Perceptions about substance use among male adolescents in juvenile detention

Although adolescents in juvenile detention represent a vulnerable population who are exposed to situations that foster risk-taking behaviors, few studies have been conducted with detained adolescents to determine their perceptions regarding substance use. Ethnographic interviews and observations were conducted with 20 male adolescents who resided in a large metropolitan area juvenile detention facility, to discover their substance use beliefs and the decisions they make to continue or discontinue substance use or abuse. The participants described how they initiated substance use and said that they had rarely made active decisions about substance use until they were detained. They explained the decisions they made, while they were in detention, to stop or cut down their substance use after release. They talked about the problems they anticipated when they returned home and how they hoped to balance their resolutions with their reputations and obligations. Time-out in juvenile detention may offer nurses the opportunity to capitalize on the potential readiness of detained adolescents to make resolution decisions regarding risky behaviors. Findings from a similar study conducted with 20 detained adolescent women were reported elsewhere.     

Appreciative inquiry and older people--finding the literature

This paper describes the results of a literature search which sought papers specifically on appreciative inquiry (AI) and older people. The results of this search suggested that there were not many papers which met these criteria, and those that did were more often discussion papers rather than research papers. This lack of publication belies the observation that research with older people could benefit from the positive approach entailed in an AI approach. The reasons for this are discussed in the paper, but the possibility is explored that some authors may be using AI, but not classifying their studies as this. The studies that do explicitly use AI have reported that participants became productively engaged in the process, but there is little evidence that this promising start has been followed up.     

Achieving the 'perfect handoff' in patient transfers: building teamwork and trust

clarke d., werestiuk k., schoffner a., gerard j., swan k., jackson b., steeves b. & probizanski s. (2012) Journal of Nursing Management  20, 592–598 Achieving the ‘perfect handoff’ in patient transfers: building teamwork and trust Aims To use the philosophy and methodology of Appreciative Inquiry (AI) in the investigation of unit to unit transfers to determine aspects which are working well and should be incorporated into standard practice. Background Handoffs can result in threats to patient safety and an atmosphere of distrust and blaming among staff can be engendered. As the majority of handoffs go well, an alternative is to build on successful handoffs. Evaluation The AI methodology was used to discover what was currently working well in unit to unit transfers. The data from semi-structured interviews that were conducted with staff, patients, and family informed structural process improvements. Key issues Themes extracted from the interviews focused on the situational variables necessary for the perfect transfer, the mode and content of transfer-related communication, and important factors in communication with the patient and family. Conclusions This project was successful in demonstrating the usefulness of AI as both a quality improvement methodology and a strategy to build trust among key stakeholders. Implications for nursing management Giving staff members the opportunity to contribute positively to process improvements and share their ideas for innovation has the potential to highlight expertise and everyday accomplishments enhancing morale and reducing conflict.     

Re-Arrest Among Juvenile Justice-Involved Youth: An Examination of the Static and Dynamic Risk Factors

The purpose of this study is to investigate the static and dynamic risk factors for re-arrest among detained youth by examining gender, race/ethnicity, age, special education, and mental health variables (i.e., anger/irritability, depression/anxiety, somatic complaints, suicide ideation, thought disturbances, and traumatic experiences). The demographic profiles of detained youth with one admit were also compared with those with multiple admits to the juvenile detention center. With regard to static risk factors, older, White, and special education were significantly at risk of re-arrest. Concerning dynamic risk factors, only anger/irritability predicted re-arrest. Practice implications are also discussed.     

Decisions About Substance Abuse Among Adolescents in Juvenile Detention

Ethnographic research was done to discover how adolescents make decisions about substance abuse while in juvenile detention. Segments of transcribed data from small focus group discussions portray the perspectives of 20 teenage girls in one juvenile detention facility located in a large metropolitan area. Observations and individual interviews corroborated the dynamic interactive dialogue occurring among the teens during group discussions. The young women described the situations and problems that led to substance abuse and their subsequent detention. The sharing of life experiences provided an opportunity to reinforce resolutions to change and plans to abstain from troublesome behaviors in the future.     

Using AI to Understand Key Success Features in Evolving CTSAs

A vital role for Clinical and Translational Science Award (CTSA) evaluators is to first identify and then articulate the necessary change processes that support the research infrastructures and achieve synergies needed to improve health through research. The use of qualitative evaluation strategies to compliment quantitative tracking measures (e.g., number of grants/publications) is an essential but under‐utilized approach in CTSA evaluations. The Clinical and Translational Science Institute of Southeast Wisconsin implemented a qualitative evaluation approach using appreciative inquiry (AI) that has revealed three critical features associated with CTSA infrastructure transformation success: developing open communication, creating opportunities for proactive collaboration, and ongoing attainment of milestones at the key function group level. These findings are consistent with Bolman & Deal''s four interacting hallmarks of successful organizations: structural (infrastructure), political (power distribution; organizational politics), human resource (facilitating change among humans necessary for continued success), and symbolic (visions and aspirations). Data gathered through this longitudinal AI approach illuminates how these change features progress over time as CTSA funded organizations successfully create the multiinstitutional infrastructures to connect laboratory discoveries with the diagnosis and treatment of human disease.     

