Compassion Fatigue in the Treatment of Combat-Related Trauma During Wartime

This article utilizes relevant data on the troops serving in Iraq and Afghanistan, and a composite case of a clinician working with combat survivors, in order to illustrate the potential for compassion fatigue in clinicians treating this cohort. Review of the literature on the effects of compassion fatigue related to combat trauma and the impact of collective shared trauma is presented. This is done in order to emphasize the complexity of the provision of war trauma treatment post 9/11 in the context of the ongoing wars. There is an urgent need for the mental health field to continue to develop interventions and educational programs that will help mitigate the deleterious effects of compassion fatigue in clinicians working with this population.     

Accountability Factors Associated with the Delivery of Mental Health Services to Children

This study describes a sample of children served in a community mental health center and identifies factors associated with the delivery of services to them. The data are from a 1993 sample. Results of the analysis indicate the number of sessions, total services and referrals are associated with the presence of treatment plans for children.     

Barriers to Integrated Treatment of Substance Abuse and Trauma Among Women

Despite increasing empirical support for an integrated approach to treating trauma and substance abuse, many substance abuse treatment programs have been slow to embrace integrated models of practice. Using an embedded case study design, the purpose of this study was to understand barriers that prevented a substance abuse treatment provider and 20 professionals and staff from adopting an integrated approach to treating substance abuse and trauma. Data analysis revealed 2 kinds of barriers that prevented substance abuse treatment professionals from fully integrating substance abuse and trauma: systemic and professional barriers. These barriers have to be taken into account when trying to move providers and professionals toward integrated approaches to treating substance abuse and trauma.     

The Role of Technology in Mediating Use of Outpatient Substance Abuse Treatment Services

ABSTRACT

This study examined the relationship between Connect, a telephone-based information and support system, and the use of outpatient substance abuse treatment services. Regression models were formulated to examine the relationship between use of substance abuse treatment services and Connect. The results indicate that Connect use was not significantly related to the likelihood of using treatment (N = 240). However, an inverse relationship was found between Connect and use of treatment services (n = 123). The findings raise the conceptual issue of whether one introduces technology as an “add-on” to or as a “substitute for” traditional substance abuse treatment services.     

Inclusion of Caregiver Supports and Services in Home- and Community-Based Service Programs: Recent Reports from State Units on Aging

Caregivers have an important role in assisting frail and/or disabled individuals to maintain their independence in the community. Support to assist caregivers in this often stressful and demanding role is critical to sustaining the caregivers' health and ability to provide care. This paper reviews federal policy changes since 2000 that have expanded and enhanced services for informal caregivers. Next, data collected from State Units on Aging and other state agencies are presented to describe the extent to which caregiver services are included in home- and community-based programs under three funding streams (Medicaid waivers, Centers for Medicare and Medicaid Services–funded programs, and state-funded programs). Program characteristics, such as eligibility and consumer-directed options, are included. Finally, the accomplishments and initiatives reported by state respondents related to supporting informal caregivers are also explained. Results indicate that services for informal caregivers are receiving greater attention and are frequently offered under home- and community-based service programs by the states that participated in this study.     

The Use of Peer Support for Parents and Youth Living with the Trauma of Child Sexual Abuse: An Innovative Approach

ABSTRACT

This article describes and reports on an innovative intervention program for parents of sexually abused children and youth. Peer support provided by non-professional staff and volunteers, who have been personally affected by the trauma of child sexual abuse, is an approach with unique advantages. Many of these consumers have not been able to benefit from traditional service delivery approaches. Goals and objectives of the Peer Support Program (PSP) have been developed through inter-agency collaboration initiatives comprised of a coalition of existing social service agencies. This report examines characteristics of service delivery and level of consumer satisfaction of parents and youth who have participated in the peer support program. Implications for interventions with sexually abused youth and parents of sexually abused children are discussed.     

