Employee violence in health care: guidelines for health care organizations

Workplace violence is increasing, and health care environments are not immune to this escalating public health problem. In order to prevent or diminish the risk of a violent episode in the health care setting committed by employees, former employees, or family/significant others, health care managers need to be cognizant of certain factors associated with violence in the workplace. These variables include employee characteristics and behavior patterns, coworker indicators, organizational policies and procedures, mentally impaired employees, and so forth. Prevention strategies, use of employee assistance programs, managerial responses in escalating situations, impact of the Americans with Disabilities Act, and postviolence interventions must also be considered as part of progressive health care system administration, relative to the phenomenon of workplace violence.     

澳门青少年物质滥用健康教育效果分析

探索物质滥用教育对青少年物质滥用拒绝倾向和滥用行为的作用,为我国物质滥用预防教育评估提供参考.方法 采用“澳门在学青少年与药物之跟进调查2010”代表性数据,从青少年对澳门各项物质滥用预防教育的评价、物质滥用拒绝倾向(即反对态度、危害认知和拒交物质滥用朋友)和物质滥用行为评估其物质滥用预防教育工作的成效.结果 学生对社工教育资讯的评价高于其对大众和媒体教育(t值分别为32.02,2.95,P值均<0.01);社工教育能有效提高学生抗拒物质滥用(即反对态度、危害认知、拒交物质滥用朋友)的倾向(β值分别为0.06,0.11,0.03,P值均<0.01),预防其滥用物质(β值分别为-0.17,-0.06,-0.09,P值均<0.01);大众和媒体教育会促使学生滥用物质(β值分别为0.01,0.03,P值均<0.01);物质滥用拒绝倾向对物质滥用预防教育与青少年物质滥用行为的关系起中介影响(P<0.01).结论 青少年物质滥用预防教育的评估应从提高评价、物质滥用拒绝倾向和减少物质滥用行为出发,并着重考查其间接预防作用.     

The Relationship Between Substance Use and Sexual Health Among African-American Female Adolescents with a History of Seeking Mental Health Services

BackgroundThis study examined relationships between substance use patterns and problems and sexual health outcomes among low-income, urban, African-American female adolescents with a history of seeking mental health services.MethodsParticipants were recruited from outpatient mental health clinics serving urban, primarily low-income youth and families in Chicago, Illinois, as part of a 2-year, longitudinal investigation of HIV risk behavior during which they completed interviews every 6 months (five time points). Girls who completed at least one follow-up interview were invited to participate in a sixth wave of assessment to assess trauma exposure, substance use problems, and sexual risk. The current study (n = 177) examined the association between sexual risk behavior and substance use problems reported at the most recent interview (ages 14–22) and substance use patterns and sexually transmitted infections (STI) reported at all six times points. Multiple regression examined the combined and unique effects of different patterns of substance use and substance use problems as correlates of sexual risk behavior and STIs.FindingsSubstance use problems were associated with increased sexual risk behavior and increased likelihood of experiencing STIs. Substance use patterns were associated with sexual risk behavior.ConclusionsResults suggest that specific patterns of substance use and substance use problems are important to address in sexual health promotion among low-income, urban, African-American girls with a history of seeking mental health services. Understanding the nuances of these relationships is important in informing how to best serve this vulnerable group of adolescents who experience significant sexual risk and mental health care disparities.     

Legislation, policy, and tobacco use among youth: implications for health care providers

This paper addresses implications of recent tobacco legislation, policy, and tobacco use among youth in the context of health care policy and services. Tobacco use prevalence and definitions and diagnoses of nicotine addiction and dependence are described. Assessment of smoking prevalence in Texas provides a case study of the problem and potential solutions for tobacco use among youth. The case study highlights specific implications to be considered when providing health care focused on prevention and risk reduction for youth. The paper concludes with implications and critical Internet resources for health care providers engaging in youth tobacco control.     

“The drug issue really isn't the main problem”— A photovoice study on community perceptions of place,health, and substance abuse

Substance abuse is a complex and challenging public health problem. In order to better address substance abuse, it is vital to understand the perspectives of people whose communities are disproportionately impacted by it. This photovoice study aimed to understand how community members perceive the relationship between place, health, and substance abuse in Hartford, Connecticut, one city grappling with substance abuse and its related challenges. Findings revealed three themes: perceived place-based environmental risk factors for substance abuse; coping strategies to maintain sobriety in this challenging environmental context; and participants' recommendations for addressing substance abuse. Implications are discussed.     

