Resilience,mental health and Assertive Community Treatment

Clinicians try to promote resilience by building an effective therapeutic relationship with their clients. Assertive Community Treatment (ACT) is an established approach for providing services to individuals with severe mental illness who have not fared well in the regular mental health system. This work underscores the importance of a resilient therapeutic relationship in preventing relapse and assuring adherence to therapeutic outcomes. Persistent psychiatric illness takes a toll on the resilience of the client, while the relationship work takes a toll on the resilience of the clinician. This article explores the concept of relational resilience between clinician and client as a dynamic process of shared success and failure, progress and regression through cycles of crisis, stabilization, relapse, and partial recovery. This is a qualitative study exploring how ACT clinicians promote and sustain resilience and is based on interviews with social workers, nurses, occupational and recreational therapists, coordinators, and psychiatrists.     

Understanding engagement in the Program of Assertive Community Treatment (PACT) from the perspectives of individuals receiving treatment

ABSTRACT

Engagement of individuals with serious mental illnesses in community mental health services is a significant challenge. The Program of Assertive Community Treatment (PACT) is an individual-centered and self-contained mental health program that provides psychiatric treatment, rehabilitation, and support services to persons with serious mental illness who have a history of or likelihood of disengagement with services. Understanding what helps and hinders consumers’ involvement in PACT services may provide information on how to tailor engagement strategies to individuals based on their treatment needs and preferences. The current study builds on existing studies by exploring factors that help and hinder engagement in PACT services from the perspectives of individuals receiving treatment. We conducted open-ended, semi-structured interviews with 17 individuals receiving PACT services. Nine themes were identified through thematic analysis: Desirable qualities of PACT, Focusing on positive outcomes, PACT as a safety net, Recovery orientation, Practical barriers, Conflictual relationships, and Medication side-effects. We conclude that the development of a trusting, therapeutic relationship that is collaborative and person-centered and that is facilitated by both practical and emotional support is critical to engaging individuals in treatment and maximizing positive outcomes.     

Children Exposed to Community Violence: Issues for Assessment and Treatment

Community violence is increasingly recognized as a risk factor for serious psychological problems with children particularly vulnerable to its effects. This article summarizes the existing knowledge on the effects of chronic exposure to community violence, highlights essential issues in assessing children for both exposure and resulting trauma from community violence, and provides treatment guidelines for those affected children.     

In Defense of the Community Reinvestment Act

In the wake of the 2008 global financial crisis, the Community Reinvestment Act (CRA) of 1977 has probably received more media attention in the past 2 years than it garnered cumulatively over the previous 30 years. Numerous conservative pundits and commentators have blamed the CRA for the subprime crisis and the subsequent worldwide financial meltdown. Most social workers are probably unaware that the CRA is probably responsible for more investment, loans, and wealth creation in low and moderate income neighborhoods than any other single piece of federal legislation over the past 40 years. This article highlights the following features about the CRA that social workers need to know: The CRA was created and passed only because of grassroots community organizing; the CRA has been directly or indirectly related to 8 trillion dollars of investments, mortgage, and small business loans in low income neighborhoods since 1977; community organizing has always been the primary enforcement mechanism of the CRA; contrary to widespread right-wing media accounts, the CRA was not responsible for the housing bubble and worldwide financial crisis in 2008. In this article, we articulate the veridical factors contributing to the financial collapse. Presently, Congress is debating reforms for the financial sector, and the way banking functions will be transacted in the future remains unclear. Regardless of the eventual restructuring of finance, moving forward, social workers should continue to advocate for legislation that will ensure housing for low and moderate income people.     

Coping with Compulsion: Women's Views of Being on a Community Treatment Order

Abstract

An interview-based study of 42 people with serious mental illness was undertaken in New Zealand during the early 2000s. Of the 42 people, 10 were women. The women were either currently on a Community Treatment Order or had been recently discharged from a long period of being on a Community Treatment Order. Analysis of the original interview data revealed how these women experienced both benefits and limitations under conditions of compulsory community treatment. The women's key workers, clinicians, and nominated family members were also interviewed. The findings indicate that women considered the overall advantages of Community Treatment Orders to outweigh the disadvantages. Advantages included: greater access to treatment and respite care in hospital; and an increased sense of safety and reassurance for women and their families. Disadvantages included: some restrictions, such as where women resided; feelings of stigma; and having to comply with treatment with the threat of being returned to hospital if they did not. Overall, Community Treatment Orders made a significant impact on the lives of the 10 women but they also allowed the women to remain out of hospital long enough to rebuild their lives and maintain their close relationships.     

