Integrating Pastoral and Clinical Identities: A Narrative Inquiry of Pastoral Counselors

Narrative inquiry methodology was used to understand the lived experiences of two ordained pastoral counselors who obtained licensure as clinical mental health professionals, particularly in terms of their identity development and integration of pastoral and clinical identities. Data analysis from semi-structured interviews revealed rich experiences with five themes: the journey; God's call; self and identity; the role of mentors; and relationships. Implications for research and practice associated with pastoral counseling and counselor education are discussed.

Strategies to destigmatize mental illness in South Africa: Social work perspective

Stigma is a contributing factor to non-help-seeking behavior and social isolation of mental health-care users. The study examined social workers' perspective regarding strategies that can be implemented to destigmatize mental illness in South Africa. A qualitative study method was adopted. Data were sourced through focus group discussions with social work students and telephone interviews with social workers working in hospitals. Data were analyzed using a thematic approach. Active involvement, education, and awareness campaigns, creating opportunities for improved well-being and constant support, were identified as relevant strategies. Given that stigma is multidimensional, various strategies are important if mental illness is to be destigmatized.

Community navigation to reduce institutional recidivism and promote recovery: initial evaluation of opening doors to recovery in Southeast Georgia

New approaches for preventing repeated inpatient psychiatric stays, detention in jails and prisons, and homelessness among individuals with serious mental illnesses with established histories of such recidivism, while promoting recovery, are direly needed. We present findings from an initial program evaluation of a new community-based, recovery-oriented "community navigation" program in southeast Georgia, called Opening Doors to Recovery. Twenty-three in-depth interviews were conducted with key stakeholders, program participants, community navigation specialist team members, and referring mental health professionals to identify hopes and strengths, challenges and weaknesses, and recommendations pertaining to the new program. Cited strengths included teamwork and pooling of resources from various partners, as well as the novel recovery-based, community navigation team approach. An initial lack of fidelity processes across teams and an ongoing scarcity of safe and affordable housing were identified as weaknesses, with the latter seen as a liability of the overall mental health and social service systems rather than the program itself. Findings from this evaluation highlight strengths and opportunities of this new community navigation approach, including those related to the involvement of certified peer specialists and multiple community partners.

Implementation of the care programme approach across health and social services for dual diagnosis clients

BACKGROUND

Care for clients with mental health problems and concurrent intellectual disability (dual diagnosis) is currently expected to be provided through the care programme approach (CPA), an approach to provide care to people with mental health problems in secondary mental health services. When CPA was originally introduced into UK mental health services in the 1990s, its implementation was slow and problematic, being hampered in part by problems occurring at a strategic level as health and social service organizations attempted to integrate complex systems. This article reports on a study of a more recent attempt to implement CPA for dual diagnosis clients in one mental health foundation trust, aiming to gauge progress and identify factors at the strategic level that were helping or hindering progress this time round.

METHODS

The study took place in a mental health National Health Service (NHS) Foundation Trust in a large English city, which was implementing a joint mental health and intellectual disability CPA policy across five of its constituent boroughs. Semi-structured interviews with key informants at Trust and borough levels focused on the Trust's overall strategy for implementing CPA and on how it was being put into practice at the front line. Documentary analysis and the administration of the Partnership Assessment Tool were also undertaken. Data were analysed using a framework approach.

RESULTS

Progress in implementing CPA varied but overall was extremely limited in all the boroughs. The study identified six key contextual challenges that significantly hindered the implementation progress. These included organizational complexity; arrangements for governance and accountability; competing priorities; financial constraints; high staff turnover and complex information and IT systems. The only element of policy linked to CPA that had been widely taken up was the Greenlight Framework and Audit Toolkit (GLTK). The fact that the toolkit had targets and penalties associated with its implementation appeared to have given it priority.

CONCLUSION

None of the contextual challenges identified in this study were specifically related to CPA as a policy or to the needs and circumstances of dual diagnosis clients. Nevertheless, they inhibited the types of organizational change and partnership working that implementing CPA for a client group of this kind required. Unless these more generic factors are acknowledged and addressed when introducing policies such as CPA, the chances of effective implementation will inevitably be compromised.