Factors associated with adoption of evidence-based substance use prevention curricula in US school districts

This paper examines factors associated with the adoption of evidence-based substance use prevention curricula (EBC) in a national sample of school districts. Substance abuse prevention coordinators in public school districts (n = 1593), which were affiliated with a random sample of schools that served students in Grades 5-8, completed a written survey in 1999. Results indicated that 47.5% of districts used at least one EBC in their schools with middle school grades. Substance use prevention coordinators reported they had the greatest input in decisions about curricula. In a multivariate analysis of factors positively associated with district-level decisions to adopt evidence-based programs, significant factors included input from a state substance use prevention group, use of information disseminated by the National Institute on Drug Abuse or Center for Substance Abuse Prevention, use of local needs assessment data, consideration of research showing which curricula are effective and allocation of a greater proportion of the coordinator's time to substance use prevention activities. State and federal agencies should increase their efforts to disseminate information about evidence-based programs, targeting in particular the district substance use prevention coordinator.     

Pregnant women with substance use disorders: The intersection of history,ethics, and advocacy

Pregnant women with substance use disorders face many obstacles, including obtaining evidence-based treatment and care. This article (1) briefly reviews the history of pregnant women in clinical trials and substance use disorders treatment research; (2) identifies current ethical issues facing researchers studying pregnant women with substance use disorders; (3) presents and describes an ethical framework to utilize; and (4) identifies future directions needed to develop appropriate research and treatment policies and practices. Current research is not providing enough information to clinicians, policy-makers, and the public about maternal and child health and substance use disorders, and the data will not be sufficient to offer maximum benefit until protocols are changed.     

Effects of the Communities That Care Model in Pennsylvania on Change in Adolescent Risk and Problem Behaviors

Despite the public health burden of adolescent substance use, delinquency, and other problem behavior, few comprehensive models of disseminating evidence-based prevention programs to communities have demonstrated positive youth outcomes at a population level, capacity to maintain program fidelity, and sustainability. We examined whether the Communities That Care (CTC; Hawkins and Catalano 1992) model had a positive impact on risk/protective factors and academic and behavioral outcomes among adolescents in a quasi-experimental effectiveness study. We conducted a longitudinal study of CTC in Pennsylvania utilizing biannual surveillance data collected through anonymous in-school student surveys. We utilized multilevel models to examine CTC impact on change in risk/protective factors, grades, delinquency, and substance use over time. Youth in CTC communities demonstrated less growth in delinquency, but not substance use, than youth in non-CTC communities. Levels of risk factors increased more slowly, and protective factors and academic performance decreased more slowly, among CTC community grade-cohorts that were exposed to evidence-based, universal prevention programs than comparison grade cohorts. Community coalitions can affect adolescent risk and protective behaviors at a population level when evidence-based programs are utilized. CTC represents an effective model for disseminating such programs.     

An integrated, multidimensional treatment model for individuals living with HIV, mental illness, and substance abuse

The challenge of providing effective treatment services for the growing population of HIV-positive individuals who are also dually diagnosed with substance use and mental disorders has only recently been recognized as an important public health concern affecting both HIV treatment and prevention. This article describes a treatment model that was created for a study of integrated treatment for HIV-positive individuals with substance use and mental disorders. The treatment model was based on the transtheoretical model of behavior change as well as evidence-based practices that are widely used in the treatment of individuals dually diagnosed with substance use and mental disorders.The model involved collaboration between medical and behavioral health care professionals and emphasized the importance of goal reinforcement across disciplines. Furthermore, it included the development and enhancement of client motivation to modify medical and behavioral health-risk behaviors using individual readiness for change and offered comprehensive care addressing a continuum of client needs that may influence treatment outcomes. Treatment modalities included individual therapy, group therapy, and psychiatric medication management. This treatment intervention was associated with positive outcomes in the integrated treatment study and can be adapted for use in a variety of psychiatric or medical treatment settings.     

