APPROPRIATELY TIMED INTERVENTIONS WITH THE FAMILY AND THE ADOLESCENT: THE ROLE OF THE THERAPIST

Family therapy conducted with a troubled adolescent is a difficult process. In this article the case scenario of a troubled teenager is presented. The adolescent's behavior is scrutinized through an examination of her growth, dynamics, family/parent interactions, and social support. Therapeutic and timely interventions-a blueprint for family therapy integrating psychoanalytic, Bowen, Milan, and behavioral approaches-are explained. The blueprint can be used to assess and assist in the change process of the adolescent. It is extremely important that new therapists realize when they are getting drawn into the content without appreciating the process of therapy. This realization will foster second-order change in the growth of a family therapist.     

Integration of a suicide risk assessment and intervention approach: the perspective of youth

The process of suicide risk assessment is often a challenge for mental health nurses, especially when working with an adolescent population. Adolescents who are struggling with particular problems, stressors and life events may exhibit challenging and self-harm behaviour as a means of communication or a way of coping. Current literature provides limited exploration of the effects of loss, separation and divorce, blended families, conflict and abuse on child and adolescent development and the increased vulnerability of at-risk youth. There is also limited research that provides clear and practical models for the assessment and management of youth suicidal ideation and behaviour. This paper will discuss the integration of a number of theories to establish a comprehensive assessment of risk. The research study described the perspective of youth and their families who had experienced this particular model; however, this paper will discuss only the youth perspective. In order for this model to be successful, it is important for mental health nurses to make a connection with the youth and begin to understand the self-harm behaviour in context of the adolescents' family, and their social and school experiences. It also requires recognition that adolescents with challenging and self-harm behaviour are hurting and troubled adolescents with hurtful and troublesome behaviour.     

Listening to the voices of important others: how adolescents make sense of troubled dating relationships

Nearly one third of adolescents experience dating relationship maltreatment. Grounded theory methods were used to explicate a typology of ways by which adolescents incorporate views of others in making sense of their troubled dating relationships. Interviews with 90 young adults (ages 18-21 years) who had troubled adolescent dating relationships were analyzed using constant comparative techniques. A typology of ways in which adolescents "listen to the voices of important others" emerged. The six ways were "preventing challenging voices of important others," "deflecting irksome voices of important others," "succumbing to demanding voices of important others," "soliciting confirming voices of important others," "considering cautionary voices of important others," and "heeding knowing voices of important others." Professionals can use this model when deciding how to offer input about troubled adolescent dating relationships.     

The efficacy of family intervention in adolescent mental health

The term 'family therapy' is used to encompass a range of approaches that share a common view about the importance of family involvement in psychiatric disorders. This paper reviews the effectiveness of family interventions in adolescent mental health with a special emphasis on single session therapy. Research evidence shows that the family intervention in psychiatric disorders such as schizophrenia, depression, attention deficit hyperactive disorder, anxiety and anorexia not only provides better outcomes, but also increases client satisfaction with services. Among the family therapy approaches, single session therapy (SST) seems to be a flexible and very effective model for adolescent mental disorders, which seem to offer an efficient means of providing rapid access to services whilst removing some of the difficulties associated with other forms of family therapy approaches. A new service development model is also discussed by drawing together a number of ideas encountered in practice settings.     

Brief strategic family therapy™ for adolescent drug abusers: A multi-site effectiveness study

Brief strategic family therapy? (BSFT) is a manualized treatment designed to address aspects of family functioning associated with adolescent drug use and behavior problems (J. Szapocznik, U. Hervis, S. Schwartz, (2003). Brief strategic family therapy for adolescent drug abuse. (NIH Publication No. 03-4751). Bethesda, MD: National Institute on Drug Abuse). Within the National Institute on Drug Abuse's (NIDA's) Clinical Trials Network, BSFT is being compared to treatment as usual (TAU) in a multisite, prospective randomized clinical trial for drug using adolescents and their families in outpatient settings. The effectiveness of BSFT is being compared to TAU in reducing adolescent drug use, conduct problems, and sexually risky behaviors as well as in improving family functioning and adolescent prosocial behaviors. This paper describes the following aspects of the study: specific aims, research design and study organization, assessment of primary and secondary outcomes, study treatments, data analysis plan, and data monitoring and safety reporting.     

Efficacy of Wilderness Therapy for Young Adults: A First Look

There has been considerable growth in outcomes research with adolescent clients in wilderness therapy. However, data on young adults are largely absent from the literature. This pilot study investigated the effectiveness of wilderness therapy for 297 young adult participants. The 3-year study found clinically and statistically significant change from intake to discharge on the Outcome Questionnaire-45.2. It also found significant change on measures of life effectiveness, motivation for therapy, therapeutic alliance, and dysfunctional attitudes. This article discusses when change occurs in the wilderness, factors that influence outcomes, differences between genders, and post-discharge outcomes for young adults.     

Continuity and Orchestration of After-Care Services to Disturbed Children

Placing older children from a Residential Treatment Center into adoptive families can be a risky process. The after-care process becomes a very important part of the treatment, and requires a positive working relationship with the other agencies involved in the process. By using family systems concepts, and paying attention to the meaning that separation, loss and transition have for troubled children, the chances of success can be increased.     

