bluuebunny/crossref_metadata_2025 huggingface dataset:
Breaking bad news
Authors: Baile Walter F. , Parker Patricia A.
Published: April 2017

Bad news is any information that adversely and seriously changes the patient’s and family’s view of the future. Factors that influence disclosure include the type of communication (e.g. diagnosis, treatment failure, medical error disclosure), cultural, ethnic and family factors, and clinician attitudes and skills. Patients in general wish to have as much information as possible, but important individual and situational differences exist. Disclosure can help patients and families cope and initiate appropriate goals of care. Barriers to giving bad news include lack of training, fear of one’s own and patient/family emotions, and concerns about destroying hope. While best practice guidelines exist, effective training using simulation, coaching, and practice is sporadic. Dealing with emotions (both the clinician’s and patient/family’s) are difficult challenges, and defensive behaviours such as avoidance of discussions, premature reassurance, and patient abandonment prove common. Controlled clinical trials of teaching bad news reveal that skills can be acquired.
Discussing prognosis and communicating risk
Authors: Butow Phyllis N. , Tattersall Martin H.N. , Stockler Martin
Published: April 2017

Understanding and communicating about risk and prognosis are difficult for doctor and patient alike, and yet are critical to enabling patient autonomy and informed consent. Most guidelines, legal frameworks, and doctors emphasize the right to disclosure, but suggest sensitivity in responding to patient preferences and needs. Most patients want to know their prognosis, but there is diversity of preferences between and within patients over time. In reality, discussions of prognoses are often avoided, and are not recorded. We suggest openly negotiating prognostic discussions, giving information clearly and honestly when desired, providing best case, worst case, and typical scenarios, using strategies to maintain hope, and recording the discussion and its outcome. Role play is a very effective method for developing skills in this area.
Responding to difficult emotions
Authors: Philip Jennifer , Kissane David W.
Published: April 2017

Patient distress can be acute or enduring, and contribute to the experience of a challenging consultation. Difficult emotions could include anger, resentment, morbid fear, intense grief, despair, or demoralization. A narrative approach is recommended involving active listening to the story, empathic acknowledgement of the emotions expressed, involvement of experienced clinicians, and reframing of the experience constructively to enable symptom relief and containment of the distress. When suffering persists, its further acknowledgement is warranted with efforts to promote adaptation and coping by exploration of the person and their life, sources of meaning, value and worth, and affirmation of these in the ill person. Role play in communication skills training involves the practice of a variety of empathic responses. Clinical scenarios for these difficult situations are provided in this chapter.
Communicating with relatives in cancer care
Authors: Merckaert Isabelle , Libert Yves , Liénard Aurore , Razavi Darius
Published: April 2017

Relatives are omnipresent in cancer care and commonly accompany cancer patients to physician consultations, increasing the complexity of the resultant communication. Relatives can provide important collaborative history, support, and advocate for their loved one, as well as have their own needs addressed. Relatives may also desire to protect their loved ones, and challenges arise if they invite the clinician to collude in keeping secrets. Optimally including relatives in a consultation is a complex task. Specific skills—for instance, asking permission, using circular questions and offering summaries—can enrich triadic communication. When breaking bad news, strategies for three-person consultations that have been used in communication skills training deliver benefits to both patients and their relatives. The successful accomplishment of three-person consultations is one hallmark of the mature clinician. It requires skill and time, but can certainly promote optimal patient care.
Conducting a family meeting
Authors: Kissane David W. , Hempton Courtney
Published: April 2017

The strategies employed in running family meetings include collaborative agenda setting, appraisal of family needs, exploration of the impact of the illness and the family’s resultant coping, the building of consensus about the goals of care, and planning for the future. Special communication skills that guide this process are the use of circular questioning techniques and integrative summaries. Beyond the education of all families, a subgroup remains at risk and requires ongoing family support. Families with young children, offspring living with disability or mental illness, those isolated or disenfranchised, and those with high conflict warrant psychosocial referral for ongoing family therapy. Role play work with simulated family members helps build co-facilitation skills, cultural sensitivity to respond to requests to collude with relatives, and confidence in dealing with difficult families.
Communication about coping as a survivor
Authors: Carlson Linda E. , Giese-Davis Janine , Bultz Barry D.
Published: April 2017

