines has permitted research atrocities. Among the worst examples was the research
conducted in the mid-20th century on 399 African American men for the Tuskegee
Syphilis Study (conducted by the U.S. government from 1932 to 1972). The men were
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deliberately denied effective treatment for syphilis to document its natural progression.
Decades later, President Bill Clinton expressed his regret: “The legacy of the study at
Tuskegee has reached far and deep, in ways that hurt our progress and divide our nation.
We cannot be one America when a whole segment of our nation has no trust in America”
(May 16, 1997). However, to many African Americans, as well as other racial and ethnic
minorities and oppressed groups, such injustices (as an example, forced sterilization of the
so-called mentally feeble) continue to pre-vail—they have just become more covert (in the
name of science). These outrages and debates have also assumed new dimensions, guises,
and significance in the AIDS pandemic (see the American Journal of Public Health, 88,
1998)—extending the boundaries to international scientific research. These are extremely
complex issues, so two related sets of ideas are examined: informed consent and
experimental-control (placebo) design.
Informed consent, a major principle of scientific research, is ensuring that a clear and
articulated procedure and process is in place so that participants understand the nature of
the research, including the right to refuse participation without any repercussions. In other
words, the process of informed consent has two key components: comprehension of
materials and voluntary participation. In an HIV testing study conducted in a South
African hospital, Karim, Karim, Coovadia, and Susser (1998) found that although
participants understood the process of informed consent (i.e., comprehension of materials),
many felt that they had little choice about enrolling in the study (i.e., voluntary
participation) because participation was their only chance of receiving needed medical care
and services. Karim and colleagues concluded that “subtle and unexpected elements of
coercion can reside in the perceptions (real or imagined) held by patients being recruited
into a research project in a medical care setting…. Ethicists and institutional review boards
should certainly explore the issue further” (p. 640).
Beyond these concerns, at a more basic level, community researchers are growing more
aware of the implicit or assumed meanings regarding research participation. Among the
questions raised are: What does consent mean to the participants in regard to their
participation, the data they provide, and its analysis? What are the costs and benefits to the
individual and to the group? Is this research on or a social service to those who are
recruited? These considerations have been raised in global and community research dealing
with medical and psychological studies (Barata, Gucciardi, Ahmad, & Stewart, 2006;
Bhutta, 2004; Dixon-Woods et al., 2007; Gone, 2008; Jenkins, 2011; Kral, Garcia, Aber,
Masood, Dutta, & Todd, 2011; Levy et al., 2010; Yick, 2006).
Once participants consent to enroll in a study, they may be assigned to an
experimental or control (or comparison) group. As noted in our description of experimental
design, a true control group is one that does not receive any intervention or treatment (but
may receive a placebo). However, what should researchers do when they know that without
any intervention or treatment, the participants in the control group will likely be in
jeopardy?
A series of group interviews among diverse ethnic groups in southern California
yielded differences in the groups’ understanding of participation in a study of children
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(Lakes et al., 2012). These variations could be found across a wide array of assumptions and
decision-making processes (see Table 2.2). Although there were many common themes,
there were enough differences to provide cautions to any assumptions about the beliefs and
expectations related to research in the wider, culturally diverse community. The White,
Latina, and Asian American samples differed in their understanding of what participation
meant. Table 2.2 summarizes these differences.
The Continuum of Research: The Value of Multiple Measures
Speer and associates (1992) found that there has been a shift in the field of community
psychology toward the use of correlational designs and away from experimentation. This is
because we have tried to address broadly based social issues. Even in cases where quasi-
experimental or experimental designs can be used, one may have to face a multitude of
methodological issues or dilemmas. One class of these concerns the logistics of
implementing a research program. For example, how do researchers locate drug-using
pregnant women to investigate drug use? Not only are such women hard to access,
especially if they do not seek medical attention, but they may also be homeless or change
addresses often.
TABLE 2.2 Understanding Participation in Research
Groups
Themes White Latina Asian American
Their anticipation of
risks
Emotional impact Being judged Possible conflicts
Sense of research
burden about
Getting ready Length of visit Obligations
Clarifications needed
on
Requirements Research not a
service
How info helps
Decisions to
participate made by
Parents Family Family w/elders
Source: Adapted from material found in Lakes, D., Vaughan, E., Jones, M. Burke, W., Baker, D., & Swansen, J.
(2012). Diverse perceptions of the informed consent process: Implications for the recruitment and participation of
diverse communities in the National Children’s Study. American Journal of Community Psychology, 49, 215–232.
CASE IN POINT 2.4
HIV Intervention Testing and the Use of Placebos
Based on findings of a trial in Thailand, the Centers for Disease Control and Prevention,
together with the National Institutes of Health (NIH) and the Joint United Nations
Program on Acquired Immunodeficiency Syndrome (UNAIDS), announced that placebos
should not be used in HIV transmission clinical trials. After discovering the effectiveness of
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a prevention program, some researchers advocated the use of equivalency trials (i.e., a new
treatment versus a standard treatment) in place of the use of a non-treatment placebo
group. This request was turned down.
For some researchers, such as George Annas and Michael Grodin (cofounders of the
Global Lawyers and Physicians), as well as the late Jonathan Mann (former director of
WHO Global Programme on AIDS and a well-known advocate for human rights in the
context of public health practice), the issue is about universal human rights. Annas and
Grodin (1998) argued that “unless the interventions being tested will actually be made
available to the improvised populations that are being used as subjects, developed countries
are simply exploiting them in order to quickly use the knowledge gained from the clinical
trials for the developed trials” (p. 561). In addition, they raised concerns about informed
consent similar to those brought up by Karim and associates (1998). It is virtually certain
that for many of the participants in these developing countries, enrollment in such trials
guarantees access to medical or health care rather than no care at all. Does this mean we
should not conduct any global studies? There are no easy answers. These debates
demonstrate the interdependence between the integrity of scientific research and societal
forces (cultural norms, economy, racism, sexism, classism, etc.). Bayer (1998) stated:
The tragedy of the recent (HIV) trials is that they bear a profound moral taint, not of
a malevolent research design but, rather, of a world economic order that makes
effective prophylaxis for the interruption of maternal-fetal HIV transmission available
but unaffordable for many—this is true, as well, for a host of treatment for AIDS and
other diseases. In a just world, this would not be the case and the research under
attack would be unnecessary. It is the social context of maldistribution of wealth and
resources that both mandates these studies, and at the same time, renders them so
troubling. (p. 570)
How do researchers increase the probability that pregnant teens will tell the truth
when using self-report measures? Another way to further validate self-reported alcohol use
would be to count the number of empty alcohol beverage containers that pregnant women
discard. A nonreactive measure like this, where people are not contacted face to face, is
called an unobtrusive measure. Although unobtrusive measures are an effective and
creative way to obtain cross-validating information, some consider them ethically
questionable because participant consent is often not obtained.
When working with complex social issues such as teen pregnancy, one should always
make an attempt to use multiple methods. For example, self-reports and nonreactive or
unobtrusive measures, as well as umbilical cord blood samples, could be obtained to
determine whether pregnant women are using drugs or alcohol. When these diverse types
of data agree with each other, the findings are more credible. However, multiple methods
take more time than single methods and may generate different conclusions for the same
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issue.
The Importance of Cultural Sensitivity
Although this seems obvious, it should be noted that different cultures may think and act
differently. If we believe the definition of culture, those with different cultures in given
situations can also have different assumptive worlds and value orientations (O’Donnell,
2006; Pederson, Carter, & Ponterotto, 1996; Reich & Reich, 2006). Growing from this
realization is another class of methodological issues or dilemmas that concerns cultural
sensitivity, or awareness and appreciation of intragroup and intergroup differences. The
authors have chosen to define cultural sensitivity in a very liberal sense. People belong to
many categories and have multiple expectations or identities. For example, a person can be
an African American (racial or ethnic identity) and also a college graduate (educational
background) and a white-collar worker (socioeconomic status). This individual may have
more in common with White college graduates (of similar educational background) who
are also white-collar workers (similar socioeconomic status) than other African Americans
who are high school dropouts (different educational background) or living on government
assistance (different socioeconomic status).
In other words, cultural sensitivity underscores the diverse ways in which our
background and experiences can influence our view of the world and our practices. In turn,
this diversity can lead to misunderstandings if it is not recognized and appreciated. An
example of how this can lead to confusion is provided by a European friend who was
offered a free television. He refused out of politeness, telling us that it should have been
offered three times. When the American did not make the offer more than once, our
European friend lost the T V. He learned a lesson. When in America (or at least that part
of America he was in at that time), don’t wait to be asked multiple times. Of course the
earlier section on diversity, found in Chapter 1, describes the community psychology
principle of recognizing the importance of diversity in any of its studies or interventions. It
is notable that cultural variations can lead to misunderstandings (in some cultures, “yes”
does not mean “yes” but “I respect you”). In research, these variations must be recognized if
we are ever to understand our world. Ecologically valid research hinges on cultural
awareness (Gone, 2011; Kelly, 2010; Kral et al., 2011; Trimble, Trickett, Fisher, &
Goodyear, 2012).
Community Researchers as Consultants
When community psychologists conduct research, they often do so in the role of
consultant. A consultant is someone who engages in collaborative problem solving with
one or more persons (the consultees) who are often responsible for providing some form of
assistance to a third individual (the client; Mowbray, 1979). Because consultants collaborate
with the consultees, those who participate in the research, including the consultees and
their clients, are not called subjects, as they are in other psychological research, but
participants.
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A variety of complex issues face most community consultants. Consultants often enter
a situation not knowing what the real problem is that they are being asked to help solve. In
a business setting, for instance, a consultant might be hired by management because
productivity is low. However, the real underlying problem might be that the management
style is so much disliked that employee productivity has declined. Would you want to be
the consultant who delivers the news to the management team who hired you that
management is the problem? Given the nature of the problems for which they are asked to
intervene, community psychologists acting as consultants need to weigh the ethical
considerations of to whom they are responsible and for what (O’Neill, 1989). The
consultation process is described in Chapter 5 as a method of intervention.
Consultants also need to ask, Are the methods and research affordable, workable, and
understandable for this set of clients? Furthermore, ethical consultants work with, not for,
those who hire them (Benviente, 1989; Christensen & Robinson, 1989). In fact, all
consultants need to ensure constituent validity, which means that those participating in
the research or change are considered, not subjects to be acted on, but participants whose
perspectives must be taken into account in planning and other related activities for the
activities to be valid (Keys & Frank, 1987). Consultants need to empower the population
with whom they are working to create and sustain the change initiated by the presence of
the consultant. This means that the consultant needs to find a good way to “wean” the
clients or participants, lest they become too dependent on the expert.
Professional change agents or consultants also need to assess the prevailing culture as
well as the trust and respect held for them in a particular setting. Such assessment will help
consultants determine how visible they should be. Consultants also need to evaluate their
own personal values and communicate them openly before the consultation or research
begins to avoid ethical dilemmas after the collaboration process has commenced (Heller,
1989a). Finally, consultants must evaluate their work with their clients; they need to ask
the question, Did I improve the community by my presence? This question can best be
answered through research. Without evaluation, how would a change agent know if the
change worked and whether it ought to be repeated?
The work of Kaufman and colleagues (2006), cited in the previous section, and the
discussion by Kelly and coworkers (2004) of an ongoing consultative-research relationship,
as described earlier, seem especially pertinent here. The consultative process is one in which
the personal aspects of systems engagement are important. What is becoming clearer in the
consultative process is the need to be aware of the larger system with its own agendas and
concerns for survival and change. Both Kaufman’s and Kelly’s work speaks to the
establishment of a working relationship in which the client/agency/community comes to
understand itself as a partner in the research/consultative process. Whether this requires just
being there at significant events, on a regular and longer term basis, or contributing
resources and time above and beyond normal expectations, the perception of a consultant
as an engaged community member or ally rather than a detached and disinterested party
places the research, data, and conclusions or recommendations in an entirely different light.
Brodsky and colleagues (2004) highlighted the role of such relationships in the community
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research context. The skill set that the community psychologist brings to the research
consultative process is a knowledge of what makes for good science but also an
understanding of what makes for usable science.
Summary
Community psychology is interested in identifying and understanding the social contexts
that contribute to the creation of healthy populations and then helping to create these
healthy contexts. In both instances, research plays a crucial role in providing an empirical
basis for the building of theory and interventions.
The community psychologist uses both traditional correlational, experimental, and
quasi-experimental designs and more adventurous alternative research designs and
methodologies. Among the more adventurous techniques are qualitative and ethnographic
studies. In a pragmatic turn, needs assessment and program evaluations are valued for
identifying problems and providing a feedback on the effectiveness of interventions. There
is also growing use of technological innovations such as global information systems to help
in examining how location relates to community phenomena. And there is a growing
awareness of the value of community partnerships in research, as is found in the
participatory action research model.
Other community-driven considerations in the scientific endeavor are the ethics of
conducting studies in diverse communities, and especially the need to ensure participants’
understanding of study implications and gaining their well-informed consent. Cultural
issues are especially important in both research and interventions as we venture into areas
whose worldviews and value assumptions may differ from collegiate-academic models.
If you are curious about how communities work from a psychological perspective or
in how and if attempts to improve communities can work, then community psychology
brings various research approaches and research considerations to you.
And so, longitudinal studies like those of Werner and Smith (2001), which we
describe in Chapter 3, can tell us that children who have caring adults around them are
likely to grow up and be successful. A very long time frame, lasting more than 30 to 40
years, shows us correlations between caring adults and children who succeed when they are
grown. Cause and effect cannot be inferred, but the linkage is made.
In a second set of studies, on the long-term effects of Head Start, which are presented
in Chapter 8, we see the research (Garces, Thomas, & Currie, 2002) as a type of
intervention (independent variable) on group child success as measured by graduation from
high school and lack of contact with the jail/legal system (dependent variables). Although
earlier studies have shown the results to be mixed and to be academically sustainable with
continued educational support, the long-term effects described by Garces et al. (2002)
demonstrate positive effects much later in life for Head Start participants.
In both the studies by Werner and Smith and those by Garces and colleagues, the
longer term data comparisons allowed the realization of the life patterns to emerge.
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Stress and Resilience
THE STRESS MODEL AND THE DEFINITION OF
COMMUNITY PSYCHOLOGY
STRESS
Stressor Events
Stress as a Process
Stress Reaction
■ CASE IN POINT 3.1 Contemporary
Racism
Coping
Social Support
■ CASE IN POINT 3.2 Mexican American
College Student Acculturation Stress, Social Support, and Coping
RESILIENCE
At-Risk to Resilient
The Kauai Longitudinal Studies
A Useful Model
The Fourth Wave
SUMMARY
There is an art to facing difficulties in ways that lead to effective solutions.
—John Kabat Zinn
Linda was the first in her family to go to college. She had done well in high school, getting
mostly A’s and an occasional B. At the encouragement of her school counselor, she applied
to a number of universities, getting scholarships to several of them.
Once at college, she felt lost. The students were different. The classes were different.
The dorms seemed very strange. She slept next to a complete stranger in a double room.
The other woman came complete with Nordstrom college accessories, whatever that was.
They all dressed a particular way. It was like they had called each other up and talked about
what to bring and what to wear. Everyone knew, except her. The rest of the hall seemed
comfortable with the setting. Their parents had talked to them about college life. They
seemed to know the acceptable language and speech cadence, which signaled that they were
on the inside. Everyone seemed to know what to do and when to do it. But for Linda, even
the food was strange. The dilemma was what to do.
A community psychologist would analyze this example, look to the systems at work
for Linda and others like her in the college setting, and make particular recommendations,
which could be based on a stress model and a resilience model. We now pursue what goes
into these related models and see what might help Linda and those in her situation.
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THE STRESS MODEL AND THE DEFINITION OF COMMUNITY
PSYCHOLOGY
The causes and effects of stress have been intricately tied to community psychology since its
inception. Barbara Dohrenwend’s presidential address to the Division of Community
Psychology in 1977 (Dohrenwend, 1978) described a model that she believed would
coalesce the many and varied activities of a new community psychology. Her stress model
described a psychosocial process leading to the development of psychopathology. In this
model, a particular event or set of events could produce stress reactions. However, the stress
event itself was just one of several factors that would determine whether an individual’s
reaction would be negative. An individual’s personal psychological characteristics needed
to be factored into the process. Examples of relevant psychological characteristics might be
a person’s temperament or their level of intelligence. There were also situational
characteristics such as when the stress event occurred, the physical setting, and whether
other people were present. In addition, there were intervening factors (i.e., between the
event and the reaction) that mediated the impact of the event on the individual. There were
situational mediators, such as social or financial support, and psychological mediators,
such as coping skills or pain tolerance. The outcome of the stressful event on the individual
was determined, then, by the combination of stress events, characteristics, and mediators.
Dohrenwend noted that a stress event could lead to either negative or positive
consequences, depending on the combination of factors. With this model in mind,
Dohrenwend saw community psychologists intervening at both the characteristics level
(education for improving psychological characteristics, political action to change the
situation characteristics) and at the level of mediators (community organization to
strengthen situational mediators or skills training to positively influence psychological
mediators). This stress model could be used to direct community intervention efforts as
well as to differentiate how community psychology was distinct from clinical psychology,
which focused almost exclusively on the individual and typically occurred after pathological
reactions had developed. The community psychologist dealt with both the individual and
the situation and intervened early in the process before severe and chronic problems might
occur.
In a later article on community psychology, George Albee (1982) reiterated the
importance of the stress model and its elements. He believed the incidence of mental
disorder took into account organic factors, stress, coping skills, support, and self-esteem.
Decreasing stress or increasing coping skills and support reduced the incidence of disorders
and increased health. Increasing stress or decreasing coping skills and support heightened
disorders and decreased health. Stressors could come from a variety of sources—economic,
social, or psychological—but the process remained the same. Hence, Albee outlined ways in
which human potential could be promoted in addition to how psychopathology could be
prevented.
As we can see from these two examples, the stress model has historically been an
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integral part of community psychology, used by some of its most respected scholars.
However, it has not been without controversy. Rappaport (1977, 1981) believed that stress
considerations were too person-focused and clinical in nature. Calling it “old wine in new
bottles,” he advocated a broader—more group, system, or policy—focus for interventions.
Yet Cowen (1985) argued that an understanding of the stress process provided valuable
information for those working person-centered interventions in the community. “A
significant portion of what we call psychological wellness derives from people’s abilities to
adapt … effectively with stressful events and circumstances” (pp. 32–33). Situation-
focused approaches look at specific stressful events and intervene in those situations.
Competency enhancement approaches look to the individual’s skills in coping with stress
in general and work to increase these skills. In both of these approaches, an understanding
of the stress model was central and included those factors that served to protect an
individual in risky circumstances and promote general well-being.
This chapter presents the development of stress concepts, explores coping styles in
dealing with stress, and reviews some of the work on social support as a mediating factor.
We then examine the work on resilience, where at-risk individuals thrive. Although
resilience takes stress and its components into account, it goes beyond the stress model.
Both the stress model and the resilience model have informed community psychology
research and community psychologists’ interventions. In Chapters 4 and 5 we look at social
change and community interventions. Here, we examine the stress and resilience models.
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STRESS
The term stress has been used to indicate the occurrence of three things: a stimulus event, a
process, and a reaction. This ambiguity is confusing, so for our purposes, we talk of the
stimulus event as a stressor, the process as a stress process, and the reaction as the stress
reaction.
Stressors Events
Stimulus events that evoke distress are known as stressors. In the 1960s, a list of life-
changing stressors was devised called the Schedule of Recent Experience (Rahe, Meyer,
Smith, Kjaer, & Holmes, 1964), along with a weighted scoring system by which to measure
the corresponding levels of stress (Holmes & Rahe, 1967). Forty-two specific life events on
this measure ranged from “death of a spouse” to “getting fired at work” to a “minor legal
violation.” The list of events with their weighting scores is called the Social Readjustment
Rating Scale (SRRS). The SRRS is one of the most widely used measures of stressors today.
The scale scores have been shown to be related to a variety of measures of stress reactions
(Scully, Tosi, & Banning, 2000).
Although the events from the SRRS are typically considered major life changes, a
second way of looking at stressful events was proposed by Kanner, Coyne, Shaefer, and
Lazarus (1981) and Delongis, Coyne, Dakof, Folkman, and Lazarus (1982). In their
research, the smaller, everyday hassles were found to be a better indicator of stress than the
major life changes. Hassles could include things like worrying about one’s weight, having
too much work with too little time, forgetting things, and concerns about home repair
needs.
Although it is fair to say that we all experience daily hassles, it is important to
remember that community context may influence the specific types of hassles most
commonly encountered. For example, Vera and colleagues (2012) conducted a study of
frequently experienced hassles experienced by urban ethnic minority adolescents. They
found that not feeling safe in one’s neighborhood was the most commonly reported hassle.
Such a finding would be less likely to occur if the study was conducted on a middle-class
suburban sample of adolescents.
ACUTE VERSUS CHRONIC STRESS. There is a distinction made in the stressful event
literature between acute, time-limited problems that can arise and chronic, persistent
demands on an individual (Gottlieb, 1997; Wheaton, 1997). However, it is not always
clear which problems are chronic and which are acute. Wheaton (1997) defines the acute
stressor as a “discrete, observable event … possessing a clear onset and offset” (pp. 52–53).
He defines chronic stressors as “less self-limiting in nature, … typically open ended, using
up our resources in coping but not promising resolution” (p. 53). These persistent
problems are seen to be “located in the structure of the social environment” (p. 57). These
classes of stressors lead to different processes and coping strategies (Gottlieb, 1997), as well
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as differing physiological results. An acute stressor (e.g., having your cellphone stolen)
brings activation of the neuroendocrine system and resultant heightened levels of adrenaline
and cortisol. Hence, the individual’s physical system is ready for “fight or flight.” However,
with prolonged stress, such as living in poverty, studies find eventual neurological
breakdowns (Compas, 2006; Romeo & McEwan, 2006). Chronic stress has been
demonstrated to have destructive effects on DNA and to contribute to aging (Epel et al.,
2004). Chronic stressors may directly contribute to the physical and mental deterioration of
the individuals or groups affected. Notably, the work on African American psychosocial
stress models supports the contention that the presence of a chronic socially based stressor
such as racism could be a significant contributor to heightened levels of physical disorders
(Clark, Anderson, Clark, & Williams, 1999). Similar claims may be made for those affected
by other forms of chronic stress.
RACISM AND MINORITY STATUS: AN EXAMPLE OF STRESSFUL SOCIAL
CONTEXTS. Moritsugu and Sue (1983) are among the many authors who have described
the negative impacts of minority status for people of color over the past several decades.
Two recent meta-analyses documented the link between experiences with perceived racism
and decreased mental health among Asian and Asian Americans (Lee & Ahn, 2011),
Latinas/os (Lee & Ahn, 2011), and Black Americans (Pieterse, Todd, Neville, & Carter,
2012). From academic achievement to physical health problems, those with minority status
may be at greater risk for poorer outcomes due to chronic exposure to the stressor of
racism. Mays, Cochran, and Barnes (2007) reported data from physiological measures of
stress that supported the contention that perception of racism serves as a chronic social
stressor for ethnic minorities. This stress, resulting from a culture of racism (Jones, 1997),
may serve as a credible explanation for some of the quality-of-life issues of many ethnic
minority groups in America.
Dovidio and his colleagues (e.g., Gomez, Dovidio, Huici, Gaertner, & Cuadrado,
2008) find that subtler, more covert forms of racism may be as harmful as more obvious
forms of racism. Instead of outright racist statements, which may be less common today
than in decades past, unconscious, nonverbal behaviors may be displayed that reflect racist
sentiments. In other words, people’s nonverbal behavior is often inconsistent with their
verbal behavior. Although this inconsistency can be changed, many people don’t know they
are behaving so incongruently. This research is explored in more detail in Case in Point
1.2.
Sue, Bucceri, Lin, Nadal, and Torino (2007) are among recent scholars who have
uncovered additional types of interpersonal racism to capture the changing nature of the
race relations referred to as microaggressions. Microaggressions are “brief, commonplace,
daily … indignities … that communicate negative or derogatory slights” (p. 271).
Examples of microaggressions include telling Asian Americans that they speak English well
or crossing the street when a Black man is walking in a person’s direction, These
microaggressions may be both unconscious and unintentional and are not limited to
expressions of racism. Recent research has documented the existence of gender and sexual
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orientation microaggressions (Sue, 2010), examples of which are presented in Table 3.1.
Table 3.1 Examples of Racial, Gender, and Sexual Orientation Microaggressions
Race Gender Sexual Orientation
Microinsult “You speak English
well”
Assume that female
doctor is a nurse
Ask a male if has a
girlfriend (assumes
heterosexuality)
Microassault Racial slur/joke Catcalls (ogling) Teasing a peer:
“You’re so gay”
Microinvalidation don’t see color Using male pronoun
as generic
Saying marriage is
only for a man and a
woman (Defense of
Marriage Acts)
Source: Adapted from material in Sue (2010).
Three kinds of microaggressions are identified: microassault (explicit racial belittling
remark or action, e.g., displaying a swastika or telling a racial joke), microinsult (racial
insult or belittling, e.g., saying the best qualified should get the job when a person of color
does not get the job), and microinvalidation (excluding or denying one’s experiences, e.g.,
“I do not believe racism exists today”—saying that someone’s report of racism is not true).
Thus, studying stressors such as racism is an example of how chronic and acute stressors
continue to affect mental health in our current society.
Stress as a Process
Lazarus and Folkman (1984) defined psychological stress as “a particular relationship
between the person and the environment that is appraised by the person as taxing or
exceeding his or her resources and endangering his or her well-being” (p. 19). They saw
stress as a process that was influenced by multiple variables and emphasized that the
appraisal of a given situation was the first step in this process. Primary appraisal
determined whether the event represented a threatening situation. The secondary appraisal
factors in the person’s expectations of handling the situation. In the secondary appraisal
stage, the individual’s coping skills and other resources are evaluated as either helpful or not
helpful in contending with the situation. Thus, the stress process was determined by the
person’s ability to deal with the environmental demands. The resulting level of distress
experienced would be influenced by how successful the person was in using the available
resources. Thus, in this model, it is possible for one person to experience extreme levels of
stress in response to an event and another person to be relatively unaffected by the same
event, depending on their appraisal of the situation and their resourcefulness in responding
to the event.
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Stress Reaction
Research has examined the variety of ways that people respond in the face of stressful events
for many decades. Hans Selye (1936) was the first to note a particular set of physiological
reactions to a variety of harmful or noxious stimuli. He came to describe this reaction
process as the General Adaptation Syndrome (GAS). This involved an initial alarm
reaction, followed by resistance, and if this fails, exhaustion. His approach was
physiological, documenting the shifts in the organism when the balanced, “homeostatic
state” was disrupted. Selye believed this syndrome was activated by any generalized
disruption to the physical system. Since then, the stress reaction has been measured in
physiological terms, such as illness, or in psychological terms, such as depression, anxiety,
or other measures of multiple symptoms, such as the Symptom Check List (Derogatis &
Coons, 1993). For example, Gaylord-Harden, Elmore, Campbell, and Wethington (2011)
studied the relationship between stress and anxiety and depression symptoms in African
American youths. The authors found that stress related to peer relationships was positively
associated with depression in African American girls, but associated with anxiety in African
American boys. This study suggests that gender may be an important factor that determines
how stress affects an individual.
Regardless of gender, however, the stress process has clear physiological consequences
that can vary by how one responds to the stressor. Kuehner, Huffziger, and Liebsch (2009)
investigated the effects of induced rumination, distraction, and mindful self-focus on
mood, dysfunctional attitudes, and college student participants’ cortisol responses. Students
were subjected to a negative mood– inducing exercise and then told to ruminate on their
feelings, engage in a distraction task, or mindfully self-focus on their mood. Findings of
their study revealed that rumination had the most negative impact on the cortisol levels of
the most depressed students. Interestingly, distraction showed a clear beneficial effect on
the course of dysphoric mood, whereas a mindful self-focus did not. This study suggests
that our stress reactions can be influenced by what we do in the wake of being exposed to
the stressor. It also supports findings of Dandeneau, Baldwin, Baccus, Sakellaropoulo, and
Pruessner (2007), who found that diverting attention away from a social stressor led to a
reduction in a physiological measure of stress (cortisol) and self-report of stress. Studies
such as these illustrate the critical role that coping plays in understanding the stress process.
CASE IN POINT 3.1
Contemporary Racism
IMPLICIT AND EXPLICIT PREJUDICE
In today’s world, racial prejudice and discrimination are not socially acceptable. In fact,
most people speak explicitly of their non-racist attitudes. That being said, we continue to
live in a world where “mainstream” culture still reflects the values and traditions of the
majority, namely, White, middle-class, Christian, heterosexual people. This bias results in
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negative connotations being associated with non-majority groups such as ethnic minorities.
While we may not be consciously aware of these connotations, they do appear to lead to
differences in how we behave toward members of different groups (Devine, 1989).
Research has found that how people verbally communicated to one other in an interracial
situation could be predicted by their explicit, stated attitudes on prejudice—that is, the less
prejudiced, the more they interacted favorably. However, the way people nonverbally
communicated was predicted by a measure of their implicit (i.e., unconscious) associations
regarding the racial group. In the same interracial situation, less favorable associations lead
to less friendly nonverbal behaviors. These unfavorable nonverbal behaviors were noted by
both the interracial partner and an independent observer (Dovidio, Gaertner, &
Kawakami, 2002).
The problem for many racial minorities, then, is dealing with the double message. At
the same time that nonfriendly, nonverbal behaviors being exhibited, there is friendly
verbal behavior and a denial of any prejudicial behavior. That is, at an explicit and
conscious level, many believe they are not racist, despite the fact that their nonverbal
behavior may suggest otherwise.
Coping
Compas (2006) defines two specific processes involved in the response to stressors. The first
is automatic and for the most part not consciously controlled. The second is a voluntary
response to the stressors at hand, which includes “regulation of emotion, cognition,
behavior, physiology and the environment in response to stressful events or circumstances”
(Compas, Connor-Smith, Saltzman, Thomsen, & Wadsworth, 2001, p. 89). As
conceptualized by Compas and others (2001), coping is a part of the self-regulatory process
in dealing with environmental demands. Studies of coping have found a variety of ways of
describing these responses to stress. We now examine some of those responses.
EMOTION-FOCUSED AND PROBLEM SOLVING-FOCUSED COPING. Lazarus
and Folkman (1984) point to two different types of coping emerging from the research
literature: emotion-focused and problem solving–focused. Emotion-focused styles work on
lessening or strengthening the emotional impact of an event. These include cognitive
activities such as distancing, selective attention, reinterpretation, or self-distraction.
Problem solving–focused coping seeks to change the environment. Individuals try to deal
with what is bothering them by examining the given situation, then weigh options as to
possible changes to make within one’s self (e.g., lowering one’s expectations, seeking
support from another friend) and within the environment (e.g., changing jobs, finding a
new boyfriend or girlfriend).
Lazarus and Folkman (1984) reported that these two styles of coping related to how
individuals felt they could control the elements in their environment. They believed the
emotion-focused styles typically are used when there is a feeling that nothing could be done
to modify the environment. The problem-solving strategies are more to be expected when a
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person believes things are changeable.
ACTIVE COPING AND AVOIDANT COPING. Carver, Scheier, and Weintraub
(1989) presented a second system for distinguishing coping styles. They constructed a
broad, theoretically based measure that presented aspects of active coping, where the
individual does something to try to solve the stressful situation, and avoidant coping,
“where responses potentially impede or interfered with active coping” (p. 280). Examples of
active coping include planning, seeking social support, turning to religion, restraining
oneself, and acceptance of reality. Avoidant coping is typified by self-distraction, denial, use
of alcohol, and withdrawing from the situation.
Much research has focused on these distinctions and pointed to their varying
effectiveness. The majority of findings suggest that active or problem-solving coping leads
to better results than avoiding/passive coping (Compas et al., 2001). However, it is not fair
to conclude that active coping is always the best coping strategy. For example, Rasmussen,
Aber, and Arvinkumar (2004) investigated how African American and Latino adolescents
coped with urban hassles and whether any particular coping styles were associated with
positive mental health outcomes. Results showed that active coping styles were associated
with increased perceptions of safety, but in some circumstances also increased exposure to
further violence in neighborhoods. Clarke (2006) argues that it is important to take into
account whether a stressor is controllable before determining which coping style might be
more advantageous. When the situation is controllable, active coping may make sense.
However, in cases where stressors are uncontrollable, avoidance strategies may be
appropriate. In a sample of urban adolescents of color, Vera and others (2011) found that
self-distraction was a significant mediator of the relationship between exposure to urban
hassles and negative affect. In other words, the more adolescents used self-distraction as a
coping style, the less likely it was that their exposure to urban stressors would lead to
negative emotional consequences. The lesson to be learned from these studies is that
different problems require different solutions.
EMOTIONAL APPROACH COPING. A study of emotional approach coping suggests
that there are healthy and productive roles for emotion in the stress process (Stanton, Kirk,
Cameron, & Danoff-Burg, 2000; Stanton & Low, 2012). Acknowledging one’s feelings
and expressing them, for example, is thought to be related to better adjustment. In addition
to the cathartic effect of expressing one’s feelings, emotions can yield useful information for
the resolution of problems. The researchers note that the appropriateness of emotional
approach behaviors depends on the actor, the situation, and the receptivity of the listener to
such behaviors. When a person is in tune with his or her emotions, in a calm situation that
facilitates sharing of those emotions, and is communicating with someone capable of
validating the person’s feelings, such communication may be an effective way of coping
with stress. On the other hand, if a person is in an inappropriate setting or dealing with a
volatile person, such communication may exacerbate the situation.
THREE DIMENSIONS OF COPING. Other variations on coping of particular note
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come from Hobfoil and Vaux’s (1993) proposal of a coping scheme that takes into account
the active-passive, prosocial-antisocial, and direct and indirect ways that coping could be
divided. He argues that such a multidimensional consideration could account for cultural
variations in coping. He emphasizes the need to take the context of the problem and the
response into account. His system gives prominence to the cultural and community/social
contributions to coping and the research literature on active versus avoidant and problem-
solving versus emotional styles researched by others. Gaylord-Hardin and Cunningham
(2009)’s research on culturally relevant coping has found that African American adolescents
benefit from utilizing culturally sanctioned coping mechanisms such as religiosity in the
face of race-related stress.
COLLECTIVIST COPING. Based on research conducted in Taiwan, Heppner et al.
(2006) report a five-factor instrument representing collectivist coping activities not usually
found in coping inventories. Examples of these collectivist styles are: I tried to accept the
trauma for what it offered me; I believed that I would grow from surviving; Shared my
feelings with my family; Saved face by not telling anyone. An adolescent coping style that
taps Chinese values has been derived by Hamid, Yue, and Leung (2003). This instrument
reflects concepts such as “as shui-chi tzu-an (let nature take its course), I pu-pien ying wan-
pien (coping with shifting events by sticking to one unchangeable way), and k’an-k’ai (to
see a thing through),” which were derivatives of a Taoist philosophy where, for example,
nonaction is not seen as avoidance but rather the understanding and acknowledgment of
the nature of things.
A SCHEMA FOR COPING. It is difficult to represent the plethora of coping styles that
have been studied in a succinct way. Skinner, Edge, Altman, and Sherwood (2003)
reviewed the literature on coping measures and reported problems with the typical ways of
organizing coping behaviors. From this review they identified 13 ways of coping (Table
3.2). Taking these basic categories and organizing them into types of coping proved more
difficult. They believed a functional definition, that is, problem-solving versus emotional-
focused coping style, was not workable because behaviors could perform more than one
function. A behavior may be both emotional and problem focused, as we can see in the
“positive emotional focus approaches” described earlier. A topological definition based on
what is done, for example, the approach versus avoidance distinction, is then confusing
because behaviors have multiple dimensions. A coping response may require both
avoidance for a time, to gain perspective, and then approach to directly contend with the
problem.
Skinner and colleagues (2003) argue that the method for organizing the specific
coping response families might be better conceptualized from an adaptive process
viewpoint. They believe the three adaptive processes to be (1) coordination of action and
contingencies within an environment, (2) coordination of social and personal resources,
and (3) coordination of preferences and options. Note that the emphasis is on
coordination, or rather, the efforts of the individual to understand the environment and
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2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
1.
themselves so as to better fit into the presenting context. Skinner and coworkers propose
that these three processes might best describe coping processes in general. Future studies of
coping might be guided by these distinctions. What we can conclude from this body of
research is that coping is an idiosyncratic process, and there is no “one size fits all” approach
that can be recommended. Although many of the coping styles discussed in this section are
individual, some coping styles are more interpersonal, such as the use of social support.
Table 3.2 Coping Families
Problem solving
Support seeking
Avoidance
Distraction
Positive cognitive restructuring
Rumination
Helplessness
Social withdrawal
Emotional regulation
Information seeking
Negotiation
Opposition
Delegation
Source: From Skinner et al. (2003, pp. 240–241).
Social Support
The concept of social support would seem to be a natural area of investigation for
community psychology. Those around us are often a resource. Seeking social support is
listed among Lazarus and Folk-man’s coping styles. It assumes there is a social support
system from which to receive assistance.
Social support might be usefully re-conceptualized as coping assistance, or the active
participation of significant others in an individual’s stress management efforts. Thus
social support might work like coping by assisting the person to change the situation,
to change the meaning of the situation, to change the emotional reaction to the
situation, or to change all three. (Thoits, 1986, p. 417)
Research has demonstrated the advantages of a good social support system to one’s health
(Barrera, 2000; Davidson & Demaray, 2007; Stadler, Feifel, Rohrmann, Vermeiren, &
Poustka, 2010). Some early research found that social support was even more powerful
than stressor measures in explaining the variations in psychopathology in a community
sample (Lin, Simonre, Ensel, & Kuo, 1979). This relationship continues to be found in a
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variety of populations dealing with different kinds of problems. The relationships are not
always direct or self-evident (Barrera, 2000) and there are distinctions found between
perceived and received support (Haber, Cohen, Lucas, & Baltes, 2007). Keinan (1997)
points to several intervening variables that figure into the translation of supportive behavior
to the appraisal of support. She finds that for low-anxiety mothers who have had experience
in birthing (not a first birth), the presence of a supportive husband during the birth process
led to higher levels of mother tension. For mothers in their first birth experience, the
presence of a husband was helpful. Keinan believes the situational and personality variables
influenced the effects of social support.
Nonetheless, the generally positive impact on adaptation continues to be
demonstrated using more and more sophisticated physiological measures of stress reactions
(Gallagher, Phillips, Ferraro, Drayson, & Carroll, 2008).
TYPES OF SOCIAL SUPPORT. Supportive behaviors are typically divided into three
areas: emotional, informational, and instrumental (Helgeson & Cohen, 1996; Thoits,
1985). Emotional support comes in the form of expressing compassion for the person. The
support is directed at making the person feel understood and cared for. In the
informational dimension, the person being supported is provided with helpful facts or
instruction. The knowledge imparted may help the person gain some mastery of required
tasks. The third form of support is instrumental, where the person is provided with
materials, transportation, or physical assistance.
Support from parents may be particularly important during childhood and, in
particular, may be an important coping mechanism when children have problems with
their peers. Poteat, Mereish, DiGiovanni, and Koenig (2011) examined the role of parental
support for kids who were being bullied by peers. They found that while parental support
was linked to lower feelings of suicidality in kids who were being bullied, it did not protect
kids from experiencing lower feelings of school belongingness. Finally, they found that
parental support was less likely to buffer the effect of teasing in gay, lesbian, bisexual, and
transgendered youths. Studies like these demonstrate that social support may be a helpful
coping mechanism for people in general, but it is not a panacea for all the harmful effects of
stressors and it may be a less powerful coping strategy for some individuals.
BUFFERING AND ADDITIVE EFFECT. So how does social support affect our well-
being? Some believed that support raised one’s well-being regardless of the stressors in the
environment (Thoits, 1984, 1985). We are happier because we have friends. The other
explanation is the “buffering” theory (Dean & Lin, 1977; Wilcox, 1981). Social support
helps us deal with stressors that arise. When facing a problem, it is good to have people to
help so the burden of the problem can be shared—often, “two heads are better than one”
when it comes to problem solving. It appears that both explanations have been supported
by research. However, individual differences must be taken into account when determining
what type of social support is most valuable in a given situation.
Brissette, Scheier, and Carver (2002) studied the reasons social support and optimism
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were associated with good psychological adjustment. They examined the experiences of
first-year college students, measuring optimism, social support systems, number of friends,
stress, and depression. They found that the correlation between optimism and well-being
(low depression and low stress) was in fact mediated by coping and social support.
Optimism was associated with more problem solving and positive-reinterpretation coping.
Optimism was also associated with perception of a good-quality social support system and
the number of friends within one’s network. These coping styles and perceptions of social
support are what relate to better overall adjustment. Optimism works through these two
mediating mechanisms, coping and social support, to bring about positive results for the
individual. The present example illustrates the importance of coping and social support in
helping mediate the effects of personality on depression.
Social support continues to prove a powerful factor in predicting health outcomes
(Richmond, Ross, & Egeland, 2007). In a national Canadian sample of indigenous people,
women reporting high levels of positive interaction, emotional support, and tangible
support were more likely to report thriving health. For men, emotional support was the
only social support variable related to thriving health. Though gender differences appeared
with regard to which specific social support components mattered, the overall trends were
clear.
Examining our chapter’s example of Linda, the first-year college student, we see high
stressor scores for life changes in coming to college. We would expect more hassles as a
result of these changes. Her social support would depend on her relationship with her
parents, family, and friends and her ability to find new friends and mentors in the college
setting. If these support systems are good, she could receive good advice and material
support when needed or a “shoulder to cry on” when things get frustrating. As for her
coping with the stressors, current research would recommend active and engaged styles of
dealing with her environment when the problems are workable. Other styles of coping may
be called for if the problems are not so workable. If she finds effective ways to deal with her
life changes—for example, meeting new people, finding constructive advice, and building a
socially supportive support group—then Linda may find her changes less stressful and more
like manageable challenges.
CASE IN POINT 3.2
Mexican American College Student Acculturation Stress,
Social Support, and Coping
There has been a 75 percent increase in the number of Latino students entering college.
Unfortunately, their rate of graduation has not kept pace with this increase of entrants. A
meta-analysis attributed these problems in retention rate to the higher levels of financial
and academic preparedness and acculturative stress (Quintana, Vogel, & Ybarra, 1991).
However, longitudinal research has revealed a wide range of risk factors that fall within the
individual, family, school, and community domains (Prevatt & Kelly, 2003). Crockett and
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colleagues (2007) studied the acculturative stress in one group of Latino college students,
Mexican Americans. Using data from a university in Texas and two universities in
California, Crockett’s group studied the relationships among acculturative stress, parent
and peer social support, coping (active or avoidant styles), and psychological distress.
Among those with low levels of social support, higher levels of acculturative stress were
related to higher levels of anxiety and depression. For those with high levels of social
support, acculturative stress was not important to the development of psychological
symptoms. There were also significant interactive effects with avoidant and approach
coping styles. The authors believe this to be the first time acculturative stress and the
buffering effect of social support and of coping styles were demonstrated with Latino
college students. The stress model and its components provide a clear framework for the
study of this at-risk population.
Research on resilience examines how people at risk survive and thrive. The stress
model is central to much of the work on resilience. Resilience is what we study next. We
reference a number of stress concepts in the following section.
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RESILIENCE
Why is it that in difficult times, some succeed while others do not? There are children born
into high-risk situations such as poverty who seem to thrive and succeed, despite the odds.
Not everyone is doomed to failure in risky situations, fortunately. Resiliency researchers
have delved into who does well in risky situations and why.
At-Risk to Resilient
One of the interesting facts about resilience is that researchers “discovered” it while they
were looking at factors placing people at risk for failure and pathology (Garmezy, 1974;
Garmezy & Streitman, 1974; Rutter, 1981). Garmezy was studying families that had at
least one schizophrenic parent. Rutter was looking at children from poor urban
neighborhoods in comparison to children from a rural setting. From this initial focus came
the insight that there were many who did well despite their circumstances (Garmezy,
Masten, & Tellegen, 1984; Rutter, 1985, 1987). Rutter (1987) emphasized that resilience
is not a characteristic of people, but rather, it is a process affected by many variables. He
pointed to the impact of gender (expectations and ways in which upsets are expressed),
temperament (likable versus unlikable), marital support in childrearing, the ability to plan,
and school successes and their effects on a child’s resilience or vulnerability. Rutter also
noted the importance of “turning points,” or important junctures, in the lives of at-risk
children. The direction taken at these critical points had long-lasting influence on the life of
the individual. Garmezy and the Project Competence group explored what it meant to
positively adapt to the environment, what was effective across multiple tasks, and
developmental phases (Masten & Obradovic, 2006).
Among the early studies of at-risk populations was one by Sandler (1980). He found
strong social support to be related to lower levels of maladjustment in at-risk inner-city
children. It was a good example of the use of the earlier described stress model for
examining the resilience process.
The Kauai Longitudinal Studies
In the 1950s, researchers began a series of longitudinal studies to look at the characteristics
of children who eventually did well despite their placement in “risky circumstances.” An
excellent example of these longitudinal studies was conducted by Werner and Smith over
several decades on the island of Kauai in the state of Hawaii. Werner and Smith (2001)
reported on this longitudinal study of individuals who appeared to be at risk based on a
history of family psychopathology, poverty, lack of education, and/or family alcoholism.
Following these at-risk subjects into their middle age (50s), Werner and Smith found
resilience to be linked to the individual’s capability in dealing with age-appropriate
developmental challenges. Because the study was situated on an island, the population was
relatively stable and the influence of off-island factors somewhat controlled. Starting in
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•
•
•
1955, the researchers looked at the developmental progression of the identified group of at-
risk infants as they matured into full adulthood. They found that about two thirds of this
at-risk population developed problems. The third that did not were characterized by their
ability to engage the environment in an age/developmental stage–appropriate way. They
were nurtured by a parent or parent substitute who served as a positive role model for
them. The “vulnerable but invincible” children also found support outside their families in
a variety of community settings: school, neighborhood, informal friend networks, churches,
or youth organizations. By late adolescence, these children had developed internalized
resources that aided in mastering their environment (high self-esteem, internal locus of
control, a feeling that life made sense, and an effective support system). The more risk
factors there were, the more protective factors were needed to deal with the risks raised.
Family protective factors related to the parents’ ability to be nurturing at critical times. The
most important community factor was the presence of caring adults who served as teachers
and mentors or later as friends, coworkers, or bosses. Among the protective factors in the
environment were emotional support throughout the life cycle and a lower number of
stressful life events. By age 30, the resilient men and women were more accomplished in
both education and careers and were more likely to be married than their nonresilient
counterparts or the national norm. By age 40, they were more likely to be settled and
contributing members in their communities. Such studies as these serve as a blueprint for
community interventions, because they pointed out those aspects of the children’s
experience that were predictive of later life success.
A Useful Model
Masten (2001) pointed to the usefulness of these naturalistic studies on resilience and
competence in at-risk populations. From the Kauai studies and the work of Garmezy and
Rutter, important protective factors in the developmental life process were identified. These
were later used in devising interventions. In particular, prevention program emphases on
parent competence, early child preparation for school success, the acquisition of specific
child skills, and expanded opportunities for community mentoring were directly in line
with resilience findings. Masten stated, “Resilience does not come from rare and special
qualities, but from the everyday magic of ordinary, normative human resources in …
children, in their families and relationships, and in their communities.” The natural
capacity to build competencies and strengths and their importance in the coping process
have shifted community prevention interventions from prevention to promotion efforts.
Examples of resiliency factors are presented in Table 3.3.
TABLE 3.3 Short List of Resilience Factors (with Implicated Human Adaptive
Systems)
Positive attachment bonds with caregivers (attachment; family)
Positive attachment bonds with caregivers (attachment; family)
Positive relationships with other nurturing and competent adults (attachment)
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•
•
•
•
•
•
•
•
Intellectual skills (integrated cognitive systems of a human brain in good working
order)
Self-regulation skills (self-control systems and related executive functions of the
human brain)
Positive self-perceptions; self-efficacy (mastery motivation system)
Faith, hope, and a sense of meaning in life (meaning-making systems of belief)
Friends or romantic partners who are supportive and prosocial (attachment)
Bonds to effective schools and other prosocial organizations (sociocultural systems)
Communities with positive services and supports for families and children
(sociocultural)
Cultures that provide positive standards, rituals, relationships, and supports
(sociocultural)
Source: Adapted from Masten, A. (2009). Ordinary magic: Lessons from research on resilience in human development.
Education Canada, 49 (3), 28–32. Retrieved from www.cea-ace.ca.
Rutter (2006) reminded us that resilience was more than the development of social
competence or positive mental health. Resilience occurred when individuals thrived despite
their risky circumstances. He cautioned that there were differences in how well people fare.
Some thrived, but a significant number did poorly and succumbed to the negative
environment. Nonetheless, for some the experience of successfully contending with stressful
situations made them stronger.
The Fourth Wave
Masten and Obradovic (2006) described four waves of resilience research. The first started
with the study of the causes of psychopathology and the discovery of children who were
healthy and successful emerging from risky circumstances. The research focused on what
was associated with such failure and illness or success and health. The second wave
examined the processes in developing resiliently. The third wave attempted to apply what
had been learned from the descriptive studies through developing and testing the efficacy of
interventions. Emerging from these first three waves has come the “discovery” of important
adaptive systems—family, school, community relationships, spiritual practices—and
important skills—self-control, goal-directed behavior, dealing with affect, motivation to
succeed, and dealing with stress.
The fourth wave of resiliency work has started to look at the integration of multiple
levels (neurological, personality, social, community) and disciplines (psychology, sociology,
biology, neurology). For example, Davis and Cummings (2006) found that parental
conflict was associated with heightened risk of childhood adjustment problems.
Hypothesizing the wear-down of the neurobiological system in children faced with such
conflict, Davis, Sturge-Apple, Cicchetti, and Cummings (2007) examined the level of stress
reaction in children of conflicted families. They discovered that children with high-conflict
parents had fewer adrenocortical reactions when exposed to a parental conflict incident.
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Adre-nocortical reaction had earlier been linked to typical physiological reactions to
stressors as a part of the hypothalamic-pituitary-adrenocortical system linked to stress. This
dampened reaction was also found to be related to heightened tendencies for acting out and
aggressive behaviors. The neurophysiological reactivity findings and their link to this class
of problem behaviors were first steps in understanding a child’s risk for acting out. Have
these children learned not to get excited when witnessing conflict? Did this in turn make
them less sensitive to the effects of aggression? Or did it mean that they required more
aggression in their world to be stimulated? Further studies are needed on these links
between lowered adrenocortical reaction and aggressive behavior. Future findings would
help direct the creation of possible early interventions to decrease the likelihood of
aggression in children.
A second example of the multilevel analysis of stress and resiliency was provided by
Greenberg, Riggs, and Blair (2007) in a multilayer analysis of the plasticity (openness to
being shaped, the ability to be altered) of the brain, and the impact of childhood and
adolescent experiences on neural development. Greenberg and colleagues elaborated on the
neurological context for the Promoting Alternative Thinking Strategies (PATHS) program,
which focused on social and emotional learning. There was clear evidence that neural
development was the product of the interactions of genetics and environment. Neuron
generation, synaptic formation, pruning, and density were all neurological developments
that over time formed the basis of frontal cortex maturation and the increasing power of
thoughtful control of behaviors. In addition, the growing complexity of right and left
hemisphere communications and the use of language in determining action were well-
documented neurological trends.
Greenberg and coworkers (2007) found Moffitt’s (1993) distinction between life
course–persistent and adolescent-limited (AL) antisocial behaviors provocative to their
program development. Life course–persistent patterns started at a young age, were
frequently found throughout the life of the individual, and were severe deviations from
acceptable behaviors. The AL behaviors did not appear until the onset of puberty, were
infrequent, and were not as grave a violation of social rules. The AL behaviors tended to
stop after adolescence and might, in fact, be normative to the developmental period. Think
of “teenage rebellion” versus criminal tendencies. Given this distinction, the importance of
early intervention in problem behavior seemed clear.
The research by Greenberg and associates with their PATHS program suggested that
the intervention could have a significant impact on young children’s (first- and second-
graders’) ability to inhibit incorrect responses and to sequence relevant information. In
turn, these capabilities have been shown to relate to teacher- and parent-reported problems.
The ability to control one’s behavior and hold back from acting inappropriately was very
important. We might think of how impulsive behaviors have been viewed as immature.
The children who received the PATHS intervention were better able to control themselves.
In turn, being able to talk things through and work out a problem verbally was important.
This skill was positively affected by the PATHS program and, in turn, related to fewer
problem behaviors.
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An awareness of the multiple levels at which the processes exist and of the interactions
among these various processes informs the derivation of new theory and interventions.
From this holistic perspective, the resilience literature provides direction for community-
based programs. The incorporation of the biological to the sociological is in keeping with
community psychology’s multidisciplinary traditions as well as to the biopsychosocial
models that are gaining currency in psychology.
Summary
The stress, coping, social support, and resilience literature has contributed to a theory and
research base for community programs. The models propose that people face a changing
and demanding world full of challenges with which the individual must cope. The existence
of social supports and the ability to access these supports are important resources for the
individual’s coping process. Examination of those who have succeeded in threatening and
risky contexts—that is, resilient people—highlights the importance of personal and social
resources to those successes.
We have come to understand that humans can successfully deal with a variety of
adversities. Our example of Linda dealing with the stress of the first year of college helps
point out that in high-risk populations (e.g., those in transition), some fail and some
succeed. The resilience research suggests that the qualities needed for success are specific to
the developmental tasks. It is not a smooth, continuous process from one point in life to
another, but a series of challenges. The difference between those who succeed and those
who fail is the ability to self-regulate and meet the challenges placed before us. Toward this
end, it is helpful to have the support of mentors. This support comes from the interaction
of personal qualities and contextual qualities helping the individual “construct” the
opportunities needed. Ask most college students and they will tell you their world is
daunting. One college graduate likened it to “entering a dark tunnel” (Candice Hughes,
commencement speech, Pacific Lutheran University, Tacoma, WA, May, 2008). What you
find there and how you cope with your discoveries in the tunnel is dependent on your
resources, including your ability to bring aid when needed. This is a normative process, or
rather the result of “ordinary magic,” within the community (Masten, 2001).
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The Importance of Social Change
REASONS FOR SOCIAL CHANGE
Diverse Populations
Social Justice : A Moral Imperative for Social Change
The Perception of Declining or Scarce Resources
■ CASE IN POINT 4.1 Funding Dilemmas for Nonprofit Organizations
Accountability
Knowledge-Based and Technological Change
Community Conflict
Dissatisfaction with Traditional Services
Desire for Diversity of Solutions
■ CASE IN POINT 4.2 Community Conflict: Adversity Turns to Opportunity
TYPES OF SOCIAL CHANGE
Spontaneous or Unplanned Social Change
Planned Social Change
■ CASE IN POINT 4.3 Working with an Indigenous People Experiencing Change
Issues Related to Planned Change
DIFFICULTIES BRINGING ABOUT CHANGE
SUMMARY
We are the ones we have been waiting for.
—June Jordan
—Alice Walker
—Barack Obama
A noted African American psychologist once told a story of traveling with her family as a child (Wyatt, G., personal
communication, August 1987). When going on a long car trip, they would pack all their necessities and carefully map
out their route. There needed to be sufficient food and water. They needed to plot where they could stop for bathroom
breaks and gas. Every detail of the trip needed to be planned. The reason for this detailed planning was that they could
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not stop just anywhere. If they did not have enough to drink, they could not just go and buy what they needed. They
could not use just any lavatory facilities, nor could they go just anywhere to eat. During those times, there were clearly
marked places designated “For Whites” and “For Blacks,” and they were not free to cross those lines. This story was
told by a friend, who is still living and is working at one of the nation’s premier research universities.
“Separate but equal” had been set as U.S. law by the Supreme Court decision in the late 1800s. The case of Plessy
v. Ferguson established that a Louisiana law mandating different facilities for Blacks and for Whites was fair, because
these facilities would be equal to each other. The Supreme Court at that time believed that this law did not make one
group inferior to the other. This interpretation allowed for separate schools, separate bathrooms, separate entrances, and
the basis for a clearly segregated society. In 1954, the Supreme Court decided in the case of Brown v. the Board of
Education of Topeka, Kansas that segregated schools led to inherently inferior facilities for a targeted group. This
decision paved the way for the desegregated society in which we live today. The idea of separate entrances, toilets, or
schools is so foreign to us that this story is sometimes met with disbelief. This landmark Supreme Court case of 1954
brought about changes in our society that are still being resolved today. We now consider the idea of separate entrances,
or separate restaurants, or separate facilities to be absurd. Social change does occur. In the case of Brown v. Board of
Education, psychology had a hand in influencing the verdict. The testimony and work of psychologists Kenneth Clark
and Mamie Phipps Clark played significant roles in this decision, changing American society and American psychology
as we know it (Benjamin & Crouse, 2002; Keppel, 2002; Lal, 2002; Pickren & Tomes, 2002). Social change in its best
sense moves us to reconsider our present circumstances, imagine improvements, and aspire toward our overall
betterment.
Trickett (2009) noted that since its inception, community psychology has had two
objectives, “understanding people in context and attempting to change those aspects of the
community that pollute the possibilities for local citizens to control their own lives and
improve their community” (p. 396). Change, some planned and some unplanned, seems to
be a pervasive condition of modern times, especially when economic divides grow deeper
within societies. Actively participating in and fashioning social change is a hallmark activity
of many community psychologists (Maton, 2000). Social change is the focus of this
chapter.
How is change defined from the perspective of psychologists? Watzlawick, Weakland,
and Fisch (1974) believed there to be two types of change: “One that occurs within a given
system which itself remains unchanged and one whose occurrence changes the system itself”
(p. 10). These two types of change have been called first order change and second order
change, respectively. First order change may describe an individual’s alteration of typical
behavior within a system such as a family. For example, a mother may choose to ignore her
two-year-old son who is throwing a temper tantrum because he wants candy at the grocery
store (and she has refused to buy it). If the typical interaction of this mother and child is
that the child’s tantrum results in him getting the candy, probably because his mother is
embarrassed by the crying and wants him to stop, one can see how ignoring his crying is a
type of behavior change. However, if this is a strongly established behavior pattern, Mom’s
new ignoring behavior, the first order change, is likely the only change we would see in this
interaction (probably because the son will fuss even louder when he is ignored). In other
words, the entire system at this point has yet to change, even though Mom’s behavior has.
If the mother in our example were to ignore and/ or negatively reinforce her son’s future
attempts to get his way by throwing a tantrum, eventually he will learn that his behavior is
ineffective and he will move onto some new way, ideally more pleasant, of getting what he
wants. When the system is no longer characterized by the son acting out and the mother
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giving in, one could conclude that second order change has occurred. As Watzlawick and
colleagues (1974) noted, second order change requires the innovator to step outside his or
her basic assumptive world and think and act in creative new ways. Second order change
requires the change agent to have sufficient perspective-taking ability to perceive the
existing problem in its entirety and to come to a solution.
FIGURE 4.1 The Nine Dot Problem. Instructions: Connect the nine dots in the grid, using four straight lines,
without lifting your pencil. The solution to this problem may be found at the end of the chapter, in Figure 4.3.
An example of second order thinking is the solution to the nine-dot grid problem
found in Figure 4.1. Try the problem to determine whether you can devise a second order
solution.
We find reference to the “revolutionary” nature of community psychology in
Rappaport’s 1977 text and many subsequent definitional articles on community psychology
(Trickett, 2009). The revolution typically refers to the shift that occurred within
community psychology to preventive mental health and away from remediation, from
person-centered to system-centered interventions, and from pathology-focused to wellness-
focused work. Social change is an integral part of this shift.
Questions regarding social change for community psychologists are complex and
interrelated. Social scientists want to know what causes change; how to predict change; how
best to cope with change; and, most of all, how to fashion or direct change that improves
the living conditions of community members.
This chapter looks at what creates social change—planned or not—especially in
today’s complex world. The discussion draws from all areas within psychology, as well as
anthropology, medicine, public health, political science, sociology, and other disciplines
(Maton et al., 2006; Wandersman, Hallman, & Berman, 1989). In fact, a multidisciplinary
approach for examining and intervening in social change is often desirable (Maton, 2000;
Seidman, 1983), especially if the diversity (U.S. Department of Labor, 2006) and
challenges of our vast population are to be appreciated (Maton, 2000; Trickett et al.,
2011).
What are some of the phenomena that induce change in society? Factors such as
diverse populations, social injustice, declining resources, demands for accountability,
expanding knowledge or changing technologies (Kettner, Daley, & Nichols, 1985),
economic changes, community conflict (Christensen & Robinson, 1989), dissatisfaction
with traditional approaches to social problems, the desire for choices and the need for
diversity of solutions to social problems (Heller, Price, Reinharz, Riger, Wandersman,
1984), and other issues lead the list of reasons for social change. Although the list is not
exhaustive, some of these forces need to be considered in more detail to help you
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comprehend their roles in shaping social change.
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REASONS FOR SOCIAL CHANGE
Diverse Populations
During the Middle Ages, no one expected a long life. Today, life expectancies in the United
States and elsewhere are increasing. The growing population of the elderly, as well as the
disabled, the unemployed, and the influx of new immigrants into our country, is an
example of how diverse populations create the need for dramatic social changes and new
community interventions.
For example, consider that within a democracy, public policy and government are
supposed to reflect the needs and wishes of all citizens. However, as we know, some
Americans do not vote. The homeless are often denied the right to vote because they do not
have fixed street addresses. Many elderly people or individuals with disabilities also do not
vote because of transportation costs and other factors (Schur & Kruse, 2000). This
situation creates the added problem that individuals who ought to voice their political
opinions on nutrition, health care, housing, and other programs do not go to the polls.
Finding transportation to the polls for the elderly or disabled on election day, or giving
them alternative means of voting, may provide them with a greater voice in issues directly
concerning them. Taking the service to the people who most need it empowers them to
participate in social change.
Thus, special populations (Fairweather & Davidson, 1986) cause changes in society
and, in turn, create more social change by virtue of either their swelling ranks or special
situations. Consider the fact that baby boomers, who number in the millions, are now
approaching older adulthood. This trend may mean that communities will need to provide
more resources for the elderly than they have had to in the past. One should never
underestimate the importance of population trends in social change (Duffy & Atwater,
2008; Light & Keller, 1985). If formal, established institutions are insensitive to the special
issues of diverse populations, these groups themselves can and will create change (Kettner et
al., 1985; Maton, 2000). Grassroots efforts to create or deal with social change are
discussed in the next chapter.
The social change described at the opening of this chapter was the result of work
across several decades. The lawsuit resulting in the Brown v. Board of Education decision
had been brought by the National Association for the Advancement of Colored People
(NAACP). As pointed out before, the court finding for Brown was pivotal in opening
opportunities for many groups who had previously been excluded from mainstream society.
Social Justice: A Moral Imperative for Social Change
One of the reasons that community psychologists are invested in helping society adapt to
population changes such as those described above is grounded in the field’s commitment to
social justice. As described in Chapter 1, social justice is a value that guides the field of
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community psychology, and a just or fair society is an overall goal of much of what we do.
One of the implications of changes in population trends, such as an influx of
immigrants, is not only that societal demographics change, but that the needs and values of
such groups must be integrated into the fabric of our democracy. This has happened in the
United States throughout history, although not without considerable strife, as was
illustrated in the Brown v. Board of Education case. Cases such as these are excellent
illustrations of how over history, the “status quo” or “how things have always been done”
must be revisited if we are to have a socially just society and a bona fide democracy.
Albee (2000) was a prominent psychologist who confronted the field of psychology
about its values, or apparent lack thereof, and as a result, its position on social justice.
Although community psychology has really always been guided by a value for social justice,
the rest of the field was much more ambivalent about the issue. Psychology, like other
social sciences, was modeled after sciences such as geology and, subsequently, was grounded
in objectivity. However, being objective when investigating rocks may be easier than being
objective or neutral when investigating human beings or dimensions of human behavior.
Thus, psychologists like Albee thought that to present psychology as a “values-free”
discipline was misleading and, perhaps even more troubling, aligned us as a field to validate
the status quo.
As Young (1990) described, the status quo in the United States and many other parts
of the world is to use marginalization to disempower large segments of the population,
which results in nondemocratic decision making. So, if psychology as field was unwilling to
take a stand on marginalization, it was undeniably complicit in supporting its existence.
This was the heart of Albee’s (2000) criticism of the field. Community psychologists such
as Prilleltensky have echoed this sentiment (Fox & Prilleltensky, 2007), noting that
although some people would like psychology to be apolitical or neutral, that does not mean
that it is (or should be).
Therefore, one of the reasons that community psychologists are involved in social
change is the value we see in social justice. Valuing social justice requires us to be
committed to changing processes and policies in our society that result in injustice or
inequities. If some children are receiving a better education than others because of their
socioeconomic background, social change is needed. If some racial groups are dying of
cancer in larger numbers than other racial groups because they are receiving substandard
healthcare, social change is needed. If there is a bias in hiring and promotion decisions that
results in women being underrepresented in leadership positions, social change is needed.
In other words, it is the inequity itself that is the rationale for social change when one values
social justice.
This is because the inequity is the signal that social injustice exists and social change is
required, just as the dying canary is the signal that there are toxic fumes in a contaminated
mine shaft. Promoting and protecting socially just policies and processes are critical to
maintaining social justice. If community psychology is led by a value of social justice, then
participating in an examination of policies and subsequently, participating in social change
is a key element of the work we do. This is illustrated again in our discussion of scarce
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resources.
The Perception of Declining or Scarce Resources
When resources are in decline, there is a perception of comparative scarcity. What has been
established as a baseline for funding is lessening. Scarcity results in changing social
dynamics, with increasing competition for these resources (Foundation Center, 2008;
Smart Growth, 2008). This issue not only affects individuals and families, it affects
community centers, public education, free health clinics, and many other services that are
funded by outside sources such as government funding, grants, private donations, or
corporate underwriting. Because so few community service programs are self-supporting,
most are highly dependent on external funding sources (Kettner et al., 1985), and most
attempts to create social change are limited by lack of funding and other resources (Maton,
2000). External funding for community services, whether it comes in the form of
government-sponsored legislation or grants from public or private endowments or
foundations, typically is awarded for a limited amount of time through a competitive
process in which there are more groups seeking funding than the funding can support. New
programs therefore compete with older programs for limited pools of money (Levine,
Perkins, & Perkins, 2004; Sarason, 1972/1999). Also, both the federal government and
local governments have provided less funding for human services than in the past, thereby
creating a sort of “Robin Hood in reverse” effect (Delgado, 1986).
Because government funding for community services is decreasing, there is more
pressure on other granting institutions, such as private foundations. Examples of such
granting foundations for community services include the Ford Foundation, the Charles
Stewart Mott Foundation, the Henry J. Kaiser Foundation, the Robert Wood Johnson
Foundation, the MacArthur Foundation, the Carnegie Foundation (Chavis, Florin, &
Felix, 1992), and more recently the Bill and Melinda Gates Foundation. More programs
and human services agencies are applying for these limited funds; hence, the competition
for both government and foundation monies is often fierce.
Although some agencies charge fees to clients for services as one revenue stream for
their organization, many are reluctant to become dependent on client fees, because such
fees also fluctuate depending on caseload and other factors such as the resources of the
clients themselves. Even agencies that charge clients on a sliding scale (where fees are tied
to income and/or number of dependents) are reluctant to increase charges to their most
financially needy clients. The trend toward allocating resources away from the poor
(Delgado, 1986) contributes to the perception of declining resources. When funding issues
become severe (and even when they are not so severe), clients and service administrators
demand reform or social change in order to increase resources. However, taxpayers often
are uncomfortable approving tax increases to fund changes.
Because it is difficult to garner support from taxpayers to increase government support
for certain community programs, organizations are often forced to try and raise money
from charitable donations. These voluntary contributions from the public also vary as a
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function of the economy and other uncontrollable factors. Community service directors are
therefore reluctant to become too dependent on charitable contributions. Funding issues
for community services have been and will continue to be delicate and volatile (Frumkin,
2000).
Case in Point 4.1 discusses in more detail some of the funding dilemmas faced by
nonprofit agencies.
CASE IN POINT 4.1
Funding Dilemmas for Nonprofit Organizations
The number of nonprofit or charitable organizations and the number of foundations
willing to make philanthropic donations to them have grown in the past few decades
(Foundation Center, 2008; Smart Growth, 2008). But are they keeping pace with each
other? In other words, are funding opportunities shrinking while the number of
organizations seeking funding is growing? Or are they growing in tandem?
In the 1950s, foundation startups grew by approximately 195 new funders a year. By
the 1980s, the average number of new funders had increased to 348 per year. Between
1980 and 1995, the number of foundations in the United States nearly doubled, from
22,088 to 40,140 (Siska, 1998). Today, there are more than 57,000 such foundations and
corporate donors that offer 246,000 different grants (Smart Growth, 2008). These grants
are available in the areas of social services, arts and sciences, protection of democracy,
support for vulnerable and needy populations, care for victims of natural disasters, health
care, and education (Independent Sector, 2006). In recent years, the leading issue in terms
of growth is peace and international affairs, which grew by a whopping 72.5% (Foundation
Center, 2008).
What about the number of nonprofit organizations that tap into or are dependent on
grants from these foundations? Have their ranks grown, too? Yes. There are now more than
1.9 million groups recognized by the Internal Revenue Service as nonprofit organizations
(Independent Sector, 2006) and vying for funding. Some are small and have receipts under
$5,000; others have receipts of millions of dollars. On the surface, then, it appears there
should be fierce competition for charitable funding despite the growth in number of grant
makers.
These statistics can be deceptive, however, because of economic and other changes—
for example, natural disasters such as the hurricanes that hit the Louisiana coast (Center on
Philanthropy, 2001; Foundation Center, 2008). Closer examination shows that money is
not evenly distributed among all nonprofit organizations. Some organizations receive very
large grants of millions of dollars; in fact, the number of grants over $5 million to
nonprofits has grown enormously. Do you think that a small human service organization
(such as a church’s nonprofit child day-care center) can compete against a large national
organization (e.g., the American Cancer Society) for such large amounts of money? Indeed,
DeVita’s (1997) study showed that although most nonprofit groups are quite small, the
largest organizations obtain the bulk of the finances. More specifically, small organizations
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1.
2.
3.
4.
5.
6.
7.
8.
with expenses of less than $100,000 accounted for 42% of the organizations, whereas
organizations with total expenses of over $10 million accounted for only 4% of charities.
The smaller charities received only 3% of the support dollars, whereas the larger
organizations received half of all support dollars. This same study demonstrated that a
disproportionate share of monies ends up in nonprofit organizations related to educational
or health issues. In addition, organizations in the northeastern United States receive the
lion’s share of support dollars. One fourth of U.S. charities are located in the Northeast, yet
they devour one third of the support dollars.
The answer to the opening question, then—Are funding opportunities shrinking?—is
likely to be both yes and no: yes in that the number of foundations pouring dollars into
nonprofit agencies is growing (but not fast enough), and no in that the support dollars are
probably not distributed equitably.
TABLE 4.1 Planning and Evaluation Strategies That Address Accountability
Why is the intervention needed?
How does the program include science and “best practices”?
How will this new program fit with other existing programs?
How will the program be carried out?
How well was the program carried out?
How well does the program work?
How can the program be improved?
What can be done to “spin off” or institutionalize the program?
Source: Adapted from Wandersman, A., Morrissey, E., Davino, K., Seybolt, D., Crusto, C., Nation, M., et al. (1998).
Comprehensive quality programming and accountability: Eight essential strategies for implementing successful
prevention programs. Journal of Primary Prevention, 19, 3–30. With kind permission of Springer Science and Business
Media.
Accountability
Accountability and its sister term, cost effectiveness, seem to be the buzzwords of today.
Accountability is the obligation to account for or be responsible for various transactions,
monetary or otherwise. In times of scarce funding, it is especially fair and reasonable to ask
for accountability from both new and continuing community programs (Wandersman et
al., 1998). Table 4.1 provides a list of questions important to planning and evaluation as
they relate to accountability.
Cost effectiveness means that money should be spent wisely—that is, there should be
some return or profit on money expended. Cost effectiveness often refers to money;
accountability can refer to such matters as time expended and quality of decisions made.
Spending has always been an important issue, but it is more likely to be in the
forefront of the minds of today’s citizens than it was in the past. Who requests
accountability? Almost anyone today: clients, staff, administrators, taxpayers, elected
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officials, licensing boards, and others. Any of these constituencies is likely to want to know
the answers to such questions as: Where was my money spent? Did the targeted population
benefit? Were goals accomplished, and if not, why not?
When answers to these questions are not forthcoming or are not the ones expected,
the parties leveling the query are likely to demand change. Some individuals may want new
administrators; others might want new spending guidelines. The list of changes demanded
can be so exhaustive that the end result is the demise of any organization not readily
accountable to its constituents. Again, the final outcome is likely to be some kind of
ongoing change.
Knowledge-Based and Technological Change
Technological changes in the form of web- and network-based communication systems
have created new demands on workforces in business as well as in human services. Some
organizations and individuals adapt well to technological advances. Others—for a
multitude of reasons such as reluctance to use new technologies or lack of funds—do not
adapt well or quickly.
People today may think that they are undergoing rapid and extreme technological
changes more than ever before. Technological changes, whenever they occur, obligate
further changes (Frank, 1983; Kling, 2000). Consider, for example, the technology divide
that exists between many youths and their parents today (Kaiser Family Foundation, 2010).
Today, you probably complete your term papers, balance your checkbook, keep track of
appointments, and perhaps pass your idle time by using the Internet. But, for your parents,
there was a time when the Internet didn’t exist and computers were only used in business
and industry, not in homes. The computer has changed our methods of conducting
business, completing homework, and socializing.
If these “galloping technological changes” (Frank, 1983) are not enough, mainstream
U.S. society is also experiencing a knowledge explosion. New methods for practicing
anything from psychotherapy to landscape architecture, new guidelines for human
resources management, additional legislation controlling all parts of people’s lives, as well as
other innovations and applications—all requiring new understanding and new skills—can
overwhelm society’s members, create additional change, and perhaps at the same time
stimulate anxiety.
Despite the fact that technology is ubiquitous in our occupational, educational, and
leisure lives (Brosnan & Thorpe, 2006), many people remain afraid of it, especially older
individuals who did not grow up with the Internet. The general fear of technology has been
called technophobia in the psychological literature (Brosnan & Thorpe, 2006). A specific
fear of computers has also been identified and is known as computerphobia (Hudiburg,
1990) or, more recently, as computer anxiety (Thorpe & Brosnan, 2007). In fact, some
claim that this phobia or fear is so strong that it might well be diagnos-able (Thorpe &
Brosnan, 2007) and in need of treatment (Brosnan & Thorpe, 2006) for success in the
modern world.
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This so-called digital divide extends to many different people and across international
borders (Cooper, 2006). Research has found computer anxiety in older adults (Laguna &
Babcock, 1997). Marginalized individuals who are not well educated, are poor or elderly or
disabled, and some minority groups remain more technophobic than the general
population (Duffy & Atwater, 2008; Karavidas, Lim, & Katsikas, 2005; National Science
Foundation, 2003). There remains a dispute in the literature, however, as to whether there
are true gender differences in computer anxiety and techno-phobia (e.g., Cooper, 2006;
Popovich, Gullekson, Morris, & Morse, 2008). Perhaps as technological changes advance,
these individuals will only fear them more. Few traditional community systems (such as the
Department of Health) provide help in coping with technical disasters (Webb, 1989)—a
situation that does not help allay fears. One possible way to address these concerns is via
community education and information dissemination. These strategies are discussed in the
next chapter on creating social change.
On the upside, Wittig and Schmitz (1996) and Kreisler, Snider, and Kiernan (1997)
found that community organizing is primarily done electronically. Such technological
organizing seems to obscure social boundaries, alter perceptions regarding stigmatized
groups, enhance participation of previous nonparticipants in civil life, and empower
activism.
Community Conflict
Some communities experience the strife of conflict—for example, in the demonstrations
and riots of the 1960s, some of which were triggered when Whites clashed with Blacks.
This is often a function of the perception that in order for one community to “win,” the
other must “lose.” Conflict, however, does not always have to produce negative changes
(Worchel & Lundgren, 1991). Sometimes a positive outcome of community conflict is
social change. Community conflict involves two or more parties with incompatible goals
that usually have specific values (positive and negative) attached to them. Because of the
strongly held values, power struggles, and varying interest levels of the parties, conflict in
the community can be difficult to resolve or manage (Checkoway, 2009). However, such
conflict, whether resolved or unresolved, often results in social change, because goodwill
alone does not always remove or dissipate the factors that led to the conflict (Fairweather &
Davidson, 1986). Yet, as was discussed in Chapter 1 with regard to social justice, in a
process where all parties are represented, the result of conflict may still be just, even if the
distribution of eventual outcomes is not necessarily even. When conflict leads to dialogue
and collaborative decision making, conflict can lead to positive social change.
Dissatisfaction with Traditional Services
Probably no other cause has fostered social change more than consumer dissatisfaction with
existing community services, especially external expert–dominated approaches (Maton,
2000). In fact, you will recall from Chapter 1 that such dissatisfaction with traditional
mental health services spawned the birth and growth of community psychology itself when
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psychologists at the Swampscott Conference expressed dismay with traditional forms of
mental health treatment.
One example of dissatisfaction creating community change relates to this chapter’s
opening vignette. The African American community was well aware of the prejudices and
discrimination present in society. The disadvantages were systemically rooted and pervasive
in their social world: a powerful example of institutionalized social injustice.
Closer to the issue of psychological interventions, it is important to look at another
example of how dissatisfaction with services leads to change. As you may already know
from your training in psychology and related disciplines, one of the earliest forms of
psychotherapy (or “the talking cure”) was psychoanalysis as developed by Sigmund Freud.
Freud’s own protégés, such as Carl Jung and Alfred Adler, became disenchanted with
Freud’s approach to therapy and modified psychoanalysis as they knew it (Phares &
Chaplin, 1997). Contemporary therapists, disgruntled with such concepts as pansexuality
and the unconscious from Freudian theory, have also developed an array of therapies
exemplified by behavior modification, cognitive–behavioral therapy, and existential–
humanistic counseling, to name a few. Today, the mental health client has a long menu of
therapies from which to choose—yet it was in response to the dissatisfaction with what was
then the “status quo” that such changes came about.
Dissatisfaction with traditional pathology-based, individually focused clinical
psychology led to the creation of community psychology. As noted in Chapter 1, there
were many reasons for the proposal of a strength-based, community-oriented intervention
coming out of the Swampscott Conference in the 1960s (Kelly, 2006; Nelson &
Prilleltensky, 2010; Rappaport, 1977). Complaints with the lack of services to ethnic
minority populations were behind similar moves toward a culturally informed
psychotherapy (Pedersen, Draguns, Lonner, & Trimble, 2008; Sue & Sue, 2008). The
inadequacies of a male-focused psychological theory gave impetus to the development of
feminist theories (Gilligan, 2011). We can find many examples of how dissatisfaction has
brought about change in psychology. Case in Point 4.2 is one such example.
Desire for Diversity of Solutions
Walk into any store in the United States and the display of available goods is
overwhelming. Americans are used to choices among brands X, Y, and Z. Americans do not
just want diversity in goods, however. They also expect diversity and choice among services.
Individuals seeking psychotherapy want to know that they have options in the training of
the therapist, the type of therapy, the payment plan, and the length of treatment. Similarly,
Americans want to be able to choose between private and public educational institutions
for their children and between law firms and lawyers when they want to recover damages or
close a real estate deal. Americans have come a long way since the 1800s, when one doctor,
one school, and one pharmacy served every family in their town. When individuals find
that agencies are insensitive or that there are few options from which to choose—and
sometimes this is coupled with dissatisfaction with those existing options—they often
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demand and create change.
CASE IN POINT 4.2
Community Conflict: Adversity Turns to Opportunity
In the 1960s, an unfortunate but interesting instance of community conflict occurred in
Rochester, New York. Surprisingly, from this adversity grew opportunity. An African
American neighborhood decided to hold a neighborhood party. The party occurred on a
hot summer night, and many young adults showed up for the festivities. Halfway through
the night, a group of White youths came to the party and were seen as intruders. One
brusque remark led to another, and the scene eventually erupted in violence. Rochester, like
many other cities, quickly exploded in racial conflict.
Several community groups, concerned that such violence not repeat itself, came
together in an attempt to find a solution to the city’s problems. As a result, the American
Arbitration Association was asked to consult on the design of a community program for
handling many types of conflict. The community mediation program was born. This
program manages community disputes between individuals or groups in a peaceful fashion
by assigning a neutral third party—a mediator—to facilitate discussion and problem
solving between the disputants (Duffy, Grosch, & Olc-zak, 1991). The program also
monitors community agency elections as well as urban renewal housing lotteries, “lemon
law” (automobile owner-manufacturer) arbitration, and other community projects where a
neutral party is needed. The initial community conflict, racial tension, was probably part of
the larger national civil rights movement—a movement that created sweeping social
changes that are not yet complete.
From the Rochester conflict, however, came more social change in the form of the
Community Dispute Resolutions Centers Act (Christian, 1986). This legislation
established in every county in New York a mediation center modeled after the one in
Rochester. With New York as the pioneer, other states followed. Today, there are hundreds
of functioning mediation or neighborhood justice centers in the United States. Some are
adjuncts to the courts; others are run by religious and other charities (McGillis, 1997). All
hope to inspire the peaceful resolution of conflict. Community conflict, then, creates
snowballing social reform and social change, of which the Rochester experience is only one
example. You will read more about community mediation in Chapter 9.
Here is an example from the justice system of how the desire for more options creates
change. Anyone who has watched one of the several televised courtroom judges hand down
a verdict knows that the courts often leave both complainants and defendants disgruntled.
Sometimes even the “winner” does not feel as if he or she has won. One answer to handling
this dissatisfaction and to providing more diversity for users of the court system is to
develop a multidoor approach, as is found in Washington, DC (Ostermeyer, 1991). This
is a coordinated system of assisting citizens involved in the justice system to find the most
appropriate option for them: various courts (small claims, city, state, and federal);
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mediation and arbitration programs; legal aid offices; public, private, and volunteer
attorneys; and other agencies, such as those assisting with mental health. The multidoor
approach helps citizens and agencies avoid the frustration of multiple and overlapping
referrals and lessens the perception that the justice system is a confusing maze of
bureaucracies (Ostermeyer, 1991).
The preceding catalog of reasons for social change, which is not exhaustive, is
summarized in Table 4.2. It will familiarize you with some of the causes for social changes.
The Brown v. Board of Education example presented at the beginning of this chapter has
multiple causes and multiple solutions. America’s history of social and economic
development has provided it with a pluralistic society. We believe in equality and freedom
of opportunity as basic rights for all people, yet we struggle with how to honor these rights
for both in-group and out-group members of our society (Gaertner & Dovi-dio, 2005).
Though we want to be fair, the common perception is that there are limited resources. Our
natural and sometimes unconscious tendencies to categorize or group people can work
against this desire for equality and freedom for all (Devine, 1989, 2005). The reasons for
our groupings have historic, economic, political, sociological, and psychological roots
(Jones, 2003). The solutions to our grouping and prejudgment tendencies and their
discriminatory outcomes are also multiple. Political and legal solutions go back to the
framing of the U.S. Constitution, the U.S. Civil War, and the 14th Amendment to the
Constitution (equal protection under the law) to name but a few. The Brown v. Board of
Education case was just one of many court decisions to help further equal treatment for all
in the United States. In the Brown case, it had to do with education, but in fact, it opened
the door for many more solutions to the issues of fairness. Through these many legal,
social, institutional, and personal solutions have come increased opportunities for contact,
interactions, mutual dependencies, and other contexts that we know can psychologically
build empathy and change the out-group members into in-group members (Allport,
1954/1979; Dovidio, Glick, & Budman, 2005). We now understand race to be a
politically derived category and that differences of skin color or facial configuration have
nothing to do with intelligence, social skill, and ambition. Thus, the reasoning for
separation of individuals according to this arbitrary categorization does not hold true. The
Supreme Court decision helped in the integration of groups. This has led to our society as
we know it today. There has been significant progress in providing access to opportunities
for all, including African Americans, other ethnic minorities, women, those with mental
health issues, the economically challenged, the disabled, and many others members of
groups categorized as outside.
TABLE 4.2 Reasons for and Examples of Social Change
Reason for Change Example of Social Change
Diverse populations AIDS patients desire emotional support from a group of other
AIDS patients, and their families get together and form a
support group.
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Declining resources The national economy is depressed; less grant money is
available from private foundations.
Accountability A taxpayer group attends a public hearing and demands to
know how a tax increase will improve community services.
Technological advances A corporation buys new software for midlevel managers who
now require training.
Community conflict An agency seeks a halfway house in a residential neighborhood
not zoned for multiple-family dwellings; two residents groups,
one in support and one against, conflict at a public meeting.
Dissatisfaction with
traditional services
An area’s private practice psychologists charge high fees not
covered by insurance, so citizens inquire about funding
possibilities for a mental health clinic that will charge on a
sliding scale.
Desire for diversity of
solutions
A multidoor courthouse program offers a variety of options
for solutions to neighbors fighting in the neighborhood.
Next we examine some ways in which change occurs, whether planned or unplanned.
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TYPES OF SOCIAL CHANGE
Forecasting social trends and social changes can be tricky but also very useful in designing
prevention programs. For example, the U.S. Census Bureau expected the 2000 census to
show demographic changes as well as population increases. The Census Bureau is able to
forecast some changes. Projected changes, though, do not always come true and are
sometimes more or less dramatic than anticipated. If the 2000 census figures are correct,
the population growth of 32.7 million people represents the largest census growth in U.S.
history. As another example, educators riding the tide of the baby boom built schools and
school annexes in the suburbs until the number of schools had soared. Today, these same
schools are witnessing a wave of violence from alienated youth. Community activists have
much that they can learn from demographers and other forecasters about where change will
occur next, particularly spontaneous or unplanned change.
Spontaneous or Unplanned Social Change
Naturally occurring change is called unplanned or spontaneous change. Most disasters are
not planned. For instance, no one planned the Great Chicago Fire in 1871, and, more
recently, few predicted the epidemic of school violence.
Natural disasters result in much distress as well as social change (Ginexi, Weihs,
Simmens, & Hoyt, 2000). Droughts, earthquakes, floods, fires, and other natural events
displace community members from their homes and jobs. Although these disasters are not
necessarily always distressing (Bravo, Rubio-Stipec, Canino, Woodbury, & Ribera, 1990;
Prince-Embury & Rooney, 1995), they typically result in some large-scale change.
Unplanned major shifts in the population also cause social change (Rosenberg, 2006)
and, in fact, much social dissatisfaction and divisiveness (Katz, 1983). For example, as the
swell of baby boomers moves through time, their needs change. Baby boomers are now
middle-aged or older (Rosenberg, 2006), and many are caring for their elderly parents
(Carbonell, 2003; Naisbett & Aburdene, 1990). They often find a dearth of community
services that provide elder care, and this creates much stress in the boomers’ lives (Duffy &
Atwater, 2008). Some baby boomers also have young children who require day care, which
can be in short supply. The stress of caring for both the younger and older generations in
their lives has resulted in such adults being labeled the sandwich generation (Spillman &
Pezzin, 2000). The baby boomers (born between 1946 and 1965) coming of age for Social
Security retirement and Medicare medical insurance adds to further social change in the
United States.
Other demographic shifts have created further shifts in lifestyle. For instance, there
has been an increase in the number of dual-career families (Cromartie, 2007; see Figure
4.2) that has increased the need for day care (Naisbett & Aburdene, 1990). One social
change invariably creates another.
What makes unplanned or unintentional change stressful is that it is often
uncontrollable and unpredictable. Uncontrollable events are quite stressful, and
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unpredictable events even more so. When individuals feel they control their fates, they
experience less stress; when they feel they have lost control, they experience distress
(Boggiano & Katz, 1991; Duffy & Atwater, 2008; Taylor, Helgeson, Reed, & Skokan,
1991).
African Americans in the civil rights movement may have felt that their lives were not
under their own control but under the control of the White majority. Studies performed
several years after the Brown v. Board of Education decision show African Americans to have
a tendency toward an external locus of control (Bruce & Thornton, 2004). However, the
study of locus of control suggests that with a more mature, sophisticated, and positive racial
identity, an African American sample shifted their locus of control from external to more
internal or self-controlled (Martin & Hall, 1992). Ruggiero and Taylor (1997), however,
still find the perception of discrimination to be a threat to self-concept and to perception of
self-control. Through organization and planned action, elements of the African American
community have moved from a feeling of uncontrolled to controlled change.
FIGURE 4.2 Work Patterns of Families Have Changed Over Time
Source: Cromartie, S. P. (July/August 2007). Labor force status of families. A visual essay. Monthly Labor Review, 35–
41.
Unplanned change is often confined to particular ecological situations in which
individuals may unwittingly be placed. For example, crime and natural disasters are
generally confined to particular environments (Taylor & Shumaker, 1990), so when
individuals find themselves in those environments, they may experience stress. In line with
this thinking, individuals walking at night in a neighborhood rife with signs of social
disintegration (e.g., graffiti and litter) may well feel distressed.
Besides assisting in the design and development of community services, community
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psychologists can also assist with coping for unplanned change by playing a role in
forecasting it. Remember that one of the tenets of community psychology is prevention. This
does not mean that community psychologists can prevent these changes—obviously
psychologists cannot prevent floods—but learning how to predict unplanned changes can
enable the community to prepare for the changes as they occur or even before. Such
preparation can prevent the change from being as severe and distressing as it otherwise
might be.
The science of prediction is complex, and there are scientists who specialize in
prediction and forecasting. Census data, for example, can help forecast population changes.
By way of example, as the baby boomers age, they will represent the largest group of elderly
the United States has ever had. This means that if elder care is in short supply now, it may
be in even shorter supply in two decades if no one prepares for it. Social indicators are
measures of some aspect of society based on combined, corrected, and refined social
statistics (Johnston, 1980) and can be used in social forecasting. By using sophisticated
statistical techniques, social trends can be forecasted and preventive measures can be
prepared (Kellam, Koretz, & Moscicki, 1999a, 1999b). We see an example of studying and
dealing with unplanned change in Case in Point 4.3.
Planned Social Change
Suppose people do not want to wait for change to happen, as in unplanned or unintended
change (McGrath, 1983)—suppose that instead they want to intentionally create change,
called “planned” or “induced” change (Glidewell, 1976). How could people go about this
seemingly monumental task? There are some venerated strategies suggested in the
community psychology literature: self-help, including grassroots activism; networking of
services and social support; the use of external change agents or consultants; educational
and informational programs; and involvement in public policy processes. All of these issues
are detailed in the next chapter. None of these approaches is easy, and each has advantages
and disadvantages. With planned change, however, the desired effects are more likely to be
obtained than with unplanned or spontaneous change.
CASE IN POINT 4.3
Working with an Indigenous People Experiencing Change
A profound example of unplanned and uncontrolled change is what has happened to the
indigenous peoples in many regions of the world. A study with the Inuit in the Arctic
Circle of Canada has been provided by Kral, Idlout, Minore, Dyck, and Kirmayer (2011).
Tracing an indigenous history and lineage that goes back about 4,000 years (McGee, 2004;
Purich, 1992), the authors describe a culture marked by the importance of “kinship,
interdependence and cross-generational teaching and support” (Kral et al., p. 427). In the
1950s and 1960s, the Canadian government moved them from family camps to settlements
and boarding schools. These changes came quickly and were not planned or controlled by
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the people themselves.
Presently, infant mortality is 3.5 times the national average for Canada.
Unemployment rates run from 15% to 72%. Life expectancy is 12 years lower than the
national norm. Youth suicide rates are among the highest in the world (Kral et al., 2011).
The numbers speak for themselves.
As a part of a larger suicide prevention project, community psychologists focused on
native concepts of well-being, happiness, unhappiness, and healing. They also sought to
examine the impact of the changes in communities on residents’ experience of well-being.
Following a regional suicide prevention conference, an Inuit steering committee was
formed, composed of representatives of the different generations: youth, adults, and elders
were on the committee.
An open-ended interview was designed in collaboration with the steering committee
and conducted with participants ranging in age from 14 to 94. Before leaving each
community, the research team presented summaries of interview data to village leadership.
In the end, research team and steering committee members met to consider the results.
Only findings about which there was intergroup consensus were reported.
The first and most consistent finding was the centrality of family to life. Being present
with, talking to, sharing meals, and just traveling together were all important to
interviewees’ experiences. Family was mentioned four times more often than anything else
in relation to happiness. (Unhappiness was most often related to romantic relationships.)
The second most important thing related to happiness was communication. They “believed
strongly that merely talking to one or more others was essential to one’s well-being” (Kral et
al., 2011, p. 430). The third theme related to well-being was connection to traditions, such
as how to hunt, go about the land, make tools and clothing, build an igloo, and generally
know of one’s culture.
The noticed changes were the increase in people, the growing distances between
family members with an attendant decrease in talking and visiting, the loss of cultural
practices, and finally less parental control. All these changes affected family and the
interactions among family. There was less “visiting” and less feeling of being loved.
Chandler and Proulx (2006) noted that disruption in culture and in identity placed
people at risk of suicide. The described changes in life certainly place these people at risk.
These findings are being used to inform both new self-determined government
policies (Baffin Mandate, Government of Nunavut, 1999), the creation of programs such
as Formation of an Elder’s Society, the opening of a community wellness center focusing
on traditions, and a Health Canada National Aboriginal Youth Suicide Prevention
Strategy.
Exactly what is planned change? Kettner and associates (1985) wrote a good working
definition. Planned change is an intentional or deliberate intervention to change a
situation—or, for the present discussion, a part of or a whole community. Planned change
is distinguished from unplanned change by four characteristics. First, planned change is
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limited in scope; that is, what is to be changed is targeted or earmarked in advance. Second,
planned change is directed toward enhancing the quality of life of the community members.
This is the primary purpose of planned change in communities. Planned change should
enhance (not inhibit) community life. Third, planned change usually provides a role for
those affected by change. Community psychologists should not impose change on
community members. Rather, their role is to inform citizens of the viable options, assist
them in the selection of appropriate options, and then participate with them in the design
and implementation of change. Finally, planned change is often (but not always) guided by
a person who acts as a change agent. Change agents (Lippett, Watson, & Westley, 1958;
Oskamp, 1984) are often trained professionals but can also be advocates for or from client
groups, political activists, educational experts, or others interested in inducing change
(Ford, Ford, & D’Amelio, 2008). Psychologists often act as consultants or change agents.
The role of consultants is detailed in the next chapter. The role of the NAACP and the
Clarks in the opening story is a very good example of planned change. They targeted the
specific school district to bring about intended changes in the law of the land, the quality of
life was most certainly improved with increased educational opportunities, and the African
American community was clearly leading in determining the goals and intervention.
Issues Related to Planned Change
A major issue regarding planned change is who decides change will occur and when, how,
and what changes will take place. Before the civil rights movement, Whites had pretty
much decided what would change in society. Blacks first (and later other less powerful
groups) wanted and were eventually provided with equal opportunity to create planned
changes in our society. Ask yourself, though—for any planned change, just who should
decide what to do? Any citizen regardless of age? Residents only? All affected voters? Only
taxpayers? Elected officials?
Community psychologists advocate for all those involved in the community having a
say in their community’s development (Fawcett et al., 1996; Fetterman, 1996; Maton,
Aber, & Seidman, 2011). Empowerment of the community itself has been a fundamental
concept in community psychology (Rap-paport, 1977; Zimmerman, 2000).
Collaboration is a hallmark of much community work (Bond, 1990; Fawcett, 1990;
Maton, 2000; Rappaport, 1990; Rappaport et al., 1985; Serrano-Garcia, 1990; Wolff,
2010). Collaboration is where social scientists and clients come together to examine and
create solutions for social problems (Rappaport, 1990). Collaboration is also called
participatory decision making, collaborative problem solving (Chavis et al., 1992; Kelly,
1986a), or empowerment evaluation (Fetterman & Wandersman, 2005). As Christensen
and Robinson (1989) have suggested, self-determination has practical problem-solving
utility in that those who live with the problem can best solve it. Acceptance of change is
therefore higher than with imposed changes. Moreover, collaborative decision making helps
build a stronger sense of community and avoids client–consultant conflict and duplication
of effort because collaboration is a mutual influence process. The key to collaboration is
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empowerment and networking, which enhance the possibility of self-determination.
Anyone embarking on planned social change needs to prepare carefully for the
changes (Maton, 2000). Ongoing, carefully planned change requires a substantial
investment of time, talent, money, and other resources that might otherwise be used
elsewhere (Kettner et al., 1985). The change agents should also prepare participants for
change to take a long time (Fairweather & Davidson, 1986; Seidman, 1990), as it is likely
to be resisted by some (Ford et al., 2008). Likewise, the more important the problem, the
more difficult it will probably be to solve (Shadish, 1990), and the more numerous the
necessary levels of intervention required (Maton, 2000).
Planners also need to consider whether change is really possible (e.g., Will all involved
parties cooperate? Are funds available?) and whether, in the end, the desired results can be
realistically achieved. For example, although thousands of community programs and
organizations exist across the country, many fail (Florin, 1989). Prestby and Wandersman
(1985) found that 50% of voluntary neighborhood associations, many of which are
designed to create and support social change, become inactive after only one year. Such
organizations seem particularly vulnerable to demise or failure (Chavis et al., 1992).
Fairweather and Davidson (1986) have explained that a single attack on a social
problem will not create substantial change. A multipronged and continual approach is
generally more successful. A once-and-for-all solution probably will not be effective, either
(Levine & Perkins, 1987). Fairweather and Davidson have also cautioned that although
some old practices might work well, any useless approaches should be discarded. It is
worthwhile to remember, too, that complete change might not always be necessary.
Besides the preceding dimensions, planners also need to consider the other parameters
of beneficial change (Fairweather & Davidson, 1986). Change must be humane—that is, it
must be socially responsible and represent humanitarian values that emphasize enhancing
human potential. Change techniques should also be problem-oriented—they should be
aimed at solutions of problems rather than theory alone. Similarly, change strategies should
focus on multiple social levels rather than on specific individuals. The techniques may
need to be creative and innovative. Creativity is the “friend and companion” of community
activists. The change plans also need to be feasible in terms of dissemination to other
groups or situations. Not all techniques fit all groups, but there are some communities that
can adopt tried methods from other communities.
Context or environment is a concept important to the ecological tradition of
community psychology (Trickett, 2009). For example, implementation of planned changes
can be influenced by the social climate of the settings. In one study, individual school
contexts predicted the level of lesson plan presentation of an antiviolence program
(Gregory, Henry, & Schoeny, 2007). Administrative leadership (e.g., “At this school,
information flows smoothly through channels”) and a supportive climate (e.g., “In this
school, even low-achieving students are respected” and “Teachers in this school are proud
to be teachers”) were found to result in better program implementation over a three-year
period.
Change agents also need to value social experimentation and action research. In this
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regard, planners cannot be timid about innovation—neither can they be afraid to evaluate
their innovations. Social experimentation and evaluation go hand in hand (Fairweather &
Davidson, 1986). Any interventions and programs developed to create community change
need to be honestly evaluated, modified based on the evaluation, evaluated again, and so
on. Then and only then do change agents and communities know that they have the best
possible ideas in place.
Finally, planners or change agents need to be realists, particularly with regard to the
prevailing political climate and the deep system structures that are in place (Light & Keller,
1985; Foster-Fishman & Long, 2009). Change always makes something different that
otherwise would not be changed (Benviente, 1989). Some individuals will like the change;
others will not. Hence, the power struggles related to change are likely to commence as
soon as change is suggested (Alinsky, 1971/1989).
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DIFFICULTIES BRINGING ABOUT CHANGE
Why do programs that are designed to create social change or provide alternative services
fail? Why do the most well-intentioned efforts sometimes go awry? What if citizens are
divided as to what they should do? A multitude of reasons exist, but only a few are
mentioned here.
One of the most important reasons for failure of planned change is resistance (Ford et
al., 2008; Glidewell, 1976; Levine & Perkins, 1987), which can come from a variety of
sources, including administrators, practitioners, clients, or any other community member.
Why does resistance occur? Societies tend to have built-in resistance to change (Ford et al.,
2008); members of groups seem trained to follow their own ways—the old ways—which
they regard as safe or superior (Glidewell, 1976). Groups feel their existence is threatened
by new groups or new ideas. Ellam and Shamir (2005) believed that the acceptance of
change is related to the change’s concordance with the organizational members’ self-
concepts. If the change is felt to be self-determined, to be in agreement with their sense of
self-distinctiveness, to be self-enhancing, and to have some continuity with existing self-
concepts, changes are much easier to accomplish. In the end, change agents themselves may
do something to alienate the community or create resistance to change (Ford et al., 2008).
There are still other reasons for the failure of social change efforts. Psychologists have
long documented the effects of in-groups and out-groups in which people favor their own
groups (the in-group) and stereotype or denigrate outsiders (the out-group) (Allport,
1954/1979; Brewer, 1999). In the community, for instance, for-profit businesses, especially
big private-sector corporations, often resist social change instituted by small nonprofit
businesses or by new government policies because the for-profit enterprises think their
revenues will be affected. The assumptions of in-group advantages and out-group
disadvantages help maintain in-group cohesion but also add to the reluctance to accept any
out-group information or characteristics. The inability to empathize and therefore
understand the situation of the out-group members can hamper in-group members’ ability
to accept information and make changes based on that information (Batson et al., 1995).
Helping for the sake of “the other” is very difficult, though not impossible, to find
(Strumer, Snyder, & Omoto, 2005).
Sometimes change is resisted by those who would benefit from it because they have
been socialized to think change is not possible and the status quo is all that is available to
them. The South American liberation educator Paulo Freire (1970) argued that the
oppressed are often unaware of the constraints they live under. As a function of the social
structure conditioning in which they have grown, they do not see any hope of change.
Conscientization occurs when the oppressed come to awareness of their oppression. Freire
(1994) believed that this occurs when individuals come to a realization of their self-
determination and the “unveiling of opportunities for hope” (p. 9). He argued for the value
of “the unity in diversity” to create a power base, and of shifting the blame for dysfunction
from the “oppressed” individual to the “oppressive” structures (pp. 157–158). These ideas
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are prescient to—that is, they seem to anticipate—the psychological research and theory
related to Bandura’s “collective self-efficacy” discussed later and Rappaport’s
“empowerment” efforts identified in Chapter 1. In many circumstances, conscientization is
necessary for the second order change (Watzlawick et al., 1974) described in the first part of
this chapter.
