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School Staff (school + staff)
Selected AbstractsUsing School Staff to Establish a Preventive Network of Care to Improve Elementary School Students' Control of AsthmaJOURNAL OF SCHOOL HEALTH, Issue 6 2006Jean-Marie Bruzzese To address these problems, Columbia University and the New York City Department of Education and the New York City Department of Health and Mental Hygiene undertook a randomized controlled trial to test the efficacy of a comprehensive school-based asthma program. In this intervention, school nurses were trained to facilitate the establishment of a preventive network of care for children with asthma by coordinating communications and fostering relationships between families, PCPs, and school personnel. PCPs also received training regarding asthma management. There was limited support for this model. While case detection helped nurses identify additional students with asthma and nurses increased the amount of time spent on asthma-related tasks, PCPs did not change their medical management of asthma. Few improvements in health outcomes were achieved. Relative to controls, 12-months posttest intervention students had a reduction in activity limitations due to asthma (,35% vs ,9%, p < .05) and days with symptoms (26% vs 39%, p = .06). The intervention had no impact on the use of urgent health care services, school attendance, or caregiver's quality of life. There were also no improvements at 24-months postintervention. We faced many challenges related to case detection, training, and implementing preventive care activities, which may have hindered our success. We present these challenges, describe how we coped with them, and discuss the lessons we learned. (J Sch Health. 2006;76(6):307-312) [source] Wide Awake to the World: The Arts and Urban Schools,Conflicts and Contributions of an After-School ProgramCURRICULUM INQUIRY, Issue 1 2001Therese Quinn While the benefits of arts involvement are increasingly clear, policies and practices consistent with this recognition are not proceeding apace. Nearly half the schools in the United States have no full-time arts teachers and emphases on "standards" have led to the elimination of the arts in many urban schools. This case study of a multi-year after-school arts program in urban public schools explores challenges and tensions that emerged during the program's implementation. Focusing on understanding the place and purpose of an arts program in a specific community, we employed a grounded theory approach and used multiple data-gathering methods, ranging from observations and interviews to surveys. We found that in serving hundreds of students, employing dozens of staff, and aiming to meet several complex goals, this arts program faced technical challenges that undermined its effectiveness. The arts program also suffered from unaddressed conflicts regarding norms and values. Artists attempted to provide students opportunities for creative exploration, while school staff emphasized control, order, and academic goals. We discuss these tensions and the ways they undermined the arts program. [source] Effectiveness of dental trauma education for elementary school staffDENTAL TRAUMATOLOGY, Issue 2 2008Judy D. McIntyre Using a newly developed reliable survey instrument, we tested our elementary school staff participants about TDI before (time0), immediately after (time1), and three months after (time2) the intervention. Schools were randomized into three groups: no intervention/control (C), pamphlets (P), and pamphlets + lecture (P + L). Outcomes of interest were TDI knowledge over time relative to the interventions vs controls. Statistical analysis involved a repeated measures linear model. At time0, TDI knowledge was low among all three groups. At time1, knowledge increased among all groups and is given by P > P+L > C. For time2 vs time1, the P + L group retained the knowledge while in both the C and P groups the knowledge level decreased. Between time1 and time2, significant differences were found between both intervention groups when compared with the control (P vs C and P + L vs C: both P < 0.05). In summary, both P and P + L groups significantly improved TDI knowledge among elementary school staff, and this difference held up over time. These interventions have the potential to improve TDI management by elementary school staff when faced with such injuries. [source] Personality types of dental school applicantsEUROPEAN JOURNAL OF DENTAL EDUCATION, Issue 3 2000David O. Morris A questionnaire-based prospective study was carried out to measure the personality styles of students being interviewed for a place on the 1997/98 dental undergraduate course in Leeds, England. A total of 334 applicants attended for interview between November 1997 and March 1998, of which 311 anonymously and voluntarily completed a personality questionnaire. The Keirsey Temperament Sorter was used to measure the strength and nature of preferences along four dimensions: extroversion-introversion (E-I), sensing-intuition (S-N), thinking-feeling (T-F) and judging-perceiving (J-P). 4 personality types accounted for 79% of the students, 21% were divided among nine personality types with no type comprising more than 6.7% of the students. The remaining 3 possible personality types were not represented in this student population. Further comparisons revealed significant differences between this student sample and the general population in the judging-perceiving preference and also an intra-group gender difference with regard to the thinking-feeling (T-F) preference. A predominance of the S-J (sensing with judging) temperament type was also confirmed. Personality questionnaires may be a useful adjunct in the selection process of dental school applicants. The identification of a student's working and learning style preference has implications for both the dental undergraduate curriculum and the teaching methods employed by dental school staff. [source] A Compositional Analysis of the Organizational Climate-Performance Relation: Public Schools as OrganizationsJOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 8 2006James Griffith The present study examined specific aspects of organizational climate related to job satisfaction, employee turnover, and organizational performance in public elementary schools. Survey data were obtained from school staff and students and from school district archives. Hypotheses tested included: (1) Employee perceptions of organizational climate and job satisfaction, when aggregated to an organizational level, would represent group-level constructs; (2) Employee perceptions of positive organizational climate would be associated with higher levels of job satisfaction and organizational performance and with lower levels of employee turnover; (3) Relations of organizational climate to organizational performance and to employee turnover would be mediated by employee job satisfaction; and (4) Employee perceptions of positive organizational climate and job satisfaction would be associated with less achievement disparity between minority and non-minority students. Study results supported all but one hypothesis. There was no evidence for the mediating effects of job satisfaction on relations of organizational climate to organizational performance and to employee turnover. Results were consistent with the broader organizational literature, which has shown the importance of orderly work environments, collegial relations, and supportive leaders for effectively functioning groups and organizations. [source] Do Satisfied Employees Satisfy