What is community psychology?
Community psychology is founded on the following precepts: an emphasis on the competence of persons and communities; an appreciation of personal and cultural diversity; an orientation that promotes prevention; a preference for organizational, community- and systems-level intervention; and a belief in the need for an ecologically valid database with which to determine the appropriateness and value of human-service interventions.
Community psychology emphasizes social, environmental, and cultural factors as significant elements influencing the development and expression of behaviors commonly identified as signs of maladjustment. Community psychology demands a respect for human diversity—people have a right to be different. Requiring that people fit into a particular mold or conform to a particular standard increases the probability that some will be considered failures or maladjusted individuals. Instead of focusing on how to motivate “deviant” people to adjust, the community psychologist attempts to increase behavioral options, expand cultural and environmental choices, redistribute resources, and foster the acceptance of variability.
From a community-psychology perspective, it is not the weakness of the individual that causes psychopathology, but a lack of person-environment fit. The concept of person-environment fit is founded in ecology. Ecology posits that each organism is in constant interaction with all aspects of its environment, including all things animate and inanimate. From the ecological perspective, it is the unique interaction of species with the environmental milieu that dictates survival. In relation to people, ecology requires an appreciation not only for the ambient environment but also for social, psychological, personal, and cultural factors that interact and influence an individual’s adjustment and survival.
Community psychologists use their knowledge of ecological principles to create culturally congruent interventions that maximize service effectiveness. To develop services that are culturally congruent requires an appreciation for the history, aspirations, belief systems, and environmental circumstances of the community or group with which one is to work. Knowing that interactions and the fit between persons and environments are of primary importance, community psychologists work to promote changes at a systems level rather than only working to change the individual. Community psychologists know, however, that even systems-level changes will be of little value—and will perhaps even lead to harm—if they are not personally and culturally relevant to the persons they are designed to help.
There is considerable diversity in the training and orientation of community psychologists. Still, as a general rule, community psychologists can be expected to have knowledge and expertise in the following areas: program development, resource utilization, community organization, consultation, community mental health programming, preventive interventions, program evaluation, grant writing, needs assessment, advocacy, crisis intervention, direct service delivery, manpower training, systems analysis, and the political ramifications of social change. Community psychologists use their knowledge of these areas as they work within the framework of one of the following models: clinical/community, community/clinical, community activist, academic/research, prevention, social ecology, evaluation/policy analysis, or consultation.
Psychologists trained in the clinical/community model have expertise in individual assessment and psychotherapy. They are likely to work within community mental health centers or other human-services programs as direct service providers. They differ from traditionally trained clinical psychologists in having an orientation that is directed toward crisis intervention, public health, and prevention.
The community/clinical model leads to a primary emphasis of working with community groups to enable the development, implementation, and administration of human-services initiatives. This model is similar to the community-activist model; persons with a community/clinical orientation, however, are more likely to work within the system than outside it.
Persons following the community-activist model draw on their training in psychology to enable them to confront social injustice and misallocation of resources. These individuals are versed in grass-roots community organization, the realities of social confrontation, and advocacy.
The academic/research model of community psychology is founded on the principles of action-oriented research. Here the researcher is directed to work on real-world problems using ecologically valid methods. Furthermore, action-oriented research requires that recommendations that follow from the researcher’s findings be implemented.
Psychologists who advocate the prevention model use epidemiological data information concerning the rates and distribution of disorders—to enable the development of programs designed to prevent mental health problems. Primary prevention programs—undertakings that attempt to keep problems from forming—are the preferred initiatives.
Persons trained in the social-ecology model participate in the development of research and interventions based on an ecological perspective. Here, an appreciation of the complexities and of the myriad interactions of communities and social organizations is paramount.
The evaluation/policy-analysis model requires that adherents be versed in program-evaluation methods—techniques related to the assessment of the quality, efficiency, and effectiveness of service initiatives. This model dictates that information obtained from program evaluation be fed back into the system in the form of policy recommendations.
The consultation model provides a framework for the dissemination of knowledge. To be an effective consultant, the community psychologist must be cognizant of various consultation methods. Furthermore, she or he must have specialized expertise founded in one of the preceding models.
Regardless of the model followed, community psychology demands a commitment to the community, group, or individual served. The job of the community psychologist is to foster competence and independence. The ideal client, whether the client is an individual or a community, is the client who no longer needs the psychologist.
Community psychology has played a major role in sensitizing human-services professionals to the need for services oriented toward prevention. Many of the assumptions and principles of prevention are taken from the field of public health medicine. Public health officials know that disease cannot be eradicated by treatment alone. Furthermore, the significant gains in life expectancy that have occurred over the last one hundred years are not primarily the result of wonder drugs, transplants, or other marvels of modern medicine. Instead, improved sanitation, immunizations, and access to an adequate food supply have been the key factors in conquering diseases and increasing the human life span.
To design and implement effective prevention-oriented programs, one must have an understanding of epidemiology, incidence, and prevalence. Epidemiology is the study of the rates and distributions of disorders as these data pertain to causes and prevention. Incidence is the number of new cases of a disorder that occur in a given population in a specific period. Prevalence is either the total number of cases of a disorder in a given population at a specific point in time or the average number of cases during a specific period. By combining information concerning epidemiology, incidence, and prevalence, it is possible to arrive at insights into the causes of a disorder, likely methods of transmission, prognosis, and intervention methods that may prove fruitful.
