Mental Health Problems of Children in Foster Care

We compared the rates of mental health problems in children in foster care across three counties in California. A total of 267 children, ages 0 to 17, were assessed two to four months after entry into foster care using a behavioral screening checklist, a measure of self-concept and, in one county, an adaptive behavior survey. Results confirmed previous research and indicated consistently high rates of mental health problems across the three counties. Behavior problems in the clinical or borderline range of the CBCL were observed at two and a half times the rate expected in a community population. Fewer children fell within the clinical range on the self-concept measure. No significant differences in rates between the three county foster care cohorts were observed, despite the different demographic characteristics of the counties. On the adaptive behavior scale, the mean scores for children in foster care were more than one standard deviation below the norm. Our findings suggest that the most important mental health screening issue with children in foster care is to identify what specific mental health problems need to be addressed so that the most effective treatment services can be provided.     

Psychiatric Symptomatology and Family Functioning in Children and Adolescents with Spina Bifida

The purpose of this study was to (a) examine the occurrence of psychiatric symptomatology in children and adolescents with spina bifida, (b) investigate the relationship between psychiatric features and aspects of disability, and (c) explore the impact of spina bifida and psychiatric status on family functioning. Fifty-four children and adolescents ages 6 to 18 years (M = 12.94, SD = 3.59) were examined. Parents completed the Child Symptom Inventory (CSI) and the Family Assessment Device (FAD). Using the CSI, a psychiatric diagnostic screen, 43% of the sample obtained one, and 13% obtained two or more screening cutoff scores reflective of psychiatric diagnoses. The two most prevalent diagnostic categories were Attention-Deficit/Hyperactivity Disorder (33%) and Oppositional Defiant Disorder (13%). The sample as a whole exhibited elevated levels of clinical symptoms, with internalizing symptoms more prominent than externalizing symptoms. No differences in diagnostic categories or overall symptomatology were found based on age, gender, ambulation status, or lesion level. Overall symptom counts were positively correlated with scales on the FAD reflecting problematic family functioning (.42–.65). Results suggest that psychiatric symptomatology occurs at a high rate in children and youth with spina bifida. Although ADHD was the modal diagnostic category, the sample as a whole exhibited extensive psychiatric symptoms independent of specific diagnostic categories. Psychiatric symptoms were also associated with increased problematic functioning in families.     

The Section of Psychology: Psychology in an Academic Health Sciences Center's Department of Behavioral Medicine and Psychiatry

This paper describes the organization of the Section of Psychology, Department of Behavioral Medicine and Psychiatry, School of Medicine, Robert C. Byrd Health Sciences Center, West Virginia University, Morgantown. The organization of psychology is described in terms of the 10 organizational variables for psychology outlined by the Working Group on Governance and Administration from the 1995 Association of Medical School Psychologists, Georgetown Conference. Several aspects of the Department are highlighted that may account for the success of psychology section model including collegial relationship between the disciplines of psychology and psychiatry. The paper describes in detail how the section works, key successes, major obstacles encountered, and future challenges.     

L’abord de la sexualité par les professionnel·le·s de santé en oncologie : une revue de la littérature

The improvement in medical techniques has drastically modified the practice of care in oncology. Supportive care, geared towards supporting patients with chronic illnesses, now occupies a greater place alongside treatments aimed at survival. These changes have conducted some health care professionals to be more interested in patients’ quality of life and, in particular, to the impact of cancer on sexuality. Repercussions on sexuality are actually one of the most problematic aspects of patients’ quality of life post cancer. The aim of this paper is to draw up a review of the English and French literature on this “new” concern which still seems to raise many challenges in practice. Our review emphasizes that despite the recognition of the importance of addressing sexuality issues post cancer in oncology, in their practices, physicians as the nurses alike find it difficult to address. In addition, it underlines that the dominant social representations of sexuality – in terms of gender, sexual orientation and age – have permeated health care professionals’ subjectivities and, at the same time, influence how sexuality is address and interfere with a systematic discussion of these issues throughout the care process. Our discussion tackles the lack of psychologists, both in research and clinic, regarding these issues. Finally, our conclusion highlights the contributions of psychology facing issue posed by sexuality in oncology.     

Using behavior contracts to improve behavior of children and adolescents in multiple settings

Research has shown that behavior contracts, a form of contingency management, can promote a wide range of behavior changes for individuals in varied populations; however, relatively few studies have been conducted in nonacademic settings. In the context of two service projects, we evaluated the extent to which behavior contracts improved problem behavior for 11 children and adolescents in residential treatment facilities and foster homes using nonconcurrent multiple baseline across participants’ designs with three or more tiers and supplemental statistical analysis for each tier. Practitioners in each setting implemented individualized behavior contracts for 5 to 59 weeks. Results show that behavior improved substantially for six participants but was relatively unchanged for the other five participants. We discuss the limitations of this clinically driven study, as well as clinical implications of our mixed findings.     

