Predictors of Placement Outcomes in Treatment Foster Care: Implications for Foster Parent Selection and Service Delivery

Treatment foster care (TFC) is a normalizing environment in which to treat those children whose particular needs are not addressed in traditional foster care and for whom an institutional setting is a restrictive and unnecessary alternative. However, when the foster care placements of these emotionally and behaviorally disturbed children fail, as they often do, the children are shifted from one home to another without the opportunity to experience permanence or emotional attachment, resulting in poor adjustment to foster care. Placement stability, which depends in part upon effective matching of foster children with potential foster families, is critical for achieving positive outcomes in TFC. Yet, there is a dearth of information to guide placement agencies in making decisions about matching foster children with families. Moreover, once a successful match has been made, it is equally vital that service delivery be of high quality so that permanence is maintained. We review research on the predictors of positive outcomes in foster care, focusing on studies involving emotionally or behaviorally disturbed children, and provide recommendations for selecting foster parents and for ensuring high quality foster care services and placement stability.     

Sexual Abuse Survivors: Identifying Symptoms and Special Treatment Considerations

Because of the prevalence of child sexual abuse, many adult counseling clients will have sexual abuse in their histories. Counselors should familiarize themselves with the symptoms of sexual abuse survivors to assist with disclosure. Failure to address the abuse will interfere with the success of the counseling process. Special sensitivity is required of counselors to provide a safe environment in which survivors can examine the pervasive impact of the abuse on their lives, explore and ventilate their feelings, and resolve the trauma so it ceases to block their development. An eclectic approach, including group counseling, is recommended.     

Children with Special Health Care Needs: Impact of Health Care Expenditures on Family Financial Burden

We investigated the relationship between health care expenditures for Special Health Care Needs (SHCN) children and family perception of financial burden. Using 2005/2006 National Survey of Children with Special Health Care Needs data, a multivariate logistic regression model was used to estimate the relationship between the SHCN child’s health care expenditure and perceived financial burden, while controlling for family and child characteristics. Our analysis suggests that health care expenditures for a SHCN child of $250 and more are associated with family perception of financial burden. In addition, families with lower socioeconomic status also perceived financial burden at lower level of expenditures. Members of the health care team who treat children with SHCN have an important role in understanding and assessing family financial burden as part of the care delivery to the child and the family. Our study reinforces the need to treat the whole family as the unit of care, especially when caring for children with special health care needs.     

儿童舒缓疗护整合模式的介绍及启示

基于文献分析的方法,梳理儿童舒缓疗护整合模式的发展历程,重点介绍儿童舒缓疗护整合模式中的儿科舒缓疗护服务理念、服务团队、服务内容、工作模式,探讨其对我国临床实践的启示。在深入分析我国儿童舒缓疗护开展的不足之处的基础上,未来我国相关临床实践可借鉴儿童舒缓疗护整合模式,通过宣传儿童舒缓疗护理念,提升儿童舒缓疗护的服务质量,建设儿童舒缓疗护服务支持体系,深入推动我国儿童舒缓疗护的发展。

     

Ethical Considerations for the Treatment of Youth in Foster Care

Mental health clinicians treating youth in foster care face several ethical challenges, such as competence for treating youth in foster care, understanding who can provide informed consent, and confidentiality. However, few articles have addressed these ethical concerns or provided recommendations for clinicians on how to navigate these issues. This article presents a brief summary of the foster care system, an overview of the major ethical challenges clinicians may encounter when treating youth in foster care, areas of the American Psychological Association’s Ethics Code, Code of Ethics of the National Association of Social Workers, and American Counseling Association Code of Ethics most germane to the treatment of youth in foster care, and general recommendations for clinicians treating this population.     

Provider Perspectives about Latino Patients: Determinants of Care and Implications for Treatment

Primary care settings are the gateway through which the majority of Latinos access care for their physical and mental health concerns. This study explored the perspectives of primary care providers regarding their Latino patients, particularly, issues impacting their patients' access to and utilization of services. Interviews were conducted with eight primary care providers-and analyzed using consensual qualitative research methods. In addition, observations were conducted of the primary care setting to contextualize providers' perspectives. Providers indicated that care for Latinos was impacted by several domains: (a) practical/instrumental factors that influence access to care; (b) cultural and personal factors that shape patients' presentations and views about physical and mental health and treatment practices; (c) provider cultural competence; and (d) institutional factors which highlight the context of care. In addition to recommendations for research and practice, the need for interdisciplinary collaboration between psychology and medicine in reducing ethnic minority disparities was proposed.     

