Mandated Reporting of Abuse/Maltreatment of Older Adults: A Primer for Counselors

Maltreatment of older adults is a serious and underrecognized problem. Every state and 6 Canadian provinces have enacted legislation to protect vulnerable older adults from abuse, and many require that mental health professionals report disclosures of abuse to authorities. However, these laws have received little attention in the counseling literature. This article examines the scope of maltreatment of older persons and describes the content of elder abuse and elder maltreatment laws, with special focus on counselors' responsibilities to report maltreatment to authorities. It concludes with strategies for assessing maltreatment and with implications of these laws for confidentiality and informed consent.     

Effectiveness of an attachment-based intervention for the assessment of parenting capacities in maltreating families: A randomized controlled trial

Even though Parenting Capacity Assessments (PCAs) are essential for child protection services to support placement decisions for maltreating families, presently no evidence-based PCA protocols are available. In this randomized controlled trial, we tested the quality of an attachment-based PCA protocol based on Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD). We recruited 56 parent-child dyads (M_age children = 3.48 years) in Dutch family residential clinics that conduct PCAs to support placement decisions. After pretest, families were randomized to receive the Regular Assessment Procedure (RAP) (n = 28), or an additional assessment based on VIPP-SD (n = 28). An immediate post-test and a 10-month follow-up were conducted. Multilevel models showed that therapists felt equally confident about their recommendations regarding child placement for both groups and that they equally often modified their initial placement recommendations. Moreover, children in the VIPP-SD group did not show fewer behavior problems and did not experience recurring child maltreatment less often than children in the RAP group. Thus, we found no evidence that PCAs incorporating the VIPP-SD protocol outperformed PCAs as usual. We discuss possible explanations why in the current study VIPP-SD did not seem to add to the quality of the RAP.     

Child-directed interaction: prediction of change in impaired mother-child functioning

The first phase of parent-child interaction therapy (PCIT), called child-directed interaction, teaches parents to use positive and differential social attention to improve the parent-child relationship. This study examined predictors of change in mother and child functioning during the child-directed interaction for 100 mother-child dyads. The children were 3-6-years-old and diagnosed with oppositional defiant disorder. After establishing that significant improvements occurred in mother report of child disruptive behavior, parenting stress, and parenting practices, these three variables were combined to form a latent impaired mother-child functioning construct. Structural equation models were examined using maternal demographic and psychosocial variables as predictors of impaired mother-child functioning before and after the child-directed interaction. Mothers' self-reported daily hassles and depressive symptomatology predicted 74% of variance in impaired mother-child functioning before treatment. Mothers' report of social support predicted impaired mother-child functioning after the child-directed interaction, with 57% of the variance accounted for in this longitudinal model. These findings suggest the importance of improving maternal social support during the initial phase of PCIT.     

Relations of intrinsic spirituality with health status and symptom interference

The purpose of this study was to examine the relationships between spiritual experience and current health status and between spiritual experience and subjective experience of symptom interference. Symptom interference is the extent to which symptoms of physical or psychological illness limited participants' activities of daily living. Participants were 49 volunteers who were enrolled in a spiritual fitness class at a variety of denominational Christian churches in Plano, Texas. The sample ranged in age from 22 to 65 years, and 84% were women. The Index of Core Spiritual Experiences and the Medical Symptoms Checklist were administered. Current health status and symptom interference were utilized from the self-report checklist. It was predicted that Index scores would be significantly different based on participants' health status and that Index scores would correlate significantly with participants' ratings of symptom interference. Analysis indicated that Index scores were significantly higher (p = .02) for participants with no current medical diagnosis than for those currently experiencing either a life-threatening or a chronic medical or psychological disorder. Also, the percentage-bend correlation between Index scores and scores for interference of symptoms in daily life was significant ((r)Pb = -.33, p = .02). These results suggest that the report of core spiritual experiences may be related to better current health status. These findings have implications for understanding the role of spirituality in the prevention of illness and in an individual's ability to cope with illness.     

‘Too busy’? Father's attendance for family appointments

Fathers are often less likely to attend for appointments with their referred children at family and child psychiatry clinics than are mothers. The literature related to this topic is examined. A study of fathers' attendance at family sessions is reported, in which attenders are compared to non-attenders. It is concluded that conventional suppositions regarding fathers' attendance, such as work hours and family roles, are not as important predictors of fathers' attendance as fathers' relationships with their own fathers and current relationships with their partners. Clinical implications are examined.     

Threshold recognition of phantom-contour objects requires constant contrast velocity

Recognition of phantom objects--those with contours defined by rapid contrast reversal of adjacent fields of dark and light random dots--was investigated under conditions of abrupt or ramped onset and offset. Discrimination contrast thresholds were determined for a random-dot phantom letter in four possible orientations. For abrupt onset or offset, thresholds were almost independent of the duration of presentation time, over a range that varied tenfold, from 34-340 msec. However, when the onset and offset were shaped by a triangular envelope, thresholds were raised, so that form blindness occurred even when peak d ot contrasts exceeded 60%. Also under ramped onset and offset conditions, threshold contrast varied strictly linearly with stimulus duration in all subjects, suggesting a new construct--contrast velocity, the rate of change of contrast critical for phantom-object recognition.     

Psychological trauma and PTSD symptoms as predictors of substance dependence treatment outcomes

Psychological trauma and post-traumatic stress disorder (PTSD) may complicate and reduce the effectiveness of treatment for substance use disorders (SUDs). This study assessed trauma history and symptoms of simple and complex PTSD at baseline in a randomized trial of contingency management (CM) compared to standard treatment (ST) with 142 cocaine- or heroin-dependent outpatients. History of exposure to each of eight types of psychological trauma was unrelated to treatment outcome, except for witnessed assaults and emotional abuse. Complex PTSD symptoms were inversely associated with short-term treatment outcomes, and PTSD symptoms were positively related to long-term outcome, independent of the effects of demographics, psychological distress, baseline substance use status, and treatment modality. Complex PTSD symptoms warrant further study as a potential negative prognostic factor in SUD interventions.