Gail W. Stuart

Early Family Experiences of Women With Bulimia and Depression

This study characterizes the early family experiences of 30 women with bulimia nervosa and 15 women with major depression, and compares them with 100 women controls, with particular emphasis placed on parental rearing practices, family conflict resolution, sexual mistreatment, problematic childhood indicators, and childhood separation experiences. There is little research on these patient populations in relation to their childhood experiences, and thus, it is difficult to identify markers for women at risk for these disorders. The findings show that there are significant differences between the experiences these women had growing up and those of the control group, and a profile of children at risk based upon the study indicators is presented.

Mental Health And Addiction Workforce Development: Federal Leadership Is Needed To Address The Growing Crisis

The mental health and addiction workforce has long been plagued by shortages, high turnover, a lack of diversity, and concerns about its effectiveness. This article presents a framework to guide workforce policy and practice, emphasizing the need to train other health care providers as well as individuals in recovery to address behavioral health needs; strengthen recruitment, retention, and training of specialist behavioral health providers; and improve the financial and technical assistance infrastructure to better support and sustain the workforce. The pressing challenge is to scale up existing plans and strategies and to implement them in ways that have a meaningful impact on the size and effectiveness of the workforce. The aging and increasing diversity of the US population, combined with the expanded access to services that will be created by health reform, make it imperative to take immediate action.

Evidence-Based Teaching Practice: Implications for Behavioral Health

Educational practices and strategies have changed very little over the years, and even emerging advances in technology have become the prisoners of traditional academic norms. Thus, while there is increasing emphasis on evaluating and aligning caregiving processes with the strongest evidence of effectiveness, there is little demonstration or role-modeling of this same expectation in either the formal or continuing educational processes of behavioral healthcare providers. This “disconnect” is a significant problem in the field. This paper addresses the urgent need to inform the education and training of the behavioral health workforce with current theories regarding the teaching–learning process and evidence about the effectiveness of various teaching strategies. The relevant theories and available bodies of evidence are described, and the implications for workforce education and training are identified.

Childhood environment of women having panic disorder with agoraphobia

Abstract This study characterizes the childhood environment of adult women having panic disorder with agoraphobia, with particular emphasis placed on parental rearing practices, family conflict resolution, experiences of sexual mistreatment, problematic childhood indicators, and childhood separation experiences. The retrospective research design included attitudinal and behavioral indicators for 80 female patients diagnosed with panic disorder with agoraphobia, and a control group of 100 female volunteers with no history of psychiatric illness. Study findings did not support evidence of parental overprotection, parental death, devorce, or sexual mistreatment as risk factors. Results did suggest the significance of childhood separation anxiety, a conflicted family environment, lack of parental warmth and support, and the presence of chronic physical illness and substance abuse in the chilhood home of patients, as well as more emotional, family, alcohol, and school problems as children and adolescents.

REPORT OF RECOMMENDATIONS: THE ANNAPOLIS COALITION CONFERENCE ON BEHAVIORAL HEALTH WORK FORCE COMPETENCIES

In May 2004, the Annapolis Coalition on Behavioral Health Workforce Education convened a national meeting on the identification and assessment of competencies. The Conference on Behavioral Health Workforce Competencies brought leading consumer and family advocates together with other experts on competencies from diverse disciplines and specialties in the fields of both mental health care and substance use disorders treatment. Aided by experts on competency development in business and medicine, conference participants have generated 10 consensus recommendations to guide the future development of workforce competencies in behavioral health. This article outlines those recommendations. A collaborative effort to identify a set of core or common competencies is envisioned as a key strategy for advancing behavioral health education, training, and other workforce development initiatives.

Training in evidence-based practice.