Building Trauma Informed Practice: Appreciating the Impact of Trauma in the Lives of Women with Substance Abuse and Mental Health Problems

ABSTRACT

This paper examines the lifetime interpersonal abuse experienced by a substance abuse treatment sample of 1,955 women with co-occurring disorders. Substantial rates of intimate and community-based interpersonal abuse and other life stressors are documented. Regression analysis shows that while trauma severity is significantly related to trauma distress, its impact on psychological symptom distress and drug severity is quite modest. The implementation of a trauma informed approach featuring trauma-specific treatment, service integration and consumer empowerment is described as a promising practice model for assisting women seeking help in substance abuse treatment programs.     

Social and Health Service Use and Treatment Outcomes for Sexual Minorities in a National Sample of Substance Abuse Treatment Programs

This study examines substance use severity, levels of social and health service utilization, and the impact of service utilization on treatment outcomes for sexual minorities versus non-minorities. The sample included 3,094 clients from the National Treatment Improvement Evaluation Study (NTIES). Substance use severity among sexual minorities and non-sexual minorities was similar at treatment entry and at 12 months post-discharge. Differences in social and health service utilization were significant for substance abuse counseling and health services. Significant interactions between sexuality and access services and sexuality and mental health services were also found. Practice and research implications are discussed.     

The Role of the Pharmacist in the Delivery of Family Planning Services to College Students

Abstract

A survey was conducted among college students to determine their assessment of the potential of the pharmacist as a family planning counselor. Pharmacists were seen as an appropriate source of contraceptive information for many contraceptive methods, but few respondents had actually consulted a pharmacist. Pharmacists were viewed as competent to provide contraceptive information by a slight majority of the respondents, but only half indicated they would use the pharmacist as a source of this kind of information.     

A First Order Markov Model for Use in the Human Services

Summary

Markov processes have found a variety of uses in human services administration, evaluation, program and policy research. The models are concerned with the movement of entities or persons through finite states or conditions, the course of a disease and the movement of persons in various states in population change problems. The possibility of using the computer to link costs factors m levels of psychiatric and medical care as persons move through a system makes the first-order Markov process a potentially powerful tool in the administration of human programs.     

Managing the Trauma of Community Violence and Workplace Accidents in South Africa

Summary

Community violence that spills over to the workplace is substantially impacting the quality of work/life in South Africa. Gold mining is one of the country's leading industries and also one of the most dangerous. Internal and external employee assistance programs are well represented in South Africa and are helping employees deal with the economic and psychological fall-out of community violence and work related accidents.     

Program Design and Planning Strategies in the Delivery of Culturally Competent Health and Mental Health Prevention and Treatment Services to Latino Communities

SUMMARY

It is important that the delivery of health and mental health prevention and treatment services within Latino communities be culturally sensitive. This article outlines several ways in which agencies can develop programs that can meet the needs of Latino communities. The most important aspect of the provision of health prevention and treatment services is that the organization integrates itself into the community through outreach, recruitment, and inclusion in decision-making. In addition, the organization needs to be structured so communication and participation from the community and health professionals are open and mixed. Otherwise, the likelihood of success of the provision of services in the community will be diminished.     

Intergenerational Practices and Possibilities Related to the HIV/AIDS Pandemic in Botswana and Nigeria

Abstract

The future of Botswana and Nigeria hangs precariously on the balance of life and death. In recent years, the latter seems to be winning as both countries face the devastation of their middle generation due to the HIV/AIDS pandemic. Neither country can afford to simply watch their populations be depleted at such an alarming rate. This paper seeks to propose how an intergenerational framework might be applied to this situation with the hope that intergenerational policies and approaches might ameliorate this social crisis.     

