Experience of cumulative trauma disorders on life roles of worker and family member: a case study of a married couple

The prevalence of diagnosed cumulative trauma disorders (CTD) within the workforce comes at a high price for employers burdened with financial losses from missed work and worker's compensation costs. Research has focused primarily on the impact of CTD on the worker role within the workplace, overlooking the impact on roles across multiple environments [24,35,54]. Furthermore, the influence of CTD on life roles of a spouse has not been examined. This single case study illustrated the experience of CTD within a marital relationship through the use of grounded theory. Results indicated that adaptations to CTD symptoms were least altering to the established routines and roles of the couple. With progression of symptoms, the spouse without symptoms was relied on more heavily for adaptations to manage pain. The results of this study indicate that occupational therapists must examine the client's valued roles and incorporate the family into intervention strategies.     

Pretest-posttest designs and measurement of change

The article examines issues involved in comparing groups and measuring change with pretest and posttest data. Different pretest-posttest designs are presented in a manner that can help rehabilitation professionals to better understand and determine effects resulting from selected interventions. The reliability of gain scores in pretest-posttest measurement is also discussed in the context of rehabilitation research and practice.     

Healing in familiar settings: support for children and youth in the classroom and community

The Classroom-Based Intervention emphasizes a specific theme each week to allow children to construct safe places to express their stories and develop coping strategies in a group environment.     

Optimizing out-of-school time: the role of free-choice learning

Free-choice learning, a new paradigm for the learning that youth and their families engage in outside school, can play an important role in the healthy development of youth, their families, and communities.     

Working with women in secure environments

1. Women's adverse experiences as patients in secure and other mental health services appear to reflect sexism in wider social and historical contexts. 2. A Women's Service Development Group in a medium secure unit in the United Kingdom has made improvements in services for female patients, including an independent advocacy and befriending service, a Well-Woman Clinic, and other gender-sensitive activities. 3. In general, services were evaluated positively by women. Some dissatisfaction primarily was related to activities, issues concerning seclusion, and the lack of a day area for women only. 4. Women had mixed views about their contact with male staff and patients. Because of this, policies and services in this and related areas should account for individual needs.     

Patterns of change in family-based aggression prevention

Patterns of change on three intervention targets were examined in 151 families that participated in a family intervention designed to reduce and prevent children's aggressive behavior. Measures of parents' alliance and parenting skills and children's aggressive behavior were obtained at five times during the intervention. Three cluster analyses were conducted to identify patterns of change on each target. Linear and nonlinear patterns of improvement as well as two distinct patterns of no change were obtained. The patterns were differentiated by net improvement, overall level of skill, and trajectory of change. Family characteristics also differentiated the patterns and relations were found among patterns across intervention targets. The clinical implications of these findings are discussed.     

GAPS between MFT supervision assumptions and common practice: suggested best practices

This article summarizes gaps between assumptions that appear in the literature, research, and accepted standards for marital and family therapy (MFT) supervision, and the common practice of supervisors. Issues that stem from these gaps are highlighted and recommendations are made for closing them. In an effort to refine the standard of practice for MFT supervision, best practice recommendations are offered for MFT supervision.     

Beyond enmeshment: evidence for the independence of intrusiveness and closeness-caregiving in married couples

In a 1996 article on family theory, we (Green & Werner) proposed that family enmeshment should not be equated with high cohesion and that the construct of enmeshment fails to discriminate between two distinct relationship processes: Closeness-caregiving and intrusiveness. In this study, our model of these two independent dimensions of family connectedness was tested by assessing spouses from 264 couples, using the California Inventory for Family Assessment (CIFA). The CIFA scales showed acceptable reliability. Significant interspouse validity correlations also were obtained. As predicted by our theory, factor analyses distinguished dimensions of intrusiveness (blurring of boundaries) from dimensions of closeness-caregiving (such as warmth and nurturance). On all but two factors, behaviors of only one spouse (but not of both) had interpretable loadings. That is, in most areas, the two spouses' behaviors did not load together to form meaningful factors. The latter finding suggests that family systems theory--with its central notion of reciprocally contingent behaviors between family members--may be useful in understanding only a few dimensions of spouses' behavior (such as reciprocal aggression) whereas personality-in-context theories may be better for understanding most other dimensions (such as warmth and nurturance).     

The power of outcomes: FOTO Industrial Outcomes Tool -- Initial assessment

OBJECTIVE: To demonstrate how outcomes assessment can assist in describing clients receiving rehabilitation in occupational health rehabilitation clinics and to describe the preliminary assessment of internal consistency reliability and construct validity of the FOTO Industrial Outcomes Tool. METHODS: 266 adults referred for acute work rehabilitation (AWR), work conditioning/hardening (WC/WH) or a Functional Capacity Evaluation (FCE) comprised the data set. Clients were treated between July 1998 and January 1999 in 15 clinics from 6 states by 46 clinicians participating in the Focus on Therapeutic Outcomes (FOTO) national rehabilitation database beta test. For AWR and WC/WH, clients completed a health status questionnaire on intake and discharge, and health status was assessed prior to the FCE. Comprehensive demographic data were collected describing the clinics, clinicians, clients and work status collected 2 weeks following discharge. RESULTS: Internal consistency reliability coefficients for the health status scores ranged from 0.57 to 0.89. Construct validity was supported. CONCLUSION: Results demonstrate the power of collecting outcomes from a variety of constructs for clients receiving industrial rehabilitation services. Initial reliability and construct validity findings were adequate and support continuing data analyses.