There is Actually Alone One Way to Accurate Accurate Adulation - Brainy Bloom Research

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.

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.

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.

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.

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.

Here is an analogy:

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.

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).

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.

Fish Oil for Affection Bloom and Affection Bloom Research

Fish oil for affection bloom is a hot topic. And for acceptable reason.

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.

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.

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.

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]

Wow! Some scientists even announce that, back omega 3 angle oil helps humans affected depression, it can alleviate a torn heart.

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.

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]

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.

A Look At Biscuit And Affection Bloom Research

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.

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.

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.

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.

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.

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.

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.

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.

Compromise - The Best That Keeps Hurting - Mental Health Research

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.

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.

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.

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.

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.

Women and insurance - Insight on the Society For girls's Health analysis (SWHR)

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.

If you reside within the us and you're a girl while not insurance, the SWHR offers helpful info on the subsequent schemes:

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.
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.
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.

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.

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.

More Evidence That Cell Phone Use Is Harmful

More Evidence That Cell Phone Use Is Bad for You

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.

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.

Integrating Data Instruments into Clinical Practice

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?  The Evaluation and Research Department uses an instrument called the Consumer Recovery Marker (CRM) and the Recovery Marker Index (RMI).  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).  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).  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.  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.  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?  In considering this issue, literature review has shown a number of factors that come into play.

Dilemma for Clinician and Organization

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.  An article by Broom, Adams and Tovey (2009) looks at this issue within the healthcare and in particular, oncology practice.  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).  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.  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.   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).  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.

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.  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).  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.  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).  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).  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.  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.

Structure and Funding

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).  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).  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).  The following is a breakdown of funding for MHCD and was taken from the “MHCD 2009: Report to the Community” and covers the fiscal year concluded June 30, 2009.

Source                                                            Amount                                  Percentage

Medicaid                                             $23,925,630                            44.4

State of Colorado                               $12,945,194                            24.0

Client, Third Party, Pharmacy            $8,826,030                              16.4

Contracts and Grants                          5,632,041                                10.5

Interest, Rent,             Other                           $1,604,777                              3

Medicare                                             $498,286                                 0.9

Public Support                                                $444,236                                 0.8

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).  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).  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 Colorado, there is already a lot of familiarity with data collection and evaluation, at least at the administrative level.  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.

Philosophy

            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.  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.  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.  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).  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).  This becomes even more difficult with less definition attributed to non-profit organizations.  This proves true with MHCD in that most of the focus to this point has been best treatment models to integrate into clinical practice.  However, with integration of data instruments, this allows for more longitudinal data and more of a focus to prevention side. 

Clinician Feeling Towards Instruments     

A study done looking at mental health field and how clinicians feel towards data instruments was conducted by Garland, Kruse, Aarons (2003).   This study was done on mental health system in California and found that 92% of clinicians reported never using scores from data instruments in their clinical practice (Garland et al. 2003: 400).   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).  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.  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).  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.  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).  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.

           

            As we can see from the literature, there are multiple interests to consider when implementing data instruments into clinical practice.  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.  MHCD has already made a lot of steps towards helping ease this transition.  The MHCD “Recovery Committee”, which is already a committee that was in place, but is now working on how to help with this transition.  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.  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.  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.  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.  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.  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. 

Submitted By Jim Linderman- Evaluation Specialist with Evaluation and Research Department at MHCD, as well as Sociology M.A. student at University of Colorado Denver Sociology Program. 

References

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).

Carman, J.G., K.A. Fredericks (2009). “Evaluation Capacity and Nonprofit Organizations: Is Glass Half-Empty or Half-Full?” American Journal of Evaluation 31:84.

DeRoche, K., Hester, M., Olmos, P.A., McKinney, C.J. (October, 2007). Evaluation of Mental Health Recovery: Using Data to Inform System Change. Poster presented at the 'Culture of Data' Conference. Denver, CO.

Garland, Ann F., M. Kruse, G. A. Aarons (2003). “Clinicians and Outcome Measurement: What’s the Use?”.  Clinicians and Outcome Measurement 30(4):393-405.

Hoole, E. and T.E. Patterson (2008). “Voices from the Field: Evaluation as part of a Learning Culture”. Nonprofits and Evaluation. New Directions for Evaluation 119:93-113.

MHCD 2009: Report to the Community (can be found at www.mhcd.org)

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.          

Denver’s Homeless Street Youth – characteristics and treatment challenges

In 2004 Denver’s homeless youth population was estimated to include approximately 850 young adults between the ages of 12 and 24[1] with at least 1500 homeless youth in the state of Colorado[2]. 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.

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[3].  For the purpose of this post I will limit the discussion to homeless street youth.

                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,  or identifies as gay, lesbian, bi-sexual, questioning, or transgender (GLBQT), this can create conflict within the home which may lead to homelessness.

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%[4] to 53%[5]. 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.

                Once on the streets youth are left to navigate a very dangerous and adult world, with little experience and limited physical/mental/emotional development.  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[6] and of being re-victimized in the future[7].

