Concentric circles of containment: a psychodynamic contribution to working in pupil referral units

This article aims to reflect on the lessons learnt from using a psychodynamic approach to offering onsite therapeutic child and adolescent mental health services (CAMHS) in four pupil referral units (henceforth referred to as PRUs). The PRUs cater for six- to 16-year-old children and adolescents permanently excluded from mainstream schools. The work takes place in an inner London borough. The approach described evolved over five years through practice-based evidence of what worked well in each particular setting. This was viewed both in terms of sustaining families' engagement in the therapeutic process, and also effectively supporting child and adolescent mental health services and education staff in their respective tasks. The model which gradually evolved owes much to Bion's concept of containment as the necessary foundation for emotional growth and genuine learning. It also draws on ideas from psychoanalytic consultation and open systems theory. The importance of work discussion groups in this setting will also be evident. Some links are made to relevant Buddhist concepts and metaphors.     

BOOK REVIEWS

Crisis resolution and home treatment teams (CRHT) are integral to acute psychiatric services. This survey quantifies staff burnout using the MBI-HSS (Maslach Burnout Inventory) and notes sources of stress and satisfaction before (2012) and after (2013) service transformation of a CRHT in Leeds into a single point of access, with home treatment devolved to community teams. Moderate to high Burnout scores were observed over the study period, with a rise in the mean depersonalisation score from 5.8 to 7.2 over the study period. Contact with colleagues; work with patients and variety of work emerged as rewarding while themes of suicide and violence were most linked with stress, with clinicians reporting self-doubt in the face of difficult clinical decisions. Clinicians positively rated a weekly psychoanalytic reflective practice group. A pictorial representation of qualitative results uses psychoanalytic theory inconceptualising ‘skins’ around various aspects of the clinical setting, which then become semipermeable in response to a patient in crisis when clinicians feel poorly supported by the changing organisation.     

Perceived organisational support influences on job satisfaction and organisational commitment among junior academic staff members

This study investigated the relationship between perceived organisational support, employee job satisfaction and organisational commitment among junior academic staff of a South African higher education institution (N =70; female = 41 .4%; masters qualification = 85 .7%). Participants completed a self-administered questionnaire on organisational perceptions, commitment and job satisfaction. Correlations investigated whether there were any relationships between variables. T-tests and Analysis of Variance (ANOVA) were also used to examine whether participants perceived organisational support differently based on their demographics. Results showed a significant and positive relationship among employee perceptions of support from their organisation, their level of job satisfaction and level of organisational commitment. Male academic staff showed higher levels of perceived organisational support, employee job satisfaction and organisational commitment than females. Gendered work participation appears to explain aspects of work participation in the context of the South African higher education sector.     

组织氛围对员工行为有效性的影响机制

该研究采用问卷调查法和专家评估法探讨员工行为有效性的影响机制.结果表明:(1)组织氛围对员工行为有效性有积极的影响.(2)员工的自我效能感在组织氛围与绩效间起完全中介作用,在组织氛围与组织承诺间起部分中介作用,在组织氛围与满意度之间没有中介效应.(3)员工的自我效能感、满意度和组织承诺在组织氛围与员工绩效间起完全中介作用.(4)组织氛围对员工绩效的影响存在双重中介效应.结论:组织氛围对员工绩效的影响机制非常复杂,不仅可以直接影响,而且还可以通过影响员工的自我效能感、满意度和组织承诺等多种中介效应来影响.     

IMPROVING RESIDENTIAL TREATMENT SERVICES: IMPLEMENTATION AND NORM-REFERENCED EVALUATION OF A COMPREHENSIVE MANAGEMENT SYSTEM

Ensuring effective service delivery by direct-care personnel in institutional living units for persons with developmental disabilities historically has been a difficult process, despite considerable attention from researchers, service providers, and governmental regulatory agencies. In this investigation, we conducted a normative evaluation of the extent and quality of treatment services currently provided in residential living units (Experiment 1) and evaluated a comprehensive management system designed to improve such services (Experiment 2). Results of the first experiment, encompassing 22 living units in three states, indicated that on the average two thirds of observed resident behavior did not involve any therapeutic activity. The results also provided social validity for the criteria used to evaluate the quality of treatment provision based on opinions of mental retardation professionals. Results of the second experiment indicated that a behavioral management program implemented during 23 separate time periods across five living units was accompanied by consistent and durable decreases in resident nontherapeutic activity as well as increases in specifically designated habilitative activity. The results provide support for the successful incorporation of behavioral management technology into human service settings on a large-scale, long-term basis.     

A STAFF MANAGEMENT SYSTEM FOR MAINTAINING IMPROVEMENTS IN CONTINENCE WITH ELDERLY NURSING HOME RESIDENTS

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.     

Social skills training for juvenile delinquents

Twenty-seven incarcerated juvenile delinquents matched on the number of previous offenses, age, WISC-R IQ, and locus of control were assigned to a Social Skills. Discussion or Control group. Social skills training consisted of instruction, feedback, modeling, behavior rehearsal, social reinforcement and graduated homework assignments. All subjects were assessed before and after treatment on a variety of self-report, role-play and behavioral measures. Analyses of variance for difference scores indicated that the Social Skills group improved significantly more than the Discussion and Control groups, which did not differ. Appropriate interpersonal skills were learned, state anxiety was reduced, internal locus of control was increased, and significant shifts in adjustment to the institutional program were evidenced for the Social Skills group.     

EVALUATING STRATEGIES TO IMPROVE CAREPROVIDER PERFORMANCE ON HEALTH AND DEVELOPMENTAL TASKS IN AN INFANT CARE FACILITY

Responding to administrative staff and parental concerns, using modified reversal and withdrawal designs, two experiments evaluated a staff-managed feedback system to improve the hygiene and developmental skills of children in an infant/toddler center. Experiment 1 examined feedback designed to increase staff performance in checking and changing diapers, and recording those changes. A chart plus supervisory feedback produced increases in and maintenance of staff performance. Experiment 2 compared an existing staff management system with a “playchart” plus feedback in increasing careprovider-infant stimulation. The data (with follow-up on a new staff) supported the use of the new feedback system. Questionnaire data further supported the utility of the playchart system.     

企业女职工的婚龄对夫妻关系及离职与独身倾向的影响

本文探讨了企业女职工的生活状况及其婚龄对减少角色倾向的影响。结果表明:①女职工的生活状况较好,她们减少角色的动机不强;②婚龄对她们的夫妻关系、独身倾向、离职倾向和家务事有相当显著的影响;③新婚期后是个婚姻危机期。     

TRAINING RESIDENTIAL SUPERVISORS TO PROVIDE FEEDBACK FOR MAINTAINING STAFF TEACHING SKILLS WITH PEOPLE WHO HAVE SEVERE DISABILITIES

We evaluated procedures for training supervisors in a residential setting to provide feedback for maintaining direct-service staff members' teaching skills with people who have severe disabilities. Using classroom-based instruction and on-the-job observation and feedback, 10 supervisors were initially trained to implement teaching programs themselves. The training improved supervisors' teaching skills but was insufficient to improve the quality of feedback they provided to direct-service staff regarding the staff members' teaching skills. Subsequently, classroom-based instruction and on-the-job observation and feedback that targeted supervisors' feedback skills were provided. Following training in provision of feedback, all supervisors met criterion for providing feedback to their staff. Results also indicated that maintenance of teaching skills was greater for direct-service staff whose supervisors had received training in providing feedback relative to staff whose supervisors had not received such training. The need for analysis of other variables that affect maintenance of staff performance, as well as variables that affect other important areas of supervisor performance, is discussed.