The Family Peace Project

Summary

Intimate partner violence-assault by a spouse, ex-spouse, intimate friend or ex-friend-is the most common cause of injury for women and a serious public health problem. As a result, the American Medical Association has recognized physicians' ethical obligation to diagnose and treat partner violence, and called for new models of training. In this article, we review literature on the health care system's response to domestic violence. We then describe the Family Peace Project, a community oriented model for training health care professionals to identify, treat and prevent partner violence in primary health care settings. This training program provides knowledge, clinical skills and a sense of professional empowerment. Unique features of this program include: involvement of community mentors (survivors of family violence) as program faculty; training in specific clinical skills and protocols for screening, assessment and intervention; a hands-on assessment of community resources; coinmunity service; and, creation of an award winning web site to promote dissemination of the training program.     

Equipping Religious Professionals to Engage Effectively with Domestic Violence

ABSTRACT

Grant-funded agencies provide the context for religious professionals seeking to engage with domestic violence. Christian and Jewish professionals are addressed. Research-driven resources sanctioned by domestic violence agencies will be identified, examining etiology, dynamics, and treatment. Domestic violence presupposes a structure of beliefs in which religious professionals participate. Physical violence may be predatory or affective and violence may be non-physical. It occurs in all congregations. Cultural norms for appropriate behavior provide a deceptive cover. Consistent resources include books, articles, information packets, audio-visual resources, seminars/workshops and the Internet. Ties between seminaries/ religious organizations and domestic violence agencies must be promoted to fully expose and reduce this public health epidemic.     

Social Responsibility and the Mental Health Professions

Summary

While mental health professionals tend to primarily focus on their professional responsibilities toward the specific members of the public whom they serve, many are also concerned about positively impacting the broader society or culture in which they live and work. This notion of social responsibility is addressed in the ethics codes of both psychologists and social workers. This article reviews how this notion is addressed for these two mental health professions and also examines the changes that have occurred for psychologists between the 1992 and 2002 ethics codes. Finally, some general issues regarding the role of mental health professionals in changing society are considered.     

Suicide and the Law

SUMMARY

The purpose of this chapter is to delineate how mental health professionals can prevent their clients from acting in a suicidal manner while protecting themselves against potential liability when a client attempts or completes suicide. In our increasingly litigious society mental health professionals can apply their understanding about the elements of legal liability in cases involving client suicidal behaviors to structure their services in a manner to meet their responsibility in treating potentially suicidal clients.     

RECENT TRENDS IN RESPONSE TO CHILD VICTIMIZATION

Abstract

This chapter serves as an introduction to the many roles of health care professionalsin the assessment, care, and treatment of child victimization. It concentrates on those professionals caring for the physical health of victims of child abuse and neglect, although there are many similarities between child maltreatment and other family violence victims. In reviewing the health impact of maltreatment and the historical contributions of health care professionals, it discusses the roles that health care disciplines play in clinical care, training, research, and advocacy and their interaction with the community's child welfare, legal, and criminal justice systems.     

Surviving the Health Care Revolution

SUMMARY

The ongoing turmoil in the health care system exacts a significant toll on consumers, providers and society. New paradigms tor service and employment relationships pose a threat to professional and personal security. Understanding the dynamic phenomena in the system, as well as our own responses to these changes, can assist practitioners in overcoming barriers that undermine our future. Managing our feelings, developing perspective on the issues, adjusting expectations, acquiring skills that transcend medical necessity, and promoting the social contract in health care are recommended strategies for dealing with the crisis in confidence affecting health care professionals.     

Nonviolent Childhood Discipline

Summary

Interpersonal violence is a leading cause of death and injury in this country. Parents normalize and validate violence when they use corporal punishment. If the legitimization of violence in the name of discipline is to end, physicians and other professionals must be convinced that spanking is harmful and unnecessary. They must help parents learn effective, nonviolent parenting practices. This article presents a program to help health educators teach physicians and others to counsel parents on nonviolent parenting practices.     

The Tarasoff Warning and the Duty to Protect

Summary

Since the case of Tarasoff v. Regents of the University of California, mental health professionals have had an explicit legal duty to warn potential adult victims of violence. Subsequent case law expanded this standard to a broader duty-to-protect. Primary health care providers are increasingly treating psychiatric patients for whom the duty to protect is applicable. However, these providers are often unaware of the legal, ethical, and clinical issues involved. Assessment of violence risk should include demographic, psychiatric, and social dimensions. Interventions include notifying law enforcement authorities, potential victims, and possible use of psychiatric hospitalization to prevent aggressive behavior. The duty-to-protect as a standard-of-care has been applied to several other clinical situations, including impaired driving capacity, high-risk HIV behavior, and child sexual abuse. The article includes a step-by-step clinical protocol for evaluation and intervention in dangerous situations.     

Under what conditions do lay people and health professionals accept a breach of doctor-patient confidentiality regarding a patient with signs of terrorist radicalization?