Customers?JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, Issue 8 2001Parents, Satisfaction Among Public School Administrators, Students, Support-Services Staff Morale Data were obtained from school staff (N= 1,567) who provided support services to schools in a major metropolitan school district. These data were analyzed in relation to data obtained from 3 customer groups (school administrators, students, and parents) who provided ratings of their satisfaction with services. Several aspects of employee morale (e. g., quality of supervision, teamwork, and goal clarity, along with workgroup service climate) were significantly and positively related to administrator and parent satisfaction, but not to student satisfaction. Relations of employee morale and workgroup service climate to administrator satisfaction and parent satisfaction were moderated by customer contact with employees. Results are discussed in relation to expectations of customers and employees that affect the nature of the service-exchange interaction. [source] Active Parent Consent for Health Surveys With Urban Middle School Students: Processes and Outcomes,JOURNAL OF SCHOOL HEALTH, Issue 2 2010Molly Secor-Turner PhD BACKGROUND: To achieve high participation rates and a representative sample, active parent consent procedures require a significant investment of study resources. The purpose of this article is to describe processes and outcomes of utilizing active parent consent procedures with sixth-grade students from urban, ethnically diverse, economically disadvantaged K-8 public schools involved in an evaluation of a middle school service-learning program. METHODS: As part of the evaluation of the Lead Peace-Plus service-learning program, active parent consent was obtained for participation in school-based health surveys conducted with sixth graders in 3 schools. To achieve acceptable rates of parent permission, we employed multiple procedures including regular communication with school staff, incentives for involved schools and teachers, a multipronged approach for reaching parents, and direct encouragement of students to return forms through repeated classroom visits, individual and classroom incentives. We used Fisher's exact tests to compare selected characteristics among students whose parents weren't reached, those whose parents refused, and those whose parents consented to survey participation. RESULTS: We achieved a parent response rate of 94.6% among sixth-grade students. No significant differences in student gender, race/ethnicity, school, or free/reduced lunch status were identified across parent consent status groups. Rates of absenteeism were significantly higher (p = .03) among students whose parents weren't reached compared to other groups. CONCLUSIONS: Employing a multifaceted active parent consent campaign can result in high rates of parental response with limited sampling bias among an urban, ethnically diverse and economically disadvantaged group of middle school students. [source] A Work Sampling Study of Provider Activities in School-Based Health CentersJOURNAL OF SCHOOL HEALTH, Issue 6 2009Brian Mavis PhD ABSTRACT Background:, The purpose of this study was to describe provider activities in a convenience sample of School-Based Health Centers (SBHCs). The goal was to determine the relative proportion of time that clinic staff engaged in various patient care and non-patient care activities. Methods:, All provider staff at 4 urban SBHCs participated in this study; 2 were in elementary schools, 1 in a middle school, and 1 in a school with kindergarten through grade 8. The study examined provider activity from 6 days sampled at random from the school year. Participants were asked to document their activities in 15-minute intervals from 8:00 a.m. to 5:00 p.m. A structured recording form was used that included 35 activity categories. Results:, Overall, 1492 records were completed, accounting for 2708 coded activities. Almost half (48%) of all staff activities were coded as direct patient contact, with clinic operations the second largest category. Limited variations in activities were found across clinic sites and according to season. Conclusions:, A significant amount of provider activity was directed at the delivery of health care; direct patient care and clinic operations combined accounted for approximately 75% of clinic activity. Patient, classroom, and group education activities, as well as contacts with parents and school staff accounted for 20% of all clinic activity and represent important SBHC functions that other productivity measures such as billing data might not consistently track. Overall, the method was acceptable to professional staff as a means of tracking activity and was adaptable to meet their needs. [source] Building a Partnership to Evaluate School-Linked Health Services: The Cincinnati School Health Demonstration ProjectJOURNAL OF SCHOOL HEALTH, Issue 10 2005Barbara L. Rose Partners from the Cincinnati Health Department, Cincinnati Public Schools, Cincinnati Children's Hospital Medical Center, and The Health Foundation of Greater Cincinnati wanted to determine if levels of school-linked care made a difference in student quality of life, school connectedness, attendance, emergency department use, and volume of referrals to health care specialists. School nurses, principals and school staff, parents and students, upper-level managers, and health service researchers worked together over a 2.5-year period to learn about and use new technology to collect information on student health, well-being, and outcome measures. Varying levels of school health care intervention models were instituted and evaluated. A standard model of care was compared with 2 models of enhanced care and service. The information collected from students, parents, nurses, and the school system provided a rich database on the health of urban children. School facilities, staffing, and computer technology, relationship building among stakeholders, extensive communication, and high student mobility were factors that influenced success and findings of the project. Funding for district-wide computerization and addition of school health staff was not secured by the end of the demonstration project; however, relationships among the partners endured and paved the way for future collaborations designed to better serve urban school children in Cincinnati. (J Sch Health. 2005;75(10):363-369) [source] School nurse perceptions of barriers and supports for children with diabetesJOURNAL OF SCHOOL HEALTH, Issue 4 2005Laura Nabors These youth often do not receive the support needed to manage their diabetes during or after school. Nurses (n = 110) from 3 states responded to a survey examining perceptions of barriers to and supports for diabetes management during school and after school activities. Results indicated that adolescents need more support at school. Support could be facilitated by education of school staff; improved communication among youth, parents, school nurses, teachers, and physicians; and more communication from adolescents to others about what they need to manage well in school. Open-ended questions allowed nurses to provide recommendations for supporting youth and ideas for addressing barriers to management at school. Future studies should address ways to enable adolescents to communicate about their diabetes and ways to educate the school team. (J Sch Health. 