Individual Risk Factors Associated with Increased Levels of Restricted Housing among Detained Youth

ABSTRACT

The current study examined individual characteristics as potential risk factors associated with increased levels of restrictive housing among detained youth. Data was analyzed from 129 youth who completed measures in a survey format upon their arrival to the facility. Data also included facility records regarding the rates of Tier 2 (e.g., day room restrictions) and Tier 3 (e.g., lockdowns and restraints) restrictive housing interventions. Findings indicated that more days in detention and low levels of perceived containment were associated with increased risk for and an increased number of both Tier 2 and Tier 3 interventions. Findings and their implications are discussed.     

Pregnancy resolution decisions in juvenile detention

A group of detained pregnant adolescents and expectant teenage fathers served as participants in a qualitative research project designed to describe how adolescents residing in a large metropolitan area juvenile detention facility make health- and pregnancy-related decisions. During the course of the study and clinical work with this population, it was found that although troubled and troublesome, these teenagers do not present as bleak and depressing a picture as might appear on the surface. Three primary themes emerged from the study findings: responsibility, reputation, and respect. These themes were bound to the important relationships in the teenagers' lives. The participants also presented some surprising strengths and resolutions for the future that psychiatric and liaison nurses working in the setting can use in program planning and clinical interventions.     

Mental health inpatient experiences of adults with intellectual disability

This paper presents findings from a study exploring the mental health inpatient care of people with a dual disability of intellectual disability and mental health issues from the perspective of those people with the dual disability. A mixture of semi‐structured interviews and focus group interviews were carried out with nine participants who had been admitted to an inpatient unit for mental health care exploring their experience of care. Interviews were transcribed and analyzed using open coding and Leximancer (an online data mining tool) analysis to identify dominant themes in the discourse. Analysis revealed themes around ‘Therapeutic and Meaningful Activity’, ‘Emotion Focussed Care’, and ‘Feeling Safe?’ Participants were able to identify the aspects of inpatient care that worked for them in terms of coping with time in hospital. This research suggests that there are several factors that should be considered in providing effective mental health inpatient care for people with dual disability. A number of strategies and recommendations for responding to their needs are identified and discussed.     

The role of contextual, child and parent factors in predicting criminal outcomes in adolescence

This study examined predictor variables that would contribute toward an explanatory model linking child maltreatment and the outcome of crime seriousness. A secondary data analysis was completed on a random sample of youth committed and detained by a juvenile justice system in the northeast United States. Although existing data indicate a predisposition to crime and violence among youth that are maltreated, more research is needed to determine the exact nature of the link, as well as the need to determine the relationship of associated factors. The aim of this analysis was to identify key contextual, child, and parental factors related to maladaptive behavior in abused and neglected adolescent offenders. Logistic regression was used to predict serious criminal outcomes. Overall, 73% of the cases were correctly classified. Ten variables remained in the model to predict serious juvenile criminal behavior. Youth who had been exposed to community violence or who had a mother with mental illness were four times as likely to commit serious criminal behaviors.     

THE ROLE OF CONTEXTUAL,CHILD, AND PARENT FACTORS IN PREDICTING CRIMINAL OUTCOMES IN ADOLESCENCE

This study examined predictor variables that would contribute toward an explanatory model linking child maltreatment and the outcome of crime seriousness. A secondary data analysis was completed on a random sample of youth committed and detained by a juvenile justice system in the northeast United States. Although existing data indicate a predisposition to crime and violence among youth that are maltreated, more research is needed to determine the exact nature of the link, as well as the need to determine the relationship of associated factors. The aim of this analysis was to identify key contextual, child, and parental factors related to maladaptive behavior in abused and neglected adolescent offenders. Logistic regression was used to predict serious criminal outcomes. Overall, 73% of the cases were correctly classified. Ten variables remained in the model to predict serious juvenile criminal behavior. Youth who had been exposed to community violence or who had a mother with mental illness were four times as likely to commit serious criminal behaviors.     

Endings,secrets, and silences: Overreading in narrative inquiry

Qualitative researchers seek to understand the words of the people they interview and may use narrative inquiry to find meaning in the stories told by research participants. Narrative inquiry entails “overreading,” a sensitivity to unspoken or indirect statement, which is central to interpretation. Some of the tools of the literary overreader are applied to two research interviews, particularly as they direct readers to attend to inconsistencies, endings, repetitions, and silence. Because overreading is also intrusive, we conclude with some considerations about how far the overreader of the research may legitimately go. © 1997 John Wiley & Sons, Inc. Res Nurs Health 20: 551–557, 1997     

American Academy of Nursing expert panel consensus statement on inequities in the juvenile justice system rooted in systemic and structural racism

The overrepresentation of youth of color has long been acknowledged and accepted in juvenile justice and legal systems. Many risk factors contribute to the detention and incarceration of youth; however, there is little evidence to explain how structural inequities and systemic racism add to that vulnerability. Historically, laws were passed to benefit the White society and resulted in outcomes that caused grave aftereffects for people of color and in some cases, ethnic minorities. Within the context of juvenile justice and the lens of critical race theory, the authors of this paper seek to illuminate selected historical educational, environmental, legal, and health care policies, practices, and decisions that led to their detrimental consequences. Recommendations for mitigating both intended (through law, funding, policies) and the unintended barriers as experienced by youth of color are presented.     

