This document summarizes a study that examined the relationship between traumatic brain injury (TBI) and substance abuse among prison inmates in a therapeutic community (TC). The study hypothesized that inmates with a history of moderate or severe TBI would have poorer health, cognitive performance, and program compliance compared to inmates without TBI. It assessed 213 inmates and found that those with moderate/severe TBI reported worse physical and mental health, and performed slightly worse on a simple cognitive test, but showed similar program compliance. It also found higher rates of reported TBI using a structured interview compared to prison records. The study provides initial evidence on the interactions between TBI and substance abuse in prisoners.
A study design proposal for incorporating photos into just-in-time interventions for smoking cessation. The presentation was given for a health communication seminar course in Fall 2016.
Depression Involved in the Chemotherapy Induced Event-based Prospective Memor...IJEAB
The aim of this study was to investigate the relationships between depression and occurrence of chemotherapy induced prospective memory impairment in patients with breast cancer (BC).The 63 BC patients before and after chemotherapy were administered with the self-rating depression scale (SDS) and a battery of cognitive neuropsychological tests including event-based and time-based prospective memory (EBPM and TBPM, respectively) tasks. The changes in their prospective memory and cognitive neuropsychological characteristics before and after chemotherapy were compared. Compared with the scores before chemotherapy, the EBPM score exhibited a statistically significant difference after chemotherapy (t = 6.069, P < 0.01), while the TBPM score showed no significant difference (t = 1.087, P > 0.05). Further, compared with the patients without depression, the patients with depression exhibited a statistically significant difference in the EBPM score (t = -4.348, P < 0.01), while the TBPM scores did not show a statistically significant difference between the two groups (t = -1.260, P > 0.05). Post-chemotherapy, EBPM and overall cognitive functions in BC patients merged with depression were found to decline, while TBPM did not show a significant change, suggesting that the combination of chemotherapy and depression might be related with the occurrence of post-chemotherapy EBPM impairment.
A study design proposal for incorporating photos into just-in-time interventions for smoking cessation. The presentation was given for a health communication seminar course in Fall 2016.
Depression Involved in the Chemotherapy Induced Event-based Prospective Memor...IJEAB
The aim of this study was to investigate the relationships between depression and occurrence of chemotherapy induced prospective memory impairment in patients with breast cancer (BC).The 63 BC patients before and after chemotherapy were administered with the self-rating depression scale (SDS) and a battery of cognitive neuropsychological tests including event-based and time-based prospective memory (EBPM and TBPM, respectively) tasks. The changes in their prospective memory and cognitive neuropsychological characteristics before and after chemotherapy were compared. Compared with the scores before chemotherapy, the EBPM score exhibited a statistically significant difference after chemotherapy (t = 6.069, P < 0.01), while the TBPM score showed no significant difference (t = 1.087, P > 0.05). Further, compared with the patients without depression, the patients with depression exhibited a statistically significant difference in the EBPM score (t = -4.348, P < 0.01), while the TBPM scores did not show a statistically significant difference between the two groups (t = -1.260, P > 0.05). Post-chemotherapy, EBPM and overall cognitive functions in BC patients merged with depression were found to decline, while TBPM did not show a significant change, suggesting that the combination of chemotherapy and depression might be related with the occurrence of post-chemotherapy EBPM impairment.
In the broader list of cognitive concerns, neuropsychological testing has shown that attentional impairment may have a specific burden in Fibromyalgia Syndrome (FMS).
Preliminary observations have reported a subset of FMS patient screened for attention disorders fulfilling the actual diagnosis of ADHD, a neurodevelopmental disorder characterized by
developmentally inadequate levels of inattention, hyperactivity and impulsivity that might persist in adulthood. Yet, no study to date has systematically examined the history and the specific
contribution of ADHD to FMS in terms of clinical impact and related specific disabilities.
In this study, 106 individuals with a FMS diagnosis based on the 2010 criteria of the American College of Rheumatology have been assessed for (a) the presence of ADHD; (b) the burden of
disability caused by ADHD versus FMS; (c) the presence of other psychiatric disorders. Results indicated that ADHD was present in 24.5% of FMS individuals, it was associated with higher FMS symptoms severity and a greater functional impairment, particularly in the work/school domain.
Moreover, patients with both FMS and ADHD had higher frequency of substance use disorders than those with FMS only (38.5% versus 3.8%) and mainly opioids. Overall, results suggest that ADHD can increase burden adding specific disability in work and social activities, and it is associated with
a trend for the excessive use of opioid painkillers. Detection of neurodevelopmental and actual symptoms of ADHD is highly recommended especially in patient prone to increase the dose of antipain medication.
