When the Norwegian child-welfare services get involved: parents making sense of referrals

There is limited research exploring parents' views and understanding of referrals to the child-welfare services (CWS). This study explores parents' understanding of the circumstances leading to a child-welfare referral, and their understanding of the reporter's objectives in making the referral. Qualitative content analysis and frequency analysis was performed on open-ended survey responses from a sample of 683 Norwegian parents in contact with the CWS. The results showed that the majority (60.2%) of the parents perceived the referral to be initiated solely because of parental difficulties and multiple family life stressors. Some of the parents (22.8%) believed the referrals were initiated exclusively because of their children's problems, whereas a few (13.3%) perceived it to be a combination of parental/familial difficulties and children's problems. The findings reveal that close to half of the parents (46.4%) felt the objective of the person making the referral was to help the child, their parents and the family. Some (36.5%) saw it as a routine or mandated action by public or official services, while others (18.7%) reported that they did not know why referrals had been made, or gave no answer to the question. A small group of parents (6%) viewed the referral as an act of harassment. The main implications of these findings are discussed.     

Resolutions

Abstract

A means of monitoring therapists' conformity with policy in a mental health clinic is the examination of annual utilization data. Specifically, graphs which display the frequency of different lengths of patient contracts reveal much about the working realities of how a clinic actually functions. Data from the mental health clinic at the University of Rochester's Student Health Service illustrate changes in staffing and ideology over a seven year period. The graph of current utilization reveals three relatively distinct cohorts of patients. Each cohort can be explicated with regard to clinical needs of patients, staff educational needs, or the clinic's embrace of time-limited therapy as a valued treatment modality. Periodic examination of such graphs can reveal whether actual practices correspond to stated ideology and policy.     

Childhood sexual abuse and psychosomatic symptoms in irritable bowel syndrome

Irritable bowel syndrome is characterized by chronic gastrointestinal symptoms without a demonstrable physical cause. In a subgroup of patients, irritable bowel syndrome may be part of a cluster of psychosomatic symptoms related to childhood sexual abuse. To investigate this possibility, the Dissociative Disorders Interview Schedule (DDIS), the Dissociative Experiences Scale (DES) and the Symptom Checklist-90 (SCL-90) were administered to 105 subjects with either irritable bowel syndrome, inflammatory bowel disease (Crohn's disease or ulcerative colitis), or other gastrointestinal disorders. The subjects in the three groups did not differ on the DES, the SCL-90 or most sections of the DDIS. However, subjects with irritable bowel syndrome reported much higher rates of childhood sexual abuse and psychosomatic symptoms.     

The social facts of deviance in school: a study of mundane reason

This paper reports an ethnomethodological study of the use of mundane reason in relation to deviance in schools. Its central theme is that the social facts of deviance in schools are constituted through the assumptions, practices and procedures which comprise mundane reason. The data upon which the study is based consist of transcribed tape recordings of meetings between teachers, psychologists and social workers at which children referred from schools to the Child and Family Guidance Service are discussed. The talk in these meetings is shown to reveal the use of mundane reason with respect to a variety of practical actions. These include categorization, accounting for referral and other actions towards referrals, referral recipiency, reporting referrals, and the formulation of reactions to referrals. Each of these practical actions is considered in turn and its contribution to fact constitution identified. Taken together and viewed consecutively, they can be seen to have a cumulative impact on the social constitution of deviance in schools.     

Risk and selection processes between the general and the specialty mental health sectors

This paper examines risk, defined as the threat of danger or disruption, as a contextual concept important for understanding patterns of patient selection and referral. We explore the hypothesis that risks associated with mental disorder, as represented by factors such as thoughts about suicide or problems associated with drinking, increase the probability of referral of patients receiving mental health care from general medical practitioners to the specialty mental health sector. Interview and claims data from the RAND Health Insurance Experiment, a large experimental study of coinsurance, are used to examine referral processes over a five-year period. Risk, and especially a measure of suicide thoughts, increase the probability of referral to specialty care. Women and persons with higher education are more likely to use specialty services; older persons are less likely to use such services. Understanding referral requires attention to the behavioral contingencies and illness behavior surrounding the presentation of mental disorder.     

Response to the Critique of the September Meningococcal Vaccine Viewpoint

Abstract

The authors report on a novel and effective peer helper program initiated by the University of Iowa Student Health Service (SHS) in fall 1992 to help prevent the development of active tuberculosis among foreign nationals attending the university. Before instituting the peer program, compliance with tuberculosis-prevention efforts for those students eligible for treatment was less than 5%. Since the peer program was initiated, compliance has risen to 50%.     