Integrating mental health parity for homebound older adults under the medicare home health care benefit

Despite high rates of mental illness, very few homebound older adults receive treatment. Comorbid mental illness exacerbates physical health conditions, reduces treatment adherence, and increases dependency and medical costs. Although effective treatments exist, many home health agencies lack capacity to effectively detect and treat mental illness. This article critically analyzes barriers within the Medicare home health benefit that impede access to mental health treatment. Policy, practice, and research recommendations are made to integrate mental health parity in home health care. In particular, creative use of medical social work can improve detection and treatment of mental illness for homebound older adults.

[Psychological support for socially vulnerable people in the context of a periodic health examination]

Social vulnerability often leads to the expression of psychological distress. The Health Examination Center of Côtes d'Armor, in Quimper, experimented with the development and implementation of psychological counseling for a highly socio-economically vulnerable population. As part of a periodic health examination, the center offers psychological counseling to patients with pathological sleep disorders and who lack sufficient psychological support. The Health Examination Center's framework and the context of the periodic health examination have facilitated the establishment of a tailored non-stigmatizing intervention well-embedded within the institutional environment. Marginalized people in situations of psychological distress are offered an opportunity to be listened to, and to receive counseling, appropriate prevention services and access to care.

[The medical social characteristic of patients with psychic disorders addressed to medical institutions with various forms of property]

The article deals with the issues of enhancement of the psychiatric service. The analysis of the results of medical social study of the patients addressed for the medical care to public and commercial structures is given. The substantiation of necessity in enhancing the quality and effectiveness of out-patient psychiatric care service are presented and the various alternative models of its development as well.

Deprofessionalization or postprofessionalization? Reflections on the state of social work as a profession

Recent literature considering the state of the social work profession has primarily focused on concerns about deprofessionalization. This article provides an overview of the literature on professionalization and professional decline in order to situate the social work profession within a broader context. The article then describes the emergence of a new role for social workers in Canada that crosses the boundaries between clinical, managerial, and legal aspects of client care in the area of mental health forensics. It is argued that the future of social work's professionalization project around the world may not be as bleak as has been portrayed in the literature.

Current practice and policy realities revisited: undertrained nursing home social workers in the U.S

Despite a nearly 20-year-old legislation to strengthen social work (SW) coverage within nursing homes and decades of literature exploring the need for SW training, untrained and undertrained social workers dominate American nursing homes. Many persons who call themselves social workers are not educated as such, but nevertheless, must work in complex, conflict-ridden nursing homes without assessment and advocacy skills essential to address the symptoms and to fully respond to subjugated residents' needs. The call for more qualified social workers to be employed in nursing homes is a recognition that the residents' psychosocial needs are not being met. We examine how inconsistent national requirements, inadequate professional educational preparation, and work overload are all symptoms of a general societal unwillingness to recognize residents' needs. The authors utilize a morphogenic systems perspective to describe the open interaction between all disciplines, which can be unduly strained without properly trained workers. The social work literature is reviewed with a renewed interest in addressing the problem profession-wide.

A crisis of credibility: professionals' concerns about the psychiatric care provided to clients of the child welfare system

OBJECTIVES

This study examined child welfare and mental health professionals' views of the quality of psychiatric services received by consumers of the child welfare system and explored root causes of perceived quality problems.

METHODS

One hundred and thirty child welfare, mental health and court professionals participated in qualitative interviews individually or in groups. Data analyses identified perceived problems in quality and perceived causes of quality problems. Participants in member checking groups were then asked to comment on and further clarify the results.

RESULTS

The participants reported concerns related to overuse of psychotropic medication, overmedicated children, short inpatient stays, and continuity of psychiatric care. Overuse of psychotropic medications and overmedication were perceived to be driven by short evaluations, liability concerns, short inpatient stays and a lack of clinical feedback to psychiatrists from child welfare partners. Medicaid reimbursement policies were at the heart of several quality concerns. These problems contributed to a distrust of psychiatric practices among child welfare professionals.

CONCLUSIONS

These findings underscore the adverse effects of modern marketplace medicine coupled with low Medicaid reimbursement rates on quality of care for vulnerable groups. Child welfare and mental health professionals and their associated stakeholders may together possess substantial clout to advocate for a reimbursement system and structure that promotes quality service. The findings also point to a crisis of credibility toward psychiatric practice among social service and other non-psychiatrist mental health professionals. Efforts are needed to increase the capacity for psychiatrists and child welfare professionals to communicate effectively with each other and for psychiatrists to receive the information that they need from their child welfare partners to ensure accurate diagnosis and effective treatment.