Change is often seen as unwelcome, not just by groups but by individuals as well
(Kettner et al., 1985). Social perception psychologists know that individual characteristics
can lead to resistance to change. So-called cognitive misers make decisions based on
stereotypical groupings and therefore less information (Fiske & Taylor, 2013; Spears &
Haslam, 1997). This is motivated by socially based desires for “belonging, understanding,
controlling, self-enhancing, and trusting” (Fiske, 2004, p. 117). Individuals resist
information or change for the same reasons as groups—because they feel that change
threatens their group, reputation, job security, or well-being. Furthermore, Kuhn’s
(1962/1996) argument regarding the difficulty of paradigm shifts—or ways of seeing the
world—suggests social change, as with worldviews, require people to overthrow that which
they have learned to be “real” and to think of things in new ways. Although this can and
does occur, a critical mass of evidence needs to accumulate first. The shift in viewpoints is
dramatic and therefore is not taken lightly. Vygotsky’s concept of proximal development
suggests that new learning beyond one level above how we presently conceptualize the
world is extremely difficult and fraught with resistance (Hedegaard, 1996). Watzlawick and
associates (1974) support this notion of difficulty in finding change. As Foster-Fishman
and Behrens (2007) suggest, change requires more than shifts in skill sets—it requires shifts
in mindsets as well. So we understand that any social change can be difficult to
conceptualize, much less execute and find acceptable to the establishment.
Often, agents of change and their programs fail (Ford et al., 2008) because their
tactics are uncomfortably confrontational and may be seen to violate “politeness norms.”
Alinsky (1971), Kettner and associates (1985), and Wolff (2010) see risk taking, including
the risk that change will be unwelcome, as part and parcel of all change. However, the
reality is that if those people planning change receive only negative exposure (by the media,
for example) or fail to suggest their own solutions to the problems they are protesting, their
protests are perceived as hollow or disruptive rather than productive. Change comes from
the perception of common goals, and commonalities (Gaertner & Dovidio, 1992;
Gaertner, Rust, Dovidio, & Bachman, 1994) and the building of empathic links to those
are negatively affected by existing systems (Batson, Ahmad, & Lisher, 2009; Dovidio et al.,
2010). Alternative to these motives are more self-serving ones, of benefit to self or one’s
group, and avoidance of aversive events.
Saul Alinsky’s (1971) community work in Chicago, and later nationally, during the
1940s, 1950s, and 1960s is seen as yet another model for change. Alinsky noted that no
power change ever occurred without some struggle. Notably, those involved in creative
power struggles can use existing rules to bring about pressure on the status quo. Table 4.3
summarizes some of Alinsky’s sometimes radical approaches.
Collective planning for change is construed as good, but this is only true within limits.
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1.
2.
3.
4.
5.
If the organization or individuals planning change are too loosely structured, if solid
leadership does not exist, or if the decision makers show no discipline in their plans, then
they can fail. Delgado (1986) reviewed several organizations that had good intent but
evaporated because of the inadequacy of their own organizational infrastructures. Maton
(1988) found that groups with higher role differentiation, greater order and organization,
and capable leaders reported more positive well-being and more positive group appraisal.
Many in community psychology now focus on “capacity building” as a way to bring
organizational strength to the communities they serve. Examples in the contemporary
research literature abound (Miao, Umemoto, Gonda, & Hishinuma, 2011; Nowell &
Foster-Fishman, 2011; Vivolo, Matjasko, & Massetti, 2011; Wilke & Speer, 2011).
Foster-Fishman and Behrens (2007) caution that too often the conceptualization of
social systems change is too simplistic. When one particular change is targeted without
consideration of the multiple levels it can affect, the change efforts can fail or fail to be
sustained. Change agents should plan globally or holistically so as to see the whole picture
rather than disjointed pieces of problems. Pluralistic (Freedman, 1989) or multilevel
planning (Maton, 2000) is likely to ensure success because the context or environment
within which the change will occur will be more likely to have been considered (Kelly,
2006; Trickett, 2009).
One of the best solutions to prevent failure (and, after all, prevention is a critical part
of all of community psychology) is to lay a good foundation for change by gaining
community endorsement for such change and establishing an empirical justification for the
need to change. Community psychologists regard research and practice as interdependent
on one another (Kelly, 1986b). Action research, as you have already read, is scientific work
grounded in theory, accounting for community input to the research and intervention
process, and directed toward resolving problems (Lewin, 1948; Jason, Keys, Suarez-
Balcazar, Taylor, & Davis, 2004; Primavera & Brodsky, 2004). Action research in the
community is not without its problems (Price, 1990; Tolan, Keys, Chertak, & Jason,
1990). Problems include the lack of trust in the researcher by community members,
breakdowns in negotiating with program and community administrators, the inability to
randomly assign subjects to conditions for experimental designs, and the selection of
appropriate and adequate measures (Fairweather & Davidson, 1986). Despite all these
reservations, “through the collaborative enterprises, we have seen many examples of
community members who have gained self-awareness, established important network
connections, and achieved social change” (Jason, Davis, et al., 2004, p. 241).
TABLE 4.3 Ten Rules for Radicals*
Use whatever you’ve got to get attention.
Don’t go outside the experience of your people.
Whenever possible, go outside the experience of the enemy.
Make the enemy live up to its own rules.
Ridicule is a potent weapon, and it makes the opposition react to your advantage.
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6.
7.
8.
9.
10.
A good tactic is one that your people enjoy—if they don’t enjoy it, there is something
wrong.
A tactic that drags on too long becomes a drag.
The threat is usually more terrifying than the thing itself.
Power is what you have and what the enemy thinks you have.
Keep the pressure on.
*These are general guidelines. According to Saul Alinsky, they should be adapted to the uniquenesses of each situation.
Source: Adapted from Alinsky (1971).
Summary
We have come to expect change in today’s world. There are many reasons why change
occurs. Diverse populations, such as the growing number of elderly, have issues that must
be addressed but for which society may not be prepared. There can be a decline in
resources, or funding due to downturns in the economy or changes in government policies.
On the other hand, accelerating technological advances can necessitate change on the part
of individuals as well as society. One technology that has caused all sorts of modification in
our daily lives and in methods of conducting business is the addition of computers and
telecommunications. On the other hand, many people fear the advance of technology
(technophobia), and traditional community services do little to help individuals cope with
the fear.
Demands for accountability also create change. People expect that funds will be
expended wisely, and they grow concerned when spending is not accounted for. Related to
accountability is cost effectiveness, which refers to how wisely money is spent (i.e., whether
there is a profit).
Community conflict is yet another reason for change. Groups in communities
experience ethnic or religious strife, conflict over resources such as land use, and so on to
create change. There is growing sentiment against traditional methods for dealing with
today’s problems—for instance, the treatment of the mentally ill—as well as a desire for
choices or diversity among solutions to problems.
There are two types of change: planned (or induced) change and unplanned (or
spontaneous) change. Planned change occurs when changes are intentional or deliberate.
Planned change is limited by its scope, usually enhances the quality of life for community
members, provides for a role for affected groups, and is often guided by a professional
change agent or consultant. In unplanned or spontaneous change, change is unexpected,
sometimes disastrous (as in a natural disaster such as a flood) and often of a large
magnitude (such as when a segment of the population experiences growth, as in the baby
boom generation).
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FIGURE 4.3 The Nine Dot Problem Solution. The solution requires you to think beyond the dots. If you go outside
the grid of dots, the solution is possible. If you were able to solve this problem, you were engaging in second order
thinking.
Source: From Watzlawick, P., Weakland, J., Risch, R., & Erickson, M. (1974). Change: Principles of Problem
Formation and Problem Resolution. New York, NY: Norton.
Community psychologists are interested in both studying and implementing social
change for the betterment of the communities served. Some of the tools they bring to this
process are discussed in the next chapter. Whether the change is planned or unplanned, the
resources of the community can be brought to bear on the problems or issues at hand.
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Community Intervention Strategies
CREATING PLANNED CHANGE
CITIZEN PARTICIPATION
■ CASE IN POINT 5.1 The Community Development Society
Community Participation and Prevention
Who Participates?
Advantages and Disadvantages of Citizen Participation
NETWORKING/COLLABORATION
■ CASE IN POINT 5.2 Online Networks for Ethnic Minority Issues
Issues Related to Networks
Advantages and Disadvantages of Networks
CONSULTATION
Issues Related to Consultants
Advantages and Disadvantages of Consultants
COMMUNITY EDUCATION AND INFORMATION DISSEMINATION
Information Dissemination
Community Education
Issues Related to Information Dissemination
Issues Related to Community Education
■ CASE IN POINT 5.3 The Choices Program
PUBLIC POLICY
■ CASE IN POINT 5.4 Rape Crisis Centers: A National Examination
Issues Related to the Use of Public Policy
Advantages and Disadvantages of Public Policy Changes
A Skill Set for Practice
SUMMARY
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I am in Birmingham because injustice is here…
I am cognizant of the interrelatedness of all communities and states…
Injustice anywhere is a threat to justice everywhere.
—Martin Luther King Jr., “Letter from a Birmingham Jail”
The neighborhood had gotten progressively worse over the previous decade. Crime rates had risen, and residential
transiency had increased. Neighbors no longer knew neighbors—out of habit, lack of interest, time pressures, or fear.
Then the drug dealers moved in. The area became known for crack houses, methamphetamine production, and the
violence that comes with their sale and use. It was a neighborhood that commanded sweeping views of the water in
places. But no one wanted to move in.
Yet it was an old neighborhood. There were residents who had lived through the decline or had chosen to move in
because of affordability, or old loyalties, or the vision of its potential. There were businesses there, there was a hospital
there, there was all one would hope for in area conveniences and services. These had been there for a long while.
Despite several transitions in economic circumstances, they remained. Yet most talked about the difficulties and risks of
business in the area.
Then it happened. A very violent incident in the neighborhood made statewide news. Reporters spoke of the
plight of those law-abiding residents, now caught in their homes with little hope of selling and moving. Few wanted to
buy and live there. In response to all of these negatives, a group of citizens came together. Some say it started with a
block party/barbecue. The neighbors banded together and identified problems and the advantages of working together.
They organized block watches and surveillance of the known drug houses. They traded phone numbers and agreed to
help each other out. They called on the police, who were encouraged by this and happy to help where possible.
The drugs moved out of the neighborhood, because drug operations require secrecy. The neighbors found
common ground and connectedness in the process. They saved their homes and their neighborhood. This was the
beginning of Safe Streets and later, the National Night Out, where neighbors come together, talk, have dinner together,
and get to know each other.
This chapter reviews some of the ways social change is facilitated by community
psychologists. These are planned efforts. They have been studied at the descriptive and
predictive levels. From a community psychology perspective, we might better understand
the processes. From this understanding, we might better devise interventions to aid in
bringing these transformations.
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CREATING PLANNED CHANGE
Sarason (1972/1999) considered at length the importance of “creating settings” for change
and the implications of these creations. Some would argue that society has never needed
change more than it does today. Multiple reports and commissions have concluded that we
are a nation at risk with regard to many social indicators, such as alcohol abuse, drug use,
teen pregnancy, and violence (Wandersman et al., 1998). Creating and sustaining social
change is not an easy task, but community psychologists are at the forefront of researching
the best ways to create and maintain positive societal change. Cook and Shadish (1994)
have suggested that there are three ways by which social change can occur. The first (which
they believe is the most successful) is by working in increments to bring gradual changes to
the system. The second is to test innovative programs and then offer them for acceptance.
The third and most dramatic is to start with radical changes to the structure of the system
in question.
Participating in social change is a fundamental value in community psychology (Jason,
1991; Maton, 2000) as well as a basic property of social reality (Keys & Frank, 1987). This
chapter examines established methods for fashioning both small- and large-scale social
change. For each technique, its use, its advantages and disadvantages, and related research
are discussed. When change is intentional and considered in advance, it is called planned
change.
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CITIZEN PARTICIPATION
The Safe Streets Project, described in the opening vignette, engaged neighborhood
residents in the solution. They understood the problem in all of its details, because they
were daily observers of the environment and its residents. They knew where the drug
houses were and the pattern of comings and goings. They could identify the drug makers
and drug dealers as well as their customers. In turn, they were the ones who constantly
inhabited the environment. It did not take time to respond to things, because they were
already there. By reporting what they saw, they could obtain better police intervention. The
citizens were the critical variable that changed the course of things in the neighborhood.
Perhaps no other method of creating social change has received as much attention as
participant-induced change, and interest in this type of change has been mounting (Linney,
1990). Various authors have given different labels to this type of change, including citizen
participation (Levi & Litwin, 1986; Wandersman & Florin, 2000), empowerment
(Rappaport, Swift, & Hess, 1984), grassroots activism (Alinsky, 1971), and self-help
(Christensen & Robinson, 1989). Citizen participation can be broadly defined as
involvement in any organized activity in which unpaid individuals participate in order to
achieve a common goal (Zimmerman & Rappaport, 1988). At the root of this method of
change is the belief that people can and should collaborate to solve common problems
(Joseph & Ogletree, 1998). In fact, some hold self-help as the most promising mechanism
for changing society (Florin & Wandersman, 1990). An example of citizen participation is
grassroots activism, which occurs when individuals define their own issues and press for
social change to address these issues and work in a bottom-up fashion (rather than top-
down). For example, when citizens who are tired of lives being senselessly taken on our
highways urge policy makers to pass laws with stiffer penalties against drunk driving, the
citizens are practicing grassroots activism. Case in Point 5.1 discusses further citizen
involvement in community change by introducing the Community Development Society.
Another example of this type of change, but at a more personal level, is self-help
groups (Levy, 2000), such as Alcoholics Anonymous, where individuals with common
issues come together to assist and emotionally support one another. Because self-help
groups are often overseen by professionals, some psychologists prefer the term mutual
assistance groups for groups made up solely of laypeople (Levine, 1988). Shepherd and
associates (1999) pointed out, however, that the dichotomy between professionally led and
peer-led groups is artificial: the extent of professional involvement in such groups varies on
a continuum of minimal to extensive, and the success of such groups comes from the
synergy between the members. Often, individuals in these groups learn coping strategies
from each other. At a personal level, community members—such as friends, family, and
neighbors— can assist in supporting each other through difficult times by providing social
support (Barrera, 2000). Social support is an exchange of resources (such as emotional
comfort or material goods) between two individuals where the provider intends the
resources to enhance the well-being of the recipient (Shumaker & Brownell, 1984, 1985).
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•
•
•
•
Social support can be another means by which social change occurs.
The usual settings for citizen participation are work settings, health care programs,
architectural environments, neighborhood associations, public policy arenas, education
programs, and situations applying science (especially social science) and technology. This
type of participation can occur by electoral participation (voting or working for a particular
candidate or issue), grassroots efforts (when citizens start a group and define its goals and
methods), or government-mandated citizen participation in which citizens are appointed to
watchdog committees or attend public hearings. Table 5.1 provides more examples of
mechanisms for citizen participation, which vary in terms of effort expended and
commitment.
CASE IN POINT 5.1
The Community Development Society
Community change and citizen participation have become an accepted—in fact, expected
—part of daily life in the United States. For this reason and others, the Community
Development Society (CDS) was established. CDS recognizes citizens’ capacity to build
and take democratic action as keys to success in a complex and ever-changing world.
Community development is a process designed to create conditions of economic and social
progress with the active participation of the whole community and with the fullest possible
reliance on the community’s initiatives (Bradshaw, 1999; Levine, Perkins, & Perkins, 2004;
Rothman, 1974).
CDS members are multidisci-plinary and come from the fields of education, health
care, social services, government, and citizen groups (to mention just a few). Members
believe that community is the basic building block of society (Bradshaw, 1999). In
addition, they realize that communities can be complex, growth and development are part
of the human condition, and development of each community can be promoted through
improvement of the individual, organizational skills, and problem-solving knowledge. CDS
members fervently believe that good practice can lead to sound community development
and social change.
In response to these beliefs, CDS has developed several principles of good practice for
community development specialists, whether they are citizens or professionals:
Citizen participation needs to be promoted so that community members can
influence the decisions that affect their lives.
Citizens should be engaged in problem diagnosis so that affected individuals can
understand the causes of the situation.
Community leaders need to understand the economic, social, political, and
psychological impact associated with various solutions related to community problems
and issues.
Community members should design and implement their own plans to solve
consensually agreed-on problems (even though some expert assistance might be
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•
needed). Furthermore, shared leadership and active participation are necessary to this
process.
Finally, community leaders need the skills, confidence, and motivation to be
influential in the community.
According to Maton (2000), these strategies for good practice result in capacity-
building or assets-based change. Do these various principles sound familiar? Many of them
are embraced by community psychologists. The significant point here is that there are
many community citizens and leaders who adopt community psychology principles and
goals without ever having studied community psychology.
Community Participation and Prevention
As was discussed in Chapter 1, prevention is a defining principle of community psychology.
In the Safe Streets/National Night Out example, citizens saw a serious community problem
and joined together to monitor their neighborhood and make it a safer place for everyone.
This type of action could be classified as a tertiary prevention program, in which the
problem already exists, and the action is meant to prevent future occurrences. Yet, in some
ways, strategies that were used to prevent future occurrences may also be successful in
preventing initial occurrences in communities that are not yet experiencing violence or
drug problems but may be at risk for such problems (i.e., secondary prevention). When
neighborhoods are full of people who demonstrate a concern for and connection to the
place where they live, it is harder for drug dealers or gang members to find a niche where
they can do business and create danger.
TABLE 5.1 Examples of Citizen Participation
Voting
Signing a petition
Donating money or time to a cause
Reading media articles on community needs or change
Boycotting environmentally unsound products
Being interviewed for a community survey
Joining a self-help group
Participating in a question-answer session or a debate
Serving on an ad hoc committee or task force
Participating in sit-ins and marches
Leading a grassroots activist group in the community
Doing volunteer work in the community
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Conducting fund raising for a community service
Offering consultation services
Serving in public office or supporting a particular candidate
So do stories like these lead us to conclude that “good” citizens need to join forces to
rid their neighborhoods of “bad” elements? Is it ever possible that community members
who were at one point involved in “bad” behavior might be a valuable asset in preventive,
grassroots action plans? One approach to prevention that we will see highlighted in several
chapters throughout this text is the use of community members as paraprofessional
interventionists, which is one of the more committed forms of citizen participation. An
example of this would be to have recovering drug addicts reach out to current drug users, or
have former gang members attempt to prevent neighborhood violence among current gang
members. These types of approaches to prevention are thought to be successful because the
community members who are intervening have credibility with those to whom they are
trying to reach. A former gang member who reaches out to current gang members may be
seen as capable of understanding gang realities in a way that a professional social worker or
other professional interventionist may not. In such a situation, the success of a prevention
program may be dependent on community members’ participation. Fortunately for our
purposes, there already exists a program that has demonstrated the merits of such an
approach to violence prevention.
An interdisciplinary, now international collaboration, the violence prevention project
that we are referring to is known as Cure Violence (http://cureviolence.org). Cure Violence
would be considered an indicated approach to violence prevention (i.e., it is offered in
specific neighborhoods) that blends elements of person-centered and environment-centered
interventions. Developed as CeaseFire by Dr. Gary Slutkin, an epidemiologist at the
University of Illinois–Chicago, CeaseFire’s original environment-centered strategy was to
select ex-convicts who were former gang members and current members of the targeted
communities to act as “violence interrupters.” These individuals served as neutral parities to
mediate conflicts between both individuals and rival gangs and, in doing so, attempt to
interrupt the cycle of retaliatory violence that often occurs in the aftermath of a shooting.
The person-centered strategies included in CeaseFire involved dispatching outreach workers
to counsel targeted youth and connect them to a range of mental health services when
necessary. Instead of being a primary or universal approach to prevention, CeaseFire
targeted its programs for specific neighborhoods that were known as hubs of violent activity
based on police databases. The goals of the project were to decrease future episodes of
violent behavior and ultimately, to change community norms surrounding violence. Some
people might wonder whether former gang members or ex-convicts could truly change in
such a way that they now were true assets to the safety of their communities. The answer to
such a questions lies in CeaseFire’s successes (http://cureviolence.org/effectiveness/). In
2012, CeaseFire became Cure Violence because the program involved more than guns—it
was a broader community approach to violence as a public health problem.
In its evaluation in the United States, the U.S. Department of Justice investigated the
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effectiveness of CeaseFire/Cure Violence programs in seven cities. Six of the seven
CeaseFire/Cure Violence cities assessed showed decreases in the size and intensity of
shooting “hot spots.” The evaluation (see Skogan, Hartnett, Bump, & Dubois, 2008) also
indicated that, in comparison to control-groups, decreases in overall violence occurred in
four of the areas where CeaseFire/Cure Violence operated. Reciprocal killings in retaliation
for earlier events decreased more in the program areas than in the comparison areas.
Additionally, the average gang involvement in homicides decreased in three of the
CeaseFire/Cure Violence areas. In some cases, decreases in murder rates were as high as
73%. Thus, the Department of Justice report validated the CeaseFire model as an evidence-
based intervention that reduces shooting and killings and ultimately creates safer
communities.
There are many impressive aspects of the CeaseFire/Cure Violence program. One of
those aspects is that it is a prevention program that was modeled after other grassroots,
community-staffed, public health programs that had been shown to be effective preventing
major public health problems, including tuberculosis and human immunodeficiency virus
(HIV), worldwide. The international presence that CeaseFire/Cure Violence has developed
now includes programs running in neighborhoods in Iraq, London, South Africa, and
Trinidad and Tobago. The program can be successful in such diverse settings because it
relies on local community members and accesses local community resources, fostering the
message that communities can solve their own problems, a sentiment affirmed by
community psychologists. Yet, prevention programs that are so deeply based on
community member participation obviously only work when community members feel
moved to actually participate. Thus, one must ask the question: Who participates?
Who Participates?
Not everyone wants to participate in social change or believes that he or she can be effective
in fashioning social change, which is known as helplessness (Zimmerman, Ramírez-Valles,
& Maton, 1999). Research by O’Neill, Duffy, Enman, Blackman, and Goodwin (1988)
examined what types of individuals are active in trying to produce social change. The
researchers administered a modified I-E Scale and an Injustice Scale to introductory
psychology students and single mothers (both of whom were considered nonactivist
groups), board members of a day-care center (a moderately activist group), and board
members of a transition house for victims of domestic violence (the high activist group).
The I-E Scale (Rotter, 1966) measures internal versus external locus of control.
Individuals with an internal locus of control believe that they control their own reinforcers;
individuals with an external locus of control believe that other people or perhaps fate
(something external to the individual) controls reinforcers. The researchers modified the
scale to measure personal power or the sense that a person is in control of his or her fate.
The Injustice Scale measures individuals’ perceptions about whether the world is just (for
example: Do the courts let the guilty go free and convict innocent people?). O’Neill and
associates found that neither personal power nor a sense of injustice alone is sufficient to
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predict who will be a social activist. Both a sense of personal power and a belief in the
injustices of society combine to produce social activism. Figure 5.1 reproduces these results
in graphic form.
FIGURE 5.1 Results of Research on Social Activism
Note: Citizens who believe in personal control (or power) and social injustice are likely to be social activists.
Source: Data compiled from O’Neill et al. (1988).
Participation appears to be related to people’s sense of rootedness in their
neighborhood—that is, the length of time in the area, plans to stay in the area, and having
children (Wandersman, Florin, Friedman, & Meier, 1987). Not surprising is a finding by
Chavis and Wandersman (1990) that a sense of community seems important to
participation in block associations. Perkins, Florin, Rich, Wandersman, and Chavis (1990)
proposed an ecological framework for understanding participation. There needs to be a
perceived need for coming together and then a set of “enabling conditions,” such as
neighborly behaviors, that allow the group to do that. Corning and Myers (2002)
developed a scale of social action engagement that has been used in subsequent studies of
this nature. Research by Sampson and Raudenbush (1999) points to the negative
relationship between strong social cohesion and crime. It seems that the residents in the
Safe Streets story, which opened this chapter, were correct in assuming that by coming
together as neighbors, they would change the climate for crime in their area. Strong
neighborhoods equaled less crime.
150
Kelly and Breinlinger (1996) suggested that community activists identify with the
group with which they are associated. They also proposed that individuals need a self-image
of themselves as activists to engage in social change projects. Finally, Perkins, Brown, and
Taylor (1996) found that community-focused thinking (such as having a sense of civic
responsibility or feeling attached to a community) as well as community-focused behaviors
(such as volunteering in the community) were consistently and positively predictive of
participation in social action efforts within the community. Zimmerman and colleagues
(1999) found that African American youths who felt high levels of sociopolitical control
were less likely to feel personally helpless (feeling of no or low control) and depressed.
Sociopolitical control may be defined as beliefs that actions in social and political realms
can lead to desired outcomes. Zimmerman and associates believe that sociopolitical control
contributes to self-esteem and self-confidence, making it more likely that individuals would
take action when challenges appear in other areas of their lives.
Measuring the impact of citizen participation is difficult but necessary if one is to
understand the process and to determine whether it works (Kelly, 1986b). The citizens—
the stakeholders, so to speak—might want hard evidence that their efforts were worthwhile,
but such direct evidence is often difficult to obtain. Involved individuals might also disagree
about what is solid evidence: cost savings, increased profits, higher client satisfaction, less
stress, improved community relations, and so forth.
Some citizens may want to participate but lack the appropriate skills; few laypeople,
for example, know how to lobby for policy change or how to conduct meaningful scientific
research. Chavis and associates (1992) noted that citizen groups might also need help in
skills relating to group dynamics. Their leaders might need training in strategic planning,
negotiations, or incentive management (Prestby, Wandersman, Florin, Rich, & Chavis,
1990).
Speer and Hughey (1995) noted that the development of power for organizations and
for individuals went together. Change in one could bring change in the other. Speer and
Hughey identified four phases to community organizing. First is assessment, through which
crucial issues affecting the community are identified. This allows the organization,
community, and its members to focus on the other three phases. The second phase is
research. In this phase, participants examine the causes for the issues identified in the
assessment phase. One important piece of information is the ways in which community
resources are allocated and how key players exercise their social power.
A third stage, action, represents the collective attempt to exercise social power. Actions
include public events that demonstrate organizational or citizen power and perhaps attract
attention from outside the community. Finally, reflection by members is important.
Effectiveness of action strategies, discussion of lessons learned, consideration of how power
was demonstrated, and development of future plans are explored. The process can then
start over again with assessment of other related critical issues for the community. Notably,
this process mirrors the action research described by Lewin (1946) and the prevention
research cycle espoused by Price (1983). The process of community engagement is a part of
the intervention and the research.
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•
•
•
Peterson and Reid (2003) found that personal involvement (person), a sense of
community (setting), and awareness of a community issue (environment) all contributed
to citizen empowerment (a combination of political effectiveness and competence)
(Zimmerman & Zahniser, 1991). People seem willing to act when they are involved, feel
connected, and are knowledgeable about the problem. These three components of
empowerment and action were found again in a study of voluntary counselors to gay–
straight youth (Valenti & Campbell, 2009).
Advantages and Disadvantages of Citizen Participation
Active participation in change efforts usually is highly motivational (Chavis et al., 1992;
Yates & Youniss, 1998). People are more likely to accept change that they themselves have
generated (Duffy, 1991). Involved individuals are also likely to know the problems that
need addressing because they have lived with the problems. For that same reason, this type
of community participation often helps build a sense of community (Levi & Litwin, 1986)
or social consensus and cohesiveness (Riger, & Wandersman, 1984 Heller, Price,
Reinharz,). Feeling a sense of community also increases participation in grassroots efforts
(Chavis & Wandersman, 1990). Exposure to information, fair treatment in discussions,
and being a part of an information-gathering process increased citizens’ sense of political
involvement (Eggins, Reynolds, Oakes, & Mavor, 2007).
Another advantage of citizen participation is that the average citizen often participates
in change efforts for little pay but with enthusiasm and a sense of responsibility (Selznick,
2000). For example, it is no secret that many community organizations are dependent on
volunteers. The Beacon Hill Institute for Public Policy Research (1997) conducted a survey
of executive directors of private charitable organizations and found the following results:
Ninety percent of the directors say that volunteers are crucial to efficiency because
they save the organization money.
Seventy-three percent said that the time and money spent on training volunteers was
well worth the effort.
Seventy-seven percent said they can depend on their volunteers.
As desirable as this type of participation is, it is not without its pitfalls (Barrera, 2000).
Christensen and Robinson (1989) reported that not every citizen wants to participate.
Although it is easy to level a charge of apathy against nonparticipants, the rights of those
who prefer not to be involved need to be respected. When asked about their willingness to
participate for a future unidentified topic, citizens in Italy based their answers on the costs
and benefits of returning and the pleasantness of the task, not on a sense of community.
Without a clear and defined topic of personal interest, people did not intrinsically want to
participate (Eggins et al., 2007).
Finally, because they often are not made up of all members of a community, but
rather of a select few, citizen groups can fail. If these individuals are not representative of
the affected groups or the population at large, the solutions might not be viable or
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1.
2.
3.
4.
5.
6.
acceptable for everyone. Recall our discussion of social justice in Chapter 1. The process by
which change is pursued can determine whether the outcomes are perceived as just. Thus, if
this small group of activists is not representative of the larger constituency, then the large
group might distrust or reject the smaller group (Worchel, Cooper, & Goethals, 1991),
which also causes failure. Participants in community intervention need to recognize the
politics of the conflicting goals and interests of the various involved parties (Riger, 1989).
Similarly, if the efforts cost more than any benefits that could accrue, individuals are likely
to be inactive (Prestby et al., 1990; Wandersman & Florin, 2000). Citizen participation
occurs when the benefits of action are apparent and the costs of such action are
outweighed by the perceived advantages of engagement. We see in Table 5.2 the types of
things that make for successful participation in block associations.
TABLE 5.2 Summary of Characteristics for Block Associations That Continue
Greater proportion of residents join
More activities and participation opportunities
More officers and committees
More methods of communication, more personalized outreach, more proactive in
recruitment and leadership training, used consensus and formal decision making
Established ties with external resources
More incentives for membership
Source: From Wandersman, A., & Florin, P. (2000). Citizen participation and community organizations. In J.
Rappaport & E. Seidman (Eds.), Handbook of community psychology. New York: Plenum, p. 259.
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NETWORKING/COLLABORATION
One means for fostering community development or community change is to develop
enabling systems (Chavis et al., 1992). Enabling systems are vehicles whereby multiple
community initiatives can be simultaneously mobilized, supported, and sustained in an
efficient and effective manner by developing specified links among the social actors (Chavis
et al., 1992). Chavis (1993) has offered a good example of enabling. He empowered many
community groups and organizations to conduct their own program evaluations by
teaching them to design, conduct, and analyze research. He has therefore made them
independent of the need for reliance on professionals in the future for their research needs.
Networks (Chavis et al., 1992; Fischer, Jackson, Stueve, Gerson, & McAllister-Jones,
1977; Sarason, Carroll, Maton, Cohen, & Lorentz, 1977) are confederations or alliances of
related community organizations or individuals. Members of networks regularly share
funding sources, information, and ideas with one another. Because they network their
information and sometimes their clients, their futures are more secure. Another advantage
is that clients are less likely to fall through the cracks in the service system. Granovetter
(1973, 1983) believed these advantages accrued to those who were even weakly tied to a
network. The advantages of strong networks were their durability and usefulness in
providing resources to their members (they would share food and babysit for each other).
However, the weak ties could serve as bridges to other networks and therefore extend the
spread of information and influence beyond the usual strongly held relationships. If one of
the functions of networks was the ability to access new information and wield influence
beyond the usual circles, then the weak networks have their place in the creation of
extended communities.
From the sociological literature comes the concept of social capital (resources made
available to individuals as the result of their placement within a social structure). “Like
other forms of capital, social capital is productive, making possible the accomplishment of
certain ends that in its absence would not be possible” (Coleman, 1999, p. 16). Through
relationships, the individual is able to do more. This concept is operationalized and used to
demonstrate the importance of social ties/networks to the development of building and
community organizations (Saegert & Winkel, 2004). Saegert and Winkel’s data suggest
that there are advantages of frequent face-to-face contact, even if the contacts are brief.
Bonding is important, even if it is not at a high level. The concept of networks is a way of
linking the individual to larger social systems. Therefore, the creation and understanding of
networks seems to be an especially relevant area for community psychologists.
At a higher systems level, umbrella organizations are created to achieve this
networking among agencies or systems. This overarching organization oversees the health
of member organizations. Again, they act as clearinghouses for information that members
can share. A concrete example might prove useful. United Way of America is perhaps one
of the best-known umbrella organizations in the United States. United Way, through
charitable contributions, is known for its financial support of community agencies that
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might otherwise flounder. In addition, it provides community service agencies with office
supplies, furniture, and other desperately needed tangible provisions. However, United
Way also offers expert consultation on fund raising, staff training, development of
publications, and other issues crucial for community agency survival.
Networking has been used to build collaborative capacity for international participants
in the European Union (García-Ramírez, Paloma, Suarez-Balcazar, & Balcazar, 2009).
Following a protocol derived by Fetterman (2001), participants from three European
nations (Spain, Belgium, Italy) worked together to increase their internal collaborative
capacity (i.e., communicate and work with other members of the network) and their
external collaborative capacity (communicate and work with those who were not members),
using Foster-Fishman, Berkowitz, Lounsbury, Jacobson, and Allen’s (2001) framework to
guide their work.
CASE IN POINT 5.2
Online Networks for Ethnic Minority Issues
A complaint of many ethnic minority psychologists is that there are not very many of them
and they are widely dispersed geographically. Outside of large urban centers such as New
York, Chicago, San Francisco, and Los Angeles, there are small numbers of psychologists of
color. If there is a question regarding a particular research or clinical issue relating to race or
racism, the likelihood of finding someone within a day’s drive is small for many parts of the
United States. It can feel lonely at times and certainly isolated.
With the development of ethnic minority psychological associations (Asian American
Psychological Association, Association of Black Psychologists, National Latina/o
Psychological Association, Society of Indian Psychologists) and the Society for the
Psychological Study of Ethnic Minority Issues (Division 45 of the American Psychological
Association [APA]), psychologists who are interested in these kinds of issues can join online
discussion groups and connect with each other. Once on one of these association groups,
access to the network of psychologists and graduate students is no more than an e-mail
away. These networks are active in sending out information on events, funding
opportunities, personal victories, and occasions for sadness. Job announcements that target
those interested in ethnic minority issues can be sent out to the entire network with no
delay. In turn, questions are asked and answered on the discussions. Who knows a good
speaker on microaggressions? What would be a good reading on diversity issues in general?
What do people think of a particular psychological test? It is like having access to all who
are in the network. Typically, news travels fast. Although the geographic dispersion of
psychologists of color continues, the linkage provided by the Internet has provided the
kinds of advantages discussed within community psychology.
They first built a good relationship and then worked on building the collaborative
capacities. Finally, they evaluated their efforts and discussed future directions for this
program. Yo u can read of another instance of good network building in Case in Point 5.2.
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Issues Related to Networks
Networks and umbrella associations offer ongoing support to participants, reciprocally
share ideas and resources, provide role modeling for each other, and offer accessible
resources to participants (Sarason et al., 1977). For instance, these systems allow small
community agencies to share information about grants, staff-training opportunities, and
resource libraries; exchange successful publicity ideas; refer clients to each other’s services;
and build lobbying coalitions. Thus, the health and success of each smaller service is
assisted or enabled. Collaborative efforts across agencies and within communities are a well-
documented community-level intervention (Foster-Fishman et al., 2001). Wolff (2010)
challenges the practitioner to understand, respect, and use the political and the spiritual
resources abiding within the communities in which they work.
Enabling systems and networks represent a form of social change because the new
systems and networks build on existing resources and develop more productive and creative
relationships between already existing services. In other words, such systems reweave the
social fabric of what might otherwise be a more tattered and frayed community and its
services and thus ensure survival and continued growth of the services.
Advantages and Disadvantages of Networks
Besides enhancing the viability of many services, networks are advantageous because they
ensure that important systems come to know each other better, find effective ways to work
together, and learn to plan or advocate for change in a collaborative rather than competitive
manner (Wolff, 1987). Likewise, enabling systems better ensure that resources are equitably
distributed (Biegel, 1984), help reduce community conflict (Christensen & Robinson,
1989), and focus collective pressure on public policy makers and other decision makers
(Delgado, 1986; Seekins & Fawcett, 1987). Networks also enable related services to detect
cracks in the service system. Cracks are defined as structural gaps in the service systems and
are exemplified by missing or inaccessible services and missing information (Tausig, 1987).
Granovetter (1973, 1983) described some of the problems of networks that are so strong
that they do not structurally encourage linkages to others. If the networks are without
connections to other networks, they exclude others and lose the information and access to
resources that others might provide.
Few authors have addressed other disadvantages of umbrella organizations, even
though several disadvantages exist. For one thing, private-sector businesses might feel
threatened by and perhaps launch a successful attack against the collective power of activist
community organizations (Delgado, 1986). Similarly, when umbrella organizations grow
large, they develop their own set of problems in terms of bureaucracy, conflict, and
expense.
Another disadvantage is that when an umbrella organization becomes a controlling,
parental organization, member agencies can become dissatisfied. The authors know, for
instance, of one rural domestic violence program that broke from a strong countywide
coalition of churches over staffing and funding issues, despite the program’s already
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precarious existence. The bad feelings between the smaller domestic violence program and
the larger parent organization resulted in the establishment of a second, redundant
domestic violence program in the same geographic region.
Another possible disadvantage of community coalitions is that different community
services as well as the whole community may be in different stages of development or
readiness for change (Edwards, Jumper-Thurman, Plested, Oetting, & Swanson, 2001).
The new services need staff training; the older ones may be seeking to expand their client
bases. Coordinating the different developmental needs of member organizations can be
difficult for the parent organization. Finally, if the reach of the association grows beyond
one particular community’s boundaries because member organizations have satellites in
other geographic areas, existing associations in neighboring communities may feel
threatened and subvert each other’s purpose. At a personal level, those who network are at a
distinct advantage over those who do not. Given the work on social capital, established
residents of the “neighborhood” are more likely to be participants and, by definition, may
glean the benefits of the network.
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CONSULTATION
In the opening scenario for this chapter, there was a neighborhood in crisis, with high
crime rates, high transiency, and a general sense of alienation among its residents. An
individual within the neighborhood or some small group of neighbors might have also
considered calling a consultant to help them in solving their problems. Some communities
write grants, get funding, and hire community organizers or professionals to provide
expertise in community functioning and interventions. Sarason (1976b) believed that one
of the advantages a community psychologist had over others was access to information.
Professional change agents or expert consultants seek to create social change through
assessment, modification, and improvement. Consultation is viewed as one of the basic
ways in which community psychologists serve in their communities (Lavoie & Brunson,
2010).
A consultant or professional change agent is someone who engages in collaborative
problem solving with one or more persons (the consultees), who are often responsible for
providing some form of assistance to another individual (the client) (Sears, Rudisill, &
Mason-Sears, 2006). Consultants are often professionals well versed in scientific research.
They are typically called on to conduct program evaluations and needs assessments for
community organizations. The traditional consultant provides leadership to organizations
who are interested in demonstrating the successes of their efforts or improving their service
delivery.
However, the community model is one that is less hierarchical and expert driven.
There is more a sense of collaboration and empowerment to the processes (Maton,
Seidman, & Aber, 2011; Serrano-Garcia, 2011; Zimmerman, 2000). The development of
relationships (Kelly, 2006) or a type of “joining” with the “consultants” and the
community (Lorion, 2011) are more characteristic of most community psychology
consultations. This orientation directs the types of consultative actions taken.
Community psychologists seem uniquely qualified to be consultants to community
groups because they possess skills in community needs assessment, community organizing,
group problem solving, and action research. The community psychologist is also likely to
focus on the social systems and institutions within a community rather than on individuals
(Nelson & Prilleltensky, 2010). Community psychologists bring a “more consciously and
expertly applied” operation of these phenomena, given their familiarity with past research
and former attempts to realize the possibilities of a better community (Sarason, 1976b, p.
328). This creates exciting opportunities for community psychology consultants to work
with community members to bring about constructive, community-directed change.
Issues Related to Consultants
An important issue that communities must consider is cost. If the consultant is paid, is that
a good use of limited resources? One way the field has tried to answer questions related to
the expense of consultants is evaluating whether they really help the client. One early study
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of the use of consultants was conducted by Medway and Updyke (1985), who reviewed the
literature on outcome of consultations. In the better designed studies, the researchers found
that compared to control groups (e.g., clients who did not have consultants), both
consultees and clients in the intervention groups (where consultants were used) made gains
in solving their problems or promoting change as measured by such things as attitude
scales, observed behaviors, and standardized scores. In the control groups (in which no
consultants were used), there were fewer of these improvements. This literature review
therefore offers statistical evidence for the value of consultants. Hylander (2004) provided a
more recent study of the impact of consultation in Sweden using a mixed methodology,
which included assessing changes such as those mentioned in the Medway and Updyke
study, but also conducting focus groups where consultants and consultees were able to talk
about the ways in which changes were connected to the work of the consultant. Her study
provided additional data on the benefit of consultants. Studies such as these provide
evidence that consultation is one viable way that community psychologists can collaborate
successfully in community change efforts.
Weed (1990) identified several steps for community psychologists acting as
consultants to primary prevention programs that are adaptable for almost all change agents
—expert or not. Homan (2010) echoed many of these steps in discussing methods for
promoting community change. The first step is defining the goals to be accomplished. The
second step is to raise the awareness of the individuals in the setting under consultation and
then to introduce the new program or research. At this point, other, related organizations or
communities can be networked for collaboration, support, and learning about new
techniques and funding sources. Consultants also need to collaborate on effective methods
for evaluating changes. Favorable evaluation justifies the money, time, and effort expended.
Evaluation also leads to modification and fine-tuning, should that be necessary.
Unfortunately, evaluation is a step sometimes forgotten in many change situations.
Without evaluation, how would people know if the change worked and whether it ought to
be repeated?
Sears and colleagues (2006) discussed a critical issue related to consultation: trust. It
takes time before consultants, who are often not members of the community with whom
they are working, to achieve the trust required to act in the role of consultant. It can in fact
take years before consultants’ ideas are viewed less skeptically by community members. As
outsiders, community members often rightly question whether consultants truly
understand their community and its goals and whether they will suggest methods that
reflect such an understanding. Serrano-Garcia (1994) explained that there are often
unequal power relationships between community members and outside professional
consultants, with the professional having more power because of specialized knowledge and
other resources. She issued a challenge to professionals who act as community consultants
to “establish more equitable professional–client relationships” (p. 17) by means of
collaboration and empowerment.
This discussion illustrates the fact that consultants, especially when not members of
the communities with whom they consult, must earn the trust of the community and not
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assume that it will be implicitly given. This issue is discussed further in the next section.
Advantages and Disadvantages of Consultants
There are several advantages to expert consultation. The first is obvious—the professional is
an expert at what he or she does. The professional change agent has been specially trained
and has the knowledge base on which to make wise decisions. One not-so-apparent
advantage is that the consultant is a neutral, presumably more “objective” person. Because
the consultant is not embroiled in the presenting problems and should have no vested
interest in the community, particular members, or the organization itself, he or she can
make unencumbered, unbiased judgments and recommendations.
Consultants also generally take a long-term approach to problem solving. Individuals
in the community or organization often focus on short-term issues because they are living
with them day to day. For the continued health of the community or organization, a long-
term approach might be best. As stated earlier, too many community groups fail quickly;
fast, ineffective fixes may be one of the reasons. For this reason, most consultants attempt
to assess the overall health and well-being of the organization with which they consult, not
solely focus on the problem that they were called in to address (Dougherty, 2000).
Finally, if a consultant is experienced, she or he comes with a vast array of ideas, past
successes, and relevant ideas because of experiences with past but similar situations.
Consultants should neither betray nor create a conflict of interest with past clients, but
previous experiences can help them find common ground that might be useful to similar
communities or organizations.
Despite these somewhat apparent advantages, professional change agents are not
without disadvantages (Maton, 2000); one is cost. Cost can be a major burden and can
thwart the best-laid plans of any community or organization needing expert assistance.
Ideally, some community psychologists acting as change agents would consider pro bono or
voluntary consultations. The American Psychological Association (APA) encourages pro
bono work by psychologists. Community psychologists may serve as consultants to the
organization and write grants for independent funding of their work, offering awareness of
the literature and knowledge of the research process (Suarez-Balcazar et al., 2004), or help
in reframing the task or the question based on the expertise that they may bring to the
process (Kelly et al., 2004). When the consultant and the community are viewed as equal
and reciprocal partners in the process, the community and the consultant are better
informed and the problem more effectively addressed.
However, developing cooperation from all involved in the consultation can be
challenging and largely dependent on the extent to which community members can trust
the consultant. Outside consultants sometimes inspire fear (of job loss or criticism),
defensiveness, and resistance to change. Often this is because the organization’s leadership
has hired the consultant to help solve a particular problem. The employees of the
organization may or may not be aware of the problem or may see the consultant as
management’s “henchman” or “henchwoman.” For this reason, consultants are often
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1.
2.
3.
4.
encouraged to assess the overall well-being of the organization, which allows them to
identify problems that may or may not be related to the original issue. Also, consultants
might want to consider using less direct or nondirective assessment techniques to avoid
these problems (Sears et al., 2006).
In addition, consultants must state up front what type of confidentiality community
members can expect in work they do with the consultant. If a community organization’s
leaders call in a consultant to resolve conflict among staff within the organization, it will be
important to be clear about whether the leaders will be privy to the information gathered in
fact-finding conversations the consultants have with the staff members. If staff members
assume they are speaking in confidence and then learn that the consultant was contracted
to share details of the assessment with the leaders, it may damage the working relationship
between the consultant and the staff for the remainder of the project. Another issue that
affects consultation work is that consultants’ contacts with their clients are often time
limited. They need to quickly assess the issues, assist in the development of solutions and
their implementation, and foster maintenance strategies in a short period of time. Often,
the issues on which they are asked to consult are complex compared to the amount of
available resources, including time. For example, many communities and their
organizations grow haphazardly rather than in a planned fashion. Thus change can be
difficult, if not impossible. Some problems defy solutions, or at least would require a total
reorganization of the structure of the system (Sarason, 1978). It does also sometimes
happen that organizations ask consultants to help them with problems that are outside the
competence of the consultant. This can be avoided if consultants carefully match their skills
and expertise to client situations (Dougherty, 2000).
Finally, clients sometimes hold high and unrealistic expectations of what a consultant
can do. Other clients may use the consultant for their own misleading purposes, especially
when there are conflicting views about what ought to be done. In these situations, the
ethical consultant will probably leave clients feeling disappointed. Again, careful intake by a
consultant to ensure that his or her expertise fits the clients’ issues can help. The consultant
is wise to be aware of the purpose for which he or she was hired and whether there are
multiple and competing interests at work. Bloom’s classic principles, found in Table 5.3,
provide useful points to community consolidation.
TABLE 5.3 Bloom’s Principles to Guide the Development of Community
Programs
Regardless of where your paycheck comes from, think of yourself as working for the
community.
If you want to know about a community’s mental health needs, ask the community.
As you learn about community mental health needs, you have the responsibility to
tell the community what you are learning.
Help the community establish its own priorities.
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5.
6.
You can help the community decide among various courses of action in its efforts to
solve its problems.
In the event that the community being served is so disorganized that representatives
of various facets of the community cannot be found, you have the responsibility to
help find such representatives.
Source: From Bloom, B. L. (1984). Community mental health: A general introduction. Monterey, CA: Brooks/Cole, pp.
429–431.
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COMMUNITY EDUCATION AND INFORMATION DISSEMINATION
The terrorized citizens of the neighborhood from the opening example would have
benefited from information on police communication procedures and response rules. They
soon came to understand the frustration of law enforcement over the lack of willing
witnesses, which led to ineffective evidence for prosecution. With the support of the police,
the neighborhood learned what they needed to know and how to contact the police in a
timely way. Sharing this type of information made for a more effective neighborhood–
police partnership.
Information dissemination and community education remain vital parts of social
change efforts. In fact, some community psychologists have challenged their colleagues to
renew efforts to disseminate useful information and innovative educational programs as a
method of addressing social problems (Nelson & Prilleltensky, 2010). Let’s address these
two related topics one at a time.
Information Dissemination
Just what is meant by information dissemination (Mayer & Davidson, 2000) in
community psychology? As you now know, community psychologists seek to prevent,
intercede in, and treat (if necessary) community problems with what are generally
innovative programs. Typically, information dissemination refers to the sharing of
successful programs or beneficial information that has been used to address community
problems with new populations. For example, in the creation of the CeaseFire/Cure
Violence program discussed earlier in this chapter, researchers who had worked in disease
transmission prevention programs used information about “what worked” about those
programs and modeled CeaseFire/ Cure Violence after those ingredients of success. If
innovative prevention programs are researched and found to be successful, but the results
are never shared with or adopted by other communities, the results are of limited use
(Nelson & Prilleltensky, 2010). In addition, it makes sense to not reinvent the wheel. If
researchers can identify “best practices” in preventing violence, risky sexual behavior, or
other community problems, then it makes sense to take that information and disseminate it
to others who are trying to curb similar problems in other communities. Thus,
dissemination of information can save time, money, and effort. However, there has been
much debate in the literature about whether successful programs developed in one
community can be effectively transferred to other potentially dissimilar communities.
Adopters of innovations from community psychology need to be careful in their translation
efforts. Although one could argue the importance of being faithful to the initial program,
especially to the mechanisms that caused change, there may also need to be some
reinventing or modification of the program to fit the unique needs of the community
trying to use the program, given that not all settings are the same (Trickett et al., 2011).
We discuss this issue at greater length in the section on issues in information dissemination.
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Community Education
Community education is a concept related to information dissemination. However,
community education is an intervention approach that often integrates psychotherapeutic
and educational components (Lukens & McFarlane, 2006; Lucksted, McFarlane,
Downing, Dixon, & Adams, 2012) that can be used in both treatment and preventative
contexts. Community education may be a focus of some programs that ultimately are
found to be successful and disseminated into other community contexts. However, not all
community programs involve community education, as will become evident as you read
subsequent chapters of this book. For example, some successful programs aimed at reducing
car accidents involve policy changes such as making seatbelts mandatory, whereas others
may emphasize education about safe driving habits.
Some community education programs that involve psychologists as consultants will be
aimed at teaching skills or knowledge that is related to specific disease prevention. Often
these programs are referred to as “psychoeducation.” Psychoeducation embodies a paradigm
of empowerment and collaboration that stresses competence building and coping and that
builds on the strengths of the community—all valued components of a community
psychology approach. Rather than solely focus on the amelioration or prevention of
symptoms, psychoeducation focuses on health promotion, viewing clients as learners and
psychologists as teachers (Morgan & Vera, 2012).
Psychoeducation has become a widespread approach to the treatment of a variety of
psychological problems. For example, recent reviews of the literature and meta-analyses
have been published on the use of psychoeducation in the treatment and/or prevention of
eating disorders (Fingeret, Warren, Cepeda-Benito, & Gleaves, 2006), bipolar disorders
(Rouget & Aubry, 2006), teenage suicide (Portzky & van Heeringen, 2006), and bullying
(Newman-Carlson & Horne, 2004). As a result of the accumulating evidence,
psychoeducation is now seen as an important component of treating a variety of medical
problems where it is used to enhance treatment compliance and prevent disease
progression.
One example of a successful psychoeducational program that was able to demonstrate
a reduction in suicidal behavior was Signs of Suicide (SOS) (Aseltine & DeMartino, 2004),
whose focus was on peer education and intervention. Peer intervention as a focus of
adolescent suicide prevention programs is rooted in studies which have found that
adolescents communicate distress more often and more easily with their friends than to
family members or other concerned adults (Kalafat & Elias, 1995). The content of SOS
includes providing information about incidence rates of suicide attempts and completions,
presenting education on risk and protective factors, and describing what is called the
“suicide process.” The suicide process involves the progression of suicide from ideation (i.e.,
thinking about suicide) to attempts (i.e., efforts to end one’s life) to completion (van
Heeringen, 2001). The model is used in psychoeducation because it implies the possibility
of intervention and help being valuable at multiple points in the process.
The peer intervention component of the program teaches participants to recognize
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warning signs of suicidal ideation and behavior and teaches appropriate strategies for
intervention (i.e., active listening, encouragement of help seeking). The program also
identifies school- and community-based resources such as school counselors or suicide
hotlines. The objective of this program is to help adolescents better monitor their friends
and peers for signs of suicidal ideation (or intent to attempt suicide) and to increase the
likelihood that such signs will be reported to adults capable of providing help.
Although psychoeducational suicide prevention programs may not be optimal for use
with acutely suicidal teens themselves, such programs appear to be an appropriate
intervention to change peers’ awareness and ability to identify those among their peer group
who may be at risk for suicide (Portzky & van Heeringen, 2006).
Whenever information from community psychology is shared with community
members, be it through information dissemination or through community education, its
main purpose should be to improve the community, promote prevention, and empower
community members to shape their own destinies (Fairweather & Davidson, 1986). These
efforts can also be used to direct action in a community, as well as to inform those in a
position of power (the gatekeepers) about the need for change and share ideas for action
plans (Levine, Perkins, & Perkins, 2004). With advances in technology—for example,
distance learning—diverse and geographically distant communities can be educated and
empowered, and information can be disseminated more easily than in the past (Kreisler,
Snider, & Kiernan, 1997).
Issues Related to Information Dissemination
Several important issues need to be carefully considered by community psychologists
hoping to disseminate information about innovative programs (Mayer & Davidson, 2000).
The dominant paradigm of psychology’s efforts to prevent and treat community
problems such as violence or crime has been to disseminate “best practices,” or those
programs that have evidence to support their success. However, there is a competing
paradigm that is gaining support in the community of scientists working to strengthen
community interventions in the United States (Trickett et al., 2011). This “best process”
paradigm is in many ways a response to the issues and critiques that have been raised in past
dissemination efforts.
One important critique of existing efforts to disseminate program information is that
they often treat knowledge of the host community as secondary to the development of the
intervention (Trickett et al., 2011). In other words, the process focuses more on what
conditions need to be in place to make the program faithful to the original prototype rather
than understanding the unique needs of the new community and seeing the program as an
event that happens within the community. An alternative perspective, and one espoused in
the newer paradigm, is that community interventions are conceptualized as system events
(i.e., as complex interactions between the structure, processes, and goals of the intervention
and those of the community itself) that emerge from and are defined by knowledge of the
community. Hence, community psychologists must begin by gaining knowledge of the
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community and then shaping programs to reflect the uniqueness of the community.
Trickett and his colleagues (2011) call this orientation a “best process” orientation, as
opposed to the “best practice” emphasis that has characterized most community
interventions in the field of psychology.
The goal of community interventions should then be community capacity building, as
opposed to program participant changes per se (Trickett et al., 2011). This is not to say
that outcomes such as increases in skill sets or information are irrelevant. However,
community interventions should be aimed at developing the community’s capacity to
address structural and/or policy factors that have served as impediments to healthier
functioning. One could argue that a program that is imported (one that has been
disseminated) from another community does little to help the community in the long run if
its success is solely connected to external resources funding the program (e.g., a grant).
A final issue related to the use of information dissemination as a component of social
change is that transferring information from one context to a new community must include
cultural sensitivity. The new paradigm of Trickett and associates is one defined by cultural
relevance. “Culture is not seen as something to which interventions are tailored; rather,
culture is a fundamental set of defining qualities of community life out of which
interventions flow” (Trickett et al., 2011, p. 1412). What works for one ethnic group
might not work in another. There is a Handbook of Racial and Ethnic Minority Psychology
(Bernal, Trimble, Burlew, & Leong, 2003) and a sixth edition of Counseling across Cultures
(Pedersen, Draguns, Lonner, & Trimble, 2008), to name just two of the many texts dealing
with this issue. However, it is not sufficient that community interventionists learn about
communities by reading books.
Culture is always changing, and there is considerable variability within any cultural
group; moreover, culture is inescapable in the community intervention process,
affecting the nature of collaboration, the meaning of constructs, the equivalence of
[outcome] measurements, and the salience of intervention goals. (Trickett et al., 2011,
p. 1413)
This sentiment echoes Pederson (2008), who warns of the dangers of oversimplifying
“multicul-turalism.” Trickett and colleagues emphasize the importance of investigator
immersion in the daily life of the community of interest, to learn about their deep cultural
lifeways and thoughtways. Such a perspective reinforces the assertion that interventions are
collaborations and are likely to fail if they are not conceptualized as such. How might
culture affect the dissemination of information or the importation of a specific community
intervention program? As one example, in considering mentoring relationships, Darling,
Bogat, Cavell, Murphy, and Sánchez (2006) noted that culture and ethnicity played a
significant role in determining the patterns of who was perceived as a mentor and the
nature of these relationships. In some cases, parents and extended family members were
important; in other cases, the family was on an equal par with nonfamily members; in still
other cases, certain family members were the farthest thing from a perceived mentor. A
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community intervention program aimed at increasing community youths’ access to
mentors would need to be aware of how the targeted community youths envisioned the
potential of various people to act as mentors. Such cultural variations should be carefully
considered in the derivation of these programs.
FIGURE 5.2 Active Life Expectancy at Age 65 by Education and Race
Source: From Kaplan, G. (1994). Reflections on present and future research on bio-behavioral risk factors. In S.
Blumenthal, K. Matthews, & S. Weiss (Eds.), New research frontiers in behavioral medicine: Proceedings of the
national conference. Washington, DC: NIH.
Issues Related to Community Education
Community education as an intervention strategy brings the advantages of affecting large
groups in short periods of time. However, as in the discussion of issues in information
dissemination, community education efforts bring the challenge of understanding one’s
audience and how to most effectively reach them and bring about the desired change. A
community psychology may inform these efforts, thus making them more effective.
To be most cost effective and to capitalize on the benefits of group dynamics, most
community education and/or psychoeducation occurs with groups of individuals who have
certain things in common. For example, parenting groups, stress management workshops
for police officers, job search clubs for the unemployed, and biofeedback training for heart
patients are examples of groups of individuals who share characteristics, have common
needs, and can provide important support to one another. The objectives of many
psychoeducational programs are often to promote healthy development or adjustment,
rather than to solely stave off psychopathology (Carlson, Watts, & Maniacci, 2006).
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Although the prevention of pathology may be an added benefit of the interventions, they
are often times not evaluated based on such criteria.
For example, a good parenting program might be based on learning theory, offered to
parents early in the process (i.e., while their children are very young), and have as goals to
increase parents’ knowledge of the developmental needs of their children and to encourage
the use of positive parenting techniques (i.e., positive reinforcement) (Carlson et al., 2006).
A long-term benefit of such a program may be to reduce incidents of child abuse. If the
program was offered to parents who might be at risk of such behavior, it would be an
example of secondary prevention. However, it might also be able to demonstrate its
effectiveness by tracking changes in participants’ knowledge base and intentions regarding
parenting. In the case of psychoeducation that is used to increase compliance to medical
treatment, evaluations may also be based on incidence rates of relapse, disease complication,
and other measures of compliance (Morgan & Vera, 2012).
One of the most critical characteristics of effective psychoeducation, however, is its
perceived relevance to the participants (Reese & Vera, 2007). This perception is often a
function of the extent to which the program has cultural relevance to the targeted audience.
Cultural relevance refers to the extent to which interventions are consistent with the values,
beliefs, and desired outcomes of a particular group of constituents such as parents
(Kumpfer, Alvarado, Smith, & Bellamy, 2002; Nation et al., 2003). Nation and colleagues
argued that program relevance is a function of the extent to which a constituency group’s
norms, cultural beliefs, and practices have been integrated into program content, its
delivery, and evaluation. Kumpfer and associates argued that including cultural relevance in
psychoeducation programs improves recruitment, retention, and outcome effectiveness.
One of the superficial ways that cultural adaptations have been made in many past
community education efforts has been what Resnicow, Solar, Braithwaite, Ahluwalia, and
Butler (2000) termed surface structure modifications. Such efforts could include translating
prepackaged intervention materials into the primary language of the participants, or hiring
program staff that have similar ethnic backgrounds to the participants. Such modifications
may be one important aspect of cultural adaptation. It may be highly advantageous to have
program participants communicate with program staff in their first languages or to interact
with staff of the same ethnicity and/or gender. However, when program content does not
reflect the reality of the participants’ experience, interventions delivered by racially or
linguistically similar staff will not make the program relevant or, more importantly,
effective.
Rather than surface modifications, it is the “deep structure modifications” (Resnicow
& Braith-waite, 2001) that often determine the cultural relevance of community education
programs. If education programs can be adapted to their target population, they have
achieved measurable successes (Hawkins, Kreuter, Resnicow, Fishbein, & Dijkstraa, 2008).
Often, the adaptations required for a program to be culturally relevant result in a program
that may be substantively different from its prototype. Reese and Vera (2007), Lerner
(1995), and Reiss and Price (1995), among others, have suggested that the most effective,
culturally relevant programs include the target program participants in the planning,
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implementation, and evaluation of the program. If this approach is followed, not only may
the content of the program become more relevant, but its very structure may also look
significantly different from a program designed for a culturally dissimilar population.
Although a preponderance of the literature suggests that a relationship with the target
community is a key to acquiring cultural knowledge, there is still a need for large-scale
epidemiological research that identifies risk factors and how they affect particular
communities. Such studies must be designed carefully and their findings examined
responsibly so as to assist community educations researchers and practitioners in more
accurately understanding the communities in which they work (Reese & Vera, 2007).
One example of a community education model that was designed to be culturally
relevant in its content was the Choices program (Vera et al., 2007). Choices is a
psychoeducation program that was developed through a collaboration with a public middle
school in a large Midwestern city that serves low-income children of color. The goal of the
program was to address the normal challenges of adolescence that are relevant to youth of
color and to enhance protective factors that are related to the array of problematic
outcomes for which urban youth of color may be at risk. The program was designed from a
competency-promotion perspective, guided by Positive Youth Development theory (PYD)
(Catalano, Bergland, Ryan, Lonczak, & Hawkins, 1999). PYD theorists contend that
children benefit from interventions that enhance their developmental competencies (e.g.,
social, emotional, academic) independent of the number of risk factors to which they are
exposed. This type of program is classified as a primary prevention approach because it is
universal in scope, not focused on particular youth who might be more likely to develop
mental health problems in the future (Romano & Hage, 2000). Case in Point 5.3 is just
such a youth program.
CASE IN POINT 5.3
The Choices Program
The Choices Program’s goals and curriculum topics were designed with the input of a series
of separate focus groups with 12- to 14-year-old urban youth of color, their teachers, and
their parents. In these focus groups, constituents were asked to discuss their aspirations for
the community’s youth, the strengths of the community, the potential barriers to success,
and their ideas for designing a program that might address these issues. Our confidence in
the validity of the participant input was high because of a 10-year relationship between the
program leader and the school. The focus groups highlighted issues facing the community
(e.g., temptations to drop out of school, lack of hope about the future, a lack of teacher
efficacy in addressing the emotional needs of the kids, parental stressors such as inter-
generational conflict, or working multiple-shift jobs). Thus, the resulting program had
components that addressed the needs of youths, their teachers, and their parents.
The youth program’s overall objective was to increase youth’s social and academic
competencies. We specifically aimed (a) to create opportunities for positive identity
development to enhance social and academic self-efficacy by promoting positive self-
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concepts and cultural identity; (b) to enhance self-awareness and empathy by focusing on
productive ways to express difficult emotions (e.g., being disappointed, angry, hurt) and to
respond to others’ feelings; and (c) to increase students’ self-efficacy in responding to peer
pressure, which is important in disengaging from and avoiding situations that can
compromise well-being. Another aim of the program was to teach communication skills to
increase the youth’s ability to avoid nonproductive and risky conflict with peers and adults.
Finally, we aimed to enhance the youth’s academic and career aspirations by examining
social barriers, enhancing study and organizational skills, and increasing their knowledge of
academic resources in the community.
For the parent program, the goals were (a) to present information on the challenges of
adolescent development and the stressors of parenting, (b) to discuss strategies to enhance
communication between parents and their children during adolescence, and (c) to present
ideas for providing academic and emotional support in the home. For the teachers, we
aimed (a) to provide group consultations that would help teachers identify the
psychological issues and needs of their students, (b) to brainstorm resources that would
help the academic progress of their students, and (c) to better understand the multiple
stressors that their students’ parents faced, which often affected their ability to participate in
the education of their children.
The program was delivered over an 8-week time span, with sessions held during the
school day for the youth, before school for the teachers, and after school for the parents.
The program was evaluated both qualitatively and quantitatively, and both program leaders
and school constituents reviewed the content and outcomes of the program and used that
information to make changes for future programming.
One of the limitations of community education is that many of the underlying causes
of problems are not directly affected. For example, the underemployment of parents that
resulted in them working multiple shift jobs and being less available to their children was
not modified in the aforementioned program. There is a need for community interventions
to be directly responsive to systemic barriers to the well-being of community members
(Homan, 2010; Trickett et al., 2011) One of the most powerful ways to affect systemic
factors is through public policy involvement.
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PUBLIC POLICY
If the besieged neighborhood in our chapter’s beginning example had decided to lobby
legislators to get particular laws passed that would make it easier to arrest the drug dealers
in the neighborhood, or had programs implemented that would address the crime in the
area, such social change would be pursued through public policy changes. Public policy
advocacy is an example of a community intervention that addresses the contextual barriers
to community well-being—in contrast to the approach of community education, which
often focuses on changing community members themselves. Though sometimes a lengthy
effort, a shift in policies can bring about long-lived changes in the way people live and serve
as the most powerful forms of prevention. Public policy interventions are direct
interventions at the systems level that require a willingness to participate in the legislative
process.
Consider: Did you vote in the last election? It is often surprising how many citizens,
college students in particular, do not vote. Voting, drafting legislation, and lobbying for
particular interests are actions that change (often dramatically) our national and local social
agendas. For citizens and community psychologists alike, participating in public policy
endeavors opens a “window of opportunity” (Nelson & Prilleltensky, 2010) for what can
often be sweeping social changes.
Just what is public policy? The aim of public policy is to improve the quality of life
for community members. Although the term is often used for government-mandated
legislation, it can refer to policy at a specific agency or at the local community and state
governmental levels. Public policy can also influence to what issues various resources are
allocated (Levine & Perkins, 1997).
A concept relevant to public policy is policy science, which is the practice of making
findings from science (and in the case of community psychology, findings from social
science) relevant to governmental and organizational policy. A well-known example of this
is the use of actual scientific studies on desegregation of schools to shape policies on
integration (Frost & Ouellette, 2004). Given the Supreme Court ruling (Meredith vs.
Jefferson County, Kentucky and Parents Involved in Community Schools-PICS vs. Seattle School
District) in June 2007 stating that schools may no longer take a student’s race into account
in attempting to devise desegregation programs (Greenhouse, 2007), the challenges of
integration continue.
Fox and Prilleltensky (2007) note that wishing psychology and politics to be unrelated
doesn’t make it so. Hence, they argue that psychopolitical literacy is an important
prerequisite of public policy involvement. Psychopolitical literacy acknowledges the
connections among politics, well-being, and social justice. Psychopolitical literacy promotes
a state of affairs whereby individuals, groups, and communities use power, capacity, and
opportunity to fulfill personal, relational, and collective needs. Transformative
psychopolitical validity refers to the extent to which interventions reduce the negative and
strengthen the positive political and psychological forces contributing to wellness and
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justice. Extensive evidence documents the restriction of psychosocial interventions to goals
such as skill development, even in fields such as community psychology explicitly
concerned with collective phenomena (Fox & Prilleltensky, 2007).
At this point in your reading, you have learned about the variety of techniques that
can be used to create social change. Any reliable change agent knows that a multifaceted
approach is best. That is, a single change strategy by itself may be weak. Using several
change techniques is more likely to result in the desired outcomes. Case in Point 5.4
describes the evolution of rape crisis centers, which generally take this multifaceted strategy
of social change. In a later chapter we describe at greater length the efforts to change the
educational system in the United States. The research evidence on resiliency shows a clear
advantage to early child enrichment and parental education. Long-term outcome studies on
Head Start are now coming on line. They support the positive effects of work with young
children (Garces, Thomas, & Currie, 2000). You will read more about these issues in
Chapter 8.
CASE IN POINT 5.4
Rape Crisis Centers: A National Examination
Campbell, Baker, and Mazurek (1998) hypothesized that many rape crisis centers have
undergone significant changes since their beginnings during the feminist movement of the
1970s. The researchers used interviews with center directors to examine the current
structure and functions of 168 randomly selected rape crisis centers across the nation.
First, the study demonstrated that there are many avenues to social change. An early
goal of rape crisis services was to provide services to survivors of sexual assault. Ancillary to
this was the provision of 24-hour crisis intervention hotlines as well as counseling and
assistance in negotiating the legal and medical systems. Many (but not all) centers also
eventually sought to raise public awareness about sexual assault in the community. Some
centers also became active in public demonstrations, such as Take Back the Night marches.
Finally, some centers also sought to conduct large-scale change by lobbying state legislatures
for reform. In response, most states did alter their rape statutes in the late 1970s and early
1980s.
Second, although the average center in the study was 16 years old, many were older or
younger than this. The older, freestanding, collective centers had larger budgets and staffs
as well as a change orientation when interacting with other social services agencies. These
centers used participatory decision making for deciding internal issues. Older centers were
also more likely to participate in public demonstrations such as Take Back the Night
marches and in prevention programming. The younger centers, especially those that were
affiliated with larger service agencies and therefore followed a hierarchical organizational
structure, were more likely to engage in political lobbying rather than preventive education
and public demonstrations as their forms of social activism.
Both types of centers, then, engaged in social activism or social change, but the types
of activities differed by organizational structure and age. In addition, this study also
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demonstrates that rape crisis organizations and perhaps other service-oriented organizations
often need to adapt to the changing political climate to continue to provide quality services
to their communities.
Issues Related to the Use of Public Policy
Politics and community psychology are deeply intertwined (Fox & Prilleltensky, 2007),
although changing social policy is a relatively unexplored extension of community
psychology (Phillips, 2000). There is general agreement among community psychologists
that their science and politics are inseparable. However, community psychologists do not
agree on how much science should impinge on policy and how much public policy should
pervade science. Some argue that good policies are those based solely on scientific evidence.
In other words, one should not attempt to influence any public policy until one has solid
scientific evidence. Others argue that pressing social problems such as AIDS and
homelessness do not afford the luxury of time for conducting research. Society is not likely
to have solutions to this complex situation for some time to come. Choi and associates
(2005) urged social scientists who wish to engage in public policy advocacy to understand
the differences between the worlds that politicians live in and the worlds that scientists
reside in. For example, they argued that policy makers often live in a world that involves
putting out fires, managing political crises, and knowing a little bit about a variety of
topics. Also, policy makers prefer clear-cut answers and want the essence of an issue laid out
for them in bullet points, whereas scientists are apt to equivocate and are often
uncomfortable giving a “bottom line.” Furthermore, scientists obsess about the quality of
evidence available about a particular research question, whereas policy makers are more
comfortable using evidence generated more informally. Although these differences may
make public policy advocacy more challenging for psychologists, we can learn to speak this
language and function within this world to make sure that good policy is developed and
guided by sound science.
Most community psychologists do agree that the development of public policy should
be a collaborative effort among researchers, affected populations, and the decision or policy
makers.
However, the political climate, lobbying groups with cross purposes, and other
vicissitudes can often influence the end product in public policy as much or more than
science and other logical factors. That being said, when public policy is based on research, it
can serve several functions: instrumental, conceptual, and persuasive (Shadish, 1990).
When research shapes the direction of change or of public policy, it serves an instrumental
purpose. Research can also be aimed at changing the way people think or conceptualize
social problems and solutions. Research with this function serves a conceptual purpose.
When research persuades policy makers to support a particular position or solution to a
social problem, it then functions in the persuasive mode. Finally, when research is designed
to forecast what change will occur in the future or predict whether change will be accepted,
the function is predictive.
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Is there any evidence that social science research influences legislators as they develop
public policy? Yes, one can see the impact of researchers in part by what type of research is
funded by the federal government. Public officials have reported using social science in
drafting policies; psychological research was cited as the most influential of all these sciences
(Frost & Ouellette, 2004).
While on the staff of the U.S. Senate, Trudy Vincent (1990) reported that the
activities in which members of Congress engage are very similar to those of ecologically
minded community psychologists. That is, legislators also need to pay careful attention to
the people, settings, events, and history of their districts before establishing policy. Directly
and indirectly, then, psychology can influence public policy.
Research in the service of public policy is not the only way to address social change.
Community psychologists and community members can also lobby to change policy.
Lobbying means to direct pressure at public officials to promote the passage of a particular
piece of legislation or policy. Individuals wishing to influence policy can also disseminate
appropriate pieces of information, such as public opinion polls and results of field research,
to policy makers in an attempt to educate them (Homan, 2011). Education and
information dissemination as a means of social change have already been discussed.
The average citizen hoping to influence legislation may find the process bewildering,
whether it is at the local, state, or federal level. Fortunately, there are materials available to
the average citizen that will take the mystery out of the legislative process (Homan, 2010).
For example, the APA has created a Public Interest Directorate, the mission of which is to
advance the scientific and professional aspects of psychology as applied to human welfare.
The directorate disseminates reports and other written materials to state and federal
governments and legislators. Similarly, the APA also developed a guide to advocacy in the
public interest that includes sections on the legislative process and on effective means of
communications with congressional staff.
A community psychologist or community member could also seek an elected office,
work on the campaign of a particular candidate, or vote for a particular candidate
supporting a favored social change program. Holding an important elected office may seem
alien to some, but it is often the ideal role for a scientist. Why? The community scientist’s
training places him or her in the position to be able to demand evidence for proposed
programs. Scientists also best know the importance of evaluating change mechanisms, such
as new or experimental programs (Fairweather & Davidson, 1986).
Another role for politically active scientists is to act as expert witnesses and amicus
curiae (friend of the court). A case of the amicus curiae role for psychologists in the courts
was the use of sex stereotyping research by Susan Fiske in the Price Waterhouse v. Hopkins
case heard and cited in the local, appellate, and U.S. Supreme Courts. The APA also filed
an amicus curiae brief in the case. The testimony about the psychology of stereotyping
played a crucial role at each court level as well as in the eventual vindication of the wronged
female employee (Fiske, Bersoff, Borgida, Deaux, & Heilman, 1991). Community
psychologists in these endeavors play a role in shaping case law and setting precedents on
which other cases may be based (Jacobs, 1980; Perkins, 1988).
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Advantages and Disadvantages of Public Policy Changes
The advantage of using public policy efforts—including research, lobbying for or
sponsoring a particular policy, and elections—is that sweeping social changes can often be
induced, especially if the efforts of broad alliances are all aimed in the same direction.
Another advantage is that the average U.S. citizen is known to have considerable respect for
the law (Kohlberg, 1984; Lempert & Sanders, 1986), and some people may accept the
change because it is the law.
Often, the real issues underlying social problems are economic and political rather
than psychological, so the policy solution might be the most appropriate anyway (Nikelly,
1990; Wolff & Swift, 2008). Finally, policy makers often (but not always) have a broad
perspective on the community that elected or appointed them and are likely to understand
the interrelationships between seemingly segregated groups and isolated social problems.
Therefore, solutions in the form of policy can take a broad-brush and long-term approach
rather than a narrow or short-term focus, which is more likely to fail.
No method of social change is without problems, however, and policy science and
public policy are not without theirs. For instance, much social science research is completed
by academics operating in a “publish or perish” mode (Phares, 1991) to impress colleagues;
the research is often not returned to the community for social change (Vera & Speight,
2003). Similarly, community researchers are often perceived as agents of a traditional
system that has historically been oppressive and are consequently not perceived as guests or
collaborators in the community (Robinson, 1990; Trimble, Scharrón-del Río, & Bernal,
2010). Therefore, research participation, results, and dissemination efforts are shunned,
rendering the research useless.
Another serious problem with using public policy avenues to create social change is
the electorate. Bond issues, school budgets, referenda, and other elections are participated
in by a select few. Most voters are disproportionately well educated and older than the
average citizen. Hence, the voices of the poor, young, and minorities are not heard via
voting. This means that those who may most benefit from prosocial change are not
participating in the direction of these changes (Hess, Markson, & Stein, 1991), which is a
social justice problem, as was discussed in Chapter 1.
Perhaps the greatest disadvantage to using public policy efforts to create social change
is that policy shaping can be a slow, cumbersome, politicized process. For instance, the
average time span from initial writing to passage of a bill in Congress is about a year.
However, less controversial policies pass more quickly. More complex or controversial
issues take much longer. In the meantime, the needs of the affected groups may have
changed; indeed, the group itself may have evaporated, or its needs may have become more
severe so that the original policy solution is insufficient.
A Skill Set for Practice
Community psychologists can go a long way toward bettering communities. Many
community members, however, do not know how to approach them or exactly what they
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•
•
•
•
•
•
do. To that end, the Society for Community Research and Action (SCRA) of the APA
proposed some crucial changes. In a report titled “Finding Work as a New Community
Psychologist,” the SCRA Practice Task Force (2007) recommended that community
psychologists not depend on their title and rather describe what they can do. By listing
competencies, they do not have to deal with a definition, and they broaden their
opportunities. These competencies could include:
Political advocacy
Assessment and evaluation
Capacity building for organizations
Collaboration and consultation skills
Communication within organizations and to the public
Report writing
An awareness and appreciation of cultural diversity
Knowledge of group processes
The ability to apply scientific knowledge
The ability to organize and supervise
An understanding of how to build and maintain a positive environment
Research skills
A veteran community psychology practitioner and member of this task force, Alan
Ratcliffe (personal communication, January, 2008) stated that he never looked at the job
title of what people were looking for. He would describe what he could do for a system, a
community, or an organization. He found there to be demand for the skills he brought.
Reflecting on a lifetime of working in the “real world,” Tom Wolff stated that he knew of
no applied community psychologist who worked as a “community psychologist” (Wolff &
Swift, 2008).
As for a mind set for community interventions, Kofkin Rudkin (2003) has said it well.
It is a matter of realizing the point between contradictions. Her admonitions regarding
action in the community include:
The situation is urgent, so take your time
The outcome is critical, so don’t worry about it
The problems are huge, so think small
Social change is complex, so keep it simple
Social change is serious business, so have fun
Social change requires staying on course, so relinquish control. (pp. 171–173)
Summary
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Many methods for creating and sustaining social change exist. Each has its own advantages
and disadvantages. Activists hoping to fashion social change need to consider what
strategies will work best for the issues they address. Some combination of strategies will
probably work better than a single strategy, and what worked once might not work again or
in a different community or for a different issue.
Planned change, such as grassroots activism and information dissemination,
intentionally addresses and prepares the community for changes. The primary purpose of
planned change should always be to improve the community. Each method of planned
change has disadvantages and advantages. Methods available for induced change include
citizen participation, networking with other community resources, the use of professional
consultants, education or knowledge dissemination, and participation in public policy
efforts by citizens and scientists.
In citizen participation, citizens produce the changes they desire by mechanisms such
as grassroots activism, which is a type of bottom-up rather than top-down change. Such
change results in empowerment, in which individuals feel they have control over their own
lives.
When community agencies come together to aid one another, they are networking.
Networking has been shown to directly assist in the longevity of community organizations.
Sometimes umbrella organizations, such as the United Way, also provide services to
community agencies or enhance their functioning, thus again ensuring their success.
Professional change agents or consultants can also help communities evolve.
Community consultants need to be careful not to overtake the community but empower
the community to create its own changes.
Education and information dissemination are still more means of producing social
change. Although these methods sometimes produce vast changes, care must be taken to
use the most appropriate information with sensitivity to the cultural diversity of the
community.
Passing new legislation and policies or revamping existing laws and policies are other
means of creating social change and are known collectively as public policy. Public policy
changes can create sweeping social change, but often such policy is fraught with the politics
of competing groups and can take time to fashion and implement.
Community practitioners find it useful to think of what skill sets they bring to social
problems. The title of “community psychologist” may be unknown to many. This
pragmatism and flexibility are good illustrations of what a community psychology should
be.
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The Mental Health System
EPIDEMIOLOGICAL ESTIMATES OF MENTAL ILLNESS
MODELS OF MENTAL HEALTH AND MENTAL DISORDER
The Medical Model
The Psychoanalytic Model
The Behavioral Model: The Social-Learning Approach
The Humanistic Model
CASE IN POINT 6.1 Mental Health Care Professionals
THE EVOLUTION OF THE MENTAL HEALTH SYSTEM
Brief History of Mental Health Care
CASE IN POINT 6.2 Rosenhan’s Classic Study of Hospital Patients’
Stigmatization
Deinstitutionalization
The Social Context to Deinstitutionalization
Early Alternatives to Institutionalization
Measuring “Success” of Deinstitutionalized Persons
BEYOND DEINSTITUTIONALIZATION
“Model” Programs for Individuals with Mental Disorders
Intensive Case Management
Wraparound
CASE IN POINT 6.3 Wraparound Milwaukee
EARLY CHILDHOOD EXPERIENCES AND PREVENTION
THE BATTLE CONTINUES: WHERE DO WE GO FROM HERE?
SUMMARY
In individuals insanity is rare, but in groups, parties, nations
and epochs it is the rule.
—Friedrich Wilhelm Nietzsche, Beyond Good and Evil
Min, age 25, was of Chinese descent and lived in the United States. Not only was she convinced that her psychiatrists
did not understand her illness, she was also convinced that they did not understand her Chinese values.
Min had drifted in and out of a large state hospital because of what her doctors called schizophrenia. Each time she
entered the hospital, she was given medication that eased her symptoms, particularly her hallucinations and the
imaginary voices talking to her. When medicated, Min would develop better contact with those around her, take better
care of her daily needs, and then be released from the hospital to her family’s care. However, her two parents worked
hard to support the family, which included Min’s brother and sister. Her siblings were in school. Therefore, Min was
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alone much of the time. Because her family was not available to supervise her medications, she often forgot to take
them. Eventually, she would become out of control, which would prompt the family to call the psychiatrist, who, after
some pleading from the family for intervention, would tell them to return Min to the hospital.
Such was Min’s state. She would leave the hospital only to return. She would take her medication and be briefly
liberated from her symptoms only to forget the medication later. She is one of the country’s chronically mentally ill
who seem to be in desperate need of long-term, coordinated intervention but who are not necessarily receiving it.
This chapter examines the plight of Min and others like her. It will begin with some
historical highlights and move to the issue of deinstitutionalizing the mentally ill. While
examining deinstitutionalization, discussions focus on how to measure the success of
moving individuals out of institutions as well as the common alternatives to
institutionalization. Interestingly, many of the early alternatives have been tantamount to
reinstitutionalization. Newer programs are coming into place. The question is whether they
do what they have been intended to do. Can there be an effective tertiary prevention
program, keeping patients out of institutions and reintegrating them successfully into the
community? First we examine the question of how many people are like Min, that is, how
many people in our community have to contend with mental health disorders.
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EPIDEMIOLOGICAL ESTIMATES OF MENTAL ILLNESS
In the early 1980s, the National Institute of Mental Health (NIMH) surveyed the
psychiatric status of more than 20,000 people in five cities. This study, known as the
Epidemiologic Catchment Area (ECA) Study, attempted to estimate and describe the
incidence and prevalence of psychiatric disorders meeting the criteria of the Diagnostic and
Statistical Manual of Mental Disorders, 3rd edition (DSM-III). For example, in a
comparison of three communities, Robins and colleagues (1984) estimated that lifetime
prevalence rate of a given DSM-III disorder was 28.8%, 38.8%, and 31.0%, respectively,
in New Haven, Baltimore, and St. Louis. Note that there are variations in numbers, as we
would expect different cities to have different characteristics. The researchers’ intention is
to gather data from enough sites in the United States so as to get a representative sample of
rates from across the nation and come to some estimate of problem rates in the United
States as a whole. Findings suggest that men and women are equally likely to be afflicted
with psychiatric disorders. This study leads us to estimates of 1-year prevalence (having
symptoms during the previous year) of anxiety disorders at 13%, of major depression at
6.5%, and schizophrenia at 1.3%. Nineteen percent of the sample is believed to have some
psychiatric disorder. A second multiple site study sponsored by NIMH in the 1990s
provides estimates based on the DSM-III Revised, a different set of criteria (Kessler et al.,
1994). This study is called the National Comorbidity Study (NCS). The 1-year prevalence
estimates for this study are anxiety disorder 18.7%, major depression 10%, any psychiatric
disorder 23.4%. Lifetime prevalence for having a psychiatric disorder is 50%. However,
17% of the population has multiple diagnoses (comorbid), and the most severe cases have
the highest concentration of disturbances. A third estimate of mental health epidemiology
was conducted in 2000–2002. This study is called the National Comorbidity Study,
Replication (NCS-R), and is based on the Diagnostic Statistical Manual IV criteria for
psychiatric disorders. Results using these criteria yield an anxiety disorder percentage of
18% for 1-year prevalence, major depression prevalence of 6.7%, and any psychiatric
disorder prevalence of 26.2% (Kessler, Chiu, Demler, & Walters, 2005). Again, a small
proportion of the population has the worst symptomatology and multiple disorders. In
both NCS reports, fewer than half of those with diagnosable disorders are in treatment.
Findings from the ECA, NCS, and NCS-R are consistent with the Midtown
Manhattan Study, a longitudinal study investigating the prevalence of psychopathology
from 1952 to 1960. Across several decades, from multiple sites, using a variety of
measurement criteria, the findings seem consistent that mental health issues are a part of
our communities. They are not a trivial part, because mental health issues should affect half
of us sometime during our lifetime.
Also notably consistent over time, the most recent epidemiological study (Kessler et
al., 2005) finds that the general practitioner MD has seen the highest rise in treatment
demands. This is reminiscent of the findings by Gurin, Veroff, and Field (1960), who
found similar reports of medical doctors being the people most likely to be consulted
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regarding psychological problems.
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MODELS OF MENTAL HEALTH AND MENTAL DISORDER
In answer to these mental health needs, psychology has traditionally responded by
providing individual-focused clinical psychological services. As you may recall, the
effectiveness of these services was called into question by Eysenck’s (1952) meta-analytic
study. We might make note of a more recent review of psychotherapy outcome studies that
examined the variety of factors that affected outcome (Lambert & Barley, 2001). The
specific therapeutic technique accounted for approximately 14% of the results, a small
amount. What did seem to matter was the therapeutic relationship that developed between
client and therapist. But we digress. The basic argument against the clinical orientation is
that it is an inefficient and reactive model of treatment of well-entrenched psychological
symptoms. This was discussed in Chapter 1. We elaborate on some of the treatment models
here so as to better understand the traditional systems that are in place and the community
applications that have, at times, evolved from them.
The Medical Model
The standard and traditional model for care is the medical model. Based on the practice of
medicine, the assumption is that the patient’s illness is based on internally based
dysfunctions. The patient is a passive recipient of knowledge from the expert physician,
who provides the answer to the patient’s problems. The patient obediently follows the
advice and partakes of the medicine (a preparation or potion that will bring about a cure of
the ailment or relief from the physical symptoms). The tradition has among its roots the
Greek and Roman physicians who dealt with physical disorders. Both physical and mental
health were the result of maintaining a balance. For the ancient Greek
philosopher/physician Hippocrates, this was a balance among the four elements within us:
phlegm, blood, black bile, and yellow bile. These traditions are believed to be traced to
even older Egyptian and Mesopotamian beliefs.
Of course, modern medicine has come a long way from this elementary model. Yet
the procedures are similar in some ways. The patient presents a set of symptoms. These are
problems with the patient’s physical functioning. Based on the presenting symptoms, there
is a diagnosis of what is malfunctioning or out of balance. We might come to understand
the etiology or origins and development of the disorder. Once the correct diagnosis is
made, the appropriate medicine or therapy is prescribed to cure the problem. The next time
you go to the doctor, note how the procedure works. He or she will ask what is troubling
you, that is, the set of symptoms; then, based on the fit of symptoms to a set of criteria for
the various illnesses, he or she will decide what is wrong. He or she will then make a set of
recommendations for therapy (bed rest and fluids, or maybe decrease sugar or salt intake)
and may prescribe certain medicines to be taken in a particular pattern so as to alleviate
symptoms (e.g., fever, chills, low energy) or strengthen the system (increase level of
antibiotics in the body) or cure the illness (correct the imbalance). The patient chooses
when to come to the doctor. This is most likely when the patient has experienced enough
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disorder to make him or her believe that help is needed. Most clinical psychologists use this
medical model of investigation of symptoms, diagnosis, and prescription of treatment and
therapy.
Given the strength of the biological, or medical, model, two authoritative references
about mental illness (The Diagnostic and Statistical Manual of Mental Disorders [DSM] and
the International Code of Diagnosis [ICD]) have been developed. The medical model leaves
at least two important legacies in traditional psychology. One is the reliance on diagnostic
labels, as found in the DSM. The other legacy is the assumption of authority and power by
the professional over the patient. Both of these legacies, though, are eschewed by
community psychologists.
The Psychoanalytic Model
FREUD. To those of you who are psychology majors or have taken a course in abnormal,
child, or personality psychology (or are fans of Woody Allen movies), Sigmund Freud
(1856–1939) will be no stranger. Freud is the father of psychoanalysis. Although many
people today disagree with his theories, it cannot be denied that Freud’s influence is felt in
psychology as well as in psychiatry. Although Freud believed that biology played an
important role in the development of psyches, he argued that most psychological disorders
are treatable or curable with the use of free association or verbal therapy. Psychoanalytic
treatment takes the form of individual verbal therapy up to five times a week over several
years.
Somewhat later, the psychoanalytic approach began to split into two paths: traditional
psychoanalytic individual verbal therapy versus biological psychiatry. A German
contemporary of Freud, Adolf Meyer (1866–1950), argued for the importance of the
interplay among biology, psychology, and environment, but many others preferred only
biology as an explanation for mental disorders, after a strict biological–medical model. The
traditional psychoanalytic individual verbal therapy model has consistently failed to show
its effectiveness with the severely mentally ill (Wilson, O’Leary, & Nathan, 1992).
ADLER. Among the alternatives to Freud coming out of the early 20th century is Alfred
Adler. He emphasized the individual’s concern about powerlessness and the person’s goal of
seeking fulfillment in his or her life. Toward this end, Adler’s work was directed at helping
people gain this sense of empowerment over their situations. He is credited by some for the
psychoeducational movement, which brought knowledge to the people so that they could
use it for their lives.
His theory also included Gemeinschaftsgefühl, which translates into “community
feeling” or what is typically called social interest. Social interest is the individual’s sense of
connection to the people around her. If there is high social interest, the individual feels a
part of her family, her neighborhood, her community. If there is low social interest, the
individual feels alienated from people and will act in her own self-interest without regard to
the consequences for others.
Adler theorizes that these social feelings and our feelings about ourselves are heavily
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influenced by childhood experiences, so his theory also focused on childhood education.
The emphasis in the teacher–child relationship is on encouragement of the child and his
curiosity about the world.
As is surely notable from this description, the emphasis is on development of a healthy
individual. Pathology is averted through provision of positive social environments that both
empower and set appropriate normative limits on the individual. This is reminiscent of
community psychology practices.
The Behavioral Model: The Social-Learning Approach
As you may recall from an introductory psychology course, by using dogs as subjects,
Russian physiologist Ivan Pavlov (1849–1936) was able to demonstrate that behavior could
be formed as a result of classical conditioning. This is the process by which a response
comes to be elicited by a stimulus, an object, or a situation other than what is the natural or
normal stimulus. Pavlov repeatedly exposed his dogs to a conditioned stimulus in the form
of a bell whenever the unconditioned stimulus in the form of meat powder was present.
Although the unconditioned response or natural response for meat powder was salivation,
eventually these dogs learned to display a conditioned response or learned response in the
form of salivation in the absence of meat powder.
Dissatisfied with the psychoanalytic approach and rejecting the method of
introspection or self-examination (a method advocated by Wilhelm Wundt, the father of
experimental psychology), two U.S. psychologists, John B. Watson (1878–1985) and B. F.
Skinner (1904–1990), further developed Pavlov’s theory by using humans as subjects.
Instead of pairing a conditioned stimulus with an unconditioned stimulus, Skinner
developed and preferred the use of operant conditioning, in which behavior is more likely
to be engaged in when it is reinforced or rewarded. Often, the reinforcers and the
conditioned and unconditioned stimuli are provided by something external to the
organism. Thus, in part, behavioral tradition provides one with a sense that ecology is
important.
Extending the principles of learning theory, or the behavioral model, Martin
Seligman (1975) argued that depression can be explained as a form of learned helplessness,
or a lack of perceived control due to uncontrollable events in the environment. Other
advocates of the social-learning approach, such as British psychiatrist Hans Eysenck, Sr.,
and U.S. psychologist Joseph Wolpe, have developed techniques such as desensitization or
step-by-step relaxation training to change phobic or fearful behavior.
Generally speaking, the social-learning model is an effective treatment with many
forms of mental distress. However, it is labor intensive because each behavioral treatment
must be tailored to match the individual’s needs. Moreover, to many critics, the social-
learning approach appears to deal with the symptoms rather than the cause of mental
distress. Finally, most community psychologists note that this model treats one individual
at a time—not a very efficient way to manage change.
However, there have been several successful attempts at translating these learning
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principles into community analysis and action. Bogat and Jason (2000) review many of
these programs, concluding that the behavioral principles provide added “technological
tools” to a community psychologist’s skill set. In particular, the use of behavioral
techniques can provide the small successes on the path toward systems change.
The Humanistic Model
The 1960s witnessed the growth and emphasis of the movement of human rights, such as
the introduction of the Civil Rights Act in 1964. The movement of human rights had a
profound impact on how mental health and mental disorders were perceived or defined.
That is, to some mental health care experts and professionals, such as U.S. psychologists
Abraham Maslow (1908–1970) and British psychiatrist R. D. Laing, maladjustment had
more to do with labeling, or an individual being told he or she is not healthy or is sick,
than with innate determinants. In other words, people sometimes behave in accord with
what they are told. Thus, treatments should be designed to help these people understand
and reflect on their unique feelings. In conjunction with this notion, U.S. psychologist Carl
Rogers (1902–1987) developed client-centered therapy, in which the role of the therapist
is to facilitate the client’s reflection on his or her experiences. Note the word client in the
previous sentence. To humanistic psychologists, clients are not sick and thus are not labeled
patients.
Similar to the psychoanalytic model, the humanistic model emphasizes the use of
verbal therapy. Unlike the psychoanalytic model, both individual and group verbal therapy
are common to the humanistic model. However, the humanistic model suffers from some
of the same criticisms as does the psychoanalysis theory. Faith, Wong, and Carpenter
(1995) found that the effectiveness of a sensitivity training group (a form of humanistic
group therapy) is not so much due to the fact that people gain a sense of self-worth but due
to improved mental health as a function of social skills learned during therapy.
There are, however, at least two more major ideas derived from humanistic psychology
that have been transplanted to the field of community psychology. One is that all people
are worthy individuals and have the right to fulfill and discover this worth. The second is
that the individual best knows him- or herself and thus needs to provide input on solutions
to problematic issues. This directly feeds into community psychology’s principle of
empowerment and the philosophical justifications for participatory action research.
These models of mental health serve to direct psychotherapy and the field of clinical
psychology. Yet there are clear connections that can and have been made between aspects of
these models and community psychology principles and practices. The shift in theory and
action in community psychology is to the social- and systems-level focus for interventions,
as well as an appreciation of the wider ecological contexts that influence human behavior
maintenance and change. The interplay of models fits well with community psychology’s
openness to multiple perspectives and the understanding of multiple levels required for
change. It also belies the clinical and counseling psychology roots to some aspects of
American community psychology. For example, the Swampscott meeting was a community
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mental health training conference. As well, there are clinical training backgrounds to many
(but not all) of the founders of this area. Nonetheless, we should see the differences
between the traditional hospital and office base of clinical psychology and the more broadly
ranging community psychology.
CASE IN POINT 6.1
Mental Health Care Professionals
Various professional services are available to help people cope with stress. Many of the
mental health care services are delivered by individuals from four major professional
disciplines. Psychiatrists are medical doctors (MDs) who specialize in psychiatry. They can
be employed in either the public (governmental) or private sector (such as private practice).
In addition to their training, psychiatrists must pass a licensing examination before they can
practice the discipline. Within the field, there are subspecialties, such as biological
psychiatry and community psychiatry. The role of psychiatry is usually medication
maintenance, although mental health patients who are financially capable can often receive
some form of therapy, such as psychoanalytic therapy, up to five times a week.
Many individuals who hold advanced degrees in any subfields of psychology consider
themselves psychologists. Clinical psychologists are mental health care professionals who
have advanced training (a doctoral degree) in clinical psychology. Their training includes
exposure to more severe psychopathology and hospital settings. Counseling psychologists
are required to hold a doctorate and go through practicum training. However, their focus is
typically on issues related to normal development and vocational choice. Both are typically
licensed at the state level as “psychologists.” Similar to psychiatrists, clinical and counseling
psychologists can be employed in either the public or private sector, working privately or
for an agency.
Unlike psychiatrists, in most states “psychologists” cannot prescribe medications. A
pilot project in the U.S. military trained psychologists in limited use of medications
directed at psychological disorders (Sammons & Brown, 1997). There are now a growing
number of psychologists trained to provide these services within the U.S. states and
territories, although only a few states provide licensure for limited prescription authority to
them. This topic is not without controversy (Fox et al., 2009: Gutierrez & Silk, 1998;
Lavoie & Barone, 2006; Sammons & Brown, 1997).
These scenarios are complicated by several other factors. Sometimes, the terms
therapist or counselor are used interchangeably with the terms clinician and psychologist,
although not all clinicians, counselors, and therapists (such as those in social work and
psychiatric nursing) have doctoral-level training in psychology. Community psychologists
may not necessarily be clinical or counseling psychologists by training or be state licensed.
There are further distinctions within the doctoral-level training in the subfields of
clinical or counseling psychology. Traditionally, clinical psychologists were trained using
the scientist–practitioner model. Under this model, training objectives are to produce a
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person who is skilled in research/science and in doing therapy. These psychologists hold a
doctor of philosophy (PhD), the highest degree in any scientific discipline (Benjamin &
Baker, 2004; Farreras, 2005). Professional psychology now has a second model for training
people as practitioner–scholars. Here the emphasis is on psychotherapy and assessment in
practice and less on research. This leads to a different degree, that of doctor of psychology
(PsyD) (Murray, 2000).
A third group of mental health care professionals called social workers help clients
find and access services in the community but also may provide treatment. They usually
hold a degree called a master’s of social work (MSW). Unlike psychiatrists, they cannot
prescribe medication. Similar to psychiatrists and psychologists, social workers can be
employed in either the public or private sector. The primary role of a social worker is as a
practitioner.
What psychiatrists, psychologists, and social workers have in common is that they
treat individuals who are experiencing stress. Note that typically these three groups of
mental health providers focus on individual functioning. Another common feature is that
all of these caregivers operate from a position of authority regarding their clients.
A final and important issue related to these mental health care providers is the one of
health insurance or third-party payments. Health insurance companies act as third parties
who pay the mental health care provider, whether that professional is a psychiatrist,
psychologist, or social worker, for the treatment of the client or person covered by the
insurance. In most states within the United States, these three professional groups are
licensed and may be covered by insurance. A growing number of states regulate master’s-
level counselors (through registration or licensure) and thus allow third-party payments to
them as well.
As of 2008, with the passage of the Mental Health Parity Act, levels of insurance
coverage for physical and mental health are supposed to be equal. The details are just
beginning to being worked out. There appears to be a somewhat disconcerting trend for
insurance companies to reduce their payment costs by using providers who charge less (for
example, the psychiatric nurses, counselors, and social workers). Community activists need
to stay vigilant—for example, by conducting research to ascertain whether there is a
relationship between the success of treatment and the cost of the treatment.
Community psychologists, who sit outside most of these insurance issues and
professional boundary disputes, believe that an “ounce of prevention is worth a pound of
cure” and that prevention is by far the most cost-effective intervention of all.
Understanding the causes and progression of psychopathology, encouraging community
support systems, and providing mental health education could go a long way toward
preventing the need for treatment and health insurance coverage all together.
Acknowledging the need for prevention and other radical shifts in mental health
thinking, Kazdin and Blasé (2011a, 2011b) called for a rethinking of the field of clinical
psychology.
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THE EVOLUTION OF THE MENTAL HEALTH SYSTEM
Brief History of Mental Health Care
Although the ancient world has always been portrayed as less than civilized, some older
cultures gave more emphasis to the study of mental health than others. For example, to
most Chinese (ancient and modern), physical and psychological well-being is thought to
depend on a balance of two natural forces: yin, the female force, and yang, the male force.
Furthermore, these two forces are thought to regulate the five elements—gold, wood,
water, fire, and earth—that are responsible for people’s daily health. Among other things,
the concentration of each element is thought to vary with the type of food group. Thus, a
proper diet and regular exercise are important to maintain a balance between these
elements.
According to Chinese folklore, a wise king named Sun Lone Tse, whose name meant
“to cultivate,” in ancient times (circa 600–700 b.c.) was thought to be responsible for the
first classification system of herbs used in medicine. Also, Chinese historical texts mention a
doctor named Wah Torr as the father of Chinese medicine. On one occasion, he performed
minor surgery on a general’s arm using acupuncture as anesthetic. Needles were used to
stick into the meridians (pressure points) to facilitate the release of endorphins (natural
pain relievers) in the brain. Wah Torr wrote many medical texts. These concepts relating
mind and body are important to the fields of clinical psychology and behavioral medicine,
sister disciplines to the field of community psychology. If Min were in ancient China or
even modern-day China, the treatments for her disorder might be different from what they
are in the United States.
As one moves through history, one notices that the ancient Greeks are also important.
Hippocrates (circa 460–377 b.c.), known as the father of Western medicine, spoke about
four natural humors, or fluids, that were thought to regulate people’s mental health.
Specifically, great fluctuations in mood were thought to be caused by an excess of blood.
Fatigue was caused by an excess of phlegm or thick mucus. Anxiety was from an excess of
yellow bile or liver fluid. Finally, depression was brought on by an excess of black bile.
Whatever medical and psychological advances in theory and practice were achieved by
the ancient Chinese, Greeks, and later the Romans, the majority of their contemporaries
relied on the supernatural to explain mental illness. After the collapse of the Roman Empire
in Europe (in 476 a.d.), supernatural or religious beliefs became model for explaining
mental illness in Western society. For example, according to the church and those in power
in many Western societies, the mentally ill and other disenfranchised people were thought
to be sinners. Religious zealotry reached its peak in the 1480s, when Pope Innocent VIII
officially sanctioned the persecution of witches, some of whom were actually suffering from
mental illness; many others were just political or social dissenters within the mainstream
cultures. This period of almost 900 years in Western societies has come to be associated
with the infamous name the Dark Ages.
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In many Western societies during the Renaissance (revival) period (circa 1300–1600),
the idea of humanism developed. Humanism proposed that we should focus on human
concerns (possibly as the result of rediscovery and interest in Greek and Roman works).
The mentally ill gained indirect benefits from the notion that all people had certain
inalienable rights and should be treated with dignity. Furthermore, some doctors began to
challenge the concept that mental illness was a defect of moral character. By the middle of
the 1600s, institutions known as asylums, or madhouses, were established to contain the
mentally ill. Perhaps the most famous was London’s Bethlehem Hospital, nicknamed
“Bedlam,” which is now a word meaning chaos and confusion. The first asylum in the
United States was established in the late 1700s. Asylums were places where the socially
undesirable or misfits were kept. More often than not, residents of the asylums were
chained.
