Family involvement has been identified as a best practice in the treatment of schizophrenia. Yet studies show a small number of families of individuals with schizophrenia are involved in treatment. In this mixed method study, community mental health practitioners from different disciplines responded to a quantitative survey (N = 88), a qualitative structured question guide (N = 8), and open-ended questions (N = 43) that explored their views of families of individuals with schizophrenia and barriers to collaboration with them. Practitioners did not blame the family for causing their family member's schizophrenia. Barriers to collaboration were reported in three main areas: (a) time/workload barriers, (b) agency/system barriers, and (c) family barriers, while at the same time recognizing family collaboration as effective practice and reporting a desire to engage more families in the treatment process. Younger practitioners viewed organizational factors as more significant barriers to collaboration. Substance use factors emerged as a theme as a barrier to collaboration.
Suicide terrorism is an international problem that endangers the well-being of whole populations. Standard explanations suggest that religious fanaticism is a primary driving force in the generation of suicide bombers. A growing body of empirically based scholarship, however, indicates that suicide terrorism is a multifactorial phenomenon that cannot easily be explained away as an outcome of religious fanaticism. Religion in general, Islam in particular, plays a minimal direct role in the generation of suicide bombers. This brief article will summarize recent studies regarding the root causes of suicide terrorism as they pertain to the fields of behavioral health, violence, and violence prevention. [Brief Treatment and Crisis Intervention 8:204–208 (2008)]
Using pilot data and practice experiences, this paper reports on an attempt at a controlled postdisaster intervention. The authors discuss use of Psychological First Aid (PFA) with children in a group format, focusing on the challenges inherent in responding to distress subsequent to a hurricane disaster. Difficulties in providing services in a timely manner are explored, and the value of PFA, even months and years after experiencing a natural disaster, is discussed. The pilot study included 27 African-American children aged 6 15 years, but due mostly to mobility, only 12 completed the entire set of six sessions and were included in the analysis. The small sample that resulted did not show positive gains with respect to reduction in trauma symptomatology but did show positive results in terms of participant satisfaction. Challenges in providing timely and relevant services included access to children, timing difficulties, multiple and ongoing sources of stress, and developmental considerations. Lessons learned are provided for others providing postdisaster services with children, as well as suggestions for subsequent research. [Brief Treatment and Crisis Intervention 8:313–326 (2009)]
This is the final published version of an article published by Oxford University Press in the Journal of Brief Treatment and Crisis Intervention. This article is published under the Creative Commons License CC-BY-NC-NC. https://creativecommons.org/licenses/by-nc-nd/4.0/
The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared to be clinically effective and cost effective. Future research directions are discussed. [Brief Treatment and Crisis Intervention 8:164–170 (2008)]
This paper explores dynamics involved in the commission of homicide followed by suicide. British and U.S. government and advocacy sources are used in addition to news accounts to examine this phenomenon. Domestic violence-related crimes are contrasted with elderly "altruistic" murder-suicide, school shootings, and political terrorism. Suicide is argued to be a primary motive in many domestic homicide situations. Limitation of the availability of firearms is seen as an important means of prevention in conjunction with a harm reduction safety plan. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (journal abstract)
This is the final published version of an article published by Oxford University Press in the Journal of Brief Treatment and Crisis Intervention. This article is published under the Creative Commons License CC-BY-NC-NC. https://creativecommons.org/licenses/by-nc-nd/4.0/
This qualitative study investigated the views of Taiwanese domestic violence workers regarding the applicability of Western feminist models of intervention in their work with battered women.The findings suggested that workers experienced discrepancies between their training in Western domestic violence practices and their work with Taiwanese women whose beliefs and culture were embedded with Confucian ideology.This study also found that workers had developed alternative strategies that they believed to be useful in working with these women.Implications for incorporating cultural knowledge into practice related to intimate partner violence are addressed.