With improvements in early detection and cancer treatments, a growing cohort of cancer survivors is emerging. Maintaining communication with survivors poses a host of new challenges to care providers that have not received ample attention in the literature. This chapter covers a number of areas relevant to enhancing communication with survivors, including various definitions of who is considered a cancer survivor (including caregivers); the ever-increasing prevalence of survivors; key issues faced by cancer survivors such as late and long-term effects and transition back to primary care; coping strategies including the use of care plans and clinical practice guidelines; communication challenges with cancer survivors and among medical professionals taking care of survivors; models for survivorship care; and details about communication techniques in the survivorship consultation.
Introducing or transitioning patients to palliative care
Authors: Urban A. Katalin , Clayton Josephine M. , Kissane David W.
Published: April 2017

Effective communication between patients, families, and healthcare professionals is critical to transitioning to a palliative approach and enables patients and their families to adjust to the life-limiting nature of the illness, avoid unnecessary and invasive treatments, accomplish remaining life goals, and prepare for death. The PREPARED acronym provides a framework to guide clinicians in discussing the transition to a palliative approach in a way that respects the patient’s preferences, provides empathy, and helps sustain realistic hope. Settings of steadily advancing disease burden, the need to change or cease disease-directed therapies, the need for specialist palliative care services, and when the patient approaches the terminal phase of life are considered. Benefits in early referral to palliative care and models of parallel care are discussed. Clinical scenarios for simulated patient encounters in communication skills training are provided as an online appendix.
Communication skills education and training in pre-registration BSc Nursing
Authors: Lewis Deborah , O’Boyle-Duggan Marie , Poultney Susan
Published: April 2017

Nursing and Midwifery Council educational standards in BSc (Hons) Nursing require students to gain key communication competences to deliver compassionate care in adult, mental health, learning disabilities, and children’s nursing. Competences include using a range of verbal and non-verbal skills to build therapeutic relationships, being respectful of confidential information, addressing diversity issues, and promoting well-being and personal safety. Nurses also need to make reasonable adjustment for patients with disabilities to ensure effective communication. High fidelity simulations using actors and clinical practice scenarios have been evaluated positively with statistically significant results, suggesting the benefits apply to all students in the classroom—although students who participate in a simulation benefit to a greater extent. Other faculty mixed-methods research led to the development of recommendations for communication skills in learning disabilities nursing. Challenges include realistic simulation in children’s nursing and developing adequate numbers of actors and facilitators, partially offset by offering in-house training.
SAGE & THYME
Authors: Connolly Michael
Published: April 2017

Unhelpful communication behaviours by nurses are known to block patients with cancer from thinking for themselves and so a new approach to training emotional support has emerged from practice. Foundation-level communication skills, including patient-centredness, are being taught in the United Kingdom within a three-hour workshop. Within it, teachers of communication skills are attempting to bridge the gap between published knowledge and clinical practice, using a structured and sequential model known as SAGE & THYME. The model is described as a starter kit to help health workers to listen carefully and practice patient-centred care. The elements of the model and the workshop are described. Published data of self-reported outcomes from workshop participants suggest that learning happens, beliefs change, confidence grows, and willingness to discuss emotional concerns increases. Dissemination of the workshop throughout the United Kingdom appears to be practical, though further research into the impact on patient outcomes is needed.
The implementation of advanced communication skills training for senior healthcare professionals in Northern Ireland
Authors: Finn Anne , King Emma , Wilkinson Susie
Published: April 2017

This chapter describes the key challenges and rewards of the implementation and delivery of a programme of advanced communication skills training (ACST) for senior healthcare professionals working in cancer and palliative care in Northern Ireland (NI). It enables participants to reflect and critically appraise their own and others communication skills and to demonstrate the skills required to facilitate a structured patient-centred assessment/consultation using specific strategies to handle complex communication scenarios. Participants should also be able to tailor complex information to meet the needs of patients and carers. The course is based on an experiential, learner-centred approach, which is known to enhance effective person-centred communication and includes cognitive, behavioural, and affective components. A 2014 analysis of the programme recommends the two-day as opposed to the three-day model for ACST, as no disadvantages have been identified and this programme is better meeting the needs of the participants.
Training facilitators to deliver an advanced communication course for senior healthcare professionals in cancer and palliative care
Authors: Wilkinson Susie , Roberts Anita
Published: April 2017

This chapter presents a communication skills training initiative designed to train facilitators to deliver an advanced communication skills training course for senior healthcare professionals working in cancer and palliative care. It is generally accepted that communication skills training benefits healthcare professionals. However, little has been written about the training and support of those healthcare professionals who deliver this training. The chapter describes the content, process, and guidelines trainee facilitators explore while learning to deliver the experiential learner-centred advanced communication skills training course for senior healthcare professionals working in oncology or palliative care. The teaching methods presented include group safety, agenda setting, didactic methods, the use of trigger tapes, working with actors, and video-recorded role play with feedback. The facilitator training course was evaluated across six UK settings and had a positive effect on the participants’ perceived confidence in delivering communication skills training.
Ambulatory care nurses responding to depression
Authors: De La Cruz Anthony , Brown Richard F. , Passik Steve
Published: April 2017

