The problem of co-occurring substance abuse and mental health disorders among the veteran population can impact numerous aspects of a veteran's life, including self-esteem, relationships, employment, and legal issues. The Mental Health Residential Rehabilitation Treatment Program (MH RRTP) at the Saint Cloud, Minnesota VA Healthcare System is a program that provides residential treatment for this population. Identifying practical and beneficial treatment methods promotes better coping mechanisms for veterans and impacts social change by providing timely and cost-efficient care for veterans, while also leading the way for overall changes and improvements in other VA residential treatment programs. This study identified how using the integrated treatment model in the MH RRTP impacted depression, anxiety, and sobriety protective factors among 1,136 veterans who completed the program between 2016 and 2017, and if there were any significant differences in outcomes among various age groups and lengths of stay in the program. Outcome measures taken at pre and post treatment, using BDI-II, BAI, and BAM, were analyzed by using six one-within one-between (mixed-model) Analysis of Variance (ANOVA) tests. Significant interaction effects were noted for protective factors in length of stay and age group categories and for depression and length of stay. Significant main effects for within-subjects factors were consistently noted for all categories, indicating a reduction in depression and anxiety symptoms, while increasing protective factors for the veterans in this study. The results demonstrated that veterans responded favorably without regard to potential differences in age groups and lengths of stay.

Domestic violence afflicts people regardless of ethnicity, socio-economically status, age, or gender. Too often, girls enter and remain in abusive relationships, despite the trauma and risks of doing so. Using Roy's theory of adaptation, this study explored the effect of witnessing inter-parental violence on girls' experiences of physical violence or sexual abuse in their dating relationships. Original data collection occurred at a Midwestern U.S. university via e-mail using questions adapted from the CDC's Youth Risk Behavior Survey Surveillance System. The study used 526 responses from female participants who self-disclosed if they had or had not witnessed inter-parental violence for categorical placement. Participants mirrored the population of the university with regard to age, race, and GPA. Using an ANOVA, the groups were compared on the independent variable of witnessing inter-parental violence and the dependent variable of experiencing physical or sexual dating violence. Results showed witnessing inter-parental violence did not predict whether or not a girl would experience physical or sexual violence in a dating relationship. Findings indicated adaptation on the part of the girls after witnessing inter-parental violence and beginning their own dating relationships. Additional research is needed to gain knowledge of this adaptation process and to explore what happened between the time of witnessing inter-parental violence and entering dating relationships that helped prevent them from experiencing dating violence. Knowledge of these participants' adaptation processes may provide insight for counselors and therapists on how to support children who witness inter-parental violence. This insight may help girls develop adaptation mechanisms to prevent experiencing violence in dating relationships.

The development of the infant from birth to four years will approximately parallel the stages of development of the profoundly retarded children enrolled in the Development Centers for Handicapped Minors ( DCHM ) in California. The retarded child is a human being and may be assumed to have the same basic equipment as the normal child. If we expand and prolong the development stated of the normal child we will be able to lead the DCHM child through these states in slow motion to insure progress. To develop a curriculum, an assessment of the abilities of the child was necessary. A screening device as designed to measure the development of the child in four areas --- Gross Motor, Fine Motor, Social, and Language. Skills leading towards ambulation were included in the Gross Motor area; skills leading toward manipulation of objects in space were included in the Fine Motor area; skills leading toward independent living were included in the Social area, while skills leading to improvement in communication were included in the Language area. Tasks in the Social area were divided into sub-groups of social interaction, feeding, dressing, and toileting. Language included two sub-groups – Receptive Language and Expressive Language. Over 800 tasks were reviewed from 18 sources. Three hundred and fifty-nine tasks were finally chosen on the basis of criteria established. The tasks were to be observable, describable, and development. The tasks were then arranged into areas mentioned above and then into levels of development. Twenty-two levels of development were necessary to show the progress of development sufficiently to be useful in the DCHM. The tasks were organized so that the teacher could determine the child developmental level of the child with very little demand on the child. Most of the assessment could be done by observation or with knowledge of the child already possessed by the teacher. A card for recording the progress and the assessment of the child was designed that would also give the teacher a graphic picture of the level of the child and would also keep an ongoing record of the progress of the child with little interruption of the normal activities in the classroom. Each of the 359 tasks was listed on a separate 5X8 Activity Card. Each Activity Card included the abbreviated description of the task, the area, the level, and a three character code designed for that task. Under this information, a behavioral description of the task was given. Next, the tasks expected at the next level were listed, and then suggested classroom activities associated with the next level were given. The Activity Card was designed so that when a teacher observed a new behavior in a child, he could refer to the card on file to note the level and area of the behavior and plan lessons or activities accordingly. A Gestalt of all tasks is included in the Appendix. The tasks selected were from recognized source and because of this, no effort was made to standardize the results. There were three purposes for this study: (1) To provide a tool for the teachers in the DCGM that would allow them to look at the developmental levels of the children; (2) To assess the functioning level of the children; and (3) To provide information about the curriculum suitable for the various levels of development.

