Grace Christ

Psychosocial Adjustment of Children with a Terminally Ill Parent

Although a substantial number of children experience serious parental illness and death, the adjustment problems attendant to the stress of having a fatally ill parent have not been examined systematically. This paper compares the psychosocial adjustment of 62 school-aged children with a terminally ill parent (study sample) with that of children in a community sample, using several standard rating scales. Study children had significantly higher levels of self-reported depression (Childrens Depression Inventory) and anxiety (State-Trait Anxiety Inventory) and lower self-esteem (Self-Esteem Inventory). Parents also reported study childrens significantly higher behavior problems and lower social competence (Child Behavior Checklist). Increased professional attention to this vulnerable population is encouraged.

Patterns of Change in Sexual Behavior Among Gay Men in New York City

In the absence of a vaccine or effective treatment for AIDS, health education remains the most effective strategy for stemming the spread of the epidemic. Among homosexual and bisexual men, who continue to account for the majority of AIDS cases, sexual practices have been identified as the principal risk factor. Consequently, public health efforts aimed at this population have focused on raising awareness of the potential risks of HIV infection associated with certain sexual practices. A sample of 162 asymptomatic gay and bisexual men were studied to examine patterns of change and stability in sexual behavior. The data reveal that while the large majority (84%) had adopted at least modification in their sexual behavior, primarily in the form of reducing their total number of partners and their number of anonymous partners, a significant proportion (48%) continued to engage in risky sexual behavior; this, despite high levels of knowledge concerning risk-reduction guidelines. The findings suggest that the mere transfer of information concerning safer sex practices is not sufficient to induce the desired behavior changes in a substantial proportion of gay men. Alternative strategies for achieving behavior change are suggested.

Therapeutic Strategies at Psychosocial Crisis Points in the Treatment of Childhood Cancer

How can we best deploy the usually scarce mental health resources to provide optimal psychosocial support to the pediatric cancer patients and their families? This is a persistent question that is asked of us by social workers from other centers, and that we ourselves must grapple with at Memorial. We are currently defining ways of tracking the illness and its treatment, including psychosocial interventions, in order to determine those points of social and emotional stress at which patients and families require special help to enhance optimal coping.

Factors Affecting Coping of Adolescents and Infants on a Reverse Isolation Unit

This paper describes factors that affect the coping processes of adolescents with aplastic anemia and infants with severe combined immuno-deficiency disease treated on a reverse isolation unit. The adolescents demonstrated a rich diversity of coping styles depending on the interaction of a variety of factors. Special stresses to other family members, such as the reactions of the child donor, are also highlighted. For the infants, the dyadic relationship with the mothering figure, the feelings of the family about the fact of genetic transmission, and the impact of isolation on the infants development are identified as important psychosocial variables in the infants adjustment. A multidimensional perspective such as that provided within a systems framework, which encourages an appreciation of the interactive diversity of all factors, is presented as the most useful approach to interventions.

“Dis-Synchrony” of Coping among Children with Cancer, their Families, and the Treating Staff

“Dis-synchrony” in coping refers to an occurrence at different points in time of unevenness in specific cognitive appraisals or affective states of parent and patient, parent and parent, patient and sibling, and patient, family, and staff. In this presentation, I will discuss the role of the mental health worker in facilitating or enabling communication and synchrony, or in Dr. Kaplan’s terms, “mediating the stresses” caused by a lack of synchrony (Kaplan, 1973). Several vignettes will be presented which demonstrate some interventions between a mother and her nine year old daughter.