Abuse Treatment Research Articles

Çocuk İstismarı ve İhmali İçin Risk Altındaki Çocukları Belirlemeye ve Müdahale Etmeye Yönelik Model/Veri Tabanı Önerisi

Çocuk istismarı ve ihmalinin çocuğun eğitim ve sosyal hayatına birçok olumsuz etkisi bulunmaktadır. Ancak ülkemizde çocuk istismarı ve ihmalini önlemek ve bu soruna müdahale bulunmak için çocukların eğitim, sağlık gibi temel gereksinimlerini karşılayan kurumlar arasında eşgüdümü sağlayan bir bilgi ağı mevcut değildir. Bu çalışmanın amacı etkin bir ulusal veri tabanının kurulmasının faydalarını açıklamak, alanyazında var olan Ortak Değerlendirme Çerçevesi hakkında bilgi sunmak ve Türkiye’de risk altındaki çocukların istismarını ve ihmalini önlemede ve bu soruna müdahalede kullanılabilecek bir sistem önerisi sunmaktır. Bu amaçlar doğrultusunda, çalışmada eğitim, sağlık ve adli kurumlarında kullanılacak söz konusu model/veri tabanı tanıtılmış ve ilgili alanyazın ışığında tartışılmıştır.

Maternal attitudes towards pre-natal substance abuse, medical care, and treatment in a historically disadvantaged South African community

This study explored maternal substance abuse and the access to pre-natal medical care and treatment for substance abuse during pregnancy. Respondent mothers (n = 102; mean age = 27.8 years, SD = 10.9 years) were from Mitchell’s Plain, a historically disadvantaged South African community. The mothers completed a mixed methods interview on the context and influences of their substance abuse during their pregnancy. Findings suggest that these mothers adopt the drug taking behaviour in their social environment. Women with prior histories of substance abuse were active consumers and dependent on drugs while childbearing. These findings may be important for possible intervention strategies among this particular group of vulnerable women.

Increased cognitive load enables unlearning in procedural category learning.

Interventions for drug abuse and other maladaptive habitual behaviors may yield temporary success but are often fragile and relapse is common. This implies that current interventions do not erase or substantially modify the representations that support the underlying addictive behavior-that is, they do not cause true unlearning. One example of an intervention that fails to induce true unlearning comes from Crossley, Ashby, and Maddox (2013, Journal of Experimental Psychology: General), who reported that a sudden shift to random feedback did not cause unlearning of category knowledge obtained through procedural systems, and they also reported results suggesting that this failure is because random feedback is noncontingent on behavior. These results imply the existence of a mechanism that (a) estimates feedback contingency and (b) protects procedural learning from modification when feedback contingency is low (i.e., during random feedback). This article reports the results of an experiment in which increasing cognitive load via an explicit dual task during the random feedback period facilitated unlearning. This result is consistent with the hypothesis that the mechanism that protects procedural learning when feedback contingency is low depends on executive function. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Pediatric Residents’ Knowledge and Attitudes Towards Child Abuse

Background: Child abuse causes serious mental, physical, and social problems, and it is considered as a universal problem occurring in every society. Pediatricians are often the first professionals who see the children with symptoms of child abuse; thus, they must play a crucial role in the diagnosis, treatment, and prevention of child abuse. This study evaluated pediatric residents’ knowledge and attitudes towards this issue. Methods: This cross-sectional descriptive study was performed to describe the knowledge and attitudes of pediatric residents toward child abuse. Eighty-one out of all pediatric residents of (n = 121) Shiraz University of Medical Sciences were enrolled (using the census sampling method). The data were collected by using a questionnaire, the validity and reliability of which were confirmed by experts in the field of pediatrics and medical ethics. The questionnaire consisted of three parts, including demographic information, questions about the knowledge of participants, and queries which were designed to assess the participants’ attitude toward child abuse. Descriptive and inferential statistics were used for analyzing the data. Results: The pediatric residents had “good” knowledge with a mean score of 57.48 ± 6.46 (score range: 23 to 69) and “moderate” attitudes with a mean score of 54 ± 7.73 (score range: 16 to 80) toward child abuse, although they did not recognize some of the most important risk factors and symptoms. No relationship was confirmed between gender, age, academic level, and previous source of information and knowledge or attitudes (P > 0.05). Conclusions: Pediatricians serve an important role in reducing the rate of child abuse. However, a large proportion of the respondents did not recognize some of the most important risk factors and symptoms regarding suspected cases of abuse in their practice. Thus, they need more specific training and support to increase their competence with better case identification and report.