A project of psychology on the topic Drug Addiction with the help of survey
Link to the powerpoint file and Questionnaire used for survey:
Powerpoint File: http://www.slideshare.net/SafeerAli7/drug-addiction-67095937
Questionnaire: http://www.slideshare.net/SafeerAli7/questionnaire-67095755
The efficacy of app-supported smartphone interventions for mental health prob...RachitSharma132
to evaluate the efficacy of app-supported smartphone interventions on
a range of mental health outcomes, and to examine whether
various features related to the intervention (theoretical orientation, whether professional guidance was offered, whether
reminders to engage were sent) and sample (degree of mental
health problem) moderated the observed effect sizes
Drug abuse has now become a major public health problem in Nigeria requiring urgent attention. Although drug abuse cut across all age groups, the youths are however the most affected. This study aimed at assessing Community Pharmacists involvement in the rehabilitation of drug abuse victims. The study was carried out in Abuja Municipal Area Council, questionnaires were administered to Community Pharmacists practicing within the Area Council. A total of 176 Community Pharmacists participated in the study, and slightly above a quarter (27.43%) of them had post-graduate degrees. More than three-quarters (79.5%) of the study participants had received training on drug abuse. A total of 89.2% of the study participants had come across persons suspected to be abusing prescription medicines. Almost all (96.6%) of the study participants indicated that they are willing to advise persons suspected to be abusing drugs on the dangers of drug abuse, and 88.1% of the study participants had spoken to clients concerning abuse of prescription medicines. Also, more than three-quarters (80.1%) of the study participants indicated that pharmacists’ role in the prevention of drug abuse is very important. The study has revealed that Community Pharmacists can play an invaluable role in the rehabilitation of drug abuse victims in Nigeria.
Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Systematic Review for the U.S. Preventive Services Task Force
A Paper Session presented at the 2014 APA Convention in Washington, D.C., on Aug. 7, 2014. This presentation reviewed findings of my predoctoral dissertation, which looked at the relationship between substance-use disorders and traumatic brain injury on measures of cognition and physical and mental health. It also looked at the prevalence of TBI among offenders in a prison therapeutic community.
http://www.ChildCareDailyApp.com
Today's parents have different communication needs and habits than previous generations. Savvy child care providers can adapt how they communicate with parents and grandparents to get the most favorable results. The same technology tools that make it easier for child care providers (from day care centers to family child care) to communicate with parents also help to stay organized and comply with QRIS programs requirements.
Enjoy this fun, fill-in-the blank attendee handout created for our presentation at the National Association for Family Child Care Conference. Child Care Daily App's Chief Operating Officer Bill Collins teamed with master speaker Marty Appelbaum of Appelbaum Training Institute to present, "Always On: Tips & Strategies for Making Today’s Connected Lifestyle Work for You."
In the broader list of cognitive concerns, neuropsychological testing has shown that attentional impairment may have a specific burden in Fibromyalgia Syndrome (FMS).
Preliminary observations have reported a subset of FMS patient screened for attention disorders fulfilling the actual diagnosis of ADHD, a neurodevelopmental disorder characterized by
developmentally inadequate levels of inattention, hyperactivity and impulsivity that might persist in adulthood. Yet, no study to date has systematically examined the history and the specific
contribution of ADHD to FMS in terms of clinical impact and related specific disabilities.
In this study, 106 individuals with a FMS diagnosis based on the 2010 criteria of the American College of Rheumatology have been assessed for (a) the presence of ADHD; (b) the burden of
disability caused by ADHD versus FMS; (c) the presence of other psychiatric disorders. Results indicated that ADHD was present in 24.5% of FMS individuals, it was associated with higher FMS symptoms severity and a greater functional impairment, particularly in the work/school domain.
Moreover, patients with both FMS and ADHD had higher frequency of substance use disorders than those with FMS only (38.5% versus 3.8%) and mainly opioids. Overall, results suggest that ADHD can increase burden adding specific disability in work and social activities, and it is associated with
a trend for the excessive use of opioid painkillers. Detection of neurodevelopmental and actual symptoms of ADHD is highly recommended especially in patient prone to increase the dose of antipain medication.
