Barbara A. Gawinski

MODELS OF COLLABORATION

For primary care clinicians to address the complex needs of their patient population, they must be able to collaborate with mental health professionals. Collaborative health care represents the creation of a new health care paradigm, and collaborative health care delivery systems mirror the complexities of human suffering. Clinicians from multiple disciplines can combine resources and strategies to share responsibility for their patients and with their patients. A brief review of the history of mind/body split and the resulting professional separatism is followed by sections on the spirit of collaboration, the spectrum of collaboration, key ingredients for effective collaboration, and some thoughts about the future of collaboration. A special practical section on getting started and following through is included.

Bridging Prevention and Health: Exploring Community Perceptions of Intimate Partner Violence in Rural Honduras

This qualitative study rooted in community-based participatory research principles utilized semi-structured interviews with 2 focus groups (n = 9) with female healthcare volunteers (FCVs) and 3 male key informants who were community leaders (MCLs). The study aimed to examine how a rural Honduran community defines and responds to intimate partner violence (IPV) in order to lay the foundation for future interventions. Based on grounded theory, the authors assessed for common themes across transcripts. Authors found that a number of participants denied the existence of IPV. Perspectives on the causes and definitions of IPV varied between FCVs and MCLs. All participants affirmed the need for intervention and many participants mentioned healthcare and legal systems as potential venues to ameliorate IPV. The results highlight potentially important differences between FCV and MCL perspectives that may inform future interventions. Findings suggest healthcare workers can play a role in IPV prevention and intervention in rural Honduras.

Premarital counseling using group process

Abstract The authors describe a premarital group counseling program involving 35 committed couples at North Texas State University. They discuss the need for premarital counseling and the applicability of their Jive-session program. Results indicate that few role models were available for couples and that communication difficulties were apparent among many of the participants. The authors urge counselors to consider group premarital counseling as a valuable process for their clients.

Protecting the Family: Domestic Violence and the Primary Care Clinician

When most clinicians first think of domestic violence, they think of partner abuse; however, the term domestic violence encompasses child abuse and neglect, partner abuse, and elder abuse. In this chapter, we will keep to this broader usage and discuss family violence in all its forms across all age groups. We propose that the clinician’s main job is to recognize the signs of domestic violence and then use those resources that exist within the family and community to protect the individual and family. Abusive families lack the internal controls needed to create a safe environment. External controls by community agencies are consequently often required. The primary care clinician’s role in treatment is to mobilize a safety network for the family to protect the individual and to initiate the work of change and healing that must occur in the family.With the help of the legal system, community agencies, and mental health professionals, the clinician can help set a process in motion that results in successful treatment for many of these families. This chapter begins with a description of common elements to all three forms of domestic violence (i.e., child, partner, elder) while recognizing there are also important differences. The next sections in the chapter describe these more unique characteristics along with suggestions for screening, detection, and intervention. Because of the dearth of research, most of the material is based on expert opinion. For many clinicians, these issues bring up strong personal reactions, and the chapter concludes with our thoughts about continuity of care, when the perpetrator is your patient, and personal issues for the clinician.

The Therapist-Investigator Relationship in Family Therapy Research

The widely held requirement of therapist-investigator nonequivalence in family therapy research studies is reviewed in light of recent discussions concerning objectivity and social constructionism. Recommendations for an alternative position are offered.

How Students Learn from Ambulatory Preceptors: Critical Incidents

This study explores the medical student’s perspective on learning in the community-based preceptor setting. Method: A critical incident narrative was collected from each fourth year student enrolled in the family medicine clerkship. A multidisciplinary team of medical educators analysed and coded the narratives. Results: Critical learning events had definitive outcomes, were problem-focused and lead the student to self-reflection. ‘Active observation’ (71%) was the most frequent mode of learning. ‘Collaboration’ and ‘coaching’ (30% and 14%) were also important. Conclusions: This study expands the idea of active learning to include observation focused by the students’s recognition of an important learning need. The study also suggests that critical learning moments are generally brief Increasing preceptor sensitivity to these results can enhance their teaching effectiveness without compromising practice efficiency.

INTELLIGENCE AND ORGANIZATION IN MEMORY SCANNING FOR TRIGRAMS

Subjects high (mean IQ 117) and moderate (mean IQ 104) in IQ scanned their memories for either sets of letters or trigrams. The trigrams were either (a) organized, i.e., the positive set items were either all straight or all curved letters, or (b) unorganized, i.e., there was no such pattern. Results showed no IQ-related differences in scanning for letters or trigrams, either organized or unorganized. Subjects in the organized condition responded faster to negative than positive set trigrams, indicating that subjects in this condition were using two separate and hierarchical comparison stages. The first comparison involved the spatial characteristics of the trigrams; if the probe was in the curved trigram category and the positive set items were in the straight trigram category, then a negative response was emitted. But if this comparison was positive, then a further comparison search was made to determine if that specific trigram was a member of the positive set. The results seem to be inconsistent with Sternbergs (1969) four-stage scanning model.