The aggression-coercion cycle: Use of seclusion and restraint in a child psychiatric hospital

The widespread use of seclusion and restraint in child psychiatric hospitals to manage aggression and noncompliance is based on the assumption that coercive consequences reduce the frequency of undesirable behaviors exhibited by the patients. We report a study of the use of seclusion and restraint in a public child psychiatric hospital during a 3-year period. Twenty-eight percent of the patients had been secluded or restrained a total of 1670 times. About 25% of these patients had been secluded more than five times during their hospitalization, and 32% had been placed in restraints more than once. Behaviors that typically resulted in repeated seclusion included physical aggression toward staff, verbal aggression toward peers, non-compliant or oppositional behavior, and self-harm. Variables that predicted patients most at risk for repeated seclusion included age, gender, and psychiatric diagnosis. The predictor variables for those most at risk for repeated restraint included age, property destruction, and self-harm. The high rates of use of seclusion and restraint suggest that these methods for controlling the behavior of children and adolescents in this child psychiatric hospital may not have been therapeutic. We suggest that staff in such hospitals engage in a pattern of behavior characterized by an aggression-coercion cycle, in which increasingly aggressive and coercive behaviors are exhibited by both patients and staff.     

Compassion: An east‐west comparison

Compassion is an emotion that occupies a central position in Mahāyāna Buddhist philosophy while it is often a neglected subject in contemporary western philosophy. This essay is a comparison between an Eastern view of compassion based upon Mahāyāna Buddhist perspectives and a western view of the same emotion. Certain principles found in Mahāyāna Buddhist philosophy such as the Bodhisattva Ideal, and suffering (dukkha) to name two, are explored for the information they contain about compassion. An essay by Lawrence Blum is taken as representative of a Western view (but not exclusively) and it is analyzed for its shortcomings in light of the Buddhist view. The conclusion briefly describes the value of understanding an eastern view on compassion as a means of filling the void one finds in western medical ethics discourse which focuses so heavily, and redundantly, upon issues such as patient autonomy and paternalism.     

The effects of a response cost treatment tactic on hyperactive children

In a pilot study, a multielement design was used to assess the effectiveness of a response cost procedure on a 7-year-old child's hyperactive behavior and academic performance across days. The procedure was effective in reducing off-task behavior and in increasing academic assignment completion. In Experiment 2, three strategies were compared to a no-treatment baseline in treating an 8-year-old hyperactive child: drug (Ritalin) alone, response cost alone, and drug plus response cost. The cost program alone and the cost program combined with medication were effective in reducing off-task behavior and in increasing academic performance. In both studies, the procedure was viewed by the teachers as practical and effective for use in a classroom setting. The subjects liked the cost system and believed that they completed more academic work when it was operative.     

A faith for all seasons

A FAITH FOR ALL SEASONS:ISLAM AND WESTERN MODERNITY. By Shabbir Akhtar. London: Bellew Publishing, 1990. 251pp. Hb. £25.00. ISBN 0–947792–41–4.     

Strategic Revenue Management under Uncertainty: A Case Study on Real Estate Projects in India

This paper proposes an approach for strategic revenue management under uncertainty for real estate projects. It integrates three modelling techniques: first, artificial neural network integrated support vector machines for forecasting the profit and loss‐making real estate residential projects; second, analytical network process approach using decision making trials and evaluation laboratory methodology for establishing interrelationships among factors; and third, multiobjective genetic algorithm approach for obtaining optimal numbers and types of apartments in a real estate project. We compare the respective revenues generated with the new number of apartments and price from the suggested revenue maximization model and that of the old practiced one through a case study of India. Copyright © 2015 John Wiley & Sons, Ltd.     

Reconciliation and the Great (whole) Commission

The label “Great Commission,” attributed to Matthew 28:16-20, has been for evangelicals the inspiration for the evangelization of the world for over a century. But there is more to the commissioning words of Jesus than the ministry of evangelism. This article contends that a missiology of reconciliation, applied to “the Great Commission,” uncovers the broader, holistic nature of the mission of the church. In addition to evangelism, reconciliation as mission also includes peacemaking and stewardship.     

Losing My Religion as a Natural Experiment: How State Pressure and Taxes Led to Church Disaffiliations between 1940 and 2010 in Germany

The sociological literature has produced a remarkably consistent picture of the quantitative patterns of religious disaffiliations in Western countries. This article argues, and demonstrates, that strong changes in a social context may lead individuals to disaffiliate rapidly, leading to very different aggregate effects from those in the “western model.” We use the unique situation of the separation of Germany from 1949 to 1989 and its subsequent reunification as a “natural experiment” to show just how much the relationships routinely found can be disrupted under changed conditions. The state socialist “treatment” affected religious disaffiliations in East Germany profoundly as it (a) made disaffiliations 10 times more probable in the East than in the West in the 1950s and 1960s, (b) shielded East German church members from factors that led to mass disaffiliations in the West in the late 1960s and early 1970s, (c) reversed the education‐disaffiliation link in the East, thus making disaffiliation more likely among the less educated, and (d) led to an especially strong increase in disaffiliations in the East right after the reunification     

Changing the Criminal Justice System Response to Sexual Assault: An Empirical Study of a Participatory Action Research Project

In jurisdictions throughout the United States, thousands of sexual assault kits (SAKs; also known as a “rape kits”) have not been submitted by the police for forensic DNA testing. DNA evidence may be helpful to sexual assault investigations and prosecutions by identifying perpetrators, revealing serial offenders through DNA matches across cases, and exonerating those who have been wrongly accused. This paper describes a longitudinal action research project conducted in Detroit, Michigan after that city discovered approximately 11,000 untested sexual assault kits in a police department storage facility. We conducted a root cause analysis to examine individual, organizational, community, and societal factors that contributed to the development of the rape kit backlog in Detroit. Based on those findings, we implemented and evaluated structural changes to increase staffing, promote kit testing, and retrain police and prosecutors so that cases could be reopened for investigation and prosecution. As we conducted this work, we also studied how this action research project impacted the Detroit criminal justice system. Participating in this project changed stakeholders’ attitudes about the utility of research to address community problems, the usefulness of DNA evidence in sexual assault cases, and the impact of trauma on survivors. The results led to new protocols for SAK testing and police investigations, and new state legislation mandating SAK forensic DNA testing.