The Adolescent, the Family and the Physician

The family physician is the ideal medical practitioner to treat the adolescent, since he has to retain a holistic concept of the person in his family and in society. We have to remember that each person has his or her own rate of development, so that what might be obnoxious to one teenager is still acceptable to another. An understanding of the psychological and social aspects of separation from the parent is necessary in treating the conflicts that arise within the adolescent. There is no point in attempting to use teenage jargon to gain confidence, because the young will find this phoney and the physician will not be able to keep up with the rapid rate of change in slang.     

Outcomes for Adolescent Girls After Long-Term Residential Treatment

Residential treatment for troubled adolescents continues to generate controversy. Youth may improve during treatment, but are these gains sustained upon return to the community? We explore this question by analyzing outcome data collected at three months and one year post-discharge for 49 adolescent girls discharged from long-term programs at a residential treatment center in Massachusetts. Qualitative data reveals the range of post-discharge challenges experienced by adolescents and their families. Quantitative data shows a 77% reduction in restrictive level of care placements comparing the year before admission to the year after discharge (p < .001). This success rate suggests that improvements accomplished during long-term residential treatment are sustained by a majority of adolescent girls up to at least one year post-discharge. We will also discuss the process we used to collect outcome data and its impact on our agency staff and clientele.     

Multiple Family Therapy for Adolescents A Case Illustration

Psychiatric hospitalization of adolescents is on the rise, with the concurrent trend toward shorter stays and increased need for expedient, effective treatment modalities. Involving families or troubled adolescents in all phases of treatment is believed to be essential and aids both in successful reintegration of the patient into the community and prevention of relapse. Psychiatric nurses can practice innovative therapies to meet the needs of hospitalized adolescents and their families. Clinical observations have shown multiple family therapy for adolescents to be a valuable component of care.     

Adolescent Suicide: Assessment and Intervention

Understanding how to prevent suicide, the third leading cause of adolescent death, is the focus of this article. To prevent suicide, the nurse assesses risk factors, covert messages, overt suicide clues, and intervenes with the adolescent and family. Suicide risk and hopelessness decrease as suicidal youths learn to clarify problems, rally significant others, expand resources and use safe coping strategies. Interventions include a no-suicide contract, family therapy and school suicide prevention programs. Nurses can identify the youth at risk for suicide awl, in many cases, provide the therapy that helps prevent suicide. Vignettes illustrate strategies that effectively reduce suicide risk.     

Organizational structure: blueprint for action

"Organizational structure is the way a group is formed and the way it functions." The authors describe the successful revision of the structure of one school. Its change process and outcome can serve as a blueprint for action for other schools that are changing or considering changing their organizational structure.     

Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity: study design and methodology

BackgroundDespite the high prevalence and negative physical and psychosocial consequences of overweight and obesity in adolescents, very little research has evaluated treatment in this population. Consequently, clinicians working with overweight and obese adolescents have little empirical research on which to base their practise. Cognitive behavioural therapy has demonstrated efficacy in promoting behaviour change in many treatment resistant disorders. Motivational interviewing has been used to increase motivation for change and improve treatment outcomes. In this paper we describe the rationale and design of a randomised controlled trial testing the efficacy of motivational interviewing and cognitive behaviour therapy in the treatment of overweight and obese adolescents.MethodsParticipants took part in a motivational interview or a standard semi-structured assessment interview and were then randomly allocated to a cognitive behavioural intervention or a wait-list control condition. The cognitive behavioural intervention, the CHOOSE HEALTH Program, consisted of 13 individual treatment sessions (12 face-to-face, 1 phone call) followed by 9 maintenance sessions (7 phone calls, 2 face-to-face). Assessments were conducted prior to participation, after the treatment phase and after the maintenance phase of intervention. Improvement in body composition was the primary outcome; secondary outcomes included improved cardiovascular fitness, eating and physical activity habits, family and psychosocial functioning.ConclusionDespite the demonstrated effectiveness of motivational interviewing and cognitive behavioural therapy in the long-term management of many treatment resistant disorders, these approaches have been under-utilised in adolescent overweight and obesity treatment. This study provides baseline data and a thorough review of the study design and treatment approach to allow for the assessment of the efficacy of motivational interviewing and cognitive behavioural therapy in the treatment of adolescent overweight and obesity. Data obtained in this study will also provide much needed information about the behavioural and psychosocial factors associated with adolescent overweight and obesity.     

