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<p dir="ltr">Military families are a unique context as they experience separation from the service member who is away from the family for a considerable duration of time for a job that puts them at risk of serious injury or death. Service members returning from deployments may display a variety of mental health difficulties including post-traumatic stress disorder, especially when they have combat experiences. Applying a family systems framework, this thesis examined the associations between both service members’ and significant others’ PTSD symptoms, their ineffective arguing, and their reports of their children’s externalizing behaviors across three time points during reintegration, or the stage in the deployment cycle when the service member returns to the family. The study tested hypotheses that these would decline over time, and that initial levels and the rate of change in ineffective arguing would mediate the effect of parental PTSD at Time 1 on children’s externalizing behaviors at Time 3. Using data from service members and significant others in 71 families (142 individuals), I estimated multilevel models using both mixed and the structural equation frameworks. I found that parental PTSD and ineffective arguing were stable across reintegration, with considerable inter-individual variation in these at baseline. There was a decrease in children’s externalizing behaviors across time. There were also significant differences in parents’ rating of children’s externalizing behaviors. I did not find evidence for mediation but did find an association between parental PTSD and baseline levels of ineffective arguing. Results suggest that while parental stress is linked with the couple’s functioning, there may be protective factors within families that act as sources of resilience for the children.</p><p><br></p>

This study was made to determine to what extent behavior problems in fourth grade children in the Palo Pinto Common School, Palo Pinto, Texas, were revealed in their drawings.

Résumé : En protection de la jeunesse, les enfants ayant des comportements sexuels problématiques (CSP) suscitent l’incompréhension des intervenants et provoquent de l’inquiétude en raison des torts qu’ils peuvent causer. Prenant appui sur un modèle explicatif, cette étude visait à identifier les facteurs qui distinguent les enfants présentant des CSP des autres enfants pris en charge en protection de la jeunesse. Des analyses secondaires ont été réalisées à partir des données de l’Étude d’incidence québécoise de 2008 sur les situations évaluées en protection de la jeunesse. L’échantillon comprenait 1020 enfants ayant fait l’objet d’un signalement retenu et fondé. Les enfants avec CSP (n = 72) ont été comparés aux enfants sans CSP (n = 948) sur un ensemble de variables personnelles et familiales au moyen d’analyses univariées, puis multivariées. Le modèle final de régression logistique révèle que les enfants avec CSP sont plus susceptibles de manifester une variété de problèmes de fonctionnement, d’avoir fait l’objet d’un signalement fondé pour agression sexuelle et d’avoir un parent qui a vécu un placement dans l’enfance. À l’inverse, ils sont moins susceptibles d’avoir fait l’objet d’un signalement fondé pour mauvais traitements psychologiques. La discussion traite de l’implication des résultats pour l’intervention en contexte de protection. / Abstract : Sexual behavior problems (SBP) generate a lack of understanding from child protective services workers and is a source of concern as they can potentially harm children. Based upon an exploratory model, this study aimed to identify the factors differentiating children with SBP from other children cared for by protective services. Secondary analysis were realised with data obtained from the Étude d’incidence québécoise, with a sample of 1020 children aged from 2 to 12 years old and the subject of a substantiated report to the child protective services. Children with SBP (n = 72) were compared to children without SBP (n = 948) on several personal and familial variables using univariate, then multivariate analysis. The final model of the logistic regression reveals that children with SBP are more likely to show a variety of functioning problems, as well as more likely to be reported for sexual abuse and having a parent who has been the subject of a placement episode during his youth. Conversely, they are less likely to be reported for psychological maltreatment. The discussion covers the results implication for psychosocial intervention in a protective services context.

