A Stepwise Approach to Evaluating Children for Parental Alienation Syndrome

ABSTRACT

Parental alienation syndrome continues to be a term that is widely used in child custody conflicts but which is also controversial. Previous authors have defined the term but have not established a standardized assessment process for PAS. The author emphasizes the importance of focusing on the child's behavior, then proceeding through a three step process: (1) determining if the refusal of contact with the parent is extreme and the alienation is severe, (2) determining if there is no basis for the extreme fear and anger toward the parent, (3) then determining if the child meets at least 10 of the 15 criteria that are proposed. The assessment process for each of the 15 criteria is outlined in detail with examples of each. Novel strategies and interview questions are suggested. The author includes a supplemental section for interview techniques that might be used with the alienating parent.     

The Problem-Oriented Method of Health Care Administration

Abstract

In 1968, Dr. Lawrence Weed^1,2 described the problem-oriented medical record as a basic tool in medical education. The authors attempted to adapt the “Weed System” for use in health care administration. The aims of the modification were to facilitate participative management in problem solving, and to formulate quality decisions by the consensus of an interdisciplinary group of managers.

Thirteen Department Heads were introduced to the Problem-Oriented System as described by Weed.^1,2 The Problem-Oriented Method of Health Care Administration (POM/HCA) was described by the Director as an extension of Weed's system.³

Weed's categories of Subjective, Objective, Assessment, and Plan (SOAP), were given for each problem presented at Department Heads' Meetings. The subjective information for the particular problem was derived from the felt or perceived needs, or the immediate pressures that so often arise in a multidisciplinary health care setting. Objective data came from identification and analysis of information about the problem. The assessment section was used by the Director to outline his thinking on the issue. The plan-for-decision section indicated the desired level of staff involvement in the decision-making process, by giving a numerical value to the area of freedom for the staff (adapted from Tannenbaum and Schmidt).⁴

Each Department Head was interviewed by the Management Consultant to find out how he or she experienced POM/HCA, their reactions to the numerical system for designating staff involvement in the decision-making process, and what he or she saw as the impact, advantages, and limitations of this method.

“Blood Doping:* An Update,” M.H. WILLIAMS. The purpose of this paper is to review the literature relating to the use of blood doping* in an attempt to improve the performance of an aerobic endurance athlete such as a five or ten km. runner or a marathoner. An earlier review of the literature by the author in 1975 concluded that there was not sufficient objective evidence to support the use of blood doping to increase endurance capacity. However, contemporary research demonstrates that when properly done, blood doping does significantly increase endurance performance in sports that are dependent on sustained, high levels of oxygen. The author also calls attention to the medical, legal, and ethical problems related to the practical application of blood doping. (The Physician and Sports Medicine 1981, July;9(7)59–64.)

* Blood doping is the process of removing blood from an athlete, usually an endurance-related sports participant, saving the blood and then about two weeks later, prior to competition, retransfusing into the system, to increase the oxygen capacity.

Contributed by John M. Miller, M.D.     

User satisfaction surveys and cognitive question testing in the public sector: the case of personal social services in England

Obtaining feedback from service users is a key element of the UK Labour Government's agenda for modernization of the public sector. This reflects a growing international trend in Europe and North America. Recognized difficulties in taking an approach to performance assessment based on the concept of user satisfaction are outlined. Ascertaining the views of people who use personal social services poses particular challenges which result from the levels of impairment and illness in the population, local variations in service provision and the 'care and control' functions of social care. It is argued that cognitive testing of questions, based on research knowledge about user views, provides a way of overcoming some of the pitfalls of traditional satisfaction surveys, while developing questions that are meaningful to respondents. The origins and principles of cognitive testing are described, followed by an example of their application in the development of a questionnaire for home care users. Strengths and limitations of the approach are identified.     

