Brief Treatment and Crisis Intervention - recent issues

Brief and Intermittent Approaches to Practice: The State of Practice

Dziegielewski, S. F. — 2008-05-01

This article is written to provide an overview of the past and present use of two common types of time-limited therapy. Brief (also known as ‘short term’) and intermittent therapies are explored. Using these time-limited frameworks, a structure and procedural review for conducting evidence-based intervention strategy is presented. Several popular methodologies that use a time-limited focus are reviewed. Recommendations, practice guidelines, and strategy for use of these methods are presented.

A Naturalistic Study of Intensive Short-Term Dynamic Psychotherapy Trial Therapy

Abbass, A. A., Joffres, M. R., Ogrodniczuk, J. S. — 2008-05-01

The objective is to study the effectiveness of Intensive Short-Term Dynamic Psychotherapy (ISTDP) trial therapies. In a tertiary psychotherapy service, Brief Symptom Inventory (BSI), Inventory of Interpersonal Problems (IIP) medication use, and need for further treatment were evaluated before versus 1-month post trial therapy in a sequential series of 30 clients. Trial therapies were interviews with active focus on emotions and how they are experienced. The interviews resulted in statistically significant improvements on all BSI subscales and one of the IIP subscales. One-third of clients required no further treatment, seven stopped medications, and two returned to work following trial therapy. The ISTDP trial therapy appeared to be clinically effective and cost effective. Future research directions are discussed.

Correlates of Crime and Violence among Persons with Mental Disorder: An Evidence-Based Review

Sirotich, F. — 2008-05-01

The issue of crime and violence among persons with mental disorder is a subject of longstanding clinical and policy importance. Over the past 15 years, much research has been conducted on the relationship between mental disorder and crime and violence. This article is a review of the research literature on the correlates of crime and violence among persons with mental disorder. To facilitate this review, the literature is organized into 4 sections that encompass research on variables that fall into one of the following four domains: demographic variables, historical variables, clinical variables, and contextual variables. It summarizes current knowledge on the sources of criminal and violent behavior and attempts to reconcile disparities across studies by taking into account methodological differences and by considering the potential role of confounding factors that require attention in future research.

Gender Differences in Coping with Victimization

Green, D. L., Diaz, N. — 2008-05-01

Individuals who are victims of crimes cope differently to reduce, tolerate, or master the victimization and ensuing emotional distress. It is unclear whether there are gender differences in regard to the stress and coping process among victims of crime. The current study examines gender differences in victimization experiences. This article examines gender differences in coping strategies, levels of depression, posttraumatic stress disorder, anger, anxiety, social support, and well-being of victims of violent and nonviolent crimes. A community sample of 175 victims of different types of crimes were recruited and interviewed face-to-face. The findings suggest different relationships between types of coping strategies and well-being by gender.

The Role of Religion in the Generation of Suicide Bombers

Kassim, S. H. — 2008-05-01

Suicide terrorism is an international problem that endangers the well-being of whole populations. Standard explanations suggest that religious fanaticism is a primary driving force in the generation of suicide bombers. A growing body of empirically based scholarship, however, indicates that suicide terrorism is a multifactorial phenomenon that cannot easily be explained away as an outcome of religious fanaticism. Religion in general, Islam in particular, plays a minimal direct role in the generation of suicide bombers. This brief article will summarize recent studies regarding the root causes of suicide terrorism as they pertain to the fields of behavioral health, violence, and violence prevention.