广州生活性服务业空间分布、成因与城市空间结构发展

本文基于广州第二次经济普查中七类生活性服务行业就业人员数据,运用集中化指数、区位商和空间分析法对广州2008年生活性服务业空间分布进行研究。研究结果表明:广州生活性服务业主要集中在CBD,呈圈层蔓延至近郊,并在远郊城市副中心集聚,已经形成"一主五次"的生活性服务业空间结构,与广州城市空间布局现状和规划具有相似性;影响生活性服务业在广州城市空间分布的因素主要是人口、政府所在地和商业发展水平三因素;生活性服务业发展有力地促进城市中心蔓延,但对多中心城市发展的影响还不强。     

HIV and the Cycle of Trauma in Gay Men

Summary

Forged within the sociocultural context of the collective trauma of AIDS, HIV prevention efforts became rigid, focusing almost exclusively on patient education as risk reduction. However, while some people have not been able to incorporate risk reduction into their behavioral patterns, others have indeed returned to high-risk behavior after a period of reduced risk as evidenced by the “Bareback” movement. HIV prevention education has overlooked the effect of oppression and sexual trauma on the lives of gay men, and the impact of these phenomena on the gay male's interest in, and ability to, negotiate safer sex. Sexual trauma has been shown to have a direct effect on HIV risk and seropositivity. Additionally, as sexual trauma (often in the form of homophobia) and HIV infection have numerous parallels, the gay man may have analogous ways of relating to, processing and dealing with the two phenomena. Case histories are offered to illustrate how the relationship between HIV and sexual trauma may be examined in an effort to enhance the self-esteem and self-concept of the gay man, and thereby offer greater possibilities for him to protect himself.     

Inducing Homogeneity in the Audit Services Market: A Cross-Industry Analysis

In an earlier study on the audit services market, I showed that an individual client firm's likelihood of imitation in auditor selection systematically varied along with its relative position among competing peers within the industry. This paper extends that finding to the aggregate industry level by shifting the analytical focus from within-industry to between-industry variation. The data on 2254 auditor–client pairs across 45 manufacturing industries in the United States are examined to specify the social structural conditions under which the firms are more, or less, likely to produce the outcome of isomorphism. In general, the more hierarchically stratified an industry, the more likely it is to have a highly homogeneous practice among the firms within it. Inequality leads to and exacts behavioral homogeneity. There is, however, a threshold in the relationship between the aggregate homogeneity and the industry structure: When the disparity between the top and middle tiers is too large, the social reference process breaks down and the level of homogeneity declines. This industry-level finding complements the earlier firm-level finding and empirically substantiates the mechanism of mimetic isomorphism, further elaborating the theory.     

Promoting Justice in the Delivery of Services to Juvenile Delinquents: The Ecosystemic Natural Wrap-Around Model

Caught between their child and doing the right thing, families of chronic juvenile delinquents often experience a series of injustices in the name of justice. Attempts by the system to correct the delinquency problem often result in the imposition of values and beliefs that negate the family's values, experiences and meanings of their child's behavior. The Ecosystemic Natural Wrap-around (E.N.W.) model attempts to respectfully account for the many influences that maintain problematic interactions, both internal and external, in the nuclear family of chronic juvenile delinquents. The model focuses on a variety of interventions at different levels and contexts, building on the strengths of the family, using the extended family and fictive kin networks, and clarifying the meanings associated with problematic behavior for the multiple players. The model proposed is an integrative theoretical approach, emphasizing systems theory and constructivism.     

Opportunities in the Hungarian Financial Services Sector as Part of the Single European Market

As Hungary became a member of the European Union, much of the legislatory environment for providing financial services has changed, although most of the integration, at least on the legislatory level, was already carried out before the accession. In my study I try to look at the developments this new status quo has brought about, even if we are quite sure that the adoption of the common currency will cause bigger steps forward in the integration process. I also have a look at another factor influencing the financial services almost as much as the European integration, namely, the development of e-finance. Finally, I make an attempt to draw a picture of the Hungarian financial services sector a few years from now.     

Factors in the transition to homelessness in the chronically mentally Ill

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for theprevious year were significantly correlated with TBH. Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.