The social work practice problem for this study was a lack of knowledge about social workers' experiences of working with deaf and hard of hearing people with mental illness. This study was needed to fill a practice gap by increasing an understanding of the experiences of social workers to inform best practices and address the needs of deaf and hard of hearing population through culturally and linguistically competent mental health services. The research questions focused on the experiences and challenges of social workers working with deaf and hard of hearing people and best practices identified by these social workers. Ecological systems theory was used to guide this study. Data were collected from a focus group comprising 9 social workers working with deaf and hard of hearing people with mental illness at a healthcare provider on the east coast of the United States that offered culturally and linguistically therapeutic services. Themes identified through thematic analysis of the data were cultural competence, empowerment and advocacy, professional education, and leadership to advance cultural competence. The findings of this study may be used to help healthcare providers identify key components of program design and service delivery that support culturally and linguistically competent mental health services for the population. This knowledge may also be used by social work practitioners and administrators to bring about positive social change by enhancing social work practice related to deaf and hard of hearing clients with mental illness, improving mental health outcomes, and supporting recognition of the importance of culturally and linguistically competent mental health services.

Counseling can promote positive outcomes for grieving clients by addressing personal loss and helping the client process their grief. However, a lack of understanding on the part of counselors of how people grieve may result in negative client outcomes such as psychological stress, poor health, or an increased risk of depression. Education and training in grief counseling can improve counselors' problem recognition and skills in treatment planning. The purpose of this study was to examine whether Council for Accreditation of Counseling and Related Educational Programs (CACREP) master's degree counseling students view themselves as having been adequately trained in grief theories and skills. The theoretical foundation used was modern grief theory based on John Bowlby's work on Attachment Theory. The overall research question was how competent do master's-level counselors view themselves regarding the education or training they received in grief theories or counseling skills in their CACREP-accredited studies. I used a non-experimental, one shot survey comparative quantitative research design. Cicchetti's Grief Counseling Competency Scale (GCCS) was administered to CACREP master's-level counseling students enrolled in their practicum or internship experience, which resulted in 153 participants. Using a MANCOVA, there was significance found for relationships between coursework taken and (a) perceived assessment skills (p = .029), (b) perceived treatment skills (p = .025), and (c) perceived conceptual skills and knowledge (p = .003). Results of this study provided insight for CACREP master's-level counseling programs to explore and discuss curriculum coursework inclusion of education and training in grief theories and skills.

Suicide ideation, suicide attempts, and suicide (SISAS) are increased in poststroke patients, yet not everyone who has suffered a stroke is at risk for SISAS. Two risk factors for SISAS, marital status and burdensomeness, may be of particular relevance to poststroke patients. The majority of poststroke patients have a disability that may require help from a family member with basic functions such as dressing and bathing. It was not known if being married decreases risk of SISAS for stoke victims as shown in studies with nonpoststroke subjects or increases risk for SISAS due to its influence on feelings of burdensomeness. Guided by the interpersonal psychological theory of suicidal behavior, the purpose of this study was to examine if marital status moderates the association between burdensomeness (measured by disability level) and suicide ideation. A secondary analysis was performed of the Outcome and Assessment Information Set data, which was collected by the National Centers for Medicare and Medicaid Services. A data sample of 1,596,962 records was obtained. This data sample included 5% of the Home Health Outcome Information and Assessment Set for the year 2008. Of those, 8,6381 (5.4%) individuals had suffered a stroke. The results suggested partial support for the hypotheses presented in this study. However, a significant moderation was found. As burdensomeness increased, suicide ideation increased in patients who were married. High levels of burdensomeness increase suicide risk to those who are married. Identifying a vulnerable population can provide potential positive social change by serving as basis for future research regarding program implementation in reducing suicide rates.

