Professionals’ Perspectives about the Challenges of Using Interpreters in Child Sexual Abuse Interviews

Interpreters play a crucial role in many investigative interviews with child complainants of sexual abuse; however, little has been written about the interpreting process from the perspective of the interviewers. This study elicited interviewers’ perspectives about the challenges of using interpreters, with the aim of understanding how investigative interviews could be improved. The participants consisted of 21 investigative interviewers and prosecutors of child abuse cases (from a range of jurisdictions) who use interpreters on a regular basis. Thematic analysis of semi-structured interviews with the professionals about the interpreting process revealed two main challenges particular to child abuse interviews, namely the interpreters’ lack of preparedness to deal with the traumatic and sensitive nature of children's abuse histories, and an insufficient understanding of ‘best-practice’ child interview process. The recommendations focus on the need for more specialised training for, and screening of, interpreters, and more extensive use of pre-conferencing to familiarise children with the interpreter-mediated interview process.     

A Randomized Trial: Are Care Navigators Effective in Connecting Patients to Primary Care after Psychiatric Crisis?

Persons with serious mental illnesses suffer excess medical morbidity compared to the general population. This RCT aimed to determine whether navigators are effective in helping patients connect to primary care after psychiatric crisis. Adults presenting for emergency care were randomly assigned to a navigator versus usual care. Navigators facilitated access to primary care. Outcomes were connection rates to medical care and the impact of health insurance, hospitalization and mental health care on primary care attendance. After 1 year, the intervention group was statistically more likely to access care, versus controls (62.4 vs. 37.6%, P < .001). Navigators were effective in helping patients connect to primary care after a psychiatric crisis. Improved access to primary care is important given the complex chronic health problems of this vulnerable cohort.     

DSM-III: A Step Forward or Back in Terms of the Classification of Child Psychiatric Disorders?

This paper appraises DSM-III as a classification of child psychiatric disorders. Its successes include the use of a phenomenological approach, its recognition that disorders rather than individuals should be classified, the introduction of a multiaxial framework, the provision of a more comprehensive listing of child psychiatric disorders, improved diagnostic criteria, the addition of codings for psychosocial stressors, and the recognition that disorders may persist into adult life. Criticisms of DSM-III as a source of discriminatory labeling are rejected. However, criticisms are made of the structure of the multiaxial system, the decision not to put mental retardation on a separate axis, the principles employed on the psychosocial axes, the proliferation of unvalidated diagnostic categories, and the extension of research diagnostic criteria to categories which lack the empirical findings which might justify them. Nevertheless, DSM-III constitutes a marked improvement over DSM-II and represents a landmark in the development of psychiatric classification systems.     

A Model of Deinstitutionalization of Psychiatric Care across 161 Nations: 2001–2014

Deinstitutionalization has been ongoing since the 1950s and is a trend that has been molded by diverse sociocultural conditions and competing ideologies. Key questions from the literature include its extent and the drivers motivating it, political and financial dimensions, and consequences in such domains as homelessness, nursing home care, and the criminalization of the mentally ill. This study specifically addresses questions about the extent of deinstitutionalization internationally, and the salience of competing explanations of this trend for understanding the extent of availability of psychiatric beds.

This study employs a secondary analysis of data from the four editions of the World Health Organization’s Mental Health Atlas, as well as supplemental international databases. It uses a regression methodology to examine rates of change of psychiatric beds during 2001–2014 in 161 nations. Predictors include key geographic, demographic, socioeconomic, political, cultural, and service system conditions.

The study reveals deinstitutionalization of inpatient care is far from universal, characterizing almost a half (45.1%) of the world’s nations. That the overall decline in inpatient beds is close to half of one percent (?0.41%) per year indicates this is a modest reduction, notwithstanding dramatic changes in both directions in subsets of nations. The regression model accounts for 55.7% of the variation of deinstitutionalization, using several significant predictors. Deinstitutionalization is associated with income inequality, racial and ethnic diversity, low population density, a high Human Development Index, psychiatric commitment laws, high incarceration rates, among other conditions.     

