Thesis (M.S.)--Boston University

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Inledning: Det finns idag en brist när det gäller forskning kring privata HVB-institutioner. Denna studie ämnar undersöka miljöterapeutiskt behandlingsarbete på HVB-institution. Författaren är intresserad av hur ett anknytningsbaserat behandlingsarbete kan se ut. Frågeställning: Hur skapar behandlingspersonalen förutsättningar för ungdomarnas möjlighet till anknytning? Metod: Genom att göra djupintervjuer med fem behandlingshemsterapeuter om deras arbete i den ostrukturerade miljöterapin, ämnar författaren att bidra till förståelsen och innebörden av anknytningsbaserat arbete på institution. Intervjuerna har analyserats med hjälp av förutbestämda dimensioner tagna från anknytningsteorin. Dessa fyra dimensioner, som beskriver olika aspekter av lyhördhet i föräldra-barn samspel, antas utgöra grunden för att anknytning skall kunna uppstå. Resultat: I intervjuerna framkommer att personalen använder sig av olika former av anknytningsbaserat samspel. I deras berättelser finns många exempel och beskrivningar av hur detta samspel tar sig uttryck i vardagliga situationer mellan personal och ungdom. Vid en analys av materialet hittar författaren samspel som faller in under samtliga fyra dimensioner. Diskussion: Författaren tycker sig kunna påvisa att det pågår ett medvetet arbete med att skapa förutsättningar för att anknytning skall kunna uppstå. Resultatet överensstämmer med den forskning som finns idag. Forskning har visat att de flesta terapeutiska behandlingar är verksamma, oavsett specifik metodik. En god allians är avgörande för ett positivt behandlingsutfall. För att kunna arbeta med anknytningsrelaterad problematik behöver fokus ligga på att åstadkomma en god relation mellan behandlare och klient. Kvar åsterstår att undersöka vilka ungdomar som kan vara betjänta av en anknytningsbaserad behandling och vilka som är i behov av andra insatser och i så fall vilka? / Introduction: There is a lack of research in the field of HVB-institutional care. In this study Environmental therapy treatments in HVB institutions are examined. The author is interested in what a attachment-based treatment can look like in the day to day work of the treatment-center therapists. Question: How do treatment-staff create the conditions for young people to have the opportunity to develop an attachment? Method: Through in-depth interviews with five treatment-center therapists about their work in unstructured environmental therapy, the author wishes to contribute to the understanding and significance of attachment-based work in HVB-institutions. The interviews have been analyzed with the help of predetermined aspects of attachmenttheory. These four dimensions, which describe different aspects of responsiveness in parent-child interaction, are assumed to be the foundation upon which it is possible for attachment to occur. Result: In the explanations, given by the staff, there are examples and descriptions of interaction which can be attributed to all four dimensions. Discussion: The author believes that they can demonstrate that there is a conscious effort to create the conditions under which it is possible for an attachment to occur. The result of this study corresponds with research which exists today. Research has shown that most therapeutic treatments are effective, regardless of the methodology. A good alliance is decisive for determining a positive result. To be able to work with attachment-based problems, there needs to be focus on achieving a strong relation between the therapist and the client. What remains is to look at which young people would benefit from an attachment-based treatment and which are in need of other treatments and in such cases, what are these?

Since this is a survey to determine the current practices and procedures of counseling in residential treatment centers for emotionally disturbed children, the problem of this study may be stated as follows: (1) to review related literature in the field of counseling and guidance in order to determine the best educational thought as to what constitutes a good counseling program; (2) by means of a survey in the form of a questionnaire, to determine what is actually being done in counseling work in established residential treatment centers for disturbed children; (3) to determine, from information received, good counseling work practices for treating emotionally disturbed children.

This study compared the attitudes of administrators, teachers and students in school settings for at-risk students. Students are considered at-risk if they are not academically successful. Teacher and student science education attitudes were analyzed by survey data and categorization of teaching practices. Additionally, data from classroom videotapes and teacher interviews was collected to support and triangulate survey data. Study participants were selected from two school settings for at-risk students 1) public alternative schools (PAS) and 2) private residential treatment centers (RTC). When the survey questions were analyzed by school type and teacher classification several differences were found between 1) teacher responses, 2) students responses and 3) the difference between student and teacher responses. However, when students were analyzed by their teachers' teaching classification no significant differences were found for any of the survey questions or question groupings.