In the 1990s, increasing rates of violence among adolescents spawned a new era of research into the causes and correlates of youth violence. The resultant data on risk factors have provided opportunities for establishing empirically based assessments and risk-focused treatment programs. Community-based treatment programs that demonstrate moderate effect in reducing violence have renewed optimism in the benefit of treatment over punishment. Current research on “adolescent psychopathy” and structured assessments of risk for violence present opportunities for advancing rehabilitation but carry a significant risk of harm. It is essential that forensic psychiatrists are guided by the available evidence and instruments when providing professional opinions on violent adolescent clients to the criminal justice system. In fitting with the evidence-based practice approach, forensic psychiatrists have an ethical responsibility to take into consideration available empirical research relevant to assessing and treating violent adolescents. Current policies that limit the ability to provide treatment in juvenile settings should be challenged by organized psychiatry.
Few measurements have been developed to aid clinicians in mental health crisis assessment. Authors developed clinical dimensions from both experienced, licensed professionals working in crisis and salient characteristics of individuals presented to a crisis service located in a community mental health center. Five criteria, combined with a standard assessment protocol, were rated by 15 licensed professionals. These five criteria were tested as plausible dimensions for future measurement development. Clinical ratings by licensed professionals on 618 episodes of crisis over an 18-month period were analyzed to determine the latent structure and predictive potential of triage dispositions. The five criteria and a composite total were predictive of differential triage dispositions. An exploratory factor analysis indicated a two-factormodel, whichwe termed ‘‘self-destructive mood’’ and ‘‘perturbation.’’ Future development of thismodel and future refinement of this measure are discussed. [Brief Treatment and Crisis Intervention 8:304–312 (2009)]
In 1992, the Danish governmental National Health Insurance Service came to a provisional agreement (Sygesikringsoverenskomsten) with the Danish Association of Psychologists. The agreement was to financially support a publicly subsidized system for people who have experienced a traumatizing or life-threatening event to be able to receive psychological counseling. The agreement specifies a number of specific incidents that would constitute as qualifying for receiving the subsidized counseling. The Danish system is unique in terms of acknowledging the need for therapy following a traumatic or life-threatening event and financially supporting anyone who meets the criteria. The first evaluation of the agreement investigated the outcome of the counseling services. The evaluation suggested some adjustments and ultimately concluded that the project was a success, which subsequently led to the agreement being made permanent. In April, 2008, the agreement was expanded with the addition of further qualifying categories for which individuals could receive subsidized counseling. [Brief Treatment and Crisis Intervention 8:352–357 (2009)]
This article will review current clinical knowledge on paraphilia and methods of assessment and treatment of sex offenders. In recent years, a better understanding of the physiological and psychological dynamics underlying abnormal sexual behavior was gained through advances on the neurobiology and neuropharmacology of sexual behaviour. Sex offenders form a heterogeneous group that presents a challenge regarding assessment. Components of a full comprehensive sexual behaviors assessment are discussed, detailing the evidence available on the use of penile plethysmography testing. Results of several studies showed that such testing discriminated child molesters from other sex offenders and non-offenders. Treatment modalities include a variety of pharmacological agents and psychological approaches, as treatment outcome studies demonstrate the overall effectiveness of treatment in reducing recidivism of sex offenders. Finally this article discusses future avenues for research, including research aimed at improving the validity and reliability of assessment of sex offenders and the development of non-invasive investigational procedures that make use of new information technology.
Evidence-based practice (EBP) has become widely established in many branches of medicine, including psychiatry. In this article, I argue that it is incumbent upon a forensic psychiatrist to examine this concept following a trend in legal decisions that increasingly demand that we based our opinion on a scientific foundation. I will briefly discuss the shortcomings of EBP and how they have been addressed in more recent commentary. I will introduce a number of articles that suggest that we are at a stage where the principles of EBP can be applied to many aspects of forensic psychiatry.
