RECENT TRENDS IN RESPONSE TO CHILD VICTIMIZATION

Abstract

This chapter serves as an introduction to the many roles of health care professionalsin the assessment, care, and treatment of child victimization. It concentrates on those professionals caring for the physical health of victims of child abuse and neglect, although there are many similarities between child maltreatment and other family violence victims. In reviewing the health impact of maltreatment and the historical contributions of health care professionals, it discusses the roles that health care disciplines play in clinical care, training, research, and advocacy and their interaction with the community's child welfare, legal, and criminal justice systems.     

Training Therapists to Treat the Psychological Consequences of Terrorism

Abstract

In the wake of 9/11, the mental health community began to develop a model for recovery and preparedness. A public information campaign regarding the psychological consequences of terrorism was launched, and it succeeded in reducing the stigma of utilizing mental health services. However, as this campaign began to succeed, it became clear that most clinicians in the community had little training in evidence-based assessment and treatment procedures for the psychological sequelae of terrorism. This article describes the development, delivery, and initial assessment of one attempt to correct this problem by broadly disseminating an effective treatment for Post Traumatic Stress Disorder (PTSD). Using models of behavior change, we were able to study trainee attitudes and the training process in ways that will help improve training effectiveness beyond what traditional Continuing Professional Education (CPE) has been able to do.     

Provider Perspectives on Disaster Mental Health Services in Oklahoma City

Abstract

Seven years after the bombing of the Murrah Federal Building in Oklahoma City, 34 individuals affiliated with various organizations were interviewed about their experiences in providing disaster mental health services to victims and the community. Their perspectives elucidated the importance of preparedness, training and education, local control, interagency cooperation, and psychosocial support for providers. Significant conflicts emerged among providers about credentials, referrals, the quality of services provided, and the appropriateness, in this context, of basing services solely on a crisis counseling model. The lack of ongoing needs assessment or evaluation data further fueled the debates. On the basis of the findings, the authors outline several recommendations for planning mental health responses to future terrorist attacks.     

African American and White Women’s Experience of Sexual Assault and Services for Sexual Assault

This article presents the results of a study assessing the needs and experiences of African American and White female survivors of sexual assault in the state of Maryland. Eight specific hypotheses regarding differences in the needs and experiences of African American as compared to White women receiving partial or no support through analyses of interview data drawn from 213 survivors (African American survivors, n = 133; White survivors, n = 80) were explored. No differences were reported in medical care received; however, in comparison to their White counterparts, African American women reported decreased use of sexual assault crisis centers and mental health services, and postassault help-seeking through use of sexual assault hotlines. Barriers and facilitators associated with treatment experiences differed by ethnicity. Findings are discussed in relation to future directions for research, and service and policy improvement for survivors of sexual assault.     

Assessing Mental Health Providers' Perceptions of Consumer-Providers

To gain insight into the challenges of the occupational role of consumer-provider, the authors describe a program evaluation that assessed mental health providers' perceptions of consumer-providers. A qualitative research design was used to assess non-consumer providers' attitudes toward and perceptions of consumer-providers, perceptions of the quality of services consumer-providers deliver, and knowledge and awareness of consumer-providers' education and training background. Four themes emerged, including: (1) service delivery, (2) comparisons between consumer-provided and non-consumer staff provided services, (3) perception and opinion of consumer-providers' education and training background, and (4) power dynamics. Implications of the findings are discussed.     

Memphis City Schools Mental Health Center

Summary

This article describes a nationally recognized integrated service program in operation since 1969 within the Memphis (TN) City Schools. Memphis City Schools Mental Health Center represents a comprehensive model for the delivery of integrated mental health and substance abuse services to children and youth with a wide range of problems. Notably, the model incorporates elements of primary and secondary prevention and community outreach into service delivery, components that may be under-emphasized in programs that are oriented toward specific clinical populations (e.g., SED). Program components are discussed in detail to demonstrate both unique and inter-related program features, reflecting the complex needs of the children and families being served. Future directions and challenges are also considered.     

Family Influences on Treatment Refusal in School-linked Mental Health Services

This study analyzed family influences on treatment refusal in school-linked mental health services (SLMHS). Specifically, it assessed whether levels of family cohesion, conflict, and organization were related to whether a family refused to initiate recommended treatment. Children (N = 133) referred for emotional and behavioral problems and their families participated. Results indicated that (1) family environment factors explained a significant amount of variance in treatment refusal after controlling for demographic factors, (2) families of children with predominantly internalizing symptoms were at greater risk for refusing treatment than families of children with predominantly externalizing symptoms, and (3) lower level of family cohesion was an individual risk factor for refusing treatment. Incorporating an evaluation of family environment within SLMHS assessments may aid in the identification of areas wherein intervention may be beneficial in preventing treatment refusal.     

家庭中心积极心理学应用

家庭中心积极心理学以积极心理学为基础,以社会生态学理论和家庭中心服务为思想来源,采用以家庭、学校、咨询者三位一体的联合行为咨询的干预策略,以实现家庭中儿童的发展性需要为最终目标。本文主要介绍了家庭中心积极心理学的内涵、理论来源、基本原则、实施方法—联合行为咨询。     

Identifying violence among women patients attending family practices: the role of research in community change

Violence against women has serious consequences. Although victims use health facilities more frequently than others, violence is still not recognized in most services and in the larger community. This study had three aims: (1) to estimate the prevalence of violence among women patients in primary care, (2) to evaluate the feasibility of asking all women about violence, and (3) to make violence visible, and thereby initiate a process of professional and community change on the issue of violence against women. The study was carried out in a small Italian town, at the initiative of a local family doctor. We conducted a cross‐sectional survey among patients of six family practices and 444 women responded to a self‐administrated questionnaire. Five per cent of respondents experienced physical or sexual violence in the last year, and 25% had experienced it in the past. Nineteen per cent had experienced psychological violence in the last 12 months. Risk factors for current violence were: younger age, being pregnant or with young children, being separated or divorced, or lack of stable employment. Most women were in favour of being asked about violence by their doctor. The study's results were disseminated in public meetings, with good press coverage. This resulted in a dramatic increase in the visibility of victims of violence, the development of a training course for health professionals, and the creation of the first women's group in the town. Along with advocacy work, the group has prepared a booklet on violence addressing women, and is now raising funds to start an ‘anti‐violence’ telephone line. Overall, the study has become a tool for change within the health services and the community. Copyright © 2004 John Wiley & Sons, Ltd.     

American Indian Youth: Who Southwestern Urban and Reservation Youth Turn to for Help with Mental Health or Addictions

We illustrate the addictions and mental health service use of American Indian adolescents. Interviews concerning mental health need and service configurations with 401 Southwestern American Indian (AI) youth used questions from the Diagnostic Interview Schedule (DIS) and the Service Assessment for Children and Adolescents (SACA). Seventy-nine percent had mental health or addiction problems, with half meeting criteria for at least one diagnosis. One in 4 youth met criteria for drug dependence'abuse or conduct disorder, 1 in 5 for depression, and 1 in 8 for alcohol dependence'abuse. Most youth were helped by a combination of providers. Youth meeting more diagnostic criteria were increasingly likely to use service configurations with adults, nonspecialist professionals, and specialists, respectively. Regardless of disorder, youth were least likely to use configurations with traditional healers or specialists and there was little difference in rates of use between the two. The lack of services from specialist providers was potentially offset by use of an extensive range of informal adults, nonspecialist professionals, and peers. Since informal helpers, peers, and nonspecialist providers, but not specialists, are providing the bulk of services they must be given support and skills so they can function effectively.