Revising a medication education program on an inpatient child and adolescent psychiatric unit

Adherence to a medication regimen can be challenging for children and adolescents with mental health disorders. Medication education can be a beneficial tool for nurses to help promote adherence to psychotropic medications. This article describes an initiative to improve medication education offered to children and adolescents and their families on an acute child and adolescent inpatient unit in a mental health facility. Strategies included adding a game to medication education groups, creating and distributing medication education handouts, and developing and implementing medication education sessions for parents. When used by the patients and families, the interventions were appreciated. Having successful interventions in place may help meet the diverse educational needs of this population as nurses seek to improve medication adherence.     

Querying meanings of adolescent peer resistance: a school choice decision revisited

For more than three decades, adolescent research within psychology has addressed developmental questions regarding resistance to peer influences from a psychosocial perspective, emphasizing autonomy development. Inferences about development have been drawn from age-related differences on peer resistance/conformity questionnaires. In this paper, we illustrate an alternative sociocultural/dialogical person-in-context approach to the study of peer resistances and development. This approach directs attention to the meanings of resistant acts as arising from adolescents' transactions with immediate and larger sociocultural contexts, and to the evaluation of development as qualitative system transformation. Our study concerns voiced resistance by eighth-grade girls to peer labeling of their sexual orientation because of the girls' choice (3 years earlier) to attend an all-girl college-preparatory middle school. Resistances expressed in interviews are evaluated within the context of current and prior I-other positionings surrounding the school choice, and we highlight the importance of considering (1) multiple rather than singular peer relations in adolescents' lives associated with connecting as well as resisting positionings; (2) meanings of ‘what’ is being resisted; (3) distinctions in how resistances are expressed; (4) emergent abstractions supporting the resistances; and (5) developmental change as a systems phenomenon.     

Taking a stand or playing it safe?: resisting the moral conservatism of risk in social work practice

An emergent critical social work risk literature positions risk as a morally conservative construct that has repressive effects in direct social work practice. In this literature it is argued that how risk is defined and operationalised in social work reflects the political dominance of neo-liberalism as an ethos of government within the context of the social and cultural conditions of the risk society. This narrative is fast becoming a dominant perspective in the social work literature. However, this perspective in effect creates a ‘catastrophe story’ where there is little room to envisage an alternative social work practice that is able to resist the conservative effects of risk. In addition there is little empirical evidence to support the relevance of this pessimistic view to the embodied aspects of social work interventions. This paper presents initial findings of a study undertaken in Australia that has explored whether risk is necessarily as totalising of our professional identities, and in turn our practices, as is suggested by this literature. The findings indicate that whilst practitioners were interpellated within conservative contexts in their front-line practice, ethical, moral and value standpoints assisted practitioners to resolve the moral dilemmas posed by risk.     

Children and psychotropic medication: a cautionary note

This report addresses how the mental health field is organized in terms of the use of psychotropic medications with children and adolescents, and the ethical challenge this presents to marriage and family therapists.     

Treatment of an acting-out adolescent girl: An interpersonal experience

The current emphasis on psychotherapy as an interpersonal or intersubjective experience is highly relevant to clinical work with adolescents. This paper presentes and discusses the treatment of an acting out adolescent girl from the perspective of the two-person relationship, emphasizing the interaction between the patient's dynamics and the therapist's responses.     

Pathways to early coital debut for adolescent girls: a recursive partitioning analysis

This study examined pathways to early coital debut among early to middle adolescent girls in the United States. In a two-year longitudinal study of 104 adolescent girls, recursive partitioning (RP) analyses were conducted to examine the specific factors that were related to engaging in first intercourse by the 10th grade among adolescent girls who had not yet engaged in sexual intercourse by the 8th grade. RP analyses identified subsamples of girls who had low, medium, and high likelihoods of engaging in early coital debut based on six variables (i.e., school aspirations, early physical intimacy experiences, depression, body objectification, body image, and relationship inauthenticity). For example, girls in the lowest likelihood group (3% had engaged in sex by the 10th grade) reported no prior experiences with being touched under their clothes, low body objectification, high aspirations to complete graduate education, and low depressive symptoms; girls in the highest likelihood group (75% had engaged in sex by the 10th grade) also reported no prior experiences with being touched under their clothes, but had high levels of body objectification. The implications of these analyses for the development of female adolescent sexuality, as well as for advances in quantitative methods, are discussed.     

