Do you hear voices? Problems in assessment of mental status in deaf persons with severe language deprivation.

When mental health clinicians perform mental status examinations, they examine the language patterns of patients because abnormal language patterns, sometimes referred to as language dysfluency, may indicate a thought disorder. Performing such examinations with deaf patients is a far more complex task, especially with traditionally underserved deaf people who have severe language deficits in their best language or communication modality. Many deaf patients suffer language deprivation due to late and inadequate exposure to ASL.

Transition of persons with developmental disability from extended sheltered employment to competitive employment.

The proposition was tested that persons with developmental disabilities randomly assigned to a supported work program would obtain more employment in the competitive labor market than would a randomly assigned group of control subjects receiving conventional workshop services. A measure of association (chi-square) conducted between the two groups and three categories of work showed that the experimental group obtained significantly more employment.

Taxpayers on the ward. Quality improvement through the Citizen Monitoring Program.

This chapter describes the Massachusetts Citizen Monitoring Program and discusses the program's history and rationale. Although the program has great intuitive and political appeal, little data currently exists with which to assess its effectiveness in improving patient care. The monitoring and evaluation model of the Joint Commission on Accreditation for Healthcare Organizations is proposed as an alternative to the present program.

Introducing quality assurance to a state hospital medical staff.

Establishing a quality assurance program in a developing state hospital requires considering the unique problems of being a physician in such a setting. The hospital and medical staff must be developed to the point where consideration of quality of care is a feasible goal. Managers can take advantage of the interests of individual medical staff as well as serendipitous factors promoting a program.

Quality improvement: a collaborative discipline approach.

In order for a quality assurance program to achieve its goal of true quality improvement, it must function in full partnership with the entire treatment team as a collaborative discipline. It must actively contribute to the care by not only developing effective studies and reports on treatment but also must share these results in an educational, timely, relevant, and individualized manner. This article offers a number of specific methods to enhance staff involvement and participation in quality assurance and describes a series of collaborative approaches and techniques to promote their collaboration.

Decision-making with psychiatrically impaired patients. A collaborative endeavor.

The courts and the physicians are engaged in assuring quality medical care to competent and incompetent patients. The evolving policy of informed consent improves medical decisionmaking by insisting that the patient's values be involved. The principle of beneficence, which the courts support in practice without using the word, is a compromise between strong paternalism and the unachievable goal of true autonomy in incompetent patients.

The evolving clinical chart. How it reflects and influences psychiatric and medical practice and the quality of care.

The clinical chart constitutes an evolving patient care document. This article compares charts from the turn of the century with those of today. It has changed from a simple user-friendly personal note record to a major medical-legal documentation system.