Mental health treatment in state prisons is revealed to be highly variable, under-funded, and systematically inadequate. Existing literature exposes this injustice but fails to provide a comprehensive proposal for reform. This paper attempts to fill that gap, outlining a cost-effective, evidence-based treatment proposal, directly addressing the deficits in care revealed through analysis of our current system. In addition, this paper provides historical overviews of the prison system and mental health treatment, utilizing theoretical perspectives to contextualize this proposal in the present state of affairs. Lastly, the evidence is provided to emphasize the potential economic and social benefits of improving mental health treatment in state prisons. Significant findings suggest a clear financial, legal, and moral incentive for states to address this issue, while the proposal provides a viable method of doing so.

Research suggests that trauma has an impact on eating disorders. While prior research has demonstrated that the trauma from abuse has a significant impact on eating disorders, research has failed to explore other types of trauma. In addition, previous studies have stopped short of examining the impact trauma has on functioning among individuals with an eating disorder. This study aimed to address that gap in the literature. The purpose of this study is to examine whether traumatic life events impact psychosocial functioning among individuals living with an eating disorder. Furthermore, this study aimed to identify which traumas are shown to have the strongest impact on psychosocial functioning. A quantitative design was used for this investigation, using measurement scales that have been shown to be valid and reliable in measuring the constructs of trauma and psychosocial functioning among individuals with an eating disorder. Participants completed a single survey of the combined measurement scales. A non-random purposive sample was collected from online social media cites Tumblr, Facebook, eating disorder message boards, and an outpatient eating disorder treatment center. Using a study sample of N= 2,319 descriptive and inferential statistics were conducted using SPSS. Based on the results of correlation and multiple regression analyses, a statistically significant relationship was found between traumatic life events and psychosocial impairment among those with eating disorders. The findings of this study have the potential to impact the way social work policies address the relationship between trauma and eating disorders, and influence the way social work clinicians implement strategies to treat both trauma and eating psychopathology.

This research on healthcare strategies of home-based, low-wage, immigrant careworkers contributes to the ways medical anthropology, migration studies and social science understand human-economy-family care relationships and health and carework as commodities in today's global economy. It reveals the consequences for workers as they defray the costs of care for the Italian government and contribute to their home economies. This research was conducted in Genoa, Italy, which has the largest percentage of people over the age of 70 in any city of its size in the world and a tradition of sending and receiving immigrant workers. The main question was: Under the circumstances of providing labor-intensive, in-home supportive services, how do immigrant workers respond to their own health needs? The researcher collected data from interviews with 50 careworkers, 25 professionals who provide services to the careworkers, and 23 administrators in the health system, government agencies, labor unions, and the Catholic Church. The careworkers interviewed were women from South America, as they do most of the carework jobs in this city. Long-term participant observation and interview data were analyzed to: 1) produce empirical data on health concerns of and healthcare resource use by migrant careworkers; and 2) investigate the relationships between health concerns, living/working conditions, and healthcare resource use of transnational immigrants in the informal economy. The data showed that the Catholic Church promoted immigrants as able workers, aided their elderly parishioners, and provided necessary mental health support to careworkers who experienced stress. The data also revealed that the health care system of Italy functioned well to address the physical health concerns of immigrant careworkers. The relationship between the client and the worker was important for the general well-being of the worker and her ability to maintain her general health, have time for medical appointments, socialize outside of the workplace, and attend community events. This study examined: strategies for using health resources; responses of the Italian medical system personnel to anti-immigrant legislation; use of non-State resources to meet health needs; the health consequences of caring for an elderly person in the private home; and ways to address these health consequences.

The purpose of the present study was to investigate the influence of pain causal attributions on patient pain-related functioning, treatment engagement, and clinical outcomes. Additionally, the impact of discordant pain causal attributions between patients and their providers as well as between interdisciplinary providers was examined. Patients rated their pain functioning and causal pain attributions during a regular clinic visit. Following the patient’s visit both the behavioral medicine provider and internal medicine resident provided ratings of similar pain-related functioning domains and causal attributions. Follow-up data were collected from the electronic medical record three months following that clinic visit. Overall, results revealed that patients’ chronic pain attributions did influence pain-related functioning, however the impact was relatively small. There was insufficient evidence to conclude that chronic pain attributions influence a patient’s readiness to adopt self-management coping strategies and their subsequent treatment engagement. Additionally, results confirmed that different health care disciplines attribute the cause of patients’ chronic pain in distinct ways and these unique perspectives can lead to discrepant pain-related functioning assessments between providers. Discordant ratings between providers were shown to influence referring patterns for interdisciplinary services and the patient’s overall opioid dose. Similarly, discrepancies between patients and their providers influenced subsequent referral for behavioral health services, the patient’s attendance at those visits, and their overall morphine equivalent doses. Together the results indicate the important role pain attributions can play in chronic pain management and highlight the central role of the patient-provider and provider-provider relationship.

