Carolyn Byrne

Effective/efficient mental health programs for school-age children: a synthesis of reviews

The prevalence of mental health problems, some of which seem to be occurring among younger cohorts, leads researchers and policy-makers to search for practical solutions to reduce the burden of suffering on children and their families, and the costs to society both immediate and long term. Numerous programs are in place to reduce or alleviate problem behaviour or disorders and/or assist positive youth development. Evaluated results are dispersed throughout the literature. To assess findings and determine common elements of effective childrens services, a literature search was undertaken for evidence-based evaluations of non-clinical programs for school-age children. Prescriptive comments aim to inform service-providers, policy-makers and families about best practices for effective services such as: early, long-term intervention including reinforcement, follow-up and an ecological focus with family and community sector involvement; consistent adult staffing; and interactive, non-didactic programming adapted to gender, age and cultural needs. Gaps are identified in our understanding of efficiencies that result from effective programs. Policy implications include the need to develop strategies for intersectoral interventions, including: new financing arrangements to encourage (not penalize) interagency cooperation and, to ensure services reach appropriate segments of the population; replication of best practices; and publicizing information about benefits and cost savings. In many jurisdictions legislative changes could create incentives for services to collaborate on service delivery. Joint decision-making would require intersectoral governance, pooling of some funding, and policy changes to retain savings at the local level. Savings could finance expansion of services for additional youth.

How People With SCHIZOPHRENIA Build Their HOPE

1. Both clinicians and consumers identified the importance of maintaining relationships and experiencing success as helpful in building and nurturing hope for consumers. 2. To provide holistic care, clinicians need to discuss spirituality and meaning with clients. 3. Because being hopeful is an active process, clinicians need to talk to clients about hope, openly, realistically, and strategically.

The Meaning of Illness Questionnaire: Reliability and Validity

The reliability and validity of a recently developed Meaning of Illness Questionnaire (MIQ) is described. Questionnaire content was based on the work of Lazarus and Folkman (1984b). Three hundred twenty chronically ill subjects completed the 33-item MIQ and two open-ended questions. Subjects also completed the 45-item Psycho-social Adjustment to Illness—Self-Report Scale (PAIS-SR) described by Derogatis and Lopez (1983). Test-retest reliability for 70 subjects was, on the whole, substantial (kappa = .45 to 1.00) as was the ability of nurse clinicians to reliably categorize the qualitative component of the questionnaire into one of 12 categories (kappa = .64). The factor structure of the questionnaire supported the theoretical assumptions underlying the instrument. Three of the factors of meaning given the illness, R2 = .46, and/or three items, R2 = .60, had more power than coping behavior in explaining a persons adjustment to chronic illness. The questionnaire has accumulated reliability and validity in measuring a variety of concurrent yet divergent meanings that may be given an illness for three chronically ill populations—those with mixed cancer, rheumatological, and gastroenterological disorders.

When the bough breaks: provider-initiated comprehensive care is more effective and less expensive for sole-support parents on social assistance

This 5-year study conducted in Ontario, Canada is designed to assess the effects and expense of adding a mix of provider-initiated interventions to the health and social services typically used in a self-directed manner by sole-support parents and their children receiving social assistance in a national system of health and social insurance. Results from a 2-year interim analysis show that providing social assistance families with proactive comprehensive care (health promotion, employment retraining, and recreation activities for children) compared to allowing families to fend for themselves in a self-directed manner, results in 15% more exits from social assistance within 1 year and substantial savings to society in terms of social assistance payouts. It is no more expensive to provide health and social services in a comprehensive fashion, and equivalent reductions in parent mood disorder and child behavior disorders, as well as equivalent increases in parent social adjustment and child competence levels were also observed. This study presents clear evidence that providing comprehensive care to social assistance recipients produces tremendous short- and long-term financial gains and societal benefits.

Hope and schizophrenia: clinicians identify hope-instilling strategies

Nurses have many opportunities to assist individuals with schizophrenia because of the frequency and nature of their contacts. The nurses in this study believed that they can make a difference and can identify hope-instilling strategies. Strategies for rehabilitation include assisting persons with schizophrenia to set goals, seeing them as people, and joining with them on their journey of recovery. Recognizing that the establishment of the relationship is central in assisting the development of client hope, and (hopefully) eventual recovery, may help nurses to persevere despite what may be a challenging and lengthy process.

