tag:blogger.com,1999:blog-35108796572612641552024-03-12T20:54:08.127-07:00Health ResearchAnonymoushttp://www.blogger.com/profile/11127883441419492372noreply@blogger.comBlogger19125tag:blogger.com,1999:blog-3510879657261264155.post-85763275261101570112014-03-12T23:47:00.002-07:002014-03-12T23:47:31.888-07:00There is Actually Alone One Way to Accurate Accurate Adulation - Brainy Bloom Research<div style="text-align: justify;">
What is the purpose of life? The alone purpose that makes rational
faculty is to accurate adulation to all active entities. All added
purposes are apprenticed to be selfish, with a "getting" motive
attached. The acquaintance of accurate adulation seems to appear rarely
on our planet, as adumbrated by the abrogating altitude of humans and
situations worldwide. The superior of our abundance and brainy bloom
depends on our alertness to accurate adulation to the activity about us.
</div>
<div style="text-align: justify;">
Many may be abashed to ascertain that accurate adulation is not a
claimed resource. I accept no adulation of my own, nor do you, or anyone
else. There is alone one way we can accurate accurate adulation to the
activity about us, that is by consistently acting on what is absolutely
right.
</div>
<div style="text-align: justify;">
Here is accession shocker; to act accurately a getting cannot be acting
selfishly. That agency that he or she cannot be acting from a egocentric
or blowhard intention. It agency that a getting cannot be in a
egocentric authoritative or artful mode, and cannot be acting to get
something for self.
</div>
<div style="text-align: justify;">
The announcement of accurate adulation requires that our intentions be
pure; that we be aboveboard will to accord with no strings attached. We
have to aswell be accommodating to act in acquiescently amenable ways,
which includes getting accommodating to accurate accuracy as we
apperceive it in adapted ways. In a egocentric environment, the
announcement of accuracy can sometimes be alarming so acumen is in
order.
</div>
<div style="text-align: justify;">
At the affection of the activity of cogent accurate adulation is a
aboveboard alertness to accurate love. Without that willingness,
whatever comes alternating shall be some anatomy of egocentric action.
</div>
<div style="text-align: justify;">
Here is an analogy:
</div>
<div style="text-align: justify;">
Think of a animal getting as a "garden hose," and his or her will as the
"faucet" absorbed to the ancillary of a house. The "water" is love.
</div>
<div style="text-align: justify;">
In adjustment for us to acquaintance or accurate love, we have to
accessible our claimed "faucet" (will) and be accommodating to acquiesce
baptize to breeze (express love). If we are accommodating to accurate
love, "water" flows through us and we feel acceptable (we acquaintance
love). In addition, those about us get "wet" (are loved).
</div>
<div style="text-align: justify;">
On the added hand, if we selfishly and defiantly debris to accurate
love, we accumulate our claimed "faucet" shut so that no "water" can
breeze through us. Like an bare garden corrupt larboard out in the sun,
it anon dries out and begins to decay.
</div>
Anonymoushttp://www.blogger.com/profile/11127883441419492372noreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-82548807485737748922014-03-12T23:42:00.000-07:002014-03-12T23:42:18.377-07:00Fish Oil for Affection Bloom and Affection Bloom Research<div style="text-align: justify;">
Fish oil for affection bloom is a hot topic. And for acceptable reason.
</div>
<div style="text-align: justify;">
You can't aces up a bi-weekly or annual after analysis account about the
amazing bloom allowances of angle oil for affection health. Doctors
acclaim it. Nutritionists acclaim it. Trainers and exercise buffs
acclaim it. Even my vet afresh recommended angle oil capsules for the
affection bloom of my amber lab, Phyto.
</div>
<div style="text-align: justify;">
Although a lot of humans accept heard of the outstanding cardiovascular
bloom allowances from omega 3 angle oil, few apperceive about all of the
agitative accurate studies of accurate after-effects abaft the angle
oil for affection bloom craze.
</div>
<div style="text-align: justify;">
A address appear in Circulation, the official account of the American
Affection Association, gives a absolute briefing on how omega 3 blubbery
acids from angle improves apportionment and why angle oil works so
able-bodied for the bloom of your affection and cardiovascular
arrangement in abundant ways.
</div>
<div style="text-align: justify;">
This abstraction shows that angle oil blubbery acids advice your
affection by blurred cholesterol, preventing aberrant baby and
abbreviation claret clots. It aswell decreases claret pressure, lowers
triglycerides, balances HDL and LDL, relaxes the arterial walls and
prevents the accumulation of new applique and inflammation,
vasoconstriction, platelet accession and abundant more. [Vol. 106:2747]
</div>
<div style="text-align: justify;">
Wow! Some scientists even announce that, back omega 3 angle oil helps humans affected depression, it can alleviate a torn heart.
</div>
<div style="text-align: justify;">
One accumulation of doctors appear a abstraction in the Account of the
American Medical Association about all of the abounding absolute
furnishings that college angle oil burning has on blurred a man's
accident of coronary affection ache (CHD). However, back added women die
of affection ache than any added cause, the scientists capital to
acquisition out if angle oil offers the aforementioned bloom allowances
for women as they do for men.
</div>
<div style="text-align: justify;">
After afterward 84,688 women for 16 years, these doctors assured that
women who eat 5 or added servings of angle a anniversary accept abundant
beneath accident of CHD or dying from a affection advance than women
who eat beneath fish. [Vol. 287, No. 14]
</div>
<div style="text-align: justify;">
If you ask me, it doesn't get any clearer than this. Angle oil for
affection bloom is awfully important. But how abundant do you need? A
lot of recommendations advance 5 or added servings of oily, algid
baptize angle a week. This is abundant and will absolutely advice
advance affection health, but it may not be enough. Abounding studies
acclaim 1 to 3 grams of angle oil circadian for a advantageous
cardiovascular system.
</div>
Anonymoushttp://www.blogger.com/profile/11127883441419492372noreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-88758460989244848002014-03-12T23:39:00.000-07:002014-03-12T23:39:01.651-07:00A Look At Biscuit And Affection Bloom Research<div style="text-align: justify;">
While, there is no accurate hotlink amid biscuit and affection health,
there are several affidavit that friends, ancestors and even those in
the bloom industry may advance biscuit for affection health.
</div>
<div style="text-align: justify;">
If you are absorbed in affection health, you should aboriginal accept
the controllable accident factors. Blazon II, developed access or
diabetes mellitus, obesity, ailing cholesterol levels, concrete
cessation and top claret burden are a part of the accident factors that
are brash controllable. This agency that with able diet, exercise and,
in some cases, medication these factors can be brash or controlled.
</div>
<div style="text-align: justify;">
Clinical trials in Europe in 2003 and 2006 abutment the use of biscuit
to lower claret glucose levels in patients with type-2 diabetes. Since
this is one of the accident factors for developing affection disease,
these studies may accept advance to the advance of biscuit for affection
health.
</div>
<div style="text-align: justify;">
There is some abashing over which blazon of biscuit was acclimated in
the trials. There are several types. In the United States, the a lot of
accepted blazon awash for additive is cassia. Some bloom agencies accept
brash adjoin arresting top amounts of cassia, because of a basic begin
in the bulb which is baneful to the alarmist and kidneys.
</div>
<div style="text-align: justify;">
Cinnamon is broadly acclimated in "fat-burners". You accept apparently
apparent them advertised in magazines on the internet or TV. They are
about awash in bloom supplement stores. These articles are declared to
admonition you lose weight by allowance your physique bake added fat.
There is no bright accurate affirmation that they will plan for
everyone, but some analysis does abutment their use and some humans
affirm by them.
</div>
<div style="text-align: justify;">
The American Affection Association and added groups complex in accession
and researching admonition accompanying to affection bloom has this
admonition about weight. If you are overweight, it is important for the
bloom of your affection to lose the weight. But, it is aswell actual
important to accumulate the weight off. Gaining and accident twenty or
thirty pounds over the advance of your lifetime is believed to be
unhealthy, possibly as ailing as abiding obesity. If anyone has
recommended that you try biscuit for affection bloom and you are
overweight, it may be because of cinnamons accessible fat-burning
attributes.
</div>
<div style="text-align: justify;">
A abstraction appear in the Indian Journal of Experimental Biology in
1999 seems to abutment the use of biscuit as a fat burner, possibly
acknowledging a hotlink amid biscuit and affection health. In this
study, the blazon of biscuit acclimated was Cinnamomum Verum, sometimes
referred to as "true cinnamon". Southern India is one of the places area
this bulb was originally cultivated. Unlike cassia, no bloom risks are
associated with the use of cinnamomum verum, but it may be harder to
find.
</div>
<div style="text-align: justify;">
In the study, rats were fed a diet top in fat, complemented with
cinnamon. Researchers did not see the accepted access in cholesterol
levels in the claret stream. This may announce that biscuit can
admonition abate or ascendancy ailing cholesterol levels, but added
analysis is needed.</div>
Anonymoushttp://www.blogger.com/profile/11127883441419492372noreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-58620096764402307662014-03-12T23:36:00.003-07:002014-03-12T23:36:32.363-07:00Compromise - The Best That Keeps Hurting - Mental Health Research<div style="text-align: justify;">
Who at times has not compromised? Accommodation is an capital allotment
of our egocentric way of life. We accommodation to get forth and to go
along. We accommodation to be accustomed and to abstain accident that
which we do not wish to lose. We accommodation because we see no added
option. Nevertheless, if any being were to attending aback at
above-mentioned times if he or she had compromised what was right, a
abutting assay would consistently acknowledge that the best to
accommodation consistently beneath a bearings or relationship.
</div>
<div style="text-align: justify;">
Choices to accommodation never advance to abiding absolute change.
Probably, every being knows that, yet, we assume afraid to compromising
what we apperceive is right. Why? The acknowledgment is for absolutely
egocentric reasons. Accommodation is "selfish action." In addition, as
with any egocentric action, it consistently after-effects in some
affectionate of negativity and pain.
</div>
<div style="text-align: justify;">
Fear usually plays a cogent role in compromise. Abhorrence is a
egocentric affect and a "selfish tool." We generally use abhorrence to
advice us get what we wish or to abstain what we do not want. We
sometimes accommodation because we abhorrence judgment, rejection, or
advance for not accordant with others or for not conforming.
</div>
<div style="text-align: justify;">
We sometimes accommodation because we abhorrence that we ability not get
as acceptable a accord or bearings as we accept now. We sometimes
accommodation because we abhorrence accident control; a admiration to
ascendancy and dispense consistently underlies a best to compromise.
</div>
<div style="text-align: justify;">
Were we not active in a egocentric ambiance there would never be a
charge to compromise. However, back we reside in egocentric families and
communities, we are consistently pressured to accomplish compromises.