O presente estudo teve por objetivo avaliar o uso de cocaína, crack e múltiplas drogas e os aspectos biológicos, psicológicos, sociais e qualidade de vida de usuários. Trata-se de um estudo do tipo transversal, de abordagem quantitativa, desenvolvido no CAPSad de Ribeirão Preto, SP, por meio de uma amostra clínica composta por 140 clientes do serviço, sendo 54 (38,6%) usuários de crack, 45 (32,1%) de múltiplas drogas e 41 (29,3%) de cocaína. Instrumento: Informações sociodemográficas, Severity Alcohol Dependence Data (SADD), Escala de Severidade da Dependência de Drogas (SDS), World Health Organization Quality of Life - versão abreviada (WHOQOL-bref), e o Addiction Severity Índex (ASI6). Para análise de dados, empregou-se oTeste Exato de Fisher a fim de avaliar a associação entre as variáveis; para a correlação, utilizou-se o coeficiente de correlação de Pearson e de Spearman; nas comparações, foi empregada a Análise de Variância (ANOVA) e, para avaliar a influência dos dados sociodemográficos e a qualidade de vida, utilizou-se o modelo de análise de regressão linear múltipla. A amostra caracterizou-se predominantemente por indivíduos do sexo masculino, religião católica, baixo nível de escolaridade e ocupação em atividades informais. Apenas a faixa etária, a raça e o estado civil diferenciaram-se entre os grupos avaliados. No entanto, somente o estado civil influenciou a percepção da qualidade de vida entre usuários de drogas. Níveis severos tanto da síndrome de dependência do álcool quanto de droga foram evidentes entre os grupos avaliados. Os grupos de cocaína e de crack não se diferenciaram entre si, porém se diferenciaram do grupo de usuários de múltiplas drogas na maioria das avaliações, evidenciando maiores escores nas escalas avaliadas (SADD, SDS e ASI6). No que se refere às correlações entre as áreas do ASI6 e do WHOQOL-bref, estas foram negativas, fracas e significativas na maioria de seus domínios, sinalizando que a gravidade dos problemas relacionados ao uso de substâncias psicoativas interfere na percepção da qualidade de vida. Desse modo, aumentando os problemas gerados pelo consumo de álcool (ASI6), maiores são também os prejuízos avaliados pelos domínios físico, psicológico, social e ambiente (WHOQOL-bref). O mesmo ocorreu com a área psiquiátrica (ASI6), que apresentou maior nível de gravidade quando relacionada aos domínios físico e social (WHOQOL-bref). As áreas médica e legal (ASI6) correlacionaram-se com os domínios físico e psicológico (WHOQOL-bref). Finalmente, a área suporte social e familiar (ASI6) correlacionou-se negativamente com os domínios social e ambiente (WHOQOL-bref).Vale mencionar que os resultados podem auxiliar no atendimento dos usuários de drogas por trazerem valiosas contribuições no que se refere à influência do uso dessas substâncias nos aspectos biológicos, psicológicos, sociais e, principalmente, na percepção da qualidade de vida. Assim, podem nortear a implementação de estratégias importantes no tratamento em dependência química. / The aim in this study was to assess the use of cocaine, crack and multiple drugs and the biological, psychological, social aspects and users\' quality of life. A cross-sectional study with a quantitative approach was undertaken at the CAPSad in Ribeirão Preto, SP, Brazil, involving a clinical sample of 140 clients at that service, 54 (38.6%) of whom used crack, 45 (32.1%) multiple drugs and 41 (29.3%) cocaine. Instrument: Sociodemographic information, Severity Alcohol Dependence Data (SADD), Severity of Dependence Scale (SDS), World Health Organization Quality of Life - short version (WHOQOL-bref), and the Addiction Severity Index (ASI6). For data analysis, Fisher\'s Exact Test was employed to assess the association among the variables; for the correlation, Pearson and Spearman\'s correlation coefficients were used; in the comparison, Analysis of Variance (ANOVA) was applied and, to assess the influence of the sociodemographic data and quality of life, the multiple linear regression analysis model was used. The sample predominantly included male individuals, Catholic religion, low education level and occupation in informal activities. Only age range, racial origin and marital status differed among the groups under assessment. Nevertheless, only marital status influenced the perceived quality of life among drugs users. Severe levels of the alcohol and drug dependence syndromes were evident in the evaluated groups. No mutual differences were found between the cocaine and crack groups, but these differed from the multiple drug user group in most evaluations, showing higher scores on the scales (SADD, SDS and ASI6). As regards the correlations between the areas of the ASI-6 and the WHOQOL-bref, these were negative, weak and significant in most domains, signaling that the severity of the drug use problems interferes in the perceived quality of life. Thus, increasing the problems caused by alcohol consumption (ASI6), greater harm is also found in the physical, psychological, social and environmental domains (WHOQOL-bref). The same was true for the psychiatric area (ASI6), which showed greater severity when related to the physical and social domains (WHOQOL-bref). The medical and legal areas (ASI6) were correlated with the physical and psychological domains (WHOQOL-bref). Finally, the social and family support area (ASI6) was negatively correlated with the social and environmental domains (WHOQOL-bref). It should be mentioned that the results can help to attend to drug users because they offer valuable contributions regarding the influence of the consumption of these substances on the biological, psychological, social aspects and mainly on the perceived quality of life. Hence, they can guide the implementation of important strategies for chemical addiction treatment.