2005;75(4):119-124) [source] Physical Activity, Dietary Practices, and Other Health Behaviors of At-Risk Youth Attending Alternative High SchoolsJOURNAL OF SCHOOL HEALTH, Issue 4 2004Martha Y. Kubik ABSTRACT: This study assessed the interest of alternative high school staff in intervention research on students' eating and physical activity habits und the feasibility of conducting such research in alternative school settings. A two-phase descriptive design incorporated both quantitative and qualitative methods. In fall/winter 2001,2002, alternative high school administrators in Minnesota were surveyed (response rate = 83%; n = 130/157). During summer 2002, one-on-one, semistruclured interviews were conducted with key-school personnel (n = 15) from urban and suburban schools. Findings indicated few schools had been invited to participate in research on nutrition (11%) and physical activity (7%). However, more than 80% of administrators reported interest in their students participating in such research. Most schools offered health and PE classes and had access to indoor gym facilities and outdoor play areas. While most schools offered a school lunch program, participation was low, cold lunches were common, and food often was unappealing. Beverage and snack vending machines were common. Overall, the physical environment of most alternative schools did not support physical activity and healthy eating as normative behavior. Interest in interventions on physical inactivity, unhealthy dietary practices, und other priority health-risk behavior common in students attending alternative schools was high among teachers and administrators. Results suggest research in alternative high schools is feasible and successful implementation and evaluation of programs possible. [source] Posttraumatic stress in AIDS-orphaned children exposed to high levels of trauma: The protective role of perceived social support,JOURNAL OF TRAUMATIC STRESS, Issue 2 2009Lucie Cluver Poor urban children in South Africa are exposed to multiple community traumas, but AIDS-orphaned children are at particular risk for posttraumatic stress. This study examined the hypothesis that social support may moderate the relationship between trauma exposure and posttraumatic stress for this group. Four hundred twenty-five AIDS-orphaned children were interviewed using standardized measures of psychopathology. Compared to participants with low perceived social support, those with high perceived social support demonstrated significantly lower levels of PTSD symptoms after both low and high levels of trauma exposure. This suggests that strong perception of social support from carers, school staff, and friends may lessen deleterious effects of exposure to trauma, and could be a focus of intervention efforts to improve psychological outcomes for AIDS-orphaned children. [source] Obesity and associated modifiable environmental factors in Iranian adolescents: Isfahan Healthy Heart Program , Heart Health Promotion from ChildhoodPEDIATRICS INTERNATIONAL, Issue 4 2003RoYA Kelishadi Abstract Objective:,To evaluate the prevalence of overweight and obesity among Iranian adolescents and their relationship with modifiable environmental factors. Methods:,The subjects of the present study were 1000 girls and 1000 boys, aged between 11 and 18 years selected by multistage random sampling, their parents (n = 2000) and their school staff (n = 500 subjects) in urban and rural areas of two provinces in Iran. Data concerning body mass index (BMI), nutrition and the physical activity of the subjects were analyzed by SPSSV10/Win software. Results:,The prevalence of 85th percentile , body mass index (BMI) < 95th percentile and BMI > 95th percentile in girls was significantly higher than boys (10.7 ± 1.1 and 2.9 ± 0.1%vs 7.4 ± 0.9 and 1.9 ± 0.1%, respectively; P < 0.05). The mean BMI value was significantly different between urban and rural areas (25.4 ± 5.2 vs 23.2 ± 7.1 kg/m2, respectively; P < 0.05). A BMI> 85th percentile was more prevalent in families with an average income than in high-income families (9.3 ± 1.7 vs 7.2 ± 1.4%, respectively; P < 0.05) and in those with lower-educated mothers (9.2 ± 2.1 vs 11.5 ± 2.4 years of mothers education, respectively). The mean total energy intake was not different between overweight or obese and normal-weight subjects (1825 ± 90 vs 1815 ± 85 kCal, respectively; P > 0.05), but the percentage of energy derived from carbohydrates was significantly higher in the former group compared with the latter (69.4 vs 63.2%, respectively; P < 0.05). Regular extracurricular sports activities were significantly lower and the time spent watching television was significantly higher in overweight or obese than non-obese subjects (time spent watching telelvision: 300 ± 20 vs 240 ± 30 min/day, P < 0.05). A significant linear association was shown between the frequency of consumption of rice, bread, pasta, fast foods and fat/salty snacks and BMI (, = 0.05,0.06; P < 0.05). A significant correlation was shown between BMI percentiles and serum triglyceride, high-density lipoprotein,cholesterol and systolic blood pressure (Pearson's r = 0.38, ,0.32 and 0.47, respectively). Conclusions:,Enhanced efforts to prevent and control overweight from childhood is a critical national priority, even in developing countries. To be successful, social, cultural and economic influences should be considered. [source] A survey investigating school psychologists' measurement of treatment integrity in school-based interventions and their beliefs about its importancePSYCHOLOGY IN THE SCHOOLS, Issue 6 2008Wendy S. Cochrane A survey of individuals holding the Nationally Certified School Psychologist (NCSP) credential was conducted via the Internet to gather information regarding their measurement of treatment integrity in school-based interventions and their beliefs about its importance. A sample of 806 self-selected professionals holding the NCSP credential provided data about the extent to which they measure treatment integrity and the methods they used to measure it when developing interventions via one-to-one and group/team consultation. Results showed that 97.6% agreed that measurement of treatment integrity was a key factor to consider and to include when evaluating interventions and when using intervention data for special education eligibility decisions. Few, however, reported regularly documenting it in one-to-one (only 11.3%) or group/team consultation (only 1.9%). Recommendations for how school psychologists and other school staff can increase their measurement of treatment integrity in school-based interventions are offered. © 2008 Wiley Periodicals, Inc. [source] School-based promotion of fruit and vegetable consumption in multiculturally diverse, urban schoolsPSYCHOLOGY IN THE SCHOOLS, Issue 1 2008Jessica Blom-Hoffman Rates of childhood overweight, have reached epidemic proportions (U.S. Department of Health and Human Services, 2001), and schools have been called on to play a role in the prevention of this medical condition. This article describes a multiyear health promotion effort,the Athletes in Service fruit and vegetable (F&V) promotion program,which is based on social learning theory for urban, elementary school children in kindergarten through third grade. Children participate in the program for a period of 3 years. The goals of the program are to increase opportunities for children to be more physically active during the school day and to help students increase their F&V consumption. This article describes the F&V promotion components of the program that were implemented in year 1, including implementation integrity and treatment acceptability data. Year 1 evaluation data demonstrated that the program is acceptable from the perspective of school staff and was implemented by school staff with high levels of integrity. Hallmarks of