The best action is to plan to accommodation as little as possible. That
best is consistently possible, provided we are will to pay whatever
amount is absorbed to abnegation to be in abrogating acceding with the
humans we consistently interact; even if it agency bounce or worse.</div>
Anonymoushttp://www.blogger.com/profile/11127883441419492372noreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-17999594299011591862014-03-12T23:34:00.001-07:002014-03-12T23:34:45.359-07:00Women and insurance - Insight on the Society For girls's Health analysis (SWHR)<div style="text-align: justify;">
Finding the correct resources for ladies while not applicable insurance coverage could be a important task. There area unit dedicated organizations that give helpful services on this issue. for instance, the Society for Women's Health analysis (SWHR) and therefore the National Women's Health info Center area unit a number of the organizations that area unit dedicated to women's medical challenges. They conjointly give made and helpful info for ladies in nice would like of health care help.<br /><br />If you reside within the us and you're a girl while not insurance, the SWHR offers helpful info on the subsequent schemes:<br /><br />o The National Breast and Cervical Cancer Early Detection Program. they furnish free or comparatively low-cost mammograms and Pap tests for ladies of 39yrs and higher than.<br />o Maternal and kid Services. they furnish medical aid girls with low financial gain and UN agency area unit pregnant with youngsters that area unit below the age of twenty-two.<br />o Women, Infants and kids (WIC). they furnish quality teachings on nutrition and kid take care of low-income, breastfeeding, and postnatal girls. WIC conjointly provides medical protection for youngsters that area unit beneath the age of five.<br /><br />Any lady that doesn't qualify for government-sponsored care services will get care from free clinics, medicament help systems or state insurance. There area unit several of such helping programs; this can be simply to call a couple of.<br /><br />Women area unit suggested to urge quality insurance programs. this can be important considering their medical desires as they become mothers. Note that obtaining quality medical coverage doesn't mean it ought to be terribly pricey. Consult leading insurance corporations and their agents, compare their free quotes and request for a free skilled consultation service on your medical cowl desires.</div>
Anonymoushttp://www.blogger.com/profile/11127883441419492372noreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-86932496493204649142011-10-26T23:57:00.000-07:002011-10-26T23:57:52.584-07:00More Evidence That Cell Phone Use Is Harmful<h3 class="post-title entry-title"> <a href="http://articlesofhealth.blogspot.com/2011/10/more-evidence-that-cell-phone-use-is.html"></a> </h3><div class="post-header"> </div><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgW4xz0yTpu-hK75nZBSI-189gBx_o5SkH9sjHnpkgKWCQLQ36NG1ei8u1pHqrGFNuEP9TxrcDHC2APhGBon_dcKEoL_ebIGulbSqARvx7dz4_GurAkKRmjp9feTwdwrGxDLYq3E6Rxmpic/s1600/toxic+emf.bmp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5667774877208538146" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgW4xz0yTpu-hK75nZBSI-189gBx_o5SkH9sjHnpkgKWCQLQ36NG1ei8u1pHqrGFNuEP9TxrcDHC2APhGBon_dcKEoL_ebIGulbSqARvx7dz4_GurAkKRmjp9feTwdwrGxDLYq3E6Rxmpic/s320/toxic+emf.bmp" style="cursor: pointer; float: left; height: 240px; margin: 0pt 10px 10px 0pt; width: 320px;" /></a><span class="Apple-style-span" style="font-family: arial,verdana,tahoma,geneva,sans-serif; font-size: 13px; font-weight: 300;"><h2 class="art_title" style="color: #333333; font-family: arial,verdana,tahoma,geneva,sans-serif ! important; font-size: 20px; font-weight: 300; line-height: 28px; margin: 0px; padding: 15px 0px 0px; text-align: left; text-decoration: none; width: 526px;">More Evidence That Cell Phone Use Is Bad for You</h2></span><span class="Apple-style-span" style="font-family: arial,verdana,tahoma,geneva,sans-serif; font-size: 13px; font-weight: 300;"><div class="article" id="ArticlePar01" style="color: #333333; float: left; font-family: arial,verdana,tahoma,geneva,sans-serif ! important; font-size: 14px; font-weight: 300; line-height: 20px; margin: 25px 0px 0px; padding: 0px; width: 526px;"><div style="font-family: arial,verdana,tahoma,geneva,sans-serif ! important; font-weight: 300; margin: 0px 0px 15px; padding: 0px; text-align: justify;">If health damage associated with mobile phones is in the news again, it is not because of the electromagnetic waves that allegedly attack the brain. But new research suggests excessive use of mobile phones can hinder sleep, trigger fatigue and stress and cause mental problems like depression and lack of concentration. At the recent annual meeting of the U.S. Associated Professional Sleep Societies (APSS), Dr. Gaby Badre from Sahlgren's Academy in Gothenburg, Sweden said teenagers who use their phones excessively are more prone to stress and fatigue. The study focused on 21 healthy people between 14 and 20 years of age with regular work or study hours and without sleep problems. The subjects were divided into two groups. Compared to the control group, who made less than five calls and/or sent five text messages a day, the experimental group made more than 15 calls and/or sent 15 text messages a day. And the latter suffered from increased restlessness, had more careless lifestyles, consumed more stimulating beverages, and reported difficulty falling asleep, disrupted sleep, and more susceptibility to stress and fatigue. Only one-third of them ate breakfast, compared with most in the control group.</div><br />
<div style="font-family: arial,verdana,tahoma,geneva,sans-serif ! important; font-weight: 300; margin: 0px 0px 15px; padding: 0px; text-align: justify;">The correlation between phone use and mental state was shown by a study published in the Korean Journal of Epidemiology in 2005 and conducted by a team led by Prof. Kim Dong-hyun, of the Department of Social and Preventive Medicine at Hallym University's College of Medicine. The team studied 501 high school students in four groups according to their cell phone use. Those who used them the least scored below 35 points on depression, while those who used the most scored above 51. The latter group also scored over 61 in terms of impulsive behavior. "We can't generalize that cell phone use causes depression or impulsive behavior, but at least we proved there's a connection," Kim said. Han Doug-hyun, a professor of neuropsychiatry at Chung-Ang University Medical Center, says a brain wave scan of children with high mobile use showed a similar sleep cycle pattern to that of a depression patient. Conversely, depressive and impulsive children tended to rely more on mobile phones. Then how much is too much? Mobile addiction is a novel concept compared to drug or Internet addictions. But experts say those who are at risk to becoming an addict are nervous without a phone, always tinker with it and are at ease only after making a call or texting someone. Doctors also note that texting can be more harmful than phone calls to mental health and sleep levels. Prof. Ha ji-hyun, of the Department of Psychiatry at Konkuk University Medical Center says, "A call is simultaneous communication, but an SMS is not. You can get nervous while waiting for the response." Texting at night, itself a stimulus, seems inimical to sleep. Prof. Hong Seung-chul of the Department of Neuropsychiatry at Catholic University of Korea's St. Vincent's Hospital, cites a survey saying sound and light from an incoming text message disturbs sleep as it suppresses the hormone melatonin. It can wake up the person or prevent a sound sleep.</div></div></span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-59736642476517381492011-03-14T16:11:00.000-07:002011-11-05T11:27:53.185-07:00Integrating Data Instruments into Clinical Practice<div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">One issue that MHCD has looked at recently in improving care of mental health consumers, is around the use of data instruments that Evaluation and Research Department uses to collect information on consumer recovery, and how to translate this back to the consumers, resulting in more insight about their treatment progress?<span style="mso-spacerun: yes;"> </span>The Evaluation and Research Department uses an instrument called the Consumer Recovery Marker (CRM) and the Recovery Marker Index (RMI).<span style="mso-spacerun: yes;"> </span>The CRM is a 15 item survey, filled out by clients and measures “active growth/orientation, hope, symptom interference, sense of safety and social networks” and is described as “consumer’s perception of their mental health recovery” (Deroche, Olmos, Hester, McKinney 2007: 1).<span style="mso-spacerun: yes;"> </span>The RMI is a 7 item survey filled out by clinicians that includes such items as “employment, education/learning, active/growth orientation, symptom interference, engagement, housing” and substance use (added since inception), and is described as measuring “indicators usually associated with individual’s recovery, but are not necessary for recovery” (Deroche, et al. 2007: 1).<span style="mso-spacerun: yes;"> </span>In combination, these two instruments allow for multiple perspectives on the consumer’s recovery, as well as collect information to make evaluation possible, as well as translating progress back to MHCD’s various shareholders.<span style="mso-spacerun: yes;"> </span>The Evaluation and Research Department also utilizes a tool, the Recovery Profile (RP), which combines all the data collected from the CRM and RMI and puts them in an interpretable form, through use of line and bar graphs, showing averages of all scores, etc.<span style="mso-spacerun: yes;"> </span>The question that MHCD faces is how to provide this information to clinicians, as well as consumers, so that it can be used to make clinical decisions around consumer treatment, as well as offering insight to the consumer about their recovery process?<span style="mso-spacerun: yes;"> </span>In considering this issue, literature review has shown a number of factors that come into play.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-align: justify;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: 'Times New Roman'; font-size: 12pt;">Dilemma for Clinician and Organization</span></u></b></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-align: justify;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Another perspective is to consider the dilemma that clinicians feel, as a result of data instruments being introduced into clinical practice, which represents a switch to more standardized, or evidence based practices.<span style="mso-spacerun: yes;"> </span>An article by Broom, <place w:st="on">Adams</place> and Tovey (2009) looks at this issue within the healthcare and in particular, oncology practice.<span style="mso-spacerun: yes;"> </span>This article describes using evidence based practices within medicine and states the challenge is to adopt these principles, while still maintaining “professional autonomy, clinical judgment, and therapeutic integrity” (Broom et al. 2009: 192).<span style="mso-spacerun: yes;"> </span>I think some of clinician fears around using instruments, is that it would minimize some of their intuitive experiences with the consumers, as well as doesn’t allow for their unique talents as clinicians to shine through.<span style="mso-spacerun: yes;"> </span>In other words, with the mental health field, a lot of a consumer’s story is shared through narrative forms, treatment plans, intakes, histories, etc. and so there might be some hesitance initially in how that can be translated into more quantitative forms, or using data instruments.<span style="mso-spacerun: yes;"> </span>From this study, it was found that executive management was more likely to be in support of using evidence based medicine as it minimizes clinician error and is more science, objective based, and clinicians were more in opposition as they felt it takes away from some of their expertise, uniqueness as individuals (Broom et al. 2009).<span style="mso-spacerun: yes;"> </span>The challenge is to try to find a balance, where the clinician’s unique talents can be represented and acknowledged, as well as having more information at the clinician’s disposal, in making decisions around the consumer’s treatment.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Another aspect of this dilemma is to consider the strain placed on an organization in trying to satisfy reporting needs of its stakeholders, as well as using that data in a way that improves its programs.<span style="mso-spacerun: yes;"> </span>Carman (as cited by Hoole and Patterson 2008) reports that 65% of nonprofits engage in formal program evaluation, 95% report to their boards and 90% experience site visits from their funders (3).<span style="mso-spacerun: yes;"> </span>The problem brought up by Hoole and Patterson (2008) in regards to this is that most of data is just collected, not used to actually improve programs.<span style="mso-spacerun: yes;"> </span>This is most likely due to conflicting shareholder demands, as well as having support and funding for data collection, being able to translate this importance to managers, as well as staff across the organization (Hoole and Patterson 2008).<span style="mso-spacerun: yes;"> </span>With nonprofit organizations, depending on funders, their outcome goals can often reflect interests of the shareholders, and thus are not intertwined with mission of the organization (Hoole and Patterson 2008).<span style="mso-spacerun: yes;"> </span>Basically, the answer to this for Hoole and Patterson (2008) are for the nonprofit to work more with the shareholders on integrating outcome requirements with that of their own internal mission or goal statements.<span style="mso-spacerun: yes;"> </span>This holds true for MHCD, as well in that they currently are making efforts to integrate data already being collected to satisfy Medicaid funding, or other state, private needs, in a way that can be translated to clinicians and used in clinical practice and making decisions around client care.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: 'Times New Roman'; font-size: 12pt;">Structure and Funding</span></u></b><span style="font-family: 'Times New Roman'; font-size: 12pt;"></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">An article by Carman and Fredericks (2009) describes that how successful evaluation is implemented depends on “autonomy, internal structures and external relations, leadership styles and maturity” (Carman and Fredericks 2009: 3).<span style="mso-spacerun: yes;"> </span>Carman and Fredericks also identify the Executive Director as the key into how research and evaluation is implemented into non-profits (Carman and Fredericks 2009).<span style="mso-spacerun: yes;"> </span>This study uses three different clusters of non-profits and finds that those that are primarily funded by government, Medicaid, public funds have fewer problems of support and funding for research and evaluation (Carman and Fredericks 2009).<span style="mso-spacerun: yes;"> </span>The following is a breakdown of funding for MHCD and was taken from the “<a href="http://www.mhcd.org/"><span style="color: yellow;">MHCD</span></a> 2009: Report to the Community” and covers the fiscal year concluded June 30, 2009.</span><span style="font-family: 'Times New Roman'; font-size: 12pt;"></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: 'Times New Roman'; font-size: 12pt;">Source<span style="mso-tab-count: 5;"> </span>Amount<span style="mso-tab-count: 3;"> </span>Percentage</span></u></b></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Medicaid<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 3;"> </span>$23,925,630<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>44.4</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">State of <state w:st="on"><place w:st="on">Colorado</place></state><span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>$12,945,194<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>24.0</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Client, Third Party, Pharmacy<span style="mso-tab-count: 1;"> </span>$8,826,030<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>16.4</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Contracts and Grants<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>5,632,041<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>10.5</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Interest, Rent, <span style="mso-tab-count: 1;"> </span>Other<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>$1,604,777<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>3</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Medicare<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 3;"> </span>$498,286<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>0.9</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Public Support<span style="mso-tab-count: 3;"> </span><span style="mso-tab-count: 1;"> </span>$444,236<span style="mso-tab-count: 1;"> </span><span style="mso-tab-count: 2;"> </span>0.8</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Some other findings were the larger the organization, more likely to identify staff resistance as a problem in evaluation, data collection (Carman and Fredericks 2009).<span style="mso-spacerun: yes;"> </span>Younger organizations were found to have more technical assistance issues with evaluation and organization; with connections to housing or community development, there are fewer problems with implementation and design (Carman and Fredericks 2009).<span style="mso-spacerun: yes;"> </span>With MHCD being a larger organization and having a lot of support for evaluation from executive management, as well as having primary funding from Medicaid and the State of <state w:st="on"><place w:st="on">Colorado</place></state>, there is already a lot of familiarity with data collection and evaluation, at least at the administrative level.<span style="mso-spacerun: yes;"> </span>However, with it being a large organization and with multiple layers and treatment teams, residential and employment facilities, translating the information that is collected by Evaluation and Research Department to the clinicians and consumers, offers chance for more resistance.