Follow‐up with Callers to the National Suicide Prevention Lifeline: Evaluation of Callers’ Perceptions of Care

Continuity of care for suicidal individuals engaged with a variety of health and mental health care systems has become a national priority, and crisis hotlines are increasingly playing a part in the risk management and continuum of care for these individuals. The current study evaluated a national initiative to have crisis centers in the National Suicide Prevention Lifeline network provide follow‐up care to suicidal callers. Data were obtained from 550 callers followed by 41 crisis counselors from 6 centers. Two main data sources provided the information for the current study: a self‐report counselor questionnaire on the follow‐up activities completed on each clinical follow‐up call and a telephone interview with follow‐up clients, providing data on their perceptions of the follow‐up intervention's effectiveness. The majority of interviewed follow‐up clients reported that the intervention stopped them from killing themselves (79.6%) and kept them safe (90.6%). Counselor activities, such as discussing distractors, social contacts to call for help, and reasons for dying, and individual factors, such as baseline suicide risk, were associated with callers’ perceptions of the impact of the intervention on their suicide risk. Our findings provide evidence that follow‐up calls to suicidal individuals can reduce the perceived risk of future suicidal behavior.     

Feminism and reproductive technologies

...Rowland is a social scientist and a radical feminist, and she has undertaken the task of making readers think twice about reproductive technologies. If a reader isn't thinking twice, it will not do to blame it on Rowland and the shortcomings of her book. She has a good deal to say that is extremely important and that needs to be considered by anyone who is interested in the moral issues, in general, and the issues for women and children, in particular, that are raised by the new and emerging reproductive technologies. Her book should be widely read. And it should generate the worries it is written to generate.     

BARBARA STRUDLER WALLSTON

The death of Barbara Strudler Wallston on January 3, 1987, brought to a sudden end the rich and diverse life of a complex personality, who combined scholarship, leadership, and advocacy with a zest for living. A highly productive scholar, inspiring teacher, and feminist leader who loved dancing and music, Barbara Wallston translated her compassion for disadvantaged individuals and commitment to social justice into direct and constructive action. In her too brief 15-year career, she generated more than 70 publications and 94 professional presentations spanning such areas as health, gender, sex roles, sexuality, and social issues. Her extraordinary leadership and scholarly achievements led to her election to Fellow in recognition of "outstanding and sustained national contributions" in five APA divisions. In 1986 she was awarded Division 35's Carolyn Wood Sherif Memorial Lectureship for contributions that continue to enrich and inform the lives of her colleagues, students, and friends, and that have earned her recognition as a pioneer in contemporary feminist psychology.     

Perceptions of health care social workers in Ontario: challenges and facilitators to reflective practice

Background: Reflective practice in health care social work ensures that social workers provide effective and efficient services to clients as well as maintaining their mental and physical health. In this study, we aim to determine how health care social workers engage in and describe reflective practice and challenges related to their reflective practice in their work in the health care system.

Methods: We used the Reflective Dialogue Rating Scale (RDRS) developed by Marion Bogo et al. to structure qualitative face-to-face interviews with 23 health care social workers employed in a hospital in a large urban area in Ontario, Canada.

Results: Findings illustrated that all participants regularly engaged in reflective practice in order to carry out everyday social work activities, promote ethical practice, and to enhance the provision of services to their clients. The social worker participants consistently agreed that as a profession they faced challenges maintaining their knowledge of current research due to few opportunities for professional development, workload competing with educational opportunities, and a work climate that is not conducive to gaining professional development, thereby challenging reflective practice. Supportive working environments include: peer supervision, safe and private spaces to talk to colleagues, a supportive supervisor, and an overall positive organizational culture.

Discussion and conclusion: Reflective practice is a key component in health care social work. All 23 social workers stated that they used reflective techniques (such as peer supervision and debriefing) to deal with their own reactions and operated in a purposeful and intentional manner to form therapeutic relationships with clients. As such, participants stated that lifelong learning was paramount in providing quality care to clients.     

The Psychology of Respite Care for People with Dementia in Australia

Australian health professional bodies promote the use of respite to ease carer burden, following well‐established findings that carers often face physical, mental, social, and financial strain while providing informal care. This narrative review examined the use and impacts of respite for older clients, with a particular focus on Australian research and on dementia respite. It was found that despite reports of high satisfaction from caregivers with respite use, barriers, such as caregiver concerns for the well‐being and safety of the care recipient during respite, limited flexibility for short‐notice respite booking, and low provision of support and education post respite, impacted on the accessibility and efficacy of respite care. It was concluded that respite care needs to move away from a custodial model to a more psychological model of care, and that more natural and flexible models (e.g., host family respite), integrated with increased post‐respite support and psychosocial education, are likely to be beneficial and need further evaluation.     

