Promoting Positive Developmental Outcomes in Sexual Minority Youth Through Best Practices in Clinic–School Consultation

TOPIC:  Educational and healthcare service delivery systems play an important role within the lives of sexual minority youth.
PURPOSE:  To provide justification and recommendations for improving the coordination and collaboration of school-based mental health professionals and child and adolescent psychiatric nurses via presentation of a set of consultation best practices.
SOURCES:  Multidisciplinary literature specific to sexual minority youth, school climate, clinical experience, and consultation practices.
CONCLUSION:  Nurses are in a position to advocate for and provide education about sexual minority youth in schools and to provide direct support to this population. By creating collaborative relationships across clinics and schools, information and expertise can be shared and applied to affect change and lead to positive outcomes for all students.     

Chinese Children's Attitudes Toward Mental Retardation

The present study aimed to: (1) examine Chinese children's attitudes toward mental retardation, (2) investigate cross-cultural similarities or differences in these attitudes, and (3) extend the use of Western-attitude questionnaires to Chinese samples. The present study included 489 Chinese children (265 boys and 224 girls), aged from 4 to 15 years. Results showed that Chinese children demonstrated favorable attitudes toward mental retardation and school integration. Gender effect was not as robust as noted in previous Western research. As compared to older children in primary and secondary schools, younger children in kindergarten, tended to show the most positive attitudes toward mental retardation. Cross-cultural differences were also found between the present sample and an Irish sample (Gash, 1993) in sharing social activities, showing social concern, and accepting school integration of children with mental retardation. The present findings also suggested that it is feasible to extend the attitude questionnaire designed for use in the Western countries to Chinese children, albeit with slight modification and attention to cultural relevance.     

Client and parent feedback on a Youth Mental Health Service: The importance of family inclusive practice and working with client preferences

In mental health settings, feedback from clients and carers is central to service evaluation, development and delivery. Increasingly, client and carer feedback is considered an integral part of service planning, and recognized as a critical element of the provision of recovery oriented service. This paper outlines the findings of a qualitative evaluation of a Youth Mental Health (YMH) service from the perspective of discharged clients and their parents. The service researcher conducted telephone interviews with 39 parents of discharged clients, and 17 young people themselves. Participants reported positive or mixed experiences with the service. In addition to more generic positive statements about the service, analysis identified two key themes: the importance of ‘family inclusive practice’ and the importance of ‘working with client preferences’. Young people and their parents want to be actively engaged in treatment and have their treatment preferences considered in treatment planning. Participants expressed the importance of “a good fit” between the client and the worker in terms of the clinician's gender, personality and treatment style/modality. While for some participants these themes were raised in the context of service strengths, others identified them as limitations or opportunities for service improvement. The extent to which clients and their parents felt engaged and heard by their allocated clinician is critical to their satisfaction or dissatisfaction with the service, depending on their unique experience. As an outcome of this evaluation, a range of service improvement strategies have been recommended.     

Emergency Medical Service Providers' Attitudes andExperiences Regarding Enrolling Patients in Clinical Research Trials

Objective: The purpose of this study was to evaluate Emergency Medical Services (EMS) providers' attitudes andexperiences about enrolling patients in clinical research trials utilizing the federal rules for exception from informed consent. We hypothesized that Emergency Medical Technicians (EMTs) would have varied attitudes about research using an exception from informed consent which could have an impact on the research. Methods andsetting: Since January 2007, the EMS system has been participating in a randomized, multi-center interventional trial in which out-of-hospital providers enroll critically injured trauma patients using exception from informed consent.A voluntary, anonymous, written survey was administered to EMS providers during an in-service. The survey included demographics andLikert-type questions about their experiences with andattitudes towards research in general, andresearch using an exception from informed consent for an out-of-hospital clinical trial. Results: The response rate was 79.3% (844/1067). Most respondents, 93.3%, agreed that “research in EMS care is important.” However, 38.5% also agreed that individual EMTs/paramedics should maintain the personal right of refusal to enroll patients in EMS trials. Fifty-four percent of respondents agreed with the statement that “the right of research subjects to make their own choices is more important than the interests of the general community.” In response to statements about the current study, 11.3% agreed that “the study is unethical because the patient cannot consent” and69.2% responded that they would personally be willing to be enrolled in the study before they were able to give consent if they were seriously injured. Those who had not enrolled a patient into the study (681 respondents) were asked their reasons: 76.8% had not encountered an eligible patient or did not work for an agency that carried the fluid; 4.3% did not have time; 4.1% forgot and1.1% stated that they were opposed to enrolling patients in studies without their consent. Conclusion: The majority of EMS personnel in one community support EMS research andthis specific out-of-hospital clinical trial being conducted under an exception from informed consent. Potential barriers to enrollment were identified. Further study in other systems is warranted to better understand EMS provider perspectives about exception from informed consent research.     