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: 'Times New Roman'; font-size: 12pt;">Philosophy</span></u></b><span style="font-family: 'Times New Roman'; font-size: 12pt;"></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;"><span style="mso-tab-count: 1;"> </span>The mental health field has some differences in philosophy in comparison to medical field as well, that have made it more difficult for evidence based practices to be implemented successfully.<span style="mso-spacerun: yes;"> </span>Rishel (2007) points out that the mental health field focuses more on clinical outcome trials or best models of treatment, rather than on prevention itself.<span style="mso-spacerun: yes;"> </span>Rishel (2007) goes on to state two of possible reasons for this are prevention coming from a public health perspective and looking at population as a whole, which varies from a clinical approach aimed at best methods to treat those already diagnosed with mental illness.<span style="mso-spacerun: yes;"> </span>Also, prevention methods are usually thought of as requiring larger samples and for participants to be followed for a long period of time, compared with clinical trials which are shorter and require smaller sample size (Rishel 2007).<span style="mso-spacerun: yes;"> </span>The mental health field is also seen as being hard to evaluate in terms of outcomes, as there are really no standardized outcomes (Rishel 2007).<span style="mso-spacerun: yes;"> </span>This becomes even more difficult with less definition attributed to non-profit organizations.<span style="mso-spacerun: yes;"> </span>This proves true with MHCD in that most of the focus to this point has been best treatment models to integrate into clinical practice.<span style="mso-spacerun: yes;"> </span>However, with integration of data instruments, this allows for more longitudinal data and more of a focus to prevention side.<span style="mso-spacerun: yes;"> </span></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><b style="mso-bidi-font-weight: normal;"><u><span style="font-family: 'Times New Roman'; font-size: 12pt;">Clinician Feeling Towards Instruments</span></u></b><span style="font-family: 'Times New Roman'; font-size: 12pt;"><span style="mso-tab-count: 1;"> </span></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">A study done looking at mental health field and how clinicians feel towards data instruments was conducted by <city w:st="on"><place w:st="on">Garland</place></city>, Kruse, Aarons (2003).<span style="mso-spacerun: yes;"> </span>This study was done on mental health system in <state w:st="on"><place w:st="on">California</place></state> and found that 92% of clinicians reported never using scores from data instruments in their clinical practice (Garland et al. 2003: 400).<span style="mso-spacerun: yes;"> </span>Further, 90% identified a collecting the data as a “significant time burden” in terms of fitting into their daily work tasks (Garland et al. 2003: 400).<span style="mso-spacerun: yes;"> </span>This data shows clinicians not putting much value into data collection, as well as thinking of it more as a burden, versus something that could be useful for them in their practice.<span style="mso-spacerun: yes;"> </span>The article also went on to show that 55% of clinicians in reference to measures used by the instrument’s, felt they were “not appropriate, nor valid, for their particular patient population” (Garland et al. 2003: 400).<span style="mso-spacerun: yes;"> </span>It would be a hard sell to get clinicians to buy into using some of these instruments, if they don’t believe they are valid or useful for their population.<span style="mso-spacerun: yes;"> </span>When asked what changes the clinicians wanted to see with how the data was reported, answers were “briefer administration” or “simpler language”, as well as wishing these were presented in “narrative, as opposed to quantitative form” (Garland et al. 2003: 400).<span style="mso-spacerun: yes;"> </span>As we can see, there seems to be a lot of doubt from clinicians around trusting the data is appropriate for their client populations, as well as being able to interpret the data, and doubting whether the data reflects anything that can be used in clinical practice.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;"><span style="mso-tab-count: 1;"> </span></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;"><span style="mso-tab-count: 1;"> </span>As we can see from the literature, there are multiple interests to consider when implementing data instruments into clinical practice.<span style="mso-spacerun: yes;"> </span>MHCD is unique from a lot of non-profits in having its own internal Evaluation and Research Department, and this creates a lot of opportunity to progress forward, in terms of how clinical information is relayed to clinicians, as well as consumers receiving mental health services.<span style="mso-spacerun: yes;"> </span>MHCD has already made a lot of steps towards helping ease this transition.<span style="mso-spacerun: yes;"> </span>The MHCD “Recovery Committee”, which is already a committee that was in place, but is now working on how to help with this transition.<span style="mso-spacerun: yes;"> </span>There were focus groups held with clinicians around what concerns they had with the instruments, and this information was used to make some changes to the instruments, as well as in developing trainings.<span style="mso-spacerun: yes;"> </span>The trainings were designed to show how the data collection instruments can be interpreted, as well as how to use that information in discussions with consumers to give them incentive in participating in data collection.<span style="mso-spacerun: yes;"> </span>MHCD also has a team made up of MHCD consumers who have taken the responsibility of going to each site and sharing with other consumers their experiences with looking at the RP, and how beneficial it is to view this data and learn more about their treatment progress.<span style="mso-spacerun: yes;"> </span>MHCD will continue to evaluate how this integration has gone, but it has created a unique opportunity as an organization, to bring various clinical teams and consumers together, to work on getting the most out of this data that is already collected.<span style="mso-spacerun: yes;"> </span>In the medical health field, I think we have seen a lot of growth in terms of how we can see lab work, communication with our doctors through e-mail, other electronic means, etc.<span style="mso-spacerun: yes;"> </span>I think through this example, MHCD has shown how the mental health field can benefit from data instruments as well, resulting in more client informed, as well as clinician informed care.<span style="mso-spacerun: yes;"> </span><a href="" name="_GoBack"></a></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Submitted By Jim Linderman- Evaluation Specialist with Evaluation and Research Department at MHCD, as well as Sociology M.A. student at <place w:st="on"><placetype w:st="on">University</placetype> of <placename w:st="on">Colorado Denver Sociology Program</placename></place>.<span style="mso-spacerun: yes;"> </span></span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">References</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Broom, A., J. Adams, P. Tovey (2009). “Evidence-based healthcare in practice: A study of clinician resistance, professional de-skilling, and inter-specialty differentiation in oncology” Social Science & Medicine 68(192-200).</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Carman, J.G., K.A. <city w:st="on"><place w:st="on">Fredericks</place></city> (2009). “Evaluation Capacity and Nonprofit Organizations: Is Glass Half-Empty or Half-Full?” American Journal of Evaluation 31:84.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">DeRoche, K., Hester, M., Olmos, P.A., <city w:st="on"><place w:st="on">McKinney</place></city>, C.J. (October, 2007). Evaluation of Mental Health Recovery: Using Data to Inform System Change. Poster presented at the 'Culture of Data' Conference. <place w:st="on"><city w:st="on">Denver</city>, <state w:st="on">CO</state></place>.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><city w:st="on"><place w:st="on"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Garland</span></place></city><span style="font-family: 'Times New Roman'; font-size: 12pt;">, Ann F., M. Kruse, G. A. Aarons (2003). “Clinicians and Outcome Measurement: What’s the Use?”.<span style="mso-spacerun: yes;"> </span><i style="mso-bidi-font-style: normal;">Clinicians and Outcome Measurement</i> 30(4):393-405.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Hoole, E. and T.E. Patterson (2008). “Voices from the Field: Evaluation as part of a Learning Culture”. <i style="mso-bidi-font-style: normal;">Nonprofits and Evaluation. New Directions for Evaluation</i> 119:93-113.</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt; text-indent: 0.5in;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">MHCD 2009: Report to the Community (can be found at www.mhcd.org)</span></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><br /></div><div class="NoSpacing" style="margin: 0in 0in 0pt;"><span style="font-family: 'Times New Roman'; font-size: 12pt;">Rishel, C. (2007). “Evidence Based Prevention Practice in Mental Health: What is it and how do we get there?” American Journal of Orthopsychiatry 77(1): 153-164.<span style="mso-tab-count: 1;"> </span></span></div></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-39994787242734534912011-02-22T15:45:00.000-08:002011-11-05T11:27:53.214-07:00Denver’s Homeless Street Youth – characteristics and treatment challenges<div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">In 2004 Denver’s homeless youth population was estimated to include approximately 850 young adults between the ages of 12 and 24</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn1" name="_ftnref1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[1]</span></span></span></span></span></a><span style="font-family: Calibri;"> with at least 1500 homeless youth in the state of Colorado</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn2" name="_ftnref2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[2]</span></span></span></span></span></a><span style="font-family: Calibri;">. I believe these figures are a serious underestimate of the actual number of homeless youth in Denver and the state. This population is notoriously hard to count due to their itinerant nature, mistrust of authority figures, unwillingness to participate in surveys or be counted, and because many simply don’t want to be found. For these reasons it can be extremely difficult to get a true idea of how many homeless youth are living on the streets using traditional survey methods administered in schools, shelters and drop-in centers. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Street youth, or youth who live primarily on the streets, are distinct from other youth experiencing homelessness who utilize shelters or transitional housing programs. Their basic needs are not consistently met; they are exposed to greater levels of stress and trauma and are more likely to engage in high risk behaviors</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn3" name="_ftnref3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[3]</span></span></span></span></span></a><span style="font-family: Calibri;">.<span style="mso-spacerun: yes;"> </span>For the purpose of this post I will limit the discussion to homeless street youth.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>There are many possible reasons a teen might choose to live on the streets rather than with relatives or in a foster home. The environment at home could be unsafe due to domestic violence, neglect, substance and/or alcohol abuse, or a combination of these issues. If the teen is having trouble following rules, exhibits features of Conduct Disorder or Oppositional Defiant Disorder, uses drugs or alcohol,<span style="mso-spacerun: yes;"> </span>or identifies as gay, lesbian, bi-sexual, questioning, or transgender (GLBQT), this can create conflict within the home which may lead to homelessness. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Sometimes it is a matter of finances; if the family can no longer afford to feed and care for all of their children, the older children may be forced to leave the house to reduce the financial burden and provide for themselves. There is also a disturbingly high rate of homelessness among kids who “age-out” of the foster care system, or who are released from the juvenile justice system. The estimated amount of homeless youth who have aged out of foster care or out-of-home placement ranges from 21%</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn4" name="_ftnref4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[4]</span></span></span></span></span></a><span style="font-family: Calibri;"> to 53%</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn5" name="_ftnref5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[5]</span></span></span></span></span></a><span style="font-family: Calibri;">. There are other situations which could result in a teen leaving home and turning to the streets, these are some of the more common explanations.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>Once on the streets youth are left to navigate a very dangerous and adult world, with little experience and limited physical/mental/emotional development.<span style="mso-spacerun: yes;"> </span>In this environment they are exposed to extreme violence, such as muggings, physical and sexual assault, shootings, gang violence, emotional abuse, etc. They have a greater chance than their housed peers of being the victims of this violence</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn6" name="_ftnref6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[6]</span></span></span></span></span></a><span style="font-family: Calibri;"> and of being re-victimized in the future</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn7" name="_ftnref7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[7]</span></span></span></span></span></a><span style="font-family: Calibri;">. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Often they will participate in illegal activities, such as theft, battery, breaking and entering, etc., to obtain food, shelter, money or drugs. Survival sex is another strategy used by some street youth; it is defined as the exchange of sex for shelter, food, drugs, or money. Teens who reported having used survival sex<span style="mso-spacerun: yes;"> </span>to meet their basic needs also reported higher rates of substance use, suicide attempts, days away from home, STD’s, pregnancy, and victimization</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn8" name="_ftnref8" style="mso-footnote-id: ftn8;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[8]</span></span></span></span></span></a><span style="font-family: Calibri;">. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">To combat some of the risks and trauma associated with life on the streets, youth will often seek to re-create the family they left behind, or never had. Typically older kids or adults who have been on the streets longer will take the newcomers under their wings. They form a large “street family,” which consists of a “street Dad” and “street Mom,” etc. Depending on the make-up of the group and their activities, street families </span><a href="" name="_GoBack"></a><span style="font-family: Calibri;">can be a protective factor for new homeless teens, or they can expose the youth to more harm than they would otherwise experience. </span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">If youth who live on the streets didn’t have a mental health or substance abuse problem when they left home, their chances of acquiring one while living on the streets are very high.<span style="mso-spacerun: yes;"> </span>Due to the increased exposure to violence and trauma, they are more vulnerable to PTSD, mood disorders, substance and/or alcohol abuse, conduct disorder, oppositional defiant disorder, and suicidal ideation/attempts.<span style="mso-spacerun: yes;"> </span>The relationship between homelessness and mental illness goes both ways; if a teen was already experiencing symptoms of mental illness before leaving home, this may contribute to familial conflict which can in turn lead to homelessness.<span style="mso-spacerun: yes;"> </span>The incidence of mental illness and substance abuse are significantly higher for homeless street youth, as compared to homeless youth who live in shelters, or the general youth population</span><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftn9" name="_ftnref9" style="mso-footnote-id: ftn9;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 11pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[9]</span></span></span></span></span></a><span style="font-family: Calibri;">.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;"><span style="mso-tab-count: 1;"> </span>The barriers to treatment for this population are numerous and difficult, but not impossible, to overcome. To begin, they are a hard population to reach physically, as they move around the city frequently, changing camp sites, squat locations, or staying with friends in different areas. This can make planning and delivering services extremely difficult. There is also a culture of mistrust with regards to authority figures and service providers, which can make building a therapeutic relationship challenging. In addition, there seems to be a lag in the mental health field when it comes to applying the principles of recovery to the homeless youth population, specifically regarding consumer directed therapy and strengths based services. It can be difficult for some providers to recognize the autonomy of these youth and their right to determine what direction their lives will take; this is due in part to their young age, their involvement in high risk behaviors, and the parental instincts of some of the providers. It’s important to remember that these kids are by now solely responsible for their own lives, where they sleep, how they eat, and how they spend their time; to treat them otherwise is counterproductive.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">I believe the foundations for treatment can be established by providers who are a consistent, caring, attentive and non-judgmental presence in the lives of our homeless youth. On the next post I’d like to discuss some of the various treatments that are currently being used with homeless youth, and which have been found to be the most successful.