O uso de drogas na adolescência é uma questão debatida nas diferentes esferas da sociedade devido aos prejuízos que ocasionados precocemente. No tratamento especializado, essa questão torna-se ainda mais complexa e desafiadora frente aos fatores intrínsecos e extrínsecos do adolescente. O estudo tem como objetivo conhecer a trajetória dos adolescentes em um tratamento para uso de drogas, desde a primeira experimentação às percepções sobre o tratamento. Baseando-se na pesquisa qualitativa, buscou-se a compreensão dos atos e comportamentos dos sujeitos ao priorizar o ponto de vista dos mesmos. A coleta de dados ocorreu por meio de um roteiro semiestruturado de entrevista. Os adolescentes sujeitos do estudo pertenciam ou já haviam abandonado o Centro de Atenção Psicossocial para Álcool e Drogas II em Ribeirão Preto-SP. Analisaram-se os dados por meio da categorização temática do conteúdo. Quatorze adolescentes foram sujeitos do estudo, sendo oito participantes do tratamento e seis que o haviam abandonado, predominante do sexo masculino com idade entre 14 e 19 anos. A maioria apresentou-se abaixo do ano escolar adequado às suas idades. A maconha foi a droga mais utilizada. Os adolescentes que abandonaram o tratamento fizeram maior experimentação de outras drogas em relação aos que estavam em tratamento. A rede de relações composta por outros usuários de drogas mostrou-se muito influente ao uso da droga, à experimentação, como fator que aumentava vontade/ intensidade do uso e como motivo para o abandono do tratamento. Outro aspecto citado foi a má utilização do tempo livre e as atividades de lazer que favoreceram a aproximação com as drogas. A droga esteve relacionada como um escape dos conflitos e próprios sentimentos. Quanto ao tratamento especializado, muitos adolescentes o iniciaram por encaminhamentos, seja judicial ou pela família. Dentre os fatores favoráveis a permanência ao tratamento esteve a rede de relações sem usuários de drogas, a participação familiar, a \"força de vontade\" e a relação com equipe profissional do tratamento. Os fatores que predispuseram ao abandono do tratamento foram a acessibilidade à droga, a inadequação dos tratamentos, a rede de amigos, a ausência de apoio familiar e o não querer parar o uso de drogas. Os adolescentes sugeriram que um tratamento atrativo e efetivo deve dispor de uma equipe profissional adequada para trabalhar com esse público, propor atividades que despertem o interesse e os motivem, e estar atento às demandas destes sujeitos às noites e finais de semana, quando o uso mais intenso de drogas ocorre. Conclui-se que os achados deste estudo podem contribuir na elaboração de propostas de intervenções terapêuticas direcionadas a adolescentes usuários de drogas, favorecendo sua adesão ao tratamento. / The use of drugs during adolescence is a question that has been discussed in the different spheres of society, due to the harms they cause precociously in the users\' lives. In the specialized treatment this question becomes still more complex and challenging in the face of the intrinsic and external factors of the adolescent. The aim of the present study is to know the life course of the adolescent during a anti-drug treatment, from the first experimentation to the perceptions on the treatment. Based on qualitative research we seek for understanding of the acts and behavior of the individuals by giving priority to their point of view. The gathering of data was performed by means of a semi-structured guideline of interviews. The adolescent participants of the study belonged to or had already abandoned the Center for Psycho-Social Care for Alcohol and Drugs II in Ribeirão Preto- SP. The data were analyzed through thematic categorization of content. Fourteen adolescents - predominantly male with an age between 14 and 19 years - were interviewed, eight of them are