A project of psychology on the topic Drug Addiction with the help of survey
Link to the powerpoint file and Questionnaire used for survey:
Powerpoint File: http://www.slideshare.net/SafeerAli7/drug-addiction-67095937
Questionnaire: http://www.slideshare.net/SafeerAli7/questionnaire-67095755
The efficacy of app-supported smartphone interventions for mental health prob...RachitSharma132
to evaluate the efficacy of app-supported smartphone interventions on
a range of mental health outcomes, and to examine whether
various features related to the intervention (theoretical orientation, whether professional guidance was offered, whether
reminders to engage were sent) and sample (degree of mental
health problem) moderated the observed effect sizes
Drug abuse has now become a major public health problem in Nigeria requiring urgent attention. Although drug abuse cut across all age groups, the youths are however the most affected. This study aimed at assessing Community Pharmacists involvement in the rehabilitation of drug abuse victims. The study was carried out in Abuja Municipal Area Council, questionnaires were administered to Community Pharmacists practicing within the Area Council. A total of 176 Community Pharmacists participated in the study, and slightly above a quarter (27.43%) of them had post-graduate degrees. More than three-quarters (79.5%) of the study participants had received training on drug abuse. A total of 89.2% of the study participants had come across persons suspected to be abusing prescription medicines. Almost all (96.6%) of the study participants indicated that they are willing to advise persons suspected to be abusing drugs on the dangers of drug abuse, and 88.1% of the study participants had spoken to clients concerning abuse of prescription medicines. Also, more than three-quarters (80.1%) of the study participants indicated that pharmacists’ role in the prevention of drug abuse is very important. The study has revealed that Community Pharmacists can play an invaluable role in the rehabilitation of drug abuse victims in Nigeria.
Behavioral Counseling and Pharmacotherapy Interventions for Tobacco Cessation in Adults, Including Pregnant Women: A Systematic Review for the U.S. Preventive Services Task Force
A Paper Session presented at the 2014 APA Convention in Washington, D.C., on Aug. 7, 2014. This presentation reviewed findings of my predoctoral dissertation, which looked at the relationship between substance-use disorders and traumatic brain injury on measures of cognition and physical and mental health. It also looked at the prevalence of TBI among offenders in a prison therapeutic community.
http://www.ChildCareDailyApp.com
Today's parents have different communication needs and habits than previous generations. Savvy child care providers can adapt how they communicate with parents and grandparents to get the most favorable results. The same technology tools that make it easier for child care providers (from day care centers to family child care) to communicate with parents also help to stay organized and comply with QRIS programs requirements.
Enjoy this fun, fill-in-the blank attendee handout created for our presentation at the National Association for Family Child Care Conference. Child Care Daily App's Chief Operating Officer Bill Collins teamed with master speaker Marty Appelbaum of Appelbaum Training Institute to present, "Always On: Tips & Strategies for Making Today’s Connected Lifestyle Work for You."
A Paper Session presented at the 2014 APA Convention in Washington, D.C., on Aug. 7, 2014. Title: TBI and Substance Abuse Correlates Within a Prison Therapeutic Community.
http://www.ChildCareDailyApp.com
Delivered at the National Association for Family Child Care annual conference, this interactive session for providers and administrators gives insight into the habits of highly successful family care providers. Learn tips to help you understand what today’s parents want in a child care partnership. Explore tools and technology that can boost your connection to parents and improve the effectiveness of your program.
Presented by Bill Collins and Marty from Appelbaum Training Institute.
This brochure contains part of the range of planters Oasis offers. Please contact 01270 750 574 or marketing@oasisinteriorlandscaping.co.uk for more details.
Our replica (artificial) plant displays brochure. We also can provide a diverse range of artwork, flowers, and exterior grounds maintenance. In season we also offer a range of Christmas Trees, complete with lighting and decorations. Please contact 01270 750 574 or marketing@oasisinteriorlandscaping.co.uk for more details.
FO613 New Written Assignment Rubric Area Minimal AdShainaBoling829
FO613 New Written Assignment Rubric:
Area Minimal Adequate Good Exceptional Total
Content of
paper
Paper shows a minimal
understanding or
application of the
reading and video
materials and addresses
only a few of the
assignment prompts.
Paper provides minimal
coverage of the required
elements, for either
diagnostic formulation or
treatment options.
Critical analysis shows
minimal insight or ability
to generalize and apply
theory to cases.
Paper demonstrates that
few of the assigned
course materials and
readings were used to
for its content.
0-6 points
Paper shows an
understanding and
application of the
reading and video
materials but only
addresses some of the
assignment prompts.
Paper provides some
coverage of the required
elements for either
diagnostic formulation
and/or treatment
options.
Critical analysis shows
some insight and/or
ability to generalize and
apply theory to cases.