the program's successful implementation and high acceptability include (a) having a school-based program champion; (b) designing the program to include low-cost, attractive, interactive materials; (c) including many school staff members to facilitate a culture of healthy eating in the school; and (d) spreading out implementation responsibilities among the multiple staff members so that each individual's involvement is time efficient. © 2007 Wiley Periodicals, Inc. [source] The successful resolution of armed hostage/barricade events in schools: A qualitative analysisPSYCHOLOGY IN THE SCHOOLS, Issue 6 2007Jeffrey A. Daniels This article explores the perceptions and reactions of school and law enforcement personnel in the successful resolution of armed hostage and barricade events in schools. A total of 12 individuals from three schools were interviewed to determine (1) their salient roles related to the situations, (2) facilitative systemic conditions, (3) to what they attributed the successful resolution, and (4) their advice to other school professionals. Results suggest that establishment of trusting relationships between school personnel and all students is essential in successfully resolving school hostage and barricade events. In addition, respondents discussed the importance of awareness, training, and communications in resolving such events. Implications for school staff are included, along with limitations and future research directions. © 2007 Wiley Periodicals, Inc. [source] Teachers: Recognising Excellence in Medical Education: a student-led award schemeTHE CLINICAL TEACHER, Issue 3 2010Nicola Louise Wheeler Summary Background:, The standard of clinical teaching is acknowledged by undergraduate medical students and their clinical teachers as being variable.1 Furthermore, there is very little recognition by medical schools of the teaching expertise and efforts of clinical teachers.2 Innovation:, In response to these issues, a group of medical students at the University of Birmingham's Medical School have established an awards scheme called Recognising Excellence in Medical Education (REME). This is a student-led award scheme that is supported by the Dean and other senior medical school staff, and by the students' medical society. Method:, This research used two focus groups, one comprising REME award winners and one comprising students who voted in the scheme, to discuss opinions regarding the awards, reasons why the students voted, and how clinical teachers feel about receiving the awards. Discussion:, The focus groups revealed that both students and their clinical teachers were very positive about the award scheme and the impact it has had, both personally and within the hospitals or Trusts of the award winners. The REME awards were viewed as motivating and encouraging for clinical teachers, and were particularly prized as teachers were nominated by their students. [source] Predicting curriculum and test performance at age 11 years from pupil background, baseline skills and phonological awareness at age 5 yearsTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 7 2007Robert Savage Background:, Phonological awareness tests are amongst the best predictors of literacy and predict outcomes of Key Stage 1 assessment of the National Curriculum in England at age 7. However, it is unknown whether their ability to predict National Curricular outcomes extends to Key Stage 2 assessments given at age 11, or also whether the predictive power of such tests is independent of letter-knowledge. We explored the unique predictive validity of phonological awareness and early literacy measures, and other pupil background measures taken at age 5 in the prediction of English, Maths, and Science performance at age 11. Method:, Three hundred and eighty-two children from 21 primary schools in one Local Educational Authority were assessed at age 5 and followed to age 11 (Key Stage 2 assessment). Teaching assistants (TAs) administered phonological awareness tasks and early literacy measures. Baseline and Key Stage 2 performance measures were collected by teachers. Results:, Phonological awareness was a significant unique predictor of all nine outcome measures after baseline assessment and pupil background measures were first controlled in regression analyses, and continued to be a significant predictor of reading, maths, and science performance, and teacher assessments after early literacy skill and letter-knowledge was controlled. Gender predicted performance in writing, the English test, and English teacher assessment, with girls outperforming boys. Conclusions:, Phonological awareness is a unique predictor of general curricular attainment independent of pupil background, early reading ability and letter-knowledge. Practically, screening of phonological awareness and basic reading skills by school staff in year 1 significantly enhances the capacity of schools to predict curricular outcomes in year 6. [source] A mand analysis and levels treatment in an outpatient clinicBEHAVIORAL INTERVENTIONS, Issue 2 2003Julia T. O'Connor An adolescent with severe mental retardation and fragile X syndrome who displayed destructive behavior maintained by positive reinforcement in the form of adult compliance with mands was assessed and treated in an outpatient setting. A levels system treatment was assessed, consisting of a continuum of attention and reinforcement ranging from access to the functional reinforcer in level 3 contingent upon appropriate behavior to a 10,min room time-out for level 1 contingent upon aggressive and dangerous behavior. While the efficacy of this treatment has been demonstrated in an inpatient setting (Hagopian et al., 2002), this application extended the findings to outpatient and community settings. The levels system treatment resulted in a 98.1% reduction in destructive behavior from baseline levels. Treatment was successfully transferred to the home and school and reductions were maintained at 6 and 9 months. Treatment acceptability ratings were high across both home and school staff. Copyright © 2003 John Wiley & Sons, Ltd. [source] ALTERNATIVE CURRICULUM: The integration of an alternative curriculum: Skill ForceBRITISH JOURNAL OF SPECIAL EDUCATION, Issue 3 2009Lynne Rogers The introduction of alternative curricula in the UK for students in the secondary phase is one of a number of strategies designed to improve attendance at school, reduce exclusion and improve attainment. Skill Force is a charitable youth initiative that offers 14- to 16-year-old students a key skills based vocational alternative to the traditional curriculum. In this article, Lynne Rogers, Susan Hallam and Jacquelene Shaw of the Institute of Education, University of London, and Jasmine Rhamie of the University of Southampton set out to explore the views of Skill Force instructors and team leaders, school staff and Skill Force Regional Directors. These participants perceived the critical factors in the successful integration of Skill Force to be: effective introduction of the programme to pupils and parents; careful selection of students; clear introduction of the programme to staff; integrated discipline policies; strong support from senior management; good communication; and a willingness to resolve practical difficulties. [source] ,I felt like I did something good', the impact on mainstream pupils of a peer tutoring programme for children with autismBRITISH JOURNAL OF SPECIAL EDUCATION, Issue 1 2007Val Jones There have been many research projects studying the use of peer intervention strategies to develop the social, communication and interaction skills of children with