Public health in hospitals: the missing link in health improvement

Traditionally, public health professionals have scorned hospitals as the antithesis of community health. Secondary care remains notably distant from public health practice and policy. Yet hospitals consume over 50 per cent of the health budget and over a quarter of the population have contact with hospital services every year. There is an important public health agenda in hospitals for promoting health and an environment that encourages community partnership and a healthy place to work and be. Public health skills have a key role in ensuring high-quality, safe and evidence-based health care. Epidemiological support for hospitals can promote a much-needed culture of monitoring and evaluation of health services. A public health approach to planning of secondary care services can encourage a more objective and strategic assessment of health needs and how these are best met. We argue that public health hospitals should not be an oxymoron, but an essential component of public health strategy. Different approaches to putting public health into hospitals are discussed.     

Determinants of physician discussion regarding tobacco and alcohol abuse

The U.S. Preventive Services Task Force recommends that clinicians screen adults for tobacco and alcohol abuse and provide appropriate interventions. This study employed direct observation and interactional analysis of medical visits to investigate factors associated with physician discussion of tobacco and alcohol use with patients. New adult patients were randomly assigned to primary care at a university medical center. Videotapes of the visits were analyzed using the Davis observation code. Regression equations related discussions of substance use (alcohol and other substances), smoking, and health promotion to patient health status, depression, age, education, income, gender, alcohol abuse, and current smoking. Patients reporting better physical health were more likely to have their physicians employ a practice style emphasizing addiction behaviors (p = .0186). Substance use (p = .0117) and health promotion counseling (p = .0130) occurred more frequently with younger patients. Physicians discussed substance use (p = < .0001) and addiction (p < .0001) more often with male patients. Problem drinkers were more likely to have physicians address their substance use (p = .0069) and focus on addiction behaviors (p = .0017). Physicians adopted an addiction-oriented practice style (p < .0001), addressing substance use (p = .0009) and smoking (p < .0001), more often with patients who smoked. Physicians appear more apt to discuss these behavioral risk factors with healthier, younger, male patients who abuse tobacco and alcohol.     

Screening,Brief Intervention,and Referral to Treatment: Public Health Training for Primary Care