Women's Work,Dirty Work: The Gynaecology Nurse as ‘Other’

This article seeks to explore the world of the gynaecology nurse. This world defines the gendered experience of nursing; that is, women in a women's job carrying out ‘women's work’. It is also a world that receives scant public recognition due to its association with the private domain of women's reproductive health. Many issues dealt with on a daily basis by gynaecology nurses are socially ‘difficult’: cancer, infertility, miscarriage and foetal abnormalities; or socially ‘distasteful’: termination of pregnancy, urinary incontinence, menstruation and sexually transmitted disease. The ‘tainted’ nature of gynaecology nursing gives it the social distinction of ‘dirty work’ but does not deter the gynaecology nurse from declaring her work as ‘special’, requiring distinctive knowledge and skills. Qualitative data collected from a group of gynaecology nurses in a North West National Health Service hospital displays how they actively celebrate their status as women carrying out ‘dirty work’. Through the use of ceremonial work that continually re‐affirms their ‘womanly’ qualities the gynaecology nurses establish themselves as ‘different’, as ‘special’, as the ‘other’.     

College Men's Health in Practice: A Multidisciplinary Approach

Abstract

After a needs assessment indicated that male students underutilized campus health services, the San Francisco State University Student Health Service developed a coordinated complement of outpatient health services for men. The authors review their experience in developing, implementing, operating, and evaluating this ongoing clinical service. The needs assessment and subsequent program evaluation data suggest that male students on a large, culturally diverse, urban campus would respond favorably to targeted, multidisciplinary health initiatives that incorporate the principles of health promotion and disease prevention.     

Client Evaluation of Therapy in an Outpatient Adolescent Service

This paper describes a follow up study of clients involved in individual or family therapy conducted by a Community Health Adolescent Service. The overall effectiveness of therapy is assessed and comparisons are drawn between individual and family therapy, one and two therapists, and client's and therapist's perceptions of outcome.     

College men's health in practice: a multidisciplinary approach

After a needs assessment indicated that male students underutilized campus health services, the San Francisco State University Student Health Service developed a coordinated complement of outpatient health services for men. The authors review their experience in developing, implementing, operating, and evaluating this ongoing clinical service. The needs assessment and subsequent program evaluation data suggest that male students on a large, culturally diverse, urban campus would respond favorably to targeted, multidisciplinary health initiatives that incorporate the principles of health promotion and disease prevention.     

The Emergency Dental Service at Southern Illinois University/Carbondale

Abstract

The Student Emergency Dental Service (SEDS), a program of Allied Health and Public Services, Southern Illinois University at Carbondale (SIUC), began treating patients in January 1978. The purpose of the program is twofold. The main emphasis of SEDS is to treat patients with dental-related disorders of an emergency nature. The other purpose of SEDS is to help raise the level of dental knowledge among the student population so as to prevent the emergency situations from occurring.

The Student Emergency Dental Service is essentially an “emergency only” service, even though prevention is highlighted. Such an emergency service cannot compete with a comprehensive service in terms of providing total patient dental care. Hence, the SEDS program has some innate limitations a comprehensive service does not. It must work from certain guidelines. It cannot treat everyone, and the mode of treatment must be altered to aid the emergency patient. This creates dilemmas that will be addressed in this paper. The organization, accomplishments, and advantages and disadvantages of the SEDS program at Southern Illinois University are also discussed.     

Children's Rights and Health Care

SUMMARY. Health and health care are defined as rights in the UN Convention on the Rights of the Child. However, although the National Health Service offers universal coverage, it is hugely expensive with growing costs and growing demands made upon it. Rationing is inevitable and priorities must be set. This paper discusses the part that children's rights can play in influencing equitable provision and the quality of care.     

Sexual Concerns and Counseling Needs of Normal Men Attending a University Student Health Service

Abstract

The responses of 582 male university students attending the UCLA Student Health Service for medical evaluation are presented. Of these students, 37% (215) were freshmen and varsity athletes having pretraining physicals, and 63% (367) were students being evaluated in the SHS primary care clinics. A self-report questionnaire examined the frequency of sexual problems experienced by the respondents and their partners. The most common concerns expressed about themselves were orgasmic difficulties, feeling too interested in sex, and trouble getting and keeping erections. Forty-one percent of the SHS group and 33% of the athletes group had sexual concerns, and, of these, 55% and 40% respectively wanted help with their problems. Specific counseling needs of students were also evaluated.     