ÇOCUK CİNSEL İSTİSMARINDA MASALLARIN TERAPÖTİK KULLANIMI

Breaking the silence of sexual abuse is a powerful recovery tool for child victims. Sexual abuse is hidden by nature and is not spoken. When children are sexually abused, they are commonly in the pre-verbal period or they have not enough vocabulary to express and make sense their experiences. In addition, children are often told to keep this event as a secret. For all these reasons, it is difficult for children to respond to familiar verbal methods during the evaluation and treatment of abuse. In addition, children perceive these methods as threatening. Creative arts (non-verbal arts, metaphorical verbal studies, etc.) are the recommended therapeutic tools in this regard. Tales that can be used as a mediator between the therapist and the client are an important source of help. Information that is very difficult to reveal in a therapeutic setting can be given through tales. Implicit sexuality themes in classical fairy tales constitute a logical basis for the use of fairy tales in sexually abused children. In this study, the function of fairy tales in psychotherapy and the use of tales in therapeutic studies with sexually abused children will be investigated.

Older adults' emotional reactions to elder abuse: Individual and victimisation determinants.

Elder abuse has been gaining public, state, and scientific attention for the past 40years, but research focusing on emotional reactions of older adults to victimisation is still scarce. The study describes the emotions and feelings of older adults who experienced abuse in a community setting, and the association between these emotions and individual or abuse characteristics. The cross-sectional study comprises 510 older adults who were identified and referred by four institutions. Participants answered a questionnaire on elder abuse experiences, including the emotion or feeling brought out by the act of abuse that was perceived to be the most serious. Fear and sadness comprised 67.1% of all provided responses. Emotional reactions were associated with functional status, the presence of depressive symptoms, relationship with the perpetrator and, to a limited degree, to the experience of multiple types of abuse. The most significant and meaningful variable was the relationship with the perpetrator. This study demonstrates that older adults present very similar patterns of emotional reactions, but individual characteristics and the established relationship with the perpetrator might mediate the emotional response. Implications for prevention and intervention of elder abuse are discussed.

1.18 Comprehensive Substance Abuse Prevention at Northern California High Schools

In the United States, fewer than 10% of 1.3 million youth who meet criteria for substance use disorders (SUDs) receive treatment. Research has shown that schools can provide an ideal setting for providing substance abuse education, conducting screening and interventions, and even providing outpatient treatment for youth. This project evaluates the implementation and efficacy of a novel substance abuse prevention program, adapted from The Neuroscience of Addiction curriculum (NOA), at several San Francisco Bay Area high schools.

A realist review of which advocacy interventions work for which abused women under what circumstances: an exemplar

This is a protocol for a Cochrane Review (Prototype). The objectives are as follows: To assess advocacy interventions for intimate partner abuse in women, in terms of which interventions work for whom, why and in what circumstances. Our strategic objective reflects our higher‐order (realist) question (Greenhalgh 2016), with four more specific descriptive questions as subcomponents and foci in our initial exploration of the data. We will determine all answers (as much as possible) from existing evidence. Research questions How do the key mechanisms associated with the delivery or use of complex interventions that include advocacy as a component interact with contextual influences, and with one another, to explain the successes, failures and partial successes of advocacy as an intervention? What are the active ingredients of advocacy interventions? What are the important moderators or contexts that determine whether the different mechanisms produce their intended outcomes? To what extent do the views and experiences of women who have used advocacy services match the intervention's aims and outcomes? How do organisational and system factors influence implementation of advocacy interventions? These questions may change as the realist review progresses. We will consider active ingredients, impact and outcomes in relation to qualitatively and quantitatively measured effects. Strategic objectives Our strategic objectives are to explain successes, failures, partial successes and small effect sizes in published, empirical studies of advocacy interventions delivered in different settings, and, in particular, to explain mechanisms of effect in heterogeneous, complex, advocacy‐containing interventions. This will enable us to make clear decisions on which studies should be aggregated or synthesised in future reviews, as well as how to interpret the evidence in future reviews of advocacy interventions for abused women. It will also enable researchers and developers to design more effective advocacy interventions in the future, determine which outcomes to include, and improve their reporting and evaluation. In addition, it will help policy makers and practitioners to better understand advocacy interventions, and their likely benefit in the local contexts in which they operate.