[Timely diagnosis and efficient early-rehabilitation for schizophrenic disorders in the community -- perspectives of a new standard]

Schizophrenia and schizophrenia spectrum disorders are severe mental illnesses with diverse courses of illness and often severe long-term disabilities. The sooner therapeutic and rehabilitative measures are taken the better the prognostic outlook is. Wrong but persistent stereotypes of incurability and dangerousness associated with schizophrenia pose severe obstacles to timely diagnosis and interventions and must be overcome. Today various efficient methods in therapy and rehabilitation are available. Evidence-based interventions are best delivered by multi-professional teams in the community. A person-centred approach combines biological, psychological, and social treatments in an integrated model including the social network and the individual goals of patients and their families. Concepts and results of international research efforts regarding state-of-the-art management of schizophrenia are presented and discussed.

Workforce competencies in behavioral health: an overview

Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.

[Social support of chronically mentally ill patients]

AIM

Assessment of the social support system of mentally ill persons covered by a local rehabilitation programme situated in Targówek, Warsaw.

METHOD

The sample consists of 92 participants with serious mental illness. Bizoń's Social Support Inventory and Social Support Map were used.

RESULTS

Patients' social networks were small (9 persons in average) but had a broad scope of functions. Therapists from community rehabilitation services constitute the biggest group of persons included in the individual network of social support. Lack of emotional support is observed.

CONCLUSION

Participation in a local system of rehabilitation improves the quantity and quality of individual systems of social support.

Mental and social health during and after acute emergencies: emerging consensus?

Mental health care programmes during and after acute emergencies in resource-poor countries have been considered controversial. There is no agreement on the public health value of the post-traumatic stress disorder concept and no agreement on the appropriateness of vertical (separate) trauma-focused services. A range of social and mental health intervention strategies and principles seem, however, to have the broad support of expert opinion. Despite continuing debate, there is emerging agreement on what entails good public health practice in respect of mental health. In terms of early interventions, this agreement is exemplified by the recent inclusion of a "mental and social aspects of health" standard in the Sphere handbook's revision on minimal standards in disaster response. This affirmation of emerging agreement is important and should give clear messages to health planners.

Reforming managed care certification of mental health services

This article examines the issues associated with the current managed care delivery system for certification of mental health services, including pain management. Inconsistencies in dispositions having impacts upon patient care appear to be inherent in the current peer review certification system. Issues related to public assistance clients will be given particular attention. After introducing the issues, this article reviews the literature to survey what facets have been the subjects of academic research and reflection. It then presents case examples of inconsistencies, followed by recommendations for a model with checks and balances. In conclusion, creation of an independent monitor group is recommended.

"Everybody puts a lot into it!" Single session contacts in hospital social work

For the most part, social casework literature is based on the assumption that social workers have on-going contacts with clients over a period of time. However, the experience of social workers in a number of fields of practice suggests that it is common for social workers to see clients only once. This paper reports on a qualitative study of hospital social workers' experiences of single session contacts with clients. Analysis of the data from focus groups with hospital social workers indicated that they do not always give single session work the significance it deserves, although a high level of skill is seen to be required to do such brief work well. A number of distinctive characteristics of single session work were identified including setting clear goals and parameters, establishing rapport quickly and adhering to the social work principle of self determination at the same time as working quite directively. The implications of these findings for future research are discussed.

[Assessing the planning of support programmes]

This paper describes the procedures in planning support programmes for persons with long term psychiatric disabilities in the Region of Hannover (1.15 mill. inhabitants) and presents some results of a research project concerning process quality of all 570 planning procedures, which took place in the year 2001. The study covers the evaluation of the type and extent of recommended support programmes in the different catchment areas of this region in relation to the psycho-social risk of the patients. Following the presentation of the results deductions for the implementation of a systematic quality development process in community psychiatry are discussed.

Clinical management. Where medicine meets management. Faith healers

An inner London mental health trust wanted to improve services for Muslim patients. Staff at the trust attended workshops on the religion and a cross-cultural nurse was appointed. Inpatient service users are feeling increasingly able to discuss their beliefs.

[The role of social support on the quality of life of patients with schizophrenia]

The importance of social support for mentally ill people has been increasingly emphasized in recent years. This has resulted from studies showing that family and professional support plays an important role in preventing rehospitalizations and in improving quality of life of patients with schizophrenia. This article presents and analyses the findings of current research concerning the effectiveness of social support in rehabilitation programmes as well as highlights the problem of matching the type and quantity of social support provided to the patients' needs and to the phase of the disease.