Identifying Training Needs of Health-Care Providers Related to Treatment and Care of Transgendered Patients: A Qualitative Needs Assessment Conducted in New England

SUMMARY

The Transgender Training Project of the New England AIDS Education and Training Center has been providing training on transgender-related issues to health-care providers in the New England region since 1999, having trained nearly 600 providers in that time. The Transgender Training Project embarked on a study during the 2001–2002 grant year to interview providers of HIV-related care and advocacy on their knowledge and experience with working with trans-gendered people and to assess training needs to increase their effectiveness with transgendered clients.

The methodology consisted of face-to-face interviews with 13 providers of HIV treatment and care who are affiliated with the New England AIDS Education and Training Center network to discuss clinical challenges in working with transgendered people.

In this exploratory study, we found that providers had:

1. Desire to treat transgendered patients respectfully but admitted discomfort and lack of tools for specific interviewing/assessments.

2. Experience with a range of transgendered patients, but lack of information on distinctions among transgendered experiences.

3. Restrictions based on time constraints that create an overarching barrier in building trusting relationships with clients, and trusting relationships are integral to quality care.

4. Concern and frustration with lack of information, studies and research.

5. Concern and frustration with lack of treatment guidelines, (or ability to access them), referral contacts and ways to advocate for transgender clients.

6. Belief that training by transgendered people themselves was an essential teaching element.

These results point to the need for the development and dissemination of specific training materials and resources for health-care providers serving transgendered people living with or at risk for HIV.     

Collective AIDS activism and individuals' perceived self‐advocacy in physician‐patient communication

In a study of AIDS activism and communication patterns between people with HIV or AIDS and health care personnel, parallel persuasive processes are described between social or political activism and personal self‐advocacy. The analysis of public and private discourse leads to 3 interrelated conclusions about AIDS activist behaviours at the collective and individual levels: (a) greater patient education about the illness and treatment options is encouraged, (b) a more assertive stance toward health care is promoted, and mindful nonadherence is considered. Activists perceived that their self‐advocacy behaviors, in turn, impact the physician‐patient interaction. In communicative interactions, education allows patients to challenge the expertise of the physician, assertiveness allows them to confront paternalistic or authoritarian interactional styles, and mindful nonadherence allows them to reject treatment recommendations and offer reasons for doing so. Participants reported that physicians had mixed reactions to their self‐advocacy attempts.     

The medical profession and the corporatization of the health sector

This article describes the most important determinant of contemporary American medical practice: the corporatization of the health care delivery system. It argues that there is an urgent need for greater reflection by physicians on the values inherent in profit-based health care and on the implications of such a model of care. Other pressures on the medical profession and several available responses are examined. The article then poses a challenge to the profession to assume a more forthright advocacy for social equity in health care provision.     

Recognizing social class in the psychotherapy relationship: a grounded theory exploration of low-income clients

The process of psychotherapy among 16 low-income clients was explored using grounded theory (Charmaz, 2006; Glaser & Strauss, 1967) in order to understand and identify their unique experiences and needs. Semistructured interviews were conducted with 12 women and 4 men who had attended at least 6 sessions of psychotherapy within 6 months of the interview. Our grounded theory that evolved depicted a tapestry of the dynamic process by which low-income clients experience social class within psychotherapy. Specific therapist behaviors that contribute to more and less positive experiences emerged from the data and pointed to the importance of acknowledging social class within the therapy room. The significance of therapists enhancing the 50-min hour via advocacy and meaningful moments within and outside of the therapy room was highlighted among all participants. Implications for practice with low-income clients and directions for future research are provided.     

