The detection and management of mental health disorders in pediatric primary care

We reviewed the literature on the detection and management of mental health disorders within the context of pediatric primary care. Pediatricians have displayed a low sensitivity and high specificity in research investigating the detection of mental health impairment in children. Active management efforts characterize approaches to identified cases with more recently trained primary care pediatricians displaying a wider range of skills in managing mental health disorders. Few efforts have been made by pediatric psychologists to develop strategies for enhancing detection rates and management or to empirically evaluate the integration of pediatric psychology services into the primary care context. A conceptual model of factors influencing detection rates and ongoing management of mental health disorders within pediatric primary care is presented. Recommendations are made for more direct involvement of pediatric psychologists within the primary care context.     

Supporting the Need for an Integrated System of Care for Youth with Co-occurring Traumatic Stress and Substance Abuse Problems

Adolescents are at high risk for violence exposure and initiation of drug use. Co-occurring substance use and trauma exposure are associated with increased risk of mental health disorders, school underachievement, and involvement with multiple systems of care. Coordination and integration of systems of care are of utmost importance for these vulnerable youth. This study delineates the negative sequelae and increased service utilization patterns of adolescents with a history of trauma, substance abuse, and co-occurring trauma and substance abuse to support the need for integrated mental health and substance abuse services for youth. Data from two national sources, the National Child Traumatic Stress Network and Center for Substance Abuse Treatment demonstrate the increased clinical severity (measured by reports of emotional and behavioral problems), dysfunction, and service utilization patterns for youth with co-occurring trauma exposure and substance abuse. We conclude with recommendations for an integrated system of care that includes trauma-informed mental health treatment and substance abuse services aimed at reducing the morbidity and relapse probability of this high-risk group.     

Stress in Clinical Psychology Trainees: Current Research Status and Future Directions

The purpose of this article is to present the current status of the literature related to stress in clinical psychology trainees (CPTs), and to offer research directions for investigating stress in this population and ways to enhance self‐care in these individuals. The following conclusions emerge from the review: (1) CPTs are vulnerable to elevated stress; (2) undue stress can negatively impact CPTs' personal and professional functioning and, in turn, result in less than optimal standards of care for clients; (3) there is a dearth of studies on stress in this population and no published intervention studies; (4) incorporating self‐care strategies into clinical psychology training is recommended; and (5) “third‐wave” cognitive behaviour therapy stress management interventions have been efficacious in comparable populations. In view of the potential costs of elevated stress to trainees themselves and their clients, research on stress and stress management in this population is of a high priority. Broad research agendas are proposed for these two domains. Modifications to clinical training programmes to reduce trainee stress are required and should be evidence‐based and systematically revaluated.     

Longing,Dread and Care: Spengler’s Account of the Existential Structure of Human Experience

ABSTRACT

In The Decline of the West Spengler puts forward a type of philosophical anthropology, an account of the structures of human experiential consciousness and a method of “physiognomic” analysis, which I argue has dimensions that can be understood as akin to existential phenomenology. Humanity, for Spengler, is witness to the creative flux of “Becoming” and constructs a world of phenomena bounded by death, underpinned by the two prime feelings of dread and longing and structured by the two forms of Destiny (Time) and Direction (Space). Human existence, Spengler argues, is future-directed and open in the sense that there is a certain degree of freedom in the ways in which humanity can actualize its existential possibilities. In the course of elaborating the existential implications of this future-orientation, Spengler introduces the concept of care (Sorge), the fundamental experiential structure.     

Gender and Sexuality in the Pastoral Encounter

Abstract

At the ‘Embodied Ministry: Gender, Sexuality and Formation’ conference at which the articles in this special issue were delivered, three people in active ministry in different denominations — United Reformed Church, Metropolitan Community Church and Roman Catholic — were invited to take part in a panel discussion on gender and sexuality in the pastoral encounter. Their remarks were originally delivered in this conversational context. Martin Pendergast chaired this panel discussion.     

Maternal and paternal infant representations: A comparison between parents of term and preterm infants

Objective

Research on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations.

Method

Mothers and fathers of term infants (≥37 weeks of gestational age, n = 71), moderately preterm infants (≥32–37 weeks of gestational age, n = 62) and very preterm infants (<32 weeks of gestational age, n = 56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D).

Results

The three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal.

Conclusion

Given the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations.     

Nonmaternal care hours and temperament predict infants’ proximity-seeking behavior and attachment subgroups

Using the NICHD Early Childcare dataset (N = 1281), this study examined whether infant temperament and the amount of time infants spend in nonmaternal care independently predict (1) the likelihood that they seek comfort from their mother when needed and (2) placement in a particular subgroup of infant-mother attachment patterns. Mothers reported the number of hours their infant spent in nonmaternal care each month and their infant's difficulty adapting to novel stimuli at 6 months. The degree to which 15-month-old infants seek comfort from their mother during reunion episodes in the Strange Situation was observed using two behavioral scales (“proximity seeking” and “contact maintaining”). Their average score forms the outcome variable of “proximity-seeking behavior.” The other outcome variables were the subgroups of infant-mother attachment patterns: two subgroups for insecure babies (resistant and avoidant) and four subgroups for secure babies (B1, B2, B3, and B4). Easy adaptability to novel stimuli and long hours of nonmaternal care independently predicted a low level of proximity-seeking behavior. These predictors also increased the likelihood of an insecure infant being classified as avoidant (vs. resistant). A secure infant with these same predictors was most likely to be classified as B1, followed by B2, and then B3, with B4 being the least likely classification. Although previous studies using the NICHD dataset found that hours of nonmaternal care had no main effect on infants’ attachment security (vs. insecurity), this study demonstrates that hours of nonmaternal care predict the subcategories of infant-mother attachment.