The further development of humanism during the American (1776) and French
(1789) revolutions provided more incentives to the mental health care reform movement
throughout the European continent and in the United States. For example, two pioneers
were instrumental in the movement in this country. Benjamin Rush (1745–1813), known
as the father of American psychiatry, wrote the first treatise on psychiatry and established its
first academic course. The second person was Dorothea Dix (1802–1887), whose
experience with mental health care was derived from her teaching of women inmates.
During her day, it was not unusual for the mentally ill to be kept in prisons. Dix traveled
extensively in the country to raise money to build mental hospitals.
The mental health care reform movement further benefited from the pioneer work of
several doctors who devoted their lives to the development of scientific nomenclatures, or
classifications, of mental illness. These classifications eventually led to the study of the
etiology, or cause, of mental illness. It was probably a French doctor named Philippe Pinel
(1745–1826) who first used the term dementia to describe a form of psychosis that was
characterized by deterioration of judgment, memory loss, and personality change. A
German doctor, Emil Kraepelin (1956–1926), further studied this condition and described
it using the term dementia praecox (premature dementia). Subsequently, Swiss doctor
Eugen Bleuler (1857–1930) gave the same disorder the name schizophrenia, which has
become a household term in today’s psychiatric practice. Also, Bleuler extended previous
work by describing several subtypes of this illness.
Meanwhile, the germ theory, as advocated by Frenchman Louis Pasteur, had gained
unprecedented recognition in the medical and scientific community. That is, many illnesses
were thought to be caused by germ infections. Thus, the development of psychiatry as a
field was destined to take on a medical or biological tone. In other words, under the
influence of germ theory, mental illness was conceptualized as a disease rather than a
disorder or psychological dysfunction.
At about the same time, the American Psychiatric Association and the American
Psychological Association were formed in 1844 and 1892, respectively. Although the
original mission of the American Psychological Association was not specifically concerned
with issues relating to mental health and mental illness, as the subdiscipline of clinical
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psychology became more dominant, these issues became a priority. This shift in emphasis
no doubt does not sit well with the American Psychiatric Association, which has seen itself
as the sole guide in the field of mental health and mental illness since its inception. Over
the years, these professional conflicts have been further complicated by a number of other
factors, including the emergence of social work as a professional field.
After the work of Rush and Dix, mental health care reform in this country can be
roughly divided into three more eras: 1875–1940, 1940–1970, and 1970 to the present
(Grob, 1991; Shadish, Lurigio, & Lewis, 1989). During the period from 1875 to 1940, the
government assumed the major responsibility in caring for the mentally ill. Two-thirds of
all the patients were living in state-run psychiatric hospitals. In many ways, this system was
an extension of Dix’s thesis of moral management. More often than not, these patients
received little treatment.
Meanwhile, there were a small number of privately owned psychiatric hospitals, such
as the Menninger Foundation and the Institute of Living, providing services or treatments
to those who could afford them. Although these services or treatments may be crude by
today’s standards, they contributed to the development of community psychiatry, a
subdiscipline of psychiatry that argues that mental patients should be treated using the least
restrictive method in the least restrictive environment. Many of these private mental
patients lived in small, comfortable units, and they were encouraged to take lessons in
cooking, sewing, and other self-improvement skills.
In the 1940–1970s phase, the initial optimism associated with moral management
began diminishing in society. In almost all instances, psychiatric hospitals were no more
than human warehouses. If treatments were provided, they tended to be electroconvulsive
therapy, or electric shock to the brain, and lobotomy, or brain surgery. Furthermore, the
cost associated with these hospitals had become a major strain on society, especially during
the Great Depression and World War II. There were concerns that hospitalization itself
brought certain self-fulfilling expectations to bear on the patient. This stigmatization was
demonstrated in the Rosenhan study of the 1970s (see Case in Point 6.2).
As noted in Chapter 1, beginning in the 1960s, the zeitgeist, or atmosphere, of the
society began to change. For example, the introduction of psychotropic drugs (mood-
altering drugs) such as Thorazine (chlorpromazine) rekindled the idea that the mentally ill
could be treated with dignity.
CASE IN POINT 6.2
Rosenhan’s Classic Study of Hospital Patients’ Stigmatization
Researcher D. L. Rosenhan was especially interested in whether mental health professionals
(particularly psychiatrists) could tell genuine mental disorders or problems from false ones.
He decided to conduct a study. First, Rosenhan (1973) trained his graduate students and
others in how to fake symptoms of psychiatric disorders. For example, he instructed the
pseudo-patients to tell hospital staff that they heard a thudding sound or a voice saying
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“thud.” Rosenhan then sent his pseudo-patients to a psychiatric emergency facility.
To Rosenhan’s amazement, the students were admitted. Soon after their admission to
the psychiatric ward, the pseudo-patients were each given diagnoses.
Not long after their admission, the pseudo-patients began to act “normal.” Curiously,
many of the other patients realized that the pseudo-patients were normal. The staff did not
recognize this normalcy partly because they rarely saw it. According to Rosenhan’s report,
the staff did not spend much time with the patients.
The pseudo-patients began to request release from the psychiatric ward. However, the
staff consistently told the students that they were not well enough to be released.
Eventually, Rosenhan had to intervene so that some of the pseudo-patients could be
released. However, on release, many were labeled schizophrenia in remission. The pseudo-
patients were kept in the hospital from 7 to 52 days, with an average stay of 19 days.
Without minimizing the agony associated with mental disorders, Rosenhan
demonstrated that many perceived disorders are due to the process of labeling. Although
some mental health professionals might argue otherwise, Rosenhan demonstrated that once
labeled, it is difficult to overcome the label and the expectations and behavioral
interpretations that go with it.
In the 1970s, community psychiatry, coupled with the use of medication, once again
shifted approaches to the mentally ill. Many of the mentally ill were discharged back into
their communities. In this chapter’s opening vignette, medications successfully allowed Min
to return to her family. When she went off the medication, her problems resurfaced. A
consequence was the development of outpatient treatment, or nonhospitalized treatment
(e.g., community mental health centers), as opposed to inpatient treatment, or
hospitalized treatment. Also, to accommodate these newly released inpatients, alternative
housing such as community residences, or group homes, was established—but not without
controversy. We now examine the deinstitutionalization of the 1960s and 1970s and the
efforts to deal with its implications.
Deinstitutionalization
Deinstitutionalization is defined by efforts to release mental patients back into the
community. Recall that Min was institutionalized and sent back to her community—in
fact, she was repeatedly released and returned to the hospital (recidivism ). There is a great
deal of controversy about what exactly deinstitutionalization is (Grob, 1991; Shadish et al.,
1989). A deeper examination of some of these definitions and related issues is in order.
John Talbott (1975) argued that the term deinstitutionalization is a misnomer. Instead, a
better term is trans-institutionalization to describe “the chronically mentally ill patient
who has his or her locus of living and care transferred from a single lousy institution to
multiple wretched ones” (p. 530). Mathew Dumont (1982), another psychiatrist, argued
that “deinstitutionalization is nothing more or less than a polite term for the cutting of
mental health budgets” (p. 368). Min presents a picture of this phenomenon. She is in and
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out of institutions, living with her family between institutionalizations.
By the late 1970s and early 1980s, the effects of deinstitutionalization were starting to
be realized. The New York Times defined deinstitutionalization as “moving mental patients
from enormous, remote hospitals into small community residences” (“Willowbrook Plan
Worked,” 1982). Another New York Times editorial stated that deinstitutionalization was
nothing more than “dumping mental patients out of state hospitals onto local
communities, with promises of community treatment that never came true.”
Deinstitutionalization was synonymous with homelessness (“Redeinstitutionalization,” 1986,
p. A24).
Indeed, these definitions illustrate the many different aspects of deinstitutionalization.
Reconciling these differences, some mental health care experts (Bachrach, 1989; Rein &
Schon, 1977; Shadish et al., 1989) proposed that the term deinstitutionalization be
understood as a semantic mechanism to frame the complex, often conflicting, and
seemingly unrelated sets of issues associated with ongoing mental health care reform. More
often than not, the concrete aspects of deinstitutionalization, such as budget constraints,
were the impetus behind mental health care reform.
Policy is likely to be the product of practical concern or ideology (Grob, 1991; Kiesler,
1992; Warner, 1989). However, a growing number of mental health care professionals are
arguing that society must look beyond the immediate practical concern to develop plans
that can anticipate long-term consequences. For example, one concern is the growing
number of the homeless mentally ill who also have human immunodeficiency virus (HIV)
or acquired immunodeficiency syndrome (AIDS). According to a survey conducted in a
New York City shelter that housed homeless men, Susser, Valencia, and Conover (1993)
found that 12 of 62 (19.4%) of the mentally ill men tested positive for HIV. The severely
mentally ill may suffer the triple strikes of mental illness, drug use, and dangerous sexual
practices (Dévieux et al., 2007).
What can a society do to anticipate some of these long-term mental health care
consequences? To that end, Bachrach (1989) provided meaningful definition of
deinstitutionalization as
the shunning or avoidance of traditional institutional settings, particularly state mental
hospitals, for chronic mentally ill individuals, and the concurrent development of
community-based alternatives for the care of this population. This definition assumes
three primary processes: depopulation— the shrinking of state hospital censuses through
release, transfer, or death; diversion— the deflection of potential institutional admissions
to community-based service settings; and decentralization— the broadening of
responsibility for patient care from a single physically discrete service entity to multiple and
diverse entities, with an attendant fragmentation of authority. (p. 165)
According to Bachrach (1989), this definition of deinstitutionalization underscores
three related elements: facts, process, and philosophy. That is, sound mental health care
policy must be based on credible research or evidence (the facts). To plan for long-term
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goals, one must know the characteristics of the mentally ill and the resources or systems
where they receive their services (process). Historical events and philosophical ideology
often determine the direction of mental health care movements (philosophy).
The Social Context to Deinstitutionalization
What were some of the anticipated and unanticipated issues or deinstitutionalization? In
the 1960s, Americans were optimistic about their ability to overcome problems. Indeed,
President John F. Kennedy was asking middle-class Americans to give to the less fortunate.
Programs were established, such as Project Head Start (including free meals for
schoolchildren from low-income families) and the Peace Corps (e.g., teaching people in
developing countries about family planning, and building new resources in communities
around the world).
Mental health benefited from these efforts, as well as from the advances in medication
that brought many symptoms under control. Psychotropic drugs such as Elavil
(amitriptyline chloride) and Thorazine controlled the more visible symptoms of
schizophrenia. Thus, professionals had more reason to use the least restrictive methods for
treating the mentally ill.
This optimism was fueled by negative reports from both professional (Thomas Szasz’s
[1961] The Myth of Mental Illness) and popular writers (Ken Kesey’s One Flew over the
Cuckoo’s Nest). People in the legal profession also took up the cause—for example, the
American Civil Liberties Union initiated the Mental Health Law Project. A common
theme in these writings and legal efforts was opposition to involuntary hospitalization
(Torrey, 1997).
However, some mental health care experts (Kiernan, Toro, Rappaport, & Seidman,
1989; Warner, 1989) believed that no matter how admirable and persuasive the
philosophical and value-based decisions regarding wide-scale release from hospitals, the
more pragmatic explanation to account for deinstitu-tionalization was economic.
Investigating deinstitutionalization in various Western countries in the past 30 years,
Warner (1989) found that
the process was stimulated by the opportunity for cost savings created by the
introduction of disability pensions and, in some countries, by postwar demand for
labor. Where labor was in short supply, genuinely rehabilitative programs were
developed. Where cost saving was the principal motivation, community treatment
efforts were weak. (p. 17)
Also, Kiernan and colleagues (1989) found that employment was negatively related to
both first admissions to state hospitals and case openings in community outpatient
facilities. When the economy was good, fewer people had mental problems or were
admitted into state psychiatric hospitals.
After World War II, the world economy had been relatively good until the 1970s. The
argument that deinstitutionalization is associated with economic stability appears to be
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consistent with the number of psychiatric hospital beds per 10,000 individuals in the
Western industrialized countries. As long as there was a demand for a labor force, more
people were deinstitutionalized.
Whether or not one agrees with this interpretation, deinstitutionalization has
significant economic impact. The federal budget for care of the mentally ill has continued
to rise. States have little financial incentive to provide comparable assistance because
significant sources of this care are in the form of Supplemental Security Income, food
stamps, Medicaid, Medicare, and so on. This imbalance between federal and state resources
directed to the care of the mentally ill has created havoc (Torrey, 1997). Indeed, in a
critical analysis of factors associated with deinstitutionalization, Brooks, Zuniga, and Penn
(1995) found that financial burden is the principal determinant in this process. These
researchers argued that “faced with the increasing costs associated with replacing or
upgrading an aging system … most changes in services have been the outcome of budget,
not medical, decisions, with medical or legal rationalizations applied post hoc or in parallel”
(pp. 55–56).
Although these findings appear to explain the reasoning behind deinstitutionalization,
they do not adequately account for its falling short of its goal to enhance the quality of life
of the mentally disordered. Community psychologists and mental health care experts
(Cheung, 1988; Earls & Nelson, 1988; Lovell, 1990; Mowbray, 1990; Mowbray, Herman,
& Hazel, 1992; Struening & Padgett, 1990) have argued that sociological factors (such as
adequate housing) and psychological factors (such as stigmatization) often hinder the
progress of deinstitutionalization. Case in Point 6.2 discussed interesting research on
stigmatization—research in which institutionalized patients faked their disorders.
Use of mental health facilities is related to personal poverty. Bruce, Takeuchi, and
Leaf (1991) demonstrated a causal link between mental disorder and poverty. They
examined the patterns of new disorders that developed over a six-month period in an
epidemiological study. Their sample included African Americans, Hispanics, and Whites.
The researchers found that a significant proportion of new episodes of mental disorder
could be attributed to poverty. In addition, Bruce and associates found that the risk for
developing disorders was equal for men and women and for African Americans and Whites
—in other words, poverty does not discriminate on the basis of race or gender.
Many people with mental disorders are discharged from hospitals into the community
without adequate planning or support systems. For example, Mowbray (1990) argued that
many of those discharged did not have adequate living or social skills (e.g., cooking and
paying bills) to survive in an unstructured environment. For deinstitutionalization to be
effective, adequate and appropriate treatments must be in place (Mowbray & Moxley,
2000). Struening and Padgett (1990) found that homeless adults in New York City had
high rates of alcohol and drug abuse as well as mental illness. It is not unlikely that a large
portion of these people were mental patients who were discharged from hospitals without
adequate planning. Thus, they became homeless and had alcohol and drug-abuse problems
(Levine & Huebner, 1991; Susser, Valencia, et al., 1993). Meanwhile, a majority of the
mentally disordered are continuously being discharged from hospitals into nursing homes
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or board-and-care homes that are ill prepared to provide the services these patients need.
A 2006 U.S. Department of Justice report states that 56% of state prisoners, 45% of
federal prisoners, and 64% of local jail prisoners have a history of mental disorder (James &
Glaze, 2006). Those with mental disorder histories were more likely to be young, female,
and White. They are more likely to be violent. In state courts, they are more likely to
receive longer sentences. According to Harcourt (2007), within the United States more
than 2 million people are imprisoned. This is 5 times Great Britain’s rate and 12 times
Japan’s rate, making for the highest number and rate of prisoners in the world. The point
of this is that the idea that deinstitutionalization from hospitals has saved money is very
incorrect. The mental patients have not been deinstitutionalized but rather
reinstitutionalized in a different setting.
In a study of what happens to the chronically mentally disordered, Diamond and
Schnee (1990) tracked 21 men who were perceived to be most at risk for potential violence
and were also high users of jails. The men were tracked for two and a half years through
various service systems. The men used up to 11 different systems, including the mental
health, criminal justice, healthcare, and social services systems. Criminal justice services
were the most frequently used, and mental health services were usually only short-term,
crisis care services, although some of the men had been hospitalized for long-term
psychiatric care. Diamond and Schnee believe that their figure is an underestimate and
calculated that the cost of care of the 21 men in all service systems totaled $694,291. That
figure does not include costs to victims, nor property damaged in the men’s violent
episodes. The researchers called for a more coordinated effort of the various systems to
better assist the men and to reduce costs.
Belcher (1988) suggested that when people with mental disorders are released from
hospitals or institutions, they are often unable or unwilling to follow through on their own
aftercare. This situation increases the likelihood that these individuals will become involved
in the criminal justice system. In addition, because the legal system and the mental health
systems view mental disorders differently (Freeman & Roesch, 1989), the mentally
disordered are not afforded the same level of therapeutic services for their disorder when
they are incarcerated. The legal system narrowly deals with mental illness only as
incompetence to testify in one’s own behalf or as insanity, which is a defense against guilt.
The U.S. Department of Justice reports that about a third of state prisoners, a quarter
of federal prisoners, and 17% of local jail prisoners receive some kind of mental health
treatment while they are incarcerated (James & Glaze, 2006). Although hospitalization is
very rare, use of medications is most popular.
The solution may be that mental health, criminal justice, and other professionals need
to collaborate in innovative and integrative ways to prevent the mentally ill from being
incarcerated in a correctional facility and to treat their disorders when they are incarcerated
(Diamond & Schnee, 1990). Another alternative is to provide treatment and community
support for these mentally ill individuals that is strong enough to forestall their ever getting
involved in the criminal justice system. Heller, Jenkins, Steffen, and Swindle (2000) argue
that the deinstitutionalization of the 1960s has come full circle. They believe the dream of
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community-based mental health treatment with community-based prevention programs
has never been realized. Among the factors they cite for the problems in implementing the
vision are a lack of understanding of what would be required for medication maintenance
programs, a disregard of natural communities and neighborhoods in setting up program
boundaries, and professional resistance to anything other than traditional treatment
programs for patients. Heller, Jenkins, et al. (2000) cite the reduction in community
support program funding occurred at the same time the economy took a downturn, leaving
many of the mentally ill to become homeless.
Seidman and Rappaport (1986) believe that in searching for solutions, we are
hampered by a tendency to overgeneralize conclusions regarding a group of people based on
extreme examples from that group. Social psychology would add that this tendency to
overgeneralize regarding negative aspects of a group is related to our feeling distant from
that group, that is, they are considered members of an out-group (Allport, 1954/1979;
McConnell, Rydell, & Strain, 2008). For example, after finding one case of an ethnic
minority mother on welfare driving a new Cadillac, people may tend to believe all welfare
recipients are members of ethnic minorities who abuse the system. In reality, most of those
on welfare are not abusive and are White. Those who have severe mental illness deal with
this problem as well. People’s preconceptions of mental illness cannot help but influence
how they think, feel and act. The stigma of mental illness remains and can be found in our
communities (Mowbray, 1999; Perry, 2011; Wahl, 2012) and our places of higher
education (Collins & Mowbray, 2005).
Early Alternatives to Institutionalization
The ideal setting for the institutionalized individual would be one that enhances his or her
well-being because of the optimal fit between his or her competencies and the support
provided in the environment. In reality, many community placements are based as much
on what is available and on economics as on the individual’s competencies (Mowbray &
Moxley, 2000).
If not in institutions, where were the people who with mental disorders placed? They
went to nursing homes and home care placements. They were discharged with little
community planning and minimal financial support.
Today, they could still be found in a variety of settings, but most often in
unsupervised sites, that is, on their own (Figure 6.1) Otherwise, the typical community
placements have been with their families, in nursing homes and halfway houses (Kooyman
& Walsh, 2011). Their care has been typically paid for by Supplemental Security Income
(disability checks). As funding for these options dwindled, so did the space for these former
clients (Heller, Jenkins, et al., 2000). They have been overrepresented in prisons and
among the homeless.
This fragmentation of care and the supposed economization of services implied that
society has essentially moved from a mental health system to a welfare system (Kennedy,
1989). The original vision was for a community mental health system that provided
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“prevention programming, reaching underserved populations, fostering community
awareness of social and environmental determinants of psychological dysfunction and
consultation to community caregivers to encourage the development of indigenous helping
networks” (Heller et al., 2000, p. 446). This vision was never realized.
FIGURE 6.1 Community Living Situations for Those with Schizophrenia
Source: Kooyman, I., & Walsh, E. (2011). Societal outcomes in schizophrenia. In D. Weinberger & P. Harrison (Eds.),
Schizophrenia, 3rd ed. Hoboken, NJ: John Wiley, pp. 644–665.
Measuring “Success” of Deinstitutionalized Persons
Many in the mental health field would quickly jump to the conclusion that
deinstitutionalization has not been successful. We have reviewed some of the myriad
problems that deinstitutionalization has created, including but not limited to trans-
institutionalization, homelessness, and jails. How is successful integration into the
community measured? The answer depends on whom you ask and what issues you discuss.
Society needs to take a closer look at the measurement of success of
deinstitutionalization. Table 6.1 shows the names of famous people who at one time or
another experienced mental impairment and were also able to integrate successfully into
society.
The typical measures of success are social integration and recidivism. Social
integration was defined in the last chapter as people’s involvement with community
institutions as well as their participation in the community’s informal social life (Gottlieb,
1981). Recidivism means relapse or return to the institution or care—in this case, return to
the psychiatric hospital. However, both of these terms imply limited criteria. Recent efforts
in the literature of the field of community psychology indicate that measurement of success
is a more complex issue.
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TABLE 6.1 Famous Individuals with Some Form of Mental Disorder
Person Field Mental Disorder
Kim Basinger Actress Anxiety disorder
Catherine Zeta-Jones Actress Bipolar disorder
J. K. Rowling Author—Harry Potter Depression
Abraham Lincoln 16th American president Depression
John Ford Nash Mathematician/Nobel prize
winner
Schizophrenia
Johnny Depp Actor Anxiety disorder
For example, Shadish, Thomas, and Bootzin (1982) found that different groups use
different criteria for success. Residents, staff, and family members of community care
facilities often express that the quality of life (e.g., a clean place to live and something to do)
ought to serve as a measure of success. On the other hand, federal officials and
academicians cite psychosocial functioning (e.g., social integration and reduction of
symptomatology) as good measures of success of community placement.
A Community Competence Scale has been devised to assess deinstitutionalized
patients’ basic living skills (Searight & Goldberg, 1991; Searight, Oliver, & Grisso, 1986).
The questions assess an individual’s ability to make judgments related to nutrition and
dealing with emergencies, to communicate with others, and to perform simple math and
verbal tasks. In their research, Searight and associates found that the scale discriminated
effectively between client groups requiring differing levels of guidance in the community.
A very different but also very prominent measure of success for deinstitutionalization
is the economic one (Brooks et al., 1995). Arguments for programs are still based on cost
efficiencies. Unfortunately, these costs are frequently based on short-term budgeting,
without regard to potential long-term savings.
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BEYOND DEINSTITUTIONALIZATION
Certainly, the preceding scenarios do not reflect the optimism when deinstitutionalization
began in the late 1960s. It was thought then that the introduction of the Community
Mental Health Act could “reduce the census of state hospitals and … provide treatment to
maintain psychiatric patients in the community” (Levine, Toro, & Perkins, 1993, p. 526).
Now, with hindsight, it seems obvious that one reason for the existing “patchwork” system
is poor coordination and a lack of systematic planning. Heller, Jenkins, and colleagues
(2000) would add that problems included “deeply entrenched attitudes and practices” (p.
448), professional resistance, and a general ignoring of local support and/or fears.
“Model” Programs for Individuals with Mental Disorders
Emerging from the deinstitutionalization movement are several model programs that may
be examined for their community psychology properties. These programs range from
empowering participatory communities for the severely mentally ill (SMI), to intensive and
comprehensive focus on management of each individual case of community-based SMI, to
a team effort to provide the multiple levels and multiple areas of services needed for adult
SMI or for youth. These are all tertiary prevention efforts, which reflect some of the basic
community psychology concepts of respect for the diversity of individuals who need
services, the empowerment of individuals or their family systems to deal with problems,
and the recognition of multiple levels of intervention required to adequately address the full
ecology of mental health needs. Last, for those who continue to require institutional care,
we review an effort to shift the social and environmental contexts within the institutions. A
program to “reduce the use of restraints” takes an approach to change the physical
environments and the social and professional assumptions related to patients and their care,
so as to shift the need for restraints in the institutional environment. We begin with an
examination of one of the earlier studies of providing an alternative, community-based
environment to SMI, the Lodge Society.
LODGE SOCIETY. It is sad to note that community psychologists and mental health care
experts know more about what does not work rather than what does work with people who
are mentally disordered. However, coupled with the knowledge gained from pioneer
programs such as the Lodge Society (Fairweather, 1980; Fairweather, Sanders, Maynard, &
Cressler, 1969) and epidemiological investigations, some innovative psychosocial
rehabilitation models (Bond, Miller, & Krumweid, 1988; Bond, Witheridge, Dincin, &
Wasmer, 1991; Bond et al., 1990; Olfson, 1990) have been developed for treating people
with mental disorders. Fairweather’s concept of lodge societies encompassed structured
halfway houses or group homes for the mentally disabled that emphasized skill building and
shared responsibility as well as decision making. The concept of empowerment was clearly a
central part of his program (Fairweather & Fergus, 1993). Groups of four to eight people
would come together around a common business venture, working for “individual
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accomplishments” in a supportive group setting. The long-standing effectiveness of the
model and its derivatives serves to demonstrate the workable nature of such community
interventions. The Coalition for Community Living (http://theccl.org) reported that as of
2012, there were 90 Lodge programs sited across the United States. A study of 25 of these
programs in 2007 showed residents’ medication compliance rate (staying on their
medications) to average 99% and rehospitalization rates to be at 60%.
Intensive Case Management
Common to the newer models is the use of intensive case management (ICM), or intensive
case sup-port, including instruction in daily living skills (e.g., cooking and paying bills).
Service delivery linking both monitoring and brokering of delivery of a variety of services
performed by the case manager is also advocated (Snowden, 1992). In other words, a case
manager (usually a social worker) works closely with former mental patients, possibly being
on call 24 hours a day for any emergency that might arise. Also, case management can
easily be integrated into residential or outpatient treatments.
It is thought that intensive social support in the form of case management should
mitigate recidivism or relapse. Compared to traditional treatments (e.g., outpatient), case
management is labor intensive. However, research indicates that case management
“repeatedly has been shown to reduce both hospital use and costs across a number of
different studies performed in different communities … although other desirable effects
(e.g., symptom reduction, improved social relationships, …) have been less than robust”
(Levine et al., 1993, p. 529). These findings are understandable, given the complex nature
of mental disorder. As you may recall, even when housing is not a problem, improved social
relationships are contingent on many different people—the patient being just one of the
many. In examining who most benefits from this form of intervention, a British study of
people who were severely mentally ill found that reductions in hospital care were significant
for heavy care users. This reduction in use was not found for patients who were did not
frequently need hospitalization (Burns et al., 2007).
Nelson, Aubrey, and Lafrance (2007) differentiate ICM from assertive community
treatment in that ICM does not employ a team approach. The individual receives close
supervision and help in accomplishing the tasks necessary to survive in normal life, but
there is not the interdisciplinary perspective that the assertive community treatment
approach brings.
ASSERTIVE COMMUNITY TREATMENT. One especially powerful variation on the case
management model is assertive community treatment (ACT), known variously as mobile
treatment teams and assertive case management. It is designed “to improve the community
functioning of clients with serious and persistent mental illness, thereby diminishing their
dependence on inpatient care while improving the quality of life” (Bond et al., 1990, p.
866). ACT focuses on teaching practical living skills, such as how to shop for groceries and
maintain finances. A multidisciplinary team of professionals provides group case
management, lending their various expertise and resources to the conceptualization of the
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case needs and to the interventions called into play. ACT ensures attention to medications,
service planning, and coordination, as well as assessment and evaluations. Assertive
community treatment uses a low staff-client ratio—approximately 10:1. Moreover, clients
do not visit staff offices, but rather, staff visit clients in vivo—that is, in their own
environments. Mowbray (1990) viewed assertive community treatment as an embodiment
of several community psychology principles:
Ecological frameworks for conceptualizing cases
A systems level approach to intervention
Working toward integration of multiple levels of service
Working for prevention of pathology in the client population
Advocacy for an underprivileged population
Promotion of competencies in the targeted population
In Madison, Wisconsin, Stein and Test (1985) developed one of the first ACT
programs in the United States. Wanting more research on ACT, Bond and colleagues
(1990) compared ACT clients to clients at a drop-in center. Drop-in centers usually
provide an informal meeting place for clients who typically are formerly institutionalized
mental patients. These centers offer a range of social and recreational programs in a self-
help atmosphere. In sharp contrast to ACT, drop-in centers have a central meeting place, a
higher client-staff ratio, and no requirement for frequent staff contact.
Bond and associates (1990) found overall that after one year, 76% of the ACT clients
were still involved in ACT, whereas only 7% of the drop-in clients were involved in their
programs. The ACT staff team averaged only two home and community visits per week per
client, but their clients averaged significantly fewer state hospital admissions and fewer days
per hospital stay. The researchers estimated that ACT saved more than $1,500 per client
per year. ACT clients themselves reported greater satisfaction with their program, fewer
contacts with the police, and more stable community housing than clients from the drop-in
center.
One reviewer (Mowbray, 1990) has questioned why community psychologists have
not been more involved in research on ACT and the seriously mentally ill. For example,
Toro’s (1990) critique of this type of program led him to suggest that more research was
needed on its impact in other domains, such as employment and social relationships. Salem
(1990) concluded that a more thorough investigation of consumer- or client-run programs
was needed, as well as more diversity among interventions for people with mental
disabilities.
Nelson and colleagues (2007) reviewed comparison studies of ACT, ICM, and
housing programs for SMI clients. They found that the provision of permanent housing for
SMI clients led to reduced rates of institutional recidivism. In addition, the ACT programs
resulted in better housing outcomes, with ICM the least successful of the newer models.
Otherwise, those in ACT and ICM usually reported better community functioning and
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better feelings about themselves. One of the studies suggested the provision of ACT to be
more expensive than standard treatment. Nelson and associates (2007) remark that ACT
and ICM appear to reduce homelessness and hospitalization and improve community
functioning. Though the intervention may be initially more costly, the reduction in
institutionalization costs compensates for these temporary and superficial up-front
expenditures (Rosenhack, Kasprow, Frisman, & Liu-Mares, 2003).
Wraparound
Wraparound services have been around and developing for a number of years. Burchard,
Bruns, and Burchard (2002) believed the evolution to have been at least 15 years in length
at the time of their chapter describing the approach. They noted that wraparound services
attempted to be “strength focused, community based, and culturally relevant” (p. 69). The
premise was simple: Determine what was needed, and then provide it for a long as it was
needed. Developed as an alternative to the medical model, and theoretically based in the
ecological principles of Bronfenbrenner (1979), learning principles of Bandura (1977), and
systems theory of Munger (1998), it works from the belief that adaptation can be learned
just as maladaptation can be learned. Thus, it sets out to create an environment, a mixture
of micro and macro settings that provide learning opportunities and support for adaptive
behaviors. The systemic understanding is that a change in one part of life influences other
parts of life. Therefore, a comprehensive systems approach is taken to each client. The
approach is clearly community based, with an emphasis on teamwork and collaboration
across agencies and the family, the active engagement of families as a part of the
intervention, and commitment to the client that is flexible, culturally informed, and long
lasting (Burns & Goldman, 1999). A review of studies demonstrates a clear evidence basis
to this service approach (Burns, Goldman, Faw, & Burchard, 1999). Ecological, systems
oriented, long lived, strength based, outcome focused (Burchard et al., 2002)—the
wraparound approach to services is replete with community psychology concepts and
practices. Case in Point 6.3 discusses an example.
CASE IN POINT 6.3
Wraparound Milwaukee
Wraparound Milwaukee is a multiyear program targeting youth with “serious emotional
disorders,” who are at risk for institutionalization in the mental health or legal system, and
their families. The key characteristics of the program are (1) a strengths-based strategy to
children and families, (2) family involvement in the treatment process, (3) a needs-based
services planning and delivery (see Table 6.2), (4) an individualized service plan, and (5) an
outcome-focused approach. These approaches are structurally integrated into and
implemented by four structural components: (1) care coordination, (2) the child and family
team, (3) a mobile crisis team, and (4) a provider network. More than “80 mental health,
social and support services” are provided within this plan.
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TABLE 6.2 Services in the Wraparound Milwaukee Benefit Plan
Care coordination Crisis home care
In-home therapy Treatment foster care
Medication management Residential treatment
Outpatient—individual family
therapy
Foster care
Alcohol/substance abuse counseling Day treatment/alternative school
Psychiatric assessment Nursing assessment/management
Psychological evaluation Job development/placement
Housing assistance Kinship care
Mental health
assessment/evaluation
Transportation services
Mentoring Supervision/observation in home
Parent aide After-school programming
Group home care Recreation/child-oriented
Respite care Discretionary funds/flexible funds
Child care for parent Housekeeping/chore services
Tutor Independent living support
Specialized camps Psychiatric inpatient hospital
Emergency food pantry
Source: Adapted from Kamradt (2000).
The plan differs from others in that it focuses on the strengths of the child and the
family systems, building on them so as to maintain the child in the community if possible.
It points to the uniqueness of each case and honors it by providing choices and
individualized programs for each client/family. It speaks of empowering families to work
with their children. Toward that end, there are family social events, satisfaction surveys,
and recruitment of families to serve on program committees and in program training.
There is a 24-hour Mobile Urgent Treatment Team (MUTT), available to all clients and
their families. The outcome focus of the program is to reduce the need for
institutionalization.
The program “sustains itself by pooling dollars from its system partners and taking an
integrated, multiservice approach … based on the Wraparound philosophy and the
managed care model, offers care that is tailored to each youth” (Kamradt, 2000, p. 14). An
innovative feature is the blending of funding (Medicaid, Supplemental Security Income,
and other insurances) to maximize quality of care based on a case management model. It is
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estimated that “child welfare and juvenile justice systems fund Wraparound at $3,000 per
month per child. Prior to Wraparound, these funds were used entirely for residential
treatment care systems [that] paid $5,000 or more per month per child” (Kamradt, 2000,
p. 18).
Preliminary results of the program indicate that use of residential treatment has
decreased by 60% (from an average daily census of 364 placements to fewer than 140 since
the inception of Wraparound Milwaukee). Inpatient psychiatric hospitalization has
dropped by 80% (Table 6.3). These positive results have continued. In an annual report for
2005, Wraparound Milwaukee reported seeing more than 1,000 youth (http://www.coun‐
ty.milwaukee.gov/WraparoundMilwaukee7851.htm). The program continues to
demonstrate the targeted youth as having decreases in legal offenses, increases in school
performance, and more positive parent evaluations. The president’s New Freedom
Commission on Mental Health named Wraparound Milwaukee as a model program in
2004.
TABLE 6.3 Recidivism Rates of Delinquent Youth Enrolled in Wraparound
Milwaukee (n = 134)
Offense
1 Year Prior to
Enrollment
1 Year
Postenrollment*
Sex offense 11% 1%
Assaults 14% 7%
Weapons offenses 15% 4%
Property offenses 34% 17%
Drug offenses 6% 3%
Other offenses (primarily disorderly
conduct without a weapon)
31% 15%
*Data collected and analyzed as of September 1999.
Source: Adapted from B. Kamradt (2000).
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EARLY CHILDHOOD EXPERIENCES AND PREVENTION
Heller, Jenkins, and associates (2000) noted that early community conceptions of mental
health issues included a focus on prevention. However, as the saying goes, “We are so up to
our eyes in alligators, it is hard to think of draining the swamp.” Focus on secondary and
tertiary prevention interventions has taken much of the energy and resources of those
working in mental health. And yet, there are clear and substantial moves within the field to
gather the research and resources necessary to mount preventive efforts.
Cicchetti and Toth’s (1998) description of the diverse pathways and multiple factors
that bring about psychopathological outcomes underscored the contributions of a
developmental psychopathology approach to the understanding of depression and its
etiology in children and youth. Considering developmental pathways and trajectories, the
influence of vulnerabilities and events are seen as a network of influential factors that affect
each other in a complex interplay of variables. Notably, support systems that can coherently
address the life challenges of the individual play a protective role. Conversely, systems that
are chaotic and incoherent or that are pathogenic in nature lead to heightened risk of
depression. Preventive interventions have been shown to increase secure mother-infant
attachment in an at-risk population (Cicchetti, Rogosch, & Toth, 2006).
These days, our conception of the causes of psychopathology are multifactorial or
multipathed (Sue, Sue, Sue, & Sue, 2013). Sameroff and Chandler (1975) described the
need for explanatory models that took into account the biological, the psychological, and
the social. Sue and associates (2013) argued that a more complete model would include the
biological, the psychological, the social, and the social- cultural. The current
psychopathology model includes genetics, the environment, and epigenetics—that is,
biology/genes affected by critical environmental events, leading to expression or lack of
expression of the genetic dispositions (Institute of Medicine, 2009, p. 147).
Among the environmental events that have recently come under scrutiny are adverse
childhood experiences (ACEs) (Table 6.4). Based on data first collected in 1995 and 1997,
clear relationships were found between ACEs and depression, suicide attempts, drug abuse,
alcoholism, and a variety of physical health related disorders (Felitti, Anda, Nordenber,
Williamson, Spitz, Edwards, Koss, & Marks, 1998). Even hallucinations have been found
related to ACE scores (Whitfield, Dube, Felitti, & Anda, 2005). Sixty-four percent of
participants reported at least one adverse event, and 21% had three or more. Early-onset
(before age 5) child maltreatment was related to less emotional regulation and more
aggressive behaviors, which later led to poorer social relationships (Kim & Cicchetti, 2010).
In turn, early-onset physical and sexual maltreatment has also been found to influence
cortisol levels (stress) and depressive symptoms (Cicchetti, Rogosch, Gunnar, & Toth,
2010). In a study of adverse life events, social class, area deprivation, and family
deprivation, adverse life events independently contributed to child psychopathology
(Flouri, Mavroveli, & Tzavidis, 2010). Studies of negative early childhood experiences have
shown a pathway to psychological, social and physical problems.
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Because behaviors are caused by multiple variables that influence each other, not all
who have these negative experiences develop pathology (see Chapter 3, Resilience). Other
studies have shown that the combination of risk and protective factors determines the
probability of development of pathology (Cicchetti & Toth, 1999; Egeland, 2007). For
example, social support provided by fathers, grandparents, and other providers serves as a
protective factor against at risk conditions. This was especially so when there were multiple
levels of positive modeling, “higher quantity, higher quality and less disruption of the social
support” (Appleyard, Egeland, & Sroufe, 2007, p. 443).
TABLE 6.4 Adverse Childhood Experiences
Abuse (Emotional, Physical, Sexual)
Neglect (Emotional, Physical)
Dysfunctional Household (Violence, Substance Abuse, Mental Illness, Incarceration,
Divorce)
Source: Centers for Disease Control and Prevention, Adverse Childhood Experiences Study website, http://www.cdc.‐
gov/ace/prevalence.htm.
Our understanding of pathological processes has continued to grow. With this
understanding has come efforts to prevent the onset of pathology or mitigate the effects of
risk factors. One example of these efforts was the Fast Track Program. The Fast Track
Program was a 10-year-long intervention for identified at-risk children. The program
included parent training in behavior management, child training in social and cognitive
skills, tutoring, home visits, mentoring, and peer relation and classroom programming.
Early school findings showed significantly lower likelihood of aggressive and antisocial
behaviors, and fewer diagnoses of conduct disorder and attention-deficit/hyperactivity
disorder in middle school (Bierman et al., 2007). A later analysis of adolescent participants
showed that those who were a part of the program were less likely to use outpatient mental
health services by nearly 90% (Jones et al., 2010).
A meta-analysis of evidence-based early developmental prevention programs delivered
to at-risk populations found stronger support for such programs when they were multiyear
and intensive (more contacts). The review found that such programs showed success at
adolescence in terms of better educational outcomes, lower social deviance, greater social
participation, better cognitive development, less involvement in crime, and better
social–emotional development (Manning, Homel, & Smith, 2010). The programs’ results
encouraged preventive and developmental programs for the mental health system. These
findings called for reconceptions of the mental health system as a whole. (Also see Chapter
8 on Schools and Children.) Mental health interventions could and should be proactive,
comprehensive, and cognizant of social ecology and epigenetics. The vision of a more
broadly defined mental health system (Heller, Jenkins, et al., 2000) makes sense.
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THE BATTLE CONTINUES: WHERE DO WE GO FROM HERE?
Although having a mental disorder still incurs a stigma in society, the general public has
become more familiar with mental health and mental illness. This awareness is responsible,
in part, for the formation of the National Alliance for the Mentally Ill (NAMI). NAMI
functions as more than a self-help group; it also operates as a political lobbying body. In
2008, NAMI had about 1,100 affiliates in the country with a membership estimated at
130,000. NAMI is a key player in the ongoing mental health care reform. At the local level,
individual chapter members provide support to each other, as well as educational activities
for the public on topics such as medication and rehabilitative services.
Some psychosocial models based on the concept of case management and political
efforts such as those engaged by NAMI appear to offer hope for the mentally disabled.
Mental health care continues to struggle with stigma and stereotype, short- and long-term
focus, responsibilities and cost, and the public will to address these issues. Although
community psychologists and mental health care professionals can help empower the
mentally ill, using appropriate and culturally sensitive intervention models, mental health
care reform must not be carried out in isolation from other health agendas. Mental health
care needs to be framed within a unified health care agenda. Research (D’Ercole, Skodol,
Struening, Curtis, & Millman, 1991; Levine & Huebner, 1991; Susser, Valencia, et al.,
1993; U.S. Surgeon General, 1999) indicates that physical health and mental health are
interdependent. D’Ercole and colleagues found that physical illnesses among psychiatric
patients tended to be underdiagnosed when using the traditional psychiatric diagnostic
tools of the DSM-IV. This was especially true for older and female patients.
Knowledge that community psychologists have gained in the past 30-plus years about
health issues (mental health and mental illness in particular) strongly cautions us against the
false optimism of the 1960s. No one should be denied mental health care services simply
because she or he cannot afford to pay, yet realistic scenarios must take into account the
economics and politics of intervention and prevention. The community as a whole must
address these problems one way or another. In an indirect manner, mental illness is
addressed in our policies for the homeless and those in prison—possibly even more so than
in programs for the hospitalized or the mentally ill within our communities.
The demands on the system are rising. Torrey (1997) believed that approximately
150,000 people with mental illness were homeless on a given day, and another 150,000
were in jails and prisons. The aging baby boomers pose another challenge for caring for the
older or elderly mentally ill (Hatfield, 1997). Each of these scenarios demands a somewhat
different response or strategy, although the populations are not mutually exclusive.
Estimates were that 26% of the U.S. population has a diagnosable mental disorder (Kessler
et al., 2005). As of December 2008, the estimated population for the United States had
passed 314 million (http://www.census.gov/population/www/pop-clockus.html). The
number 78 million, which is approximately 26% of the population, seems almost
incomprehensible.
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Proponents such as Breakey (1996) have argued that the pressure of managed care on
psychiatry and clinical psychology is likely to limit the role of these clinicians. Although
evidence (e.g., ACT, Wraparound, Fast Track) reviewed in this chapter suggests that people
at risk of mental illness who receive integrated services tend to fare better than those who do
not receive such services, integrated care comes with a bigger initial price tag (real dollar
and other human capital and resources) (Sharstein, 2000). Can we be farsighted enough to
pay the bill? What role does community psychology play in communicating the advantages
of tertiary prevention over traditional services?
On the other end of the continuum, influential psychiatrists such as Torrey (1997)
have argued that recent discoveries in biological psychiatry indicated that “severe psychiatric
disorders are no more linked to minor mental perturbations than are multiple sclerosis or
Parkinson’s disease. Their proper treatment demands expertise in brain physiology and
pharmacology, rather than human relationships” (p. B5). Torrey argued that resources
should be redirected to allow psychiatry to merge with neurology to produce researchers
and clinicians who possess expertise on the full spectrum of brain diseases. This would place
neuropsychiatry as a single entity exactly where it was 100 years ago, before the Freudian
revolution and the mental-hygiene movement led it to focus on general mental health
rather than the most severe mental disorders (1997, p. B5).
This is both provocative and ominous! Given the rapid advancement in medical
technology, it is all too easy to lose sight of the human side of feelings and behaviors.
And yet, the findings in epigenetics (Fraga et al., 2005; Jaenisch & Bird, 2003)
remind us of the importance of the environmental interactions with genetic potentials.
People in community psychiatry and community mental health have the task to argue
that inte-grated care (e.g., coordinated, comprehensive, ecologically minded) should be the
norm. Meanwhile, the shift to an emphasis on biological psychiatry could hinder work
already under way in areas such as social support. We can hope that the work being done
on resilience (see Chapter 3), with its emphasis on multilevel interactive processes, will
bring better appreciation of the interplay among the biological, the personal, the social, and
the institutional variables affecting well-being. The field of mental health services continues
to increase in its use of the ecological model (Bronfenbrenner, 1977; Bronfenbrenner &
Morris, 2006; Kelly, 1990, 2002, 2006) for understanding the human experience.
Heller, Jenkins, and associates (2000) mark the neglect of prevention programs in the
traditional mental health care programs. Others have noted that one of the problems of
prevention programs is the delay in detectable results. A time frame of a decade or two may
seem impossible in our minute-to-minute and year-to-year mentality. The economic
pressures are to demonstrate present savings to the system (Felner, Jason, Moritsugu, &
Riger, 1983). Nonetheless, prevention has been demonstrated to work, focusing on
children and working with systems that are important to the lives of those children—that
is, families and schools (Albee & Gullotta, 1997; Durlak & Wells, 1997; Heller, 1990;
Ialongo et al., 2006). The aim of these prevention programs is of course to divert the
trajectory of the potential mental health client, providing personal and social resources that
may aid in dealing with life stressors and in learning life tasks (see Chapter 3 regarding
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resilience and social support). The present chapter has extensively discussed these programs
and their potentials. However, the focus here has been on tertiary prevention for cases
within the mental health system, which has a scarcity of prevention programs. The progress
in prevention research and action is measurable nonetheless.
The concern raised by Heller, Jenkins, and colleagues (2000) is the lack of natural
communities in the first community mental health center formulations (Hunter & Riger,
1986). The concept of a catchment area (geographic region that the community mental
health center served) used large areas based on street boundaries. There was no sense of
naturally defined neighborhoods (boundaries used by the members of the community),
whose strengths and existing networks could be brought to bear on problems. This
shortcoming may now be addressed by the inclusion of communities in devising programs
and research for themselves via the participatory action research models that are
increasingly used.
Summary
The presence of mental health concerns in the U.S. population has been studied for several
decades, and the results point to a sobering conclusion. The prevalence of mental illness is
substantial, and the possibility of some disturbance within an individual’s lifetime is nearly
one in two. Yet there is a concentration of disorders in a smaller segment of the population,
usually with multiple problems co-occurring. For these few, the impact of mental illness is
devastating.
Our traditional models of mental health are individual focused and reactive. The
shortcomings of these models have led us to the community perspective with its preventive
orientation and ecological perspective.
Although a historical overview of treatment for mental illness shows a progression
toward more humanitarian and inclusive treatment, the deinstitutionalization of the
mentally ill has not come without major problems. A casual review of the field of mental
health and illness indicates that there is a great deal of controversy about exactly what
deinstitutionalization is. Some have argued that a better term is trans-institutionalization to
describe the dumping of patients from one setting to another. Also, the characteristics of
the mentally disabled have changed in the past 30-plus years. Now, ethnic minorities
constitute a sizable sample of the mentally disordered, and they are likely to be undetected
by the existing systems.
The placement for a deinstitutionalized individual is, interestingly, another institution
—possibly jail or prison. Many of the deinstitutionalized end up among the homeless.
Most are in unsupervised settings, where problems of medical regimen compliance and
adverse social influences make successful reintegration into the community very unlikely.
We measure successful functioning of the mentally ill in their community in terms of social
integration and recidivism, or rate of return to the psychiatric hospital, but the economic
indicators of cost have remained important determinants for policy decisions. Most analyses
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of success focus on problems of the individual, but the environment plays a significant role
in successes or failures. Depersonalization of services can also account for problems faced by
deinstitutionalized individuals. Lack of adequate or integrated support lead to problems,
especially for those who have lost their natural social supports or who have care needs
beyond the resources of those supports.
The ideal that led to the enactment of the Community Mental Health Act in the
1960s has not been fully realized. Now it seems obvious that one reason for the existing
patchwork system is the lack of systematic planning and poor coordination.
Innovative psychosocial rehabilitation models have been developed for treating the
severely mentally ill. Common to these models are the provision of comprehensive,
integrated, and personal programs for identified clients, which include forms of daily living
skill training and empowerment of the support systems that help these clients. These may
be the natural systems, such as families and friends, or might be the formal systems of
agencies and programs that offer services. Individualized case management and smaller case
loads that allow for that can be very helpful.
Studies of early childhood experiences tell us that experiences in the formative years
are important to the development of normal or pathological pathways. Use of what has
been learned about these pathways, and of our understanding of what makes for resiliency,
has been useful in producing successful programs to reduce pathology in children and
adolescents. This challenges us to broaden our conception of the mental health system and
the resources it requires.
Although community psychologists and mental health care professionals can empower
the mentally ill by using appropriate and culturally sensitive intervention models, mental
health care reform must not be carried out in isolation from other health agendas. That is,
mental health care needs to be framed within a unified health care agenda. A holistic
approach with an understanding of the interactions of the mind and body and transactions
with ecological settings seems the prescription for treatments of the future, based on the
extant research in our communities at present. There is a lot of promise yet to be realized.
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Social and Human Services in the
Community
HISTORICAL NOTES ABOUT SOCIAL WELFARE IN WESTERN SOCIETY
■ CASE IN POINT 7.1 Poverty in America
■ CASE IN POINT 7.2 The Grameen Bank
SPECIFIC SOCIAL ISSUES AND SOCIAL SERVICES
Child Maltreatment
Intimate Partner Violence
Teen Pregnancy
The Elderly
Homelessness
■ CASE IN POINT 7.3 How Do Cultures Differ on the Issue of Homelessness?
SUMMARY
Of all the people in the world, 852 million are chronically hungry; every day, almost 16,000
children die from hunger-related causes.
—MCC.org/food
An empty sack cannot stand up.
—Haitian proverb
Rock was a high school senior. His girlfriend, Monique, was a sophomore in the same school. Both teenagers lived in
middle-class suburban homes. Rock was bored with his humdrum life in the suburbs and liked to “live on the edge.”
He listened to the newest music, had many tattoos, smoked weed, and liked to thrill ride on his motorcycle. His
unpredictability and careless living attracted Monique to Rock, although neither set of parents was thrilled with their
child’s choice of dating partner. Monique’s parents were especially displeased because her mother thought several pieces
of her gold jewelry were missing and might have found their way into Rock’s pockets.
Both Rock and Monique had a history of cutting classes and occasionally not coming home for several days. Rock
taught Monique to buy and smoke marijuana early in their relationship, and their use increased as the relationship
progressed. They ultimately were caught smoking marijuana behind their school. Because both were minors, the judge
ordered them to enroll in a drug-treatment program.
The treatment program was one of a dozen funded by a federal agency in collaboration with two state agencies.
The goal of the program was to prevent youths from using alcohol and other drugs—not to intervene or treat them. Past
research has shown that youths who have various risk factors (e.g., cutting class and stealing) are more likely to use or
abuse drugs than those who do not. Thus, youths who have certain risk factors were identified by the child and family
welfare divisions of government-sponsored social services and were referred to the drug-treatment programs at another
state agency.
In the case of Rock, he was ordered by the court (rather than identified by the child and family welfare agency) to
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enroll in the drug-treatment program. After intake, he was immediately placed into one of the programs. He was to
participate in both individual and group counseling. Family counseling with Rock’s parents was provided on a limited
basis because the program was mainly designed for drug treatment.
Monique’s treatment placement was still pending because during her intake, it was discovered that she was
pregnant. The state agency responsible for the drug-treatment programs did not accept pregnant clients. Thus, staff at
both state agencies did not know what to do with Monique. Both agencies were also experiencing some difficulty in
complying with all of the requirements of the federal agency that funded their drug-treatment programs.
Since the inception of the drug-treatment programs, several major political changes at the state level had led to a
leadership vacuum at the state agencies. The two executive directors of the respective agencies resigned after the
governor announced that she would not seek reelection. A consequence was the lack of coordination of the patient
referral process.
Meanwhile, direct-care staff felt strongly that alcohol and other drug abuse in youths was likely to be symptomatic
of other issues, including parent–child and school problems. Moreover, most of these youths were already using or
abusing some form of drug; therefore, to talk about prevention was utter folly. However, because the government
funding agency focused on prevention, the staff was obligated to comply by educating about prevention of use of drugs.
This true story illustrates that social problems often do not have a single cause and do not develop in isolation. In
the case of Rock and Monique, direct-care staff appeared to be correct in that drug treatment for both teens was merely
treating their symptom (marijuana use) but not the cause(s) (e.g., school alienation and generational conflicts between
parents and children). Moreover, Monique needed a treatment program that specialized in drug rehabilitation for
pregnant women. However, staff at the drug-treatment program was limited by resources and expertise. Here is a good
example of the inappropriate depletion of limited and sometimes scarce social and human resources. As you can see
from this case, effective social services delivery is contingent on good organizational infrastructure and management.
This chapter begins with a review of what poverty is and how social services emerged in
Western society to respond to the needs of the poor. Poverty, although not the cause of
Rock and Monique’s situation, is one of the root causes and complications of many societal
problems that ultimately affect all of us, whether or not we are poor (Grogan-Kaylor, 2005;
Rank, 2005). The chapter then reviews selected social and human services as well as
affected groups.
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HISTORICAL NOTES ABOUT SOCIAL WELFARE IN WESTERN
SOCIETY
What is poverty? Does poverty merely mean the lack of sufficient money to acquire
essential things to survive, such as food? Or does poverty mean being born and living in a
ghetto or slum, which might lead to attending a substandard school and might further lead
to a vicious circle of unemployment and subsequent homelessness (Hochschild, 2003)? The
latter notion is probably what President Lyndon B. Johnson had in mind when he made his
1964 State of the Union address about the War on Poverty. Poverty is not just about
lacking money; it is also about a sense of hopelessness and injustice (Yang & Barrett, 2006).
For example, without a good education, an individual is unlikely to find a decent-paying
job. Poorly educated people are less likely to be well-informed citizens—especially about
their basic rights and entitlements—compared to those who are educated. Poverty affects
all of us, not just the poor, in myriad ways and is not just about individual shortcomings
but about economic structures and failed political policies (Rank, 2005).
Although poverty does affect us all, it clearly harms some of us more than others. The
U.S. Census Bureau (2007) reported that the poverty rate for White Americans was 8.62%
in 2006, whereas it was 24.3% for Blacks, 20.6% for Latinos, and 10.3% for Asian
Americans. For American Indian or Alaskan Natives, the poverty rate was 27% (U.S.
Census Bureau, 2007). Scholars such as Smith (2009) have argued that we are living at a
time in U.S. history that is what Collins and Yeskel (2005) have termed economic apartheid,
or a widening equity gap in which increasing numbers of Americans are being left farther
and farther behind economically. The Economic Policy Institute conducted an analysis that
found since the late 1990s, incomes have declined by 2.5% among the poorest fifth of
American families, while they have risen 9.1% among the wealthiest fifth (Bernstein,
McNichol, & Nicholas, 2008).
With these thoughts in mind, we are ready to examine the effectiveness of public
assistance, one objective of which is to lift people from poverty and from other social
problems so that they can move on to a better life. First, Case in Point 7.1 provides some
compelling and alarming statistics about poverty in the world and, in particular, the United
States.
What has been done to help those who live in poverty? Social welfare is one response
that has tried to address the numerous needs of the poor. According to Handel (1982),
social welfare is “a set of ideas and a set of activities and organizations for carrying out
those ideas, all of which have taken shape over many centuries, to provide people with
income and other social benefits in ways that safeguard their dignity” (p. 31). Without
sounding simplistic, this seemingly innocuous statement describes the complex nature of
social welfare. Social welfare serves both ideological (e.g., political and religious) and
practical (e.g., inability to provide for oneself) concerns.
CASE IN POINT 7.1
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•
•
•
•
•
•
•
Poverty in America
Community psychologists and other experts consider poverty the number one social problem in the United States as
well as the root cause of many other social problems, such as delinquency, substance abuse, school problems, crime, and
homelessness. Here are some startling statistics about poverty both in the United States and worldwide. Additional
statistics can be found at two websites dedicated to combating poverty (solvingpoverty.com and www.poverty-usa.org).
Although being a college student does not necessarily mean that you will live a life of luxury, it may be hard to imagine
yourself living in poverty.
Worldwide, 25,000 people die each day of hunger; every 3.5 seconds, someone in the world dies of hunger.
In the United States, 1 in 6 or 47.4 million people live in poverty. The 2011 federal poverty guideline is that a
family of two that lives on less than$14,710 a year lives in poverty (see
http://aspe.hhs.gov/poverty/11poverty.shtml).
In the United States, 16 million Americans live in extreme poverty (that is, they live at less than half of the federal
poverty guidelines).
The United States leads all industrialized nations in child poverty.
Poverty rates for African Americans, Latinos, and single mothers are the highest—in some cases, twice that of
White men.
Fifty-nine million Americans are without health insurance; that translates into 1 of every 4 Americans between the
ages of 18 and 64.
Food stamp programs provide only$1 per meal per person. Could you live on that?
Until modern times, one major form of social welfare was charity, otherwise known as
philanthropy. Charity/philanthropy refers to social welfare in which a donor (voluntary
giver) assists a recipient (beneficiary). An example of this is when an individual donates
money to Habitat for Humanity so that this nonprofit organization can buy building
materials to help a homeless family build a house. The nature of charity/philanthropy is
largely a function of the ideology of the time period. For example, research indicates that
during religious seasons (e.g., Christmas and Passover), people are more likely to be
charitable than during nonreligious seasons. Public welfare, on the other hand, is where
the government (rather than private donors) assumes responsibility for the poor or for
recipients of aid who have not contributed to this particular system of aid.
Charity/philanthropy and public welfare are likely to create social stigmas whereby
some individuals hold negative views of those who require such aid (Applebaum, Lennon,
& Lawrence, 2006; Cadena, Danziger, & Seefeldt, 2006). Specifically, Handel (1982)
succinctly argued that recipients of social welfare
are widely believed to be lazy and immoral…. Although recipients must prove their
need, their claims are often thought to be fraudulent…. These people receive less
social honor than other members of society. Such methods of providing income are
therefore regarded as demeaning, as impairing the dignity of the people who depend
upon them. (pp. 8–9)
Even recipients of social welfare are likely to have a negative view of themselves (Chan,
2004; Sennett, 2003) or of other recipients (Coley, Kuta, & Chase-Lansdale, 2000). This
negative self-concept can translate into self-defeating behaviors. For example, there are
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millions of students attending public school whose families qualify for free breakfast and
lunch programs because they live at or below the poverty level. Yet, imagine that many of
these same students would rather skip lunch altogether than to have the stigma of being
poor broadcast to their peers in the lunch line. Thus, there are social welfare programs that
have been developed with the best of intentions whose effectiveness is questionable.
Moving beyond these so-called traditional forms of social welfare, we now turn to two
more modern forms of social welfare: social service and social insurance. Social services
(nonmaterial benefits) are an offshoot of charity/philanthropy. In a system derived from the
19th century, the government uses taxes to provide services rather than direct monetary aid.
A major goal of social services is to ensure and maintain a productive workforce via
prevention of or intervention in social problems. Rock and Monique, the two teenagers in
the opening vignette, were the recipients of social services (e.g., treatment programs from
the substance-abuse agency). It was hoped that these services could prevent both youths
from becoming more dependent on marijuana or other drugs in the years to come.
Social insurance (or public assistance, as it is otherwise known) has its origin in the
19th century, around the time of the Industrial Revolution. The basic premise of social
insurance is that the government assumes responsibility for individuals who may have
contributed in some way to the assistance system. The funds for these systems generally derive
from taxes. In other words, the difference between public welfare and social insurance (i.e.,
public assistance) is that “the recipients of social insurance are receiving benefits that have
been earned by work, either their own, or work by someone else on their behalf” (Handel,
1982, p. 15), whereas recipients of public welfare do not contribute to this process. Because
Monique had never held a job, if she turned to the government for benefits for her baby,
she would be deemed in the strictest sense to be on public welfare, not on public assistance.
Some well-known programs of social insurance/public assistance in this country include
Medicare (healthcare for the elderly), Social Security (unemployment and disability benefits
or old-age pensions for the formerly employed), and veterans’ benefits. Eligibility guidelines
(e.g., the federal poverty guidelines) are established by the government and can often be
cumbersome.
Public welfare programs have changed under the Personal Responsibility and Work
Opportunity Reconciliation Act of 1996. Public welfare recipients now have to transition
to full- or part-time work and cannot remain indefinitely on government assistance except
under certain extreme circumstances. Interestingly, research demonstrates that most welfare
recipients would like to work (Allen, 2000; Bell, 2007; Scott, London, & Edin, 2000).
Perhaps one reason for their motivation is that such assistance, as mentioned previously,
creates a social stigma against the recipients as well as diminishing recipients’ own sense of
dignity.
This seemingly more enlightened view of public welfare is emerging in the United
States among the public and some government officials. First, there is growing concern that
people should be less dependent on public welfare. Such assistance is seen as degrading and
stigmatizing. Second, recipients should be encouraged to work; that is, incentives to
encourage work should be more available than incentives to encourage dependence on
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public assistance. This appears to be the underlying philosophy of the Personal
Responsibility and Work Opportunity Reconciliation Act of 1996, already mentioned
(Scott et al., 2000). Third, there is growing recognition that if employment participation is
mandatory, employment should make families better off by working rather than by not
working. Some recent studies have found that movement into employment and away from
public welfare is associated with increases in income and personal well-being but may have
little effect on other aspects of family life, such as parenting skills or home environments
(e.g., Coley, Lohman, Votruba-Drzal, Pittman, & Chase-Lansdale, 2007). At the time of
this writing, results of other studies on welfare-to-work programs are mixed (e.g., Cadena et
al., 2006), so more research is needed to sort out the effects of this new effort. In addition,
the current economic crisis that has affected the United States as well as the rest of the
world has resulted in greater rates of joblessness and underemployment. Thus, transitioning
people off of public welfare into work may be more easily said than done. Interestingly,
other countries have instituted very different alternatives to welfare as a means of reducing
poverty; for example, read Case in Point 7.2 on the award-winning program at the
Grameen Bank.
Because welfare-to-work programs appear to have mixed results (Geen, Fender, Leos-
Urbel, & Markowitz, 2001), such programs are not without their critics. Piven and
Cloward (1996) noted that proponents claim miraculous social and cultural
transformations that are unrealistic, such as increased family cohesion and lower crime
rates. Piven and Cloward viewed such welfare-to-work programs as nothing more than a
class war between the haves and the have-nots. Opulente and Mattaini (1997) suggested
that sanction-based programs (such as the Personal Responsibility and Work Opportunity
Reconciliation Act) are likely to be ineffective and produce undesirable side effects, such as
anger. Wilson, Ellwood, and Brooks-Gunn (1996) and also Cadena and associates (2006)
have offered the criticism that the best research methods are not being used to examine the
outcomes and processes of such programs. Finally, Aber, Brooks-Gunn, and Maynard
(1995) as well as Coley and colleagues (2007) concluded that welfare-to-work programs do
little to enhance children of poor parents. In fact, poor children continue to be exposed to
more family turmoil, family separation, and instability; come from more polluted
environments; live in more dangerous neighborhoods; and experience more cumulative risk
factors than wealthier children (Evans, 2004).
CASE IN POINT 7.2
The Grameen Bank
Can a small loan (microcredit) of $25 to $50 “cure” poverty? An interesting experiment is under way worldwide. The
experiment in microcredit is known as the Grameen Bank. Founder Muhammad Yunus was struck by the extreme
poverty, especially of women, in Bangladesh. In 1976, with some difficulty, he took out a loan from a bank and
distributed the money to poor women in Bangladesh. In fact, his loans went to the poorest of the poor. The small loans
are generally used by the women to begin their own cottage-type industries, such as raising farm animals and producing
or creating crafts to sell. Yunus views microcredit as a cost-effective weapon to fight poverty. He could not, however,
convince any traditional banks to continue lending money to the poor, so he started his own bank, the Grameen Bank,
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and continued his microcredit loan program.
The Grameen Bank uses principles that run counter to traditional banking wisdom. It seeks the poorest borrowers.
No collateral is necessary for a loan. Instead, the system is based on trust, accountability, participation, and creativity.
Borrowers are required to join the bank in groups of five; the group members provide each other with support and
advice.
The Grameen Bank is now the largest rural financial institution in Bangladesh, with more than 8.35 million
borrowers, 96% of whom are women, in over 80,000 villages. Furthermore, in line with community psychology, the
bank brings the loans to the people, rather than the other way around. Of course, community problems cannot always
be solved by merely throwing money at people, but in this instance, the amount of money is nominal, and the return is
enormous.
A cogent question is this: Do the Grameen Bank and microcredit have a positive and long-term effect on these
impoverished individuals? The answer is a resounding “yes.” First, more than 97% of the loans are repaid, indicating
that people are not always looking for a free handout. Second, the bank has a positive effect on both the women and
their children. Independent research demonstrates that the women’s economic security and status within the family are
elevated. The children of the women are better schooled and healthier than other children in the community. Best of
all, extreme poverty (as defined by the United Nations) declines by more than 70% within five years of the borrowers
joining the bank.
Elsewhere in this chapter, some information on how poverty is measured in the United States (e.g., annual
household income for various size families) is provided. The Grameen Bank measures poverty level in completely
different and more functional and practical ways. Staff members monitor borrowers to determine whether their quality
of life is improving. For example, if a family successfully owns a house with a metal roof, has a sanitary latrine, drinks
potable water, finally has adequate clothes for everyday use, eats three square meals a day, gains access to schooling for
the children, and has reasonable access to healthcare, then that family is considered to have moved beyond poverty.
Would such a program work in the United States? Yunus thinks not. Costs in the United States are such that the
operations would be far more expensive. However, individuals from other nations have completed Grameen Bank
training so as to create replication programs in dozens of different countries.
The Grameen Bank concept for addressing poverty has been so successful that in 2006 Muhammad Yunus and the
Grameen Bank were awarded the Nobel Peace Prize. Muhammad Yunus, by the way, has a degree in economics, not in
community psychology. He is living proof that professionals from many disciplines can come together to address serious
community issues such as poverty.
Adapted from Yunus (1999, 2007) and www.grameen-info.org.
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1.
2.
3.
4.
5.
SPECIFIC SOCIAL ISSUES AND SOCIAL SERVICES
Many groups access social and human services for a variety of reasons. To evaluate and
judge the effectiveness or impact of these services, a consensus of standards is essential.
According to Price, Cowen, Lorion, and Ramos-McKay (1988), model programs possess
one or more of five characteristics:
The programs have a specific target audience.
The goal of the programs is to make a long-term and significant impact on the target
groups, thus enhancing their well-being.
The programs provide the necessary skills for the recipients to achieve their objectives.
The programs strengthen the natural support from family, community, or school
settings.
The programs have evaluative mechanisms to document their success.
Using these criteria as standards, our attention turns to five groups to examine the
problems, people, and interventions to the problems within social and human services
systems. These groups have been selected for several reasons. First, these groups are large or
growing in number. Second, some of these groups are currently receiving much media
attention, including maltreated children and pregnant teens. Third, all five groups have
received attention to some extent in the field of community psychology. The groups are
maltreated and neglected children, survivors of domestic violence, pregnant teens (like
Monique), the elderly, and homeless individuals.
Child Maltreatment
Child maltreatment is a complex and emotionally charged issue. Defining child
maltreatment is very difficult, so there is no universally agreed-on definition. One reason
for definitional difficulties is that each culture sets its own generally accepted principles of
childrearing, child care, and discipline (Elliott & Urquiza, 2006; Runyan, Shankar, Hassan,
Hunter, Jain, Dipty, et al., 2010). Child abuse is known to exist universally, however, and
there is general agreement across many cultures that child abuse should not be allowed and
that harsh discipline and sexual abuse are not allowable at all (Runyan et al., 2010). Also
making a clear definition difficult is the fact that some definitions take into account the
impact or harm on the child, whereas others focus more on the behavior or actions of the
perpetrators.
For now, let’s use a broad definition as provided by the World Health Organization
(WHO) (2004):
Child abuse or maltreatment constitutes all forms of physical and/or emotional ill-
treatment, sexual abuse, neglect or negligent treatment or commercial or other
exploitation, resulting in actual or potential harm to the child’s health, survival,
development or dignity in the context of a relationship of responsibility, trust or
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power.
SCOPE OF THE ISSUE. The Centers for Disease Control and Prevention (CDC)
(2011c) reported that in the United States in 2008, there were nearly 772,000 cases of
verified child maltreatment and that 1,740 children died as a result of maltreatment.
Worldwide, as many as 40 million children may be abused (WHO, 2004). Though these
statistics are alarming, they need to be viewed with some qualifications, because many
authorities believe there is underreporting. Why? First, many child injuries and deaths are
not routinely investigated, and postmortem examinations are not always carried out, which
makes it difficult to establish the precise number of cases (CDC, 2007c; Runyan et al.,
2010). Furthermore, many cases of abuse and neglect are concealed from investigators, and
there is great variation in how states review and report suspected cases. Also, medical
personnel sometimes make inaccurate determinations of the manner and cause of injuries
and death of children—for instance, blaming a neglected child’s death on sudden infant
death syndrome. In addition, investigations are often uncoordinated and not
multidisciplinary in their approaches (CDC, 2007c). Although these data are disheartening,
recent trends indicate that child maltreatment may be declining. The exact causes for the
decline and whether it is permanent or temporary are still unknown (Finkelhor & Jones,
2006).
As shown in Figure 7.1, nearly 80% of victims were abused by a parent acting alone or
in conjunction with another person. Approximately 40% of child victims were maltreated
by their mothers; another 18% were maltreated by their fathers; and 17% were abused by
both parents. Victims abused by nonparental perpetrators accounted for 11%. A
nonparental perpetrator is defined as a caregiver who is not a parent and can include foster
parents, child day-care staff, nannies, an unmarried partner of a parent, a legal guardian, or
a residential facility staff member. Data for victims of specific maltreatment types can also
be analyzed in terms of perpetrator relationship to the victim. Of the types of maltreatment
children experience, 65.8% were neglected by a parent. Of those who were sexually abused,
30.8% were abused by a relative other than a parent (Administration for Children and
Families, 2010).
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•
•
•
•
•
•
FIGURE 7.1 Victims by Perpetrator and Relationship, 2005
Source: Administration for Children and Families (2005). Child maltreatment. Washington, DC. U.S. Department of
Health and Human Services.
The toll of child abuse on the victim, family, community, and society are enormous
and quite varied. Here are some of the consequences of maltreatment.
Children who experience maltreatment are at increased risk for adverse health effects as
adults, including smoking, alcoholism, drug abuse, eating disorders, severe obesity,
depression, suicide, sexual promiscuity, and certain chronic diseases (English et al.,
2005; Runyan, Wattam, Ikeda, Hassan, & Ramiro, 2002).
Child abuse and neglect are associated with an increased risk of major depressive
disorder in early adulthood (Widom, DuMont, & Czaja, 2007).
Individuals with a history of child abuse and neglect are 1.5 times more likely to use
illicit drugs, especially marijuana, in middle adulthood (Widom, Marmorstein, &
White, 2006).
Maltreatment during infancy or early childhood can cause important regions of the
brain to form improperly, which can cause physical, mental, and emotional problems
such as sleep disturbances, panic disorder, posttraumatic stress disorder, and attention
deficit hyperactivity disorder (Cicchetti, 2007; Cicchetti & Valentino, 2006; U.S.
Department of Health and Human Services, 2001a; Watts-English, Fortson, Gibler,
Hooper, & De Bellis, 2006).
Approximately 1,400 children experience severe or fatal head trauma as a result of
abuse each year. Nonfatal consequences of abusive head trauma include varying
degrees of visual impairment (e.g., blindness), motor impairment (e.g., cerebral palsy),
and cognitive impairments (National Center on Shaken Baby Syndrome, 2011).
The economy may be contributing to incidents of infant abuse. In a study of children’s
hospitals, incidents of infant abuse were reported to average 4.8 per month before the
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•
•
recession and 9.3 per month after the recession began (National Center on Shaken
Baby Syndrome, 2011).
Early child maltreatment can have a negative effect on the ability of both men and
women to establish and maintain healthy intimate relationships in adulthood (Coulton
& Korbin, 2007)
Emotional and behavior dysregulation, school failure, and antisocial behaviors are
consequences to the victims (Olds et al., 2007).
The costs to society are monumental as well. Abused children, in addition to the
abusers, are typically the focus of intensive efforts from various social and human services
specialists. Suspected cases of maltreatment are often investigated by the Department of
Social Services and law enforcement. Abused children and their parents are often referred
by judges and other professionals to mental health care providers for treatment. These
direct costs are estimated at billions of dollars a year; indirect costs (such as long-term
economic consequences) add more billions annually.
Perhaps if we know the causes of maltreatment, we can better design prevention and
intervention programs. We’ll examine the complex causes next. From what you have
learned already, try to determine whether you think Monique and Rock might be at risk to
maltreat their expected child.
CAUSES OF MALTREATMENT. There is widespread agreement among family
violence experts that multiple factors are responsible for child maltreatment, such as
stressors in the parents’ lives, poverty, social isolation, and unrealistic expectations by
parents of children. Studies have also identified poor prenatal care, dysfunctional
caregiving, closely spaced unplanned pregnancies, dependence on welfare, community
violence, and parental substance abuse among multiple causes. Researchers, therefore, need
to look at several levels including (but not limited to) societal, institutional, and
interpersonal factors as providing the explanatory framework for child maltreatment and
other forms of family violence, such as partner violence. Societal factors, for example, can
contribute to child maltreatment in the following ways. Poverty and economic downturn
diminish the capacity for consistent and involved parenting. Parental job loss might
produce pessimism and irritability in the parent. The parent might then become less
nurturing and more arbitrary in interactions with the children.
Community psychologists would be quick to point out that other ecological factors
contribute to child maltreatment. Indeed, child maltreatment may represent one of the
greatest failures of the environment to offer opportunities for fostering wellness (Cicchetti,
Toth, & Rogosch, 2000; Cicchetti & Valentino, 2006). Garbarino and Kostelny (1992,
1994) investigated community dimensions in child maltreatment. They examined two
predominantly African American and two predominantly Hispanic areas of Chicago. Some
60,000 child maltreatment cases were plotted for location for the years 1980, 1983, and
1986. Garbarino and Kostelny found significant location differences in maltreatment. As
part of this same research, community leaders from social services agencies were also
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interviewed. The interviews revealed that high-risk locations were characterized by a lack of
community identity, whereas low-risk areas were characterized by a sense of community or
greater community cohesiveness. Garba-rino concluded that abuse is not necessarily a sign
of an individual or a family in trouble but a sign of a community in trouble. Other
scientists agree that neighborhood factors, such as impoverishment (Coulton & Korbin,
2007; Euser, van Ijzendoorn, Prinzie, & Bakermans-Kranenburg, 2011) and community
violence (Lynch, 2006), affect child maltreatment and child development as much as or
more than individual risk factors. You will read more about community disorder and
disintegration in the chapter on crimes and communities.
Korbin and Coulton’s (1996) research, in which they conducted in-depth interviews
with residents in 13 high-, medium-, and low-risk census tracts in Cleveland, Ohio, also
demonstrated that intervention efforts can be reoriented to the neighborhood level. They
found that neighborhood conditions, such as distrust of neighbors and of social agencies as
well as the dangers and incivilities of daily life, limit the abilities of neighbors to help one
another act in the best interests of neighborhood children. Neighbors do feel that they
should be able to help each other; in fact, many participants reported being optimistic that
they could help prevent child maltreatment. However, neighborhood conditions often
inhibited their willingness to do so. The researchers concluded that because economic and
social conditions are inextricably bound together, child maltreatment prevention programs
must be embedded within comprehensive efforts to strengthen communities.
Freisthler, Bruce, and Needell (2007) also examined how neighborhood characteristics
were associated with rates of child maltreatment. Their study included 940 census tracts in
California. Their results demonstrated that for Black children, higher rates of poverty and
higher densities of off-premise alcohol outlets were positively associated with maltreatment
rates. Percentage of female-headed families, poverty, and unemployment were positively
related to maltreatment rates among Hispanic children. For White children, the percentage
of elderly people, percentage of poverty, ratio of children to adults, and percentage of
Hispanic residents were positively associated with neighborhood maltreatment rates. The
researchers concluded that reducing neighborhood poverty may reduce rates of child
maltreatment for all children, and efforts to prevent maltreatment at the neighborhood
level may need to be tailored to specific neighborhood demographic characteristics to be
most effective.
Just what efforts have been made to intercede in child maltreatment and neglect?
Traditional efforts at intervention occur at the individual clinical level, where maltreated
children and their parents are given counseling to help overcome personal problems and
understand the abuse. Although these methods may be laudable, they do little to prevent
the abuse in the first place. This method of treatment is also difficult and expensive to
implement on a wide scale. Moreover, these methods focus only on the individual or family
and not on other ecological systems (e.g., poverty and community violence) that share
responsibility.
Some people have argued that the best way to improve the situation for abusers and
their victims is through national policies aimed at creating jobs, reducing unemployment
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and poverty, or providing income maintenance, such as welfare or public assistance.
Prevention experts, like community psychologists, believe better and more targeted
strategies can be aimed at high-risk groups before the maltreatment commences (Olds,
2005, 2006). Prevention of child maltreatment and neglect is certainly the more humane
route to take.
PREVENTION PROGRAMS. Perhaps one of the oldest, best known, and most highly
acclaimed preventive programs is one designed by David Olds and his research team (Olds,
Henderson, Chamberlin, & Tatelbaum, 1986; Olds et al., 2007). Their project, known in
its earliest form as the Prenatal/Early Infancy Project and more recently as the Nurse-
Family Partnership, provides nurse home visitation to prevent a wide range of maternal and
child health problems associated with poverty, one of which is child abuse. Despite the
usual criticisms of the program (see Chaffin, 2004; Olds, Eckenrode, & Kitzman, 2005),
one of the aspects that makes it outstanding is that evaluation research typically is well
designed, using randomly assigned experimental and control groups. Likewise, by recruiting
a heterogeneous group of participants, these interventionists are better able to compare
those who are not at risk for abuse with those who are.
Primiparous mothers (women having their first child) who are young, single parents,
or from the lower socioeconomic class are welcomed into the program. The researchers
want to avoid the appearance of being a program only for potential child abusers and on
the other hand to ensure family engagement and avoid stigmatization. Olds and colleagues,
therefore, have actively avoided labeling the program as one aimed at preventing
maltreatment. Nevertheless, it was developed explicitly to reduce risk and at the same time
promote protective factors associated with child abuse and neglect (Olds et al., 2005).
Nurses typically visit the participants’ homes every other week during the prenatal
(before birth) and the perinatal (after birth) periods. The mother’s primary support person
(perhaps her own mother, a friend, or the baby’s father) is also invited to attend. Social
support from the nurses and significant others is a vital component of this program. The
nurses carry out three major activities during their home visits: educating parents about
fetal and infant development, promoting the involvement of family members and friends in
support of the mother and care of the child, and developing linkages between family
members and other formal health and human services in the community. In the education
component, mothers and family members are encouraged to complete their own education
and make decisions about employment and subsequent pregnancies. Before the baby’s
birth, the nurses concentrate on educating the prospective mothers to improve their diets
and eliminate the use of cigarettes, drugs, and alcohol; recognize pregnancy complications;
and prepare for labor, delivery, and care of the newborn. After the baby is born, the nurses
concentrate on improving parents’ understanding of the infants’ temperaments and
promoting the infants’ socioemotional, cognitive, and physical development. The nurses
also provide links to other formal services, such as health providers, mental health
counselors, and nutritional supplement programs for mothers and infants (Women,
Infants, and Children [WIC] programs) (Olds, 2005, 2006).
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One of the most important results of the program is its effect on verified cases of child
abuse and neglect. For women with all three risk characteristics of abuse (poor, unmarried,
and adolescent), there is usually a remarkable 80% difference in the incidence of verified
cases of child abuse and neglect over the comparison (nonintervention) group. Remarkably,
these differences persist at the 15-year follow-up. The mothers in the nurse-visited group
also report that their infants are easier to care for. The interviewers of the mothers often
observed less punishment and restriction of the mothers toward their children and a greater
number of growth-promoting playthings in the homes of the nurse-visited mothers. The
medical records of the nurse-visited families show fewer visits to emergency rooms for
illnesses and fewer childhood accidents. This is true even for the women who reported little
sense of control over their lives when they first registered for the program. The results also
hint at improved developmental life courses for the nurse-visited mothers, as well. For
example, once these mothers become older and more employable, they work at their jobs
longer than do their counterparts in the comparison group. Thus, program participants are
less dependent on public welfare. The mothers also have fewer subsequent pregnancies, and
both the mothers and their children are less likely to become entwined with the criminal
justice system. Olds (1997, 2005; Olds, Hill, & Rumsey, 1998) has replicated this program
in several communities across the United States with equally impressive results. At present,
the program is being disseminated for public investment throughout the United States
(Olds, 2007).
Research, however, has unveiled at least one limitation of the nurse home visit
program. In homes where other forms of domestic violence are occurring, nurse home
visitation is less effective at reducing child maltreatment (Eckenrode et al., 2000; Gomby,
2000). Further research has also shown that other, more long-term programs, such as ones
based in schools where children are taught to identify abuse, especially sexual abuse, may be
as effective as nurse home visitation programs (Davis & Gidycz, 2000).
The causes of child maltreatment are many. Cases of abuse keep large numbers of
social workers and mental health professionals busy with the aftermath. However, Olds’
and others’ programs demonstrate that child maltreatment can be prevented. Expenditure
of human and social service efforts at the outset may be more productive and humane, less
destructive, and more cost effective than efforts after the fact.
Intimate Partner Violence
SCOPE OF THE ISSUE. Intimate partner violence, also known as domestic violence, is a
societal issue that is often closely related to child maltreatment. According to the CDC
(2010b), intimate partner violence (IPV) describes physical, sexual, or psychological harm
by a current or former partner or spouse. This type of violence can occur among
heterosexual or same-sex couples and does not require sexual intimacy. The overlap
between IPV and child maltreatment is often high (Olds, 2010). In other words, in families
where children are being abused, there is also a greater tendency for violence among adults
in the family to exist. The most common type of interpersonal violence that is experienced
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globally is violence toward women. Although there are instances of men being abused by
women, they are in the minority of total reported cases. For example, the Bureau of Justice
reported that in 2005, IPV resulted in 1,510 deaths. Of these deaths, 78% were females
and 22% were males (Bureau of Justice Statistics, 2007). Although death may be seen as
the ultimate risk of IPV, there are enormous costs and consequences, both physical and
psychological, to the survivors and society in general.
In terms of consequences, there are some obvious physical costs of being in a
relationship with an abusive partner (e.g., bruises, broken bones, concussions) (Breiding,
Black, & Ryan, 2008). However, research has also revealed that there are significant
consequences of IPV on the endocrine and immune systems, including fibromyalgia,
irritable bowel syndrome, gynecological disorders, central nervous system disorders,
gastrointestinal disorders, and heart and/or circulatory conditions (Crofford, 2007;
Leserman & Drossman, 2007). Equally disturbing are the emotional and psychological
consequences of IPV, including reduced self-esteem, feelings of helplessness, depression,
fear, and psychological numbing (Moradi & Yoder, 2012). Although some of the
aforementioned physical consequences either heal in time or can be successfully treated
medically, the extent to which a survivor of IPV ever completely recovers from the
psychological wounds varies from person to person. In addition, for children who are raised
in a home where a parent is being abused, the impact of such role modeling can greatly
increase the likelihood that they will be in an abusive relationship as an adult (Olds, 2010).
Thus, preventing incidents of IPV is of paramount importance to the entire family.
The Duluth Model (Figure 7.2) was conceived in the early 1980s and was one of the
first documented IPV models to focus on issues of power and control (Domestic Abuse
Intervention Programs, 2008). Their well-known “Power and Control Wheel” depicts the
multifaceted ways in which abusers use this power and control—through minimizing,
denying, and blaming, and through using intimidation, coercion and threats, economic
abuse, male privilege, children, isolation, and emotional abuse.
CAUSES OF IPV. Violence toward women is considered both a public health issue and a
social justice issue. Because of the gender disparity of prevalence rates, which is exacerbated
in certain cultures, and the fact that men hold economic capital that can be used to control
their partners, community psychologists view this issue as one that is in need of systemic
intervention. There are a variety of theories that have been proposed to explain the abusive
behavior of perpetrators of IPV, many of which focus on gender role adherence and conflict
(Schwartz, Waldo, & Daniels, 2005) and male privilege (Stanko, 2003). These theories
essentially explain IPV as a function of exaggerated, stereotypical male gender role
acceptance, which requires women to stay in a subordinate role in the home. There is
empirical evidence for all these theories, including international research that has
documented higher rates of sexual assaults in countries where there is less occupational and
educational equality across genders (Yodanis, 2004).
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FIGURE 7.2 The Duluth Model
Figure reproduced with permission of : Domestic Abuse Intervention Program Duluth, MN 55812
Yet all theories of human behavior are imperfect, and several criticisms of these IPV
theories have been leveled. First, there is limited research that has specifically and
empirically examined patriarchy (i.e., institutionalized sexism) and its relation to IPV
(Woodin & O’Leary, 2009). Second, these theories do not adequately explain incidents of
IPV against men, be it by women or other males, nor do these theories apply in the same
way to same-sex female couples who exhibit IPV (Burke & Follingstad, 1999). Perhaps the
most obvious criticism of these theories, however, is that they do not explain why all, or
even most, men are not abusive partners (Healey & Smith, 1998). In other words, similar
to our previous discussions of poverty and child maltreatment, just as it cannot be said that
poverty “causes” child maltreatment, it also cannot be said that gender inequity “causes”
IPV. There are individual and interpersonal factors that must be taken into account when
explaining such behavior. Thus, programs that have been designed to eliminate IPV have
been focused on both individual/interpersonal factors that may explain why some
individuals are abusive and the community factors that make women vulnerable.
PREVENTION PROGRAMS. According to Davidson, Schwartz, and Waldo (2012),
there are two important ways that professionals have attempted to prevent IPV. One way is
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through early intervention efforts with youths (i.e., person-centered programs) and the
other is through public awareness campaigns (i.e., environment-centered programs). An
example of the former is a program called the Youth Relationships Project (YRP), an
adolescent-focused program that aims to prevent abusive behavior as well as promote
healthy, nonviolent relationships (Wolfe, Wekerle, Scott, Straatman, Grasley, & Reitzel-
Jaffe, 2003). This prevention program is focused on youth who are at risk for IPV because
of their history of maltreatment, a research finding that was discussed earlier in this chapter
(Olds, 2010). As was discussed in Chapter 1, this type of a program is classified as a
secondary prevention program in that it targets participants who are higher risk for a specific
behavior than the population in general. The content of this program is psychoeducational
in that it teaches participants new ways of thinking about and behaving in their romantic
relationships. For example, the program teaches participants interpersonal relationship
competencies such as conflict resolution and decision making, and nonviolent
communication skills within the context of current and future intimate partnerships. To
address the influence of gender role adherence, this program also emphasizes awareness of
power dynamics and abuse in intimate relationships (Wolfe et al., 1996, 2003). To further
model gender role equity, the sessions are cofacilitated by a woman and a man, enabling
positive modeling of relationship skills including assertiveness and sharing of power. The
program uses a variety of learning approaches including videos, role playing, guest speakers,
visits to community agencies, and a community social action project.
Research has shown the YRP program to be effective. Using an experimental,
longitudinal design with random assignment to intervention and control conditions, Wolfe
and associates (2003) found that program participants demonstrated decreasing severity
and frequency of abuse trajectories compared with participants in the control condition.
Interestingly, participants in both the intervention and control conditions showed decreases
in both abuse perpetration and victimization over time. However, the participants in the
YRP intervention condition decreased at a faster rate compared to those in the control
condition. This finding suggests that as these adolescents grew older, whether or not they
participated in the YRP program, there was a positive trend for relationships to become
healthier and less abusive. However, those who were in the program seemed to reach the
desired outcome of the program sooner, presumably reducing incidents of IPV along the
way.
Another type of intervention that Davidson and associates (2012) describe is
environmentally focused, whereby the goal of the program is to change the culture
surrounding IPV and attitudes toward violence against women. One example is Men
Against Violence (MAV) (Hong, 2000), a university-based prevention program that aims to
engage men in activism and social change regarding conceptions of masculinity and gender
roles, including violence against women. M AV began at Louisiana State University in
1995 as a service organization focused on opposing and preventing a variety of violence-
related activities including stalking, IPV, sexual assault, hate crimes, and hazing. Since its
inception, other universities have created their own chapters of MAV. According to Hong
(2000), the organization uses a community action-based peer education model and is
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sponsored by the university health center. An elected executive board of undergraduate and
graduate students manages the organization with input from an advisory board made up of
faculty, staff, and alumni.
The explicit purpose of M AV is to decrease both the frequency and severity of
violence among all members of the campus community, with an express emphasis on men’s
responsibility in this mission. This is accomplished through a variety of activities including
media campaigns to the campus and wider community (e.g., a campus-wide newsletter);
community action activities including organizing political activism projects; and raising
students’ awareness of the relationships between sexism, masculinity, and violence by
making presentations in university classes, fraternities, and residence halls. In this program,
college-aged men are asked to take leadership positions in changing the campus climate
(and societal norms) toward IPV. Although this program has not yet undergone the type of
evaluation that would determine its long-term impact on the college campus communities
it serves, it has promise as a grassroots approach to prevention of IPV.
While programs such as MAV and YRP attempt to decrease future incidents of IPV
by working with individuals whose beliefs about IPV and their experience in actual
relationships are still “works in progress,” social welfare approaches, often publicly funded,
have played an important role in tertiary prevention efforts by offering services to women
who escape abusive relationships. Domestic violence shelters are the most common example
of these approaches.
DOMESTIC VIOLENCE SHELTERS. Davidson and colleagues (2012) note that there
are more than 2,000 community-based programs focused on protecting and supporting
victims of IPV in the United States, which provide emergency shelter to approximately
300,000 women and children each year (National Coalition Against Domestic Violence,
2010). According to Walker (1999), the establishment of domestic violence shelters
emerged in the 1970s as a community-based crisis intervention. The location of shelters is
kept confidential so that IPV perpetrators are unable to locate their victims once they are
relocated. Shelters provide physical safety, access to resources (e.g., counseling, medical
services), and emotional peace of mind to the women and children they serve and aim to
empower women to start new lives with the economic and psychological independence that
they often lacked in their lives with their abusers. According to Chronister and colleagues
(2009), one of the key factors in permanently escaping violence relationships is economic
self-sufficiency. Unfortunately, many women who end up seeking the services of domestic
violence shelters have significant disadvantages to overcome on their way to obtaining
economic self-sufficiency. Abusers often have directly sabotaged women’s attempts to gain
employment and access economic resources while they were in the relationship, but they
also have denigrated these women, often to the point of destroying their confidence and
efficacy for identifying and pursuing economic opportunities in the future (e.g.,
employment, vocational training), which further exacerbates their emotional and economic
dependence (Chronister, 2007).
Recent research (Chronister & McWhirter, 2006) has demonstrated that interventions
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aimed at career development in domestic violence shelters can positively affect both the
women’s employment self-efficacy (their confidence in their ability to successfully find and
maintain employment) and their progress toward securing work, compared to women who
resided in shelters who did not undergo specific career development interventions.
Addressing barriers to economic independence is argued to be as important as addressing
those that prevent emotional independence. Failure to do so may be part of the reason that
some women return to the same abusive relationships or end up in new relationships that
are violent. The fact that domestic violence shelters do not provide sufficient services to
“guarantee” that women will permanently escape IPV is often leveled as a criticism
(Davidson et al., 2012). However, few types of community intervention have 100% success
rates, and the reasons that some women stay in violent relationships is a complex interplay
of individual, interpersonal, and societal factors.
Teen Pregnancy
SCOPE OF THE ISSUE. Adolescent pregnancy, such as Monique’s, has long been a
concern, but the issue has recently become one of the most frequently cited examples of
perceived social decay in the United States. Between 750,000 and 1 million teenagers
become pregnant each year (McCave, 2007), with over 80% of the pregnancies unintended
(National Campaign to Prevent Teen and Unwanted Pregnancy, 2012). Although the rate
of teen pregnancy dropped in the mid-1990s, new data indicate that it is again on the rise
(National Center for Health Statistics, 2007a). Adolescent birth rates in the United States
still remain higher than those in other industrialized countries (CDC, 2011d; Coley &
Chase-Lansdale, 1998; National Campaign to Prevent Teen and Unwanted Pregnancy,
2012). Even though U.S. teenagers do not exhibit different patterns of sexual activity
compared with teens from other countries, they use contraception less consistently and less
effectively, thereby giving the United States a much higher birth rate (Coley & Chase-
Lansdale, 1998).
Teen pregnancy is an important issue because these mothers’ babies are often low in
birth weight and have a disproportionately high mortality rate (McCave, 2007; National
Campaign to Prevent Teen and Unwanted Pregnancy, 2012; Olds, 2005). The young
mothers themselves have a high rate of dropout from school and often live in poverty;
therefore, they are likely to end up on public assistance (McCave, 2007; National
Campaign to Prevent Teen and Unwanted Pregnancy, 2012; U.S. Department of Health
and Human Services, 2001b). Monique may be at risk for all of these problems. Teen
mothers also have lower levels of marital stability and lower employment security compared
to peers who postpone child-bearing (Coley & Chase-Lansdale, 1998). Teen mothers and
their children are more likely to end up in prison, and their daughters are more likely to
become teen mothers themselves compared to other teens (National Campaign to Prevent
Teen and Unwanted Pregnancy, 2012). Teen pregnancy can also be hard on teen fathers,
such as Rock. The pregnancy can strain fathers’ relationships with their girlfriends and their
own parents. Teen fathers do not go as far in school and make less money when they go out
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on the job market than do teens who are not fathers (4parents.gov, 2007). Teen pregnancy
costs the United States at least $9 billion annually in public assistance, medical care, and
other expenses (National Campaign to Prevent Teen and Unwanted Pregnancy, 2012).
CAUSES OF TEEN PREGNANCY. Some critics argue that the social welfare system in
the United States may, in fact, be responsible for the nation’s high pregnancy rate among
teens. In particular, they believe that such assistance as a source of income actually
promotes teen pregnancy and the growth of female-headed households. However, this
assumption is not supported by research. Other industrialized countries, such as Sweden
and the United Kingdom, that have more comprehensive welfare programs than the United
States have lower teenage pregnancy rates (Alan Guttmacher Institute, 2004, 2006; CDC,
2007a; Singh & Darrock, 2000). Therefore, public assistance does not appear to cause
young women to become or want to become pregnant.
Besides focusing mainly on females, mainstream psychological literature on adolescent
pregnancy focuses on the individual and individual deficits as causes, something
community psychologists would shun. However, there have been investigations of
contextual factors that may influence teenage pregnancy rates in the United States versus
other Western countries. For example, Darrock (2001) found that American teens have less
access to free or low-cost prescription contraceptives, primary care physicians in the U.S.
are far less likely to offer birth control help to teenagers than are physicians in other
countries, comprehensive sex education (vs. abstinence only) is favored more in other
countries, and other countries have parental leave policies that provide incentives to
postpone childbearing. Findings like these highlight the importance of contextual factors in
understanding causes of teenage pregnancy.
Community psychologists typically examine different causes—contextual or ecological
ones—for adolescent pregnancy, such as school alienation that produces low educational
aspirations. Another contextual factor is living in poverty (Crosby & Holtgrave, 2005), as
experienced by many minorities in America. It is not surprising, given the poverty of many
African Americans and Hispanics, that major disparities exist in pregnancy and birth rates
by race and ethnicity. Hispanics and Blacks have the highest pregnancy and birth rates of
all, nearly 3.5 times higher than White teens (CDC, 2007a). Other ecological reasons for
teen pregnancy include perceptions of limited life options as well as exposure to the mass
media or to peer pressure to engage in sex (Alan Guttmacher Institute, 2004; Schinke,
1998). These latter reasons help explain teen pregnancies such as that of Monique, a White,
suburban teen who was not living in poverty. On the other hand, perhaps Rock, two years
older and adored by Monique, put immense pressure on her to engage in sex. Also
contributing to teen pregnancy are lack of a support system (parents or peers) and being the
victim of sexual assault (Alan Guttmacher Institute, 2004). In addition, social capital,
defined in Chapter 4 as resources made available to individuals as the result of their
placement within a social structure, is beginning to emerge as another important ecological
feature that can prevent teen pregnancy (Crosby & Holtgrave, 2005). In this case, social
capital includes trust, reciprocity, cooperation, and supportive interaction within families,
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neighborhoods, and communities. Deficient social capital can contribute to teen
pregnancy. Whatever the causes of adolescent pregnancy, the issue is better addressed on a
large scale, rather than by individual counseling.
PREVENTION PROGRAMS. Although the majority of American teachers and parents
agree that sex education is needed in our schools (Alan Guttmacher Institute, 2006), the
overly rationalistic perspective that such efforts simply need to expose adolescents to more
information or provide them with contraceptives is too narrow (Reppucci, 1987; SIECUS
National Guidelines Task Force, 2004). Early in the teen pregnancy intervention
movement, Reppucci (1987) reiterated, “The limited effects of these changes are evident in
the [still] concomitant high rates of pregnancy, clinic dropouts, and contraceptive nonuse”
(p. 7).
What is needed is less focus on individual education (Patterson, 1990) and more focus
on an ecological or transactional approach to teen pregnancy (Allen-Meares & Shore,
1986). The ecological approach takes into account the environment surrounding the
adolescent. However, the ecological perspective is complicated. It is complex because the
adolescent may be confronted by differing viewpoints on sexuality by peers, family
members, the community, and the culture. Furthermore, the media to which the
adolescent is exposed flagrantly exploit sexuality (Alan Guttmacher Institute, 2004) yet
prohibit contraceptives from being advertised (Reppucci, 1987). Early motherhood may be
an attractive alternative to low-paying, dead-end jobs available to young, uneducated, and
impoverished women (Lawson & Rhode, 1993).
Adding to the conundrum of what to do about sex education, President George W.
Bush intensified efforts to direct federal funding to abstinence-only sex education programs
as well as to faith-based institutions (rather than schools) (Marx & Hopper, 2005; McCave,
2007). Fortunately, federal funding has now been expanded to include prevention efforts
that focus on contraception as well as abstinence (see the Personal Responsibility Education
Program, part of the Affordable Care Act). However, in the years where contraception was
not included in federally funded prevention efforts, there were undoubtedly some teens
who failed to benefit from that information. Monique (but not Rock) was exposed to a
little bit of sex education in her health class, but it clearly was not enough to prevent her
pregnancy.
Comprehensive sexuality education should cover sexual development, reproductive
health (including contraception and sexually transmitted diseases), interpersonal
relationships, emotions, intimacy, body image, and gender roles, not just abstinence
(SIECUS National Guidelines Task Force, 2004). Moreover, there are important issues
related to these more comprehensive types of programs that speak to their significance
compared to abstinence-only sex education. First, most teachers believe that topics such as
birth control methods, sexual orientation, and other information should be taught alongside
abstinence. Second, 82% of American adults support comprehensive—not abstinence-only
—sex education. Third, research demonstrates that the use of contraceptives explains 75%
of the above-mentioned (early 1990s to mid-2000s) decline in teen pregnancies while
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•
•
•
•
•
•
•
•
abstinence explains only 25% (SIECUS National Guidelines Task Force, 2004).
We now focus on one well-known comprehensive program—the Carrera Program. In
1984, Dr. Carrera and The Children’s Aid Society developed a comprehensive sex
education/teen pregnancy prevention program that centers on the belief that success in
school, meaningful employment, access to quality medical and health services, and
interactions with high-caliber, adult role models have a potent “contraceptive” effect on
teens. The Carrera Program takes a holistic view of adolescents, which is a relatively new
direction for the prevention of teen pregnancy (Allen, Seitz, & Apfel, 2007). Specific
program components include:
Education: Individual academic plans for each participant, daily one-on-one or small
group tutoring, PSAT and SAT preparation, college trips, and a college scholarship
fund.
Employment: Job Club is a full introduction to the world of work, including opening
bank accounts, exploring career choices, and providing summer and part-time jobs.
Participants are paid a stipend and make monthly deposits in their bank accounts.
Family Life and Sexuality Education (FLSE): Weekly comprehensive sexuality
education sessions taught in an age-appropriate fashion.
Self-Expression: Weekly music, dance, writing and drama workshops led by theater
and arts professionals, where children can discover talents and build self-esteem.
Lifetime Individual Sports: A fitness program emphasizing sports that build self-
discipline and can be played throughout life, including golf, squash, swimming, and
surfing.
Full Medical and Dental Care: Comprehensive physicals and medical services in
partnership with the Adolescent Health Center of the Mt. Sinai Medical Center. Full
dental services provided by The Children’s Aid Society.
Mental Health Services: Counseling and crisis intervention as needed, and weekly
discussion groups led by certified social workers.
Parent Family Life and Sexuality Education: A program that facilitates
parents’/adults’ ability to communicate more effectively with their [adolescent]
children about important family life and sexuality issues (The Children’s Aid Society,
2008).
These programs run five days a week during the school year. In the summer, young people
receive assistance with employment, and maintenance meetings are held to reinforce sex
education and academic skills. There are also occasional social, recreational, and cultural
trips (Philliber, Kaye, & Herrling, 2001).
In a multisite program evaluation using random assignment of at-risk youths to either
control or treatment groups, researchers (Philliber et al., 2001) determined that the
program successfully reduced teen sexuality and teen pregnancy by 50% in the
communities served. One way the program produced this latter result was to facilitate
effective use of protection (contraception) among young women who became sexually
active. The program also resulted in additional benefits, such as linking young people with
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medical care (private physicians rather than visits to the emergency room), encouraging
them to participate in the workforce, enhancing participants’ computer skills, promoting
higher graduation rates, and increasing certain standardized test scores (Children’s Aid
Society, 2008).
Community psychologists would remind us that prevention programs need to be
culturally sensitive, too—an important topic not yet addressed on the issue of teen
pregnancy—because no one program or component holds all the solutions for all groups
(Stoiber & McIntyre, 2006). Just as surely as culture and ethnicity influence childrearing,
they undoubtedly shape sexual practices and beliefs, such as when, where, and with whom
to engage in sex.