Paper demonstrates that
some of the assigned
course materials and
readings were used to
for its content.
7-10 points
Paper shows a clear
understanding and
application of the
reading and video
materials and addresses
most of the assignment
prompts.
Paper provides
substantial coverage of
the required elements,
including a diagnostic
formulation and
treatment options.
Critical analysis often
shows insight and ability
to generalize and apply
theory to cases.
Paper demonstrates that
most of the assigned
course materials and
readings were used to
for its content.
11-13 points
Paper shows a thorough
and in-depth
understanding and
application of the
reading and video
materials and fully
addresses all the
assignment prompts.
Paper provides
comprehensive/ detailed
coverage of the required
elements, including a
cogent diagnostic
formulation and relevant
treatment options.
Critical analysis
consistently shows
insight and ability to
generalize and apply
theory to cases.
Paper demonstrates that
the assigned course
materials and readings
were used to for its
content.
14-15 points
15.0
points
APA style and
grammar
Poor attention to
structure and form of
APA style for title page,
content, citations, and
references.
Paper contains repetitive
errors in grammar,
and/or the writing style
is disorganized or casual.
2 points
Basic structure of APA
followed with 3 or more
errors in APA style for
title page, content,
citations, and references.
Paper contains 3 or more
errors in grammar,
and/or the writing style
is casual or lacks a
professional approach.
3 points
Basic structure of APA
followed with no more
than 2 errors in APA style
for title page, content,
citations, and references.
Paper contains 2 or more
errors in grammar,
and/or the writing style
is adequate.
4 points
Basic structure of APA
followed with no more
than 1 error in APA style
for title page, content,
cita ...
Running head COMPREHENSIVE QUALITY CARE1COMPREHENSIVE QUALIT.docxjoellemurphey
Running head: COMPREHENSIVE QUALITY CARE 1
COMPREHENSIVE QUALITY CARE 10
Improving the Quality of Comprehensive Care for the OEF and OIF Veterans with Posttraumatic Stress Disorder (PTSD)
Ashlie Burnett
Capella University
2/15/15
Research Questions
1. How efficiently can quality of Comprehensive care be improved to ensure quality care to the OEF and OIF with posttraumatic stress disorder?
2. To what extent are the problems faced by the OEF and OIF with posttraumatic disorder matched by the available ways of serving them?
Research Objectives
1. The general objective of this research was to determine how efficiently quality of comprehensive care be improved to ensure quality care to the OEF and OIF with posttraumatic stress disorder.
2. The paper also sought to determine the extent to which the problems faced by the OEF and OIF with posttraumatic disorder matched by the available ways of serving them.
Sub-related questions
1. What are the most common problems facing the war veteran’s over the world?
2. What are the medical covers available for the victims of posttraumatic disorders?
3. What are the inefficiencies in the health care provision of the PSTD veterans?
Relevance of the Sub-related questions
The sub-related questions form the basis of finding the needed results for the general objectives of this paper. To find an effective measure of improving quality of health care for the victims of post traumatic disorder, the first question will help find the main problem to be addressed in order to avoid cases of mismatch of services and problems experienced. The second sub-related question on the will helps the available medical cover for the victims of posttraumatic disorder in order to help make any further recommendations on where and how to improve the services. Finally, the last sub-related question will assist in pointing the inefficiencies in the health care services offered to the PSTD veterans. Knowing these inefficiencies will help the researcher to make educated recommendations as per what measures can be taken to address them.
Important Information about the Issue and Types of Data to be collected
To understand the issue of quality of comprehensive care for the OEF and OIF veterans with posttraumatic stress disorder, the research must understand the kind of challenges these veterans go through in the battlefields. Also of importance is information on the available medical care options at the disposal of these veterans plus the number qualified personnel in this area. The data to be collected, on the other hand, will mostly be experiences and awareness of the victims. The research will also collect records of relevant institution that will be analyzed qualitatively.
Action Plan
The paper desired for a future in which medical programs offer the best possible financial and technical support to those who had sacrificed their comfort to help the OIF/OEF veterans. The policies must be able to authorize veterans to provide ...