Changing practice: involving mental health service users in planning service provision

Changes to professional work now ensure that social care and health care workers should be accountable to service users, and not only to their professional colleagues. This paper seeks to explore how this may eventually be realised in new working relationships that will profoundly affect mental health social work. These changes are driven by factors that are external to the social work profession-in policy initiatives that introduce measures of performance that incorporate the service user in both evaluating and planning services, in efforts to build new relationships, and in a breakdown of barriers between social work practitioners and service managers. While these changes are sometimes likely to be resisted by practitioners and service users alike, the demands of policy makers for a new professional accountability to service users can be used to pave the way for effective dialogue. The paper outlines the steps necessary to build confidence among both service users and service providers. This requires sensitive management and leadership. It also requires that action demonstrably follows from such dialogue. The paper uses evidence from Community Mental Health Teams in Swansea, over a three-year period, to demonstrate how the policy and management imperatives faced by service providers can be reconciled with the expressed desires of mental health service users.

Partnership in mental health and child welfare: social work responses to children living with parental mental illness

Mental illness is an issue for a number of families reported to child protection agencies. Parents with mental health problems are more vulnerable, as are their children, to having parenting and child welfare concerns. A recent study undertaken in the Melbourne Children's Court (Victoria, Australia) found that the children of parents with mental health problems comprised just under thirty percent of all new child protection applications brought to the Court and referred to alternative dispute resolution, during the first half of 1998. This paper reports on the study findings, which are drawn from a descriptive survey of 228 Pre-Hearing Conferences. A data collection schedule was completed for each case, gathering information about the child welfare concerns, the parents' problems, including mental health problems, and the contribution by mental health professionals to resolving child welfare concerns. The study found that the lack of involvement by mental health social workers in the child protection system meant the Children's Court was given little appreciation of either a child's emotional or a parent's mental health functioning. The lack of effective cooperation between the adult mental health and child protection services also meant decisions made about these children were made without full information about the needs and the likely outcomes for these children and their parents. This lack of interagency cooperation between mental health social work and child welfare also emerged in the findings of the Icarus project, a cross-national project, led by Brunel University, in England. This project compared the views and responses of mental health and child welfare social workers to the dependent children of mentally ill parents, when there were child protection concerns. It is proposed that adult mental health social workers involve themselves in the assessment of, and interventions in, child welfare cases when appropriate, and share essential information about their adult, parent clients. Children at risk of abuse and neglect are the responsibility of all members of the community, and relevant professional groups must accept this responsibility.

Readiness to adopt best practices among adolescents' AOD treatment providers

Social work, along with other human services professions, is increasingly moving to establish guidelines for treatment interventions that are based on empirical knowledge about populations, needs, and treatment effectiveness. This work, however, is in the beginning stages. This article explores how substance abuse treatment providers for adolescents attempt to obtain and use information to guide a "best practices" approach to treatment. Focus group data were analyzed for themes indicating supportive attitudes toward adopting and evidence of capacity to implement an evidence-based approach. Although support was fairly strong, capacity was relatively weak.

[Current social workers' task: promoting a life model]

The enactment of Psychiatric Social Workers Act was passed the National Diet in 1997. With this professional certification, psychiatric social workers are expected to help discharging more mental patients. For the further development of community care system, community agencies need to work as equal partners. It is critical to developing a team concept in the time that Japan is implementing case management service for the mentally ill. We should be able to work for the cause and think alike what we are for. Whether Japanese care management service empower the consumers or not depends on what model this service is based on, and whether community agencies and consumers working together. Social workers need to advocate for mental health consumers' choose from available resources, consent to treatment, create natural support networks, feel empowered, and allow themselves to live as an integral part of the community.

Interventions and outcomes of health and social care service provision for people with severe mental illness in England

BACKGROUND

Mental health policy in England is undergoing radical change involving the integration of services aimed at improving outcomes for patients. At the same time, there is limited evidence about how conventional services are performing. The present paper reports data on the services provided and short-term outcomes achieved in eight community services in England.

METHOD

A survey of caseloads of nurses and social workers was undertaken using a single-page assessment tool (MARC1) (n = 3024). After 5 months a random sample of psychotic cases was followed up (n = 393).