autism, yet few of these studies focus in detail on the impact of such strategies on the mainstream peers. In this article, Val Jones, an advisory teacher for autism spectrum conditions, explores the impact of peer tutoring children with autism on the peer tutors themselves. This enquiry focuses on ten to eleven-year-old mainstream pupils who were paired with twelve children with autism and associated learning difficulties for weekly peer tutoring sessions at a primary school with a specialist autism unit. At the end of a series of tutoring sessions, the perspectives of the peer tutors were gathered through questionnaires. All of the peer tutors reported that they had enjoyed the experience and most felt that the peer tutoring had brought them direct benefits by building confidence, teaching responsibility, encouraging caring attitudes and helping them to acknowledge diversity. Val Jones also gathered the views of parents and school staff who again reported largely positive outcomes from the peer tutoring process. While this small-scale study focuses on findings from one school, there are wider implications here for the development of inclusive policies and practices and this article will be of interest to professionals working across the range of specialist and mainstream settings. [source] Child psychiatric skills in primary healthcare , self-evaluation of Finnish health centre doctorsCHILD: CARE, HEALTH AND DEVELOPMENT, Issue 2 2002A. Heikkinen Abstract Objective To study Finnish general practitioners' (GP's) perceptions of their child psychiatric skills. Methods The study sample consisted of physicians (n = 755) working in health centres situated in the special response area of the Tampere University Hospital, Finland. They were requested to assess their competence in 16 areas on a four-step Likert scale. The response rate was 66.1% (n = 499). Results Physicians evaluated their child psychiatric skills as inadequate on many issues. The ability to identify depression was poorer the younger the child in question. Only a minority (14%) felt they were well able to identify a depressed infant. Many physicians considered themselves poorly skilled in assessing the relationship between infant and parents (39.8%), in assessing a child's need for psychiatric treatment (42.7%) and in identifying a child with attention-deficit disorder (40.7%). A majority (75.9%) rated their skills poor in co-operating with daycare personnel or school staff in matters concerning a child with conduct disturbance. Only 26.8% could assess the necessity of taking a child into custody. Women gave higher ratings of their skills in identifying depressed infants and in assessing the infant,parent relationship than men, whereas men assessed their skills as better in cases in which there were problems in co-operation with parents. Conclusions In order to provide good psychiatric services for children, attention should be paid to the GPs' child psychiatric skills. [source] Proceedings of the 20th Annual Conference of the Japanese Association for Adolescent Psychotherapy, 16 November 2002, Tokyo, JapanPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 5 2003Article first published online: 28 AUG 200 Inpatient treatment of obsessive,compulsive disorder in a child and adolescent psychiatry ward M. USAMI National Center of Neurology and Psychiatry, Kohnodai Hospital, Chiba, Japan This is a case report of a 13-year-old-boy (2nd grade in junior high school). His father had poor communication; his mother was a very fragile woman. The boy had been overprotected by his parents, as long as he responded to their expectations. He did not have any other siblings. He played well with his friends since he was young, and did not have problems until the 1st term (from April to July) of 1st grade in junior high school. However, in September he started to have difficulties going well with his friends, and going to school. He spent most of his time in his room, and began to repeat checking and hand-washing frequently. Even at midnight, he forced his mother to touch the shutter from outside of the house for many times. He also ritually repeated to touch his mother's body, after he licked his hands, for over an hour. He became violent, when his parents tried to stop him. In April, year X, his parents visited our hospital for the first time. From then, his mother could not tolerate her son's coerciveness any longer. His father explained to the boy that ,your mother has been hospitalized', and she started to live in the next room to the boy's without making any noise. After 3 months he noticed that his mother was not hospitalized, and he got very excited. He was admitted to our hospital with his family and relatives, in October, year X. At the initial stage of hospitalization he showed distrust and doubt towards the therapist and hospital. He had little communication with other boys and did not express his feelings. Therefore, there was a period of time where he seemed to wonder whether he could trust the treatment staff or not. During his interviews with his therapist he repeated only ,I'm okay' and did not show much emotional communication. For the boy, exposing himself was equivalent to showing his vulnerability and incompleteness. Therefore, the therapist considered that he was trying to denying his feelings to avoid this. The therapist set goals for considering his own feelings positively and expressing them appropriately. Also, the therapist carried out behavioral restrictions towards him. He hardly had any emotional communication with the staff, and his peer relationship in the ward was superficial. Therefore, he gradually had difficulty spending his time at the end of December On the following day in which he and the therapist decided to return to his house for the first time, he went out of the ward a few days before without permission. From thereon it was possible for him to share feelings such as hostility and aggression, dependence and kindness with the therapist. The therapist changed his role from an invasive one to a more protective one. Then, his unsociability gradually faded. He also developed good peer relationships with other boys in the ward and began to express himself feeling appropriately. He was also able to establish appropriate relations with his parents at home, and friends of his neighborhood began to have normal peer relationships again. During childhood and adolescence, boys with obsessive,compulsive disorder are known to have features such as poor insight and often involving their mothers. We would like to present this case, through our understanding of dynamic psychiatry throughout his hospitalization, and also on the other therapies that were performed. Psychotherapy with a graduate student that discontinued after only three sessions: Was it enough for this client? N. KATSUKI Sophia University, Tokyo, Japan Introduction: Before and after the psychotherapy, SWT was administrated in this case. Comparing these two drawings, the therapist was provided with some ideas of what kind of internal change had taken place inside this client. Referring to the changes observed, we would like to review the purposes and the ways of the psychotherapy, as well as the adequacy of the limited number of the sessions (vis-a-vis result attained.) Also we will discuss later if any other effective ways could be available within the capacities of the consulting system/the clinic in the university. Case: Ms. S Age 24 years. Problems/appeal: (i) awkwardness in the relationship with the laboratory colleagues; (ii) symptoms of sweating, vomiting and quivering; and (iii) anxiety regarding