The research is an examination of a collaborative crisis intervention and assessment experience coordinated by the Miami-Dade Housing Agency (MDHA) after Hurricane Andrew destroyed eight public housing communities that housed over 1,000 residents in August 1992. A local school of social work coordinated with the MDHA and several social service agencies to train 30 students to do crisis intervention with older adult public housing residents (N=225). The assessments ascertained that the respondents had multiple chronic health problems and in many cases needed medical and/or mental health intervention immediately. Some psychosomatic problems were a direct result of the hurricane trauma. Implications are discussed in relation to public housing authority (PHA) responses to ongoing disasters and the need for PHAs to take a leadership role in disaster planning for older adult residents.
Though crime rates are falling, violence continues to be a public health problem in the United States, particularly for many urban children whose lives are characterized by chronic community violence. The following literature review examines studies related to elementary age children's exposure to community violence and the impact of such on their psychological and emotional wellbeing. A framework for viewing community violence exposure as a potential risk factor for the development of mental disorders in children is provided. Practice recommendations for universal, selective, and indicated interventions to prevent the development of mental disorders in children exposed to community violence are provided.
Intimate violence has become a high priority on the nation's public policy agenda. However, the research on victims of intimate violence and intervention by the civil justice system is scant. The research which has been conducted is limited by purposive sampling and is primarily qualitative. This article reviews the literature on the civil justice system's intervention in intimate violence cases, categorizes the research, describes its strengths and weaknesses, and suggests ways of operationalizing the variable “effectiveness” regarding civil protection orders.
Although the literature includes growing reference to the strengths perspective paradigm, there is continued emphasis on pathology and deficit in actual clinical practice. While there are various reasons for this gap, me focus on pathology is particularly prevalent and damaging in work with culturally diverse groups. The core elements of the strengths perspective and of brief treatment are both discussed in this paper The components of both cross cultural and strengths perspective approaches are discussed and contrasted with the pathologizing of culturally diverse populations. Two cases of African-American clients are then presented which demonstrate clinical use of the strengths perspective within the brief treatment paradigm where the workers focus on strengths rather than pathology with positive treatment outcomes.
As new members of a culture, Hispanic Spanish dominant mothers must learn a new language as well as adjust to new and different values and expectations. To facilitate culturally sensitive practice, this article revisits a psyche-educational group model (Leon, Mazur, Montalvo & Rodriguez, 1984). This model was originally developed and successfully utilized by the first author in the mental health setting. The article uses the author's group experiences and the existing literature to emphasize the importance of integrating aspects of Hispanic culture in delivering group services to Hispanic immigrant mothers. Cultural and programmatic considerations for the successful development and implementation of a time-limited short-term group model are presented. Through group sessions facilitated by a bilingual therapist, Hispanic mothers are given the opportunities to develop mutual support systems, learn about their community resources and increase their knowledge on child development.
This article describes a solution-focused approach to working with ethnic minority families. Solution-focused therapy is a brief, time-limited approach with an emphasis on strengths and resources rather than pathology and deficits (Berg, 1994; de Shazer, 1988; O'Hanlon & Weiner-Davis, 1989). Assumptions of the model will be delineated and illustrated with case examples from African-American and Mexican-American families who have been referred for child behavior problems.
While functional psychosis and medically-induced psychotic disorders outwardly appear to have similar presentations, clinician familiarity with the differences between them is essential for effective treatment as the consequences of misidentification range from inappropriate hospital admissions to preventable fatalities. This paper will clarify the differences between functional and medically-induced psychoses and provide useful guidelines to assess patients for medical referral.
Spirituality, in the broadest sense of the word, can be seen as the frame that guides individuals in finding meaning in their lives and the events that occur. Historically, therapists have been reluctant to explore the spiritual aspects of their clients' lives. This article discusses this reluctance and the importance of understanding clients' spiritual beliefs, especially during a crisis event, such as bereavement. Culture shapes spiritual beliefs, which influence how the crisis is processed and resolved. The impact of these beliefs is explored in several areas of concern to bereaved clients. If therapists are not aware of different cultural belief systems, they may dismiss their clients' beliefs as superstitious or label them as pathology.