<span style="mso-spacerun: yes;"> </span></span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Written by Felice Seigneur</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">Felice Seigneur is and Evaluation Specialist with the Evaluation and Research Department</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">at the Mental Health Center of Denver</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="font-family: Calibri;">The content of this blog is based on current and past research on the subject of homeless and street youth, and in part from my own experience as an outreach counselor working with homeless street youth in Denver. If you have any questions about what has been written, or would like to add to the conversation, please feel free to leave a comment below.</span></div><div class="MsoNormal" style="margin: 0in 0in 10pt;"><span style="mso-tab-count: 1;"><span style="font-family: Calibri;"> </span></span></div><div style="mso-element: footnote-list;"><br clear="all" /><span style="font-family: Calibri;"><hr align="left" size="1" width="33%" /></span><div id="ftn1" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref1" name="_ftn1" style="mso-footnote-id: ftn1;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[1]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Metropolitan Denver Homeless Initiative, Final Report, www.cdhs.state.co.us/shhp/PDFs/2004_PIT_Final_Report.pdf</span></div></div><div id="ftn2" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref2" name="_ftn2" style="mso-footnote-id: ftn2;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[2]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Colorado Dept. of Public Health, www.cde.state.co.us/cdeprevention/download/pdf/Office%20of%20Homeless%20Youth%20Report.pdf</span></div></div><div id="ftn3" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref3" name="_ftn3" style="mso-footnote-id: ftn3;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[3]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Treatment Outcome for Street-Living, Homeless Youth. Natasha Slesnick, Ph.D,Jillian L. Prestopnik, Ph.D., Robert J. Meyers, Ph.D., and Michael Glassman, Ph.D. Addict Behav. 2007 June ; 32(6): 1237–1251.</span></div></div><div id="ftn4" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref4" name="_ftn4" style="mso-footnote-id: ftn4;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[4]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Cauce, A. M., Paradise, M., Embry, L., Morgan, C., Theofelis, J., Heger, J., & Wagner, V. (1998).</span></div><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><span style="font-family: Calibri; font-size: x-small;">Homeless youth in Seattle: Youth characteristics, mental health needs, and intensive case</span></div><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><span style="font-family: Calibri; font-size: x-small;">management. In M. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and</span></div><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><span style="font-family: Calibri; font-size: x-small;">youth with emotional and behavioral disorders and their families: Programs and evaluation best</span></div><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><span style="font-family: Calibri; font-size: x-small;">practices. Austin, TX: PRO-ED.</span></div></div><div id="ftn5" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref5" name="_ftn5" style="mso-footnote-id: ftn5;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[5]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Toro, P. A., & Goldstein, M. S. (2000, August). Outcomes among homeless and matched housed</span></div><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><span style="font-family: Calibri; font-size: x-small;">adolescents: A longitudinal comparison. Presented at the 108th Annual Convention of the</span></div><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><span style="font-family: Calibri; font-size: x-small;">American Psychological Association, Washington, DC.</span></div></div><div id="ftn6" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref6" name="_ftn6" style="mso-footnote-id: ftn6;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[6]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> - Homeless Youth in the United States: Recent Research Findings and Intervention Approaches. Paul A. Toro, PhD, Wayne State University, Detroit, MI, Amy Dworsky, PhD, University of Chicago, Chicago, IL, Patrick J. Fowler, MA, Wayne State University, Detroit, MI. The 2007 National Symposium on Homelessness Research</span></div></div><div id="ftn7" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref7" name="_ftn7" style="mso-footnote-id: ftn7;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[7]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Whitbeck, L. B., Hoyt, D. R., & Ackley, K. A. (1997). Abusive family backgrounds and victimization among runaway and homeless adolescents. Journal of Research on Adolescence, 7, 375–392.</span></div></div><div id="ftn8" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref8" name="_ftn8" style="mso-footnote-id: ftn8;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[8]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Prevalence and Correlates of Survival Sex Among Runaway and Homeless Youth. Jody M. Greene, MS, Susan T Ennett, PhD, and Christopher L. Ringwalt, DrPH. American Journal of Public Health, September 1999, Vol. 89, No. 9</span></div></div><div id="ftn9" style="mso-element: footnote;"><div class="MsoFootnoteText" style="margin: 0in 0in 0pt;"><a href="http://www.blogger.com/post-create.g?blogID=4095615647425961527#_ftnref9" name="_ftn9" style="mso-footnote-id: ftn9;" title=""><span class="MsoFootnoteReference"><span style="font-family: Calibri;"><span style="mso-special-character: footnote;"><span class="MsoFootnoteReference"><span style="font-family: Calibri; font-size: 10pt; line-height: 115%; mso-ansi-language: EN-US; mso-bidi-language: AR-SA; mso-fareast-font-family: 'Times New Roman'; mso-fareast-language: EN-US;">[9]</span></span></span></span></span></a><span style="font-family: Calibri; font-size: x-small;"> Toro, et al., 2007</span></div></div></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-79436242541295382202011-01-25T13:43:00.000-08:002011-11-05T11:27:53.239-07:00Future Blogs<div class="MsoNormal">We would like to let you know it takes time to compile Research on different subjects. <o:p></o:p></div><div class="MsoNormal">Because of this reason we will only be posting on this blog monthly.<o:p></o:p></div><div class="MsoNormal">Hopefully the subjects will be of interest to you and we hope you will continue to visit our blog in the future.<o:p></o:p></div><div class="MsoNormal">Thank you</div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-40035152778044308162011-01-10T09:28:00.000-08:002011-11-05T11:27:53.263-07:00ResillenceThe term “resilience” is a word and concept that often gets thrown around in a variety of contexts within the mental health field. Despite the prevalence of the terminology, it is frequently unclear as to what professionals are trying to capture through the use of this construct. The multitude of definitions and interchangeability of resilience with other constructs (such as recovery) make it difficult to establish a common language among mental health providers, particularly with regard to interventions and research designed to facilitate resiliency. In <a href="http://www.michaelungar.com/files/a_constructionist_discourse_on_resilience_youth_and_society.pdf"><span class="Apple-style-span" style="color: yellow;">Ungar’s 2004 article</span></a> on resilience, he points out the “definitional ambiguity in the resilience construct.” Through this article I hope to provide a brief overview of the etiology and evolution of resilience while highlighting some of the past and recent research. Hopefully this information will help to inform our future application and efforts to foster resiliency in our own lives and those around us.<br />Historical accounts date the origin of resilience from between 1620-30 C.E. with the Latin root “resiliens,” meaning to “spring back” or “rebound” (Friesen, 2005; Luthans, Vogelgesand, & Lester 2006; Online Etymology Dictionary, 2008). The resilience that we now associate with mental health became a prominent construct in the 1970s when researchers began to examine individuals who were able to follow a positive developmental trajectory despite the presence of high-risk conditions or adversity (Luthar & Zigler, 1991). Since that time, there have been three recognized waves of research involving resiliency, “resilient qualities,” “the resiliency process,” and “innate resiliency” (Richardson, 2002). <br />Resilient qualities research has sought to identify particular traits or characteristics that have helped them survive some form of adversity. Various studies have identified these protective factors to include items such as gender, tolerance, achievement orientation, good communicator, altruism, self-efficacy, future orientation, high expectations, good self-esteem, happiness, faith, creativity, and morality, among others (Baumeister & Exline 2000; Buss, 2000; Myers, 2000; Simonton, 2000; Werner, 1982; 2005; Werner & Smith 1992). These specific developmental assets remain of interest to resiliency researchers while an emphasis on the process involved in fostering resilient responses has gained even greater attention.<br />The resiliency process research has sought to view resiliency as more of a dynamic developmental process between person and environment while reflecting some positive adjustment despite some form of adversity (Friesen, 2005; Edeschi & Kilmer, 2005). This movement within the field of resilience has sought to transform the construct from a trait to be expressed into a state that is either developed or elicited within particular context (Lussier, Derevensky, Gupta, Bergevin, & Ellenbogen, 2007). The exploration of the interactional and environmental nature of resiliency welcomed another wave of research into how resilience might be fostered, developed, and learned.<br />Innate resiliency research drew into question many of the assumptions that had previously been made about the resilience construct. Resilience was beginning to be viewed as no longer an either yes or no condition that individuals were predetermined to have (or not), but a construct that falls along a continuum and may be continually enhanced (Cairns-Descoteaux, 2005). This further development also began to draw into question the necessity that there be the presence of some stressor or adversity (to overcome) in order for their truly to be a resiliency process in effect.<br />Many current explorations of resiliency have begun to view resiliency as something innate to us all. <a href="http://www.resiliency.com/htm/research.htm"><span class="Apple-style-span" style="color: yellow;">In Bonnie Benard’s The Foundations of the Resiliency Framework</span></a> emphasizes the “process of connectedness” within resiliency and the importance of the how we do what we do, trying to move our focus in mental health from our fixation on the content of what we do and instead on the context. This concept is further elucidated (within an educational context) by <a href="http://blog.wholechildeducation.org/2010/11/29/resilience-research-and-educational-reform/"><span class="Apple-style-span" style="color: yellow;">Dr. Truebridge’s in her blog Resilience, Research, and Educational Reform</span></a> resilience-research-and-educational-reform/) in which she discusses the importance of change in the person delivering a particular service and the way it is delivered (and not necessarily the service itself) in terms of facilitating resilience in those with whom we come in contact. These recent examinations have helped to highlight the role of our own beliefs (and those within the broader social context) as a crucial element in creating resilience.<br />As can be seen by the previous review of resiliency literature, the construct remains somewhat of an enigma. The many various interpretations and understandings of resilience has led to much of the ambiguity in the term and has led some researchers to draw into question the utility of the construct itself in meaningfully contributing to the research and literature. Through my own research of resilience I tried to address this issue through the process of a meta-synthesis of other resiliency studies in the hopes of identifying common themes and creating a more meaningful understanding of the construct. The results of the study suggested the presence of eight core processes within resiliency of internal locus of control, reconstruction of the narrative, altruism, acceptance, flexibility, optimistic outlook, interpersonal effectiveness, and social support (<a href="http://outcomesmhcd.com/presentations/SCOTT_NEBEL_DOC_PAPER.pdf">Nebel</a>, 2008).<span class="Apple-tab-span" style="white-space: pre;"> </span>Resilience remains a prominent issue of debate within the clinical and research fields of psychology. Hopefully this blog was able to provide a brief overview of some of the current views and applications of the resiliency construct in mental health while highlighting the ongoing need for continued dialogue and research.<br /><br /><br /><div class="MsoNormal" style="margin-bottom: 0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;"><div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">By Scott Nebel, Psy.D.</div></div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: 0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in;">Scott is a Psychologist on MHCD’s Intensive In-Home Treatment Team and collaborates with the MHCD Research Institute.</li></ul><br /><br />Baumeister, R., Exline, J. (2000). <a href="http://cat.inist.fr/?aModele=afficheN&cpsidt=1328851"><span class="Apple-style-span" style="color: yellow;">Self-Control, Morality, and Human Streng</span>th</a>, Journal of Social and Clinical Psychology, 19, 29-42.<br /><br />Buss, D. (2000). <a href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WY2-46T4CY0-5W&_user=10&_coverDate=01/31/2000&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1602240459&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=7d06e83ae5fafeacab32bc7b381d26f3&searchtype=a"><span class="Apple-style-span" style="color: yellow;">The Evolution of Happiness</span></a>. American Psychologist, 55, 15-23.<br /><br />Cairns-Descoteaux, B. (2005). The Journey to Resiliency: An Integrative Framework for Treatment for Victims and Survivors of Family Violence. Social Work & Christianity, 32(4), 305-320.<br /><br />Friesen, B. (2005). The Concept of Recovery: “Value Added” for the Children’s Mental Health Field?. Focal Point, 19(1), 5-8.<br /><br /><br />Lussier, I., Derevensky, J., Gupta, R., Bergevin, T., Ellenbogen, S. (2007). Youth Gambling Behaviors: An Examination of the Role of Resilience. Psychology of Addictive Behaviors, 21(2), 165-173.<br /><br />Luthans, F., Vogelgesang, G., Lester, P. (2006). <a href="http://hrd.sagepub.com/content/5/1/25.short"><span class="Apple-style-span" style="color: yellow;">Developing the Psychological Capital of Resiliency. Human Resource Development Review</span>,</a> 5(1), 25-44.<br /><br />Luthar, S., Zigler, E. (1991). Vulnerability and Competence: A Review of Research on Resilience in Childhood. American Journal of Orthopsychiatry, 61(1), 6-22.<br /><br />Myers, D. (2000).<a href="http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WY2-46T4CY0-61&_user=10&_coverDate=01/31/2000&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_searchStrId=1602300912&_rerunOrigin=scholar.google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=04289d75b5e552dfb6fe83f30f061a7a&searchtype=a"> <span class="Apple-style-span" style="color: yellow;">The Funds, Friends, and Faith of Happy People</span></a>. American Psychologist, 55, 56-67.<br /><br />Online Etymology Dictionary, 2008<br /><br />Richardson, G. (2002). The Metatheory of Resilience and Resiliency. Journal of Clinical Psychology, 58(3), 307-321.<br /><br />Simonton, D. (2000). Creativity. American Psychologist, 55, 151-158.<br />Ungar, M. (2004). A Constructionist Discourse On Resilience. Youth & Society, 35(3), 341-365.<br /><br />Werner, E. (2005). Resilience and Recovery: Findings From the Kauai Longitudinal Study. Focal Point, 19(1), 11-14.<br /><br />Werner, E., Smith, R. (1992). Overcoming the Odds: High Risk Children from Birth to Adulthood. Ithaca, NY: Cornell University Press.<br /><br /><div><br /></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-74412242616966841442010-11-09T13:21:00.000-08:002011-11-05T11:27:53.291-07:00Client Suicide and Clinician Response: Ensuring Policy Guidelines and Clinician Safety<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script>In looking at issue of suicide within mental health field, we know that a person who suffers from mental illness, is more likely to be at risk for suicide. According to the <a href="http://www.nmha.org/index.cfm?objectid=c7df901d-1372-4d20-c8265c5e278c11c0),"><span class="Apple-style-span" style="color: yellow;">Mental Health America website</span></a><span class="Apple-style-span" style="color: yellow;"> </span>of suicide victims suffer from major depression or bipolar (manic-depressive) disorder”. One aspect that doesn’t often get looked into, is how does suicide of a client affect the clinician that they work with? In working in mental health field, depending on setting and caseload, clinician’s often have fluctuating caseloads, and might lose a client to suicide, and then be required to have short turnaround in picking up a new client to replace them. In dealing with a population that might show higher risk of suicide, the question becomes, are we ensuring that clinician’s are protected by policies, have confidence in being able to assess suicidal behavior? An<a href="http://www.ncbi.nlm.nih.gov/pubmed/20822359"><span style="color: yellow;"> article</span></a> does a study on 172 therapists, 125 who are from private practice, and 47 from institutions, and tries to assess their responses to suicide from clients. The study finds that of these therapists, 85% from institutional setting and 17% from private practice had experienced at least one suicide in their professional careers. From this <a href="http://www.ncbi.nlm.nih.gov/pubmed/20822359"><span class="Apple-style-span" style="color: yellow;">article</span></a>, it appeared there was more of a propensity for clinicians from institutional settings to be more at risk for having experienced a client suicide. This would make sense in that institutional setting, clients would have more severe symptoms of mental illness, and in general, having to be institutionalized is a result of not being able to take care of one’s self, or possibly self harming behavior in the past.