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.     

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.     

"He is everything": religion's role in the lives of immigrant youth

Using emergent theme analysis of qualitative interview data in combination with quantitative survey data, the role of religion in the lives of immigrant youth was explored. Latino, Haitian, and Chinese teenagers described, in their own rich words, the significance of religion to them; their responses are reflected in themes that point to the potential protective role of religion for some immigrant groups.     

Attitudinal acceptance of intimate partner violence among U.S. adults

Attitudinal acceptance of intimate partner violence (IPV) is an important correlate of violent behavior. This study examined acceptance of IPV using data collected from a nationally representative telephone survey of 5,238 adults. Multivariable logistic regression analyses were used to test for associations between sociodemographic characteristics, exposure to violence, question order, and acceptance of hitting a spouse or boyfriend/girlfriend under specific circumstances. Depending on the circumstance examined, acceptance of IPV was significantly higher among participants who were male and younger than 35; were non-White; were divorced, separated, or had never married; had not completed high school; had a low household income; or were victims of violence within the past 12 months. Participants were more accepting of women hitting men; they also were consistently more likely to report tolerance of IPV if they were asked first about women hitting men rather than men hitting women. Reports of IPV tolerance need to be interpreted within the context of the survey. Efforts to change IPV attitudes can be tailored to specific IPV circumstances and subgroups, and these efforts should emphasize that the use of physical violence is unacceptable to both genders.     

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.     

Contributions of Look Duration and Gaze Shift Patterns to Infants’ Novelty Preferences

Data from 72 infants, tested using a serial paired‐comparison paradigm, were analyzed to better understand infant novelty preferences. Infants between the ages of 15 and 26 weeks were tested in three studies with familiar stimuli displayed adjacent to novel stimuli on each trial. Differences in look duration, look number, and gaze shifts directed at novel versus familiar stimuli were assessed to measure their contributions to group and individual novelty preferences. Infants produced longer looks for novel stimuli in all three studies, and stimulus differences in look duration accounted for more than 50% of the variability in individual novelty preferences. Infants that produced more looks to novel rather than familiar stimuli did not produce overall novelty preferences unless they also looked longer at novel stimuli. Gaze shift patterns did not predict individual novelty preferences, and novel stimuli did not determine where infants looked. The infants’ visual exploration was constrained by memories for the direction of the previous look as well as by the attention‐holding features of novel stimuli.     

Statistical modeling for Bayesian extrapolation of adult clinical trial information in pediatric drug evaluation

Children represent a large underserved population of “therapeutic orphans,” as an estimated 80% of children are treated off‐label. However, pediatric drug development often faces substantial challenges, including economic, logistical, technical, and ethical barriers, among others. Among many efforts trying to remove these barriers, increased recent attention has been paid to extrapolation; that is, the leveraging of available data from adults or older age groups to draw conclusions for the pediatric population. The Bayesian statistical paradigm is natural in this setting, as it permits the combining (or “borrowing”) of information across disparate sources, such as the adult and pediatric data. In this paper, authored by the pediatric subteam of the Drug Information Association Bayesian Scientific Working Group and Adaptive Design Working Group, we develop, illustrate, and provide suggestions on Bayesian statistical methods that could be used to design improved pediatric development programs that use all available information in the most efficient manner. A variety of relevant Bayesian approaches are described, several of which are illustrated through 2 case studies: extrapolating adult efficacy data to expand the labeling for Remicade to include pediatric ulcerative colitis and extrapolating adult exposure‐response information for antiepileptic drugs to pediatrics.