Since mid-1995, much progress has been made against the human immunodeficiency virus (HIV) with the dramatic effects of antiretroviral therapy. Provocative speculation about the eradication of HIV virus is based on the assumption that cellular reservoirs have a short half- life and aggressive intervention through antiretrovial therapy prevents de novo infection of cells (Volderding & Deeks, 1998). The possibility of experiencing undetectable plasma HIV RNA levels, through combination therapy (antiretrovirals and protease inhibitors) is real and dramatic. As the medical profession focuses on advancing the viral suppression of HIV, mental health professionals attempt to provide services for clients who are dealing with a wide range of effects made by medication. Treatment of HIV through antiretroviral therapy, however, is costly and requires adherence to complex regimens and careful monitoring. Inequitable distribution of medical resources, in particular, new medications, excludes the poor, minorities and women. The mental health profession, while facing the challenges of the psychological effects of immunological improvements among some, must be careful not to allow the needs of the most vulnerable groups among the HIV infected to become obfuscated and neglected. Women continue to represent the fastest growing number among the recently diagnosed HIV infected (CDC, 1996). It is anticipated that advances in antiretroviral therapy may create a shift among women, who have over the history of HIV epidemic, presented long delays in being tested for HIV. These changes present formidable challenges for mental health practitioners, especially among the brief treatment community. Brief therapies such as cognitive and cognitive-behavioral treatments hold much promise in providing gender-specific and culturally-sensitive treatment for newly- diagnosed women during this period towards immuno-improved living.
This paper explores psychotherapy between a North American female social worker and a Vietnamese adolescent. Self psychological and constructivist frameworks are integrated to accommodate clinical work with a client from a different culture. Clinical case material illustrates the multifaceted nature of cross-cultural therapy.
Providing crisis services to refugee clients demands that practitioners develop knowledge and skills to address the trauma that accompanies migration. Beyond coping with the basic standards for living in a new country, survivors of torture must also deal with the legacy of their experiences from their homeland. Due to the complexity of issues surrounding the effects of torture, crisis interventions must be centered in a multidisciplinary community effort. Crisis events faced during the migration process are reviewed in this paper with special attention to the particular needs of survivors of torture. The effects of torture, including physiological, psychological, and social impacts are reviewed. Selected professional issues faced by professionals who work with refugee populations are discussed including, the assessment of torture impact on the family, developing a working alliance with culturally diverse refugees, countertransference issues in working with survivors of torture, and recommendations for mobilizing a multidisciplinary approach to intervention.
The State of Georgia passed legislation in 1993 to reform the public mental health system and directed that services be provided in the community whenever possible. In addition, the legislation mandates outcome studies including consumer satisfaction with services received. This study evaluated satisfaction with brief mental health, substance abuse, and mobile crisis services provided by a public crisis stabilization program in an urban setting. After services concluded, consumers (n= 54) and family members (n= 29) completed the Client Satisfaction Questionnaire (CSQ-8). The overall mean score of 27.6 compares favorably with similar outpatient services. An analysis of variance found that family members who received services from the mobile crisis program rated services significantly higher than two of the other three clients groups.
Family preservation programs have proliferated in recent years and attempts have been made to evaluate these efforts. However, synthesizing the literature in this area is difficult given the varieties of programs. To meet this challenge. it has been recommended that programs be compared across shared characteristics (Tracy, 1991). One such salient characteristic is theoretical orientation as this guides the purpose and methods of programs (McGowan, 1990). This review will concentrate on crisis intervention models, which comprise the theoretical framework of initial family preservation efforts as exemplified by the Homebuilders programs. A critique of the research in this area is offered and key findings are explored. In addition, suggestions for service delivery and future research are provided.
Through a law passed in 1993, the State of Georgia reformed the public sector mental health system to include more consumers of services and their families on local boards, to provide services in the community, and to measure and report the outcomes of these services. Using the Brief Psychiatric Rating Scale, this field study investigates the changes in the level of psychiatric symptoms between admission and discharge for clients (N = 14) who were treated for an average of 2.8 days (SD = 1.23). A t-test calculated to compare pretest and posttest scores completed by social workers found a significant difference (p < .001) between scores. Although this study provides optimism that mental health clients can be stabilized in community settings, further research is needed with larger numbers of clients to evaluate differences by diagnoses, levels of symptomatology, lengths of stay, and types of settings.
This article attempts to identify normal recovery symptoms in the process of recovery from cocaine dependence as related to possible changes in brain dopaminergic function during use and in early recovery. Practical observation leads to description of stages of recovery and the associated recovery symptomology associated with each stage of recovery. The author applies Roberts' seven-stage crisis intervention approach to cocaine dependent individuals in early recovery to address issues as they present. Applications of this approach have been effective in addressing the early recovery symptoms verses relapse prevention models that identify early recovery symptoms as signs of pending relapse.