Essa pesquisa tomou por objeto a explicação de trabalhadores da Secretaria Municipal de Saúde de São Paulo para o aumento da sífilis congênita na região em que trabalham - instâncias administrativas da Coordenadoria de Saúde Norte e da Supervisão Técnica de Saúde Santana-Tucuruvi-Jaçanã-Tremembé. No Brasil, a sífilis congênita, indicador de qualidade da assistência ao pré-natal, tem apresentado nos últimos anos um acentuado crescimento. Em São Paulo, na região Tremembé e Jaçanã, o crescimento se acentuou a partir de 2008, concomitante à adoção pela SMS do modelo de gestão por Organizações Sociais para a maioria das unidades da Atenção Básica. Utilizou-se como marco teórico o Estado, compreendido como instituição inseparável do modo de produção capitalista, que mede a relação de reprodução do capital e as políticas estatais, como instrumentos dessa mediação. O objetivo do estudo foi identificar a explicação de trabalhadores da Secretaria Municipal para o aumento da sífilis congênita a partir da adoção do modelo de gestão por Organizações Sociais, uma vez que a justificativa para a adoção desse modelo foi a promessa de melhor eficiência e eficácia dos serviços. Metodologia. Trata-se de pesquisa qualitativa de caráter descritivo-analítico, que utilizou a técnica de entrevista para obtenção dos dados e o método da análise de conteúdo para a análise dos depoimentos. Os resultados mostraram que os trabalhadores da Administração Direta reconhecem a piora da qualidade na assistência à saúde da região e a associam ao crescimento dos casos de sífilis congênita. Atribuem à piora, tanto da qualidade da atenção quanto do quadro epidemiológico, explicações identificadas com o âmbito institucional e com o âmbito individual. No âmbito institucional, destaca-se a priorização das metas quantitativas e o encerramento contratual das Organizações Sociais gerando insegurança e insatisfação do trabalhador, além de relatos sobre a qualidade da assistência antes da adoção desse modelo de gestão. Já no âmbito individual, aponta-se a 9 mulher no centro do crescimento da sífilis congênita e o homem e o jovem no centro do crescimento da sífilis congênita. Explicação para o crescimento da sífilis congênita recaiu também nas características da própria doença e na redução do Estado. Discute-se que essas explicações para o aumento da sífilis congênita, tanto no âmbito institucional, sem o questionamento do modelo de gestão por Organizações Sociais adotado para o município, como na perspectiva dos indivíduos, particularmente nas suas precárias condições de vida, parecem identificadas com o posicionamento desses trabalhadores que indica que a realidade epidemiológica da doença na região é um fenômeno inevitável e imutável. Considera-se por fim que as explicações dos sujeitos estão coerentes com os argumentos do Plano Diretor de Reforma Administrativa do Estado mostrando que as estratégias de convencimento social utilizadas para implantação do modelo privatizante da gestão alcançou os espaços que foram objeto de politização durante a reforma sanitária. / The object of this research is the explanation of the workers of the Health Department of São Paulo city for the congenital syphilis increase in the area they work administrative instance of the Northern Health Coordination and of the Santana-Tucuruvi-Jaçanã-Tremembé Health Technical Supervision. In Brasil the congenital syphilis is an indicator of prenatal care assistance quality that has been sharply increasing in the last years. In the area of Tremembé and Jaçanã in São Paulo, the sharp increase has been occurring since 2008 concomitant with the adoption of the Health Social Organization administrative model by the Health Department for the majority of the Primary Health Care units. Considering our theoretical framework we advocate that the State is an inseparable institution from the capitalist mode of production that mediates the relation between the capital reproduction and the state policies, which are instruments of this mediation. The objective of the study was to identify the explanation of the Health Department workers for the congenital syphilis increase activated by the Health Social Organization administrative model adoption. The justification of the adoption of this model was the promise of efficiency and efficacy enhancement of the health care services. Methodology: This is a descriptive-analytical qualitative research that used interviews to collect data. The content analysis method was used for the testimonials analysis. The results show that the workers recognized the decrease of the health assistance quality in the area and associated that to the growth of the congenital syphilis cases. Considering the assistance quality and the epidemiology scenario, the subjects attributed explanations identified as belonging to the institutional sphere and to the individual sphere. In the institutional sphere, there is prioritization of quantitative goals, end of Health Social Organization contract generating workers insecurity and dissatisfaction, and reports about the quality of the assistance before the Health Social Organization administrative model. In the individual sphere, women in the center of the congenital syphilis growth, and men and youth in the center of the congenital 11 syphilis growth are highlighted. The characteristics of the congenital syphilis and the State reduction are also taken as explanations for the disease growth. We discuss that these explanations for the increase of congenital syphilis seem to be consistent with the workers positioning, which regards to the inevitability and immutability of the epidemiological scenario, both in the institutional sphere and the individual perspective. They do not question the Health Social Organization administrative model adopted by the city nor the precarious life condition of the individuals. We consider that the subjects explanations are coherent with the State Administrative Reform Plan argument, showing that the social convincing strategies to implant the private administration model have reached the spaces that were object of politicization during the sanitary reform.