Clinicians’ Attitudes Regarding Barriers to the Implementation of Psychiatric Advance Directives

Objective Psychiatric advance directives (PADs) may include documenting advance instructions (AIs) and/or designating health care agents (HCAs). Laws authorizing PADs have proliferated in the past decade, but there has been little research regarding perceptions of barriers to the implementation of PADs among groups of mental health professionals. Methods A total of N=591 mental health professionals (psychiatrists, psychologists, and social workers) completed a survey regarding their perceptions of potential barriers to the effective implementation of PADs. Results Across the three professional groups barriers related to operational features of the work environment (e.g., lack of communication between staff, lack of access to the document) were reported at a higher rate than clinical barriers (e.g., inappropriate treatment requests, consumers’ desire to change their mind about treatment during crises). However, psychiatrists were more likely to report clinical barriers to implementation than both psychologists and social workers. In multivariable analyses, legal defensiveness, employment in public sector mental health services, and a belief that treatment refusals will outweigh the benefits of PADs were associated with more perceived barriers, whereas age and endorsing positive perceptions of PADs were associated with fewer perceived barriers. Conclusion Psychiatrists, psychologists and social workers tend to perceive significant potential barriers to PADs, related to operational aspects of these professionals’ work environment as well as certain clinical features of PADs for persons with severe mental illness. Additionally, legal defensiveness and general endorsement of PADs appear to shape perceptions of barriers to the effective implementation of PADs.     

Can Child Care Workers Contribute to the Early Detection of Autism Spectrum Disorders? A Comparison Between Screening Instruments with Child Care Workers Versus Parents as Informants

Several screening instruments for ASD in young children were developed during the last decades. Only few studies compare the discriminative power of these instruments in the same sample. In particular comparisons of instruments that use different informants are scarce in young children. The current study compared the discriminant ability of the Checklist for Early Signs of Developmental Disorders (CESDD) filled out by child care workers with that of frequently used parent questionnaires in a sample of 357 children between 5.57 and 48.13 months old who showed signs of ASD or language delay. The discriminant power of the CESDD was as good as that of parent questionnaires. Therefore, inclusion of child care workers in the early detection of ASD seems promising.     

Latino Adults’ Access to Mental Health Care: A Review of Epidemiological Studies

Since the early 1980s, epidemiological studies using state-of-the-art methodologies have documented the unmet mental health needs of Latinos adults in the U.S. and Puerto Rico. This paper reviews 16 articles based on seven epidemiological studies, examines studies methodologies, and summarizes findings about how Latino adults access mental health services. Studies consistently report that, compared to non-Latino Whites, Latinos underutilize mental health services, are less likely to receive guideline congruent care, and rely more often on primary care for services. Structural, economic, psychiatric, and cultural factors influence Latinos’ service access. In spite of the valuable information these studies provide, methodological limitations (e.g., reliance on cross-sectional designs, scarcity of mixed Latino group samples) constrict knowledge about Latinos access to mental health services. Areas for future research and development needed to improve Latinos’ access and quality of mental health care are discussed.     

Clients’ experiences of moments of sadness in psychotherapy: A grounded theory analysis

Abstract

Although few studies have examined the experience of depression, no research has been conducted on the experience of sadness in psychotherapy. In this study, clients were interviewed about their experience of sadness using an interpersonal process recall method, these interviews were subjected to grounded theory analysis, and a model of sadness experienced in psychotherapy was derived. The resulting core category—in therapy, the experience of sadness is a struggle against the fear of becoming trapped within the painful, existential question “Who am I?”—captures the essence of the experience of the clients’ sadness and describes the struggle, the causes of sadness, and ways therapists facilitated sadness exploration. The findings are discussed in reference to clinical application and future psychotherapy research.     

Coherence of Representations Regarding the Child,Resolution of the Child’s Diagnosis and Emotional Availability: A Study of Arab-Israeli Mothers of Children with ASD

This study examined the interplay of mothers’ coherent representations of their child (i.e., multidimensional and balanced view); resolution of the child’s ASD diagnosis (i.e., acceptance); and emotional availability to the child in the unique cultural context of Arab-Israeli families. Participants were 46 mothers and their 2–8 year old sons. Coherent representations and resolution of the diagnosis were assessed using narrative measures. Emotional availability (namely, sensitivity, structuring, and lack of intrusiveness and hostility) was observed during mother–child play interactions. Results suggested that coherent and resolved mothers were more emotionally available than incoherent and/or unresolved mothers. These findings highlight the importance of supporting mothers’ ability to accept the child’s diagnosis and see the unique characteristics of the child beyond his ASD symptoms.