To enlarge on the issue of culture, let’s focus on Hispanic teen pregnancy, because the
rates currently are highest for this group. Several authors have elaborated on values and
themes in Hispanic cultures that may account for the higher rates of teen pregnancy in that
population. Gilliam (2007) explains that Latina parents rely on fear to dissuade their
daughters from pregnancy as opposed to open communication about sexuality and
contraception. Wilkinson-Lee, Russell, and Lee (2006) identified other facets of Hispanic
culture that may be important to pregnancy prevention. One cultural value is familismo,
which is a collective loyalty to the extended family that outranks the needs of the
individual. Personalismo, translated as “formal friendliness,” is another important value in
which Hispanic individuals expect to have formal but warm personal relationships with any
authority figure, such as healthcare professionals or educators. Wilkinson-Lee and her
colleagues remind us that Hispanic teens often hear conflicting messages from their
traditional culture and religion versus mainstream American culture. Clearly, cultural
sensitivity is important to program design and effectiveness. Here we examine a sample
program related to these issues.
Méndez-Negrete, Saldaña, and Vega (2006) preliminarily report on a culturally
sensitive program in San Antonio, Texas, called Escuelitas for Mexican American girls who
are at risk for pregnancy. San Antonio unfortunately leads the nation in pregnancy among
girls age 15 and under. Escuelitas provide an after-school organizational and social structure
that supplements the formal, social institutions of traditional schools and families. The
Escuelitas (translated as “little schools”) provide experiences and activities that support and
encourage academic, personal, cultural, and social achievements designed to prevent teen
pregnancy and delinquency as well as reduce school dropout rates.
Girls come from low-income families and are recruited from schools with high
incidences of teen pregnancy, delinquency, and school dropout. In the Escuelitas, students
meet after school for three 90-minute sessions each week. Activities consist of guest
speakers, tutorials, group discussions, and relational workshops with their mothers or
guardians (familismo). University students and adult Hispanic role models act as mentors
and presenters (personalismo). Presentations by the Hispanic role models, for example,
focus on the cultural assets of the students and on their cultural heritage. Note that
students are not randomly assigned to the Escuelitas and are not compared to a no-
intervention group. However, the preliminary results point to program successes. As of
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2004, none of the participants had dropped out of school, and none had become pregnant.
Though these results are encouraging, we certainly need more data and better designed
research on Escuelitas before the program is adopted and disseminated elsewhere.
One of the major problems of teen pregnancy prevention is that although effective
and scientifically based programs are available, they are not well known in local
communities across the country. Efforts are now under way to build prevention
infrastructures in and guide large-scale prevention strategies for various communities,
thanks to the efforts of certain community psychologists (Lesesne, Lewis, White, & Green,
2008).
The Elderly
SCOPE OF THE ISSUE. The population of the United States is aging. As the swell of
baby boomers moves through time, the ranks of the aged are increasing. Medical advances
allow people to live longer, with most women outliving men. At the beginning of the 20th
century, only 4.1% of the total U.S. population was elderly (Blakemore, Washington, &
McNeely, 1995). Today, the percentage of Americans age 65 and older has tripled, and the
total number has increased almost 12-fold (from 3.1 million to 36.3 million). Figure 7.3
illustrates the dramatic increase in our elderly population and provides projections through
2050.
The elderly, unfortunately, have been largely ignored in the community psychology
literature. Steffen (1996) reviewed articles in the American Journal of Community Psychology
from 1988 to 1994 and found a weak emphasis on aging. Over the seven-year period, only
13 articles focused specifically on older adults. Given that in 2005 many elderly lived at
(3.6 million) or near (2.3 million) the poverty line, and given the demographics in Figure
7.3, the topic of aging Americans should not be so ignored in the literature. Other
professionals agree that as a society, we are way behind in our efforts to study and promote
optimal aging (Chapman, 2007).
The stereotype of the elderly in the United States is that of a wrinkled, incoherent
person rocking in a chair in a nursing home. Obviously, this negative stereotype, although
incorrect, persists (Cuddy, Norton, & Fiske, 2005; Kite, Stockdale, Whitley, & Johnson,
2005). Most elderly, in fact, live and die in their own homes (Steffen, 1996) rather than in
hospitals or nursing homes. Separation of the young and the old in American culture is one
factor that leads to such stereotyping (Hagestad & Uhlenberg, 2005).
Although these stereotypes often result in adults of any age fearing the prospect of
growing old, there is good news to report. The concept of “healthy aging” has emerged in
the past several years to provide a new lens through which aging can be viewed. The term
healthy aging has guided the development of social initiatives to promote quality of life in
old age. Peel, Bartlett, and McClure (2004) noted that the concept of healthy aging has
received substantial international attention in countries including Canada, Australia, and
parts of the European Union. For example, one Canadian initiative embraced a framework
supported by three values: (1) the celebration of diversity, (2) a refutation of ageism in all of
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its forms including economic inequities, and (3) the active creation of opportunities within
the community for independence and quality of life (Menec, Button, Blandford, & Morris-
Oswald, 2007).
This perspective is very compatible with a community psychology philosophy in that
well-being of older adults is significantly influenced by the environments they live in where
resources must be accessible and stressors such as ageism must be eliminated.
This is not to say that our aging population, as with any group, is entirely without
problems. For example, two frequent and particularly important transitions of aging are
loss of health and loss of spouse. Loss of spouse and significant others in an elderly person’s
life can cause depression and stress (Vacha-Haase & Duffy, 2011). In addition, declining
health is exacerbated by perceived lack of control over health matters, personal barriers such
as memory deficits, and societal barriers such as lack of transportation and high-cost
healthcare (Dapp, Anders, von Rentein-Kruse, & Meier-Baumgartner, 2005). Families of
the elderly who provide caregiving can also find themselves under stress (Hardin & Khan-
Hudson, 2005; Singleton, 2000), especially employed family members (Hardin & Khan-
Hudson, 2005).
FIGURE 7.3 Number of People Age 65 and Over, by Age Group, for Selected Years 1900–2000 and Projected to
2010–2050
Source: U.S. Census Bureau (2000), Decennial Census and Projections. Washington, D.C.
ELDER ABUSE. Unfortunately, because the elderly at some point often do become
dependent on others to care for them, they are as vulnerable to maltreatment as are
children. Elder abuse is a societal problem in the United States that is defined very similarly
to how child maltreatment was defined earlier in this chapter. The one way in which elder
maltreatment can manifest differently, however, is in the financial exploitation of the
elderly. The National Center on Elder Abuse, an office of the U.S. Administration of Aging
(www.ncea.aoa.gov), in a 2005 publication reported that between 1 and 2 million
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Americans age 65 or older have been injured, exploited, or otherwise mistreated by
someone on whom they depended for care or protection. Perhaps more disturbing are the
estimates of elder maltreatment that go unreported. For example, current estimates put the
overall reporting of financial exploitation at only 1 in 25 cases, suggesting that there may be
at least 5 million financial abuse victims each year. Furthermore, it is estimated that for
every one case of elder abuse, neglect, or exploitation reported to authorities, about five
more go unreported. These statistics suggest that the scope of this problem may be grossly
underestimated.
Although most states have laws to protect against elder mistreatment, if elderly people
are segregated from others, which may be the case in a homebound or nursing care facility
situation, it may be difficult to know mistreatment is happening. Another complication is
that those elderly who are frail from physical or mental illnesses are prone to accidental
injuries from falling. Thus, it is often not easy to determine whether bruises are the result of
a fall or of maltreatment. For this reason and many others, enhancing the well-being of the
elderly has been a priority in the prevention arena. Keeping the elderly mentally and
physically healthy offers the direct benefit of keeping them socially active and less
vulnerable to the maltreatment that confined settings may present.
We concentrate here on two issues that have received attention in the prevention
literature that has examined elder health—personal control and social support. Both are
postulated to enhance the well-being of the elderly. Note, however, that there are many
other factors affecting the welfare of the elderly (Lehr, Seiler, & Thomae, 2000) that we
cannot include here because of limited space.
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PREVENTION PROGRAMS
Social Support. Myriad programs exist for the elderly that focus on enhancing the
quality of their lives, with only a few mentioned here. One well-examined approach to
preserving the emotional well-being and sense of security of the elderly is to provide them
with social support (Greenglass, Fiksenbaum, & Eaton, 2006). Social support by means of
informal networks of family (Tice, 1991), confidants (Lowenthal & Haven, 1968), or
others (Abrahams & Patterson, 1978–1979) has been reputed to increase morale, buffer the
effects of loss of loved ones, and slow the deterioration of health (Choi & Wodarski, 1996;
Greenglass et al., 2006).
More recently, researchers have made use of the Internet to provide social support to
the elderly, especially those who might feel isolated because of age or disability. First, the
Internet can be viewed as a preventive tool that might delay or avert age-associated
physiological and behavioral changes restricting elderly functioning, for example, isolation.
Second, the Internet might help compensate for age-related losses in strength and
perceptual-motor functioning, such as slowed eye-hand coordination. Third, it might be a
good communication tool for the frail elderly, those too frail or too hard of hearing to leave
their homes or use their telephones for social interaction (Fozard & Kearns, 2007).
Shapira, Barak, and Gal (2007) compared older adults in day-care centers and nursing
homes trained in Internet use with a comparison group of nontrained individuals. Both
groups were administered interviews, health assessments, and life satisfaction, depression,
loneliness, and other scales. On all measures (except physical functioning) the Internet
group improved while the comparison group declined. The researchers concluded that
indeed, Internet use can contribute to older adults’ well-being and sense of empowerment
by affecting their interpersonal interactions, promoting better cognitive functioning, and
contributing to the sense of personal control and independence. This last finding provides
an interesting segue to our next topic.
Sense of Self-Control. As mentioned, self- or personal control is one issue relevant to
the elderly. Every facet of aging, such as health and cognitive functioning, involves the issue
of control (Baltes & Baltes, 1986). Self-control is the belief that we can influence events in
our environment that affect our lives (Duffy & Atwater, 2008). Increasing the sense of self-
control of the elderly is a technique that has proven to produce positive results (Shapira,
Barak, & Gal, 2007; Thompson & Spacespan, 1991; Zarit, Pearlin, & Schaie, 2003), such
as better mental health (Reich & Zautra, 1991). An enhanced sense of control leads to
feelings of empowerment, a coveted principle of community psychology.
In a very early test of this issue, Langer and Rodin (1976) matched two groups of
elderly in a nursing home on age, health, and other important dimensions. One group was
shown in detail how much control they had over their lives. They decided how to arrange
their rooms, when to greet visitors, and how to spend spare time. Each of these residents
was given a plant to care for. The second group was told that their lives were mainly under
staff control. For example, these elderly were also given a plant but were told the staff
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would take care of it. Pre-and postintervention questionnaires about feelings of personal
control, happiness, and activity level were administered to the elderly and completed by the
care staff. Almost all before-and-after comparisons favored the intervention group—the one
with a higher sense of self-control. Eighteen months later, Rodin and Langer (1977)
conducted a follow-up. Half as many experimental participants had died as had control
participants. This study demonstrates that the quality of life for the elderly can indeed be
enhanced when they believe they have more control over it (Schulz & Heckhausen, 1996).
Subsequent research has replicated the fact that a sense of self-regulation (e.g., Wrosch,
Dunne, Scheier, & Schultz, 2006) or self-control (e.g., Zarit et al., 2003) has an enhancing
effect on the quality of life and the health of older individuals.
Homelessness
Some Americans stereotype the homeless as drunk or mentally disabled old men who
deserve what they get—a life of misery on the streets. Rock and Monique, for example,
would taunt the homeless who lived near subway entrances of the city close to the suburbs
where they lived. On the other hand, some people feel sorry for homeless individuals and
hand them money. Community psychologists are concerned with homelessness not just for
humane reasons but because homelessness carries with it myriad problems for the
individual. The issue of homelessness is discussed here for these reasons and because
homeless individuals end up interfacing with a variety of social and human services.
SCOPE OF THE ISSUE. The extent of the problem of homelessness is difficult to
determine, for one thing because homelessness is difficult to define (National Coalition for
the Homeless, 2011; Shinn et al., 2007; Tompsett et al., 2006). According to the U.S.
Government’s Homeless Management Information System data, nearly 1.6 million people
used emergency or transitional shelters between October 1, 2006, and September 30, 2007.
However, other agencies estimate the problem to be greater. For example, the National
Coalition for the Homeless (2011) estimates that more than 3.5 million men, women, and
children are homeless. One reason for the difficulty in making accurate estimates is that the
homeless are a heterogeneous group; the group includes people of all races, families with or
without children, single individuals, individuals who move from temporary shelters to
homelessness and back to some type of shelter, as well as others (National Coalition for the
Homeless, 2011).
Who are today’s homeless? Rossi (1990) devised an interesting way of classifying the
homeless. He suggested that there are old homeless and new homeless. The old homeless
are the individuals who are generally stereotyped as homeless. These are older, alcoholic
men who sleep in cheap flophouses or skid-row hotels. They are “old” because they are the
type of homeless who were seen on city streets after World War II. The new homeless are
indeed truly homeless. They do not sleep in cheap hotels but are literally on the streets or at
best may find shelters to escape into during inclement weather.
The new homeless include more women and children than in the past, although the
National Coalition for the Homeless (2011) estimates that single men make up over half of
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all homeless adults (see also Shinn et al., 2007). Likewise, there are age differences between
the new and old homeless, with the new homeless being much younger. The National
Coalition for the Homeless (2011) estimated that children under the age of 18 account for
1.35 million of the homeless population. Another difference is that the new homeless suffer
a much more profound degree of economic destitution than the old homeless. One final
difference between the old and the new homeless is that the ethnic and racial composition
has changed over the years. Today’s homeless are more likely to be from minority groups
rather than White, as was true of the old homeless. For example, some databases report
racial breakdowns of homeless individuals to be 42% African-American, 39% White, 13%
Hispanic, 4% Native American, and 2% Asian (American Psychological Association, 2005;
National Coalition for the Homeless, 2011).
As for families experiencing homelessness, homeless children suffer a number of
compounding problems, largely due to their homelessness (Burt, Pearson, & Montgomery,
2007). Studies have consistently shown that homeless children have elevated levels of acute
and chronic health problems compared to housed children (Gewirtz, 2007; Walsh &
Jackson, 2005) as well as poorer nutrition (Molnar, Rath, & Klein, 1990). Homeless
children are also more likely to experience developmental delays, such as short attention
spans, speech delays, inappropriate social interactions (Rafferty, Shinn, & Weitzman,
2004), and psychological problems such as anxiety, behavior disorders, and depression
(Rafferty & Shinn, 1991). In addition, achievement scores on standardized tests for
homeless children are well below those of housed children (Rafferty, 1990), primarily
because homeless children frequently move from school to school—when they are lucky
enough to be enrolled in school.
Zugazaga (2004) and Muñoz, Panadero, Santo, and Quiroga (2005) have also studied
homelessness in relationship to stressful life experiences. The latter group of researchers has
found that there are distinct groups of homeless based on analyses of stressful life events.
Their results revealed the existence of three subgroups of homeless. Group A was
characterized by economic problems, such as unemployment; this group functioned well
and had few mental health or substance abuse problems. Group B was typified by substance
abuse and health problems, resulting in longer durations of homelessness. Psychologists and
healthcare professionals have long recognized that poor health and homelessness are
intricately intertwined (Flick, 2007; O’Connell, 2007; Smith, Easterlow, Munro, &
Turner, 2003). Group C was of lower average age and manifested multiple problems, many
stemming from childhood (such as abuse or parental alcoholism). Note that this study was
conducted in Spain, but the overarching conclusion is important—the existence of
subgroups of homeless people emphasizes the importance of designing different
interventions for each group, adapted to their diverse needs. Another stressful life event
related to homelessness but not necessarily revealed in the cited research is exposure to
trauma or traumatic life events, such as being the victim of violence (Kim & Ford, 2006).
Preventing posttraumatic stress disorder and addressing its influence on people in the early
stages of homelessness can go a long way toward intervening in homelessness.
Interest in understanding cross-national homelessness is also growing in the field of
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community psychology because there may be much we can learn from the experiences of
other countries. Interest in the United States is mounting, especially in other developed
countries and their programs designed to address homelessness. For example, in Great
Britain and the countries of the European Union, men and minorities (those discriminated
against) are overrepresented among the homeless ranks just as in the United States (Toro,
2007). Case in Point 7.3 provides more information on international perspectives on
homelessness.
CASE IN POINT 7.3
How do Cultures Differ on the Issue of Homelessness?
You have been reading the American perspective on homelessness. Because one of the goals of this text is to introduce
you to multicultural aspects of community problems, we are well served by examining how other countries are
researching and managing homelessness. As we turn our attention to other cultures to learn from them, be mindful that
we “cannot transplant policies and programs from one country to another without considering the foreign soil in which
the plants must take root” (Okamato, 2007, p. 525).
A 2007 edition of the Journal of Social Issues offered articles from authors and researchers from around the world.
Understanding what produces homelessness and just who is homeless in other countries might provide lessons and
insights for the American public as well as for community psychologists. Two particular authors from seemingly
different cultures—the Czech Republic and Japan—offered interesting cultural perspectives on homelessness.
In Japan, there was no word for homelessness until after the destruction of World War II (Okamato, 2007). With a
changing economy (i.e., movement toward a technological society) and government policy changes, there is now not
only a phrase, “rough sleeping,” but increased interest in home-lessness. The term rough sleepers was essentially coined
by the media for individuals who sleep in public places, such as parks. Many of the rough sleepers are minorities, just as
they are in the United States. Koreans, for example, are minorities in Japan and are thus more likely to be homeless
than are Japanese citizens. As in the United States, the majority of homeless are men—some are even employed—but
they are likely to be older than homeless men in the United States. One major cause of homelessness in Japan is that
housing was often tied to employment; that is, employers offered housing to employees as a perk, so when jobs were
lost, housing was lost. Japanese companies today are less likely to offer the lifetime employment and housing security
they offered in the past.
As in the United States and Japan, in the Czech Republic there are personal as well as structural reasons for
homelessness. A personal reason might be divorce or loss of employment; a social or structural reason is the problem of
runaway or homeless youth for whom there are no shelters. In both Japan and the Czech Republic (and some would
argue, the United States) the government provides low budgets for social welfare spending (Shinn, 2007).
There are differences, however, between Japan and the Czech Republic. In the Czech Republic (Hladikova &
Hradecky, 2007), rough sleepers are those who are literally roofless; they do not sleep under a roof, as in a shelter.
Other nomenclature exists in the Czech Republic for the remainder of the homeless population, such as those in
insecure housing (where the housing might be lost at any minute because of job loss) and those who have inadequate
housing (where an apartment is too crowded or substandard with no heat or running water). To mention a few other
differences, homelessness historically became an issue and a larger problem in the Czech Republic with the fall of
communism. People today retain a right to work (just as they did under the communists), but continual corruption and
bribery make the employment system much more competitive and difficult than in the past. The political breakup of
Czechoslovakia also contributed to much social strife; no such massive political upheaval has occurred recently in Japan
to contribute to the homeless problem. In the Czech Republic, rather than the government providing social services,
nongovernmental organizations (NGOs) or private social services and charities have taken up the banner of helping the
homeless. In Japan, the law states that all people shall have the right to maintain minimum standards of wholesome and
cultured living. Furthermore, in all spheres of life, the state shall use its endeavors for the promotion and extension of
social welfare and security, although this is not a common practice (e.g., low government spending) when it comes to
housing. In reality, Japanese families, rather than NGOs and the government, have often taken over the burden of
providing housing for those in need.
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CAUSES OF HOMELESSNESS. To prevent something from happening, one needs to
know what causes it or have the ability to predict in advance when or to whom it will
happen; this, of course, applies to homelessness (Burt et al., 2007). Studies show that
homelessness is often episodic, or at least is not a chronic condition for all individuals
(National Coalition for the Homeless, 1999; Shinn, 1997; Sosin, Piliavin, & Westerfelt,
1990), so focusing only on person-centered factors may not account for all cases of
homelessness. Person-centered causes include but are not limited to issues such as mental
disorders and life stressors, as previously mentioned. Unemployment is also another major
consideration in homelessness (McBride, Calsyn, Morse, Klinkenberg, & Allen, 1998;
Shaheen & Rio, 2007; Shinn et al., 2007).
Person-centered explanations such as mental disorders, life stressors, and
unemployment are only partially useful for explaining homelessness—regardless of how
popular these explanations are in the mass media. We wisely turn our attention to
ecological factors. Shinn (1992) conducted some seminal research to expand the
understanding of whether structural variables explain homelessness. In her study, a sample
of 700 randomly selected homeless families requesting shelter were compared to 524
families selected randomly from the public assistance caseload. The first group represented
“the homeless” and the second “the housed poor.” Only 4%—a small percentage—of the
homeless in the sample had been previously hospitalized for mental illness. Only 8% of the
homeless and 2% of the housed poor had been in a detoxification center for substance
abuse. Shinn concluded that individual deficits were relatively unimportant in
differentiating the homeless from the housed poor.
Shinn also found that only 37% of the homeless, compared to 86% of the poor
housed families, had broken into the housing market (i.e., had been primary tenants in a
place they stayed for a long time). In addition, 45% of the homeless versus 26% of the
housed poor reported having three or more persons per bedroom in the place they had
stayed the longest. The researcher regards poor housing opportunities and crowding to be
better explanations for homelessness than personal deficits or individual level explanations.
(See also Shinn & Tsemberis, 1998.)
In a five-year follow-up on homelessness, Shinn and associates (1998) stated that
“subsidized housing is the only predictor of residential stability after shelter” (p. 1655). In
other words, the research team found that once a family entered a shelter, five years later
many were able to have their own residences, but only with financial assistance. Zlotnick,
Robertson, and Lahiff (1999), in a 15-month prospective study, also reported that
subsidized housing is one of the most important factors associated with exiting
homelessness. Thus, because of the newer welfare laws as well as fewer new units of
subsidized housing, future homeless families may not fare so well (Western Regional
Advocacy Project, 2006).
Other ecological and structural causes—outside of the person—have been identified.
The National Coalition for the Homeless (2007b) identifies lack of affordable healthcare as
a cause of homelessness. Individuals who are struggling to pay the rent and also have a
serious illness or disability can start a downward spiral into homelessness when payment of
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medical bills results in lack of funds to pay rent (Burt et al., 2007). Domestic violence also
results in homelessness (National Coalition for the Homeless, 2007b). Many women
choose to become homeless rather than remain with an abuser. Recently, Shinn and
colleagues (2007) also identified a paucity of social capital (defined earlier) as a major
contributor to homelessness. Without social support and nearby family members or friends
who can provide aid, many individuals find themselves homeless. These factors do not
exhaust the list of causes but do help identify the myriad pathways by which individuals
and families descend into homelessness. Because no social problem originates from a single
cause, clearly, solutions to the problem of homelessness are not simple. Until prevention
policies focus on a general strategy against all aspects of poverty (Firdion & Marpsat,
2007), focusing on keeping people in their homes or on person-centered factors such as
unemployment is less likely to work. Poverty indeed is a primary contributor to nearly
every major social problem in this chapter.
PREVENTION PROGRAMS. Several suggestions for addressing homelessness have
already been reviewed—planning psychiatric hospital discharges better, addressing
unemployment, increasing the amount of affordable housing, and subsidizing housing
expenses, to mention a few. Given that these approaches take much time and money or are
subject to the caprices of politicians, what else is available to address homelessness?
Many communities in the United States have programs in place to prevent or address
homelessness. Some professionals, though, argue that these community programs have yet
to provide strong evidence that their homelessness prevention efforts are effective (Burt et
al., 2007). Others appear more optimistic and suggest that prevention efforts are promising
(Moses, Kresky-Wolff, Bassuk, & Brounstein, 2007). Fortunately for us, Burt and
colleagues (2007) have published fairly new, albeit sketchy evidence that community-wide
strategies for preventing homelessness, especially among those being released from
institutional care, can be successful. The researchers, with great difficulty, identified five
possibly effective programs from a multitude of federal grant applications. Not surprisingly,
they also found that many of the programs they reviewed but did not include in their
analysis did not maintain adequate data on the efficacy or efficiency of their programs.
Because the sample is small and because of other design factors, the following results must
be balanced with some uncertainty while we await other such studies.
Burt and colleagues found five activities that are useful for preventing homelessness
and may be used alone or in combination in community-wide prevention programs:
Providing housing subsidies (money) for first-time homeless individuals and families
Coupling supportive social services with permanent housing
Using housing-court mediation between tenants and landlords to prevent eviction
Cash assistance for rent or for mortgage arrears
For secondary prevention, rapid exiting from homeless shelters to housing
Burt and associates—and the American Psychological Association (2005)—also emphasize
that merely throwing money and services at high-risk populations will not work unless the
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following key elements are also present in the programs:
At-risk populations need to be well targeted, using data from multiple agencies.
The community must accept as important its obligation to assist at-risk populations.
Relevant community agencies must collaborate with one another on prevention
efforts.
Someone or some agency needs to take the lead collecting data on progress,
monitoring gaps in the system, knowing the needs of the population, and contacting
agencies so as to establish collaboration.
The best solution to the homeless problem in the United States, though, may be a
concerted and organized public policy program at the federal level. Charities and local
governments alone cannot meet the growing needs of the homeless (Gore, 1990). One
piece of legislation aimed at grappling with the homeless problem on a national level is the
McKinney-Vento Homeless Assistance Act. It established an Interagency Council on
Homelessness to coordinate, monitor, and improve the federal response to the problems of
homelessness. The act established an Emergency Food Shelter Program National Board as
well as local boards across the country to determine how program funds could best be used.
Grants and demonstration programs—for example, for drug and alcohol-abuse treatment
for addicted, homeless individuals—were authorized by the law, and the Temporary
Emergency Food Assistance Program was reauthorized as well (Barak, 1991). A coherent
policy of federal legislation needs to pursue increased low-income housing, treatments for
mentally disabled and substance-abusing homeless, and education and job training for
homeless individuals (American Psychological Association, 2005; Gore, 1990).
What have we learned by examining child maltreatment, intimate partner violence,
teen pregnancy, the elderly, and the homeless? Messages for community psychologists and
other prevention experts cut across these groups.
The types of individuals affected by these problems are diverse.
There are multiple causes for each of these social problems, few of which are created
by the individuals affected by the problem.
Single solutions for these problems will not work; multifaceted efforts will yield
better results.
When various social service agencies are involved in interventions—whether the
interventions are primary or secondary in nature—their efforts need to be
coordinated to be effective.
Government officials, affected individuals, and social service agencies must come
together or collaborate in order to address these issues.
Summary
Social welfare or ideas and activities to promote social good have a long history in Western
society. Until modern times, two major forms of social welfare were charity/philanthropy
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(private assistance) and public welfare (public assistance). During the 19th century (around
the time of the Industrial Revolution), two other forms of social welfare were born: social
insurance (public assistance derived from taxation) and social service (public nonmaterial
human services derived from taxation). To receive social welfare, people must demonstrate
their need, usually in the form of a low standard of living or poor economic means.
It is generally believed (i.e., stereotyped) that recipients of social welfare are lazy,
despite the fact that they might genuinely need such assistance. On the other hand, donors
to community services are perceived to be honorable people, although research indicates
that willingness to help is often a function of environmental factors (e.g., people are more
generous during religious seasons).
Five groups that interface regularly with human services in U.S. communities are
maltreated children and their families, survivors of domestic violence, pregnant teens, the
elderly, and the homeless.
Teen parents and others—such as people who themselves were abused children—are
predicted to be at risk for maltreating a child. Providing social support, parenting and
prenatal education, and links between the parents and services in the community can
sometimes prevent child abuse. The Nurse-Family Partnership program has proven to be
particularly successful in reducing child maltreatment among first-time, at-risk teen
mothers and has been disseminated nationwide.
Women who are being victimized by intimate partner violence are at risk for
enormous physical and psychological injuries, including death. Those who are able to
escape such situations often face an uphill battle as they attempt to gain emotional and
economic independence for themselves and their children. Programs to address this
problem include prevention aimed at changing gender role beliefs, improving interpersonal
skills, and attempting to provide psychological and career services for women who seek
safety in domestic violence shelters.
The problem of pregnant adolescents is major; the United States leads other
industrialized countries in this statistic. The prevailing culture does not provide good role
models; thus, the problem persists. Programs to reach teenagers before they become sexually
active include abstinence-only and comprehensive sex education. Comprehensive sex
education (rather than abstinence-only education) provides teens with sex education that
better ensures they will not be stuck in the welfare quagmire so frequently found in teen
parenthood.
The elderly sometimes interface with services in the community, too, although the
elderly are a rather neglected group in the community psychology literature. Declining
health, loss of mobility, death of loved ones, and loss of control are problems for the
elderly. As is true with other groups, not all community interventions are effective with the
elderly. However, providing the elderly with social support and increasing their sense of
control or sense of personal efficacy can maintain their self-esteem and health for longer
periods.
Homelessness is an increasing problem in the United States. Stereotypically, the
homeless are drunk or mentally disabled old men. The new homeless, however, include
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many children and women as well as previously employed and previously housed
individuals. Providing more affordable housing and better and coordinated public policies
and social services will go a long way toward solving this problem.
What has been learned from the examination of maltreated children, survivors of
domestic violence, pregnant teens, the elderly, and the homeless? For one thing, not all
interventions work equally well, and no single intervention works for all groups.
Interventions need to be multifaceted; that is, they must address multiple issues and use
multiple approaches. Efforts should take into account ecological factors as well, and not just
focus on the individual level. Efforts by all affected individuals and groups need to be well
coordinated to be effective and efficient.
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Schools, Children, and the Community
THE EARLY CHILDHOOD ENVIRONMENT
Child Care
Enrichment Education and Early Intervention
Self-Care Children
THE PUBLIC SCHOOLS
Desegregation, Ethnicity, and Prejudice in the Schools
The Schools and Adolescents
■ CASE IN POINT 8.1 Dual-Language Immersion Programs
■ CASE IN POINT 8.2 Children of Divorce
SUMMARY
I touch the future. I teach.
—Christa McAuliffe (teacher, astronaut)
Mi nombre es Roberto. Nací en Mexico y me mude a los Estados Unidos cuando era un niño. En mi casa, solamente se
hablaba español. Un día, cuando estaba en el séptimo grado, mi maestra me pidió que leyera en frente de la clase. Yo
trate de leer, pero no pude reconocer algunas de las palabras en inglés. La maestra me interrumpió y me dijo que yo no
sabía leer muy bien y que debía sentarme. Después, ella llamó a un niño Americano, quien leía mejor que yo. Yo me
senti bastante avergonzado.
Could you read this passage? Imagine how frustrating textbooks, television programs, and public announcements
are to individuals for whom English is a second or third language. Programs that might help individuals such as
Roberto are discussed later in Case in Point 2. For now, we begin again, this time in English.
My name is Roberto. I was born in Mexico, and I moved to the United States when I was a child. In my house,
only Spanish was spoken. One day, when I was in the second grade, my teacher asked that I read in front of the class. I
tried to read, but I was not able to recognize some of the English words. The teacher interrupted me and told me that I
did not know how to read very well and to sit down. After that, she called on an American child who read better than I.
I was quite embarrassed.
Roberto’s story continues: I had to repeat the second grade, but this time with a different teacher, Miss Martinez.
She had experienced much the same embarrassment when she was a child, so she was sympathetic to my situation. Her
extra help inspired me to do my best. In no time, I was speaking and reading English well, almost as well as my
classmates. By high school, I was a very good student. My good grades and my ability to play soccer well had endeared
me to my fellow classmates enough so that they liked me. Unlike some of the other Hispanic students, I was quite
popular, which made my life easier than theirs.
Today, I am in college; I am studying to be a lawyer. Actually, I don’t want to be a lawyer; I want to be a
legislator. I view law as the avenue to a political career. One of my goals as a legislator is to reform American schools so
that all children will feel welcome and comfortable in them.
Consider for a moment how it feels to be a child whom others view as different because of a
different skin color, a foreign-sounding name, an accent or language other than English, or
the use of a wheelchair. This chapter explores the world of schools as it relates to children
and families. In a special issue about human capital, the National Behavioral Science
research agenda committee of the American Psychological Society (1992) remarked, “There
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is no better way to invest in human capital than to improve our schools” (p. 17). The
schools themselves are small communities as well as integral parts of the communities they
serve. Every school issue cannot possibly be covered here, but this chapter touches on some
of the more salient ones: child care, diversity in the classroom, and stressful events such as
school violence and parental divorce.
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THE EARLY CHILDHOOD ENVIRONMENT
Urie Bronfenbrenner (1979, 1999) presented what he considered at the time to be an
unorthodox conceptualization of child development. He formulated the ecological
perspective of human development. Development, to Bronfenbrenner and other
psychologists, involves “a lasting change in the way in which the individual perceives and
deals with the environment” (p. 3 , 1979). The ecological setting refers to a set of
interdependent contexts, or settings, embedded within one another. At the innermost level
are the immediate settings in which the child exists, such as the home or a classroom. The
next layer consists of the interrelationships between these settings, as in the links between
the child’s home and the school. The third level, interestingly, is the environment in which
the child has not direct participation but that has an indirect effect on development, such as
the policies of the parents’ places of employment (e.g., availability of day care and
healthcare). All levels in this conceptualization are interconnected rather than independent.
The way the individual interacts with these settings and perceives them is important in
influencing the course of the individual’s development. As you may already know, the
ecological perspective and the transactional nature of the individual’s encounters with
various elements in the environment are of utmost importance in community psychology.
A concrete example might further your understanding of this model. Suppose Johnnie
is having trouble focusing his attention on his studies in the third grade. Using the
individual level of analysis, his teacher might believe that Johnnie needs additional
assistance with his math and spelling (e.g., tutoring) or medication for his attention-deficit
disorder. An ecological perspective would take into account other contexts, such as
Johnnie’s home situation and neighborhood or even the playground at the school. The
reality might be that Johnnie’s home life is stressful because his parents are divorcing.
Furthermore, his father might be unemployed, which is contributing to his parents’ discord
and Johnnie’s inattention. Johnnie is also being teased on the playground and thus finds
concentrating in the classroom difficult when surrounded by the bullies. Perhaps what
would most assist Johnnie is some social support from other children whose parents have
divorced or an adult who watches over his safety on the playground—not extra tutoring
from the teacher.
As Bronfenbrenner suggested, advances in understanding development require
investigation of the actual environments, both immediate and remote, in which human
beings live. This chapter examines settings in which children develop—especially
educational ones such as day-care centers and schools. Although we review these settings
separately, it is important to remember that they are interconnected with each other as well
as other contexts not specifically discussed in this chapter. For example, immediately
following this paragraph, the topic of child care will be discussed. Research has
demonstrated that the triad of family structure (one versus two parents), the day-care
structure (in-home care or daycare center), and the day-care process (content of the
activities) influence a child’s language development in very complex ways (National
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Institute of Child and Human Development [NICHD], 2006). Research has demonstrated
that other ecological factors such as the family environment and teacher perceptions of
students predict future academic success (Baker, 2006). Studies generally show that
inschool prevention programs have significant positive impacts on children (Durlak,
Weissberg, & Pachan, 2010). Because the organization of this chapter is chronological (i.e.,
human developmental), early childhood care is discussed first.
Child Care
Child (day) care can be defined as ways children are cared for when they are not being
cared for by their parents or primary caregivers (NICHD, 2001). In the opening vignette,
Roberto did not reveal whether his parents worked during his early childhood. However, if
his parents worked and he was left with a neighbor, he would have been in a form of day
care. Child-care or day-care providers can include licensed and unlicensed centers, family
members or relatives other than the parents, neighbors, informal sitters, and even
preschools. Some provide nothing more than babysitting services, whereas others provide
healthcare, educational materials, nutritious meals, and field trips (Haskins, 2005). Indeed,
we have a mixed system of child care in the United States (Lamb & Ahnert, 2006;
Muenchow & Marsland, 2007), making this important issue difficult to research and data
difficult to interpret.
NECESSITY FOR CHILD CARE. The need for day care for children in the United
States has grown historically over the past half century. Today, more than 90% of all
families have at least one parent in the labor force. In two-parent families, 62% have both
parents employed. In female-headed households, 72% of the mothers are employed, and in
male-headed households, 93.5% of the fathers work. Of mothers with children under a
year old, more than 56% work. Because more and more parents are working today than
ever before, there are more and more children at younger and younger ages in nonparental
child care (Belsky, 2006) as demonstrated in Figure 8.1. Notice that today, not only are
higher percentages of children in child care, but child-care centers are used more frequently
than any other type of care. This latter point is relevant to later discussions.
Day care in the United States is not without controversy. Some individuals believe
that day care can be harmful to young children because it separates them from their
parents. Others argue that it is not whether care is provided but the type and quality of care
that makes a difference in the children’s lives. Still others comment that the scarcity of good
care at a reasonable cost is this nation’s biggest problem. These and other issues are
explored here in more detail.
EFFECTS OF CHILD CARE. In the 1970s, as more middle-class mothers entered the
workforce, a popular question asked by parents and researchers was: “How much damage is
done to infants and young children by working mothers?” (Scarr & Eisenberg, 1993).
What was really being asked, if not assumed, was whether nonmaternal care was a threat to
the child. For example, if Roberto was left with a neighbor, would that affect his
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development differently than if his mother cared for him at home and did not work? A
second related issue is what effect nonmaternal care has on the child’s development: social,
cognitive, language, and other abilities. Scarr (1998) warned that there are no simple
answers to these questions. Nonparental child care, for example, includes for-profit (such as
the large national chains) and not-for-profit centers (such as church-sponsored centers), as
well as family-based care and other permutations. Not only are there different types of care
but also differences in the quality of care within the same category.
FIGURE 8.1 Child-Care Arrangements of Preschool Children by Year and Type of Arrangements
Note: Columns do not add up to 100$ because children were sometimes in mixed types of
care or were cared for by parents.
Source: U.S. Census Bureau (2008) . The 2008 statistical abstracts. Washington, DC:
Author.
Because high-quality care, whether provided by parents or others, is the cornerstone of
child development, we examine the issue of child care in more detail. Only well-designed,
large-scale studies allow us to tease out conclusions about the effects of early child care—
parental or nonparental—on child development (NICHD, 2001). Fortunately for us, a
current, large-scale, well-designed, and ongoing NICHD study (2006) is helping sort out
some of the caregiving factors that enhance or hinder optimal child development. The
study, known as the NICHD Study of Early Child Care, followed the development of
more than 1,000 children from birth through age 3 at 10 different sites in the United
States. A second phase of the study followed their development through first grade, and
Phase III studies their development in middle childhood (NICHD, 2006).
The primary purpose of the NICHD study is to examine how variations in
nonmaternal care are related to children’s social adjustment as well as cognitive and
physical development. Family characteristics are also a consideration. The life course
approach of this study helps focus attention on not only the timing of events but also the
transitions in the lives of the young children and their families. The network of researchers
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has attempted to obtain a sample of children that includes families from diverse geographic,
economic, and ethnic backgrounds with parents who have diverse work-related issues. The
parents, however, come from higher educational and income levels than census data
indicate are typical, and Whites are overrepresented in the sample. However, on many
other dimensions the sample is quite representative of the U.S. population (2001).
The study involves researchers making observations in the home and administering
various measures of social-emotional as well as linguistic and cognitive development.
Several indices of quality of day care, such as training of the staff and child-to-staff ratios,
are also assessed. Because of the study’s design, the psychologists are able to follow children
through a wide range of child-care experiences and to assess combinations and changes in
child-care arrangements over time. For example, some infants are cared for at home in the
first few months of life, then are turned over to a relative (perhaps a grandmother or an
aunt) until the parents decide the child can attend day care or preschool at the age of 2.
Some of the early results are in.
A critical first question is, what constitutes high-quality child care? The NICHD
(2006) identified the following specific and measurable guidelines as indicating high-
quality care:
Appropriate adult-to-child ratio (e.g., for infants, a maximum of six children to one
adult)
Small group size (e.g., for children one and a half to two years old, a maximum of
eight children)
Appropriate caregiver education (e.g., completed high school and better yet,
completed college with a degree in early childhood education or child development)
Accreditation by state and/or federal agencies
Notably, quality of care has been linked to both good cognitive and social
development (Brooks-Gunn, 2004; NICHD, 2006; Ramey, Ramey, & Lanzi, 2006), with
high-quality care, of course, enhancing development no matter where it is provided. It is
not surprising that NICHD researchers found that when these guidelines are followed (i.e.,
the standards are high), child care leads to better outcomes for children. For example, the
higher the standards, the better the child’s cognitive functioning and language
development. Similarly, the higher the standards, the more cooperative and sociable the
children are. The NICHD study (2006), however, found that most child care in the
United States rated only “fair,” with a mere 10% of children receiving very high quality
care and another 10% receiving very poor quality care. On some quality dimensions (such
as child-to-adult ratio), only 20% of the caregiving arrangements met important criteria.
The NICHD study also made clear that beyond these guidelines there are processes
that also contribute to high-quality care, such as the caregivers’:
Positive attitudes, positive interactions, and warm physical contact (e.g., holding
hands) with the children
Communications to the child, such as asking questions, making comments, or
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Reading stories, singing songs, and other activities designed to help children learn
Encouragement of the child’s development, such as helping an infant walk
Social behaviors, such as smiling and laughing
Sadly, the NICHD (2006) study found that only a small percentage of children have access
to these positive processes. The study also found that as the child grows older (and thus
becomes more sociable), the child receives less positive caregiving. We might conclude,
then, that the child-care experience provides both risks and benefits in the United States
(Belsky, 2006).
One other finding of the NICHD study is very important. In the end, despite these
interesting results, child-care arrangements had less impact on social-emotional and
cognitive development than did family characteristics. This finding has been documented
by other researchers (de Schipper, Van Ijzendoorn, & Tavecchio, 2004). In fact, the
NICHD researchers concluded that family characteristics overall were better predictors of
child development than any other aspects of the child-care situation. Effective parenting
may be the most protective factor a child can experience (Knitzer, 2007). Thus, it is clear
that early child care cannot be adequately assessed without taking into account the
children’s experiences in their own families. In addition, one could argue that good child
care may not be able to compensate for negative family environments. All of these findings,
as ever, hold important implications for public policy and for families making decisions
about child care.
PLANS FOR THE CHILD CARE DILEMMA. More than two decades ago, child-care
expert Edward Zigler and his colleague Mary Lang (1991) asked how we could make our
mixed system of child care effective for all families. The same question persists today: How
can we make quality, affordable child care available to the many who need it? The solutions
are not simple, but the United States seems to have made some steps in the right direction,
even if more needs to be done (Muenchow & Marsland, 2007). Progress can be made on
the family, employer, governmental, and societal levels.
At the most immediate ecological level—the parental or family level—parents can and
should familiarize themselves with information about quality child care. Recent studies (for
example, the NICHD study) have detailed characteristics of high-quality care. Parents,
however, might not know where to search for such information, so pediatricians, public
schools, health departments, and other agencies need to help them find it. Families also
need to understand the value of participating in and asking appropriate questions about
their children’s care. This may be affected by the sense of empowerment that a parent feels
in his/her life in general and in relation to advocating for his/her children. Additionally,
many low-income families and single working parents may benefit from higher child tax
credits or other subsidies for child care.
At the employer level, there is also much that can be done to improve access to child
care and promote healthy child development (Murphy & Halpern, 2006). Generous family
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leave time, flexible working hours, telecommuting, and in-house child-care centers would
help ensure that the organizational climate is family friendly. A menu of these workplace
enhancements, rather than just one option, would also demonstrate to employees that they
need not be afraid to use them. Working families are here to stay, and what happens to
families and children in society should be everyone’s concern (Murphy & Halpern, 2006).
Other experts call for sweeping policy changes and rethinking of current policies and
funding at the state or federal level (Doherty, Forer, Lero, Goelman, & LaGrange, 2006;
Haskins, 2005; Knitzer, 2007; Muenchow & Marsland, 2007) or increased funding for
early childhood care and education (Ludwig & Phillips, 2007). Some of these professionals
have called our federal policies downright antifamily in comparison to other countries
around the world (Murphy & Halpern, 2006). European countries, for example, often
provide generous family leave time for the arrival of a new child. Sweden allows more than
400 days of paid leave combined for new mothers and fathers. Likewise, based on their
research, Burchinal and colleagues (2000) favor more federal intervention because state
policies vary from good to nonexistent or unenforced regulations. There is much variety
among states in their regulations (Riley, Roach, Adams, & Edie, 2005), and states with
more demanding standards house fewer centers providing poor-quality care (Lamb &
Ahnert, 2006). Rigorous standards, however, are no guarantee of high-quality care.
Doherty and her team (2006) found that because appropriate education of child-care
workers translates into better care, requiring people who have no interest in working with
children (such as in the work-for-welfare programs mentioned in Chapter 7) to provide
care to them is incompatible with providing quality care. Others suggest paying child-care
workers higher salaries and requiring that they be trained in early childhood education
(Doherty et al., 2006).
Certainly, although it is difficult, child-care research needs to continue. We know
relatively less, for example, about after-school care for older children or the effects of day
care on children from various cultural backgrounds. Further research into the exact
processes that contribute to high-quality care is also needed, although the NICHD study is
a good beginning. Among other research issues that are rather neglected are the effect of the
child’s attachment to the surrogate caregiver, his or her relationship to peers as affected by
day care, and how to improve support among the public for high-quality child care (Lamb
& Ahnert, 2006). Furthermore, most research is center based, but much care is provided
informally or in family/home settings. More research is needed on this latter type of care,
too (Raikes, Raikes, & Wilcox, 2005).
Enrichment Education and Early Intervention
Many professionals argue that child care alone is not enough for some children to flourish
developmentally, because of other factors in their environment such as poverty or elevated
levels of family conflict. Research has found that on average, children from low
socioeconomic-level families are relatively less well prepared for school (Administration for
Children and Families, 2008; Magnuson & Waidfugel, 2005; Stipek & Hakuta, 2007) and
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are more at risk for later behavior problems (Caputo, 2003; Webster-Stratton & Reid,
2007), such as crime and risky behavior. In addition to these potential risks, there is also
serious concern about what is called the achievement gap. The achievement gap refers to
the multitude of ways that impoverished children, often children of color, fail to keep up
academically with their middle-class or upper-class peers when it comes to test scores or
standardized measures of achievement (Ladson-Billings, 2006). Deciding the best way to
close the achievement gap is one of the most perplexing problems facing educators today.
Many have argued that the key to addressing this problem is in early intervention.
Early intervention programs designed to assist economically disadvantaged children
first came to be known as compensatory education or early intervention programs. Today
such programs are more likely to be known as enrichment education. Such programs are
thought to form an “invisible safety net” (Currie, 2006) to prevent future problems of
children at risk (Administration on Children and Families, 2008).
However, in an age of economic crisis, policy makers have to ask, are compensatory
education programs really beneficial to these children, especially given their costs, most of
which are carried by the taxpayers? For example, if Roberto had attended a preschool
designed especially for Hispanic children about to enter mainstream public schools, would
his early elementary education have been more beneficial? To address this question, we
explore the best-known enrichment education program: Head Start.
The Economic Opportunity Act of 1964, as part of the “War on Poverty,” established
a variety of ways that children might benefit from social programs, one of which was
Project Head Start (Ludwig & Phillips, 2007). In many ways a national preschool program,
the goal of Head Start is to reach children between the ages of 3 and 5 from low-income
families. It is a total or comprehensive program in that it attempts to meet the children’s
mental, emotional, health, and educational needs (Haskins, 2005). Typically, a child
receives a year or two of preschool along with nutritional and health services as part of the
program. The federal government picks up much of the cost, although under various
administrations the program has fared better or worse (Ludwig & Phillips, 2007; Knitzer,
2007; Zigler, 1994; Zigler & Muenchow, 1992). Head Start is now the largest program
providing comprehensive educational, health, and social services to young children and
their families living in poverty; thus, it is an important player in the early childhood service
delivery system. Here are some program statistics for 2009 (Office of Head Start, 2012),
the latest available at the time of this writing:
More than 904,000 children were enrolled (since its inception, Head Start has served
24 million children).
Over 39% of the children were White, over 30% were Black, and 36% were
Hispanic.
77% of Head Start teachers have at least an AA degree in early childhood education.
26% of Head Start program staff members were parents of current students or were
former Head Start children.
Nearly 850,000 parents volunteered in their local Head Start program.
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More than 228,000 Head Start fathers participated in organized, regularly scheduled
activities designed to involve them in Head Start programs.
94% of Head Start children had health insurance.
Head Start historically has been somewhat unusual among early childhood education
programs. Because of some of its unique features, the program incorporates some of the
principles of community psychology as outlined earlier in the book. First, although it is a
nationwide program, Head Start programs can be tailored to each individual community.
Second, it was one of the first programs to demonstrate that a single approach or a single
intervention is insufficient. For example, Project Head Start is not just a preschool
program. One of the revolutionary ideas of this program is to involve parents as decision
makers and learners (Zigler & Muenchow, 1992). Parents serve on policy councils, work
directly with children in the classroom, attend parenting programs, and receive services for
their own social, emotional, or vocational needs. Many Head Start parents have become
certified Head Start teachers. Project Head Start was not designed simply to enrich
children’s environments so as to enhance IQ. Rather, the program was developed so that
children would be motivated to make the most of their lives (Zigler & Muenchow, 1992).
An important question is, Has it done this?
Head Start has been in existence for more than 50 years, so researchers should easily
be able to assess both its short- and long-term effects. Right? Not exactly! Head Start
research is extremely difficult to conduct for a number of reasons. First, the programs are
rather variable across the country and do not use random assignment for enrolling children
(Lamb & Ahnert, 2006). Moreover, Head Start programs have been evolving over time
such that today’s programs are not identical to the earlier ones; the few long-term
evaluations that have been conducted do not take this into account (Ludwig & Phillips,
2007). Third, researchers do not agree on exactly what constitutes “progress” by the
children. Is it improvements in school readiness? Social skills? Cognitive skills? Better
health? What if gains are so small that the program is not cost effective? In addition, the
larger ecological environment surrounding Head Start children is continually in flux—for
example, when societal prejudice waxes and wanes, more single mothers enter the
workforce, and public opinion about such programs shifts (Ludwig & Phillips, 2007).
Given this ever-changing political context, program effects are more difficult to tease out.
We examine some of the newest research next, but the Head Start program will probably
always fluctuate from site to site, forever have its critics, be subject to research biases, and
continue to transform as federal and state policies, the political climate, and funding
change.
Many authors claim that Head Start demonstrates that the program provides benefits
for children (Administration for Children and Families, 2005; Love, Tarullo, Raikes, &
Chazan-Cohen, 2006; Ludwig & Phillips, 2007). Some studies do show short-term gains
for the children. For example, a major research study (3,200 children in 40 programs)
reviewed by Love and colleagues (2006) concluded that Head Start narrows the gap
between disadvantaged children and all other children in vocabulary and writing skills.
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Another study (Administration for Children and Families, 2006) also resulted in findings
that showed Head Start children over time improved social skills and that Head Start led to
better word knowledge, letter recognition, and math and writing skills compared to
nonprogram children when they reached kindergarten. The same study also showed that
Head Start children experienced modest gains in health status as well as improved parenting
(e.g., use of more educational materials and less physical discipline).
But what about long-term effects? In a study of some of the earliest graduates of Head
Start, the researcher found that as adolescents, Head Start students appeared comparable to
other adolescents in regard to the highest grade completed, their sense of personal mastery,
health, and mental health (Caputo, 2004). Other studies have echoed these findings (Love
et al., 2006; Mashburn, 2008). Another way to look at long-term effects is by means of
cost-effectiveness. In these terms, early intervention programs such as Head Start again
appear to pay their way. Cost-effectiveness is a measure of great interest to taxpayers and
policy makers. Ludwig and Phillips (2007) reviewed the cost-benefit literature on the
program. They determined,“There is now an accumulating body of evidence on Head
Start’s long-term impacts that seems to suggest the program probably passed a benefit-cost
test for those children who participated during the program’s first few decades” (p. 3).
For example, children from Head Start (as compared to nonparticipating siblings) are
more likely to complete high school and more likely to attend college (Mashburn, 2008).
Head Start also reduces the chances of being arrested and subsequently being charged with
a crime (Garces, Thomas, & Currie, 2002). Many of these results held regardless of the
child’s race or ethnicity. There are also benefits to parents and society in that high-quality
child care is typically provided in Head Start, special education placements are reduced, and
grade retention (repeating a year) is lower. In sum, Ludwig and Phillips (2007) and others
conclude that Head Start generated benefits in excess of program costs, with the ratio
possibly being as high as seven to one. Notably, Ludwig and Phillips also argue that the
benefits from each extra dollar of program funding a county spends easily outweigh the
extra spending.
Head Start is not the only early intervention program available, but it probably is the
best-known one. The High/Scope Perry Preschool program was also designed to intervene
in the process that links childhood poverty to school failure to subsequent adult poverty
and related social problems, such as involvement with the criminal justice system. The
High/Scope program incorporates into its design developmentally appropriate learning
materials based on psychological principles of development, small class sizes, staff trained in
early childhood development, in-service training for staff, parental involvement, and
sensitivity to the noneducational needs of the child and family. What is fairly unique about
this program is that it views the child as an active rather than passive, self-initiating learner.
Typically, the child selects his or her own activities from among a variety of learning areas
the teacher prepares—called participatory learning (Schweinhart, 2006; Weikart &
Schweinhart, 1997).
Research on the High/Scope Perry Preschool project is impressive. In the short run
the High/Scope Perry project improves educational outcomes, such as higher IQ and
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achievement test scores. The program also reduces the need for academic remedial services
(Ramey & Ramey, 2003). In the long run, evidence collected over more than two decades
shows that the program results in lowered crime rates, reduced high school dropout, less
need for welfare assistance, increased earnings as adults, and higher personal wealth
(Schweinhart & Weikart, 1998), including higher likelihood of employment and home
ownership and fewer evictions from rental units (Schweinhart, 2007).
Nores, Belfield, Barnett, and Schweinhart (2005) claim that the High/Scope Perry
Preschool program returns an amazing $5.67 to $12.90 for every dollar expended,
depending on the calculations used. Savings or benefits occur in lowered welfare assistance,
lower special education and justice system costs, savings to crime victims, and increased tax
revenues from higher earnings by the participants (Nores et al., 2005; Parks, 2000). This
research again illustrates that the participants, their parents, the public, and the adult
graduates of early interventions programs all benefit from such programs.
Self-Care Children
Before leaving the topic of child care and its importance, it is appropriate to discuss the fact
that for many children of working parents, the need for supervised, structured child care
continues even after they enter public schools. Approximately 7 million children between
the ages of 5 and 13 lack adult supervision when they come home from school (Durlak &
Weissberg, 2007). These children, referred to as self-care children, may be on their own
because of a lack of after-school child care, which is especially true in low-income
neighborhoods (Afterschool Alliance, 2004), or because they are in the home with older
siblings who may be charged with the role of babysitter. For low socioeconomic–status
families who lack other options, children spend more hours on their own in comparison to
families of higher socioeconomic status (Casper & Smith, 2002). Depending on the age of
the children who are caring for themselves, the extent to which they are being monitored
by adults (e.g., by telephone), and what they are doing with their time (e.g., homework,
chores, playing videogames), there is great variability in whether self-care arrangements are
problematic for children. For example, younger school-age children who spend more time
alone, as opposed to those involved in structured activities, are more likely to have
emotional and social problems (Vandell & Posner, 1999). At the same time, there are
potential problems for older children who are left on their own in that they may be more
vulnerable to peer pressure or the temptation to engage in risky behaviors (Coley, Morris,
& Hernandez, 2004).
Not surprisingly, all things being equal, research suggests that being involved in high-
quality after-school care is more beneficial than being at home by oneself (Durlak &
Weissberg, 2007). In particular for lower socioeconomic–status children, being involved in
after-school programs that offer academic assistance (e.g., tutoring) and enrichment
activities (e.g., art, physical recreation) seems to result in superior classroom work habits,
academic achievement, and prosocial behavior as compared to children who are in self-care
environments (Vandell et al., 2006). Thus, community psychologists advocate for
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increasing the availability of child care and enrichment programs for both preschool and
school-aged children.
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THE PUBLIC SCHOOLS
Although education laws vary by state, at the age of 5 or 6, most children in the United
States attend public schools: elementary, then middle school, and then high school. Many
students breeze through the school system without difficulty. Others experience difficulties
on entering school, and some develop problems later in their academic careers. For
example, the transition from early childhood—whether the child is reared at home or
provided day care or preschool—can be difficult for some children. Transition from middle
school to high school can also be troublesome. Such times of transition or milestones help
psychologists predict who might be at risk for developing school-related problems
(Koizumi, 2000; Warren-Sohlberg, Jason, Orosan-Weine, Lantz, & Reyes, 1998).
In addition, schools are remarkable social institutions shaped by political and social
events, such as the civil rights movement, the advent of modern technology, and the
changing demographic trends, such as the increase in our Hispanic population. One event
of major importance—the desegregation of schools—is reviewed first.
Desegregation, Ethnicity, and Prejudice in the Schools
Because Roberto, the young man in the opening vignette, is now about 26 years old, he has
benefited from the civil rights movement of the 1950s and 1960s. Or has he? It is necessary
to examine the complex effects of societal prejudice as well as public policy changes
designed to confront prejudice, discrimination, and segregation—in particular, on children
and schools. Seymour Sarason (1997), a leading expert on U.S. schools, called the nation’s
schools our Achilles’ heel. He argued that the nearly total failure of the education reform
movement has had, and will continue to have, consequences beyond the educational arena,
one of these being racism. Has anything improved in the years since Sarason made these
comments?
THE HISTORICAL CONTEXT. Despite the fact that amendments to the U.S.
Constitution long ago gave equal protection under the laws and the right to vote to all
citizens, it was not until the 1950s that events took place that have had a lasting and
sweeping effect on our schools. In 1954, the Supreme Court of the United States decided
the case of Brown v. Board of Education of Topeka, Kansas. In fashioning their decision, the
Supreme Court justices heard major testimony from social scientists about the detrimental
effects of segregation on African American pupils (see, for example, Clark & Clark, 1947).
In the official unanimous rendering, the judges cited social science research as being
influential in their deliberations (Levine & Perkins, 1997). The consequence of the
decision was that there would no longer be a place for segregation in schools, not even
for“separate but equal” educational facilities. Interestingly, the judges were not initially
concerned with implementing their decision, or in the precise effects of desegregation on
children once it was instituted. Despite school desegregation, the ruling did little to alter a
society that remained segregated in housing and other social institutions, such as places of
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worship (Well, Holme, Atanda, & Revilla, 2005).
Some school authorities scrambled to comply with the ruling. The chosen method for
desegregation was often“one-way busing” (Oskamp, 1984), where inner-city children were
bused to the suburbs and all-White districts. Some school systems dragged their heels, and
some openly defied the ruling; subsequent court-ordered desegregation plans were imposed
on them. Public policy changed some discriminatory behaviors, voluntarily or
involuntarily, but an important question is, Did it change all related behaviors? An equally
important matter was whether the children were really better off with this policy. Social
scientists quickly became concerned with these and other issues of desegregation
(Maruyama, 2003).
PREJUDICE AND ITS COMPANIONS. In the opening vignette, Roberto revealed that
he thought the other children believed he was dumb. Is this a form of prejudice? If yes, how
did the children form this impression?
Prejudice is an unjustified attitude (usually negative) toward the members of some
group, based solely on their group membership. If Roberto’s classmates thought he was
dumb because he was Hispanic, they were indeed prejudiced. A companion to prejudice is
discrimination. Discrimination involves prejudiced actions toward particular groups based
almost exclusively on group membership. If Roberto’s classmates refused to play with him
on the playground because of his ethnic background, they would have been discriminating
against him. Recall that we discussed in Chapter 3 the changing faces of racism and other
forms of discrimination, called microaggressions. Often, discrimination is influenced by
stereotypes. Stereotypes are beliefs that all members of certain groups share the same or
common traits or characteristics. Believing all Asian Americans are good at math is a
stereotype. In keeping with the earlier example, if Roberto’s classmates classified all
Hispanics as dumb, then they would have held a stereotype.
Important historical research on stereotyping in classrooms was conducted by
Rosenthal and Jacobson (1968). In their study, teachers were told that perfectly normal
children were either“bloomers” or“normal.” Teachers were not told to treat these two
groups differently. By the end of the study, the so-called bloomers showed dramatic
improvements in classroom performance and IQ scores, probably because they had been
the beneficiaries of positive prejudice. It is important to remember that all children were
randomly assigned to the conditions of normal or bloomer. This study demonstrates that
teachers’ labels and their stereotypes of children somehow fulfill the teachers’ prophecies.
This phenomenon, where a labeled individual fulfills someone else’s forecast, is called the
self-fulfilling prophecy. Studies have shown that teachers’ expectations in a variety of
classroom settings do influence student achievement and motivation (Weinstein, 2002).
As discussed in Chapter 3, research on contemporary society indicates that people’s
prejudices and labels may be quite different from those of the generations previous to the
civil rights movement (Hitlan, Camillo, Zárate, & Aikman, 2007). Before 1950,
traditional racism was more overt (Dovidio, Gaertner, Nier, Kawakami, & Hodson, 2004),
with open name calling, different laws for certain groups (“Negroes ride in the back of the
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bus”), and, in fact, mob actions against as well as lynchings of certain groups. In modern
prejudice (Dovidio & Gaertner, 1998; Duffy, Olczak, & Grosch, 1993), sometimes called
aversive racism (Dovidio et al., 2004), people’s attitudes are more covert and subtle. These
subtle forms of prejudice and discrimination allow their users to conceal the negative views
they really hold.
Prejudice, then, has not disappeared simply because the courts have ruled that
desegregation and equal opportunity must prevail. It has simply taken on a different
appearance—a more subtle form. Given that prejudice still pervades society and that more
diverse groups (e.g., Hispanics and Asians) are being added to the United States (American
Psychological Association, 2005), we should devote some attention to immigrant
experiences.
Until recently, the United States boasted of its heritage of immigrants (Mahalingam,
2006). Indeed, today, we are still a nation of immigrants (Deaux, 2006). Much of our
population is first-, second-, or third-generation immigrants. Census data tell us that since
1970, the number of immigrants living in the United States has tripled, and during the
1990s, the immigrant population grew by more than 50% (Silka, 2007). Census data also
reveal that large cities are made up of multiple immigrant populations. New York City’s
population, for example, was composed of 28% immigrants in 1990; today, immigrants
make up 40% of New York’s population (Deaux, 2006). What census data do not tell us is
that arriving immigrants face different cultural traditions and values, different languages,
and different religions. They also face different business customs, healthcare practices, art
forms, and school systems than in their countries of origin (Silka, 2007). Immigrants also
face much prejudice, marginalization, and discrimination that cause myriad adjustment
problems for them (Mahalingam, 2006). Immigration undeniably is a“hot button” issue
today (Deaux, 2006).
Immigrants of color face the most prejudice (Mahalingam, 2006) compared to
immigrants from European countries or Canada. Historically, biases against various
immigrant groups have waxed and waned; Japanese citizens, for instance, faced high levels
of prejudice before, during, and after World War II. More recently, Arab and Mexican
immigrants have faced immense prejudice (Hitlan et al., 2007). White Americans who
perceive themselves as truly“American” often manifest the most prejudice (Hitlan et al.,
2007), especially those high in social dominance (Danso, Sedlovskaya, & Suanda, 2007).
They do so by overincluding strangers in immigrant out-groups (this concept is covered
shortly) (Kosic & Phalet, 2006) and by dehumanizing immigrants—not seeing them in
personalized ways (Danso et al., 2007)—or isolating them (Silka, 2007). Unfortunately,
teachers are not immune to this phenomenon, which is why special efforts have been made
to have teachers learn about various immigrant cultures so that they can better understand
immigrant students and their families.
The actions that people take toward immigrants occur, for the most part, at the
community level (Silka, 2007). For this chapter, then, an important question is, When
children from all of these different backgrounds are intermingled in classrooms, do they
experience prejudice? Discrimination? Stereotyping? If yes—and you already know the
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1.
2.
3.
4.
5.
answer is yes—what can we do to lessen the effects of any prejudices children bring from
home? Given that children begin to develop ethnic attitudes by age 3 and systematic racial
prejudices between 5 and 7 years of age (Houlette et al., 2004), most intervention efforts
are directed at young children. Psychologists have some interesting and innovative
programs to address this issue.
FOSTERING ACCEPTANCE OF DIVERSITY IN THE CLASSROOM. In a famous
demonstration with children called “The Eye of the Storm,” teacher Jane Elliot told the
dark-eyed children that they were inferior to the light-eyed children. In fact, she said they
were so inferior that the light-eyed children were not to play or have contact with the dark-
eyed children. The light-eyed children soon segregated, taunted, and mistreated the dark-
eyed children. Elliot then reversed the roles; the light-eyed children were now the inferior
ones. When she debriefed the children and they discussed their feelings, the children talked
about how horrible it felt to be the victims of such intense prejudice. This demonstration
reveals just one means by which children in schools can be familiarized with what prejudice
feels like. What other techniques are in the psychological arsenal for fostering acceptance of
diversity in classrooms?
One other approach to reduce prejudice is to actively involve children with one
another. Intergroup contact is when two conflicting groups come together, and the contact
enables them to better understand and appreciate one another (Brewer, 1999; Buhin &
Vera, 2009; Kawakami, Phills, Steele, & Dovidio, 2007; Molina & Wittig, 2006; Paluk,
2006; Zirkel & Cantor, 2004). Research demonstrates that only certain intergroup contacts
enhance people’s understanding and acceptance of each other (Kawakami et al., 2007;
Marcus-Newhall & Heindl, 1998; Molina & Wittig, 2006).
Stuart Cook has been a leading proponent of the contact hypothesis for reducing
prejudice. The contact hypothesis states that personal contact between people from
disliked groups works to decrease the negative attitudes but only under certain conditions.
The five conditions are:
The groups or individuals must be of equal status.
The attributes of the disliked group that become apparent during the contact must be
such as to disconfirm the prevailing stereotyped beliefs about the group.
The contact situation must encourage, or perhaps require, a mutually independent
relationship or cooperation to achieve a joint goal.
The contact situation must promote association of the sort that will reveal enough
details about members of the disliked group to encourage seeing them as individuals
rather than as persons with stereotyped group characteristics.
The social norms of contact must favor the concept of group equality and egalitarian
intergroup association (Allport, 1954/1979; Cook, 1985).
Of all of these, interdependence appears to be very important (Molina & Wittig,
2006). Molina and Wittig would also add that respected authority figures need to support
such intergroup efforts if they are to decrease bias, for example, in the schools. In other
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words, teachers and school administrators cannot ignore or tolerate any instances of
discrimination if these efforts are to be effective. They also acknowledge that knowing
which contact conditions are optimal for what outcomes and for which groups will improve
success in intergroup contact programs. In other words, one size does not fit all.
Several quasi-experimental and laboratory experimental studies of the intergroup
contact hypothesis have been conducted, and they support the hypothesis (Pettigrew,
1998). Only one set of studies are reviewed here. Wright, Aron, McLaughlin-Volpe, and
Ropp (1997) examined the hypothesis that if it is known that an in-group member has a
close relationship with an out-group member, more positive intergroup attitudes will result.
The in-group is the group with which one identifies, whereas the out-group is the group
one perceives as being different from one’s own group, as in racial groups to which one
does not belong (Duffy & Atwater, 2008).
In one study, Wright and colleagues (1997) found that participants who knew an in-
group member who had a friendship with an out-group member held less negative attitudes
toward the out-group. In another study, competition and conflict were induced to create
in- and out-groups. When in-group members discovered that their own group members
had cross-group friendships (that in-group members were friends with some members of
the out-group), negative attitudes toward the out-group were reduced.
In line with these studies, other authors have found that intergroup contact reduces
prejudice or creates a greater appreciation for diverse groups at a variety of grade levels—
college, for example (Gunn, Ratnesh, Nagda, & Lopez, 2004; Hurtado, 2005; Lopez,
2004). Molina and Wittig (2006) recently found that in schools, the opportunity for
individualized interactions with members of diverse groups helps reduce prejudice.
Kawakami and associates (2007) found that merely approaching members of a certain
group can lead to more favorable attitudes toward that group.
Kawakami and colleagues warn, though, that their research addresses only a basic and
limited mechanism—approach behavior. In the world at large, their research does not speak
to the more general questions related to the impact of contact in everyday settings and over
extended periods of time. Research on intergroup contact needs to continue. Undoubtedly,
many schools, workplaces, and other organizations promote diversity or provide some form
of diversity or cultural sensitivity training (Paluk, 2006). However, because these programs
are not always grounded in sound theory—such as intergroup contact theory—and
research, nor are they always desired by the participants, they do not always work (Paluk,
2006).
Elliot Aronson (2004) and his colleagues pioneered another technique called the
jigsaw classroom. In this type of classroom, students initially work on a project in mastery
groups. In this first type of group, students all learn the same general material, but each
group learns different details about that material. The mastery groups then break into
jigsaw groups such that each jigsaw group contains one student from each mastery group.
For example, if students were learning about prejudice, one mastery group would learn the
definitions and examples for prejudice, discrimination, and stereotypes. A second mastery
group would learn about the detrimental effects of prejudice. A third might learn about
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ways to reduce prejudice, and so on. In the jigsaw groups, one student from the definition
group, one student from the detrimental effects group, and one from the how-to-reduce-
prejudice group would come together and teach the others the appropriate module. In this
way, isolated students become more central to the group, and competitive students learn to
cooperate. Without everyone’s interdependence and cooperation in the jigsaw group, the
group cannot achieve its learning goals. This process can be particularly useful for English
language learners in that students who trip over English words are prompted and assisted
by the other children; otherwise, no one can learn (Aronson, Blaney, Stephan, Sikes, &
Snapp, 1978; Walker & Crogan, 1998).
In one of the first major experiments on the jigsaw technique, Blaney, Stephan,
Rosenfield, Aronson, and Sikes (1977) found that attitudes toward classmates and the
school, self-esteem, cooperative learning, and school performance all improved over those
of control students in standard classrooms. Of course, competitiveness also declined. Other
research has documented that peer teaching, as used in the jigsaw method, improves peer
liking, learning, and perceptions of the classroom climate (Slavin, 1985; Wright & Cowen,
1985). Exciting news is that positive results from cooperative strategies such as peer
teaching seem to generalize to children not in the immediate school environment (Miller,
Brewer, & Edwards, 1985)—for example, to all members of a minority group. Some
authors have even suggested that the jigsaw classroom will work with older students,
including college students (Williams, 2004).
Since the jigsaw technique was introduced, other similar cooperative learning
techniques have been developed (e.g., Houlette et al., 2004; Slavin, 1996). What is
important is that the positive results of these forms of cooperative learning have been
replicated in thousands of classrooms, thus making cooperative learning“a major force
within the field of public education. … [Cooperative learning] is generally accepted as one
of the most effective ways of improving race relations and instruction in desegregated
schools” (Aronson, Wilson, & Akert, 1999, p. 544).
Some states have experimented with magnet schools to reduce prejudice, where
students from a variety of school districts attend a certain school because it specializes in a
particular discipline, such as music or foreign languages. Interested students are thus
attracted to the schools like iron to a magnet. These schools create a natural experiment on
intergroup contact because students of many backgrounds attend. Rossell (1988) compared
the effectiveness of voluntary plans at magnet schools to mandatory-reassignment
desegregation plans. She found that magnet schools produce greater long-term interracial
exposure than mandatory reassignment, probably because of what she and others have
called“White flight” from the reassigned districts. In line with this, Fauth, Leventhal, and
Brooks-Gunn (2007) reported that even court-ordered moving of disadvantaged, minority
students and their families to higher income neighborhoods (and schools) can have
deleterious effects not only on the youths but on their parents and their parenting styles.
Forced desegregation does not appear to be working as well as some of the programs
described here.
We can conclude that once classrooms are desegregated, by court order or by
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•
•
•
•
•
voluntary design, there are some good, empirically tested means by which children can
become more accepting and helpful to one another. But what happens to the academic and
social performance of these students? If the courts determined that separate education was
not only unequal but inferior for many economically disadvantaged students, does
desegregation in any form accelerate the upward path of the targeted children?
EFFECTS OF DESEGREGATION. One noted authority (Pettigrew, 2004) reviewed
research on the effects of desegregation and concluded that desegregation does have positive
academic effects as supported by research, but only when the research controls for social class.
As you may have learned in Chapter 7, socioeconomic class is intricately intertwined with
race and ethnic inequities (Hochschild, 2003), so it needs to be carefully scrutinized
alongside desegregation. Specifically, Pettigrew’s review concluded that compared to Black
children in segregated schools, Black children from desegregated schools are more likely to:
Attend and finish college, even White-dominated colleges
Work with White co-workers and have better jobs
Live in interracial neighborhoods
Earn higher incomes
Have more White friends and more positive attitudes toward Whites
Pettigrew laments, however, that the historic upward trajectory toward equal
education for Blacks and Whites was slow and circuitous, whereas the retreat from it has
been swift and direct, with much of the backpedaling blamed on court decisions. In fact,
some courts have even lifted desegregation orders, for example, in Nashville, Tennessee
(Goldring, Cohen-Vogel, Smrekar, & Taylor, 2006). In many of these instances, students
returned to neighborhood schools that were closer to their homes. What has been the result
of this latest trend? Once again, social scientists have some interesting perspectives and
answers.
Goldring and colleagues studied schooling closer to home and found that geographic
proximity to school does not necessarily translate into supportive community contexts for
children. Black children, they found, were more likely to be reassigned to schools in higher
risk (high poverty and crime rates) neighborhoods than were White children. Another
noted expert on desegregation, John Diamond (2006), explains that even in integrated
(wealthier?) suburbs, the playing field still is not level at school. For one thing, suburban
Blacks often teeter on the fence between privilege and peril, as he calls it, because of the
difference between“wealth” and“assets.” Blacks in suburbs still do not have as many assets
(e.g., own their homes) as Whites. Daniel (2004) adds that the new emphasis
on“accountability” and“achievement” has undermined the movement toward desegregation
by distracting attention away from it. Furthermore, Davis (2004) suggests that segregation
issues have also become less urgent because Americans are now focused more on school
safety issues. Arias (2005) also bemoans that fact that the Brown v. Board of Education was
designed to assist African Americans, and to date we have little information about whether
desegregation and other related strategies are appropriate for Latinos and other ethnic or
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racial minorities. There is still much to be done to research and overcome these and other
educational issues (King, 2004).
The Schools and Adolescents
Despite nationwide efforts to desegregate U.S. schools, and despite the best-laid plans to
provide early intervention programs for targeted children, it remains true that many
children isolated in the inner city continue to be economically disadvantaged and receive
poor-quality education. These children are usually from a racial or ethnic minority, yet they
have never benefited from any of the mentioned programs; thus, inner-city children mature
to adolescence still trapped in poverty. Psychologists consider inner-city adolescents most at
risk for academic failure, dropping out of school, teen pregnancy, drug use, and myriad
other problems that interfere with obtaining an education necessary to break the cycle of
poverty (Caputo, 2003; Magnuson & Waidfugel, 2005; Stipek & Hakuta, 2007; Webster-
Stratton & Reid, 2007). Eventually, as adults, they are more likely to experience life’s
stresses and strains (Golding, Potts, & Aneshensel, 1991; Rank, 2005).
In the interest of space, two relevant issues are examined here: dropping out of school
and school violence. First, however, we will discuss the role of the school itself in creating
some of the problems found within it (Branson, 1998).
THE SCHOOL CLIMATE. It is not just inner-city and minority children who have
problems in school. There are multitudes of reasons middle-class students drop out, get
pregnant, fail, or underachieve in school. Some of the reasons are the same as for the inner-
city students. It would be easy to blame students for being alienated or for having some
personality flaw that makes them restless and unmotivated (Legault, Green-Demers, &
Pelletier, 2006), but research shows that even gifted children become bored with,
uninterested in, or bullied at school (Feldheusen, 1989; Meade, 1991). One useful way of
categorizing contextual factors related to school problems (e.g., dropout, failure) is the
distinction between “push factors” and“pull factors.” Push factors are aspects of school
environments that cause students to become academically disengaged, whereas pull factors
are events and circumstances outside of school that compel students to disengage (Lehr,
Johnson, Bremer, Cosio, & Thompson, 2004). Because of poor school conditions in high-
poverty neighborhoods, such as higher levels of chaos and teacher turnover, students may
be pushed out of school during the middle grades. Students may also feel pulled to
disengage from school by increased demands in the home and/or temptations to participate
in wayward activities (Shin & Kendall, 2012). Obviously, students at greatest risk for
dropout may experience both push and pull factors. Imagine for example, a student whose
teacher has underestimated his intelligence, who is being bullied by peers, and who feels
unsafe in school. This same student might be vulnerable to recruitment by a neighborhood
gang that offers a sense of importance, protection, and a source of income. This
combination of push and pull factors might be enough to result in the student dropping
out of school.
One common factor that is studied by researchers who investigate academic
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achievement in adolescents is alienation from school. According to Bronfenbrenner
(1986), alienation means lacking a sense of belonging, feeling cut off. School alienation
means lacking a sense of belonging in school. This phenomenon has received much
attention in the community psychology literature, but community psychologists focus on
the circumstances in which the alienated child finds him- or herself rather than just on the
child.
In 1983, Seymour Sarason authored Schooling in America: Scapegoat and Salvation, in
which he suggested that schools are relatively uninteresting places for both children and
teachers. Sarason contended that children often exhibit more intellectual curiosity and learn
faster outside of school (Sarason, 1983; Weinstein, 1990). Bronfenbrenner (1986) added
that children under stress at home can easily feel distracted and alienated at school. Some
20 years later, Aronson (2004) issued a rather harsh indictment against American schools,
particularly our high schools, in his analysis of the Columbine (Colorado) school tragedy in
which a teacher and 14 students were killed. He stated that
the rampage killings are just the pathological tip of an enormous iceberg: The
poisonous social atmosphere prevalent at most high schools in this country—an
atmosphere characterized by exclusion, rejection, taunting and humiliation. In high
school there is an iron-clad hierarchy of cliques. … At the bottom are kids who are too
fat, too thin, too short, too tall, who wear the wrong clothes or simply don’t fit in. …
My interviews with high school students indicate that almost all of them know the
rank ordering of the hierarchy and are well aware of their own place in that hierarchy.
(p. 355)
Contemporary authors have identified some of the ecological components of schools
or, loosely, of the school climate—which encompasses the entire culture of the school and
not just educational methods and goals (Van Houtte, 2005)—that contribute to school
alienation. Teacher, administrative, and peer support (Gregory, Henry, & Schoeny, 2007),
as well as clarity and consistency of school rules and regulations, are some of the features
contributing to a school’s climate (Way, Reddy, & Rhodes, 2007). Safety in the physical
facility, student autonomy, and teacher/administrator abuse of power, among others, are
also characteristics that contribute to school climate (Langhout, 2004). Loukes, Suzuki, and
Horton (2006) also mention cohesiveness between, friction with, and competition against
other students as components of school climate. These and other aspects of school climate
are related to student problems such as violence and school dropout. School climate can be
experienced in different ways by students with different needs. An example of this is
discussed in Case in Point 8.1.
As you can see, the nature of schools is complex, so responses require an array of
options that should have their foundations in research (Freiberg & Lapoint, 2006). One
sample response to poor school climate and subsequent school alienation is alternative
education. Alternative education, or alternative schools, have components that differ from
traditional schools. For example, in traditional schools, the curriculum and requirements
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are designed by teachers and administrators. In alternative settings, the students and
perhaps their parents in consultation with teachers design the curriculum or select classes in
which the student will enroll or help set up rules (Vieno, Perkins, Smith, & Santinello,
2005). Students generally express a desire to have some autonomy, independence, and
choice in school (Langhout, 2004). This more democratic type of school environment is
reminiscent of the High/Scope Perry Preschool discussed previously and has been identified
for being responsible for creating a greater sense of community in the school (Vieno et al.,
2005). In addition, in alternative schools, the classes might also be smaller (Boyd-Zaharias,
1999; Muir, 2000–2001), and learning can occur outside a traditional classroom setting
(Coffee & Pestridge, 2001).
Solomon, Watson, Battisch, Schaps, and Delucchi (1996) designed an alternative
program to provide students with experiences essential to the development of a sense of
community in their schools. Students in the alternative program were compared to
nonparticipating students to evaluate the program. Specifically, the program included
cooperative rather than individual learning, interpersonal helping and other prosocial
activities, active promotion of discussions about prosocial values (such as fairness), and
empathy and interpersonal understanding. Results indicated that the program was
successful in heightening the sense of community in the classrooms. Moreover, sense of
community related positively to a number of student outcomes, such as ability to manage
conflicts with and likelihood of helping others. Further studies indicate that alternative
education is successful in creating higher student and teacher satisfaction with the schools
and better student achievement (Arnold et al., 1999; Catterall & Stern, 1986; Coffee &
Pestridge, 2001; Gray & Chanoff, 1986; Trickett, McConahay, Phillips, & Ginter, 1985).
CASE IN POINT 8.1
Dual-Language Immersion Programs
After reading the story of Roberto, you will not be surprised to learn that approximately one in every five students in
the United States has a native language other than English (National Center for Educational Statistics, 2011). All
together, this means that more than 11.2 million children who speak a language other than English at home attend
U.S. schools, a statistic that has more than doubled since 1980. Many of these children are not yet fluent in English,
creating challenges for school systems, which typically deliver instruction only in English. A common approach to
accommodating English language learners such as Roberto has been to teach English as a second language (ESL) as a
remedial course that has the goal of English proficiency. Thus, once Roberto’s language“deficiency” can be remediated,
he can benefit from instruction in traditional subjects such as math, reading, and science. The problem with this
approach is that there are both educational and socioemotional consequences to segregating students such as Roberto
until they can“catch up” to their English-speaking peers. This approach also sends the message that literacy in languages
other than English is not valued in the United States.
The good news is that schools are now considering a new approach to teaching English language learners called
dual-language immersion programs. These programs are not remedial programs but rather enrichment programs from
which both native English speakers and non–native speakers benefit. The goal of dual-language immersion programs is
bilingual proficiency for all students. Typically such programs enroll an equal balance of native English speakers and
native speakers of a second language such as Spanish. Each language group serves as a linguistic resource for the other,
an important method of reducing prejudice that will be talked about in the next section of this chapter. Heterogeneous
classes address the concern that ESL programs isolate English language learners from other students (Alanis &
Rodriguez, 2008). The important difference between dual-language immersion programs and ESL programs for
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students such as Roberto are that the goal is to retain the native language and promote academic achievement, as
opposed to remediating a linguistic problem that interferes with academic achievement. The benefit of such a program
for native English speakers is that they have an opportunity for foreign language immersion by being taught traditional
courses in a second language.
Typically children begin dual-language immersion programs in kindergarten or first grade, when language
acquisition abilities are at their peak, and they remain in them throughout middle school. Traditional subjects are
taught in both languages to all students, as is literacy in both languages. Academically, students in these programs,
regardless of their native language, outperform their peers in standardized testing. Non–native English speakers make
phenomenal academic gains in dual-language programs in comparison to their peers in ESL programs (Thomas &
Collier, 2003). For native English speakers, dual-language immersion students even outscore their native English
speaking peers in English proficiency. The dual-language immersion program represents a pluralistic view of language
and cultural competence that cultivates an understanding and appreciation of other cultures, instead of an“English
only” view that can be very marginalizing for immigrant families.
Studies on dual-language immersion programs by researchers such as Alanis and Rodriguez (2008) have found that
such programs are most successful when they exhibit the following characteristics: pedagogical equity, effective teachers,
active parent participation, and knowledgeable leadership. Pedagogical equity refers to the rigor of standards used in
teaching traditional subjects as well as language acquisition, with attention to not promoting one language over another.
Effective teachers must truly understand the philosophy and mechanics of teaching in a dual-language immersion
program (e.g., following recommended ratios of linguistic use, ensuring heterogeneous student workgroups, having high
expectations of all students). Active parent participation not only refers to the ways in which parents supported their
children in the program, but in many programs, the school provides opportunities for parents to learn their nonnative
language. Knowledgeable leadership refers to the support and expertise that school administrators have in implementing
and supporting such programs.
While dual-language immersion programs are not the norm in U.S. schools, think about the role they could play
in reshaping community values about bilingualism and the role of immigrants in society. Imagine, too, how they might
help in reducing the injustices and discrimination experienced by children such as Roberto. Keep these issues in mind as
you read about strategies to combat prejudice in educational settings.
Just what are the mechanisms by which alternative education creates these effects?
Studies have identified the elements of student participation, self-direction, and
empowerment (Gray & Chanoff, 1986; Matthews, 1991); innovative and relaxed
atmospheres (Fraser, Williamson, & Tobin, 1987; Matthews, 1991); and empathetic
teachers (Taylor, 1986–1987). All of these factors are outside the student; they are not
personality attributes of the students in the alternative settings but factors related to the
ecology of the alternative setting, which is in line with principles of community psychology.
One other promising intervention currently receiving attention in the literature is the
use of mentors to assist children with their social, interpersonal, and other skills both inside
and outside the school (Cassinerio & Lane-Garon, 2006; Durlak, Weissberg, & Pachan,
2010; Novotney, Mertinko, Lange, & Baker, 2000; Phillip & Hendry, 2000). A mentor is
a caregiver or other adult who develops a close bond with the child. Mentors often make a
positive and lasting impression on a child. Cassinerio and Lane-Garon, for example,
assigned university-level students to urban middle school children learning to become
mediators or neutral conflict managers for their schools. Analysis of results of the
mentoring program reveals that at year’s end the school climate was rated more positively,
and there were fewer reports of violence in the school compared to the previous year. The
study is notable because the school enrolled not only White students but many Asians,
Hispanics, and African Americans—a situation ripe for student conflicts.
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OTHER FACTORS RELATED TO SCHOOL SUCCESS OR FAILURE. The school
climate is not the only school-related risk factor affecting children. Students who transfer
from one school to another and those who are moving from elementary to junior high or
junior high to high school (Compas, Wagner, Slavin, & Vannatta, 1986; Koizumi, 2000;
Reyes, Gillock, Kobus, & Sanchez, 2000; Reyes & Jason, 1991) are also considered at risk
for problems. These and a host of other factors require attention from educators if children
are to adjust to schools. Also important is the finding that poor grades in school, absence of
positive coping behaviors, and presence of negative coping behavior in the early grades
predict mental health problems some 15 years later (Ialongo et al., 1999; Spivack &
Marcus, 1987).
One of the most promising approaches to ensure healthy adjustment—not just in
school but throughout life—is cognitive problem solving (Cowen, 1980) or other
programs that teach social skills (Durlak et al., 2010). Cognitive problem solving involves
generating alternative strategies to reach one’s goal as well as consideration of the
consequences of each alternative. Cognitive problem solving also generally includes
developing specific ideas for carrying out one’s chosen solution (Elias et al., 1986).
Cognitive problem solving can be used for interpersonal problems, such as racial and
teacher–student conflicts, school-related problems, and many other areas of concern. When
used for interpersonal problems, it is called interpersonal cognitive problem solving
(Rixon & Erwin, 1999; Shure, 1997, 1999; Shure & Spivack, 1988). Research has
uncovered the fact that a significant difference between well-adjusted and less well-adjusted
children is that the latter group fails to generate and evaluate a variety of solutions for
coping with a personal problem. Training in cognitive problem solving has been used
successfully as an intervention to assist children with coping with stressors and reducing
student conflict (Edwards, Hunt, Meyers, Grogg, & Jarrett, 2005). Both teachers and
parents can be trained to teach children cognitive problem solving.
Well over 50 child and adolescent interventions have been conducted based on the
premise that cognitive problem-solving skills mediate adjustment (Denham & Almeida,
1987; Shure, 1999) and improve interpersonal skills (i.e., reduce conflict) (Edwards et al.,
2005; Erwin, Purves, & Johannes, 2005). Although many of the studies support this
strategy as competency enhancing, cognitive problem solving is not without its critics.
Durlak and his colleagues (2010), for example, advocate task-specific rather than generic
problem-solving training.
DROPPING OUT OF SCHOOL. In the opening vignette, Roberto wisely chose to stay
in school despite his early feelings of frustration and alienation. Some students, however, do
not choose to stay in school; they drop out. More than 500,000 public school students
drop out of grades 9 through 12 each year (National Center on Education Statistics, 2007).
This translates into one in eight students never graduating from high school, and one
student dropping out of high school every nine seconds (Christenson & Thurlow, 2004).
Demographic differences exist, just as we might expect. Dropout rates for males are
higher than for females, except for Hispanic students (Kaplan, Turner, & Badger, 2007), in
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particular Mexicans (Olatunji, 2005). The dropout rate varies by race and ethnicity, as
Table 8.1 illustrates. Notice that dropout rates have diminished only slightly over time, and
Hispanics still have the highest dropout rates of the groups covered in the table. Inner-city
youth, especially those living in poverty (Pong & Ju, 2000; Roscigno, Tomaskovic-Devey,
& Crowley, 2006), students who are chronically absent (Sheldon & Epstein, 2004),
students who repeat a grade (Entwisle, Alexander, & Olson, 2005; Stearns, Moller, Blau, &
Potochnick, 2007), those who attend large urban schools (Christenson & Thurlow, 2004),
and adolescents who switch schools multiple times (South, Haynie, & Bose, 2007) are at
particular risk for dropping out. Family factors, such as English as a second language and
the absence of learning materials in the home, have been implicated as well. Students who
have friends who drop out are also likely to drop out. Some young people drop out because
they would rather work or need to earn money (Entwisle, Alexander, & Olson, 2004;
Olatunji, 2005). Recall our discussion of push and pull factors earlier in this chapter. The
need to earn money for the family would be a pull factor. In addition to push and pull
factors, however, there are individual predictors of school dropout. For example,
personality variables such as low self-esteem, loss of sense of control (Reyes & Jason, 1991),
and shyness (Ialongo et al., 1999) predict dropping out. Dropout rates are worrisome not
only in the United States but around the world, making it a vexing and perplexing issue
almost everywhere (Smyth & McInerney, 2007).
TABLE 8.1 Percent of High School Dropouts among Persons 16 Years and Older by
Race/Ethnicity and Historic Time Frame
Year Percent of
Total Number
of Students
White Black Hispanic
1985 12.6% 10.4% 15.2% 27.6%
1995 12.0% 8.6% 12.1% 30.0%
2005 9.4% 6.0% 10.4% 22.4%
Source: National Center for Education Statistics (accessed February 18, 2008).
Perhaps the most daunting task that dropout researchers have grappled with over the
years is the question of how to accurately predict which students are most likely to leave
school early (Shin & Kendall, 2012). Realizing the fact that there is no one singular risk
factor for dropping out of school, researchers have focused on identifying predictive clusters
or composites of factors (e.g., Balfanz, Herzog, & Mac Iver, 2007; Gleason & Dynarski,
2002). The findings from the majority of studies demonstrate that the use of groupings of
risk factors can increase the probability of accurately identifying students who will drop out
of school. However, the relatively low predictive ability reported in most studies (typically
around 40%) and the lack of a clear-cut group of factors that can be viewed as the “best
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cluster” do not warrant the design and implementation of prevention programs focused on
specific factor groupings (Hammond, Linton, Smink, & Drew, 2007). In other words,
researchers cannot accurately predict which specific students are in most need of
interventions to predict dropout—although it stands to reason that the more “risk factors”
a student is exposed to, the greater the likelihood that he or she will be one of the millions
who end up without a high school diploma. Not only does failure to earn a high school
diploma hurt the individual in terms of earning potential, but it also has enormous costs for
society in general.
The costs of dropping out of school are immense. High school dropouts experience
more unemployment during their work careers, have lower earnings when employed, are
more likely to be on public assistance, and are more likely to use illegal substances or
commit crimes than those who complete high school or college (Christenson & Thurlow,
2004; Christie, Jolivette, & Nelson, 2007). Young women who drop out of school are
more likely to become pregnant at young ages and more likely to become single parents
living in poverty (Cantelon & LeBoeuf, 1997). Thus, finding preventions and interventions
for those at risk of dropping out are extremely important.
What can be done about the dropout problem in the United States? Early efforts were
focused on the individual student and included counseling (Baker, 1991; Downing &
Harrison, 1990; Rose-Gold, 1992) or improvement of self-image or self-esteem (Muha &
Cole, 1990). Because there are multiple causes of dropping out (Christie et al., 2007;
Christenson & Thurlow, 2002; Ialongo et al., 1999; Lee & Breen, 2007; McNeal, 1997;
Svec, 1987), a more ecological approach is desirable (Oxley, 2000). An ecological approach
would take into account situational or contextual factors—for example, characteristics of
the schools, including the same push and pull factors mentioned along with school
alienation (Christie et al., 2007; Patrikakou & Weissberg, 2000). Community and
neighborhood variables (Leventhal & Brooks-Gunn, 2004), such as social isolation
(Vartonian & Gleason, 1999), poverty (Christie et al., 2007), and adult involvement with
the student (e.g., community mentors) (Sheldon & Epstein, 2004), would also be
considered ecological factors that affect students’ decisions to stay or leave school.
One of the more successful, better-known prevention programs for students at risk for
dropping out is one designed by Felner (Felner, 2000a; Felner, Ginter, & Primavera,
1982). Today the program is known as STEP, or the School Transitional Environment
Program. STEP was designed to address multiple issues, and it is discussed here as a model
program to address school dropouts. Felner and associates understood that transitions in
school are themselves risk factors for children—for example, the transition from junior high
to high school, especially when the high school population is made up of students from
multiple feeder schools or who have other risk factors, such as low socioeconomic class,
minority group membership, simultaneous life transitions, or low levels of family support
(American Youth Policy Forum, 2008).
There are two major components to STEP. The first is reducing the degree of flux and
complexity in the new high school (e.g., participants or cohorts are in classes together in
only one wing or section of the school), so that in essence a smaller school is created within
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a larger one (Felner, Seitsinger, Brand, Burns, & Bolton, 2007). The second component
involves restructuring the roles of the homeroom teachers (e.g., more informal and
individualized meetings with the students). Notably, the homerooms are also made up
solely of program participants (American Youth Policy Forum, 2008). The teachers, who
undergo two-day training, use meetings to discuss students’ personal problems, help select
classes and schedules, and clarify understanding of school rules and expectations. Teachers
also maintain contact with the students’ families as well as with other STEP teachers within
the school.
The beauty of STEP is that it takes precious little time away from instruction, costs
very little, does not change instructional methods or content, and lasts only one year, the
transitional year. With these simple ecological changes and short intervention, program
participants compared to nonparticipants show better attendance, higher grade-point
averages, more stable self-concepts, and lower transition stress (Felner, 2008; National
Center on Secondary Education and Transition, 2008). Important to this discussion is the
lower dropout rate for STEP participants. Positive effects for the teachers includes higher
job satisfaction and higher comfort levels in the school (American Youth Policy Forum,
2008).
SCHOOL VIOLENCE. School violence and aggression is a difficult and complex issue
and an important one because of its escalation in the past decade. The National School
Safety and Security Services (2008) reports that for the 2006–2007 school year there were
32 school-associated deaths in the United States, with another 171 additional nondeath but
high-profile incidents, including shootings, stabbings, and riots. The fact that there have
been several high-profile acts of violence on college campuses in the past decade also
illustrates the severity of this problem.
The costs to victims of school violence are enormous, not the least of which are
emotional, social, behavioral, and academic problems. The costs to society are large, too. In
tracking 227 truly troubled youths who were removed from school and placed in special
behavioral units, researchers found that the cost of these units to society was over $10
million. This figure did not include ancillary costs, such as police work, court appearances,
property damage, detention and housing costs, professionals’ time spent with the youths
(e.g., psychologists and social workers), and treatment programs (Eisenbraun, 2007).
The U.S. Department of Education (1998), out of concern for this epidemic of
violence, issued A Guide to Safe Schools. Other authors have echoed similar concerns (e.g.,
Garbarino, 2001). The guide offers warning signs for parents and teachers of potentially
violent students: social withdrawal, excessive feelings of isolation and rejection, low school
interest and poor performance, a history of discipline problems including aggressive
behavior, intolerance for differences and prejudicial attitudes, and access to drugs, alcohol,
and/or firearms.
Many of these warning signs appear to blame the individual student and do not
address issues of student–school fit or of school climate (Reid, Peterson, Hughey, &
Garcia-Reid, 2006), which may inadvertently present challenges to violence-prone children
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(Baker, 1998). In addition, these warning signs do not directly address prevention—a key
concept for community psychologists. Just what can be done in the schools to reduce or
prevent violence and aggression among students? Are the schools waiting for violence to
occur, or are the schools working with younger children (students not yet in middle or high
schools) to prevent violence altogether?
First, research on crime in schools shows that many situational crime-prevention
techniques in schools (e.g., installing video cameras or metal detectors) are not working
(O’Neill & McGloin, 2007). Second, national data seem to demonstrate that we are
waiting too long to introduce nonviolent methods into the schools. Adolescence may be too
late, because it is clear that the incidence of aggressive behavior problems in young children
is also escalating (Webster-Stratton & Reid, 2007). Until recently, at best, many high
schools offered counseling after a particularly violent incident or harsh discipline or
increased security as a response to school violence (Klein, 2005). However, such methods
do nothing to prevent violence from occurring in the first place.
Clearly, we need to dip earlier into children’s academic careers to abate this epidemic
of violence (Espelage & Low, 2012). We also need to continue to find ways to improve
school climates (Khoury-Kassabri, Benbenishty, Astor, & Zeira, 2004). In particular,
violence prevention programs need to take into account family and community
characteristics, not just youth or school characteristics (Laracuenta & Denmark, 2005)
during program design, because school violence appears to be a multilevel and ecologically
nested issue (Eisenbraun, 2007; Farver, Xu, Eppe, Fernandez, & Schwartz, 2005). Poverty,
discrimination, lack of opportunities for education and employment, and paltry social
capital (as defined elsewhere in the book) are also community risk factors for interpersonal
violence (Farver et al., 2005).
Research is demonstrating that school-based programs that are comprehensive (that is,
address a variety of problem behaviors with a variety of curricula), holistic (address the
whole child), and well integrated with parents and the community are the most successful
(Flay & Alfred, 2003). Programs that are also research based, where program participants or
schools are compared to nonparticipants over time, are most effective (Scheckner, Rollin,
Kaiser-Ulrey, & Wagner, 2004). We examine one sample program here—the Positive
Action (PA) program (Flay & Alfred, 2003)—but there are others.
The PA program was developed by Carol Alfred, a schoolteacher, and researched by
Brian Flay. The program is comprehensive in that it includes the entire school, staff,
teachers, administrators, families, and students. Another component is that students
making positive and healthy choices will develop a higher sense of self-worth, which in turn
will result in better outcomes for the student and the school (Flay & Alfred, 2003). Starting
in the early school years, students are exposed to more than 100 15- to 20-minute lessons
designed to focus on multiple behaviors. For example, there is a unit on getting along with
others (topics covered include respect, fairness, and empathy among others), a unit on
being honest (e.g., not blaming others, finding one’s weaknesses as well as strengths), and a
unit on the need to seek continual improvement (e.g., better problem solving, the courage
to try new things). Working with school personnel, PA attempts to change the school
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climate to one that focuses on positive actions rather than negative ones (such as violence
and alienation). The program also extends itself in that families receive some training in PA
and are encouraged to become involved with the school and the program. A program kit is
available to the community so that the students, their families, the schools, and the
community align seamlessly in their efforts toward promoting student well-being.
One of the positive results of the program, based on well-designed research, is that PA
schools, as compared to control schools, experience a dramatic drop in school violence,
specifically, 68% fewer violent incidents per 100 students. There are also other behavioral
changes—for example, far fewer school suspensions, fewer students absent for multiple
days, fewer other problem behaviors (such as substance use), and lower dropout rates.
Academically, program participants are far more likely to graduate and continue their
education, probably in part because academic scores rise (Flay & Alfred, 2003; Office of
Juvenile Justice and Delinquency Programs, 2008a). What is interesting about this program
is that many positive effects of PA endured from primary school through to middle school
and high school (Flay & Alfred, 2003).
Two other programs designed to reduce school violence that you might want to
research further include Safe Harbor (Nadel, Spellmann, Alvarez-Canino, Lausell-Bryant,
& Landsberg, 1996; Office of Juvenile Justice and Delinquency Programs, 2008a) and
PeaceBuilders (Embry, Flannery, Vazsonyi, Powell, & Atha, 1996; Office of Juvenile
Justice and Delinquency Programs 2008a).
Other ideas for reducing school violence and victimization are appearing in the
literature. For example, the violence surrounding children in their own neighborhoods
(Raviv et al., 2001) and in the media (Jason, Kennedy, & Brackshaw, 1999) needs to be
reduced, perhaps by public policy or otherwise. Likewise, when teachers make salient to
their students that there are norms against aggression, aggressive behavior diminishes
(Henry et al., 2000; Khoury-Kasssabri et al., 2004). Programs need to be designed for after
school as well (Bilchik, 1999; Danish & Gullotta, 2000; Taulé-Lunblad, Galbavy, &
Dowrick, 2000), because this is a time when violence escalates. Attempts to control
Internet bullying, which is on the rise (Williams & Guerra, 2007), might also prove useful.
There are, of course, many other school problems that we could discuss, such as peer
pressure to engage in sex or try illicit drugs. Because of limited space, we include only one
other, one that affects a large number of children. Case in Point 8.2 discusses the high
divorce rate in the United States and its effects on children even as they cross the threshold
of the school’s door.
CASE IN POINT 8.2
Children of Divorce
One million children each year experience the stress of parental divorce (Pedro-Carroll, 2005a), which suggests that
cumulatively, by age 18, 40% of American children will have experienced parental divorce (Greene, Anderson, Doyle,
& Riedelbach, 2006). Divorce and subsequent life in a single-parent family have become reality for a large number of
children. In fact, children of divorce spend on average 5 years in a single-parent home (Hetherington & Kelly, 2002);
most typically they reside with their mothers (Federal Interagency Forum on Children and Family Statistics, 2008).
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•
Children’s reactions to divorce include (but, of course, are not limited to) anxiety, behavior problems at home and at
school, and somatic symptoms (Pedro-Carrolla, 2005a).
Studies of divorce have indicated that in the child’s natural environment are several factors that can moderate the
effects of stress from divorce, such as the availability of support from other family members (Hetherington, 2003) and
peer support (Lussier, Deater-Deckland, Dunn, & Davies, 2002). In fact, there is a consistent and fairly strong
correlation between the child’s adjustment to divorce and the availability of social support.
Some interventionists prefer not to take a passive role—waiting to see whether there are tools available in the
child’s natural environment that can help him or her cope. The schools can build and participate in interventions for
children of divorce. Cowen (1996) and his colleagues at the Primary Mental Health Project, a comprehensive school-
based program that promotes overall mental health in children, did just that. One aspect of the multifaceted project is
the Children of Divorce Intervention Program (CODIP). CODIP is based on the premise that timely preventive
intervention for children of divorce can offer important short- and long-term benefits. CODIP’s goals, simply stated,
are to provide social support and to teach coping skills to children of divorce (Pedro-Carroll, 2005a).
The program was initially designed for fourth- to sixth-graders. Newer versions have been tailored to younger and
older children, each with its own unique techniques matched to the developmental needs of the particular age group
(Pedro-Carroll, 2005a). Older children, for example, are plagued by loyalty conflicts and anger, whereas younger
children experience intense sadness, confusion, and guilt (over having caused the marital breakup). CODIP is
conducted in age-matched groups because children who have gone through common stressful experiences are more
credible to peers than those who have not had these experiences or, alternatively, authoritative-sounding adults.