Objectives. The purpose of this study was to elucidate changes in attitudes, experiences, readiness, and confidence levels of medical residents to perform screening, brief intervention, and referral to treatment (SBIRT) and factors that moderate these changes.Methods. A cohort of 121 medical residents received an educational intervention. Self-reported experience, readiness, attitude, and confidence toward SBIRT-related skills were measured at baseline and at follow-up. Analyses were conducted to evaluate the effects of medical specialization.Results. The intervention significantly increased experience (P < .001), attitude (P < .05), readiness (P < .001), and confidence (P < .001). Residents were more likely to report that their involvement influenced patients’ substance use. However, experience applying SBIRT skills varied by country of birth, specialty, and baseline scores.Conclusions. This study suggested that SBIRT training was an effective educational tool that increased residents’ sense of responsibility. However, application of skills might differ by specialization and other variables. Future studies are needed to explore and evaluate SBIRT knowledge obtained, within the context of cultural awareness and clinical skills.Substance use disorders are a major public health problem, contributing substantially to the nation''s morbidity and mortality. Substance abuse is estimated to cost more than $484 billion per year in the United States.1 Health care providers exert time and resources treating patients with substance abuse related injuries and illnesses. This suggests that health care providers have a vital role in the prevention and intervention of substance use disorders.Despite the US Preventive Services Task Force recommendation to provide screening and counseling for alcohol, tobacco, and illicit drug use among adults, pregnant women, and adolescents, many medical health care professionals face barriers and challenges providing early intervention, motivating change of behavior, facilitating access to treatment when appropriate, and improving quality of care with at-risk users.2 Barriers to providing optimal care may include deficient clinical skills and knowledge,3 negative attitudes,4 and discomfort with patient discussions about substance use.5 Studies suggest physicians report low confidence in their skills and poor satisfaction in treating substance use disorders,6,7 and often overlook the opportunity to diagnose alcohol problems in primary care settings.4,8–11 When health care professionals confront the consequences of substance abuse during patient care, they often lack the expertise to facilitate behavior change.12 Overall training in substance use related diagnosis, treatment, and prevention with chronic disease management has been inadequate for physicians.13 To address the demand for prevention and intervention in the health care setting, health care professionals must have the education and training to effectively identify substance use problems, provide behavioral counseling, and coordinate treatment. Increased education, cultural awareness, and clinical skills training of health care professionals on substance use disorders is imperative in providing quality and competent care for patients. According to the Substance Abuse and Mental Health Administration and the Office of National Drug Control Policy, screening, brief, intervention, and referral to treatment (SBIRT) is a comprehensive and integrated public health approach to the delivery of early intervention and treatment services for substance use disorders.14,15 The SBIRT approach reduces substance use consumption, improves population health, and promotes health equity through the effective integration of primary care with public health.16 Alcohol screening and brief intervention offers an evidence-based and cost-effective approach.17,18 There is strong evidence documenting the efficacy and effectiveness of screening brief intervention in reducing alcohol consumption for at-risk individuals in meta-analyses of randomized control trials and systematic reviews.19–21 In addition, the efficacy and cost effectiveness of SBIRT has been demonstrated in primary care, emergency departments, and trauma centers.22 Thus, the integration of SBIRT training for primary care residency programs lays the foundation for physician practices that may ultimately reduce substance abuse among at-risk users and dependent patients.Research suggests that medical specialization influences screening and brief interventions among physicians. Freidmann et al. 23 found that physicians practicing internal medicine and psychiatry were more likely to screen patients than family medicine or obstetrics/gynecology physicians. Also within this study, psychiatrists were most likely to attempt a brief intervention.23 However, little is known about the influence of SBIRT training on the health care providers’ attitudes, experiences, readiness, and confidence in performing SBIRT-related skills. In an evaluation of an SBIRT curriculum for emergency department providers, significant improvements in the providers’ self-reported confidence in ability and responsibility to intervene were noted.22The purpose of this study was to examine changes in residents’ attitude, experience, confidence, and readiness to implement SBIRT with patients. The study also elucidated the moderating effects on changes in attitudes, experiences, readiness, and confidence level of medical residents.     

An analysis of stressors and co-morbid mental health problems that contribute to youths' paths to substance-specific services

Substance-specific services are tailored to address the inappropriate use of chemicals such as alcohol and marijuana. Unfortunately, few teens ever access such need-based services. This article explores the paths to substance-specific service use in a sample of urban adolescents who are public service sector users: a direct path from substance misuse and an indirect path from general mental health service use. Results indicate that even though a significant percentage of youths frequently consume substances and display negative use-related behaviors, few actually received substance-specific services. Contributors to the substance misuse path included youths' family substance dependence and environmental stressors. Contributors to the mental health services path were comorbid depression and substance misuse.     

Family planning for teens: strategies for improving outreach and service delivery in public health settings

The persistent underuse of family planning services by inner-city, low-income, sexually active youth underscores the importance of testing innovative programs that maximize participation. Presented in this paper is an analysis of a Chicago public health clinic's special program for adolescents that originated from the staff's observations of the scheduling, educational, and support needs of teens seeking family planning services from a traditionally managed public health facility. Between December 1982, when the special program--the Teen Clinic--was implemented, and March 1985, more than 600 adolescents sought social support and contraceptive services--an 82 percent increase in new-patient registration compared with the enrollment before the program began. In contrast, two neighboring public health department facilities without special family planning programs for teens experienced either a small increase, 4 percent, or a modest decrease, 17 percent, in utilization by teenagers during the same period. The increased use of the study facility by teens, coupled with patients' self-reported nonuse of alternative sources of care and referral patterns, suggests that the new program was successful in recruiting sexually active teens who had previously been inadequately protected against pregnancy. The perceived institutional and interpersonal factors influencing 153 teens' initial and repeated use of the Teen Clinic, as measured by a structured survey, echo the findings of previous research. Strategies suggested by the study's findings for improving outreach and service delivery are described.     

