The relationship between statistically and clinically significant change has been enigmatic. Jacobson and Truax (1991) have proposed an important step toward rapprochement. However, their suggested index of clinically significant change neglects possible confounding of improvement rate estimates by regression to the mean. An alternative method is described that incorporates an adjustment that minimizes this confounding when statistical regression has been shown to be present. If regression is not present, the Jacobson and Truax method is more appropriate; if regression is present, the Edwards-Nunnally method (Edwards, Yarvis, Mueller, Zingale, & Wagman, 1978) is more appropriate. The two methods are compared, and the effects of instrument reliability and sample deviance on estimated improvement rates are demonstrated using general well-being test-retest data from a sample of older adult mental health outpatients.

Interest has been renewed in methods for determining individual client change. Currently, there are at least 4 pretreatment-posttreatment (pre-post) difference score methods. A 5th method, based on a random effects model and multiwave data, represents a growth curve approach and was hypothesized to be more sensitive to detecting significant (p < .05) change than the pre-post methods. The change rates produced by the 5 methods were compared in a sample of 73 older outpatients with 3 to 5 assessments per client on a measure of well-being (H. J. Dupuy, 1977). Results indicated that the growth curve approach improvement rate was the highest (68.5%). The growth curve and the Edwards-Nunnally (63.0%) methods produced significantly (p < .05) higher improvement rates than the other 3 methods, with 1 exception.

The role of family homeostasis in Conjoint Family Therapy is reviewed and examined from the standpoint of the Sociocultural Systems framework as presented by Buckley. Sociocultural Systems concepts are presented, and an attempt is made to relate them to a view of the family. It is concluded that the concept of homeostasis by itself is insufficient as a basic explanatory principle for family systems and that it may limit both our expectations for families and our approaches to helping families. The concepts viability, positive feedback processes, morphogenesis, and “variety” are presented and emphasized as important for a more tenable conceptualization of the family system in our society today. An attempt is made to relate these concepts to some of the clinical family literature and to examine the implications of these concepts for mental health and educational approaches to the family.

The convergence of a number of disparate factors has led to opportunities to help address the mental health needs of older adults in primary care (PC) or “integrated care” settings. Older adults are disproportionately high users of health care resources, and cost projections for coming decades have catastrophic implications. Elders shun mental health services, instead turning to their personal physicians when troubled. The PC system is clogged with patients without medical problems or whose medical conditions are exacerbated by psychosocial factors (estimated at 60% to 70%), resulting in overutilization of services and high costs. However, PC physicians detect and adequately treat or refer only 40% to 50% of patients with mental health problems. Early experience with brief and/or structured interventions in PC settings is promising and suggests opportunities for multidisciplinary team geriatric practice.

There is an urgent need for pertinent outcome information. Relevance for decision maker5 must take priority over scientific rigor. However, a review of computeridentifled outcome evaluation reports from community service settings, during the past 5 years, suggests that much more has been said than has been done. Although relatively heterogeneous in scope, these studies focused on the effects of community support sewices for adulb with persistent and severe mental illness; traditional outpatient sewices have been neglected. Studies are characterized by multidimensional, standardized outcome assessment, and nonequivalent comparison group and single cohort deslgns. Randomized designs, wHh usual services as the control condition, were feasible in some situations. Inadequate sample sin and attrition continue to be method problems.