RESULTS

A tendency was observed for health and social care practitioners to use the services available from within their own organisation. Over time, in the most severe cases, there was a substantial increase in provision of the services of the other organisation. Outcomes in terms of changes in HoNOS, GAS and MARC1 scores were similar for both professional groups, and both reported similar amounts of met and unmet need (and in the same categories) at follow-up.

CONCLUSION

The most likely explanation for the change in service provision is the separate operation of different professional groups acting as gatekeepers for their own resources.

Mental health training and development needs of community agency staff

Emphasis has long been placed in UK national policy on providing 'seamless' mental health services to meet both the health and social care needs of service users. While attention has been paid to the training required by specialist mental health and primary care staff in order to achieve this, the needs of other community agency staff have received less attention. The present article describes a study designed to identify the training needs of staff working within a broad range of agencies. Focus group discussions were used to explore participants' experiences of mental health problems amongst clients, their confidence in dealing with these, current sources of support and perceived training needs. The results indicate that participants in all agencies routinely encountered a range of problems. Colleagues were the main source of support, followed by line managers, but supervision structures and wider organisational support were lacking in some cases. Joint working with specialist mental health services was almost universally problematic and all groups identified a range of training needs. On the basis of the results, the present authors put forward suggestions as to how these needs might be met.

Mental health recovery paradigm: implications for social work

Social workers have long been involved in developing, administering, and providing services for people with psychiatric disabilities. Critics of the system, including social workers and mental health consumer-survivor practitioners, have noted that the medical model has been a driving force in policy and services provision. This model is detrimental to consumers' self-efficacy and sense of hope and conflicts with a number of central social work values. The article argues that the values and beliefs of the consumer-survivor recovery movement are closely aligned with those of the profession, and that the movement offers social workers a more promising perspective from which to practice. The primary concepts and values of the evolving recovery paradigm are delineated, and implications for direct practice, administration, policy making, education, and research are discussed.

A comparison of psychiatrists' clinical-impression-based and social workers' computer-generated GAF scores

The authors studied the utility of the DSM-IV Global Assessment of Functioning (GAF) scale for improving interdisciplinary communication about patient care. Discharge GAF scores for 165 discharged inpatients were computer generated by 13 trained unit social workers and derived by eight psychiatrists on the basis of their clinical impressions. Differences between the scores obtained by the two disciplinary groups were tested by using the paired t test and the nonparametric signed-rank test. Agreement between scores for various GAF categories was tested with kappa agreement indexes. Interdisciplinary agreement on discharge GAF scores was observed across diagnostic categories and across most categories of length of stay. The results suggest that social workers, after receiving systematic training in computer-based GAF reports, can provide reasonable assessments of clients' functioning.

Postnatal depression: use of health services and satisfaction with health-care providers

The objective of this study was to compare health-care use and satisfaction with health-care providers between depressed and non-depressed women in the first 4 months after childbirth. Sixteen weeks after delivery a questionnaire, which included the Edinburgh Postnatal Depression Scale (EPDS) and items about health-care use and satisfaction, was mailed to women who attended the antenatal clinic, Royal Women's Hospital, Brisbane. Completed questionnaires were returned by 574 (86.4%) of the 664 women surveyed. During the study period most women (91%) visited a general practitioner at least once and 117 (12%) saw their doctor on five or more occasions. A total of 118 (20.7%) scored above 12 on the EPDS. Depressed women were more likely to visit a psychiatrist (OR, 9.2; 95% CI, 4.3-19.6), social worker (OR, 6.1; 95% CI, 3.3-11.1), postnatal depression group (OR, 4.0; 95% CI, 1.3-12.6), paediatrician (OR, 2.5; 95% CI, 1.6-3.9), or a general practitioner (OR, 2.1; 95% CI, 1.4-3.2) than non-depressed women. Twenty-two (18.5%) of the depressed women had contact with a psychiatrist. Compared with non-depressed women, those scoring above 12 on the EPDS were less satisfied with the services of general practitioners (P=< 0.000), paediatricians (P=0.002), Nursing Mothers' Associations of Australia (P=0.043) and obstetricians (P=0.045). Postpartum depression leads to an increase use of health-care services and has a negative effect on satisfaction with some services.