Parents and patients: Members of an interdisciplinary team on an adolescent inpatient unit

In a six-year study on a locked psychiatric hospital unit for adolescents, first patients and then their families became integrated into the interdisciplinary treatment team. The results were universally beneficial. After initial resistance and some fine tuning of their skills, the staff became strong supporters of the program. Parents, no longer one down, developed a close working relationship with the therapists and milieu staff. Treatment planning and implementation was enriched by the interaction and dissension was minimized. Most important of all, the adolescents improved more rapidly and hospital stays were significantly shortened.     

Treatment of incarcerated, sexually-abused adolescent females: an outcome study

This study examined the psychosocial functioning of 100 adolescent females (ages 12-17) sentenced to secure care in a southeastern state and the impact of gender-specific, cognitive-behavioral therapy (CBT) intervention on the psychosocial functioning of subjects who reported a history of sexual abuse. The Multidimensional Adolescent Assessment Scale (MAAS) was used to assess psychosocial functioning. Pre-test scores on the MAAS revealed significantly higher scores on 12 of 16 dimensions of psychosocial functioning and higher rates of serious criminal behavior for youth who subsequently disclosed sexual abuse histories as compared to those without such histories. At post-test, statistically significant improvements in psychosocial functioning were observed on 14 of 16 MAAS subscales for those who received the CBT intervention. Thus, incarcerated female adolescents who reported a history of sexual abuse demonstrated more impairment in their functioning as compared to those without a reported history of sexual abuse and responded positively to gender-specific, CBT-based intervention.     

Adapting an evidence-based model to retain adolescent study participants in longitudinal research

Maintaining contact with and collecting outcome data from adolescent study participants can present a significant challenge for researchers conducting longitudinal studies. Establishing an organized and effective protocol for participant follow-up is crucial to reduce attrition and maintain high retention rates. This paper describes our methods in using and adapting the evidence-based Engagement, Verification, Maintenance, and Confirmation (EVMC) model to follow up with adolescents 6 and 12 months after implementation of a health program. It extends previous research by focusing on two key modifications to the model: (1) the central role of cell phones and texting to maintain contact with study participants throughout the EVMC process and, (2) use of responsive two-way communication between staff and participants and flexible administration modes and methods in the confirmation phase to ensure that busy teens not only respond to contacts, but also complete data collection. These strategies have resulted in high overall retention rates (87–91%) with adolescent study participants at each follow-up data collection point without the utilization of other, more involved tracking measures. The methods and findings presented may be valuable for other researchers with limited resources planning for or engaged in collecting follow-up outcome data from adolescents enrolled in longitudinal studies.     

Taking culture (and race) beyond dichotomies: a reply to Gans

Gans' (2012 Gans, H. 2012. Against culture versus structure. Identities: Global Studies in Culture and Power, 19(2): 125–134. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]; Against culture versus structure. Identities: Global Studies in Culture and Power, 19 (2), 125–134) indictment of cultural sociology (CS) and his anointment of structural sociology would have us believe the two are incommensurate paradigms. I do not agree. I deconstruct this binary with theory and empiricism from the intersection of CS and the sociology of race and ethnicity (SRE). First, I redefine the project of CS, contra Gans' interpretation. Second, I refute Gans' assumption that ‘CS is not much interested in cultural processes' by demonstrating how CS is concerned with the process and action of the material and symbolic aspects of social life. Third, I examine why well-placed trepidation over ‘culture of poverty’-style explanations may influence a negative view of CS/SRE. Fourth, I map advances birthed from the CS/SRE connection that contest Gans' assertion that ‘CS has not paid much attention to policy’. And fifth, I show how CS avoids tautological arguments in which culture would be ‘its own cause’.     

A recovery-oriented approach to psychiatric medication: guidelines for nurses

Despite the well-documented effectiveness of psychiatric medication, studies reveal that it is used by only approximately half of those for whom it is prescribed. Whereas large-scale studies have focused primarily on the consequences of not taking medication as prescribed, a number of recent qualitative studies have tried to understand the phenomenon from the perspective of consumers. Findings have revealed that nonadherence may not always reflect psychopathology or a lack of insight, but rather a personal choice directed toward engaging in activities that provide meaning and purpose. In this article, we review the literature on medication use, emphasizing the importance of the practitioner-consumer relationship. We also present a recovery-oriented perspective to understand consumers' choices regarding medication use and discuss practical guidelines for psychiatric nurses.     

Don't just do something, stand there: responding to unrelieved patient suffering

Nurses are taught a variety of interventions to relieve patient suffering. They are often more comfortable with patient suffering that is physical in nature rather than psychological, existential, and spiritual. Remaining present for patients and families whose suffering cannot be easily relieved is particularly challenging. This article describes how an expert nurse responded to unrelieved suffering and offers insight into ways of being present for patients and families.