participating in the treatment and six had abandoned it. The major part had a school education below the appropriate level for their age. Marihuana was the most used drug. The adolescent who abandoned treatment had more experimentation of other drugs in comparison to those who were under treatment. The network of relationships composed of other drug users appeared to be very influent for the use of the drug, for the experimentation, as a factor which increased the desire/ intensity of use and as a reason for abandoning the treatment. Another aspect mentioned was the bad usage of free time and the recreational activities which favor the contact with drugs. The drug was related to an escape from conflicts and own feelings. With regard to the specialized treatment, many adolescents started it on referral by judicial authority or by the family. Among the favorable factors of maintaining the treatment were the network of relationships without drug users, the family participation, the \"power of will\" as well as the relationship with the professional treatment team. The factors which predispose the abandonment of treatment were accessibility to the drugs, the inadequacy of treatment, the network of friends, the absence of familiar support and the reluctance to abandon the use of drugs. Finally, the adolescents suggested that an attractive and efficient treatment should dispose of a professional team appropriate for working with the adolescents. The activities proposed by the treatment should arouse their interest and motivate them, and the treatment must be attentive to the needs of these individuals at night and during weekends when the use of drugs occurs more intensively. The study concluded that the findings made are able to contribute to the elaboration of suggestions for therapeutic interventions addressed to adolescent drug users, thus favoring their adhesion to the treatment.

O presente estudo teve por objetivo avaliar o uso de cocaína, crack e múltiplas drogas e os aspectos biológicos, psicológicos, sociais e qualidade de vida de usuários. Trata-se de um estudo do tipo transversal, de abordagem quantitativa, desenvolvido no CAPSad de Ribeirão Preto, SP, por meio de uma amostra clínica composta por 140 clientes do serviço, sendo 54 (38,6%) usuários de crack, 45 (32,1%) de múltiplas drogas e 41 (29,3%) de cocaína. Instrumento: Informações sociodemográficas, Severity Alcohol Dependence Data (SADD), Escala de Severidade da Dependência de Drogas (SDS), World Health Organization Quality of Life - versão abreviada (WHOQOL-bref), e o Addiction Severity Índex (ASI6). Para análise de dados, empregou-se oTeste Exato de Fisher a fim de avaliar a associação entre as variáveis; para a correlação, utilizou-se o coeficiente de correlação de Pearson e de Spearman; nas comparações, foi empregada a Análise de Variância (ANOVA) e, para avaliar a influência dos dados sociodemográficos e a qualidade de vida, utilizou-se o modelo de análise de regressão linear múltipla. A amostra caracterizou-se predominantemente por indivíduos do sexo masculino, religião católica, baixo nível de escolaridade e ocupação em atividades informais. Apenas a faixa etária, a raça e o estado civil diferenciaram-se entre os grupos avaliados. No entanto, somente o estado civil influenciou a percepção da qualidade de vida entre usuários de drogas. Níveis severos tanto da síndrome de dependência do álcool quanto de droga foram evidentes entre os grupos avaliados. Os grupos de cocaína e de crack não se diferenciaram entre si, porém se diferenciaram do grupo de usuários de múltiplas drogas na maioria das avaliações, evidenciando maiores escores nas escalas avaliadas (SADD, SDS e ASI6). No que se refere às correlações entre as áreas do ASI6 e do WHOQOL-bref, estas foram negativas, fracas e significativas na maioria de seus domínios, sinalizando que a