Section A reviews the clinical and risk implications of dual diagnosis along with the treatment context. The value of gathering firsthand accounts of service users to inform the planning and delivery of healthcare is touched on. The second part of the paper centres on theories of motivation and how they might be applied to help explain low rates of dual diagnosis treatment uptake and engagement. Finally, gaps in the literature are highlighted with recommendations for further research. Section B There is an emerging evidence base to support the use of integrated approaches that treat co-existing mental health and substance use disorders simultaneously. However, low rates of treatment uptake and engagement remain a concern. To address this, it would seem important to understand dual diagnosis treatment motivation and engagement, an area that has received little attention from the research community. The aim of this study was to explore service users’ and clinicians' understandings of how treatment motivation and its relationship with treatment engagement relate specifically to people with dual diagnosis. Transcripts from semi-structured interviews with four service users and four clinicians were analysed using narrative methodology. The study suggests that the factors underpinning treatment motivation and engagement among people viewed as having dual diagnosis are similar to those thought to be associated with addictions and mental health disorders generally although their relative influence and interaction effect might be different. It is suggested that negative perceptions of services, difficulties with trust, and therapeutic relationship are particularly important issues among dual diagnosis populations. Clinical and theoretical implications of the study are discussed in relation to the literature as well as recommendations for future research. Section C: Critical Appraisal. This paper provides a general overview of narrative research, including strengths and limitations as they relate to this study. With reference to the literature, clinical and theoretical implications are elaborated along with recommendations for future research. The author’s critical self-reflections regarding the process of initiating, carrying out and completing the study are highlighted. Following this, there is a section on the ethical considerations of the study. Finally, the measures taken to ensure the quality of the study and maximise internal consistency are presented.

A literature review in Section A reviews the conceptual and empirical literature with regard to the usefulness and challenges inherent in applying recovery approaches in secure services, with a particular focus on women with a diagnosis of personality disorder. Section B. Background: Some studies have suggested that recovery approaches could be facilitated in secure mental health services despite a number of inherent tensions. However, none have explored if this applies to women with a diagnosis of personality disorder in secure care. A group whose needs have historically been overlooked, and can present with complex care-seeking behaviours. Aims. To explore how staff working with these women understand and apply recovery approaches in secure units. Method. Eleven multidisciplinary staff members working in a medium-secure unit in the UK participated in in-depth interviews. The data was analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: secure base, balancing tensions, therapeutic relationship, initiating recovery, and nurturing recovery. These appeared to interact and influence each other throughout the recovery process. Conclusions. Staff are required to continually balance a number of tensions and as such they need a secure base from which to explore the service-users’ unique recovery process through the medium of collaborative therapeutic relationships. Staff sharing a recovery ethos that is embedded in the culture of a conducive environment, and is supported by supervision and teamwork, fosters the actualisation of recovery principles of empowerment, identity formation, and hope. Section C provides a critical appraisal of the study as well as a personal reflection on what was learnt through the process of the conducting the study.

Accurate, early diagnosis of Alzheimer's Disease is becoming increasingly important in light of its growing prevalence among the expanding older-aged adult population. Due to its ability to assess multiple domains of cognitive functioning and provide a profile of impairment rather than a simple global score, the Neurobehavioral Cognitive Status Examination (NCSE) is suggested to better assess such patterns of cognitive deficit for the purpose of diagnosis. The performance of the NCSE was compared with that of the Mini-Mental State Examination (MMSE) for diagnostic sensitivity in a sample of patients diagnosed as having probable Alzheimer's Disease. The strength of correlation between severity of cognitive impairment on these tests and report of behavior problems on the Memory and Behavior Problems Checklist (MBPC) was also explored, as was performance on the NCSE and report of behavior problems using the MBPC in predicting Single Photon Emission Computed Tomography (SPECT) scan results. The NCSE was found to exhibit greater sensitivity to physician diagnosis of probable Alzheimer's Disease relative to two versions (Serial 7's or WORLD) of the MMSE (.90, .77 and .68, respectively). While both measures were found to correlate significantly with the report of behavior problems, only a moderate proportion (NCSE = .22 and MMSE = .33) of the explained variance was accounted for by either test. Severity of cognitive impairment on the NCSE was found to be significant, though small in estimate of its effect size, for predicting the absence/presence of pathognomic findings on SPECT scans. In contrast, the report of behavior problems on the MBPC did not significantly predict SPECT scan outcomes. The NCSE would appear to be a sensitive tool for the identification of the extent and severity of cognitive impairment found among demented individuals; however, it may be "over"-sensitive to such diagnosis. Although relationships between cognitive impairment and behavior problems and/or neuroradiological findings are observed, their meaningfulness remains with the need for further, more detailed, study using standardized criteria for comparison purposes.