When You Look Like the Enemy

Akiyama, C. — 2008-05-01

After the horrific attacks of September 11, 2001, the U.S. Congress' response to the attacks was the approval of the USA. Patriot Act. This broad legislative policy gave the government investigative powers to fight against terrorism and subsequently targeted those in the Arab, Muslim, and South Asian communities with not just prejudices against these communities, but blatant racism toward innocent people, just because they appear to look like they "identify" with those who have made terrorist threats. The government acted similarly against a group of people in this country that had a supposed connection with a terrorist threat. On Sunday, December 7, 1941, the Japanese attacked Pearl Harbor, Hawaii, and killed over 2,500 Americans. Seventy-three days after the bombing of Pearl Harbor, the government responded by retaliating against those of Japanese ancestry living in the United States. President Franklin D. Roosevelt signed Executive Order 9066 to authorize the military to construct and run 10 internment camps that imprisoned over 120,000 Japanese Americans living on the West Coast in California, Oregon, and Washington. This entire ethnic community living on the West Coast was sent to internment camps in California, Idaho, Utah, Wyoming, Colorado, Arizona, and Arkansas. Two-thirds of those Japanese Americans who were sent to camp were U.S. citizens. The Japanese Americans were removed by the military, and thousands were questioned and detained by the Federal Bureau of Investigation (FBI) under the charge of "military necessity" and denied due process, despite the fact that there was no record of sabotage or spying, and their loyalty had been attested to by the FBI and Naval Intelligence.

Fast forward the clock to September 11, 2001, as many persons of Arab, Muslim, and South Asian descent were-and continue to be-rounded up, just like the Japanese Americans were in 1942.

If we are to learn anything, we need to learn from Executive Order 9066 and September 11, 2001, and how we as a country treat our citizens in time of paranoia and crisis. We must never forget what happened to the Japanese Americans in 1942 and what continues to happen to the Arab, Muslim, and South Asian Americans, which is hatred toward those that "look like the enemy."

Evidence-Based Practices Applied to Forensic Psychiatry: Introduction to Special Issue

Glancy, G. D. — 2008-02-25

Evidence-based practice (EBP) has become widely established in many branches of medicine, including psychiatry. In this article, I argue that it is incumbent upon a forensic psychiatrist to examine this concept following a trend in legal decisions that increasingly demand that we based our opinion on a scientific foundation. I will briefly discuss the shortcomings of EBP and how they have been addressed in more recent commentary. I will introduce a number of articles that suggest that we are at a stage where the principles of EBP can be applied to many aspects of forensic psychiatry.

Avoiding Malpractice Lawsuits by Following Risk Assessment and Suicide Prevention Guidelines

Roberts, A. R., Monferrari, I., Yeager, K. R. — 2008-02-25

Every 17 min, someone in the United States commits suicide. This equates to 83 suicides every day throughout the year (A. R. Roberts & K. Yeager, 2005). Suicide results in approximately 30,000 reported deaths annually. The loss of a patient to suicide is often a feared outcome among psychiatrists, psychologists, social workers, and crisis counselors, especially because the law assumes that in most situations suicide is preventable. Suicide accounts for many of the largest monetary settlements and judgments as well as a large proportion of malpractice lawsuits filed against mental health clinicians. Yet, clinician's often lack sufficient education on the legal aspects of malpractice associated with patient suicide. This article reviews several legal cases in which psychiatrists and/or social workers failed to protect patients. This includes failure to conduct a comprehensive biopsychosocial and lethality assessment, failure to warn of imminent risk of suicide, and/or breach of duty to care standards. Each case presentation concludes with recommendations for actions. Next, the article identifies common allegations made in suicide malpractice lawsuits. Conditions necessary to meet the criteria for a malpractice suit are laid out. The article concludes with the authors' guideline (FIKKE) for managing malpractice risk along with a decision-making flowchart designed to reduce a patient's risk of suicide during the treatment process.

Management of the Mentally Abnormal Offender

Chaimowitz, G. A., Mamak, M., Padgett, R. — 2008-02-25

Discussions about the prediction of dangerousness, a legal or social construct, often extend beyond forensic psychiatry into the general practice of psychiatry. Dangerousness can drive the entrance to and exit from the mental health and forensic system. Better conceptualized as risk prediction, it has been seen as a core skill for forensic psychiatry and an increasing requirement for general psychiatrists. Yet, for all the expertise in and the usefulness of risk prediction, it is the daily management of the mentally abnormal offender that taxes the clinical skills of the forensic psychiatrist. This article will address what we know about this area and suggest a model for managing mentally abnormal offenders.

