Orientador: Carmen Maria Bueno Neme / Banca: Monica Perri Kohl Greghi / Banca: Erico Bruno Viana Campos / Resumo: O consumo de substâncias psicoativas entre adolescentes é uma grande preocupação para estudiosos, governantes, profissionais da saúde e da educação. Este trabalho teve como objetivo investigar alguns fatores que possam influenciar na não adesão ao tratamento dos familiares de adolescentes usuários de substâncias psicoativas que frequentam um Centro de Atenção Psicossocial Álcool e Drogas Infantojuvenil de um município do interior de São Paulo. Nesta instituição, foi realizado levantamento dos prontuários dos pacientes atendidos no período de agosto de 2014 a junho de 2017 para a obtenção do percentual de não adesão das famílias ao tratamento dos adolescentes e propostas entrevistas clínicas e aplicação do instrumento projetivo "Desenho da Família com Estória" aos adolescentes e a pelo menos um familiar responsável pelos adolescentes. Os dados obtidos dos prontuários foram descritos e analisados por meio da técnica de análise de conteúdo e os "Desenhos da Família com Estória", por meio de Protocolo de Análise, com interpretação baseada nos pressupostos psicanalíticos. Os resultados indicaram que de 655 prontuários, apenas 43 estavam ativos no período analisado, sendo que desses, 12 adolescentes não eram acompanhados pelos familiares, representando 30% dos familiares. Foram encontrados neste estudo elementos como novos arranjos familiares; uso de substâncias psicoativas por pelo menos um dos genitores; conflitos, agressões físicas e/ou verbais entre genitores e adolescentes; de... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The consumption of psychoactive substances among adolescents is a major concern for scholars, government officials, health professionals and education. This study aimed to investigate some factors that may influence the non adherence to the treatment of family members of adolescents who use psychoactive substances attending a Psychosocial Care Center to Alcohol and Drug for Child and Adolescent of a municipality in the interior of São Paulo. In this institution, a survey was carried out of the medical records of the patients treated from August 2014 to June 2017 to obtain the percentage of non-adherence of the families to the treatment of adolescents and proposed clinical interviews and application of the projective instrument "Desenho da Família com Estória" to adolescents and to at least one family member responsible for adolescents. Data were analyzed through the content analysis technique and the "Desenho da Família com Estória", through Analysis Protocol, with interpretation based on psychoanalytical assumptions. The results indicated that of 655 medical records, only 43 were active in the analyzed period, of which 12 adolescents were not accompanied by their relatives, representing 30% of the family members, such as new family arrangements, psychoactive substance use least one of the parents, conflicts, aggression physical and/or verbal relations between parents and adolescents, among other aspects. In the clinical interviews, there were objective difficulties of the re... (Complete abstract click electronic access below) / Mestre

Research on mental health outcomes among racial-ethnic, sexual, and gender minority young people indicates that they may be at increased risk for service use disparities when these identity statuses intersect. However, evidence of how having multiple minority identities is related to using mental health services is lacking. This dissertation used a mixed-methods, convergent design to explore and describe relationships between intersecting minority identities and mental health service use in the experiences of 31 Black and Hispanic, sexual and gender minority young adults. Consistent with an intersectional perspective, findings indicated that mental health service use was more strongly associated with minority identities collectively than with any single minority identity, and that experiences of intersecting minority identities could facilitate, as well as hinder, mental health service use among participants. A theoretical model was revealed in which participants negotiated multiple minority identities within four dimensions related to their service use: ethnic-racial culture, intersecting identities, family, and personal identities. Results suggested provider strategies that support intersecting minority identity strengths around culture, community belonging, and self-efficacy may encourage service use and engagement with treatment.

Pakistani women in the UK have high levels of mental illness, alongside low levels of outpatient mental health service use, compared with women of other ethnic groups. Further, previous studies have suggested that Pakistani women have particularly low levels of social support, and high levels of social isolation which may reduce their chances of coming into contact with mental health services. However, to date, there has been little empirical evidence to support this. This thesis investigated the mental health service use, social networks' structure and function, and the relationship between the two, for Pakistani women compared with women of other ethnic groups. This was done using a systematic review of the relevant literature, and statistical modelling using two large nationally representative datasets from the UK. The first dataset, Understanding Society, was used to formulate latent classes of support networks, subsequently used in regression models to compare the support available in Pakistani women's networks with women of other ethnic groups. The second dataset, Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC), was used to ascertain the influence of social networks (perceived social support, contact with relatives and friends, network composition, and size) on the use of outpatient mental health services, using logistic regression modelling. These data were also used to build a structural equation model to test the direct and indirect effects of social networks on outpatient mental health service usage, via their impact on mental illness. Pakistani women (along with Bangladeshi women) had the lowest rate of mental health service use, compared with women in other ethnic groups. Further Pakistani women were more likely to be socially isolated than White majority women, but there were largely no differences between Pakistani women and other ethnic minority women in the structure and function of social networks. Finally, there was evidence to suggest that social networks indirectly reduced mental health service use via their impact on mental illness. There were only small ethnic differences in the indirect effect of social networks on mental health service use, and these differences did not explain Pakistani women's under-use of mental health services.