IntroductionConfidentiality is crucial to the establishment of a strong patient-physician relationship. However, certain situations create a dilemma for the physician who is faced with the choice of either respecting medical confidentiality or protecting others from a serious risk of violence.ObjectiveThis study aimed to observe how lay people and health professionals assessed the acceptability of breaching confidentiality when a physician is confronted to a patient showing signs of terrorist radicalization.MethodA total of 228 participants (174 from the general population and 54 health professionals) judged the acceptability of 54 scenarios which were constructed through the orthogonal combination of 4 factors frequently mentioned in the literature: presence of a “Psychiatric disorder”; “Signs of radicalization”; “Projects of violence”; “Collegiality”. Variance and cluster analyses were performed on all the raw data.ResultsResults showed that all factors influenced the judgment of participants but that “Psychiatric disorders” had a weaker impact. Five clusters were identified: “Favorable if collegiality” (n = 23); “Favorable to breach confidentiality” (n = 77); “Unfavorable to breach confidentiality” (n = 26); “Sensitive to all factors” (n = 71); “Favorable if violence” (n = 31), respectively with mean ratings of 5.87, 8.42, 3.64, 6.30 and 7.16, on an acceptability scale of 0–10.ConclusionThe importance that the great majority of participants attribute to these factors indicates that they influence their judgments in this specific context.     

Domestic Violence Screening in Medical and Mental Health Care Settings

ABSTRACT

Health care providers and patients agree that domestic violence presents a serious health issue that falls within the purview of medical care. The patient-physician encounter has the potential to assist domestic violence victims in considering their options of living without violence and playing a critical role in preventing future violence. Despite this possibility, many persons evaluated in the health care system do not experience the benefits of such interactions. This article reviews current research that evaluates physician, patient, and systems barriers to providing care to patients experiencing domestic violence as well as gaps in the current research and suggestions for how these barriers might be overcome. Educational initiatives, implementation of protocols, and increasing environmental cues that prompt patients and physicians to discuss domestic violence may all increase the likelihood of screening and the success of interventions.     

Threat assessment: defining an approach for evaluating risk of targeted violence.

Although the field of risk assessment has made tremendous advances in the past 20 years, assessments of targeted violence continue to pose a significant challenge to law enforcement, mental health, and other professionals. These specific and critical assessments require an innovative approach. The threat assessment model, developed and refined by the U.S. Secret Service, provides a useful framework for thinking about assessments of potential for targeted violence. In this paper, we attempt to define this approach as it has been developed by the Secret Service, and apply it within the existing professional/scientific literature on risk assessment. We begin with a brief review of existing models and approaches in risk assessment, and identification of some gaps in our existing knowledge as it relates to assessments of targeted violence. We then proceed with an outline of the threat assessment approach, including a review of principles and guiding operational questions, and discussion of its use in assessment of targeted violence.     

Sympathy for the Devil

Abstract

This article describes the personal and professional experiences of the author while working as a mental health trainer in Serbia. In addition, various approaches to victims and perpetrators are reconsidered, along with the ethical implications of this work. The relationship between working with violence in a war zone and in a peaceful society is also explored.     

Limitations in the Prediction of Mass Violence: Cautionary Tales

The incidents of mass violence that have occurred in the United States have been deeply disturbing to the public as well as to mental health professionals. The public, the media, as well as our patients, family members, and friends have reached out to mental health professionals in the hope that we can provide an understanding of these events that might serve to reduce their frequency in the future. This article explores how we can best respond to these requests, including the current limitations of psychologists in the prediction of mass violence. Two incidents of mass violence are used to illustrate these issues. The first is a review of the investigation of the explosion on the U.S.S. Iowa in April 1989 that resulted in the deaths of 47 seamen. The second incident used for illustration purposes will be the University of Texas Clock Tower shootings that occurred in August 1968. This article discusses the reliability and validity problems inherent in retrospective reviews of the personality characteristics of perpetrators, and the limitations imposed by base-rate issues in the prediction of mass violence.     

Schools as Health Service Delivery Sites: Current Status and Future Directions

Summary

The health of our nation is inextricably linked with the health of our children. While families and professionals alike have recognized this truth for decades, current social reform movements in education and health services have provided an unprecedented opportunity for schools to become equal partners in addressing the needs of children, families, and communities in a wholistic, boundary-free, and collaborative manner. Since schools are the one social institution with which every child has contact, they offer a natural environment for assessment, services, and follow-up to promote the convergent education and health agendas articulated in Goals 2000 and Healthy People 2000. This article examines the components of education and health care reform with particular attention to a recon-ceptualization of health care services in schools. Within this framework, special services professionals are highlighted as leaders in service coordination and delivery for students, staff, and the community at large.     