La présente thèse explore, à travers quatre papiers, la possibilité d’étendre le régime d’assurance maladie sociale (SHI) vers la couverture santé universelle (CSU) et ce en présence d’obstacles structurels économiques.Les effets moyens de deux traitements, les deux assurances MHI et MAS, sur l’utilisation des soins de santé (consultations externes et hospitalisations) sont estimés. L’actuel régime d’assurance sociale en Tunisie (SHI), malgré l’amélioration de l’utilisation des soins de santé procurée aux groupes couverts, reste incapable d’atteindre une couverture effective de tous les membres de la population vis-à-vis des services de soins dont ils ont besoin. L’atteinte de cet objectif requière une stratégie qui cible les ‘‘arbres’’ et non la ‘‘forêt’’.Le chapitre deux contourne les principaux obstacles à l’extension de la couverture par l’assurance maladie et propose une approche originale permettant de cibler les travailleurs informels et les individus en chômage. Une étude transversale d’évaluation contingente (CV) a été menée en Tunisie se proposant d’estimer les volontés d’adhésion et les consentements à payer (WTP) pour deux régimes obligatoires présentés hypothétiquement à l’adhésion. Les résultats confirment l’hypothèse selon laquelle la proposition d’une affiliation volontaire à un régime d’assurance obligatoire serait acceptée par la majorité des non couverts et que les WTP révélés pour cette affiliation seraient substantiels. Enfin, dans le chapitre trois, on insiste sur l'’importance de prendre en compte les attitudes protestataires en évaluant la progression vers la CSU. / This thesis explores, in a four paper format, the possibility of extending social health insurance (SHI) schemes towards Universal Health Coverage (UHC) in presence of structural economic obstacles.The average treatment effects of two insurance schemes, MHI and MAS, on the utilization of outpatient and inpatient healthcare are estimated. The current Tunisian SHI schemes, despite improving utilization of healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for needed services. Attaining the latter goal requires a strategy that targets the “trees” not the “forest”.Chapter two gets around major challenges to extending health insurance coverage and proposes an original approach by targeting informal workers and unemployed. A cross-sectional Contingent valuation (CV) study was carried out in Tunisia dealing with willingness-to-join and pay for two mandatory health and pension insurance schemes.Results support the hypotheses that the proposition of a voluntary affiliation to mandatory insurance schemes can be accepted by the majority of non-covered and that the WTP stated are substantial.Finally in chapter three we focus on methodological aspects that influence the value of the WTP. Our empirical results show that the voluntary affiliation to the formal health insurance scheme could be a step towards achieving UHC in Tunisia. Overall, we highlight the importance of taking into account protest positions for the evaluation of progress towards UHC.