The study sought acceptance of an inventory of program objectives for a community college mental health technology program within the social and behavioral science structure. It adapted a set of program objectives, using an inventory from the Southern Regional Education Board, and provided composite list stated in competency or performance levels and a list of academic requirements showing what fundamental areas of competency or performance would be most germane for a mental health technology candidate.

Research on the effects of progress feedback and clinician problem-solving tools on patient outcome has been limited to a few clinical problems and settings (Shimowaka, Lambert & Smart, 2010). Only one randomized clinical trial has examined feedback-assisted treatment in an inpatient eating-disordered population. Results from this study suggested that those who received feedback-assisted (Fb) treatment were more likely to meet Jacobson and Truax's (1991) criteria for recovery than participants in the treatment-as-usual (TAU) condition; however, while these interventions appear to have worked well in the inpatient setting, the long-term effects of this treatment have not been investigated. This is especially pertinent in an eating disorder population, where outcomes tend to be poor and course of illness tends to be chronic. In this study, the effect of feedback interventions on long-term outcome was investigated. Fifty-three of the individuals from the aforementioned original study were contacted by mail, email, or telephone three to four years after leaving the inpatient facility to assess their current level of distress (as measured by the OQ-45) and overall psychological functioning. Comparisons were made between the outcomes of patients assigned to the experimental feedback condition and the TAU condition. Results suggested that both treatment conditions were nearly indistinguishable from one another and did not significantly differ at follow-up; however, the study was significantly underpowered. Our effect size suggested that the Fb group slightly deteriorated over time, while the TAU group slightly improved; however, effect sizes were minimal and did not meet criteria for "small" change according to Cohen's d. Patients’ Body Mass Index (BMI) largely remained the same since leaving the hospital, with a small portion deteriorating. The vast majority of women sought out multiple forms of treatment over the follow-up period, regardless of treatment condition. This is consistent with past research that suggests women with more severe pathology, and who thus require inpatient treatment, tend to experience a more chronic pattern of symptoms even after receiving intensive treatment. Overall, the superiority of feedback-assisted treatment that was found post-treatment appeared to diminish over time and was not detected at follow-up. Suggestions for further research are delineated.

Post-Traumatic Stress Disorder (PTSD) has affected millions of veterans who have served in the United States Military. PTSD causes severe impairments in one's mental health, and is correlated with homelessness, substance abuse, and unemployment. Recently, the United States Department Veterans Affairs has been funded more to improve services of mental health and other health care services. Specifically, this study was interested in exploring the perceptions that veterans have of the quality of services that have been provided for PTSD. Results indicated that the participants who utilized services felt individual and family therapy services were most helpful in reducing PTSD symptoms. Medication was less helpful suggesting further research on what types of medication are helpful. Participants also reported group therapy and service connected disability financial assistance were not helpful even though a majority of participants did not access it. Research indicates that veterans do not perceive services to be helpful; therefore they do not utilize them. Additional research can focus on exploring why veterans have not utilized services. Social workers can intervene by educating veterans about PTSD and the services that are provided in addition to other community agencies. Furthermore, social workers can evaluate returning veterans and their perception of the quality of services they have received to further improve services.

Psychiatric emergency services are recognized as an essential component in the provision of mental health care. This study describes the delivery of psychiatric emergency services in selected Oregon comm.unities. The theoretical framework was developed to consider the problem of psychiatric emergency service delivery from the perspective of the individual experiencing the emergency, the social milieu, and the health care system. The literature describing psychiatric emergency service programs, the characteristics of those who use these services and the roles of direct service providers was reviewed. On the basis of the review a study was undertaken to describe the delivery of psychiatric emergency services in selected Oregon counties, to identify variables that determine the nature of psychiatric emergency services provided and to develop recommendations for existing psychiatric emergency services.