Developmental factors shape the group size as well as the methods used (e.g., puppets, roleplays, books, discussion,
games). For example, younger children have shorter attention spans and are more prone to want concrete activities than
are older children.
In a typical group, both a man and woman (selected from school personnel) act as leaders. They are selected
because they are interested, skilled, and sensitive to the needs of the children of divorce and are trained in the CODIP
program techniques. Modules for a typical fourth- to sixth-grade group might include the following:
Fostering a supportive group environment (e.g., the importance of confidentiality)
Understanding changes in the family (e.g., a group discussion that stimulates children to express their feelings
about changes)
Coping with change (e.g., discussing adaptive ways to cope with divorce rather than losing one’s temper)
Introducing a six-step procedure for solving interpersonal problems (similar to interpersonal cognitive problem-
solving, discussed earlier)
Understanding and dealing with anger (e.g., how to use/statements) • Focusing on families (e.g., understanding
that there are diverse family forms)
Program evaluations of CODIP demonstrate that the program results in gains for
children’s school-related competencies and their ability to ask for help when needed.
Likewise, the program appears to decrease school-related problem behaviors in children of
divorce. Parents also report improvements in their children’s home adjustment; for
example, they report that the children are less moody and anxious (Cowen et al., 1996;
Pedro-Carroll, 1997, 2005a). Follow-up research on early program participants also
demonstrates that program effects endure. Program children report less anxiety, more
positive feelings, and more confidence about themselves and their families compared with
children of divorce who do not participate. Amazingly, teachers “blind” to whether the
children have participated in the program or not report fewer school problems and more
competencies in program participants than in a comparison group of children of divorce.
CODIP and other programs like it (e.g., Children’s Support Group) provide evidence that
early and systematic intervention—empirically documented—with children of divorce has
promising preventive potential (Pedro-Carroll, 2005a). The next steps for these programs
may well be concurrent parent programs and/or collaborative partnerships between courts,
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researchers, and community organizations (Pedro-Carroll, 2005a, 2005b).
Summary
The world of schools, children, families, and communities is fascinating and complex.
Some children enter school at risk for a variety of problems, but innovative programs are
available to intercede with the children, their families, and their communities. Traditional
interventions have focused mostly on deficits of the child or the family, but the more
effective programs usually take into account the setting, such as the school climate or the
neighborhood, as well as the actors in it.
Psychologists recognize how important the early childhood environment is. Children
who are advantaged economically or otherwise in early childhood often have fewer
problems in later life than disadvantaged children. Intervention programs for young
children at risk include quality day care and enrichment education programs. Research has
demonstrated that children of working mothers may not be disadvantaged; nonetheless, if
they are to stay employed, these mothers need day care for their children. On the other
hand, inner-city and some minority children are at risk for a variety of problems day care
alone cannot adequately address. Programs designed to give them the early push they need
to later succeed in school are often successful. Project Head Start is one such example.
Head Start programs are all-encompassing programs; for example, they include parental
involvement, healthcare, academic pursuits, and so on. Studies demonstrate that children
who have attended Head Start have an easier transition into elementary school,
academically achieve at higher levels, and have had their health problems attended to, as
compared with children who do not enroll in such programs. Longitudinal studies are now
demonstrating some of Head Start’s positive long-term effects.
Desegregation has had an interesting effect on U.S. schools. Desegregation touches
children of all ages and races. When the courts ordered the schools to desegregate, the
Supreme Court justices did not envision the effects of desegregation on children, nor did
they formulate methods for fostering acceptance of diversity in schools. Those jobs fell to
psychologists and school staff, who have demonstrated that desegregation often has positive
effects for minority as well as White children. Various active methods for decreasing
prejudice include intergroup contact—for example, the jigsaw classroom. The more passive
programs, such as mere exposure to diverse others, are more likely to fail.
Young children are not the only ones facing problems in this country. Adolescents
often use drugs, drop out of school, or become pregnant. Most of the programs that are
successful in preventing school dropout do not try to change only the at-risk individual but
also make adjustments in the school environment or the community to better
accommodate the individual student.
School violence is another concern because it is escalating in the United States. Again,
appropriate programs and student involvement can enhance school safety and decrease
violence. Children of divorce are often considered at risk for a variety of school-related as
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well as other problems. Once again, intervention programs for children of divorce have
proven successful when they provide for appropriate changes and needed social support.
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Law, Crime,
and the Community
THE TRADITIONAL JUSTICE SYSTEM
Introduction
Crime and Criminals
■ CASE IN POINT 9.1 Neighborhood Youth Services
Jails and Prisons
Victims and Fear of Being Victimized
Enforcement Agencies
ADDRESSING JUSTICE SYSTEM ISSUES
Primary Prevention
■ CASE IN POINT 9.2 Working with At-Risk Youth
Secondary Prevention
■ CASE IN POINT 9.3 Huikahi: The Restorative Circle
SUMMARY
I am not a therapist … but I know one thing. Anger is very expensive.
—Kyabje Gelek Rinpoche
Mike was only four months old when he was adopted by a middle-class, older couple, Edna and Walt Farnsworth, who
had always wanted children but were unable to bear their own. Mike’s childhood was uneventful, although his father,
Walt, felt that his wife “doted on the boy a bit too much.”
During his childhood, Mike was an average student in school. By junior high school, he seemed more interested in
sports and cars than in his studies. When Mike reached puberty, he grew quickly, and by the time he was 16, he soared
to 6 feet 2 inches, 210 pounds. His imposing size and apparent boredom with school inspired consternation in his
teachers, who weren’t quite sure how to manage him.
It was at this point that trouble came to the Farnsworth home. Mike realized that his father, who was a slender
man of small frame, was intimidated by him. Mike would yell at his mother and disrespect his father. Mike called his
father “old man” as often as he could to embarrass Walt. He reasoned that his parents were older than his friends’
parents, so why not call them old?
When Mike could finally drive a car, he wanted nothing but to take his parents’ car after school and drive around
his small town, showing off to his friends or assessing what “action was going down” on Main Street. The town had few
organized activities for its youth. He and his father argued often about the car, Mike’s coming home late, and his school
grades. His mother, Edna, felt torn between the son and the husband she loved.
One night, Mike had been drinking beer despite knowing that he was under the legal age. His father was
particularly angry when he smelled his son’s breath. When Walt yelled, “You could have killed somebody with my car!”
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Mike struck out at his father. Walt went crashing through the drywall of their small home. Mike fled into the night,
leaving Edna intensely worried as to what he would do next and deeply sad that her husband had been injured in the
fracas.
This scenario was repeated again and again between Mike and Walt, who raged at both his wife and his son that he
“didn’t want this kid around anymore.” Edna tried to referee these fights, but to no avail. As the conflicts escalated,
Mike asserted his size and independence more.
Taking matters into his own hands, and without consulting Edna, Walt went to the local police department to
have his son arrested for “anything you can arrest him for—just get him out of my house.” The police were used to such
domestic squabbles and didn’t feel an arrest was in order. Instead, they referred Walt to the probation department so
that he could have Mike declared a PINS (Person in Need of Supervision). The Probation Department was not
surprised to see Walt; they had interviewed many parents just like him, all making the same request.
Was Mike really headed for a life of crime? Was the family at fault for the turmoil in their home? Were any
community systems to blame? For example, was the school environment so alienating that Mike’s disenchantment with
school was displaced onto his family? How better could the justice system manage this family conflict?
This chapter examines crime and community in the United States. We not only examine
the traditional system and how it manages those individuals who interact with it, we also
address some alternative and innovative programs designed to humanize this same system
that are more in line with community psychology. Of course, as community psychologists,
we also examine how the environment or context contributes to crime, fear of
victimization, and other justice-system issues.
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THE TRADITIONAL JUSTICE SYSTEM
Introduction
Pick up any newspaper from a major city in the United States, and you see splashed across
its pages reports of crime—crime in the streets, conflict in homes, corruption in business
and government, Internet fraud, identity theft—crime just about everywhere.
Yet crime rates appeared to be decreasing as of 2009. The 2010 numbers show a
similar drop (Federal Bureau of Investigation, 2010). The total crimes reported in 2010
were a little over 10 million. There were a little over 1 million violent crimes, and 9 million
were crimes of property (such as larceny, theft, or burglary). Police made 550,000 arrests
for violent crimes and 1.6 million for property crimes. Those arrested were predominantly
male (74.5%) and White (69.4%). Total losses from crime were approximately $15.7
million.
These statistics are based on the compilations of reported crimes of local law
enforcement agencies, such as city police and county sheriff departments throughout the
nation. The data, however, include only crimes known to the police. There may be little
correspondence between the crimes that are committed in a community and the crimes that
are reported. The caution is that the numbers are only as good as their reporting and
measurement.
The rate of imprisonment places the United States at the top of the world (Liptak,
2008). The United States accounts for a little under 5% of the world population, yet has
25% of its prisoners. According to Liptak’s New York Times report, there are more ways
one can commit an offense (more laws to be broken), and penalties are usually for longer
periods of incarceration. The U.S. had 2.3 million in prison in 2008. The rate of
imprisonment is 751 per 100,000. The second highest rate is Russia, with a little over 600
per 100,000. In comparison, Germany jails 88 per 100,000; England, 151; and Japan, 63.
Community psychologists share in citizens’ concern about crime and violence from
the victims’ viewpoint and from the perspective of prevention (Thompson & Norris,
1992). In a special edition of the American Journal of Community Psychology many years
ago, Roesch (1988) called for increased involvement by community psychologists in
criminal justice issues by going beyond the individual level of analysis to the examination of
situational and environmental factors that contribute to criminal behavior. He called for
community psychologists to help predict problematic behavior and adopt preventive
measures for at-risk individuals. Yet today, there is still little involvement by community
psychologists in the justice system, or research on it in our journals. In fact, Biglan and
Taylor (2000) argued that we have made more progress on reducing tobacco use than we
have on reducing violent crime. We lack both a clear, cogent, empirically based analysis and
a set of organizations that effectively advocate policies and programs with regard to crime.
Melton (2000) added to this emphasis by suggesting that law should be a major focus of
study for those who wish to understand community life.
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The justice and enforcement systems in our country are multilayered and complex.
They involve the various courts (municipal, state and federal, civil and criminal, and higher
and lower) as well as the judges, juries, lawyers, plaintiffs, and defendants; the prisons, jails,
and corrections officers; the police, sheriffs, and other enforcement agencies; the
departments of parole and probation; and the multitude of ancillary services, such as legal
aid societies and neighborhood justice centers. We turn our attention to some aspects of
this system.
Crime and Criminals
Did Mike commit a crime because he hit his father? Some would argue he did. Others
would suggest that he was simply a confused or frustrated adolescent—a person in need of
some counseling, but certainly not a criminal.
Just what is a crime, and who exactly are criminals? It is beyond the scope of this book
to argue about definitions of the term crime. Just as laws are never perfect, definitions are
never perfect. Laws that determine and therefore define crime change from society to
society and from one historical era to the next (Hess, Markson, & Stein, 1991), making the
definition of the term difficult. Nonetheless, a rudimentary definition of crime might assist
you in understanding its complexity. A crime is an intentional act that violates the
prescriptions or proscriptions of the criminal law under conditions in which no legal excuse
applies and where there is a state with power to codify such laws and to enforce penalties in
response to their breach.
The uninformed public might well blame Mike for being “a bad kid” or his parents
for being “bad parents.” Psychologists, sociologists, and criminologists might view the
situation in a completely different way. Rather than examining what’s “wrong” with Mike
or his family, they would turn to ecological or contextual explanations for crime and
violence, including Mike’s.
One of the first factors to capture the attention of psychologists was the availability of
guns in the United States. Gun violence represents a major threat to the health and safety
of all Americans. Every day in the United States, more than 90 people die from gunshot
wounds, and another 240 sustain gunshot injuries. Incredibly, a teenager in the United
States is more likely to die of a gunshot wound than from the total of all natural causes of
death. Young African American males have the highest homicide victimization rate of any
racial group.
Often, in a particular country, other methods of committing homicide (e.g., with a
knife) are more common, yet no one would say that high rates of knife ownership caused
the killing (Kleck, 1991). We would need to know more about a nation’s cultural and
ethnic background, history of racial conflict, rigidity and obedience to authority, subjective
sense of unjust deprivation, and so on before we could make claims that gun control within
a nation causes fewer handgun deaths (Kleck, 1991; Spitzer, 1999). Guns alone do not
cause crime. What else is responsible for the high crime and incarceration rates in the
United States?
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A well-researched topic is child exposure to violence. This exposure may be in the
form of parent physical abuse or media violence. Being physically abused certainly
heightens the risk that a child will become aggressive (Connor, Doerfler, Volungis,
Steingard, & Melloni, 2003; Dodge, Pettit, & Bates, 1997; Muller & Diamond, 1999).
Research over the years has demonstrated that media violence also correlates with violent
behavior (Graber, Nichols, Lynne, Brooks-Gunn, & Botvin, 2006). Patchin, Huebner,
McCluskey, Varano, and Bynum (2006) reconfirmed this connection among a group that
are sociologically at high risk for crime and violence—urban minority youth.
Representatives of the American Psychological Association (APA) have also testified before
Congress on the impact of media violence on children (McIntyre, 2007). Specifically, the
APA warns that repeated exposure to media violence places children at risk for:
Increased aggression
Desensitization to acts of violence
Unrealistic fears of becoming a victim of violence
However, media violence alone does not account for all crime and violence. What else do
we know about circumstances related to crime?
Witnessing community violence often leads to delinquency, crime, and more violence
(Lambert, Ialongo, Boyd, & Cooley, 2005; Youngstrom, Weist, & Albus, 2003), but this
factor is more complicated than it first appears (Bolland, Lian, & Formichella, 2005). In
the psychological literature, it is now quite well known that decaying, disordered,
unstable, and disorganized communities can contribute to delinquency and crime
(Patchin et al., 2006). This alone may explain to a significant degree why urban minority
youths are more prone to crime and violence than other youths. Beyond these community
factors, though, are the pockets of extreme poverty found in some communities. Poverty
and economic disadvantage are highly related to neighborhood decay and are highly
predictive of crime and violence as identified in research by Strom and MacDonald (2007),
Krueger, Bond Huie, Rogers, and Hummer (2004), Hannon (2005), and Eitle, D’Alessio,
and Stolzenberg (2006). It is not surprising, then, that unemployment also corresponds
with increased levels of crime and violence, even in relatively crime-free places such as
Korea (Yoon & Joo, 2005). The migration of job opportunities to other countries has
probably resulted in the increase of low-income Americans and youth participating in the
underground economy and the drug trade (Cross, 2006).
What else in communities besides disintegration and economic disadvantage
contribute to crime and violence? For one thing, in disorganized and decaying
neighborhoods, there may be a paucity of supportive community institutions (e.g.,
religious, social service, and neighborhood organizations) and deprivation of other resources
(e.g., recreational programs to provide youths with after-school activities) to help buffer the
deleterious effects of economic disadvantage (Hannon, 2005). Thus, an already at-risk
individual (e.g., someone maltreated as a child) may be more crime-prone in this type of
neighborhood (Schuck & Widom, 2005). Likewise, a poor overall quality of life may lead
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•
•
to more substance abuse and mental health problems (and perhaps criminal activity)
(Gabbidon & Peterson, 2006). These environments also contribute to a sense of
hopelessness and the fear or perception that one is not in control of one’s life (Bolland et
al., 2005). Any expectation of reducing such hopelessness would probably require a
restructuring of American society—a seemingly difficult task. Research on impoverished
African American communities by Bolland and colleagues (2005) found that half of their
research participants expressed strong feelings of hopelessness. This in turn increased their
tendency to engage in risky behaviors. After all, why care?
Parental monitoring has been studied as another possible factor in dealing with high-
risk neighborhoods. Studies suggest that when parents know where their adolescents are
and with whom they are spending time, risks for actual violence and crime as well as
exposure to community violence are reduced. This is not to say that “bad” parenting causes
crime and violence, although there is a strong link between child maltreatment and later
crime activity (Schuck & Widom, 2005). Rather, good parenting (i.e., monitoring of
youth) offsets risk trajectories and promotes forms of competence among adolescents
(Graber et al., 2006). Essentially, poor parental monitoring increases a youth’s opportunity
to associate with delinquent peers, to be victimized, or to witness others committing
violence (Lambert et al., 2005). Campaigns such as “Do you know where your child is
tonight?” and parenting classes where monitoring issues are discussed might go a long way
toward preventing youth crime and violence.
Case in Point 9.1 offers an example of what one community did about its high
incidence of crime.
CASE IN POINT 9.1
Neighborhood Youth Services
Neighborhood Youth Services (NYS) is an award-winning, community-based program for so-called at-risk youth in
Duluth, Minnesota. At the outset, a cadre of youth care workers at NYS decided not to use the label “at risk,” primarily
because they see all of the youngsters as having great potential. The program was established in a neighborhood with the
distinction of having one of the highest crime rates in all of northern Minnesota, so it is primarily designed to intervene
with and prevent children from becoming involved in the juvenile justice system. The neighborhood is also
exceptionally diverse, so program staff is representative of this diversity.
Staff members work daily to:
Break down stereotypes that each racial or ethnic group holds of each other
Identify children’s strengths • Teach children new ways to engage in society
Discover the children’s hidden potential
Encourage the children to express themselves freely and in safe ways
Explore new ways of relating to others
In the NYS youth center, which was planned to feel homelike, the children involve themselves in art, reading,
poetry, and other projects designed to allow free expression. This after-school program also offers tutoring services,
computers, and athletic activities. The children and staff exhibit respect for each other. As with some other programs
(e.g., Head Start), parents are encouraged to become involved.
NYS is housed in a building with other community services, so referrals to additional resources are easily provided
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and readily available to families. The program is funded by individual donations, state prevention funds, and grants, so
it is free and voluntary for all community children and families. The program lives by the adage that money spent up
front (in early intervention) pays important dividends to communities willing to invest. NYS is just one example of the
burgeoning programs spawned by mounting attention to prevention and intervention—one of the cardinal principles of
community psychology.
Source: Adapted from Quigley (2005).
Three other community-level factors are undoubtedly contributing to crime
(Caldwell, Kohn-Wood, Schmeelk-Cone, Chavous, & Zimmerman, 2004)—racial/ ethnic
prejudice, discrimination, and segregation. Most of these terms were defined earlier. In
review, prejudice is an attitude toward members of some group; discrimination involves
prejudiced actions against a particular group; segregation means isolation of a group from
others in the community. Racial discrimination leads to fewer opportunities (i.e., jobs) and
less social support from others and thus may lead to crime or violence (Caldwell et al.,
2004). Being African American is not a cause for violence; being subjected to high levels of
discrimination and prejudice may be. And of course, along with discrimination and
prejudice go high rates of poverty. With the increase in America’s Hispanic-Latino
population, data are now showing that social isolation (à la discrimination and segregation)
may also be contributing to that population’s homicide rates (Burton, 2004).
Although this review is not exhaustive, by now you should understand that there exist
multiple factors that contribute to violence and crime. Many risk factors are contextual
rather than individual, so it does little good to blame Mike or any other person for criminal
behavior. Sadly, individuals who experience more than one of these risk factors are
exponentially more likely to become involved in crime or violence. Again, however, there is
evidence that certain individuals casting about in these environments do escape the cycle of
crime and violence that such settings can engender (Farmer, Price, O’Neal, & Man-Chi,
2004). We will explore these factors shortly.
Jails and Prisons
Once an individual commits a crime or act of violence, it may be too late for prevention. It
might appear that prevention efforts are few and far between, given the number of
Americans locked up in jails and prisons. Let’s look first at the traditional U.S. criminal
system and its statistics. Traditional in this context usually entails a crime, followed by
arrest, prosecution, conviction, and imprisonment or incarceration of the guilty individual.
When Walt Farnsworth approached his local police department in the opening vignette, he
had this process in mind. He wanted his son arrested, taken out of the home, and removed
from him and the rest of society.
The philosophy behind incarceration is generally retribution, not rehabilitation.
Retribution in the legal system is supposed to mean repayment for the crime, but it
translates in reality to punishment for the crime. If anyone is repaid, it is usually not the
victim. Indeed, the victim is the only person who has no official role in the process and so is
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the “forgotten” participant (Wemmers & Cyr, 2005). Amazingly, the victim need not even
appear at the trial. The state is the entity that seeks justice and administers the punishment.
For instance, if an individual is found guilty and is fined, the fine does not go to the victim
but to the state. If the guilty party is sent to prison, the state decides the sentence and the
type of prison. In the past, the victim was rarely allowed to address the offender or have a
say in any of these issues.
Does the retribution and punishment approach work? Is the convicted person
reformed or corrected in correctional facilities? Or does he or she return to a life of crime?
In 2006, 2,258,983 individuals were incarcerated in federal or state prisons or local jails. As
stated in the beginning of the chapter, the United States has a higher percentage of its
population in jail than any other country in the world. (See Figure 9.1.) In 2006, more
than 5 million individuals were being supervised by federal or state authorities (on
probation and parole) for crimes committed. This statistic represents a 1.8% increase from
the year before (Bureau of Justice Statistics, 2008).
Recidivism is the re-arrest of released prisoners. It is a way to measure the effective of
the imprisonment. Does time in jail deter future criminal behavior? A report on recidivism
issued by the U.S. Department of Justice (Langan & Levin, June, 2002) provided
discouraging data. Examining prisoners released in 1994, in a 15-state sample, they found
that 67% were rearrested within three years. The highest reoffense rates were robbers
(70%), burglars (74%), and automobile thieves (79%). The lowest reoffense rates were held
by murderers (40%) and rapists (46%). There were 272,000 released prisoners in this
study. Within three years after release, they accumulated 744,000 criminal charges. The
length of time in jail did not increase recidivism. There were also mixed results on whether
the length of incarceration decreased recidivism. In a European study of prison time versus
noncustodial sentencing, the rates of recidivism eight years later were found to be lower for
the noncustodial sentencing. This was after other factors related to recidivism had been
controlled for (Cid, 2009). So it would appear that spending time in prison increases the
likelihood of reoffending. A meta-analysis of studies on predictors of recidivism identified
“criminogenic” factors (antisocial attitudes, criminal associates, impulsivity, criminal
history, low levels of educational and job achievement, family factors) as the best predictors
for return to jail or prison (Gendreau, Little, & Goggin, 1996). Several of these factors can
be specifically targeted for psychological intervention. However, this is not done without a
shift in focus to deducing recidivism. That would require a shift in our understanding of
the criminal justice system, from retribution to rehabilitation.
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FIGURE 9.1 Rates of imprisonment around the world
Source: New York Times, April 3, 2008. http://www.nytimes.com/2008/04/23/world/americas/23iht-
23prison.12253738.html?pagewanted=all.
As for the demographics within prison, many of the inmates were of minority status,
with Blacks being by far the most likely to be incarcerated, as illustrated in Figure 9.2. The
number of women in prison increased 4.5% and that of men increased 2.7% from the
previous year (Bureau of Justice Statistics, 2008). A USA Today article (posted July 18,
2007, at http://www.usatoday.com/news/nation/2007-07-18-prison-study_N.htm) stated
that Blacks were imprisoned at a rate that was five times that for whites. Hispanics’ rate was
twice that of whites. The disproportionality is staggering. In 12 states, more than 1 in 10
Black males can be found in jail (Human Rights Watch, February 7, 2002;
http://www.hrw.org/news/2002/02/26/us-incarceration-rates-reveal-striking-racial-
disparities). Keen and Jacobs (2009) found that perception of racial threat helped to explain
some of these prison discrepancies, with political and social factors heightening fear of
Blacks in certain localities, which then result in longer prison terms. One might be
surprised that community psychology is not more involved in investigating these
discrepancies.
A classic study in psychology highlights what occurs in prisons that makes inmate
reform unlikely. Philip Zimbardo and colleagues (Haney, Banks, & Zimbardo, 1973)
obtained volunteers to act either as prisoners or guards in a mock prison. Subjects were all
mentally healthy before the study began and were randomly assigned to their roles. The
researchers told the guards to “Do only what was necessary to keep order.” The prisoners
were all “arrested” unexpectedly at their homes and driven to the mock prison by real police
officers. The prisoners were stripped, searched, dressed in hospital-style gowns, and given
identification numbers by the guards. Within a few days of assuming their roles, the guards
became abusive of the prisoners. They harassed the prisoners, forced them into crowded
cells, awakened them in the night, forced them into frequent countdowns, and subjected
them to hard labor and solitary confinement. Conditions in the mock prison became so
brutal, the prisoners so depressed, and the guards so involved in their roles that Zimbardo
and his colleagues prematurely ended the study. The prison experience, even for these
“normal” men, proved overwhelming.
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FIGURE 9.2 Blacks Are More Likely to Be in Jail: Jail Incarceration Rates by Race and Ethnicity, 1990–2006
Note: U.S. resident population estimates for race and Hispanic origin were made using a U.S. Census Bureau Internet
release with adjustments for census undercount. Estimates for 2000–2006 are based on the 2000 Census and then
estimated for July 1 each year.
Source: Bureau of Justice Statistics Correctional Surveys (The Annual Survey of Jails and Census of Jail Inmates) as
presented in Correctional Populations in the United States, 1997, and Prison and Jail Inmates at Midyear series, 1998–
2006.
Inmates today often live in overcrowded conditions (Lösel, 2007). This overcrowding
has led to early release of prisoners because courts determine the conditions to be cruel and
unusual punishment. More and more individuals are living under community supervision,
which may be unsettling to community citizens. Additionally, human immunodeficiency
virus (HIV) is present in our prisons, and the rates of transmission of this virus and
hepatitis are growing rapidly (Myers, Catalano, Sanchez, & Ross, 2006). Inmate-to-inmate
violence and a prison culture that is not conducive to successful and productive return to
mainstream society are further problems with the prison and jail system (Lahm, 2008). On
top of these issues, substance abuse among inmates is increasing (Office of Justice
Programs, 2006), and allegations of sexual violence are on the rise in prisons (Bureau of
Justice Statistics, 2007). Incarceration is also demonstrated to have negative effects on
intergenerational relations (e.g., between children and incarcerated parents) and to create
family instability (Bonhomme, Stephens, & Braithwaite, 2006). In fact, one set of justice
system experts claimed that local jails serve only to brutalize and embitter individuals,
further preventing them from returning to a useful role in society (Allen & Simonsen,
1992). Had Walter Farnsworth known the realities of the corrections system, perhaps he
would not have jumped so quickly at the notion of having his son arrested. Not
surprisingly, Ortmann (2000), based on his own longitudinal research, contended that
prisons are extremely unfavorable places for the positive correction of people.
Courts have ruled that the prison system must be restructured (Ruiz v. Estelle), but
this restructuring has sometimes escalated inmate–inmate and inmate–guard violence.
Inmate lawsuits over the crowded conditions in prisons have led to early release for many,
which sometimes results in higher recidivism rates and subsequent return to the crowded
prisons (Kelly & Ekland-Olson, 1991). Although legal decrees to change prisons have been
issued, there is concern that the decrees do not translate readily into real change. In the
meantime, the growth in the number of inmates continues to exceed the growth in prison
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space, which leads to more overcrowding. There must be a better way than to incarcerate all
individuals who break the law.
In a cautionary sense, mounting evidence suggests that some alternative forms of
punishment outside of the traditional prison system are not good substitutes for
incarceration. Several studies have demonstrated that shock incarceration camps or boot
camps that are run by corrections personnel but resemble intensive army training camps
fall short of their goals (MacKenzie, Wilson, Armstrong, & Gover, 2001; Palmer &
Wedge, 1989). A report of work by the Office of Juvenile Justice and Delinquency
Prevention (U.S. Department of Justice, 1997) revealed that “reoffending youth in the
experimental groups (boot camps) committed new offenses more quickly—that is, had
shorter survival periods—than reoffending youth in the control group” (p. 23). In
programs described in the report, youth in some of the boot camps actually recidivated at
rates higher than the control group.
Prison may not be the best solution for dealing with crime and providing the
community with productive members for the future. Some promising alternatives include
prevention of crime through both social and environmental interventions, and providing
conditions that support positive behavioral change. We review some of those efforts later.
Let us now turn to the victims of crime and the fears of ordinary citizens about being
victimized.
Victims and Fear of Being Victimized
In 2010, U.S. citizens experienced more than 10 million crimes. The number of violent
victimizations alone is about 26 per thousand for men and 23 per thousand for women
(Bureau of Justice Statistics, 2006). Given that many crimes are never reported to
authorities, the true number is likely to be higher. DeFrances and Smith (1998) surveyed
households that had been victimized and found that 44% said the crime problem was so
objectionable that they wished they could move out of the neighborhood. One-third of
U.S. residents are afraid to walk alone where they live (Rader, May, & Goodrum, 2007).
Community psychologists, sociologists, and criminologists are interested both in fear
of crime and in its relationship to actual victimization (Chadee, Austen, & Ditton, 2007;
Kruger, Reischl, & Gee, 2007; Thompson & Norris, 1992). Those who are the most
fearful are sometimes the least likely to be victimized—a phenomenon called the fear-
victimization paradox. One reason for this paradox may be that risk perceptions are based
on interpretations of the world that are not based on statistical realities (Chadee et al.,
2007; Rader et al., 2007). We now discuss data that support the paradox.
Men (compared to women) are more likely to be victimized, yet are less afraid of
violent crime (Schafer, Huebner, & Bynum, 2006). Young urban men are especially likely
to be crime victims but are not very fearful of crime as compared to young women (Bayley
& Andersen, 2006; Perkins, 1997; Roll & Habemeier, 1991). The elderly are more afraid
of crime even though their victimization rate is much lower than they actually perceive
(Beaulieu, Dubé, Beron, & Cousineau, 2007; Schuller, 2006). Especially fearful of crime
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are elderly women. And yet they are least likely to be victimized of any group (Bayley &
Andersen, 2006; Mawby, 1986; Perkins & Taylor, 1996; Rountree, 1998). Even though
Black-on-Black crime has been frequent, young Black men are less likely to fear crime than
are Whites or Hispanics (Bayley & Andersen, 2006).
Thompson and Norris (1992) and Youngstrom and associates (2003) found that
victims of violent crimes, especially those of low economic status, suffered alienation, fear,
and avoidance. Additional studies have demonstrated that neighborhood deterioration,
which can also signal unsafe conditions (i.e., potential victimization), is related to stress and
depression (Kruger et al., 2007). Some authors claimed that fear of crime might have
helped bring about America’s obesity epidemic (Loukaitou-Sideris & Eck, 2007), because
fear of victimization could reduce the likelihood of walking around one’s neighborhood or
enjoying other forms of active and healthy outdoor activities.
Why did some individuals fear crime even if they were not likely to be victimized? For
one, people often perceived environments, especially urban ones, as dangerous (Glaberson,
1990; Wandersman & Nation, 1998). City residents with the greatest fear were usually
dissatisfied with their neighborhoods or mistrust other residents (Ferguson & Mindel,
2007; Schafer et al., 2006). When an area contained symbols of disintegration and
disorganization such as abandoned buildings, vandalism, graffiti, litter, unkempt lawns, and
other signs of “incivilities” (Brown, Perkins, & Brown, 2004; Kruger et al., 2007; Taylor &
Shumaker, 1990), its residents were more fearful because these signs suggested
neighborhood deterioration (Kruger et al., 2007) and social disorder (Ross & Jang, 2000),
both of which they identified with threats to their personal safety. In neighborhoods
perceived to be disordered, even indirect victimization, that is, hearing of crime problems,
heightened fear. However, if the neighborhood was perceived as ordered, neither direct nor
indirect victimization affected people’s fear (Roccato, Russo, & Vieno, 2011).
Other research demonstrated that adverse neighborhood conditions, such as poverty,
also increased the risk of children’s emotional and behavioral problems above and beyond
genetic predispositions (Caspi et al., 2000). The perception of crime level and risks of
victimization could undermine an individual’s confidence in the effectiveness of the
government, its elected officials, and its enforcement agencies (Williamson, Ashby, &
Webber, 2006).
Fortunately, there were factors that reduced fear of crime and actual crimes, such as
attachment to one’s neighborhood and social cohesiveness in a community (Brown et al.,
2004). Availability of social support networks (e.g., nearby family and friends) and various
types of police presence (Ferguson & Mindel, 2007) enhanced perceptions of safety.
Similarly, high levels of social capital contributed to reduced fear of crime (Williamson et
al., 2006). Social capital, as defined elsewhere in this book, includes trust, reciprocity,
cooperation, and supportive interaction within families, between neighbors, and among
those in the community. Prezza and Pacilli (2007), studying Italian adolescents, discovered
that the more they played independently in public places as children, the less their fear of
crime in those areas and the more they felt a sense of community. These in turn related to
feeling less lonely. This is an interesting finding in that it suggests we might lessen fear of a
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neighborhood by having residents become familiar with and frequent sites within that
community.
Aside from fear of crime, there are other concerns about victims. Victims often do not
know their rights; because of this, many victims’ assistance programs have flourished in
the United States. There are more than 3,000 such organizations today, but only a fraction
of crime victims receive much-needed services (Turman, 2001). Victim assistance can
include crisis intervention, counseling, emergency transportation to court, and support and
advocacy during the justice process. Because of fairly new public policy, victims in most
states now have the right of notification of all court proceedings; the right to participate in
proceedings; the right to be reasonably protected from the accused; the right to have input
at sentencing; and the right to information about the conviction, imprisonment, and
release of the offender.
Enforcement Agencies
Some see the police as peace officers, keeping communities harmonious and free of crime.
Perhaps this attitude led Walt Farnsworth to the police when the conflict with his son
escalated. Others see enforcement officers or the police as dishonest, unethical, prejudiced,
and prone to misconduct (Ackerman et al., 2001; Dowler & Zawilski, 2007; Ross, 2006;
Weitzer & Tuch, 2005). This is particularly true of America’s racial and ethnic minorities,
with Blacks and Hispanics holding far more negative attitudes toward the police than do
Whites.
Regardless of one’s views of the police, interesting research has demonstrated how
difficult the job of policing communities can be. In fact, there is mounting interest in
police burnout and stress (Anshel, 2000; Goodman, 1990). Why is the career of an
enforcement officer so difficult? One reason is that the police force and community citizens
hold different views of the role of the officers. New police recruits often maintain a serve-
and-protect orientation toward the community, but after training, their attitudes often shift
toward one of remoteness. In fact, police officers increasingly see themselves as hampered
by community attitudes and constraints (Ellis, 1991) and as holding differing views from
the community as to what police actually do (Salmi, Voeten, & Keskinen, 2005).
The police force and citizens also hold different views as to which community
incidents ought to involve the police. Police are often called by citizens for public nuisance
offenses (e.g., loud noise or drunkenness), traffic accidents, illegally parked vehicles, and
investigation of suspicious persons. Answering such mundane calls is surely not the kind of
exciting role portrayed in television dramas about the police. In fact, heavy users of the
media are more likely to believe that police use unpopular methods (such as racial profiling)
and participate in misconduct than are low-level users (Dowler & Zawilski, 2007; Weitzer
& Tuch, 2005). The police are also likely to be called to intervene in family conflicts—a
role for which they need more training—which can sometimes lead to assault on the officer
if managed ineffectively. Another frequent role of the police is to intervene in mental health
crises; that is, the police are asked to intercede in an incident involving someone with a
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mental disorder, then make a quick evaluation, and promptly decide whether to use
placement in a hospital or a jail based on whether the person is a danger to self or others.
Police officers do not relish this job and are often required to make such decisions without
much training in mental health issues (Borum, 2000; Cordner, 2000).
A primary question about policing is whether active enforcement and a police presence
in a community affect its actual crime rate and the fear of crime as well as residents’
perceptions of their community. In one study of the use of police foot patrols in violent
crime hotspots, reductions in violent crime were found in comparison to control sites. The
mere presence of police “increased certainty of disruption, apprehension and arrest”
(Ratcliffe, Taniguchi, Groff, & Wood, 2011, p. 795) and thus served to deter crime.
In another vein, community policing emerged in the early 1980s as a response to
criticism regarding the stiff and professional style of policing used at the time (Roh &
Oliver, 2005). Community policing involves forming partnerships or collaboration
between police and community citizens. A major tenet of community policing is to identify
problems based on the needs of the particular community and then deal with those
problems with the cooperation and participation of the residents and related agencies
(Zhong & Broadhurst, 2007). For example, the police might casually drop in on businesses
to see how things are going, stop and talk to citizens on the street even when no crime has
been reported, or provide talks to schoolchildren in an effort to gather knowledge about the
community in general and crime in specific.
Salmi, Voeten, and Keskinen (2000) found that seeing police on foot patrol around
the neighborhood (rather than in patrol cars) increased police visibility and improved the
relationship between the police and the public. Later, these same researchers demonstrated
that many citizens responded more positively to the police simply because of community
policing (Salmi et al., 2005). Community policing also appeared to reduce fear of crime,
but it seemed to do so in indirect ways. Specifically, community policing reduced the
perception of “incivilities,” as mentioned before (Roh & Oliver, 2005). Reducing residents’
dissatisfaction with their community and quality of life (Roh & Oliver, 2005) as well as
decreasing neighborhood disorder and disintegration (Wells, 2007) accounted for positive
views of the police.
Yet, research has demonstrated that in the highest crime neighborhoods, citizens were
least likely to become involved in crime prevention strategies such as community policing
(Pattavina, Byrne, & Garcia, 2006). It appears that where crime reduction is needed most,
the community policing program is least likely to succeed.
A case study of a department shifting from traditional methods to a community
policing model focused on capacity building (Ford, 2007) found that, organizationally, the
shift required team involvement and decision making, and an active learning environment.
The change was possible given good leadership with regard to the preparations for the
change and patience and willingness to work through the problems it brought.
Community psychologists, of course, believe that crime prevention is better than
police patrols, citizen arrest, prosecution, and possible incarceration after a crime has been
committed. In the next section, we examine programs designed by community
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psychologists and other prevention experts interested in tackling the diverse needs of the
citizens, victims, offenders, and relevant professionals involved in the criminal justice
system.
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ADDRESSING JUSTICE SYSTEM ISSUES
Was there anything in Mike Farnsworth’s background that would have helped someone
predict he would turn into an irascible and difficult adolescent? Perhaps his adoption, being
placed with older parents, his large size, school alienation, and other factors contributed to
his family difficulties. Maybe there were community-level factors, such as befriending
delinquent peers, that would have helped us predict he would eventually turn aggressive
toward his father.
Earlier in this chapter, we examined some of the predictors of criminal and violent
behavior. Knowing of them, we might be able to intercede better with prevention
programs. In review, some of the factors alluded to include access to guns, lack of parental
monitoring, family instability, child maltreatment, exposure to violence in the community
or in the media, prejudice and its horrific companions (discrimination and segregation),
and especially poverty and neighborhood disorder. What can be done about these issues so
as to prevent crime or to improve a community to make it safer?
Primary Prevention
PREVENTION WITH AT-RISK INDIVIDUALS. Given the list of risk factors just
mentioned, you can probably guess some of the suggested methods for reducing risk for
violence and crime. Removing violence from the media might go a long way toward
changing the cultural norms for violence. Similarly, the nurse home visitation program
developed by David Olds and colleagues (see Chapter 7) is also helpful. These programs
align with the principles of community psychology, but first we examine what has
traditionally taken place with adjudicated or delinquent youth.
You probably already know there are juvenile “correctional” facilities dotted around
every state—each meant to “reform” juvenile “offenders.” In large part, these facilities do
not work. Some states report that recidivism rates for youth emerging back into the
community are as high as 55% (Woodward, 2008). Research also demonstrates that many
youth in these facilities are uncertain about their ability to change their behavior, and they
think their incarceration will not deter future delinquent activity. In addition, most youth,
when interviewed, articulate that there is a major disconnect between what they learned on
the “inside” and the reality of life on the “outside” (Abrams, 2006). When youth are
released from these facilities, their families are considered critical to interrupting the pattern
of delinquent and criminal behavior, but other research shows that follow-up, face-to-face
family visits by youth service workers are few and far between (Ryan & Yang, 2005). Youth
service workers and community psychologists—indeed, anyone working with such youth—
can have a difficult time interacting with these individuals, not just because of their
backgrounds and their sense of hopelessness, but also because of the subculture that they
live in. Case in Point 9.2 offers some insight into how difficult it is to work with at-risk
youth.
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CASE IN POINT 9.2
Working with At-Risk Youth
Working with youths at risk for delinquency, running away from home, and dropping out of school can be extremely
challenging. Such youths live in a rather closed subculture where “squealing” is not only looked down on but can be
downright dangerous. Community psychologists and other professionals are learning how to work better and smarter
with street youth, who can be resistant to the most well-intentioned efforts.
In an interesting project, Hackerman (1996) recognized that just as a country has its own language, so do street
youth. Street gangs in particular, such as the Crips and the Bloods, use their own symbols and words to communicate.
Psychologists and others (such as ministers, school officials, and youth probation officers) need to be able to speak the
unique street language of these young people if they are to work with and design programs for them. In essence, they
need to become cultural anthropologists in addition to their other training. Over a two-year period, Hackerman put
together a muchneeded glossary of terms for individuals working with this target group. She noted that not all terms
were used by all youth. Hispanic youth in Los Angeles often speak a language different from African American youth in
New York City. Hackerman’s work demonstrates the importance of ethnography in community psychology. Some of
the terms from her glossary are shown next. Cover the right side and see how many terms on the left side you know.
Based on your awareness of terminology, how successful do you think you would be working with street youth?
Street Terminology Meaning of Term to Youth
Blue light Order someone killed
Bo A marijuana cigarette, a joint
Flying colors Wearing gang colors
Jack up Rob someone
Strap A gun
Jankin’ Teasing
Taylor and Taylor (2007) identified hip hop as an important, evolving youth subculture with its own language.
Because hip hop has gone somewhat mainstream, it is essential that community psychologists and other adults (parents,
social workers) understand the words. Much of the language used in the hip hop movement expresses what young
people encounter in their struggle to find meaning in home communities that too often leave them feeling hopeless
(Taylor & Taylor, 2007). Here are some examples of this language. See if you know any just from listening to hip hop
music or by walking around your community.
Street Terminology Meaning of Term to Youth
Running a train Multiple men engaging in sex with one woman
Blazing Violence
Hurting someone Gun violence
Ho Whore
Bitch Woman
Punks Adults
What do you think the effects are on young people of hearing such terms over and over again?
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On the other hand, although a positive adult role model cannot single-handedly
change families or whole communities (Broussard, Mosley-Howard, & Roychoudhury,
2006), research with at-risk youth who are involved with a caring, consistent adult
suggests that such youths are more likely to withstand a range of negative influences, such
as poverty, family conflict, and impoverished neighborhoods (Rhodes, Spencer, Keller,
Liang, & Noam, 2006; Southwick, Morgan, Vythilingam, & Charney, 2006). Positive
adult role models are considered preventive in that they contribute to the completion of
future important milestones, such as high school graduation or employment (Broussard et
al., 2006). In general, positive adult role models are considered to enhance a young person’s
development by providing successful models for coping and thus influencing the youth’s
resiliency. Resiliency can be defined as the capacity of those who are at risk to overcome
those risks and avoid long-term negative outcomes (Masten, 2009). Specifically as related to
this chapter, a close bond with a supportive caregiver or other adult—in other words, a
mentor—might help prevent a young person from entering a life of delinquency and
crime. A mentor, as defined in the chapter on schools, is a caring and responsible adult role
model who can make a positive and lasting impression on a child.
Mentoring can be informal, such as when a neighbor has frequent, unstructured
contacts with a child over a period of time, or it can be formalized, as in a community
mentoring program. Informal mentoring occurs spontaneously in the form of attentive and
caring athletic coaches, teachers, neighbors, or clergy. Research reveals that informal
mentoring can and does occur quite naturally (Hamilton et al., 2006; Helping America’s
Youth, 2008; Masten, 2009) when an extended family member (e.g., an uncle) or even a
shopkeeper or municipal worker (Basso, Graham, Pelech, De Young, & Cardy, 2004)
watches over a particular child’s safety and well-being when the parents are not around. In
fact, some studies indicate that over 50% of youth report having a natural mentor (Helping
America’s Youth, 2008). For children who do not have a naturally occurring mentoring
network, a formal mentor can supply the extra attention, affection, supervision, and
prosocial role modeling that is not always available in other environments (Bilchik, 1998).
Formal mentors tend to come from youth development, service-learning, or faith-based
organizations (Hamilton et al., 2006).
Mentors, formal or informal, play various roles, such as providing tutoring for school
subjects, attending or participating in recreational activities with the child, and talking to
the child about various personal issues. On a more psychological level, mentors appear to
help children escape from daily stresses (such as parental discord), provide positive
interpersonal relationships that may generalize to the child’s other relationships (peers and
parents), assist in modeling better emotional regulation (e.g., when and why not to lose
one’s temper), and bolster the child’s self-esteem (Rhodes et al., 2006).
There are now an estimated 3 million young people who have an adult, volunteer
mentor (Rhodes, 2008). One of the best-known and oldest formal mentoring programs is
Big Brothers/Big Sisters. This program primarily connects middle-class adults with
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disadvantaged youths, or a fatherless boy with an adult male, or a motherless girl with an
adult female. Another federally sponsored program is JUMP (Juvenile Mentoring
Program). In both programs, mentors are selected, trained, and matched to children (often
by race and/or gender). The mission of such mentoring programs is usually to prevent
delinquency and/or improve school performance by providing a caring adult role model.
JUMP also involves coordination among community resources (referrals to human service
agencies in the community), the schools, and the families, although there is variation from
program to program (Bilchik, 1998).
Two meta-analyses of mentoring programs concluded that mentoring has several
positive effects (Dubois, Holloway, Valentine, & Cooper, 2002; Eby, Allen, Evans, Ng, &
Dubois, 2008).
Tierney, Grossman, and Resch (1995) compared data from mentored youths in the
Big Brothers/Big Sisters Program to youths on a waiting list. At the end of the 18-month
study period, several positive results were documented for the mentored youths. Mentored
youth were less likely to use or initiate use of drugs and alcohol, more likely to attend
school (missing half as many days as the wait-list group), and less likely to report hitting
someone. Subsequent research has illustrated that the program does have beneficial effects
in other areas, such as reduced emotional problems and social anxiety as well as better self-
control (De Wit et al., 2007). Research also found that a mentor’s inconsistent presence
might be detrimental to the children (e.g., lower the child’s self-esteem) (Helping
America’s Youth, 2008) and in fact do more harm than good (Karcher, 2005). Before
assigning “Bigs” and “Littles,” careful screening should occur for this and many other
reasons.
Some preliminary data are also available for JUMP (Bilchik, 1998). Both youths and
mentors responded positively on a survey about the mentoring experience, with youths
being more positive than their mentors. When mentors and youths were asked whether
mentoring improved or prevented problems, they generally responded “yes” to varying
degrees. Adults and children reported that the mentored child was getting better grades;
attending classes; staying away from alcohol, drugs, gangs, knives, or guns; avoiding friends
who start trouble; and getting along better with his or her family. Mentoring, then, holds
great promise for reducing the risk of delinquent behavior. Community psychologists are
continuing their efforts to sort out the literature and continue researching the best practices
for youth mentoring programs (Rhodes, 2008).
Mentoring is not the only solution to juvenile delinquency problems. A much newer
program is Safe Start. In 2000, the Office of Juvenile Justice and Delinquency Prevention
of the federal government launched Safe Start to address the needs of children exposed to
community violence. Recall that witnessing community violence often leads to
delinquency, crime, and more violence (Lambert et al., 2005; Youngstrom et al., 2003).
Safe Start is designed to reduce the negative consequences of exposure to violence and
create conditions that enhance the well-being of all children and adolescents through
prevention interventions. Safe Start’s definition of exposure to violence includes direct
exposure (such as child maltreatment) and indirect exposure (such as witnessing family or
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community violence). The Safe Start Initiative envisions federal, state, and local
governments working together (Office of Juvenile Justice and Delinquency Prevention,
2008b). Some local programs have been established in early child-care centers so as to reach
children as early as possible (Hampton, Epstein, Johnson, & Reixach, 2004). Safe Start
sometimes engages classroom teachers who have been mentored by a trained professional to
model appropriate strategies for children’s socioemotional development. Other programs
use social workers who arrive on the scene of violence to which young children are
witnesses, and other programs establish groups of parents of children who have been
exposed to violence that are facilitated by a trained leader. Each program depends greatly
on the community and its unique issues with crime and violence, as well as on local
agencies available to participate. Programs such as Big Brothers/Big Sisters and Safe Start
show great promise as crime prevention programs because they address multiple and
complex risk factors and target appropriate subgroups of children and adolescents (Case &
Haines, 2007).
DESIGNING THE ENVIRONMENT TO PREVENT CRIME. The issue of how the
environment contributes to whether an individual is likely to fear crime or be an actual
victim needs to be examined here. Environmental psychologists—those who study the
effect of the environment on behavior—have much to offer community psychologists in
terms of recommendations for arranging the environment so that crime is less likely to
occur.
Do characteristics of the environment influence crime? Traditional approaches to
crime deterrence in various environments include installing burglar alarms, motion sensors,
and other devices designed to prevent or catch someone in the act of breaking the law.
Schools have made a particularly concerted effort to reduce crime by widening corridors,
limiting the number of entrances to the building, using landscaping to define campus
boundaries, and keeping up the facility to deter vandalism and crime (Kennedy, 2006).
However, some of the solutions to altering the built environment (e.g., gated communities)
are purchased at the cost of loss of movement and even greater fear of crimes (Zhong &
Broadhurst, 2007). Many of these techniques simply do not completely prevent crime,
whereas others prevent one type of crime but not others (Farrington, Gill, Waples, &
Argomaniz, 2007). Short of creating the perception of a community or building as a
fortress (Davey, Wootton, Cooper, & Press, 2005), there must be other aspects of
environments and communities that can be altered to help reduce crime and fear of crime.
The pioneer and rebel urban planner Jane Jacobs (1961/2011) argued that it was not
the physical aspects of design itself so much as what the design accomplishes on the human
level. As opposed to the planners of her day who emphasized highways and large parks,
Jacobs argued persuasively with her human-level stories of urban dwellers that city planning
should be about the opportunities for face-to-face interactions and ownership of public
spaces. What she noted were those aspects of the settings that helped people feel safe and to
use their environment. Among her findings was that use and ownership were important to
places. When there were people using spaces, observing and interacting with the users of
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the space, people felt more comfortable. Ownership of that space was also most helpful to
get people to take responsibility for what happened there. The ownership did not have to
be literal—they did not have to own the property. Rather, the
owners/participants/observers had to understand that they had a stake in what happened in
those spaces. The danger was apathy. Her solution was to have naturally evolving designs of
space that facilitated “liveliness.” Although Jacob’s work is not without its modern critics
(Zukin, 2010), her work provided narrative evidence of crime prevention in urban
design/sociology/psychology and is still cited among the classics of urban design.
When citizens and residents feel a lack of social solidarity and attachment to the
community, traditional approaches to altering the built environment simply create
indifference, suspicion, or even outright hostility. Furthermore, such approaches isolate
prevention activities from the surrounding social context—such as citizen diversity—and
fail to take into account community needs, priorities, and capacities. Merely altering the
physical environment by means of better lighting or redesign will not work, because such
projects reflect top-down decision making where outsiders bring prevention to the
community, without an understanding of the psychological impact on those who people
that setting (Kelly, Caputo, & Jamieson, 2005).
Many community psychologists and criminologists echo this feeling—that citizens
need to feel an attachment to (Brown, Perkins, & Brown, 2003) and ownership of their
communities to prevent crime. Research on the effects of crime on citizen participation or
empowerment is ambiguous at present, with some studies indicating that crime has a
chilling effect on participation and others demonstrating that it has an energizing effect
(Dupéré & Perkins, 2007; Saegert & Winkel, 2004). However, several authors suggest that
citizens can become more interested in and empowered to do something about crime in
their particular building or their own community (e.g., Dupéré & Perkins, 2007). One
approach is to empower citizens to design their own programs so that the response comes
from an integral knowledge of the social fabric of the community (Kelly et al., 2005). One
means for empowering and involving citizens is to take advantage of or build the social
capital of community citizens. Social capital helps groups achieve both individual and
collective goals. Social capital is exemplified by a sense of shared obligation, shared norms,
trustworthiness, and information flow (Dupéré & Perkins, 2007). Let’s examine two ways
to build social capital—one at the building level and one at the community level.
An example of a building-level intervention (which could also be used at the
community level) designed to increase social capital is the development of neighborhood
crime watches (National Crime Prevention Council, 1989). In neighborhood crime
watches, neighbors are on active alert for suspicious activity or actual break-ins to each
other’s homes (Bennett, 1989). Certain environmental factors predict who will and will not
join neighborhood watches (Perkins, Florin, Rich, Wandersman, & Chavis, 1990;
Sampson, Raudenbush, & Earls, 1997). Crime watches are a collaborative activity among
neighbors, which helps to build a sense of community (Levine, 1986). These watches
introduce neighbors to each other, provide information on how to communicate with each
other, and serve as the basis for common agreements to be “watchful and responsible”
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around the neighborhood. Researchers found that a sense of community was one of the
most important variables related to lower fear of crime (Schweitzer, Kim, & Mackin,
1999).
A second sample program of social capital building is at the community level. We
have already reviewed the discrepancies between police attitudes and community citizens’
attitudes about how the police should serve their communities. Programs that reduce these
differences might give citizens more confidence in their police and allow the police to better
service each individual community. Walker and Walker (1990) have described a
Community Police Station Program in which citizens play a major role in the
determination, design, and delivery of crime-prevention programs. Citizens from the
community see to the daily operation of the station and to the delivery of specific
programs, such as Seniors Calling Seniors, a program designed to give shut-in or isolated
seniors a sense of contact with others as well as a sense of safety. The program also includes
a citizens’ advisory board that helps identify the neighborhood crime-prevention needs of
each area of the city and sees that programs are developed to address those needs. In the
Community Police Station Program, the police and citizens collaborate to make police
services more acceptable and effective. In other communities, citizens and community
members have been used to help recruit and select new police officers, again allowing
collaboration and building a sense of community among citizens and enforcement
personnel.
Secondary Prevention
This section explores exemplary measures designed to intercede as early as possible after a
crime. Primary prevention at this point is too late. The strategy thus becomes secondary
prevention. In the case of the Farnsworths from the opening vignette, when Mike first
argued with his father, stayed out beyond the agreed-on curfew, or missed school, someone
should have or could have intervened before the situation deteriorated. As it was, Mike
struck his father and, in so doing, committed a crime. Primary prevention was too late.
EARLY ASSISTANCE FOR CRIME VICTIMS. Victims need their concerns addressed
as early as possible after the victimization. They may experience a wide variety of emotions,
ranging from fright, rage, a sense of violation, and vengefulness to sorrow, depression,
despair, and shock. Victims can also experience an array of health consequences after the
crime—for example, HIV infection after a rape (Britt, 2000). As mentioned earlier, the
justice system does little for the victim, who does not even have an official role to play in
the trial, if there is one (Wemmers & Cyr, 2005). The National Victims Resource Center is
a national clearinghouse that provides victims with educational materials, funds victim-
related studies, makes referrals to assistance programs, and provides information on
compensation programs. Some state governments have also developed victim assistance
programs (Woolpert, 1991) in which victims are compensated for their injuries or awarded
money from the offender’s selling his or her story to the media, or where victims can
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participate in decisions on their offender’s parole (Educational Conference on Psychiatry,
Psychology and the Law, 1990). (Parole is supervision of the offender in the community
after incarceration.) However, victim compensation programs are rare because an offender
in prison does not earn much money that could be used for restitution.
Financial compensation alone, though, cannot take away the psychological pain of
being victimized or the victim’s vengeful or angry thoughts. Even with a trial, victims may
have to wait months or years before their side of the story is aired in court. There are at
least two types of programs available to victims that afford early and substantially successful
interventions. The programs are crisis intervention and neighborhood justice centers.
CRISIS INTERVENTION FOR VICTIMS. One program available to victims is crisis
intervention, which is a set of procedures used by a trained individual to help others
recover from the effects of temporary or time-limited but extreme stress. Early efforts at
crisis intervention were focused on potential suicides, victims of violence, unpredictable or
dangerous situations, and natural disasters. Since its early days, crisis intervention has
expanded to assistance of victims of major school incidents (Eaves, 2001; Weinberg, 1990),
sexual assaults (Kitchen, 1991), individuals with chronic mental disorders (Dobmeyer,
McKee, Miller, & Westcott, 1990), and even victims of international terrorism (Everly,
Phillips, Kane, & Feldman, 2006). Every year, millions of individuals are confronted with
crisis-producing events that they are unable to resolve on their own, so they frequently seek
help from crisis intervention specialists. Crisis intervention has become the most widely
used, time-limited treatment in the world. Although its potential uses seem limitless, not all
situations are appropriate for it (Roberts & Everly, 2006).
Crisis intervention is usually a face-to-face or phone (hotline) intervention that uses
immediate intercession in the form of social support and focused problem solving to assist a
person in a state of elevated crisis or trauma. Its immediate purpose is to avert catastrophe
and quell distress, so in this way it is a sort of psychological first aid (Everly et al., 2006).
Crisis intervention centers can be staffed by professionals or trained volunteers and are
often open 24 hours a day. Note, though, that crisis intervention is not designed to be a
stand-alone intervention; usually it is the beginning of a continuum of future interventions
for the same individual. For example, many people witnessed the September 11, 2001,
terrorist bombings or lost loved ones in the collapse of the World Trade Center towers.
Others were traumatized when they visited the devastated site or witnessed news reports
over and over again. Although crisis intervention teams were available to many affected
individuals and helped them in about 90% of the cases (Jackson, Covell, Shear, & Zhu,
2006), some required ongoing therapy or other interventions.
A pertinent question about crisis intervention is whether it is an effective means of
providing help at the onset of the crisis and thus of preventing future problems. Mishara
(1997) examined the effects of different telephone styles used with suicidal callers. Using
calls from 617 callers, nearly 70,000 responses by crisis counselors were categorized and
then evaluated for success of the crisis intervention. Mishara found that Rogerian-based,
nondirective (rather than directive) interaction with the caller resulted in better outcomes
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—that is, it resulted in decreased depressive mood and in contractual behavior as to how to
manage the crisis. Crisis counseling is even being conducted electronically (Wilson &
Lester, 1998), but whether this is as effective as phone contact remains to be determined.
Campfield and Hills (2001) found that the sooner the crisis intervention occurs after an
actual crime, the lower the number and severity of symptoms for the victim in the long
run.
Because of the maturation of the crisis intervention field and proliferating research on
it, Roberts and Everly (2006) were able to conduct a literature review (meta-analysis) of
well-designed crisis intervention studies to determine whether it is superior to psychiatric
hospitalization and other long-term interventions. The 36 studies they examined all had
pre-post designs or an experimental and control group matched on multiple variables. The
researchers concluded that “adults in acute crisis or with trauma symptoms and abusive
families in acute crisis can be helped with intensive intervention [crisis intervention].” (p.
10).
RESTORATIVE JUSTICE PROGRAMS. You have already learned that recidivism
rates for inmates of correctional facilities (juvenile detention centers, prisons, and jails) are
quite high. Once these individuals are released, they often return to a life of crime. What
can be done to reduce recidivism? This question speaks to the issue of secondary
prevention. Although community psychologists much prefer primary prevention, secondary
prevention becomes an important issue in this chapter because of the likelihood of
recidivism, especially when the person is released into the same environment and the same
peer group that may have cued crime in the first place.
Recidivism remains just one of the problems when crime-prone individuals emerge
from any of the traditional forms of justice (e.g., incarceration). The traditional system is
designed to administer retribution or punishment. You read earlier that incarceration
generally does not deter a person from committing a subsequent crime. In fact, some
studies find that very few persons who experience retribution or punishment from the
traditional system are deterred from crime, so the rate of recidivism may be as high as 90%
at times (Bradshaw & Roseborough, 2005). What the traditional system offers in the form
of secondary prevention is supervision in the community, such as parole. Less frequently,
rehabilitation services might be offered to the juvenile delinquent or adult offender and are
designed to reform or dissuade the individual from crime-prone activities such as using
illegal drugs.
Neighborhood justice centers or community mediation centers, on the other hand,
comprise a category of secondary intervention for both the offender and their victims where
a third type of justice is offered—restorative justice, a method for making right the wrong
that was done (Wemmers & Cyr, 2005). Restorative justice can involve victim
compensation, but in this case, restoration also includes repairing the psychological harm
done by the crime. The process aims to benefit the victim, the offender, and the
community. Victims are able to express their feelings, emotionally heal, get questions
answered regarding the crime, and have input into a reparation plan. The offender is held
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personally accountable for the crime (Rodriguez, 2005) by providing restitution as well as
details about the crime and his or her plans to reintegrate into the community.
Neighborhood justice centers are almost always linked to courts, where judges or intake
workers refer cases away from adjudication and to mediation. Community mediation
centers are often nonprofits that use volunteer mediators to facilitate discussion among
individuals involved in conflicts. Both types of centers are established in the local
community and are designed to handle cases from criminal, juvenile, family, and civil
courts or from other community agencies, such as community mental health centers and
religious organizations (Hedeen, 2004). Although the exact number of such programs is
elusive, estimates range from between 500 and 1,000 centers in the United States that
manage a remarkable 100,000 cases a year (Hedeen, 2004).
At these centers, a special type of mediation is used to provide restorative justice when
crimes have been committed. Victim-offender mediation is attempted. In this type of
mediation, a trained person hears the case as presented by both the victim and the
offender. This neutral person, the mediator, assists the two parties in understanding their
involvement and fashioning a resolution that is satisfactory to each. Mediators use a variety
of strategies to facilitate discussion and guide the parties toward restoration (Carnevale &
Pruitt, 1992; Heisterkamp, 2006; Ostermeyer, 1991). Mediators are supposed to use reality
testing (a process in which one person is asked to “get in the other person’s shoes”), a
futuristic (rather than retrospective) orientation, turn taking, compromise, reciprocity in
concession making, and active listening, among other skills. Analysis of the process of
mediation demonstrates that mediators generally do remain neutral and use unbiased
paraphrasing as well as invitations to take the other person’s perspective. In some respects,
mediation and psychotherapy are parallel processes, but mediation focuses more on
problems and issues than on emotions or relationships (Forlenza, 1991; Milne, 1985;
Weaver, 1986). The resolutions in most programs are legally binding, do not require
decisions about guilt or innocence (thus can “clear” an arrest record), and must be mutually
agreed (Duffy, 1991).
The centers and the process of mediation embody many of the values of community
psychology. The centers are generally available to the parties in or near their own
neighborhoods. The centers provide an alternative to the sometimes oppressive,
bureaucratic, and almost always adversarial court system (Duffy, 1991). Mediation
empowers the parties to play a major and active role in determining their own solutions.
Research on compliance with the contracts suggests that they usually prevent conflicts and
crimes from recurring in the future (Duffy, 1991). Similarly, the centers are generally
available to every community citizen regardless of income, race, or creed (Crosson &
Christian, 1990; Duffy, 1991; Harrington, 1985), and the mediators are trained to respect
the unique perspective and diversity of the parties (Duffy, 1991). Empirical research has
demonstrated that mediation is a humanistic process because it enhances the functioning of
both participants as measured by Maslow’s hierarchy of needs (Duffy & Thompson, 1992).
These centers hold several advantages over more traditional forms of seeking justice.
For one thing, the centers dispense with cases in a more timely fashion than the court
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system (Duffy, Grolsch, & Olczak, 1991; Hedeen, 2004). One state reports a 15-day
turnaround time from intake to resolution at its mediation centers (Crosson & Christian,
1990; Duffy, 1991), so in essence they offer early intervention. Second, victims no longer
have to play a passive role in the justice system; in mediation, the victim plays an active role
(Smith, 2006). Third, some studies have shown that victims demonstrate very little
knowledge about the justice system and services available for them (Sims, Yost, & Abbott,
2005), so referral to mediation, where subsequent referrals to helping services can be made,
educates victims about their rights and about other available supports. Furthermore, other
research has found that victims are very dissatisfied with more traditional forms of justice
(such as trials). They often are not told the full facts of the case and frequently have
difficulty trying to recover personal property or even a loved one’s remains because the
police view these items as evidence (Goodrum, 2007). Additionally, many crime victims
can achieve emotional repair, even forgiveness, in the mediation process (Armour &
Umbreit, 2006; Strange, Sherman, Angel, & Woods, 2006). Charkoudian (2005) found
that community mediation reduces repeat police calls for the same or continuing problem.
Importantly, recent studies have found that offenders who take part in restorative justice
programs such as victim-offender mediation are far less likely to recidivate (Bradshaw &
Roseborough, 2005; de Beus & Rodriguez, 2007; Rodriguez, 2007). One study followed
parties in victim-offender mediation for three years and found that restorative justice
programs are related to significantly better outcomes (e.g., less recidivism) than are
traditional programs (e.g., parole).
Most victims are highly satisfied with the process of mediation (Bazemore, Elis, &
Green, 2007; Carnevale & Pruitt, 1992; Duffy, 1991; Hedeen, 2004; McGillis, 1997;
Wemmers & Cyr, 2005) because they get to tell their version of the story soon after their
victimization. They are also allowed to vent their emotions (something usually prohibited
in court), and they are given the opportunity to address the person they believe caused their
distress. Respondents or offenders appreciate the process because they typically do not come
out of it with a guilty verdict or an additional criminal record. Likewise, they are afforded
the opportunity to provide evidence that the other party may have played a role in the
“crime” (as in harassment, where both parties may have actually harassed each other). From
the victim’s perspective, the mediation process helps by allowing them to share with others
their tale of victimization, get more information, and receive a sincere apology from the
perpetrator (Choi, Green & Kapp, 2010). This is viewed as a reempowering process and a
way to achieve restorative justice.
The end result in about 85% to 90% of the cases is an agreement or contract between
the parties (Duffy, 1991; Hedeen, 2004; McGillis, 1997). What is equally important is that
80% to 90% of victims and defendants emerge from the process satisfied (Duffy, 1991;
Hedeen, 2004; McGillis, 1997). The agreements can contain anything from restitution and
apologies to guidelines as to how the parties will interact in the future. Just about anything
that both parties agree to that is legal can be part of the mediated settlement. Mediation has
been successfully used in landlord-tenant and consumer-merchant disputes; neighborhood
conflicts; crimes such as assault, harassment, and larceny; family dysfunction; racial conflict;
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environmental disputes; school conflict; and a host of other areas where individuals disagree
or infringe on each other’s rights.
In fact, the opening vignette of Mike Farnsworth is a true story; Mike and his parents
were referred to a mediation center by the probation department. Although the hearing was
long, Mike and his parents eventually agreed on rules (e.g., curfews) and a reward system
(which had been missing before the mediation). A punishment system had long been in
place. The reward system would be used when Mike’s grades were good or when his
behavior was positive. During the hearing, Mike and his father finally listened to one
another (rather than bellowed) and began to better understand each other’s perspective.
Mike’s mother, Edna, learned some valuable skills from the mediator, such as compromise
and reciprocity of concessions, for use in refereeing future disagreements between Mike and
his father, should they arise. The Farnsworths (whose name we changed to protect their
anonymity) have lived much more harmoniously since the mediation.
Neighborhood justicparties (Duffy, 1991). Eme centers have experienced tremendous
growth in the past three decades (Duffy, 1991) but are not without their critics (e.g.,
Greatbatch & Dingwall, 1989; Presser & Hamilton, 2006; Rodriguez, 2005; Vidmar,
1992). Some critics argue that mediators hold too much control over the process and the
parties and fail to challenge attitudes conducive to crime (Presser & Hamilton, 2006).
Others point out that Hispanic/Latino and Black juveniles are less likely than Whites to be
referred to restorative justice programs (Rodriguez, 2005). Finally, Latimer, Dowden, and
Muise (2005) argue that some of the research on restorative justice is poorly designed, and
because it is often voluntary—even for the offender—there is an important self-selection
bias in the research. The foregoing information, then, needs to be considered in light of
these criticisms.
REINTEGRATION PROGRAMS FOR INCARCERATED INDIVIDUALS. You
know now that Mike Farnsworth’s story had a fairly happy ending. Imagine, though, how
Mike would feel if he had been imprisoned because of his repeated assaults on his father
and then released after five years. He would have learned much in prison, most of it
counterproductive. He may have learned how to fashion weapons out of ordinary
household implements, such as mirrors and pens. He may have learned how to intimidate
others merely by staring at them in a certain way, and he may have learned how to commit
more heinous crimes than the assault on his father. Even though prison might have
hardened Mike, he might also have felt intimidated about his reentry into society and
insecure about his newly acquired freedom. Where would he find a job? How would he feel
about going to see his parole officer? Would his parents allow him to come home? What
would the neighbors and his friends think?
Each year, thousands of individuals are released from prisons and jails to communities
(Byrne & Taxman, 2004; Mellow & Dickinson, 2006). The increase in number of parolees
over the past few years is indicated in Figure 9.3. Although crime rates are declining
somewhat, inmate numbers continue to rise because many are serving longer sentences or
sentences that are now mandatory rather than discretionary on the part of a judge or jury
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(Bracey, 2006). For most inmates, returning to the community is problematic. First, their
lives and decisions are totally controlled by the correctional staff while they are incarcerated.
Thus, day-to-day prison life runs counter to the day-to-day life inmates will face outside of
prison (Taxman, 2004). Furthermore, inmates probably lack skills to obtain employment.
They may emerge from incarceration with some of the same problems (i.e., substance
abuse) that got them there in the first place. Some inmates reappear in the community with
health problems they did not have on entry to the prison (i.e., HIV/AIDS). Some of them
have learned negative institutional behaviors (e.g., gang behavior), have lost contact with
family members and friends, and will be stigmatized by community members and potential
employers so that they cannot find housing or employment (Byrne & Taxman, 2004).
Heap on top of these issues the stigma of having lost personal rights such as voting and
parental rights, compounded by not being able to run for elective office and being unable
to sit on juries, and the parolee can experience a profound sense of disconnection from the
same community in which the crime was committed (Bazemore & Stinchcomb, 2004).
Also, predictably, the longer the individual remains incarcerated, the more likely there will
be changes in the family, peers, and neighborhood dynamics (Byrne & Taxman, 2004). It
should not be unexpected, then, that recidivism occurs. Criminologists project that more
than two-thirds of all parolees will eventually be rearrested, and 40% of them will likely
return to jail (Byrne & Taxman, 2004).
FIGURE 9.3 Number of Individuals on Parole in the Community
Source: Bureau of Justice Statistics (Glaze & Palia, 2004). One in every 32 adults is now on probation, on parole, or
incarcerated. Retrieved from http://bjs.gov/index.cfm?ty=pbdetail&iid=1109.
As already mentioned, the typical program for those being released from incarceration
is parole. Some previously incarcerated persons are also court-ordered into treatment
programs, but data reveal that they are unlikely to attend. Correctional personnel have
known for decades that the high rate of recidivism is largely related to ineffective transition
programs (e.g., parole) for inmates released back to the community (Bonhomme et al.,
2006). Better pre- and postrelease programs are necessary. Research clearly shows that
getting “started right” immediately on return to the community is extremely important
(Bullis, Yovanoff, & Havel, 2001) if recidivism is to be reduced and the former inmate is to
become a successful community member (Baltodano, Platt, & Roberts, 2005).
As for prerelease programs, we know little about them empirically (Byrne, 2004).
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Many prisons and jails now offer mental health counseling and substance abuse
rehabilitation, as well as educational programs, to inmates. It is well known that the prison
population is less well educated than the general population. There are, however, limited
data on how well schooling programs work or how much education actually takes place.
What we do know is that such programs are quite variable (Byrne & Taxman, 2004),
depending on the state, the community, and available funding. Some states do not offer
educational programs. The existing studies, however, do indicate that prisonbased
education programs have positive effects on reducing recidivism (Vacca, 2004).
Unfortunately, the number of prison staff dedicated to providing inmate education has
declined over the years (Bracey, 2006).
Another well-known factor that enhances positive reintegration to the community is
family and social support. Formerly incarcerated individuals who return home or live with
relatives have a lower probability of rearrest and reincarceration than those who do not
(Bahr, Armstrong, Gibbs, Harris, & Fisher, 2005; Baltodano et al., 2005). Of course,
having stable housing and being employed also reduce the likelihood of running into
trouble with the law. Practical prerelease programs designed to help former inmates secure
housing and jobs before they are released would be advantageous because most inmates enter
the community with no money, a poor work history (Bahr, et al., 2005; Shivy, Wu, Moon,
Mann, & Eacho, 2007), and no housing options because they are expected to make all such
arrangements while they are still in prison (Taxman, 2004). An interesting attempt to bring
the one’s community and culture into the jail release process is described in Case in Point
9.3.
CASE IN POINT 9.3
Huikahi: The Restorative Circle
One promising program designed to address all these needs and to reduce recidivism is the Huikahi (hui means
“group”; kahi means “individual”) restorative circle. These circles empower the inmate to choose how he or she will
live on the outside—which may create higher compliance with such programs (Taxman, 2004) . Circle programs were
originally developed in Hawaii for foster children aging out of the foster care system. In prison, the restorative circle is a
group planning process for inmates, their families, significant others, and prison staff. In restorative circles, the
professional facilitators do not tell inmates and their families how they should deal with problems but instead ask
appropriate questions so that the involved parties can find solutions themselves. In many instances, family members or
other emotionally supportive individuals reach out with suggestions for the inmate in developing the plan (Walker,
Sakai, & Brady, 2006).
Circles can occur when the individual is first incarcerated and detail who will visit the inmate, how often, and so
forth. On the other hand, a community reentry circle might include topics such as where the inmate will live, how
much interaction he or she will have with the family, where a job or job skills training will be sought, and what the
inmate will do to remain crime-free and drug-free once in the community. In both cases (on admission or on release),
circle plans can also describe how the inmate will restore justice (e.g., write a letter to the victim, return stolen items).
Identifying strengths of the inmate is also a key feature of this solution-focused approach. For example, if the inmate is
identified as being highly intelligent, family members might encourage him or her to include an education component
in the plan while in prison or after release. The program eventually results in a written plan (Walker et al., 2006). A
recircle meeting is also planned for a later time where the written plan is reviewed to tweak its various components.
Restorative circle programs certainly feature many of community psychology’s tenets (such as empowerment and social
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support), but the programs are so new that we await sufficient literature on their efficacy (Walker et al., 2006). In a
two-year follow-up to this prison reentry program, recidivism rates were at 30% (versus typical rates of 50–80%).
Admittedly, the number of prisoners in this study was small, and no final conclusions could be drawn with regard to
recidivism. Other data from the program did point to its desirability to the population of prisoners trying to reenter
their communities. Of the participants (prisoners, families, prison staff) in this program, all evaluated it as a positive
experience. The demand for the program outstripped the capabilities of the prison. Only 37% of those who requested it
were able to be seen. This program is seen as a “public health” approach to criminal behavior—that is, one that
emphasizes learning and prevention (tertiary and targeted) (Schwartz & Boodell, 2009).
In conclusion, criminal justice is a complex system made up of many different players with a variety of motives and
functions. Effectiveness of programs dealing with criminality can be influenced by many different individual, relational,
or community factors (O’Donnell & Williams, 2013). Community psychologists are collaborating with individuals
involved in the justice system, and together they are making headway on preventing crime and assisting those involved
in the crime once it occurs. Better yet, community psychologists and others hope to keep the community and its
members “whole” before, during, and after the crime.
Summary
The traditional justice system includes enforcement agencies such as the police, the courts,
the prisons, and related programs. Such programs allow only a small role, if any, for the
victim and tend to seek retribution or punishment for the offender.
Psychologists who have tried to parcel out the causes of crime know that guns, gun
control, and related factors are not the only predictors of crime. Certain ecological settings
and certain groups of individuals are likely to be involved in crime. Young African
American men are most likely to be victimized by crime and most likely to be convicted of
and incarcerated for crime. Societal prejudice and the history of African Americans in the
United States may in part be what underlies some of the statistics. Poverty and community
disorder are other good predictors of crime rates.
Prisons are bleak, overcrowded institutions often fraught with problems such as
violence, AIDS, and illegal substances. Prisons do not tend to rehabilitate or treat offenders.
Thus, recidivism rates remain high.
Victims and those who fear crime have been neglected populations in the traditional
criminal justice system. An interesting phenomenon, the crime-victimization paradox,
which has tempered support in the literature, suggests that those who fear crime the most
are often least likely to be victimized. An example would be an elderly woman who fears
crime but is very unlikely to be a victim.
Police are asked to play a variety of roles in a community. Some are roles for which
they are ill prepared, such as intervention in domestic disputes and mental health issues.
Police officers often report that they feel alienated from the communities they serve and feel
that their superiors offer little understanding for street life.
Community psychologists believe that criminal behavior can be predicted. Some
studies have successfully predicted delinquent behavior in at-risk youths. Environments can
also be altered to reduce the probability of crime. An example is removing violent cues from
the media, which tend to bias reports of crime.
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Community programs, such as neighborhood crime watches, are successfully reducing
the fear of crime. Other innovative programs involve citizens in collaborative efforts with
officers at enforcement agencies.
In terms of secondary prevention, community-based programs show much promise
for intervening in the cycle of delinquency and recidivism. There also exist programs for
early assistance to actual crime victims. Two such programs include crisis intervention and
neighborhood justice centers or community mediation centers.
Victims, for example, may need follow-up services long after the crime. One new and
interesting program is the victim-offender mediation program in which the victim and
offender meet face to face and discuss their impact on one another as well as plans for
restitution to the victim.
Programs comparing incarceration to alternative community services are difficult to
assess with research because of confounding issues, but many community programs offer
hope that even chronic offenders can be assisted. An especially important type of program is
one, such as a restorative circle program, that is designed to ease adjustment of an
incarcerated person returning into the community.
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■
The Healthcare System
THE AMERICAN HEALTHCARE SYSTEM
National Health Indicators
Observations on the System
COMMUNITY PSYCHOLOGY AND THE HEALTHCARE SYSTEM
Prevention over Remediation
Shifting Focus from Individuals to Groups, Neighborhoods, and Systems
Building Systems
Increasing Accessibility
CASE IN POINT 10.1 Teen Pregnancy Prevention
Social Support and Health
SUMMARY
The speaker was a famous Black American figure. He was being honored by the association
for his work and accomplishments. The band played, and the audience came to its feet.
The speaker spoke in stentorian tones about the honor and his life. But before he did so, he
dedicated the time there and his comments to his recently departed uncle. Dearly
remembered, the uncle had been a friend and a grounding force in the famous person’s life.
As the story unfolded, it became apparent why this uncle was the point of dedication.
It turned out that he had had health problems for a while. However, like many, he put off
going in to see a doctor. It was too expensive. It seemed a needless cost when times were
difficult economically, or at least it did not seem worth the extra expense. By the time the
uncle made it to the doctor’s office, the cancer had progressed to the point of irreversibility.
Then it was just a matter of time. The family came together. People said their goodbyes.
The uncle died. The speaker had nearly canceled his engagement with the award ceremony.
He was grieving. Yet he decided to come and to speak about his uncle. He hoped to point
out the example this presented for us all. Was the delay in seeking healthcare necessary?
Was it a function of poor habits? Was it a pattern of behavior that was culturally
established long ago? Were the concerns about money justified? What was the cost in the
end? These are the questions he put to the audience that evening. These were the challenges
the speaker wanted to present to those who honored him. Where are the answers? Would
they come from those to whom he spoke that night? What could we, would we contribute
to solving this problem, made personal by his uncle, but otherwise found in data collected
every year in the United States?
A second story completes our picture of a healthcare system looking for answers. In
this story, we find a successful clinical psychologist, working in a large metropolitan area.
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When she went for a checkup for symptoms she could not explain, her physician discovered
over the course of several days and many tests that she had a rare form of cancer that was
quite aggressive. To receive the cutting-edge treatment that could provide her with the best
chance of survival, she needed to go to where the treatment was being tested.
Unfortunately, the medical center where this treatment occurred was in another state,
several hundred miles away. At first she was able to travel between her home and the other
site. However, besides the travel expenses, her medical expenses mounted quickly. Soon,
she discovered that the regimen of therapies cost in the hundreds of thousands of dollars.
While her insurance decided if she qualified, and if her treatment qualified, she had to bear
the cost herself. Eventually, the determination was that the insurance did not believe they
were responsible for her treatments. Meanwhile, the psychologist had to close down her
practice because she was not able to adequately care for her patients. Soon she had run
through her savings and was looking at the choices of death or going further into debt. She
also had to decide whether to stay in her home city with her circle of friends or move to a
strange city where she knew no one.
So what, then, of our healthcare system? What could community psychology contribute to
making it better? That is what we explore in this chapter.
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THE AMERICAN HEALTHCARE SYSTEM
National Health Indicators
The World Health Organization reports on global health indicators. Among them are life
expectancy and neonatal mortality rates. The 2011 World Health Statistics state that the
average life expectancy for those who live in the United States is 79 years, slightly lower
than many European countries, Japan, and Canada. However, these numbers still look
much better when compared to global life expectancies (World Health Organization,
2011). Neonatal mortality rates per 1,000 follow a similar pattern (Table 10.1).
In the 2011 annual report on health within the United States, life expectancy was at
an all-time high. Life expectancy in 2009 was four years greater for males and two years
greater for females than in 1990. Given the 2009 figures, the United States ranks 32nd in
the world for life expectancy (Japan is ranked first, and Singapore is second). Infant
mortality is also low at 7 infants per 1,000 or 4 neonates per 1,000, making us 30th in
world rankings (Singapore and Sweden are first and second). However, these health status
indicators were not uniformly found throughout the U.S. population, with ethnic minority
groups faring less well. In particular, African Americans had more than double the norm for
both infant and neonatal deaths. Blacks or African Americans also had lower life
expectancies than their white counterparts by approximately 5 years (White males—75
years, Black males—70 years; White females—80 years, Black females—76 years) (National
Center for Health Statistics, 2011). Also cited in the report were concerns over the
problems of rural health. Despite increasing sophistication in medications and interventions
that could help treat a variety of physical illnesses, access to healthcare is still more easily
attained in urban centers. For example, we see in Figure 10.1 that in the specialty area of
obstetrics and gynecology, there were large (mostly rural) sectors of the nation without any
identified physicians with this specialty. These shortages mean that patients have to travel
far to obtain services, and these services, in turn, were placed under extraordinary demands
to meet the health needs of the wider geographic area, which may mean greater delays
between seeking and receiving services.
TABLE 10.1 Comparative World Health Status Statistics: Mortality Measures,
2010
Life Expectancy (Age in
Years)
Neonatal Mortality (Number
Who Die per 1,000, Birth to 28
Days of Age)
Male Female Both Sexes
Canada 79 83 5
Cuba 76 80 5
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France 78 85 3
Germany 78 83 3
Ireland 77 82 3
Japan 80 86 2
Mexico 73 78 14
Spain 78 85 4
Switzerland 80 84 4
United Kingdom 78 82 5
United States 76 81 7
Global 66 71 24
Source: World Health Organization. (2011). Global health indicators. Geneva, Switzerland: Author.
In addition to concerns about unequal access to healthcare, there is still an overall
concern about unhealthy lifestyles, which include diet, exercise, risky behaviors, and
alcohol- and drug-related habits. The combination of these lifestyle risk factors contributed
to a formidable portion of health-related concerns. For example, it was estimated that in
2006, approximately 39% of the population over 18 years of age were inactive during their
leisure time (p. 286). Among those 18 years and older who drank, more than a third
reported consuming more than five alcoholic drinks in one day during the past year (p. 9).
Given these health statistics, one can conclude that the United States does well in
healthcare, although it is not the best, and there are national behavior patterns that place us
at risk. It is also true that the benefits of living in the United States are not evenly
distributed, with health advantages going to the upper- and middle-class White ethnic
majority, those in urban centers, and those who have insurance.
Observations on the System
In the not too distant past, access to healthcare more or less depended on one’s ability to
pay for it. The establishment of federally funded programs, such as Medicaid and Medicare,
in the 1960s, as well as the institutionalization of employment-based healthcare, has been a
significant step forward for a healthy nation. However, health maintenance organizations
(HMOs) have the potential to place restrictions on doctor–patient discourse.
Given the aforementioned issues of inequity in healthcare, however, there continues to
be a need for a meaningful discourse on healthcare reform. This conversation would need
to include four elements: financing healthcare, implementing appropriate public policy,
working with healthcare providers, and partnering with patients. Typically, most
conversations about healthcare reform focus on one or two elements. Often, the first, the
economics of the situation, dictates ability to access healthcare. Until this barrier is
removed, there will always be less than optimal health among some segments of the
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population.
FIGURE 10.1 OB/GYNS per 10,000 Female Population Age 15+, by County (2004)
Sources: Centers for Disease Control and Prevention; National Center for Health Statistics (2007b), Fig. 23. Data from
the Area Resource File.
Although the United States spends more money than any other country in the world
to pay for its citizens’ healthcare, the country has found itself in a state of flux over the past
few decades, struggling to contend with the expenses of healthcare and the manner in
which patients can pay for it. For example, in 2009, 32% of costs were paid by private
insurance, 35% by the federal government, and 12% as “out of pocket” expenditures.
However, there have continued to be problems for people who are not covered by private
insurance or federal programs such as Medicare and Medicaid. Uninsured individuals who
do not qualify for Medicaid still get sick and, as explained in this chapter, the cost of their
care when they go to an emergency room is indirectly passed along to taxpayers and those
who are insured. Thus, in an effort to reform healthcare in at least several significant ways,
in 2011, the Obama Administration developed and the Congress passed the Affordable
Care Act. As is the case with much legislation, many compromises were made in order to
pass the law, and political infighting delayed that passage.
Many positive changes are contained in the act, to be phased in from 2011 to 2014.
Among the highlights of the act are that insurance companies can no longer deny coverage
to individuals with preexisting conditions and that adult children up to the age of 26 can
continue to be covered by their parents’ health insurance policies. Perhaps the most
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controversial aspect of the act is its mandate that all citizens must have health insurance
coverage or be willing to pay a fee as a penalty for being out of compliance. Given that the
major focal point of the act is to increase the percentage of citizens who are covered by
healthcare insurance, the government has already begun collecting data on changes in
insured citizens. The National Center for Health Statistics has tracked changes to the rates
of uninsured citizens that are encouraging, despite the fact that the mandate has yet to be
enforced (this will not occur until 2014). For example:
The percentage of people with employment-based private health insurance increased
from 15.6% in 2007 to 26.9% in the first six months of 2011.
The percentage of people covered by directly purchased private health insurance
increased from 39.2% in 2007 to 53.2% in the first six months of 2011.
The percentage of adults aged 19–25 who were uninsured decreased from 33.9% (10
million) in 2010 to 28.8% (8.7 million) in the first six months of 2011.
The percentage of adults aged 19–25 covered by a private plan in the first six months
of 2011 increased to 55.0% from 51.0% in 2010.
COST AND ACCESS. While the Affordable Care Act attempts to rectify inequities in
cost and access to healthcare, there is still a demand to minimize the overall costs associated
with healthcare, especially the healthcare that is subsidized by taxpayers or paid out of
pocket by those lacking coverage. Ross, Bradley and Busch (2006) noted that lack of health
insurance places none-too-subtle pressure on the potential patient to be frugal with
healthcare usage. The threshold for seeking help may be higher because of the drain on
resources that occurs when a person seeks medical help. In other words, when individuals
lack coverage, they may practice far less preventative care, waiting to see a doctor only if
they are already symptomatic. Because people without insurance also typically do not have
a regular physician, many patients seek treatment in emergency rooms, which are typically
the most costly places to receive care. What results, then, is a more passive form of
healthcare from the patient’s perspective. Patients who lack the financial and institutional
resources to be proactive about their health may also begin to feel a sense of
disempowerment about being in control of their health in general. This sense of
disempowerment, which is felt more commonly in low-income communities, may also
contribute to the inequities we see in healthcare across the U.S. population.
Inequities in healthcare access and health outcomes in general are known as health
disparities. Disparities are evident when there is a statistical overrepresentation of people in
a category when compared to the population in general. For example, there are health
disparities between ethnic minority groups in comparison to the U.S. norms (National
Center for Health Statistics, 2011). Ethnicminority, low–socioeconomic-status, immigrant,
and older women suffer a disproportionate burden of breast and cervical cancer (Institute of
Medicine, 1999). Although the number of new cervical cancer cases has declined overall,
African American women have an incidence rate that remains 39% higher than that of
non-Latina White women (Buki, Montoya, & Linares, 2012) Many federal entities have
made the elimination of these disparities a major priority. For example, in 2000, Congress
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founded the National Center on Minority Health and Health Disparities with the specific
mission of helping to reduce, and ultimately eliminate, health disparities. Through this
initiative, each institute in the National Institutes of Health designed a plan for eliminating
health disparities, each of which became part of a larger national strategic plan to reduce
and ultimately eliminate health disparities (Institute of Medicine, 2006).
There are passionate debates about why health disparities exist. Some argue that some
ethnic minority groups may be more susceptible to certain health problems (e.g., Native
Americans and alcoholism). Others have argued that the stress of being an ethnic minority
member results in physiological consequences that put communities of color at greater risk
for health problems (Steffen, McNeilly, Anderson, & Sherwood, 2003). Still others
postulate that it is not necessarily susceptibility as much as it is less effective healthcare
behaviors due to a lack of access to the system or a lack of understanding how the system
works. Imagine for example, a family of immigrants living in a rural part of the country.
Not only may this family live far away from a doctor’s office, but they may also lack the
language skills (and be unable to converse with bilingual staff) to use the system effectively.
It is possible that all the aforementioned factors play a role in explaining why health
disparities exist.
Although disparities may be in part due to language barriers and to geographic
distance from facilities, other sociocultural factors are also likely to be at work. For example,
one’s cultural norms around seeing doctors and engaging in routine exams may be a factor.
Overall, African American women are twice as likely to die from cervical cancer as non-
Latina White women (Buki et al., 2012). This may be explained in part by circumstance
that African American women visit a gynecologist less often. With cancer such as cervical,
breast, and colorectal types, the importance of regular exams among high-risk populations
seems clear. Cancer is best diagnosed early. Early discovery and treatment leads to higher
rates of treatment success. Therefore, it is important to do regular checkups once
individuals pass the age of 50 (U.S. Preventive Services Task Force, 2002). Despite these
recommendations, checkups for colorectal cancer follow the same pattern of low rates
among the ethnic minority elderly (National Center for Health Statistics, 2011). Shih,
Zhao, and Elting (2006) studied various possible causes for these low rates. They find that
the access issues of language, lack of health information on this topic, and culturally based
perceptions of the screening procedures stand as barriers to these examinations.
In both of our opening stories, we find concerns about access and cost. The
perception of the cost of regular medical checkups held back the individual in the first
vignette from going until his ailment progressed to an untreatable stage. A lack of
knowledge relating to health issues played an important role in both cases. They did not
know the symptoms. The psychologist discovers that medical treatment can be expensive,
that it is not available near her home where she needs it, and that her insurance coverage is
inadequate. She is in private practice, and therefore is a small business, which brings high
insurance costs and lower benefits. Once her insurance runs out or is denied, she is left with
no coverage. This is inevitably a bad set of scenarios.
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ADHERENCE AND COMPLIANCE. Beyond cost and access, there is the issue of the
patient/consumer doing as instructed. This is called adherence or compliance. Haynes,
McDonald, and Garg (2002) note that typical adherence runs about 50% for medication
regimens. Lower rates of adherence are reported for prescriptions of changes in lifestyle—
for example, changes in diet and exercise. So if adherence is so low, can anything be done to
make patients more compliant? Following a review of research on adherence, McDonald,
Garg, and Haynes (2002) report that short-term compliance (less than 2 weeks) can be
increased with patient instruction, but long-term compliance takes a combination of
instruction, social support, emphasis of the importance of the prescription, provision for
positive feedback on compliance, and regular reminders of the regimen. This represents a
cultural change in the patient’s context or his or her social environment.
Using newer technologies such as the Internet, psychology might inform the manner
in which compliance or adherence is measured and its effects on program success. An
example of this is presented by Manwaring, Bryson, and Goldschmidt (2008). Using
adherence measures, the number of weeks in an Internet-based treatment program, the
number of pages read over the Internet, the number of times engaged in online discussions,
and the use of a computer-based booster program, Manwaring and colleagues (2008) found
these measures to be a good gauge of patient compliance in an eating disorders program.
Other researchers in this area have studied whether particular subgroups of patients
are more or less likely to be compliant with medical orders. For example, one group of
researchers wanted to know who complies with instructions for physical exercise and who is
not compliant. Butcher, Sallis, and Mayer (2008) identified older adolescent girls and lower
income youth as segments of the population who were less likely to follow up on exercise
regimens. Using a 100-city sample, they found that these two groups did not adhere to
physical activity guidelines as presented. Though Butcher and colleagues did not provide
explanations for this finding, one could speculate that living in an inner city may present
unique challenges to being physically active. In a neighborhood where there are safety
concerns and a lack of recreational facilities, it may be much more challenging to find ways
to increase one’s physical exercise.
DiMatteo (2004) conducted a meta-analysis of studies examining medical adherence
and the role of social support. The study aimed to examine what types of support might
cause a patient to be more compliant. The results suggested functional social support (i.e.,
people giving help directly to the individual) to be more beneficial than structural social
support (e.g., marital status, living alone or with others). Of the ways in which functional
support was provided, practical social support (instrumental—providing information,
lending a hand) was the best predictor of medical adherence, suggesting that a team
approach to medical care is superior to an individual one. These patterns were helpful in
devising interventions to increase following of medical instructions.
The former studies emphasized patient characteristics that were relevant to
understanding compliance. However, it might not be surprising to know that some
physician characteristics also influence patient compliance. In an earlier study of how
physician characteristics related to patient adherence, DiMatteo and associates (1993)
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found that the physician’s ratings of overall job satisfaction, the number of patients seen by
the physician in a week, and his or her willingness to answer questions were all significantly
predictive of patient compliance. Thus, one could conclude that a physician who liked
what he or she was doing, was thoroughly engaged in the work, and communicated well
with patients was more effective at providing the type of environment that maximized
patient compliance. Such physicians also tend to have stronger relationships with their
patients, which may make it more likely they want to be seen as “good patients.”
From a number of the studies discussed, it seems obvious that supportive relationships
and a broader network of support for healthy behaviors are both important. It was more
than the correct technique or adequate technology; it was the ability of the medical system
to reach out to the consumers/clients, connect with them, and then make a meaningful
impact on the larger social context within which the consumers/clients reside. Given these
findings, it is easier to see how a community psychologist might find important ways to
contribute to improving the healthcare system.
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COMMUNITY PSYCHOLOGY AND THE HEALTHCARE SYSTEM
Revenson and Schiaffino (2000) argued that the cost versus benefit of our healthcare system
indicated that things were not working. They proposed that the focus on preventive health
services needed to be further developed and the emphasis on hospitals and emergency
rooms as primary sites for receiving medical care needed to be reexamined. Because many
of the physical illnesses that presently concern modern American medicine were related to
lifestyle choices and habits, community psychology could help in changing these from
unhealthy to healthy practices. They suggested that community intervention programs
should incorporate sociocultural contexts, build off of community strengths, emphasize the
adaptation of healthy behavior styles, seek change at the community level, and target
communities, rather than individuals, for intervention. Among the intervention strategies
they listed were mass media campaigns, community organizing, use of existing community
institutions such as schools and churches, and social policy changes. We next examine how
community psychology and community psychologists have contributed to these concepts.
Prevention over Remediation
The Stanford Heart Disease Prevention Project served as an excellent example of a program
aimed at public education of a targeted population on the topic of factors contributing to
heart disease. The project reported on use of media (newspapers, radio, TV, printed matter)
aimed at identified California coastal communities who were demographically at risk for
heart disease in comparison to the population in general. The targeted communities
showed significant improvement in heart disease–related factors in comparison to the one
control community without the educational program (Maccoby & Altman, 1988). A
second study on five cities produced similar findings in the two program-targeted urban
sites compared to three reference-control cities (Farquhar et al., 1985; Flora, Jatilus, &
Jackson, 1993). A followup study three years later showed these effects to have lasted
(Winkleby, Taylor, Jatilus, & Fortmann, 1996). The intervention phase lasted for six years.
Working with a multidisciplinary team, the Stanford Project showed the effectiveness of a
primary preventive, universal population, targeted multimedia program that included radio
and TV spots, flyers, and classes. The Stanford Project was similar to two other
community-based disease prevention programs of that era: the Minnesota Heart Health
Program (Luepker et al., 1994) and the Pawtucket Heart Health Program (Carleton,
Lasater, Assaf, Feldman, & McKinlay, 1995). All of these programs attempted to change
how individuals behaved within their community settings. They were multidisciplinary,
and they involved the targeted communities in organizing and implementing programs.
Other population-focused prevention programs have been developed and run
successfully. They used media along with multiple interventions within the community.
These programs worked to ensure community involvement in project development. This
involvement has helped establish and maintain new norms for behavior and new values to
sustain healthy choices (DuRant, Wolfson, LaFrance, Balkrishnan, & Altman, 2006; Jason,
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1998).
Shifting Focus from Individuals to Groups, Neighborhoods, and Systems
Whereas large community interventions are clearly the focus of public health initiatives, the
focus on groups, neighborhoods, and community systems has also been of interest to
community psychology. Further discussion of the public health perspective occurs in the
next chapter. However, suffice it to say that, as stated in previous chapters, the traditional
health focus, be it physical or mental health, is on treatment of the individual. Broadening
the focus of interventions from the individual to the community or neighborhood is a
strength of the community psychology tradition. The public health model of studying the
patterns of illness (i.e., epidemiology) and health and the factors that contribute to those
patterns also contribute to a community research methodology. The previous section on
prevention demonstrates the effectiveness of such interventions.
Stephens (2007) discussed the shift to health promotion efforts using community
concepts. We earlier provided descriptions of the debates over how to define community—
that is, whether it should be a matter of place or of identity (Campbell & Murray, 2004).
Beyond these basic considerations, what community psychology has added to this model
has been to define what variables contribute to the psychological awareness of
neighborhood and community and how this has been used to advance efforts to influence
entire groups. What were the natural boundaries to communities, who were the agents of
change within those groups, how was the message effectively communicated, and how was
the community awareness and motivation aroused (Altman & Wandersman, 1987; Imm,
Kehres, Wandersman, & Chinman, 2006; Manzo & Perkins, 2006; Nicotera, 2007;
Perkins, Florin, Rich, Wandersman, & Chavis, 1990; Shinn & Toohey, 2003)? An
extensive body of literature has addressed these issues. The work of Wandersman and his
colleagues has been previously cited in earlier chapters. Indicators of social cohesion versus
social disorganization, defined by existence of local friendship networks, and participation
in community organizations, as well as other neighborhood characteristics, have been
shown to be associated with physical health indicators (Caughy, O’Campus, & Brodsky,
1999; Shinn & Toohey, 2003). Goodness of fit between individual and social
environment—as defined by (1) similarities between the individual and the social
environment, (2) the individual’s needs and the environment’s resources, and (3) the
agreement of environmental features and individual preferences—has been linked to well-
being (Shinn & Rapkin, 2000). Following a review of the community context variables
studied in psychology, Shinn and Toohey (2003) caution against “context minimalization
error,” or a tendency to focus on the individual and to ignore the community/context that
brings about behaviors and health outcomes. Community psychology has brought a focus
on the larger picture. It has also helped conceptualize, develop, and evaluate systems
addressing health issues. This has many implications for improving healthcare.
Snowden (2005) wrote of “population thinking,” or consideration of given groups of
people, how well they do in their environment, and the variables affecting that status. The
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focus was on the social mechanisms and how they work. What brought about and what
maintained the population’s health or illnesses? In Snowden’s discussion, he cited the work
done on poor communities as a good example of what these analyses yielded. Poverty
placed communities at risk, but there have been poor communities where residents do well
—that is, they were resilient, a concept discussed in Chapter 3. Studies of these resilient
communities found them to have people who feel responsible for what happens and who
actively help their communities maintain a positive orientation. Poverty was not what brings
about the higher risks; it was that poverty made this positive orientation harder to
maintain.
Bolland, Lian, and Formichella (2005) found measures of social disruption and social
connectedness to predict levels of hopelessness in poor inner-city youth. It was not the
poverty per se but the exposure to violence, worry, and trauma (social disruption) and the
sense of community, warmth toward mother, and religiosity (social connectedness) that
influenced the hopelessness, with disruption increasing and connectedness decreasing
despair. Bolland (2003) had earlier found hopelessness to be related to risky behaviors.
Therefore, any work on hopelessness was really work on risky behaviors. The community
psychology orientation yielded social variables that have been demonstrated to have a link
to a community’s health. The lesson to be learned? Treat the social disruptions, intervene
in hopelessness, and decrease risky behaviors.
Building Systems
Community psychologists have long had interests in the creation of more functional
systems and settings (Sarason, 1972/1999). Emshoff and associates (2007) described a
program of collaboration building among community agencies that aimed to change
systems of healthcare in Georgia. Lasker, Weiss, and Miller (2001) have defined
collaboration as “a process that enables independent individuals and organizations to
combine their human and material resources so they can accomplish objectives they are
unable to bring about alone” (p. 183). Roussos and Fawcett’s (2000) review of
collaborations led them to the conclusion that the collaboration in itself brought about
changes to the system. Specifically, collaboration led to an increase in efficiencies in the
system (i.e., because duplication of services is reduced), and the overall functioning of the
health system for an area was improved. Emshoff and colleagues (2007) found that changes
in service delivery did occur in the first few years, that the number of meetings was directly
related to greater changes, and that the longer term collaborative leadership helped bring
about greater systems changes. The overall impression of the collaborative was that the
successful ones could do more and could do it better. This would fit with the belief of
Lasker and associates (2001) that when collaboration was best realized and created the
opportunity for synergy among the elements, the result was more than the sum of its parts.
The health community has come to realize that “most objectives… cannot be achieved by
any single person, organization or sector working alone” (Lasker et al., 2001, p. 179).
This study of forming new systems to provide services and the effects on service
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provision have been within the purview of community psychology. These collaborative
systems may represent the wave of the future for healthcare, with its attendant demands on
cost and the need for a variety of expertise and equipment.
Increasing Accessibility
TIMELY INTERVENTIONS. There are several ways to consider accessibility problems,
one of which has been discussed earlier in this chapter: the cost of services. Yet from a
secondary prevention point of view, timely interventions, early in the process—for example,
at first exposure to a risk factor—are one of the answers to the cost containment issue. As
noted earlier, some of the costs of healthcare are related to lifestyle choices. These choices
can and have been modified by psychological interventions at the community level.