Mutant Spiritualities in a Secular Age: The ‘Fasting Body’ and the Hunger for Pure Immanence

This article will explore the ‘return of the repressed’ of secular materialism, in the form of ‘mutant spiritualities’, with a particular focus on the significance of the fasting body, once an accepted product of ascetic spiritual practice, and now cultivated by those seeking a range of experiences; including the anorexic, the model or celebrity trading in beauty and elegance, and those in search of a new age spiritual enlightenment. I argue that further exploration of the range of contexts in which the fasting body is cultivated reveal that what is desired is a lost experience of the body as an expanded field of energetic confluences, an assemblage of affects in the manner of Deleuze and Guattari’s ‘body without organs’. Such an experience of the body is termed as expanded, light and even ecstatic by those following fasting regimes, in that it overcomes the experience of the body as ‘heavy’, burdensome or limiting. The word ecstasy derives from the Greek ‘ekstasis’, meaning to stand outside oneself. Through a textual analysis of web content of cyber communities dedicated to these food practices, I suggest that fasting expresses a hunger for ‘self transcendence’ as pure immanence, that is both subversive of secular materialism and limited by narcissistic pathology.Jo Nash, PGDip Ed, PhD (Psychotherapy Studies), MA., BA (Hons) has taught on the Masters in Psychoanalytic Studies at the University of Sheffield since 1998 and became Course Director in October 2001. Before becoming an academic she worked in mental health services for over 15 years as a student nurse, social worker, advocate, trainer and researcher. She is currently working on a series of essays on the application of psychodynamic theory to the study of social processes, in relation to new spiritualities, religion and political processes, and gender and mental health. Correspondence to Dr Jo Nash, Mental Health Section, School of Health and Related Research, University of Sheffield. Regent Court, 30 Regent Place, Sheffield, UK: S1 4DA. J.T.Nash@shef.ac.uk She can be contacted by email at J.T.Nash@shef.ac.uk     

Childhood abuse and depressive vulnerability in clients with gender dysphoria

Background: Childhood abuse in the early lives of gender variant people has been under‐reported, although higher psychiatric morbidity, particularly depression and suicidality, than in the general population is more widely recognised. There are increasing numbers of people seeking advice and treatment for gender dysphoria (GD) some of whose experiences of depression and childhood abuse may be additional treatment considerations. Aim: To illuminate the issues relating to childhood abuse, depression and GD via case examples underpinned by a summary review of the relevant literature, for their combined relevance to therapeutic practice and service provision. Methods: A review of relevant online literature was conducted and two case examples were developed subsequently to capture the core review themes from a practice perspective. Results: Nine studies met the inclusion criteria. Gender variant children and adolescents may experience abuse by peers and teachers, as well as parents and caregivers. Emotional abuse and neglect may have more adverse consequences than more active forms of abuse. Conclusions: This is an under‐researched area, and inconsistencies of design, definition, measurement and controls were evident in the literature. While no clear association between depressive vulnerability and childhood abuse could be found, prevalence of such abuse was high. A case is made for clients with GD to have the opportunity to explore the influence and meaning of their adverse childhood experiences on their social and psychological development, and for additional training and education for practitioners.     

Immigration and Psychosis: an Exploratory Study

This qualitative study aimed to explore views (and related experiences) of healthcare providers regarding immigration and its relation to psychosis, such as schizophrenia, particularly to identify support needs and challenges of immigrants with psychosis and related challenges and enablers of their mental health service providers. The objectives of this study were to identify (1) barriers and enablers of mental health and other services for Canadian immigrants with psychosis and (2) barriers and enablers for their mental health service providers. The study used a phenomenological approach to elicit views of 12 mental healthcare providers with experience in providing mental healthcare to immigrants with psychosis. Semi-structured individual interview data obtained were coded and thematically analyzed. Six themes in relation to the experience of service provision to immigrants with psychosis were found: the immigration process, service availability and accessibility, social determinants of health, cultural context, psychosocial stressors, and enablers and facilitators of recovery. The most prominent challenges/barriers were related to cultural context, language, social and health services, and support. Most mental healthcare providers believed that immigration process precipitates the first episode of psychosis in a majority of immigrants and that psychosis was undetected/non-present when in the country of origin. This study demonstrated system challenges and related opportunities for service provision for immigrants with psychosis. We identified important areas for intervention to reduce disparities for immigrants with psychosis in their use of social and health services. Future directions for research in relation to immigration of people with psychosis are discussed.     

Between the street and the consulting room: The role of therapeutic frame in working with homeless clients

This paper explores the context of psychotherapy with people who are homeless and the kinds of dynamics and challenges that typically arise in this work. The paper specifically considers the process of therapy as it takes place with clients who have been recurrently homeless and who have difficulties with sustaining shelter that has its roots in deficits in early containment. Clinical case material from psychotherapy conducted with two homeless men is presented and the implications of the approach adopted are explored both in relation to policies around the provision of services for homeless people and the more specific issue of psychotherapy intervention.

