Predictors of treatment outcome in a child and adolescent psychiatry clinic: A naturalistic exploration

We present data on predictors of treatment outcome for 3200 consecutive referrals to a child and adolescent psychiatry clinic. Using Reliable Change Index (RCI) methodology, we divided children into those who, between intake and discharge, improved, stayed the same, or got worse according to clinician-rated impairment. Most predictors of improvement were related to parent variables (marital status, maternal anxiety, and ethnicity), while those associated with deterioration were tied to child status (extent of psychiatric comorbidity, history of placement in a self-contained classroom, and a prior trial of psychotropic medications). The implications of these findings for data-driven program development, clinic management, treatment planning, and systems of care are discussed.     

Enclosed versus open nursing stations in adult acute care psychiatric settings: does the design affect the therapeutic milieu?

Specific efforts by hospital accreditation organizations encourage renovation of nursing stations, so nurses can better see, attend, and care for their patients. The purpose of this study was to examine the effect of nursing station design on the therapeutic milieu in an adult acute care psychiatric unit. A repeated cross-sectional, pretest-posttest design was used. Data were collected from a convenience sample of 81 patients and 25 nursing staff members who completed the Ward Atmosphere Scale. Pretest data were collected when the unit had an enclosed nursing station, and posttest data were collected after renovations to the unit created an open nursing station. No statistically significant differences were found in patient or staff perceptions of the therapeutic milieu. No increase in aggression toward staff was found, given patients' ease of access to the nursing station. More research is needed about the impact of unit design in acute care psychiatric settings.     

Delirium: a very common problem you may not recognize

Older adults with multiple pre-existing conditions are admitted to hospitals with acute illnesses and injuries every day. Delirium is not recognized by clinicians across health care settings. With awareness of risk factors and knowledge of delirium, nurses can play a pivotal role in the early identification, treatment, and, most important, prevention of delirium in older adults. Nurses often display a lack of knowledge related to delirium and the complex symptoms that appear differently in the presence of other complicating co-morbid conditions in aging adults. Nurses play a crucial role in keeping patients safe and ensuring optimal outcomes, regardless of the setting. With the growing population of older adults and the expected increases in chronic illness and dementia, delirium is a problem nurses are likely to experience in all practice settings. Knowing what to look for facilitates recognizing the risk and acting early to minimize (or even prevent) delirium.     

Risky recreation: synthetic cannabinoids have dangerous effects

Use of synthetic marijuana (also known as spice, K2, aroma, and eclipse) is often viewed by young people as harmless recreation. Until recently, the substance was freely available in U.S. convenience stores and head shops, and it is still available via the Internet. Emerging evidence shows a wide range of responses to the drug, including paranoia, aggressive behavior, anxiety, and short-term memory deficits. Synthetic cannabinoids are not currently detectable via standard toxicology tests. Recognition and management of synthetic cannabinoid use are discussed.     

Approaches used by employee assistance programs to address perpetration of intimate partner violence

Employee Assistance Programs (EAPs) are workplace resources available to employees with problems impacting work performance. EAPs are well-positioned to address intimate partner violence (IPV), a major public health problem with workplace impacts. A purposeful sample of 28 EAPs across the United States was surveyed to identify policies and programs to address IPV, including perpetration. Most EAPs did not report having standardized approaches for addressing IPV perpetration. EAPs also described significant barriers to identifying IPV perpetrators, with the majority relying on self-disclosure on the part of the perpetrator when contacting the EAP. These results suggest that many EAPs--even when interacting with employees who present with issues known to correlate with IPV--are missing a potential opportunity to assess and intervene with IPV perpetrators.     

The effects of tact training on stereotypic vocalizations in children with autism

This study was a systematic extension of Karmali, Greer, Nuzzulo-Gomez, Ross, and Rivera-Valdes (2005) and Ahearn, Clark, MacDonald, and Chung (2007). We investigated the effects of a tact correction procedure on stereotypic vocalizations in 4 children diagnosed with autism who ranged in age from 6 to 16 years. Participants had limited vocal verbal repertoires and were primarily dependent on prompts for the emission of appropriate vocalizations. A multiple-baseline design across participants was used. Data were collected on instances of stereotypic vocalizations and independent tacts during baseline conditions and on instances of stereotypic vocalizations, independent tacts, and echoic-tacts during intervention. Procedural integrity and social validity data were also obtained. The results indicated a decrease in stereotypic vocalizations for 3 of the 4 participants and a slight increase in appropriate vocal verbal behavior (i.e., tacting) for all participants. The study provides support for the use of tact correction procedures to decrease stereotypic vocalizations and increase appropriate vocalizations in children with autism.     

Theory,practice and use of self in the open dialogues approach to family therapy: A simple complexity or a complex simplicity?

In the family therapy literature there is increasing interest in the dialogical approach, particularly as it becomes well‐grounded in psychotherapy research. One embodiment is ‘open dialogues’, which has developed over a 30‐year period in Western Lapland, Finland. This paper outlines my experience of visiting Keropudas Hospital in Tornio, Finland, the birthplace of open dialogues. It explores the seven theoretical principles of open dialogues, associated elements of clinical practice, and the therapist use of self. The author utilises these aspects to reflect on dialogical moments through words and images based on three conceptual themes, which illustrate the relevance of open dialogues for family therapy practitioners and their contexts.