The main objectives of this research were to determine the influence of bush identity on attitudes to mental health in rural Australia, what influence these attitudes have on service provision and utilisation, and what measures can be taken to improve attitudes to mental health and services in the bush. The research has included an extensive literature review of Australian historical and contemporary rural culture, the political economy of rural restructuring, rural mental health, as well as State and Federal policies and programmes for mental health care delivery. An ethnographic community study of “Ruraltown”, a rural centre in Queensland, was undertaken over a three-year period which involved semi-structured interviews, questionnaires, observations and community interaction. The results from the questionnaires and interviews in the community study indicate that attitudes to mental health in rural areas are influenced by bush identity, defined by reference to historical and current characteristics which include self-reliance, resilience, independence and stoicism. Social identity theories have been applied in this study to determine how the socialisation processes have incorporated these characteristics among the rural population, and rural males especially. In turn, these incorporated attributes and values have a direct impact on their attitudes to mental health and the willingness to seek help for problems of a psychological nature. Other aspects of rural life such as perceived lack of confidentiality and anonymity, fear of gossip, and isolation also impact on attitudes and the utilisation of mental health resources. Stigma is a significant barrier to recognition and acceptance of mental health issues. Hence, seeking help for mental health problems does not form part of the coping strategies for many in the bush. Mental health services, therefore, are not as readily accepted or utilised in rural Australia. Although some rural people do access mental health services, many more go on suffering with mental health problems rather than addressing them. Recommendations have been made to promote awareness and enhance education and attitudes to mental health, improve services and increase service utilisation. The study has also identified the problems facing mental health consumers in Ruraltown and some suggestions have been made to overcome these and assist in consumer empowerment.

The provision of school based psychological services in Victorian primary and secondary schools dates back to well before the Second World War. Since then, however, the activities that make up the role of school psychologists have changed substantially. School psychologists' roles have become more varied than the original psychometric focus and reflect a more systemic approach to the conceptualization of student problems. Within Australia, school psychologists can be found servicing single or multiple schools in the government, independent and Catholic school sectors, fulfilling a range of functions and dealing with a diversity of student issues. However, Australian academic research into the professional practice issues associated with the provision of school-based psychological services is rare. Therefore, this thesis sought to investigate a range of professional issues associated with the provision of school-based psychological services for Victorian school psychologists working in single and multiple schools in the government and non-government primary and secondary school sectors. In addition to surveying Victorian school psychologists, principals and teachers were also surveyed in order to ascertain their attitudes towards school-based psychological services. The sample consisted of 81 school psychologists, 21 principals and 86 teachers. The results revealed that school psychologists participate in a variety of activities, including a number of activities that reflect a systemic model of service delivery. They also deal with a broad range of student issues, some of which are quite serious in nature. However, the study also revealed a number of professional issues that were in need of improvement. Some of these included a lack of participation in regular supervision for school psychologists, school psychologists' dissatisfaction with some industrial and professional conditions associated with their role and differences in attitudes between psychologists, principals and teachers regarding the activities and responsibilities of school psychologists. Results from the study provide plausible evidence for the need to support school psychologists in the valuable work that they do within schools through improved industrial conditions, appropriate professional development, and regular supervision. Furthermore the results also reveal a need to educate and participate in dialogue with the educational community in order to increase understanding of school psychologists' roles and professional responsibilities.

This thesis is based on a research project that explored the deinstitutionalisation and eventual closure of a large residential facility for people with an intellectual disability. The thesis is focused on family experiences of deinstitutionalisation in order to understand how families interacted with this major process of social change, and pays specific attention to the role of adult siblings within this context. Unstructured interviews were held with thirty-five families who had family members with an intellectual disability who were being resettled from an institution to alternative disability support services. Families were interviewed at three specific phases during the deinstitutionalisation process: prior to the resettlement of their family member; 1-3 months following resettlement; and one year after resettlement. In keeping with the constructivist paradigm that underpinned this qualitative study, repeated contact with families enabled me to develop some insights into how families made decisions relevant to their family members� transitions from the institutional environment. The study findings highlight the complexity and heterogeneity of families. While families who participated in this study were found to have shared a similar journey toward institutionalisation, their responses and reactions to deinstitutionalisation and the decision-making associated with such a process were more diverse. My analysis presents the notion that taking a constructivist approach to theorising can facilitate an understanding of how families are influenced in their decision-making with regards to the resettlement of a family member with an intellectual disability. That is, we may be able to gain greater understanding of families� perceptions of their family members who have an intellectual disability and, subsequently, the decisions that families make regarding the care of that person by exploring the meanings they assign to their world. Ascertaining how families come to construct their understandings of disability is, in my view, critical to responding appropriately to families� needs within the context of disability support and service provision.