continuing study and job hunting. Diagnosis: > c/o PTSD. Psychotherapeutic setting: At the therapy room in the clinic, placed at the university, 50 min-session; once a week; paralleled with the medical treatment. Process: (1) Since she was expelled from the study team in the previous year, it has become extremely difficult for her to attend the laboratory (lab) due to the aforementioned symptoms. She had a feeling of being neglected by the others. When the therapist suggested that she compose her mental confusions in the past by attending the therapy room, she seemed to be looking forward to it, although she said that she could remember only a few. (2) She reported that she overdosed on sedatives, as she could not stop irritating. She was getting tough with her family, also she slashed the mattress of her bed with a knife for many times. She complained that people neither understood nor appreciated her properly. and she said that she wanted revenge on the leader of the lab by punishing him one way or other. (3) Looking back the previous session, she said ,I had been mentally mixed up at that time, but I feel that now I can handle myself, as I stopped the medication after consulting the psychiatrist. According to what she said, when she disclosed the occurrences in the lab to her mother, she felt to be understood properly by her mother and felt so relieved. and she also reported that she had been sewing up the mattress which she slashed before, without any reason. She added, " although I don't even know what it means, I feel that this work is so meaningful to me, somehow". Finally, she told that she had already made her mind to cope with the situation by herself from now on, although it might result in a flinch from the real solution. Situations being the above, the session was closed. Swt: By the remarkable changes observed between the two drawings, the meanings of this psychotherapy and its closure to the client would be contemplated. Question of how school counselors should deal with separation attendant on students' graduation: On a case in which the separation was not worked through C. ASAHARA Sophia University, Tokyo, Japan Although time limited relationship is one of the important characteristics in school counseling, the question of separation attendant on it has not been much discussed based on specific cases. This study focuses on the question of separation through looking at a particular case, in which the separation was not worked through, and halfway relationship continued even after the student's graduation and the counselor's resignation. I was a part time school counselor at a junior high school in Tokyo. The client was a 14-year-old female student, who could not go to her classroom, and spent a few hours in a sick bay when she came to school. She was in the final grade and there was only half a year left before graduation when we first met, and we started to see each other within a very loose structure. As her personality was hyper-vigilant and defensive, it took almost 2 months before I could feel that she was nearer. Her graduation was the first occasion of separation. On that occasion, I found that there had been a discrepancy between our expectations; while I took it for granted that our relationship would end with the graduation, she expected to see me even after she graduated, and she actually came up to see me once in a while during the next year. A year later, we faced another occasion of separation, that was my resignation. Although I worried about her, all I have done for her was to hand a leaflet of a counseling office, where I work as a part time counselor. Again I could not refer to her feelings or show any concrete directions such as making a fixed arrangement. After an occasional correspondence for the next 10 months (about 2 years after her graduation), she contacted me at the counseling office asking for a constant counseling. Why could I not deal with both occasions? and how did that affect the client thereafter? There were two occasions of separation. At the time of the client's graduation, I seemed to be enmeshed in the way of separation that is peculiar to the school setting. In general in therapeutic relationship, mourning work between counselor and client is regarded as being quite important. At school, however, separation attendant on graduation is usually taken for granted and mourning work for any personal relationship tends to be neglected. Graduation ceremony is a big event but it is not about mourning over one's personal relationships but separation from school. That may be why I did not appreciate how the client counted on our relationship. At the time of my resignation I was too worried about working through a change from very loose structure which is peculiar to the school setting to a usual therapeutic structure (fees are charged, and time, place are fixed). That is why I did nothing but give her a leaflet. In this way, we never talked about her complex feelings such as sadness or loneliness, which she was supposed to experience on separation. Looking at the aforementioned process from the client's viewpoint, it can be easily imagined that she could not accept the fact of separation just because she graduated. and later, she was forced to be in double-bind situation, in which she was accepted superficially (handed a leaflet), while no concrete possibility was proposed concerning our relationship (she could never see me unless she tries to contact me.) As a result, she was left alone and at a loss whether she could count on me or not. The halfway situation or her suspense was reflected in her letter, in which she appeared to be just chatting at first sight, but between the lines there was something more implying her sufferings. Above discussion suggests that in some case, we should not neglect the mourning work even in a school setting. To whom or how it is done is the next theme we should explore and discuss in the future. For now, we should at least be conscious about the question of separation in school setting. Study of the process of psychotherapy with intervals for months M. TERASHIMA Bunkyo Gakuin University, Tokyo, Japan This is a report on the process of psychotherapy of an adolescent girl who showed manic and depressive state. At the time of a depressed state, she could not go to a college and withdrew into home, and the severe regressive situation was shown. Her therapy began at the age of 20 and she wanted to know what her problem was. The process of treatment went on for 4 years but she stopped coming to sessions for several months because of failure of the therapist. She repeated the same thing twice. After going through these intervals the client began to remember and started to talk about her childhood , suffering abusive force from her father, with vivid impressions. They once were hard for her to accept, but she began to establish the consistent figure of herself from past to present. In this case, it could be thought that the intervals of the sessions had a certain role, with which the client controlled the structure of treatment, instead of an attack against the therapist. Her object relation, which is going to control an object offensively, was reflected in these phenomena. That is, it can be said that the ambivalence about dependency , difficult to depend but desirous of the object , was expressed. Discontinuation of the sessions was the product of the compromise formation brought about the ambivalence of the client, and while continuing to receive this ambivalence in the treatment, the client started to realize discontinuance of her memories and then advanced integration of her