InCrisis Review

By:  Richard Dana, PhD
Researcher and Professor Emeritus
Regional Research Institute
Portland State University

Dr. Dana is a distinguished expert in psychological assessment specializing in multicultural assessment. Dr. Dana has authored numerous books, chapters and articles on the subject of psychological assessment and assessment across cultures.

Introduction

We enter this new millennium confronting extraordinary problems of how to nourish, support, educate, and prepare our children emotionally and intellectually during adolescence to become responsible and well functioning adults.  Adolescents are faced with challenges and opportunities hitherto unimaginable by their parents and grandparents.  Adolescents experience demands for coping skills and adaptations to an unprecedented rate of social change and are beset by multiple pressures, temptations, and perceived barriers to which they are compelled to respond and simultaneously to maintain a sense of self with intact boundaries and an emerging sense of presence and focus in the adult environment.  Adolescence has always been a difficult and frequently stormy transition predicated on generational differences providing a potential for conflict and rebellion.  These generational differences are now exacerbated without any commensurate increase in adolescent skills and within a climate of parental time constraints and often without mediation by an intact and extended family. 

As professional caregivers we enter this new millennium with cumbersome and imperfect tools for assessment, intervention, and evaluation of adolescent mental health status.  We have made many attempts to employ systems of care for adolescents within a managed care context with inordinate constraints on available professional time and financing.  For increasing numbers of these clients either no services are obtained or the services from mental health facilities and professions are inadequate and ineffective.  Lower class parents feel abandoned and ignored by the mental health system. Multicultural parents frequently feel their cultural identities are misunderstood, disrespected, and disparaged by managed care systems. Middle class parents are forced to assume financial and emotional responsibility for services often in the absence of adequate involvement, cooperation, facilitation, and support by professionals.  Many managed care systems espouse a “one size fits all” philosophy that ignores individual differences by reducing available intervention options and minimizing their potential efficacy in favor of cost containment.

The internet has been perceived by some professionals as a potential resource for ameliorating some of these deficiencies in providing adequate services for adolescents. Nonetheless, for approximately 20 years, awareness of this increasingly available resource by professionals has witnessed a plethora of serious problems resulting in both cautious and careless use of the internet as a vehicle for providing direct mental health services.  During this same time period, InCrisis was developed to address these problems from an alternative perspective employing new assumptions, a reconstituted definition of bona fide screening services, and a novel internet service delivery process to increase consumer awareness as well as to facilitate availability, immediacy, and responsiveness by families as well as professional audiences to these services in an informed, responsible, and proactive manner. 

Review

Several salient and essential characteristics of InCrisis will be described: (1) Empowerment of parents; (2) Cost-effectiveness, adequacy, and relevance of services; (3) New services (i.e., Clinical Screening Report, Intervention Report; Risk Assessment Report); (4) New standards for internet practice by professional service providers including privacy/security of communication, professional cooperation/ethics, and shifting primary responsibility to parents as consumers of services for their children; and (5) Reconceptualization of the contemporary cognitive-behavioral, assessment-intervention model and adapting this model to focus on prevention as a primary objective of mental health services.

(1) The quintessential assumption of this new service/service delivery screening-intervention practice model is that professional mental health activities can no longer be conducted in isolation from parents and families.  Implied herein is a radical shift in the balance of power between parents and professionals and in the “doctor-patient relationship”.  This is accomplished first by an organized array of informational documents prepared for parents. These information resources include lucidly and cogently presented information concerning the several reports, available intervention programs/options, U.S. government mental health handouts, descriptions of mental health and educational resources, and specific descriptions of psychological problems and disorders. Long ago psychologists were enjoined unsuccessfully by a president of the American Psychological Association to “give away” our research and experiential knowledge as well as methodology for understanding persons as individuals in a social milieu.  We cannot realize this objective unless there is respect for the primacy of parental obligation for responsible decision-making affecting the welfare of their children.  In order to comprehend and negotiate the increasing array and magnitude of adolescent problems, parents as consumers of mental health services must be empowered to work cooperatively with professionals as a means to minimize the distrust, confusion, and misunderstanding inherent in the current climate of unequal relationships.  Services designed to realign the balance of power between parents and professionals do not invariably foster more adequate and responsible mental health care for adolescents.  The assumption is made in this service model is that parents are well-functioning, clear-eyed, responsible advocates for their children.  Unfortunately, since this is not always a valid premise, the Clinical Screening Reports completed by parents should ultimately be designed to incorporate “red flags” to indicate parental dysfunction that can invalidate their perceptions of their children. The current protocol is to enjoin parents to discuss the results with a qualified counselor, psychologist, social worker or physician. It is ultimately desirable and necessary to conduct further research based on samples of adolescent behaviors from a variety of professional perspectives in schools and other activity contexts outside of the home.

