Custody and Access Evaluations: Issues for Mental Health Professionals Conducting Assessments withMentally Disordered or Mentally Retarded Parents

Mental health professionals are increasingly beingcalled upon by the courts to offer their expertise inchild custody and access disputes. This paperaddresses the specialized role mental healthprofessionals have in custody and access hearings,particularly in cases wherein one or both parents havereceived a mental diagnosis (i.e., of mental disorderor mental retardation). The focus upon thispopulation of parents is warranted, as there is adearth of both empirical literature and professionalguidelines to provide direction to the mental healthprofessional that is offering his or her expertise tothe court regarding these parents. Additionally,there are specific issues that the mental healthprofessional needs to remain cognizant of, above andbeyond general issues associated with conductingcustody and access assessments, when conductingassessments on parents with mental diagnoses. Theliterature on the parenting behaviors and risk ofchild abuse and neglect associated with mentallydisordered and mentally retarded parents is reviewed,and the limitations in our empirical knowledge ofthese areas are highlighted. Recommendations formental health professionals conducting custodyevaluations in hearings where one or both parents havea mental diagnosis are provided.     

A profile of young adolescents attending a teen family planning clinic.

The purpose of this study was to assess the client records of adolescents attending a teen family planning clinic to determine the reported episodes of sexually transmitted diseases, sexual abuse, alcohol and drug use, and other dysfunctional situations in the family. In addition, information about the initiation of sexual activity and sexual partners was assessed in the record review. Data were obtained from a county health department located in a metropolitan area of a southeastern state. A review of the records of 183 adolescents 15 years of age or younger provided information on ethnicity, grade in school, and assessment data from the clinic interviews and exams. Twenty-five clients said they were not sexually active when they came to the family planning clinic for the first time, and were brought to the clinic by a parent (usually the mother). Those clients who came without parents said they were sexually active. Forty-one percent had their first sexual experience between 12 and 13 years of age, 18% between the ages of 14 and 15, and the remainder before the age of 12. While over 7% specifically stated that they had been sexually abused or raped, an additional 19% described situations in the home or exhibited symptoms associated with a history of sexual abuse. Eleven percent had a history of two to three different sexually transmitted diseases, and 26% had three or more diseases. Seventy-two percent indicated that there was conflict in the home; several had left home because of abuse. Fourteen percent admitted using drugs, mostly cocaine or marijuana, and 17% reported that they used alcohol at least occasionally.     

Normalized demand for drugs and other reinforcers.

The concepts of behavioral economics have proven to be useful for understanding the environmental control of overall levels of responding for a variety of commodities, including reinforcement by drug self-administration. These general concepts have implications for the assessment of abuse liability and drug abuse intervention and the formulation of public policy on drug abuse. An essential requirement is the ability to compare the demand for different drugs directly in order to assess relative abuse liability, and to compare demand for the same drug under different environmental and biological interventions to assess their ability to reduce demand. Until now, such comparisons were hampered by the confounding effect of varying drug doses and potencies that prevent quantitative comparisons of demand elasticity--sensitivity of consumption and responding to the constraint of price (effort). In this paper we describe a procedure to normalize demand-curve analysis that permits dose- and potency-independent comparisons of demand across drugs. The procedure is shown to be effective for comparing drug demand within and across the drug classes. The technique permits a quantitative ordering of demand that is consistent with the peak levels of responding maintained by the drugs. The same technique is generalized for the comparison of other types of reinforcers under different biological conditions.     

Provision for and Promise of Counseling and Guidance Components Within the Comprehensive Employment and Training Act

As president-elect of NECA, I am a member of an APGA task force, along with representatives from ASCA and NVGA, that is dealing with our professional concerns in the implementation of PL 93–203, CETA. This task force met in November 1976 at Lake Tahoe, Nev. We formulated the following statements and questions that have been addressed to appropriate Congressional committees as they meet to consider CETA renewal or to develop the need to justify oversight hearings.     

Training Employment Acquisition Skills for Adolescents with a Substance Abuse History

Obtaining paid employment is beneficial for youth during and following treatment for substance abuse. A training program for acquiring employment was implemented at a residential drug and alcohol rehabilitation facility for nine residents who were near to completing the program. Data are presented from three residents with the most complete data sets. Skills training was provided for completing biographic information on job application forms, job searching by telephone and in person, and job interviews. The training process included behavioral procedures of providing instructions, modeling, role‐play, and feedback. Improvements were demonstrated across all behaviors and participants after the training and generalized to real community materials and settings. All participants who remained in treatment also gained real work experience opportunities or regular paid employment. Copyright © 2011 John Wiley & Sons, Ltd.     

