Attachment intervention through peer-based interaction: Working with Istanbul's street boys in a university setting

Street youths are a particularly vulnerable group because of early experiences of emotional and physical neglect and abuse which can make them difficult to approach. Traditional interventions such as 1 h weekly therapy sessions do not meet their needs. This article describes a creative and novel approach to the rehabilitation of street children implemented during the To-Gather with Youth Project (TYP) under the aegis of the Research and Application Center to Support Children/Youth Living and Working in the Streets (SOYAÇ) at Maltepe University in Istanbul, running in collaboration with state-run care institutions for boys since 2010. The approach consists of a peer-based supportive model that provides adolescent boys care with emotional and social security through attachment relationships that they develop with university students. The teaching staff and students of the psychology department constitute the core group running the program, which also includes workshops assisted by teachers and students from humanities departments such as philosophy, drama, and radio. These workshops are organized to promote the psychosocial and cognitive development of the participating street boys as well as to enable their direct access to the public through their art and photography. Based on a qualitative analysis of narrative interviews with boys and detailed observational reports by project volunteers, we identify several mechanisms that we believe contribute to change in the boys, including the development of secure attachment relationships with a trusted adult, a child-centered approach, and a socially safe environment created by peer-support in a university setting. The boys and volunteers also reported incidents and feelings that seem to suggest that the boys' have increased their capacity to regulate their emotions, sense of self-esteem and resilience, and desire to develop their lives in the future. This paper offers this intervention as a feasible service model for the rehabilitation of street boys in other cities.     

Barriers to substance use disorder treatment in a sub-acute setting

ABSTRACT

With the changing times, it is essential integrate behavioral health within the primary care of patients. The need is based on the research that links a number of health issues being directly to substance use and mental health diagnosis. With the current opioid epidemic there is a need to address substance use disorders when treating patients in different health care settings. Despite the necessity of integrated care, there are barriers to addressing addiction in sub-acute care settings. With the lack of buy-in from the patients and health care providers and the stigma surrounding addiction it is time to address the barriers that prevents integration of care where it is most needed.     

Characteristics of cocaine users in a private inpatient treatment setting.

Patient records were reviewed from an eighteen-month period of a private hospital adult addictive disease unit. Of 667 consecutive admissions, sixty-five (49 males, 16 females) were diagnosed with cocaine abuse or dependence; 38 percent were from rural areas. Although mean age of males and females was similar, males had a longer duration of use (8.2 years versus 5.8 years), however, females used an average of 14 grams per week versus 9.5 grams per week for males. African-American patients were over-represented among the cocaine using sample and also among the sample who chose smoking as their route of administration. A larger percentage of males had legal problems and admitted to "dealing," when compared to females. Those from rural areas were more likely to be married and less apt to have legal problems.     

Ergonomics in a hospital and a university setting: The effect of worksite analysis on upper extremity work-related musculoskeletal disorders

OBJECTIVES: The purpose of this study was to determine whether individuals with work-related injuries receiving worksite analysis would have less lost workdays than individuals not receiving worksite analysis. Therapeutic management of work-related injuries in a hospital and a university setting were also compared. STUDY DESIGN: Over a one-year period, employees who sustained an upper extremity work-related injury were issued questionnaires regarding their injury, treatment, functional status and pain level. Participants were divided into three groups: group 1 consisted of hospital employees (N=14) who underwent worksite analysis, group 2 included university employees (N=15) who underwent worksite analysis whereas group~3 included university employees (N=14) who underwent no analysis. RESULTS: All groups were similar in demographics, functional status, and pain level. Satisfaction with the worksite analysis was similar for groups one and two. CONCLUSION: A pattern of less absenteeism but greater modified duty days was associated with those individuals undergoing worksite analysis.     

Assessing adult attention deficit hyperactivity disorder (ADHD) in the university setting

Objective: To address the increasing demand for assessments of Adult Attention Deficit Hyperactivity Disorder (ADHD), the primary author developed a protocol for Counseling and Psychological Services (CAPS) at Stanford University's Vaden Student Health Center to improve the efficiency of such evaluations. Participants: As part of quality assurance, we reviewed the charts of Stanford students who sought assessment for ADHD before the protocol was implemented (September 2011–June 2013) and after the protocol was established (October 2013–August 2014). An IRB exemption was obtained. Methods: The protocol includes questionnaires that solicit detailed clinical information from a variety of sources prior to the student's initial visit. Results: A peer chart review of 35 randomly selected charts showed that students completing the protocol are receiving a more thorough assessment. Conclusion: The new Stanford ADHD protocol, designed to improve clinic efficiency, also increases the availability of relevant clinical information.     