Confidant Relations Among Taiwanese: Implications for Ethnic Chinese Health Care Treatment

The select individual(s) whom one trusts in sharing important personal matters is sometimes referred to as a confidant. The confidant relationship has received increasing attention in recent years as a major social factor contributing to individual health and wellness. Yet, little empirical data has been available to guide health researchers, policy-makers, and practitioners. In this study, 142 adult Taiwanese responded to a structured questionnaire. Participants comprised 105 females, 32 males, and five with sex unspecified (overall mean age?=?33.8, age range?=?18 to 74 years). They were asked whether they had a confidant, and if so, to describe various features of this relationship. Contrary to previous studies conducted in Europe and the Americas, our investigation found that Taiwanese men were equally likely as Taiwanese women to have a confidant (87.5 % of males and 89.5 % for females). Taiwanese women were significantly more likely to have a female rather than a male confidant, whereas males showed no such sex difference. A significantly higher percentage of confidants were non-family members rather than spouses or other immediate/extended family members. This finding is consistent with research on the relatively minor salience of emotional intimacy in Taiwanese marriages and the hierarchical structures of many Taiwanese families. The implications of our findings for enhancing Taiwanese and broader ethnic Chinese health treatment are discussed.     

Managed Care: Ethical Considerations for Counselors

Key factors and trends in health care will have an impact on the ethical practice of counselors. Ethical challenges to clinical practice presented by trends in managed care are discussed in relation to the American Counseling Association (1995) Code of Ethics and Standards of Practice. Recommendations for practice are also included.     

Comorbid ADHD: Implications for the Treatment of Anxiety Disorders in Children and Adolescents

Despite high comorbidity rates and potential clinical implications, the influence of co-occurring attention-deficit/hyperactivity disorder (ADHD) on outcomes of cognitive-behavioral treatment (CBT) for anxious youth remains poorly understood. In this qualitative review, the current literature on the influence of comorbid ADHD on CBT of youth with diverse anxiety disorders is explored. Peer-reviewed studies examining ADHD, at the diagnostic and symptom level, received highest priority. In addition, inasmuch as some studies did not isolate the effects of ADHD from other disruptive behavior disorders (DBDs: oppositional defiant disorder, conduct disorders), studies with the three DBDs were explored as well. Ten studies met our specified methodological criteria. Findings are discussed in relation to the following two factors: type of anxiety disorder and measurement of ADHD (diagnostic or symptom level) in these studies. There was evidence that youth with a variety of anxiety disorders and with co-occurring ADHD fared worse than their counterparts without ADHD. Additionally, grouping ADHD with other DBDs tended to obscure the negative impact of ADHD on treatment outcomes. Additional research is needed to delineate the influence of comorbid ADHD specifically on treatment outcomes for the various anxiety disorders. Clinical implications of treating anxious youth with comorbid ADHD are explored.     

Foster Children Caught in Loyalty Conflicts: Implications for Mental Health Treatment Providers

Fifty-two foster parents participated in a two-hour training on the topic of children caught in loyalty conflicts. Prior to and following the training attendees completed measures including one in which they rated their foster children's exposure to 15 different family situations which research indicates are likely to induce feelings of loyalty conflict in children. Analyses of these data indicate that each of the situations was endorsed by between one fourth and one half of the sample. Three-fourths of the foster parents endorsed at least one of the situations, with the average number 5.5. Implications for clinicians working with this population are discussed.     

Problems in Families with Gifted Children: Implications for Counselors

The authors consider, through a review of relevant literature and personal observation, the larger context of the family life of gifted children. The purpose is to identify possible problem areas for the counselor to assess and to suggest directions that the counseling process might take.     

Sustainable Family Care for Children with Disabilities

The majority of parents want to continue caring for their sons and daughters with disabilities at home, and they are expected and actively encouraged to do so. Notwithstanding, and for reasons that are not well understood, a substantial number of parents seek to place their disabled son or daughter out-of-home. The aim of this study was to investigate the attitudes of parent-carers in Alberta, Canada, toward out-of-home placement. The primary objective was to identify factors that may explain why some families, and not others, seriously consider out-of-home placement as an option for their child. This knowledge is vital for developing social care policies and programs that support parents and promote sustainable family care for children with disabilities. A stratified (by child age group) random sample of 538 families raising children with disabilities in Alberta, Canada took part. Participants completed the family life survey, which incorporated measures of child and family characteristics, sustainability of the daily routine, and out-of-home placement propensity. Results suggest that family placement propensity is inversely associated with the sustainability of the daily routine. Sustainability of the daily routine is, in turn, more strongly associated with social-ecological resources, including parental control-over-work and the adequacy of child care options, than with child characteristics, including activity limitations and behaviour problems. If families have the social-ecological resources they need to create and maintain a daily routine that is congruent with their values and goals, and with the needs, interests and competences of family members, then they are unlikely to give out-of-home placement any serious consideration.     