<br /><br />The same study found that for psychiatrists who had “less than 5 years of professional experience” reported significantly more feelings of “guilty, shocked and insufficient” at their job, after 6 months of the study, opposed to colleagues with more experience. This makes argument for importance of developing policies, as well as offering trainings to ensure new staff feel confident in assessing clients for suicidal risk. One of the main sources of distress, interestingly enough, was that of “fear of reaction of parent’s relatives” and that was found to be even higher than fear of a lawsuit in this study. This study also found that in dealing with client suicides, of the therapist responses, 80% reported being “supported by the institution” they worked for, 72.3% found some type of “conference” around grieving to be helpful, and 44% had reported wishing they had some type of “conference”. This data shows support for clinicians wanting to feel supported or protected by policy guidelines of institution, as well as some type of debriefing process to allow discussion of the client’s case. Of all the therapists involved in the study, “one third or 34.5% suffered from severe distress”, which the study did not find significant differences in gender, but were slightly more prevalent among women, and also the study pointed out distinction that with mild distress, usually over 6 months, symptoms lessened, but with severe distress, symptoms were persistent over this time. The study shows a prevalence of “severe distress” within clinician’s, which argues for being able to notice this within staff, as well as developing policies that ensure staff protection and confidence in being able to assess client’s for suicidal risk.<br /><br />Another <a href="http://books.google.com/books?id=UgOWO8IUqbIC&pg=PA137&lpg=PA137&dq=Oordt,Jobes,Fonseca,Schmidt&source=bl&ots=9Dr4PT33U6&sig=uWuGkHqX3LDT8uVPwpE3SASCCZI&hl=en&ei=arTZTLeUCIOBlAfU3sHbCQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBUQ6AEwAA#v=onepage&q=Oordt%2CJobes%2CFonseca%2CSchmidt&f=false"><span style="color: yellow;">article</span></a> was a study done within the United States Air Force and collected information from 74 of medical treatment facilities, to determine if trainings around suicide assessment, could impact clinician confidence, as well as impact policy or clinician ability to assess suicidal behavior. One argument that the article starts with is the fact that most clinician ability to do suicide assessment effectively, is dependent upon organizational policies, as well as clinician motivation to access literature on, or continuing education into this area. For instance, Bongar and Harmatz (as cited by Oordt et al. 2009) found that “only 40% of graduate programs in clinical psychology provided any formal training in clinical work with suicide patients”. In other words, even clinicians with advanced degrees in psychology or other mental health degrees, would have minimal exposure with how to work with suicide patients, which puts their ability to be effective on what they learn working in the field, putting further emphasis on training their employer offers, what program policies are around this, etc. Depending on what state this occurs, continuing education might not be required, and so this would put more emphasis on the clinician seeking out these trainings. The <a href="http://books.google.com/books?id=UgOWO8IUqbIC&pg=PA137&lpg=PA137&dq=Oordt,+Jobes,+Fonseca,+Schmidt&source=bl&ots=9Dr4QQ1306&sig=Kt9RyRinQprLat2yGXuzRUzImRM&hl=en&ei=Wr7aTK6HDsHflgelxN3aCQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBgQ6AEwAA#v=onepage&q=Oordt%2C%20Jobes%2C%20Fonseca%2C%20Schmidt&f=false"><span class="Apple-style-span" style="color: yellow;">article</span></a> offers a link to the <a href="http://afspp.afms.mil/"><span class="Apple-style-span" style="color: yellow;">Air Force website</span></a><span style="color: yellow;">,</span> which offers “18 recommendations for effective clinical work with suicidal patients”. Without continuing education, the article by Oordt et al. (2009) describes that clinical supervision would be primary source of setting guidelines for how to assess suicide risk. This requires that with good policies, supervisors could also feel confident in providing feedback to clinicians, as well as in clinicians being trained and having knowledge of what to do in these situations, wouldn’t need as much supervision. <br /><br />Going back to the <a href="http://books.google.com/books?id=UgOWO8IUqbIC&pg=PA137&lpg=PA137&dq=Oordt,Jobes,Fonseca,Schmidt&source=bl&ots=9Dr4PT33U6&sig=uWuGkHqX3LDT8uVPwpE3SASCCZI&hl=en&ei=arTZTLeUCIOBlAfU3sHbCQ&sa=X&oi=book_result&ct=result&resnum=1&ved=0CBUQ6AEwAA#v=onepage&q=Oordt%2CJobes%2CFonseca%2CSchmidt&f=false"><span style="color: yellow;">article</span></a>, the study used a 12 hour training session, with 4 hours spent on “suicide assessment”, 4 hours on “management and treatment of suicidal behavior” and 4 hours on “military specific practices, policies” around suicidal assessment. The goal of the study was to follow up on participants from the training and see if this impacted them, up to 6 months after the trainings. The study was made up primarily of 82 participants, 48% who were doctorate psychology clinicians, 27% doctoral social work majors, and 13% that were psychiatrists. Initially, of these participants, 43% reported “little or no formal trainings in graduate programs” around suicidal assessment, and 42% reported “little or no postgraduate or continuing education”. This information supports the findings that even with advanced degrees, clinicians don’t have much exposure to policies or guidelines around how to do suicide assessment? At the 6 month follow up, 44% of all participants reported “increased confidence in managing suicidal patients”, 83% “changing suicide practices”, and 66%, “changing clinical policy”, as a result of attending the trainings. The article also offers a 9 step guide to what trainings should look like, around suicidal assessment. This study was done specifically with the Air Force, but offers an example of support for giving clinician’s trainings around practice of suicide assessment, as well as making sure they have knowledge of what policies are and what is expected of them by organization, in doing suicide assessments.<br /><br />From these articles, we can see prevalence of “distress” amongst clinicians in having to deal with a client who has committed suicide. Oftentimes, as clinician’s, we feel sense of needing to be detached or be professional in dealing with our clients, and yet it is important to understand it is normal to experience some grief in losing a client to suicide, or other factors. What is important is knowing organizational policies, or ways in which we are expected to assess suicidal risk, as well as knowing resources available to aid us. As these articles point out, through trainings and continuing education, we can feel more confident, as well as develop better policies to deal with clients that display suicidal behaviors. Here are some lists of resources for info on defining policies around suicide assessment, as well as helpful tips for clinician being able to deal with loss of a client to suicide. <br /><span class="Apple-style-span" style="color: yellow;">M</span><a href="http://www.nmha.org/index.cfm?objectid=c7df901d-1372-4d20-c8265c5e278c11c0"><span class="Apple-style-span" style="color: yellow;">ental Health America (Suicide Info)</span></a><br /><a href="http://www.oas.samhsa.gov/violence.htm#Suicide"><span class="Apple-style-span" style="color: yellow;">SAMHSA (Statistics on Suicide Likelihood)</span></a><br /><a href="http://www.suicide.org/suicide-warning-signs.html"><span class="Apple-style-span" style="color: yellow;">Suicide.Org Non-Profit Organization (Warning Signs)</span></a><br /><a href="http://www.mayoclinic.com/health/suicide/MH00048"><span class="Apple-style-span" style="color: yellow;">Mayo Clinic Website (General Coping Skills for Losing Someone to Suicide</span></a><span class="Apple-style-span" style="color: yellow;">)</span><br /><br />Citations<br /><br />Oordt, M.S., D.A. Jobes, V.P. Fonseca, S.M. Schmidt (2009). “Training Mental Health Professionals to Assess and Manage Suicidal Behavior: Can Provider Confidence and Practice Behaviors Be Altered?” Suicide and Life-Threatening Behavior 39(1).<br /><br />Wurst, F.M., S. Mueller, S. Petitjean, S. Euler, S. Thon, G. Wiesbeck, M. Wolfersdorf (2010). “Patient Suicide: A Survey of Therapists’ Reactions”. Suicide and Life-Threatening Behavior 40(4).<br /><div><span class="Apple-style-span" style="font-family: inherit;">submitted by Jim Linderman. Jim is currently a M.A. student with University of Colorado-Denver Sociology Program.</span></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-45114366949911055492010-11-03T07:15:00.000-07:002011-11-05T11:27:53.324-07:00More about evidence based practices<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script>Last week we spoke about Evidence Based Practices (EBP) and how their use has helped create more effective interventions. However, we also mentioned that EBP are difficult to implement. We spoke about how part of the problem is that they can be costly and can go against what most people in the field are used to doing in their practice. This time, I want to explain why most times, these interventions are costly and difficult to move into real-world practice, not only because they may go against what the field is used to do, but also for some other practical reasons.<br />EBP are usually tested under very rigorous conditions: The most stringent criteria for calling something an Evidence-Based Practice requires the use of a randomized control trial approach. That means that participating individuals may be assigned to one of two (or maybe more) groups: One that receives the treatment or one that receives nothing. Now the justification for doing something like this is because we want to be able to demonstrate that the reason we see change after the treatment, is due to the treatment and not other reason (for example: just the passing of time or in some cases, due to some developmental reasons, when developmental changes make sense). Now, even in those conditions, there may be potential confounding variables that may affect the final outcome.<br />One of the biggest problems facing many treatments is the fact that many times, individuals show improvement just because they are told (or they believe) that they are receiving some wonder-therapy (or drug). This is so prevalent in clinical trials that people speak about the “<a href="http://www.scientificamerican.com/article.cfm?id=placebo-effect-a-cure-in-the-mind"><span class="Apple-style-span" style="color: yellow;">placebo effect</span></a>”. Therefore, a way to control for the potential effect of placebos is to include a treatment condition which is a placebo (when testing medications, people speak about “sugar pills”) or what may be considered the “normal treatment” (which sometimes is labeled as “business as usual”), where those who did not go into the treatment being tested are receiving the treatment that they might have received had there not been this treatment under testing. Placebo is a very powerful effect, and most of the therapies that sometimes are advertised on TV may work, because of this effect (quiz: how many times have you seen in those late TV ads a comparison group? Or comparisons against a placebo control?).<br />There are multiple ways to try to prove that a specific intervention is working, but as explained, most people tend to agree that the best approach is to use what is known as the “gold standard” or random assignment to different clinical conditions. The reason random assignment is considered the “gold standard” is that for the most part, it balances out many variables that could potentially affect the outcomes in unexpected ways. Things like age, gender, ethnicity, length of time with the illness, type of treatments received in the past and so forth. How will random assignment control for all of that? Because every individual with any potential combination of these variables has the chance of being assigned to one of the treatments in the study. Therefore, it is expected that individuals with many if not all the potential combinations that may affect the final outcomes end up in one of the groups in the study, and therefore the effect of all those variables cancels out.<br />All this dancing is so scientists and the public in general can make informed decisions about the effectiveness of a treatment (i.e., are my outcomes better when I use treatment “A” as opposed to treatment “B”), as well as being able to generalize to a larger group of people than those included in the study. After all, if you were not included in the study, what good will it do to you to know that a program may work if you are not sure that the treatment will work in people like you?<br />Doing this work means time and money. People involved in testing the treatment needs to conduct multiple studies so they can get some assurance that the results are sound and can withstand multiple tests, under different conditions. They also need to be closely monitored so researchers can be alert if something is not going well. If the new treatment under scrutiny has the potential for being harmful, then they may want to stop the study before too long. On the other hand, if the results are going very well, perhaps it is time to stop the study with confidence that the new treatment will work as expected (though when treating human lives, you don’t want to take any chances).<br /> There are multiple institutions that have created databases where evidence for or against Evidence Based Practices can be found. <a href="http://www.samhsa.gov/ebpWebguide/appendixB_Health_Disorders.asp"><span class="Apple-style-span" style="color: yellow;">The Substance Abuse and Mental Health Services Administration (SAMHSA)</span></a> maintains a website with links to several organizations where such information can be found.<br />Creating and documenting the effectiveness of a specific intervention is not enough. In a country as diverse as the U.S., there are many instances where an intervention that has been proven to work for a specific group of people (say African American), may not necessarily work for another ethnic group (e.g., Latino). The reasons can be associated with genetic makeup as well as with ethnic background (customs and traditions, for example, can be a big impulse or deterrent for some interventions). Therefore sometimes interventions that have been proven to work in an ethnic group (or in a research setting) need to be tested under different conditions (e.g., a different ethnic group or on a community-based environment). This is no easy task, which once more affects how quickly an intervention can be used outside the testing grounds.<br />This is a very active area of research which is known as validity. People speak about internal or external validity, and if you ever took a “research methods” class in college, then you may recognize many of these ideas or even terms. One book that describes the rationale an many specific examples is <a href="http://www.amazon.com/Experimental-Quasi-Experimental-Designs-Generalized-Inference/dp/0395615569/ref=sr_1_1?ie=UTF8&qid=1288645429&sr=8-1"> <span class="Apple-style-span" style="color: yellow;">Shadish, Cook and Campbel</span></a><span class="Apple-style-span" style="color: yellow;">l</span>. However, be warned that this book can be hard to read without some introduction to research methods<br />One final note: Evidence Based Practices are the top of the pyramid, but there are some interventions/programs that have not been able to prove their worth using the most restrictive criteria (the gold standard) and yet are considered worth more research.<br />A ‘Promising model/practice’ is defined as “one with at least preliminary evidence of effectiveness in small-scale interventions or for which there is potential for generating data that will be useful for making decisions about taking the intervention to scale and generalizing the results to diverse populations and settings.” <a href="http://edocket.access.gpo.gov/2003/pdf/03-17395.pdf"><span class="Apple-style-span" style="color: yellow;">Department of Health and Human Services Administration for Children and Families Program Announcement. Federal Register, Vol. 68, No. 131, (July 2003), p. 40974</span></a>. These are interventions where some initial testing has been done, and the outcomes observed so far seem to indicate that the intervention may be effective. However, more and more strict testing is needed to endorse it as an EBP.<br />Emerging practices, on the other hand, are “practices that have very specific approaches to problems or ways of working with particular people that receive high marks from consumers and/or clinicians but which are too new or used by too few practitioners to have received general, much less scientific attention.” We took this definition from the <a href="http://www.occmha.org/index.php?option=com_content&view=article&id=117:definition-of-best-practices&catid=47:projects&Itemid=177"><span class="Apple-style-span" style="color: yellow;">Oakland County Community mental health authority</span></a>. In this case, it is argued just like in the case of the promising practices, that the intervention being described has produced effective outcomes, but much more testing is still necessary.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-36116640639965634902010-10-25T13:58:00.000-07:002011-11-05T11:27:53.349-07:00Evidence based practices<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script>Currently, one of the most important areas in healthcare is accountability. As part of this movement toward accountability, the mental healthcare industry and their stakeholders tend to talk about <span style="color: white;">Evidence Based Practices</span> (EBP) as a way to link programs to desirable outcomes.