Group psychotherapy for adolescents comorbid for substance abuse and psychiatric problems: a relational constructionist approach

The group psychotherapy of adolescents comorbid for psychiatric and substance abuse problems is fraught with inconsistent attendance, frequent verbal and physical disruptions by the adolescents, and intense countertransference toward patients and their parents on the part of treating staff. A relational constructionist approach assists staff and patients in overcoming these obstacles and in focusing on the adolescents' search for personal meaning. Multiple group psychotherapy conducted in a combined day treatment and high school program is described and illustrated by case examples during the course of a year of treatment. These examples illustrate the importance of a relational non-hierarchical approach to adolescent patients by treating staff.     

Training direct service staff in congregate settings to interact with people with severe disabilities: A quick,effective and acceptable program

An area of traditional as well as recent concern in congregate settings for people with severe disabilities is ensuring frequent social interactions between direct service staff and individuals who live in the residences. This study evaluated a program for training staff to interact frequently and positively across clients while in group situations in living units. The program involved a short classroom instructional session encompassing less than 1 h, followed by a maximum of 4 brief on-the-job observations and feedback sessions. Results indicated interaction rates of all 9 participating direct service staff increased above a normative criterion rate while participating in the training program. All staff also increased the proportion of their social interactions with clients that were positive in nature, and 6 of the 9 staff increased their distribution of interactions across clients. The improved interaction performances occurred when staff were provided with immediate on-the-job feedback regarding their performances as well as when provided with delayed feedback. Acceptability measures indicated the training program was well received by staff, although program components also were noted that may have affected staff acceptance differentially. Directions for future research are suggested in regard to further evaluating and increasing staff acceptance of effective training procedures.     

Supportive school climate and student willingness to seek help for bullying and threats of violence

This study investigated the relations between student perceptions of support and student willingness to seek help for bullying and threats of violence in a sample of 7318 ninth-grade students from 291 high schools who participated in the Virginia High School Safety Study. Hierarchical linear modeling indicated that students who perceived their teachers and other school staff to be supportive were more likely to endorse positive attitudes toward seeking help for bullying and threats of violence. In schools with more perceived support, there was less of a discrepancy in help-seeking attitudes between girls and boys. Findings suggest that efforts by school staff to provide a supportive climate are a potentially valuable strategy for engaging students in the prevention of bullying and threats of violence.     

Integrating instructional procedures into traditional congregate care situations for people with severe disabilities

Many institutional and community residential agencies experience difficulties in providing habilitative services when direct care staff are working with groups of people with severe disabilities. We evaluated a means of assisting direct care personnel in integrating instructional strategies into traditional congregate care situations. In Experiment 1, integrated teaching strategies were operationalized for two direct care staff persons. The strategies were based on individualized client habilitative goals and the use of brief response prompting and contingent reinforcement paradigms. The staff members integrated the teaching procedures into their group routines with clients upon implementation of an integrated-teaching staff training and management program. The program involved two staff training sessions and ongoing performance feedback. In Experiment 2, four staff members in another living unit integrated the strategies into their group routines upon implementation of a simplified version of the program. Additionally, while the program was in effect, adaptive behaviors increased in frequency for 19 of 20 clients with profound multiple disabilities. Results of the experiments demonstrate a means through which residential agencies may enhance provision of continuous active treatment in accordance with clinical and governmental guidelines. Suggestions for future rescarch are provided, focusing on overcoming obstacles residential personnel face in providing treatment services in congregate situations.     

Staff and Resident Involvement in a Therapeutic Community: For Better or Worse?

Therapeutic communities are a commonly used context for counseling persons with drug problems or emotional problems and for other populations of clients. The group dynamics of therapeutic communities are very complex. When the staff members of a therapeutic community develop communication problems with one another or when these staff members become overly involved with residents, staff problems almost always have a negative impact on the program of the therapeutic community. This article describes how staff problems can negatively affect the program of a therapeutic community and also relates the kinds of problems encountered in a therapeutic community to the problems encountered in rehabilitation programs in other settings.     

The management of sexual issues in adolescent treatment programs

Disturbed adolescents confined to inpatient treatment settings present special problems for the management of sexual behaviors. Ego impaired, delinquent, and autonomy-seeking adolescents provoke unique conflicts among their peers and staff. Staff's sexual anxiety caused by societal stereotypes of adolescents, inexperience with the techniques of unbiased observation and limit-setting, ignorance of normal adolescent development, and countertransference may lead to inadequate or inappropriate interventions. The authors describe the goals of a training program to reduce staff sexual anxiety: to develop a body of knowledge about the interaction between normal sexual development and psychopathology; to promote awareness about the staff's own feelings and the ways they influence observation and interaction; to lessen anxiety about self-exposure in the group setting; and to gain mutual support. Specific guidelines regarding effective staff interventions at an individual and group level are described. Alertness to the broad implications of sexuality in staff and patients and the necessity for careful monitoring of ward anxiety is emphasized.     

