Toward an understanding of the etiology and treatment of psychological dysfunction among single teenage mothers: Part 1, a review of the literature

Abstract

This paper, the first of a two‐part series to be published in sequential issues of the journal, reviews the recent intervention literature about single teenage mothers who are psychologically dysfunctional. It emphasizes the interplay of social, economic and developmental factors as stressors in the lives of these young women and explores some of the issues that need to be addressed in constructing effective therapeutic programs. The second paper describes an intervention program consisting of long‐term developmentally‐oriented groups for single teenage mothers and their children.     

Is “humane managed care” an oxymoron? (Essay Review)

Abstract

Though the impact of managed care on clinical social work practice and education has been widely acknowledged and critiqued, Humane Managed Care? edited by Schamess and Lightburn, represents a compendium of papers addressing all aspects of the recent phenomena and its impact on practitioners, educators, and most especially our clients. In reviewing this impressive and comprehensive volume, this paper addresses many of the most controversial and painful aspects of the “Managed Care Revolution,” including its impact on the level of clinical practice and its economic and political ramifications. It is suggested that the editors and some of the authors are less hopeful about the possibility of providing “humane” treatment in the managed care environment than they were only a few years earlier, as indicated by a comparison of this volume with the 1996 special edition of Smith College Studies in Social Work. This article also critiques some of the anthology's chapters, which suggest that the changes in health care delivery will ultimately be beneficial to clinical social workers.

Essay Review: Humane Managed Care? Gerald Schamess, M.S.S. & Anita Lightburn, Ph.D. (Eds.). (Washington, DC: NASW Press, 1998.)     

Forced termination: Reconsidering theory and technique

Abstract

Forced terminations typically are described in the therapy literature as grim mourning processes fraught with peril and little benefit. Such endings, although not optimal, are potential opportunities for mastery, growth, and maturation. Overemphasizing the grim aspects of forced termination may impair the departing therapist's ability to sustain a belief in the client's ability to survive loss, use the process productively and, when indicated, transfer to another therapist. Case histories are used to illustrate other constructions and differential interventions during forced terminations.     

‘We’re Civil Servants’: The Status of Trauma-Informed Care in the Community

ABSTRACT

Trauma-informed care (TIC) in social service organizations means that the organizations operate with the understanding that everyone involved has possibly experienced trauma in their lifetime. This qualitative study examined local service organizations’ usage of the 5 main principles of TIC: safety, trustworthiness, collaboration, empowerment, and choice (as developed by Fallot & Harris, 2006). Ten focus groups (n = 69) and 6 individual interviews (n = 6) with employees from administration through management were interviewed such that almost all facets of each agency were represented. The participants were asked about their agencies’ policies and practices for utilizing the 5 principles of TIC. The results suggest that the vast majority of organizations in this study implemented many of the principles of TIC with clients, though they had not labeled their practices as “trauma-informed.” However, although clients were receiving TIC, some of the principles were neglected as they pertain to staff, such as choice and empowerment. The findings of this study suggest that agencies are unaware of the relevance of TIC as it relates to staff. It is recommended that future research examine whether the use of TIC in agencies prevents “burnout,” high turnover rates, and vicarious traumatization of staff.     

Daubert v. Merrell Dow pharmaceuticals: Toward a better relationship between law and science

[Scientists] are neither Gods nor charlatans; they are merely experts, like every other expert on the political stage. They have, of course, their special area of expertise, the physical world, but their knowledge is no more immaculate than that of economists, health policy makers, police officers, legal advocates, weather forecasters, travel agents, car mechanics, or plumbers. The expertise that we need to deal with them is the well‐developed expertise of everyday life; it is what we use when we deal with plumbers and the rest. Plumbers are not perfect-far from it‐but society is not beset with anti‐plumbers because being anti-plumbing is not a choice available to us.1     

Competence and consent to research: A critique of the recommendations of the national bioethics advisory commission*

Concern about the participation of incompetent subjects in psychiatric research has grown in the last several years. In response, the National Bioethics Advisory Commission (NBAC) recommended in its recent report that all investigations involving persons with mental disorders that may be associated with cognitive impairment that may pose greater than minimal risk to subjects utilize independent assessors to verify the capacities of subjects prior to entry into the study. This recommendation poses several problems for the conduct of research and the protection of research subjects. First, it fails to target that group of subjects most likely to be at risk for incapacity. Second, it focuses on too broad a range of research projects, many of which pose little risk to participants. The substantial costs of this approach are therefore not likely to be outweighed by concomitant benefits. In place of the NBAC recommendation, the author proposes a more flexible system of capacity assessment, designed to balance the costs with a greater likelihood of achieving meaningful protection for research subjects with mental disorders.