The major restructuring of the health care and social service delivery systems under managed care has resulted in significant changes in expectations regarding job performance by clinicians. This new health care environment demands restrictions on length and type of care, as well as proof of effectiveness, efficiency, and accountability in practice. Students will need preparation in a new set of skills and types of knowledge in order to function effectively and with confidence in this environment. This article outlines the major components of a one-semester graduate course in brief, problem-focused treatment designed to address these new learning needs. It presents educational objectives, content areas, course structure, teaching methods, and methods for evaluating student progress. The focus of the article is on the content of the five course modules, which includes brief treatment principles and techniques, practice models, application to different clinical populations, and problems and ethical dilemmas.
The treatment of adolescents with comorbid depression and conduct problems poses significant challenges to the clinician. These patients, in contrast to those who present for depression alone, are more prone to be at risk for suicide. to be involved in alcohol and drug abuse, to have disturbed families, and to be difficult to engage in the process of therapy. In addition, these adolescents often enter therapy in the aftermath of a crisis, and are at risk for repeated crises throughout treatment. Two case illustrations of crisis intervention with depressed adolescents who have comorbid conduct problems are presented. The therapist, who works out of a cognitive-behavioral perspective, demonstrates the importance of dealing directly, and openly with the crisis situation from the outset. Further, transcript material from each case highlights how the therapist can use confrontation, as well as Socratic questioning. to stimulate resistant adolescent patients into active engagement in the process of therapy.
Outcome studies of inpatient psychiatric treatment programs in the case of children, adolescents, as well as adults have generally found that extended hospitalization provides little added benefit over shorter inpatient treatment programs averaging no more than one month in length and frequently considerably shorter. As a consequence, brief hospitalizations have become the standard of inpatient care and are increasingly thought of in the larger context of treatment programs that include post-discharge outpatient follow-up and clinical management.
The health care industry is changing rapidly, and with it will come changes to managed health care as it is now known. This article addresses a fundamental paradigm shift with far reaching implications for the effectiveness of health care, the cost-efficiency of health care systems, and the service integration of systems (Masia, Anderson, McNeil, & Hawkins, 1997). These changes are affecting previously segregated delivery systems, specifically those of health and mental health. Increased costs and proposed budget cuts are forcing segregated systems into an overall integrated delivery system.Successful therapeutic outcomes in psyche-social treatment depend on a number of variables. In this manuscript, the author outlines worker characteristics that are recommended based on various research studies and general outcomes of behavioral change. Issues discussed include the similarity of client and worker characteristics, attributes of professionals versus paraprofessionals, and many common factors of worker efficacy. In addition, many treatment components are discussed such as length of therapy, behavior acquisition procedures, enhancement of treatment technologies, and level of intervention strategies such as individual treatment versus group treatment. A detailed cost analysis of social work follows, including cost benefits and cost effectiveness.Finally, a profile of the behavioral/health social worker is given that defines what abilities an effective behavioral social worker should possess. Among these are the depth of an acceptable knowledge base, the behavioral skills necessary for an intellectual and conceptual understanding of theories of human development and learning, and the utilization of techniques necessary to bring about behavioral changes in clinical practice. From these characteristics, a basis is formed for the emerging roles for behavioral interventions in primary care that will ultimately increase the quality of mental health care while effectively controlling medical costs.It has been shown that increasingly health care costs and the effective management of health care are of primary importance and concern to federal, state, and local governments. It is necessary to develop innovative, successful, and cost effective treatments and procedures. This manuscript proposes such a procedure by first defining the problems to be addressed, by applying research and studies for support, and by presenting an innovative model for cost effective managed health care and empirically based psycho-social intervention.
Seropositive gay men experience multiple losses in their lives resulting in layers of grief. Models of grief were not developed for people experiencing multiple losses therefore lack the capacity to help crisis workers with this population. Counseling strategies developed specifically for seropostive gay men also may not be adequate because are not crisis oriented. This paper suggests the use of the Tirage assessment Form as a means of assessing the multiple losses experienced by this population. Used in conjunction with models of grief and counseling approaches for seropositive gay men, the Triage Assessment Form helps crisis workers identify and monitor the layers of grief experienced by this population.
