Primary Counsellors Research Articles

70.1 SUBSTANCE SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT): IS IT WORKING FOR ADOLESCENTS?

The objectives of this presentation are to: 1) review the principles of Screening, Brief Intervention, and Referral to Treatment (SBIRT); and 2) review adolescent outcomes of SBIRT implementation. A review of the literature was conducted in PubMed. We will review validated adolescent substance use screens and utilize case vignettes with examples of brief interventions, including referral to treatment, that illustrate the foundational principles of SBIRT. Substance use and other clinical outcomes, including specialty care follow-up, will be reviewed. An estimated 14.4% of youth ages 12 to 18 years old meet the DSM-5 criteria for a substance use disorder (SUD), of whom less than 10% receive treatment. Universal substance use screening, brief intervention (BI), and referral to treatment (RT) is recommended starting at age 12 years old. BI is an evidence-based, individualized intervention to respond to adolescent substance use screening results. Utilization of BI is associated with significant efforts to change substance use behaviors, including reduction in binge drinking episodes, drinking and driving, and alcohol-related injuries. While studies show that BI is associated with an overall decrease in cannabis and other illicit drug use, results for alcohol consumption are mixed. Adolescents who receive BI also have fewer acute care visits and lower use of outpatient services, including mental health. To date, the majority of “SBIRT” studies do not report on RT or adolescent follow-up with substance use treatment specialists post-BI. In adults, SBIRT is not associated with establishing specialty outpatient care. Two SBIRT trials in emergency department settings report that 5% to 25% of adolescents who received SBIRT interventions sought outpatient treatment. Delivery by a behavioral health clinician or the adolescent’s primary counselor significantly increases the odds of initiating outpatient treatment. SBIRT is an evidence-based intervention recommended for all adolescents to prevent or delay the onset of substance use and to provide individualized BI and RT for adolescents with problematic substance use and SUD. However, significant barriers remain to facilitating adolescent participation in outpatient specialty treatment.

Practices, attitudes, and knowledge about Crohn’s disease and smoking cessation among gastroenterologists

Cigarette smoking is one of the most important, modifiable environmental factors in Crohn's disease (CD) and screening for tobacco use is an official recommendation and quality measure in the care of CD patients. The objective of this study was to learn more about gastroenterologists' practices, opinions, and knowledge in this area. A 15 question survey was sent through email to two national gastroenterology distribution lists. Questions were written in multiple choice formats and were designed to collect information about gastroenterologists' practices, attitudes, and knowledge regarding smoking cessation in CD patients. Responses were stratified by practice setting, experience, and inflammatory bowel disease-focus. Responses were anonymous and were collected in a secure, online database. A total of 141 respondents completed the survey. Overall, 89% of participants screened their CD patients for smoking more than 75% of the time. In all, 62% provided smoking cessation counseling more than 75% of the time. Overall, 94% of respondents felt comfortable discussing the benefits of smoking cessation with their patients. In all, 56% felt comfortable discussing smoking cessation strategies with their patients. Overall, 88% of respondents agreed that gastroenterologists should provide smoking cessation counseling; however, 43 and 11% agreed that the gastroenterologist should be the primary counselor and primary prescriber of cessation-related pharmacotherapy, respectively. Surveyed gastroenterologists agree that smoking cessation is an important part of the care of CD patients and this is reflected in their screening practices. Counseling occurs irregularly and many gastroenterologists do not feel comfortable discussing cessation strategies. Future guidelines should provide further guidance on the gastroenterologist's role in smoking cessation counseling for CD patients.

No internet? No problem! Creative approaches to cost-effective e-learning delivery in resource-constrained settings

