A family-based approach to adult mental disorders

Recent research studies have provided strong support for a collaborative approach between families and mental health services in the clinical management of major mental disorders. A comprehensive approach to adult mental health care that employs cognitive-behavioural family therapy as the basis for clinical assessment and treatment is described. This model emphasizes home-based intervention, collaboration with primary care, targeted specific interventions, achievement of the personal goals of index patients and their family members, long-term rehabilitation, and assessment of benefits and costs.     

Stress,coping, and resources in mothers of adults with developmental disabilities

This study examined the relationship of various stressors, coping resources, and coping strategies on the level of stress reported by 147 mothers of adults with delayed development. A sense of mastery and the mother's health as well as financial well-being were significantly negatively related to stress. Coping behaviours of reframing of the problem and acquisition of social support were also significantly negatively related to stress. Implications of the results of this study for service providers are discussed.     

Case study: Reinforcement control of severe aggression exhibited by a child with autism in a family home

This clinical case study describes in-home treatment of severe aggression and tantrum behavior exhibited by an 11 -year-old child with autism, using methods of differential reinforcement comparable to those of a case study by Luiselli (1990). No significant reductions in problem conduct occurred when a parent implemented differential reinforcement of other behavior (DRO) in conjunction with publicly posted ‘good behavior rules,’ physical management training, and redirection to relaxation. Control was established when the child was reinforced for compliance with task demands in conjunction with extinction, implemented directly by professional support staff working in the home. Despite demonstrable parental consistency, systematic training, and fading of supports, results were not maintained at follow-up. The generality of differential reinforcement as a practical intervention for severe aggression in family homes is questioned.     

Science Anxiety as a Function of Gender and Experience

This study examined the influence of gender and various background factors on science anxiety. Students (50 women, 37 men) took the Science Anxiety Scale (Mallow, 1994), provided information about high school and college academic accomplishments, described gender-role stereotyping in the home, and evaluated their science teachers and science experiences. Most participants were Caucasian and from an upper-middle class background. Women were not uniformly more science anxious and had a relatively similar science background to men, although they had higher science grades in high school and did report less stringent sex-role socialization in the home. However, students with high science anxiety took fewer science courses in college, had lower SAT-Q scores, and reported that their high school science teachers were not helpful. The findings regarding gender- and anxiety-linked differences are discussed in terms of women's and men's differential interpretations of their abilities, the influence of parental gender typing on pursuit of science, and the gender-appropriateness of studying science.     

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.