Fetal Alcohol Syndrome: Implications and Counseling Considerations

This article presents the special considerations in counseling fetal alcohol syndrome children and their mothers.     

Cultural Considerations for Psychologists in Primary Care

Many health concerns in the United States (e.g., diabetes) are routinely managed in primary care settings. Regardless of the medical condition, patients’ health is directly influenced by factors such as healthcare providers and cultural background. Training related to how behaviors influence health, coupled with training on how cultural diversity intersects with mental health, allows psychologists to have the relevant expertise to assist in the development of primary care behavioral health interventions. However, many psychologists in primary care struggle with how to integrate a culture-centered paradigm into their roles as behavioral health providers. This paper provides an introduction on how three culture-centered concepts (providers’ cultural sensitivity, patient–provider cultural congruency, and patients’ health literacy) can be applied in primary care using the Five A’s Organizational Construct and a model of cultural competence. In addition, the paper includes a section on integration of cultural considerations into consultation and training and concludes with a discussion of how the three culture-centered concepts have implications for health equity.     

Inpatient Group Psychotherapy: Practical Considerations and Special Problems

A comparison is made between group-analytic and group focal conflict theory in terms of the conceptualization of the group as a whole; the emergence of group-level phenomena from the interaction of individuals; the associative flow as the material for therapy; facilitative and nonfacilitative group conditions; the therapist's aims on behalf of the persons in the group and perceived routes toward therapeutic gain; general factors contributing to therapeutic gain; specific factors contributing to therapeutic gain; and the therapist's role. Differences in terminology are examined to determine whether and how they reflect differences in substance. Many similarities and some differences in emphasis can be shown to exist. Both approaches generate respect for the power and potential of the group to support significant reexperiencing, with attendant opportunities for personal benefit and change.     

Antecedent Selection: Comparing Simplified and Typical Verbal Antecedents for Children with Autism

This study measured the differential effects of simplified and typical verbal antecedents on acquisition of picture discriminations for four preschool children with autism. During baseline probes, participants emitted no correct selection responses to pictures of common stimuli during either simplified or typical verbal antecedent conditions. Using an adapted alternating treatments design during training, instructors presented a simplified verbal antecedent (i.e., “Give me car”) or a typical verbal antecedent (i.e., “One of these is a car. Which one is it?”), and differentially reinforced participants’ correct selection responses given the target picture and two non-targets. Results showed that one participant emitted more correct responses during simplified than typical verbal antecedent conditions, one participant emitted more correct responses during typical than simple verbal antecedent conditions, and there was no clear difference for the other two participants.     

Crisis Model for Older Adults: Special Considerations for an Aging Population

As the U.S. population ages, counselors must begin structuring their interactions to meet the unique needs of older adults, especially in the area of crisis intervention. The authors propose a new crisis intervention model that accounts for the needs of older adults in crisis by giving special attention to the roles of advocacy, education, and prevention.     

Models of Psychotherapy: Implications for Pastoral Care Practice

Pastoral care givers are called to provide care and counseling to parishioners that are suffering in many ways. A core question is what does a pastor rely on to provide this care? Pastors usually call on models of psychotherapy to inform their care giving. A framework of theological anthropology, cosmology, soteriology and harmatiology is developed for analyzing the worldviews inherent in models of psychotherapy. The specific models of Adler’s Individual Psychology, Narrative therapy, Horney’s personality theory, and Intersubjective theory are used to demonstrate the application of this framework. Several pastoral care implications are developed following the application of the framework.     

Behavior Treatment: General Considerations

The principal goal of behavior treatment for retarded clients is that of modifying behavior as it occurs in a given environment in such a manner that it becomes more appropriate to that environment. The therapeutic or change agents can involve a variety of persons other than the counselor, teacher, and client--this may include parents, peers, work supervisors and others who can provide supportive influences. Education and rehabilitation programs should be tailored to the occupational and social environment of the retarded client and designed to teach those behavior patterns that are relevant to that environment. Additionally, the work tasks for which retarded clients are trained should be highly structured and routine. Excessive demand for adaptability or decision making is a major cause of training failure for retarded clients.