self-image. For the young client with conflict to dependence such as her, an interval does not destroy the process of treatment but in some cases it could be considered as a therapeutic element. In the intervals the client could assimilate the matter by herself, that acquired by the sessions. Psychotherapy for a schizoid woman who presented eccentric speech and behaviour M. OGASAWARA Osaka University Graduate School of Medicine, Osaka, Japan Case presentation: A case of a 27-year-old woman at the beginning of therapy. Life history: She had been having a wish for death since she was in kindergarten and she had been feeling strong resistance to do the same as others after school attendance. She had a history of ablutomania from the age of 10,15, but the symptom disappeared naturally. and she said that she had been eliminated from groups that she tried to enter. After graduating a junior college, she changed jobs several times without getting a full-time position. Present history: Scolded by her boy friend for her coming home too late one day, she showed confusion such as excitement, self-injury or terror. She consulted a psychiatrist in a certain general hospital, but she presented there eccentric behaviours such as tense facial expression, stiffness of her whole body, or involuntary movement of limbs. and because she felt on bad terms with the psychiatrist and she had come to cause convulsion attacks in the examination room, she was introduced to our hospital. Every session of this psychotherapy was held once a week and for approximately 60 min at a time. Treatment process: She sometimes presented various eccentric attitudes, for example overturning to the floor with screaming (1), going down on her knees when entrance at the door (5), entering with a knife in her mouth and hitting the wall suddenly (7), stiffening herself just outside the door without entering the examination room (9), taking out a knife abruptly and putting it on her neck (40), exclaiming with convulsion responding to every talk from the therapist (41), or stiffening her face and biting herself in the right forearm suddenly (52). She also repeated self-injuries or convulsion attacks outside of the examination room in the early period of the therapy. Throughout the therapy she showed hypersensitivity for interpersonal relations, anxiety about dependence, terror for self-assertion, and avoidance for confrontation to her emotional problems. Two years and 6 months have passed since the beginning of this therapy. She ceased self-injury approximately 1 year and 6 months before and her sense of obscure terror has been gradually reduced to some extent. Discussion: Her non-verbal wariness and aggression to the therapist made the sessions full of tension and the therapist felt a sense of heaviness every time. In contrast, she could not express aggression verbally to the therapist, and when the therapist tried to identify her aggression she denied it. Her anxiety, that she will be thoroughly counterattacked to self-disintegration if she shows aggression to other persons, seems to be so immeasurably strong that she is compelled to deny her own aggression. Interpretations and confrontations by the therapist make her protective, and occasionally she shows stronger resistance in the shape of denial of her problems or conversion symptoms (astasia, aphonia, or involuntary movements) but she never expresses verbal aggression to the therapist. and the therapist feels much difficulty to share sympathy with her, and she expresses distrust against sympathetic approach of the therapist. However, her obvious disturbance that she expresses when she feels the therapist is not sympathetic shows her desire for sympathy. Thus, because she has both strong distrust and desire for sympathy, she is in a porcupine dilemma, which is characteristic of schizoid patients as to whether to lengthen or to shorten the distance between herself and the therapist. This attitude seems to have been derived from experience she might have had during her babyhood and childhood that she felt terror to be counterattacked and deserted when she showed irritation to her mother. In fact, existence of severe problems of the relationship between herself and her mother in her babyhood and childhood can be guessed from her statement. Although she has been repeating experiences to be excluded from other people, she shows no attitude to construct interpersonal relationship actively. On the contrary, by regarding herself to be a victim or devaluating other persons she externalizes responsibility that she herself should assume essentially. The reason must be that her disintegration anxiety is evoked if she recognizes that she herself has problems; that is, that negative things exist inside of her. Therefore, she seems to be inhibited to get depressive position and obliged to remain mainly in a paranoid,schizoid position. As for the pathological level, she seems to have borderline personality organization because of frequent use of mechanisms to externalize fantastically her inner responsibility. For her high ability to avoid confronting her emotional problems making the most of her verbal ability, every intervention of the therapist is invalidated. So, it seems very difficult for her to recognize her own problems through verbal interpretations or confrontation by the therapist, for the present. In general, it is impossible to confront self problems without containing negative emotions inside of the self, but her ability seemed to be insufficient. So, to point out her problems is considered to be very likely to result in her confusion caused by persecution anxiety. Although the therapy may attain the stage on which verbal interpretation and confrontation work better some day, the therapist is compelled to aim at promoting her ability to hold negative emotion inside of herself for the time being. For the purpose, the therapist is required to endure the situation in which she brings emotion that makes the therapist feel negative counter-transference and her process to experience that the therapeutic relation itself would not collapse by holding negative emotion. On supportive psychotherapy with a male adolescent Y. TERASHIMA Kitasato University Health Care Center, Kanagawa, Japan Adolescent cases sometimes show dramatic improvements as a consequence of psychotherapy. The author describes how psychotherapy can support an adolescent and how theraputic achievements can be made. Two and a half years of treatment sessions with a male adolescent patient are presented. The patient was a 19-year-old man, living with his family. He had 5 years of experience living abroad with his family and he was a preparatory school student when he came to a mental clinic for help. He was suffering from not being able to sleep well, from difficulties concerning keeping his attention on one thing, and from fear of going to distant places. He could barely leave his room, and imagined the consequence of overdosing or jumping out of a window. He claimed that his life was doomed because his family moved from a town that was familiar to him. At the first phase of psychotherapy that lasted for approximately 1 year, the patient seldom responded to the therapist. The patient was basically silent. He told the therapist that the town he lives in now feels cold or that he wants to become a writer. However, these comments were made without any kind of explanation and the therapist felt it very difficult to understand what the patient was trying to say. The sessions continued on a regular basis. However, the therapist felt very useless and fatigued. Problems with the patient and