Staff members' feelings toward psychiatric patients related to their own and the patient's self-image and gender

The relation between staff members' feelings toward a patient and their own and the patient's self-image in different gender combination groups was studied. Staff at 16 psychiatric treatment homes for patients with severe psychopathology reported their feelings toward their patients on a number of occasions. At the start of treatment, both staff members and patients rated their self-images using the Structural Analysis of Social Behavior (SASB). Male staff seemed less influenced by the patient, with their feelings relating mainly to aspects of their own self-image, while the feelings of the female staff were more related to the patient's self-image. The patient's diagnosis was less important for a staff member's feelings than that member's self-image. Generally, the relation between feelings and self-image was stronger for negative feelings. The results point to the importance of understanding more about the influence of staff members' self-structure on their negative feelings toward their patients and how this relates to both the staff member's and patient's gender.     

REDUCING WANDERING BY PERSONS WITH DEMENTIA USING DIFFERENTIAL REINFORCEMENT

Wandering behavior of 4 geriatric patients with dementia residing in a long-term care facility was assessed using direct behavioral observations. The consequences identified during the observations as maintaining wandering for each patient were then applied for the absence of wandering using differential reinforcement of other behavior (DRO). The effectiveness of the DRO procedure was evaluated using an ABAB design. Results indicated significant reductions in wandering during treatment.     

‘The lesser of two evils…’ – views of persons with rheumatoid arthritis on medication adherence: a qualitative study

Objective: This study aimed to explore medication adherence among adherent and non-adherent persons suffering from rheumatoid arthritis (RA). A special focus was put on the reasons accounting for successful medication adherence and on potential barriers or facilitating factors.

Design: A qualitative study with semi-structured interviews was conducted. Eighteen participants were recruited through stratified purposive sampling according to their medication adherence level. Interviews were analysed by interpretative phenomenological analysis.

Results: Medication adherence behaviour was described on a continuum ranging from non-adherent to adherent. Participants’ current adherence level was represented as a result of inner negotiations between a variety of influential factors and the successful application of a range of strategies. The influential factors were: experiences with medication, outcome expectations, knowledge of therapeutic options, the traits ‘openness’ and ‘conscientiousness’, belief in medical progress, characteristics of the medication, level of trust in one’s physician, and perceived autonomy. Facilitating strategies were: establishing routines, using social support and the deliberate suppression of information about potential adverse events.

Conclusion: The experience of and the reasons for medication (non-)adherence from the perspective of people with RA were explored comprehensively. Participants’ ongoing negotiations between adherence and non-adherence emerged as a key finding with implications for health service providers.     

Insurance Coverage and Mental Health Service Use by Adolescents with Serious Emotional Disturbance

This paper examines the relationships between insurance coverage, need, and mental health services in a community-based sample of 1,015 youths who were 9, 11, and 13 years old at the beginning of the study. They were followed over a two-year period. A strong measure of need based on a standardized diagnostic interview was available and repeated over three annual waves. Data on service use was collected quarterly across two years. Major findings included: (a) high need (serious emotional disturbance [SED]) was strongly related to use of any mental health services; (b) services use was much more likely to occur with public (Medicaid) insurance coverage than either private or no insurance; (c) considerable unmet need was observed even for youths with SED; (d) school-based mental health services potentially substituted for professional mental health services; and (e) there was little unnecessary use of mental health services in the low need group. The major policy implication of these findings is that the regulation of insurance benefits should be based on level of need, rather than on arbitrary limits which are likely to either reduce the probability of or appropriate amount of care for youths who most need mental health services.     

Exploring the Theory and Paradigm Base for Wraparound

Until recently, family-centered policy and practice used expert models which defined families of children with serious emotional disturbance as dysfunctional A collaborative model, called wraparound, is emerging which engages these families as decision making participants, using naturally occurring strengths to wrap individualized supports around the child and family. However, because wraparound has been defined only through value-based principles, the fidelity of the model is threatened by a developmental paradox. Those who have received training and whose careers have been shaped in more traditional expert models of deficit remediation can interpret these value-based principles as an emergent form of case management methodology. Critical and constructivist paradigms, and ecological systems theory, form a basis for negotiating this paradox to maintain fidelity of wraparound process. Anchored in this base, and derived from wraparound's value-based principles, a single construct with an operative focus is suggested to ensure the integrity of this collaborative model.     

An analysis of the relationship of teachers' reported use of classroom management strategies on types of classroom interactions

The results of an investigation to determine teachers' reported use of classroom management strategies and their relationship to teacher and student interactions are presented. We interviewed 20 teachers to determine how they developed and used classroom management strategies, and then observed the interactions of these teachers with children with serious behavior disorders (SBD). Results identified two groups of teachers: one that scored high on planned use of the strategies, and one that scored low. Comparisons between the two groups of the interaction patterns revealed small, but statistically significant differences in the mean length and total percent time involved in positive interactions. The group reporting higher use of the management strategies engaged in positive interactions which were longer in duration than the interactions of the group reporting lower use. The results are discussed in terms of further research needs and implications for teacher training programs.     

The Angry Patient: Case and Session Presentation

Responding to patients who become angry at the therapist is difficult for many clinicians. In the case and session presented, the patient is not only angry, but devalues the therapist by not paying while asking for more frequent sessions. The therapist loses it, states she is angry, and remains insistent on the patient keeping his bills paid or reducing the frequency of sessions. The therapist is conflicted over confronting the patient with what she believes has to change in order for his symptoms to diminish—the irrational beliefs, life style, and sense of entitlement related to the personality disorder of this patient, but likely to drive him away from treatment. The therapist engages in a risky confrontation and remains unclear about the eventual benefit of this response.     

Sensitivity to Levels of Importance in the Logical Memory Subtest

The performance of Alzheimer's disease (AD) and neuropsychiatric patients was examined using the Logical Memory (LM) subtest of the WMS-R, utilizing a levels of importance methodology described by Haut et al. (1990). Although patient groups were matched for dementia severity, we found the expected differences between groups in terms of absolute level of performance. There was considerable variability, however, in the AD patients' performance. AD patients' recall and sensitivity to levels of importance depended on the story (Anna or Robert), and when the passages were recalled (immediate or delayed recalls). Results suggested that AD patients were able to utilize semantic information in their immediate recall, though this was dependent on individual story characteristics. AD patient's delayed recall was essentially absent. Thus, no conclusions could be drawn with respect to the level of importance factor. NP patient's recall performance was similar to patterns observed in other clinical samples for both immediate and delayed memory.