Patient Abuse and Trauma: A Policy Analysis of the Regulation of Seclusion and Restraint in Mental Health Care

Historically, justifications for the seclusion and physical restraint of hospital patients have stereotyped individuals with mental illness as “dangerous” to themselves and others (Huckshorn, 2004a). It can be argued, however, that it is the policies that regulate the use of seclusion and physical and chemical restraints that are dangerous. This article analyzes the Patients’ Rights section of the Hospital Conditions of Participation (CoPs), Part 482 of CFR 42, including sub-sections: e. Standard: Restraint or seclusion; f. Standard: Restraint or seclusion: Staff training requirements; and g. Standard: Death reporting requirements. The set of CoPs regarding Patients’ Rights are analyzed from a value-critical, process-oriented perspective. This article proposes the following six-point framework as uniquely suited to evaluating 42 CFR 428.13: 1) introduction to the background and historical significance of the problem; 2) evaluation of the clarity and measurability of the goals and objectives of the policy; 3) overview of the intended impact of the policy; 4) examination of the value criteria; 5) examination of existing power struggles for those impacted by the policy; and 6) examination of the actual impact of the policy. Results of the policy analysis suggest that the policy does not go far enough to reach its stated goals and objectives in full. In the conclusions, suggestions for further protection of patients’ rights are provided. Examples of alternatives to restraint and seclusion are discussed. Finally, the grave importance of reshaping the culture of mental health care, in terms of life-and-death consequences, is considered.     

Affective Qualities of Sibling Disputes, Mothers' Conflict Attitudes, and Children's Theory of Mind Development

Preschoolers' theory of mind (ToM) was examined in relation to emotional features of their conflicts with siblings, using mothers as privileged informants. Fifty-four children aged 3 to 5 years and their 54 mothers took part. Children were given 10 standard false belief tasks and a standardized language test. Mothers completed questionnaires, rated vignettes, and kept a conflict diary to provide detailed data on siblings' conflicts, mothers' conflict attitudes, and mothers' use of mental state language to talk about children's disputes. Results revealed that children's ToM scores were significantly correlated with affective dimensions of their sibling disputes, including more frequent expression of positive emotion while disagreeing and less post-conflict distress. Logistic regression showed these associations were independent of age and verbal ability. Mothers' conflict attitudes were significantly correlated with the affective outcome of their children's disputes but not with the preschooler's level of ToM understanding. Findings are discussed in relation to possible reciprocal influences between ToM development and the growth of affectively positive and constructive conflict resolution skills.     

Exploring the Relationship between Exposure to Violence,Perceptions of Neighborhood Safety,and Children's Adaptive Functioning: Clinical and Community Implications

This study explored the relationship of exposure to violence and children's perceptions of neighborhood safety and children's adaptive functioning. It used a cross-sectional quadi-experimental design of 300 inner-city children and a bttery of standardized measures, which included the Child Maltreatment Classification Scheme, Exposure to Community Violence Scale, the Domains of Safety Subscale for Neighborhood, and the Child Behavior Checklist-Teacher's Report form. Hierarchal regression analysis revealed that child maltreatment history and perceptions of neighborhood safety were significantly related to children's overall adaptive functioning. Social workers can help by engaging in efforts to increase neighborhood safety and reinforcing positive adaptive psychosocial functioning of children at risk or exposed to violence.     

Ecological Risks to Fossorial Vertebrates from Volatile Organic Compounds in Soil

The past several years has seen an increased awareness of the need to conduct ecological risk assessments (ERAs) for hazardous waste sites. One technique used in ERAs involves estimating contaminant exposure to individual animals of selected species, which is then compared to a reference dose derived from the literature. Exposure estimates are conducted on those species which are representative of the different trophic levels found at the site. In many terrestrial systems, fossorial (burrowing) vertebrates are found in both lower and upper trophic levels. As part of the ERA conducted for Site 300, Lawrence Livermore National Laboratory's high-explosive test facility, contaminant exposures were estimated for fossorial and nonfossorial vertebrates spanning two trophic levels. The results of the evaluation revealed that a significant pathway by which fossorial vertebrates could be exposed to trichloroethylene in soil was through the inhalation of contaminated subsurface burrow air. This was the first time that the importance of this ecological exposure pathway has been recognized. The results of this analysis suggest that further research into the ecological significance of subsurface burrow air contaminated with volatile organic compounds is warranted.     

Ethnicity and Status Attainment: The Case of the Roman Catholic Clergy*

This paper examines the influence of ethnic background on organizational status attainment. The data are taken from a national sample of 2,755 Roman Catholic diocesan priests and bishops. The sample is divided into seven ethnic categories: Irish, German, French, Italian, Anglo-Saxon, Polish, and other. Controlling for the overall distribution of status positions within the diocese and the individual's age/seniority, a “non-preferential” model of status attainment is constructed. Average expected status on the basis of this non-preferential model for these ethnic groups in seven different regions of the country is compared to average actual status. Although we found three isolated cases of particular ethnic groups in specific regions doing significantly poorer in status attainment than predicted by the non-preferential model, the only consistent effect of ethnicity found across the entire sample is a slight advantage enjoyed by Irish clergy. No significant effect was associated with belonging to the largest ethnic group in a diocese. The very small advantage enjoyed by the Irish suggests that Irish domination of the Catholic hierarchy in the United States is maintained less by selective promotion within the ranks of the clergy and more by a disproportionate recruitment of Irish priests at the entrance levels of the organization. Disproportionate recruitment and preferential promotion are discussed as alternative mechanisms of domination within organizations.