his family were also present at this phase of psychotherapy. He felt unpleasant at home and felt it was useless to expect anything from his parents. These feelings were naturally transferred to the therapist and were interpreted. However, interpretation seemed to make no changes in the forms of the patient's transference. The second phase of psychotherapy began suddenly. The patient kept saying that he did not know what to talk about. However, after a brief comment made by the therapist on the author of the book he was reading, the patient told the therapist that it was unexpected that the therapist knew anything of his favorite writer. After this almost first interaction between the patient and the therapist, the patient started to show dramatic changes. The patient started to bring his favorite rock CDs to sessions where they were played and the patient and the therapist both made comments on how they felt about the music. He also started asking questions concerning the therapist. It seemed that the patient finally started to want to know the therapist. He started communicating. The patient was sometimes silent but that did not last long. The therapist no longer felt so useless and emotional interaction, which never took place in the first phase, now became dominant. The third phase happened rapidly and lasted for approximately 10 months. Conversations on music, art, literature and movies were made possible and the therapist seldom felt difficulties on following the patient's line of thought. He started to go to schools and it was difficult at first but he started adjusting to the environment of his new part-time jobs. By the end of the school year, he was qualified for the entrance to a prestigious university. The patient's problems had vanished except for some sleeping difficulties, and he did not wish to continue the psychotherapy sessions. The therapist's departure from the clinic added to this and the therapy was terminated. The patient at first reminded the therapist of severe psychological disturbances but the patient showed remarkable progress. Three points can be considered to have played important roles in the therapy presented. The first and the most important is the interpretation by behavior. The patient showed strong parental transference to the therapist and this led the therapist to feel useless and to feel fatigue. Content analysis and here-and-now analysis seemed to have played only a small part in the therapy. However, the therapist tried to keep in contact with the patient, although not so elegant, but tried to show that the therapist may not be useless. This was done by maintaining the framework of the therapy and by consulting the parents when it was considered necessary. Second point is the role that the therapist intentionally took as a model or target of introjection. With the help of behavioral interpretation that showed the therapist and others that it may not be useless, the patient started to introject what seemed to be useful to his well being. It can be considered that this role took some part in the patient going out and to adjust to the new environment. Last, fortune of mach must be considered. The patient and the therapist had much in common. It was very fortunate that the therapist knew anything about the patient's favorite writer. The therapist had some experience abroad when he was young. Although it is a matter of luck that the two had things in common, it can be said that the congeniality between the patient and the therapist played an important role in the successful termination of the therapy. From the physical complaint to the verbal appeal of A's recovery process to regain her self-confidence C. ITOKAWA and S. KAZUKAWA Toyama Mental Health Center, Toyama, Japan This is one of the cases at Toyama Mental Health Center about a client here, we will henceforth refer to her simply as ,A'. A was a second grade high school student. We worked with her until her high school graduation using our center's full functions; counseling, medical examination and the course for autogenic training (AT). She started her counseling by telling us that the reason for her frequent absences from school began because of stomach pains when she was under a lot of stress for 2 years of junior high school, from 2nd grade to 3rd grade. Due to a lack of self confidence and a constant fear of the people around her, she was unable to use the transportation. She would spend a large amount of time at the school infirmary because she suffered from self-diagnosed hypochondriac symptoms such as nausea, diarrhea and a palpitation. She continued that she might not be able to have the self-confidence to sit still to consult me on her feelings in one of our sessions. A therapist advised her to take the psychiatric examination and the use of AT and she actually saw the medical doctor. In counseling (sessions), she eventually started to talk about the abuse that started just after her entering of junior high school; she approached the school nurse but was unable to tell her own parents because she did not trust them. In doing so, she lost the rest of her confidence, affecting the way she looked at herself and thought of how others did. At school she behaved cheerfully and teachers often accused her of idleness as they regarded this girl's absences along with her brightly dyed hair and heavy make-up as her negligent laziness. I, as her therapist, contacted some of the school's staff and let them know of her situation in detail. As the scolding from the teachers decreased, we recognized the improvement of her situation. In order to recover from the missed academic exposure due to her long absence, she started to study by herself. In a couple of months her physical condition improved gradually, saying ,These days I have been doing well by myself, haven't I?' and one year later, her improved mental condition enabled her to go up to Tokyo for a concert and furthermore even to enjoy a short part-time job. She continued the session and the medical examination dually (in tangent) including the consultation about disbelief to the teachers, grade promotion, relationships between friends and physical conditions. Her story concentrated on the fact that she had not grown up with sufficiently warm and compassionate treatment and she could not gain any mental refuge in neither her family nor her school, or even her friends. Her prospects for the future had changed from the short-ranged one with no difficulty to the ambitious challenge: she aimed to try for her favorite major and hoped to go out of her prefecture. But she almost had to give up her own plan because the school forced her to change her course as they recommended. (because of the school's opposition with her own choice). So without the trust of the teachers combined with her low self-esteem she almost gave up her hopes and with them her forward momentum. In this situation as the therapist, I showed her great compassion and discussed the anger towards the school authorities, while encouraging this girl by persuading her that she should have enough self-confidence by herself. Through such sessions, she was sure that if she continued studying to improve her own academic ability by herself she could recognize the true meaning of striving forward. and eventually, she received her parents' support who had seemed to be indifferent to her. At last she could pass the university's entrance exams for the school that she had yearned to attend. That girl ,A' visited our center 1 month later to show us her vivid face. I saw a bright smile on her face. It was shining so brightly. [source] | |||||||||||||||||||