Mixing qualitative methods versus methodologies: A critical reflection on communication and power in inpatient care

This paper offers an illustrative example to demonstrate one way of combining qualitative methods. The context for the study was a UK inpatient psychiatric hospital. Data set one was collected from weekly ward rounds where inpatient staff met with autistic patients to review medication, listen to patient concerns and make plans or adjustments in light of this. Data set two was reflective discursive interviews with patients and staff. The research objective was to critically consider the potential reasons for discrepancies in dissatisfaction reports from patients in the interviews, compared to relative compliance exhibited by patients in the ward rounds. Utilising a video‐reflexive design and critical discursive psychology approach, both data sets were analysed together. It is possible to simultaneously analyse two different data sets, one naturally occurring and one researcher generated because of the epistemological congruence in the overall design. We have presented an argument for the benefits of mixing two qualitative methods, thereby extending the mixed‐methods evidence base beyond the traditional discussions of quantitative and qualitative paradigms.     

L’enfant visiteur en réanimation adulte : vécu psychologique de la visite et dispositifs d’accompagnement

IntroductionWhile ICUs encourage visits from patients’ loved ones, visits from children and adolescents have remained a rather sensitive issue. In an attempt to protect children from a potentially traumatic environment, certain services refuse or restrict their visits.ObjectiveIn this context, the question arises as to whether the visit in intensive care constitutes a psychological risk for the child and adolescents. Based on the literature, this article discusses the experience of the visit on the child, the research methodology implemented with child visitors, and finally the existing support systems.ResultsThe analyzed studies do not consider the psychological disorders associated with ICU visits. Moreover, there are many studies on this field and the methodologies have yet to be developed. Support measures exist but are at the initiative of the intensive care teams.ConclusionThere is now an urgent need to build on the studies focused on this field in order to propose a genuine policy with regard to the reception and support of children visiting ICU patients.     

Vécu des situations à risque d’erreur en réanimation : une étude qualitative auprès des médecins et infirmiers

Intensive care units are considered as services with a high risk of error. More and more studies have measured the incidence and impact of errors in intensive care units, but few of them are centered on the impact of the risk of error for professionals. This study focuses on the perception of the risk of error, how it is experienced, and the way in which professionals cope with it. Forty professionals (20 physicians, 20 nurses) participated in clinical interviews. We transcribed recordings and analysed the data using a phenomenological approach. The risk of error is omnipresent in intensive care units. For nurses with less than one years experience, the risk of error is associated with important manifestations of anxiety. On the contrary, for doctors and nurses who have worked for more than one year in ICU, their experience and the relationship of cooperation built with colleagues gives them a feeling of control over risky situations. Our results show that it is important to take into account the risk of error in order to better target the support and training for the ICU professionals.     

Foot care, ‘spousal’ support and type 2 diabetes: an exploratory qualitative study

Objectives: People with type 2 diabetes (T2DM) should check their feet and protect them against harm, but few do. Living with a spouse contributes to good foot care behaviour. This study explores awareness, perceived susceptibility of, and concern about, foot problems, and reported foot care behaviour, and ways in which a spouse may or may not contribute to foot care in T2DM.

Methods: 1:1 interviews were conducted with 6 individuals with T2DM. Half had a spouse half did not. There was one person at low, medium and high risk in each sample. Each spouse participated in a separate interview, and the dyads were interviewed together. Interviews were analysed using Applied Thematic Analysis.

Results: All participants knew that diabetes was associated with foot problems. Not all people with T2DM thought that they were susceptible; spouses perceived greater susceptibility for the patient. This was unrelated to risk level. Most people with T2DM and all spouses engaged in behaviour to identify problems or protect feet, but rarely both. Spouses’ attitude and behaviour did influence the patients’ own behaviour. At times spouse support was perceived positively, and at times negatively.

Conclusion: Engaging spouses in foot care education may improve foot care behaviour.     

General mood of professional caregivers in child care centers and the quality of caregiver–child interactions

The present study is the first to relate professional caregivers’ general mood to the observed quality of their interactions with the children in their care. A total of 238 female caregivers from 133 child care groups in 64 centers completed the General mood scale of Bar-On’s Emotional Quotient Inventory (1997) and was observed while playing with small groups of children. Factor analysis on the General mood scale yielded five general mood factors, one negative and four positive. Two positive mood factors in particular, i.e., positivity and optimism, were found to contribute positively to the quality of professional caregivers’ behavior toward the children and, through their caregiving behavior, to the children’s well-being.