A nursing tool for adherence and recovery in psychosis: a pilot study

Clients with psychotic disorders are at great risk for relapse and rehospitalization. This risk is magnified by poor adherence to medications, as well as refusal to accept optimal treatment planning, including more beneficial atypical medications. Adherence can be even more compromised because of clients' poor insight into these illnesses and their inability to recognize the potential for recovery that exists when taking medications as prescribed. This poor insight makes effective collaboration in treatment more difficult and is an exceptionally troubling impediment to successful treatment. Currently, there are few effective strategies to improve insight into psychosis. We have developed the Levels of Recovery from Psychotic Disorders Scale (LORS) as a teaching tool. It is designed to identify strengths and weaknesses in insight in order to provide the basis for an intervention to enhance and promote change. This article reviews the relevant literature on adherence and insight in this population of clients with psychotic disorders. It also reviews a pilot study comparing the LORS to the BASIS-32. The findings provide the basis for future studies using the LORS to enhance insight, adherence, and recovery.     

Challenging the one-size-fits-all myth: findings and solutions from a statewide focus group of rural social workers

Of America's counties, 76% are rural, comprising 83% of U.S. land and 25% of the American population. Yet most child welfare programs are designed to fit the needs of urban and suburban families. This article reviews the unique needs and assets of rural children and families in Texas. It presents recommendations from a focus group for overcoming the inappropriate transfer of urban models to rural communities.     

Opportunity theory and adolescent school-based victimization

While school-based adolescent victimization has received a great deal of public attention, there exist relatively few theoretically driven studies aimed at explaining this phenomenon. We address this paucity by providing a test of a criminal-opportunity model of school-based victimization using data on over 3,000 students from 40 different Kentucky middle and high schools. The effects of opportunity-related concepts are estimated for both violent and property victimization, and comparisons are made for each victimization type across middle- and high-school student subsamples. Findings suggest that criminal opportunity theory is relevant to the understanding of school-based victimization. In particular, indicators of exposure to crime and target antagonism appear to be robust predictors. Further, there appears to be substantial generalizability in the effects of opportunity-related variables across violent versus property victimization as well as across middle-school versus high-school contexts.     

Implementation issues for consumer-directed programs: comparing views of policy experts, consumers, and representatives

An increasing number of aging community providers and consumers support consumer-direction (CD) in long-term care services. In regard to devolution, consumer-direction goes beyond the usual approach of shifting responsibilities from the federal government to state governments to bring programs "closer to the people." Consumer-direction goes even further by placing resources directly in the hands of consumers. Yet, many questions remain unanswered regarding how to implement CD personal assistance services in general, and especially for older persons. This article describes the importance of examining views from multiple key stakeholders involved in implementing CD programs. We report on three background studies that have informed the Cash and Counseling Demonstration and Evaluation (CCDE) design and implementation-policy expert interviews as well as surveys and focus groups with consumers and representatives. As a fourth data source, we drew upon experiences in designing the CCDE and initial results from the first year of implementation. Each of the three studies on its own provided essential information for planning the CCDE. However, when we examined the studies together, and added CCDE design and implementation experiences, views expressed by the different stakeholders formed a type of multi-perspective "dialogue" that expanded our knowledge about implementing CD services. We hope this increased knowledge will help expand the availability of such services for consumers of any age who want to direct their own care.     

Vicarious traumatization,secondary traumatic stress,and burnout in sexual assault and domestic violence agency staff

This study investigated three occupational hazards of therapy with trauma victims: vicarious trauma and secondary traumatic stress (or "compassion fatigue"), which describe therapists' adverse reactions to clients' traumatic material, and burnout, a stress response experienced in many emotionally demanding "people work" jobs. Among 101 trauma counselors, client exposure workload and being paid as a staff member (vs. volunteer) were related to burnout sub-scales, but not as expected to overall burnout or vicarious trauma, secondary traumatic stress, or general distress. More educated counselors and those seeing more clients reported less vicarious trauma. Younger counselors and those with more trauma counseling experience reported more emotional exhaustion. Findings have implications for training, treatment, and agency support systems.     

The wireless network jamming problem

In adversarial environments, disabling the communication capabilities of the enemy is a high priority. We introduce the problem of determining the optimal number and locations for a set of jamming devices in order to neutralize a wireless communication network. This problem is known as the wireless network jamming problem. We develop several mathematical programming formulations based on covering the communication nodes and limiting the connectivity index of the nodes. Two case studies are presented comparing the formulations with the addition of various percentile constraints. Finally, directions of further research are addressed.     

A painful labour: responsibility and photography

This paper considers the tension between photography and responsibility despite the avalanche of objections regarding documentary's false promise to awaken social conscience. By examining the encounter with images of suffering through a psychoanalytic register, the paper tries to articulate what Barthes describes as the ‘painful labour’ of responding to the photographic other – an encounter that illuminates the limit of the spectator's ability to respond. Photographs provide an occasion to register this limit, which, I argue, opens up the spectator's traditional notions of responsibility from a set of moral duties towards a questioning of the ethical relation.     

The effects of child support guidelines: An analysis of the evidence in court records

Court records from four Ohio counties were used to compare child support orders before and after promulgation of federally mandated guidelines in 1987. There was no significant change in probability of Court Ordered Child Support. Amount Ordered in constant dollars increased between 1985 and 1987–88. Variables influencing Court Ordered Child Support differed post-guidelines. Years Married, Attorney for Both and Attorney for Wife were significant in both years. Number of Children, Rural, and Wife's Motions were significant in 1987–88. Variables affecting amount ordered also differed after adoption of the guidelines. Wife Contested, Husband's Motions, Defendant and Plaintiff no longer were significant in 1987–88. Years Married and Payment by Father were significantly related to Amount Ordered in 1985 but not in 1987–88. Number of Children, Expenses Paid, and Number of Assets were significantly related to Amount Ordered in both years.Salaries and research support were provided by state and federal appropriations to the Ohio Agricultural Research and Development Center, and by the Department of Family Resource Management, and The Office of Research and Graduate Studies, The Ohio State University.Kathryn Stafford is Associate Professor, Department of Family Resource Management, 1787 Neil Avenue, Columbus, OH 43210-1295. Her research interests include household management and time use. She received her Ph.D. from Cornell University.Golden Jackson is Assistant Professor, Department of Family Resource Management, 1787 Neil Avenue, Columbus, OH 43210-1295. Her research is primarily in the area of the economic effects of divorce. She received her Ph.D. from The Ohio State University.Sharon Seiling is Assistant Professor and Extension Specialist in Family Resource Management, Department of Family Resource Management, 1787 Neil Avenue, Columbus, OH 43210-1295. Her research is on the impact of family change, especially divorce, on access to housing and overall financial well-being. She received her Ph.D. from Cornell University.     

Does Family Structure Matter in the Relationships Between Youth Assets and Youth Alcohol,Drug and Tobacco Use?

This study investigated significant relationships between youth assets and youth alcohol, tobacco, and drug use that differ according to family structure (one- or two-parent households). Data were collected from a randomly sampled inner-city population (n=1,256 teenagers and 1,256 parents of the teenagers) using in-home, in-person interviews. Logistic regression analyses, stratifying by one- and two-parent household status, were conducted with nine youth assets as the independent variables and youth alcohol, tobacco, and drug use as the dependent variables. Results indicated that the associations between assets and risk behaviors varied depending upon whether the youth lived in one- or two-parent households. Continued research is warranted to further investigate associations among family structure, youth assets, and youth risk behaviors.