A New Approach to Religious Commitment

Abstract

The authors propose a new framework for studying religious commitment. Commitment is viewed as a general social process which occurs in various aspects of life (e.g., marriage, work, politics, and religion). It consists of subjective and behavioral components. Religious commitment is defined as the interaction between people's religious consciousness and religious participation. Other religious beliefs, feelings, and intellectual inclinations are considered to be parts of people's religious orientations, not aspects of commitment as other approaches have suggested. Data from members of six Christian denominations are used to explore this conceptualization and the relationships among these variables. Some determinants and consequences of commitment also are considered. The evidence yields several propositions regarding factors that affect commitment and the effects of religion on people's attitudes and behaviors. The paper's implications for future research on religious commitment in particular and commitment in general also are discussed.     

Chapter 4. Older Latinos and Mental Health Services

SUMMARY

This article discusses the biopsychosocial and spiritual aspects related to older Latinos' use of mental health care. It also addresses the environment that older Latinos have to navigate to access mental health services. Structural barriers to mental health services are emphasized as critical to a holistic assessment of the client's situation.     

Reducing High-Risk Drinking Among Student-Athletes: The Effects of a Targeted Athlete-Specific Brief Intervention

Abstract

Objective: This study examined the effects of a single-session motivational interviewing–based in-person brief alcohol intervention that contained student-athlete–specific personalized drinking feedback. Participants: Participants were 170 National Collegiate Athletic Association Division I student-athletes meeting screening criteria for heavy episodic drinking. Methods: Baseline assessments of alcohol use frequency and quantity, norm perceptions of peers' alcohol use, experiences of negative consequences, and use of protective behaviors were administered to student-athletes prior to a 1-session brief intervention containing personalized feedback highlighting the relationship between alcohol use and athletic performance. Follow-up assessment was conducted 3 months post intervention. Results: Student-athletes participating in the athlete-specific brief intervention showed significant reductions in their alcohol use and alcohol-related negative consequences, increases in use of protective behavioral strategies, and corrections in norm misperceptions at 3 months post intervention relative to a no-treatment comparison group. Conclusions: Student-athlete–specific brief alcohol interventions show promise in addressing high-risk drinking, reducing associated harms, and supporting health.     

The Work of Caring for Children

Abstract

In this article I present a textual analysis of the child care policy debates that took place in the United States during the late 1980s. I identify and illustrate two themes that emerged in these debates. The first expressed a commitment to the “traditional” nuclear family and a belief in the importance of full-time motherhood for children's well-being. The second expressed a devaluation of two aspects of women's caregiving: the mother-work of welfare recipients and the work performed by child care providers. I argue that the views comprising these two themes contributed to the limitations of the federal child care legislation that was adopted in 1990.     

'He's not my carer—he's my husband': Personal and policy constructions of care in mental health

This paper is based on empirical research into the skill needs of care managers and examines the legacy of care management and the effect that 'new managerialist' approaches have had on care management work. The concept of emotional labour is used in context and applied to the work of care managers where the ultimate aim is quality outcomes for users of services. The paper argues that recognising the validity of the concept of emotional labour in context relates to the need for a greater acknowledgement of the skills required by care managers. 'Soft skills' that involve improving own learning and performance through reflection, problem solving and working with others are the key skills required for complex care management work. A rationale is made for reconsidering competency approaches to training in favour of continuing professional development. A preferred approach is one that emphasises both the personal and professional aspects of learning and the social world of the learner.     

Variables Affecting Patient Satisfaction with Health Care Services in the College Health Setting

Abstract

Patient satisfaction with health care services is an important factor in health care delivery. It will significantly influence whether or not a patient seeks medical care, complies with prescribed treatment, and/or maintains a continuing relationship with a medical practitioner.

A survey questionnaire, relating patient satisfaction with a number of variables identified through a literature review, was mailed to a random sample of 500 students utilizing Student Health Service (SHS) at Kent State University (KSU) during the five week study period. The data obtained would be utilized to help with planning future health care services and staff inservice education programs.