Serious mental illness (SMI) affects 5% of the United States population and is associated with increased morbidity and mortality. Use of high-cost healthcare services is common, including hospitalizations and emergency department (ED) visits. Integrating behavioral and physical healthcare may improve care for consumers with SMI, but prior research findings have been mixed. This quantitative retrospective cohort study addressed the impact of integrated care on physical health and ambulatory care sensitive (ACS) utilization via a program evaluation of an integrated health clinic (IHC) at a community mental health center (CMHC). The research questions assessed whether there was a predictive relationship between IHC enrollment and physical health and ACS-specific service utilization for consumers with SMI when controlling for demographic characteristics and disease severity. Secondary administrative healthcare data, including authorization and electronic medical record data, were provided by the CMHC. Logistic regressions assessed the odds of experiencing an inpatient admission or ED visit before or after IHC enrollment; the predictive relationship between IHC enrollment and service utilization was assessed using multiple linear and Poisson regression analyses. There was no statistically significant impact of integrated care clinic enrollment on physical health or ACS-specific utilization. The sample had lower levels of physical health utilization than would have been expected. In terms of positive social change, results may help the CMHC assess the IHC program, overall clinic success, and use of data. Since policy and payment structures continue to support integrated care models, further research on different programs are encouraged, as each setting and practice pattern is unique.

Drug injection is an increasingly important risk factor in the transmission of blood-borne pathogens, including the hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The purpose of the study was to examine the influence of social network factors on HCV and HIV. The study was grounded in social network theory and sought to determine whether social network characteristics affect high-risk sexual and drug injection behavior as well as self-reported HIV and HCV status. The study design was a quantitative cross-sectional survey. A total of 181 participants in a needle exchange program completed a survey in Spanish assessing individual drug and sex risk practices as well as gathering information to describe the characteristics of participants' personal networks from an egocentric perspective. General estimating equation techniques were used to analyze the data. Results showed that only social network size was related to risky sexual behavior. Injecting risk behaviors were only impacted by personal network exposures, measured by the average number of years network members had injected. HIV self-reported serum status was correlated with trust, closeness, and number of family members named among the closest 5 network members. Last, HCV self-reported serum status was only related to the years that network members had been injecting drugs. This study has implications for positive social change in that public health practitioners may gain a better understanding of the social network characteristics associated with high-risk behaviors of those infected with HCV and HIV in order to develop health promotion programs to lower infections and mortality.

Numerous studies have focused on the effectiveness of integrated treatment services for people with cooccurring disorders (CODs) within the criminal justice system (CJS). However, there has been a paucity of research on the effectiveness of community-integrated treatment services with CODs and influences on decreasing their interaction within the CJS. This study quantitatively examined the possible relationships between integrated treatment services and CODs and their effect on decreasing interactions within the CJS. The sample (N = 320) consisted of people with CODs from a community-based facility. The statistical analysis was a 2-way (2 x 2) and 3-way (2 x 2 x 2) mixed factorial analysis of variance. Results indicated a statistically significant difference in the number of interactions within the CJS between integrated treatment services and single treatment services, as well as a statistically nonsignificant difference between male and female. Future studies are recommended to examine the predictive value of the long-term effects of integrated treatment services in decreasing interactions within the CJS. The social implications of the study could be integral to community behavioral health care agencies and administrators of correctional institutions in demonstrating how pertinent integrated treatment services can be in decreasing the overrepresentation of people with CODs within the CJS. Furthermore, it will contribute to the continuous need for developing evidence-based programming and practices for CODs within community-based programs, increasing public safety to communities, and the tremendous cost-effectiveness to correctional programs.

Mental health professionals (MHPs) play a pivotal role in enhancing treatment outcomes for drug-using populations and minimizing their harm to the public. In response to a gap in the literature, this study sought to (a) assess MHPs' attitudes about the use and abuse of substances and their perception of their role in tackling substance abuse and related disorders in Nigeria, (b) identify predictors of perception, and (c) explore regional variations in attitude. Based on the validated drug and drug users' problems perception questionnaire and the substance abuse attitude survey, a cross-sectional survey was conducted in a randomized sample of 292 MHPs practicing in neuropsychiatric hospitals and in the mental health departments of teaching hospitals from 4 geopolitical zones of Nigeria. A response rate of 81.1% was achieved. MHPs' attitude about substance use tended towards the non-permissive, stereotypical, and moralistic spectrum, and its role perception was distinctly defined. Educational attainment (O.R = 0.50, p = 0.030), work-motivation (O.R = 0.55, p < 0.0001), and role-support (O.R = 1.48, p < 0.0001) significantly predicted MHPs' role perception. The Kruskal-Wallis test showed that there were significant regional variations in the attitudes of multidisciplinary MHPs, H (3) 18.727, p < 0.0001. Step-down follow up analysis revealed that the distribution of attitude total score vary significantly between the south-southern and southwestern region (p< 0.001), the northeastern and southeastern region of the country (p < 0.028). To foster the rehabilitation of this population and its reintegration into mainstream society, a holistic approach toward the standardization of drug treatment is needed. It should take into account the cultural, religious, and ethnic differences predominating in different regions.