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Background: Evidence suggests that minority populations have lower levels of attendance and retention in mental health care than non-Latino whites. Patient activation and empowerment interventions may be effective in increasing minority patients' attendance and retention. Objectives: This study developed and evaluated a patient self-reported activation and empowerment strategy in mental health care. Research Design: The Right Question Project-Mental Health (RQPMH) trainings consisted of 3 individual sessions using a pre/post test comparison group design with patients from 2 community mental health clinics. The RQP-MH intervention taught participants to identify questions that would help them consider their role, process and reasons behind a decision; and empowerment strategies to better manage their care. Subjects: A total of 231 participated, completing at least the pretest interview (n = 141 intervention site, 90 comparison site). Measures: Four main outcomes were linked to the intervention: changes in self-reported patient activation; changes in self-reported patient empowerment; treatment attendance; and retention in treatment. Results: Findings show that intervention participants were over twice as likely to be retained in treatment and over 3 times more likely than comparison participants to have scheduled at least 1 visit during the 6-month follow-up period. Similarly, intervention participants demonstrated 29% more attendance to scheduled visits than comparison patients. There was no evidence of an effect on selfreported patient empowerment, only on self-reported patient activation. Conclusions: Results demonstrate the intervention's potential to increase self-reported patient activation, retention, and attendance in mental health care for minority populations. By facilitating patientprovider communication, the RQP-MH intervention may help minorities effectively participate in mental health care.

The authors developed and delivered a brief patient activation intervention (PAI) that sought to facilitate physician-patient communication. The intervention was designed to assist low-income, racial/ethnic minority users of community health centers in building skills and confidence asking questions. The PAI takes 8 to 10 minutes to deliver and consists of five steps that can be carried out by individuals with minimal formal medical training. A total of 252 patients waiting to see their physician participated in the intervention and completed the follow-up semistructured interview after their health care visit. The authors describe the intervention and the results of their qualitative evaluation of patient's responses. Overall, the PAI was valued by patients, appeared to add to patients' satisfaction with the health care they received, and was feasible to implement in the primary care setting. Furthermore, findings from this study provide indirect insight regarding factors that influence minority patient's question-asking behavior that include patient's attitudes, social factors, and patient's self-efficacy in question formulation.

Frontline staff people are largely untapped resources as potential social innovators. This article describes how one staff person strengthened the ability of low-income clients to become more self-sufficient by adapting a cost-effective and capacity-building educational strategy to her daily work environment. The same educational strategy can lead to “microdemocracy” in which individuals use essential democratic skills in ordinary encounters with public agencies. The article concludes by presenting several criteria that must be met in order to make it possible for frontline staff to become social innovators.Dominique had recently moved to Philadelphia when her landlord insisted that she immediately sign a document he presented to her. She hesitated, thought about what she was being asked to do, and refused to sign.Her hesitation saved her, because the document would have effectively forced her to vacate her apartment in 30 days so that it could be rented to another tenant. Had she signed, Dominique might have found herself in a homeless shelter. She could have been one of many standing in line for a Section 8 certificate, or appealing to an overwhelmed Legal Aid lawyer for help to get back into her apartment. She did not have to disrupt her life or access additional social services to put her life back in order.What is most inspiring about this story, though, is that Dominique’s refusal to be coerced resulted from skills that she had just learned in her GED and job training class. In effect, in addition to teaching reading and math skills, Dominique’s instructor taught her taught her how to ask her own questions and pay attention to decisions affecting her — how to be her own advocate.In teaching Dominique these self-advocacy skills, the GED instructor, Ms. Earldine Tolbert, demonstrated how frontline staff in social and human service agencies can become drivers of innovation in daily practice. She took initiative to adapt an educational strategy to her workplace and began to work in a different way — and, in the process, demonstrated the great potential for frontline staff to build the capacity of clients and consumers to become more self-sufficient. The important individual, programmatic, and social outcomes resulting from this increase in self-sufficiency and self-advocacy can all be accomplished without additional funding, personnel, or resources that would be required if creating a separate discrete program.

Rothstein discusses ways that asking questions can help to hold people in power accountable. As people identify their objectives and information through a questioning process, they can help various processes become more efficient and effective.

Discussion of the Israeli elections next Monday has revived the generalization that the major cleavage in Israeli society is between \"hawkish Orientals\" (North Africans and Middle Easterners) and \"dovish Ashkenazis\" (Europeans). Because Orientals have supported the more hawkish Likud Party and the bulk of support for the Labor Party comes from Ashkenazis that analysis at first glance appears accurate. Emotional and sometimes violent confrontations sparked by foreign policy debates often pit Orientals against Ashkenazis, and this contributes to the general view of the division. Certainly, the Likud mismanagement of the economy, exacerbated by the expense of the war in Lebanon, leaves it vulnerable to attack in this campaign. However, the suspicion of many Orientals that a return to a Labor- ruled country would only distance them from power counters the appeal of a Labor economic alternative to the Likud. Young Oriental leaders who followed [David Levy]'s example and joined the Likud have enjoyed some degree of power in the last few years, and neither they nor their constituents will easily relinquish that in exchange for Labor's promise of a return to the good old days. Given that the cleavage between Ashkenazi backers of Labor and Oriental supporters of Likud runs deeper than the hawkish-dovish divide, the tension has been a strong undercurrent throughout the campaign. Each party is attempting to mobilize support based on fear and distrust of the other, to apportion blame for either perceived historical grievances or for current disastrous policies. In this setting, with so many social tensions rooted in a history of class, ethnic and political conflict, shopworn generalization about Oriental hawks and Ashkenazi doves should be shelved, or at least used with utmost caution.

Discussion of the Israeli elections next Monday has revived the generalization that the major cleavage in Israeli society is between \"hawkish Orientals\" (North Africans and Middle Easterners) and \"dovish Ashkenazis\" (Europeans). Because Orientals have supported...

THE KATAMON QUARTER, one of Israel's poorest areas, was an unexpected place to find opposition to the invasion of Leban-on. Populated by first and second generation Oriental Jewish immigrants from Arab countries, Kata-mon residents have voted overwhelming-ly for Menachem Begin and his Likud Party.