Overt and covert antisocial behavior: Child and family characteristics among psychiatric inpatient children

The present study examined child and family characteristics associated with overt and covert antisocial child behaviors. Child psychiatric inpatients (N=258, ages 6–13) were identified as high in overt and/or covert antisocial behaviors (e.g., aggression and stealing, respectively) based on a structured parent interview measuring antisocial behavior. Children were classified into four groups derived from the factorial combination of level of overt (high vs. low) and covert (high vs. low) antisocial behaviors. Analyses were made of the children's reactions to hostile and anger-provoking situations, deviant and prosocial child behaviors at home and at school, and family structure and organization. Children higher in overt antisocial behaviors were more negative, resentful, and irritable in their reactions to hostile situations and more aggressive at school. They came from families with significantly greater conflict and less independence among family members. Children higher in covert antisocial behavior participated in fewer social activities and were higher in anxiety; their families showed significantly lower family cohesion and organization and less of an emphasis on moral-religious values. The results suggest reliable differences in child and family functioning as a function of patterns of overt and covert antisocial behavior.     

Confidentiality: an ethical and legal conundrum for family therapists

There are several important issues influencing the holding of confidences in family therapy, among them are privacy, family secrets, confidentiality, and privileged communication. Clinicians need to be aware that breach of confidentiality is considered a high-risk area in clinical practice, which could be brought within a "low profile" malpractice configuration by adopting certain risk management techniques. Family therapists have an obligation to maintain their practice under the guidance of professional ethics, agency policies/procedures, and within emerging judicial parameters. The questions of confidentiality that confront family therapists have no clear and easy answers and the legal dilemma is ever present.     

Symptom endorsement differences on the Children's Depression Inventory with children and adolescents on an inpatient unit

Responses to the Children's Depression Inventory (CDI; Kovacs, 1992), administered during intake, were collected from 521 children and adolescents (aged 7 to 17) at an inpatient crisis stabilization unit. Participants were grouped into 1 of 3 diagnostic groups: solely depressive, solely aggressive, or both depressive and aggressive. Self-report of symptoms for each diagnostic group, age and gender differences, and racial and ethnic differences in symptoms were examined in this study. There was a significant difference between the endorsement pattern of solely depressive and solely aggressive participants, whereas those categorized as both depressive and aggressive displayed an endorsement pattern similar to those who were solely aggressive. There was a significant gender difference in overall symptom report, with girls showing higher overall symptom levels than boys. This gender difference was significant for both the younger and the older age groups. These results held true even when gender was covaried out of the diagnostic group analyses and when diagnostic group was covaried out of the gender analyses. Symptom endorsement did not differ based on race and ethnicity. The primary contribution of this study centers around the findings from the item analyses of the CDI. These results are discussed in relation to the discriminant validity of the CDI and the need for additional research into comorbidity.     

Determining the need for community alternatives to prevent unnecessary admissions to an adult inpatient psychiatric unit

Admissions to an adult psychiatric inpatient unit were monitored for a period of 4 months in order to determine the necessity for those admissions. Staff considered that 34–58 per cent of admissions would have been unnecessary if appropriate alternatives had been available in the community. The study was repeated using a different methodology and 50 per cent of admissions were then considered unnecessary. As these results are based on post-hoc judgements, made with some knowledge of outcome, the conclusions are drawn cautiously. Implications regarding the development of services are considered.     

Mankind and Kind Men: an agenda for male family therapists

This article examines some of the gender issues involved when male therapists interview women, children and other men. It looks at issues in the family life of male therapists which have parallels with therapy, and offers some practical suggestions for beginning to overcome obstacles of gender in therapy.     

Shame,attachment, and addictions: Implications for family therapists

Research based on attachment theory is reviewed for its relevance to the development of later addictions. The problem of internalized shame as an attachment related issue is discussed. Some original research into internalized shame using the Internalized Shame Scale is summarized. The relevance of this research and theory for family of origin based treatment of addictions is explored.     

Use of didactic training and feedback to improve quality and acceptability of progress notes written by direct-care staff on a psychiatric inpatient unit

Writing progress notes represent a critical activity of practicing clinicians in a variety of settings. They provide a way for medical practitioners, insurance companies, and others to communicate in a timely fashion regarding ongoing clinical care. Previous research showed that intervention components like didactic training, using note templates, and feedback improved the quality of progress notes. At least two questions remain despite several studies already addressing progress note writing. First, previous research most often used multiple intervention components to improve progress notes. Thus, the relative impact of two common components of interventions, such as didactic training and feedback, is unclear. Second, previous research has not evaluated the acceptability of improved progress notes for the practitioners that actually utilize them. Thus, the purpose of the current study evaluated the components of didactic training and feedback on improved progress note writing for four direct staff employed by a psychiatric inpatient unit. A second purpose of this study was to evaluate the acceptability of the training procedures by both (a) the direct-care staff participating in this study and (b) four members of the psychiatric treatment team that used direct-care staff progress notes to inform their clinical care. Results showed that feedback was necessary to improve the accuracy of progress notes for three of four participants. The direct-care staff reported the training procedures as acceptable and the treatment team noted improvements in the quality of the progress notes after intervention. These data will be discussed in terms of ways to arrange effective training programs to improve direct-care staff's progress notes.     

