The problem-oriented medical record as a training tool for staff.

After numerous deficiencies were found in a psychiatric center's medical records, a task force devised a system that incorporated the four components of the problem-oriented medical record plus other elements required by the center's structure. They divided the record into ten sections and also developed a four-page form for recording the patient's assessment and treatment plan. Two-hour mandatory training sessions were held to teach all levels of mental health staff how to use the new system; various kinds of follow-up instruction were also given. That training, the authors say, was a valuable way to teach staff not only proper record-keeping but also clinical thinking and logical treatment planning.     

Exploring Snapchat as a dynamic capture tool for social networking in persons with aphasia

Background: Physical, communication, geographic, and attitudinal factors place individuals with aphasia at risk for social isolation. Social networking applications may reduce the impact of such factors, providing an accessible context that reduces isolation. While individuals with aphasia desire to use social networking technologies, high linguistic demands and complex interface design constrain participation. Modified social networking applications may scaffold successful participation, capitalizing on multimodality communication tools, including photograph-based exchange to support participation.

Aims: This study examined the ability of individuals with aphasia to share daily experiences using Snapchat. The utility of the Snapchat platform in facilitating social exchange opportunities among individuals with aphasia was also explored.

Methods & Procedures: Six participants with aphasia participated in a 1-month trial of peer-to-peer social networking via Snapchat, using iPods equipped with Snapchat. Following hands-on training and an aphasia-friendly reference manual, participants posted images using Snapchat. Technology support was provided throughout the trial. Screenshots of posted images with or without text or other modalities were collected during the 1-month trial. Qualitative coding characterized the nature of posted images. Post-trial interviews were recorded from five out of the six participants.

Outcomes & Results: A total of 126 posts were collected (0–20 per day, 4–47 per person). Images, unaccompanied by text or drawing features, accounted for 79% of posts. Three participants accounted for almost 50% of the posts. Qualitative analyses generated three schemes for characterizing images: objective, engagement, and identity. Post-trial interviews revealed unanimous dissatisfaction with Snapchat as a social networking tool. While participants reported minor difficulties with technology and access to application, the primary barriers were a lack of reciprocity with other participants.

Conclusions: Although the participants reported difficulty with Snapchat, they each used posts to share about themselves. Participants shared meaningful images, sometimes augmented with text or drawing. Our research team concluded that there is a need for individualized, ongoing access to technology support for troubleshooting. Further, participants need to feel comfortable in utilizing that support. Constraints on use, necessary for data collection, complicated implementation and reduced participation. Our team believes that offering individuals with aphasia more freedom to use the application features, such as friend-to-friend communication, would reduce challenges with viewing and responding to peer posts. Individuals with aphasia express a desire for a reviewable timeline of posts that they can revisit as many times as they like, at their own pace. Despite dissatisfaction expressed by participants, Snapchat and related applications hold promise as universally available social networking tools given some adjustments.     

Tendon vibrations as a tool for clinical investigation of the myotatic loop

The degree of alteration of the myotatic loop was evaluated in 6 patients with polyradiculoneuropathy by studying deep reflexes and vibratory motor responses. The results showed that the reflex motor responses induced by vibration reappeared 2 to 4 weeks before the deep reflexes. Vibrations, therefore, could be a useful tool for the clinical follow-up of polyradiculoneuropathy.     

National survey of psychotherapy training in psychiatry, psychology, and social work

CONTEXT: Approximately 3% of the US population receives psychotherapy each year from psychiatrists, psychologists, or social workers. A modest number of psychotherapies are evidence-based therapy (EBT) in that they have been defined in manuals and found efficacious in at least 2 controlled clinical trials with random assignment that include a control condition of psychotherapy, placebo, pill, or other treatment and samples of sufficient power with well-characterized patients. Few practitioners use EBT. OBJECTIVE: To determine the amount of EBT taught in accredited training programs in psychiatry, psychology (PhD and PsyD), and social work and to note whether the training was elective or required and presented as a didactic (coursework) or clinical supervision. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey of a probability sample of all accredited training programs in psychiatry, psychology, and social work in the United States. Responders included training directors (or their designates) from 221 programs (73 in psychiatry, 63 in PhD clinical psychology, 21 in PsyD psychology, and 64 in master's-level social work). The overall response rate was 73.7%.Main Outcome Measure Requiring both a didactic and clinical supervision in an EBT. RESULTS: Although programs offered electives in EBT and non-EBT, few required both a didactic and clinical supervision in EBT, and most required training was non-EBT. Psychiatry required coursework and clinical supervision in the largest percentage of EBT (28.1%). Cognitive behavioral therapy was the EBT most frequently offered and required as a didactic in all 3 disciplines. More than 90% of the psychiatry training programs were complying with the new cognitive behavior therapy requirement. The 2 disciplines with the largest number of students and emphasis on clinical training-professional clinical psychology (PsyD) and social work-had the largest percentage of programs (67.3% and 61.7%, respectively) not requiring a didactic and clinical supervision in any EBT. CONCLUSION: There is a considerable gap between research evidence for psychotherapy and clinical training. Until the training programs in the major disciplines providing psychotherapy increase training in EBT, the gap between research evidence and clinical practice will remain.     