Spirituality within the family and the prevention of health risk behavior among adolescents in Bangkok, Thailand

This study investigates the influences of a family's spiritual beliefs and practices on substance use and sexual risk behaviors among young adolescents 13-14 years old in Bangkok, Thailand. Independent predictor variables are the parents' and teens' spiritual beliefs and practices in Buddhism and parental monitoring behaviors. The study uses data from the 2007 Baseline Survey of the Thai Family Matters Project, which adapted a U.S. based family prevention program for Thai culture. A representative sample of 420 pairs of parents and teens from the Bangkok metropolitan area was recruited to participate in the study. Structural equation models indicate that positive direct and indirect associations of the spirituality of parents and teens within a family and the prevention of adolescent risk behaviors are significant and consistent.     

Rapid assessment response (RAR) study: drug use and health risk - Pretoria, South Africa

Background

Within a ten year period South Africa has developed a substantial illicit drug market. Data on HIV risk among drug using populations clearly indicate high levels of HIV risk behaviour due to the sharing of injecting equipment and/or drug-related unprotected sex. While there is international evidence on and experience with adequate responses, limited responses addressing drug use and drug-use-related HIV and other health risks are witnessed in South Africa. This study aimed to explore the emerging problem of drug-related HIV transmission and to stimulate the development of adequate health services for the drug users, by linking international expertise and local research.

Methods

A Rapid Assessment and Response (RAR) methodology was adopted for the study. For individual and focus group interviews a semi-structured questionnaire was utilised that addressed key issues. Interviews were conducted with a total of 84 key informant (KI) participants, 63 drug user KI participants (49 males, 14 females) and 21 KI service providers (8 male, 13 female).

Results and Discussion

Adverse living conditions and poor education levels were cited as making access to treatment harder, especially for those living in disadvantaged areas. Heroin was found to be the substance most available and used in a problematic way within the Pretoria area. Participants were not fully aware of the concrete health risks involved in drug use, and the vague ideas held appear not to allow for concrete measures to protect themselves. Knowledge with regards to substance related HIV/AIDS transmission is not yet widespread, with some information sources disseminating incorrect or unspecific information.

Conclusions

The implementation of pragmatic harm-reduction and other evidence-based public health care policies that are designed to reduce the harmful consequences associated with substance use and HIV/AIDS should be considered. HIV testing and treatment services also need to be made available in places accessed by drug users.     

Substance use and mental health problems as predictors of HIV sexual risk behaviors among adolescents in foster care

This study examined the relationship between substance use, mental health problems, and HIV sexual risk behaviors among a sample of foster care adolescents. Data were collected through structured baseline interviews with 320 adolescents (ages 15 to 18 years) who resided in foster care placements and participated in a larger evaluation study of an HIV prevention program. Final logistic regression models indicated that delinquent behavior and marijuana use were the most significant predictors of engaging in any one HIV risk behavior. Adolescents who reported delinquent behaviors, alcohol use, and marijuana use and who were female were more likely than their counterparts to engage in vaginal sex without using a condom. Future research is needed to further identify risk and protective factors for substance use, mental health problems, and HIV sexual risk behaviors among adolescents in foster care. HIV prevention efforts for these vulnerable adolescents should target those with substance use and delinquent behaviors.     

"Patients like us": pregnant and parenting teens view the health care system

As a supplement to traditional ways of measuring health care quality, the patient's perspectve is an essential indicator, yet it is often overlooked in evaluations of health care for pregnant teenagers. This report reveals how 40 young women receiving publicly funded care viewed their physicians and the clinics and other facilities at which they received health care serv ces. Pregnant and parenting urban teens face stigmatization in many aspects of their lives. The author concludes, based on her interviews with the 40 teens, that providers and health care systems should combat such negative influences with support and respect for these patients. The data also point to the need for comprehensive health care for low-income adolescents that extends beyond prenatal care, which may focus on the needs of the fetus or infant to the exclusion of the needs of the young mother.     

Adolescent substance abuse: The challenge for clinicians

Substance abusing adolescents represent a unique population of patients within substance abusing communities. The interrelationship between the characteristics of problem substance use and the developmental tasks of adolescence is considerable and often presents the clinician with a diagnostic and treatment challenge. The identification, evaluation, treatment, and prevention of substance abuse among teens requires extensive knowledge of substance abuse as well as knowledge of the typical developmental tasks of adolescence.