In today's health care marketplace dominated by Health Maintenance Organizations and managed care, psychology internship and residency programs must increasingly prepare child psychologists to practice in a variety of managed care settings.Educational and training considerations are outlined to provide a framework for supervising child psychologists in such settings.Principles of practice in managed care are first addressed.Training should be guided by both the teaching of evidence-based
This study describes the prevalence of childhood trauma and maltreatment antecedents among 111 criminal offenders referred for forensic and mental health counseling. Sixtynine percent reported such antecedents. Seventy percent had Axis 1 mental health disorders including anxiety, depression, posttraumatic stress disorder, and substancerelated disorders. Many were comorbid. The implications of developmental psychopathology arising from childhood trauma and maltreatment for counselors who treat forensic clients are addressed. [Brief Treatment and Crisis Intervention 8:294–303 (2009)]
Rarely does a police officer list providing services to the mentally ill as a reason for becoming a law enforcement professional. However, a review of case records illustrates the frustrating, and often tragic, outcome of police service calls for ‘‘mental disturbance.’’ A closer examination of these cases demonstrates the reality that police are usually the initial contact into both the criminal justice and the social service systems for mentally ill persons. Unfortunately, there exists a disconnect in the process from the first police contact to the next level of appropriate care due largely to a lack of proper training, resources, and collaborative community support. The purpose of this paper is to provide an overview of the research and public policy on law enforcement response to the mentally ill. An evaluative review of investigative efforts in this area reveals methodological shortcomings in the extant research which (a) prevent definitive conclusions regarding efficacy of police interventions (e.g., Memphis Crisis Model), (b) have significant implications for the development of policy, standard operating procedures, and training of law enforcement personnel, and (c) are potentially relevant to the safety of mentally ill persons who, as subjects or suspects, also become potential victims. Suggestions for directions that future research on policing and the mentally ill might take are offered. [Brief Treatment and Crisis Intervention 8:236–250 (2008)]
Every 17 min, someone in the United States commits suicide. This equates to 83 suicides every day throughout the year (A. R. Roberts & K. Yeager, 2005). Suicide results in approximately 30,000 reported deaths annually. The loss of a patient to suicide is often a feared outcome among psychiatrists, psychologists, social workers, and crisis counselors, especially because the law assumes that in most situations suicide is preventable. Suicide accounts for many of the largest monetary settlements and judgments as well as a large proportion of malpractice lawsuits filed against mental health clinicians. Yet, clinician's often lack sufficient education on the legal aspects of malpractice associated with patient suicide. This article reviews several legal cases in which psychiatrists and/or social workers failed to protect patients. This includes failure to conduct a comprehensive biopsychosocial and lethality assessment, failure to warn of imminent risk of suicide, and/or breach of duty to care standards. Each case presentation concludes with recommendations for actions. Next, the article identifies common allegations made in suicide malpractice lawsuits. Conditions necessary to meet the criteria for a malpractice suit are laid out. The article concludes with the authors' guideline (FIKKE) for managing malpractice risk along with a decision-making flowchart designed to reduce a patient's risk of suicide during the treatment process.
Improving the functioning of families at high risk of child maltreatment poses considerable challenges. One issue is the dilemma of how and when it is appropriate to provide an intervention designed to improve family functioning when the level of risk of the family to the child has not been fully established. A recently reported proposal is to assess the family's capacity to change by assessing the family's response to a brief intervention. This proposed model for assessing capacity to change rests on the assumption that brief interventions can achieve meaningful short-term change in high risk families. The current study evaluated the effectiveness of a home-based intensive treatment program in families referred by child protection services. The program, Parents Under Pressure, was designed for multiproblem families and addresses problems across ecological domains, including problem child behavior, parental stress, family relationships, social isolation, and coping with life demands. Ten families completed the program. Statistically significant improvement was found between the pre- and postassessment measures on measures of parent functioning, child functioning, parent-child relationships, and social contextual measures. The majority of families showed clinically significant improvement, although a small proportion of the families showed no change or deteriorated. The presenting problems and pattern of change varied between families. The study adds to the increasing body of evidence that intensive, ecologically informed interventions can achieve short-term change in some but not all multiproblem families. Implications of the results for assessing parental capacity to change are discussed.