Depression is a common occurrence among cancer patients; however, it goes undetected by healthcare providers in about 50% of cases. Ambulatory nurses are in a key position to identify and respond to a patient’s emotional distress and aid in the detection of patients at risk for or suffering from depression. Programmes in communication skills training have been shown to help nurses detect and respond to patient depression. A model of core communication components consisting of strategies, skills, and process tasks is presented. This model will enable nurses to gain an understanding of the patient’s experience and assist in the recognition and treatment of depression. The results of a pilot programme utilizing this model and skills will also be presented. An overview of the nature of depression and risks factors and barriers to the identification of depression is presented.
Communication in the last days or hours of life
Authors: Roberts Anita
Published: April 2017

This chapter discusses effective communication in the last days or hours of life. It describes communication including verbal, non-verbal, and paralinguistic elements together with how to structure complex conversations. It recognizes the importance of communication when a person is expected to die within the coming days or hours. Sensitive communication is essential when dealing with uncertainty inherent at this time and strategies are identified to enable clinicians to elicit the needs and concerns of patients and families. The chapter also examines how the priorities for the care of the dying person can be ascertained. Strategies for giving information and discussing care in a sensitive and supportive manner are described, including how to assess informational needs, effective ways to break bad news, and ways of responding to difficult questions. Finally, the importance of having a competent workforce is recognized and some communication skills training opportunities for healthcare staff are discussed.
E-learning as a medium for communication skills training
Authors: Waterhouse Hannah , Burton Melanie , Neal Julia
Published: April 2017

This chapter explores the use of e-learning as a format for training communication skills within a degree level module in non-malignant palliative care. It discusses the need for such training before evaluating the benefits e-learning has to offer as a learning tool in the healthcare context. It describes how a ‘blended learning’ approach was taken with one study day combined with online interactive learning materials. Online exercises such as ‘drag and drop’ were used to facilitate students’ learning, together with the use of videos, external online links, and reflective diaries. The development of a summative assignment is discussed and its need to assess students’ use of these skills in clinical practice. Finally, the future developments of the e-learning platform to further enrich the students’ learning experience are presented. These include the use of online forums, both synchronous and asynchronous, which encourage peer-to-peer and peer-to-tutor communication.
Enrolment in clinical trials
Authors: Brown Richard F. , Albrecht Terrance
Published: April 2017

Cancer clinical trials are conducted to progress the efficacy of cancer treatments. The success of such clinical trials is dependent on enrolling cancer patients. However, enrolments rates remain low, and lower participation rates are reported in minority patients. The goal of this chapter is to outline issues involved in recruitment to clinical trials and to describe the ethical principles underlying informed consent. A model of communication skills training is presented to provide suggested strategies to aid communication between healthcare providers and patients about clinical trials. The programme involves training in shared decision-making, information flow, and the disclosure of information. The results of a pilot programme utilizing this model and skills are also presented.
Communicating genetic risk
Authors: Gaff Clara , Keogh Louise , Lobb Elizabeth
Published: April 2017

The discovery of cancer predisposing genetic mutations has heightened community awareness of the link between family history, genetic constitution, and personal risk. The component of an individual’s cancer risk that is due to their genetic make-up can be described as their ‘genetic risk’. Knowledge of genetic risk can assist both individuals with cancer and unaffected individuals to make decisions about healthcare and inform relatives who may share that genetic risk. Accordingly, patients seek advice about their risk and its implications and management from general practitioners (primary healthcare physician) or cancer specialists. In this chapter, we discuss the interlinked processes of risk assessment, risk perception, and risk communication in the context of genetic risk of cancer. While this is only one component of an individual’s risk of cancer—other factors including lifestyle, medical history, and environmental exposures—the principles of risk communication are applicable to each of these individual risk factors.
Discussing unproven therapies
Authors: Schofield Penelope , Jefford Michael
Published: April 2017

The use of unproven therapies, or complementary and alternative medicine (CAM) continues to evoke strong debate and diverse views within the medical community. Many doctors are concerned about the lack of scientifically credible research to support the claims of CAM proponents. However, a large and growing number of cancer patients use CAM. Evidence indicates that clinicians neglect to appropriately discuss issues surrounding CAM use with their patients. Improving CAM-related communication between clinicians and cancer patients has been widely advocated by researchers, medical practitioners, CAM practitioners, and patients. Assisting clinicians to initiate and engage patients in discussions about CAM is an essential contribution to improving health-related communication. This chapter presents a definition of CAM, explores the rationale supporting the need to improve communication about CAM, and considers evidence-based guidelines about how to discuss CAM in a conventional oncology setting.
Promoting treatment adherence
Authors: Haskard-Zolnierek Kelly B. , Miller Tricia A. , DiMatteo M. Robin
Published: April 2017