Controversy surrounds the concept of EBP. Many individuals question whether research is capable of guiding decisions about diagnosis and treatment, or whether it simply gives oversimplified answers to highly complex questions about human behavior. These concerns aside, it is hard to envision a future in which consumers and payers do not demand that the health professions ground their interventions in an evidence base. It is sobering to recognize that training in EBP has been far from the norm in the various behavioral health disciplines. This is just one aspect of a much larger crisis in behavioral health workforce education. Graduate and residency programs have not kept pace with many of the changes in behavioral health care delivery over the past decade. The field continues to use continuing education strategies that are ineffective, and little training is offered to the paraprofessional and bachelor-prepared staff members who comprise a large segment of the workforce in public sector and inpatient settings. Broad strategies are needed to overcome the lethargy in behavioral health education and training programs to make them more relevant to contemporary clinical practice. Incorporating evidence-based approaches to treatment is one critical element of needed reforms. General medicine has laid a foundation that can be built on for teaching the process of EBP. Psychiatry and psychology have taken the lead in identifying those interventions to be taught that are evidence-based or empirically supported. Research on continuing education and adult learning illuminates the educational strategies that are likely effective in teaching evidence-based interventions and an evidence-based process of care. Additionally, the research on changing provider behavior shows the importance of ensuring practice environments that support and reinforce, rather than thwart, the practice of evidence-based treatment. There are many resources to draw on but the task facing educators is substantial.

The Inextricable Nature of Mental and Physical Health: Implications for Integrative Care

There is growing evidence that physical health problems are caused and exacerbated by psychological factors. Research indicates that psychological distress leads to physical disease through impairment of the neuroendocrine system and its interface with the body’s immune response. However, the current health care delivery system splinters care into “psychiatric” and “physical” health silos. New approaches are needed to assure adequate professional knowledge of behavioral health at basic licensure, to increase the use of advanced practice psychiatric—mental health nurses in primary care settings, to identify and teach behavioral competencies for primary care providers, and to fund the design and evaluation of integrative models of care.

TRAINING AND EDUCATION NEEDS OF CONSUMERS, FAMILIES, AND FRONT-LINE STAFF IN BEHAVIORAL HEALTH PRACTICE

Much of the behavioral health care delivered to people with serious mental illnesses and chronic addictive disorders is provided by front-line or direct service mental health workers. Issues related to the qualifications, training, and ongoing evaluation of the competencies of this important provider group have received scant attention in the behavioral health field. This paper explores the educational needs and best practices of the consumers and families who carry much of the burden of caring for disabled populations, as well as the front-line staff, many of whom are employed in state psychiatric hospitals and community mental health or addiction treatment systems. Within the overall context of culturally competent behavioral health care, specific recommendations are proposed in an attempt to move the field forward.

THE EFFECT OF AURICULAR ACUPUNCTURE ON PSYCHOPHYSIOLOGICAL MEASURES OF COCAINE CRAVING

This study used a randomized pretest/posttest control group design to test the effectiveness of auricular acupuncture interventions in diminishing psychological and physiological changes associated with cocaine craving in 30 treatment-seeking cocaine-dependent patients. The experimental group received the real auricular acupuncture intervention, insertion of needles into ear point locations specifically targeted for drug withdrawal. The control group received sham or placebo auricular acupuncture, insertion of needles into ear point locations not targeted for any specific therapeutic benefit. Psychological (Cocaine Craving Questionnaire - Now) and physiological (skin conductance activity) changes associated with cocaine craving were measured. Results showed no differences between the control and the experimental group in diminishing psychological and physiological measures associated with craving. There were differences from pre- to posttest on measures of psychological but not physiological craving for the combined experimental and control groups.

Evidence-based psychiatric nursing practice: Rhetoric or reality

The most desirable basis to substantiate clinical practice is the evidence of well-established research findings. Developing evidence-based care involves defining the clinical question, finding the evidence, analyzing the evidence, using the evidence, and evaluating the outcome. Practice guidelines and clinical algorithms are useful tools for applying research findings in a practical way. Other mental health professionals are actively incorporating an evidence-based approach into their practice, training, and research activities. This article raises questions about whether psychiatric nursing has evidence-based models of care, is contributing to advancing knowledge related to the nature, process, and outcomes of psychiatric care, and is incorporating evidence-based psychiatric nursing care in its educational programs.