Quality assurance in mental health-care: a case study from social work

The quality of health and social care is now a high priority for government, professionals, and the public. This is particularly true of mental health, where explicit standards lie at the centre of current policy, demanding the development of reliable means for quality assurance. These need to allow for the multiplicity of stakeholders in mental health-care, and their different constructions of "quality". The challenges presented are illustrated by this account of an action research programme, which was developed to improve social work practice in a multidisciplinary mental health service, and evaluated using a case study design. An action research approach was chosen in preference to an "off-the-shelf" quality assurance system, because it possessed features that appeared to match the context of the work. It involved feeding back the findings of a baseline assessment of service quality to four teams of social workers, who used the information to select priority areas for improvement. An action plan was developed with them, and its implementation and impact were examined. Substantial improvements were observed in only one of the chosen target areas--the quality of case recording. For the other--securing the clients' full involvement in their care plan--very limited improvements occurred. Interview data suggested that this was due to the presence of extensive organisational support for the first objective, but not the second. These findings suggest that while some features of action research can contribute to quality improvement, these must be incorporated into a more comprehensive programme of change, which commands the support of all the stakeholders involved.

Comparisons of marriage and family therapists, psychologists, psychiatrists, and social workers on job-related measures and reactions to managed care in Iowa

This study compares marriage and family therapists (MFTs) to psychologists, psychiatrists, and social workers on job-related measures, such as job autonomy, job satisfaction, burnout, and intention to stay in their present position, as well as on reactions to a managed care initiative in the state of Iowa. Findings indicate that MFTs scored significantly lower than other practitioners on job autonomy and intention to stay in their present position, but there were no differences in job satisfaction or burnout. Marital and family therapists also reported less dissatisfaction with the managed care initiative than psychiatrists, although virtually all practitioners were dissatisfied with the managed-care program. These findings indicate some dissatisfaction within the MFT profession and may be relevant to practitioners seeking to change or expand their practice, as well as to the needs of MFTs in their training programs.

Screening for psychosocial risk in an urban prenatal clinic population: a retrospective practice-based research study

Recognition of the need for early identification of risk factors led a "practice-based research" (Epstein, 1995) team of social workers in the prenatal clinic at Mount Sinai to develop a standardized, comprehensive screening, monitoring and evaluation instrument for all patients in their service. To explore the effects of psychosocial risk factors empirically, available information collected from 435 women screened with the original instrument between 1992-93 was converted into a quantitative data-base. The intention was to conduct a retrospective study of the prenatal patient population, including demographic characteristics, problems presented, social work interventions, and treatment outcomes. Among the findings anxiety and ambivalence related to pregnancy were significant risk factors. This model of social work service delivery is consistent with the focus of prenatal care as clinical preventative medicine.

Using available clinical information in practice-based research: mining for silver while dreaming of gold

Social workers in health and mental health settings routinely collect and record enormous quantities of clinical information about clients, psycho-social interventions and client responses to these interventions. Despite its abundance and non-intrusiveness, social work researchers generally have ignored available clinical information, claiming that it is unreliable and subject to too many threats to validity to warrant serious consideration as a data source. Instead, many researchers have advocated "gold standard" experimental studies, employing standardized instruments and prospective data-collection. As a result, the research potential of retrospective studies based on available clinical information has been relatively unexplored and untested. This paper asserts that available clinical information can be converted into valuable retrospective, data-bases for practice-based research studies. Exemplars of such studies in health and mental health settings are provided as are guidelines for their conduct.

Cultural and linguistic considerations in psychodiagnosis with Hispanics: the need for an empirically informed process model

It is estimated that in the next century nearly half of the clientele seeking mental health services will be members of ethnic minority groups. Hispanics are the most rapidly growing population in the United States, and epidemiological evidence suggests that they present higher levels of psychiatric symptomatology and prevalence rates of disorder compared with other ethnic groups. Despite the unprecedented recognition of cultural considerations found in DSM-IV for rendering a psychiatric diagnosis, there is still surprisingly little empirical research examining cultural and linguistic factors influencing the diagnostic process. This article critically reviews this research and considers process variables that can inform social workers' culturally sensitive diagnosis of Hispanics.

Mining clinical information in the utilization of social services: practitioners inform themselves

When fully invested in applied studies regarding their own clinical and programmatic concerns, social work practitioners find that "mining" clinical information enriches their performance and services.

Prevention principles for practitioners: a solution or an illusion?

The social work profession has sought to eliminate, or at the very least, ameliorate those social ills that were believed to contribute to severe social and personal dysfunction. Prevention programs have been a primary factor in this endeavor. Prevention programs have addressed a vast array of difficulties including adolescent suicide, youth violence, teenage pregnancy, home visiting programs for families at high-risk for neglect and abuse as well as out-of-home placement. This paper addresses the concept of prevention and incorporates the notion of resilience in eight (8) prevention practice principles. Case examples are provided as well as a discussion for future directions for prevention in the field of social work.