Pathways into the Work Force: Antecedents of School and Work Force Status

OBJECTIVE The study aim was to identify risk factors for specific pathways into the work force using data from the Ontario Child Health Study Follow-up. METHOD Potential predictor variables were derived from data collected in 1983 on adolescents aged 13 to 16 years. The subjects were followed up 4 years later and the school/work force outcome was determined. Bivariate and multivariate statistical analyses were used to identify variables with a strong independent association with this outcome. RESULTS Subjects in the work force were four times more likely than those attending school to have come from a low-income family and at least two times more likely to have a family background of low maternal education, to have failed a grade, or to have used substances heavily during early adolescence. Subjects with two or more of these risk factors were likely to be in part-time work or unemployed. CONCLUSIONS Preventive interventions should be targeted at children from poor families, or who fail at school, or show early onset of substance abuse and other deviant behaviors. Studies are needed to further elucidate the relationship between these risk factors and pathways into the work force and beyond.

Adult Psychosocial Adjustment Following Childhood Injury: The Effect of Disfigurement

The literature investigating the psychosocial adjustment of burn survivors is limited and that addressing such adjustment in burned children is contradictory. Forty-two adults, burned in childhood, were assembled into burn severity cohorts and compared as to burn severity, intensity of stress, and extent of disfigurement and disability. The findings substantiated the hypothesis that the biologic variables of years since burn and severity would not explain psychosocial adjustment in adulthood; lower adjustment correlated with visible disfigurement and less peer support rather than with severity of burn.

Prevalence of dysthymic disorder in primary care

BACKGROUND Dysthymic disorder is characterised as a chronic state of depressed mood which is not otherwise attributable to physical, psychological or social events. While it can occur alone, there is increasing evidence that the majority of individuals who meet criteria for dysthymic disorder also experience more severe episodic mood disorders throughout their lifetime, and there is also an aggregation of mood disorders within their family members. Patients with dysthymic disorder are most often seen in primary care. Some researchers suggest that the majority of these individuals are never diagnosed or are not diagnosed until a more severe episodic mood disorder develops. The objective of this study was to determine the 12-month prevalence of Axis I psychiatric disorders, and in particular dysthymic disorder, in a primary care Health Service Organization in Ontario, Canada. METHODS Eligible and consenting adults registered with a primary care Health Service Organization were screened using the modified form of the University of Michigan Composite International Diagnostic Interview. RESULTS Of the 6280 eligible subjects, 4327 (69%) consented to screening. Two hundred and twenty-two (5.1%) subjects screened positive for dysthymic disorder. In addition, 90% of those who screened positive for dysthymic disorder also screened positive for other Axis I disorders including major depressive disorder, panic, simple phobia, and generalized anxiety disorder. CONCLUSIONS There is much potential for the primary care physician to play a pivotal role in the recognition and treatment of dysthymic disorder and associated Axis I disorders. A focus on the family as a unit for care may be especially important given the reported aggregation of dysthymic disorder within families.

Analyses of Coping Responses and Adjustment: Stability of Conclusions

This study was conducted to determine the stability of conclusions derived from analyses of different ways of scoring coping responses in relation to the adjustment of subjects who had survived a burn injury. As part of a larger study of adjustment to burn injury, 260 adults who had sustained a burn injury over a 12-year period consented to complete the Billings and Moos Coping Responses Scale (CRS; Moos, Cronkite, Billings, & Finney, 1984) and the Psychosocial Adjustment to Illness Scale (PAIS; Deragotis & Lopez, 1983). A clinician made a global assessment of each subjects adjustment. Three ways of scoring the CRS were used for analyses: (a) Method and Foci of coping (Indices of Coping Responses), as suggested by Moos et al. (1984), (b) new factor analysis, and (c) separate responses. Stepwise multiple regression analysis of each of these with three different outcomes of adjustment (PAIS, global clinical judgment scores, and the PAIS psychological distress component) gave consistent results. The more adjusted burn survivors used more problem-solving coping responses and fewer avoidance responses. The two responses in the individual multiple regression analysis gave a higher correlation than the factor or index descriptors. These two responses correlated well with all three adjustment outcomes, r = .49, .37, and .47. The relationship between coping behavior and adjustment to illness was not sensitive to the different ways of scoring the CRS.

Facilitating empowerment groups: dismantling professional boundaries.

The purpose of this study was to identify the issues and the process faced by public health nurses facilitating empowerment groups with people with a chronic and persistent mental illness. Five public health nurses facilitated seven groups which met weekly for a period of one year. Nurses kept field notes following each group session and methods of grounded theory were used to develop an understanding of the process of facilitating empowerment groups. A process of dismantling professional boundaries was identified which included three dimensions: experiencing the clash of worlds; joining the lives of people with a mental illness; and an exploration of professional self. The results highlight the need to challenge traditional ways of practicing.