Abstract Background Frontline health-care workers have traditionally travelled away from their job sites to receive continuing education and training, which not only disrupts continuity of patient care but also incurs travel costs and causes scheduling issues. Asynchronous e-learning is an effective, non-disruptive, and economical alternative to the traditional model of continuing education and training. However, in resource-constrained settings, poor access to computers and unreliable internet connectivity have slowed implementation of e-learning. Here, we report on the effectiveness of our flexible, open-source method for the delivery of distance training on Android tablets that does not require access to the internet. Through five training programmes we aimed to assess learner satisfaction, costs compared with traditional training models, technical feasibility, completion rates, and challenges affecting implementation to continuously improve our framework. Methods Five tablet-based training programmes were developed by the University of Washington Department of Global Health E-learning Programme (eDGH) and delivered in Namibia, Tanzania, and Zimbabwe. Participants were health care professionals, including clinical assistants, frontline health care workers, primary counsellors, pharmacists, physicians, nurses, and community health workers. The training programmes preserved much of the experience of a traditional online course, with videos, assessments, and interactive features such as discussion forums via the messaging application WhatsApp. Training programmes included a 24-month clinical officer training, month-long trainings on prevention of mother-to-child-transmission of HIV and child and adolescent HIV counselling, interactive job aides for clinical mentors, and health information systems. Tablets were usually loaned to participants for the duration of the training. Implementation partners included non-government organisations and ministries of health. Data collection methods varied by project but included focus group discussions, structured interviews, and online surveys. Findings We included data from 248 participants who completed one of the five training courses between November, 2014, and September, 2016. For training programmes that evaluated learning with pre-tests and post-tests, the target audience demonstrated increased learning, although pass rates differed between programmes. In Namibia and Tanzania, per person costs for the tablet-based version of the training programme was about three times less than the in-person training. Because participants completed most of their training at the job site or home, off-site time decreased from 4 days for the in-person training to under 1 day. For training programmes that used text messaging to keep learners engaged, all participants finished in the time allotted. Overall, feedback showed that participants are enthusiastic about the tablet-based training. In Zimbabwe, many participants reported sharing the training programmes with co-workers and several participants requested more ways to engage with other learners. The training programme in Namibia and Tanzania had no technical difficulties with the tablets, while in Zimbabwe there were minor issues with the software. Interpretation We plan to improve flexibility and usability of e-learning programmes through additional testing to ensure users on all devices have the best learning experience possible. We will continue to expand the types of learning activities and incorporate more real-time interactions among peers and course facilitators through text-message-based discussion groups or added face-to-face interactions for participants at the same facility. Funding The President's Emergency Plan for AIDS Relief (PEPFAR), and Centers for Disease Control and Prevention.

UNARV: A district model for adolescent school mental health programme in Kerala, India

Background: About a half of life time cases of mental disorders start by 14 years of age. First sign of mental illness or emotional distress can emerge in school environment. So schools are to be viewed as the potential place for recognition of mental health problems, but an unexplored area. This study describes the working of a new model for district adolescent school mental health programme, UNARV in Kerala. Methods: A descriptive study of adolescents referred from schools, seen at UNARV clinic over a period of 5 years (2007–2012). Study sample consisted of students with behavioral and scholastic problems who were referred by trained teachers from Government and Government aided High School (8th to 10th class) and Higher Secondary School (11th and 12th class) under aegis of District Panchayath, Thiruvananthapuram, Kerala. They were evaluated and given psychosocial and pharmacological interventions by child mental health expert. Results: Total 2432 students attended UNARV clinic during the period. Most common problems observed were involvement in physical fights (38.3%), viewing and showing pornography to others (21.8%), poor scholastic performance (20.7%), skipping classes (19.1%), alcohol abuse (19%), smoking (14.2%), and engaging in love affair (8.5%). Common mental disorder diagnosed was conduct disorder (36.4%). UNARV helped in reintegration of such students back in to schools and stalled the trend of such students from being dismissed or suspended from class. Conclusion: UNARV forms a sustainable alternative district model in a resource poor environment. School teachers were trained as primary counselors and expert intervention was ensured.

Obstetrician and gynecologists’ population-based screening practices

Background: The ability to obtain genetic information can now be accomplished in far greater detail, and more quickly than in the past. It is important to understand obstetrician–gynecologists’ (ob-gyns) screening practices as these changes occur.Methods: Cross-sectional survey was performed by mailing paper surveys to Fellows of the American College of Obstetricians and Gynecologists and a subset of Fellows who belong to the Collaborative Ambulatory Research Network (CARN).Results: Response rates were 57% for the CARN network. Almost all responders (92%) offer population-based genetic screening in the prenatal period and almost all (93%) conduct counseling prior to the provision of genetic testing. Almost all (92%) counsel patients when the result is positive, with 46% being the primary counselor and 55% calling the patient themselves. When results are negative, 73% counsel with 58% indicating they are the primary counselor and 17% call patients themselves. A total of 72% have received continuing medical education (CME) on genetics within 5 years, with 79% receiving CME at conferences and 21% receiving CME online.Conclusion: Ob-gyns have a large role in providing patients new genetic screening technologies. This role requires a significant knowledge base, some of which can be obtained by online modules; however, our study suggests online education is underutilized as a means for CME on genetic screening among ob-gyns.

A Counseling Program for Clients in Substitution Treatment: Effects and Dropout Prediction

The present research reports the evaluation of a counseling program for substance abusers in outpatient substitution treatment. Clients were assessed at two time points to evaluate their development on various variables such as psychosocial functioning and substance abuse. Importantly, central outcome variables were assessed via self-reports and ratings by the primary counselor. Methodologically, the challenge was to estimate program impact without a control group as by German law any client in outpatient substitution treatment must be provided with psychosocial counseling. While results suggest that the program positively influences psychosocial functioning, the level of substance abuse did not significantly decrease during the course of the study (N = 101). Furthermore, because program dropout is a major problem in interventions for substance abusers, logistic regression analysis was employed to identify relevant preconditions which predict future program dropout (N = 172). Although several significant predictors were identified, they only provide a modest increase in prediction performance.