Determinants of housing quality: A comparison of white,African-American,and Hispanic single-parent women

This study examines housing quality among three groups of single-parent women: white, African-American, and Hispanic. Three indicators of housing quality—crowding, affordability, and satisfaction—are used to discover the extent to which these groups experience housing problems. This study also explores differences and similarities in the factors that precipitate problems in housing quality for these three groups of single parents. Findings suggest important differences and similarities in the nature of housing quality problems among white, African-American, and Hispanic single-parent women. The specified variables explained about 20% of the variance in crowding, housing affordability, and housing satisfaction. On measures of objective and subjective housing quality, white single mothers are better housed than their African-American or Hispanic counterparts. Hispanic single mothers have the largest housing cost burden and average more persons per household than the other groups. African-Americans are twice as likely as either group to live in low-quality housing and reported the lowest average satisfaction with their housing. Her research interests include housing and neighborhood assessment and women and public policy issues. She has recently published articles inUrban Affairs Quarterly andHousing and Society on housing and neighborhood assessment criteria among black urban households and the housing cost burden of various groups of female-headed households. She received her Ph.D. from Ohio State University. Her research interests include the housing adjustment behavior of women and public policy. She has recently completed her thesis on the role of noncustodial parents in determining the quality of life of their children. She is also the recipient of the Tessie Agan Award for research excellence from the American Association of Housing Educators for a paper titled “Unterstanding Constraints and Residential Satisfaction among Low-Income Single-Parent Families.”     

Purpose and life satisfaction during adolescence: the role of meaning in life,social support,and problematic digital use

This study examined the characteristics of youth with different types of purpose in life, as well as the associations between adolescents’ life satisfaction, purpose in life, meaning in life, social support, and problematic digital use. The sample included 193 participants aged 14–18 who completed self-report questionnaires on life satisfaction, purpose in life, meaning in life, social support, and problematic digital use. The following purpose in life clusters were found: (1) other-oriented goals (n?=?33); (2) self-oriented goals (n?=?42); and (3) both other- and self-oriented goals (n?=?107). Adolescents with both self- and other-oriented goals had significantly higher life satisfaction, meaning in life, and social support compared to the other groups. Meaning in life and greater support from parents and teachers were significantly associated with greater life satisfaction. In addition, having other-oriented goals was associated with lower life satisfaction. Finally, support from parents (p?=?0.05) mediated the association between problematic digital use and life satisfaction. Findings are discussed in light of previous research and the theoretical and practical implications are examined.     

Precariously placed: housing affordability,quality and satisfaction of Australians with disabilities

Access to adequate, safe, secure, accessible and affordable housing is a fundamental human right and one stipulated in the United Nations Conventions on the Rights of Persons with Disabilities. Australian adults with disabilities experience housing disadvantage including homelessness, poor-quality housing and housing unaffordability; however, we lack a comprehensive comparison of the housing circumstances of people with and without disabilities and differences by impairment type. We analysed data from a nationally representative sample of 11,394 working-aged Australians collected in 2011. We found that people with disabilities experienced disadvantage across all housing indicators, and people with intellectual and psychological disabilities fared worst. These findings suggest that there is a housing crisis for Australians with disabilities, which may intensify with the introduction of the National Disability Insurance Scheme. There is a need to develop long-term housing solutions that promote independence, are accessible and affordable, and that consider location and neighbourhood context.     

Forensic Patients and Forensic Mental Health in Victoria: Legal Context,Clinical Pathways,and Practice Challenges

Forensic mental health services in Australia have evolved and developed considerably over the past two decades. To clinicians unfamiliar with them, the contemporary practice environments in which professionals deliver specialised forensic mental health services and the legislation governing offenders with a mental illness can appear extremely complex. This article outlines the legislation applying to individuals found not guilty of a serious offence on the grounds of mental impairment in the State of Victoria, describes the characteristics of the forensic patient population, and delineates the clinical pathway forensic patients typically take, using an illustrative case example. The competencies and attributes required by forensic practitioners are highlighted, along with the clinical challenges they face, including the inherent need to address risk in a service that has become recovery-focused in orientation. A central theme of the discussion is how social workers adapt their practice within these highly regulated settings to effectively meet forensic patients' needs.     