An initial exploration of community mental health nurses' attitudes to and experience of sexuality-related issues in their work with people experiencing mental health problems

Human sexuality is a complex dynamic concept that escapes simple definition. Within nursing there seems to be a preference for broad holistic definitions that emphasize sexuality as an aspect of the unique human character. Whilst the nursing literature mostly portrays sexuality as wholesome and good, it also notes that sexuality can be a vehicle for the expression of power, hostility or hatred. In this study, the authors did not prescribe or limit the definition of 'sexuality'. Rather the term 'sexuality' was used in a broad sense in order to embrace the range of variables within the concept and allow respondents to consider the issues according to their own perspective. Despite broad acceptance of sexuality as a legitimate focus of health care, clinicians remain ambivalent about actively broaching sexual issues and there is a potential for clients' needs to go unmet. A number of intertwining variables can influence sexuality-related nursing practice. Nurses' attitudes are regarded as major barriers that prevent open discussion on the topic. This study aims to explore a sample of community mental health nurses' views on the topic of sexuality in relation to their work with clients. The authors adapted a sexual ideology scale previously used for the purposes of teaching students and promoting discussion. The questionnaire was distributed to nurse delegates at an annual CPNA conference. Two of the authors were available throughout the conference to discuss the study. Delegates were asked to recruit CMHN colleagues following the conference in order to increase the sample. The data are described and analysed using SPSS for Windows. Respondent characteristics have been cross-tabulated with item responses and analysed using chi-square and other statistical tests of association. The respondents (n = 122) confirmed sexuality as a relevant clinical issue and there was an overwhelming affirmation of people with mental health problems as sexual beings. Sixty-three per cent (n = 77) of respondents anticipated that people with mental health problems who are in relationships might experience sexual problems, and 52.4% (n = 64) agreed that a sexual history should be routinely included in assessment. Seventeen per cent (n = 21) had encountered clients becoming sexually aroused during the administration of a depot injection in the community. The authors identify this as an area of concern that warrants further investigation. The results indicate that although awareness of sexuality issues may be high there may be less agreement as to how such awareness should translate into CMHN practice.     

Primary Care for Lesbian,Gay, Bisexual,Transgender, and Queer/Questioning (LGBTQ) Patients

The lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) community is a vulnerable populace that accounts for 4.5% of the United States population. Unfortunately, this group of individuals faces discrimination. They need access to quality, prejudice-free health care. This article initiates the discussion of how nurse practitioners, primary care, and family practice providers can provide inclusive, unbiased, quality care to this community that is evidence based. Information is provided about common barriers preventing this population from receiving equitable care. Evidence-based methods are outlined for screening this population for common health conditions, paying particular attention to an established HIV risk assessment and its application in clinical settings to identify candidates for pre-exposure prophylaxis. Finally, pharmacologic information about preexposure prophylaxis and transgender hormone therapy is presented. The information presented prepares nurse practitioners to begin caring for this population.     

Developing a Clinical Framework for Children/Youth Residential Treatment

The idea of implementing consistent overall clinical approaches in residential treatment facilities may improve care by influencing family engagement, interactional styles of residential staff and clinicians with children and youth, specific therapeutic interventions including the management of problematic behaviors, milieu approaches, and group interventions, as well as inform programmatic structure, rules, and expectations of residential living. A clinical framework should demonstrate contemporary and evidence supported practices in order to achieve meaningful success. This article summarizes a literature search and discussion points regarding family/community engagement, individualized assessment/treatment, interprofessional teams, and organizational factors in developing a clinical framework for children/youth residential treatment.     

Development and Validation of the Palliative Care Attitudes Scale (PCAS-9): A Measure of Patient Attitudes Toward Palliative Care

ContextPalliative Care is underutilized, and research has neglected patient-level factors including attitudes that could contribute to avoidance or acceptance of Palliative Care referrals. This may be due in part to a lack of existing measures for this purpose.ObjectivesThe objective of this study was to develop and validate a nine-item scale measuring patient attitudes toward Palliative Care, comprised of three subscales spanning emotional, cognitive, and behavioral factors.MethodsData were collected online in three separate waves, targeting individuals with cancer (Sample 1: N = 633; Sample 2: N = 462) or noncancer serious illnesses (Sample 3: N = 225). Participants were recruited using ResearchMatch.org and postings on the web sites, social media pages, and listservs of international health organizations.ResultsInternal consistency was acceptable for the total scale (α = 0.84) and subscales: emotional (α = 0.84), cognitive (αs = 0.70), and behavioral (α = 0.90). The PCAS-9 was significantly associated with a separate measure of Palliative Care attitudes (ps < 0.001) and a measure of Palliative Care knowledge (ps < 0.004), supporting its construct validity in samples of cancer and noncancer serious illnesses. The scale's psychometric properties, including internal consistency and factor structure, generalized across patient subgroups based on diagnosis, other health characteristics, and demographics.ConclusionFindings support the overall reliability, validity, and generalizability of the PCAS-9 in serious illness samples and have implications for increasing Palliative Care utilization via clinical care and future research efforts.     