Initial Validation of the Motivational Interviewing Measure of Staff Interaction

Many residential treatment programs train their staff in Motivational Interviewing (MI) to encourage that the MI “spirit” (collaboration, evocation, and autonomy/support) be used in interactions with clients by all staff members, not just primary counselors. Small nonprofit agencies may not be able to provide the taping, coding, and coaching that are recommended to best learn MI and need another method to evaluate skill acquisition. This study validated a measure of MI spirit, the MI Measure of Staff Interaction. Forty items measuring MI spirit were given to 227 clients at two residential treatment programs along with an already validated measure of working alliance. Principal components analysis found 10 items measuring the three spirit factors. Concurrent validity was established through significant correlations between the scale, its factors, and the alliance measure. This scale may provide an alternative for program evaluation of agency atmosphere and staff interaction with clients.

The Implementation of Inmate Mentor Programs in the Correctional Treatment System as an Innovative Approach

ABSTRACT In October 2006, the California Men's Colony (CMC) in San Luis Obispo, faced with staff recruitment and retention difficulties, took an innovative step to utilize long-term sentenced inmates as peer mentors and primary counselors to lead their prison-based therapeutic community (TC) program. The program was designed, developed, and implemented through the collaborative efforts of CMC's Our House program, the California Department of Corrections and Rehabilitation (CDCR), the University of California, San Diego (UCSD), Center for Criminality and Addiction Research, Training and Application (CCARTA), and the Orange County Department of Education (OCDE). The program is designed to be a peer mentor-driven 24-hour TC built to uphold the fundamental TC principles that have been lost in many treatment programs. UCSD CCARTA was instrumental in training the long-term residents who served as peer mentors in substance abuse treatment principles and strategies, equivalent to the training received by state-fu...

In Defense of TJ's Mother: Neonaticide and the Implications for Counselors

Neonaticide is the murder of an infant within 24 hours following birth. As the primary counselor for a woman charged with neonaticide, the writer reviews the research found in forensic and legal writings and examines the psycholegal issues underlying the phenomenon of neonaticide and the implications for counselors.

Obsessive-compulsive disorder among patients entering substance abuse treatment. Prevalence and accuracy of diagnosis.

Patients (N = 217) admitted to two community-based substance abuse outpatient treatment programs participated in a structured clinical interview to determine the comorbidity of obsessive-compulsive disorder. Twenty-four patients (11.1%) met the diagnostic criteria for obsessive-compulsive disorder, which is significantly higher than the general population prevalence of this disorder. However, only eight of these patients were accurately diagnosed with this condition by their primary counselors. Clinical implications of these findings are discussed.

Client perceptions of dietetic students and registered dietitians at a university-based nutrition clinic

Client perceptions of students enrolled in a nutrition counseling practicum were compared with client perceptions of those students' clinical instructors, who were registered dietitians. One hundred forty-two clients who had either a student (no. = 81) or a dietitian (no. = 61) as primary counselor completed a postcard evaluation or a telephone interview. Students were rated significantly more positively (p less than .01) than their instructors for the item "I would recommend the clinic to others" and (p less than .05) for the items "The counselor helped me with my problem" and "I learned at the clinic what I did not know before." Seventy-two of the 89 clients interviewed by telephone replied to the question "Did students enhance or detract from services provided?" Sixty-one percent replied that students enhanced, but 25% replied that students detracted in some way, primarily because of concerns about having an additional observer during counseling sessions. In general, clients receiving nutrition counseling evaluated student dietitians very positively.

Guidance and counseling program development in Botswana

In this article the procedures utilized in developing recommendations for guidance and counseling programming in Botswana are discussed. Initially, the status of guidance and counseling was determined through numerous interviews with individuals in many locations in the country. In addition to the information gained from these interviews, a needs assessment was conducted through reviewing national documents and surveying primary and secondary teachers and secondary students. Questionnaires administered to 106 primary school teachers, 89 secondary school teachers and 405 secondary school students were analyzed. Data from these sources comprised the foundation for recommendations for a sequence of developmental tasks for Guidance and Counseling Program Development in the Botswana Educational System. Six primary counselor roles including 1) Counseling Service, 2) Consulting Service, 3) Information Service, 4) Referral Service, 5) Placement and Follow-up Service and 6) Evaluation and Research Service serve as the basis for these recommendations.

A Model for Training Nursing Staff as Primary Counselors for Psychiatric Service

A Model for Training Nursing Staff as Primary Counselors for Psychiatric Service