Relationships between patients' perceived improvement and their evaluations of treatment components in a behaviorally-oriented psychiatric inpatient unit

Patients on a behaviorally-oriented inpatient psychiatric unit were asked to rate their perceptions of treatment outcome and the value of 16 program components in producing that outcome. Significant correlations were found between perceived outcome and positive evaluations of the overall behavioral treatment plan, individual meetings with nursing staff, individual meetings with team psychologists, assertion group training, and daily group therapy. Patients perceived individual meetings with the nursing staff to be the single most valuable program component among those related to favorable outcome. Implications for the increased utilization of nursing staff during a time of dwindling resources for mental health are discussed.     

Spirituality and Substance Abuse Recovery

Researchers explored patient and staff perceptions of spiritual well-being and the spiritual needs of patients enrolled in a residential substance abuse treatment program. The Spiritual Well-Being Scale was used to gather quantitative data. Additionally, a brief questionnaire containing one qualitative and two quantitative questions was completed by both clients and staff. A statistically significant difference was found, indicating a more positive sense of spiritual well-being among patients upon discharge. Although the staff and clients of the residential program have similar perceptions regarding the concept of spiritual well-being, their definitions do not appear identical.     

Preparing direct service staff to teach people with severe disabilities: A comprehensive evalution of an effective and acceptable training program

In light of the continuing need for residential, direct service staff to be able to teach people with severe disabilities, we comprehensively evaluated a program to train staff in behavioral teaching strategies. The program was developed and evaluated with attention given to recent concerns in the staff management literature regarding shortcomings with staff training research. The training program, involving a maximum of four, 2-hr classroom instruction sessions and three in vivo observation and feedback sessions, was evaluated in four studies. In Study 1, the program was shown to improve verbal skills of 13 direct service staff regarding behavioral teaching principles and terminology. In Study 2, the program was demonstrated to improve performance based teaching skills of nine staff and four staff supervisors. In Study 3, the program was shown to result in improvements in adaptive skills of three clients with severe disabilities when direct care staff used their newly acquired teaching skills with the clients. In Study 4, the training program was shown to be well received among 17 staff trainees, although the trainees were more accepting of some program components than others. Results of the studies are discussed in regard to the importance of agencies providing effective and acceptable staff training programs. Future research areas also are noted, focusing on the need to determine, and minimize where possible, the amount of time required to conduct successful staff training.     

Take care! The evaluation of a team-based burnout intervention program for oncology care providers

In this quasi-experimental study among staff of 29 oncology wards, the authors evaluated the effects of a team-based burnout intervention program combining a staff support group with a participatory action research approach. Nine wards were randomly selected to participate in the program. Before the program started (Time 1), directly after the program ended (Time 2), and 6 months later (Time 3), study participants filled out a questionnaire on their work situation and well-being. Results of multilevel analyses showed that staff in the experimental wards experienced significantly less emotional exhaustion at both Time 2 and Time 3 and less depersonalization at Time 2, compared with the control wards. Moreover, changes in burnout levels were significantly related to changes in the perception of job characteristics over time.     

A systematic program to enhance clinician group skills in an inpatient psychiatric hospital

This article describes the collaborative effort of a team of discipline directors, administrators, and academicians to create a systematic program to enhance the group competencies of a large clinical staff working at a state hospital. The effects of the program were tested by a quasi-experimental field study. Quantitative measures of group process provided limited support for program effectiveness. Stronger support came from qualitative inquiry. The development and effectiveness of the program is examined within a larger context of group programs housed in large health care organizations.     

Machiavellianism and manipulation in the mental patient role

Patients’ Machiavellian orientations were compared to their reputations among the staff as manipulators, helpers, or model patients. For both acute and chronic patients, Machiavellianism was consistently found to relate significantly to the manipulator reputation and not to the other reputations The relationships held for patients diagnosed psychotic as well as nonpsychotic. These findings support the propositions that mental patients attempt to manipulate the staff in their everyday contact with them and that manipulation constitutes one of the major adaptive styles employed by patients The relationships were demonstrated more reliably in group treatment programs than in an individual treatment program Expected differences in the relationships according to birth order were not found Machiavellian social desirability significantly related to the helper and model patient reputations for acute patients, suggesting its potential value as a dispositional variable also.     