<br />Evidence based practices can be found in multiple areas: from Education to Mental Health. And within mental health you can find them from medication (<a href="http://www.nri-inc.org/projects/CMHQA/EBPDocs/EBP2006ConfKY28noon.pdf"><span style="color: yellow;">Kentucky Medication Algorithm;</span></a> and <a href="http://www.actassociation.org/"><span style="color: yellow;">Texas Medication Algorithm</span></a> where the main goal is to use the medication that will create the best outcomes), to specific interventions or programs like <a href="http://www.actassociation.org/"><span style="color: yellow;">Assertive Community Treatment</span></a> (ACT) in adult individuals and <a href="http://www.mstservices.com/"><span style="color: yellow;">Multi-systemic Therapy</span></a> (MST) for youngsters; to specific illnesses like <a href="http://www.medscape.com/viewarticle/706936"><span style="color: yellow;">Schizophrenia</span></a> and <a href="http://www.mentalhealth.com/rx2/bp-can1.html"><span style="color: yellow;">Bipolar disorder</span></a>. Furthermore, the Substance Agency (SAMHSA) which supports most substance abuse and mental health funding at the Federal level, maintains and supports through funding multiple studies to determine and encourage the use of EBP throughout the country (go here to see what <a href="http://www.samhsa.gov/ebpwebguide/index.asp"><span style="color: yellow;">SAMHSA</span></a> endorses) Professional organizations like the <a href="http://search.apa.org/search?query=evidence%20based%20practice%20in%20mental%20health"><span style="color: yellow;">American Psychological Association</span></a>, the <a href="http://www.psych.org/MainMenu/Research/PracticeResearchNetworkandHealthServicesResearch/PostersPresentationsandNewsletters/PRNDatagrams/SchizophreniaFamilyBrochure.aspx"><span style="color: yellow;">American Psychiatric Association</span></a>, as well as organizations for <a href="http://www.otseeker.com/resources/default.asp#5"><span style="color: yellow;">Occupational Therapy</span></a>, <a href="https://netforum.avectra.com/eWeb/DynamicPage.aspx?Site=USPRA&WebCode=psyrpractices"><span style="color: yellow;">Psychiatric Rehabilitation</span></a>, <a href="http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No2May07/HirshInstituteArticle/ReviewofPsychiatricNursingInterventionStudies.aspx"><span style="color: yellow;">Nursing</span> </a>, etcetera, endorse the use of EBP with their members. Insurance providers, Federal funded entities like the <a href="http://grants.nih.gov/grants/guide/search_results.htm?text_curr=EBP&Search_Guide.x=0&Search_Guide.y=0&scope=pa-rfa&year=active&sort="><span style="color: yellow;">National Institute of Health</span></a> and Consumer advocacy groups like <a href="http://www.nami.org/Template.cfm?Section=Fact_Sheets1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=63974"><span style="color: yellow;">NAMI</span> </a> fund or endorse <a href="http://www.nami.org/Template.cfm?Section=Fact_Sheets1&Template=/ContentManagement/ContentDisplay.cfm&ContentID=63974"><span style="color: yellow;">Evidence Based Practices</span></a>. In fact, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2008.01020.x/abstract"><span style="color: yellow;">Tanenbaum</span></a> 2008 states that “EBP is a matter of mental health policy in USA” (page 699). <br />So what is the big deal about EBP? Why would we want to use EBP rather than other practices that are not considered EBP’s? The main reason has to do with the definition of EBP, and the rationale for the creation of EBP. There are multiple definitions for <span style="color: white;">Evidence Based Practices</span> (<a href="http://en.wikipedia.org/wiki/Evidence-based_practice"><span style="color: yellow;">this is one</span></a>); but most of them speak about interventions that are backed by empirical or scientific research. What that means for the individual on the receiving end is the certainty that what is being used is scientifically sound, and not just some unproven therapy, or, even worse, some form of quackery that will not deliver the expected outcomes on a regular basis.<br />If EBPs are the best thing since sliced bread, then why is there resistance to implement them? There are several issues associated with the implementation of EBP. One is related to the level of information regarding EBPs (who knows about them and how much). Evidence about consumers knowing or participating in decisions regarding services (in this case, EBP services) is usually limited. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2753.2008.01020.x/abstract"><span style="color: yellow;">Tanenbaum</span></a>, for example, found out that though consumers may be willing to use EBP, they are rarely consulted about the services they received (the decision is not up to them).<br />Another area is the science to service gap associated with research. There are multiple numbers being tossed around, but <a href="http://ps.psychiatryonline.org/cgi/content/full/56/5/543"><span style="color: yellow;">Druss</span></a> 2005 speaks about a twenty year gap between scientific research and implementation in an <span style="color: white;">applied setting</span>. In that regard entities like SAMHSA are doing the best to help move research to practice. For example, SAMHSA instituted an award for centers that do their best to bridge that gap (MHCD received this <span style="color: white;">award</span> in 2009 for its <a href="http://www.samhsa.gov/scienceandservice/cod2009.aspx"><span style="color: yellow;">Growth and Recovery Opportunities for Women</span></a> (GROW) program). <br />Finally, there is also resistance from providers to implement EBP for multiple reasons: From need for new training, to expense, to the importance of fidelity to the model. <br />• Regarding training, most EBP require that clinical people learn new techniques, or ways to do things that seem to be counterintuitive to what is known or has been practiced for many years. As an example, of new implementations for trauma-oriented for women survivors of trauma, the <a href="http://www.ncstac.org/index.php?option=com_content&view=article&id=83:trauma-recovery-and-empowerment-model-trem&catid=38&Itemid=56)"><span style="color: yellow;">Trauma Recovery and Empowerment Model</span></a> TREM; uses an approach where abuse is not seen as “the primary problem”. <br />• Regarding expense, many of these interventions require very extensive training, or require special certifications to be used. This not only means expense in terms of training and materials, but also certifications; not many centers can afford such implementations. <br />• Finally, most of these models have been created in research settings, under very controlled situations, and they have been proven to work –mostly-- under those circumstances. Therefore, the model creators will require that you “follow the model” with fidelity. For example, clinicians may have to be on call on a 24 hours/7 days a week schedule; or the ratio of clinician to individuals receiving services is 1-10. And if you do not follow the model within some specific bounds (determined by instruments created by the model designers), then the center or clinicians doing the implementation are formally not using the model, or will not be endorsed by the model developer.<br />Why then try to use Evidence based practices? The short answer is because they have been proven to work in most situations. That is, the expected outcomes are met as described by the model. For example, youth receiving Multi-Systemic Therapy (MST) will stay at home (rather than at out-of-home-placements), stay in school, reduce the number of arrests, and reduce psychiatric symptoms and substance/alcohol use. Therefore, most people figure that the cost, extra training, continuing certification is worth the hassle. But the field is new, and sometimes it is not clear whether all the program components work as intended, or whether the model really works as intended outside the –most times-- very restrictive conditions imposed by the program developers. This is a new field, and new evidence is mounting every day that speaks in favor or against what we know about EBP. We’ll have more to say about this area in future blogs.Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-1162675945259019712010-10-14T13:14:00.000-07:002011-11-05T11:27:53.379-07:00Mindfulness and Psychotherapy<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script><span style="background-color: black;"><span class="Apple-style-span" style="color: white;">The practice of mindfulness is a practice that is finding increased attention in the application of psychotherapy. What exactly is mindfulness as it relates to psychotherapy? </span></span><span style="background-color: black; color: white;">The term mindfulness comes from the word sati, taken from the Buddhist tradition of meditation and psychology. This word suggests awareness, attention and remembering. According to<a href="http://www.healthgrades.com/health-professionals-directory/ronald-siegel-psyd-5b699fd5"> <span style="color: yellow;">Dr. Ronald Siegel, Psy.D, Assistant Clinical Professor of Psychology</span></a> at the Harvard Medical School, mindfulness as it relates to psychotherapy is assisting a person to learn to cultivate a practice of awareness of a present emotional experience. In the book co-edited by <span style="color: yellow;">Dr. Siegel (2005), </span><a href="http://www.wisdom-books.com/ProductDetail.asp?PID=20817"><span style="color: yellow;">Mindfulness and Psychotherapy</span></a><span style="color: yellow;">, New York: Guilford Press,</span> Dr. Siegel suggests that it is also very important that the person is able to practice acceptance of that emotional state as it arises. As used in psychotherapy, mindfulness is a practice that systematically teaches the patient how to accept their emotional experience. This is similar to the use of mindfulness in Marsha Linehan’s Zen-inspired dialectical behavior therapy (DBT). <span style="color: yellow;">Linehan, M. (1993).</span><a href="http://www.amazon.com/Cognitive-Behavioral-Treatment-Borderline-Personality-Disorder/dp/0898621836/ref=sr_1_2?s=books&ie=UTF8&qid=1287072733&sr=1-2"><span style="color: yellow;"> Cognitive-behavioral Treatment of Borderline Personality Disorder</span></a><span style="color: yellow;">. New York: Guilford Press</span>. As emphasized in DBT, emotions can become overwhelming, and this may impact one’s behaviors and thoughts in a negative or destructive manner. Mindfulness as utilized in dialectical behavioral therapy attempts to break this pattern by helping the patient better manage these emotions.</span><br /><span style="background-color: black; color: white;"> </span><span style="background-color: black; color: white;">While mindfulness has most often been related to Buddhist or religious/contemplative practices, mindfulness is now also being integrated into what we might call the more traditional forms of psychotherapy as what is now being called the third wave in behavior therapy. The first wave was Operant and Classical Conditioning and the second one is Cognitive Behavioral Therapy. The third wave now incorporates mindfulness into the well know evidence based practice of <a href="http://www.amazon.com/Cognitive-Behavioral-Treatment-Borderline-Personality-Disorder/dp/0898621836/ref=sr_1_2?s=books&ie=UTF8&qid=1287072733&sr=1-2"><span style="color: yellow;">Cognitive Behavioral Therapy as Mindfulness-Based Cognitive Therapy</span></a>, (MBCT).</span><br /><span style="background-color: black; color: white;"> Mindfulness-based cognitive therapy was developed by <span style="color: yellow;">Zindel Segal, Mark Williams and John Teasdale (2001), </span><a href="http://www.amazon.com/Mindfulness-Based-Cognitive-Therapy-Depression-Preventing/dp/1572307064"><span style="color: yellow;">Mindfulness-Based Cognitive Therapy for Depression: a New Approach to Preventing Relapse, New York: Guilford Press</span></a>. Their work was largely influenced by the work of Jon Kabat-Zin whose work was discussed in a previous article found on this <a href="http://mhcdresearchinstitute.blogspot.com/2010/09/mindfulness-and-mental-health.html"><span style="color: yellow;">blog site</span></a> regarding the work of Kabat-Zin and the development of the <a href="http://www.umassmed.edu/cfm/index.aspx"><span style="color: yellow;">Mindfulness-Based Stress Reduction Program at the University of Massachusetts Stress Reduction Center</span></a>.</span><br /><span style="background-color: black; color: white;">Mindfulness-based cognitive therapy is a blend of cognitive behavioral therapy (CBT) which focuses on changing our thoughts in order to change our behaviors, and the meditative practice of mindfulness, a process of identifying our thoughts on a moment-to-moment basis while trying not to pass judgment on them and experience them with acceptance as suggested by Dr. Ronald Siegel. While cognitive behavioral therapy has always emphasized the end result of change of one’s thoughts, mindfulness really looks at how a person thinks — the process of thinking — to help one be more effective in changing negative thoughts. What does some current research suggest about the effectiveness of this newer form of psychotherapy? <br />Coelho et. al. looked at research about mindfulness-based cognitive therapy and found four relevant studies that examined the effectiveness of this approach. <span style="color: yellow;">Coelho, H.F. (2007). </span><a href="http://psycnet.apa.org/journals/ccp/75/6/1000/"><span style="color: yellow;">Mindfulness-based cognitive therapy: evaluating current evidence and informing future research</span></a><span style="color: yellow;">. J Consult Clin Psychol., 75(6):1000-5</span>.<br />The current evidence from the randomized trials suggests that, for patients with 3 or more previous depressive episodes, MBCT has an additive benefit to usual care. It is important to note here that MBCT is designed to help people who suffer from repeated bouts of depression. Coelho found however, because of the nature of the control groups, these findings cannot be attributed to MBCT-specific effects. The researchers did suggest that MBCT has found some positive results for those with a more chronic depression but they could not say that this was as a result of specifically MBCT alone. <br />It is clear that there is an ever increasing mindfulness oriented model of psychotherapy. Treatment strategies can be derived from the basic elements of mindfulness – awareness of present experience, with acceptance. A review of the empirical literature by Baer <span style="color: yellow;">(2003); Baer,R. , </span><a href="http://onlinelibrary.wiley.com/doi/10.1093/clipsy.bpg015/abstract"><span style="color: yellow;">Mindfulness training as a clinical intervention</span></a><span style="color: yellow;">: A conceptual and empirical review. Clinical Psychology: Science and Practice, 10(2), 125-142</span>, suggests that mindfulness based treatments are “probably efficacious” and en route to becoming “well established”. <br />The possible emerging model of mindfulness as integrated into psychotherapy can be seen to have promise in many areas of psychology and psychotherapy and has indeed become well established. Similarly empirical research in this area has seen a significant increase. In 2003 at the time of the review by Baer, there were several hundred empirical research articles on mindfulness and psychotherapy and now, 2010, one can find several thousand. Mindfulness is beginning to move into other areas such as brain science, health/medical psychology and positive psychology. It seems that the clinical literature is promising and psychologists and mental health clinicians have the opportunity to integrate a form of mental practice that is based on a 2,000 year old contemplative practice of bringing the mind to the present state, experiencing this state and accepting this state. </span><span style="background-color: black; color: white;">Additional Resources<br /><a href="http://www.umassmed.edu/cfm/index.aspx"><span style="color: yellow;">University of Massachusetts Medical School, Center for Mindfulness and Medicine</span></a> </span><br /><a href="http://www.nicabm.com/"><span style="background-color: black; color: yellow;">www.NICABM.com</span></a><span style="background-color: black; color: white;"> </span><span style="background-color: black; color: white;"><br /><a href="http://www.amazon.com/Mindfulness-Solution-Everyday-Practices-Problems/dp/1606232940"><span style="color: yellow;">Dr. Ronald Siegel, (2010), The Mindfulness Solution: Everyday Practices for Everyday Problems, New York: Guilford Press</span></a></span><br /><span style="background-color: black; color: white;">By Marcia Middel, Ph.D.</span><br /><span style="background-color: black; color: white;">Dr. Middel is the chief psychologist at the <a href="http://www.mhcd.org/"><span style="color: yellow;">Mental Health Center of Denver</span></a></span><span style="background-color: black; color: white;">. She is also the Director of the <a href="http://www.mhcd.org/CIPS.html"><span style="color: yellow;">Center for Integrated Psychological Services</span></a> (<a href="http://www.mhcd.org/CIPS.html"><span style="color: white;">CIPS</span></a>)</span><span style="background-color: black; color: white;"> and team associate with MHCD <a href="http://www.outcomesmhcd.com/TeamAssociates.htm"><span style="color: yellow;">Evaluation and Research team</span></a> </span><br /><span style="background-color: black; color: white;"> </span>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-34428870836570262862010-10-07T09:02:00.000-07:002011-11-05T11:27:53.480-07:00Our Role in Preventing Suicide…<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script><div class="MsoNormal" style="margin: 0in 0in 0pt; text-indent: 0.5in;">With the recent untimely death of Broncos WR Kenny McKinley and tragic loss of several college youth across the nation this question has been thrust into our community’s collective conscious. Sadly, suicide has become an all too common occurrence within our society, while at the same time remaining a rather taboo subject for our own interpersonal relationships. Despite our frequent reluctance to discuss this issue with those that we care about, there are vey few of us who have not had our lives directly touched by suicide, whether through a child, parent, sibling, relative, neighbor, coworker, or acquaintance. We’re often left with lingering existential questions that challenge our own sense of meaning in life... <i style="mso-bidi-font-style: normal;">Why? How could someone with seemingly so much going for them take their own life? What could lead a person to believe that suicide was an option in their situation? What could I have done differently or how could I have known this was going to happen?