A literatura científica biomédica tem apontado que pessoas em intenso sofrimento psíquico encontram no consumo de drogas um modo de lidar com esse sofrimento. Assim, o consumo de drogas tem alta prevalência entre pessoas que apresentam algum quadro clínico psiquiátrico e este aparece muitas vezes como uma estratégia de lidar com os sintomas. Em contrapartida, este consumo aparece descrito como causador de pior prognóstico, colocando o usuário em situações de maior vulnerabilidade. Esta pesquisa teve como objetivo compreender a perspectiva de profissionais de um serviço de saúde mental sobre o consumo de drogas por pessoas em tratamento psiquiátrico. O estudo tem caráter qualitativo, descritivo e exploratório e foi aprovado por Comitê de Ética em Pesquisa. Foram realizadas entrevistas semi-estruturadas com 16 profissionais de um Centro de Atenção Psicossocial III (CAPS) do interior de São Paulo. Para a análise dos dados, considerou-se o papel da linguagem como construtora da realidade. Foi realizada análise de conteúdo temática, sendo construídas quatro categorias: Especificidades do contexto; O fenômeno da droga; O uso de drogas durante o tratamento psiquiátrico; e Fronteira entre a saúde mental e o uso de drogas. Os profissionais destacaram a presença do uso de drogas em pacientes do serviço, apesar da disposição da rede local em dividir o cuidado às duas demandas. Os participantes compreendiam que o sofrimento era o principal motivador para o uso de drogas nesta população. A identificação do consumo foi tema relevante para os profissionais não havendo, porém, protocolo específico para isto. O vínculo estabelecido com o paciente foi apontado como principal estratégia para identificação. O uso de drogas em pacientes do CAPS foi relatado como fomentando preconceito por parte de alguns profissionais, influenciados pelo discurso moral na construção de sentidos sobre os usuários de drogas. O tabaco não era descrito como uma droga, sendo algumas vezes compreendido inclusive como parte do tratamento no CAPS. Os discursos moral e biomédico construindo sentidos sobre o uso de drogas concorrem nas falas dos profissionais para explicar o fenômeno da droga. Da mesma forma, estratégias de cuidado dividem-se entre aquelas voltadas à redução de danos ou em busca da abstinência, sendo mais prevalentes as voltadas à abstinência. O papel central atribuído ao medicamento no tratamento suscitou questionamentos a respeito do lugar ocupado por este como droga ou como tratamento. Ações que proporcionem aos profissionais mais espaços para construção de sentidos a respeito do tema, seja de mais ajuda do que apenas uma divisão arbitrária (e aparentemente impossível de ser implementada na prática) entre as duas demandas. O momento das entrevistas foi uma oportunidade para a construção destes sentidos. / Biomedical scientific literature has showed that people under severe mental suffering conditions usually consume drugs as a coping strategy. Therefore, the drug consumption has high prevalence in psychiatric patients and is frequently described as a coping strategy to deal with theirs symptoms. On the other hand, this drug consumption is described as causing poorer prognosis, including putting the users in vulnerable situations. This research aimed to understand the perspective of professionals from a mental health service about the patients drug use during psychiatric treatment. This study is qualitative, descriptive and exploratory and was approved by the Research Ethics Committee. Sixteen semi-structured interviews were conducted with professionals of a Psychosocial Care Center (CAPS- 3) in a medium city in the countryside of São Paulo state. For data analysis, we consider the role of language as a constructor of reality. A thematic content analysis was performed, resulting in four categories: Particularities of the context; the drug phenomena; drug use during psychiatric treatment; and the boundaries between mental health and drug use. The professionals highlighted a perceived presence of drug use in patients, despite of the local network willingness in offering care for both demands. Participants understood that suffering was the main motivator for the use of drugs in this population. Identifying the drug consumption was a relevant issue for professionals, however, there was no specific protocol to address this issue. Establishing bonding with the patient was pointed out as the main strategy for drug use identification. The drug use in CAPS patients was reported as contributing to the stigma by some professionals, mostly influenced by the moral discourse on meaning making attributed to drug users. Tobacco was not described as a drug, and sometimes was even understood as part of treatment in CAPS. Both moral and biomedical discourses constructed meanings about the use of drugs compete in the professionals´ speeches to explain the drug phenomena. Similarly, care strategies were divided between those aiming to reduce damage or seeking withdrawal, and the most prevalent ones were those focused on drug abstinence. The central role assigned to medication in the treatment raised questions about the place occupied by the medication as drug or as a treatment tool. Actions providing professionals more opportunities for meaning making about this subject can be more helpful than the currently arbitrary division (and seemingly impossible to implement in practice) for addressing both demands. The interviews offered the professionals an opportunity for the construction of these meanings and senses.

