Dissertation (Ph.D.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p.145-155).

Thesis (Ph.D.) - University of Queensland, 2005. / Includes bibliography.

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With psychiatric disabilities representing a large number of transition-age youth in the US and low employment rates for individuals with disabilities in general, it is necessary to identify the patterns of service variables that are more likely to lead to a competitive employment outcome for this population. This study was an investigation of the vocational rehabilitation case service variables provided through the federal-state vocational rehabilitation system to transition-age consumers with psychiatric disabilities. The identified variables were then studied to determine relationships that exist as they pertain to employment outcomes. The population of vocational rehabilitation consumers was accessed using the Rehabilitation Services Administration 911 database for fiscal year 2007. The database was analyzed using a series of cluster analyses to determine patterns of services associated with competitively employed or unemployment outcomes for this population. A total of 5744 cases were analyzed in this study. The results indicated that there were three distinct clusters of vocational rehabilitation services delivered to this population: Basic services, Job Focused, and College Plus. The results also showed that employment status at application, medical insurance at closure, Job Focused Cluster, and race - African American were significant predictors of rehabilitation outcome. Significant predictors of yearly earnings at closure were employment status at application, medical insurance at closure, Basic Services Cluster, and Job Focused Cluster. The Hispanic race was not found to be a significant predictor in this study. Implications, suggestions for future research, and limitations of the study are discussed.

The study sought to analyse the referrals received by a psychiatric unit in a general hospital in the Western Cape by studying the referral letters and the referral responses. The study sought to determine which departments were referring patients and which patients were being referred. The completeness and appropriateness of the referrals were also studied. The major inferences drawn from this study are that health care workers have a poor concept of what information the psychiatric units needs and about the scope and function of the unit. The poor feedback from the psychiatric unit to the referral source is indicative of the poor communication amongst the health care team members. / Health Studies / M.A. (Advanced Nursing Sciences)

Recent evidence indicates that the proportion of young people developing significant psychosocial problems is increasing (Rutter, 1995). This thesis focuses upon a small percentage of the growing number of adolescents who experience significant psychopathology; adolescents admitted to a regional inpatient psychiatric unit. Chapter 1 provides the theoretical background to the thesis; reviewing the literature on both the methodology and outcome of studies conducted with adolescents in inpatient adolescent psychiatric services. It suggests that future investigations take account of the practical impossibility of conducting high quality, standard double-blind control trials in such settings and outlines four empirical alternatives to such designs; evaluation of components of the therapy employed in residential settings; the use of problem-oriented case records; prediction of outcome across time; investigating the reasons for the effectiveness of established predictors of outcome. The next four chapters describe a series of studies utilising the last three of these suggested approaches in a cohort of adolescents admitted to a regional psychiatric unit. Chapter 2 is a cross-sectional study describing the sample upon which the remainder of the thesis is based. It focuses principally upon describing the psychopathology of the adolescents from three perspectives; that of the adolescent, their parents and the therapeutic team. It examines the interrelationships between mood, behaviour and family functioning. Chapter 3 describes the results of an investigation into the relationships between selfesteem, autobiographical memory, attributional style, social problem-solving and the experience of depression and hopelessness. Chapter 4 examines the clinical effectiveness of the treatment at the unit as assessed by problem severity as rated by adolescents and their parents and standardised measures of mood and self-esteem. Chapter 5 examines to what extent outcome can be predicted on the basis of initial problem severity, mood and cognitive style (autobiographical memory, attributional stye, problem-solving and selfesteem). Each chapter is written as a separate paper with abstract, literature review, method, results and discussion; however, reference to the overall findings is made throughout for ease of reading. The final chapter draws together themes from the whole thesis and discusses the psychological processes which mediate change during the adolescent treatment programme described here. It concludes that the cognitive and meta-cognitive processes which mediate change are best understood as related to internal working models derived from attachment experiences. A model for understanding individual variation in these processes is outlined and strategies for testing the proposed model are advanced.

Benzodiazepine dependence is a significant national problem. Although benzodiazepines — a class of drugs that includes drugs such as alprazolam, lorazepam, temazepam, clonazepam, and diazepam—have a wide range of uses including the treatment of insomnia, anxiety, and seizures; they are addictive. Individuals taking these drugs can quickly develop dangerous tolerances. Therefore, these drugs should not be selected as first choice nor used for more than short periods, yet a significant portion of the population uses benzodiazepines for long periods. This problem is significantly more pronounced in the elderly, a population that scholars have agreed should not use these drugs outside of extreme circumstances. Because benzodiazepines may be wrongfully perceived as an easy treatment for so many common afflictions, providers continue to prescribe them, and patients may be reluctant to discontinue use due to the symptoms associated with withdrawal (i.e., insomnia and anxiety). To avoid these symptoms, the standard discontinuation approach seen in an outpatient setting is a long-term taper that may take eight to 12 weeks of gradual reduction. However, in an inpatient setting, this long-term approach is unfeasible due to the short length of patient stays. The literature has given little consideration to this problem. Thus, it was necessary to review evidence and develop a guideline for benzodiazepine tapering in elderly patients receiving inpatient psychiatric care. The purpose of this project was to develop a guideline to taper benzodiazepines in the elderly using the Johns Hopkins Nursing Evidence-Based Practice Model (JHNEBP). The guideline was validated by expert peer reviewers using the AGREE II instrument. The completed guidelines offer recommendations on the tapering of benzodiazepines in an inpatient geropsych unit and best practices for interventions to increase the success rate of discontinuation.

Magister Curationis - MCur / Due to the large student-supervisor ratio, a school of nursing at an university in the Western Cape, developed specific preceptorship training for professional nurses working in e.g. psychiatric hospitals. This aimed at improving the clinical teaching expertise of professional nurses and ensuring positive experiences around placement of student nurses. It was unclear how undergraduate student nurses experienced their interactions with their preceptors while placed in psychiatric units. The study used a descriptive phenomenological design to describe the lived experiences of student nurses with preceptors during their clinical placement at a psychiatric hospital. Undergraduate student nurses who were allocated to a preceptor at a psychiatric hospital in the Western Cape served as the population of the study. Purposive sampling was applied and individual unstructured interviews (n=11) held. This study adopted Collaizi's method of data analysis. Results of this study indicated that the nurse preceptors played a supportive role towards students during placement in psychiatric units. This resulted in meeting the students' objectives and needs in clinical placement. A challenge around a comprehensive learning environment was interpreted as a great need during students' training. Ethical clearance was sought from the Ethics Committee of the University of the Western Cape and ethical principles followed in conducting the study. Trustworthiness was ensured during the research process.