Forensic Psychiatry and Violent Adolescents

O'Shaughnessy, R. J., Andrade, H. T. — 2008-02-25

In the 1990s, increasing rates of violence among adolescents spawned a new era of research into the causes and correlates of youth violence. The resultant data on risk factors have provided opportunities for establishing empirically based assessments and risk-focused treatment programs. Community-based treatment programs that demonstrate moderate effect in reducing violence have renewed optimism in the benefit of treatment over punishment. Current research on "adolescent psychopathy" and structured assessments of risk for violence present opportunities for advancing rehabilitation but carry a significant risk of harm. It is essential that forensic psychiatrists are guided by the available evidence and instruments when providing professional opinions on violent adolescent clients to the criminal justice system. In fitting with the evidence-based practice approach, forensic psychiatrists have an ethical responsibility to take into consideration available empirical research relevant to assessing and treating violent adolescents. Current policies that limit the ability to provide treatment in juvenile settings should be challenged by organized psychiatry.

Fitness/Competency to Stand Trial: A Conceptual Overview, Review of Existing Instruments, and Cross-Validation of the Nussbaum Fitness Questionnaire

Nussbaum, D., Hancock, M., Turner, I., Arrowood, J., Melodick, S. — 2008-02-25

Competency to Stand Trial or Fitness to Stand Trial (FST) is the most frequent referral issue facing forensic mental health professionals (FMHPs) and consumes considerable scarce resources in the process. This article summarizes minimalist and expanded legal approaches to FST and briefly describes three instruments developed by FMHPs to structure FST assessments. We then present evidence supporting the validity of the Nussbaum Fitness Questionnaire for efficiently screening individuals for fitness and blatant or subtle malingering. The paper ends with a number of suggestions to optimize use of these instruments within the current set of forensic mental health practices. Specifically, it is suggested that use of the screening instrument could reliably eliminate up to 70% of current referrals for complete assessments while the more in-depth semistructured interviews be utilized to confirm unfitness, especially when the mental health professional has more than trivial doubt regarding an individual's FST.

The Prediction of Violence; Detection of Dangerousness

Norko, M. A., Baranoski, M. V. — 2008-02-25

Contemporary evidence on the correlates of violence and the accuracy of predictions of violent outcomes is derived from a large body of research dating from approximately 1990. Substance abuse and several demographic variables have clearly been demonstrated to be significant risk factors for violence. The data on the link of various specific symptoms of psychiatric disorders to violence are inconclusive, though suggestive, because of conflicting research findings. Mental disorder does, however, represent a modest risk factor for violence. Actuarial predictions of future violence based on static nonpsychiatric characteristics achieve greater statistical accuracy than purely clinical methods, but the former are insensitive to effects of treatment and do not inform clinical intervention in an established way. Future research directions are encouraging in attempting to identify dynamic actuarial risk factors that will be both accurate and mutable. Substantive critiques of violence prediction and limitations of this body of research present a useful framework for evaluating both assumptions and conclusions about the prediction of violence in a psychiatric population.

Insanity Defense Evaluations: Toward a Model for Evidence-Based Practice

Knoll, J. L., Resnick, P. J. — 2008-02-25

The insanity defense has been described as a symbol of the relationship between law and psychiatry (Stone, 1984b). As such, it has always been the subject of intense legal and public scrutiny, despite the fact that it is infrequently raised and seldom successful. Forensic psychiatrists are often depended upon by the criminal justice system to provide these evaluations, which require a high degree of training and expertise. In 2002, the American Academy of Psychiatry and the Law published it's Practice Guideline for Forensic Psychiatric Evaluation of Defendants Raising the Insanity Defense (AAPL, 2002). While noting that any attempt to promulgate guidelines will be limited by evolving legal doctrine and psychiatric science, the intent of the guidelines was to describe "acceptable forensic psychiatric practices."