The adolescent who does not finish anything

Practical information for therapists who deal with adolescents who do not finish tasks is presented. The relationship of task incompletion to neurosis, psychosis, depression, homosexuality, and drug abuse is described, and techniques and guidelines for treatment are provided.     

Medicalizing the drug war

Recent findings in the field of psychopharmacology pertain to the abuse of drugs and alcohol among criminal offenders and have implications for new management techniques. Drugs of abuse exert their effects on areas of the brain responsible for pleasure, providing a powerful reinforcement for drug usage. Furthermore, there is a prevalence of psychological, psychiatric and social dysfunctions that antedate drug use which are identifiable at an early age. It is suggested that drugs of abuse differentially influence users via these biological, psychological and social mechanisms, reinforcing the development of serious and chronic abuse in a vulnerable subgroup. Studies of drug abuse specially indicate that within this subgroup, antisocial behavior precedes and exacerbates drug abuse, and multiple risk factors contribute to the concomitant development of criminality and drug abuse. Early detection and comprehensive treatment of underlying disorders that may both precipitate and result from drug abuse promise to improve possibilities for prevention and reducing relapse rates. Furthermore, the inclusion of pharmacologic treatments may further enhance the success of conventional drug treatments. This article proposes that incorporating scientific data and medicalizing our approach to drug abuse is essential to win the war against drugs.     

It is time for a general comment on children’s spiritual development

Reviewing the general comments by the Committee on the Rights of the Child (CRC) and the state reports to the CRC reveal a mixed picture. How could a general comment by CRC on the right to spiritual development assist states in their policies and programmes? First, current understandings of spiritual well-being – one’s relationship to oneself, others, nature and the transcendent – encompass all relevant dimensions of meaning-making, enhanced awareness and connectedness. Second, the CRC has elaborated on spiritual development in 16 of its 21 general comments, providing sources from which a comprehensive elaboration can be done. Third, the understanding of the term spiritual is diverse among states. Fourth, a general comment will clarify the term spiritual development and inspire and guide relevant policies and programmes.     

Regulating Human Participants Protection in Medical Research and the Accreditation of Medical Research Ethics Committees in the Netherlands

The review system on research with human participants in the Netherlands is characterised as a decentralised controlled and integrated peer review system. It consists of an independent governmental body, the Central Committee on Research Involving Human Subjects (or Central Committee), which regulates the review of research proposals by accredited Medical Research Ethics Committees (MRECs). The legal basis was founded in 1999 with the Medical Research Involving Human Subjects Act. The review system is a decentralised arrangement since most research proposal are reviewed by the 30 accredited MRECs in the country. It is a controlled system in which the Central Committee is responsible for the accreditation and oversight of the MRECs and can make legally binding directives for these committees. The assessment of research proposals is an integrated peer review process in which all documents of the research file are reviewed by experts in one committee only. A small number of research proposals are assessed by the Central Committee and not by accredited MRECs. These proposals are on specific research categories such as gene therapy, cell therapy and embryo research. The review of research with surplus human embryos is regulated separately in the Embryos Act. The Central Committee provides support to the accredited MRECs and to researchers and sponsors. It is currently developing an internet portal to reduce the bureaucracy and make the review process more efficient and transparent. The Central Committee stimulates confidence on medical research in society by providing a public trial registry with core data on reviewed research proposals.     

Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: implications for substance abuse prevention.

The authors suggest that the most promising route to effective strategies for the prevention of adolescent alcohol and other drug problems is through a risk-focused approach. This approach requires the identification of risk factors for drug abuse, identification of methods by which risk factors have been effectively addressed, and application of these methods to appropriate high-risk and general population samples in controlled studies. The authors review risk and protective factors for drug abuse, assess a number of approaches for drug abuse prevention potential with high-risk groups, and make recommendations for research and practice.     

Oversight framework over oocyte procurement for somatic cell nuclear transfer: comparative analysis of the Hwang Woo Suk case under South Korean bioethics law and U.S. guidelines for human embryonic stem cell research

We examine whether the current regulatory regime instituted in South Korea and the United States would have prevented Hwang’s potential transgressions in oocyte procurement for somatic cell nuclear transfer, we compare the general aspects and oversight framework of the Bioethics and Biosafety Act in South Korea and the US National Academies’ Guidelines for Human Embryonic Stem Cell Research, and apply the relevant provisions and recommendations to each transgression. We conclude that the Act would institute centralized oversight under governmental auspices while the Guidelines recommend politically-independent, decentralized oversight bodies including a special review body for human embryonic stem cell research at an institutional level and that the Guidelines would have provided more vigorous protection for the women who had undergone oocyte procurement for Hwang’s research than the Act. We also suggest additional regulations to protect those who provide oocytes for research in South Korea.     