Comparison of the attitudes of Israeli therapists and lay persons to ethical dilemmas in psychotherapy

The issues of confidentiality and boundaries cause ethical dilemmas for psychotherapists. We investigated whether therapists have ethical attitudes to confidentiality and boundaries that are unique to their professional group compared with lay persons and whether gender or professional characteristics are associated with these attitudes. Clinical vignettes capturing ethical dilemmas regarding confidentiality and boundaries were presented to 93 psychotherapists of different professional backgrounds (professional group) and 55 staff and students from the fields of law and the humanities (lay group). In general, the lay group showed a greater tendency to maintain confidentiality than the professional group. Regarding boundaries, the majority of psychotherapists were against initiating any sexual relationship with current patients, former patients, students, or supervisees; the differences between the groups in this area were statistically significant. The vast majority of therapists (96.7%) disapproved of accepting money in advance compared with only 54.4% of the lay group. Analysis of the psychotherapists by professional background revealed that for the majority of the vignettes, there was no difference in attitude to confidentiality and boundaries between psychiatrists, psychologists, and social workers. The present study shows that therapists have different ethical codes from nontherapists regarding the issues of boundaries and the treatment contract. Therapists are stricter than nontherapists regarding issues of boundaries but less strict regarding issues of confidentiality, and there are some minor differences in the attitudes to these issues among different types of therapists.

Patient satisfaction with the information provided at a psychiatric emergency unit

OBJECTIVE

Evaluation of patient satisfaction with information at a psychiatric emergency unit.

DESIGN

Patient survey.

SETTING

Psychiatric patients assessed information provided by staff on illness, symptoms, treatment alternatives, treatment design, medication, time schedule for treatment and the expected therapeutic response.

PARTICIPANTS

The sample included 100 subjects (63% response rate).

OUTCOME MEASURE

Patient satisfaction.

RESULTS

59% were women. Mean age was 43 years. 87% were Swedish. 30% had psychotic, 35% bipolar and 35% anxiety disorders. 87% were admitted voluntarily. Almost 80% were satisfied with the patient-staff relationship. Questions on information, except medication, scored low. Patients with non-psychotic disorder were more satisfied with information on symptoms, treatment alternatives and treatment design, and voluntary patients with information about medication. Patients born in Sweden and voluntary patients awarded influence on treatment planning higher scores.

CONCLUSIONS

Psychiatric patients requiring emergency care did understand information. The staff provided satisfactory information only when knowledgeable.

The experience of women in unsuccessful infertility treatment: what do patients need when medical intervention fails?

Approximately half of the women who seek medical treatment for infertility never give birth to a child. Extended infertility treatment extracts a particularly devastating toll on female patients. The inability to bear children creates a developmental crisis for a woman, disrupting her identity, her relationships, and her sense of meaning. Infertility treatment tends to be delivered in an impersonal way, with little attention to the psychosocial needs of patients. Social workers can play a key role in preventive and clinical intervention, and can educate medical professionals about the needs of their patients when treatment fails. The author presents interview data from a recent study in order to illustrate these needs, offering guidelines for social workers and medical professionals.

Identifying human remains following an air disaster: the role of social work

An area of disaster response with high risk of inducing trauma in response workers is recovering and identifying human remains. Following a review of the literature addressing the significant stressors associated with handling dead bodies, we present a case study which describes professional social work intervention and support to disaster response workers and volunteers assigned to the morgue following a major air disaster. A primary task was helping workers cope with the unique stresses associated with recovering dead bodies. Opportunities for social workers to use their professional skills for disaster response work is discussed along with recommendations for social work education.

Adequacy of discharge plans and rehospitalization among hospitalized dementia patients

Because of the rapid growth of the elderly population and the decreasing number of days that patients are able to remain in the hospital, the task of discharge planning has become increasingly critical and challenging. This article reports on a study undertaken to examine the adequacy of discharge plans developed for dementia patients and to investigate factors related to inadequate plan development and patient readmission. Study results suggest that a sizeable proportion of dementia patients are discharged without adequate aftercare plans and are at risk of rehospitalization. The findings of this study point to significant family and resource-related factors that compromise discharge plan adequacy for dementia patients. Implications for practice, education, and policy are discussed.