A School-Based,Primary Violence Prevention Program

Summary

This article presents findings from an evaluative study of a multidisciplinary violence prevention project jointly administered by a family practice clinic and junior high school in Santa Fe, New Mexico. The project team hypothesized that an intervention established on a public health model and aimed at enhancing adolescent self-esteem through cognitive and behavioral strategies would reduce the tendency to engage in violence of participating students. The project united health care personnel, social workers and legal profession-als in an effort to teach students specific cognitive tools for the reduction and avoidance of violent encounters. The experimental results do not reveal Project effectiveness in boosting self-esteem indicators among students, although the Project docs seem to have contributed to the control of students' behavioral aggression. Although a clear relationship between self-esteem and violent behavior is not demonstrated by the experimental results, the project study suggests that school-based, anti-violence programs based on a public health model can have a positive effect in the reduction of physical and verbal aggression among adolescents.     

Anti-Racism Strategies in Pediatric Psychology: Using STYLE Can Help Children Overcome Adverse Experiences With Police

Black children are exposed to police violence at alarming rates. Such stress impacts development and treatment of physical health problems. In the current discourse, we introduce STYLE (Self-examination, Talk about community-police relations and racism, Yield space and time to anti-racism work, Learn about how structural racism impacts child health, Evaluate policies and practices through an anti-racism lens). STYLE offers a framework through which professionals in pediatric psychology can engage in anti-racist work across contexts from clinical care to academic and advocacy settings. Pediatric psychologists have a responsibility to be on the frontline as interventionists, educators, researchers, organizers, and advocates for racial justice through anti-racism practices. The current paper introduces STYLE in clinical care, community service, training/supervision, and academic and advocacy contexts. Case examples are provided. Professionals in pediatric psychology must first focus on changing their STYLE to promote individual and infrastructural change consistent with anti-racism work.

     

The Role of Attitudes and Awareness in Anti-Violence Education

Summary

Most interventions for the prevention of violence in relationships aim at attitudes and awareness. Prevailing attitudes in our society already condemn violence, however, and wife assault is viewed as particularly serious. Some research shows that perpetrators have attitudes more supportive of violence than other people do, but the link between attitudes and behavior can be complex. Trying to persuade people to change their attitudes in one direction can lead instead to people taking more extreme versions of their existing attitudes. Some interventions that raise awareness and promote availability of services appear to teach participants to take the problem less seriously. Most students report neither undesirable attitudes nor low awareness of violence in relationships. But their behavior appears inconsistent with their reported attitudes and awareness. If interpersonal violence has its roots in a problem more fundamental than the views of contemporary society, then anti-violence education based on attitudes and awareness will have limited benefits, and possibly some harmful effects. This article encourages a cautious rethinking of assumptions underlying current anti-violence education and alternative theories of violent behavior. It offers some suggestions for ways to reduce violent behavior, and encourages integration of violence prevention efforts into regular curricula and extra-curricular activities.     

The Occupational Therapy Elder Abuse Checklist

ABSTRACT

Occupational therapists encounter elder abuse in society and in clinical practice; however, the occupational therapy literature is void of information and tools for assessing and treating individuals at risk. Occupational therapists are in a unique position to identify elder abuse. Definitions of elder abuse, signs and symptoms of elder abuse, and reporting practices required of professionals coming in contact with individuals who may have been abused are presented. The Occupational Therapy Elder Abuse Checklist was developed to assist the occupational therapist as well as other health care professionals in uncovering abusive situations of elders who are either living alone or living with others. Guidelines are provided for use with the tool. A case study illustrates use of the tool for reporting suspected abuse, and the assessment and treatment of an individual who is a victim of elder abuse.     

Seeking help when transgender: Exploring the difference in mental and physical health seeking behaviors between transgender and cisgender individuals in Ireland

Abstract

Background: While there is growing awareness of the need to support the physical and mental wellbeing of transgender people, some may be reluctant to seek help from healthcare professionals. Little is understood about the mechanisms that influence help-seeking behavior in this group.

Aims: This study aimed to compare transgender and cisgender participants in their likelihood to seek help for both physical and mental health conditions, and to explore whether this help-seeking behavior is predicted by a range of sociodemographic and psychological variables.

Methods: 123 participants living in Ireland (cisgender= 67; transgender= 56) completed a questionnaire which included demographic questions, as well as measures of optimism (LOT-R), self-esteem (RSES), psychological distress (GHQ-12), attitudes towards seeking psychological help (ATSPPH-SF), and attitudes towards seeking help for a physical health problem (Attitudes Towards Seeking Medical Help Scale- Action/Intervention subscale). Associations between predictor variables and mental and physical health seeking were explored using correlation analysis and stepwise regressions.

Results: Transgender participants were less likely to seek help for a physical health issue than cisgender participants, but did not differ in mental health help-seeking behaviors. Results suggest that this may be due to differences in optimism, self-esteem and psychological distress. Transgender participants had significantly lower optimism and self-esteem, which were two factors linked to poorer physical health seeking behaviors. Optimism also emerged as a significant predictor in mental health seeking behaviors.

Discussion: The lack of a significant difference for mental health help-seeking between the transgender and cisgender participants is encouraging, as it suggests that there is less stigma surrounding mental illness than expected, however findings also contradict previous findings suggesting that physical health is less stigmatized. This could be due to stigma relating to gender-specific healthcare and suggests that healthcare professionals should acknowledge the specific healthcare needs and concerns among transgender individuals.