Empirical evidence demonstrates that quality healthcare outcomes depend greatly upon patients’ adherence to their recommended treatments. Patient adherence is a patient’s ability to follow his or her treatment recommendations given by a healthcare provider. Rates of adherence, however, can be as poor as 50% or less among patients with certain chronic diseases. For cancer patients, non-adherence can have serious consequences, including increased disease morbidity and mortality. Factors associated with non-adherence in cancer patients include treatment complexity, illness severity, patients’ beliefs and attitudes, lack of social support, and depression. Improving adherence depends upon effective provider–patient communication, trust in the therapeutic relationship, shared decision-making, and a realistic assessment of patients’ knowledge and understanding of their treatment. To assist cancer patients in acquiring appropriate disease and treatment information, to build commitment and motivation, and to assist in the development of strategies to overcome treatment barriers, healthcare professionals can use the Information-Motivation-Strategy model.
Communicating about sexuality in cancer care
Authors: Robinson John W. , Lounsberry Joshua J. , Walker Lauren M.
Published: April 2017

Extensive research has shown that cancer, and the treatment thereof, can interfere with healthy sexual functioning. Indeed, sexual dysfunction is frequently cited as one of the top adverse effects of cancer treatment. However, while healthcare professionals routinely discuss quality-of-life issues with cancer patients, the literature suggest that too often this does not include an assessment of sexual concerns. This chapter explains how the responsibility to initiate discussion on sexuality rests with the healthcare professional. Establishing the sexuality information needs of the cancer patient can sometimes be difficult and it becomes more so when healthcare professionals make erroneous assumptions concerning sexuality. Whether or not to assess sexuality is no longer a question, it must be a routine part of cancer care. While there are several different intervention models for patients suffering from sexual difficulties, the PLISSIT model is frequently used in cancer centres and easily adapted to various types of practice.
Communication in surgical oncology
Authors: Tristram Amanda
Published: April 2017

Surgical oncology provides a number of challenges in communication. Having basic frameworks for initial consultation, pre-operative counselling, and post-operative communication can be invaluable. Putting a diagnosis of cancer and treatment options into context, in terms the patient can understand is essential for informed consent; ensuring that written communication is accurate and comprehensive is equally important. Ensuring that all members of the team know what the patient is aware of will also reduce the risk of misunderstandings later. Communication in surgical oncology can be extremely challenging, but also extremely rewarding. It will not always be possible to be perfect, especially in complicated situations. Two basic principles will help here, as in most encounters: be honest and be kind.
Communication in oncology pharmacy
Authors: Tranter Bethan , Noble Simon
Published: April 2017

Pharmacists are considered to have a pivotal role in the provision of information in oncology, and in hospice and palliative care. Effective communication is essential for optimal drug safety, timely treatment, medication compliance, and education. The role of the pharmacist has expanded to offer enhanced pharmaceutical care, which serves to improve the communication between healthcare providers and the function of the multidisciplinary team. Furthermore, through optimal communication with patients there will be increased treatment adherence and improved overall care. This chapter focuses on the breadth of communication issues faced by pharmacists involved in cancer care through the full length of the cancer journey, be it curative or palliative.
Communicating with children when a parent is dying
Authors: Moore Cynthia W. , Rauch Paula K.
Published: April 2017

Concerns about dependent children are prominent, and distressing, for parents diagnosed with a life-threatening illness. Helping parents feel prepared to talk with children about their illness and possible death, at any stage of illness, has the potential to alleviate distress in both parents and children. This chapter provides a summary of how children at different ages understand and respond to a death, and offers suggestions about how clinicians can support parents’ open communication with their children about illness and death, based on the child’s developmental stage, and phase of illness and treatment. Clinicians can start by making the effort to ask parents about their children, to learn a bit about child development, and to identify or create some resources for these families.
Facilitating communication role play sessions
Authors: Manna Ruth , Bylund Carma L. , Brown Richard F. , di Ciccone Barbara Lubrano , Konopasek Lyuba
Published: April 2017