Among the array of such programs is an early study on the reduction of a risky
behavior: not using seatbelts for securing children in cars (Fawcett, Seekins, & Jason,
1987). Through collection of data on actual seatbelt usage and social opinion data on
acceptability of requiring use, followed by strategic use of this information with legislatures,
community psychologists were able to help in the passage of child seatbelt laws in the states
of Kansas and Illinois. This program was successful before use of seatbelts came to national
attention. These laws helped pave the way for the seatbelt laws found throughout the
United States today. In today’s world, most people would consider the use of seatbelts to be
a normal behavior. However, this was not always the case. It is exciting to think that other
health-promoting behaviors (e.g., healthy diets) might one day be viewed in such a
“business as usual” fashion.
More recently, community psychology has provided research and programs in tobacco
use, alcohol use, and safe sexual practices. These efforts are described and discussed in the
next chapter. These are all health system interventions in that they are directly aimed at
changing behavioral contributions to healthcare. Pregnancy prevention is a topic covered
earlier in the text, within the chapter on social and health services. As noted there, infants
of teen mothers have lower birth weight and higher mortality rates. Case in Point 10.1
takes a second look at pregnancy prevention and community perspectives on what can help.
As was discussed earlier in this chapter, two elements that affect healthcare are a
willingness to take part in regular health visits and in increasing one’s health literacy
(knowledge of health-related issues). Having an annual checkup and being willing to visit a
physician when experiencing symptoms of any health problem means that a person is
willing to risk hearing bad news about his or her health (Rothman & Salovey, 1997). This
mindset and the ability to respond to such news constructively are influenced by knowledge
of procedures, cost, and the likelihood of treatment success. In addition, there are
expectations and assumptions regarding the resources that one has to call on, if there is
need for treatment. For example, it is often assumed that people trust physicians and will
readily reach out to them when symptoms arise. Yet this is often not the case. Reluctance to
go to the doctor delayed the diagnosis in this chapter’s first story. Delaying the inevitable
only places the potential patient at higher risk. Unfortunately, this behavior is typical of
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many ethnic minority community members, which may contribute to health disparities
such as breast cancer deaths (Buki et al., 2012). Unfortunately, in the case presented in the
story, waiting was fatal. So how can these disparities be addressed?
DEALING WITH DIVERSE COMMUNITIES. Snowden (2006) studied a variety of
clinic program variables believed to affect minority client use of mental health services in
California. Looking at Medi-Cal (California’s Medicaid program) patients, Snowden found
that outreach (where clinic staff would go out into the community to meet people and,
when needs were discovered, bring patients in to the clinic) helped increase Latino and
Native American use of mental health services. For Asian Americans, having clinic staff
who were bilingual (speaking English and an Asian language) or bicultural (being familiar
with American and Asian cultures) was associated with better care usage rates. In an
unexpected finding of this study, having bilingual and bicultural receptionists led to
decreases in Asian Americans receiving services, which may have to do with some element
of stigma that Asian Americans may experience in initiating mental health services. For all
groups, including Whites, increased numbers of mental health providers led to increased
use rates. These findings are highly suggestive of ways for programs to increase health usage.
CASE IN POINT 10.1
Teen Pregnancy Prevention
The U.S. teen pregnancy rate is the second highest among industrialized nations
(Darrouch, Frost, & Singh, 2001; Kirby, 2007). In a study of five developed Western
countries, Darrouch and associates (2001) found sexual activity in females before age 20 to
be nearly equivalent (see Table 10.2), yet the pregnancy rates for the United States were
notably higher (see Table 10.3). Among the reasons cited for this difference was that the
U.S. women were less likely to take measures to prevent pregnancy.
Kirby’s (2007) review of pregnancy prevention programs examined which ones had
been successful. He considered only programs that were examined using experimental or
quasiexperimental designs (see Chapter 2) and had an adequate sample size for meaningful
statistical analyses. He found that comprehensive prevention programs that taught
contraceptive procedures as well as encouraging abstinence could be effective. However,
abstinence-only programs did not demonstrate positive effects (which lends support to the
increased level of federal funding now available to more comprehensive sex education
programs). Programs that focused on nonsexual protective factors, such as plans for the
future, school performance, connections to family, and religion, were successful. Also,
participation in service learning programs, such as volunteering in the community, proved
to significantly decrease teen pregnancy rates. From program evaluations of a variety of teen
pregnancy programs, a clear picture emerges. More comprehensive programs have
demonstrated positive effects, and programs that are less comprehensive (e.g., abstinence
only) do not have evidentiary support.
TABLE 10.2 Percentage of Women Aged 20–24 Who Had First Intercourse before
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•
•
•
•
•
•
•
TABLE 10.2 Percentage of Women Aged 20–24 Who Had First Intercourse before
Age 20
Sweden: 86%
France: 83%
Canada: 75%
Great Britain: 85%
United States: 81%
TABLE 10.3 Teenage Birth Rate per 1,000 Births
Sweden: 7
France: 9
Canada: 20
Great Britain: 31
United States: 49
Beyond the evaluation of the specific programs, the importance of context to these
programs was demonstrated in the implementation of a comprehensive, school- and
community-based teen pregnancy prevention program in Kansas (Paine-Andrews et al.,
2002). This study found that the prevention program success varied as a function of the
amount of community change that resulted from the program. Specifically, in areas that
produced more system and program changes, the pregnancy rates dropped. In areas where
fewer system and program changes occurred, the pregnancy rates did not drop.
Pursuing the goal of providing the appropriate contexts and capacities for
implementation of effective teen pregnancy prevention programs, Rolleri, Wilson, Paluzzi,
and Sedivy (2008) described their work at the national level with Healthy Teen Network
and Education Training and Research Associates. Using a training model, they taught
practitioners in the use of a logical process for defining interventions through the Behavior,
Determinant, Intervention Logic model. This model called for a four-step process: goal
definition, identifying behaviors to achieve the goal, identifying determinants to those
behaviors, and identifying interventions to affect the determinants. Follow-up evaluations
and future work with the practitioner systems have continued to build their understanding
of the program and evaluation/research processes. The authors’ work has helped in the
implementation of prevention programs at the state level and built programs’ capacities to
do more science-based work.
In an outreach and education program for New York state on breast cancer, Rapkin et
al. (2006) used a partnership model between the state Department of Health and
community-based organizations (CBOs). This program, called ACCESS, brought
discussions of health information needs to specific community sites. From these
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discussions, interventions were developed for that particular site. Learning from the CBOs
about the targeted communities, the program could devise information tailored for the
population to be found in each given context. These site discussions resulted in more
effective interventions and in building better relationships with the community
organizations. At the end of the project, the CBOs requested more information and more
opportunities to work with the program. The community program worked to bring about
partnerships between the medical education center and the various sites (e.g., churches,
youth groups, schools), which extended the reach of the program out into the
neighborhoods. The program served as an entry point into these settings. The working
relationships that developed seemed likely to be useful for future efforts at extending
medical information beyond the traditional office or hospital settings. The program
described was ecologically formulated to promote growth. This would be the ideal goal for
any program, especially one that dealt with diversity in its many forms.
RURAL HEALTH. Making treatment relevant to the community is important. This
particularly applies in rural parts of the country. The ACCESS plan described in the last
section was a good example of working to make the interventions fit the settings where they
resided. These cancer education programs were in a variety of communities throughout
New York, which includes both rural and urban settings. In other programs focused on the
growth of rural health services, including the community in the process of determining
needs and services has had good results. Such empowerment of the community is very
much in the tradition of community psychology.
Two separate programs serving different parts of the country described similar
approaches to community inclusion in definition of problems and in decision making. In
North Dakota, organizations working in rural settings and in Native American
communities held meetings to define the healthcare barriers and to ask how the rural health
center could help (Moulton, Miller, & Offutt, 2007). From these conversations, strategic
plans were devised and groups formed to address the problems identified. The engagement
of the community in participating has resulted in more useful interventions for the targeted
groups. A second study in a similar vein used a participation model (Hoshin) for engaging
community members in defining goals, strategies, objectives, and action plans for health
programs in rural Hawaii. What they found was a great deal of involvement and agreement
within the participant groups. Among the common community needs identified were
economic factors within the community (poverty, unemployment, insurance, ability to
pay), drug use, lack of leadership, lack of health services or access to such services, lack of
healthy activities for youth, and poor public education. These concerns are broadly defined
and demonstrate an ecological perspective on the problems. All this emerges from
community discussions. The concerns of rural health are more than a lack of medical
doctors. They suggest that multilevel interventions for multideterminant problems are
needed, along with a comprehension of these needs within the rural community contexts.
Among the issues raised are those that might be characterized as social support and network
resources. We examine some of the work on the importance of social support next; keep in
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mind that these considerations might be guided by models of stress, coping, and resilience
described earlier.
Social Support and Health
Studies of the health benefits of a good social support system have been a part of the
community psychology literature for several decades (Wallston, Alagna, & DeVellis, 1983).
In their early review of the existing work on social support and health benefits, Wallston
and colleagues found few studies that clearly demonstrated the advantages of social support
for overall health. However, there was research indicating such support was helpful in
health recovery.
More than a decade later, however, a review of the literature by Uchino, Cacioppo,
and Kiecolt-Glaser (1996) found studies suggesting that social support was beneficial to
cardiovascular, endocrine, and immune system health. The precise physiological
mechanisms that affected these relationships were unclear. However, theories explaining the
relationship between social support and specific health outcomes were beginning to emerge.
Social interactions have the potential to shape attitudes, beliefs, knowledge, and emotions
about health problems, their prevention, and the importance of screening exams (Mobley,
Kuo, Clayton, & Evans, 2009). Social networks consist of friends, family, colleagues, and
other sources of contact (Katapodi, Falcione, Miaskowski, Dodd, & Waters, 2002) that
may lay the foundation for information acquisition about health (e.g., through discussions
within the family and peer education; Campos et al., 2008; McCloskey, 2009). Buki and
associates (2012) argue that when patients do not have adequate support, their health
literacy as well as follow-through with preventative behaviors may suffer.
An additional mechanism through which social support may affect health outcomes is
an indirect one. Social support was seen to influence both behavioral and psychological
processes, which then influenced physiological reactions related to positive health
(Berkman, Glass, Brissette, & Seeman, 2000; Uchino, 2004). Findings are starting to more
clearly demonstrate the physiological pathways from social support to the cardiovascular,
endocrine, and immune systems (Uchino, 2004, 2006). Social support is a community
variable. Interventions to improve social support may become a regular part of treatment
prescription. Experimental studies are examining the impact of programs to improve the
social connections of patients contending with medical conditions. If such treatments prove
successful, new systems for treatment will need to be implemented for dealing with health
promotion and health remediation.
Summary
The healthcare system appears to be a natural place for the application of community
psychology principles. Although there are a variety of healthcare systems in the world, the
United States serves as our focal point. In this national example, we found a sophisticated
and modern set of personnel and facilities, with vast amounts of money expended for care.
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Although U.S. technological and research capacities are among the world’s best, with vast
amounts of money in play, the outcomes still leave the United States ranking 26th in the
world for longevity.
In analyzing areas of concern that contribute to this ranking, several issues arise.
Among the more conspicuous are access and cost. Access can be defined in terms of timely
medical information and the means to gain and use that information. Cost, of course, has
to do with how much the individual and his or her family has to pay for this access. Clearly
defined populations within the United States are at risk because of access and cost
problems. These include those in rural settings, particular ethnic minority groups, and
those without health insurance. A second identified area of concern regarding healthcare
has to do with compliance issues. Of course, compliance may be influenced by cost and
access, but there are socially driven ways to increase compliance.
In response to these concerns, community psychology argues for the advantages of
prevention rather than reparative treatment; a focus on the efficiencies and benefits of a
community, neighborhood, or group focus for intervention; knowledge and technologies
for building systems of care; ways to increase accessibility; and knowledge of the healthy
effects of social support. Although community psychology historically has had issues with
the medical model, it has always been an advocate for the health model and the holistic
approach. The challenge and the opportunity is to realize the potential for community
psychology applied to health systems (Minden & Jason, 2002; Revenson & Schiaffino,
2000).
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Community Health and Preventive Medicine
TOBACCO
Extent of the Problem
Antitobacco Efforts
Community-Based Approaches
ALCOHOL
Extent of the Problem
Alcohol Safety Laws
A Community Psychology Approach
ILLICIT DRUGS
Extent of the Problem
Possible Solutions and Challenges
CASE IN POINT 11.1 Prescription Drug Misuse: Risk Factors for Problem
Users
SEXUALLY TRANSMITTED DISEASES
Extent of the Problem
Possible Solutions and Challenges
HIV AND AIDS
Overview
Extent of the Problem
Complexities and Controversies
Possible Solutions: Community-Based Approaches
CASE IN POINT 11.2 Evaluation and Implementation of STD/HIV
Community Intervention Program in Lima, Peru
CASE IN POINT 11.3 The Bilingual Peer Advocate (BPA) Program
OBESITY
Scope of the Problem
Community Prevention Efforts
SUMMARY
All human actions have one or more of these seven causes: chance, nature, compulsion, habit,
reason, passion, and desire.
—Aristotle, c. 384–322 BCE
Elizabeth is a freshman in college at a large state school. She considers herself similar to many of her peers—she drinks
on the weekends and has occasionally blacked out. Elizabeth likes to have a good time, but she definitely thinks she
doesn’t have a problem. On homecoming weekend, she spends the day tailgating and pregame partying. In the evening,
she attends several parties, where she takes multiple shots of vodka and plays various drinking games. At one of the
parties, she runs into Jake from her chemistry class, who proceeds to flirt with her all evening. When Jake suggests that
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she come back to his place, Elizabeth eagerly joins him; he is cute, and she reminds herself that this is what college is all
about. They end up having drunken sex, and in the morning Elizabeth realizes that in their inebriated state they did not
use a condom. Her mind races: She is not taking birth control pills—what if she gets pregnant? Jake is a nice guy, but
people say he gets around. What if he has a sexually transmitted disease (STD)? Where could she go for help?
Biological and natural sciences have made tremendous progress in recent decades, ranging
from the first open heart surgery, to the cloned sheep named Dolly, to the morning-after
pill and the so-called miracle drug Viagra (sildenafil). Yet, as discussed in Chapter 10, there
exist great health disparities: Americans and people living in the industrialized world are
dying from noncommunicable and often preventable diseases, whereas in the developing
world people are dying of communicable diseases and easily treatable infections (Centers
for Disease Control and Prevention [CDC], 2011a). Although the overall health status of
Americans has improved greatly, there still exist great public health challenges. In 2009,
there were more than 10,800 fatalities in crashes involving a driver with a BAC of .08 or
higher, representing 32% of traffic fatalities for that year (National Highway Traffic Safety
Administration, 2011). Infectious diseases (including some STDs) are at an all-time high,
coupled with the emergence of drug-resistant bacteria and viruses (Morbidity and Mortality
Weekly Report [MMWR], 2011). Globally, 33 million people are living with human
immunodeficiency virus (HIV) (United Nations Programme on AIDS/HIV [UNAIDS],
2010). Collectively, these scenarios speak to the importance of community health and
preventive medicine as integral components of a healthy lifestyle. With education and
prevention campaigns, Elizabeth would have recognized her risky behavior and been able to
access available resources.
To that end, this chapter examines six health issues from the perspectives of
community psychology and preventive medicine; policy-based prevention targeting society
in general or a single community are also discussed. These health issues were chosen for two
main reasons. First, they have each received enormous attention in the media. Second, each
is highly preventable if certain precautions are taken. Finally, a large number of people are
affected or have the potential to be affected by these issues if no prevention efforts are
made.
Statistics used to describe each of the health issues are drawn from various agencies in
the U.S. Department of Health and Human Services (DHHS) and other federal (e.g.,
National Highway Traffic Safety Administration), state (e.g., Massachusetts Department of
Public Health), national (e.g., American Public Health Association), and local (e.g., Asian
and Pacific Islander Coalition on HIV/AIDS), as well as international (e.g., the United
Nations Programme on HIV/AIDS [UNAIDS]), entities. Each agency or source has its
own approach and method for estimating the extent of a health issue. For example, the
Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within
the DHHS whose mission is providing substance-abuse treatment and services, conducts
the National Household Survey on Drug Abuse targeting noninstitutionalized individuals
age 12 and older nationwide. Another DHHS agency, the Centers for Disease Control and
Prevention (CDC), whose mission is public health epidemiology and surveillance, conducts
the Youth Risk Behavior Surveillance System (YRBSS)—a school-based survey—and also
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yields estimates of alcohol use. Given this variability and the lag time in reporting the latest
findings, you are encouraged to check these various resources for their methodologies and
updated information (see Table 11.1 for some examples).
TABLE 11.1 Some Resources for Health-Related Statistics and Information
Agency Source Web Address
American Psychological
Association
APA Monitor (June 2001,
special issue on substance
abuse)
www.apa.org
American Public Health
Association
The Nation’s Health www.apha.org
Asian and Pacific Islander
Coalition on HIV/AIDS
www.apicha.org
Asian and Pacific Islander
Wellness Center
www.apiwellness.org
Centers for Disease Control
and Prevention (including
National Center for Health
Statistics, Office on Smoking
and Health)
Morbidity and Mortality
Weekly Report Behavior Risk
Factor Surveillance (adults
only) Youth Risk Behavior
Surveillance System
www.cdc.gov
Food and Drug
Administration
www.fda.gov
Legacy Foundation www.americanlegacy.org
National Institutes of Health
(including National Cancer
Institute, National Institute
on Drug Abuse)
www.nih.gov
Office of National Drug
Control Policy
www.whitehouse.gov/ondcp
Substance Abuse and Mental
Health Services
Administration
National Household Survey
on Drug Abuse
www.samhsa.gov
United Nations Programme
on HIV/AIDS
AIDS epidemic update
Declaration of Commitment
on HIV/AIDS
www.unaids.org
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TOBACCO
Extent of the Problem
According to the World Health Organization (2011), globally, tobacco use is the cause of
more than 5 million deaths each year. According to the CDC (2011b):
For every person who dies from a smoking-related disease, 20 more people suffer with
at least one serious illness from smoking (e.g., heart disease, stroke, emphysema).
Worldwide, current trends show that tobacco use will cause more than 8 million
deaths annually by 2030.
In the United States, tobacco use is responsible for about one in five deaths annually
(i.e., about 443,000 deaths per year, and an estimated 49,000 of these smoking-related
deaths are the result of secondhand smoke exposure).
On average, smokers die 13 to 14 years earlier than nonsmokers.
Acetaldehyde (irritant)
Benzopyrene (cancer-causing agent)
Cadmium (used in car batteries)
Formaldehyde (embalming fluid)
Lead (nerve poison)
Nicotine (addictive drug)
W-Nitrosamines (cancer-causing agents)
Polonium-210 (radioactive element found in nuclear waste) Uranium-235 (radioactive element used in nuclear
weapons)
FIGURE 11.1 Some Ingredients in Smokeless Tobacco
Tobacco use is the leading preventable cause of death. Yet, each year, it causes more
deaths than HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders
combined (CDC, 2011b). Tobacco use and smoking are often used interchangeably; note,
however, that tobacco use also includes smokeless tobacco (see Figure 11.1), which is linked
to various oral cancers.
The National Household Survey on Drug Use and Health (NSDUH) is the
primary source of information on the prevalence, patterns, and consequences of drug and
alcohol use and abuse in the general U.S. civilian noninstitutionalized population
(including shelters, rooming houses, dormitories, and civilians living in military bases) aged
12 and older (see http://oas.samhsa.gov/nsduh/2k7nsduh/2k7results.cfm#Ch4). With
regard to tobacco, results from the 2007 NSDUH survey indicated that 70.9 million
Americans aged 12 or older were current tobacco product users, representing 28.6% of the
population in that age range. In addition, young adults between the ages of 18 and 25 had
the highest rate of current tobacco product use, comprising 41.8% of users. In terms of
gender, the 2007 survey found that current use of a tobacco product was reported by a
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higher percentage of males (35.2%) among persons aged 12 or older than females (22.4%).
In women aged 15 to 44, combined 2006 and 2007 data indicated that the rate of cigarette
use in the past month was lower among pregnant women (16.4%) than among women
who were not pregnant (28.5%). However, when isolating the women aged 15 to 17, the
rate of cigarette smoking for pregnant women (24.3%) was significantly higher than for
nonpregnant women (16%). The NSDUH also analyzes tobacco product use across several
other determinants, including education, employment, and geographic area (SAMHSA,
2007).
The YRBSS is a nationwide survey funded by the CDC that monitors priority health-
risk behaviors among youth and young adults, including 40 state surveys and 21 local
surveys among students in grades 9 through 12 (MMWR, 2011). Findings indicated that,
in 2010, 19.5% of students had smoked cigarettes on at least one day in the preceding 30
days (“current cigarette use”). White and Hispanic students were more likely (22.5% and
18%, respectively) than Black students (9.5%) to report current smoking. Overall, cigarette
use in general was higher among male (19.8%) than female students (19.1%). In terms of
age, older students were more likely to smoke than younger students. In 2010, only 5.2%
of middle school students reported having smoked cigarettes. After decelerating
considerably in recent years, the long-term decline in cigarette use, which began in the mid-
1990s, came to a halt in the lower grades in 2010. Indeed, both 8th and 10th graders
showed evidence of an increase in smoking in 2010, though the increases did not reach
statistical significance (Johnston, O’Malley, Bachman, & Schulenberg, 2010). Perceived
risk and societal disapproval had both leveled off some years ago, which may account for
this trend.
Among women, cigarette smoking increases the grave risk for infertility, preterm
delivery, stillbirth, sudden infant death syndrome (SIDS), and low birth weight (U.S.
Department of Health and Human Services, 2011 ). Birth weight is directly correlated with
chances of child survival. Smoking also strongly contributes to ectopic pregnancy and
spontaneous abortion (U.S. Department of Health and Human Services, 2011).
Nevertheless, 13% to 17% of pregnant women continue to smoke throughout their
pregnancies (U.S. Department of Health and Human Services, 2011).
Another way to appreciate the negative consequences of smoking is to calculate or
estimate the money needed to provide medical and health-related services to people who are
suffering or dying from smoking-related diseases or illnesses. These services include but are
not limited to ambulatory care, prescription drugs, hospital care, home health services, and
nursing home care. These services are used to calculate state medical expenditures—the
financial cost to the state in providing medical and health-related services to people
suffering from smoking-attributable diseases or illnesses (CDC, 2011b). During 2000–
2004, cigarette smoking was estimated to be responsible for $193 billion in annual health-
related economic losses in the United States ($96 billion in direct medical costs and
approximately $97 billion in lost productivity) (MMWR, 2008).
Even nonsmokers are not safe from tobacco-related health issues. Secondhand smoke,
formally called environmental tobacco smoke (ETS), is classified as a Group A (known
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human) carcinogen by the U.S. Environmental Protection Agency. In fact, more than 50
individual carcinogens have been identified in secondhand smoke (U.S. Department of
Health and Human Services, 2006). Exposure to secondhand smoke alone causes
approximately 49,400 deaths each year from heart or lung disease in nonsmokers (CDC,
2011b). Although there has been a decline in exposure of nonsmokers to secondhand
smoke since 1986, secondhand smoke remains a major cause of premature death and
disease among both children and adults (U.S. Department of Health and Human Services,
2006). Despite efforts to control tobacco in public areas, millions of American nonsmokers,
children and adults alike, are still exposed to secondhand smoke, especially in their homes
and workplaces (U.S. Department of Health and Human Services, 2006).
Antitobacco Efforts
Since the establishment of the connection between tobacco use and lung cancer and several
other health issues, antitobacco efforts have taken place at many levels, spanning from
elementary school awareness programs to state-enforced smoking bans in restaurants. Based
on the connection between smoking and lung cancer, the National Cancer Institute
(NCI), as part of the U.S. National Institutes of Health, funds a number of smoking
awareness and prevention programs. One program was the America Stop Smoking
Intervention Study (ASSIST). The study, which took place from 1991 to 1999, was one of
the largest government-funded demonstration projects to help states develop effective
smoking reduction strategies. ASSIST provided funding for 17 states and found a
noticeable decrease in per capita cigarette consumption among the states that experienced
improvement in tobacco control policies. The study also sheds light on the latest evidence
available with regard to state tobacco control programs: investing in state tobacco control
programs that focus on strict policies and regulation is an important and effective strategy
for reducing tobacco use (National Cancer Institute, 2004).
The American Legacy Foundation, “dedicated to building a world where young
people reject tobacco and anyone can quit,” is a foundation that has developed a number of
programs to combat tobacco and cigarette smoking (American Legacy Foundation, 2008a).
The foundation has been involved in antitobacco efforts from the national “Truth” youth
smoking prevention campaign to research initiatives aimed at tobacco reduction and
outreach programs that target smoking cessation among priority populations (American
Legacy Foundation, 2008b). Among one of the foundation’s most recent campaigns is the
Smoke Free Movies Campaign. With the motivation of eliminating the deep smoking
impressions left by Hollywood on youth, the campaign aims to make any new movie with
smoking in it rated R, end brand appearances on the screen, and include antismoking ads
before movies that contain tobacco of any sort (American Legacy Foundation, 2008a).
At the global level, the World Health Organization (2008c) has created a new
landmark report that represents “the first in a series of WHO reports that will track the
status of the tobacco epidemic and the impact of interventions implemented to stop it.”
The report outlines six policies as part of the WHO’s MPOWER package that will serve to
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•
•
•
•
•
•
“counter the tobacco epidemic and reduce its deadly toll.” The components of the
MPOWER package consist of the following:
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion, and sponsorship
Raise taxes on tobacco
Despite a variety of antitobacco efforts, every year the tobacco industry spends millions of
dollars in advertising and promoting tobacco (e.g., free coupons, or leather jackets with
logos of the product). In 2006, cigarette companies spent $12.4 billion on advertising and
promotional expenses in the United States alone, down from $13.1 billion in 2005, but
more than double what was spent in 1997 (CDC, 2011b). In addition, the industry is
quick to use image-based propaganda, which has been demonstrated to be effective with
youth as well as the less educated. For instance, DiFranza and colleagues (1991) found that
Joe Camel (a cartoon character smoking a Camel cigarette) was more readily recognized by
children than Mickey Mouse. Although the U.S. government has implemented policies
restricting the use of such characters in advertising in the United States, such images
continue to be used in international markets. Based on the money spent on advertising
alone, those who engage in antitobacco efforts (including the NCI and the WHO) are
facing a Herculean task in creating effective antitobacco and antismoking public health
efforts.
Community-Based Approaches
Among the 15.7% of underage students (under 18) who reported being habitual smokers
in 2009, 14% usually bought them on their own in a store or gas station, presumably
without proof of age (MMWR, 2010a) suggesting that health-related legal policy (e.g., “No
sale to minors”) is just the first step in the fight for a smoke-free environment (Jason, Berk,
Schnopp-Wyatt, & Talbot, 1999), and one that is obviously not adequate to stop the
problem. Biglan and associates (1996) argued that
many law enforcement officers feel that there are more important crimes to deal with
and that judges will be annoyed if such cases are brought before them. In addition, if
the value of reducing such sales has not been adequately publicized, there is a risk that
enforcement will produce a backlash against tobacco control efforts. (p. 626)
These sentiments are still true today. So if laws are ineffective in curbing dangerous
behaviors such as smoking, what other strategies would be more effective? Researchers in
this field believe that members of a community must have a sense of ownership of health
related problems, including how they view and implement health-related legal policy. To
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test this premise, Biglan and colleagues designed a five-component intervention program to
reduce youth access to tobacco products in two small Oregon communities. The outcome
of interest was the proportion of tobacco outlets in the community that were willing to sell
tobacco products to youth.
Using a quasi-experimental design, Biglan and colleagues (1996) conducted their
intervention in the two selected Oregon communities; two other similar communities did
not receive the intervention. Specifically, activities of mobilization of community support
included a letter and signature campaign sought from members of various community
sectors (e.g., school district, healthcare providers, and civic organizations) to produce a
proclamation that tobacco would not be sold to youth. Merchant education involved visits
and distribution of the proclamation to all tobacco outlets. A modified sting operation was
employed to change consequences to clerks for selling or not selling tobacco to those under
age 18. That is, those who complied with the law were rewarded each time with a gift
certificate worth $2 for use in a local business. Those who violated the law were given a
reminder of the law and the community proclamation of no sale of tobacco to youth. These
activities were described in public media (e.g., newspapers) as part of the publicity
intervention strategy. Finally, owners of tobacco outlets were personally informed about these
activities (identities of clerks were masked). In brief, the five components represented a
range of macro-level (e.g., mobilization of community) to micro-level (e.g., feedback to
store owners) comprehensive community intervention strategies. Results indicated that
tobacco outlets’ willingness to sell tobacco products to youth was significantly lower in the
intervention group than in the control group.
The research by Biglan and colleagues (1996) speaks to the importance of
community-based involvement in augmenting health-related legal policy. Unfortunately,
the significance of community norms and sentiment toward substance use may not be well
understood by the population in general. Many people may not realize that their
community as a whole can have an impact on issues such as tobacco access among youth.
To explore the adult attitudes and beliefs surrounding the issue of restricting youth access
to tobacco, Siegel and Alvaro (2003) conducted a study in two Arizona counties. According
to their findings, an overwhelming majority of adults believed that it was easy for minors to
get access to tobacco and that the parents of the youth purchasing tobacco were most
responsible for the problem. Furthermore, most adults responded that “there is nothing
that they or the community can do to stop minors who wish to purchase tobacco.” Clearly,
although there are proven cases in which the community at large can play a significant and
important role in improving the status of a health-related issue, there is also a sense that
individual community members do not understand their role as part of the fabric of the
community. This sense of disempowerment is a social justice issue that affects many
communities that are at highest risk for substance use problems.
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ALCOHOL
Extent of the Problem
In addition to cigarettes, alcohol is a gateway drug to other drug use and abuse. In some
ways, one could argue that alcohol, independent of its relationship to other drugs, is more
of a health risk to young people than are all other drugs including tobacco. First, drugs like
tobacco do the most damage when used over long periods of time, as opposed to alcohol,
which can result in life-threatening circumstances in a single use (e.g., drunk driving
accidents). Second, alcohol is perceived as a much more socially acceptable drug than is
tobacco. For example, it is unlikely that there will be a day when consuming alcoholic
beverages in a restaurant is banned the way that smoking has been banned in most
restaurants. Third, although there is a legal age limit for both alcohol and tobacco, a
disturbing number of underage youths have and will use alcohol at some point in their
lives. For example, according to the 2009 YRBSS data (MMWR, 2010b), 72.5% of all
students had had at least one drink of alcohol during their lifetimes. Furthermore, it
appears that the age at which youths are having their first experiences with alcohol are quite
young. For example, 21.1% of students had drunk alcohol for the first time before age 13
and 63.4% of 9 th graders had already had their first experience with alcohol. Gender, age,
and racial/ethnic differences served to further define the profile of students who drank
alcohol by the time they reached 9th grade. For example, a higher percentage of females
(66.4%) reported having drunk before by 9th grade than did males (60.8%). However, a
higher percentage of males (23.7%) than females (18%) had had their first drink by age 13.
Nationwide, 41.8% of students were current alcohol users (or had least one drink of
alcohol in the past 30 days). Current alcohol use also varied across gender, age, and
racial/ethnic differences. For example, current alcohol use was more prevalent among
White and Hispanic females (45.9% and 43.5%, respectively) than Black females (35.6%).
Furthermore, 24.2% of all students had participated in episodic heavy drinking (at least five
drinks of alcohol in a row within a couple of hours on more than one of the 30 days
preceding the survey). Prevalence of episodic heavy drinking was higher among male (30%)
11th graders than among those who were female (26.5%). In addition, White students
(27.8%) were more likely to have taken part in episodic heavy drinking than Black (13.7%)
and Hispanic (24.1%) students.
In terms of trends that researchers have seen over the past several decades, alcohol use,
including binge drinking, continued its longer term decline among teens, reaching
historically low levels in 2010 (Johnston et al., 2010). Use has been in a long-term pattern
of decline since about 1980, with the interruption of a few years in the early 1990s in
which alcohol use increased along with the use of cigarettes and almost all illicit drugs. For
example, among 12th graders in 1980, 41% admitted to having five or more drinks in a
row on at least one occasion in the two weeks before the survey. This statistic fell to 28%
by 1992, before its rebound in the 1990s, but has now fallen further, reaching 23% in
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2010—a marked improvement (Johnston et al., 2010).
Alcohol use before or during sex is a major risk for unprotected sex (Cooper, 2002),
which might result in unwanted pregnancy and acquisition of STDs (including HIV).
According to the 2009 YRBSS data, nearly one-fifth (21.6%) of all students had used
alcohol or drugs before their most recent sexual intercourse. (Overall, 34.2% of students
were sexually active at the time of the survey.) Prevalence of drinking alcohol or using drugs
before the last sexual intercourse was much higher among male (25.9%) than female
(17.1%) students. In terms of racial/ethnic differences, White and Hispanic students
(22.9% and 18.9%, respectively) were more likely to engage in this behavior than Black
students (18%). Note, however, that a higher percentage of Black students (47.7%)
reported being currently sexually active (had sexual intercourse with at least one person
during the three months preceding the survey) than White and Hispanic students (32.0%
and 34.6%, respectively).
Finally, binge drinking is a major issue associated with alcohol use and abuse that
spans from college campuses to entire societies across the globe. The National Institute of
Alcohol Abuse and Alcoholism defines binge drinking as “a pattern of drinking that brings
a person’s blood alcohol concentration (BAC) to 0.08% or above,” a level that is usually
reached by men after consuming five or more drinks and by women after consuming four
or more drinks in a time span of approximately two hours. According to the CDC, binge
drinking is associated with a multitude of health problems, from unintentional injuries and
neurological damage to sexual dysfunction and liver disease (CDC, 2011e). In the United
States, binge drinking makes up a large part of alcohol consumption. In fact, approximately
90% of alcohol consumed by youth under 21 years of age is in the form of binge drinks
(Pacific Institute for Research and Evaluation, 2005). In addition, about 92% of adults
who drink excessively report binge drinking within the past 30 days (Town, Naimi,
Mokdad, & Brewer, 2006).
Might there be a cultural component to binge drinking? International research has
examined use patterns in countries that are known to have higher levels of alcohol abuse
and dependency. For example, for Russians, who have been found by several sources to
drink less frequently but consume larger amounts of alcohol per occasion, binge drinking is
a specific norm of alcohol consumption (Bobak et al., 2004; Jukkala, Makinen, Kislitsyna,
Ferlander, & Vagero, 2008; Leinsalu, 2004; Simpura, Levin, & Mustonen, 1997). In their
2008 study, Jukkala and colleagues explained binge drinking as an important factor in
Russia’s mortality crisis and found binge drinking patterns to be related to an individual’s
“economic situations and social relations.” Furthermore, gender was found to be an
important factor in whether an individual would participate in binge drinking. Some of the
key findings were as follows:
Russian men with economic problems drink heavily, whereas women with economic
problems drink less.
Married Russian men binge drink as much as their nonmarried friends, whereas
married women binge drink much less than their nonmarried friends.
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Russian women’s drinking is concentrated in the context of friends, whereas men’s
occurs elsewhere.
Drinking patterns indicate that Russian women and young people of both genders
seem to be drinking more than they were previously.
Although the study sheds light on issues that justify worry with regard to the future of
Russia’s alcohol-related problems, it also makes important connections between individual
health and the community (i.e., accepted norms around drinking) with regard to binge
drinking. Because binge drinking is a possible contributor to the “extremely large gender
gap in Russian mortality statistics,” these connections can potentially serve as important
points of emphasis in a community health approach to solving important public health
issues (Jukkala et al., 2008). When addressing preventive health issues across the globe, it is
necessary to assess the community in terms of its own unique cultural phenomena.
Alcohol Safety Laws
In the United States, motor vehicle crashes are the leading cause of death for Americans
between the ages of 2 and 34 years, and 41% of these fatal crashes involve alcohol
(National Highway Traffic Safety Administration, 2008). Approximately one-third of
driving while intoxicated (DWI) or driving under the influence (DUI) arrests each year
involve individuals who were previously convicted of DWI or DUI (National Highway
Traffic Safety Administration, 2008). Furthermore, impaired driving is the most frequently
committed crime in the United States (National Highway Traffic Safety Administration,
2008).
Despite these grim statistics, alcohol-related deaths have been more controlled today
than they were before the 1990s, due in part to a series of laws that have sought to limit
and discourage alcohol-related driving incidents. In one study Voas, Tippetts, and Fell
(2000) evaluated the effect of three major alcohol safety laws, including administrative
license revocation laws, 0.10 illegal per se laws, and 0.08 illegal per se laws. The results of
the study indicated that each of the three types of laws had a significant relationship to the
downward trend in alcohol-related fatal crashes in the United States between 1982 and
1997. The study also pointed out that the significant decline in alcohol-related fatal crashes
could not be attributed to one single law, but to the combined effect of several laws over
time. However, as was the case with tobacco laws, the fact that such policies exist and are
enforced cannot be the sole reason that drinking and driving is on the decline. Other
factors, such as the media’s attention to drinking-and-driving issues and increased use of
sobriety checkpoints, were also identified as possibilities not tested in the model but that
may also have contributed to the decline. The many contributors to increased alcohol safety
on the road show the importance of implementing a comprehensive community approach
when addressing preventive health issues such as limiting the number of deaths or injuries
as a result of traffic accidents.
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A Community Psychology Approach
As argued earlier, health-related legal policy is most effective when people feel they are
empowered to make informed choices and decisions, including why they should heed
health advice by experts or government officials. A key component in this equation is that
empowerment (and its effect on decision making) often begins at home (e.g., parents talk
to their children about the good and bad of drinking, premarital sex) and at school (e.g.,
peers for prosocial behaviors). In other words, values and skills learned and supported by
peer norms are thought to be instrumental in health-related decision-making processes.
Thus, next is a brief review of a study using parent–child involvement as a strategy to
address alcohol use among youth.
Spoth, Randall, Shin, and Redmond (2005) studied family- and school-based alcohol
abuse prevention strategies’ effects on ability to delay initiation and decrease regular use and
weekly drunkenness in a large-scale randomized clinical study involving middle schoolers.
The study compared the effectiveness of a family-focused program combined with a school-
based intervention, a school-based intervention without the family program, and a no-
treatment control group. The family-focused program was the Iowa Strengthening Families
Program (Spoth, Redmond, & Shin, 2001; Spoth, Redmond, Shin, & Aze-vedo, 2004),
and the school-based intervention was the Life Skills Training program (LST; Botvin,1996;
Botvin, Baker, Dusenbury, Botvin, & Diaz, 1995).The family-focused intervention
included seven sessions that involved parent education, youth skills building, and a joint
family session where participants practiced their new skills with other families. The
individual youth sessions focused on strengthening future goals, dealing with stress and
strong emotions, increasing the desire to be responsible, and building skills to appropriately
respond to peer pressure. Topics covered in parent sessions included discussing social
influences on youth, understanding developmental characteristics of youth, providing
nurturant support, dealing effectively with youth in everyday interactions, setting
appropriate limits and following through with reasonable and respectful consequences, and
communicating beliefs and expectations regarding substance use.
The primary goals of the 15-session LST are to promote skills development (e.g.,
social resistance, self-management, and general social skills) and to provide a knowledge
base concerning the avoidance of substance use. Students are trained in the various LST
skills through the use of interactive teaching techniques, including coaching, facilitating,
role modeling, feedback, and reinforcement, plus homework exercises and out-of-class
behavioral rehearsal. The results of their analyses revealed that the multicomponent
intervention generally showed stronger results in intervention–control comparisons than
did the control comparisons with LST only and the no-treatment control group, especially
on measures of delaying initiation and weekly drunkenness. Unfortunately, there were not
the same positive effects of regular use of alcohol.
Results from studies such as Spoth and associates (2005) suggest that although we
have identified solid programs to prevent alcohol abuse in youth, we have not yet figured
out how to minimize youths’ temptation to use alcohol at all.
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Vimpani (2005) states, however, that “much remains to be done to enable the promise
of effective universal and targeted early intervention to be translated into policies, programs
and practices.” Thus, although many relationships between early alcohol intervention, the
family, and the community have been established, existing programs that serve to take
advantage of these important connections are still lacking.
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ILLICIT DRUGS
Extent of the Problem
Use of illicit drugs is a problem across the globe. According to the World Health
Organization (2010), at least 15.3 million people in the world have drug use disorders.
Drug use not only causes adverse personal and community health consequences, it is also
the source of a huge economic and financial burden in terms of treatment for drug users in
the short and long term. As a result, investing in drug treatment early on can limit future
health and social costs. In fact, for every $1 invested in drug treatment, approximately $10
is saved in health and social costs (WHO, 2010).
In the United States, among other countries, youth drug use is a serious issue.
According to the YRBSS survey (MMWR, 2010b), at least one instance of use (“ever
used”) of (1) marijuana, (2) cocaine (including powder, crack, and freebase), (3) illegal
injection drugs, (4) illegal steroids, (5) inhalants, (6) hallucinogenic drugs (including
LSD [lysergic acid diethylamide], acid, PCP [phencyclidine] [angel dust], mescaline, and
mushrooms), (7) heroin, (8) methamphetamine (also known as “speed,” “crystal,”
“crank,” and “ice”), and (9) ecstasy (methylenedioxymethamphetamine, MDMA) was
reported by 36.8%, 6.4%, 2.5%, 3.3%, 11.7%, 8.0%, 2.5%, 4.1%, and 6.7%, respectively,
of all students. Less than 1 in 10 of all students (7.5%) had tried marijuana before 13 years
of age. There were gender, grade, and racial/ethnic differences in this behavior. For
example, male students (9.7%) were significantly more likely than female students (5%) to
have tried marijuana before age 13. The study also began asking about prescription drug
abuse, given its rise in popularity. Nationwide, 20% of students had taken prescription
drugs (e.g., Oxy-Contin, Percocet, Vicodin, Adderall, Ritalin, or Xanax) without a doctor’s
prescription one or more times during their life. Overall, the prevalence of having ever
taken prescription drugs without a doctor’s prescription was higher among White (23.0%)
than Black (11.8%) and Hispanic (17.2%) students. Compared to other illicit drugs that
have been traditionally the concern of parents, it seems clear that more attention must be
paid to prescription drug abuse given the easier access that exists to such drugs.
Marijuana was the most popular choice of drug—20.8% of all students had used
marijuana one or more times during the 30 days preceding the survey. However, there is a
great deal of variability in illegal drug use depending on such factors as gender, grade, and
race/ethnicity. For example, male students were more likely than female students to have
ever used marijuana (39.0% versus 34.3%) and illegal steroids (4.3% versus 2.2%), whereas
females were more likely than males to have ever used inhalants (12.9% versus 10.6%). In
addition, White and Hispanic students (6.3% and 9.4%, respectively) were more likely to
report having ever used cocaine than Black students (2.9%).
In terms of trends of illicit drug use over the past few decades, according to Johnston
and colleagues (2010), marijuana use, which had been rising among teens for the past two
years, continued to rise in 2010 in all prevalence. This stands in stark contrast to the long,
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gradual decline that had been occurring over the preceding decade. Of particular relevance,
daily marijuana use increased significantly in all three grades in 2010 and stands at 1.2%,
3.3%, and 6.1% in grades 8, 10, and 12. In other words, nearly 1 in 16 high school seniors
today is a current daily, or near-daily, marijuana user. There was a significant increase in
heroin use using a needle among 12th graders in 2010, with annual prevalence rising from
0.3% in 2009 to 0.7% in 2010. Cocaine and powder cocaine use continued gradual
declines in all grades in 2010. Sedative use and use of narcotics other than heroin, which
are reported only for 12th graders, similarly continued their slow, nonsignificant declines in
2010. The use of quite a number of drugs held fairly steady in 2010, including LSD,
hallucinogens other than LSD taken as a class, PCP, crack cocaine, heroin without using
a needle, OxyContin, amphetamines (Ritalin and Adderall specifically),
methamphetamine, crystal methamphetamine, tranquilizers, cough and cold medicines
taken to get high, several so-called “club drugs” (Rohypnol, GHB, and ketamine), and
anabolic steroids. Johnston et al. (2010) also note that the drugs that are not down much
from peak levels are the narcotics other than heroin.
The misuse of psychotherapeutic prescription drugs (amphetamines, sedatives,
tranquilizers, and narcotics other than heroin) has become a more important part of the
nation’s drug problem in recent years. Use of most of these classes of drugs continued to
increase beyond the point at which most illegal drugs ended their rise in the late 1990s; use
of the latter group of illegal drugs has declined appreciably since then (Johnston et al.,
2010). The proportion of 12th graders in 2010 reporting use of any of these prescription
drugs without medical supervision in the prior year was 15.0%, up slightly from 14.4% in
2009 but a bit lower than in 2005, when it was 17.1%. Lifetime prevalence for the use of
any of these drugs without medical supervision in 2010 was 21.6%.
Because most illicit drugs are not regulated for content, it is impossible for users to be
sure exactly what they are consuming. Marijuana, for example, may be more dangerous for
users today than it was 30 years ago. At the time of this writing, levels of THC, the
psychoactive ingredient in marijuana, are at the highest recorded amount since scientific
analysis of marijuana began at the end of the 1970s (Office of National Drug Control
Policy, 2008). The outcome of the analysis of THC levels from the University of
Mississippi’s Potency Monitoring Project, released by the Office of National Drug Control
Policy (ONDCP) and the National Institute on Drug Abuse (NIDA), is cause for
authorities to be concerned. In the ONDCP press release on increased marijuana potency,
John Walters, director of National Drug Control Policy and former President Bush’s “drug
czar,” expressed his concern (echoed by Johnston et al., 2010) with the finding:
Baby boomer parents who still think marijuana is a harmless substance need to look at
the facts. Marijuana potency has grown steeply over the past decade, with serious
implications in particular for young people, who may be not only at increased risk for
various psychological conditions, cognitive deficits, and respiratory problems, but are
also at significantly higher risk for developing dependency on other drugs, such as
cocaine and heroin than are non-smokers.
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Finally, there are many dire consequences due to illicit drug use, including but not
limited to crime, domestic violence, illnesses, loss in productivity, and increases in STDs,
including HIV/AIDS. For instance, of the 136 countries that reported injecting drug use,
93 reported HIV infection among the same population (WHO, 2010). This is just one
statistic among many that demonstrates the fact that the effects of illicit drugs are far-
reaching, penetrating societies far beyond the users themselves.
Possible Solutions and Challenges
The National Drug Control Strategy 2011 Annual Report outlines several characteristics
of the drug problem in the United States and the programs and interventions proposed or
in place to combat the issues at hand. In May 2010, President Obama released the
Administration’s inaugural National Drug Control Strategy, a comprehensive approach to
combat the public health and safety consequences posed by drug use (see
http://www.whitehouse.gov/sites/default/files/ondcp/policy-and-
research/2011strategyexecutivesummary_0 ). A year later, the administration released an
update building on that initial strategy. The Strategy establishes ambitious goals to reduce
both drug use and drug-related consequences. This five-year plan aims to cut drug use
among youth by 15%, drug-induced deaths and drug-related morbidity by 15%, and
drugged driving by 10%. To achieve these goals, the Strategy focuses on seven core areas:
Strengthening efforts to prevent drug use in our communities
Seeking early intervention opportunities in health care
Integrating treatment for substance use disorders into health care, and supporting
recovery
Breaking the cycle of drug use, crime, delinquency, and incarceration
Disrupting domestic drug trafficking and production
Strengthening international partnerships
Improving information systems to better analyze, assess, and locally address drug use
and its consequences
The report emphasizes the costs to the United State of drug abuse and addictions. Overall,
the economic impact of illicit drug use on American society totaled more than $193 billion
in 2007, the last year for which data are available. The report also echoes concern about the
abuse of pharmaceutical drugs, mentioned earlier in this chapter and highlighted in the
upcoming Case in Point 11.1.
CASE IN POINT 11.1
Prescription Drug Misuse: Risk Factors for Problem Users
Prompted by data that documented that 10 million individuals, or 7% of the U.S.
population, reported nonmedical use of prescription drugs (Substance Abuse and Mental
Health Services Administration, 2000), Simoni-Wastila and Strickler (2004) set out to
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2.
3.
4.
5.
identify the risk factors associated with problem use of prescription drugs. Nonmedical
prescription drug use encompasses a vast range of behaviors, from simple non-compliance
to recreational use and serious abuse (Wesson, Smith, Ling, & Seymour, 1997).
Simoni-Wastila and Strickler first estimated the prevalence of problem use of
prescription drugs using the National Household Survey on Drug Abuse. “Problem users”
were identified based on meeting one of the following criteria for dependency/heavy use:
Inability to cut down
Getting less work done
Using substance in past month and being depressed, argumentative, anxious, or upset,
feeling isolated, and/or having health problems and/or difficulty thinking clearly
Needing larger amounts
Experiencing withdrawal symptoms
In the study, identified problem users were analyzed based on race, age, gender,
marital status, urbanicity, education, work status, health insurance, income, and general
health status. The results showed that more than 8.2 million individuals, or 4% of the U.S.
population, report some sort of past-year nonmedical use of prescription drugs annually.
Furthermore, of these 8.2 million, 1.3 million individuals were categorized as “problem
users of prescription drugs.” Discovered risk factors for problem use included being female,
being in poor or fair health, and drinking alcohol daily. Conversely, being young (under
the age of 25 years) and employed full-time were found to protect against problem use. In
addition, other factors, such as marital status, education, employment status, and income,
were found to be uniquely associated with individual therapeutic classes of drugs. For
example, being an unmarried woman above the age of 35 was found to increase an
individual’s likeliness of being a problem user of narcotic analgesics.
Simoni-Wastila and Strickler point out that their study, the first to estimate the
prevalence of problem use of prescription drugs, illustrates a possible need for further risk
factor identification and treatment for problem users of prescription drugs in the future.
This case study shows that prescription drugs, although regulated and legal, can easily fall
into the same category as illicit drugs in terms of their far-reaching effects and consequences
for a population and may require the same community health measures necessary to address
illicit drug problems in the United States and abroad.
Specifically, the largest number of past-year new users initiated drug use with psycho-
pharmaceuticals, more than any other drug, including marijuana. In the past 10 years,
drug-induced deaths—driven by prescription drugs—have more than doubled (National
Drug Control Strategy, 2011). Whether or not the strategy will achieve its goals by 2015
remains to be seen, but reducing drug abuse and addiction appears to be a high priority of
the current administration.
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SEXUALLY TRANSMITTED DISEASES
Susan Chandle debated whether to vaccinate her 12-year-old daughter, Alexandra, with the
human papillomavirus (HPV) vaccine. It seemed odd to vaccinate against a sexually
transmitted virus before her daughter became sexually active. She had barely spoken to
Alexandra about sex and was uncomfortable even mentioning the premise of the vaccine.
But Susan considered herself a vigilant mother and wanted to protect her daughter from
the possibility of developing cervical cancer. She spoke to the doctor and weighed the pros
and cons of the vaccine. The vaccine, known as Gardasil, was recently approved by the
Food and Drug Administration (FDA) to provide complete immunity from the four most
predominant strains of HPV. However, there are hundreds of strains of HPV; thus it is
possible to have the vaccine and not be protected from all types of HPV or all forms of
cervical cancer. Also, Susan was concerned this vaccine would embolden her daughter to
believe she was protected against all STDs and thus engage in more sexual activity. In
addition, the vaccine was costly; it required three doses at $120 per dose over a seven-
month period and was not yet covered under the family’s insurance plan. The vaccine was
still relatively new, and the side effects and long-term health risk were unknown.
When she finally decided to vaccinate her daughter, she told her daughter that she was
getting a vaccine to protect against cancer. Susan made no mention that HPV was sexually
transmitted and decided to wait until Alexandra was taught about sex at school.
Extent of the Problem
Sexually transmitted diseases (STDs) have long been considered a hidden epidemic of
tremendous health and economic consequences. Many Americans are reluctant to address
sexual health topics openly because of both the biological and social characteristics of these
diseases. Although progress has been made in the treatment, diagnosis, and prevention of
STDs, 19 million new infections occur each year in the United States (CDC, 2007b), with
more than 340 million new cases of sexually transmitted bacterial and protozoal infections
occurring throughout the world every year (WHO, 2010). Moreover, the United States has
one of the highest rates of STDs in the industrialized world. In addition, adolescents (10-
to 19-year-olds) and young adults (20- to 24-year-olds) are at the highest risk of
contracting an STD. Table 11.2 is an overview of symptoms, prevalence, and modes of
transmission of prevalent STDs.
The nature and impact of STDs are multifaceted. They pose a substantial economic
burden; the direct medical costs associated with STDs are estimated as up to $14.7 billion
annually. In 2000, there were 9 million new cases of STDs among 15- to 24-year-olds, and
the direct economic burden of STDs was estimated to be $6.5 billion. Costs differ
depending on specific the disease, with HPV having the highest direct medical cost ($2.9
billion) and syphilis the least ($3.6 million) (Chesson, Gift, & Pulver, 2004). Although
many people experience few or no symptoms (and thus are never treated), diseases can still
cause a great impact on personal health. For example, chlamydia, whether or not it is
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detected, may be the cause of a woman’s infertility. Moreover, rates of STDs tend to be
higher among drug users (both intravenous and nonintravenous [including alcohol] drug
users). Epidemiological studies consistently demonstrate that concurrent STDs increase the
transmission probability for HIV infection. In fact, it is the potent interaction between very
early HIV infection and other sexually transmitted infections that could account for 40%
or more of HIV transmissions (WHO, 2007).
Possible Solutions and Challenges
Given the devastating toll that STDs take on both individuals and communities, what is
known about their prevention? Because STDs are considered a global epidemic,
organizations such as the World Health Organization have been very actively involved in
increasing the ability of communities to decrease infection rates through prevention. There
are several core elements to a public health approach to prevention and control of sexually
transmitted infections, according to the WHO. Effective prevention and care can be
achieved by use of a combination of responses. Services for prevention and for care of
people with sexually transmitted infections should embrace a public health package that
includes the following elements:
Promotion of safer sexual behavior
Promotion of early health-care–seeking behavior
Introduction of prevention and care activities across all primary health-care programs,
including sexual and reproductive health and HIV programs
A comprehensive approach to case management that encompasses:
identification of the sexually transmitted infection;
appropriate antimicrobial treatment for the syndrome;
education and counseling on ways to avoid or reduce risk of infection with sexually
transmitted pathogens, including HIV;
promotion of the correct and consistent use of condoms;
partner notification.
TABLE 11.2 Overview of Symptoms, Prevalence, and Modes of Transmission of
STDs
Name Symptoms Transmission Treatment Prevalence
Chlamydia,
Chlamydia
trachomatis
Known as the “silent”
disease, as many
infected people show
no symptoms
In women, symptoms
may be abnormal
vaginal discharge or
Transmitted
during
vaginal, anal,
or oral sex
Transmitted
by infected
mother to her
Can be easily
treated and
cured with
antibiotics
More than 1
million
infections in
2006
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burning sensation while
urinating In men,
discharge from penis or
burning sensation when
urinating
If untreated, women
can develop pelvic
inflammatory disease
baby during
vaginal
childbirth
Genital herpes
Herpes
simplex virus,
either type 1
(HSV-1) or
type 2 (HSV-
2)
Outbreak occurs within
two weeks after initial
infection Primary
episode includes blisters
around the genitals or
rectum that gradually
give way to sores
(ulcers)
Other outbreaks can
appear weeks or months
later, usually four to
five outbreaks within a
year, decreasing
frequency over the years
Most people with HSV-
2 infection never have
sores or have
unrecognizable signs
Virus released
from the sores,
but can also be
released from
skin that does
not appear to
have sores
HSV-1 causes
“fever blisters”
of the mouth
and lips and
can cause an
infection of
the genitals by
oral–genital or
genital–genital
contact
No treatment
to cure herpes,
but antiviral
medications
shorten or
prevent
outbreaks
Daily
suppressive
therapy for
symptomatic
herpes to
prevent
transmission
45 million
people ages 12
and older have
genital herpes
One out of
five
adolescents
and adults
have genital
HSV More
common in
women
Syphilis
Caused by
bacterium
Treponema
pallidum
Many people do not
have any symptoms for
years but are at risk for
later complications
Primary stage is the
appearance of a single
sore; if not treated,
infection progresses to
secondary stage
Secondary stage is
characterized by skin
rashes and mucous
membrane lesion
Late and latent stages
cause damage to the
Passed
through direct
contact with
syphilis sore,
sores occur
commonly on
external
genitals and
lips and
mouth
Transmission
during
vaginal, anal,
oral sex
Easy to cure in
the early stages
Treated with
injection of
penicillin
Most syphilis
cases occur in
people aged
20–39 years
Between 2005
and 2006,
syphilis cases
increased by
11.8% 64% of
cases in 2006
were among
men who have
sex with men
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internal organs and
difficulty coordinating
muscle movements
Gonorrhea
Caused by
bacterium
Neisseria
gonorrhoeae
In men, symptoms
include burning
sensation while
urinating or white,
yellow, or green
discharge from penis
Gonorrhea can cause
epididymitis and lead to
infertility if not treated
Women often
experience mild or no
symptoms and often
symptoms mistaken for
bladder or vaginal
infections
If untreated, can cause
pelvic inflammatory
disease
Spread
through
contact with
penis, vagina,
mouth, or
anus
Can be
transmitted
from mother
to baby during
delivery
Several
antibiotics are
used to treat
gonorrhea, but
the increasing
number of
drug-resistant
strains is a
cause of
concern
In 2006, the
rate of
reported
infections was
120.9 per
100,000
people CDC
estimates over
700,000 new
cases each year
Source: CDC (2006a). Reproduced by kind permission of UNAIDS, www.unaids.org.
There has been sufficient evidence to show that condoms, when used correctly and
consistently, are effective in protecting against the transmission of HIV and STDs to
women and men. As was discussed in Chapter 7, it is important that sex education include
instruction on the use of condoms as a cornerstone of a comprehensive approach. However,
the WHO (2007) also recommends the following strategies as important in a successful
prevention approach: promoting the correct use of male and female condoms, and their
distribution; sexual abstinence; delaying sexual debut; and reducing the number of sexual
partners. In settings where the infections are concentrated in high-risk populations, targeted
interventions should be a priority, but not to the exclusion of education and other
prevention and care services for the general population.
As is true with most prevention, targeting youths is typically more advantageous than
waiting until adulthood. Accordingly, it is important to acknowledge that sexual behaviors
have changed, especially among adolescents. The Kaiser Family Foundation reports a
decline in the percentage of high school students engaging in sexual intercourse and an
increase in contraceptive use among sexually active teens in the past decade. These both
have contributed to a decreased pregnancy rate; however “about a third (34%) of young
women become pregnant at least once before they reach the age of 20” (Kaiser Family
Foundation, 2005a). These developments show that community-based public health
348
programs have been effective in targeting youth. However, there still exist many barriers for
adolescents to receive comprehensive reproductive care and services. These factors include
state laws regarding parental consent, cost of care, few youth-friendly service delivery
systems, and general ignorance of services available.
In the story that began this section, Susan decided to vaccinate her daughter despite
her reluctance. By doing so, she is aiding in the fight to eliminate HPV. Currently HPV is
the most common STD, and at least 50% of sexually active men and women will contract
genital HPV at some point in their lives (CDC, 2004b). This scenario represents the
discrepancies between culture, medical technology, and basic epidemiology. HPV poses a
serious health risk that cannot be overlooked. The new technology offers a way of
combating HPV, but it is by no means a cure. Multiple approaches in treatment and
prevention are needed to address STDs. In addition, there needs to be a concerted effort by
public health officials, schools, and parents in the realm of adolescent sexual health. Susan
assumed that Alexandra’s school would talk to her daughter, but conversations about sex
must occur early and often.
349
HIV AND AIDS
As discussed in the previous section, condom use is perhaps the most effective means of
reducing the transmission of STDs, including HIV. However, given that the likelihood of
all people using condoms, even with that knowledge, is very low, is there a way to inoculate
against HIV? An AIDS vaccine is considered the safest, most inexpensive, effective, globally
accessible, and practical means of controlling and ending the HIV/AIDS pandemic.
However, HIV presents unique challenges for vaccine development because it does not
have many of the viral features that vaccinologists have used to develop successful vaccines
(Berkeley & Koff, 2007). In September 2007, the most promising vaccine failed in a large
international human trial, and further development was halted. The HIV Vaccine Trail
Network, a consortium including Merck, the National Institute of Allergy and Infectious
Disease (NIAID), and academic members, used a new approach to develop immune
response by generating T-cell response to limit viral load and disease progression (Sekaly,
2008). The STEP Trial, as it was known, consisted of immunizing close to 3,000 healthy
HIV-negative participants. The vaccine was designed to produce visible cellular immunity,
but it demonstrated no protection against infection. More alarmingly, the vaccine may have
increased the risk of HIV transmission in some study participants (Altman, 2008).
The failure of the vaccine thus far demonstrates that the HIV/AIDS epidemic involves
a complex infectious disease that a vaccine will not instantly cure. Not only does HIV pose
an immunological challenge, it requires international cooperation by the medical
community, governments, and other community leaders. Currently, the HIV/AIDS
epidemic is one of the greatest challenges in public health.
Overview
By the end of 2007, more than 33 million people were living with HIV worldwide. AIDS
remains one of the top 10 causes of death globally and the primary cause of death in sub-
Saharan Africa. Although 2007 marked a significant revision of global estimates of the
AIDS epidemic due in part to better surveillance programs, AIDS remains a global crisis.
Every day more than 6,800 people become infected with HIV, and slightly fewer than
6,000 people die from AIDS (UNAIDS, 2010). It is important to note that HIV is not the
cause of AIDS. Rather, being HIV-positive weakens one’s immune system, thus opening
the door for opportunistic infections that lead to AIDS (see Figure 11.2).
Brain lesions (advanced stage of AIDS)
Frequent diarrhea
Loss of appetite
Low-grade fever that will not go away
Low T-cell count (below 400; T cells are involved in fighting infection)
Oral thrush (e.g., fungus inside the mouth)
Pneumonia
Skin lesions (e.g., Kaposi’s sarcoma)
Swollen glands
350
Weight loss
FIGURE 11.2 Characteristics of People with HIV or AIDS
TABLE 11.3 Regional HIV Statistics and Features, End of 2007
Region
Epidemic
Started
Adults and Children
Living with
HIV/AIDS
Adult
Prevalence
(Age 15–49)
Adult and Child
Deaths Due to
AIDS
Sub-Saharan
Africa
Late
1970s–
early
1980s
22.5 million 5.0% 1.6 million
North Africa
and Middle
East
Late 1980s 380,000 0.3% 25,000
South and
Southeast Asia
Late 1980s 4.0 million 0.3% 270,000
East Asia and
Pacific
Late 1980s 800,000 0.1% 32,000
Latin America Late
1970s–
early
1980s
1.6 million 0.5% 58,000
Caribbean Late
1970s–
early
1980s
230,000 0.1% 11,000
Eastern Europe
and Central
Asia
Early
1990s
1.6 million 0.9% 55,000
Western and
Central Europe
Late
1970s–
early
1980s
760,000 0.3% 12,000
North America Late
1970s–
early
1980s
1.3 million 0.6% 21,000
Oceania Late 75,000 0.4% 12,000
351
1.
1970s–
early
1980s
Total 33.2 million 0.8% 2.1 million
Source: UNAIDS (2007).
In the late 1970s and early 1980s, the medical community in the United States began
to notice a strange disease, mostly infecting homosexual men and IV drug users. Very soon
after, terms such as HIV, AIDS, and ARC (AIDS-related complex) became household
words. Although HIV and AIDS were first recognized in homosexual men in this country,
the disease has now been shown to infect all men, including heterosexual men, and women
(see Table 11.3). Scientists and laypeople alike speculate about the origin of HIV and
AIDS; theories range from the “green monkey theory” (a species of African monkey that is
thought to be the genesis of the incurable disease) to biological warfare conducted by the
U.S. Central Intelligence Agency. Still others (Eigen, 1993) have argued that HIV has been
present in human beings for more than 120 years, just waiting for the right circumstances
to attack the human immune system. Figure 11.3 presents some statements about AIDS to
test your knowledge about this disease.
There have been encouraging developments in the battle against the AIDS epidemic,
including improving prevention programs and increasing access to effective treatment.
However, the number of people living with HIV continues to rise yearly. In many global
regions, new HIV infections are concentrated among young people (15–24 years old). Sub-
Saharan Africa bears most of the burden of disease—roughly two-thirds of all adults and
children with HIV live there (UNAIDS, 2010).
Extent of the Problem
In the United States, AIDS cases have been reported in all 50 states; however, 10
states/areas make up 71% of all reported cases. AIDS cases in the United States are
concentrated in urban and southern areas, with the District of Columbia having the highest
case rate in the nation. In addition, AIDS has disproportionately affected racial and ethnic
minorities, predominately Blacks and Latinos. More alarming is the demographic
comparison of AIDS diagnoses and the U.S. population. For instance, whereas Blacks make
up 12% of the population, they account for 49% of AIDS cases. In 2004, HIV was the
fourth leading cause of death for Black men and the third for Black women aged 25–44
(Kaiser Family Fund, 2008b). The impact of HIV and AIDS among the various
racial/ethnic minority communities can be gleaned and understood from at least three
interrelated perspectives: (1) knowledge, attitudes, beliefs, and behaviors (KABBs), (2)
HIV testing, and (3) linkage to care.
Determine whether the following statements are true (T) or false (F):
Most infants born to mothers infected with HIV will test negative after 18 months.
352
2.
3.
4.
5.
6.
7.
8.
The window period refers to the time between infection and the detection of antibodies in the blood.
Once you have tested positive for HIV, it is certain that you will develop AIDS.
Confidential testing means that you do not have to give your name when you get tested.
Latex condoms are an effective barrier to HIV.
You cannot get HIV if you are having sex with only one partner.
Oil-based lubricants should be used with latex condoms to prevent HIV.
In 2001, complications from AIDS was the leading cause of death for all Americans ages 25 to 44.
Answers: 1. F; 2. T; 3. T; 4. F; 5. T; 6. F; 7. F; 8. T
FIGURE 11.3 Test Your Knowledge of AIDS
Although research on HIV/AIDS prevention and intervention indicates that KABBs
alone are not sufficient for safer behavioral maintenance (staying HIV-negative or
practicing safer behaviors among HIV-positive individuals) or changes for safer behaviors
(Choi & Coates, 1994), misconception or less than optimal KABBs are likely to place
people at risk. Researchers report that members of the African American community
consistently underestimate their risk of contracting HIV. The CDC found that many
sexually active Black women in North Carolina engaged in high-risk sexual behaviors. The
reasons for involvement in these behaviors reported were:
1) financial dependence on male partners, 2) feeling invincible, 3) low self-esteem
coupled with a need to feel loved by a male figure, and 4) alcohol and drug use. In
addition, participant’s proposed strategies for reducing HIV transmission among black
women in North Carolina included 1) introducing HIV and STD educational
activities in elementary and middle schools, 2) increasing condom availability and
usage, and 3) integrating targeted HIV-education and prevention messages into
church and community activities, as well as into media and popular culture.
(MMWR, 2005b)
One barrier to combating the AIDS epidemic is HIV testing, which serves as a critical
entry point to ensure linkage to care. In the three national surveys of household-based
probability samples on which these figures are based, rates of testing were much higher for
persons at increased risk (e.g., multiple sexual partners, IV drug use) for HIV. Twice as
many people received HIV tests in private locations (medical offices, hospitals and
emergency rooms, employee clinics, nursing homes, and at home via home testing kits) as
in public locations (health departments, community clinics, HIV counseling and testing
sites, family planning clinics, military and immigration sites, and STD clinics). Of those at
increased risk for HIV, 70% had been tested for it. These patterns of findings suggest that
there are at least two aspects to HIV testing: ability to access services and willingness to
access services. Just because service is available does not mean that people (especially
disenfranchised populations, including immigrants and refugees as well as those with
limited English-speaking ability and some segments of racial/ethnic and cultural groups)
will use it. In fact, available data indicate disparity in HIV testing among certain
racial/ethnic and cultural groups. For example, Asians and Pacific Islanders have one of the
353
lowest testing rates. However, little is known about why people are unwilling to access HIV
testing. Meanwhile, although the overall rates of HIV testing are high, more than half of
the persons tested in public programs did not report that a health professional talked to
them about HIV-related issues (KABBs) when they were tested, indicating that many either
are not receiving counseling or are not recognizing their interaction with staff as counseling.
The rate of counseling is even lower in private settings. These findings further underscore
the complex relationship of KABBs, HIV testing, linkage to care, and most of all, their less
than optimal effect in the fight against HIV. One theory, for example, acknowledges the
relationship between an individual’s sense of optimism and pessimism and HIV screening.
A study of pregnant women in Ghana found that those who were most optimistic were not
tested for HIV before pregnancy and had the least knowledge of HIV. This raises the
question as to whether optimism translates into a denial or ignorance of potential risk. On
the other hand, are pessimists better suited when it comes to HIV testing because they may
be prepared for the worst (Moyer, Epko, Calhoun, Greene, Naik, Sippola et al., 2008)?
These findings acknowledge that psychosomatic issues and emotional difficulties are
involved in electing to test for HIV.
Prevention and testing alone cannot combat HIV. Treatment of HIV-positive
individuals with antiretrovirals (ARTs) can extend their lives and increase quality of life.
However, some argue that ARTs are expensive and the lack of health infrastructure in
developing countries is a serious impediment to the delivery of treatment. However, Paul
Farmer of Partners in Health created a successful HIV treatment program in rural Haiti,
demonstrating that community-based approaches to HIV treatment in resource-poor
settings are possible. Partners in Health provided directly observed therapy combined with
highly active antiretroviral therapy (HAART). Each patient had an “accompagnateur” or
health advocate (often a community health worker) who observed the ingestion of pills and
provided emotional, moral, and social support. In addition, monthly meetings were offered
to discuss illness and other concerns. The initial cohort responded extremely well to
medicine, was less likely to be hospitalized, and reported higher morale. Farmer argues that
the success of the HAART program in the poorest country in the Western hemisphere
shows it can be implemented anywhere (Farmer et al., 2001).
Complexities and Controversies
AIDS education raises many controversial questions. As part of education, should condoms
be distributed in schools to prevent the spread of AIDS? If so, at what grade level? Such
controversy has almost torn apart school systems across the nation. People with AIDS are
growing impatient with the FDA in the regulation of experimental drugs and treatment
criteria. To be treated, people must have more than 20 symptoms as defined by the CDC,
the federal agency that oversees most HIV and AIDS surveillance. However, it took a lot of
political lobbying before the CDC added to its list symptoms specific to women with AIDS
(e.g., cervical cancer). Meanwhile, many people with AIDS have died from taking illegal
treatments (usually smuggled into this country). The American Foundation for AIDS
354
Research publishes a listing of all drugs for treating AIDS, including those that do not have
FDA approval. The list is available free of charge.
On one hand, the pandemic has decreased in the United States and other
industrialized countries due in large part to public health efforts and antiretroviral drugs.
Yet in sub-Saharan Africa, AIDS continues to have devastating social, economic, political,
and demographic consequences. Some argue that prevention and control in Africa has been
based on earlier public models that were derived from policies from industrialized countries
that did not take into account the nature of the epidemic (generalized rather than in
specific risk groups) and African culture. In addition, a uniform global approach may not
be suited to the extreme political and epidemiological diversity of the pandemic. Questions
have arisen as to how to best tackle the epidemic in Africa. Should health officials require
mandatory testing? Howshould limited funds be allocated within a country—on prevention
or treatment? How do you combat stigma, discrimination, and the depression seen in HIV-
positive individuals? What should be done when ARTs are available but there is not enough
medical staff to administer them? Who should pay for treatment and testing? Should
policies be made by local governments or international governing bodies such as the WHO
or the World Bank?
Morality and politics aside, community psychologists and public health advocates
have learned to use the public health model to slow down the spread of AIDS. After two
decades of fighting the epidemic, it has been widely recognized that behavioral changes are
paramount in preventing the transmission of HIV (National Commission on AIDS, 1993).
Moreover, attitudinal variables are often viewed as determinants of compliance with HIV
prevention recommendations (Fisher & Fisher, 1992). According to the Health Belief
Model (Becker, 1974; Rosentock, 1986), readiness to perform health-related behaviors is
seen as a function of perceived vulnerability, perceived severity of disease, perceived barriers
to health-protective action, and feelings of self-efficacy concerning ability to protect oneself
from disease. This meta-model has since been adapted or modified to meet the challenges
and needs of the specific populations participating in HIV prevention programs.
Possible Solutions: Community-Based Approaches
The preceding issues only scratch the surface of a very complex—and often volatile—
problem. The virus is more than a biological epidemic; it has political and social valences,
as well. It is beyond the scope of this chapter to review all solutions; however, a heuristic
approach is to conceptualize solutions (with an emphasis on the principles of community
psychology) along three interrelated dimensions: (1) prevention (KABBs), (2) HIV testing
(see Case in Point 11.2), and (3) linkage to care (including psychosocial support; see Case
in Point 11.3). The term prevention is used here in an inclusive sense to capture the overlap
of primary, secondary, and tertiary modalities that occur in the AIDS literature and in the
implementation of the clinical programs.
CASE IN POINT 11.2
355
Evaluation and Implementation of STD/HIV Community
Intervention Program in Lima, Peru
Community programs focus on affecting the entire community to create widespread change
in behavioral norms. The U.S. National Institute of Mental Health (NIMH) developed a
collaborative model of community-level prevention focusing on mobilizing and training
community popular opinion leaders (CPOLs) to promote healthy sexual behavior.
NIMH is in the process of testing implications and effects of this intervention in Lima,
Peru, in three different populations: men who identify as homosexual, women with
multiple partners, and heterosexually identified men. This study looks at midterm
evaluation of programs and how to best implement STD prevention programs in low-
income communities.
The program is based on Jeff Kelley and colleagues’ Popular Opinion Leader model
and adapts the four core elements (1) visible target population, (2) identification of CPOLs
(criteria often include how popular, trusted, or respected they are among their peers), (3)
training CPOLs over multiple sessions on theory-based prevention methods, and (4) goal
setting with CPOLs.
The intervention in Peru is called Qué te Cuentas (What’s up) and targets the young,
urban, poor population where the HIV/STD epidemic is largely concentrated. Qué te
Cuentas uses an innovative training approach and gives CPOLs information on sexuality,
HIV and STDs, effective communication, and how to deliver nonthreatening, brief, and
informal prevention messages. Researchers found the program to be overwhelmingly
successful. CPOLs felt empowered by their position and ability to effect change in the
community. Many CPOLs were surprised that conversations flowed easily at social spaces,
including bars, soccer games, and homes. The intervention seems to be well accepted by the
community, and a sense of ownership has developed among neighbors who perceive the
intervention as a positive asset for the community.
Further evaluation of the program found that using CPOLs to disseminate STD
prevention information created more culturally appropriate messages. Given the context of
poverty and societal exclusion, CPOLs were given a chance to feel useful and a part of
something. Initial findings also demonstrated that the intervention has directly changed
CPOLs’ knowledge, attitudes, and sexual risk behavior. In addition, the community has
greater knowledge of how to prevent STDs and HIV (Maiorana et al., 2007). (See
Community-Based Approaches for more information on this diffusion model.)
CASE IN POINT 11.3
The Bilingual Peer Advocate (BPA) Program
Nationwide, a majority of the Asian and Pacific Islanders (APIs) with AIDS/HIV are
foreign-born individuals. In New York City, AIDS cases among APIs account for 95% of
adult AIDS cases among APIs in the state and 13% of adult cases among APIs in the
356
•
•
•
•
•
United States (Sy, Chng, Choi, & Wong, 1998).
Although they represent an expanding population (e.g., the highest growth rate from
1980 to 1990 in New York City) with increasing needs for HIV-related services, APIs are
prevented from adequately accessing such services because of a number of barriers,
including the following:
Lack of culturally competent, linguistically accessible, and HIV-sensitive providers
Lack of health insurance
Distrust of institutions
Stigma in API communities surrounding sex, substance use, homosexuality, illness,
and death
Lack of coordinated primary care and case-management services
Ideally, any API immigrant living with AIDS/HIV in New York City would be able to
access any needed HIV-related service in the language that he or she speaks. In this ideal
situation, the service would also be provided in a way that recognizes the cultural practices
and attitudes of the client or patient. But given a tight funding environment, a lack of
prioritization of API issues, and the numerous API languages and national and cultural
groups, such an ideal is difficult to achieve. As part of a five-year national demonstration
study (Chin & Wong, 2003), the Bilingual Peer Advocate (BPA) program, with its reliance
on part-time peer workers, was designed to allow the Asian and Pacific Islander Coalition
on HIV/AIDS (APICHA) to hire a large team of workers to meet the diverse language and
cultural needs of APIs living with AIDS while also remaining within realistic cost
parameters.
The program trains and maintains a corps of paid, part-time BPAs to act as language
interpreters, cultural guides, and advocates for clients as they negotiate New York City’s
service system. In addition to helping service providers understand the clients’ culture,
BPAs are able to explain the culture of the health and social services to clients. BPAs are
provided clinical supervision by three full-time case managers, one speaking Mandarin
Chinese and two more speaking Japanese.
BPAs are paid because they commit more time to work and training than volunteers
do. These individuals start with a three-day intensive training program and then receive a
two- to three-hour follow-up training each month after. They are expected to be available
on a regular basis; some are on call and carry beepers. BPAs work only part-time to retain a
level of flexibility that full-time staff do not have and, more important, to allow APICHA
to hire a broader range of individuals to represent more cultures and languages.
Currently, APICHA maintains a corps of 15 BPAs. Among them, they speak the
following major languages: Bengali, Cantonese, English, Gujarati, Hindi, Japanese, Korean,
Mandarin, Tagalog, Toisanese, and Urdu. Of API-CHA’s current 70-plus HIV-positive
clients receiving comprehensive case management, 24 are being served by BPAs. Each
month, BPAs spend about 8 to 12 hours working directly with clients, 3 to 5 hours
conducting client outreach, 10 hours in travel, and 2 hours in training.
357
OBESITY
Before concluding this chapter on behavioral health and the community psychology
response, we consider a final health problem that has a uniquely American flavor:
childhood obesity.
Scope of the Problem
Within the past three decades, the percentage of children and adolescents who are
overweight or obese has more than doubled (Ogden, Carroll, Curtin, Lamb, & Flegal,
2010). According to the most recent National Health and Nutrition Examination Survey
(NHANES; Ogden et al., 2010), over a third of children ages 6 to 19 are obese (i.e., body
mass index [BMI] for age at the 95th percentile or higher) or overweight (i.e., BMI for age
at the 85th percentile or higher). Moreover, there are ethnic disparities in childhood obesity
rates and rates of being overweight: African American and Latino/a children are at greater
risk than their White counterparts (Ogden et al., 2010). Specifically, of children between
the ages of 6 and 19, 43.0% of Mexican American children and 38.7% of African
American children have BMIs at or above the 85th percentile, compared with 32.5% of
White children. Across all racial and ethnic groups in this age range, the prevalence of
children being overweight and childhood obesity appears roughly equivalent in boys and
girls. However, some noteworthy gender disparities exist within specific racial groups.
Forty-three percent of African American girls were overweight or obese, compared with
34.4% of African American boys. As is the case with other health problems, socioeconomic
status (SES) is negatively associated with childhood obesity (Shrewsbury & Wardle, 2008).
Thus, disparities in the prevalence of obesity are likely attributable to the confounding of
SES and ethnic and racial group membership.
Although genetic factors are known to influence BMI (Mazzeo, Gow, & Bulik, 2012),
the rapid increase in childhood obesity rates is considered primarily attributable to
environmental factors. In fact, some leading scholars in the area have argued that obesity in
Western society is caused by a “toxic environment” (Brownell, 2002) than includes too
easily accessible calorie-dense foods, increases in sedentary behavior, and correspondent
decreases in physical activity. Early intervention for obesity is important to prevent the
development of obesity-related health problems, such as diabetes (Wang & Dietz, 2002).
Further, quality of life among severely overweight children is significantly impaired, with
some indication that it is worse than that of children with cancer (Schwimmer, Burwinkle,
& Varni, 2003). Moreover, overweight children ages 10 to 17 are more than 20 times as
likely to be obese in adulthood compared to their nonoverweight peers (Whitaker, Wright,
Pepe, Seidel, & Deitz, 1997). Perhaps the strongest case to be made for early intervention,
however, is that outcomes of adult obesity interventions are notoriously poor (Cooperberg
& Faith, 2004; Mazzeo et al., 2012; Whitaker et al., 1997).
Community Prevention Efforts
358
A few recent studies have begun to examine the effects of obesity prevention, although
much more work is needed in this area (Carter & Bulik, 2008). Although one can imagine
that teaching healthy eating habits and promoting recreational activity are key components
of obesity prevention, as discussed in earlier chapters, knowing what is healthy and
behaving in healthy ways are often compromised by contextual factors. For example,
imagine a child growing up in a low-income neighborhood where healthy food is less
available than is fast food. “Food deserts” may be one of the reasons that obesity is
overrepresented in poor children, making it a health disparity. Add to the scenario that the
family lives in a neighborhood that is unsafe, with random violence, and it becomes easier
to understand why a family would struggle to “eat healthy” and exercise often. Because
contextual constraints often keep individual children and families from attaining goals that
promote health and well-being, scholars have designed prevention programs that target the
community level. Two of the most common policy efforts to control obesity levels involve
modifying school lunch programs and mandating BMI assessments in the schools.
The first community-based strategy for preventing obesity includes making significant
changes in foods and snacks provided to children in schools, especially for children whose
families lack the means or access necessary to provide nutritious food in the home.
Although it is widely believed that changing meal choices at schools can help children eat
better and potentially desire healthier foods in their home environment, few studies have
decisively determined whether or not this actually occurs. For example, in a study involving
middle school students, Schwartz and colleagues (Schwartz, Novak, & Fiore, 2009)
investigated outcomes of an intervention targeting the removal of snacks of low nutritional
value from schools. Six schools were involved in the study (three intervention, three
control), and outcomes assessed by the researchers included changes in food consumption
(both at school and at home) and dieting behavior. Results indicated that students in
intervention program schools decreased their consumption of sugar-sweetened beverages
and salty snacks of low nutritional value (e.g., chips) over the one-year study period.
Meanwhile, students in the control group increased their consumption of these foods and
beverages. Students in intervention program schools also increased their intake of water,
nonartificially sweetened juice, less calorically/fat-dense salty snacks (e.g., pretzels), and
healthy sweet snacks (e.g., fruit). Meanwhile, control group students’ consumption of these
foods and beverages was unchanged. However, there were no differences between groups in
consumption of sweet snacks, such as ice cream. In addition, the program did not appear to
have a significant effect on dietary intake in the home environment. Finally, there were no
differences between groups in dieting behavior.
In a related study, Foster and associates (2008) investigated the effects of a school
nutrition policy intervention (The School Nutrition Policy Initiative, SNPI) on fourth- to
sixth-grade children from 10 schools with a high proportion of low-income students. As
part of the SNPI, intervention program schools removed sodas, sugar-sweetened beverages,
and snacks of low nutritional value from vending machines and cafeteria service. Water,
low-fat milk, and nonartificially sweetened juice were the only beverages available in
intervention program schools during the course of the project. In addition, school staff in
359
the intervention program schools participated in nutrition education, and students were
provided with 50 hours of nutrition education each school year. Students in intervention
program schools were also offered incentives (e.g., raffle tickets for prizes) for the purchase
of healthy foods.
Two years after the initiation of the SNPI, significantly fewer children in the
intervention group had become overweight or obese (i.e., had a BMI at or above the 85th
percentile for their age and sex), compared with the control group (Foster et al., 2008).
Specifically, 15% of children in control schools became overweight during the study period
(i.e., their BMIs moved from below the 85t h to between the 85th and 95th percentiles),
compared with 7.5% of children in the intervention schools. Moreover, the intervention
was particularly effective for African American children, who were 41% less likely to be
overweight at two-year follow-up than their African American peers in control schools.
Data from the two studies reviewed here suggest that increasing nutritious foods available
in school environments is a viable way to decrease obesity rates in children.
Another wide-scale intervention that has been used is school-based BMI screening.
BMI screening is recommended by the Institute of Medicine as an important approach to
the primary and secondary prevention of pediatric obesity (Institute of Medicine, 2004).
BMI screening occurs regularly in many schools in the United States and other
Westernized countries (Nihiser et al., 2007) and is even mandated in several U.S. states
(Illinois, Maine, New York, Pennsylvania, Tennessee, and West Virginia) (Mazzeo et al.,
2012). Proponents of school-based BMI screening note that it has several appealing
features. It is a minimally invasive and relatively low-cost approach that can assess nearly all
children and alert parents that their child might have a health concern (Mazzeo et al.,
2012). In this sense, as has been argued (Morgan, 2008), BMI screening is analogous to
routine vision and hearing screenings conducted in school settings. Given the vast numbers
of uninsured families in the United States, many children might have no opportunity for
routine BMI assessment outside of the school setting (Nihiser et al., 2007; Presswood,
2005). Results from BMI assessments are then communicated to parents (along with
educational material about reducing obesity) on the assumption that if parents are unaware
that their child’s weight is a problem, they are obviously unlikely to facilitate behavioral
changes that would address this issue.
So do such programs result in behavior changes? Few studies have assessed the impact
of BMI screening programs. One that did was conducted by Chomitz, Collings, Kim,
Kramer, and McGowan (2003). The authors compared a BMI screening program to a
comparison group and found that parents in the BMI screening group whose children were
overweight were more likely to seek medical treatment for their child compared to parents
in the control group (25% vs. 7%). BMI screening group parents were also more likely to
make changes in their children’s diet and physical activity compared to parents in the
comparison group. Mazzeo, Gow, Stern, and Gerke (2008), however, caution that the
effectiveness of such programs is predicated on the ability of parents to communicate with
their children about a potentially uncomfortable topic, given the stigma of being
overweight in U.S. culture. Thus, in sum, these data suggest that prevention efforts should
360
• • •
include parents and incorporate information and skills training regarding
communicating with one’s child about weight, appearance, and health.
Community-based approaches to obesity prevention appear to hold great promise.
However, as is true with most programs, these approaches are not without their critics. For
example, some disagree with the idea that foods should be presented as inherently “good”
or “bad” (Mazzeo et al., 2012). A more acceptable way to categorize foods semantically may
be as foods to “promote” versus foods to “limit.” In addition, some eating disorder
specialists have expressed significant concern that obesity prevention programs and policies
will lead to extreme dieting among children (Cogan, Smith, & Maine, 2008). This is
alarming because research has indicated that dieting is associated with the onset of eating
disorder symptoms (Neumark-Sztainer et al., 2006). However, to date, research does not
generally suggest that existing obesity interventions are associated with the onset of dieting
in children or adolescents, at least at the aggregate level (Carter & Bulik, 2008).
Nonetheless, some individuals, especially those with other underlying predispositions to
develop an eating disorder (e.g., genetics), might be especially vulnerable to potential
iatrogenic effects of obesity prevention. Thus, it is important that researchers not only
evaluate the effects of their interventions at the aggregate level, but also track individual
adverse events, including identifying individuals who develop eating pathology after
exposure to obesity-related interventions (Carter & Bulik, 2008). Current data suggest such
adverse outcomes will be relatively rare. However, as interventions and policies evolve and
are more broadly disseminated, it will be important to rapidly identify such individuals,
along with tracking characteristics that might have made them vulnerable to negative effects
(Mazzeo et al., 2012).
Summary
This chapter has reviewed six health issues: tobacco, alcohol, illicit drugs, STDs,
HIV/AIDS, and obesity. These issues were examined from the perspectives of community
psychology and preventive medicine; policy-based prevention (targeting a community) was
also discussed (see Table 11.4). These issues were chosen for two main reasons: (1) They
have each received enormous attention in the media, and (2) each is highly preventable. In
addition, a large number of people are affected or have the potential to be affected if
prevention does not occur.
TABLE 11.4 Five Issues of Community Health and Preventive Medicine: A
Snapshot
Issue Extent of the
Problem
Consequence Possible Solution
Tobacco 23.0% of all
adolescents
smoked a cigarette
Smoking is a
strong contributor
to ectopic
America Stop Smoking
Intervention Study
(ASSIST)
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
at least once in
past 30 days
pregnancy and
spontaneous
abortion
An estimated
$72.7 billion in
tobacco-related
medical
expenditures was
recorded in 1993–
2003
Smoke Free Movies
campaign
Alcohol 74.3% of all
students havehad
at least one drink
of alcohol during
their lifetimes
25.6% of all
students have used
alcohol before age
13
41% of fatal
motor vehicle
crashes involve
alcohol
Risk for
contracting HIV
is increased
Parent–child skill building
(Spoth, Redmond,
Hockaday, & Yoo, 1996)
Early intervention that
involves the family and
community
Illicit
Drugs
Marijuana—
38.4% of students
ever used
Cocaine—7.6% of
students ever used
Injection drugs—
2.1% of students
ever used
Steroids—4.0% of
students ever used
Inhalants—12.4%
of students ever
used
Hallucinogenics—
8.5% of students
ever used
Heroin—2.4% of
students ever used
Methamphetamine
—6.2% of
students ever used
Users are
consumingdrugs
without?
knowledge
ofunmonitored
content?and
potential
adversehealth
effects (rising?
THC levels in
marijuana)
HIV cases are
directlylinked to
injection drug?use
worldwide
Nonmedical use
ofprescription
drugs is?becoming
just as highrisk as
“traditional”?
narcotics
National Drug Control
Strategy, 2008 (Office of
National Drug Control
Policy, 2008): early
preventive programs,
intervention and healing of
current drug users,
combating the market of
illegal drugs
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•
• •
•
•
•
•
•
• •
•
•
•
•
•
•
Ecstasy—6.3% of
students ever used
STDs In 2000, there
were 9 million
new cases of STDs
among 15- to 24-
year-olds
Risk for
contraction of
HIV is increased
New infections in
mostly young
people
Direct economic
burden of STDs is
estimated to be
$6.5 billion yearly
Advisory Committee for
HIV and STD Prevention
(MMWR, 1998a)
Community intervention
(e.g., Peru)
HIV/AIDS In 2004, HIV was
the fourth leading
cause of death for
Black men and
third for Black
women aged 25–
44.
HIV deaths seen
predominately in
Africa
Incurable disease
with a long
incubation period
Resource
allocation
Stigma
KABBs prevention and
intervention
HAART
HIV testing
Obesity 33% of 6- to 19-
year-olds
Higher rates of type
2 diabetes
Self-esteem issues
BMI Testing
Modified school lunch
Internationally, tobacco is the cause of more than 5 million deaths each year (WHO,
2008c). In the United States alone, tobacco use (including smoking) is the number one
preventable cause of death (U.S. DHHS, 2001b). Each year, tobacco use causes more
deaths than HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders
combined (U.S. DHHS, 2011; McGinnis & Foege, 1993). The American Legacy program
has been effective in its antismoking efforts, as seen in its Truth youth smoking prevention
and Smoke Free Movie campaigns. Biglan and colleagues illustrated the use of information
and public policy to change behavior (cigarette sales to minors) for the good of the
community. Biglan’s research also demonstrated how various community services such as
the police, elected officials, merchants, and psychologists can collaborate on programs for
the community.
Like cigarette smoking, alcohol is a gateway drug to other drug use and abuse. More
American students are consuming alcohol with 43.3% of students current alcohol users (or
had least one drink of alcohol in the past 30 days) (MMWR, 2005a). Binge drinking is a
major issue associated with alcohol use and abuse that spans from college campuses to
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entire societies across the globe. Research has shown that family greatly influences substance
use and later misuse in young people. Other health policy–related research suggests that
alcohol warning labels and signs may be a useful way to inform women of child-bearing age
about the danger of alcohol use during pregnancy.
Overall, illicit drug use has remained stable in this country. Globally, there are at least
15.3 million people in the world who have drug use disorders (WHO, 2008b). Yet certain
drugs continue to be used by some segments of the population. For example, marijuana is
the most popular drug used among youth and young adults. Consequences of illicit drug
use include crimes, domestic violence, and other problems (e.g., increased HIV
transmission). Proportionately, this country spends more money on law enforcement–
related activities than on drug prevention, intervention, and treatment. Research has
demonstrated the contribution of community psychology in preventing drug use; yet
community psychologists need to take a more proactive role in advocating for more
resources in prevention activities (i.e., other than law enforcement–related activities).
The United States has one of the highest rates of STDs in the industrialized world.
Furthermore, epidemiological studies consistently demonstrate that concurrent STDs
increase the transmission probability for HIV infection. Unfortunately, community
psychologists have done little or no work in this area. It is recommended that the field of
community psychology take a proactive role in heeding the recommendations of the
Advisory Committee for HIV and STD Prevention, including promoting sexuality as a
healthy lifestyle.
In the absence of a cure or vaccine, prevention and information dissemination and
behavioral intervention (e.g., the diffusion model) appear to be the only hope to slow the
spread of HIV. Given that HIV/AIDS is also a political and social disease, coupled with the
advent of new medical technologies, prevention takes on added dimensions and meanings
beyond the traditional definition used in community health and community medicine.
Finally, obesity is considered an epidemic that is taking its toll on U.S. children.
Racial disparities exist in prevalence rates of obesity just as they do for other health
problems. The most commonly used community prevention strategies have included
making systemic changes in foods and drinks available in public schools and including BMI
assessments as mandatory components of health screenings conducted by schools. Although
evidence suggests that these approaches may have a positive impact on children, they have
yet to be implemented on a wide scale.
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■
■
Community/Organizational Psychology
WHAT DO ORGANIZATIONAL AND COMMUNITY PSYCHOLOGY SHARE?
Organizational Psychology, Organizational Behavior
Ecology and Systems Orientation
Distinctions
EVERYDAY ORGANIZATIONAL ISSUES
Stress
Stress Reduction
Burnout
Organizational Culture
Organizational Citizenship Behaviors
Work and Self-Concept
Dealing with a Diverse Workforce
Other Ecological Conditions
CASE IN POINT 12.1 Consulting on Diversity
TRADITIONAL TECHNIQUES FOR MANAGING PEOPLE
Compensation Packages
Rules and Regulations
OVERVIEW OF ORGANIZATIONAL CHANGE
Reasons for Change
Issues Related to Organizational Change
CHANGING ORGANIZATIONAL ELEMENTS
Leadership
Reorganization
Quality of Work Life Programs
Team Building
CASE IN POINT 12.2 Managing Change
SUMMARY
A business that makes nothing but business is a poor kind of business.
—Henry Ford
As Sarah Anderson walked out the door of Harmony House, she glanced back at the
building that had been her home away from home for the past eight months. She felt a
sense of relief and a paradoxical sense of sadness as she exited for the last time. “What went
wrong?” she wondered. “How could my job have become such a sore point in my life when
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only a few short months ago I accepted it so enthusiastically?”
Harmony House was run by a private nonprofit corporation that managed eight
group homes for at-risk adolescents in Sarah’s city. The adolescents were sent to the homes,
including Harmony House, by judges, probation officers, schools, and parents. The group
homes boasted of the ability to “turn kids around”–that is, get them off drugs, raise their
school grades, and make them productive citizens again–in about six months.
A psychology major with a human services minor from a small liberal arts college,
Sarah had been actively recruited by Harmony House after summer volunteer work there.
Her grades were very good, and the combination of training in college and volunteer work
plus her winning personality during interviews made her eagerly sought after by several
community organizations. She had always wanted to be a case manager for one of them.
Harmony House won her over because they offered the best salary, had an excellent
training program, and had a good reputation. Harmony House seemed to be on the leading
edge of innovations in treatment, which Sarah thought would give her the upper hand
when she sought to move on to bigger and better agencies.
Idealistic and perhaps naïve, Sarah approached her first few days at Harmony House
with immense enthusiasm. Her supervisor, Jan Hayes, mentored and coached her for the
first few months. Sarah felt she was getting plenty of attention and good training under Jan.
She was slowly developing a sense of confidence in handling each new difficult youth as he
or she entered Harmony House.
Six months into her service, Sarah’s career took a downturn that mirrored the changes
occurring at corporate headquarters. Jan was moved from Harmony House to headquarters
to become the chief trainer, and Sarah received a new supervisor who cared much less about
mentoring her and more about keeping costs low. Sarah explained to her supervisor that
she was fairly new to the job so would like to be mentored, but the new supervisor told her
to stop complaining and start performing.
As the weeks passed, Sarah realized that not only was she without the tutelage and
attention afforded her by Jan but that the budget cuts at the group home were taking their
toll on the clients. The television broke, which left the youths with more free time than
they needed. The furniture was in need of replacement, and the menu each day was much
less appetizing. There were fewer field trips and fewer group therapy sessions, too. All these
changes and others made the youths more discontented and harder to work with.
Sarah approached her supervisor and commented on these negative changes. His
response was, “These are tough times; I have to make these cuts and changes. I suggest that
if you think things are better elsewhere, you find another job.” Sarah worked another two
months before she resigned. She did not have any active job prospects, but she was so
utterly dismayed with the changes at Harmony House that she felt she had to quit.
What would a community psychologist have to say about Sarah and her work situation?
We review the organizational community’s possible insights in this chapter.
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WHAT DO ORGANIZATIONAL AND COMMUNITY PSYCHOLOGY
SHARE?
Community psychology examines the effects of social and environmental factors on
behavior as it occurs in various levels in communities to produce beneficial change. To
understand the effects of environmental factors or settings on individuals, one must
understand something about the setting—in this case, organizations, whether they are
private sector businesses, mental health clinics, prisons, or any other community
organization. In fact, it is community psychology’s position that it is futile to attempt to
understand individuals apart from the settings or the contexts to which they belong (Keys
& Frank, 1987; Trickett, 2009). This chapter looks at organizational psychology as it may
relate to community psychology. Specifically, discussions cover ways that organizations can
be conceptualized from a community perspective and how an organizational psychology
might inform efforts to realize a community psychology.
Organizational Psychology, Organizational Behavior
Organizational psychology approaches the examination of organizations from the
perspective of the individual, whereas organizational behavior approaches the study of
organizations from a systems perspective (Smither, 1998).
What do organizational psychology and organizational behavior have in common with
community psychology? First, organizational specialists have developed theories and
methodologies that go beyond the individual level of analysis (Riger, 1990; Shinn &
Perkins, 2000). This is a goal of community psychology. For instance, from the study of
organizations comes organizational development (OD). OD is a set of social science
techniques designed to plan and implement long-term change in organizational settings for
purposes of improving the effectiveness of organizational functioning and enhancing the
individuals within the organizations (Baron & Greenberg, 1990; French & Bell, 1990).
There is concern for both the organization and the individual within the organization (Beer
& Walton, 1990). This focus is “in general the goals of I/O psychology … to better
understand and optimize the effectiveness, health and well-being of both individuals and
organizations” (Rogelberg, 2007, p. xxv).
An aspect of organizational psychology that parallels community psychology is the
understanding that individuals and organizations have an active relationship—that is, an
ever-changing, transactional relationship that occurs over an extended period of time (Keys
& Frank, 1987; Maton, 2008). This is at the core of an ecological model of psychology
(Kelly, 2006). For instance, at one point, an individual might be highly motivated to stay
in an organization, whereas at another time, he or she may be motivated to leave, as did
Sarah. Sometimes, just when a disgruntled individual wants to leave the organization, the
organization needs that person and so seeks to retain him or her. The study of such
dynamic relationships is pertinent to both community psychology and organizational
psychology. In a review of 45 years’ worth of articles in the Journal of Applied Psychology and
367
the journal Personnel Psychology, Cascio and Aguinis (2008) identified job satisfaction, work
teams, and organizational culture to be among the most popular topics in recent times
(2003–2007).
Ecology and Systems Orientation
Organizational scientists have a tradition of conducting research from an ecological
perspective as well as a systems perspective (Foster-Fishman, Nowell, & Yang, 2007; Shinn
& Perkins, 2000). They typically include multiple levels of a work setting (e.g., managers
and employees) as well as coordinating mechanisms and processes in their research
endeavors as they attempt to study and change the overall organization. It is this multilevel
or holistic type of research that community psychologists hope to achieve, rather than
endeavors focused merely on the individual.
Cascio (1995, 2010) challenged those in industrial/organization psychology to
examine the shifts in work and technology, globalization, and the definitions of worth
change the nature of organizations and leadership and management. He believed the worth
of a worker shifted with changes in fundamental assumptions in business and the
workplace. These paradigm shifts were important to new models for I/O psychology
applications and research. For example, among the new ways of determining work
performance might be “in situ” (in context) evaluations (Cascio & Aguinis, 2008).
Distinctions
There is a point at which organizational and community psychology diverge from one
another (Riger, 1990; Shinn & Perkins, 2000). In the field of organizational behavior, most
efforts are aimed at improving organizational efficiency and profits, sometimes at the
expense of the individuals in the organizations. Organizational efforts that benefit the
individual are often incidental to the main task of improving the organization (Lavee &
Ben-Ari, 2008; Riger, 1990). For instance, supervisory consideration of Sarah’s concerns
about budget cuts would focus on how it affected Harmony House and not on what would
made Sarah happier. More specifically, suppose Sarah knew of a dangerous circumstance
that might have resulted in Harmony House being sued, such as an elevator that was in
disrepair. Her new supervisor might likely have listened to her, but not to please her.
Rather, he would have been concerned about the financial well-being of the organization.
On the other hand, the primary aim in community psychology is to enhance the
functioning of individuals in organizations (Shinn & Perkins, 2000). The intent is to
empower individuals within organizations to create innovative solutions to the problems
facing them, ensure that the innovations and changes are humanistic, and promote a sense
of community within the organization (Peterson & Zimmerman, 2004). Community
psychologists create a sense of community within an organization or a sense of belonging to
the organization and hope to enhance human functioning. Organizational psychologists
focus on the sense of community reducing turnover (Moynihan & Pandey, 2008).
Organizational psychology and community psychology may be linked in the use of
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organizational theories in community interventions and in the community research and
perspectives that may inform organizational change (Keys, 2007). Though this relationship
has some strong historical ties (e.g., Michigan State University’s Ecological Psychology
Program and University of Illinois at Chicago Circle’s Organizational-Community
Psychology Program’s evolution into the Community and Prevention Research Program),
Keys (2007) noted that these linkages were sometimes ignored or less evident in
community psychologists’ considerations.
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EVERYDAY ORGANIZATIONAL ISSUES
Why have this interest in organizations? People spend a great deal of their adult lives in
organizations, particularly in their place of employment but also in volunteer, recreational,
and educational groups. One’s organizational affiliations often bring economic well-being,
emotional security, happiness, a sense of self-esteem, and status, as well as the social rewards
of belonging to a group and a sense of accomplishment (Schultz & Schultz, 1998). On the
other hand, organizations can also frustrate and alienate people and cause much stress
(Rubin & Brody, 2005). With that in mind, we turn to a sampling of the problems of
today’s organizations.