Parenting contributors to early emerging problem behaviour in children of mothers in methadone maintenance treatment

This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behaviour problems in their young children and whether specific parenting practices are associated with specific types of behaviour problems. Mother‐reported and observational assessments were used to examine contributions of parenting behaviour and home environment to internalizing and externalizing behaviour problems in 150 preschool children of mothers receiving methadone‐maintenance treatment for heroin addiction. In multivariate analyses, mother‐reported child externalizing behaviour was related to greater maternal harshness and to mother history of illicit drug use during pregnancy but not other features of substance use and treatment history. Observer‐coded child internalizing behaviour was related to less maternal sensitivity and less provision of learning activities in the home. Additionally, mother report of her own psychopathology symptoms was related to mother‐reported, but not observer‐coded, child internalizing and externalizing problems. Findings suggest that women in substance abuse treatment should receive parenting interventions and that interventions should focus on increasing maternal sensitivity, reducing harshness, and providing children with cognitively stimulating environments. Findings also suggest that the need for attention to ongoing mental health problems of women in substance abuse treatment—both for their own well‐being and the well‐being of their children.

Highlights

• This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behavior problems in their young children.
• Maternal harshness was related to child externalizing behavior, low sensitivity, and low provision of learning opportunities to child internalizing problems.
• Findings suggest that women in substance abuse treatment should be provided access to parenting interventions.

     

Should the State Fund Religious Schools?

abstract   In this article, I make a philosophical case for the state to fund religious schools. Ultimately, I shall argue that the state has an obligation to fund and provide oversight of all schools irrespective of their religious or non-religious character. The education of children is in the public interest and therefore the state must assume its responsibility to its future citizens to ensure that they receive a quality education. Still, while both religious schools and the polity have much to be gained from direct funding, I will show that parents and administrators of these schools may have reasons to be diffident toward the state and its hypothetical interference. While the focus of the paper is primarily on the American educational context, the philosophical questions related to state funding and oversight of religious schools transcend any one national context.     

Co‐Occurring Disorders in Treatment‐Based Courts: Results of a National Survey

Drug courts and mental health courts have expanded rapidly in the past several decades to provide more efficient coordination of treatment and supervision of offenders with behavioral health problems. A significant number of offenders in these court‐based programs have co‐occurring mental and substance use disorders, which predict early termination, relapse, rearrest, and other negative outcomes. A web‐based national survey examined programmatic adaptations for co‐occurring disorders (CODs) among 54 drug courts, mental health courts, and freestanding COD dockets. COD dockets were smaller and of longer duration, and provided more intensive services than programs situated in drug courts or in mental health courts. However, more similarities than differences were noted across the different types of court‐based program. Key adaptations for CODs included extended program duration, highly intensive and integrated treatment, smaller, less formal, and more frequent hearings, and use of specialized supervision teams and dually credentialed staff. Copyright © 2012 John Wiley & Sons, Ltd.     

The reliability of a computer interview for drug use/abuse information

A computer interview was developed to collect information about drug use/abuse from high school students. Responses to this interview were compared with those obtained from an identical paper-and-pencil questionnaire given to the same students, in counterbalanced order. Results were comparable for the two methods, but missing data and logically inconsistent answers obtained with the paper-and-pencil questionnaire were not possible with the computer interview. The overwhelming majority of respondents preferred the computer interview as a means of data collection.     

Child abuse: is there a mandate for researchers to report?

During the past 20 years, states have increasingly expanded the lists of individuals who are obligated to report their suspicions of child abuse and neglect. These legal requirements are juxtaposed with ethical considerations in research and professional practice. The ethical issues include the obligation to maintain both confidentiality of information provided by human participants and the safety and protection of these participants. This article reviews the types of state child abuse reporting statutes and outlines the categories of mandated reporters. I develop a model of how individual researchers should approach deciding whether they are mandated reporters of child abuse and neglect.     

Problem definition and information provision by federal bureaucrats

Federal bureaucrats are important sources of information about policy problems. However, federal officials compete for this influence with organized interests plying their own problems and solutions. We attribute the differential agenda influence of the federal bureaucracy to efforts in Congress to construct workable problem definitions in a context of uncertainty about issues. From both behavioral and rational models of congressional decision making, we develop a theory of congressional search for information during problem definition under conditions of uncertainty. The theory presages the prominence of federal bureaucrats in this search, and especially under uncertainty. Using new data sets capturing the appearance of federal bureaucrats at congressional hearings, we find that the mobilization, prominence, and types of federal bureaucrats providing information is explainable in terms of congressional uncertainty about problem definitions.