This investigation examines how knowledge of a researcher's intent, as well as gender, influences the clinical judgments of mental health professionals in sex role research. Conscious awareness of the study's aim was manipulated by varying experimental instructions to minimize (not salient) or maximize (salient) sex role awareness. Subjects were mental health professionals who rated a protocol of a female or male pseudopatient exhibiting masculine, and lacking feminine, stereotyped behaviors. It was hypothesized that if sex biases affect judgments, more negative ratings should be assigned to a female with cross sex role behavior than to male-appropriate role behavior. Differences should be greater when subjects were unaware of the nature of the study.

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Excerpt: Last fall, I sat through an uncomfortable board meeting. I was charged to work with a Clinical Social Worker, Licensed Practicing Counselor, a Counseling Psychologist, and a Licensed Nurse Practitioner to develop an integrated care training program as part of a rural workforce development project.

Suicide is the third leading cause of death among youth and young adults ages 10--24. In 2001 the U.S. Surgeon General laid out a national strategic plan to more effectively address suicide prevention (United States Public Health Service, 2001). In 2008, Gene Cash, then president of The National Association of School Psychologists, made a "call to action" to prevent suicide. Although suicide prevention has been repeatedly identified as a priority in mental health care, the vast majority of interventions with suicidal youth are not evidence based due to a lack of research utilizing controlled studies (Daniel & Goldston, 2009). Unfortunately this leaves mental health professionals (MHPs) to routinely implement interventions that are not research based and not proven effective in deterring suicidal thoughts and actions. No-suicide contracts (NSCs), commonly used in clinical and medical settings, solicit a commitment from a suicidal individual, a promise not to complete suicide. The prevalence of school-based MHPs' use of NSCs with suicidal youth (SY) is unknown. Additionally, minimal feedback is available regarding MHPs' perceptions of and current practice regarding implementation of NSCs. Likewise, school policy directing MHPs' intervention when working with SY is neither well described nor understood. A brief survey was created to access these perceptions and practices. Of 326 MHPs attending a Utah Youth Suicide Prevention Conference, 243 completed a survey (74.5% participation rate). Half of participants intervening with SY reported using NSCs. Only 27 of the 243 participants indicated that their school's policy encouraged or required a NSC. Only 8 participants reported knowledge of a formal written school policy that specifically guided their intervention with SY. Reasoning underlying decisions to use or not to use NSCs were explored. Common explanations included attending to individual student needs, following perceived guidelines, building trust with SY and adapting contracts to fit student needs, and opening discussion about suicide. Several participants expressed a need for additional training with no-suicide contracting. A few participants called for either renaming NSCs or implementing a similar, but more positive, "commitment to treatment" strategy. Participants did not mention a need for additional research to explore the efficacy of NSCs. In fact, research was not mentioned. This reflects the gap between research and practice and the dependency on personal experience and going along with the status quo versus depending on research findings to dictate improvement and change in practice.

This photovoice study explored the lived experiences of nine Puerto Rican mental health professionals who provided postdisaster counseling services to children. Due to the complex and multilayered experiences of Puerto Rican mental health professionals, this study used intersectionality as the theoretical lens to facilitate thematic analysis of the data. Results from coresearchers' narratives and photographs generated seven major themes: (a) la politiquería of disasters; (b) the impact of compounding disasters; (c) Puerto Rico se levanta: strategies for collective healing; (d) impact of disasters on children; (e) experiences with clients; (f) awareness, action, change; and (g) supporting, connecting, and transforming. The results and discussion provide awareness into the experiences of Puerto Rican clinicians who formed part of disaster response efforts in their own community. Clinical, educational, and research implications are drawn from coresearchers' narratives and insight.