Working with families of severely disturbed children in a day treatment setting

This article deals with the use and effectiveness of family therapy techniques, particularly structural and systems techniques, in working with the families of severely disturbed children in a day treatment setting. Case examples and a segment of an audiotape of one family demonstrating circular questioning will be included. The paradigm for dealing with these families is based on systems theory rather than a model of individual dynamics. I see the task of the future as solidifying of systems theory and skills and an integration of all that we have learned about individual dynamics and systems into a cohesive model for helping people.Presented to the NASW Symposium in Washington, D.C., November 22, 1983, under the title Family Therapy in a Children's Day Treatment Setting. The author acknowledges appreciation to the staff of the Seattle Children's Home Day Treatment Program, whose case material is presented; Liz Belniw, Phil Bohn, Randy Brandies, and Wanda Welch-Bresnick.     

The development and evaluation of a spouse abuse treatment program in a military setting

The development and evaluation of a spouse abuse treatment program in a military setting are described. Preliminary studies on the correlates of interspousal violence found that measures of locus of control, marital adjustment, and stressful life events differentiated abusive from non-abusive service members. A treatment program for abusive couples was developed based on the preliminary findings. Program evaluation data involving pre- and post-program administrations found significant positive change on The Dyadic Adjustment Subscales, Consensus and Cohesion, and on the Norwicki Strickland Locus of Control Scale. The implications of these findings for family advocacy programing are discussed.     

Integrative module-based family therapy: a model for training and treatment in a multidisciplinary mental health setting

Thirty years ago, leaders in psychiatry expressed hope for more interdisciplinary collaboration with family therapy. Since then marriage and family therapy (MFT) has entered the mainstream of clinical practice in psychiatry and psychology. It is mandated for training in psychiatry and psychology. We propose a model for collaboration, training, and treatment in interdisciplinary mental health settings that strives to integrate empirical bodies of knowledge in MFT, psychiatry, and psychology and to provide a usable and testable clinical approach to treatment. It can be taught to trainees with various or limited training in MFT This model delineates nine critical domains that guide treatment. Flexibility is central to this model, focusing on techniques and clinical methods based on empirically supported treatments, when available, and best-practice standards.     

Youth engagement and service dosage in a mandated setting: A study of residential treatment centers

Treatment theory in residential treatment centers (RTCs) is conceived as a two-stage process of first engaging the client and then delivering services or interventions aimed at presenting problems. This treatment logic has been criticized for “creaming clients” or reserving services for clients easier to engage or more amenable to treatment but less in need. The present study examines whether higher early levels of engagement by youth in RTCs leads to more intervention and compares the relative effects of engagement and seriousness of presenting problems on the quantity of services provided by the mid-point in the adolescents' stay. Data come from interviews with a clinical sample of 71 male and 59 female adolescents in two RTCs in an eastern state. Findings indicate that higher level of engagement predicts more treatment interventions. Treatment staff delivered higher dosages of services to youth with more current behavioral problems, not those with problematic behaviors at intake. Youth with positive peer group backgrounds also received more services. Findings extend knowledge of how treatment staff provide treatment to clients and the role engagement plays in RTC service delivery.     

Web-based triage in a college health setting

The authors describe the initiation and use of a Web-based triage system in a college health setting. During the first 4 months of implementation, the system recorded 1,290 encounters. More women accessed the system (70%); the average age was 21.8 years. The Web-based triage system advised the majority of students to seek care within 24 hours; however, it recommended self-care management in 22.7% of encounters. Sore throat was the most frequent chief complaint (14.2%). A subset of 59 students received treatment at student health services after requesting an appointment via e-mail. The authors used kappa statistics to compare congruence between chief complaint and 24/7 WebMed classification (kappa = .94), between chief complaint and student health center diagnosis (kappa = .91), and between 24/7 WebMed classification and student health center diagnosis (kappa = .89). Initial evaluation showed high use and good accuracy of Web-based triage. This service provides education and advice to students about their health care concerns.     

Envy and anger in a boarding-school setting

Abstract

This paper looks at social work practice in a boarding-school setting. Individual work with mothers of two of the children is described, and structures which may help the school in dealing directly with parents are examined, focussing particularly on feelings of envy and anger. The counter-transference feelings of the worker in this kind of setting are touched on briefly, and it is concluded that a link with a boarding-school may be a useful tool in establishing support and working with deprived families.