Using Social Work Theory and Values to Investigate the Implementation of Community Treatment Orders

Abstract

This paper establishes the value of a social work investigation of good practice with people on Community Treatment Orders in the context of social work's longstanding interest in the ethical challenges of working with involuntary clients. The emancipatory values of social work were used to guide this research, thereby ensuring the participation of consumers and their families or carers. Critical social work theory provided an important theoretical base. A mixed methods approach was undertaken, including a cluster analysis and case studies. Five principles of good social work practice emerged from the qualitative data: (a) use and develop direct practice skills; (b) take a human rights perspective; (c) focus on goals and desired outcomes; (d) aim for quality of service delivery; and, (e) enhance and enable the role of key stakeholders. These principles are briefly presented along with recommendations for practice and service development.     

Problem Gambling and Comorbid Psychiatric and Substance Use Disorders Among Drug Users Recruited from Drug Treatment and Community Settings

Little is known about gambling rates of drug users recruited from drug treatment compared with those recruited from the community. We use the Diagnostic Interview Schedule (DIS) to provide lifetime prevalence estimates of problem gambling (i.e., at least one gambling problem) and DSM-III-R pathological gambling (i.e., at least four gambling problems) and describe the association between gambling and psychiatric disorders for drug users recruited from drug treatment settings (n = 512) and from the community (n = 478). We also report the relative risk of being a recreational and problem gambler in this sample. The sample was first interviewed in 1989–90 as a partof two NIDA-funded St. Louis-based studies. The prevalence of problem gambling in the overall sample was 22% and the prevalence of pathological gambling was 11%. There were no statistically significant differences in problem and pathological gambling rates for subjects recruited from drug treatment and those recruited from the community. The conditional prevalence rates, that is, the rate of problem and pathological gambling only among gamblers were 27% and 13.5%, respectively. Major findings indicate that problem gambling was associated with Antisocial Personality Disorder (ASPD), even after controlling for recruitment source and socio-demographic characteristics. In fact, when examining the temporal order of these disorders, we found that pathological gambling was always secondary to ASPD, occurring on average 11.4 years after the onset of ASPD. Problem gamblers, compared with everyone else, were more likely to be male, African-American, recruited from drug treatment, have ASPD and be dependent on illicit drugs. Multinomial logistic regression analysis predicted the relative risk of being a recreational and problem gambler (compared with a nongambler) in this sample according to socio-demographics, ASPD, and dependence on illicit drugs. Results imply that screening for gambling problems will need to be broad-based among drug users.     

Exploring the effectiveness of methadone treatment from the perspective of drug users and their families: a qualitative study in Iran

ABSTRACT

The aim of this study was to explore the effectiveness of Methadone Maintenance Treatment (MMT) from the perspective of drug users and their families. For this qualitative content analysis study, 15 participants were selected via purposive sampling. Data collection was done using deep and semi-structured interviews, which were then analyzed. The results showed that MMT can bring favorable impacts into the patients’ lives and help them with the process of treatment and rehabilitation despite the medical side effects.     

Examining the Interaction of Daily Hassles Across Ecological Domains on Substance Use and Delinquency Among Low-Income Adolescents of Color

The increased risk for substance use and delinquency among adolescents of color has been partially attributed to increased exposure to daily hassles. Although a certain number of hassles are normative, especially among family and peers, adolescents of color experience more stressors in their neighborhood or directly related to fewer resources than their White counterparts. These hassles may interact across ecological systems to impact behavioral outcomes among adolescents. This may be especially true for young people living in public housing. Based on ecological systems theory, this study tests the relationship between experiences of hassles across multiple ecological levels and problem behaviors in a sample of 315 ethnically diverse early adolescents (M_age = 12; 51% female) living in public housing neighborhoods in two large metropolitan areas in the United States. A positive relationship was found between family hassles and both substance use and delinquency, as well as between school hassles and substance use. When the interactions between family, peer, school, and neighborhood/resource hassles were considered, five statistically significant interactions were found. The study results reinforce the role of contextual factors, such as living in low-income neighborhoods and the complexity of hassles interacting at multiple levels of a young person’s daily ecology, on adolescent outcomes.     