Evaluating the quality of training delivered by direct-care staff in a state mental retardation center

This study evaluated a center-wide training system in a state-operated mental retardation center. Staff performance was assessed under varying conditions with collateral measures collected on resident behavior. The quality of training delivered by direct-care staff was measured following the completion of an inservice training program and when individual feedback and praise were available or a group contingency where feedback, praise, and money were available. Inservice training was not found to be sufficient to maintain staff training skills. Providing feedback and praise had mixed results in maintaining staff behavior. A group contingency using feedback, praise, and money was found to be immediately effective in improving and maintaining staff behavior. Collateral measures on student behavior were also provided that indicated that consistent, quality training by staff resulted in increased student skill acquisition. These results are discussed within the framework of conducting research in applied settings.     

Introducing Spirituality into Psychiatric Care

Spirituality is important to many psychiatric patients, and these patients may be moved toward recovery more effectively if their spiritual needs are addressed in treatment. This, however, is rarely given expression in the psychiatric services of teaching hospitals. In order to develop this potential area of improved care, we (1) evaluated the differential attitudes of patients and psychiatric trainees toward the value of spirituality in the recovery process, (2) established a program of group meetings conducted by psychiatric residents and staff where patients can discuss how to draw on their spirituality in coping with their problems, and (3) established related training experiences for psychiatric residents. The results and implications of these three initiatives are presented.     

A Review of: “Barkley,R. A., & Robin,A. L. (2008). Your Defiant Teen: 10 Steps to Resolve Conflict and Rebuild Your Relationship.”

We report a study that addressed behavior data recording by direct-care staff at a child services program. In response to a decreasing percentage of daily data recording in two community-based group homes, a supervisory intervention was implemented, consisting of a revised data recording form and providing performance feedback to the direct-care staff. The intervention increased and maintained the percentage of daily data recording each month across the two group homes and seven sets of child behavior data. The study represents one approach toward staff performance improvement within child services programs.     

Application of social skills training in a group of institutionalized aggressive elderly subjects

A social skills training program consisting of instructions, modeling, role playing, and feedback was carried out with a group of 6 verbally aggressive institutionalized elderly patients. Dependent measures included confirmed incidents of verbal aggressive behavior monitored across an ABAB design with a 5-month follow-up period. Results indicated that verbally aggressive behavior can be significantly decreased in a group-training setting and subsequently generalized to ward and other socialized behavior. Ancillary aspects of the study include the role of social reinforcement, participant modeling, and staff attitude, perception, and motivation. Implications for future research are discussed.     

Training community residential staff: Evaluation and follow-up

The purpose of this study was to evaluate the effect of a comprehensive residential direct-care staff training program on staff knowledge, record keeping, habilitation delivery, and turnover. A 40-hour training course was presented to 18 direct-care staff employed in three community residential facilities (CRF), while 18 staff in three other CRFs were placed on a waiting list. Sixteen of 18 trained staff (89%) increased use of habilitation activities, averaging 35.44% programming after training. Only six (33%) of the staff on the waiting list increased programming. The effectiveness of training was assessed against the gains of developmentally disabled (DD) consumers. In the training group, 31 of 36 (86.11%) residents increased on-task behavior while only 7 of 22 (31.6%) of the waiting list residents increased on-task behavior. Training also yielded improved client program records and a 50% decrease in staff turnover. Follow-up over 12 months showed behavior maintenance. Results suggest that training based on clear learner objectives, presented using behavioral procedures, and taught to the entire staff including managers improves staff performance and client benefit.     

The International Test Commission Guidelines on the Security of Tests,Examinations, and Other Assessments

The amount and severity of security threats have increased considerably over the past two decades, calling into question the validity of assessments administered around the world. These threats have increased for a number of reasons, including the popular use of computerized and online technologies for test administration and the use of almost undetectable technologies for capturing test content and illegally sharing it instantly across borders and cultures. No assessment program, large or small, is immune to this potential damage. The International Test Commission has recognized the critical need for every organization with an important assessment program to be aware of these and be prepared to counter them. It was for this purpose that these guidelines were developed. Knowing the threats and the guidelines will lead to effective measures to protect the program and its assets, maintaining the value of the tests and assessments to the international community. The guidelines listed in this article provide recommendations on planning for better security, maintaining security during the development of tests and while they are administered, and responding well when a security breach occurs. Following these guidelines will create a significant protective barrier between those who willingly commit test fraud and the valuable assets a program has spent time and money to build.