Challenges for Teaching Injury Prevention in a Juvenile Detention Center

This case study explored the injury related experiences and perceptions of youth in detention and the delivery of first aid education in youth detention contexts. It aimed to develop an understanding of how a mainstream injury prevention intervention could be modified for youth detention populations. Teacher and student reactions to the program were examined and injury checklists, focus groups, and staff interviews were conducted. Analysis revealed serious injuries related to criminal behaviors, violence, dangerous driving, and substance use. Recommendations for youth detention interventions include lesson flexibility, discussions, role-plays, visual materials, peer support strategies, student-teacher relationships, and positive reinforcement.     

Health Status of Young Offenders and Their Families

Purpose: To describe the health status of youth committed and detained by the Maryland Department of Juvenile Justice. The problem of complex health needs of young offenders is gaining importance as the number of youth under the care of state juvenile justice systems steadily increases.
Methods: The health status of a random sample (N = 350) of male and female committed or detained young offenders was assessed utilizing a record review and a self-report health survey.
Results: Ninety-seven percent of the sample reported levels of physical discomfort and 92% reported emotional discomfort. Nearly half (45%) of the youth had some medical condition, 53% had been abused, 20% injured, 16% sustained a gunshot or stab wound. Of youth reporting physical injury, 12% did not receive treatment. Family members, including siblings experienced similar health problems.
Conclusions: Patterns of physical and behavioral health problems were noted within these families, as were patterns of criminal behavior. Trans-generational patterns of at-risk behaviors were evident. Most youth (86%) perceived themselves to be healthy. However, when specific health indicators were examined, discrepancies between health status and health perceptions were noted.     

A critical examination of the role of appreciative inquiry within an interprofessional education initiative

Appreciative inquiry (AI) is a relatively new approach to initiating or managing organizational change that is associated with the ‘positiveness’ movement in psychology and its offshoot positive organizational scholarship. Rather than dwelling upon problems related to change, AI encourages individuals to adopt a positive, constructive approach to managing change. In recent years, AI has been used to initiate change across a broad range of public and private sector organizations. In this article, we report findings from a subset of 50 interviews gathered in a wider study of interprofessional education (IPE) in which AI was employed as a change agent for implementing IPE in a number of health care institutions in a North American setting. A multiple case study approach. (Yin, 2002) was employed in the wider study and semi-structured interviews were undertaken with participants both before their IPE programs and directly afterwards to obtain a detailed understanding of their expectations and experiences of IPE. Interviews were analyzed in an inductive thematic manner in order to produce key emergent themes from each of the IPE programs. A process of re-analysis provided a set of themes which offered an understanding of the role of AI within this IPE initiative. Our findings identify a strong resonance and fit for AI both among the health and social care professionals who participated in this initiative. Numerous individuals commented on the enthusiasm and energy AI engendered, while praising its ability to enhance their working lives and interprofessional relationships. Yet a number of difficulties were also reported. These focused on problems with the translation of the AI process into achievable structural level (e.g. professional, cultural) changes. Based on these findings, the article goes on to argue that the use of AI can overlook a number of structural factors, which will ultimately limit its ability to actually secure meaningful and lasting change within health care.     

The quest for meaning in aging

A qualitative research design using narrative interviews was used to explore how a group of older adults experienced meaning and purpose in their lives. In-depth interviews conducted with 11 older adults ranging in age from 66 to 92 years revealed 6 dimensions through which meaning is experienced and created. Through the sharing of their narrative life stories, these individuals described how meaning in their lives contributed to a sense of self that allowed them to embrace life with a sense of purpose and enthusiasm.     

Life stories of older adults with sickle cell disease

Sickle cell disease (SCD) is a chronic disease with acute, painful exacerbations that often results in a shortened life expectancy. We explored the life stories of middle-age and older adults with SCD to ascertain how they explain their longevity and how they see the place of SCD in their lives. Data were gathered using semi-structured interviews with 12 individuals living with SCD--seven women and five men. Respondents offered four main reasons for their longevity: self-care, supportive family/friends, a higher power, and medical care. Respondents reported life satisfactions of family, employment/education, and religious activities. The life stories reflect challenges of often living with a disease prior to diagnosis and without modern advances and the unpredictable nature of the disease. Their stories provide healthcare providers with insight into the supports SCD patients need to improve their health outcomes as they move through the life course.