Exploring School Mental Health Collaboration in an Urban Community: A Social Capital Perspective

Collaboration between community mental health professionals and school professionals involves sharing knowledge and resources to accomplish more than could be achieved by practicing in isolation. Despite its role in school mental health (SMH), there is little research evidence that collaboration is associated with improved outcomes. This qualitative study used focus group methodology to explore collaboration among 26 mental health and school professionals. The constant comparative method was used to analyze focus group data. Central categories that emerged from the analysis included the importance of integrating professionals from collaborating agencies into the school community, communication between school professionals and community providers, and the perceived positive contributions of SMH collaboration for engaging families in schools. Study findings are interpreted from a social capital perspective and implications for SMH practice and research are offered.     

A model for developing outcome measures from the perspectives of mental health service users

It is becoming increasingly recognized that conventionally derived outcome measures in mental health research are problematic. This is both because of the methodology used and because a 'good' outcome is framed from the perspective of clinicians and researchers. This paper describes a methodology for developing outcome measures for use in large studies entirely from the perspective of mental health service users. It is a mixed methods model starting with a participatory and qualitative methodology and proceeding to psychometric testing. At all stages, the researchers are themselves mental health service users. In the first phase of the model, focus groups are convened comprising people who have received the treatment or service being measured. The focus groups meet twice resulting in a draft mixed-methods questionnaire devised from thematic analysis of the focus group data. This is then taken to expert panels, again comprising individuals who have received the treatment or service being evaluated for refinement. Following this, a feasibility study is conducted with N?～?50 participants and changes made iteratively to the questionnaire in light of feedback. The final measure is subject to psychometric testing both to ensure it is robust and to explore similarities and differences with conventionally derived measures.     

EATING DISORDERS AND ADOLESCENCE

This paper introduces nine steps that are recommended in conducting focus group discussions in rural communities and gives an example of how they can appropriately and fruitfully be employed in adolescent health behavioural research. The paper also reviewed issues related to methods of data collection, data analysis, reliability and validity in qualitative research.

Focus group discussions took place in classrooms in three schools in Mankweng, Limpopo Province of South Africa. Three groups (boys only, girls only and mixed) took part in each school. Participants were selected from the pool of standard seven (grade 9) students from the chosen schools. The nine steps that were involved in using focus group discussions as a research method and the Mankweng experience is discussed. These steps include: (1) conducting a social influence analysis; (2) identifying the specific information to collect; (3) designing focus group discussion guide; (4) choosing the participants for the focus group discussion; (5) selecting focus group discussion moderators; (6) training focus group discussion moderators; (7) conducting the focus group discussion; (8) analysing the data collected; (9) formulating study conclusions and policy recommendations.

Little adolescent health research in South Africa has been based upon methods that can capture the complexity of the role of significant others in adolescent health and development and the powerlessness of rural communities in dealing with the 'new morbidity' of adolescent risk behaviours. Understanding what sort of power relations, for example, that are involved in being relatively disadvantaged and how the power of such social groups can be increased is common concern of development managers and other individuals and institutions engaged in policy changes and implementation and deserve to be an essential component of child and adolescent health research.

Well-collected and well-analysed qualitative data is needed in order to clearly understand some of the underlying predisposing, enabling and reinforcing factors that could account for adolescent risk behaviours in rural communities. Qualitative research method is important in that they capture the complexity of life, rather than trying to 'reduce' this complexity, and the potential for gaining an understanding of what is going on in the situation with the phenomenon is greater. Focus group discussions, a qualitative research methodology, can yield valuable data.     