Relatively few studies have investigated the relationship between executive functioning (EF) and language development, and even fewer have researched hot and cool EF as a predictor language development. This study is an investigation into the relationship between EF and language development in preschool aged children. More specifically, the ability for hot or cool EF to predict language, this will be the focus of the study. It was found that hot EF was a better predictor of language development in preschool aged children.

Objectives. Evaluate differences in depressive symptoms, compare sociodemographic and health-related variables associated with depressive symptoms and report level of impact of depressive symptoms on daily activities. Methods. Cross-sectional study using a self-administered questionnaire and Patient Health Questionnaire-9 (PHQ-9) diagnostic survey on 1115 patients aged 60–93 years who attended a primary care clinic in Korea, Russia or USA. Results. At least mild depression (PHQ-9 score of ≥5) occurred in 28% of Koreans, 65% of Russian and 27% of US participants. Russians scored more depressed on all PHQ-9 items (P < 0.01) and more suicidal thoughts (P < 0.001), while Koreans had less feelings of worthlessness (P < 0.001). Depression predictors included poorer self-rated health [odds ratio (OR) 2.47, 95% confidence interval (CI) 1.84–3.33, P < 0.0001], chronic diseases (OR 1.34, CI 1.21–1.48, P < 0.0001), female gender (OR 1.56, CI 1.15–2.12, P = 0.0046) and religious attendance (OR 0.88, CI 0.79–0.97, P = 0.0099) for all subjects. Being employed was protective in Korea (OR 0.41, CI 0.21–0.77, P = 0.0061) and being married (OR 0.42, CI 0.27–0.66, P = 0.0002) and of older age (OR 0.95, CI 0.93–0.98, P = 0.0006) protective in US participants. Vascular disease was associated with depressive symptoms in Russia (OR 3.47, CI 1.23–9.80, P = 0.0187). In regression analyses stratified by country for a given level of depressive symptoms, the Russian sample had less impact on daily activities (Russia R2 = 0.107 versus Korea R2 = 0.211 and US R2 = 0.419) P = 0.029. Conclusions. Depressive symptoms were more common in Russia than in Korea and USA but had less impact on daily functioning. Cultural or environmental factors may account for this finding.

The Merriam-Webster Dictionary (2018) defines heartbreak as “crushing grief, anguish or distress.” Heartbreak can lead to biological, psychological and social responses and consequences. Heartbreak from the dissolution of a romantic relationship is a form of disenfranchised grief, which is defined as the griever’s belief that society does not recognize their source of grief as legitimate (Doka, 1989). The literature shows that talking about grief helps those who experience it (Fisher & Archer, 2008). Hence, the present study sought to provide a consensus of the best practices that marriage and family therapists have utilized to help broken-hearted clients. I employed a modification of the Delphi technique, a research method which seeks to reach consensus on a topic through group communication between experts in the subject area discussed (Hsu & Sandford, 2007) in order to gather data about best practices from marriage and family therapists on how they have helped their broken-hearted clients. This study consisted of a total of 20 experts, who are licensed marriage and family therapists. The findings suggest that the disenfranchisement of the grief resulting from the dissolution of a romantic relationship is closely associated with the symptom of sadness experienced by the broken-hearted. In addition, the way in which MFTs can help the disenfranchised griever is by providing an empathic presence in sessions, generating historical conversations through the use of a genogram, involving family members in the therapeutic process and having future oriented conversations. The results of this study have illustrated a plethora of techniques and best practices that have reportedly proven successful in helping the broken-hearted client.

Social workers are trained during the course of their education to work with the elderly and to understand the various dynamics of aging. These professionals also receive education on substance abuse and how to assess clients as well as link them to appropriate supportive services. How can social workers be more inclined to effectively treat the elderly substance abuser? What are, if any, special considerations a social worker should be aware of when working with the geriatric population? What treatment modalities seem to be more effective with the elderly client? This study utilized a qualitative analysis consisting of interviews with eight clinicians who specialize in the area of addiction treatment amongst the aging population. The purpose of this study was to gain insight and knowledge that can be used to promote social worker awareness of elderly substance abuse as well as the identification of effective addiction treatment methods in the field of gerontological social work. The findings of this study will impact future social work practice, policy and research in the areas of education, treatment, and advocacy for the aging and substance abuse populations. Keywords: gerontology, substance abuse, aging, polypharmacy, interventions