</i> Perhaps the most important question we can ask ourselves, as we seek to move forward and create meaning from such a seemingly senseless act, is <i style="mso-bidi-font-style: normal;">what can we do to reach out to those still suffering in silence to help prevent suicide from taking another life?</i> Through this brief post I hope to review current research to provide some context to the national suicide epidemic, dispel some myths about suicide, and empower you with some tools and resources to make a positive impact on the struggle against suicide.<state w:st="on"><place w:st="on">Colorado</place></state> consistently has one of the highest suicide rates in the nation, with suicide representing the 7<sup>th</sup> leading cause of death across all age groups and the 2<sup>nd</sup> leading cause of death for young people ages 10-34. Just last year <state w:st="on"><place w:st="on">Colorado</place></state> had its most deaths by suicide on record at 940. Nationally, death by suicide claimed the lives of 34,598 people in 2007. It is estimated that another 11 suicide attempts occur for every 1 death by suicide. These are staggering and heartbreaking statistics that highlight the all too prevalent nature of suicide within our nation and immediate community. For more information on some of the national suicide statistics you can visit the <a href="http://www.nimh.nih.gov/health/publications/suicide-in-the-us-statistics-and-prevention/index.shtml"><span style="color: blue;"><span style="color: yellow;">National Institute of Mental </span></span><span style="color: yellow;">Health (NIMH)</span></a> or see the <a href="http://www.cdphe.state.co.us/pp/suicide/SuicideReport.pdf"><span style="color: yellow;">Suici</span><span style="color: yellow;">de in Colorado</span></a> report for information specific to this State.</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"> Given the widespread nature of suicide within our communities, one might think that this issue would be a more frequent topic of conversation and routine preventative effort by nearly all people. Unfortunately, some of the myths and stigma surrounding suicide has prevented this from becoming the case and we all too rarely openly discuss or ask about suicide until the topic has been thrust before us by the loss of someone we love or a prominent public figure. By then it’s already too late. Our own fears, assumptions, and false beliefs about suicide often get in the way of reaching out to those in need around us. </div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l1 level1 lfo2; tab-stops: list .5in;"><i style="mso-bidi-font-style: normal;">How can I possibly say anything that might be helpful to someone considering suicide?</i> People contemplating suicide are just like you and me. We have all been through some difficulty in our own lives and share a common humanity which gives us the capacity to help someone who is depressed or thinking of taking their own life. </li><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l1 level1 lfo2; tab-stops: list .5in;"><i style="mso-bidi-font-style: normal;">If I say anything it might make the person upset or give them an idea that makes them more likely to hurt themselves</i>. This is actually the opposite of what research has found to be true. Being direct with someone about suicide generally lowers their anxiety and sense of isolation that has been created by the stigma surrounding suicide. By opening a line of communication we can cue in to any warning signs and decrease the risk of an impulsive act. Additionally, if you’re worried that someone you know might be considering suicide, it’s nearly a guarantee that they’ve already at least thought about this themselves. </li><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l1 level1 lfo2; tab-stops: list .5in;"><i style="mso-bidi-font-style: normal;">People who consider suicide keep their plans to themselves</i>. This is another common misperception that has been debunked by the literature. Psychological autopsies on those who have completed suicide found that approximately 95% of these individuals had in some way communicated their suicidal intent. </li><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l1 level1 lfo2; tab-stops: list .5in;"><i style="mso-bidi-font-style: normal;">People who talk or joke about suicide don’t actually do it</i>. As previously highlighted, nearly all people who attempt suicide convey their intentions in some way. Increased talking about death or suicide is a frequently evident precursor in individuals who try to take their own life. </li><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l1 level1 lfo2; tab-stops: list .5in;"><i style="mso-bidi-font-style: normal;">Once people make up their mind to complete suicide there’s no way to stop them</i>. Most people have conflicting feelings about suicide and are generally ambivalent about their decision to complete the act. Interviews with <place w:st="on"><placename w:st="on">Golden Gate</placename> <placetype w:st="on">Bridge</placetype></place> survivors indicated that one of the most common thoughts that entered their minds after jumping from the bridge was “I wish I hadn’t done it.” This is also why the vast majority of people convey their intentions in some form or another before performing a suicidal act. People generally want help but don’t know how to ask. Suicide is the most preventable cause of death and any positive action you take may save a life.</li></ul><div class="MsoNormal" style="margin: 0in 0in 0pt;"> I know how incredibly difficult it can be to break the circle of silence surrounding suicide. I live with my own painful reminder of how I was unable to do just that with an acquaintance during my sophomore year of college. However, as I’ve learned to break that silence and reach out to those in both my personal and professional lives (as both a crisis helpline worker and therapist) I’ve come to appreciate the incredible power of a simple question or gesture of support to someone contemplating suicide. Whether a person is actually considering suicide or not, the mere act of asking a question offers a tremendous opportunity to create a profoundly meaningful connection with another person that you may find not only has a significant impact on that person’s life but on yours as well.</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"> So what can we do to help? Everyone can play an important role in suicide prevention by being mindful of several simple things and being willing to reach out to others whenever warning signs arise. Moreover, we can all work together to help break the silence and lower the social stigma surrounding suicide. </div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l0 level1 lfo3; tab-stops: list .5in;">Be attuned to any suicide cues or warning signs in those around you. Listen for direct verbal cues (e.g. <i style="mso-bidi-font-style: normal;">I wish I were dead, I’m going to kill myself, I’m going to end it all</i>) and indirect verbal cues (e.g. <i style="mso-bidi-font-style: normal;">I’m tired of life, You won’t have to worry about me much longer, You’d be better off without me anyway, I just want out of it all</i>). </li><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l0 level1 lfo3; tab-stops: list .5in;">Be on the lookout for behavioral cues (e.g. previous suicide attempts, giving away possessions, sudden disengagement, making arrangements for an absence, acquiring a weapon, storing large quantities of pills). Symptoms of depression and drug/alcohol abuse are present in approximately 90% of instances of suicide. </li><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l0 level1 lfo3; tab-stops: list .5in;">Also, be mindful of times in which previously depressed individuals seem to be getting better or have an increased level of energy as they may now feel as though they have the resources to carry out the act they have been thinking about for so long. Moreover, as counterintuitive as it may sound, the hours preceding an attempt may involve an air of happiness or calm as the person has resigned themselves to death. </li><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l0 level1 lfo3; tab-stops: list .5in;">Check-in with people following any major life changes that may represent a situational cue for suicide (e.g. loss of job, end of a significant relationship, death of a family member or friend, difficulties at school, serious medical condition).</li></ul><div class="MsoNormal" style="margin: 0in 0in 0pt;"> Whenever you have any concerns the most important thing you can do is simply ask if someone is considering suicide, or if you’re unable to then find someone who can. Ask the question and then listen. Listen without judging and then ask if you can help them get connected with resources to help. For additional information on suicide and how you can help people struggling with this issue checkout the <span style="color: yellow;">National Suicide </span><a href="http://www.suicidepreventionlifeline.org/"><span style="color: yellow;">Prevention Lifeline</span></a> and the <a href="http://www.sprc.org/stateinformation/statepages/showstate.asp?stateID=6"><span style="color: yellow;">Suicide Prevention Resource Center</span></a>.</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br /></div><div class="MsoNormal" style="margin: 0in 0in 0pt;">By Scott Nebel, Psy.D.</div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin: 0in 0in 0pt; mso-list: l2 level1 lfo1; tab-stops: list .5in;">Scott is a Psychologist on MHCD’s Intensive In-Home Treatment Team and collaborates with the MHCD Research Institute.</li></ul><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br /></div><div class="MsoNormal" style="margin: 0in 0in 0pt;">Books on Suicide and Depression:</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><a href="http://www.qprinstitute.com/Foreverweb.htm"><span style="color: yellow;">Suicide: The Forever Decision</span></a> by Paul Quinett</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><a href="http://books.google.com/books?id=jDVJXC8InxUC&dq=darkness+visible+william+styron&source=bl&ots=_LMfjCUCpD&sig=4I4uKr3kMZw_iNtfv8J9aS5NLNY&hl=en&ei=CVSmTKGZMMP88Aam5-33AQ&sa=X&oi=book_result&ct=result&resnum=5&sqi=2&ved=0CCYQ6AEwBA"><span style="color: yellow;">Darkness Visible</span></a> by William Styron</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><a href="http://books.google.com/books?id=zdlrAAAAMAAJ&q=Kay+Redfield+Jamison&dq=Kay+Redfield+Jamison&hl=en&ei=fVSmTJb9DsO78gaOwcmWDw&sa=X&oi=book_result&ct=result&resnum=2&ved=0CDcQ6AEwAQ"><span style="color: yellow;">Night Falls Fast</span></a> by Kay Redfield Jamison</div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br /></div><div class="MsoNormal" style="margin: 0in 0in 0pt;"><br /></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-19401078965141804192010-09-30T10:41:00.000-07:002011-11-05T11:27:53.582-07:00Mindfulness and Mental Health<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script><div class="MsoNormal" style="margin-bottom: 0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; text-indent: 0.5in;"><span class="Apple-style-span" style="line-height: 200%;">Psychotherapy and spirituality have mingled with one another since the early development of talk therapy. Early psychotherapists relied on their philosophical and spiritual beliefs as they worked towards an understanding of the soul, the spirit and the self. With the development of more concrete therapeutic techniques, the use of religion and spirituality in psychotherapy has fallen out of favor (especially with the growing interest in evidence-based practice). One exception to this is the major influence that meditation has had on modern day psychotherapy. Meditation has been a part of many different religious traditions (e.g., Hinduism, Taoism); however, I believe that most of us associate it with Buddhism. As a beginning point for my research, I conducted an online search using only the term “Mindfulness”. The results pointed to Jon Kabat-Zinn, a physician who has dedicated his career to highlighting the benefits of the use of meditation in health care. The results also helped to clarify the definition of the term “mindfulness” as a reference to the therapeutic application of meditation. This helps in understanding the interchangeable relationship between the terms meditation and mindfulness.</span></div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt; text-indent: 0.5in;">Understanding the use and benefits of mindfulness required more in-depth research, much of which lead to resources rather than answers. For example, Dr. Daniel Seigel has written several books on the process of incorporating mindfulness based practice with psychotherapy: <i style="mso-bidi-font-style: normal;"><a href="http://drdansiegel.com/?page=books&sub=mindsight"><span style="color: yellow;">Mindsight</span></a></i> and <i style="mso-bidi-font-style: normal;"><a href="http://drdansiegel.com/?page=books&sub=the_mindful_brain"><span style="color: yellow;">The Mindful Brain</span></a></i>.<br /><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt;">Jon Kabat-Zinn, mentioned earlier, has written extensively on the use of mindfulness in reducing stress and anxiety. His books include: <a href="http://www.mindfulnesscds.com/books.html"><span style="color: yellow;"><i style="mso-bidi-font-style: normal;">Full</i> <i style="mso-bidi-font-style: normal;">Catastrophe Living, The mindful Waythrough Depression</i></span></a>, and <i style="mso-bidi-font-style: normal;"><a href="http://www.mindfulnesscds.com/books.html"><span style="color: yellow;">Wherever You Go, There You Are</span></a></i>. </div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt; text-indent: 0.5in;">Common to both these authors is their emphasis on the relationship between mind and body. Many who practice mindfulness in psychotherapy believe that awareness of the self in the present moment (including past repressed emotions and memories) is the pathway towards successful living. Through mindfulness, a clinician can help a client move away from the avoidance strategies implemented in the past. The goal, in this type of therapy, is to help a client gain awareness of the self by understanding and processing feelings throughout the body – notably while processing painful affect and memories. In essence, mindfulness is the opposite of mindlessness. This idea is rooted in the belief that negative emotions need to be processed before an individual can move towards successful living. </div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt; text-indent: 0.5in;">Now to the ultimate question, “Does Mindfulness Work?” For this question I moved away from “Google” research and utilized other resources (e.g., PsychInfo and PsychArticles databases). The results led to many articles with only a few catching my attention. For instance, an article titled “<a href="http://www.ncbi.nlm.nih.gov/pubmed/20350028"><span style="color: yellow;">The Effect of Mindfulness-Based Therapy on Anxiety and Depression: A Meta-Analytic Review</span></a><i style="mso-bidi-font-style: normal;">”</i> reviewed 39 studies with participants receiving mindfulness-based therapy for a range of conditions (i.e., cancer, generalized anxiety disorder, depression, and other psychiatric or medical conditions). The researchers found that mindfulness-based therapy was moderately effective for improving anxiety and mood symptoms, concluding that mindfulness-based therapy is a promising intervention for treating anxiety and mood problems in clinical populations. It is important to note that this study is a summary of 39 other studies on the topic of mindfulness. This is a convenient way of capturing a wide-range snapshot of the available research.</div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt; text-indent: 0.5in;">A study titled “Mindfulness-Based Stress Reduction and Health Benefits: A Meta-Analysis” concluded that Mindfulness-Based Stress Reduction (MBSR, “…a structured group program the employs mindfulness meditation to alleviate suffering associated with physical, psychosomatic and psychiatric disorders…”) may help a broad range of individuals to cope with their clinical and nonclinical problems. Finally, a study titled “The Effects of Mindfulness-Based Stress Reduction Therapy on Mental Health of Adults with a Chronic Medical Disease: A Meta-Analysis” concluded that the same intervention (MBSR) has small effects on depression, anxiety and psychological distress in people with chronic somatic diseases. They add that integrating MBSR in behavior therapy may enhance the efficacy of mindfulness based interventions. Here below is a link to the first <a href="http://www.psychosomatik-basel.ch/deutsch/publikationen/pdf/grossman_mindfulness_psychosom_res_2004.pdf"><span style="color: yellow;">MBSR</span></a> article and an abstract of the second MBSR<span style="color: yellow;"> </span><a href="http://www.psychologie-aktuell.info/reha/2010/01/the-effects-of-mindfulness-based-stress-reduction-therapy-on-mental-health-of-adults-with-a-chronic-medical-disease-a-meta-analysis/"><span style="color: yellow;">article</span></a>: </div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt; text-indent: 0.5in;">So, back to the question “Does mindfulness work?” In my opinion, the answer is that it does work, however (like all other interventions/techniques), not across all populations, conditions or contexts. Current research is primarily focused on understanding which populations, conditions and contexts would benefit most from mindfulness. The first meta-analysis covered above showed that the use of mindfulness is moderately effective while the following two studies resulted in less positive findings (e.g., “may help…” and “…has small effects…”). I think this speaks to the need for a more detailed understanding of mindfulness as a technique in psychotherapy. For instance, it may be the case that mindfulness successfully compliments certain traditional forms of psychotherapy while conflicting negatively with others. It may also be the case that mindfulness fits well when it comes to certain psychological/psychiatric conditions but not others. For now, it does seem that mindfulness based psychotherapy is a useful practice for addressing general anxiety and depression. </div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt; text-indent: 0.5in;">By Ous Badwan</div><div class="MsoNormal" style="line-height: 200%; margin: 0in 0in 0pt; text-indent: 0.5in;">Ous is a Psy.D. Student from the <a href="http://www.du.edu/gspp/degree-programs/clinical-psychology/application.html"><span style="color: yellow;"><place w:st="on"><placetype w:st="on">University</placetype> of <placename w:st="on">Denver</placename></place>’s Counseling Psychology</span></a> program currently doing a research internship at <a href="http://mhcd.org/"><span style="color: yellow;">MHCD</span></a>.