Systematic Monitoring of the Implementation of a Case Management Model

A systematic approach for monitoring case management service provision and the results obtained when this approach was applied to a program for community-dwelling elders with severe mental illness are presented. A detailed, closed-ended, daily service log was used to collect data on 713 client-contact days. Participants (N = 24) were predominantly female (71%), were White (63%) or African American (37%), and tended to have diagnoses of either schizophrenia (42%) or major depression (21%). Services were delivered most frequently in the client's home (47%), the program office (35%), or by phone (27%); most frequent activities were monitoring psychiatric symptoms/medications (62 %), and monitoring physical symptoms or medications or both (54%). Service characteristics did not differ with regard to demographics but did vary with living situation and psychiatric diagnosis. The findings point to the need for flexible programs capable of meeting diverse service needs as well as the utility of a daily service log in studying case management.     

Discomfort with space and motion: A possible marker of vestibular dysfunction assessed by the situational characteristics questionnaire

Space and motion discomfort (SMD) refers to the situational specificity of symptoms occurring in some patients with vestibular dysfunction, such as those with balance disorders and some with panic disorder. SMD occurs in situations characterized by inadequate visual or kinesthetic information for normal spatial orientation. We report the results of two studies of the construct validity of the Situational Characteristics Questionnaire (SitQ), which has two subscales, both of which measure SMD: the SMD-I and SMD-II. In Study 1, the SitQ was administered to members of a self-help group for balance disorders, a psychiatric sample consisting of patients with panic disorder, nonpanic anxiety disorders, depression, and a sample of normals. SMD levels were the highest in the self-help balance group, next to the highest in the panic groups, and lowest in the remaining groups. In Study 2, the SitQ was administered to otolaryngological patients with vestibular dysfunction and to patients with hearing loss. SMD levels were higher in the vestibular patients. Data on internal consistency, test-retest reliability, and convergent and discriminant validity are presented. The SitQ, particularly the SMD-II, is recommended for quantifying space and motion discomfort in patients with anxiety and/or balance disorders.Study 1 was funded by MH 40757. Study 2 was funded by a grant from the Upjohn Company and MH 19816.     

Applying Research Domain Criteria to the study of emotion dysregulation in infancy and early childhood

Emotion regulation is a principal task of early development. The failure to develop effective emotion regulation skills is associated with behavioural, academic, psychological and socioemotional difficulties. Although researchers have studied emotion regulation for decades, work on emotion dysregulation—defined as the inability to maintain emotional control, engage with the environment or recover from distress in a developmentally appropriate manner—is rare and there are discrepancies in its conceptualisation among very young samples. While some scientists refer to emotion dysregulation as if it were a discrete concept, it may be more accurately depicted as a multidimensional system of developmental processes. The National Institute of Mental Health's Research Domain Criteria (RDoC) is a framework that allows researchers to track dysfunction across multiple areas of analysis and may be an ideal system for exploring the multidimensional nature of infant emotion dysregulation. In this paper, we draw on empirical studies to describe how the RDoC framework can be used to support studies of emotion dysregulation in infancy. This proposed model can also serve as a roadmap for future researchers to follow to generate the evidence base for a multidimensional conceptualisation of infant emotion dysregulation and its underlying mechanisms.     

A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema

Objective: Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

Design: Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

Main Outcome Measures: Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy–Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

Results: There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

Conclusion: These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.     

Investigating the Potentially Protective Effects of Neighborhood Processes in Intimate Partner Violence

Women who experience intimate partner violence (IPV) are often mothers. This study seeks to further the understanding of IPV in families, as well as social factors that can prevent violence from occurring. Based on existing literature and theory, we hypothesize that social cohesion and informal social control are associated with lower rates of IPV. To test this theory, we use a total sample of 2,344 mothers with partners surveyed in the Families and Child Wellbeing study and analyze the effects of neighborhood social cohesion and informal social control on reported IPV experiences. This was done by using a negative binomial regression. Findings show that informal social control is associated with lower levels of IPV experiences among mothers with partners.     

Building seven bridges with young asylum seekers living in exile in the UK (Part 1)

This first paper focuses on the key themes that emerge in work with young asylum seekers and refugees and on our assessment of the needs of individual young asylum seekers, alongside the ways in which we meet the needs of these young people given the holistic, integrated and developmental approach of the Baobab Centre. The fact that psychotherapeutic methods are useful in this context and the need to have flexible approach to psychotherapy in our context are two ideas explored here. This paper will explore how we can slowly build sturdy and protective connections during and after the developmental years following experiences of sequential violence. This means building bridges and links within the internal worlds of these young people between: (1) different aspects of themselves that emerge after violence and loss; (2) themselves and their peers; (3) listening adults; (4) various social influences; (5) cultural influences; (6) their past, present and future lives; (7) links with local, national and international communities all of which are addressed via a ‘Transitional Non-Residential Therapeutic Community’. A case example will illustrate how this work may take place.     

Building seven bridges with young asylum seekers living in exile in the UK (Part 2)

This paper is derived from a talk given in November 2016 as the Birkbeck Counselling Association Autumn Talk in collaboration with Psychodynamic Practice. The original talk has been divided into two related papers of which this is the second, concentrating on the effects on young asylum seekers of the political and social situation in which they find themselves when they reach the UK. Both papers explore how, working with young asylum seekers, we can slowly build sturdy and protective connections during and after the developmental years following experiences of sequential violence. This means building links within the internal worlds of these young people between themselves and: (i) different aspects of themselves that emerge after violence and loss; (ii) their peers; (iii) listening adults; (iv) various social influences; (v) cultural influences; (vi) their past, present and future lives; (vii) links with local, national and international communities. Describing further the work that takes place at the Baobab Centre, a ‘transitional therapeutic community’, and using case material to illustrate this, the author raises the challenge of how we might best address the needs of this group of children, adolescents and young adults who objectively have to live for several years of their lives in a situation of ongoing uncertainty that is in fact much more than a young person can bear. As Jo Goldstein a legal specialist, Anna Freud a child psychoanalyst and Al Solnit a paediatrician write, in their trilogy of works, States and State Agencies cannot parent children, and children need involved parenting, (i.e. involved relationships with individual caring adults). Often for children separated from their original families, the parenting role is split between large bureaucracies and foster carers who work with agencies outsourced from the Social Services Departments. Yet this country makes Social Services Departments and the Home Office responsible for decisions about whether or not child asylum seekers might remain in the UK, in fact often without a very deep assessment and hence little knowledge and understanding of their experiences and their developmental needs. Asylum seeking minors usually have to wait for decisions about their safety and protection, and about permanence and continuity, for a much longer period of time than a child can bear.     

Predicting Treatment and Follow-up Attrition in Parent–Child Interaction Therapy

Predictors of attrition from individual parent–child interaction therapy were examined for 99 families of preschoolers with disruptive behavior disorders. Seventy-one percent of treatment dropouts were identified by lower SES, more maternal negative talk, and less maternal total praise at pretreatment. Following PCIT, families were randomly assigned to an Assessment-Only or Maintenance Treatment condition. Higher maternal distress predicted 63% of dropouts in the Assessment-Only condition. Lower maternal intellectual functioning predicted 83% of dropouts from Maintenance Treatment. Findings highlight a continuing need for evidence-based retention strategies at various phases of engagement in PCIT. This study was funded by the National Institute of Mental Health (RO1 MH60632). We thank the members of the UF Child Study Laboratory for their contributions to this study.