Characteristics of Adult Caretakers of Children and Youth Served by an Urban Child Welfare Agency

The child welfare system of the early 1990s was marked by the proliferation of home-based services. Research on the effectiveness of various home-based interventions indicates results have been equivocal. The need to make explicit the specific characteristics of the adults and children targeted for home-based services, particularly families from diverse cultural backgrounds, has been identified as a critically needed contribution to the literature. In this study, the characteristics and service utilization experiences of adults and families served in an urban, home-based, child welfare program was examined. The results are discussed in relation to findings on the characteristics and experiences of adults and families served in other settings. Implications for future research and service delivery are discussed.     

Billing and Record-Keeping for Familial Cancer Risk Counseling: A National Survey

We surveyed 111 genetic counselors providing cancer risk counseling (CRC) in order to document their billing and record-keeping practices. Of the 75 respondents, billing was generally done under the supervising physician with a wide variation in charges. Follow-up telephone interviews with 28 counselors who charge patients revealed that billing was usually done using the CPT codes for consultations, and the ICD-9 diagnostic codes for cancer (if applicable), a medical complaint, or a family history of cancer code. Most counselors exclude some clinical information from the patient's medical record. In consultation notes, 81% of counselors document a discussion of genetic testing, but only 37% document the patient's actual testing decision, and only 19% document test results. In anticipation of increased referrals for CRC, data are needed on the components of a CRC visit, the amount of time required to provide CRC, patient outcomes measures, and charges and reimbursement. The feasibility and advisability of keeping results separate from the patient's medical record also needs to be addressed.     

Wrapping services in an urban setting

Efforts to reform services for children and their families in Baltimore City have included providing Wraparound services to youth returned or diverted from out-of-state residential treatment. We briefly present the history and evolution of the system reform efforts in Baltimore City that were necessary to support the implementation of a Wraparound model of service delivery. The characteristics of the Wraparound service model is presented along with the referral pathway of the youth into the service system, the components of the service delivery system and an overview of step-down services and linkages utilized to transition the youth. Data are presented that demonstrate the level of community adjustment of a subset of the 121 youth served through the Wraparound model in contrast to the level of community adjustment achieved by nonequivalent comparison groups. We discuss the use of report card type of outcome measures, its user-friendly features, limitations, and the developmental steps needed to refine it further.     

Mental Health and Incarcerated Youth. II: Service Utilization

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarcenation may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.     

The Relationship Between Health and Human Services and the Personal Goal-Directed Activities of Persons Living with AIDS

This study evaluates the relationship between the social climate from different services and the personal goal-directed activities of 224 individuals with AIDS. The study's results supported the main hypothesis that recipient and participatory service involvement uniquely influence personal goal-directed activities, even after considering individuals with AIDS' physical symptoms, psychological distress, income, and recruitment site. Income and involvement with participatory services were both positively related to the amount of personal goal-directed activity. Longitudinal analyses suggest that personal initiative contributes to the subsequent amount of personal goal-directed activities a person pursues. These results suggest further examination of factors contributing to the selection of different service types and of the processes underlying the relationship between participatory services and positive outcomes for clients with AIDS.     

Faire face à des émotions négatives intenses en protection de l’enfance : un travail émotionnel qui mobilise des processus de régulation de l’anxiété et de la colère avec le soutien de l’équipe

This research aims at a better understanding of one aspect of emotional labor in child welfare: coping with intense negative emotions. It is based on 15 interviews conducted with social workers from Child Protective Services. Results indicate that the drivers of this aspect of emotional labor are characterized by unpredictability and interpersonal conflict. They give rise to surprise, anxiety and especially anger, particularly against institutions. Emotional regulation is carried out implicitly with a professional instrumental purpose. Different strategies are mobilized sequentially: social sharing of emotions and cognitive strategies allow recovery. The team social support during informal times appears central. These results underline the role of the team and plead for the recognition and professionalization of emotional work in this sector.     

Using phenomenography to unearth factors influencing the delivery of guidance services

Which factors influence the delivery of school guidance services in Colleges of Education (CoEs) in Ghana? The guidance needs of students in the CoEs may not be fully met if the factors that influence guidance service delivery at that level of education are not explored for effective upgrade of service quality. This phenomenographic study therefore explored factors influencing the delivery of guidance services in CoEs in Ghana. We interviewed second-year teacher trainees (n = 24) and counsellors from three randomly selected CoEs in the Volta region of Ghana (n = 3). The findings indicate that material resources and awareness influenced guidance service delivery in the CoEs. It was also found that although students reported that confidentiality and attitude influenced service delivery in the colleges, the counsellors did not agree with this. Finally, the study discovered that human resource does not influence guidance service delivery in the colleges. It was recommended that college authorities should provide the material resources, such as offices, computers, and test batteries, that are needed for counselling, and counsellors should publicise the guidance programme to raise awareness and lead to the development of positive attitudes towards the programme. This study contributes to the guidance and counselling literature by illuminating the factors influencing guidance service delivery in CoEs. This should be of interest to practitioners, policymakers and researchers in school guidance and counselling.     

EXPANDING INFANT MENTAL HEALTH TREATMENT SERVICES TO AT‐RISK PRESCHOOLERS AND THEIR FAMILIES THROUGH THE INTEGRATION OF RELATIONAL PLAY THERAPY

The expansion of infant mental health (IMH) to at‐risk preschoolers and their families has contributed to the integration of relational play therapy (RPT) into IMH treatment services for this population. Integrating RPT allows access to specialized play and expressive techniques specific to preschool and family development, which improves the clinical ability to meet the multiple and complex needs of at‐risk parent–child dyads and their families. This article will examine the RPT literature and explore the similarities and differences between IMH and RPT. In addition, two case studies will highlight a five‐phase, integrative clinical‐treatment process and provide insight into how IMH clinicians are integrating RPT models and maintaining adherence to the IMH treatment approach.     

The association between religion and self-reported academic honesty among college students

Current research yields inconsistent findings about the association between religious variables and academic cheating among college students. In this study, we investigated possible reasons for this disagreement by examining whether, and to what extent, three particular religious variables: religious identity, affirmation of importance and religious services attendance, are associated with academic honesty among college students. Specifically, we utilised a sample of 2503 American college-aged students from Gallup^® daily tracking survey and used analysis of variance (ANOVA) to address the proposed research question. Research findings indicate that religious service attendance is positively associated with academic honesty among college students. Specifically, students who attend religious services more frequently are less likely to be engaged in academic misconduct than students who attend less frequently. This finding remains consistent when other important factors such as student attitudes toward cheating and gender were included in the analysis.     

Investigating the outcome of the initial assessment at a national transgender health service: Time to review the process?

Background: Globally, there is a lack of a standardized assessment process prior to the initiation of gender affirming medical interventions and consequently there is a discrepancy in this process among different transgender health services.

Aim: The main objective of this study is to investigate the outcome of the initial assessment process at a national transgender health service.

Method: The outcome of people over the age of 17 years, assessed at a large national transgender health service in the United Kingdom during a 2-year period was categorized into: (1) recommendation for cross-sex hormone treatment, or (2) no recommendation for cross-sex hormone treatment. In addition, 200 case notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process.

Results: During the study period, a total number of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for cross-sex hormone treatment, leaving 237 (38.4%) patients who required a longer assessment period or were discharged. The factors associated with being recommended for cross-sex hormone treatment were having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88% (n = 176) of the cases.

Discussion: Although the results of the study may not be generalizable to other international centers, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the routine inclusion of two assessors needs to be reviewed.