The comparative study on parent-adolescent communication between the model student family and the delinquent adolescent family

This research is based on the communication system theory which considers the family as a communication system or a communication network and which understand interpersonal relations among family members through a communication. This research is intended to define the difference of Parent-Adolescent Child communication between the model student family and the delinquent adolescent family, and also found the factors affecting parent-adolescent child communication. This aims to clarify wether a delinquent behavior is associated with family members' relations caused by dysfunctional communication between parents and their child, moreover explorate their problem to find the method of nursing intervention for prevention and treatment for delinquency. Subjects are 190 families (570 persons: father, mother, adolescent child) of model high school students and 87 families (261 persons) of delinquent adolescents. The employed tool is Olson et al's Parent-Adolescent Communication Scale (PAC, 20 items). The followings are the results derived through hypotheses verification. First, Comparison of two groups showed a significant difference in Parent-Adolescent Communication (t = 2.77, p less than 0.1). In the communication of delinquent group showed lower response than the model group. And also communication of the model group was more opened and positive (t = 2.41, p less than .05), and showed fewer problems (t = 2.06, p less than .05), the delinquent group had more problems. 2ndary, the delinquent group showed significantly more disagreement in response to variable of PAC than the model group. As analyzing of factors affects the Parents-Adolescent Communication, the best method to protect juvenile from delinquency are consistent open-hearted, congruent communication with mutual concern and warm mind between parents and child. And even though the all family don't hardly send together their time for their job, parents have to arrange many times to hold communication with children and to listen attentively to and respond to them, and so to increase their satisfaction for their parents. In conclusion, it seems that delinquent behavior is the outcome caused by dysfunctional communication between the parents and the child because of severe generation gap at adolescence period when the child needs communication with their parents. Therefore, it seems that the delinquent adolescent is the scape-goat of the family. Finally, it seems that more effective method to solve juvenile delinquents increasing day by day, is the family therapy that all family members participate than the individual therapy.     

青春期功能失调性子宫出血的性激素止血治疗分析

目的探讨青春期功能失调性子宫出血的性激素止血治疗方法。方法回顾性分析1996~2004年我院重型青春期功能失调性子宫出血收入院病例19例。结果19例患者入院后经过性激素止血治疗(内膜生长或内膜萎缩法)及支持治疗,均快速止血,贫血好转出院。结论性激素止血治疗是较快速、有效的治疗青春期功能失调性子宫出血的方法,但须注意使用要规范。     

Quality assurance of test blueprinting

Tests offer scores that measure student learning and programs outcomes. Valid examinations are needed to accurately reflect scores related to dimensions of knowledge, analysis and different competencies in health education. The primary step in the process of exam development should be the construction of a test blueprint. The degree of alignment of a test with its blueprint is a critical element of content validity. However, the availability of a published blueprint does not ensure that instructors adhere to it when developing their tests. This article aims to present a tool for quantitative determination of the degree of consistency between the actual test and the developed blueprint. Ensuring the quality of the test blueprinting process, through objective verification of alignment of the test with the test blueprint, increases the extent of content validity of students' assessments.     

A developmental approach to the treatment of bipolar disorder: IPSRT with an adolescent

Aim. This case study explains how a psychotherapy previously used with adults can be used with adolescents by focusing on the specific developmental issues associated with adolescence. Background. Bipolar disorder is a damaging disorder to experience during the developmental phase of adolescence. Interpersonal social rhythm psychotherapy has been developed as an adjunct to medication for managing bipolar disorder and shows some promising outcomes in adults. Design. This is a single case study design drawn from a larger randomised control trial of two psychotherapies for bipolar disorder. The case study addressed the question: How can Interpersonal social rhythm therapy be applied with adolescents who have bipolar disorder? Method. This study used a purposeful sampling process by selecting the youngest adolescent participating in the randomised control trial. All the subject’s sessions of Interpersonal social rhythm therapy were taped, transcribed and analysed. The analysis involved describing the process of psychotherapy as it occurred over time, mapping the process as a trajectory across the three phases of psychotherapy experience and focusing the analysis around the impact of bipolar disorder and IPSRT on adolescent developmental issues, specifically the issue of identity development. Results. Interpersonal social rhythm therapy allowed the therapist to address developmental issues within its framework. As a result of participation in the psychotherapy the adolescent was able to manage her mood symptoms and develop a sense of identity that was age‐appropriate. Conclusion. Interpersonal social rhythm therapy provided the adolescent in the case study the opportunity to consider what it meant to have bipolar disorder and to integrate this meaning into her sense of self. Relevance to clinical practice. Bipolar disorder is a chronic and recurring disorder that can have a serious impact on development and functioning. Interpersonal social rhythm therapy provides an approach to nursing care that enables adolescents to improve social functioning.     

The Curriculum Blueprint: An Application to Nurse Practitioner Education

A psychometric model for the construction of examinations (the test construction process) is adapted as a conceptual framework for curriculum design. The outcome of the process, the curriculum blueprint, is proposed as particularly advantageous for nurse practitioner education, which is somewhat unique among nursing specialties in its need to accommodate the competing demands of several regulatory or educational approval bodies that influence the content of its curriculum. The curriculum blueprint provides a visual dimension and therefore is useful as a communication tool. An excerpted example of a curriculum blueprint is offered.     

Neuman's Systems Model for Nursing Practice as a Conceptual Framework for a Family Assessment

Neuman's Systems Model was used as a guide to the assessment and intervention for a dysfunctional family. The model gave direction to the selection of family therapy as the appropriate and successful intervention. The case example illustrates the application and use of Neuman's model in child and adolescent nursing practice.