Assessment of HIV counselling and social care services in a London hospital

The use of, and satisfaction with, counselling and social care services was investigated among HIV-infected clients attending HIV specialist climes at Guy's Hospital and Southwark Social Services, London. A survey of 71 clients with HIV infection was carried out using a self-administered questionnaire. The greatest demand was for advice about income support, housing, counselling for the HIV test, counselling for depression or anxiety, psychological support for coping with HIV, help with sleeping problems, mobility allowance, and help with furniture/household appliances. Overall, 57% thought the service was good or excellent; 66% of respondents thought they would use the services in the future. Over nine in ten clients had used the psychosocial support services at some stage since their HIV diagnosis, although only two-thirds anticipated that they would have need of these services in the future. The psychosocial support service will need to remain responsive to the shift in demand for this service, as well as the changing needs of clients who use it.     

Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5

The relationships between severity, chronicity, and timing of maternal depressive symptoms and child outcomes were examined in a cohort of 4,953 children. Mothers provided self-reports of depressive symptoms during pregnancy, immediately postpartum, and when the child was 6 months old and 5 years old. At the age 5 follow-up, mothers reported on children's behavior and children completed a receptive vocabulary test. Results suggest that both the severity and the chronicity of maternal depressive symptoms are related to more behavior problems and lower vocabulary scores in children. The interaction of severity and chronicity of maternal depressive symptoms was significantly related to higher levels of child behavior problems. Timing of maternal symptoms was not significantly related to child vocabulary scores, but more recent reports of maternal depressive symptoms were associated with higher rates of child behavior problems.     

Integrating biological and social processes in relation to early-onset persistent aggression in boys and girls

This study examined the relationship between biological and social risk factors and aggressive behavior patterns in an Australian high-risk sample of 370 adolescents. Perinatal, temperamental, familial, sociodemographic, and behavioral data were collected during interviews completed during pregnancy. immediately postpartum, and when the children were 6 months old and 5, 14, and 15 years old. Youths were given tests of verbal and neuropsychological functioning at the age 5 and age 15 follow-ups. Youths were divided into early-onset persistent aggression, adolescent-onset aggression, and nonaggressive behavior groups. Results revealed that the interaction of biological and social risk factors was significantly related to early-onset persistent aggression. Gender and developmental phase of measurement moderated the relationship between biosocial risks and the outcomes of early-onset persistent aggression and adolescent-onset aggression.     

Maintenance of Treatment Gains: A Comparison of Enhanced,Standard, and Self-directed Triple P-Positive Parenting Program

This report describes the 3 year outcomes of three different variants of the Triple P-Positive Parenting Program, a behavioural family intervention. Families were randomly assigned to one of three intervention conditions or to a waitlist condition. At 1 year follow-up there were similar improvements on observational and self-report measures of preschooler disruptive behaviour for Enhanced, Standard and Self Directed variants of Triple P. At 3 year follow-up (completed by 139 families), each condition showed a similar level of maintenance of intervention effects. Approximately 2/3 of preschoolers who were clinically elevated on measures of disruptive behaviour at pre-intervention moved from the clinical to the non-clinical range. Across conditions, there was a comparable preventive effect for each intervention for these high risk children. The implications of the findings for the development of brief, cost effective parenting interventions within a public health framework are discussed.     

Selective Disclosure: A Pilot Investigation into Changes in Family Relationships Since HIV Diagnosis

The aim of this research was (1) to determine the impact of HIV infection on the family as experienced by a sample of HIV infected males and females attending a London hospital HIV/AIDS service, and (2) to examine the feasibility of conducting this investigation in a clinical setting. Fifty patients (predominantly gay males and heterosexual females) attending an HIV outpatient clinic were assessed using a self-administered questionnaire covering family relationships and disclosure of HIV. The results showed a similarity for gay males and heterosexual females in the definition of 'close family', yet a difference in the disclosure of HIV status to their family of origin. We conclude that the impact of HIV on the family can be examined in a clinical setting, although the question of validation must be addressed.     

