The College Mental Health Center: A Report After Ten Years

Abstract

The College Center is a unique mental health facility providing care for thousands of students from many colleges in the Greater Boston area. The authors report on data collected during the 1975–76, 1976–77 school years regarding patient variables such as: gender, year in school, academic major, presenting problem, and others. The center's handling of these patients is reported in terms of diagnoses, treatment recommendations, and numbers of visits. Several commonly held staff assumptions and hypotheses are tested, and from the data available in this study, are not generally confirmed. The impressions, however, of a more recent decrease in antisocial acting out behavior and drug abuse (other than alcohol) and an increase in patients presenting with more classical neurotic and adjustment symptoms are confirmed.     

Community Aged Care Case Managers Transitioning to Consumer Directed Care: More Than Procedural Change Required

Abstract

Consumer directed care (CDC) is increasing in community aged care. However, limited information is available to successfully transition social workers and other case managers to their new role. This paper reports on a case study of six senior case managers who supervised staff in three Australian community-aged care agencies as they transitioned from agency directed care to consumer directed care. A change management framework was used to analyse the qualitative data collected in 12 semistructured interviews. A key finding is that changes in values, attitudes, and organisational culture are needed before staff can fully implement CDC principles of service user self-determination, empowerment, and choice. Process changes needed to assist staff transition to CDC are: using a change management strategy that maximises certainty; monitoring and responding to feelings of anxiety through ongoing consultations; and providing ongoing education and support in group sessions.     

Awareness of Elder Abuse Among Community Health and Social Care Staff in Northern Ireland: An Exploratory Study

ABSTRACT

This article reports on one of the first surveys of multi-disciplinary staff awareness of elder abuse in this region of the United Kingdom (UK). Forty staff from eight professional groups in the Southern Health and Services Board area were surveyed about their knowledge of elder abuse, the types of help they thought they could offer the abused and the abuser, and the level of abuse in their current caseload. Thirty-five per cent of respondents had cases of physical, psychological, financial, and sexual abuse as well as care-giver neglect of people aged 65 and over in their caseloads. The findings suggest that while staff had differing levels of awareness of elder abuse, further training is necessary.     

A Standard of Care for the Prevention of Sexual Misconduct by School Employees

ABSTRACT

This article describes the development of a standard of care for the prevention of adult to student sexual abuse in pre K-12 schools. Standard of care is not a phrase often used in educational practice, and yet, it is a legal concept that may be useful for school administrators. A sample of administrators, child sexual abuse specialists, and attorneys with experience in school employee sexual misconduct responded to 101 items that the literature indicates should be included in a standard of care. There was agreement on 94 of these items by sample participants. Categories of the standard of care were policies, hiring process, hiring screening, hiring interview, training, and reporting. Where there was disagreement by role of respondent, attorneys, child sexual abuse specialists, or both rated the item as more important for inclusion than did administrators.     

Primary Care Screening of Depression and Treatment Engagement in a University Health Center: A Retrospective Analysis

Abstract

Objectives: This retrospective study analyzed a primary care depression screening initiative in a large urban university health center. Depression detection, treatment status, and engagement data are presented. Participants: Participants were 3,713 graduate and undergraduate students who presented consecutively for primary care services between January and April 2006. Methods: A standardized 2-tiered screening approach for an inception cohort of students utilizing primary services. Primary care providers were trained to triage students with depressive symptoms. Results: Six percent of participants had clinically significant depressive symptoms (CSD). Severe depressive symptoms were found in less than 1.0% of participants. Male rates of severe depressive symptoms were more than double that of females. Only 35.7% of untreated depressed participants started treatment within 30 days following identification. Conclusions: Systematic primary care depression screening in a college health center is a promising approach to identify untreated students with depression. More study is needed to improve rates of treatment engagement.     

Kinship Care: Analysis of the Health and Well-Being of Grandfathers Raising Grandchildren Using the Grandparent Assessment Tool and the Medical Outcomes Trust SF-36 TM Health Survey

ABSTRACT

As more and more children are being separated from their biological parents because of AIDS, substance abuse, mental and physical illness, incarceration, and child abuse and neglect, child welfare agencies are relying more often on kinship care as a viable option for out-of-home placements. In many cases, kinship care falls on the grandparents. While keeping children within their families is generally viewed as preferable by child welfare agencies, it can be a burden on grandparent caregivers, who often exist on severely limited incomes and without much assistance or support from social service agencies. A research project was conducted which used both quantitative and qualitative data from research conducted by Jones and Gibbons (2000) on grandparent care, but this study focuses on the experiences of grandfathers who participated in the project and examines their outcomes in several different areas.     