Community psychologists identify prevention activities as falling into one of three classifications: primary prevention, secondary prevention, and tertiary prevention. Although some have argued that only primary prevention activities should be recognized as prevention, all three classifications have a place.
In tertiary prevention, the underlying disorder is not directly treated or eliminated; instead, tertiary prevention focuses on mitigating the consequences of a disorder. Tertiary prevention has no effect on incidence rates and little or no effect on prevalence rates. Reducing the stigma associated with the label“mental illness,” increasing the self-help skills of persons who have mental retardation, promoting the independence of persons with chronic mental disorders, and developing programs to provide cognitive retraining for persons who have suffered head injuries are examples of tertiary-prevention activities.
An example of a tertiary-prevention program is the community lodge program developed by George Fairweather, which has come to be known as the Fairweather Lodge Program. The program was begun as an attempt to solve a problem that arose in an experiment in giving psychiatric patients the power to direct their treatment by means of self-governing groups. Although it was quite effective, the program suffered because many of its gains did not carry over after patients were discharged. The community lodge program was developed to deal with this problem. During their hospital stays, patients were encouraged to form small support groups. Prior to discharge, members of these support groups would be introduced to the lodge concept. The lodge concept called for former patients to live together, pool their resources, and work as a team in a lodge-owned enterprise. This program, which began in the early 1960s, has been replicated on numerous occasions. Data show that patients discharged to a community lodge are more likely to maintain gainful employment and are less likely to be readmitted to the hospital than are patients discharged to a traditional community mental health program.
Secondary prevention has its basis in the belief that prevalence rates can be reduced if disorders are identified and treated as early as possible. Diversion programs for youths who manifest predelinquent behavior, acute care for persons with mental disorders, employee assistance programs, and psychological screenings for schoolchildren are examples of secondary prevention.
An example of a secondary-prevention program is the Primary Mental Health Project (PMHP) developed by Emory Cowen in the late 1950s. The PMHP was founded on the basis of the idea that maladjustment in early school grades is associated with the development of behavioral and emotional problems later in life. The program was designed to provide early detection so that interventions could be introduced before significant dysfunction had an opportunity to develop. Furthermore, consultation and competency building—rather than traditional therapeutic techniques—were viewed as the most effective interventions. Although the PMHP has not had a demonstrated effect in reducing later psychiatric disorders, the program has been shown to have other beneficial effects.
Primary prevention is aimed at the eradication of the causes of disorders and the development of interventions that can be initiated before pathology develops. Primary prevention results in a lowering of both incidence and prevalence rates. Psychological services for disaster victims, genetic screening, parenting classes, reducing exposure to toxins, immunization for rubella, and maternal nutrition programs are examples of primary-prevention activities. Another example of primary prevention is community education programs designed to teach safe sex and to reduce the sharing of contaminated needles. To the extent that these programs reduce the spread of acquired immunodeficiency syndrome (AIDS), they will also decrease the incidence of AIDS dementia complex.
Community psychologists are involved in many service activities besides prevention-oriented enterprises. These initiatives include the training and utilization of paraprofessionals, the promotion of self-help groups and natural helping networks, advocacy, community consultation, program evaluation, the planning and implementation of new human-services programs, crisis intervention, and mental health education.
Community psychology had its origins in the 1960s, a time of radical ideas, antiestablishment attitudes, and a belief in the perfectibility of humankind. In 1965, in Swampscott, Massachusetts, a meeting was called to ascertain how psychology could most effectively contribute to the emerging community mental health movement.
A transformation in treatment focus was taking place at the time of the Swampscott meeting. This change had been provided with a blueprint for its development in a report by the Joint Commission on Mental Illness and Health written in 1961. The Joint Commission report, Action for Mental Health, called for a shift from treating psychiatric patients in large state mental hospitals to the provision of care through outpatient community mental health clinics and smaller inpatient units located in general hospitals. Additionally, the report included the following recommendations: increasing support for research, developing “aftercare,” providing partial hospitalization and rehabilitation services, and expanding mental health education to ensure that the public became more aware of mental disorders and to reduce the stigmatization associated with mental illness.
On February 5, 1963, President John F. Kennedy became the first US president to address Congress regarding the needs of the mentally ill and the mentally retarded. President Kennedy called for a “bold new approach” that would include funding for prevention, expanding the knowledge base regarding causes of disorders and treatment alternatives, and creating a new type of treatment facility that, independent of the ability to pay, would provide high-quality comprehensive care in the local community—the creation of community mental health centers.
In October of 1963, President Kennedy signed into law the Community Mental Health Act. The law required that programs funded through the act provide five essential services: inpatient care, outpatient treatment, emergency services, partial hospitalization, and consultation and education.
Although the initial purpose for convening the Swampscott meeting had been to determine how psychology could contribute to the staffing needs of community mental health centers, the conferees took a broader perspective and chose to view the community mental health movement as addressing a limited aspect of a larger set of social problems. As a consequence, the meeting failed to address adequately the training needs of psychologists who would be working in the new community mental health centers; instead, the most significant result of the meeting was the birth of community psychology.
In the ensuing years, community psychology and community psychology training programs have varied in the degree to which they involve the educational needs of psychologists employed by community mental health centers. Still, there is no doubt that the research and service initiatives that community psychologists have developed in regard to crisis intervention, consultation, prevention, empowerment, the use of paraprofessionals, program planning, resource development, and program evaluation serve as valuable models and contribute to the successful operation of community mental health programs and a variety of other human-services activities.
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