Genograms in counselling practice: A review (Part 1)

Genograms are an important clinical tool for many counsellor, therapists and other health care professionals and can be used for assessment, gathering information on family relationships and exploring themes in counselling practice. This article reviews the recent literature on genograms and examines the efficacy and use of this tool from a number of perspectives including the use of genograms in health care, psychological counselling and in genetic counselling. The predictive value, and future development of the use of the genogram in counselling are also discussed.     

The impact of disclosure of HIV on the index patient's self-defined family

For most people facing a serious illness, the family is regarded as the primary source of support. Research suggests that patterns of support may differ for people infected with HIV. Access to support normally requires disclosure of one's health problem to others. This study examined the impact of disclosure of HIV on the index patient's self-defined family. Most participants were gay men attending a London HIV clinic. Both they and the care-givers whom they identified to the researchers were interviewed. The results of this qualitative study highlight the fact that many gay men with HIV do not regard their biological family as their primary social support system. Friends and partners were commonly cited as primary care-givers. Most of those interviewed who provided support to the infected individual clearly remembered the disclosure event. They also had a number of emotional reactions, over time, to disclosure. We argue that adjustment to illness among care-givers is a complex two-way, reciprocal process whereby the infected individual and care-giver take subtle cues from one another in terms of how they appear to one another to cope. Some emotionally painful feelings may be experienced but not openly expressed. Therapists who work with families affected by illness should first learn from the patient who he or she defines as 'family'. They should also enquire about the impact of disclosure of illness on all care-givers as well as subsequent reactions and unexpressed feelings associated with this.     

Family relationships in Greek insulin-dependent diabetics

This exploratory pilot study was designed to investigate the relationship between Greek Insulin Dependent Diabetics and their family members. A secondary purpose was to explore the availability of sources for diabetes related education and to assess whether diabetics and their family members had seen a psychologist for counselling. Twenty patients with Insulin Dependent Diabetes Mellitus (IDDM) (Group A) and their parents (Group B), were randomly selected from a group of families attending the Athens Diabetic Centre of Social Security. Children and parents were given a specially prepared questionnaire, which addressed the impact of IDDM on their relationships and daily activities. There was also an interview with each of them separately. The results indicate that sources of education for diabetics are limited in Greece and that the majority of diabetics and their families have never seen a psychologist with a view to assessment and support. It is concluded that the diabetics in this study were generally content in their relationships with their parents although overprotectiveness by parents is a problem sometimes experienced by the children. After the initial shock of the diagnosis of diabetes, the majority of the families gradually returned to their premorbid state and relationship patterns.     

Counselling patients with AIDS-associated Kaposi's sarcoma

Kaposi's Sarcoma is a disfiguring and feared symptom of HIV disease. Structured interviews of patients, family members and health care providers were conducted in three settings: USA (11), UK (8) and sub-Saharan Africa (20). These sought to identify: (a) contextual and cultural differences; (b) the main fears of patients and others; (c) practical ways of addressing these and coping with stigma, and (d) methods for ‘inoculating’ non-KS patients against psychological distress before there is any evidence of clinical signs or symptoms. It was found that context and culture mediated social responses to KS and disfigurement. Patients in Africa seemed to be less affected than Western patients by appearance and stigma. Issues relating to secrecy were common to both groups. Compliance with treatment was good as long as it was efficacious. When no further treatment of Kaposi's sarcoma was possible, there is greater emphasis on counselling. Patients (particularly in the West) appreciated treatment of lesions on the hands and face, and advice about cosmetic applications, even if lesions on other parts of the body could not be treated. Perceptions about being able to find a new partner were reduced among Western patients with KS. Patients with KS or an associated fear may benefit from counselling in which ideas relating to stigma, secrecy, treatment, cosmetic applications, the effects on family and fears of disfigurement are discussed.