Managing self determination and sexual violence in homes for young adults with mental handicap--report from an ongoing German model project

This report is based upon a model project financially assisted by a grant from the German Federal Ministry for Families, Senior Citizens, Women and Youth, starting in 1999 and ending at the end of 2003. In cooperation with two disability care residential institutions, a conceptual approach and method to the questions of sexual self-determination and sexualized violence is being developed. Through qualitative methods of research e.g. focus groups, professional helpers of all hierarchies of the institution, including management, and the residents themselves, all had the chance to contribute their own opinions and experiences to the research topic. Specifically, to ensure their voice was heard, the people with mental retardation had an important impact on the questionnaire themselves. All aspects of sexuality were discussed--with notable difficulty arising in particular over the subject of sexual violence. It turned out that nonverbal communication and the interaction between the group members in the residents group were most indicative of their concerns. The staff at the nursing and living areas discussed the following topics: distance and closeness in the interaction between staff and residents, standards, reflections of their own professional attitudes, questions of legality as well as the tense topic of individual needs and tasks of the group. How those questioned described their solutions and ways of coping, and the impressions of the researchers forms the starting point for the compiled work. The initial ideas for the topics and the design of the concept are now laid out.     

Cell implantation therapies for Parkinson's disease using neural stem, transgenic or xenogeneic donor cells

A new therapeutic neurological and neurosurgical methodology involves cell implantation into the living brain in order to replace intrinsic neuronal systems, that do not spontaneously regenerate after injury, such as the dopaminergic (DA) system affected in Parkinson's disease (PD) and aging. Current clinical data indicate proof of principle for this cell implantation therapy for PD. Furthermore, the disease process does not appear to negatively affect the transplanted cells, although the patient's endogenous DA system degeneration continues. However, the optimal cells for replacement, such as highly specialized human fetal dopaminergic cells capable of repairing an entire degenerated nigro-striatal system, cannot be reliably obtained or generated in sufficient numbers for a standardized medically effective intervention. Xenogeneic and transgenic cell sources of analogous DA cells have shown great utility in animal models and some promise in early pilot studies in PD patients. The cell implantation treatment discipline, using cell fate committed fetal allo- or xenogeneic dopamine neurons and glia, is currently complemented by research on potential stem cell derived DA neurons. Understanding the cell biological principles and developing methodology necessary to generate functional DA progenitors is currently our focus for obtaining DA cells in sufficient quantities for the unmet cell transplantation need for patients with PD and related disorders.     

The evaluation of a learner‐centred training programme for spouses of adults with chronic aphasia using qualitative case study methodology

Background: Family education, training, and counselling programmes have been cited as one way to complement traditional interventions for the individual with aphasia. However, the literature still represents the speech‐language pathologist as the expert in a directive role. Aims: This article describes the second phase of a research study aimed at addressing the psychosocial sequelae of aphasia by developing and studying the effects of a learner‐centred training programme for spouses of adults with chronic aphasia designed to improve conversational interaction between couples. The first phase of this research included the development of a communication‐training programme that integrated principles and strategies from speech‐language pathology and adult education (Sorin‐Peters, 2002). The second phase described in this paper included the delivery and evaluation of the programme using a qualitative case study methodology. The use of the qualitative case study methodology to study the psychosocial consequences of aphasia is described in a companion paper (Sorin‐Peters, 2004). This paper presents the results of one qualitative case study in detail to demonstrate how the qualitative case study methodology was implemented, and a summary of the cross‐case analysis for the five couples, examining the effectiveness of the programme. Methods & Procedures: Using videotaped data, the Couple Questionnaire, and a semi‐structured interview, this study examined changes in attitudes and communication behaviours in five couples immediately after conversation partner training and at 2 months follow‐up. All data were transcribed and analysed for patterns of change. Outcomes & Results: Communication outcomes included changes in conversational interaction as well as in the transaction of information in conversation for all five couples. These included positive changes in the management of conversational repair. There was more balanced control after training and the cognitive competence of the partners with aphasia was revealed following the training. In addition, different conversational genres emerged throughout the programme that could be organised hierarchically. Results indicated ways in which the adult learning principles were actualised across the five cases. Themes emerged related to the expression of emotion about aphasia, including feelings of anger, sadness, and grief, and increased acceptance of the aphasia after the training. Themes related to marital issues emerged and were intertwined with emotions and communication. Conclusions: The adult learning model approach promoted positive and comprehensive changes, and perhaps more than those achieved via existing medical‐model or psychosocial approaches. The adult learning approach to individuals with chronic aphasia extends the existing psychosocial model by acknowledging both the spouse's and person with aphasia's competence as adult learners, by viewing the person with aphasia not only as part of a social unit, including the family, but also as part of a broader system, including multiple environmental and cultural factors that interact interdependently to effect change, and by focusing on the importance of communication for the expression of emotions and the maintenance and development of marital relations. The results suggest the benefits of the expansion of the speech‐language pathologist's role with couples with aphasia to include an adult learning approach to improving conversational interaction between people with aphasia and their spouses.     

