Brief Treatment and Crisis Intervention - Advance Access

Reducing Child Abuse Potential in Families Identified by Social Services: Implications for Assessment and Treatment

Harnett, P. H., Dawe, S. — 2008-04-11

Improving the functioning of families at high risk of child maltreatment poses considerable challenges. One issue is the dilemma of how and when it is appropriate to provide an intervention designed to improve family functioning when the level of risk of the family to the child has not been fully established. A recently reported proposal is to assess the family's capacity to change by assessing the family's response to a brief intervention. This proposed model for assessing capacity to change rests on the assumption that brief interventions can achieve meaningful short-term change in high risk families. The current study evaluated the effectiveness of a home-based intensive treatment program in families referred by child protection services. The program, Parents Under Pressure, was designed for multiproblem families and addresses problems across ecological domains, including problem child behavior, parental stress, family relationships, social isolation, and coping with life demands. Ten families completed the program. Statistically significant improvement was found between the pre- and postassessment measures on measures of parent functioning, child functioning, parent–child relationships, and social contextual measures. The majority of families showed clinically significant improvement, although a small proportion of the families showed no change or deteriorated. The presenting problems and pattern of change varied between families. The study adds to the increasing body of evidence that intensive, ecologically informed interventions can achieve short-term change in some but not all multiproblem families. Implications of the results for assessing parental capacity to change are discussed.

Maternal Filicide and Its Intersection With Suicide

Friedman, S. H., Holden, C. E., Hrouda, D. R., Resnick, P. J. — 2008-04-09

Maternal filicide, child murder by the mother, may occur either alone or as part of a joint filicide–suicide. This study considered differences among 3 groups of mothers who committed filicide: those who did so without a concomitant suicide attempt, those who made a nonfatal suicide attempt, and those who completed suicide. Traditional predictors of completed suicide did not distinguish mothers who completed or attempted suicide from those who did not. Mothers who completed suicide following filicide often had altruistic motives and more frequently utilized firearms.

Unintended Impact of Psychiatric Safe Rooms in Emergency Departments: The Experiences of Suicidal Males With Substance Use Disorders

2008-04-09

In general hospital emergency departments (EDs), management of psychiatric crises is challenging. We analyzed issues related to use of psychiatric assessment rooms using semi-structured interviews with adult, male, suicidal ED patients, and ED staff (physicians, nurses, and others). An iterative, thematic analytic process was employed. Although ED psychiatric assessment rooms were designed to provide a safe and therapeutic environment, participants held negative attitudes about the physical attributes and the emotional responses to these rooms. Many patients presented at the ED because they were alone, scared, and lacking social supports, but felt punished when assigned to a psychiatric room. Physical separation and observation were said to escalate symptoms leading participants to question the therapeutic value of the rooms. Although believed to be in the best interest of patients and staff, these rooms may have an unintended negative impact.