It is argued that a clear, well-articulated set of expectations has to be developed around this work in order to protect it and to provide it with the greatest opportunity for providing the kind of safety that is required for the development of this work. It is argued that the most important issue here relates to the provision of a consistent therapeutic framework and a care around the development of the specific psychotherapeutic frame within, and in relation to, the other frames present in the person's life.     

Integrating Advocacy for Marginalized Children and Families Into Evidence-Based Care During COVID-19: Clinical Vignettes

The novel coronavirus (COVID-19) has disproportionately impacted the health and socioeconomic outcomes for low-income populations, people of color, and immigrant children and families in the United States. As inequities in resources (i.e., food, internet, housing), health care, and education increased for marginalized families as a result of COVID-19, child-focused clinicians had to broaden their professional scope and implement new advocacy efforts. The current paper uses clinical vignettes taken from a New York State Office of Mental Health–licensed child and adolescent outpatient clinic in the Bronx, New York. The vignettes highlight the social inequities that impacted marginalized children and families during the pandemic, as well as the clinical team’s response through the integration of evidence-base practice and advocacy. Implications for practice with vulnerable populations as the COVID-19 pandemic persists are discussed.     

Clinical Implications for Supporting Caregivers at the End-of-Life: Findings and from a Qualitative Study

Despite families providing considerable care at end of life, there are substantial gaps in the provision of supportive care. A qualitative interview study was conducted with 17 caregivers of people supported by an adult hospice to explore the support needs of families. Family members readily identified the ways in which the diagnosis of a life-limiting illness impacted on them and the family as a whole, not just the patient. Implications for practice demonstrate the need to intervene at a family and relational level prior to bereavement, in order to mitigate complicated grief for the surviving family members. Such an approach offers a fruitful prospective alternative to supporting caregivers post-bereavement.     

Integrating Behavioral Aspects into Community Preparedness and Response Systems

Summary

This article examines the role of psychosocial and behavioral dimensions of terrorism that influence community preparedness and homeland defense efforts. Public health interventions will fail if people do not follow the recommendations. A broader public health model is applied to help identify the interactions between risk and safety appraisals, social factors, and behavioral response to uncertain and stressful situations. Community preparedness would benefit by linking disparate programmatic and advocacy initiatives that already exist. It stands to reason that improving the cohesiveness of existing systems of social organization would strengthen community resilience and serve as effective countermeasures for terrorism.     

Social and Medical Transgender Case Advocacy

SUMMARY

While some clients are confident self-advocates, many transgender individuals and loved ones find it difficult to advocate for themselves and turn to a trusted clinician for assistance. This article discusses the role of the health and social service clinician in transgender case advocacy. Although the setting, circumstances, and client needs vary greatly, the overarching goal of clinical advocacy is to address the societal barriers that interfere with clients' functionality and well-being. We suggest a protocol for advocacy assessment in the clinical setting and discuss trans-specific advocacy concerns relating to financial assistance, employment, changing identification, general advocacy, and outline concerns of specific populations within the transgender community.     

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.     

Contrasting jail diversion and in-jail services for mental illness and substance abuse: do they serve the same clients?

Baseline data from a study of jail diversion services and in-jail behavioral health services were used to examine the differences in clients served by these two models of responding to people with co-occurring mental health and substance abuse problems in the criminal justice system. Clients of the diversion service had more acute psychiatric symptoms and were more likely to have a diagnosis of psychosis NOS. Clients of the in-jail service were more likely to have been on probation or parole in the past and to have received substance abuse treatment. Different service models may attract and serve different populations of clients. Diversion services may cast a wider net that includes clients who may not have otherwise been involved in forensic services.     

Health Care Behaviours and Beliefs in Hasidic Jewish Populations: A Systematic Review of the Literature

Cultural issues impact on health care, including individuals’ health care behaviours and beliefs. Hasidic Jews, with their strict religious observance, emphasis on kabbalah, cultural insularity and spiritual leader, their Rebbe, comprise a distinct cultural group. The reviewed studies reveal that Hasidic Jews may seek spiritual healing and incorporate religion in their explanatory models of illness; illness attracts stigma; psychiatric patients’ symptomatology may have religious content; social and cultural factors may challenge health care delivery. The extant research has implications for clinical practice. However, many studies exhibited methodological shortcomings with authors providing incomplete analyses of the extent to which findings are authentically Hasidic. High-quality research is required to better inform the provision of culturally competent care to Hasidic patients.