gravidade dos problemas relacionados ao uso de substâncias psicoativas interfere na percepção da qualidade de vida. Desse modo, aumentando os problemas gerados pelo consumo de álcool (ASI6), maiores são também os prejuízos avaliados pelos domínios físico, psicológico, social e ambiente (WHOQOL-bref). O mesmo ocorreu com a área psiquiátrica (ASI6), que apresentou maior nível de gravidade quando relacionada aos domínios físico e social (WHOQOL-bref). As áreas médica e legal (ASI6) correlacionaram-se com os domínios físico e psicológico (WHOQOL-bref). Finalmente, a área suporte social e familiar (ASI6) correlacionou-se negativamente com os domínios social e ambiente (WHOQOL-bref).Vale mencionar que os resultados podem auxiliar no atendimento dos usuários de drogas por trazerem valiosas contribuições no que se refere à influência do uso dessas substâncias nos aspectos biológicos, psicológicos, sociais e, principalmente, na percepção da qualidade de vida. Assim, podem nortear a implementação de estratégias importantes no tratamento em dependência química. / The aim in this study was to assess the use of cocaine, crack and multiple drugs and the biological, psychological, social aspects and users\' quality of life. A cross-sectional study with a quantitative approach was undertaken at the CAPSad in Ribeirão Preto, SP, Brazil, involving a clinical sample of 140 clients at that service, 54 (38.6%) of whom used crack, 45 (32.1%) multiple drugs and 41 (29.3%) cocaine. Instrument: Sociodemographic information, Severity Alcohol Dependence Data (SADD), Severity of Dependence Scale (SDS), World Health Organization Quality of Life - short version (WHOQOL-bref), and the Addiction Severity Index (ASI6). For data analysis, Fisher\'s Exact Test was employed to assess the association among the variables; for the correlation, Pearson and Spearman\'s correlation coefficients were used; in the comparison, Analysis of Variance (ANOVA) was applied and, to assess the influence of the sociodemographic data and quality of life, the multiple linear regression analysis model was used. The sample predominantly included male individuals, Catholic religion, low education level and occupation in informal activities. Only age range, racial origin and marital status differed among the groups under assessment. Nevertheless, only marital status influenced the perceived quality of life among drugs users. Severe levels of the alcohol and drug dependence syndromes were evident in the evaluated groups. No mutual differences were found between the cocaine and crack groups, but these differed from the multiple drug user group in most evaluations, showing higher scores on the scales (SADD, SDS and ASI6). As regards the correlations between the areas of the ASI-6 and the WHOQOL-bref, these were negative, weak and significant in most domains, signaling that the severity of the drug use problems interferes in the perceived quality of life. Thus, increasing the problems caused by alcohol consumption (ASI6), greater harm is also found in the physical, psychological, social and environmental domains (WHOQOL-bref). The same was true for the psychiatric area (ASI6), which showed greater severity when related to the physical and social domains (WHOQOL-bref). The medical and legal areas (ASI6) were correlated with the physical and psychological domains (WHOQOL-bref). Finally, the social and family support area (ASI6) was negatively correlated with the social and environmental domains (WHOQOL-bref). It should be mentioned that the results can help to attend to drug users because they offer valuable contributions regarding the influence of the consumption of these substances on the biological, psychological, social aspects and mainly on the perceived quality of life. Hence, they can guide the implementation of important strategies for chemical addiction treatment.