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  to meet their basic needs also reported higher rates of substance use, suicide attempts, days away from home, STD’s, pregnancy, and victimization[8].

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 can be a protective factor for new homeless teens, or they can expose the youth to more harm than they would otherwise experience.

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.  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.  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.  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[9]. 

                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.

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. 

Written by Felice Seigneur

Felice Seigneur is and Evaluation Specialist with the Evaluation and Research Department

at the Mental Health Center of Denver

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.

               

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[1] Metropolitan Denver Homeless Initiative, Final Report, www.cdhs.state.co.us/shhp/PDFs/2004_PIT_Final_Report.pdf

[2] Colorado Dept. of Public Health, www.cde.state.co.us/cdeprevention/download/pdf/Office%20of%20Homeless%20Youth%20Report.pdf

[3] 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.

[4] Cauce, A. M., Paradise, M., Embry, L., Morgan, C., Theofelis, J., Heger, J., & Wagner, V. (1998).

Homeless youth in Seattle: Youth characteristics, mental health needs, and intensive case

management. In M. Epstein, K. Kutash, & A. Duchnowski (Eds.), Outcomes for children and

youth with emotional and behavioral disorders and their families: Programs and evaluation best

practices. Austin, TX: PRO-ED.

[5] Toro, P. A., & Goldstein, M. S. (2000, August). Outcomes among homeless and matched housed

adolescents: A longitudinal comparison. Presented at the 108th Annual Convention of the

American Psychological Association, Washington, DC.

[6] - 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

[7] 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.

[8] 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

[9] Toro, et al., 2007

Future Blogs

We would like to let you know it takes time to compile Research on different subjects.  

Because of this reason we will only be posting on this blog monthly.

Hopefully the subjects will be of interest to you and we hope you will continue to visit our blog in the future.

Thank you

Resillence

The 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 Ungar’s 2004 article 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.
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).
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.
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.
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.
Many current explorations of resiliency have begun to view resiliency as something innate to us all. In Bonnie Benard’s The Foundations of the Resiliency Framework 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 Dr. Truebridge’s in her blog Resilience, Research, and Educational Reform 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.
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 (Nebel, 2008). 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.

By Scott Nebel, Psy.D.

• Scott is a Psychologist on MHCD’s Intensive In-Home Treatment Team and collaborates with the MHCD Research Institute.

Baumeister, R., Exline, J. (2000). Self-Control, Morality, and Human Strength, Journal of Social and Clinical Psychology, 19, 29-42.

Buss, D. (2000). The Evolution of Happiness. American Psychologist, 55, 15-23.

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.

Friesen, B. (2005). The Concept of Recovery: “Value Added” for the Children’s Mental Health Field?. Focal Point, 19(1), 5-8.


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.

Luthans, F., Vogelgesang, G., Lester, P. (2006). Developing the Psychological Capital of Resiliency. Human Resource Development Review, 5(1), 25-44.

Luthar, S., Zigler, E. (1991). Vulnerability and Competence: A Review of Research on Resilience in Childhood. American Journal of Orthopsychiatry, 61(1), 6-22.

Myers, D. (2000). The Funds, Friends, and Faith of Happy People. American Psychologist, 55, 56-67.

Online Etymology Dictionary, 2008

Richardson, G. (2002). The Metatheory of Resilience and Resiliency. Journal of Clinical Psychology, 58(3), 307-321.

Simonton, D. (2000). Creativity. American Psychologist, 55, 151-158.
Ungar, M. (2004). A Constructionist Discourse On Resilience. Youth & Society, 35(3), 341-365.

Werner, E. (2005). Resilience and Recovery: Findings From the Kauai Longitudinal Study. Focal Point, 19(1), 11-14.

Werner, E., Smith, R. (1992). Overcoming the Odds: High Risk Children from Birth to Adulthood. Ithaca, NY: Cornell University Press.

Client Suicide and Clinician Response: Ensuring Policy Guidelines and Clinician Safety

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 Mental Health America website 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 article 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 article, 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.

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.

Another article  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 article offers a link to the Air Force website, 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.

Going back to the article, 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.

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.
Mental Health America (Suicide Info)
SAMHSA (Statistics on Suicide Likelihood)
Suicide.Org Non-Profit Organization (Warning Signs)
Mayo Clinic Website (General Coping Skills for Losing Someone to Suicide)

Citations

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).

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).

submitted by Jim Linderman.  Jim is currently a M.A. student with University of Colorado-Denver Sociology Program.

More about evidence based practices

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.
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.
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 “placebo effect”.  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?).
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.
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?
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).
 There are multiple institutions that have created databases where evidence for or against Evidence Based Practices can be found. The Substance Abuse and Mental Health Services Administration (SAMHSA)  maintains a website with links to several organizations where such information can be found.
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.
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  Shadish, Cook and Campbell. However, be warned that this book can be hard to read without some introduction to research methods
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.
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.” Department of Health and Human Services Administration for Children and Families Program Announcement. Federal Register, Vol. 68, No. 131, (July 2003), p. 40974. 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.
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 Oakland County Community mental health authority. 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.