Facilitating small group role play is an integral component in effective communication skills training (CST) for healthcare professionals, and requires its own training and review in order to provide replicable high-quality CST. This chapter outlines the structure and critical elements of facilitator-led role play sessions. Elements include the importance of structuring the role play; recognizing the importance of established learning goals as expressed by each learner; navigating and directing the simulated patient (SP) to partake in a realistic clinical encounter relevant to the learner; managing an effective role play session with learner and SP; and providing meaningful feedback both directly to the learner, as well as overseeing balanced group feedback provided by observing peers in the small group. This chapter also provides helpful processes in training new and sustaining competent facilitators, keeping in mind available resources for training. Finally, this chapter points to necessary areas for continued development in facilitation.
The role of the actor in medical education
Authors: Heinrich Paul
Published: April 2017

The role of standardized or simulated patient, whether played by professional actor or lay member of the public, is an acting role, requiring at least a basic level of acting. This chapter proposes a taxonomy of five different modes of performance in medical education, namely, assessment, audit, experiential learning, demonstration, and instruction. Each role play mode comprises three players—actor, role-player, and educator—who work together in what might be called a simulation triad. Each mode leads to a distinctive mode of performance, which determines the roles and relationships within the simulation triad, and the nature of the decisions that need to be made in relation to recruitment, training, performance, and feedback. It is hoped that this proposed taxonomy of performance may contribute to clarification for the future development of medical simulation.
Communication in cancer care in Europe and EU policy initiatives
Authors: Grassi Luigi , Travado Luzia
Published: April 2017

Awareness of cultural differences when communicating with cancer patients has become an increased focus of attention in European countries. The historically paternalistic approach by doctors in knowing what is best and deciding what should be done for a patient has been replaced by a shared decision-making approach, with attention being given to cultural and individual patient needs. In a rapidly changing world, with increased immigration, many European countries are becoming multiethnic and multicultural. It is important to understand the ways in which cultures, language, thoughts, customs, beliefs, values, religion, and illness influence communication within the context of the doctor-patient relationship. These issues should be considered in the development of European communication skills training programmes and guidelines. In this chapter, some of the main aspects of doctor-patient communication in a culturally diverse Europe will be discussed, and some training initiatives presented.
Communication skills training in Arab countries
Authors: Bylund Carma L. , Scott Stephen , Alyafei Khalid
Published: April 2017

In this chapter, we describe some of the challenges present in healthcare communication in Arab countries, including: disclosure of diagnosis; working with families; and language barriers. We then focus specifically on the efforts being made in the multicultural state of Qatar to improve communication skills in healthcare. We describe the curricular approach with medical students at Weill Cornell Medical College in Qatar, with examples of challenges faced surrounding gender and culture issues. We then describe the communication skills training programme for residents, fellows, and practising physicians at Hamad Medical Corporation, the public healthcare system. Challenges in Arab countries for healthcare communication result predominantly from multicultural populations and from cultural differences with the West. This chapter explores how these clinicians can face and transcend these challenges via communication skills training.
Qualitative approaches to clinician–patient communication
Authors: Roberts Felicia
Published: April 2017

Data collection techniques and qualitative approaches to analysis are described, along with relevant empirical studies of provider-patient communication in oncology and palliative care. A variety of frameworks are reviewed (ethnography, focus groups, grounded theory, conversation analysis, postmodernism), with differences in scope, focus, or fundamental philosophy addressed, along with the value of each approach for inductive research. Whatever the philosophical grounding researchers gravitate towards, these approaches are all interested in patients’ and practitioners’ beliefs, practices, and understandings of health and illness. They are attempting to derive participants’ understandings from the researcher’s detailed observation, description, and analysis of behaviour and artefacts. In addition to covering several qualitative approaches, the chapter also reflects on the ethical challenges facing researchers engaged in field-based studies. Finally, a brief discussion is offered concerning the trade-offs between reliability and validity in qualitative research.
NCDs: Risk factors and determinants
Authors: Rayner Mike , Wickramasinghe Kremlin , Williams Julianne , McColl Karen , Mendis Shanthi
Published: April 2017

This chapter introduces the main risk factors for non-communicable diseases (NCDs), using different causal webs. It uses the Global Burden of Disease data to describe the burden of these NCD risk factors. It uses the socioecological model and the World Health Organization’s conceptual framework for social determinants of health to show the different levels of influences relevant to NCDs. This chapter presents case studies to show how a life-course approach and health-in-all-policies approach could address these broad ranges of NCD risk factors. It discusses the importance of primary prevention efforts organized around multilevel interventions and shows that they are more likely to be more successful than single-focus efforts.
Public health advocacy for the prevention of NCDs
Authors: Rayner Mike , Wickramasinghe Kremlin , Williams Julianne , McColl Karen , Mendis Shanthi
Published: April 2017