A Call for Culturally-Relevant Interventions to Address Child Abuse and Neglect in American Indian Communities.

The American Indian population has the highest rate of child abuse and neglect in the country at 14.2 cases per 1000 children. Yet, there is a paucity of child abuse interventions available and an even deeper need of culturally relevant interventions for American Indian families. This paper explores the literature of the existing interventions that are specifically used with American Indian families affected by child abuse and neglect. This paper is also a call for culturally relevant interventions and a proposal of recommendations for child abuse and neglect interventions for American Indian families.

Challenges Encountered by Children with Disabilities Accessing Child Sexual Abuse Interventions in Zimbabwe

This article brings to the fore the challenges encountered by child sexual abuse survivors with disabilities accessing existing child sexual abuse medical, legal, social and psychological interventions in Zimbabwe. Using qualitative data from a multiple-case study research project, this article argues that child sexual abuse survivors with prelingual deafness, physical, mental, hearing and visual disabilities experience social and physical barriers, communication challenges and lack of participation in the Victim Friendly System. The authors further argue that impairments have tended to militate against children with disabilities’ capacity to access existing services. The Victim Friendly System is a confluence of medical, legal, psychological and social services for child sexual abuse survivors. To enable capacity to access existing services by child sexual abuse survivors with disabilities, the training of professionals in sign language and the use of braille is recommended. The paper also calls for the adoption and implementation of disability-sensitive policies.

Teaching SBIRT through simulation: Educational case studies from nursing, psychology, social work, and medical residency programs

Abstract The prevalence of substance use disorders remains high in the United States and healthcare professionals are largely ill-equipped to intervene with patients experiencing substance misuse or use disorders. To address this issue, substance abuse intervention curricula such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) are being integrated into university healthcare programs through the use of simulation to provide healthcare students with the necessary skills to address patient substance use. Teaching SBIRT with simulation provides students with an authentic clinical environment in which to learn and refine clinical skills. Simulation also supports reflective practice by providing an opportunity for instructors and peers to directly observe and provide feedback on students' patient care. Additionally, students can review (through video recording) and reflect on their own performance within the simulation to build self-awareness and improve their skills and approach to clinical work. This paper describes how SBIRT simulation was integrated into nursing, psychology, and social work curricula at a medium-sized northwest university and a family medicine residency program in the same community. Satisfaction with SBIRT simulation as well as students’ perceived change in confidence in addressing substance use was recorded. Overall, instructors, students, and medical residents were highly satisfied with simulation experiences. Students and medical residents also reported increases in understanding of and confidence in executing SBIRT. Simulation implementation strategies and resources are provided and discussed.

What can surveillance data and risk factor research contribute to a public health approach to preventing child sexual abuse?

AbstractThe aim of this article was to consider how population‐level surveillance data and risk factor research might be applied to a public health approach to preventing child sexual abuse. The focus is on the collection of data in relation to ethnicity. By drawing from the four principles approach to ethical decision making developed by Beauchamp and Childress, the expected benefits of data collection are weighed against possible harms to individuals and communities. It concludes that the identification of high‐risk groups can inform prioritisation of resources, and the development of context‐specific and culturally sensitive child sexual abuse prevention and intervention programmes. However, it is crucial to explain why child sexual abuse is more prevalent in some ethnic communities than others. Explanations about causes can reduce the potential for stigmatisation and marginalisation of individuals and communities, as well as challenge widely held myths about biological determinism and inability to change.