Family therapy outcome research: a trial for families, therapists, and researchers

This article describes the process of an evolving research project. Initially conceived as a study investigating outcome measures and their sensitivity to change after a course of family therapy, the project soon changed its focus. As unexpected results were recorded, the clinical research team became destabilized and the individual team members responded by making their own "sense" of the data, reflecting their respective clinical and scientific positions. As clinicians and researchers began to challenge each other's belief systems, the project entered a new stage. The interactions within the team became of increasing interest and themselves objects of research. The recursive nature of re-search was demonstrated, and the act of writing this report completed the circle, as the various authors tried to achieve a balance between reporting the content and the process of this project.     

Working with the families of children with mental handicap in India: Various models

This paper presents a rationale for working with families who have children with disabilities in India. The various types of parent and family involvement which have been developed at the National Institute for the Mentally Handicapped are described. These include: individual programmes; group activities; family cottages; parent training programmes; sibling groups; and, self-help groups. Finally, the difficulties encountered in working with such families in India are discussed.     

Understanding autism: how family therapists can support parents of children with autism spectrum disorders

The number of children diagnosed with an Autism Spectrum Disorder has increased dramatically in the last 20 years. Parents of children with autism experience a variety of chronic and acute stressors that can erode marital satisfaction and family functioning. Family therapists are well-suited to help parents stay connected to each other as they create a "new normal." However, family therapists need updated information about autism, and they need to understand how family therapy can help parents of children with autism. Because having a child with autism affects multiple domains of family life, this paper explores how family therapists can utilize an integrative approach with parents, enabling them to flexibly work with the domains of action, meaning, and emotion.     

Child characteristics,family demographics and family processes: Their effects on the stress experienced by families of children with disabilities

Parents of children with disabilities are often reported as having more stress than their counterparts. Because past investigations of parent stress have been limited by considering too few sources of stress, this study gathered a large variety of demographic, child and family process variables. Two domains of parenting stress, including those aspects related to the child's characteristics (child related) and those aspects concerned with the parent's attitudes toward parenting (parent related) were analyzed separately. The results showed that the circumstances and processes of a family, as well as child characteristics, must be taken into account when clinicians attempt to mediate problems. This research has direct application for clinicians and interventionists. If intervention hopes to truly serve families, a thorough understanding of parenting stress is needed.     

A Web-based family problem-solving intervention for families of children with traumatic brain injury

We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.     

A team format for the Global Assessment Scale: reliability and validity on an inpatient unit

The Global Assessment Scale (GAS) is a 100-point rating instrument which purports to measure psychological adjustment on a continuum from self-actualization to severe regression. Its reliability and validity were examined on the admitting ward of a state hospital where GAS ratings are assigned to patients by computing a mean of the individual ratings assigned by a team of clinicians. Results showed such team GAS ratings to have good reliability. As for validity, team GAS predicted the outcomes of court hearings at two stages of the civil commitment process and showed construct validity in its relevant correlations with the Psychotic Inpatient Profile. A predicted association between team GAS and a ward atmosphere measure was not obtained. Taken as a whole, the results support the use of team GAS ratings in inpatient settings.     

Silence and survival: Working with strategies of denial in families of traumatized pre-school children

Silence and denial about previous traumatic experiences are common features in families exposed to organized violence. Mutual protection between family members, and especially between parents and children, is seen as the fundament for the silencing of traumatic experiences. This strategy is suggested to have adaptive advantages in dangerous situations in general, where it serves the function of saving the child's internal representations of his/her parents as secure bases. If, however, the dangerous situation escalates and a psychic trauma cannot be avoided, the strategy of mutual silence concerning the event(s) becomes an obstacle for giving traumatized children parental support and professional treatment. It is argued that clinicians need to take seriously the strong reasons families have for upholding their strategy of denial, if they want to help traumatized families to a better functioning. A case presentation is made to illustrate how it is possible to use refugee children's re-enacting play as a source of information about past traumatic events in order to change destructive post-traumatic family dynamics and improve parental support to the child.     

Working nonstandard schedules and variable shifts in low-income families: associations with parental psychological well-being, family functioning, and child well-being

Longitudinal data from the New Hope Project--an experimental evaluation of a work-based antipoverty program in Milwaukee, Wisconsin--was used to explore concurrent and lagged associations of nonstandard schedules and variable shifts with parental psychological well-being, regularity of family mealtimes, and child well-being among low-income families. Working a combination of variable shifts and nonstandard hours was associated concurrently with lower teacher-reported school performance and engagement and higher levels of externalizing behavior problems. Fixed nonstandard schedules were associated with lagged decreases in parent-reported school performance, whereas working variable shifts was associated with lagged increases in parent-reported school performance.     

A web-based family problem-solving intervention for families of children with traumatic brain injury.

We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.     

Working with the institutionalized aged and their families: Considerations for clergy

The institutionalization of an aged parent presents unique challenges and strains to the family system. It also provides opportunities for limited intervention and support by empathic clergy. It is often difficult for middle-aged children to understand some of the strong and often sudden emotions they experience regarding their institutionalized parents, particularly as these feelings become confused with their own sense of having reached middle age. Again, opportunities present themselves for clergy to be sensitive to these confusing feelings.