This chapter highlights the need for sustained advocacy to address the challenges posed by the sociopolitical landscape relating to non-communicable diseases (NCDs) as described in Chapters 4 and 5. It focuses on advocacy carried out by civil society (non-governmental agencies, charities, academia, and professional organizations). The chapter introduces different tools, tactics, and techniques to influence the setting and implementation of decisions that affect people’s lives. It provides case studies to share the experience of advocacy work carried out to protect against unhealthy diets. The chapter also discusses the role of social media in advocacy and the future potential to contribute towards creating a healthy environment. It concludes by providing a number of recommendations to increase the effectiveness of public health advocacy for the prevention of NCDs.
Developing a prevention strategy
Authors: Rayner Mike , Wickramasinghe Kremlin , Williams Julianne , McColl Karen , Mendis Shanthi
Published: April 2017

This chapter describes the process of building an NCD prevention strategy. It discusses the components of a successful strategy. It discusses concepts such as the values which underpin the development of a strategy and provides illustrative examples from global prevention strategies. The chapter goes on to identify the stages in developing a strategy by discussing the various steps of the policy-making cycle. It discusses the menu of policy options set out by the WHO Global NCD Action Plan and lays out tools for prioritizing areas of action. Case studies illustrate how communities can prioritize actions to help build a prevention strategy and describe some of the tools available to help policy-makers to take action on NCDs and their risk factors.
Implementation of an NCD prevention strategy
Authors: Rayner Mike , Wickramasinghe Kremlin , Williams Julianne , McColl Karen , Mendis Shanthi
Published: April 2017

This chapter is about the implementation of an non-communicable disease (NCD) prevention strategy, which is a specified set of activities designed to put interventions or policies into practice. After an overview of the various types of implementation and the emerging type of research which focuses on this, this chapter describes frameworks which can be useful in guiding the planning and organization of implementation. The chapter then describes the role of national health systems in responding to NCDs. It provides case studies which illustrate the implementation of NCD prevention interventions from around the world. The chapter includes an important discussion about tackling social inequalities in health and provides examples of entry points and some possible interventions to address CVD inequalities. The chapter also discusses disadvantaged groups as key stakeholders in developing global and national strategies to prevent and control NCDs.
Implementation
Authors: Rayner Mike , Wickramasinghe Kremlin , Williams Julianne , McColl Karen , Mendis Shanthi
Published: April 2017

A multisectoral approach involving other sectors is essential to bring about changes to the environmental and social factors involved in non-communicable disease (NCD) development. This chapter explores the process of moving beyond the health sector and into some of these other areas. This chapter provides a brief overview of the rationale for multisectoral action. It goes on to discuss the key steps for policy-makers to follow when developing and implementing a multisectoral action plan and provides an overview of the practical tools available to assist in this process. To illustrate some of these principles, the chapter includes case studies development and implementation of a multisectoral NCD control and prevention plan.
Revisiting the stages of the policy cycle
Authors: Rayner Mike , Wickramasinghe Kremlin , Williams Julianne , McColl Karen , Mendis Shanthi
Published: April 2017

This final chapter argues that the policy cycle should be seen as just that—a cycle, rather than a linear process with a defined start and finish. To generate effective policies, the stages need to be revisited over time. In revisiting these steps, it will be necessary to ask new questions about the problem and the solutions. The chapter includes case studies that illustrate how non-communicable disease (NCD) prevention and control interventions do not always follow the four steps of the policy cycle in a linear process. This chapter emphasizes that NCDs are multifactorial conditions with complex causal webs that require a sophisticated mix of solutions that reflect the specific context. The theoretical background, practical pointers, and case studies from this book should help to equip policy-makers, researchers, health advocates, and students with the knowledge and tools required to reduce the burden of death and disability from NCDs.
Idiots in America
Authors: Trent James W.
Published: April 2017

The chapter first considers the place of idiots in colonial America and in the early republic of the United States. During the period most Americans saw idiots as an expected part of their community, regarding them with pity, humour, but usually kindness. In the 1840s, Americans began to open residential schools for educating idiots. Through articles in popular journals and through local demonstrations of their pupils’ learning, leaders of these schools gained widespread social and legislative support for their schools. The support for their work, however, proved to be a mixed blessing. Economic downturns meant that their graduates could not find gainful employment, while local officials pressured them to take more pupils into their facilities. By the 1860s, their schools were becoming institutions/asylums in which the goal of education for community living would give way to permanent institutional incarceration.
The Menace of the Feebleminded
Authors: Trent James W.
Published: April 2017