Molecular Genetics and New Medication Strategies for Opioid Addiction.

The opioid epidemic is at the epicenter of the drug crisis, resulting in an inconceivable number of overdose deaths and exorbitant associated medical costs that have crippled many communities across the socioeconomic spectrum in the United States. Classic medications for the treatment of opioid use disorder predominantly target the opioid system and thus have been underutilized, in part due to their own potential for abuse and heavy regulatory burden for patients and clinicians. Opioid antagonists are now evolving in their use, not only to prevent acute overdoses but as extended-use treatment options. Strategies that target specific genetic and epigenetic factors, along with novel nonopioid medications, hold promise as future therapeutic interventions for opioid abuse. Success in increasing the treatment options in the clinical toolbox will, hopefully, help to end the historical pattern of recurring opioid epidemics. [AJP at 175: Remembering Our Past As We Envision Our Future Drug Addiction in Relation to Problems of Adolescence Zimmering and colleagues wrote in the midst of an opiate epidemic among young people that "only the human being, or rather certain types of human beings, will return to the enslaving, self-destructive habit." (Am J Psychiatry 1952; 109:272-278 )].

Concept Mapping: Engaging Urban Men to Understand Community Influences on Partner Violence Perpetration.

Intimate partner violence (IPV) is a significant health concern rooted in community experiences and other social determinants. The purpose of this study is to understand community-based risk and protective factors of IPV perpetration through participatory research that engages men who use IPV. Secondarily, we assess the relative influence, as measured by ranking, of these factors regarding risk of IPV perpetration and stress. We conducted concept mapping with Baltimore men (n = 28), ages 18 and older, enrolled in an abuse intervention program (AIP), through partnership with a domestic violence agency. Concept mapping, a three-phase participatory process, generates ideas around an issue then visually presents impactful domains via multi-dimensional scaling and hierarchical clustering. Most participants were Black (87.5%) and 20-39years old (75%). Seven key domains, or clusters, were established. "No hope for the future" was the greatest contributor to IPV perpetration. "Socioeconomic struggles" (i.e., lack of employment) and "life in Baltimore" (i.e., homicide) were most likely to result in stress. Emergent domains related to IPV perpetration and stress were ranked similarly, but with some nuance. Having good support systems (i.e., family, community centers) were felt to prevent IPV and reduce stress. This participant-driven process among a primarily young, Black sample of Baltimore men speaks to the influence of perceived social disempowerment and underlying trauma on intimate relationships and the potential for mitigation. Few studies have engaged men who use IPV through participatory research to understand the comprehensive dynamics of an impoverished, urban environment. Results provide direction for community-based intervention and prevention programming to increase self-efficacy, particularly among younger men, and to enact trauma-informed violence prevention policy from the perspectives of male IPV perpetrators.

퍼지이론을 이용한 노인학대에 대한 사회적 개입의식의 구조 및 수준 분석

퍼지이론을 이용한 노인학대에 대한 사회적 개입의식의 구조 및 수준 분석

Development and testing of AAV-delivered single-chain variable fragments for the treatment of methamphetamine abuse.

Methamphetamine (METH) substance abuse disorders have major impact on society, yet no medications have proven successful at preventing METH relapse or cravings. Anti-METH monoclonal antibodies can reduce METH brain concentrations; however, this therapy has limitations, including the need for repeated dosing throughout the course of addiction recovery. An adeno-associated viral (AAV)-delivered DNA sequence for a single-chain variable fragment could offer long-term, continuous expression of anti-METH antibody fragments. For these studies, we injected mice via tail vein with 1 x 1012 vector genomes of two AAV8 scFv constructs and measured long-term expression of the antibody fragments. Mice expressed each scFv for at least 212 days, achieving micromolar scFv concentrations in serum. In separate experiments 21 days and 50 days after injecting mice with AAV-scFvs mice were challenged with METH in vivo. The circulating scFvs were capable of decreasing brain METH concentrations by up to 60% and sequestering METH in serum for 2 to 3 hrs. These results suggest that AAV-delivered scFv could be a promising therapy to treat methamphetamine abuse.