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Background: Difficulties with anxiety among children and young people are common and can impact upon their developmental trajectory leading to adverse outcomes in later life. There is, therefore, a need to increase access to early intervention services. Existing research has indicated that school-based cognitive behavioural interventions are effective for children and young people experiencing difficulties with anxiety, yet there remains a proportion of the population for whom they are not effective. In addition, there is a lack of research on how these may be implemented in real world settings as opposed to a research trial. The present research focuses on the provision of cognitive behavioural school-based interventions in two parts: a systematic review of psychological, interpersonal and social variables as predictors, mediators and moderators of mental health outcomes following a school-based intervention and an empirical mixed methods evaluation of the facilitators and barriers to the implementation of a school-based intervention. Method: A systematic search of electronic databases for studies examining interpersonal, psychological and social predictors, moderators and mediators of mental health outcome following school-based cognitive behavioural interventions was conducted. Effect sizes for these analyses were calculated and the quality of eligible studies was assessed using a standardised rating tool. Within the empirical project, the implementation of a school-based cognitive behavioural intervention was evaluated through a mixed methods approach. Semi-structured interviews with stakeholders in the intervention were analysed using grounded theory integrated with framework analysis. Quantitative data on the reach of the intervention, practitioner evaluation of training and coaching as well as routine outcome measures from children and young people receiving the intervention was collected. Results: Within the systematic review, twenty-two studies (N=22) met the predefined eligibility criteria. There was heterogeneity in the variables explored, effect size of these on treatment outcome and the quality of the literature within the included studies. Cognitive style was found to mediate treatment outcome, but there was limited evidence for other predictors, mediators and moderators of treatment outcome within the review. Quantitative results of the empirical project indicated that the model of the intervention was acceptable to both practitioners and children and young people, and preliminary data indicated a significant improvement in mental health outcomes. Facilitators that emerged from qualitative data included an enabling context, therapeutic engagement, motivation and congruence, self-efficacy and containment and encouragement. The exclusivity of the intervention, a lack of systemic understanding and transparency as well as demands and pressure on resources were barriers to implementation. Conclusions: Although preliminary evidence for potential predictors, mediators and moderators is presented, further research with improvements in the design and reporting of explanatory variables on treatment outcome is required prior to informing clinical decision-making. The successful implementation of school-based interventions requires multi-agency integration and collaboration as well as on-going support in managing systemic pressures and skill development.

xv, 177 p. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / The purpose of this dissertation was to develop and conduct initial validation procedures for the Environmental Justice Advocacy Scale (EJAS). Environmental justice refers to the equitable distribution of environmental risks and benefits across diverse groups in terms of the development, implementation, and enforcement of environmental laws and regulations. Environmental justice advocacy involves efforts to organize communities and collaborate with policymakers to prevent or remediate environmental injustice. The findings of three studies are presented and describe reliability, concurrent and discriminant validity, and internal structural validity analyses. A national sample of graduate students, practitioners, and faculty in the specialties of counseling psychology, counseling, and social work were surveyed ( n = 43, n = 294, and n = 295, respectively). Study 1 addresses initial scale development procedures that resulted in a 47-item measure. In Study 2, an exploratory factor analysis suggested a three-factor structure (Attitudes, Knowledge, and Skills) with excellent reliability and strong concurrent and discriminant validity. The results indicated that two of the subscales were correlated ( r = .16 and r = .1 6, p < .01) with a measure of social desirability. In Study 3, a confirmatory factor analysis failed to replicate the three-factor model. However, four factors (Attitudes, Knowledge-General Environmental Justice, Knowledge-Psychological and Physical Health Environmental Justice, and Skills) explained a statistically significant amount of variance in question items. Suggestions for modification of the measure and recommendations for future research, training, and practice related to environmental justice advocacy for mental health professionals are provided. / Committee in charge: Ellen McWhirter, Chairperson, Counseling Psychology and Human Services; Benedict McWhirter, Member, Counseling Psychology and Human Services; Keith Zvoch, Member, Educational Methodology, Policy, and Leadership; Michael Dreiling, Outside Member, Sociology