Attitudes of Social Service Providers towards the Sexuality of Individuals with Intellectual Disability

Background The sexual lives of people with intellectual disability is made complex by the involvement and influence of social service providers, whose beliefs and values have a great impact on the support they provide. We hypothesized that social service providers’ role, educational level and service in which they worked could affect attitudes towards the sexual behaviour of individuals with intellectual disability. Materials and methods The current study describes attitudes of social service providers towards the sexuality of individuals with disability measured by 20 items of Sexuality and Mental Retardation Attitudes Inventory (SMRAI). This instrument was devised by Brantlinger [Mental Retardation (1983) Vol. 21, pp. 17–22] to assess the attitudes of the staff employed by organizations that supplied services to individuals with intellectual disability. Specifically, analysis of variance (type of service × professional role × education) was performed on participants’ scores. Results Results suggested that the social service providers participating in this research study tended to have moderately liberal attitudes. Educational level and role carried out did not produce differences in their attitudes. A significant difference emerged between those who operated in different services. It was especially the staff of the outpatient treatment services who revealed the most liberal and positive attitudes towards the sexuality of individuals with intellectual disability. Conclusions The data reported in the present study seem to underline some differences between the data collected from the Italian and the Anglo‐Saxon social service providers. Failure to record influences associated with the role carried out and previous training could be related to the different contextual differences. Results suggest that particular attention should be paid to the training of those who hold managerial posts in Italian residential services.     

Exploring Suicide Risk History Among Youth in Residential Care

Adolescents in residential care settings have double the national average of suicide risk histories (attempts, threats, and ideation). However, little is known about youth with specific suicide-risk histories. This study explored differences in demographic characteristics and mental health variables for 509 youth in residential care with high and low suicide-risk histories. Overall, nearly 40% of participants had a high suicide-risk history, and significant differences between low and high suicide-risk history groups were found for multiple variables (e.g., gender, ethnicity, number of diagnoses). This study highlights a need for research into areas associated with suicide-risk history in residential care.     

Community Adaptation of Youth Accessing Residential Programs or a Home-Based Alternative: Contact With the Law and Delinquent Activities

This article presents the findings from a longitudinal investigation of the prevalence of negative contact with the law for a sample of youth 12–18 months after graduating from residential and intensive children's mental health programming. Results of this study suggest serious community adaptation difficulties face many youth graduating from these children's mental health programs. This study suggests that delinquency outcomes may be particularly problematic for older males who are transitioning out of treatment programs, as well as for youth with prior contact with the law, and greater challenges adapting to school at program admission.     

Translating theory into practice: results of a 2-year trial for the LEAD programme

This paper presents data for 2 years of a continuing study aimed to reduce the risk of first-time involvement by minority youth with the juvenile justice system. A quasi-experimental design was used to test a 14-week expressive art curriculum (LEAD: leadership, education, achievement and development) implemented in two rural communities. A total of 70 African American youth participated in the programme over a 2-year period. Pre- and post-test differences were examined for protective factors, behavioural self-control, self-esteem and resilience measures. When compared with the after-school programme (control group), youth in the LEAD programme in both communities had more dramatic increases in post-test scores following the intervention. The combined data from year 1 and year 2 provide positive findings in support of LEAD as a prevention programme for young offenders. The placement of the programme within an African American church in year 2 improved the processes of the LEAD programme and seemed to provide a better fit with the original design of the programme, highlighting the importance of the context, in which the programme was provided.     

Overweight and Obesity Among Youth Entering Residential Care: Prevalence and Correlates

Little is known about the prevalence of clinical weight problems for youth living in residential care. Therefore, this study examined the prevalence and correlates of overweight and obesity in a large sample of youth (N = 1709) entering a residential care program. Results indicated that 48% of youth were overweight or obese at the time of intake, which is much higher than national pediatric rates. Females had higher rates of overweight/obesity, as did youth referred from moderately restrictive placements such as foster care. Youth who were overweight/obese had greater internalizing symptoms at intake. Clinical and research implications are discussed.     

Attitudes of postgraduate nursing students towards consumer participation in mental health services and the role of the consumer academic

Consumer participation in health care is increasingly becoming an expectation of health services. While important progress has been made in the mental health area, the attitudes of mental health professionals towards consumers poses a severe limitation. Greater consumer involvement in the education of mental health professionals has been presented as a strategy to encourage the development of a greater acceptance of consumer involvement by health professionals. A consumer academic position has been introduced into the Centre for Psychiatric Nursing Research and Practice. An important aspect of this role concerns the education of postgraduate psychiatric/mental health nursing students, in order to provide a consumer perspective and encourage greater consumer participation. In order to determine the impact of this project a questionnaire was developed by the authors to measure attitudes to consumer participation and the role of the consumer academic. This paper presents the first stage of this study. The questionnaire was administered to students (n = 25) on the first day of the course. The findings suggest that most students favour a high level of consumer participation but that this is limited to specific areas of treatment planning and delivery. Furthermore, the students' demonstrate some level of ambivalence regarding the value and necessity of the consumer academic role.