The findings of this survey indicate that patient satisfaction has a statistically significant correlation with perceived technical competence of the practitioner and perceived adequacy of the interpersonal aspects of the practitioner-patient relationship. A significant relationship did not exist between satisfaction and expectations the patient holds of the practitioner's role performance. A statistically significant relationship was found to exist between receiving health information/education related to diagnosis, prognosis, and treatment plan and satisfaction with health care services. This relationship did not hold for health information/education related to activity restrictions or preventive measures. The study also revealed that time waited during the medical care encounter was inversely related to satisfaction. Last, stepwise regression found that perceived technical competence of the practitioner was the most important variable influencing patient satisfaction with health care services.

This study provides data about factors important to personal satisfaction with health care services for a selected group of college students.     

Watching the Detectives

Abstract

Do popular authors of African detective fiction use their sleuths to clean up what they perceive to be post-colonial crimes? And is it possible for readers of whodunnits to make any sort of serious assessment of the socio-economic conditions of a country through following the trail of these ‘ethical eyes’? This article investigates Dan Fulani's Special Agent Pius Shale 005, Unity Dow's Amantle Bokaa, Alexander McCall Smith's Precious Ramotswe and Deon Meyer's Zatopek van Heerden.     

Development,Evaluation, and Validation of Environmental Assessment Tools to Evaluate the College Nutrition Environment

Abstract

Objective: To develop, evaluate, and validate 2 nutrition environment assessment tools (surveys), for specific use in combating overweight on college/university campuses. Participants and Methods: Invitations to complete surveys were e-mailed to food service and health center directors at 47 universities, Winter 2008. Overall response rate was 48%. Responses from the 39 individuals who completed tool evaluations at the end of each survey were analyzed. Follow-up interviews and site visits performed through Summer 2008 validated responses. Results: The majority of respondents (64%) indicated tools were effective at assessing their nutrition environments; 78% believed these types of assessment tools to be important to their school. Conclusion: Food service and health center directors support use of nutrition environment assessment tools and found them effective at clarifying existing nutrition programs, policies, and food offerings on their campuses. Conducting assessments using these tools could improve university nutrition environments by identifying areas needing improvement.     

Observing Different Faiths,Learning About Ourselves: Practice with Inter-married Muslims and Christians

Abstract

Advanced care planning and end-of-life decision making are part of contemporary debates about death and dying. A data-mining study reviewing medical records of patient deaths in hospital investigated these issues and the utilisation of social work services. Findings indicated that the majority of records included some form of documentation about end-of-life care, including cardio pulmonary resuscitation (CPR) orders and that family members and surrogate decision makers were more likely to be consulted than patients about these plans. The incidence of referrals to social workers was found to be highest “out-of-hours”. Key social work interventions were identified, including establishing the reliability of surrogates' decisions through social work assessment. This paper discusses elements that contribute to a supportive environment for patients and family members to facilitate the decision making process, including the need for a broader ethical discourse to accommodate the increasing complexity of end-of-life decision making in hospital settings.     

The Education of Children in Out-of-home Care

Abstract

In spite of a high investment in out-of-home care services across Australia, the educational attainment of children in care remains an issue of concern. This paper discusses findings from a study designed to identify the factors that promoted educational attainment of children in care based on 18 university-educated women with a care background. The narratives of these women from primary schooling through to graduating from a university were collected and analysed using narrative inquiry. The women's narratives strongly suggested that the educational needs of children in care vary according to individual care circumstances and individual characteristics, and can be identified in five groups: Destined, Decision, Determined, Denied, and Delayed. It was concluded that the promotion of educational attainment for children in care requires carefully tailored support and resources following assessment based on this information.     

Managing the process of change in residential child care: A consultancy approach

This article explores the impact of a consultancy undertaken with groups of residential child care staff within a large local authority who were experiencing considerable changes in their working environment as a result of a review of residential care structures. The authors were invited to engage directly with staff on an individual and group basis to help them work through the barriers they perceived to changing their approach to practice. The theoretical underpinning for the work was Charles Handy's [1993, Understanding Organisations (Harmondsworth, Penguin)] belief that change is more likely to have a positive outcome when staff have an investment in and contribution to the change processes. The model of change utilised within the sessions with staff was Kurt Lewin's three stages of 'unfreezing', 'change' and 'refreezing'. The consultancy raised a number of issues about the process of change and how this can be achieved within the residential child care context. In particular, it highlighted the problems of assuming that change is a linear process which can be directly controlled and managed in the flux and uncertainty which characterises this sector.     