Effects of substance use screening and brief intervention on health-related quality of life.

Screening, brief intervention, and referral to treatment interventions have been shown to positively impact alcohol use. These programs utilize motivational interviewing techniques in an effort to reduce risky substance use among those at elevated risk of developing a disorder. However, there is a dearth of research assessing positive impacts above and beyond changes in alcohol use. This study examines potential benefits of brief interventions, utilizing motivation interviewing, on mental and physical quality of life. The present quasi-experimental study examined changes in health-related quality of life among individuals presenting at urban emergency departments. The analyses included the use of propensity score matching to minimize potential biases resulting from differences between groups at baseline. The results indicated that the intervention group experienced significant increases in perceptions of mental health over those of the comparison group, regardless of changes in substance use. These findings have implications for practice, as they suggest that brief substance abuse interventions delivered in the emergency department settings may have effects beyond those targeted by the intervention. Specifically, brief substance abuse interventions may positively impact mental health, thus enhancing the quality of life among targets of the intervention.

Reaching Out for Help: Recommendations for Practice Based on an In-Depth Analysis of an Elder Abuse Intervention Programme

Elder abuse is a growing public health concern with serious and sometimes fatal consequences. Intervention research is lacking despite its potential value to victim protection. This study investigates the first and longest running social work intervention program for elder abuse in Canada. The aim of this study is to provide a better understanding of the scope of the problem and needs of the population to inform program development through the recommendations made. 164 cases of elder abuse reported from January 2012 to April 2014 were examined. Case characteristics and related recommendations are reported. Third parties reported most abuse, which was typically emotional and financial

Economic Abuse Experiences and Depressive Symptoms among Victims of Intimate Partner Violence

There are significant, detrimental effects of physical, sexual, and psychological intimate partner violence (IPV) on victims’ mental health and well-being. However, little is known about the impact of economic abuse. To address this gap, the purpose of this study was to examine the association between economic abuse and depression and to explore whether the association between economic abuse and depression could be accounted for by other forms of IPV victimization (physical, sexual, and psychological abuse). Data from 457 female victims of IPV, recruited from 14 domestic violence programs across 10 states and Puerto Rico, were examined to explore the association between economic abuse and depressive symptoms. A series of hierarchical regressions were used to examine whether the addition of economic abuse improved the association between depression over and above participants’ sociodemographic characteristics and experiences of psychological, physical, and sexual IPV. The majority (93%) of participants reported experiencing economic abuse from their intimate partner. The findings from a series of multiple regression analyses revealed that economic abuse was uniquely associated with depression after accounting for other forms of IPV victimization and the sociodemographic characteristics of the participants. Implications include the need for screening, intervention, and prevention of economic abuse among IPV victims and continued research regarding economic abuse experiences.

Exchange sex among people receiving medical care for HIV in the United States – medical monitoring project 2009–2013

ABSTRACTMany studies of persons who exchange sex for money or drugs have focused on their HIV acquisition risk, and are often limited to select populations and/or geographical locations. National estimates of exchange sex among people living with HIV (PLWH) who are in medical care, and its correlates, are lacking. To address these gaps, we analyzed data from the Medical Monitoring Project, a surveillance system that produces nationally representative estimates of behavioral and clinical characteristics of PLWH receiving medical care in the United States, to estimate the weighted prevalence of exchange sex overall, and by selected socio-demographic, behavioral and clinical characteristics. We found 3.6% of sexually active adults reported exchange sex in the past 12 months. We found a higher prevalence of exchange sex among transgender persons, those who experienced homelessness, and those with unmet needs for social and medical services. Persons who exchanged sex were more likely to report depression and substance use than those who did not exchange sex. We found a higher prevalence of sexual behaviors that increase the risk of HIV transmission and lower viral suppression among persons who exchanged sex. PLWH who exchanged sex had a higher prevalence of not being prescribed ART, and not being ART adherent than those who did not exchange sex. We identify several areas for intervention, including: provision of or referral to services for unmet needs (such as housing or shelter), enhanced delivery of mental health and substance abuse screening and treatment, risk-reduction counseling, and ART prescription and adherence support services.