Stress
Stress was discussed at length in Chapter 3 as a possible guiding model for community
psychology studies or community psychologist interventions. For most, the workplace is
one of the central defining contexts to one’s identity. It can provide a source of both pride
and pain (Blustein, 2008). Think about how, when we want to get to know someone, we
ask what they do and who they work for. At least a third of our adult lives is usually spent
working. The work setting changes and demands naturally affect our lives. Zohar (1999)
found that work hassles are correlated with negative mood and later fatigue. And although
stress from home can spill over into the workplace, the likelihood of workplace stress
interfering with home life has been shown to be significantly greater (Mennino, Rubin, &
Brayfield, 2005)
A person’s experience within an organization can vary greatly because of many
different variables. So we might expect that work stress and its causes are also quite varied
(Rubin & Brody, 2005). Workers can be too busy or too bored. Interpersonal conflicts
among coworkers may exist, or the individual may not feel competent or sufficiently
trained to do the work. The job may be dangerous, such as working on a ward with violent
individuals, or may be in a demanding and hazardous environment where noise, fumes,
poor lighting, or the work itself can produce stress. There could be supervisory problems,
too many or too few rules, or too much or too little structure.
Zohar (1997) proposed three types of work hassles: role conflict (when there are
different and opposing work expectations, such as to be a friend but also to be able to
criticize performance); role ambiguity (when it is unclear what one is expected to do, for
example—not being told what the job expectations are); and role overload (there is just too
much to do … empty the warehouse in 10 minutes, or do what used to be two full-time
jobs).
The workplace culture has significant effects on negative work-to-home spillover of
stress. The informal, often unspoken, expectations and values within the setting influence
how much pressure people experience. For both males and females, time pressure on the
job negatively influenced the work-to-home spillover. However, the perception of a “family
friendly environment” and the ease with which one could take time out of the day for
370
family-related events—that is, family-friendly cultural practices—seemed to ease the work-
to-home intrusiveness (Mennino et al., 2005).
As a measure of stress-induced reactions, a link between everyday job stress and
alcohol and drug abuse has been demonstrated (Frone, 2008). Early attempts to link
overall alcohol and substance abuse to overall work stress were not consistently supportive
to this position. But when the question was made explicit to a given context (a specific day
with specific stressors), the work stress and substance abuse relationship appeared (How
many drinks did you have at the end of that day?). Frone (2008) believed the stress-
dampening efforts behind substance abuse were clearly demonstrated from these contextual
data. Later findings suggested that a permissive climate at the workplace might encourage
alcohol and drug use there (Frone, 2009) This climate was measured through three
dimensions: substance availability, workplace descriptive norms, and workplace injunctive
norms. In one estimate, 62% of a national sample reported that it was easy to bring alcohol
into the workplace (Frone, 2012). However, this facilitative climate was in turn related to
poor safety, to high levels of strain, and to poor morale in the workplace. These might be
held within a definition of the workplace cultural context (O’Donnell, 2006). The
influence of the unspoken and assumed values and expectations, that is, culture, seemed
critical to any consideration of workplace stress. If unchecked, this could lead to burnout.
Stress Reduction
Social support from coworkers ameliorated the effects of stress and burnout in various
community agencies (Bernier, 1998; Turnipseed, 1998). Snow, Swan, and Raghavan
(2003) found in a sample of secretarial staff that both coping style and social support were
predictive of reduced stress reactions. Active coping (dealing with the problem) led to the
eventual lessening of stress symptoms (anxiety, depression, physical complaint), whereas
avoidance coping (ignoring the problem, distracting oneself) did not. Having good social
support increased active coping, which in turn led to fewer problems. A social support
system helped the worker solve work problems. This would fit with the resilience models
that were described and discussed in Chapter 3 resilience models.
Cautions are needed here, however. Social support often operates in complex ways in
organizational settings (Schwarzer & Leppin, 1991). In some instances, social support can
actually worsen the individual’s situation (Grossi & Berg, 1991). Similarly, regard must be
given to each person’s cultural background and what kind of support is most appropriate
for that person (Jay & D’Augelli, 1991).
Quillian-Wolever and Wolever (2003) wrote on work stress management programs.
They note that these programs are based on the extensive research done on stress and
coping (see Chapter 3). They propose a framework for program organization that addresses
the multiple layers of the stress reaction: physical, cognitive, emotional, and behavioral.
Among the interventions for physical and cognitive coping are exercise, with its positive
effects on the entire organism (Freeman & Lawlis, 2001); massage therapy, which decreases
muscle tension and enhanced immune functions (Zeitlin, Keller, Shiflett, Schleifer, &
371
1.
2.
3.
Bartlett, 2000); relaxation techniques leading to positive changes in several physiological
indicators of stress (Cruess, Antoni, Kumar, & Schneiderman, 2000; Freeman, 2001); and
meditation with its mental focusing and attendant positive immunological and neurological
shifts (Davidson et al., 2003). Many techniques have been incorporated into stress
management programs. The durability of these programs over time is less clear. Quillian-
Wolever and Wolever (2003) conceptualize the stress management programs in terms of
secondary prevention (dealing with early signs of dysfunction), yet describe universal
prevention-educational programs for all workers.
The challenge to stress interventions, therefore, would be to devise environments that
foster the protective and promoting factors for its members.
Burnout
Burnout is a feeling of overall exhaustion that is the result of too much pressure and not
enough sources of satisfaction (Maslach, Schaufeli, & Leiter, 2000; Moss, 1981). Burnout
has three components:
The feeling of being drained or exhausted
Depersonalizatio n or insensitivity to others, including clients, and a kind of cynicism
A sense of low personal accomplishment or the feeling that one’s efforts are futile
(Jackson, Schwab, & Schuler, 1986; Leiter & Maslach, 2005)
Symptoms of burnout include loss of interest in one’s job, apathy, depression,
irritability, and finding fault with others. The quality of the individual’s work also
deteriorates, and the person often blindly and superficially follows rules and procedures
(Schultz & Schultz, 1998)—topics discussed a little later in this chapter.
Burnout is most likely to affect organizational members who are initially eager,
motivated, and perhaps idealistic (Van Fleet, 1991). Research has demonstrated that many
individuals in community service organizations—including police officers, Social Security
employees, social workers, teachers, and nurses—suffer from burnout (Adams, Boscarino,
& Figley, 2006; Pines & Guendelman, 1995). You may have realized that many of these
occupations are filled by women. Although an earlier study suggests that women suffer
more from burnout than men (Pretty, McCarthy, & Catano, 1992), we have come to
understand that there are no gender differences in burnout, but women’s health may be
more susceptible to work stressors (Toker, Shirom, Shapira, Berliner, & Melamed, 2005).
Perhaps this was part of Sarah’s problem; she was simply too burned out and was beginning
to feel unhealthy, so she resigned. Poor fit between the person and the organization can also
result in burnout (Maslach & Goldberg, 1998). For example, Xie and Johns (1995)
examined the roles of job scope or job-related activities performed by the employee and
burnout. They found that individuals who perceived a misfit between their abilities and the
demands or scope of the job experienced higher burnout and stress.
Six organizational factors have been identified as contributing to burnout (Leiter &
Maslach, 2004, 2005):
372
1.
2.
3.
4.
5.
6.
Workload: Overload of duties and responsibilities
Control: Lack of participation in decision making
Reward: Inadequate social, institutional, and/or monetary recognition
Community: Social support is wanting and lack of social integration
Fairness: Do not feel just or equitable environment, lack of reciprocity
Values: Incongruency of meaning and goals between individual and environment
Maslach and Leiter (2008) found that they could identify those who are at high risk
for burnout by looking at the worker’s perception of site fairness and earlier reports of
exhaustion or cynicism. When the individual’s expectations of fairness do not match those
of the work site, the tendency to move toward exhaustion and cynicism increases. However,
when work site fairness expectations are met, the individual seems to become more engaged
(as opposed to burned out) with his or her work. These findings highlight both burnout
and engagement tendencies as playing a role in burnout. Whereas Leiter and Maslach’s
(1998) earlier suggestion was to identify those who could stay energetic, involved, and
feeling effective (i.e., engaged) versus those who would burn out, the later findings
supported the role of the perceived work environment in determining these behaviors and
attitudes. Fair settings retain personnel and maintain job effectiveness over time.
Organizational Culture
Why is it that as individuals come and go from organizations, much as Sarah did,
organizations do not seem to change much, even though their members do? The answer is
organizational culture (Baron & Greenberg, 1990). Earlier in the history of its study, and as
a narrower concept, organizational culture was referred to as organizational climate. Just as
type A personality (e.g., hostile, competitive) is related to an individual’s style,
organizational culture is related to the personality of the organization. Organizational
culture consists of the beliefs, attitudes, values, and expectations shared by most members
of the organization (Schein, 1985, 1990). Once these beliefs and values are established,
they tend to persist over time as the organization shapes and molds its members in its
image. For example, can you recall how different all of the freshmen looked in appearance
and dress your first week of classes? By senior year, many of these same students looked
more similar because other students pressured them to conform to the organization’s image.
Students who most deviated from the campus norm often left rather than change.
Besides conformity, the prevailing organizational culture guides the organization’s
structure and processes. How decisions are made in the organization relates to its structure.
For instance, whether decisions originate from the bottom, as when average organizational
citizens participate in decisions, or from the top, when a centralized management makes the
decisions, is part of the organization’s structure (top and bottom) and processes (how the
decision is made).
The organizational structure, including the decision-making system, also determines
social class distinctions within organizations, such as status differences between executives
373
and middle managers. The distribution of power is also likely to be affected by the
organization’s culture. If lower-level members make decisions, they will have more power
than if they are not allowed to participate in decision making. Finally, organizational
culture affects the ideology of the organization. If the organization views human nature as
good, it will tend to allow subordinate participation (Tosi, Rizzo, & Carroll, 1986). If the
culture emphasizes the development of human potential, then the members are more likely
to be allowed to develop and create new ideas without much interference from the
organization.
An open culture, one appreciative of human dignity and one that enhances human
growth, is preferred by most organizational members and by most community
psychologists. Open cultures foster a sense of community, better communication, and more
empowerment, which can exist in an organization just as it may in neighborhoods (Detert
& Edmondson, 2007; Klein & D’Aunno, 1986; Pretty & McCarthy, 1991). Such
organizational cultures tend to foster employee commitment (Shadur, Kienzie, & Rodwell,
1999), among their other positive effects. However, when the culture is repressive in that it
inhibits human growth or when there are huge gaps in what the organization professes to
be and what it actually is (e.g., professing to have a positive culture that is negative in
reality), high levels of member cynicism develop, performance deteriorates (Baron &
Greenberg, 1990), and cohesiveness drops. Perhaps this is what happened to Sarah as she
felt the disregard of her new supervisor flood over her.
Community psychologists are studying a phenomenon related to organizational
culture: the sense of community within an organization. Chapter 1 discussed sense of
community in some detail. Sense of community pertains to an individual’s feeling that he or
she is similar to others and that he or she and the other individuals in the setting belong
there. There is a sense of “we-ness” and belonging coinciding with a sense of community.
Pretty and McCarthy (1991) explored the sense of community in men and women in
corporations. They found that different features of the organization helped to predict the
sense of community. What these characteristics were depended on gender and on position
in the workplace. Male managers’ sense of community was predicted by their perceptions of
peer cohesion and involvement, whereas female managers’ sense of community was
predicted by their perceptions of supervisor support, involvement, and amount of work
pressure.
Another aspect of organizational culture is the extent to which staff in the organization
perceive a sense of empowerment; in fact, organizational culture provides an excellent
framework for understanding and assessing the person–environment fit needed if
empowerment is to succeed in organizations (Ambrose, Arnaud, & Schminke, 2008;
Foster-Fishman & Keys, 1997). Empowerment in organizations was found to be related to
employee effectiveness (Spreitzer, 1995). Pereira and Osburn (2008) reported in their
review of quality circle research that work effectiveness was improved but employee
attitudes toward work were not. What are the organizational characteristics that inspire
empowerment? Using the case study method, Maton and Salem (1995) found at least four:
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A belief system that inspires growth, is strengths-based, and focuses beyond the
individual
An opportunity structure that is highly accessible
A support system that is encompassing, is peer-based, and provides a sense of
community
Leadership that is inspiring, talented, shared, and committed to both the setting and
the members
Such qualities very much parallel those of an open culture.
We are reminded of Leiter and Maslach’s (2004, 2005) research on organizational
factors related to burnout, mentioned earlier. The six dimensions of workload, control,
reward, community, fairness, and values all fit within our discussions of organizational
climate. Note that the fairness dimension proves pivotal in considerations of resiliency or
burnout within the worksite (Maslach & Leiter, 2008). The importance of fairness and
support as contextual factors has been demonstrated in a study of women and ethnic
minority police officers in New York City (Morris, Shinn, & DuMont, 1999). Their
commitment to the work was significantly influenced by these elements of organizational
culture. The perception of fairness is important to everyone. It may be especially so for
members of categories that have historically been discriminated against, such as a given
gender or ethnic minority.
Elaborating on those aspects of organizational culture that encourage diversity, Bond
(1999) describes a model of connectivity in which gender, race, and class might be
appreciated within a work setting. Connectivity would result from (1) a culture of
connection where people’s reliance on each other to accomplish goals is known and
appreciated, and (2) a recognition of multiple realities that notes many perspectives and
invites participation in the creation of the narrative of what is real. She describes the
creation of an organizational culture at odds with traditional American organizations’
emphasis on individuality and autonomy and the norm of sameness.
As we can see, the consideration of what makes an organizational culture and what
qualities of that culture encourage or sustain its members are very much a concern of
community psychology. There has been increased focus on the ways in which
organizational settings produce positive worker attitudes, or good citizens.
Organizational Citizenship Behaviors
Organizational citizenship behaviors (OCBs) are the “contributions to the maintenance and
enhancement of the social and psychological context that supports performance” (Organ,
1997, p. 91). Early work on these behaviors defined two different types of responses, the
first an altruistic willingness to help others, and the second a conscientious willingness to
meet the demands of the work setting. The second type of behavior is likened to being the
“good soldier” (Organ, 1988).
Later conceptualizations of OCB have expanded these factors to include:
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Altruism—helping of individuals
Conscientiousness—helping the organization to function
Sportsmanship—tolerating unexpected demands
Courtesy—helping others avoid problems
Civic Virtue—participating in the life of the organization (Organ, 1997; Lievens &
Anseel, 2004)
Organ, Podsakoff, and Mackenzie (2006) have described civic virtue as an
involvement with and responsibility for the life of the organization. Sportsmanship, or the
willingness to do more without complaint for the good of the company, is also a more
system-focused aspect of citizenship. Both of these are contrasted to the altruism factor,
which is being helpful to individuals with whom one works. Coyne and Ong (2007) found
that sportsmanship was a very good indicator of institutional commitment—that is, it was
negatively related to intentions to leave a workplace. Similarly, Paillé and Grima (2012), in
a study of white-collar French workers, found sportsmanship to be a strong predictor of
commitment to the work organization.
Research has suggested that leader–member communications influence OCB
(Truckenbrodt, 2000; Wayne & Green, 1993) and/or perceptions of system fairness
(Organ, 1990; Schnake, 1991). Tepper (2000) wrote of “interactional justice,” where
“treating employees with respect, honesty, propriety, and sensitivity to their personal needs”
(p. 179) contributed to an individual’s commitment to the work setting.
Burroughs and Eby (1998) studied workplace sense of community and its relationship
to OCB. Their sense of community scale had nine factors:
Sense of belonging (membership)
Coworker support (influence; expression of ideas)
Team orientation (integration; engaged and involved)
Emotional safety (shared emotional connection; mutual and trusting interaction)
Spiritual bond (anchored in common values and spirit)
Tolerance for differences (diversity is all right)
Neighborliness (help with advice and resources)
Collectivism (similarity with others)
Reflection (time for thinking out problems)
Of note, the four factors originally identified by McMillan and Chavis (1986) were
present here in some form. McMillan and Chavis’ four dimensions were: (1) membership,
(2) influence, (3) integration and fulfillment of needs, and (4) shared emotional
connection. However, Burroughs and Eby’s (1999) work related context for sense of
community produced dimensions reflecting this context. These nine factors combined into
a single Psychological Sense of Community at Work measurement (PSCW). The PSCW
was significantly related both to organizational citizenship behavior and to workers’ job
satisfaction.
The relationship between psychological sense of community and organizational
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outcomes was again shown in an Australian study (Purkiss & Rossi, 2007). Better sense of
community was predictive of better workplace attachment, less absenteeism, and lower job
turnover.
Recent refinements to the study of OCB and its impact on workers suggest differences
in how we think about our team group (who we work with) and how we think about the
larger organization or company. Organizational support for the worker leads to
commitment to the organization. Work team support leads to commitment to the team.
Both organizational and team commitment result in OCB. However, job performance—
that is, how well one does—is more related to team commitment. Loyalty to one’s job is
more a matter of commitment to one’s organization. Change-oriented (being helpful to
innovations within the setting) organizational citizenship behavior was found to be best
predicted by employees’ identification with their working group in combination with their
openness to change when they felt a sense of control and power in their workplace. When
the sense of control and power was not present, this prediction did not hold true (Seppälä,
Lipponen, Bardi, & Pirttilä-Backman, 2012). In a related manner, perceived organizational
support and psychological empowerment were positively related to organizational citizen
behaviors. In turn, perceived psychological empowerment and organizational citizen
behaviors positively related to overall job performance (Chiang & Hsieh, 2012).
These findings extend our understanding of behaviors in the workplace—in
particular, the concept of being a “good citizen” or as Organ (1988) puts it, a “good
soldier” in service to his or her work setting. The research highlights that the phenomenon
is transactional in nature, with the setting needing to provide a reason for the “good
citizenship” and the promise of better performance and loyalty.
Work and Self-Concept
Work has consequences for our sense of well-being and how we feel about ourselves
(Blustein, 2006, 2008; Fassinger, 2008; Fouad & Bynner, 2008; Lucas, Clark, Georgellis,
& Diener, 2004).
When people work or consider work, they are engaging in an overt and complex
relationship with their social world. For many people, working is the ‘playing field’ of
their lives, where their interactions with others and with existing social mores are most
prominent with opportunities for satisfaction and… joy, as well as major challenges…
and at times, pain. (Blustein, 2008, p. 232)
Given this importance of work to our self-definition, any holistic consideration of our
functioning should include aspects of our working world.
Dealing with a Diverse Workforce
Findings on the effects of group diversity on group functioning have been mixed over the
past few decades of research. Tsui, Egan, and O’Reilly (1992) found that as workers
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became more different from their groups, absenteeism increased and the level of job
commitment declined. This finding was strongest for Whites and for males. However, Huo
(2003) has found that “super-ordinate” group membership could overcome “sub-ordinate”
group memberships, so if identification with a company is powerful enough, individuals
would come to ignore the other differences of race, gender, or other diversity designators.
Mannix and Neale (2005) summarize the studies to date on diversity in the workplace as
mixed in their results. They point out the importance of organizational context to the
outcomes. They cite as an example Chatman and Spataro’s (2005) finding that visibly
different individuals were more cooperative within a business setting when collectivist
values were emphasized over individualistic values. Following their review of the research
on diversity in the workplace, Mannix and Neale (2005) provide three recommendations:
(1) the types of tasks and goals given diverse teams should be carefully determined, because
what is being asked of the team determines the dynamics within the team; (2) efforts to
connect team members by establishing commonalities and similarities result in better group
identity and effort; and (3) encouragement should be given to respect the minority voice,
because the pressure to conform is a normal part of group processes. Ely and Thomas
(2001) encourage a shift in rationale for diversity within business settings. They argue that
a “learning and effectiveness” focus for diversification efforts would highlight the
advantages to seeking different perspectives and the rewards that underlie the
understanding of these perspectives. Diversity is important because we live in a diverse
world. An awareness of the processes whereby diverse perspectives may be of value to group
products and the manner in which these contributions may best serve the group can affect
the integration of diverse populations and diverse perspectives into organizations. This
knowledge derived from organizational psychology is certainly applicable to communities as
a whole and community psychology in particular.
Organizations can promote diversity by encouraging a culture of connectedness and
collaboration and of recognizing multiple realities (as opposed to insisting on a singular
reality, determined by the historically empowered). To bring about change, the usefulness
of “connected disruption,” where the value of “both/and” challenges the value of the
singular truth of the powerful and privileged, is suggested (Bond, 1999).
Other Ecological Conditions
Size of organizations is important, too. Members of small organizations report more
supportive environments, less discrimination, and more loyalty to the organization
(MacDermid, Hertzog, Kensinger, & Zipp, 2001). On the other hand, large organizations
often create negative conditions. For instance, Hellman, Greene, Morrison, and
Abramowitz (1985) examined residential mental health treatment programs by measuring
staff and client perceptions. Not surprisingly, the larger the program, the more the
members experienced anxiety, held negative views of the psychosocial aspects of the
organization, and perceived greater psychological distance from the organization.
However, size is just one consideration in cultural milieu. Examining the
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psychological sense of community (PSC) at work, Burroughs and Eby (1998) found that
size of work group did not affect people’s PSC. Rather, the individual’s match between
their personal goals and those of the organization significantly predicted PSC. In turn, the
PSC related to job satisfaction, which related to loyalty, courtesy, and willingness to help
within the organization.
The growing diversity in the workplace has produced other ecological considerations
for organizations. Fassinger (2008) discussed the trends toward larger proportions of the
workforce being women, people of color, sexual minorities, and people with physical
disabilities. The impact of such shifts in the composition of organizations can be both
beneficial and challenging. Case in Point 12.1 is an excellent illustration of the way
organizational psychology and applied social psychology can make contributions to the
concerns of the work setting ecology and its impact on a diverse workforce.
CASE IN POINT 12.1
Consulting on Diversity
In the 1990s, a New England company called on a team of community psychologists to
help deal with diversity issues (Bond, 2007). A multiyear assessment and intervention
followed. Previous work on systems-level change pointed out the positive effects of a
culture that sought to “learn from diversity” (Kochan et al., 2002). Such deeper level
attitudinal shifts brought more lasting changes within an organization’s culture (Harrison,
Price, & Bell, 1998; Harrison, Price, Gavin, & Florey, 2002; Thomas & Ely, 1996). The
consultants sought to bring about more than superficial alterations in the company’s
numbers.
Using a social ecological perspective, the consultants were mindful of resources, the
distribution of those resources, and the importance of understanding behaviors in context.
Using a language of worker “needs and competencies” and company “resources and
demands,” they looked at how actors and settings influenced each other. At the same time,
given the nature of system interdependency, the consultants were aware that changes could
be considered synergistic in nature. Small, specific changes could result in larger and wider
alterations in attitudes and behaviors. The changes could be at the formal policy level or at
the informal, cultural level (O’Donnell, 2006).
To support diversity, they aimed to foster an organizational climate that emphasized:
Understanding others in the context of their culture and their situation
Shared goals and destiny (we all win or lose)
An understanding and valuing of differences (along with appreciation of the larger
social and historical forces that have brought about these differences)
Taking responsibility for their effects on their environment (impact versus intent—
what happens to others versus what an individual meant to do)
They also were respectful of individual experience—that is, the subjective world.
Facing changing local demographics and global markets, the company realized the
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need for change. With support from the top (president, human resources director), the
consultants worked through a variety of departments, using existing leadership and work
teams. The interventions were fitted to the situation, in collaboration with onsite workers.
The phases to the intervention included needs assessment, setting the stage for
collaboration, developing training appropriate for the site in collaboration with workers and
leaders, providing training and dealing with group dynamics, assessing change, and working
for institutionalization of changes.
Outcomes of the various phases of this long-term intervention were measured both
qualitatively and quantitatively. The results supported the effectiveness of the project in
terms of attitudinal change and in terms of enhanced understanding of the nuances of what
it means to support diversity in the given company context. Changes in the organizational
culture were notable and included some measurable differences in both formal policies and
informal practices along with some attendant changes in employment patterns (e.g., more
diversity in the workplace, more diversity in leadership).
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TRADITIONAL TECHNIQUES FOR MANAGING PEOPLE
When Sarah left Harmony House, she was a discontented employee. She was not the only
one hurt by her decision to leave, though. The organization also suffered. Harmony House
would now have to recruit and select a replacement for Sarah as well as train and
indoctrinate the new person. Clients might feel disoriented when they came looking for
Sarah and could not find her. What do organizations traditionally do to attract and retain
good members and manage poor members? Are these strategies helpful?
Compensation Packages
Many of the traditional attempts by organizations to treat employees well or terminate
them focus on the individual. An age-old method of motivating employees to work hard
and work well is to manipulate compensation levels. In fact, setting compensation levels is
often considered the primary function of many human resources management staffs
(Milkovich & Boudreau, 1991). Interestingly, organizational members rarely mention pay
as the job facet most related to job satisfaction. Nonetheless, one of the common ways
organizations attempt to motivate their members is by adjusting compensation and benefits
packages. One study showed that raising wage and salary levels was the most common
response to reducing quitting in organizations (Bureau of National Affairs, 1981).
However, in reality, pay adjustments only partially increase job satisfaction (Schultz &
Schultz, 1998). Even when employees participate in their own performance reviews, which
are often tied to compensation levels, satisfaction with pay remains unaffected (Morgeson,
Campion, & Maertz, 2001).
Unfortunately, wage disparities between men and women have not been rectified.
One study reports that women make 75% of what men make (American Association of
University Women [AAUW], 2007). The wage difference appears to grow over time past
college graduation, from 20% less 1 year postgraduation to 31% smaller 10 years
postgraduation while controlling for occupation, hours working, and parenthood factors.
Data from the U.S. Census (2009) placed women earning 77% of men’s earnings and
ethnic minorities at even greater disadvantage (African American women make 70 cents on
the dollar; African American men make 74 cents; Hispanic or Latina women make about
60 cents; Hispanic men make almost 66 cents; AAUW, 2011). Note that earlier
descriptions of burnout and of good citizenship both emphasize the need for fairness. One
might wonder what Sarah was earning compared to her level of responsibilities, as well as
her comparison points.
Rules and Regulations
Organizations control member behavior by means of policies and regulations. Policy
manuals and codes of ethics for employees have become quite common. Some policies are
specific: “No gambling on company property.” Others are less so: “Employees are expected
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to be loyal to the company.” Add to this the multitude of public policies or federal and
state legislation intended to regulate organizations and the individuals in them, and the
total number of regulations is overwhelming. Federal Equal Employment Opportunity
Guidelines and the Occupational Safety and Health Regulations alone would create a stack
of policies higher than the average person is tall!
The extent to which employees follow organizational policies is unclear, but some
classic studies of employee behavior indicate that not all organizational members appreciate
regulations. In the classic study of the Western Electric Plant in Hawthorne, Illinois, the
men of the bank wiring room purposely worked below the production standard set by their
supervisors. Why? They believed that if they worked up to standard, their superiors would
simply raise the standard (Roethlisberger & Dickson, 1939), thereby forcing the men to
work harder. It is known today that in professional bureaucracies such as hospitals,
universities, and other human services agencies, professionals prefer to operate according to
their own codes rather than the formal policies of their organizations (Cheng, 1990;
Mintzberg, 1979). Most organizational members have little say in the policies or
regulations of their organization; that may be the primary reason they are discontented with
the guidelines and violate the rules, as is often found in studies of organizational rules. In
addition, rule violation can result in discipline, such as termination, demotion, or leave
without pay. Atwater, Carey, and Waldman (2001) found that discipline is often perceived
as unfair and that both recipients and observers consequently lose respect for the person
administering the discipline as well as for the organization. Notably, the perception of
fairness is seen as critical to work-setting stress (Maslach & Leiter, 2008). This appears to
be a prime focus for anyone dealing with a work-setting community.
These traditional methods of regulating individuals in organizations have not typically
been what community psychologists would recommend. Most were aimed at the individual
within the organization. They neither addressed nor acknowledged the role that the context
or the organization itself plays in producing and influencing individual behavior. However,
there is a growing body of work focusing on the culture and the contexts of work. Findings
have reinforced the advantages of fairness, empowerment, and the development of a sense
of community.
We turn our attention to aspects of organizational change.
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OVERVIEW OF ORGANIZATIONAL CHANGE
Reasons for Change
Organizations require change for a number of reasons, a few of which are mentioned briefly
here. Pressures for change may be internal or external. Internal pressures to change come
from within and include pressures from clients, staff, and supervisors. As in the case of
Harmony House, internal budget pressures can force change. Organizations also sometimes
change their focus or offer new or different services, which leads to further change.
Forces outside of the organization create external pressures to change. Government
regulations, external competition, political and social trends, and other factors create the
need for organizations to adapt. For example, the move to deinstitutionalize people who are
mentally disabled has forced communities to provide alternative services, such as group
homes. Both the availability of homes and the conditions in the institutions have been
affected by this trend.
Issues Related to Organizational Change
As already mentioned in Chapters 4 and 5, change is difficult. One reason organizational
change is hard is because many organizational members resist change. They feel threatened
by changes, perhaps because they do not feel competent to handle them or they do not
want to put forth the effort to adapt to them. Similarly, some organizations are more
difficult to change than others—for example, public sector organizations, which are often
restricted by laws and civil service requirements (Shinn & Perkins, 2000).
There are other reasons change in organizations is complicated. Organizations are
interdependent systems (Tosi et al., 1986). The people in the organization influence the
organization, and the organization influences the people. One cannot be changed without
changes occurring in the other. For example, suppose in his budget cuts, the Harmony
House supervisor also decided to cut staff to save money. Fewer staff members means less
attention to each youth; fewer staff members also means more work for the remaining staff.
Hence, the services of the organization may start to decline; its reputation might also
decline, and it would perhaps attract fewer clients and fewer qualified job applicants
because of the budget cuts. Change also means a reallocation of resources and a change to
the processes by which allocation is determined (Seidman & Tseng, 2011). This process is
perceived to be fraught with risk (Stebbings & Braganza, 2009).
Difficulty in changing organizations also lies in the organizational tendency to look
for change that fits within the existing organizational paradigm (Cheng, 1990). Changing
organizations requires customizing the intervention and fitting the change to one the
organization can understand, fitting the assumptions regarding operational paradigms
(Constantine, 1991).
To ensure that change is indeed needed, change should commence with action
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research. The research can also address whether the organization is ready for change. Survey-
guided feedback has been suggested as a viable method for monitoring organizational
change (Shinn & Perkins, 2000). Survey-guided feedback involves the systematic
collection of data from organizational members who also receive subsequent and repeated
feedback about the changes.
Both need and readiness for change are generally prompted by dissatisfaction with the
organization by its members (Baron & Greenberg, 1990). The age of the organization is
also important, because there are different stages of development for community
organizations (Bartunek & Betters-Reed, 1987). Some preliminary plan for change should
also be in place, although a long-range plan may be better (Taber, Cooke, & Walsh, 1990).
Such planning should involve staff and perhaps clients in all phases. Staff participation has
a significant effect on both job satisfaction and self-esteem (Roberts, 1991; Sarata, 1984).
Feeling empowered—that is, that one makes a difference and that one has some control
over their work situation—is clearly related to positive feelings about what one does in the
work setting as well as to one’s effectiveness (Gregory, Albritton, & Osmonbekov, 2010;
Spreitzer, Kizilos, & Nason, 1997).
Change in organizations can occur at the organizational level, the group level, or the
individual level. Although some community psychologists might prefer to change the whole
organization—the whole community, so to speak—often it is the subparts of the
organization that are easiest to change. Next is an examination of selected organizational
change methods.
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CHANGING ORGANIZATIONAL ELEMENTS
Change can occur at the top and all the way to the bottom of an organization. We consider
possible changes in leadership style, which can influence how an organization functions,
and then the processes by which organizational change can be facilitated. We finish with
two examples of organizational change that have been attempted at the production level.
Leadership
Eagly, Johannesen-Schmidt, and van Egan (2003) described and discussed the variety of
ways in which leadership styles have been defined. Early studies spoke in terms of task-
focused versus interpersonally focused leaders (Bales, 1950; Fiedler, 1971; Likert, 1961).
The task-focused leader was interested in getting the work done the most efficient way
possible. The interpersonally focused leader was concerned for the people in the process,
worrying about how people feel and seeing the importance of the social climate and
interpersonal relations as end products in and of themselves. An interesting development in
understanding the effectiveness of these styles was studied and summarized by Fiedler
(1971), who found the task focus style most effective in very favorable and unfavorable
situations. On the other hand, the interpersonal focus style was best suited to nonextreme
situations. He called this a contingency model for leadership style. (See Table 12.1.)
Other researchers distinguish between democratic/participatory styles and more
autocratic/directive styles (Lewin & Lippett, 1938). The democratic leader asked for
opinions and discussed the options with those to be affected. The autocratic leader made
the decisions him- or herself and then acted. In a classic study on the effects of democracy
versus autocracy leadership, Lewin, Lippett, and White (1939) found the autocratic style to
yield more aggression and frustration in a children’s group and the democratic style to
result in more spontaneity. These initial findings have led to the study of leadership styles’
effects on productivity and satisfaction. Gastil’s (1994) meta-analysis of these studies on the
two types of leadership yields mixed results. Although democratic styles brought more
group satisfaction, the results were moderate at best. Neither democratic nor autocratic
styles led to superior productivity.
Eagly and associates (2003) performed a meta-analysis of leadership studies using the
newer categories of transformational, transactional, or laissez-faire styles (Bass, 1998). In
the transformational style, the leader inspired through example, established trusting
relationships, empowered those they worked with, encouraged worker efforts, and worked
for innovation. The transactional style was characterized by feedback on performance—
positive when things were done well and negative when there were problems, intervening
only when things were “exceptionally” bad. A third style of leadership, called laissez-faire,
was one where the leader was absent and uninvolved. Eagly and colleagues found women to
be more transformational and better at contingent rewarding, and men to be more
transactional, using negative corrective feedback. Notably, both men and women preferred
the leadership qualities in women. Women leaders were seen as inspiring better effort,
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being more effective, and resulting in better satisfaction with their leadership.
TABLE 12.1 Examples of Three Leadership Styles
Transformational—Interactions are positive and inspirational. You feel like a valued
member of a team whose opinion is respected, valued, and sought out. You sense the
leader’s commitment to and interest in the work. This enthusiasm is contagious, and so
you go seeking the leader when you have a good idea and take the initiative at times.
Transactional—The leader is seen and heard from when directives are being issued or
feedback being provided. Often, seeing the leader could mean more work or feedback on
what one has done. You work to complete tasks. There is a focus and a goal, and it is clear
that your worth is determined by how well you follow orders.
Laissez faire—The leader is rarely seen or heard from in a meaningful way. S/he is absent
from your work life. It feels as if you are working by yourself rather than in a workgroup
or team that is interdependent on each other. Things can feel chaotic, unfocused, or not
goal directed.
Source: Adapted from: Eagly, Johannesen-Schmidt, & van Engen (2003).
One might expect that there would be more women leaders, given these findings. But
such is not the case. Later studies found that despite women’s better leadership behaviors,
the “definition” of a good leader remained “masculine” in nature (Koenig, Eagly, Mitchell,
& Ristikari, 2011). Women faced the dilemma of being seen as nonfeminine when
exhibiting good leadership skills (Eagly & Karau, 2002).
Although the conceptual and research-based framework for understanding leadership
and its effects on groups has been changed by the work of Eagly and her associates, the
problem of gender-based expectations continues to plague organizations.
In an even more radical shift in understanding leadership, Wielkiewicz and Stelzner
(2005) took exception to its person-centered focus. They argued that leadership was not a
personal characteristic. Rather, leadership “emerged” from the interactions with a given
context. Using James Kelly’s (1968) ecological framework, Wielkiewicz and Stelzner argued
that leadership was more process-driven and dynamic. Decisions were not made by the
leader so much as they emerged from the interactions of those involved. Given this model,
what was critical to leadership were the participatory structures and the genuineness of the
interactions. Both structure and process were involved. The advantages of participation,
diversity of opinion, and democracy were a part of the dynamic model.
Eagly and Chin (2010) have criticized the lack of research on diversity in leadership.
What advantages are there to a leadership with a diverse background in times of
increasingly diverse demographics? What new leadership models might emerge from
expanded global and cultural backgrounds? And what happens when advantages have been
demonstrated (such as women’s superior transformational leadership style, mentioned
earlier)? Community psychology would echo the need to answer these questions.
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The work on gender and transformational leadership fit well with community
psychology aspirations to diversity, empowerment, and relational processes. In Wielkiewicz
and Stelzner’s model, we see a proposal for a contextually driven, process-oriented model
leadership. Finally, the dearth of work on diversity and leadership denies us information on
new models, new skill repertoires, and more diverse understanding of leadership processes
and what goes into the selection of leaders. Community psychology would, by its nature,
find all of these issues and questions of interest.
Reorganization
Several techniques may be employed for changing the whole organization or system; two
are examined here. One change strategy is reorganization of the organization.
Reorganization means that a structural change takes place; that is, the tasks, interpersonal
relationships, reward system, or decision-making techniques are rearranged (Beer &
Walton, 1990).
Organizations can also be reorganized by becoming linked to, affiliated with, or
networked with other organizations. Networks, enabling systems, and umbrella
organizations were discussed in an earlier chapter. Suffice it to say here that these “master”
organizations help ensure the survival and success of their member organizations. However,
competition, lack of coordinating mechanisms, and other factors can diminish the
effectiveness of such federations. The power of collaboration is exemplified in Nowell’s
(2009) study of community organizations that networked to bring greater effectiveness to
their work. She found that the member relationships were the best predictors of system
changes and of willingness to organize and to change policies. If one was going to take the
risk of committing to doing something, it was best if the partners knew each other. As
described in the Crude Law of Social Relationships (Deutsch, 2000), the stronger the
relationships, the more likely the cooperation. This is related to “social capital,” or the value
placed on the relationship to the person and/or to the system. (An example could be a
group of friends whom you like and hold in high regard, who have done favors for you
before. If that group calls on you to do them a favor, it is likely you will do it. In contrast, a
group of people whom you barely know might ask for the same favor, and you might find
it easy to decline.) However, in bringing about the actual coordination efforts, such as
changing forms to get greater compatibility across agencies or developing explicit
procedures for referrals, relationships themselves were insufficient. For achieving these
specific types of activities, “strong leadership” and “decision-making capabilities” were
necessary.
Foster-Fishman and colleagues (2007) provide a systems-based model for examining
organizational and community systems and then using the findings to help direct change.
Drawing on the earlier work based on Checkland’s (1981) ideas of soft systems, Foster-
Fishman and associates (2007) gather qualitative data to understand the subjective nature
of the system targeted for change and the multiplicity of perspectives that make up the
perception of the system. They also use a system dynamics theory (Forrester, 1969; Jackson,
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2003) to look at feedback and interaction within the system, causes and consequences of
action, and what brings about shifts in a system. By studying these patterns, the “levers for
change” might be identified. When these levers are activated, the system as a whole
changes. Foster- Fishman and coworkers believe that this richer and more complex
paradigm provides a true picture of a system at work and helps devise meaningful shifts in
what that system is. More linear and simplistic explanatory models lead to the proposal of
one component interventions for system change, which by its nature leads to failure or at
best serendipitous success. Foster-Fishman and colleagues (2007) argue that systems-level
changes may not be always needed, but when they are, an understanding of the various
parts of an organization and how the parts interact is critical to making changes. Systems
theories are helpful to understanding and acting in organizations. We now look at two
types of organizational change. Both emphasize the importance of interconnectedness and
of empowerment of the workers within the organization.
Quality of Work Life Programs
Another change that can be made throughout an organization is to introduce quality of
work life (QWL) programs, or programs of participatory decision making that create long-
term change in organizations. Recall that these programs include participatory decision
making, designed to encourage democracy and staff motivation, satisfaction, and
commitment. Such programs also foster career development and leadership by empowering
or fostering decision making in others besides the leaders or managers already designated on
the organizational chart (Hollander & Offerman, 1990). In QWL programs, the staff and
possibly the clients design programs and action plans that they think will be effective and
are well reasoned. The programs are then implemented and perhaps funded by higher levels
in the organization. Such programs have been shown to be effective in improving
organizational productivity as well as employee satisfaction in various settings (Baron &
Greenberg, 1990). Some (Labianca, Gray, & Brass, 2000; Randolph, 2000) found that
empowerment can be particularly elusive and a resisted concept in many organizations.
Managers have found that empowering those under them to participate in decision
making in QWL programs can be a good idea (French & Bell, 1990). One example of a
QWL program has been quality circles. In quality circles, small groups of volunteer
employees (or volunteer clients of a community service) meet regularly to identify and solve
problems related to organizational conditions. Quality circles can humanize organizational
environments as well as increase participants’ satisfaction with the organization (Baron &
Greenberg, 1990). A meta-analysis of quality circle studies found that they have a moderate
but significant effect on employee performance (Pereira & Osburn, 2007). If Sarah and
other employees of Harmony House had participated in a quality circle, they might have
realized that they were all discontented with the changes and developed innovative
solutions to the organization’s problems before staff turnover became high. Quality circles
exemplify the “participation and democracy” work practices of empowerment theory,
which have shown positive results (Klein, Ralls, Smith Major, & Douglas, 2000).
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Hamilton, Basseches, and Richards (1985) suggested that the number of programs in
communities that promote participatory decision making is steadily increasing, but several
studies suggest that simply allowing participation in community organizations is hollow
and therefore not beneficial. Prestby, Wandersman, Florin, Rich, and Chavis (1990) found
that for individuals to continue to participate in block or neighborhood booster
associations, benefits (such as getting to know one’s neighbors better or learning a new skill
such as public speaking) must exceed costs (such as feeling the association never gets
anything done or having less time to spend with friends and family). Community
organizations need to manage their incentive efforts so that participation by others results
in satisfaction. Researchers have shown that quality circles improved employee satisfaction
and performance (Klein et al., 2000). However, these results were short-lived without wider
support. The larger ecological context played a critical role in the integration of these kinds
of organizational changes.
Those living and working closest to the issues seemed best informed on how to
address them. Quality circles and other participatory methods in organizations take
advantage of this by empowering involved individuals to solve their own problems.
Workplace effectiveness has been shown to improve (Klein et al., 2000; Pereira & Osburn,
2007). Yet efforts to change must be considered within the larger system (Kelly, 1980;
Jackson, 2003).
Team Building
One technique for improving groups in organizations is team building. Team building is
an ongoing method in which group members are encouraged to work together in the spirit
of cooperation that contributes to the group’s sense of community. The purpose of team
building is to accomplish goals and analyze tasks, member relations, and processes such as
decision making in the group. In other words, the group is simultaneously the object of and
a participant in the process. Teams are proving to be such a powerful force for
empowerment that they form the basic building block for “intelligent organizations”
(Pinchot & Pinchot, 1993). Three meta-analyses of team building across three decades have
shown team building to be effective (Klein et al., 2009; Neuman, Edwards, & Raju, 1989;
Svyantek, Goodman, Benz, & Gard, 1999). Klein and colleagues (2009) found team
building to relate to better cognitive and emotional outcomes. As well, teamwork brought
better processing—working through of problems—and better results.
Team building, or team development, as it is also known (Sundstrom, DeMeuse, &
Futrell, 1990), has been used to improve staff services to clients at mental health agencies
(Bendicsen & Carlton, 1990; Cohen, Shore, & Mazda, 1991), as well as to implement
interventions in schools (Nellis, 2012) and improve the performance of both the
corrections officers and staff at forensic (psychiatric) prisons (Miller, Maier, & Kaye, 1988).
Some argue, however, that many employees resist teams primarily because of mistrust and
low tolerance for change (Kirkman, Jones, & Shapiro, 2000).
The demand for team development consultation in business continues to grow along
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with research publications defining and explaining the processes (Offerman & Spiros,
2001; Stagl & Salas, 2008). Surveying members of the Academy of Management’s
Organizational Development and Change Division, the authors find the two most often
cited goals for training are goal setting and communication. The three areas with least
adequate theory for practice are diversity issues, empowerment, and resource management.
It is hard not to note that of these three areas, two come directly from the community
psychology lexicon. In turn, note that the issues of team building (i.e., sharing of
information, developing common goals, establishment of identity) are clearly skills that
come from team building/organizational management studies.
CASE IN POINT 12.2
Managing Change
The assumption is that what managers do can influence worker well-being. Grant,
Christianson, and Price (2007) considered how well-intentioned management decisions
could bring negative as well as positive consequences. They found an abundant research
literature on the positive effects of organizational interventions on employee well-being
(Fisher, 2003; Judge, Thoresen, Bono, & Patton, 2001; Podsakoff, MacKenzie, Paine, &
Bachrach, 2000).
On closer examination, they found that sometimes practices that brought increased
satisfaction in one aspect of well-being brought decreases in well-being on another
dimension. For example, when workers got increased responsibility, they reported greater
psychological satisfaction with their work, but also reported increased stress and strain as
the result of these changes (Campion & McClelland, 1993). Also, if there were monetary
incentives built into job performance, the resulting pay discrepancies could lead to social
discord (Ferraro, Pfeffer, & Sutton, 2005; Munkes & Diehl, 2003). These have been seen
as “trade-offs” in the efforts to bring about well-being.
Grant and associates (2007) proposed that an alternative way to think of these trade-
off potentials was to consider them synergistically (that they could react together to bring
about an even greater effect). This called for a broader conceptualization of who could be
affected by changes and how the changes affected the larger system. So measurement of
effects must examine more than the individual; it should include those around them. Also,
measurements should be on several different aspects of well-being—physical, psychological,
and/or social. Grant and colleagues also recommended that managers think along longer
timelines and be aware of the influence of historical influences on effects. Managers who
have longer time horizons for their actions have happier workers (Bluedorn & Standifer,
2006). Finally, the recommendation was to seek deeper as well as broader data on workers
(attitudes?) on a continuing basis. Companies that performed regular attitudinal surveys
reported less job turnover, greater worker satisfaction, and better performance at the
individual and company level (Huselid, 1995).
Clearly, driven by ecological considerations of complex effects and awareness of
context and time dimensions, these recommendations use community perspectives as well
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as research bases to derive their directions.
All efforts at change need to be approached with caution. In Case in Point 12.2, we
are reminded that systems are complex. Some outcomes are unintended and a long time in
developing.
Summary
Organizational and community psychology are related, with common origins in theory and
applications (Shinn & Perkins, 2000). Whereas organizational psychology primarily focuses
on the workplace, community psychology takes in a wider array of settings and
interventions. They have much to learn from each other’s research literature (Keys, 2007).
Organizational psychology addresses a wide variety of workplace topics: work stress,
burnout, organizational culture, “good citizenship,” diversity in the workforce. Notably, the
conceptual models increasingly use ecological models, empowerment, and participation
among their important factors.
Organizations and agencies that are better places to work provide better services and
products to their clients. Historically, organizations have considered individual employees’
characteristics rather than anything organizational to be the root of problems. Traditional
techniques for managing problem individuals have been to alter compensation packages, or
to institute rules and regulations. However, the development of new work models (or the
return to older work models) provides alternatives to the dehumanizing, industrial-age
conceptions of work and performance. How we think of leadership has been evolving away
from a White, male model. Methods for changing the whole organization include
reorganization—for example, creating smaller, friendlier work teams within a larger
company or corporation. Another organizational strategy for change is to institute quality
of work life programs. These are programs where staff members and perhaps clients
participate in planning and designing the changes the organization needs.
The parallel course of organizational psychology and community psychology can be
seen from this brief survey of work-setting topics.
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The Future of Community Psychology
THE ESTABLISHMENT OF INSTITUTIONAL MARKERS
GROWING BEYOND NATIONAL BOUNDARIES
A USEFUL PARADIGM
COMMENTARIES
ANSWERING THE PRESENT AND FUTURE NEEDS OF SOCIETY
Appreciation of Differences and the Search for Compassion
Sustainability and Environmental Concerns
Disparities in Opportunity for Health, Education, and Economic Success
Aging and End of Life
SUMMARY
FINAL REFLECTIONS
We are the dreams of our parents.
—Deborah Iida, Middle Son
Our human families have been extending and our empathy expanding for thousands of years.
—Ehrlich and Ornstein, Humanity on a Tightrope
Mary’s first choice for college was Cambridge University in England. Of course, she was
eight years old at the time. When she finally applied to colleges several years later, she did
not include Cambridge, but decided to try the American University of Paris. She was
accepted. What surprised her parents was her willingness to even consider going away from
home, much less away from Wisconsin and the Midwest. She had redefined her
boundaries. The normal had expanded beyond her parents’ horizons.
What she found in Paris was a student body and a faculty that was equally open to
global and multicultural perspectives. They were happy to read novels from around the
world as readily as those from the American, British, or French canon. She loved it. The
university challenged her and her understanding of the world. She believed she was being
prepared for the world in which she would live.
This story matches with other trends in colleges and universities. Study-abroad programs
have existed for a long time, and they are now being used in record numbers. These
programs encourage travel, exploration of global sites, and the development of an
international perspective. At some U.S. colleges, more than half of the student body has
studied abroad before graduation. One college we know of had students on all the world’s
continents at one time (including Antarctica). In similar ways, community psychology has
grown beyond its original boundaries, and we are in areas never imagined by the original
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Swampscott, Massachusetts, “community psychologists.” In what ways have we lived the
dreams of the founders of the American movement? And in what ways have we gone
beyond their horizons? Where are the challenges for today and tomorrow?
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THE ESTABLISHMENT OF INSTITUTIONAL MARKERS
The dream of community psychology seems to be born in “distant mists” by now. Yet it
was really just a few academic generations ago that community psychology in the United
States was formally born. From a set of ideas and concepts regarding the potential for
psychology outside of the office and the laboratory, community psychology has developed a
value system, an intervention focus, a skill set, and theories to direct our work in society
and our research programs.
There are several markers of the establishment of this area of psychology. There is a
Handbook of Community Psychology (Rappaport & Seidman, 2000). The Annual Review of
Psychology publishes community psychology–oriented chapters with regularity (Table 13.1).
The Annual Review is considered by many to be among the flagship publications in
psychology (Robins, Gosling & Craik, 1999). It is ranked number one in citations by the
Reuters Journal Citation Report (Annual Reviews, 2011).
TABLE 13.1 Annual Review of Psychology Chapters on Community Psychology, Authors and Dates Since 1973
(First Chapter)
1. Cowen (1973)
2. Kessler and Albee (1975)
3. Kelly, Snowden, and Munoz (1977)
4. Sundberg, Snowden, and Reynolds (1978)
5. Bloom (1980)
6. Iscoe and Harris (1984)
7. Gesten and Jason (1987)
8. Heller (1990)
9. Levine, Toro, and Perkins (1993)
10. Reppucci, Woolard, and Fried (1999)
11. Shinn and Toohey (2003)
12. Trickett (2009)
TABLE 13.2 Journals in Community and Preventive Psychology
American Journal of Community Psychology
Journal of Community Psychology
Journal of Community and Applied Social Psychology
Global Journal of Community Psychology
Journal of Prevention and Intervention in the Community
Journal of Primary Prevention
Prevention Science
There are also several research journals dedicated to community and preventive
psychology (Table 13.2). Research universities are producing a steady stream of articles in
community psychology journals. A review investigated which universities produced the
most articles published in the American Journal of Community Psychology and the Journal of
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Community Psychology (Jason, Pokorny, Patka, Adams, & Morello, 2007). These
universities were numbered among the top major research universities within the United
States (Table 13.3).
A number of graduate programs can be found in community psychology or clinical-
community psychology (as cited in Chapter 1) . Because there are graduate programs, there
are graduates in community psychology who in turn produce their own work. The future
of community psychology seems established within the systems of psychology with regard
to publications, institutions of higher education, and the products of these institutions—
research and graduates.
TABLE 13.3 Universities Publishing in the American Journal of Community Psychology and Journal of
Community Psychology, 1973–2004
1. UCLA
2. Arizona State University
3. University of Illinois, Chicago
4. University of Michigan
5. Vanderbilt University
6. Michigan State University
7. University of Rochester
8. University of Illinois, Urbana–Champaign
9. Yale University
10. University of Maryland, College Park
11. University of California, Berkeley
12. DePaul University
13. Pennsylvania State University
14. New York University
15. University of South Carolina
Source: Jason et al. (2007).
Despite all these signs, Weinstein (2006) expressed concern over several institutional
trends. She believed the number of identified community and clinical-community
programs to be declining. Was this because there was no longer a need to make the
distinction between clinical and community psychology perspectives, with clinical
psychology embracing the concept of prevention and psychoeduca-tion, or was it because
there was decreasing interest in community psychology—in social justice, social change,
and the systems-level interventions that would facilitate this change? Or was this an artifact
of the historical and political cycle of the opening decade of the 21st century in the United
States? Could shifts in political and social philosophy have affected interest in these
programs? And could other changes bring renewed and greater interest in this area of
psychology? Weinstein offered no answer, but cautioned community psychologists that
they needed to attend to this possible decline. The struggles were not over.
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GROWING BEYOND NATIONAL BOUNDARIES
Beyond the U.S. borders, community psychology appears to continue to grow. Among the
articles found in the AJCP and JCP for 2006 through 2011 was research derived from a
variety of global settings (Table 13.4). These articles are representative of the growing
international body of community psychology literature.
Lorion’s (2007) editor’s comments for the Journal of Community Psychology explicitly
mentioned the expanded international composition of the journal’s editorial board in a
strategic decision to broaden perspectives beyond the United States. The American Journal
of Community Psychology has psychologists from Japan, Brazil, and Chile on its Board of
Editors. The “gatekeepers” for the journals have become international.
TABLE 13.4 A Limited Selection of International Articles and Authors from the American Journal of
Community Psychology and the Journal of Community Psychology
Stress and the role of religion in a South African township (Copeland-Linder, 2006)
Australian Aboriginal sense of community (Bishop, Colquhoun, & Johnson, 2006)
Israeli volunteer burnout (Kulik, 2006)
Jamaican attitudes toward mental illness (Jackson & Hetherington, 2006)
Filial piety and kinship care in Hong Kong (Cheung, Kwan, & Ng, 2006)
Italian crime (Amerio & Roccato, 2007)
Colombian violence (Brook, Brook, & Whiteman, 2007)
Canadian homeless youth (Kidd & Davidson, 2007)
Support systems for HIV/AIDS in South Africa (Campbell, Nair, & Maimane, 2007)
Help-seeking behavior of West African migrants (Knipscheer & Kleber, 2008)
Sense of community and prejudice in a heterogenous neighborhood of Milan, Italy (Castellini, Colombo, Maffeos, &
Montali, 2011)
Afghan women’s organization: education, community, and feminism (Brodsky et al., 2012)
Values as predictors of anticipated sociocultural adaptation among potential migrants from Russian to Finland (Yijälä,
Lönnqvist, Jasinskaja, Lahti, & Verkasalo, 2012)
The analysis of the resilience of adults one year after the 2008 Wenchuan earthquake (Li, Xu, He, & Wu, 2012)
Adolescent religiosity and substance abuse in Mexico (Marsiglia, Ayers, & Hoffman, 2012).
There is a text on Community Psychology and Social Change: Australian and New
Zealand Perspectives in its second edition (Thomas & Veno, 1996). A text on Critical
Community Psychology (Kagan, Burton, Duckett, Lawthom, & Siddiquee, 2011) was
written by a team out of Manchester, England. A text on International Community
Psychology edited by Reich, Riemer, Prilleltensky, and Montero (2007) has chapters with
contributors from Argentina-Uruguay, Canada, India, Australia, New Zealand, Japan,
Hong Kong, Britain, Germany, Italy, Norway, Spain, Portugal, Israel, Poland, Greece,
Turkey, Cameroon, Ghana, and South Africa. That means authors covered all the
continents of the world except Antarctica.
The website for Division 27 of the American Psychological Association (Society for
Community Research and Action) lists among its goals the promotion of an “international
field of inquiry and action” (www.scra27.org). Besides the researchers and applied
psychologists within the United States, community psychology has proponents from
around the world. This is a long way from Swampscott, Massachusetts, where the American
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version of community psychology had its birth.
One future trend for community psychology is already well on its way. Community
psychology has crossed borders and is well at work in Latin America, Europe, Africa, Asia,
and the Pacific. One can see it in the study sites, the researchers and writers, and the
graduate programs.
The original framers of the community psychology movement in the United States
did not directly mention crossing international boundaries. Glidewell’s (1966) discussion of
“social change” anticipated the implications of a “shrinking globe” and what it would mean
to our challenges:
The population of the world moves about and one value system confronts another
value system, as social systems grow in size, specialization and complexity, as the
population shifts from rural to metropolitan areas, as mutual expectations become
subject to much faster change, inter-personal and inter-group tensions rise. The
tension may become a motivating force toward flexibility … or inducing emotional
confusion and … rigidity…. Whether the tension provokes one or the other depends
upon the capacity of the individual and the social organization to develop innovations.
(p. 44)
Community psychology has acquired many of the systems-level markers of
establishment in the United States. It also has growing recognition of its concepts, research,
and applications in this “shrinking globe.”
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A USEFUL PARADIGM
The various chapters in Part III of this text have demonstrated the usefulness of the
community approach to various systems. Whether it is research and programs in the
tertiary prevention of mental health problems, the promotion of well-being and the
prevention of stress in business settings, the provision of alternative school programs, or
community programs to prevent drug abuse and violence in youth, the application of
community psychology principles can provide a useful and sturdy programmatic
framework. In all cases, it is useful to consider the advantages of a preventive orientation to
problems and of collaborative efforts in defining problems and solutions. Yet as the field
matures and takes new directions, those who have applied its principles comment on their
journey and the lessons learned along the way. These commentaries follow.
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COMMENTARIES
What would seasoned community psychologists bring to our attention as we move into the
future? What hopes and cautions might they provide? The following section presents
commentary on the research and applications of community psychology. They provide
advice and direction for the present and the future.
Julian Rappaport (2005) cautioned against becoming too sure as to what was being
studied or too set in how it was to be studied. He worried that the quest to be a “science”
would lead to doctrinaire approaches of what was correct and acceptable versus incorrect
and unacceptable. He would rather have us remember the rebellious origins of community
psychology and the role of the community psychologist as a “critical consciousness” to the
status quo. Community psychology should be where innovation and change can find a
home. This means that the methodologies for discovery should be curious about the new
and flexible. Having been influenced by Kuhn’s schema of scientific revolutions,
community psychology has always looked for the anomalies in the established and the
traditional.
Seymour Sarason (2004) cautioned that the intervention process was not easily
captured in the research literature. The methodological descriptions of studies could give an
impression of a clean and linear process to community work. He did not believe this to be
so. What he did believe was that the process of research and intervention was important.
The “before-the-beginning” phase of development was rich with critical details. Before a
“beginning,” we establish the relationships with those in the community with whom we
collaborate.
Who we are and who they are provides the meaningful context for whatever comes
from the relationship. The contacts with community leaders and the community systems
are the context that give birth to the eventual social action or research. Sarason raised the
issue of people skills in the community process. He saw the ability to establish good
relationships as essential to good community work. And he asked the question, can it be
taught?
The beginning times were exciting, with new ways to conceptualize the problems of
our society. James Kelly (2002) warned of the loss of this excitement, passion or spirit as
the field matures. He too noted the difficulty of maintaining the balance between being a
respected science and not being constrained by traditional designs or methodologies derived
for the laboratory. He challenged us to be adventuresome in our research (Tolan, Keys,
Chertak, & Jason, 1990, p. xvi). So we should be creative, and take a few chances in what
we do. Although the field has succeeded in many ways, it must be careful to maintain its
spirit of openness and willingness to disagree with the status quo. Kelly called for us to
think beyond the ordinary and the confines of the psychological discipline. Among other
ideas to help in doing this, he suggested increasing our use of interdisciplinary perspectives,
increasing our use of cultureand systems-level focus (as opposed to the individual level),
and adding community organizers (such as Saul Alinsky, 1971/1989) to our list of teachers.
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Rhona Weinstein (2006) warned about the loss of community psychology’s original
initiatives. She challenged the field to raise its sights and work on systems-level
interventions. Her top social priorities were to deal with “entrenched disparities and
perceptions of the other.” The disadvantaging differences were sustained because of our
perceptions of others as different—difference meant the others were outsiders and therefore
less worthy. The resulting discrepancies in treatment could be found in schooling
advantages, health treatment opportunities, housing access, economic opportunities, and
favoritism in the legal system. This broad band of disadvantage was a powerful systemic
deterrent to achievement and advancement. At the heart of this system of advantage and
disadvantage was the perception of “us” versus the “others” in our society, and how “they”
deserved what they got. These structural advantages could not help but lead to advantages
at the personal level. The advantages of an internal locus of control, a sense of self-efficacy,
and an agentic attitude (willingness to act) have been clearly demonstrated. These personal
styles have been found to be associated with favorable placement in our social structure.
Contextual and environmental factors facilitate the development of advantageous or
disadvantageous personality styles. For example, the problems of self-fulfilling prophecy
and negative expectations within the school system have led to inequalities in schooling
outcomes. Weinstein therefore argued for intervention within the schools to address these
negative expectations.
Stephen Fyson (1999) , following over 20 years of community work in the schools of
Australia, discussed community psychology’s efforts to resolve the tension between the One
(individual) and the Many (collective). He believed that a transformational sense of
community can bring together these two extreme positions. It is what Newborough (1995)
called the third position. Between the “I” and the “they” is the “we.” From what we
understand of the importance of this perspective, the advantages that accumulate to the in-
group, those who are perceived as a part of one’s community, the “we,” are substantial. The
disadvantages of perception as a member of the out-group, those seen as not part of our
community, the alien, the “they,” are also substantial. Researchers have demonstrated the
subtle and blatant ways in which these differences in membership continue to affect us
(Gaertner & Dovidio, 2005).
Lonnie Snowden (2005) called for social and community analyses at the level of
populations, in what he calls population thinking. From this perspective, population
parameters were the level of analysis and focus and the “underlying processes and structures
of social change” (p. 3) and maintenance. He cited as an example a study by Sampson,
Raudenbush, and Earls (1997), who found collective efficacy to be the variable related to
reduced crime in neighborhoods. So it is efficacy and not ethnic minority composition of
those neighborhoods that was the critical variable to crime in a community. Snowden
argued for the development of prosocial norms and practices as well as constructive
traditions and institutions. In this manner, the disparities in our society could be more
effectively addressed. The population level of thinking should lead to research uncovering
the social mechanisms perpetuating these differences and to policy-level solutions for the
attendant problems. For example, knowing that crime is based on collective efficacy and
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not on race should direct our interventions to empowerment.
Rodney Watts and Irma Serrano-Garcia (2003) presented a broad challenge in their
call for a “liberating community psychology ” engaged in social and political power
issues that underlie the community’s problems. They conceptualized the typical
community concerns over violence, identity, stress, and education as the result of systems of
oppression. Fostering an awareness of these systems, the intervention researchers helped
groups change these systems. The importance of contexts and the need to create or re-create
these contexts were the focus of interventions. The goal was to build systems to promote
health as opposed to reacting to health problems once they arise. De Fatima Qunital de
Freitas (2000) stated that among the guiding principles of community psychology in
Brazil/Latin America was the realization that “it was clearly political.” From an ecological
point of view, the acknowledgment of this larger exosystem (Bronfenbrenner, 1979)
seemed appropriate.
Emory Cowen (2000) believed in a shift from a risk and prevention model to
promotion of growth, competency, and enhancement-of-life models. The community
provided opportunities for successful development and the realization of potential. The
focus of community psychology might be better placed on how various community
contexts can foster and develop trajectories for success. With a better understanding of
these trajectories and the factors that help bring them to fruition, our interventions may be
positively focused on critical time frames and the adaptive capacities of communities and
their members. Longitudinal studies of the effects of social competence are starting to
discern the relationship between childhood competencies and the development of
pathology over time (Burt, Obradovic, Long, & Masten, 2008).
For community psychologists to effectively work within the various cultural and
ethnic communities, Stanley Sue (2006) focused on the need for cultural competencies.
Three general processes were important to cultural competency. The first was “scientific
mindedness,” or the formulation of hypotheses based on initial observations rather than
preconceived conclusions based on group membership. Openness to reality was called for.
The hypotheses could then be tested through observations. The second process was called
“dynamic sizing.” An individual needed the skill to know when to generalize based on
group membership and when to individualize. People did have commonalities in values and
behaviors that came from social group regularities in practice. At the same time, each
individual was unique. Knowing when and how to determine uniqueness and group
commonalities was a skill. Finally, the process of acquiring “culture-specific skills” had to
do with cultural knowledge. Any good clinician/counselor/therapist needed to understand
the individual at these three levels, in order to fully comprehend their influences on
behavior. Sue’s work underscored the necessity for cultural competency in mental health
settings. Several decades earlier, he had noted discrepancies in community mental health
center use and in treatment outcomes (Sue, 1977). His 2006 article articulated the
processes discovered to be necessary to correct these discrepancies.
Cliff O’Donnell and Roland Tharp (2012) wrote of the importance of culture in
community psychology, proposing that “cultural community psychology” might better
401
capture the nature of community work. They note that both culture and community
emphasize the derivation of shared meanings resulting from the interactions of their
members. The shared nature of meanings extends to “activity settings,” in which repeated
exposure to behaviors within that setting helped those within it to derive meaning. (Think
of a family holiday gathering and how, over time, the holiday gains meaning for the people
who regularly participate in those gatherings.) An understanding of culture is considered
critical to the development of effective relationships within the community. Such an
understanding will inform our conceptions of phenomena and processes as well as influence
the ways in which we act and how we see outcomes.
Bret Kloos (2005) provided fair warning that community psychology must be sure
not to become too insular. By having our own journals and our own conferences, we have
been able to communicate more efficiently with each other, but at the same time we have
become isolated from the broader field of psychology and from interdisciplinary settings.
His challenge to community psychology was to continue to be relevant and continue to
have an impact on the broad range of areas that affect the health of the community we
hope to serve.
Carolyn Swift noted the role played by both “real world” and “academic” community
psychologists throughout the history of the field. She saw difficulties with the two groups’
appreciation of each other’s contributions. Her challenge was for both groups to achieve a
two-way admiration with attention to sharing leadership, responsibilities, and
acknowledgments of contributions. “Such activities are likely to increase…. It will take each
group reaching out to the other, not as outsiders but as partners …” (Wolff & Swift, 2008,
p. 618).
Tom Wolff called for an active embrace of politics and political activities to foster
system change. His own experience in building healthy communities verified the need for
and effectiveness of such a focus. He too recommended better integration of the “real
world” and the “academic world.” Just as academics have been received into the
community, the community should be invited into academia (Wolff & Swift, 2008).
Prilleltensky (2012) cautioned that psychology will “err on two counts:
overestimating its importance for well-being, and not paying sufficient attention to
justice” (p. 1). Making the argument that the literature in public health (Levy & Sidel,
2006), organizational development (Fujishiro & Heaney, 2009), interpersonal relations
(Olson, DeFrain, & Skogrand, 2008), and personal well-being (Prilleltensky &
Prilleltensky, 2006) supported the importance of justice to physical and psychological well-
being, he states his belief that there was insufficient work in this area. Justice could be
defined as distributive (“the equitable allocation of burdens and privileges,” p. 6) and
procedural (“fair, transparent … respectful treatment,” p. 7). Both were important to our
sense of justice. Community psychologists needed to pay attention to the conditions for
justice and work to promote optimal and responsive conditions for justice processes to
occur.
This sample of observations relating to the state of the field provides a fairly diverse
sampling of community psychologists. Their common challenge to us is to be more
402
ambitious in our thinking, to remember our humanity, with all its complexity, and to be
bold in our ambitions. Community psychology can be applied to a variety of systems. We
have reviewed a number of them. Yet the tendency has been to work on what Cowen
(1985) would call person-oriented programs. After all, there are pressing needs at the personal
level, and the outcomes are more immediate. However, the community psychologist
perspective requires thinking in terms of both short-term outcomes, which demonstrate the
usefulness of the paradigm, and longer term outcomes, which may be required to bring
about systemic (r)evolution. Although there are many environmental demands for quick
results, what we all desire is lasting change. These commentaries all argue for the
importance of a long-term relationship with the community. They also call for respect, an
understanding of similarities and differences within and between communities, openness to
learning, and flexibility with regard to our own models and worldviews.
The theme of justice is also found in these comments. One would expect this, given
community psychology’s appreciation for diversity and for the problems that an
unenlightened approach to differences can bring.
A community member once commented that the difference between the community
psychologist and others who had come to do research before is that the community
psychologist attends neighborhood events, celebrates the successes, and commiserates over
the sorrows the community experiences. The psychologist becomes a part of the
community in which she works. She is not “the professor” from the university, who flies in,
hands out surveys, and leaves; she demonstrates her caring, concern, and connection with
her community.
Having reviewed the status of current thinking and progress in the field, we turn our
attention to areas for future work for community psychologists.
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ANSWERING THE PRESENT AND FUTURE NEEDS OF SOCIETY
As communities participate in defining the direction interventions should take (Jason,
Keys, Suarez-Balcazar, Taylor, & Davis, 2004), the role of the community psychologist will
continue to require us to use our understanding of how communities and systems work.
The goal continues to be helping groups implement programs and interventions that they
determine to be relevant. Though the obvious problems of crime, drug and alcohol abuse,
serious mental illness, and the epidemic spread of HIV/AIDS are among the immediate
issues facing all communities, we would add the challenges of developing an appreciation
for differences; the search for compassion; sustainability and environmental concerns;
disparities in opportunities in education, health, and economics; and the issues around an
aging population and end-of-life care. These areas of warrant further study and possible
intervention within the community psychology framework being used in the 21st century.
Christens, Hanlin, and Speer (2007) remind us that we must have a social
imagination—we must be able to make the connection between the individual’s
experiences and the social systems that influence those experiences. From this ability to
conceive of social systems linked to the personal, we can start to conceptualize community
interventions. Social change (social, economic, political, environmental) is personal change.
We have to be able to imagine things differently before we can make things different.
Boyd and Bright (2007) wrote of the potential in shifts of perspective from problem-
focused to opportunity-focused research and intervention. Using a participatory research
methodology called the appreciative inquiry technique, they engage poor rural communities
in a process of defining problems and opportunities for their area. Appreciative inquiry asks
neighborhood members to imagine what a community can do with the strength of its
connections to each other and beyond. This is one way of gathering the resources available
to a given group. Again, the emphasis is on being able to imagine what can be.
Appreciation for Differences and the Search for Compassion
Differences can make contributions to our success. Different people bring different
perspectives and different information to problem-solving situations. This diversity can
come from background, experiences, or cultures. We usually associate this diversity with
demographic variables, such as ethnicity, social class, geographic origin, or gender. This
argument has been made with regard to educational or economic advantages (Bowen &
Bok, 2000; Gurin, Nagda, & Lopez, 2004; Page, 2007). We are better informed, more
open to differing opinions, and more comfortable with ideas beyond our typical range of
thinking as the result of experiences with difference. In the end, this diversity can provide
better decision making and more comfort with the pluralistic society found within the
United States that is to be expected from expansion to global perspectives. The United
States is indeed becoming more diverse (U.S. Census Bureau, 2011). Between 2000 and
2010, the total U.S. population grew by 9%. The fastest growing groups were
Hispanic/Latino at 43% and Asian at 43%. Blacks grew approximately 12% and American
404
Indian/Alaska Natives 18%. Those identifying as White grew 5.7%. Projections are that
the combination of all “ethnic minority” groups will become a majority by 2050. Diversity
will become the norm. Understanding it and how it may help is both future oriented and
adaptive.
An appreciation of differences challenges the tendency to categorize and exclude based
on superficial characteristics, such as physical appearance or demographic variables. This
tendency to categorize can lead to advantages for those perceived to be in-group members.
The definition of an in-group is based on establishment of shared characteristics (physical
appearance, hometown, friends, and tasks). Community psychology may have some helpful
perspectives on how these characteristics might be structured into social settings, so that an
appreciation of the differences and a compassionate attitude is fostered—that is, an
awareness of others’ suffering and a willingness to help. This is certainly a positive human
quality (Cassell, 2009). Although there is a wealth of psychological research on empathy
and altruism (Batson, 2011; Batson, Ahmad, & Lishner, 2009), we have not yet seen
empathy or compassion as dependent variables in the community literature; they would
seem to be natural outcome variables for those interested in building community.
The area of resilience implies a compassionate community. Jason and Perdoux (2004)
describe compassionate qualities in their text on “havens for community healing.”
Cook (2012) reminds us that Sarason’s definition of the public interest has to do with
the individual, society and how the individual and society provide meaning and purpose to
each other. Cook argues that
through compassion we may begin to understand problems not as problems that affect
just others, but as our problems…. Compassion will allow us to lose ourselves, our
presumptions, and our preconceived notions and allow us to see the interconnections
between each other…. Perhaps the study of compassion at all levels of analysis is the
center of community psychology. (p. 223)
Ehrlich and Ornstein (2010) write on the importance of getting beyond our natural
limitations for building community, and feeling empathy for others. The expanding human
capacity to know others and to feel close and empathic is a part of our trajectory, but is
hampered by our biological boundaries. Finding ways to accomplish this is a worthy
ambition for community psychology.
What structural qualities facilitate the appreciation of differences? How can we help
generate compassionate communities? At what stage can this occur? Jason and Moritsugu
(2003) posed the question of how Buddhism and community psychology might have
overlapping themes and challenges. In a book chapter on resilience, Greenberg, Riggs, and
Blair (2007) discussed the development of resiliency and emotional intelligence. Could this
be brought to bear on our community efforts? When and how can compassion be brought
more explicitly into the work of community psychology? Or are we already studying it
under another name?
405
Sustainability and Environmental Concerns
Many people consider environmental concerns, global warming, and the waste of natural
resources to be urgent international issues. The United Nations Framework Convention on
Climate Change was entered into on March 21, 1994. Under this convention, governments
from around the world joined in an effort to deal with the problems of greenhouse gases
and carbon dioxide. The world’s climate was recognized as a natural resource (see
http://unfccc.int/essential_background/convention/items/2627.php; July 31, 2008). The
reduction of greenhouse gases is the target for international strategies. What it requires is an
overall consciousness regarding renewable resources to power the world.
Increases in energy costs have underscored the necessity of such concerns and brought
the immediacy of this topic to prominence. Consumption practices are under discussion,
and renewed efforts are being made to modify them. To the rest of the world, this
realization may seem late in coming, but psychologically we know that this awareness and
willingness to act are based on multiple factors.
These concerns and efforts have now evolved into the newer term of sustainability.
Sustainability is different from purely environmental concerns in that sustainability is about
maintaining a lifestyle; environmental concerns deal with not harming the planet (possibly
a more abstract and indirect concept). We have seen a rapid multiplication of sites and
services that claim to be “green” or working on “sustainability.”
Community psychology can have some role in helping curb local community and
national appetites for consumption of nonrenewable resources and instead learning to live
in a finite world. Two articles provide examples of work in this area of sustainability and
environment. The first is literally close to the Earth and at the personal level, a description
of community garden projects (Okvat & Zautra, 2011). The community garden requires
activity from its members. Tidball and Krasy (2007) believe that this style of gardening
builds supportive and strong communities because of the creation of interdepen-dency, the
frequency of contacts, and the diversity of participants. Kuo (2001) found that being in
“greenery” improved attention. Gardens could decrease isolation (Wakefield, Yeudall,
Taron, Reynolds, & Skinner, 2007) and increase nutrition and activity levels (Stein, 2008).
At the same time, gardens have a direct impact on the quality of the environment. Okvat
and Zautra (2011) suggested that community psychologists help to develop, to sustain, and
to research grassroots efforts on these gardens. Beyond this micro-level work, community
psychology might aid in the creating a network of such gardens.
At a policy level, Quimby and Angelique (2011) examined people’s perceived barriers
to and facilitators for environmental advocacy. They surveyed individuals who had engaged
in a pro-environment activity. They found that the primary reason respondents did not
become more active was that they did not feel they could bring about change. Other factors
were lack of time and money and lack of social support. The possible reasons for becoming
active were a perception that others were doing the same—that is, there was a social norm
for action.
Both Okvat and Zautra (2011) and Quimby and Angelique (2011) are informative for
406
those who want to bring about action. They are examples of community psychology
engaging in sustainability issues. There are of course many more questions. How do
members of the community become more aware? How do we change our behaviors? How
are these efforts sustained in a world where we find ourselves highly distractible? Once we
have some of these answers, how do we successfully implement these programs within
communities, across a nation, and around the world?
A lot of work can be done on placement of, attitudes toward, and practices to
optimize the use of mass transit. Attitudes regarding alternative power sources, the
construction of networks to support these alternatives, and the building of public will are
also important. Lifestyle shifts away from the five-day work week could be studied. The
definition of work sites (e.g., home, away from headquarters, distant from other workers)
and work times (e.g., midnight to the early morning, staggered hours) could be researched,
as well as work practices to adjust to these new definitions to accommodate personal
preferences, spreading the load on the transportation infrastructure or global time frames.
Dean and Bush (2007) have described environmental organization processes,
identifying five in particular that are relevant to these issues: problem analysis, impacting
decision making, working on organizational relationships, involving the community, and
transferring gained knowledge beyond the organization or project. They believe that the
community psychology perspective can contribute to all of these processes.
Disparities in Opportunity for Health, Education, and Economic Success
Prilleltensky and Fox (2007) discuss the relationship between wellness and justice. They
argue that to feel one lives in a just society and has been treated justly contributes to one’s
sense of well-being. Psychopolitical literacy is the recognition of this relationship between
societal conditions and psychological states. This is in the tradition of Freire’s (1970)
“pedagogy of the oppressed” mentioned in an earlier chapter.
Weinstein (2006) specifically called for studying the disparities in our society and
mounting interventions to rectify them. These differences are attributed to social, cultural,
or institutional barriers to equality of opportunity. Although the work on disparities is no
small task, it is worthy of attention from a discipline that espouses justice and liberation
among its principles. This goes beyond the appreciation of diversity. These disparities have
historical roots, and shifts in these patterns require patient and persistent efforts at the local
and policy levels. There are instances where addressing these disparities requires changes in
patterns of power and reexamination of the basic assumptions regarding the social status
quo. Beliefs in a just world and in the presence of equal opportunity may be among the
basic assumptions of established life that need to be examined and changed. What
structural obstacles exist to reduction of disparities? How are these obstacles vulnerable to
influence? Community psychology may contribute to answering these questions. Is it a
matter of empowerment? If so, Maton (2008) calls on community psychology to use what
it has learned about empowering groups to foster these groups and their development. He
presents the characteristics of successful empowered groups as having a central belief
407
system, a clear and inspirational purpose, and an opportunity role structure. There need to
be meaningful and engaging tasks for members; core activities that reinforce self-efficacy
and skill development; a caring and supportive relational environment; leadership that is
inspirational, motivating, has contact with most members, and is empowered to do things;
and an organization that is open to learning and has bridges to the external environment
(i.e., is not isolated). Wolff and Swift (2008) have already called for political involvement
to deal with these kinds of issues. There are examples in the literature of community
psychologists becoming involved in legislation (Jason & Rose, 1984) and policy change
(Jason, 2012). There are surely many more instances where advocacy in the public area has
been accomplished (work on domestic violence, alcohol and drug abuse, and health care
disparities comes to mind). How might these processes empower more people and bring
about the dissolution of social disparities?
Aging and End of Life
Growing old and dying are two of the inevitabilities of life. The population in the United
States is aging quickly (He, Sengupta, Velkoff, & DeBarros, 2005). U.S. Census estimates
report that those over 65 years of age will double in numbers from 2000 to 2030. He and
colleagues (2005) state that worldwide, there were approximately 420 million people over
the age of 65 in 2000. Projections were made for 974 million people over 65 years old in
2030. Aging of the population is a global phenomenon. Japan, Hong Kong, and Sweden
have the longest life expectancies at 82, 81.7, and 80.6 years. Some regions of the world
will experience increases in their elderly population of approximately 200% to 300%
between 2005 and 2050. The North American should see an increase of over 100%. These
demographic pressures call for attention to the issues of aging.
What are the issues of aging? How does staying in a community help? How do we deal
with the attendant concerns of death and dying? Karel, Gatz, and Smyer (2012) warn of
problems of chronic physical illnesses, limitations on mobility, and dementia. LaVeist,
Sellers, Brown, and Nickerson (1997) reported that extreme isolation for African American
women (isolation defined by living alone and not seeing family or friends for over two
years) was related to higher likelihood of death within five years. This was after controlling
for physical conditions. In a later study of Hong Kong elderly by Cheng, Chan, and
Phillips (2004) that combined qualitative interview and quantitative survey data, four
factors were found to determine quality of life for this population:
Contributing to society (generativity)
Good relationships with family and friends
Good health
Comfortable material circumstances
In post survey interviews, the importance of interpersonal relationships and health was
overwhelmingly endorsed. In a qualitative study of White American elderly, Farquhar
408
(1995) found quality of life to be defined in terms of family, being active, social
relationships, health, and material comfort. These community studies consistently
emphasize the importance of social contact and social purpose, with noticeably greater
significance than the more obvious health and material well-being factors.
Cheng and Heller (2009) point to issues of age discrimination and lack of support in
old age, and the problems for elderly women that come with surviving to advanced age.
They note that community psychology has neglected this population over the years. In a
literature search in selected community journals, they could find only 40 articles on aging.
They cite attitudinal issues within our profession and society as contributing to this lack of
interest. Programmatic issues they believe community psychology could address include
alternative long-term care; aging in place (staying in one’s own home); empowerment of
the elderly; and development of volunteer opportunities, family support, and community
care.
These studies are helpful in guiding future programs related to aging. Although the
field is silent on the topic of death and dying, one wonders what variables may play a role
in the final phase of life—that is, having a good death. The topic of good aging and death
and what that means seems quite appropriate for consideration in the context of
community psychology.
Summary
Community psychology has established itself over the past 40 years in many of the formal
ways that one expects. There are journals devoted to the topic, a division in the American
Psychological Association, and regular contributions made to the Annual Review of
Psychology and other texts.
Commentaries on the state of the field have been offered by community psychologists
of note. Points are made on the accumulation of professional gains, but there remain
cautions with regard to the need to preserve our original enthusiasm and to remain open to
the revolutionary, continued focus on social and systems-level interventions, the need to
promote well-being as well as prevent pathology, the applied nature of our field, the
importance of social justice, and the reminder that the processes attendant to community
change are long, complex, and based on human relationships.
Given the move to empower communities to help in defining issues and problems and
how research and interventions are to be conducted, the direction of the field in terms of
topics is harder to define. The obvious concerns over crime, mental illness, and drug and
alcohol abuse are present but tend toward tertiary preventions. Potential areas for growth
and development include an appreciation for diversity and the development of compassion
and of sustainability potential, rectifying social disparities in the many domains where they
are found, and the issues of aging and death. Though not exhaustive, these topics have
currency in today’s society and bring possibilities for prevention and promotion to our
conceptions of community.
409
Final Reflections
Chapter 1 started with quotes from individuals who called us to action. When faced with
social problems, they examined them, looked for solutions, and then moved forward,
looking for feedback on the effectiveness of their actions. This is what a good community
psychologist would do. The final chapter’s opening quotes remind us of how far we have
come and what our horizons might be.
The opening vignettes in Chapter 1 presented stories emphasizing the need for
community for all people. We are also reminded that
place characteristics provided cues about their personal histories as members of the
community; communicated messages about the value and character of the community
and its residents; defined social norms and behavior within the community; and
provided markers that could remind residents of who they are and inspire a sense of
possibility for who they could become. (Newell, Berkowitz, Deacon, & Foster-
Fishman, 2006, p. 29)
The following excerpt from the novel Volcano by Garrett Hongo expresses the desire
for home and community. Hongo speaks of land and a mountain, but in a metaphorical
sense, he captures the feeling that community psychology endeavors to create.
Years later, I was returning to Hawai’i to spend a week…. I stepped off the plane, and
when the full blast of the island’s erotic and natal wind hit me, when I caught sight of
Mauna Loa’s1 purple slopes disappearing into clouds, a sob of gratitude filled my
chest…. What radiates as knowledge from that time is that there is a beauty in
belonging to this earth and to its past…. Every singer of every mountain of
magnificence in every land knows it. I wish you knowing. I wish you a land.
The land and the mountain are our communities. When we are grounded in them, we
are connected to our heritage and our sources of strength. We may wander from that
community, but we know when we are back and drawing on all that it can give us.
Although it is a feeling, we also know it. The science of community psychology looks at
how the community contributes to our resilience and how it has a hand in shaping us
through its contexts. As we have reviewed in this text, science has made progress in
discovering the variables of importance, and psychologists have used them in intervention.
There have been both successes and challenges. As we suggest at the opening of this final
chapter, the dreams of our founders have been put into action and in some ways have gone
beyond their vision. Yet the work is far from complete. There are new dreams to be
dreamed and realized. But that is for you, the student, to help determine.
_______________
1Mauna Loa is the largest volcano in the Hawaiian chain, situated on the biggest island in the archipelago.