Proposition d’une méthode d’évaluation de l’entretien psychodynamique : analyse approfondie d’une étude de cas en oncologie

ObjectivesThe aim of this study is to evaluate the effects of the psychodynamic approach in the context of psychoanalytical psychotherapy in clinical interviews conducted by the clinical psychologist.MethodologyIt involves analyzing the narrative productions of the interaction patient–psychologist to determine mental processes in a single-case design protocol. This approach integrates the three dimensions qualitative, quantitative and statistical of research. We will test the clinical study with a intensive case or a deeply analyzed single case.EthicsOur approach answers to the inquiry of evaluation in Public Health, according to the psychoanalytical epistemology into methodology, principle and practice of objectification, intersubjectivity and singularity. By combining research and clinical interviews we would like to respond to be the closest of the patient's experience and his work of mental development.ResultsThis work should help to argue the interest of proposals for supportive or psychodynamic psychotherapy in psychiatry as well as medical departments. Being at the heart of the clinic, we focus on the changing processes at work in psychological development work without ever reaching a standardized clinic which would replace the theoretical-clinical orientation of the practitioners.     

Qualitative research in psychiatry.

This paper is an overview of qualitative research and its application to psychiatry. It is introductory and attempts to describe both the aims of qualitative research and its underlying philosophical basis. We describe the practice and process of qualitative research and follow this with an overview of the 3 main methods of inquiry: interviews, focus groups, and participant observation. Throughout the paper, we offer examples of cases where qualitative research has illuminated, or has the potential to illuminate, important questions in psychiatric research. We describe methods of sampling and follow with an overview of qualitative analysis, appropriate checks on rigour, and the presentation of qualitative results. The paper concludes by arguing that qualitative methods may be an increasingly appropriate methodology to answer some of the demanding research questions being posed in 21st century psychiatry.     

Aberrant folate status in schizophrenic patients: what is the evidence?

A vast amount of case reports, open studies and, to a lesser extent, case-control studies have been published on the topic of psychopathology and folate deficiency. These studies reported a high incidence of serum folate deficiency in patients with various psychiatric disorders. Folate deficiency seems to be a particular consistent finding in depressive patients. The evidence for an association between aberrant folate status and schizophrenia seems less convincing. The lack of stringent methodology such as inclusion of age- and sex-matched controls was thought to be the main reason for the inconclusive results. The purpose of this article is to review the published case-control studies that provide data on folate levels in the population of patients with schizophrenia. Data extracted from these studies comprised methodological design, clinical characteristics and folate measurements. We found that none of the 7 case-control studies included in this review (in total 325 cases and 560 control subjects) explicitly reported on all critical factors in the assessment of folate. In addition, only three studies found lower plasma folate levels more frequently in patients with schizophrenia compared to controls. Further research on this topic is required to clarify the relationship between folate status and schizophrenia and should avoid the methodological pitfalls mentioned in this review. In addition, research should also focus on polymorphisms of genes related to folate metabolism.     

The relevance of qualitative research for clinical programs in psychiatry.

It is time to move beyond education about qualitative research theory and methods to using them to understand and improve psychiatric practice. There is a good fit between this agenda and current thinking about research use that broadens definitions of evidence beyond the results of experiments. This paper describes a qualitative program evaluation to illustrate what kind of useful knowledge is generated and how it can be created through a clinician-researcher partnership. The linkage and exchange model of effective knowledge translation described involves interaction between clinicians and researchers throughout the research process and results in mutual learning through the planning, disseminating, and application of existing or new qualitative research in decision making.     