Around 1910 the meaning of intellectual disability shifted from feeblemindedness as a burden to a menace. Thus, the simple idiot of the 1850s and burdensome feebleminded of the late 19th century became the menacing moron of the 1910s, 1920s, and beyond. Two matters affected this change: eugenics and the intelligence test. As such, heredity and intelligence embodied in the “pedigree studies” of the period linked with all kinds of social problems. The petty criminal was a wrongdoer, the prostitute prostituted, and the hobo wandered because they were feebleminded. And they were feebleminded because of their low intelligence and fecundity that they were passing along generation after generation. The principal offenders were “morons,” a new category of feeble minds. These morons looked normal, but they were polluted and propagating. Two methods evolved to “treat” the problem of the menace: institutional segregation and sterilization. Both facilitated eugenics.
Sterilization, Parole, and Routinization
Authors: Trent James W.
Published: April 2017

During the years between the Great Depression and end of World War II, intellectual disability, like the rest of the nation, experienced a period of social and economic stress. For two decades the populations of institutions grew dramatically, while during the war years, attendant staff found more lucrative war-related jobs or were drafted. With greater demands for care, yet with fewer resources, the institutions by the late 1940s had become “snake pits.” For these reasons, superintendents during the 1930s and 1940s advocated for what would have been impossible decades earlier. They called for the parole of mentally deficient inmates, especially if those inmates had been sterilized.
Introduction
Authors: Drozd Leslie M. , Bala Nicholas
Published: April 2017

This introduction provides a synopsis of the overall scope of this volume as well of its individual chapters, which cover a range of issues related to parent–child contact problems and family-based interventions to address them. The traditional approaches of the law and the justice system have failed to deal adequately with these alienation cases. Family-based therapeutic approaches that use psychoeducation and clinical interventions with the parents, the child, and the family offer promise for improving parent–child relationships and child outcomes. While the book focuses in great depth on the Overcoming Barriers approach, chapters are also dedicated to other such interventions. The authors endorse the need for further research and program development.
Clinical Decision-Making in Parent–Child Contact Problem Cases
Authors: Fidler Barbara J. , Ward Peggie
Published: April 2017

This chapter summarizes the continuum along which parent–child contact problems may be conceptualized and differentiated and addresses how legal and clinical interventions may be tailored to the nature and severity of the problem in a particular family. Parent–child contact problems include affinity, alignment, justified rejection, and alienation as well as hybrid cases, each of which can range from mild to severe. Which of these problems is observed in a given family and parent–child relationship depends on numerous factors, including the child’s developmental stage, whether a parent has engaged in parental alienating behaviors, whether and when there was violence between the parents, and whether a parent was abusive or neglectful of the child. The chapter provides an overview of psychoeducational and clinical interventions for mild, moderate, and severe cases. It also explicates protocols for managing initial queries, preliminary screening, clinical intake, and contracting for such interventions.
More Than Words
Authors: Judge Abigail M. , Bailey Rebecca
Published: April 2017

This chapter proposes the integration of experiential therapy techniques with family treatment for use with families experiencing parent–child contact problems, including parental alienation. This population typically enters family therapy with high levels of defensiveness, treatment resistance, and mistrust of mental health interventions. This situation requires a high degree of clinical flexibility and tools that include, but are not limited to, traditional talk-based techniques. The authors provide a theoretical and clinical rationale for integrating experiential techniques with family therapy. A range of experiential strategies are detailed (e.g. play, recreational therapy, and animal-assisted treatment) as techniques to enhance families’ engagement, relax treatment resistance, impart psychoeducation, and provide opportunities for reconnection. Case material illustrates key points.
“West Group”
Authors: Sullivan Matthew J.
Published: April 2017

This chapter describes the characteristics of the parents in the Overcoming Barriers camp program whose children are resisting contact with them as well as the group work that is done with these parents. The West Group process from beginning to closure is described, as well as specific goals, objectives, and techniques that contribute to the other components of the camp intervention. The shared experiences of these parents have generated common beliefs, feelings, and attitudes—often focused on a sense of victimization—that pose significant obstacles to reconnecting with their children and developing a more functional coparenting relationship with the children’s favored parent. The group work draws on these commonalities to build group cohesion and mutual support. At the same time, it challenges group members to take responsibility for their contributions to the child’s rejection and to shift to more active and adaptive coping with their difficult family situations.
Skills Training
Authors: Willer Jan
Published: April 2017