Mitigating Intergenerational Trauma Within the Parent‐Child Attachment

Nine‐year‐old Ben was said to hate women. His mother was terrified he'd ‘grow up a woman basher’. This paper describes the work done with Ben and his family at the Hobart Child and Adolescent Mental Health Service. We drew predominantly on three therapeutic modalities: Theraplay, Family Attachment Narrative Therapy and Dyadic Developmental Psychotherapy. Our work enabled Ben's mother to navigate the aftermath of her own trauma history in order to heal Ben's attachment trauma.     

Predictors of Supervisors' Referrals of Employees to an Employee Assistance Program

The purpose of this study was to determine what variables are associated with supervisors' referrals or nonreferrals of subordinates to an EAP. Variables selected for the study included variables found in prior research to be associated with referral or nonreferral and additional variables suggested by the human performance model of Gilbert (1978). Supervisors at the Iowa Department of Transportation were surveyed through in-house mail. Supervisors were identified as referrers or nonreferrers based on the records of the EAP. Discriminant analysis was used to determine which variables were associated with referral. A factor analysis was performed on the predictor variables to determine which were significantly interrelated.     

Threshold decisions: how social workers prioritize referrals of child concern

This paper examines local authority social workers' decision‐making when considering referrals of children, where the concerns are on the margin of child protection procedures. In doing so, it describes the findings of a qualitative research study undertaken in the policy context of attempts to ‘refocus’ social work practice in the late 1990s and early twenty‐first century. Data collection involved interviews with social workers and parents in 23 cases. Conclusions are that referrals were evaluated on the basis of five key factors, specificity, severity, risk, parental accountability and corroboration, the use of which determined whether an initial assessment or an investigation of alleged abuse took place. The analysis builds on previous work in the child protection field, but demonstrates how the application of these factors differs between cases of child concern and cases of child protection. Policy implications concern the complexity of decision‐making in the uncertain context of limited referral information and it is proposed that the simplistic notion of a continuum of abuse is now outdated. Copyright © 2006 John Wiley & Sons, Ltd.     

The Diagnostic/Therapeutic Preabortion Interview

Abstract

This paper discusses the therapeutic and diagnostic aspects of the preabortion interview, giving attention to those specifics which will help identify students with the greatest likelihood for psychological sequelae and for repeat abortions. The circumstances of the pregnancy change what should be a “normative life crisis” in a planned pregnancy into an acute emotionally and physically intrusive crisis when it is unwanted. The openness of sexually active partners on today's campuses, along with liberalized abortion laws, have generated a sharply increased demand for abortions, and a significant population of young college women seek help from their Student Health Services. Rising expectations for care require optimal coordination of Gynecology and Mental Health Clinics.     

Healthy Barbs: Activism Confronts Mortality

Barbara Brenner, JD, was the Executive Director of Breast Cancer Action (BCA) from 1995–2010. Before that, she was a longtime activist in the anti-war movement and an attorney who, for most of her career, practiced public policy law. After she was diagnosed with breast cancer in 1993 at the age of 41, she took the helm of BCA. Under her leadership, the organization moved into a position of national advocacy—demanding research on the causes and prevention of breast cancer, including the role of industrial pollutants. Barbara started the “Think Before You Pink” campaign, encouraging people to question whether companies that display pink ribbons actually produce products that harm women's health or generate any funds to fight breast cancer. Her blog, “Healthy Barbs,” challenged readers to critique routine healthcare practices and policies. Barbara received numerous awards, including a Jefferson Award for Public Service in 2007, the Smith College Medal in 2012, and the ACLU-Northern California's Lola Hanzel Courageous Advocacy Award in 2012. Barbara had a recurrence of breast cancer in 1996. She died of complications associated with amyotrophic lateral sclerosis, ALS, on May 10, 2013.     

“A lot of work needs to be done”—Service provider perspectives of mental health services available to Croatia- and Bosnia-born migrants

Research suggests that migrants have higher rates of mental health disorders but are less likely to access mental health services, which highlights both their vulnerability to mental illness and inequity in service provision. Despite being large and established culturally similar migrant cohorts in Australia, Croatians and Bosnians are invisible in mental health research. This qualitative study collected practice-based evidence from eight mental health service providers who have had direct professional contact with these communities, in order to understand how they engage with services, barriers to uptake and provide suggestions for service improvements. Thematic analysis was used to identify themes across interviews, which were then compared against Yang and Hwang's Migrant Mental Health Service Utilisation Model. The study identified unique factors specific to Croatia- and Bosnia-born migrants that impact how they engage with services, including mandated/prescribed services, religious resources, knowledge resources, referral pathways and procedures, and service provider competencies. This study will promote a better understanding of the limitations of the current mental health service offerings for Croatia- and Bosnia-born migrants, making it significant to practitioners, mental health organizations, policymakers and the general public.