College Health as a Partner in the Care of Pediatric Cancer Survivors

Abstract

Objective: This study reviews an initiative to educate providers on pediatric cancer survivor care and to establish a cancer survivor registry in a college health center. Participants: Participants were University of Georgia (UGA) college health providers. Methods: Providers attended lectures on survivor care and were encouraged to register on Cancer SurvivorLink. Changes in provider familiarity and practice were measured using baseline and follow-up surveys. A survivor registry was created using health entrance forms and medical records abstraction. Results: Twenty-four providers registered on SurvivorLink, and 16 completed both surveys. Familiarity with survivor care (p = .003) and a survivor health care plan (p = .016) increased. Likelihood to deliver survivor care increased (p = .01). UGA follows 95 survivors; 71 diagnosed at < 21 years. Among survivors diagnosed at < 21 years, 91% reported their diagnosis on entrance forms. Conclusions: Through education and optimization of health informatics, college health centers can identify and provide survivor care to this medically vulnerable population.     

Lifetime exposure to abuse,current stressors,and health in federally qualified health center patients

ABSTRACT

Purpose: The purpose of this study was to examine the impacts of lifetime exposure to abuse and current stressors on health, an integrative concept of physical, mental and social health, among patients of a Federally Qualified Health Center.

Method: The sample included 1,055 patients (male: N = 346; female: N = 709) who were at least 18 years of age and completed an assessment on their first visit between January 2015 and March 2017 at a Federally Qualified Health Center. The assessment contained subscales of the DUKE Health Profile measuring physical, mental, and social health; four questions assessing lifetime exposure to abuse; and a relational and socioeconomic stressor checklist.

Results: Results from structural equation modeling analyses showed that for both male and female groups, lifetime exposure to abuse, relational stressors and socioeconomic-related stressors were strongly associated with health. In the male group, socioeconomic-related stressors were the strongest predictor of health, while in the female group, lifetime exposure to abuse was the strongest predictor of health.

Conclusions: Understanding the relationships between health and the combined factors of a lifetime exposure to abuse, relational stressors, and socioeconomic stressors can provide insight to patient care professionals who treat patients in lower income, underserved communities. Ecological Systems Theory provides a framework to plan interventions or to prevent potential negative outcomes associated with these stressors.     

Perceived need for care and mental health service utilization among college students with suicidal ideation

ABSTRACT

Objective: This study aimed to identify correlates of service utilization and perceived need for care among college students with suicidal ideation. Participants: Respondents were recruited from introductory psychology courses at an undergraduate college during the Fall 2014 semester. Methods: Independent correlates of (1) mental health service utilization, (2) self-perceived need, and (3) other-perceived need for mental health services among college students (N = 190) with suicidal ideation were identified. Results: Service utilization was associated with need for care as perceived by others. Perceived need for care by others was associated with suicidal ideation intensity and suicide attempt history. Perceived need by the respondents themselves was correlated with depression severity, sex, and race but was not independently associated with actual service utilization. Conclusions: Perceived need by others was the sole significant correlate of service utilization, suggesting it is an important target for public health interventions aimed at facilitating pathways into mental health treatment.     

Mental Health and Substance Abuse Screening in Primary Care

ABSTRACT

An automated screening system for substance abuse and mental health problems was developed and implemented in a rural primary care clinic. Eighty-nine patients were assessed with this system. The incidence of identified problems, 35% in total, was consistent with that found in previous studies of patients in general and medical settings. Additionally, over half of the patients assessed felt at least some need for mental health or substance abuse treatment. Nonetheless, because of the staff's concerns over patient privacy, impeding patient flow, and the physician's perceived ability to adequately identify these problems without assistance, the system was not adopted.     

Potential for the Abuse of Medication for the Elderly in Residential and Nursing Homes in the UK

ABSTRACT

Abuse of the medication prescribed to the elderly living in long-stay care homes may be perpetrated by a minority of unscrupulous doctors, pharmacists, or home staff caring for the residents. Disorganised practices and homes, poor communications, and sloppy professional practices may create opportunities for over-dosing, errors, fraud, or theft. This article describes the circumstances leading to the potential abuse of elderly residents' medication, and the measures that may be taken to avoid or minimise such abuse from occurring.     

A Survey of 100 Community Colleges on Student Substance Use,Programming, and Collaborations

Abstract

Objective: The objective was to survey community college personnel about student substance use, and infrastructure (staff and funding), programs, and collaborations dedicated to substance use prevention. Participants: The sample included 100 administrators, faculty, and health services staff at 100 community colleges. Methods: Participants completed a Web-based survey. Results: Participants reported a number of alcohol and other drug (AOD) related concerns. Despite limited staff and funding dedicated to AOD, institutions are implementing a number of programs, although many are not implementing some of the programs popular at traditional 4-year colleges. They are also collaborating with a number of on- and off-campus groups. The availability of staff and funding dedicated to AOD, and the presence of residence halls, is associated with health programming and substance abuse collaborations. Conclusions: Results suggest that there is a need for increased research to understand the most effective AOD prevention strategies for community colleges.     