The comprehensive community mental health center as a field placement for graduate social work students

The comprehensive community mental health center, as a new organization, has many characteristics that make it a unique setting for the training of social workers. The organization's struggles for identity create a fluidity that requires the development of flexibility greatly needed in the mental health professions. Students can make valuable contributions to the functioning of the center if allowed to become fully involved in its activities. A generation gap may exist between senior staff, trained in traditional settings, and new staff and students whose orientations are more relevant to community practice.     

Mental health training for county welfare social work personnel: An exercise in education and community organization

The background, need for and implementation of a training program for a group of county welfare caseworkers representing ten counties in southwestern Minnesota is outlined. The program, which evolved from a cooperative effort by two community mental health centers, is described in terms of its philosophy, content and results. Implications for extended training of welfare and other social service personnel are denied.     

Teamwork in juvenile social work as an instrument in crisis intervention

The changing emphasis in psychiatric care demands the use of new strategies and the development of sociopsychiatric institutions. The term 'crisis intervention' is suitable in this respect insofar as it also includes the aspects of prevention and follow-up care. An attempt at the development of a model for multiprofessional teamwork in juvenile social work is outlined under the aspect of sectorised sociopsychiatric care. The exhaustion of the basically available possibilities is at the moment limited due to structural difficulties.     

Video and CD-ROM as a training tool for performing neurologic examinations of 1-year-old children in a multicenter epidemiologic study

In lieu of traditional training of examiners to identify cerebral palsy on a neurologic examination at age 1 year, we proposed an alternative approach using a multimedia training video and CD-ROM we developed after a two-step validation process. We hypothesized that use of CD-ROM interactive training will lead to reliable and valid performance of the neurologic examination by both pediatric neurologists and nonpediatric neurologists. All examiners were asked to take one of six interobserver variability tests found on the CD-ROM on two occasions. In the first interobserver variability evaluation, 89% (531 of 594) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the two items that had a 60% correct rate, the correct response rate rose to 93% (114 of 123). In the second interobserver variability evaluation, 88% (493 of 560) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the four items that had a 70% correct rate, the correct response rate rose to 96% (104 of 108). Interactive CD-ROM examination training is an efficient and cost-effective means of training both neurologists and non-neurologists to perform structured neurologic examinations in 1-year-old children. It provides an effective means to evaluate interobserver variability, offers a route for feedback, and creates an opportunity to reevaluate variability, both immediately and at periodic intervals.     

Family appraisal of paediatric acquired brain injury: a social work clinical intervention trial

ABSTRACT

Objective: To compare the efficacy of a new intervention ‘Family Forward’ with ‘Usual Care’ social work practice in optimising family appraisal of a child’s acquired brain injury to ensure better adaptation during the inpatient rehabilitation phase of care and early transition home.

Research Design: Single site, prospective, sequential comparison group design.

Methods and Procedures: Families were recruited on admission to an inpatient rehabilitation service based at a tertiary paediatric hospital. The ‘Usual Care’ group (n = 22; 29 parents) recruitment, intervention and data collection were completed first (Phase 1), followed by the ‘Family Forward’ group (n = 25; 43 parents) (Phase 2). Parents/caregivers completed measures: (Impact of Event Scale- Revised: IES-R; Parents Experience of Childhood Illness and Brief Illness Perception Questionnaire: Brief IPQ) at the time of their child’s inpatient rehabilitation admission, inpatient rehabilitation discharge, and 6 weeks post-discharge.

Main Outcomes and Results: There were more children with traumatic brain injuries in the Family Forward group (n = 13) than Usual Care (n = 6) and the Family Forward group had a longer hospital admission (days, M = 56.4, SD = 46.1 vs. M = 37.5, SD = 16.4, p = 0.019). No significant group differences were found for family appraisal outcomes at any of the three time-points. Both groups reported reductions in trauma and grief responses, emotional experiences and perceptions of their child’s injury at post-intervention and follow-up. Both groups continued to have depleted emotional resources (PECI scale) at 6 weeks post-discharge.

Conclusions: The study contributes important insights into family appraisal experience in the early stages following paediatric acquired brain injury. In this context, ‘Family Forward’ needs to incorporate interventions that support and promote ongoing family appraisal as issues related to their child’s injury arise over time. Future research is needed to focus on whether the Family Forward approach does sustain family system adaptation (a key aim informing the design of the intervention) over the longer term.