Evidence Base of Custody and Access Evaluations

Saini, M. A. — 2008-02-25

Custody and access evaluations are routinely conducted by psychiatrists, psychologists, social workers, and other mental health professionals. The primary goal of the evaluation is to assist judges, lawyers, and families by providing expert opinions regarding the level of interparental conflict, parent functioning, child–parent relationships, and the children's developmental, social, emotional, and educational needs post separation and divorce. Custody and access evaluations are given considerable weight by the courts with the expectation that custody evaluators will report within the best available scientific evidence and they will use objective, reliable, and valid procedures within the evaluation process. Although there is a growing body of scientific literature that explores children's and parents' adjustment after separation and divorce, there remains less evidence regarding the efficacy of custody evaluations as a tool to assist the courts and families in this adjustment process. Best practice guidelines, surveys, and analytical discussions about what constitutes best practice remains the focal point of these discussions. This evidence-based review systematically draws on studies of custody evaluations to determine the current state of scientific knowledge. Multiple databases of peer-reviewed and unpublished literature were searched to critically review the existing evidence. Data from cross-sectional designs, content analysis methods, and outcome-based studies represent aggregate data of over 1,945 mental health professionals, 417 lawyers and judges, and 568 children and families involved in custody evaluations. Outcome-based studies reflect the dual focus of evaluations to provide the courts with the best evidence and to provide families with opportunities to step out of the litigation process. Data synthesis within the evidence-based approach provides the opportunity to evaluate the current empirical evidence, identify gaps, and highlight areas for further review and for future research work. Framing custody and access evaluations within the evidence-based movement has implications for the judicial system, custody evaluators, researchers, families, and children.

Evidential Basis for the Assessment and Treatment of Sex Offenders

Bourget, D., Bradford, J. M. W. — 2008-02-25

This article will review current clinical knowledge on paraphilia and methods of assessment and treatment of sex offenders. In recent years, a better understanding of the physiological and psychological dynamics underlying abnormal sexual behavior was gained through advances on the neurobiology and neuropharmacology of sexual behaviour. Sex offenders form a heterogeneous group that presents a challenge regarding assessment. Components of a full comprehensive sexual behaviors assessment are discussed, detailing the evidence available on the use of penile plethysmography testing. Results of several studies showed that such testing discriminated child molesters from other sex offenders and non-offenders. Treatment modalities include a variety of pharmacological agents and psychological approaches, as treatment outcome studies demonstrate the overall effectiveness of treatment in reducing recidivism of sex offenders. Finally this article discusses future avenues for research, including research aimed at improving the validity and reliability of assessment of sex offenders and the development of non-invasive investigational procedures that make use of new information technology.

Child Maltreatment and Domestic Violence Editorial: Current State of Knowledge and Emerging Strategies for Policy and Practice

Shlonsky, A., Friend, C. — 2007-10-24

Double Jeopardy: Risk Assessment in the Context of Child Maltreatment and Domestic Violence

Shlonsky, A., Friend, C. — 2007-10-24

Investigations of child maltreatment often involve domestic violence, but there is little guidance about how to properly assess risk in such cases. Empirically validated risk assessment tools have been used successfully in child welfare and, to a lesser extent, in cases involving domestic violence, but these have generally not been utilized in tandem. Using the allegation of child maltreatment as the entry point for services, this paper proposes a nested risk assessment framework whereby risk of both child maltreatment and domestic violence are considered simultaneously using two different standardized instruments.

In Whose Best Interest? A Canadian Case Study of the Impact of Child Welfare Policies in Cases of Domestic Violence

Alaggia, R., Jenney, A., Mazzuca, J., Redmond, M. — 2007-10-24

North American child protection systems have been experiencing an era of sweeping child welfare reform over the last decade. Despite the breadth of these changes, legislative and policy impacts are rarely evaluated to ascertain whether changes are resulting in the outcomes they were designed to achieve. Using a participatory research framework, 70 participants from relevant service sectors and service recipients from a large urban centre in Canada, were interviewed about legislation in cases of children exposed to domestic violence. While most stakeholders noted the "spirit of the Act" to be well-meaning and based on a credible body of child research, there were serious concerns cited with the implementation and impact of policies that resulted from this piece of child welfare legislation. Reluctance of abused women to disclose or seek services for their families, isolation between helping professionals from different sectors, increased demand for services, increased surveillance of mothers, and decreased accountability of perpetrators were predominant themes identified. These data strongly suggest that response models be tested as pilot studies, rigorously evaluated and fully implemented only when there are assurances that appropriate and adequate services are available to meet the complex needs of the communities they are designed to serve.