O uso de drogas na adolescência é uma questão debatida nas diferentes esferas da sociedade devido aos prejuízos que ocasionados precocemente. No tratamento especializado, essa questão torna-se ainda mais complexa e desafiadora frente aos fatores intrínsecos e extrínsecos do adolescente. O estudo tem como objetivo conhecer a trajetória dos adolescentes em um tratamento para uso de drogas, desde a primeira experimentação às percepções sobre o tratamento. Baseando-se na pesquisa qualitativa, buscou-se a compreensão dos atos e comportamentos dos sujeitos ao priorizar o ponto de vista dos mesmos. A coleta de dados ocorreu por meio de um roteiro semiestruturado de entrevista. Os adolescentes sujeitos do estudo pertenciam ou já haviam abandonado o Centro de Atenção Psicossocial para Álcool e Drogas II em Ribeirão Preto-SP. Analisaram-se os dados por meio da categorização temática do conteúdo. Quatorze adolescentes foram sujeitos do estudo, sendo oito participantes do tratamento e seis que o haviam abandonado, predominante do sexo masculino com idade entre 14 e 19 anos. A maioria apresentou-se abaixo do ano escolar adequado às suas idades. A maconha foi a droga mais utilizada. Os adolescentes que abandonaram o tratamento fizeram maior experimentação de outras drogas em relação aos que estavam em tratamento. A rede de relações composta por outros usuários de drogas mostrou-se muito influente ao uso da droga, à experimentação, como fator que aumentava vontade/ intensidade do uso e como motivo para o abandono do tratamento. Outro aspecto citado foi a má utilização do tempo livre e as atividades de lazer que favoreceram a aproximação com as drogas. A droga esteve relacionada como um escape dos conflitos e próprios sentimentos. Quanto ao tratamento especializado, muitos adolescentes o iniciaram por encaminhamentos, seja judicial ou pela família. Dentre os fatores favoráveis a permanência ao tratamento esteve a rede de relações sem usuários de drogas, a participação familiar, a \"força de vontade\" e a relação com equipe profissional do tratamento. Os fatores que predispuseram ao abandono do tratamento foram a acessibilidade à droga, a inadequação dos tratamentos, a rede de amigos, a ausência de apoio familiar e o não querer parar o uso de drogas. Os adolescentes sugeriram que um tratamento atrativo e efetivo deve dispor de uma equipe profissional adequada para trabalhar com esse público, propor atividades que despertem o interesse e os motivem, e estar atento às demandas destes sujeitos às noites e finais de semana, quando o uso mais intenso de drogas ocorre. Conclui-se que os achados deste estudo podem contribuir na elaboração de propostas de intervenções terapêuticas direcionadas a adolescentes usuários de drogas, favorecendo sua adesão ao tratamento. / The use of drugs during adolescence is a question that has been discussed in the different spheres of society, due to the harms they cause precociously in the users\' lives. In the specialized treatment this question becomes still more complex and challenging in the face of the intrinsic and external factors of the adolescent. The aim of the present study is to know the life course of the adolescent during a anti-drug treatment, from the first experimentation to the perceptions on the treatment. Based on qualitative research we seek for understanding of the acts and behavior of the individuals by giving priority to their point of view. The gathering of data was performed by means of a semi-structured guideline of interviews. The adolescent participants of the study belonged to or had already abandoned the Center for Psycho-Social Care for Alcohol and Drugs II in Ribeirão Preto- SP. The data were analyzed through thematic categorization of content. Fourteen adolescents - predominantly male with an age between 14 and 19 years - were interviewed, eight of them are participating in the treatment and six had abandoned it. The major part had a school education below the appropriate level for their age. Marihuana was the most used drug. The adolescent who abandoned treatment had more experimentation of other drugs in comparison to those who were under treatment. The network of relationships composed of other drug users appeared to be very influent for the use of the drug, for the experimentation, as a factor which increased the desire/ intensity of use and as a reason for abandoning the treatment. Another aspect mentioned was the bad usage of free time and the recreational activities which favor the contact with drugs. The drug was related to an escape from conflicts and own feelings. With regard to the specialized treatment, many adolescents started it on referral by judicial authority or by the family. Among the favorable factors of maintaining the treatment were the network of relationships without drug users, the family participation, the \"power of will\" as well as the relationship with the professional treatment team. The factors which predispose the abandonment of treatment were accessibility to the drugs, the inadequacy of treatment, the network of friends, the absence of familiar support and the reluctance to abandon the use of drugs. Finally, the adolescents suggested that an attractive and efficient treatment should dispose of a professional team appropriate for working with the adolescents. The activities proposed by the treatment should arouse their interest and motivate them, and the treatment must be attentive to the needs of these individuals at night and during weekends when the use of drugs occurs more intensively. The study concluded that the findings made are able to contribute to the elaboration of suggestions for therapeutic interventions addressed to adolescent drug users, thus favoring their adhesion to the treatment.

The problem with which this study is concerned is the delineation of current practices in therapeutic recreation in psychiatric treatment centers in Texas, The programs of the forty-two hospitals responding to the survey questionnaire were evaluated in terms of the National Therapeutic Recreation Society's "Standards for Therapeutic Recreation in Psychiatric Facilities." It was determined that, while the use of recreation in psychiatric rehabilitation is widespread, many programs are not administratively independent., A close association between recreation and occupational therapy was found. Extensive recreation facilities and activities were reported. Use of community resources was widespread, but follow-up and leisure counseling services were rare. Most personnel had no recreation training. The evaluation showed limited compliance with the standards.