(2) Mental health services for adolescents in both the public and private sectors are increasingly limited in their availability, adequacy, and potential for favorable behavioral outcomes.  For examples, managed care has set an upper limit of two compensated professional hours for assessment-diagnostic services, severely limited providers in numbers of mental health sessions, and encumbered their interventions by intrusions on provider privacy and confidentiality as well as by required time-consuming accountability procedures perceived as irrelevant to quality of care. To achieve the objective of cost-effective, high-profit managed care health services, low priority mental health initiatives for adolescents are accomplished by inadequately trained and compensated professionals and paraprofessionals. Thus, an erosion of quality adolescent mental health services has occurred within a context of increasing numbers of potential clients, formidable and incompletely addressed social problems augmenting the seriousness of individual symptomatologies, and obfuscated by inconsistent intervention evaluations and outcomes.  InCrisis provides effective professional services that can be monitored, evaluated, and modified online. These services are more readily and rapidly available at lower cost and within an aegis of informed parental input, responsibility, control, and understanding.  Satisfaction with services is a contractual provision only rarely envisioned or realized by professional providers historically.

(3) The above-described virtues inhere precisely because the services themselves are new and were unimaginable and hence unavailable prior to an adequate understanding of internet functions, requirements, capabilities, and safeguards.  The 16 plus page Clinical Screening Report, based on over 500 questions identifying the client and the seriousness of his/her presenting problems in four major areas, introduces a Behavioral Profile Graph summarizing the reported history, observations, and opinions to provide a reliable screening of adolescent behavior followed by a discussion of diagnostic issues and Summary. The Clinical Screening Report is designed for parents as an information and education tool.  In concert with available InCrisis information resources, the Report identifies problems in everyday language, accompanied by a careful statement of limitations and exclusions.  This Report informs parents and suggests possible intervention options by qualified professional providers.

The 40-page Intervention Report represents careful research and evaluation of intervention alternatives currently available for adolescents.  A comprehensive compendium containing these contents is not available from any other source. This Report provides an overview of the current status of educational and health care opportunities in sufficient detail to permit understanding the goodness-of-fit between a designated adolescent’s issues/problems and an array of potential opportunities, avenues, and venues for problem remediation.

The Risk Assessment Report, was developed during 15 years of research and predicated on the contents of the preceding Clinical Screening Report, provides specific information concerning risk factors for violent, self-harming, and suicidal behaviors.  In addition, although these reports are designed to provide information for parents and professionals consulted by these parents.

These reports are not intended to replace standard individualized assessment of adolescents, or to deny the necessity for alternative multifaceted and coordinated attention from a variety of professional resource persons in schools and community agencies.  InCrisis reports and other information resources cannot be duplicated otherwise at the present time.

This information serves to coordinate, facilitate, focus, and expedite parental efforts to document, understand, locate, and authorize relevant and potentially beneficial interventions from qualified service providers.

(4) The Surgeon General has presented an overview of mental health research and services for mainstream and multicultural populations as well as barriers that limit availability of these services. Service providers and their professional organizations have prepared guidelines or proposals for practice.  These guidelines are propaedeutic to evidence-based standards for a clinical science of assessment and intervention legitimized by ethical codes.  InCrisis provides an exemplar of explicit standards for internet operation by professional service providers regarding privacy and security of communication, accuracy and reliability of essential information, and identification of qualified health care, crisis intervention, and educational consultant professionals, counselors, therapists, as well as community care and emergency resources.  

(5) The contemporary presence of InCrisis suggests that our model of an assessment-intervention science has been incomplete and copes ineffectively with the immediacy, intensity, and magnitude of contemporary social and individual problems as well as new problems and new populations requiring services.  InCrisis represents a humanized, democratized, and moral science.  InCrisis recognizes that only socially responsible services can transform and humanize health care transactions by responding to individual differences.  InCrisis is democratizing by advocating shifting the balance or professional and parental/family power and by sponsoring the availability and utilization of hitherto professionally sanctioned, protected, privileged, and linguistically coded information resources.  To be sure the Internet has made democratization of information resources feasible and practical, at least for computer-literate individuals. InCrisis provides user-friendly access to information resources present in everyday language.  InCrisis advocates moral accountability for professional services by modest fees and a no-fault refund policy.

Mainstream assessment-intervention science in the United States has been preoccupied with general laws of human behavioral function and dysfunction, focused on prediction and control of behaviors, employed low inferences procedures by preference, and a research and practice models distinguishing between researchers/practitioners and subjects/patients.  This narrow scientific attitude has not succeeded in demonstrating social responsibility, incorporating new methodologies, recognizing the superordinate role and power of researchers rather than complementary roles for participants and researchers, or adequately recognizing individual and cultural differences among human beings.  Similarly, intervention or treatment of manifest problems has been prioritized while prevention, among other medical-offset activities, has been minimized or disregarded by scientists, practitioners, and politicians. InCrisis recognizes and incorporates primary ingredients that contribute to an enlarged human mental health science (i.e., prevention focus, open-ended/flexible instruments, interactive procedures, support of parents as primary care-givers and advocates for their children, supplementary-complementary assessment-intervention procedures).  These ingredients are integumented within a socially-professionally responsible aegis for services.

Dr. Dana has been associated with Portland State's Regional Research Institute for the past 10 years. He was the Director of Research for Mentor Research Institute in 1994.

Return to review by  experts.  Read More >>