The Powerlessness of Control: A Unifying Model for the Treatment of Male Battering and Substance Addiction

ABSTRACT

The high incidence of partner abuse among substance addicted men calls for a unified model of treatment. Grace Therapy is an approach for the treatment of male batterers based on the 12-Step Program of AA/NA. Clinical evidence relates the internal processes of male batterers and substance-addicted men to similar issues in which feelings of powerlessness arise. Powerlessness has three levels: behavioral, mental, and spiritual. By addressing the behavioral and mental levels, men can become abstinent by avoiding the situations, behaviors, and mental motives that lead them to violence and substance abuse. Recovery and healing occur within the spiritual level through a transformation of the men's attitudes towards the world and themselves–a transformation from self-centeredness to God-centeredness, which produces a growing capacity within the men to care for others unconditionally.     

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.     

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.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

Variations in Provider Capacity to Offer Accessible Health Care for People with Disabilities

Abstract

Since social workers are likely to practice in a range of health care settings, their training focusing on human behavior in the social environment could help providers develop strategies to improve access to care for people with disabilities. In this article, results from a comprehensive survey of providers about access to health care for people with a broad range of disabilities are reported. Results suggest that a minority of providers report difficulty serving people with disabilities. However, dentists and mental health/substance abuse providers are significantly less likely than other providers to report that they provide accessible services to individuals with disabilities. These providers are less likely to report having had training related to mobility impairments, providing mirrors at their facility, having an accessible door, or providing assistance with personal care needs, and are more likely to report that their building poses a barrier for people with disabilities. Social workers are well positioned to take a leadership role in working with providers and patients to improve access to health care for people with disabilities. A social work framework of understanding the individual in a social environment may be the most appropriate perspective for creating innovative strategies for addressing the complex, multidimensional needs of people with disabilities who experience limited access to care.     

Medication Abortion Within a Student Health Care Clinic: A Review of the First 46 Consecutive Cases

Abstract

Objective: Medication abortion with mifepristone and misoprostol has been available in the United States since 2000. The authors reviewed the first 46 medication abortion cases conducted at a university-based student health care clinic to determine the safety and feasibility of medication abortion in this type of clinical setting. Participants: Female patients presenting for medication abortion at a student health care clinic between October 1, 2006, and April 1, 2009. Methods: Retrospective consecutive case review. Results: Successful completion not requiring uterine aspiration occurred in 85% of the cases that were not lost to follow-up. Six cases (15%) required uterine aspiration for completion: 3 underwent uterine aspiration only; 3 had aspiration after failing an additional dose of misoprostol. Only 1 patient visited the emergency room. There were no hospitalizations. Conclusions: Medication abortion services in a student health care clinic are safe and feasible. However, additional treatment may be required with some patients.     

Elder Abuse in Residential Settings in Sweden

ABSTRACT

To investigate frequencies and types of elder abuse occurring in residential settings in two municipal areas of Sweden, nursing staff were asked to answer a questionnaire; 499 responded. The findings indicated that elder abuse involving the staff did occur. Eleven percent of the staff knew of situations of elder abuse and two percent admitted that they themselves had been abusive towards an elderly resident. Psychological and physical abuse related to caring activities were most common. In the specific situations reported, the abusers were mostly characterised as hot-tempered, exhausted, and burned out. The abused people were often mentally and/or physically handicapped and generally over 80 years old. Feelings such as powerlessness, anger towards the abuser, and compassion for the abused person were reported. To cope with the situation, they talked to each other or to the manager. They recommended more education and support as the main preventive strategy.     

Resource Effects on Access to Long-Term Care for Frail Older People

Abstract

Access to long-term care depends primarily on personal resources, including family members and income, and on external resources, including Medicaid and Medicare. This study investigates how resources affect frail older individuals' access to long-term care, with a focus on Black and White widows. Data from the 1989 National Long-Term Care Survey is used, in conjunction with state-level Medicaid and Medicare reimbursement rates for nursing home and home health care, to estimate the likelihood of five types of care arrangements. Results show that children are a primary resource for unmarried individuals in maintaining access to informal care. Income effects are nonlinear in relation to nursing home care: increasing incomes below the mean income are associated with decreasing probabilities of nursing home care, while increasing incomes above the mean are associated with increasing probabilities of nursing home care. Income and Medicaid effects are interrelated, with nonlinearities associated with income having the potential to adversely affect some older persons' ability to access nursing home care.