Coercive and disruptive behaviors in pediatric obsessive compulsive disorder: a qualitative analysis

OCD is a common disorder in children and adolescents. Disruptive or coercive behaviors among children with OCD have not been a focus of much research until recently. Family accommodation of OCD is strongly related to symptom severity, level of impairment, and treatment outcomes. The possibility of family accommodation being forcefully imposed on family members against their will has not been investigated systematically, although clinical experience points to the existence of such situations. The present study represents an early, qualitative exploration of such situations. The parents of 10 children and adolescents with OCD, who reported the existence of violent or disruptive behavior on the part of the child, were interviewed and their narratives analyzed using grounded theory methodology. Findings from the interviews point to the existence of a pattern of coercive behaviors in which rules and prohibitions, driven by the child's OCD, are aggressively imposed on parents and siblings. The emergent themes are analyzed in relation to obsessive compulsive symptom dimensions and in relation to the means and goals they represent for the obsessive compulsive children.     

Diagnosing young children with autism

The starting point for any research on Autism Spectrum Disorder (ASD) involves the identification of people who evince the condition. From this point follows research on symptom presentation, genetics, epidemiology, animal models, treatment efficacy, and many other important topics. Major advances have been made in differential diagnosis, particularly with young children. This fact is particularly important since ASD is a life long condition. This review documents recent advances and the current state of research on this topic.     

Patients' experience of violence within mental health systems: The need for further research

The aim of this article is to outline the need for systematic research into experiences of violence among patients of mental health services. Most of the literature on violence in mental health systems has concentrated on mentally ill people as perpetrators of violence. We examined the origins of this emphasis. We conducted a literature search using Medline between the periods 1978–1999 and searched relevant publications from the papers reviewed. We found a paucity of published research on patients' experience of being victims, perpetrators or witnesses of violence within mental health services. More information is needed about patients' perspectives of what precipftates violence and the impact being labelled as violent has on patients. We recommend the adaptation of qualitative methodologies for exploring patients' experience of violence, the impacts of violence on victims and the effects of being labelled as a perpetrator of violence. This recommendation is based on there being a shortage of existing data on the topic, the experiential nature of such research, the strong need to reduce investigator bias and expected lack of co‐operation from patients participating in such studies. Qualitative methodology is known to yield better quality data in such situations. The challenges of using qualitative methodolgy in such research are examined.     

Spirituality in children and adolescents: research findings and implications for clinicians and researchers

Spirituality is a powerful force in the lives of children. Although spirituality has only recently begun to be a focus for psychiatric research, initial qualitative data suggest that children experience themselves as spiritual beings and that understanding and connecting with them around their spiritual lives can be an important adjunct to treatment. Clinicians should feel free to ask about a child's spiritual life and to work with the family using their spiritual resources if they are perceived to be beneficial in helping the child and family cope with their current situation. Because the work with children's spirituality is in its preliminary stages, qualitative methodology is still the recommended research method for investigating questions in this research area.     

Patient and parent/guardian perspectives on the health care of adults with mental retardation

Individuals with mental retardation and their parents/guardians have long been neglected in health care research. In this study we used a qualitative methodology to describe the experiences adults with mental retardation and their parents/guardians have with the delivery of primary care services. Semi-structured in-depth interviews were conducted with 12 adults who had mental retardation and 9 parents/guardians. The grounded theory approach was utilized to guide data collection and analysis. Findings suggest an overall positive experience with primary care services. Unique themes were identified that distinguished parent/guardian experiences from those of adults with mental retardation, who focused on immediate, concrete issues related to service delivery, whereas parents/ guardians focused on more peripheral or abstract issues related to the delivery of primary care.     

The Use of Psychotropic Medications in Eating Disorder Patients with Personality Disorders

The use of psychotropic medications in eating disorder patients with personality disorders (PDs) is a complex topic. In this overview, we do not focus on individual studies, but rather on the philosophical issues and broader management principles of medications in this comorbid population. We review a general construct of personality and PD development, the theories that underlie how medications might work in PDs, and the target-symptom approach to treatment. We also discuss the essential elements of the prescribing context, an approach to psychotropic medication selection in the borderline personality population, and general caveats for medication use in those with eating disorders. Despite available data, significantly more research is needed in this area.