410
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486
NAME INDEX
Abbott, C., 218
Abdou, C. M., 235
Aber, J. L., 149
Aber, M. S., 36, 54, 65, 87, 105
Abrahams, R. B., 165
Abramowitz, S. I., 274
Abrams, L. S., 210
Aburdene, P., 84
Ackerman, G., 208
Adams, C., 108
Adams, D., 178
Adams, M., 286
Adams, R. E., 28, 269
Adelman, H. S., 15
Adler, N., 62
Aguinis, H., 266
Ahluwalia, J., 112
Ahmad, F., 54
Ahmad, N., 90, 193
Ahn, S., 62
Ahnert, L., 175, 178, 179, 180
Aikman, S. N., 184
Ajzen, I., 40
Akert, R. M., 186
Alagna, S., 234
Alanis, I., 190
Albee, G. W., 19, 23, 60, 76, 143, 285
Albritton, M. D., 277
Albus, K. E., 202, 207, 213
Aldeguer, C., 89
Alexander, K. L., 192
Alfred, C. G., 195
Alinsky, S., 88, 90, 91, 95, 289
Allen, G. A., 169
Allen, H., 206
Allen, J. P., 162
Allen, N. A., 4, 19, 102, 103, 149
Allen, R. P., 4
Allen, S. M., 19
Allen, T. D., 212
Allen-Meares, P., 161
Allport, G. W., 83, 89, 133, 185
Almeida, M. C., 182
Altman, D. G., 75, 230
Altman, I., 25, 230
Altman, J., 66
Altman, L., 252
487
Alvarado, R., 112
Alvarez, R., 10
Alvarez-Canino, T., 195
Alvaro, E. M., 242
Alverez, A., 106
Ambrose, M., 271
Amerio, P., 287
Amici, M., 28, 29
Anda, R. F., 140
Andersen, J. D., 207
Anderson, B., 208
Anderson, E. R., 196
Anderson, F., 255
Anderson, J., 165
Anderson, L. S., 7, 24, 25, 35
Anderson, N., 62, 227
Aneshensel, C. S., 188
Angel, C. M., 218
Angelique, H., 294
Angell, R., 15
Annas, G. J., 55
Anseel, F., 272
Anshel, M. H., 209
Anson, E., 153, 154
Antoni, M., 269
Apfel, N. H., 162
Applebaum, L. D., 148
Appleyard, K., 141
Argomaniz, J., 213
Arias, B. M., 188
Armour, M. P., 218
Armstrong, A. H., 220
Armstrong, G. S., 207
Arnaud, A., 271
Arnold, D. A., 191
Aron, A., 185
Aronson, E., 186, 189
Arteaga, S., 46, 57
Arvinkumar, B., 65
Ary, D., 241, 242, 262
Aseltine, R., 109
Ashburn-Nardo, L., 90
Ashby, D., 208
Ashcroft, R. E., 54
Assaf, A., 230
Astor, R. A., 195
Atanda, A. K., 183
Atha, J., 196
Atwater, E., 76, 80, 84, 166, 185
Atwater, L., 276
Atwood, L. D., 54
Aubrey, T., 136, 137
Aubry, J., 109
Auerbach, J. D., 39
488
Austen, L., 207
Ayers, S. L., 287
Azelton, L., 52, 106
Azevedo, K., 245
Babcock, R. L., 80
Baccus, J., 64
Bachman, J. G., 239, 243, 246, 247
Bachrach, D. G., 282
Bachrach, L. L., 130
Badger, L. W., 192
Bahl, A., 166, 167, 169
Bahr, S. J., 220
Baker, C. K., 115
Baker, D. B, 54, 126
Baker, D. C., 125
Baker, E., 245
Baker, J. A, 175, 194
Baker, R. A., 193
Baker, T. K., 191
Bakermans-Kranenburg, M. J., 153
Balcazar, F., 102
Baldwin, M., 64
Bales, R., 278
Balfanz, R., 193
Balkrishnan, R., 230
Ballestar, M. L., 142
Baltes, B., 67
Baltes, M. M., 166
Baltes, P. B., 166
Baltodano, H. M., 220
Bandura, A., 13, 14, 17, 40, 138
Banker, B. S., 184, 186
Banks, C., 205
Banning, K., 61
Banyard, V., 46
Baptista, L., 130
Barak, A., 166
Barak, G., 171
Barata, P. C., 54
Bardi, A., 273
Barker, R. G., 11, 12
Barley, D. E., 122
Barnes, N., 62
Barnett, S. W., 181
Baron, R. A., 266, 270, 277, 280, 281
Barone, S., 125
Barrera, M., 67, 95, 101
Barrett, N., 147
Bartlett, H., 164
Bartlett, J., 268
Bartunek, J. M., 277
Bass, B. M., 278
Basseches, M., 281
489
Basso, R. V. J., 212
Bassuk, E. L., 170
Bates, J. E., 202
Batson, C. D., 89, 90, 193, 293
Batson, J., 89
Battisch, V., 189
Bayer, R., 55
Bayley, B. K., 207
Bazemore, G., 218, 219
Beaulieu, M., 207
Becker, M. H., 40, 256
Beehler, S., 75, 108, 110, 113
Beer, M., 266, 279
Behrens, T., 90, 280
Belcher, J. R., 132
Belfield, C. R., 181
Bell, C. C., 149
Bell, C. H., 266, 280
Bell, L. A., 23
Bell, M. P., 274
Bellamy, N., 112
Belsky, J., 175, 177
Bena, K., 61
Ben-Ari, A., 267
Benbenishty, R., 195
Bendicsen, H., 281
Benjamin, E. J., 54
Benjamin, L. T., 6, 74, 126
Bennett, C. C., 7, 24, 25, 35
Bennett, T., 214
Benviente, G., 57, 88
Benz, L. L., 281
Berg, B. L., 268
Bergeron, C., 207
Bergland, M. L., 113
Berk, M., 192, 196
Berkeley, S., 252
Berkman, L., 235
Berkowitz, S. L., 102, 103, 297
Berliner, S., 269
Berman, S., 75
Bernal, G., 10, 110, 117
Bernier, D., 268
Bernstein, J., 147
Bernstein, S., 40
Bersoff, D. N., 117
Betters-Reed, B. L., 277
Bezrukova, K., 274
Bhutta, Z. A., 54
Biegel, D., 104
Bierman, K. L., 141
Biernacki, P., 40
Biglan, A., 201, 241, 242, 262
Bilchik, S., 196, 212, 213
490
Bird, A., 142
Birman, D., 9
Bishop, B., 26, 29, 287
Black, M. C., 156
Blackburn, E., 62
Blackman, E., 99
Blackmon, S., 61
Blair, C., 71, 293
Blakely, C. H., 43
Blakemore, J. L., 163
Blandford, A., 164
Blaney, N. T., 186
Blasé, S. L., 126
Blau, J., 192
Blease, S., 54
Blechman, E. A., 9
Bloom, B. L., 19, 107, 285
Bluedorn, A., 282
Blustein, D. L., 267, 273
Bobak, M., 243
Bogat, G. A., 13, 27, 110, 124
Boggiano, A. K., 84
Bok, D., 293
Bolland, J. M., 202, 203, 231
Bolt, D., 182
Bolton, N., 193
Bond Huie, S. A., 202
Bond, G. R., 87, 136, 137
Bond, M. A., 11, 25, 46, 202, 271, 274
Bondy, J., 153, 154
Bonhomme, J., 206, 220
Bono, J., 282
Boodell, D., 221
Bootzin, R. R., 135
Borgida, E., 117
Borradaile, K. E., 259
Borrero, M., 40
Borum, R., 209
Boscarino, J. A., 269
Bose, S., 192
Botvin, E. M., 245
Botvin, G. J., 202, 203, 245
Boudreau, J. W., 275
Bouey, P. D., 38, 39, 41, 43, 45, 50
Bowen, W., 293
Boyd, N., 292
Boyd, R. C., 202, 203, 213
Boyd-Zaharias, J., 189
Bracey, G. W., 219, 220
Bracht, N., 230
Brackshaw, E., 196
Bradley, E., 227
Bradshaw, T. K., 96
Bradshaw, W., 217, 218
491
Brady, K., 221
Braganza, A., 277
Braithwaite, R., 112, 206, 220
Brand, S., 193
Branson, R. K., 188
Brass, D. J., 280
Bravo, M., 84
Brayfield, A., 267, 268
Breakey, W. R., 142
Breen, L., 193
Breiding, M. J., 156
Breinlinger, S., 99
Bremer, C. D., 188
Brewer, M. B., 89, 185, 186
Brewer, R. D., 243
Bright, D., 292
Brissette, I., 68, 235
Britt, C. L., 215
Broadhurst, R. G., 209, 213
Brodie, H. K. H., 39
Brodsky, A. E., 14, 28, 29, 46, 57, 90, 231, 287
Brody, C. J., 267
Brokaw, T., 6
Bronfenbrenner, U., 14, 15, 22, 138, 142, 174,
188, 189, 290 Brook, D., 187, 287 Brook, J., 187, 287
Brooks Gunn, J., 107, 149, 177, 193, 202, 203 Brooks, E. R., 131, 135, 149 Brosnan, M. J., 80 Brounstein, P., 170
Broussard, A. C., 211, 212 Brown, A., 125
Brown, B. B., 99, 182, 207, 208, 214 Brown, C. H., 159, 191, 192, 193
Brown, G., 208, 214
Brown, K., 296
Brown, P. A., 28
Brownell, A., 95
Brownell, K. D., 258
Bruce, E., 154
Bruce, M. L., 84, 131
Brummett, B., 89
Bruns, E. J., 137, 138
Brunson, L., 17, 104
Bryant, D., 178
Bryson, S., 228
Bucceri, J., 62
Buckley, J., 143
Buckner, J. C., 29
Buhin, L., 185
Buki, L., 227, 228, 232
Bulik, C. M., 258, 259, 260
Bullis, M., 220
Bump, N., 98
Burchard, J. D., 137, 138
Burchard, S. N., 137, 138
Burchinal, M. R., 178
Bürgi, T., 29
Burke, C., 281
Burke, G., 39
492
Burke, I. K., 157
Burke, J., 121
Burke, W., 54
Burlew, A. K., 110
Burns, A., 193
Burns, B. J., 138
Burns, T., 136, 193
Burroughs, S. M., 272, 274
Burt, K., 290
Burt, M. R., 159, 167, 169, 170
Burton, C. E., 204
Burton, M., 8, 288
Burton, P. R., 54
Burwinkle, T. M., 258
Busch, S., 227
Bush, R., 295
Butcher, K., 228, 229
Butler, J., 112
Button, C., 164
Bybee, D., 46
Bynner, J., 273
Bynum, T. G., 207, 208
Bynum, T. S., 202
Byrne, J. M., 209, 210, 219
Caceres, C., 257
Cacioppo, J., 235
Cadena, B., 148, 149
Caldwell, C. H., 204
Calhoun, C., 255
Call, S., 51, 57
Calsyn, R. J., 169
Cameron, C., 65
Camillo, K., 184
Campbell, C. L., 63, 230, 287
Campbell, D., 38, 44, 45, 46
Campbell, R., 46, 100, 115
Campfield, K. M., 216
Campion, M. A., 275, 282
Campos, B., 235
Canino, G. J., 84
Cantelon, S., 193
Cantor, N., 185
Caplan, G., 19
Caputo, R. K., 179 188, 180
Caputo, T., 214
Carbonell, J., 84
Cardey, R., 212
Carey, J., 276
Cargo, M., 14
Carlaw, R., 230
Carleton, R., 230
Carlo, G., 68
Carlson, J., 111, 112
493
Carlton, S., 281
Carnevale, P. J., 217, 218
Carpenter, K. M., 125
Carrillo, A., 287
Carroll, C. F., 102, 103
Carroll, D., 67
Carroll, M. D., 258
Carroll, S. J., 270, 277
Carter, F. A., 258, 260
Carter, J. S., 29
Carter, R. T., 55, 62
Carver, C. S., 65, 68
Cascio, W. F., 266
Case, S., 213
Casper, L, 182
Caspi, A., 28, 208
Cassell, E. J., 293
Cassinerio, C., 191
Castagnera-Fletcher, A., 46, 57
Castellini, F., 287
Castillo, Z., 39
Catalano, G., 206
Catalano, R. F., 113
Catano, V. M., 269
Catterall, J. S., 191
Catty, J., 136, 193
Cauce, A., 46
Caughy, M., 231
Cavell, T., 110
Cawthon, R., 62
Cepeda-Benito, A., 109
Chadee, D., 207
Chaffin, M., 154
Chamberlin, R., 154
Chan, A., 296
Chan, C. K., 148
Chandler, M. J., 86, 140
Chanoff, D., 191
Chaplin, W. F., 81
Chapman, L., 164
Charkoudian, L., 218
Charney, D., 211
Chase-Lansdale, P. L., 17, 148, 149, 159, 160
Chatman, J., 273
Chavis, D. M., 28, 29, 77, 87, 88, 99, 100, 101, 102, 214, 230, 272, 281
Chavous, T. M., 204
Chazan-Cohen, R., 180
Checkland, P., 280
Checkoway, B., 80
Cheng, S., 276, 277, 296
Chertak, F., 35, 90, 289
Chesson, H., 249
Cheung, C., 287
Cheung, F. M., 131
494
Chiang, C., 273
Chibnall, S., 14, 52
Chin, J. J., 257, 279
Ching, A., 39
Chinman, M., 230
Chiu, W., 121, 142
Chng, C. L., 39, 257
Choi, J. J., 218
Choi, N. G., 165
Choi, S. T., 257
Chomitz, V. R., 260
Christens, B., 292
Christensen, J. A., 57, 75, 87, 95, 101, 104
Christenson, S. L., 53, 192, 193
Christian, T. F., 82, 217, 218
Christiansen, M. K., 282
Christie, C. A., 193
Chronister, K. M., 159
Cicchetti, D., 71, 140, 143, 152, 153
Cid, J., 205
Clabby, J. F., 181
Clark, A. E., 273
Clark, K. B., 6, 183
Clark, M. P., 6, 183
Clark, R., 62
Clark, V., 62
Clarke, A., 65
Claude, M. S., 255
Clayton, L. J., 235
Clipp, E., 4
Cloward, R. A., 149
Coates, T., 257
Cochran, S., 62
Coffee, J. N., 189, 191
Cogan, J. C., 260
Cohen, A., 166, 167, 169
Cohen, J., 67, 180
Cohen, M. D., 281
Cohen, S., 67, 102, 103
Cohen-Vogel, L., 187
Coie, J. D., 141
Cole, C., 193
Cole, R., 153, 154
Coleman, J., 102
Coley, R. L., 17, 148, 149, 159, 160, 182
Collier, A., 49
Collier, V., 190
Collings, J., 260
Collins, C., 147
Collins, M. E., 133
Colombo, M., 287
Colquhoun, S., 29, 287
Compas, B. E., 62, 64, 65, 191
Connor, D. F., 202
495
Connors, M. M., 39
Connor-Smith, J. K., 64, 65
Conover, S., 130
Constantine, L. L., 277
Conyne, R. K., 22
Cook, S. L., 293
Cook, S. W., 185
Cook, T. D., 44, 48, 94
Cooke, R. A., 277
Cooley, M. R., 202, 203, 213
Coons, H., 63
Cooper, H., 212
Cooper, J., 80, 101
Cooper, M. L., 243
Cooper, R., 213
Cooper, S., 7, 24, 25, 35
Cooperberg, J., 258
Coovadia, H. M., 53
Copeland-Linder, N., 287
Cordner, G. W., 209
Corning, A., 99
Cosio, S., 188
Cotter, P. R., 28
Coulton, C. J., 29, 153
Cousineau, M., 207
Covell, N. H., 216
Cowen, E. L., 3, 19, 21, 22, 24, 28, 60, 186,
191, 197, 285, 290, 292
Cox, R. S., 27
Coyne, I., 272
Coyne, J. C., 61
Craik, K., 285
Cressler, D. L., 135
Crockett, L., 68
Crofford, L. J., 157
Crogan, M., 186
Cromartie, S. P., 84, 85
Crosby, R. A., 160, 161
Cross, W., 202
Crosson, M. T., 217, 218
Crouse, E., 6, 74
Crowley, M., 192
Cruess, D., 269
Crusto, C. A., 51, 57, 75, 112
Csikszentmihalyi, M., 24
Cuadrado, I., 62
Cuddy, A. J. C., 165
Cummings, E., 71
Cunningham, J., 65
Currie, J. M., 58, 114, 179, 181
Curry, J. C., 191
Curtin, L. R., 258
Curtis, J., 141
Cutrona, C. E., 28
496
Cyr, K., 204, 215, 217, 218
Czaja, S., 152
D’Alessio, S. J., 202
D’Augelli, A. R., 25, 87, 89, 90, 268
D’Aunno, T. A., 270
D’Ercole, A., 141
Dakof, G., 61
Daley, J. M., 75, 76, 77, 87, 89
Dalton, J. H., 3, 8, 11, 18
Dandeneau, S., 64
Daniel, P. T. K., 187
Daniels, D., 156
Danish, S. J., 196
Danoff-Burg, S., 65
Danso, H. A., 184
Danziger, S., 148, 149
Dapp, U., 165
Dar, I., 196
Darling, N., 110
Darnell, A., 231
Darnell, D., 231
Darrock, J., 160, 161
Darrouch, J., 233
Darrow, W. W., 39
Dash, M., 136, 193
Davey, C. L., 213
Davidson II, W., 10
Davidson, L. M., 67, 287
Davidson, M. M., 157, 159
Davidson, R., 269
Davidson, W. B., 28
Davidson, W. S., 76, 80, 87, 88, 91, 108, 109, 116
Davies, L., 196
Davino, K., 75, 112
Davis, D. M., 36, 90, 91, 106, 188, 292
Davis, M. K., 155
Davis, P., 71
Davison, L., 39
De Bellis, M. D., 152
De Beus, K., 218
De Fatima Qunital de Freitas, M., 290
De Schipper, J. C., 177
DeYoung, T., 212
Deacon, Z., 52, 53, 297
Dean, A., 68
Dean, J., 295
Deater-Deckland, K., 196
Deaux, K., 117, 184
DeBarros, K., 295
DeFrain, J., 291
DeFrances, C., 207
DeGraaf-Kaser, R., 136, 137
Deitz, W. H., 258
497
DeLeon, P. H., 125
Delgado, G., 77, 90, 104
Delongis, A., 61
Delucchi, K., 189
Demaray, M. K., 67
DeMartino, R., 109
DeMeuse, K. P., 281
Demler, O., 121, 142
Denham, S. A., 182
Denmark, F. L., 195
Derogatis, L., 63
Detert, J. R., 270
Deutsch, C., 75, 108, 110, 113
Deutsch, M., 280
DeVellis, B., 234
Dévieux, J. G., 130
Devine, P., 64, 83
DeVita, C. J., 78
Dey, A., 46, 54
Dhabhar, F., 62
Diamond, J. B., 187
Diamond, P. M., 132, 133
Diamond, T., 202
Diaz, T., 245
DiazGranados, D., 281
Dick, L., 61
Dickinson, J. M., 219
Dickson, W. J., 276
DiClemente, R. J., 39
Diehl, M., 282
Diener, E., 273
Dietz, W. H., 258
DiFranza, J. R., 241
DiGiovanni, C. D., 67
Dijkstra, A., 112
DiMatteo, M. R., 229
Dincin, J., 136, 137
Dingwall, R., 219
Ditton, J., 207
Dix, D., 3, 127
Dixon, L., 108
Dixon-Woods, M., 54
Dobmeyer, T. W., 216
Dodd, M. J., 235
Dodge, K. A., 141, 202
Doerfler, L. A., 202
Doherty, G., 178
Dohrenwend, B. S., 60
Dolbeare, C. N., 27
Donn, J. E., 4
Doom, E., 259, 260
Dore, P., 28
Dougherty, A. M., 106, 107
Douglas, C., 281
498
Dovidio, J. F., 62, 64, 83, 90, 184, 185, 186, 290
Dowden, C., 219
Dowler, K., 208, 209
Downing, D., 108
Downing, J., 193
Dowrick, P., 196
Doyle, E. A., 196
Draguns, J., 9, 81, 110
Drayson, M., 67
Drew, S., 193
Drossman, D. A., 156
Dube, S. R., 140
Dubé, M., 207
DuBois, D. L., 212
Dubois, J., 98
Dubowitz, H., 152
Duckett, P., 8, 288
Duffy, C., 99
Duffy, K. G., 76, 80, 82, 84, 100, 166, 184, 185, 217, 218, 219
Duffy, M., 164
Dumas, J. E., 9
DuMont, K., 152, 271
Dumont, M. P., 129
Dunivin, D. L., 125
Dunkel-Schetter, C., 235
Dunn, J., 196
Dunne, E., 166
Dupéré, V., 214
Duran, B., 39
DuRant, R. H., 230
Durlak, J. A., 21, 22, 175, 182, 191, 192
Dusenbury, L., 245
Dutta, U., 54
Dworski-Riggs, D., 52
Dyck, R. J., 10, 54, 56, 86
Dyer, J. G., 130
Dymnicki, A. B., 22
Dynarski, M., 193
Eacho, C., 220
Eagly, A. H., 67, 278, 279
Earls, F., 214, 290
Earls, M., 131
Easterlow, D., 167
Eaton, J., 165
Eaves, C., 216
Eby, L. T., 212, 272, 274
Eck, J. E., 207, 208
Eckenrode, J., 154, 155
Edge, K., 66
Edie, D., 178
Edin, K., 149
Edmondson,A. C., 270
Edwards, D., 192
499
Edwards, J. E., 281
Edwards, K., 186
Edwards, R. W., 104
Edwards, V., 140
Egan, T., 273
Egeland, B., 68, 140, 141
Egeland, G., 68
Eggins, R. A., 101
Ehrlich, P., 293
Eigen, M., 253
Eisenberg, M., 176
Eisenbraun, K. D., 194, 195
Eitle, D., 202
Ekland-Olson, S., 206
Ekpo, G., 255
Elder, G., 4
Elias, M. J., 3, 8, 11, 18, 109, 181
Elis, L., 218
Ellam, G., 89
Elliott, K., 151
Ellis, D. B., 166, 167, 169
Ellis, R. T., 209
Ellwood, D. T., 149
Elmer, P., 230
Elmore, C. A., 63
Elting, L., 228
Elvin, J., 4
Ely, R., 273, 274
Elze, D., 28
Embry, D. D., 196
Emshoff, J., 231
English, D. J., 152
Enman, M., 99
Ensel, W., 67
Entwisle, D. R., 192
Epel, E., 62
Eppe, S., 195
Epstein, J. L., 192, 193
Epstein, M. J., 213
Erel, O., 196
Erickson, S., 231
Eron, L., 196
Erwin, P. G., 191, 192
Eshleman, S., 121
Espelage, D. L., 195
Esteller, M., 142
Euser, E. M., 153
Evans, A. S., 48
Evans, G. W., 149
Evans, S. C., 212
Evans, W. D., 235
Everly, G. S., 216
Eysenck, H. J., 4, 7, 122
Eysenck, H., Sr., 4–5
500
Facione, N. C., 235
Fairweather, G. W., 76, 80, 87, 88, 91, 109, 116, 135, 136
Faith, M. S., 125, 258
Falkenstein, C., 159
Farmer, P., 255
Farmer, T. W., 204
Farquhar, J., 230
Farquhar, M., 296
Farrall, S., 282
Farreras, I., 126
Farrington, D. P., 213
Farver, J. M., 195
Fassinger, R., 273, 274
Fauth, R. C., 107
Faw, L., 138
Fawcett, S. B., 13, 87, 104, 231, 232, 233
Feifel, J., 67
Feldheusen, J. F., 188
Feldman, D., 216
Feldman, H., 230
Felitti, V. J., 140
Felix, M. R. J., 77, 87, 88, 100, 102
Fell, J., 244
Felner, R. D., 22, 25, 142, 193, 194
Felton, B., 47
Fender, L., 149
Ferguson, K. M., 208
Ferlander, S., 243
Fernandez, A., 195
Fernandez, P., 257
Ferrari, J., 31, 106
Ferraro, A., 67
Ferraro, F., 282
Fetterman, D. M., 50, 87, 102
Fiedler, F., 278
Field, S., 122
Figley, C. R., 269
Fiksenbaum, L., 165
Fingeret, M.C., 109
Finkelhor, S., 151
Fiore, S. S., 259
Firdion, J., 169
Fisch, R., 74, 89, 90
Fischer, C. S., 102
Fishbein, M., 40, 112
Fisher, A. T., 26, 29
Fisher, C., 47, 56, 282
Fisher, J. D., 156, 233
Fisher, J. K., 220
Fisher, J. L., 87
Fisher, P. H., 191
Fisher, W. A., 156
501
Fiske, S. T., 89, 117, 165
Flannery, D. J., 196
Flay, B. R., 39, 195
Flegal, K. M., 258
Fletcher, C., 241
Flick, U., 167
Flora, J., 230
Flores, C., 39
Florey, A., 274
Florin, P., 77, 87, 88, 95, 99, 100, 101, 102, 214, 230, 281
Flouri, E., 140
Foege, W. H., 262
Folkman, S., 61, 63, 64, 67
Follingstad, D. R., 157
Fong, K. T., 10
Ford, J. D., 87, 89, 90, 167
Ford, J. K., 210
Ford, L. W., 87, 89, 90
Forer, B., 178
Forlenza, S. G., 217
Formichella, C. M., 202, 203, 231
Forrester, J., 280
Fortmann, S., 230
Fortson, B. L., 152
Foster, E. M, 141
Foster, G. D., 259
Foster-Fishman, P. G., 14, 52, 53, 88, 90, 102, 103, 266, 271, 280, 297
Fouad, N., 273
Fox, D., 77, 114, 115, 295
Fox, N. A., 196
Fox, R. E., 125
Fozard, J. L., 165
Fraga, M. F., 142
Francisco, V. T., 87
Franco, M. M., 11
Frank, J. D., 79, 80
Frank, S., 57, 94, 265, 266
Fraser, B. J., 191
Freedman, A. M., 90
Freeman, L., 268, 269
Freeman, R. J., 132
Freiberg, J. H., 189
Freire, P., 89, 295
Freisthler, B., 154
French, S., 25
French, W. L., 266, 280
Fried, C., 285
Friedman, R., 99
Friedman, S. R., 51, 57
Frisman, L., 137
Frone, M. R., 268
Frost, D. M., 114, 116
Frost, J., 233
Frumkin, P., 78
502
Fujishiro, K., 291
Futrell, D., 281
Fyson, S., 290
Gabbidon, S. L., 203
Gaertner, S. L., 62, 64, 83, 90, 184, 186, 290
Gal, I., 166
Galbavy, R., 196
Gallagher, S., 67
Ganzel, B., 155
Gara, M., 181
Garbarino, J., 153, 194
Garces, E., 58, 114, 181
García, J. I., 54
Garcia, L., 209, 210
García-Ramírez, M., 102
Garcia-Reid, P., 194
Gard, J., 281
Garg, A. X., 228
Garmezy, N., 69
Gastil, J., 278
Gatz, M., 296
Gavin, J., 274
Gaylord-Harden, N. K., 63, 65
Gee, G. C., 207, 208
Geen, R., 149
Gendreau, P., 205
Genzuk, M., 27
Georgellis, Y., 273
Gerke, C. K., 260
Gerson, G., 102
Gesten, E., 285
Gewirtz, A. H., 267
Gibbs, B. G., 220
Gibler, N., 152
Gibson, C., 46, 54
Gidycz, C. A., 155
Gift, T. L., 249
Gill, M., 213
Gillespie, C., 27
Gilliam, M. L., 162
Gilligan, C., 81
Gillock, K. L., 191
Ginexi, E. M., 84
Ginter, M. A., 191, 193
Glaberson, W., 208
Glass, T., 235
Glaze, L., 132, 220
Gleason, P. M., 193
Gleaves, D., 109
Glenwick, D. S ., 13, 36
Glick, P., 83
Glidewell, J. C., 85, 89, 288
Glynn, L. M., 235
503
Godwin, J., 141
Goelman, H., 178
Goethals, G. R., 101
Goggin, C., 205
Goldberg, J., 269
Goldberg, M. A., 135
Golding, J. M., 188
Goldman, S. K., 138
Goldring, E., 187
Goldschmidt, A., 228
Goldstein, N. E., 191
Gomby, D. S., 155
Gomez, A., 62
Gomez, K., 61
Gonda, D., 90
Gone, J. P., 47, 54, 56
Gonzales, N., 17
Goodman, A. M., 209
Goodman, S.A., 281
Goodrum, S., 207, 218
Goodwin, J., 99
Goodyear, L., 56
Gore, A., 170, 171
Gorny, S. W., 4
Gosling, S., 285
Gottlieb, B. H., 61, 134
Gottlieb, J., 166, 167, 169
Gough, B., 158
Gover, A. R., 207
Gow, R. W., 258, 259, 260
Graber, J. A., 202, 203
Graham, J. C., 152, 212
Grams, G. D., 14
Granovetter, M., 102, 104
Grant, A. M., 282
Grasley, C., 158
Gras-ley, C., 158
Gray, B., 280
Gray, P., 191
Greatbatch, D., 219
Green, D. C., 163
Green, D. L., 218
Green, E. P., 11
Green, L., 75, 108, 110, 113
Green, S. A., 272
Greenbaum, C., 196
Greenberg, J., 266, 270, 277, 280, 281
Greenberg, M. T., 71, 141, 293
Green-Demers, I., 188
Greene, J., 255
Greene, L. R., 274
Greene, S. M., 196
Greenglass, E., 165
Greenhouse, L., 114
504
Greenwood, D. J., 52
Gregory, A., 88, 189
Gregory, B. T., 277
Gregory, K., 46
Gridley, H., 26
Grier, M., 39, 40
Griffin, K., 25
Griggs, P., 46, 54
Grima, F., 272
Grisso, J. T., 135
Grob, G. N., 128, 129, 130
Grodin, M. A., 55
Groff, E., 209
Grogan-Kaylor, A., 146
Grogg, K. R., 192
Grosch, J. W., 82, 184, 218
Grossi, E. L., 268
Grossman, J. B., 212
Gruenberg, E., 121
Grummer-Strawn, L., 259, 260
Grundy, K. M., 259
Gucciardi, E., 54
Guendelman, S., 269
Guerra, N. G., 196
Guitierrez, L., 75
Gullekson, N., 80
Gullotta, T. P., 143, 196
Gunn, P., 186
Gunnar, M. R., 140
Gurin, G., 122
Gurin, P., 293
Gutherie, R. V., 9
Guzicki, M., 166
Habemeier, W., 207
Haber, M., 67
Hackerman,A. E., 211
Hadley-Ives, E., 28
Haffey, W. G., 197
Hage, S., 20, 113
Hagestad, G. O., 164
Haggerty, R., 20, 21
Haines, J. I., 260
Haines, L., 213
Hakuta, K., 179, 188
Hall, G. N., 84
Hallman, W., 75
Halpern, D., 178
Hamid, P. N., 66
Hamilton, C. A., 219
Hamilton, M. A., 212
Hamilton, S. F., 212, 281
Hammond, C., 193
Hampton, C. V., 213
505
Hanauer, N., 5
Handel, G., 147, 148
Haney, C., 205
Hanks, C., 153, 154
Hanlin, C., 292
Hannon, L. E., 202
Harcourt, B., 132
Hardin, E., 165
Harkavy, I., 52
Harrell, S., 11
Harrington, C., 217
Harris, K., 233
Harris, L., 285
Harris, P. E., 220
Harrison, D. A., 274
Harrison, T. C., 193
Hartnett, S., 98
Haskell, W., 230
Haskins, R., 175, 178, 179
Haslam, S., 89
Hassan, F., 151, 152
Hassol, L., 7, 24, 25, 35
Hatfield, A. B., 142
Haughton, C., 40
Havel, E., 220
Haven, C., 165
Haviland, L., 39
Hawe, P., 75, 108, 110, 113
Hawkins, J. D., 113
Hawkins, R. P., 112
Haynes, R. B., 228
Haynie, D. L., 192
Hays, P. A., 9
Hazel, K., 131
He, W., 295
He, Y., 287
Heaney, C., 291
Heckhausen, J., 166
Hedeen, T., 217, 218
Hedegaard, M., 90
Heilman, M. E., 117
Heindl, T. R., 185
Heisterkamp, B. L., 217
Helgeson, V. S., 67, 84
Heller, K., 3, 6, 7, 19, 20, 28, 57, 75, 133, 135, 141, 143, 296
Hellman, I. D., 274
Helzer J., 121
Henderson, C. R., 154, 155
Henderson, J., 241, 242, 262
Hendry, L. B., 191
Henrickson, M., 39
Henry, D. B., 88, 189, 196
Heppner, M. J., 66
Heppner, P. P., 66
506
Herman, S. E., 131
Hernandez, D., 182
Herrling, S., 162
Hersch, C., 7
Hertzog, J. L., 274
Herzog, L., 193
Hess, B. B., 117, 201
Hess, P., 95
Hess, R., 25
Hessling, R. M., 28
Hetherington, E. M., 196
Hetherington, L., 287
Hightower, A. D., 197
Hill, J., 3, 8, 11, 18, 25, 46
Hill, P., 155
Hills, A. M., 216
Hiltzik, M., 5
Hinman, A. R., 39
Hirsch, B. J., 212
Hishinuma, E. S., 90
Hitlan, R. T., 184
Hladikova, A., 168
Hobel, C. J., 235
Hobfoil, S., 65
Hochschild, A. R., 147, 187
Hockaday, C., 261
Hodges, W. F., 19
Hodson, G., 184
Hoffman, S., 287
Hollander, E. P., 280
Hollingshead, A., 6, 7
Holloway, B. E., 212
Holme, J. J., 183
Holmes, T. H., 61
Holtgrave, D. R., 160, 161
Holtz Isenberg, D., 36, 90, 91
Homan, M. S., 105, 113, 116
Homel, R., 141
Hong, L., 158
Hooper, S. R., 152
Hopper, F., 161
Hops, H., 9
Horne, A., 109
Horton, K. D., 189
Houlette, M. A., 184, 186
Hoyt, D. R., 84
Hradecky, I., 168
Hsieh, T., 273
Hudgins, R., 231
Hudiburg, R., 80
Huebner, B. M., 202, 207, 208
Huebner, R. D., 132, 141
Huesmann, R., 196
Huffziger, S., 63
507
Hughes, B. J., 212
Hughes, D., 25
Hughes, J., 212
Hughes, M., 121
Hughey, J., 29, 46, 47, 54, 100, 194
Huici, C., 62
Hulley, S., 230
Hummer, R. A., 202
Humphreys, K., 52
Hunt, M. H., 192
Hunte-Marrow, J., 40
Hunter, A., 143
Hunter, W. M., 151
Huo, Y, 273
Hurtado, S., 186
Huselid, M., 282
Hylander, I., 105
Ialongo, N. S., 143, 191, 192, 193, 202, 203, 213
Idlout, L., 10, 54, 56, 86
Ikeda, R., 152
Imm, P., 75, 230
Isabel, A., 151
Iscoe, I., 7, 285
Isenberg, D., 52
Iturbide, M., 68
Iwamasa, G., 10
Jackson, C. J., 54, 230
Jackson, C. T., 216
Jackson, D., 287
Jackson, J. H., 165
Jackson, M., 280, 281
Jackson, R. M., 102
Jackson, S. E., 269, 274
Jacobs, D., 205, 230
Jacobs, J. B., 117, 214
Jacobson, L. V., 183
Jacobson, S., 102, 103
Jaenisch, R., 142
Jaffe, R. D., 241
Jahoda, M., 24
Jain, D., 151
James, D., 132
Jamieson, W, 214
Jang, S. J., 28, 208
Janskym, E. J., 234
Janz, N. K., 40
Jarrett, O., 192
Jasinskaja-Lahti, I., 287
Jason, L. A., 12, 13, 25, 35, 36, 53, 90, 91, 94, 104, 124, 142, 182, 191, 192, 196, 230, 232, 235, 285, 286, 289, 292,
293, 295
Jatulis, D., 230
Jay, G. M., 268
508
Jehn, K., 274
Jemmott, J. B., 40
Jemmott, L. S., 40
Jenkins, R., 19, 20, 133, 135, 141, 143
Jensen, S., 208
Johannes, C. K., 192
Johannesen-Schmidt, M., 278, 279
Johns, G., 269
Johnson, B. T., 164
Johnson, D. B., 213
Johnson, D. R., 188
Johnson, G., 29, 287
Johnson, J. D., 90
Johnson, Kelly, M., 184, 186
Johnson, S. D., 28
Johnson, S., 47
Johnston, D. F., 85
Johnston, L. D., 239, 243, 246, 247
Jolivette, K., 193
Jones, D., 141
Jones, E. E., 26
Jones, J., 62, 83
Jones, L., 151
Jones, M., 54
Jones, R. G., 281
Joo, H., 202
Jorgen-son, K., 61
Joseph, M., 95
Joshi, A., 274
Ju, D. B., 192
Judge, T., 282
Jukkala, T., 243, 244
Jumper-Thurman, P., 104
Kabat Zinn, J., 269
Kagan, C., 8, 288
Kaiser-Ulrey, C., 195
Kalafat, J., 109
Kalichman, S., 130
Kamradt, B., 138, 139
Kane, D., 216
Kanner, A. D., 61
Kaplan, C. P., 192
Kaplan, G., 111
Kapp, S. A., 218
Karavidas, M., 80
Karcher, M. J., 213
Karel, M. J., 296
Karim, Q. A., 53
Karim, S. S. A., 53
Kasprow, W., 137
Katapodi, M. C., 235
Katsikas, S. L., 80
Katz, D., 84
509
Katz, P., 84
Kaufman, J. S., 51, 57
Kawakami, K., 184, 185
Kaye, J., 162
Kaye, M. S., 136
Kazden, A. E., 18
Kazdin, A. E., 126
Kearns, W. D., 165
Keen, B., 205
Kegeles, S., 257
Kehres, R., 230
Keinan, G., 67
Kellam, S. G., 85, 191, 192, 193
Keller, S., 76, 88, 268
Keller, T. E., 211, 212
Kelly, C., 99
Kelly, F. D., 68
Kelly, G. W. R., 206
Kelly, H. H., 26
Kelly, J. G., 2, 6, 7, 13, 15, 16, 17, 19, 25, 26, 51, 52, 53, 56, 75, 81, 87, 90, 100, 105, 106, 142, 196, 214, 266, 285,
289
Kelly, K. D., 214
Kelsey, J. L., 48
Kendall, M. A., 188, 193
Kendler, K., 121
Kennedy, C., 133
Kennedy, H. L., 196
Kennedy, M., 213
Kensinger, K. B., 274
Kenyon, D., 29
Keppel, B., 6, 74
Kerlinger, F. N., 36
Keskinen, E., 209
Kessler, M., 285
Kessler, R. C., 121, 142
Kettner, P. M., 75, 76, 77, 87, 89
Keyes, C. L. M., 24
Keys, C. B., 35, 36, 57, 90, 91, 94, 265, 266, 267, 271, 282, 289
Keys, K., 292
Khan-Hudson, A., 165
Khoury-Kassabri, M., 195
Kidd, S., 51, 52, 287
Kiecolt-Glaser, J., 235
Kienzie, R., 270
Kiernan, M., 131
Kiernan, N. E., 80, 109
Kiesler, C. A., 130
Kim, J. W., 140, 214, 255, 260
Kim, M. M., 167
King, J., 212
King, R. H., 188
Kirby, D., 19, 233
Kirk, S., 65
Kirkman, B. L., 281
510
Kirmayer, L. J., 10, 54, 56, 86
Kislitsyna, O., 243, 244
Kitchen, C. D., 216
Kite, M. E., 164
Kitzman, H., 153, 154, 155
Kivits, J., 54
Kizilos, M. A., 277
Kjaer, G., 61
Klaw, E. L., 52
Kleber, R. J., 287
Kleck, G., 202
Klein, C., 281
Klein, D. C., 7, 24, 25, 35
Klein, J., 195
Klein, K. J., 270, 281
Klein, T. P., 167
Kling, R., 79
Klinkenberg, W. D., 169
Kloos, B., 3, 8, 11, 18, 29, 291
Knight, G. P., 17
Knipscheer, J. W., 287
Knitzer, J., 177, 178, 179
Kobus, K., 191
Kochan, T., 274
Koehn, V., 241, 242, 262
Koenig, A. M., 67, 279
Koenig, B., 67
Koff, W., 252
Kofkin Rudkin, J., 8, 118
Kohlberg, L., 117
Kohn-Wood, L. P., 204
Koizumi, R., 182, 191
Kooyman, I., 133, 134
Korbin, J. E., 29, 153
Koretz, D., 85
Kosic, A., 184
Kostelny, K., 153
Kostelny, L., 153
Kral, M. J., 10, 51, 52, 54, 56, 86
Kramer, E., 260
Krasy, M., 294
Kreisler, A., 80, 109
Kresky-Wolff, M., 170
Kreuter, M., 112
Krueger, P. M., 202
Kruger, D. J., 207, 208
Krumweid, R. D., 136
Kruse, D. L., 76
Kubinova, R., 243
Kuehner, C., 63
Kuhn, T., 36, 37, 38
Kulik, L., 287
Kumar, M., 269
Kumpfer, K. L., 20, 112
511
Kuo, F. E., 17, 294
Kuo, T., 235
Kuo, W., 67
Kuta, A., 148
Kwan, A., 287
Labianca, G., 280
Ladson-Billings, G., 179
Lafrance, A., 136, 137
LaFrance, B., 230
LaGrange, A., 178
Laguna, K., 80
Lahiff, M., 169
Lahm, K. F., 206
Lakes, K. D., 54
Lal, S., 74
Lamb, M. E., 175, 178, 179, 180
Lamb, M. M., 258
Lambert, E. Y., 40
Lambert, M. J., 122
Lambert, S. F., 202, 203, 213
Landers, S., 27
Landsberg, G., 195
Lane-Garon, P. S., 191
Lang, M., 178
Langan, P. A., 204
Lange, J., 191
Langer, E. J., 166
Langer, L. J., 166
Langhout, R. D., 52, 189
Lantz, G. D., 182
Lanzi, R., 177
Lapoint, J. M., 189
Laracuenta, M., 195
Lardon, C., 52, 106
Lasater, T., 230
Lasker, R., 231
Latimer, J., 219
Lausell-Bryant, L., 195
Lavee, Y., 267
LaVeist, T., 296
Lavoie, F., 104
Lavoie, K. L., 125
Lawlis, G., 268
Lawrence, A. J., 148
Lawson, A., 161
Lawthom, R., 8, 288
Lazarus, R. S., 61, 63, 64, 67
Lazere, E. B., 27
Le, H., 281
Leaf, P. J., 131
Leandre, F., 255
Leavitt, L. A., 196
LeBoeuf, D., 193
512
Lee, D. L., 62, 182
Lee, D.-G., 66
Lee, F. C. H., 162
Lee, S. M., 259, 260
Lee, T., 193
Legault, L., 188
Legler, R., 14, 52
Lehr, C. A., 188
Lehr, U., 165
Leinsalu, M., 243
Leiter, M. P., 269, 270, 271, 276
Lempert, R., 117
Lennon, M. C., 148
Leonard, P. A., 27
Leong, F., 110
Leos-Urbel, J., 149
Leppin, A., 268
Lerner, B. G., 130
Lerner, R. M., 112
Lero, D. S., 178
Leserman, J., 156
Lesesne, C. A., 163
Lester, D., 216
Lettieri, D. J., 39
Leung, C. M., 66
Leventhal, T., 107, 193
Levey, B., 291
Levi, Y., 95, 100
Levin, B. M., 243
Levin, D. J., 204
Levine, I. S., 132, 141
Levine, M. D., 19, 77, 88, 89, 95, 135, 136, 183, 214, 285
Levings, D., 241, 242, 262
Leviton, L. C., 39, 48
Levy, B., 291
Levy, D., 54
Levy, L. H., 95
Lewin, K., 11, 51, 90, 278
Lewis, D. A., 128, 129, 130
Lewis, K. M., 163
Lewis, R. K., 87, 233
Li, M., 287
Lian, B. E., 202, 203, 231
Liang, B., 211, 212
Liebsch, K., 63
Lievens, F., 272
Light, D., 76, 88
Likert, R., 278
Lim, N. K., 80
Lin, A., 62
Lin, J., 62
Lin, N., 67, 68
Lin, Y., 191, 192, 193
Linares, D. E., 227, 228, 232
513
Lindemann, E., 5
Ling, W., 248
Link, B., 130, 132, 141
Linney, J. A., 25, 95
Linton, D., 193
Lippett, R., 87, 278
Lipponen, J., 273
Liptak, A., 201
Lishner, D. A., 90, 193
Litrownik, A. J., 152
Little, T., 205
Litwin, H., 95, 100
Liu, E., 5
Liu-Mares, W., 137
Livert, D., 25
Lo, W., 39
Lochman, J. E., 141
Lockwood, A., 136, 193
Lohman, B. J., 149
Lonczak, H. C., 113
London, A. S., 149
Long, D., 29
Long, J., 290
Long, R. L., 88
Lonner, W., 9, 81, 110
Lönnqvist, J., 287
Loo, C., 10
Loomis, C., 46, 52, 57
Lopez, G. E., 186, 293
Lopez, M. M., 26
Lord, J., 25
Lorentz, E., 102, 103
Lorion, R. P., 22, 35, 44, 105
Lösel, F., 206
Loukaitou-Sideris, A., 207, 208
Loukes, A., 189
Lounsbury, D. W., 10, 102, 103, 234
Love, J. M., 180
Lovell, A. M., 131
Low, C., 65
Low, S., 195
Lowenthal, M. F., 165
Lubin, B., 46, 54
Lucas, R. E., 273
Lucas, T., 67
Lucenko, B., 130
Lucksted, A., 108
Ludwig, J., 178, 179, 180, 181
Ludwig, R., 208
Luepker, R., 230
Luke, D. A., 46
Lukens, E. P., 108
Lundgren, S., 80
Lunt, I., 4
514
Lurigio, S. J., 128, 129, 130
Lussier, G., 196
Lynch, M., 153
Lynne, S. D., 202, 203
Lyons, R., 281
Mac Iver, D. J., 193
MacBryde, J., 29
Maccoby, N., 230
MacDermid, S. M., 274
MacDonald, J., 202
MacGillivary, H., 25
MacKenzie, D. L., 207
MacKenzie, S. B., 272, 282
Mackin, J. R., 214
Maffeis, D., 287
Magnuson, K. A., 179, 188
Mahalingam, R., 184
Maier, G. J., 136
Maiman, L. A., 40
Maimane, S., 287
Maine, M. D., 260
Maiorana, A., 257
Makinen, I. H., 243, 244
Malow, R., 130
Malyutina, S., 243
Man-Chi, L., 204
Maniacci, M., 111, 112
Mankowski, E., 46
Mann, J., 40
Mann, S. C., 220
Manning, M., 141
Mannix, E., 273
Manrique, M., 166
Manwaring, J., 228
Manzo, L., 230
Marchel, C., 46
Marcus, J., 191
Marcus-Newhall, A., 185
Marin, G., 9
Markowitz, T., 149
Marks, J. S., 140
Markson, E. W., 117, 201
Marmorstein, N., 152
Marmot, M., 243
Marpsat, M., 169
Marshall, J. M., 136, 152, 193
Marsiglia, F., 287
Marsland, K. W., 175, 178
Martin, J., 84
Martin, P., 10
Martin-Baró, I., 23
Maruyama, G., 183
Marx, C., 46, 57
515
Marx, J. D., 161
Mashburn, A. J., 180, 181
Maslach, C., 269, 270, 271, 276
Mason-Sears, C., 104, 106, 107
Masood, N., 54
Massetti, G. M., 90
Massie, M. J., 234
Masten, A. S., 24, 69, 70, 71, 72, 212, 290
Matjasko, J. L., 90
Maton, K. I., 14, 25, 36, 52, 74, 75, 76, 77, 81, 87, 90, 94, 96, 102, 103, 105, 106, 212, 266, 271
Maton, K. L., 98, 100
Mattaini, M. A., 149
Matthews, D. B., 191
Mavor, K. I., 101
Mavroveli, S., 140
Mawby, R., 207
May, D. C., 207
Mayer, J. P., 108, 109, 228, 229
Maynard, H., 135
Maynard, R. A., 149
Mays, V., 62
Mazda, N. A., 281
Mazurek, T. L., 115
Mazzeo, S. E., 258, 259, 260
McAllister-Jones, L., 102
McBride, T. D., 169
McCann P., 52, 53
McCarthy, M. E., 269, 270, 271
McCave, E. L., 159, 160, 161
McClelland, C., 282
McCloskey, J., 235
McClure, R., 164
McCluskey, J. D., 202
McConahay, J. B., 191
McConnell, A., 133
McDonald, H. P., 228
McEwan, B., 62
McFadden, L. S., 87
McFarlane, W. R., 108
McGee, R., 86
McGillis, D., 82, 218
McGinley, M., 68
McGinnis, J., 262
McGloin, J. M., 194
McGonagle, K. A., 121
McGowan, R., 260
McGrath, J. E., 85
McGrath, J. W., 39
McGrath, R. E., 4
McInerney, P., 192
McIntyre, J. J., 162, 202
McKee, P. A., 216
McKenna, M., 259, 260
McKinlay, S., 230
516
McLaughlin-Volpe, T., 185
McLeroy, K., 75, 108, 110, 113
McMillan, D. W., 28, 29, 272
McNeal, R. B., 193
McNeely, R. L., 163
McNeilly, M., 227
McNichol, E., 147
McSweeney, A. J., 129, 130
McWhirter, E. H., 159
Meade, J., 188
Medway, F. J., 105
Meehl, P. E., 4
Meier, R., 99
Meier-Baumgartner, H. P., 165
Meissen, G., 95
Melamed, S., 269
Melloni, R. H., 202
Mellow, J., 219
Melton, G. B., 201
Méndez-Negrete, J., 163
Menec, V., 164
Mennino, S. F., 267, 268
Mereish, E. H., 67
Mertinko, E., 191
Meyer, A., 123
Meyers, J., 192
Meyers, M., 61
Miao, T. A., 90
Miaskowski, C., 235
Miers, R., 29
Milkovich, G. T., 275
Miller, K., 46
Miller, L. D., 136
Miller, M., 234
Miller, N., 186
Miller, R. D., 136, 216, 231
Millman, J., 141
Milne, A., 217
Mindel, C. H., 208
Minden, J., 235
Minore, J. B., 10, 54, 56, 86
Mintzberg, H., 276
Mischel, W., 12, 17
Mishara, B. L., 216
Mitchell, A. A., 67, 279
Mittelmark, M., 230
Mobley, L R., 235
Mock, L., 52, 106
Moffitt, T. E., 28, 208
Mokdad, A. H., 243
Molina, L. E., 185, 186
Moller, S., 192
Molnar, J. M., 167
Monahan, J., 3
517
Montali, L., 287
Montero, D., 208
Montero, M., 288
Montgomery, A. E., 167, 169, 170
Montoya, Y., 227, 228, 232
Moon, A. E., 220
Moore, M., 39
Moore, R., 130, 132, 141
Moos, R. H., 17, 24, 47
Moradi, B., 156
Morello, T., 286
Morgan, C. A., 211
Morgan, L., 260
Morgan, M., 109, 112
Morgeson, F. P., 275
Moritsugu, J., 25, 62, 142, 293
Morris, A., 271
Morris, L., 182
Morris, P, 142
Morris, S., 80
Morrison, T. L., 274
Morris-Oswald, T., 164
Morrissey, E., 75
Morrissey-Kane, E., 112
Morrow, J., 62
Morse, B., 80
Morse, G. A., 169
Morton, C., 47
Moscicki, E. K., 85
Moses, D. J., 170
Mosley-Howard, S., 211, 212
Moss, L., 269
Moua, Y., 49
Moulton, P., 234
Mowbray, C. T., 56, 131, 132, 133, 137
Moxley, D. P., 132, 133
Moyer, C. A., 255
Moynihan, D. R., 267
Mrazek, P., 20, 21
Muenchow, S., 175, 178, 179, 180
Muha, D. G., 193
Muir, E., 189
Muise, D., 219
Mukherjee, J., 255
Muller, D., 269
Muller, R. T., 202
Mulvey, A., 11, 25, 46
Munger, M., 49
Munger, R. L., 138
Munkes, J., 282
Muñoz, M., 167
Munoz, R., 285
Munro, M., 167
Murabito, J. M., 54
518
Murphy, P. D., 234
Murphy, S. E., 178
Murphy, S., 110
Murray, B., 126
Murray, D., 230, 241
Murray, M., 230
Murry, V., 28
Mustonen, H., 243
Myers, D., 99
Myers, W. C., 206
Nachmani, J., 259
Nadel, H., 62, 195
Nagda, A., 186
Nagda, B. A., 293
Naik, S., 255
Naimi, T. S., 243
Nair, Y., 287
Naisbett, J., 84
Nason, S. W., 277
Nathan, P., 123
Nation, M., 75, 112, 208
Neale, M., 273
Neebe, E., 178
Needell, B., 154
Neiderheiser, J., 143
Nellis, L. M., 281
Nelson, C. B., 121
Nelson, G., 3, 23, 25, 81, 105, 108, 114, 131, 136, 137, 193
Nelson, M., 193
Nemeroff, C. J., 29
Nemoto, T., 39
Netter, T., 40
Neuman, G. A., 281
Neumark-Sztainer, D., 260
Nevil, P., 255
Neville, H. A., 62
Newbrough, J. R., 28
Newell, B. L., 297
Newman, R., 125
Newman-Carlson, D., 109
Ng, S., 287
Ng, T., 212
Nicholas, A., 147
Nichols, A. W., 75, 76, 77, 87, 89
Nichols, T., 202, 203
Nickerson, K., 296
Nicotera, N., 230
Nier, J. A., 184
Nievar, M. A., 52, 53
Nihiser, A. J., 259, 260
Nikelly, A. G., 117
Nisbett, R. E., 26
Noam, G., 211, 212
519
Nordenberg, D., 140
Nores, M., 181
Norris, F. H., 201, 207
Norton, M. I., 165
Novak, S. A., 259
Novotney, L. C., 191
Nowell, B., 52, 53, 90, 266, 280
Nyden, P., 106
O’Brien, K., 159
O’Campus, P., 231
O’Donnell, C. R., 31, 221, 291
O’Leary, D., 157
O’Leary, K. D., 123
O’Malley, P. M., 239, 243, 246, 247
O’Neal, K. K., 204
O’Neill, L., 194
O’Neill, P., 99
O’Reilly, C., 273
O’Reilly, K., 51, 57
Oakes, P. J., 101
Obradovic, J., 69, 71, 290
Ochocka, J., 25
Oetting, E. R., 104
Offerman, L., 280, 281
Offutt, S., 234
Ogden, C. L., 258
Ogletree, R., 95
Okamato, Y., 168
Okazaki, S., 9
Okvat, H. A., 294
Olatunji, A. N., 192
Olczak, P. V., 82, 184, 218
Olds, D. L., 153, 154, 155, 156, 158
Olfson, M., 136
Oliver, J. M., 135
Oliver, W. M., 209
Olsen, B., 106
Olson, D., 291
Olson, L. S., 192
Olson, M. R., 206
Omoto, A., 89
Ong, T., 272
Opulente, M., 149
Organ, D. W., 271, 272
Ornstein, R., 293
Orosan-Weine, A. M., 182
Ortiz, C., 191
Ortmann, R., 206
Orvaschel, H., 121
Osburn, H., 281
Oskamp, S., 87, 183
Osmonbekov, T., 277
Ostermeyer, M., 82, 217
520
Ottoson, J. M., 14
Ouellette, S. C., 114, 116
Owens, S., 46
Oxley, D., 193
Pachan, M., 21, 175, 191, 192
Pacilli, M. G., 208
Padgett, D. K., 131, 132
Padilla, A., 10
Page, S., 293
Paillé, P., 272
Paine, J., 282
Paine-Andrews, A., 87, 233
Pajak, A., 243
Palia, S., 220
Palmer, T., 207
Paloma, V., 102
Paluk, E. L., 185, 186
Paluzzi, P., 233
Panadero, S., 167
Pandey, S. K., 267
Pargament, K. I., 17
Park, H.-J., 66
Parka, M., 286
Parker, E. A., 14
Parker, G. R., 28
Parks, G., 181
Patchin, J. W., 202
Patrikakou, E., 193
Pattavina, A., 209, 210
Patterson, D., 46, 161
Patterson, R. D., 165
Patton, G., 282
Patton, J., 233
Patton, M., 51
Paula, C. S., 151
Paulman, P. M., 241
Paz, M. F., 142
Pearlin, L., 166
Pearson, A. R., 90
Pearson, C., 167, 169, 170
Pearson, H. W., 39
Pechman, E., 182
Pedersen, P., 9, 81, 110
Pederson, P. B., 10, 55
Pedro-Carroll, J. L., 197
Peel, N., 164
Pelech, W., 212
Pelletier, L., 188
Penn, N. E., 131, 135, 149
Pepe, M. S., 258
Perdoux, M., 293
Pereira, G., 281
Perkins, C. A., 114, 183, 207
521
Perkins, D. D., 14, 29, 75, 99, 117, 189, 207, 208, 214, 230
Perkins, D. N. T., 231, 266, 267, 277, 282
Perkins, D. V., 19, 77, 88, 89, 135, 136, 183, 285
Perry, B. L., 27, 133
Perry, K., 27
Pestridge, S., 189, 191
Peterson, J. L., 17, 39
Peterson, N. A., 29, 47, 100, 194, 267
Peterson, S. A., 203
Petraitis, J., 39
Petras, H., 143
Pettigrew, T. F., 185, 187
Pettit, G. S., 202
Pezzin, L. E., 84
Pfeffer, J., 282
Pfeifer, M., 49
Phalet, K., 184
Phares, J. E., 81, 117
Philliber, S., 162
Phillip, K., 191
Phillips, A., 67
Phillips, D. A., 178, 179, 180, 181, 191, 296
Phillips, S. B., 216
Phills, C. E., 185
Pickren, W., 4, 74
Pierce, K., 182
Pieterse, A. L., 62
Pikhart, H., 243
Piliavin, I., 169
Pinchot, E., 281
Pinchot, G., 281
Pinderhughes, E. E., 141
Pinel, P., 3
Pines, A., 269
Pirttilä-Backman, A., 273
Pittman, A., 158
Pittman, L. D., 149
Piven, F. F., 149
Plante, N., 208
Plante, T., 18
Platt, D., 220
Plested, B. A., 104
Plomin, R., 28, 208
Podsakoff, P. M., 272, 282
Pokorny, S., 286
Polanin, M., 19
Pong, S. L., 192
Ponterotto, J. G., 55
Popovich, P. M., 80
Popper, K. R., 38
Portnoy, G. A., 287
Portzky, G., 109
Posner, J., 182
Poteat, V. P., 67
522
Potochnick, S., 192
Potts, M. K., 188
Poustka, F., 67
Powell, K. E., 196
Powell, S., 234
Powers, J., 155
Press, M., 213
Presser, L., 219
Presswood, R. F., 260
Prestby, J., 88, 100, 101, 281
Pretty, G. M., 269, 270, 271
Prevatt, F., 68
Prezza, M., 28, 29, 208
Price, K. H., 274
Price, L. N., 204
Price, R. H., 6, 7, 19, 22, 28, 35, 75, 90, 100, 112, 282
Prilleltensky, I., 3, 23, 25, 77, 81, 105, 108, 114, 115, 288, 291, 295
Prilleltensky, O., 291
Primavera, J., 90, 193
Prince-Embury, S., 84
Prinz, R. J., 9
Prinzie, P., 153
Proescholdbell, R. J., 29
Proulx, T., 86
Pruessner, J., 64
Pruitt, D. G., 217, 218
Pulver, A. L. S., 249
Purich, D., 86
Purkiss, R. B., 272
Purvee, D., 192
Quan, M. A., 51, 57
Quigley, R., 203
Quillian-Wolever, R., 268, 269
Quimby, C. C., 294
Quintana, S., 68
Quiroga, M. A., 167
Rader, N. E., 207
Raffaelli, M., 68
Rafferty, Y., 27, 167
Raghavan, C., 268
Rahe, R. H., 61
Raikes, H. H., 179, 180
Raikes, J. A., 179
Raju, N. S., 281
Ralls, R. S., 281
Ramey, C. T., 177, 181
Ramey, S. L., 177, 181
Ramirez, M., 23
Ramírez-Valles, J., 98, 100
Ramiro, L., 152
Ramos-McKay, J., 22
Randall, G., 245
523
Randolph, W. A., 280
Rank, M. R., 146, 147, 188
Rapkin, B. D., 234
Rappaport, J., 3, 4, 7, 9, 17, 18, 25, 60, 75, 81, 87, 95, 131, 133, 285, 289
Rasmussen, A., 65
Ratcliffe, J. H., 209
Rath, W. R., 167
Ratnesh, B., 186
Raudenbush, S. W., 99, 214, 290
Raviv, A., 196
Reddy, R., 189
Redlich, C., 6, 7
Redmond, C., 245, 261
Reed, G. M., 84
Reese, L. E., 112
Regier, D., 121
Reich, J. A., 55
Reich, J. W., 166
Reich, S. M., 55, 288
Reid, M. J., 179, 188, 195
Reid, R. J., 47, 100, 194
Rein, M., 130
Reinharz, S., 6, 7, 19, 28, 75
Reischl, T. M., 87, 207, 208
Reisner, E., 182
Reiss, D., 112
Reitzel-Jaffe, D., 158
Reixach, K. A., 213
Reppucci, N. D., 161, 285
Resch, N., 212
Resnicow, K., 112
Revenson, T., 25, 229, 235
Revilla, A. T., 183
Reyes, O., 182, 191, 192
Reynolds, J., 294
Reynolds, K. J., 101
Reynolds, W., 285
Rhode, D. L., 161
Rhodes, J. E., 189, 211, 212, 213
Ribera, J. C., 84
Rich, R., 100, 101, 281
Richards, F. A., 281
Richards, J. W., 241
Richmond, C., 68
Richter, K. P., 87
Riedelbach, H., 196
Riek, B. M., 184, 186
Riemer, M., 288
Rienold, C., 259, 260
Riger, S., 6, 7, 14, 19, 28, 46, 75, 101, 142, 143, 266, 267
Riggins, Jr., 178
Riggs, N., 71, 293
Riley, D. A., 178
Rio, J., 169
524
Ristikari, T., 67, 279
Rivera-Medena, E., 26, 39
Rixon, R., 191
Rizzo, J. R., 270, 277
Roach, M. A., 178
Roberts, A. R., 216
Roberts, C. W., 136, 193, 220
Roberts, D. G., 277
Roberts, J. E., 178
Roberts, L. J., 87
Robertson, M. J., 169
Robins L., 121
Robins, R., 285
Robinson, J. W., 57, 75, 87, 95, 101, 104
Robinson, W. L., 117
Roccato, M., 208, 287
Rodin, J., 166
Rodriguez, M. A., 190
Rodriguez, N., 217, 218, 219
Rodwell, J. J., 270
Roesch, R., 132, 201
Roethlisberger, F. J., 276
Rogelberg, S. G., 266
Rogers, R. G., 202
Rogosch, F. A., 140, 143, 153
Roh, S., 209
Rohrmann, S., 67
Roll, J. M., 207
Rolleri, L., 233
Rollin, S. A., 195
Rollock, D., 9
Romano, J., 20, 113
Romeo, R., 62
Room, R., 243
Rooney, J. F., 84
Roosa, M. W., 17, 29
Ropero, S., 142
Ropp, S. A., 185
Roscigno, V. J., 192
Rose, T., 295
Roseborough, D., 217, 218
Rose-Gold, M. S., 193
Rosenberg, L., 170
Rosenberg, Y., 84
Rosenblum, G., 7, 24, 25, 35
Rosenfield, D., 186
Rosenhack, R., 137
Rosenhan, D. L., 129
Rosenkranz, M., 269
Rosenthal, R., 183
Rosentock, I. M., 256
Ross, C. E., 28, 208
Ross, E., 51, 57
Ross, J., 227
525
Ross, L., 206, 208
Ross, M. M., 206
Ross, N., 68
Rossell, C. H., 187
Rossi, P. H., 27, 167
Rossi, R. J., 272
Rothbaum, P. A., 181
Rothman, A., 232
Rothman, J., 96
Rotter, J., 98
Rouget, B., 109
Rountree, P. W., 207
Roussos, S. T., 231
Routh, D. K., 4
Roychoudhury, A., 211, 212
Rubin, B. A., 267, 268
Rubio-Stipec, M., 84
Rudisill, J., 104, 106, 107
Ruggiero, K., 84
Ruiz, R., 10
Rumsey, E., 155
Runyan, D. K., 151, 152
Rush, B., 127
Russell, D. W., 28
Russell, S. T., 162
Russo, S., 208
Rutter, M., 69, 71
Ryan, G. W., 156
Ryan, J. A., 113
Ryan, J. P., 210
Ryan, K., 19
Ryan, W., 24, 26
Rydell, R., 133
Ryerson Espino, S. L., 25
Saegert, S., 75, 102, 214
Saenz, D., 17
Sáez-Santiago E., 10
Saguy, T., 90
Sakai, T., 221
Sakellaropoulo, M., 64
Salas, E., 281
Salazar, X., 257
Saldaña, L. P., 163
Salem, D. A., 14, 52, 137, 271
Sallis, J., 228, 229
Salmi, S., 209
Salovey, P., 232
Saltzman, H., 64, 65
Samani, N. J., 54
Sameroff, A. J., 140
Sammons, M. T., 4, 125
Sampson, R. J., 99, 214, 290
Sanchez, B., 110, 191
526
Sanchez, D. L., 206
Sanders, D. H., 135
Sanders, J., 117
Sandler, I., 69
Sandman, C. A., 235
Sandoval, C., 257
Santinello, M., 189
Santorelli, S., 269
Santos, E. P., 167
Sarason, S. B., 28, 77, 94, 102, 103, 104, 105, 107, 182, 189, 231, 289
Sarata, B. P. V., 277
Saw, A., 9
Sayers, M., 39
Scaon, K., 39
Scarr, S., 176
Schaefer, C., 61
Schafer, J. A., 207, 208
Schaie, K. W., 166
Schaps, E., 189
Scharrón-del Río, M. R., 117
Schaufeli, W. B., 269
Scheckner, S., 195
Scheibler, J. E., 287
Scheier, M. F., 65, 68, 166
Schein, E. H., 270
Schellinger, K. B., 22
Schensul, J. J., 39
Schiaffino, K., 229, 235
Schinke, S. P., 160
Schleifer, S., 268
Schmeelk-Cone, K. H., 204
Schminke, M., 271
Schmitz, J., 80
Schnake, M., 272
Schnee, S. B., 132, 133
Schneider, S., 4, 231
Schneiderman, N., 269
Schnopp-Wyatt, D. L., 192, 196
Schoenberg, M., 95
Schoeny, M. E., 88, 189
Schon, D. A., 130
Schuck, A. M., 202, 203
Schueller, S. M., 24
Schulen-berg, J. E., 239, 243, 246, 247
Schuler, R. S., 269
Schuller, N., 207
Schultz, D., 267, 269, 275
Schultz, J. A., 87
Schultz, S., 267, 269, 275
Schulz, R., 166
Schumacher, J., 269
Schur, L. A., 76
Schuyler, T., 181
Schwab, R. L., 269
527
Schwartz, D., 195
Schwartz, J. P., 156, 157, 159, 195
Schwartz, M. B., 259
Schwartz, S., 221
Schwarzer, R., 268
Schweinhart, L. J., 181
Schweitzer, J. H., 214
Schwimmer, J. B., 258
Scileppi, J. A., 19, 20
Scott, E. K., 149
Scott, K., 158
Scully, J., 61
Searight, H. R., 135
Sears, R., 104, 106, 107
Secrist, Z. S., 49
Sedivy, V., 233
Sedlovskaya, A., 184
Seefeldt, K., 148, 149
Seekins, T., 104, 232
Seeman, T., 235
Seidel, K. D., 258
Seidman, E., 13, 17, 25, 36, 75, 87, 105, 131, 133, 277, 285
Seiler, E., 165
Seitsinger, A. M., 193
Seitz, V., 162
Sekaly, R., 252
Seligman, M. E. P., 20, 24, 124
Sellers, R., 296
Selye, H., 63
Selznick, P., 101
Sember, R. E., 39
Sengupta, M., 295
Sennett, R., 148
Senuta, K., 46, 57
Seppälä, T., 273
Serrano-García, I., 26, 87, 105, 106, 290
Setien, F., 142
Seybolt, D., 75, 112
Seymour, R. B., 248
Shadish, W. R., 44, 48, 87, 94, 128, 129, 130, 135
Shadur, M. A., 270
Shahane, A., 159
Shaheen, G., 169
Shakow, D., 4
Shamir, B., 89
Shankar, V., 151
Shapira, I., 269
Shapira, N., 166
Shapiro, D. L., 281
Sharstein, S., 142
Shaw, L., 89
Shear, K. M., 216
Sheldon, S. B., 192, 193
Shepherd, M. D., 95
528
Sheridan, J., 269
Sherman, L., 218
Sherman, S., 259
Sherwood, A., 227
Sherwood, H., 66
Sherwood, N. E., 260
Shiflett, S., 268
Shih, Y., 228
Shin, C., 245
Shin, R. Q., 188, 193
Shinn, M., 27, 166, 167, 168, 169, 230, 231, 266, 267, 271, 277, 282
Shirom, A., 269
Shivy, V. A., 220
Shore, D. A., 161
Shore, M. F., 281
Shrewsbury, V., 258
Shults, J., 259
Shumaker, S. A., 85, 95, 208
Shure, M. B., 191, 192
Siddiquee, A., 8, 288
Sidel, V., 291
Sidora, K., 155
Sidora-Arcoleo, K., 153, 154
Siegel, J. T., 242
Sikes, J., 186
Silka, L., 184
Simmens, S. J., 84
Simoni-Wastila, L., 248
Simonre, R., 67
Simonsen, C. E., 206
Simpura, J., 243
Sims, B., 218
Singer, M., 39, 40
Singh, S., 160, 233
Singleton, J., 165
Sippola, E., 255
Siska, D., 78
Skinner, A., 294
Skinner, B. F., 12, 124
Skinner, E., 66
Skodol, A. E., 141
Skogan, W., 98
Skogrand, L., 291
Skokan, L. A., 84
Slavich, S., 95
Slavin, L. A., 191
Slavin, R. E., 186
Smart Growth., 77, 78
Smink, J., 193
Smith Major, V., 281
Smith, C., 141
Smith, D. E., 248
Smith, E., 155
Smith, H. P., 218
529
Smith, J. P., 260
Smith, K., 182
Smith, L., 147
Smith, M., 61
Smith, P., 112
Smith, R., 58, 61
Smith, S. J., 167, 207, 241, 242, 262
Smith, T. M., 189
Smither, R. D., 266
Smith-Fawzi, M., 255
Smrekar, C., 187
Smyer, M. A., 296
Smyth, J., 192
Snapp, M., 186
Snider, A. B., 80, 109
Snow, D., 268
Snowden, L. R., 19, 136, 231, 232, 285, 290
Snyder, M., 89
Solar, R., 112
Solarz, A., 27
Solomon, D., 189
Sosin, M., 169
South, S. J., 192
Southwick, S. M., 211
Spacespan, S., 166
Spataro, S., 273
Spears, R., 89
Speer, P. W., 14, 29, 46, 47, 54, 90, 100, 292
Speight, S., 23, 117
Spellmann, M., 195
Spencer, R., 211, 212
Spillman, B. C., 84
Spiros, R., 281
Spitz, A. M., 140
Spitzer, R. J., 202
Spivack, G., 191
Splansky, G. L., 54
Spoth, R., 245, 261
Spreitzer, G. M., 271, 277
Sroufe, L. A., 141
Stadler, C., 67
Stagl, K. C., 281
Standifer, R., 282
Stanko, E. A., 156
Stanley, J., 38, 44, 45
Stanton, A., 65
Stearns, E., 192
Stebbings, H., 277
Steele, J. R., 61, 185
Steffen, A. M., 19, 20, 133, 135, 141, 143, 163
Steffen, P. R., 227
Stein, C., 46
Stein, L., 137
Stein, M., 294
530
Stein, P. J., 117, 201
Steingard, R. J., 202
Stelzner, S., 279
Stephan, C., 186
Stephens, C., 230
Stephens, T., 206, 220
Stern, D., 191
Stern, M., 260
Stewart, D. E., 54
Stiffman, A. R., 28
Stinchcomb, J., 219
Stipek, D., 179, 188
Stockdale, G. D., 164
Stoiber, K. C., 162
Stokols, D., 26
Stolzenberg, L., 202
Story, M. T., 260
Stowe, R. M., 191
Straatman, A. L., 158
Strain, L., 133
Strand, N. K., 54
Strange, J., 218
Streitman, S., 69
Strickler, G., 248
Strom, K., 202
Strother, C. R., 4, 25
Struening, E. L., 131, 132, 141
Strumer, S., 89
Stueve, C. A., 102
Stumpf, J., 158
Sturge-Apple, M., 71
Su, M., 29, 153
Suanda, S. H., 184
Suarez-Balcazar, Y., 36, 90, 91, 102, 106, 292
Sue, D. W., 9, 62, 81, 140
Sue, S., 9, 10, 41, 62, 140, 290, 291
Sullivan, W. C., 17
Sundberg, N., 285
Sundstrom, E., 281
Susser, E., 130, 132, 141
Susser, M., 53
Sutton, R. M., 282
Suzuki, R., 189
Svec, H., 193
Svyantek, D. J., 281
Swan, S., 268
Swansen, J. M., 54
Swanson, L., 104
Swift, C., 95, 117, 118, 291, 295
Swindle, R. W., 19, 20, 133, 135, 141, 143
Sy, F. S., 257
Szasz, T. S., 4
Taber, T. D., 277
531
Tagg, S. K., 29
Takeuchi, D. T., 131
Talbot, B., 192, 196
Talbott, J. A., 129
Talwar, G., 287
Tandon, S., 52, 106
Taniguchi, T., 209
Tarantola, D., 40
Taron, C., 294
Tartaglia, S., 29
Tarullo, L. B., 180
Taulé-Lunblad, J., 196
Tausig, M., 104
Tavecchio, L. W. C., 177
Taxman, F. S., 219, 220, 221
Taylor, A., 28, 208
Taylor, C., 187, 211, 230
Taylor, D., 84
Taylor, L., 15
Taylor, R. B., 85, 99, 207, 208
Taylor, R. D., 22, 36, 90, 91, 292
Taylor, S. E., 84, 89, 191
Taylor, T. K., 201
Taylor, V., 211
Tebbs, J., 46
Tedeschi, G., 28, 29
Teed, E. L., 19, 20
Tein, J., 17
Tellegen, A., 69
Tepper, B. J., 272
Terenzio, M., 11, 25, 46
Test, M. A., 137
Tetelbaum, R., 154
Tharp, R. G., 291
Thoits, P., 67, 68
Thomae, H., 165
Thomas, D. R., 26, 58, 114, 181, 273, 274, 288
Thomas, E., 3, 8, 11, 18
Thomas, M., 52, 106
Thomas, S., 135
Thomas, W., 190
Thompson, J., 218
Thompson, M. P., 188, 201, 207
Thompson, S. C., 166
Thompson, W. D., 48
Thomsen, A. H., 64, 65
Thoresen, C., 282
Thornton, M., 84
Thorpe, S. J., 80
Thurlow, M. L., 192, 193
Tice, C. H., 165
Tidball, K., 294
Tierney, J. P., 212
Tippetts, A. S., 244
532
Tiziana, R., 28, 29
Tobin, K. G., 191
Tobin, M. D., 54
Tobler, W., 47
Todd, N. R., 54, 62
Todd, R. M., 89
Toker, S., 269
Tolan, P., 35, 90, 196, 289
Tomaskovic-Devey, D., 192
Tomes, H., 74
Tompsett, C. J., 166
Toohey, S., 230, 231
Torino, G., 62
Toro, P. A., 10, 87, 131, 135, 136, 166, 168, 285
Torres, R. D., 19, 20
Torres-Stone, R., 68
Torrey, E. F., 131, 142
Tosi, H. L., 61, 270, 277
Toth, S. C., 143, 153
Toth, S. L., 140
Town, M., 243
Townley, G., 11, 29
Trickett, E. J., 3, 9, 10, 13, 17, 25, 46, 56, 74, 75, 88, 90, 108, 110, 113, 191, 265, 285
Trimble, J. E., 9, 47, 56, 75, 81, 108, 110, 113, 117
Trotter, R. T., 40
Truckenbrodt, Y., 272
Tsemberis, S., 169
Tseng, V., 13, 25, 277
Tsui, A., 273
Tuch, S. A., 208, 209
Turman, K. M., 208
Turner, K. M., 167
Turner, S. G., 192
Turnipseed, D. L., 268
Tzavidis, N., 140
Ubriaco, M., 181
Uchino, B., 235
Uhlenberg, P., 164
Umbreit, M. S., 218
Umemoto, K., 90
Upadhyaya, M. P., 152
Updyke, J. F., 105
Urquiza, A., 151
Vacca, J. S., 220
Vacha-Haase, T., 164
Vagero, D., 243, 244
Valdiserri, R. O., 39
Valencia, E., 130
Valenti, M., 100
Valentine, J. C., 212
Valentino, K., 152, 153
Van den Berg, P. A., 260
533
Van Engen, M., 278, 279
Van Fleet, D. D., 269
Van Heeringen, C., 109
Van Heeringen, K., 109
Van Houtte, M., 189
Van Ijzendoorn, M. H., 153, 177
VanAcker, R., 196
Vandell, D., 182
Vander Veur, S. S., 259
Vannatta, K., 191
Varano, S. P., 202
Varni, J. W., 258
Vartonian, T. P., 193
Vaughn, E., 54
Vaux, A., 65
Vazsonyi, A. T., 196
Vega, A., 163
Velkoff, V., 295
Veno, A., 288
Vera, E. M., 19, 23, 61, 109, 112, 117, 185
Verkasalo, M., 287
Vermeiren, R., 67
Veroff, J., 122
Vidmar, N., 219
Vieno, A., 189, 208
Vimpani, G., 245
Vincent, T. A., 116
Vivolo, A. M., 90
Voas, R. B., 244
Voeten, M. J. M., 209
Vogel, M., 68
Volungis, A. M., 202
Von Rentein-Kruse, W., 165
Votruba-Drzal, E., 149
Vythilingam, M., 211
Wadsworth, M., 64, 65
Wagner, B. M., 191
Wagner, R., 195
Wahl, O. F., 133
Waidfugel, J., 179, 188
Wakefield, S., 294
Waldman, D., 276
Waldo, M., 156, 157, 159
Walker, C. R., 215
Walker, I., 186
Walker, L. E., 159, 221
Walker, S. G., 215
Wall, M. M., 260
Wallerstein, N., 40
Wallston, B., 234
Walsh, E., 133, 134
Walsh, J. T., 277
Walsh, M. E., 165
534
Walsh, R. T., 4, 6
Walters, E., 121, 142
Walton, E., 266, 279
Wandersman, A. W., 3, 6, 7, 8, 11, 18, 19, 28, 75, 87, 88, 95, 99, 100, 101, 112, 208, 214, 230, 281
Wang, G., 258
Wang, L.-F., 66
Wang, S., 191, 192, 193
Wang, Y.-W., 66
Waples, S. J., 213
Ward, P., 14
Wardle, J., 258
Warner, R., 131
Warren, C. S., 109
Warren, M. R., 15, 95
Warren-Sohlberg, L., 182
Wasco, S., 46
Washington, R. O., 163
Wasmer, D., 136, 137
Waters, C., 235
Watson, J., 87
Watson, John B., 124
Watson, M., 189
Wattam, C., 152
Watters, J., 40
Watts, R. E., 9, 111, 112, 290
Watts-English, T., 152
Watzlawick, P., 74, 89, 90
Way, M., 189
Wayne, S. J., 272
Weakland, J., 74, 89, 90
Weaver, J., 217
Weaver, S. R., 17
Webb, D. H., 80
Webb, J., 136, 137
Webber, R., 208
Webster-Stratton, C., 179, 188, 195
Wechsler, H., 259, 260
Wedge, R., 207
Weed, D. S., 105
Weeks, M. R., 39, 40
Weihs, K., 84
Weikart, D. P., 181
Weinberg, R. B., 216
Weinstein, R. S., 183, 189, 287, 289, 295
Weintraub, J. K., 65
Weiss, C., 46, 57
Weiss, E., 231
Weissberg, R. P., 20, 21, 22, 175, 182, 191, 192, 193
Weissman M., 121
Weist, M., 202, 207, 213
Weitzer, R., 208, 209
Weitzman, B., 167
Wekerle, C., 158
Well, S. S., 183
535
Wells, A. M., 21
Wells, W., 209
Welsh, E. A., 287
Wemmers, J., 204, 215, 217, 218
Werner, E., 58, 61
Werthamer, L., 191, 192, 193
Wescott, J. S., 216
Wesson, D. R., 248
West, G., 39
Westerfelt, H., 169
Westley, B., 87
Wethington, A., 63
Wett, J. L., 166, 167, 169
Wettersten, K. B., 159
Wheaton, B., 61
Whitaker, R. C., 258
White, C. P., 163
White, H., 152
White, R. M. B., 17, 278
White, R. W., 24
Whiteman, M., 187, 287
Whitfield C. L., 140
Whitley, B. E., 164
Whyte, W. F., 52
Widom, C. S., 152, 202, 203
Wielkiewicz, R., 279
Wilcox, B., 68, 179
Wilke, L. A., 14, 90
Wilkinson, D., 29
Wilkinson-Lee, A. M., 162
Williams, D., 62, 186
Williams, E., 233
Williams, I., 221
Williams, K. R., 196
Williams, P., 230
Williams, S. S., 39
Williamson, D. F., 140
Williamson, J. C., 191
Williamson, T., 208
Wills, T., 67
Wilson, D. B., 207
Wilson, G. T., 123
Wilson, G., 216
Wilson, J. B., 149
Wilson, M., 233
Wilson, T. D., 186
Winkel, G., 102, 214
Winkleby, M., 230
Witheridge, T. F., 136, 137
Wittig, M. A., 80, 185, 186
Wituk, S., 95
Wodarski, J. S., 165
Wolever, M., 268, 269
Wolfe, D. A., 158
536
Wolff, T., 87, 90, 103, 104, 117, 118, 291, 295
Wolf-Gillespie, N., 241
Wolfson, M., 230
Wombacher, J., 29
Wong, F. Y., 38, 39, 41, 43, 45, 50, 125, 257
Wong, N. T., 14
Wood, J., 209
Woodbury, M. A., 84
Woodin, E. M., 157
Woods, D. J., 218
Woodward, T. G., 210
Woolard, J., 285
Woolpert, S., 215
Wootton, A. B., 213
Worchel, S., 80, 101
Work, W. C., 28, 197
Worsham, S. L., 43
Wright, J. A., 258
Wright, S. C., 185, 186
Wright, Z., 241, 242, 262
Wrosch, C., 166
Wu, J. J., 220
Wu, Z., 287
Wundt, W., 124
Wyman, M. F., 19
Wyman, P. A., 28, 197
Wypijewska, C., 39
Xie, J. L., 269
Xu, J., 287
Xu, Y., 195
Yanez, V., 208
Yang, H., 53, 210, 266, 280
Yang, P., 147
Yapchai, C., 14, 52
Yasuda, T., 29
Yates, M., 100
Ybarra, V., 68
Yershova, K., 191
Yeskel, F., 147
Yeudall, F., 294
Yick, A., 54
Yijälä, A., 287
Yodanis, C., 156
Yoder, J. D., 156
Yoo, S., 261
Yoon, O., 202
Yost, B., 218
Young, I. M., 23, 76
Youngstrom, E., 202, 207, 213
Youniss, J., 100
Yovanoff, P., 220
Yue, X. D., 66
537
Yunus, M., 150
Zahniser, J. H., 100
Zárate, M. A., 184
Zarit, S. H., 166
Zatakia, J., 166
Zautra, A. J., 166, 294
Zawilski, V., 208, 209
Zeira, A., 195
Zeisel, S. A., 178
Zeitlin, D., 268
Zeldin, S., 14
Zeljo, A., 191
Zhao, L, 228
Zhao, S., 121
Zhong, L. Y., 209, 213
Zhu, C., 216
Zigler, E. F., 178, 179, 180
Zimbardo, P., 205
Zimmerman, M. A., 13, 14, 87, 95, 98, 100, 105, 204, 267
Zinner, E. S., 4
Zipp, J. F., 274
Zirkel, S., 185
Zlotnick, C., 169
Zohar, D., 267, 268
Zolik, E. S., 12
Zugazaga, C., 167
Zuniga, M., 131, 135, 149
538
SUBJECT INDEX
Abused children, and social services, 151–155
ACCESS, 234
Accountability, 79
Acquired immunodeficiency syndrome (AIDS), 252–257, 262
drug use and, 247
Action research, defined, 25
Active coping, 65, 268
Active-passive coping, 65
Activity, defined, 49
Acupuncture, 127
Acute stress vs. chronic stress, 61–62
Adaptive capacity, 16
Additive effect, social support, 68, 69
ADDRESSING framework, diversity, 9
Adherence, 228–229
Administrative leadership, 88
Adolescent-limited (AL) antisocial behavior
life course–persistent vs., 71–72
Adolescents
dropping out of school, 192–194
obesity (See Obesity)
school climate and, 188–191
Adventuresome, 289
Adverse childhood experiences (ACEs), 140
Affordable Care Act, 226, 227
African Americans
life expectancy, 224
Aging, and end of life, 295–296
Alcohol, 242–245, 261, 268
Alcohol abuse prevention strategies, community psychology and, 244–245
Alcohol safety laws, 244
Alienation from school, 188
Alternative education, 189
Alternatives, 7
Altruism, 272
American Journal of Community Psychology
universities publishing in, 286
American Legacy Foundation, 240
American Psychological Association (APA), 10
America Stop Smoking Intervention Study (ASSIST), 240
Amicus curiae, 116–117
Annual Review of Psychology chapters on community psychology, 285
Antiretrovirals (ARTs), 255
Antitobacco efforts, 240–241
Asian Americans, microagressions and, 62
Assertive community treatment (ACT), 136–137
Asylums, 127
539
Baby boomers, 6
Behavior
and environment, 12
reinforcement/punishment for, 12
Behavioral model, mental health/disorder, 124
Behavior settings, 11
Bicultural clinical staff, 233
Big Brothers/Big Sisters program, 212
Bilingual clinical staff, 233
Bilingual peer advocate (BPA) program, 257
Binge drinking, 243
Blacks. See African Americans
Block associations, characteristics of, 101
Bloom’s principles, on community programs, 107
Body mass index (BMI), 258
school-based screening, 259–260
Boot camps, 207
Brown v. Board of Education of Topeka, Kansas, 5–6, 74, 76, 82, 83, 183, 188
Buffering effect, social support, 68, 69
Burnout, 269–270
Carrera Program, 161–162
Catchment area, 143
CeaseFire program, 97–98, 108
Change agents, 87
Change management, 282
Charity/philanthropy, 148
Child care, 175–179
effects of, 175–178
high-quality, guidelines for, 177
necessity for, 175
nonparental, 176
plans for, 178–179
Childhood environment
day care, 175–179
early, 174–182
enrichment education, 179–181
interventions, 179–181
Child maltreatment, 203
causes of, 153–154
prevention programs, 154–155
scope of issue, 151–153
and social services, 151–155
Children of Divorce Intervention Program (CODIP), 196–197
Chlamydia, 250
The Choices Program, 113
540
Chronic stress, acute stress vs., 61–62
Citizen participation, 95–101
advantages/disadvantages of, 100–101
defined, 95
examples of, 97
and prevention, 96
Civic empowerment, 14
Civic virtue, 272
Civil Rights Act, 124
Classical conditioning, 124
Client-centered therapy, 124
Clients, 56, 104, 124
Clinical-community psychology, 31
doctoral programs in, 30
Clinical psychologists, 4, 125
Clinical psychology
community psychology vs., 18
defined, 4
Cocaine, 246
Cognitive misers, 89
Cognitive problem solving, 191
Collaboration, 26, 87, 102–104
defined, 231
Collectivist coping, 66
Commentaries, 288–292
Community
awareness of, 100
defined, 28
health promotion efforts shifted to, 230–231
psychological sense of, 28–29
sense of, 28, 100, 270–271
Community-based approaches, against tobacco use, 241–242
Community-based organizations (CBOs), 234
Community Competence Scale, 135
Community conflict, 80–81, 82
Community Development Society (CDS), 95, 96
Community Dispute Resolutions Centers Act, 82
Community education, 108–109
issues related to, 111–112, 113
Community intervention strategies, 93–118
and citizen participation, 95–101
community education, 108–113
consultation, 104–107
information dissemination, 108–113
networking/collaboration, 102–104
planned change, creation of, 94–95
and public policy, 114–118
Community mediation, 82
centers, 217
Community Mental Health Centers Act of 1963, 6, 135
Community Police Station Program, 215
Community policing, 209
Community popular opinion leaders (CPOLs), 256
Community programs, Bloom’s principles on, 107
541
Community psychiatry, 128 Community psychologists, 126
community psychology vs., 7
as consultants, 56–57, 105
on social justice, 23
Community psychology
and alcohol abuse prevention strategies, 244–245
birth in United States, 7
cautions/considerations, 52–57
commentaries, 288–292
defined, 3, 7–8
doctoral programs in, 30
freestanding, 31
fundamental principles, 8–18
future of, 284–296
goal of, 7
graduate programs, 286
and health care system, 229–235
historical background, 3–7
interdisciplinary perspectives, 25–26
intervention strategy in, 35
journals in, 286
liberating, 290
master’s programs in, 32
objectives, 74
and organizational psychology, 265–267
principles, 288
stress model and, 60–61
training in, 29–32
vs. clinical psychology, 18
vs. community psychologist, 7
Community research and action, guiding principles of, 8
Community residences, 129
Community spirit, 28
Compassionate community, 293
Compensation packages, 275–276
Compensatory education, 179
Competence, 23–24
importance of, 24
Competency enhancement approaches, 60–61
Compliance, 228–229
Comprehension, 53
Computer anxiety, 80
Computerphobia, 80
Conceptual purpose, 116
Conditioned response, 124
Conditioned stimulus, 124
Confounding effects, 38, 41
Connectivity, 271
Conscientiousness, 272
Conscientization, 89
Consistent adult, 211
Constituent validity, 57
Consultants
community psychologists as, 56–57, 105
542
defined, 56, 104
issues related to, 105–106
Consultation, 104
on diversity, 274–275
issue related to, 106
Consultees, 56, 104
Consumer-run agency, 47
Contact hypothesis, 185
Context
conceptualization of, 13
cultural, 17
and environment, importance of, 11–13
Contingency model, 278
Contraceptive, usage by teens, 161
Convenience sample, 43
Coping
active, 65
collectivist, 66
dimensions of, 65
emotional approach, 65
emotion-focused, 64–65
families, 66
problem solving–focused, 64–65
schema for, 66–67
with stress, 64–67
ways of, 66
Correlational methods, scientific research, 43–44
Cost effectiveness, 79
Counseling psychologists, 125
Counselor, 126
Courtesy, 272
Cracks, defined, 104
Crime
and criminals, 201–204
defined, 201
recidivism and, 204
Crime prevention, environment and, 213–215
Crisis intervention for victims, 215–216
Critical consciousness, 289
Crude Law of Social Relationships, 280
Cultural community psychology, 10, 291
Cultural contexts, 17
Culturally centered interventions
framework for, 10
Cultural relativism, 53–54
Cultural relativity, 7
Cultural sensitivity, in research, 55–56
Culture-specific skills, 291
Cure Violence program, 97–98, 108
Cycling of resources, 16
Cynicism, 269
Day care. See Child care
Deinstitutionalization, 129–133
543
alternatives, 135–139
defined, 129, 130
social context to, 130–133
success of, 134–135
Dementia, 128
Dementia praecox, 128
Democratic/participatory, leadership style, 278
Dependent variable, 44
Depersonalization, 269
Desegregation, 187–188
Desensitization, 124
Design, defined, 42
Developing Communities Project (DCP), 52
Development, 174
Developmental pathways, 140
Diagnostic and Statistical Manual of Mental Disorders (DSM), 123
Digital divide, 80
Direct way, coping, 65
Discrimination, 183
prejudice and, 204
Discriminative stimulus, 12
Disparities. See Health disparities
Dissatisfaction with traditional services social change and, 81
Distribution of power, 270
Diversity, 7
ADDRESSING framework for, 9
appreciation of, 11
in classroom, 184–187
consulting on, 274–275
in health care, 232, 233–234
respect for, 9–11
social change and, 75–76
of solutions, desire for, 81, 82, 83
workplace, 273–274
Division of Community Psychology, 7
Divorce, children of, 196–197
Doctoral programs
in clinical-community psychology, 30
in community psychology, 30
in interdisciplinary community, 31
in prevention, 31
Domestic violence. See Intimate partner violence (IPV)
Donor, of charity/philanthropy, 148
Driving under the influence (DUI), 244
Dropping out, school, 192–194
Drug use, 245–248, 261, 268
Dual-language immersion programs, 190
Duluth Model, 156, 157
Early intervention programs, and childhood
environment, 179–181
Ecological principles, 15–16
Ecological setting, 174
Ecological systems, 14–17
544
layers of, 14–15 (See also specific layers)
Ecology, 7
and systems orientation, 266
Economic apartheid, 147
Economic Opportunity Act of 1964, 179
Economic success, disparities in opportunity for, 295
Ecstasy, 246
Education
alternative, 189
community (See Community education)
disparities in opportunity for, 295
Elder abuse, 165
Elderly people
and crime, 207
prevention programs, 165–166
and social services, 163–166
stereotype of, 164
Electroconvulsive therapy, 128
Emotional approach coping, 65
Emotional support, 67
Emotion-focused coping, 64–65
Empathic links, 90
Empiricism, 35
Empowerment, 244–245
defined, 13–14
and individualism, 14
outcomes, 14
Empowerment evaluation. See Collaboration
Empowerment evaluators, 50
Enabling systems, 102
Endorphins, 127
Enforcement agencies, 208–210
Enrichment education, and childhood environment, 179–181
Environment
context and, importance of, 11–13
and crime prevention, 213–215
Environmental concerns
sustainability and, 294–295
Environmental psychologists, 213
Environmental tobacco smoke (ETS), 240
Epidemiologic Catchment Area (ECA) Study, 121
Epidemiology, 47–48
Escuelitas, 163
Ethics, and research, 53–54
Ethnic minority issues, online networks for, 103
Ethnography, 45–46, 47
Etiology, of mental illness, 128
Exclusion, 23
Exhaustion, 269
Exosystem, 15
Experimental mortality, 41
Experimental research, 44
External locus of control, 98
External pressures to change, 276
545
External validity, research, 41
Falsifiability, 38
Families
coping, 66
and social support, 220
work patterns of, 85
Familismo, 163
Family Life and Sexuality Education (FLSE), 162
Fast Track Program, 141
Fear-victimization paradox, 207
Females. See Women
First order change, 74
Freestanding community psychology, 31
Fundamental attribution error, defined, 27
Funding, nonprofit/charitable organizations, 78
Gatekeepers, 109
Gender
and alcohol use, 242, 243
and drug use, 246
Genital herpes, 250
Geographic information systems, 47
Germ theory, 128
Goal, defined, 49
Gonorrhea, 251
Goodness of fit, 231
Good science, 10
Grameen Bank model, 150
Grassroots activism, 95
Great Depression, 5
Gun violence, 201–202
Halfway houses, for mental ill, 133
Hallucinogenic drugs, 246
Head Start, 6, 179–181
Health, disparities in opportunity for, 295
Health Belief Model, 256
Healthcare system
accessibility to, 227–228, 232–234
adherence/compliance, 228–229
American, 224–229
building, 231–232
community psychology and, 229–235
cost associated with, 227–228
diversity in, 232, 233–234
national health indicators, 224–225
observations on, 225–229
prevention over remediation, 230
rural health, 234
social support, 234–235
Health disparities, 227–228
Health insurance, 227–228
546
Health literacy, 232
Health-related statistics, resources for, 238
Healthy aging, 164
Helplessness, 98
Heroin, 246
Highly active antiretroviral therapy (HAART), 255
Hispanics
culture, and pregnancy prevention, 163
HIV Vaccine Trail Network, 252
Hmong community, needs assessment, 49
Homelessness, 26–27
causes of, 169–170
cultural differences and, 168
and mental illness, 130
and poverty, 167
prevention programs, 170–171
problem extent, 166–168
and social services, 166–171
Huikahi, 221
Human immunodeficiency virus (HIV), 252–257, 262
characteristics, 252
community-based approaches, 256–257
complexities and controversies, 255–256
and incarceration, 206
intervention program in Lima, Peru, 256–257
intervention testing, placebos and, 55
prevention, 39–41
statistics and features, 253
testing, 254, 255
Humanism, 127
Humanistic model, mental health/disorders, 124–126
Hypothesis, defined, 42
Incarceration, 204–207
Incidence, 48
Independent variable, 44
Indicated prevention programs, 20
Indirect way, coping, 65
Individualism
empowerment and, 14
Informational support, 67
Information dissemination, 108
issues related to, 109–111
Informed consent, 53
In-group, 89, 185
Inhalants, 246
Injection drugs, 246
Inpatient treatment, 129
Institute of Medicine (IOM), 20
Institutionalization, alternatives to, 133–134
Institutional markers, establishment of, 285–287
Institutional review board, 53
Instrumental purpose, 116
Instrumental support, 67
547
Intensive case management (ICM), 136, 137
Interdependence, 15
Interdisciplinary community doctoral programs in, 31
Intergroup contact, 185
Internal locus of control, 98
Internal pressures to change, 276
Internal validity, research, 38, 41
International Code of Diagnosis(ICD), 123
Interpersonal cognitive problem solving, 191
Interpersonally focused leaders, task-focused leaders vs., 278
Inter-rater reliability, 38
Intimate partner violence (IPV)
causes of, 156–157
prevention programs, 157–159
shelters for victims, 159
and social services, 156–159
Introspection, 124
Jails, 204–207
Jigsaw classroom, 186
Job autonomy, 14
Journal of Community Psychology universities publishing in, 286
Justice system
at-risk behavior, 210–213
preventive environment, 213–215
primary prevention, 210–215
secondary prevention, 215–220
traditional (See Traditional justice system)
Juvenile Mentoring Program (JUMP), 212
Knowledge, attitudes, beliefs, and behaviors
(KABBs), 254, 255
Labeling, 124
Laissez-faire, leadership style, 278
Latino college students, and acculturation stress, social support, coping, 68
Leadership, in organization, 278–279
Learned helplessness, 124
Liberating community psychology, 290
Life course–persistent antisocial behavior
adolescent-limited vs., 71–72
Life expectancy, statistics on, 224, 225
Life Skills Training (LST) program, 245
Linkage to care, 254
Lobotomy, 128
Lodge society, for mental ill, 135–136
Low personal accomplishment, 269
Loyalty, 273
National Alliance for the Mentally Ill (NAMI), 141
National Association for the Advancement of Colored People (NAACP), 76
National boundaries, growing beyond, 287– 288
National Cancer Institute (NCI), 240
National Center for Health Statistics, 227
National Center on Elder Abuse, 165
National Coalition for the Homeless, 167
National Comorbidity Study (NCS), 121
National Comorbidity Study, Replication (NCS-R), 121
National Drug Control Strategy 2011 Annual Report, 247
National Household Survey on Drug Use & Health (NSDUH), 239
National Institute of Mental Health (NIMH), 4, 7, 121
National Mental Health Act, 4
National Training Laboratories, 5
Naturally defined neighborhoods, 143
Needs assessment, 48
of Hmong community, 49
Neighborhood crime watches, 214
Neighborhood justice centers, 217
Neighborhoods, defined, 29
Neighborhood Youth Services (NYS), 203
Networking, 102–104
advantages and disadvantages of, 103–104
issues related to, 103
Networks
defined, 102
online, 103
New Deal, 5
New homeless, 167
NICHD Study of Early Child Care, 176–177
Nine dot problem, 75
Nomenclatures, 128
Nonequivalent pretest-posttest control design, 45
Nonparental child care, 176
Nonprofit/charitable organizations, funding dilemmas for, 78
Nurse-Family Partnership, 154
Nursing homes, for mental ill, 133
Obesity, 258–260, 262
community prevention efforts, 258–260
intervention for, 258
Ob/gyns, and female population in U.S., 226
Objective, defined, 49
Observer reliability, 38
Old homeless, 167
Open culture, 270
Operant conditioning, 124
Organizational behavior, defined, 266
Organizational change
causes of, 276–277
550
issues related to, 277
Organizational citizenship behaviors (OCBs), 271–273
conceptualizations of, 272
Organizational culture, 270– 271
Organizational development (OD), 266
Organizational psychology
burnout, 269–270
community psychology and, 265–267
defined, 266
organizational culture, 270– 271
stress and (See Stress)
and techniques for managing people, 275– 276
Organizational theories, 267
Ortgeist, 3
Outcome evaluation, 49
Out-group, 89, 185
Outpatient treatment, 129
Outreach, 232
Overmanning, 12
Paradigm, defined, 37
Paradigm shift, 38
Parental monitoring, 203
Parole, 215, 220
Participant observation, 46
Participatory action research (PAR), 51–52
Participatory decision making, 87, 280. See also Collaboration
Participatory learning, 181
PATHS program. See Promoting Alternative Thinking Strategies (PATHS) program
Patients, 124
Pavlov’s theory, 124
Peace Corps, 6
Pearson correlation coefficient, 43
Perceived work environment, 270
Permissive climate, 268
Personal involvement, 100
Personalismo, 163
Personal psychological characteristics, 60
Personal Responsibility and Work Opportunity Reconciliation Act of 1996, 149
Person-environment fit, 17
Persuasive function, 116
Pharmacologic agents, 4
Philanthropy. See Charity/philanthropy
Placebos, and HIV intervention testing, 55
Planned social change, 85, 86–87
creating, 94–95
failure of, resistance and, 89
issues related to, 87–88
vs. unplanned social change, 86–87
Plessy v. Ferguson, 74
Police presence, 208
Policy science, 114
Politics and science, relationship of, 53
Population, defined, 43
551
Population thinking, 290
Positive Action (PA) program, 195
Positive adult role model, 211–212
Positive mental health attributes, 24
Positive Psychology movement, 24
Poverty
in America, 147
and crime, 202
homelessness and, 167
rate, 147
War on, 147
Power, distribution of, 270
Practitioner-scholars, 126
Predictive function, 116
Pregnancy, teenage. See Teenage pregnancy
Prejudice
defined, 183
and discrimination, 204
implicit and explicit, 64
modern, 184
Prenatal/Early Infancy Project, 154
Prescription drugs, misuse of, 246, 248
Pretest-posttest control group design, 44
nonequivalent, 45
Prevalence, of disease, 48
Prevention
with at-risk individuals, 210–213
community-based strategy, for obesity, 258–260
community participation and, 96–98
doctoral programs in, 31
early childhood experiences and, 139–141
HIV/STDs, 39–41
indicated, 20
over remediation, 230
primary, 19
programs (See Prevention programs)
secondary, 20
selective, 20
tertiary, 20
types of, 20
vs. treatment, 19–22
universal, 20
Prevention programs
for child maltreatment, 154–155
elderly people, 165–166
health care, 230
homelessness, 170–171
for intimate partner violence, 157–159
for teenage pregnancy, 161–163, 233
Primary appraisal, 63
Primary prevention, 19, 21–22, 210–215
Prison-based education programs, 220
Prisons, 204–207
violence in, 206–207
552
Problem solving–focused coping, 64–65
Process evaluation, 49
Professional change agent. See Consultants
Program evaluation, 48, 49–51
components, 49
defined, 48
example of, 50
as form of intervention, 51
Promoting Alternative Thinking Strategies (PATHS) program, 71, 72
Prosocial-antisocial coping, 65
Prosocial norms, 290
Prospective design, 48
Psychiatrists, 125
Psychiatry, 4
social, 5
Psychoanalysis (Freudian), 3, 123
Psychoeducation, 109
Psychological empowerment, 14
Psychological mediators, 60
Psychological sense of community (PSC), 28–29, 274
Psychological Sense of Community at Work measurement (PSCW), 272
Psychopolitical literacy, 114, 295
Psychotropic drugs, 128
Public assistance. See Social insurance
Public policy
advantages and disadvantages, 117
defined, 114
issues related to, 115–117
Public schools, as social institutions, 182–197
and adolescents, 188–191
desegregation, 187– 188
diversity in, 184–187
dropping out, 192–194
historical context, 183
prejudice, 183–184
success/failure, factors related to, 191–194
violence in, 194–196
Public welfare, 148
vs. social insurance, 148
Punishment, for behavior, 12
Purposive sample, 43
Qualitative information, 46
Quality circles, 280–281
Quality of work life (QWL) programs, 280–281
Quantitative data, 46
Quasi-experimental design, 45
Race
and alcohol use, 242, 243
and drug use, 246
and life expectancy, 224
Racism
aversive, 184
553
and implicit and explicit prejudice, 64
stress and, 62–63
traditional, 184
Radicals, rules for, 91
Random sample, 41, 43, 44
Rape crisis centers, 115
Recidivism, 129, 134
and crime, 204
in mentally ill, 139
Recipient, of charity/philanthropy, 148
Rehabilitation services, 217
Reinforced behavior, 124
Reinforcement, for behavior, 12
Reintegration programs for incarcerated individuals, 219–221
Reliability, research, 38
Reorganization, 279– 280
Repressive culture, in organizations, 270
Residential treatments, for mentally ill, 136
Resiliency, 69–72, 212
fourth wave of, 71–72
Kauai longitudinal studies on, 69–70
useful model, 70–71
Resistance
and failure of planned social change, 89
Restorative circle, 221
Restorative justice
defined, 217
programs, 216–219
Retribution, 204, 217
Retrospective design, 48
Role ambiguity, 268
Role conflict, 268
Role overload, 268
Rough sleepers, 168
Rules/regulations, organizations, 276
Rural health, 234
Safe Start, 213
Safe Streets Project, 95
Sample, defined, 43
Scarce/declining resources, social change and, 77–78
Schedule of Recent Experience, 61
Schizophrenia, 128
people with, community living situations for, 134
School alienation, 188–189
School climate, and adolescents, 188–191
The School Nutrition Policy Initiative (SNPI), 259
School Transitional Environment Program (STEP), 193–194
Scientific mindedness, 290
Scientific research
across time, 44
defined, 36
designs, characteristics of, 42
essence of, 35–42
554
fidelity of, 38, 41–42
methods (See Scientific research methods)
need for, 35–36
process of, 36
Scientific research methods
correlational, 43–44
epidemiology, 47–48
ethnography, 45– 46, 47
experimental, 44
geographic information systems, 47
needs assessment, 48
participatory action research, 51–52
population, 43
program evaluation, 48, 49–51
quasi-experimental, 45
sample, 43
traditional, 42–45
Scientific revolutions, 38
Scientist-practitioner model, 4, 126
Secondary appraisal, 63
Secondary prevention, 215–220
defined, 20
Secondhand smoke, 240
Second order change, 74–75
Selective prevention program, 20
Self-care children, 181–182
Self-concept, 273
Self-control, 166
Self-fulfilling prophecy, 183
Self-help groups, 95
Sense of community, 28, 100, 270–271
transformational, 290
Setting control, 12
Severely mentally ill (SMI), 135, 137
Sexually transmitted diseases (STDs), 248–252, 261
challenges associated with, 249, 251–252
impact of, 249
intervention program in Lima, Peru, 256–257
modes of transmission, 250–251
prevalence, 250–251
prevention, 39–41
solutions to, 249, 251–252
symptoms, 250–251
Shelters, for IPV victims, 159
Signs of Suicide (SOS), 109
Situational characteristics, 60
Situational mediators, 60
Situation-focused approaches, 60
Sliding scale, 77
Smoke Free Movies Campaign, 240–241
Smokeless tobacco, ingredients in, 239
Smoking. See Tobacco use
Social activism, results of research on, 99
Social capital, 102, 161, 208, 214
555
role of, 27
Social change
accountability and, 79
and action research, 25
causes of, 75–83
and community conflict, 80–81
and desire for diversity of solutions, 81–82
and dissatisfaction with traditional services, 81
and diversity, 75–76
examples of, 83
failure of, 88–91
planned, 85, 86–87
and scarce/declining resources, 77–78
and social justice, 76–77
and technological change, 79–80
types of, 84–88
unplanned/spontaneous, 84–85
Social cohesiveness, 208
Social connectedness, 231
Social disruption, 231
Social empowerment, 14
Social imagination, 292
Social indicators, 85
Social insurance, 148
public welfare vs., 148
Social integration, 134
Social interest (Adler), 123
Social justice, 22–23
goal of, 22
social change and, 76–77
Social-learning approach, 124
Social psychiatry, 5
Social psychologists, defined, 26
Social psychology, 26–27
Social Readjustment Rating Scale (SRRS), 61
Social Security, 149
Social services
child maltreatment and, 151–155
elderly people and, 163–166
goal of, 148
homelessness and, 166–171
intimate partner violence and, 156–159
social issues and, 150–171 (See also specific issues)
teenage pregnancy and, 159–163
Social support, 67–69, 95
from coworkers, 268
effects of, 68, 69
for elderly, 165–166
families and, 220
healthcare system, 234–235
networks, 208
types of, 67
Social welfare
defined, 147, 148
556
forms of (See Social insurance; Social services)
Social workers, 126
Societal processes, 23
Society for Community Research and Action, 7, 8
Sociopolitical control, 100
Solutions, desire for diversity of, 81, 82, 83
Spontaneous social change, 84–85
Sportsmanship, 272
Spurious associations, 43
Stanford Heart Disease Prevention Project, 230
State medical expenditures, 240
STEP Trial, 252
Stereotypes
defined, 183
of elderly, 164
Steroids, 246
Stratified sample, 43
Strength, individuals, 23–24
Strengthening Families Program, 245
Stress
acute vs. chronic, 61–62
coping with, 64–67
defined, 61
in organizations, 267– 268
as process, 63
racism and minority status, 62–63
reaction, 63, 64
reduction, 268–269
workplace, 267
Stress model, and community psychology, 60–61
Stressor, 61
acute, 61–62
chronic, 61, 62
Stress process, 61
Stress reaction, 61
Substance abuse, prevention, 39–41
Substance Abuse and Mental Health Services Administration (SAMHSA), 237
Sudden infant death syndrome (SIDS), 239
Supportive community institutions, 202
Surface structure modifications, 112
Survey-guided feedback, 277
Sustainability, 294–295
Swampscott Conference, 7, 13, 19
Symbols of disintegration, 208
Syphilis, 250
Systems-level interventions, 289
Task-focused leaders vs. interpersonally
focused leaders, 278
Team building in organizations, 281– 282
Technological change, social change and, 79–80
Technophobia, 80
Teenage pregnancy
causes of, 160–161
557
prevention programs, 161–163, 233
rate of, 159
and social services, 159–163
Tennessee Valley Authority, 5
Tertiary prevention, 20
Test-retest reliability, 38
Theory, 36–37
defined, 36
Therapists, 126
Time, scientific research across, 44
Timely interventions, in health care, 232
Tobacco use, 238–242, 261
community-based approaches against, 241–242
Traditional justice system
crime and criminals, 201–204
enforcement agencies, 208–210
jails and prisons, 204–207
overview, 200–201
victims and victimization, 207–208
Traditional racism, 184
Training, in community psychology, 29–32
Trajectories, 140
Transactional leadership style, 278
Transformational leadership style, 278
Transformational sense of community, 290
Trans-institutionalization, 129. See also Deinstitutionalization
Treatment, prevention vs., 19–22
Triangulation, 47
Trust, 17
Umbrella organizations, 102
Unconditioned response, 124
Unconditioned stimulus, 124
Undermanning, 12
Unemployment, and crime, 202
United Nations Framework Convention on Climate Change, 294
Universal human rights, 53–54
Universal prevention program, 20
Unobtrusive measure, 55
Unplanned social change, 84–85
example of, 86
planned social change vs., 86–87
Unsupervised sites, 133
Validity, research, 38, 41
Victim blaming, 26
Victim-offender mediation, 217
Victims
assistance for, 208, 215
crisis intervention, 215–216
and victimizations, 207–208
Vietnam War, 6
Violence
gun, in United States, 201–202
558
intimate partner (See Intimate partner violence (IPV))
in prisons, 206–207
in schools, 194–196
and victimization, 207–208
War on Poverty, 147
Women
alcohol use among, 243
cigarette smoking among, 239– 240
drug use and, 246
sense of community in, 271
in World War II era labor force, 5
Work patterns, families, 85
Workplace
culture, 268
stress, 267
Workplace diversity, 273–274
Work pressure, 271
World Health Organization (WHO)
on drug use, 245
MPOWER package, 241
Wraparound Milwaukee, 137–139
Yang, male force, 127
Yin, female force, 127
Young urban men, 207
Youth Relationships Project (YRP), 158, 159
Youth Risk Behavior Surveillance System (YRBSS), 237, 238
Youths at risk, 210, 211
Zeitgeist, 3, 128
559
Cover
Title Page
Copyright Page
Table of Contents
Preface
Chapter 1 Introduction: Historical Background
Historical Background
Social Movements
Swampscott
What Is Community Psychology?
Fundamental Principles
A Respect for Diversity
The Importance of Context and Environment
Empowerment
The Ecological Perspective/Multiple Levels of Intervention
▶ Case in Point 1.1 Clinical Psychology, Community Psychology: What’s the Difference?
Other Central Concepts
Prevention Rather than Therapy
▶ Case in Point 1.2 Does Primary Prevention Work?
Social Justice
Emphasis on Strengths and Competencies
Social Change and Action Research
Interdisciplinary Perspectives
▶ Case in Point 1.3 Social Psychology, Community Psychology, and Homelessness
▶ Case in Point 1.4 The Importance of Place
A Psychological Sense of Community
Training in Community Psychology
Plan of the Text
Summary
Chapter 2 Scientific Research Methods
The Essence of Scientific Research
Why Do Scientific Research?
What Is Scientific Research?
The Fidelity of Scientific Research
▶ Case in Point 2.1 A Theory of Substance Abuse and HIV/STDs that Incorporates the Principles of Community Psychology
Traditional Scientific Research Methods
Population and Sampling
Correlational Research
■ Box 2.1 Research across Time
Experimental Research
Quasi-experimental Research
Alternative Research Methods Used in Community Psychology
Ethnography
▶ Case in Point 2.2 Case Study of a Consumer-Run Agency
Geographic Information Systems
Epidemiology
Needs Assessment and Program Evaluation
▶ Case in Point 2.3 Needs Assessment of a Hmong Community
Participatory Action Research
Cautions and Considerations Regarding Community Research
The Politics of Science and the Science of Politics
Ethics: Cultural Relativism or Universal Human Rights?
The Continuum of Research: The Value of Multiple Measures
▶ Case in Point 2.4 HIV Intervention Testing and the Use of Placebos
The Importance of Cultural Sensitivity
Community Researchers as Consultants
Summary
Chapter 3 Stress and Resilience
The Stress Model and the Definition of Community Psychology
Stress
Stressor Events
Stress as a Process
Stress Reaction
▶ Case in Point 3.1 Contemporary Racism
Coping
Social Support
▶ Case in Point 3.2 Mexican American College Student Acculturation Stress, Social Support, and Coping
Resilience
At-Risk to Resilient
The Kauai Longitudinal Studies
A Useful Model
The Fourth Wave
Summary
Chapter 4 The Importance of Social Change
Reasons for Social Change
Diverse Populations
Social Justice: A Moral Imperative for Social Change
The Perception of Declining or Scarce Resources
▶ Case in Point 4.1 Funding Dilemmas for Nonprofit Organizations
Accountability
Knowledge-Based and Technological Change
Community Conflict
Dissatisfaction with Traditional Services
Desire for Diversity of Solutions
▶ Case in Point 4.2 Community Conflict: Adversity Turns to Opportunity
Types of Social Change
Spontaneous or Unplanned Social Change
Planned Social Change
▶ Case in Point 4.3 Working with an Indigenous People Experiencing Change
Issues Related to Planned Change
Difficulties Bringing About Change
Summary
Chapter 5 Community Intervention Strategies
Creating Planned Change
Citizen Participation
▶ Case in Point 5.1 The Community Development Society
Community Participation and Prevention
Who Participates?
Advantages and Disadvantages of Citizen Participation
Networking/Collaboration
▶ Case in Point 5.2 Online Networks for Ethnic Minority Issues
Issues Related to Networks
Advantages and Disadvantages of Networks
Consultation
Issues Related to Consultants
Advantages and Disadvantages of Consultants
Community Education and Information Dissemination
Information Dissemination
Community Education
Issues Related to Information Dissemination
Issues Related to Community Education
▶ Case in Point 5.3 The Choices Program
Public Policy
▶ Case in Point 5.4 Rape Crisis Centers: A National Examination
Issues Related to the Use of Public Policy
Advantages and Disadvantages of Public Policy Changes
A Skill Set for Practice
Summary
Chapter 6 The Mental Health System
Epidemiological Estimates of Mental Illness
Models of Mental Health and Mental Disorder
The Medical Model
The Psychoanalytic Model
The Behavioral Model: The Social-Learning Approach
The Humanistic Model
▶ Case in Point 6.1 Mental Health Care Professionals
The Evolution of the Mental Health System
Brief History of Mental Health Care
▶ Case in Point 6.2 Rosenhan’s Classic Study of Hospital Patients’ Stigmatization
Deinstitutionalization
The Social Context to Deinstitutionalization
Early Alternatives to Institutionalization
Measuring “Success” of Deinstitutionalized Persons
Beyond Deinstitutionalization
“Model” Programs for Individuals with Mental Disorders
Intensive Case Management
Wraparound
▶ Case in Point 6.3 Wraparound Milwaukee
Early Childhood Experiences and Prevention
The Battle Continues: Where Do We Go from Here?
Summary
Chapter 7 Social and Human Services in the Community
Historical Notes about Social Welfare in Western Society
▶ Case in Point 7.1 Poverty in America
▶ Case in Point 7.2 The Grameen Bank
Specific Social Issues and Social Services
Child Maltreatment
Intimate Partner Violence
Teen Pregnancy
The Elderly
Homelessness
▶ Case in Point 7.3 How Do Cultures Differ on the Issue of Homelessness?
Summary
Chapter 8 Schools, Children, and the Community
The Early Childhood Environment
Child Care
Enrichment Education and Early Intervention
Self-Care Children
The Public Schools
Desegregation, Ethnicity, and Prejudice in the Schools
The Schools and Adolescents
▶ Case in Point 8.1 Dual-Language Immersion Programs
▶ Case in Point 8.2 Children of Divorce
Summary
Chapter 9 Law, Crime, and the Community
The Traditional Justice System
Introduction
Crime and Criminals
▶ Case in Point 9.1 Neighborhood Youth Services
Jails and Prisons
Victims and Fear of Being Victimized
Enforcement Agencies
Addressing Justice System Issues
Primary Prevention
▶ Case in Point 9.2 Working with At-Risk Youth
Secondary Prevention
▶ Case in Point 9.3 Huikahi: The Restorative Circle
Summary
Chapter 10 The Healthcare System
The American Healthcare System
National Health Indicators
Observations on the System
Community Psychology and the Healthcare System
Prevention over Remediation
Shifting Focus from Individuals to Groups, Neighborhoods, and Systems
Building Systems
Increasing Accessibility
▶ Case in Point 10.1 Teen Pregnancy Prevention
Social Support and Health
Summary
Chapter 11 Community Health and Preventive Medicine
Tobacco
Extent of the Problem
Antitobacco Efforts
Community-Based Approaches
Alcohol
Extent of the Problem
Alcohol Safety Laws
A Community Psychology Approach
Illicit Drugs
Extent of the Problem
Possible Solutions and Challenges
▶ Case in Point 11.1 Prescription Drug Misuse: Risk Factors for Problem Users
Sexually Transmitted Diseases
Extent of the Problem
Possible Solutions and Challenges
HIV and AIDS
Overview
Extent of the Problem
Complexities and Controversies
Possible Solutions: Community-Based Approaches
▶ Case in Point 11.2 Evaluation and Implementation of STD/HIV Community Intervention Program in Lima, Peru
▶ Case in Point 11.3 The Bilingual Peer Advocate (BPA) Program
Obesity
Scope of the Problem
Community Prevention Efforts
Summary
Chapter 12 Community/Organizational Psychology
What Do Organizational and Community Psychology Share?
Organizational Psychology, Organizational Behavior
Ecology and Systems Orientation
Distinctions
Everyday Organizational Issues
Stress
Stress Reduction
Burnout
Organizational Culture
Organizational Citizenship Behaviors
Work and Self-Concept
Dealing with a Diverse Workforce
Other Ecological Conditions
▶ Case in Point 12.1 Consulting on Diversity
Traditional Techniques for Managing People
Compensation Packages
Rules and Regulations
Overview of Organizational Change
Reasons for Change
Issues Related to Organizational Change
Changing Organizational Elements
eadership
eorganization
uality of Work Life Programs
eam Building
#x25B6; Case in Point 12.2 Managing Change
Summary
Chapter 13 The Future of Community Psychology
The Establishment of Institutional Markers
Growing Beyond National Boundaries
A Useful Paradigm
Commentaries
Answering the Present and Future Needs of Society
Appreciation of Differences and the Search for Compassion
Sustainability and Environmental Concerns
Disparities in Opportunity for Health, Education, and Economic Success
Aging and End of Life
Summary
Final Reflections
Bibliography
Name Index
Subject Index
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