Economic stress greatly increases the likelihood of mental health issues occurring within a family. Although this is widely known within the mental health profession, there is a lack of literature that assists therapists in working effectively with lowincome clients. As a result, marriage and family therapists may be ill equipped to meet the needs of those in poverty, and may even be conducting therapy that is ethically unsound. The authors of this article discuss several ethical and professional issues regarding therapy with families in poverty. A number of suggestions are presented for improving the effectiveness of therapy with low-income clients.

A demonstration respite project for caregivers of older people with Alzheimer's disease was evaluated by a randomized experiment. Three hundred and sixteen volunteer primary caregivers were offered respite services and 315 completed the research portion without the offer of respite. The research indicated that even before the demonstration most families had some respite help in place. Of all those offered respite, 58% availed themselves of the offer. During the project year experimental and control subjects were equal in using slightly more services and there was no evidence that formal services had substituted for informal.

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The use of performance indicators to develop a case for resources is illustrated. Factors which may lead to ophthalmology becoming a possible problem service for managers are mentioned. A case study is discussed.

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