Developing effective organizing and planning skills is an essential element of effective treatment of ADHD because these skills improve functioning. People without ADHD learn organization and planning skills naturally as they go through life. Because of cognitive differences, these skills do not come naturally to adults with ADHD, so they may have to be learned. Almost all adults with ADHD have some deficits in organizational skills. Clients with ADHD do not typically think through their problems systematically, prioritize, and make plans. Instead, they tend to react impulsively or avoid. The information in this chapter draws heavily on two manualized treatments to help people with ADHD manage their symptoms and improve their skills in managing everyday life.
Defining Evidence-Based Practice
Authors: Norcross John C. , Hogan Thomas P. , Koocher Gerald P. , Maggio Lauren A.
Published: April 2017

This opening chapter sets the stage for the book by sketching a brief history of evidence-based practice (EBP), explicating the definition and goal of EBPs, outlining controversies about EBP, and introducing three composite patients who will reappear as examples throughout the book. It introduces the sequential core skills of EBP, summarized by the mnemonic AAA TIE or triple A TIE: Asking a specific, clinical question; Accessing the best available research; Appraising that research evidence critically; Translating that research into practice with a particular patient; Integrating the clinician’s expertise and the patient’s characteristics, culture, and preferences with the research; and Evaluating the effectiveness of the entire process. Subsequent chapters take up each of these skills in turn.
Translating Research Into Practice
Authors: Norcross John C. , Hogan Thomas P. , Koocher Gerald P. , Maggio Lauren A.
Published: April 2017

This chapter assists practitioners in translating the research evidence into direct applications to their patients. It reviews the imperative of translational research and the stance of the reflective practitioner. The chapter helps practitioners translate the results of randomized clinical trials into practice by applying the CONSORT checklist. It considers potential harms that might accrue to patients in applying the research. The chapter also examines the process of identifying discredited practices—interventions that do not work—and reflects on how to proceed in the face of inconsistent evidence. The chapter concludes by applying clinical decision analysis, using decision trees to explore choices at critical junctures.
Integrating the Patient and the Clinician With the Research
Authors: Norcross John C. , Hogan Thomas P. , Koocher Gerald P. , Maggio Lauren A.
Published: April 2017

This chapter demonstrates how research is integrated with the two other pillars of evidence-based practice (EBP): clinical expertise and patient characteristics. Research alone never suffices for making clinical decisions, nor does the simple extrapolation of research qualify as EBP. The chapter begins by correcting pernicious myths about EBP and then discusses enlarging clinical decision-making by adding the clinician and the patient into the mix. The chapter describes several ways in which the three pillars of EBP can be integrated and considers what to do when they cannot be integrated, particularly in complex cases. Clinicians will ultimately adopt, adapt, or abandon a research-supported intervention for a specific case. Finally, the chapter reviews the research on being responsive to patients’ transdiagnostic features, such as preferences, stages of change, and culture.
Motivational Enhancement Therapy for Increasing Antidepressant Medication Adherence and Decreasing Clinical Depression Among Adult Latinos
Authors: Interian Alejandro , Prawda Ariana , Fishman Daniel B. , Buerger William M.
Published: April 2017

Case Studies Within Psychotherapy Trials: Integrating Qualitative and Quantitative Methods presents a specific, mixed-methods approach, called the “Cases Within Trials” (CWT) model, to psychotherapy research, combining the results from a randomized clinical trial (RCT), from case studies drawn from the RCT, and a synthesis of the two types of knowledge. Chapter 6 of the book applies this model to a study of the application of a three-session, individual, “motivational interviewing” therapy—specifically labeled “motivational enhancement therapy for antidepressants” (META). META was employed for treating disadvantaged, predominantly Spanish-speaking Latinos with depression. Finding META plus routine individual psychiatric therapy based in a community mental health center (CMHC) to be statistically and substantially superior to the CMHC-therapy-only condition, the authors then analyze and compare the positive-outcome case of Lupe, the mixed-outcome case of Ana, and the negative-outcome case of Maria, all drawn from the META condition.
STEPPS in a Residential Therapeutic Community in Italy
Authors: Lombardo Aldo
Published: April 2017

This chapter describes the implementation of STEPPS in a residential therapeutic community in Rome, Italy. STEPPS is integrated with sociotherapy to provide residents and staff with a common language. STEPPS is adapted on a daily basis as homework for residents, as well as for support training for social rehabilitation workers without a background in cognitive behavioral therapy. There is an emphasis on patient empowerment and providing residents with new skills and strategies to reduce their overly intense emotions. Mutual support has been enhanced, and trust, empathy, and personal awareness have increased. The program has led to a reduced length of stay and to a general improvement in perceived quality of life. The chapter describes challenges associated with its implementation. STEPPS has been translated into Italian.