Characteristics of Supervised Visitation Programs Serving Child Maltreatment and Other Cases

Crook, W. P., Oehme, K. — 2007-10-24

Supervised visitation programs allow parents who may be a risk to their children or to another parent to experience parent–child contact while in the presence of an appropriate third party. Use of a "neutral third party" to oversee such contact has long been recognized as essential in child maltreatment cases in which the child has been removed from the home. This paper presents the results of an exploratory study of the structural and functional characteristics of 47 supervised visitation programs in Florida. Findings indicated that programs are typically operated on small budgets, with the related challenges of limited hours of operation, delayed or denied services to families in need, small and/or unpaid staff, and inadequate security measures. Recommendations for stable and sufficient funding as well as statutory legitimization are provided.

Intimate Partner Violence and Child Maltreatment: Overlapping Risk

Zolotor, A. J., Theodore, A. D., Coyne-Beasley, T., Runyan, D. K. — 2007-10-24

Studies of intimate partner violence (IPV) and child maltreatment (CM) have examined the association between IPV and physical abuse. Children in homes with IPV may also experience other forms of CM. The objective is to determine the prevalence of CM in homes with and without IPV using cross-sectional analysis of survey data of mothers with partners (n = 1,232). The Conflict Tactics Scale and Parent Child Conflict Tactics Scale were used to determine IPV, physical, psychological, sexual abuse, and neglect. Mothers reporting IPV (either man to woman or woman to man) report 2.57 times the odds of physical abuse compared to those not reporting IPV (95% CI 1.11–5.97). Moms reporting IPV report 2.04 times the odds of neglect. Those reporting IPV report 9.58 times the odds of psychological abuse (95% CI 4.27–21.49). Mothers reporting IPV report 4.90 times the odds of sexual abuse (95% CI 0.43–55.67). IPV is associated with all forms of CM in this sample. Providers of IPV services for women with children should also assess for all forms of child maltreatment.

A Critical Review of Quantitative Analyses of Children Exposed to Domestic Violence: Lessons for Practice and Research

Fowler, D. N., Chanmugam, A. — 2007-10-24

Increased recognition of the unique needs of children exposed to domestic violence (CEDV) is evidenced by the evolving knowledge base on this issue. The breadth of quantitative research that exists has laid a foundation upon which to build effective time-limited intervention strategies. Still, intervention research in this area has yet to move toward advanced practice models. Definitional and methodological limitations have also impeded knowledge advancement. This paper uses a novel approach to critically review 5 quantitative meta- and mega-analyses on the effects of childhood exposure to domestic violence. Research and practice implications derived from these quantitative analyses that may assist child welfare professionals, domestic violence advocates, and researchers interested in providing effective intervention and services to CEDV are discussed.

From Culture Clash to New Possibilities: A Harm Reduction Approach to Family Violence and Child Protection Services

Shlonsky, A., Friend, C., Lambert, L. — 2007-10-24

This article examines the separate but sometimes overlapping foci of domestic violence (DV) and child protection services. When these sectors interact, the resulting tension becomes part of a complex dialectic and multiple opposing propositions that are explored here with respect for how they affect practice. A review of 30 years of DV discourse leads to systematic examinations of the DV literature for battered women, mental health, children, and offenders. The article proposes a radical shift by pairing a harm reduction approach with an evidence-based practice model when DV and child protection intersect. The implications of Stage of Change theory are considered in relationship to the harm reduction approach.

The Relationship Between Domestic Violence and Child Neglect

2007-10-24

This study examined the comorbidity of child neglect and domestic violence (DV) in a sample of public child welfare cases. All cases investigated for child neglect in 1999 (N = 2,350 families) from a single county in Kentucky were included in the analysis. Findings indicate that DV was comorbid in approximately 29% of the cases and, although cases were more likely to be opened when child neglect was substantiated, they were less likely to be opened when DV was also present. A secondary random subsample of 100 cases were reviewed to examine the impact of this comorbidity on the child welfare workers' assessment of risk and problems in children's functioning, the relationship between DV and risk factors contained on the risk assessment, and the workers' response to DV through legal actions and incorporation of DV into the case plan. The results showed that child welfare workers rate families at significantly greater risk, particularly when there was previously unreported DV, and identified more problems in children's interpersonal functioning when DV was present. DV was significantly correlated with more severe neglect and a limited social support network for the family. Although workers took a number of legal actions in response to DV, DV was addressed in only 35% of child welfare case plans.