Social Work Assessment of Children with Oppositional Defiant Disorder

Abstract

A review of the empirical literature was conducted concerning the use of the Child Behavior Checklist(CBCL) in the assessment and treatment of children meeting the DSM-IV criteria for Oppositional Defiant Disorder. Even though the information is more limited on the CBCL in regards to ODD, compared to youth with Conduct Disorder, it is evident that this scale is a practical rapid assessment instrument with clinical, administrative, research, and program evaluation uses. Social workers serving children meeting the criteria for ODD, and those engaged in research and evaluation with such children, are encouraged to consider using the CBCL as a part of a comprehensive social work assessment package.     

Broadening the Array of Services: Integrating Legal and Social Work Services for Youth and Families

ABSTRACT

The Community Justice and Legal Assistance Clinic (CJLA) is a unique community-based legal clinic developed through a partnership between a law school and a child and family service agency embedded within a low-income community. This article describes the development of this clinic through a community assessment process; its unique multidisciplinary features; the services provided to clients in three of the agency's service areas; the benefits of the partnership for clients, the social service agency, the participating law students, and the law school; and lessons learned for replication of this type of clinic in other communities.     

Identity Consequences of Religious Changing: Effects of Motivation for Change on Identity Outcomes

Abstract

Comparisons of religious identity are made between two types of religious changers: (1) converts, those individuals who have changed their religious group affiliation due to change of religious belief, and (2) alternators, who have changed their religious group affiliation for some motive other than a change of belief. The religious changers are drawn from a variety of religious affiliations using a convenience sample. Analysis is quantitative, using logistic regression analysis and difference of means testing.

Predictions based in identity theory (Stryker 1980, 1987) argue that converts will show higher levels of salience and commitment to the religious identity as well as behave in ways more appropriate to the religion. Results indicate no postconversion difference between the two types. The project is a first attempt to use identity theory to address the consequences of identity change based on differing motivations. The literature is advanced through the application of quantitative methodology to a traditionally qualitative question (the conversion experience) and by shifting the focus from the process of religious conversion to its identity consequences.     

Social Work Assessment of Adaptive Functioning Using the Vineland Adaptive Behavior Scales

Abstract

The assessment of client adaptive functioning is often an important component of a comprehensive social work evaluation. The Vineland Adaptive Behavior Scales (VABS) are the most commonly used quantitative measures of adaptive functioning for clients meeting the criteria for a wide range of disorders. We review the development of the VABS and current knowledge pertaining to the instrument's reliability and validity. We conclude that the ability to administer and interpret the VABS is an important skill for clinical social workers to acquire.     

Auditing Nonphysician Providers' Visits through a Computer-Assisted System

Abstract

The Medical Department is using a computer-assisted system for auditing care provided by mid-level practitioners. Standards of care and corresponding checklist forms have been developed for six common ambulatory problem areas. These include: Respiratory complaints, headache, gastrointestinal disorders, urinary tract infections, male genitourinary problems, and minor trauma. The standards for the diagnostic process and treatment of each complaint were developed by a working group of physicians and mid-level practitioners. Providers complete a checklist form for each patient presenting with problems covered by the protocol. The checklist serves as the medical record for the visit. Checklist data is entered into a computer which audits the visit record against protocol standards. The computer identifies records containing discrepancies in the appropriateness of diagnosis, treatment plan, and physician consultation. The computer output is not the end of the audit process. It identifies encounter records which need further review. Because a discrepancy from the programmed standards does not necessarily reflect faulty medical judgement or care, these records are referred weekly to a physician-nurse audit team. The computerized system allows the auditors to focus their efforts on problems which may make a significant difference in patient care.

As a result, the Medical Department's audit process is both more comprehensive and more thorough than it was prior to the inception of this program. Since April 1, 1977, more than 15,000 encounters have been audited through this system.