</div></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-38400037743438786572010-09-24T05:51:00.000-07:002011-11-05T11:27:53.683-07:00More about neuroplasticity<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script><br /><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span class="Apple-style-span" style="font-family: 'Century Gothic';">Last week we described briefly some research about the relationship between bran plasticity and emotional wellbeing. This week, we would like to talk about another area where there is some very exciting research that links brain plasticity and mental wellbeing. </span><span style="font-family: 'Century Gothic';">In addition to the symptoms usually associated with schizophrenia (hallucinations, delusions, disordered thinking; see <b style="mso-bidi-font-weight: normal;"><a href="http://www.nimh.nih.gov/health/topics/schizophrenia/index.shtml"><span style="color: yellow;">NIMH’s website</span></a></b> for a description of schizophrenia and its symptoms</span><span style="font-family: 'Century Gothic';">, there are other symptoms which are as important but hardly mentioned and include: inability to understand information, trouble focusing attention, and problems with memory (in particular, maintaining and using information which is known in behavioral research as “working memory”). The reason why this is an important deficit, is because there is evidence that shows that cognitive deficits like those described, will have an impact on more functional outcomes; things like employment, education, social interaction, and even ability to live independently.</span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">There is some very recent research that focuses on some of the brain mechanisms that may be involved in this deficit (some neurochemicals and their receptors that do not work as intended). Also, there is some research that tries to tackle these deficits from a different point of view: <b style="mso-bidi-font-weight: normal;"><u>Cognitive Remediation Therapy (CRT)</u></b>, whose main goal is to teach individuals some strategies to improve their cognitive skills <b style="mso-bidi-font-weight: normal;"><a href="http://www.newscientist.com/article/mg20227044.600-mind-gym-helps-people-live-with-schizophrenia.html"><span style="color: yellow;">go here</span></a></b> </span><span style="font-family: 'Century Gothic';">and <b style="mso-bidi-font-weight: normal;"><a href="http://www.braintrain.com/main/cognitive_training_research.htm#Schizophrenia"><span style="color: yellow;">here</span></a></b><span style="color: yellow;"> </span></span><span style="font-family: 'Century Gothic';"> for links to some of these studies). These skills include things like rote memorization, and/or the use of strategies to memorize/pay attention to key pieces of information. Regarding CRT, one study that we found is a meta-analysis by <b style="mso-bidi-font-weight: normal;"><a href="http://ajp.psychiatryonline.org/cgi/reprint/164/12/1791"><span style="color: yellow;">McGurk and others</span></a></b></span><span style="font-family: 'Century Gothic';">. Meta-analysis is a great tool for research, because it helps summarize in a scientific way the information contained in many studies. In this case, the authors summarized and compared the results of 26 studies to explore whether the use of CRT helped individuals with schizophrenia not only to have better memory, attention and problem solving, but also better functional outcomes. The analysis showed great promise in several areas: improvement in cognitive areas like attention, verbal learning and memory, ability to process information faster and ability to solve problems. Interestingly, the analysis also showed that at least within these studies, there seems to be no relationship between the length of the program (number of hours spent learning the techniques and practicing) and the improvements observed. It seems that as long as the individuals practiced between 5 and 15 hours (the program with the maximum length was 15 hours), there were no differences in improvement, with one exception: Verbal learning and memory. However, it is possible that this relationship does not seem to be important, because the studies did not go far enough in time to observe changes. Only six programs assessed changes in the individuals 8 months after the program ended. Therefore there will be no way to know if the effect of number of hours helped change or maintain the improvements after 8 months.</span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">There were two other interesting findings. One is that the CRT programs seem to have minor impact on the more traditional symptoms of schizophrenia (though there are some other studies that suggest improvements in mood and self-esteem). The other finding is also a minor improvement on the functional outcomes; things like working on competitive jobs, improvement in the individual’s social relationships and ability to solve interpersonal problems. However, for the second finding, the researchers also found that studies that combined CRT with psychiatric rehabilitation had a stronger effect than those studies that used only CRT.</span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">Although the results are not conclusive, this time, the bottom line seems to be that the combination of clinical therapy, psychiatric rehabilitation and some type of cognitive improvement program holds the most promise as far as being able to improve memory, attention, concentration, and also improve functional outcomes like maintain employment, and have meaningful relationships with other individuals (<span style="color: yellow;">go</span> <a href="http://www.cognitive-remediation.com/"><b style="mso-bidi-font-weight: normal;"><span style="color: yellow;">here</span></b> </a></span><span style="font-family: 'Century Gothic';">for similar conclusions). </span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">Is it possible that the results found are just like a “sugar pill” (i.e., a placebo effect)? It does not seem likely. Some of the studies compared CRT versus more clinician’s attention and found that individuals who attended CRT showed much more improvement than those who received only more clinician’s attention.</span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">Some factors still need further study. For example, since only a few studies reassessed individuals a few months (8 at most) after the program ended, it is unclear if the number of hours of practice will have a significant impact on maintaining this cognitive improvement longer. Similarly, only a few studies try to relate changes in the more cognitive tasks (memory, attention, problem solving) with functional outcomes (going back to –and maintaining—employment, improvement in social relationships). This is an area where the <a href="http://www.mhcd.org/"><span style="color: yellow;">Mental</span><span style="color: yellow;"> Health Center of Denver</span></a><span style="color: yellow;"> </span>(MHCD) and the <a href="http://mhcdresearchinstitute.blogspot.com/"><span style="color: yellow;">MHCD Research institute</span></a> are currently working to further understand the relationship. Stay tuned for forthcoming blogs where we will talk about mental health research using functional outcomes.</span></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-9220455998015156552010-09-16T09:06:00.000-07:002011-11-05T11:27:53.782-07:00Research on brain plasticity<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span class="Apple-style-span" style="font-family: 'Century Gothic';">There has been some recent research that seems to point toward the fact that the brain is much more pliable than what we used to think. This is part of a field known as Neuroplasticity. Just to check, I decided to run a quick search on<span lang="EN"></span> Google of the word “neuroplasticity”. <span lang="EN"></span>According to Google, I got “about 838,000 results”, and it only took “0.20 seconds”. This can be a little overwhelming, if you want to learn about what neuroplasticity can do for you. There are a few blogs where the term neuroplasticity can be found, but someone who has written a lot is</span><span style="font-family: 'Century Gothic';"> <a href="http://bipolarblast.wordpress.com/category/neuroplasticity/"><span style="color: yellow;">beyond meds</span></a> </span><span style="font-family: 'Century Gothic';">. Many of the posts related to neuroplasticity can be traced back to a book written by Norman Doidge: <i style="mso-bidi-font-style: normal;"><a href="http://www.amazon.com/s/ref=nb_sb_ss_c_1_9?url=search-alias%3Dstripbooks&field-keywords=norman+doidge&sprefix=norman+do)"><span style="background-color: white;"><span style="color: yellow;"><span style="background-color: black; color: yellow;">Th</span><span style="background-color: black;"><span style="color: yellow;">e</span> brain that changes itself</span></span></span></a></i></span><span style="font-family: 'Century Gothic';">. In his book , Dr. Doidge had stories about different individuals who have been able to overcome challenges by </span>“<span style="font-family: Times, 'Times New Roman', serif; font-size: large;"><span style="font-size: small;">rewiring their brain”. Some of the individuals and stories were related to some major issues, like having a stroke and having to relearn how to walk or talk. But there were a couple of chapters dedicated to emotional imbalances. One that tries to explain sexual disturbances and one related to mental illness. If you have a chance to read this, it is highly entertaining, and is highly exciting to learn about everything that in theory can be achieved by just rewiring our brains. However, be warned that it may be too easy to assume that everything can be achieved if we just try to rewire ourselves.</span> <span style="font-size: small;">Life is never that easy.</span></span><br /><span style="font-family: 'Century Gothic';">In a more recent story, at <a href="http://www.sciencedaily.com/releases/2010/08/100816155000.htm"><span style="color: yellow;">science daily</span></a></span><span style="font-family: 'Century Gothic';"> we found a description of recent research with a more direct relationship between brain plasticity and mental illness coming out of the <place w:st="on"><placetype w:st="on">University</placetype> of <placename w:st="on">Oregon</placename></place>. The original research tries to link the relationship between changes in emotional wellbeing (such as reduction in stress, anxiety and depression) and changes in neuroplasticity. What the research seems to show is that if we meditate, (as opposed to just learn to relax) using a technique called <i style="mso-bidi-font-style: normal;">Integrative Body Mind Training</i>, and if we train in these technique long enough, our brain eventually learns how to keep this state of mind and changes its structure so it can respond to stressors in a more adequate way. For example, in the same<span style="color: yellow;"> </span><a href="http://www.sciencedaily.com/releases/2010/08/100816155000.htm"><span style="color: yellow;">article</span></a>, </span><span style="font-family: 'Century Gothic';"> it is explained how students who learned those techniques, “showed lower levels of anxiety, depression, anger and fatigue than students in a control group” before a math test. The changes were associated with a specific part of the brain (the anterior cingulate cortex, which is connected with the amygdala and other midbrain structures usually associated with emotions). To make matters more interesting, it is explained that the anterior cingulate cortex is associated with several mental illness and emotional disturbances like attention deficit disorder, dementia, depression and schizophrenia. </span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">Does this mean that we need to stop doing whatever we are doing and just start learning <i style="mso-bidi-font-style: normal;">Integrative Body Mind Training</i>? Probably not; I am sure we can use it in addition to whatever other medications/therapies/strategies are currently being used to recover from mental illness, but I do not think that anyone at this point will endorse shifting to this therapy while forgetting other options. There are many reasons why shifting is not a good idea. First of all, different individuals seem to respond in different ways to some therapies. I am sure many of us have experienced with medications or other types of home remedies in our daily encounters with fevers, cold or other illnesses, just to find out that what works fine for some individuals, do not necessarily work for us. Further, the research is still considered preliminary, and much more testing needs to be done to be considered as an alternative to other types of therapies. Why more testing? It could be possible that the individuals who were in the study were somehow predisposed to show better outcomes, because they knew that they were in a study. This is similar to the type of precautions that are taken when pharmaceutical companies are testing medications, and they found out that a sugar pill has the same effect that this very expensive medication that has taken years of research. Furthermore, if you have a chance to read Dr. Doidge’s book you’ll notice that his stories are based on individuals and not groups of people. If we want to be able to generalize to more than single individuals, we need to replicate the studies in multiple settings and across different types of people, to determine that the effects are not restricted to a specific type of people, or even worse, to some very unique characteristic that can only be found on a few individuals.</span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">Although more testing needs to be done, this does not undermine the importance, excitement and potential that some of these findings bring to the field of mental health. Clearly, there is so much that we still need to learn about the brain and its connection to behavior, that it can be a little bit intimidating and perhaps overwhelming, especially when you feel that you need to know that now for your own personal reasons. On the other hand, it can be exciting to think about how much more we can learn about the relationship between our genetic makeup, the brain and the environment and how all three shape our behavior.</span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"><span style="font-family: 'Century Gothic';">There are other types of meditation such as "sitting meditation" also called "mindfulness meditation" or "vipassana"/insight meditation that have long been utilized to address both emotional issues and health issues. We will discuss these practices in a future blog as they relate to both mental and physical health.</span></div><div class="MsoNormal" style="margin: 0in 0in 12pt;"></div>Unknownnoreply@blogger.comtag:blogger.com,1999:blog-3510879657261264155.post-3073656661818179312010-09-07T14:30:00.000-07:002011-11-05T11:27:53.882-07:00Research on Mental Health and Recovery from Mental Illness<script type="text/javascript"> var _gaq = _gaq || []; _gaq.push(['_setAccount', 'UA-7889942-8']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })();</script>We are the <a href="http://mhcdresearch.org/"><span style="color: #f1c232;">Research Institute</span></a> at the <a href="http://mhcd.org/"><span style="color: #f1c232;">Mental Health Center of Denver</span></a>, and although technically we were just funded on May 2010, we have been doing research on mental health for the last 10 years.<br /><br />We have been doing research in many areas associated with both <a href="http://www.outcomesmhcd.com/Adults.htm"><span style="color: #f1c232;">Adults</span></a><span style="color: #f1c232;"> </span>and <a href="http://www.outcomesmhcd.com/Children.htm"><span style="color: #f1c232;">Children's</span></a><span style="color: #f1c232;"> </span>mental health. More recently however, we have concentrated our research on Recovery, Resiliency and Wellness in general. We have found that people outside the field of mental health, sometimes can confuse recovery from mental illness with recovery from substance abuse therefore, we are beginning to shift toward the word "wellness", which captures a lot of what is meant by recovery from mental illness.<br /><br />Part of our research duties include to search for research in many places (including the internet), and since sometimes it is difficult to find good information, we decided to start this blog that will try to bring together research that we find interesting in areas associated with in mental illness and Recovery, Resiliency and Wellness.<br /><br />We also maintain another <a href="http://mental-health-recovery.blogspot.com/"><span style="color: #f1c232;">blog</span></a> where we speak much more about recovery from mental illness and substance abuse. If you are interested in learning more about those topics, and the impact it may have on everyday’s life, we invite you to visit our blog. If you are interested to learn about our research, we invite you to visit two of our websites: <a href="http://www.outcomesmhcd.com/"><span style="color: #f1c232;">http://www.outcomesmhcd.com/</span></a> where we describe our work at MHCD in recovery, resiliency and wellness in both adults and children, as well as a current list of our publications and presentations. Or you can visit <a href="http://mhcdresearch.org/"><span style="color: #f1c232;">http://mhcdresearch.org/</span></a> where we present more of the services we can offer to centers and other entities interested in doing research and evaluation in recovery, resiliency and wellness, improving clinical practices, creating more effective and efficient use of clinical resources, mining clinical data, etcUnknownnoreply@blogger.com