Women Reentering the Community: Understanding Addiction and Trauma-Related Characteristics of Recidivism

Women represent 26% of those arrested for serious crimes; many have posttraumatic stress and co-occurring substance use disorders, which may influence recidivism. This study examined 57 women residing in a community re-entry program after exiting prison. Participants completed the Trauma Symptom Inventory and Substance Abuse Subtle Screening Inventory. A discriminant function analysis accounted for 34% of between-group variability and provided a profile of women who recidivated. Women who recidivated had greater alcohol dependence and lower rates of sexual dysfunction and sexual concerns. Practitioners should consider potential links between substance abuse, trauma, and sexual behavior in treatment settings.     

Building School,Family, and Community Partnerships: Developing a Theoretical Framework

School, family, and community partnerships are among the suite of strategies advocated for improved school outcomes in which social workers can play a valuable role. Such partnerships are complex to implement in practice and there is little systematic research to guide the practitioner. This study evaluated an early intervention partnership program involving school, family, community, and philanthropic partners implemented in two primary schools in rural Victoria, Australia. The findings highlighted challenges in the process of evaluation and program implementation and in the opportunities this provided to identify key enabling factors. These involved having: a shared vision and aims; democratic governance; a supportive policy and organisational environment including external funding; workers with skills and clear roles; activities for project momentum; and ongoing review and evaluation. These factors can be used by social workers and others working with schools as a valuable conceptual framework to facilitate school, family, and community partnership processes.     

Substance use disorders and COVID-19: the role of telehealth in treatment and research

ABSTRACT

Telehealth, or the use of telecommunications and virtual technology to deliver health care and engage with patients outside of traditional health-care facilities, can play an important role in addressing the treatment and study of substance use disorders (SUDs) during the ongoing COVID-19 crisis. COVID-19 and related safety restrictions have thrust healthcare workers and researchers into a new reality of healthcare that relies heavily, or even exclusively, on telehealth methods. These changes have forced treatment providers and researchers to be agile in adopting these methods in order to maintain continuity of patient care and data collection. There are unique considerations that should be taken into account as telehealth practices continue to augment SUD care and research, even when restrictions have been lifted. Overall, we propose that telehealth can support innovation in treatment and research focused on SUDs and should be an integral part of our work, beyond COVID-19.     

Parental co-residence,shared living and emerging adulthood in Europe: semi-dependent housing across welfare regime and housing system contexts

Transitions to adulthood not only represent a key period for individual development but also contribute to processes of social stratification. Growing evidence has pointed to increased complexity, postponement and individualization in transition dynamics. Previous research has focused on trends in school-to-work transitions and family formation; however, the central role of housing represents an interrelated process that is less understood. As pathways to adulthood have diversified, many young people experience partial independence in one sphere while continued dependence in others. Semi-dependent housing, either through parental co-residence or shared living, can be an important coping mechanism. Using the European Survey on Income and Living Conditionst, the research investigates the role that semi-dependent living plays within emerging adulthood across varied European contexts. The data suggests that the extent and type of semi-dependent housing varies substantially across EU15 countries. The findings indicate that levels of housing independence can be partly explained by welfare regime context while the propensity for shared living appears correlated with affordability in the rental market. Although socio-cultural and economic trends play an important and interrelated role, the study argues that housing dynamics of young adulthood and the role of semi-dependent living is fundamentally shaped by the context of the housing system and welfare regime.     

Planning for community: understanding diversity in resident experiences and expectations of social connections in a new urban fringe housing estate,Australia

Master-planned estates are a major source of new housing for growing cities. Much research finds these residential developments lack genuine social connections between residents despite marketing of ‘close-knit’ community. Selandra Rise is a new residential development on the urban fringe of Melbourne, Australia. The estate was planned with a focus on community infrastructure and resident well-being. The resident population was younger and more culturally diverse than most other master-planned community case studies. A longitudinal research design was used to explore resident understanding, experiences and needs relating to place-based community. Interviews were conducted with residents before moving to the estate and 9–18 months after moving. Some residents considered community as an amenity provided by the master-planned environment that did not require their social participation. Others aspired to make social connections with neighbours but had varying levels of success. Past experiences which contributed to aspirations for connecting with local community, and the ways that these aims were realised or hindered, are discussed. Understanding diverse resident expectations of community and insights from their lived experience are used to make recommendations for planning new neighbourhoods and designing community development programmes.