Rates and Predictors of Suicidal Ideation During the FirstYe.docxaudeleypearl
Rates and Predictors of Suicidal Ideation During the First
Year After Traumatic Brain Injury
Jessica L. Mackelprang, PhD, Charles H. Bombardier, PhD, Jesse R. Fann, MD, MPH, Nancy R. Temkin, PhD,
Jason K. Barber, MS, and Sureyya S. Dikmen, PhD
Suicide is a major public health problem among
the 1.7 million people who sustain traumatic
brain injury (TBI) each year in the United
States.1 People with a history of TBI in both
civilian and military populations are 1.55 to
4.05 times more likely to die by suicide than
the general population.2---5 In a study of
Australian outpatients with a history of TBI,
the majority of whom had no preinjury history
of suicide attempts, suicide attempts were
reported by 17.4% (30 of 172) of the sample
over a 5-year period.6 Nearly half of the
individuals who attempted suicide had made
multiple attempts.6,7 The Centers for Disease
Control and Prevention recently called for
investigations of individual-level risk and
protective factors for self-directed violence
among people with TBI as an important com-
ponent of improving long-term outcomes.8
Rates of suicidal ideation (SI) after TBI
have been found to exceed 20% in some
studies6,9---14; however, in a recent systematic
review of SI and behavior after TBI, Bahraini
et al. highlighted the paucity of research in
this area.15 They concluded that additional
research is needed to determine the prevalence
of SI and behavior after brain injury, as well as
to ascertain patient-level factors that may be
associated with increased suicide risk. Studies
examining whether injury severity predicts
post-TBI suicidality have yielded inconclusive
findings.6,13,16,17 In perhaps the most thorough
study on this topic to date, Tsaousides et al.12
surveyed 356 community-dwelling adults with
a self-reported history of TBI and found that
preinjury substance abuse was the only corre-
late of current SI. Risk factors for SI after TBI
have been underinvestigated. Research in this
area has been limited by reliance on retro-
spective reporting and self-reported history of
TBI,12,18---20 with only a few studies including
objective indicators of TBI severity.6 Most
studies have involved cross-sectional designs
and have included participants whose time
since injury varied from several months to
many years.12,21 Finally, because most existing
studies have included relatively small, poten-
tially biased samples21 recruited from outpa-
tient clinics or TBI survivor programs,6,7,12 they
may not be representative of the population of
people who sustain TBI.
Given these gaps in the existing literature,
our objectives were (1) to investigate rates of SI
during the first year after complicated mild to
severe TBI in a representative sample of adults
who had been admitted to a level I trauma
center and (2) to investigate whether demo-
graphic characteristics, preinjury psychiatric
history, or injury-related factors predicted SI.
METHODS
This study was part of the recruitment phase
of a clinical trial ...
Improving Comprehensive Carefor OEF and OIF Vetsby Aslie.docxbradburgess22840
Improving Comprehensive Care
for OEF and OIF Vets
by Aslie Burnett
FILE
T IME SUBMIT T ED 20- MAR- 2015 10:4 4 AM
SUBMISSION ID 51867 4 598
WORD COUNT 64 25
CHARACT ER COUNT 39906
DISSERT AT ION_PROPOSAL.DOC (125.5K)
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Improving Comprehensive Care for OEF and OIF Vets
ORIGINALITY REPORT
PRIMARY SOURCES
vets.arizona.edu
Int ernet Source
www.ejpt.net
Int ernet Source
Karen H. Seal. "VA mental health services
utilization in Iraq and Af ghanistan veterans in
the f irst year of receiving new mental health
diagnoses", Journal of Traumatic Stress, 2010
Publicat ion
www.f as.org
Int ernet Source
Submitted to Maryville University
St udent Paper
store.samhsa.gov
Int ernet Source
yellow-f ever.rki.de
Int ernet Source
cstsf orum.org
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St udent Paper
akf sa.org
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iris.lib.neu.edu
Int ernet Source
www.acpmh.ipag.f r
Int ernet Source
onlinelibrary.wiley.com
Int ernet Source
Submitted to University of Western Australia
St udent Paper
Submitted to University of Southern Calif ornia
St udent Paper
scindeks.nb.rs
Int ernet Source
cdn.intechopen.com
Int ernet Source
www.healthemotions.org
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Submitted to Palo Alto University
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amhi-treatingpreventing.oup.com
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www.mindf ully.org
Int ernet Source
Submitted to Pennsylvania State System of
Higher Education
St udent Paper
www.rand.org
Int ernet Source
gradworks.umi.com
Int ernet Source
patriotoutreach.org
Int ernet Source
Ticknor, Bobbie and Tillinghast, Sherry. "Virtual
Reality and the Criminal Justice System: New
Possibilities f or Research, Training, and
Rehabilitation", Journal of Virtual Worlds
Research, 2011.
Publicat ion
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Michael E. Smith. "Bilateral hippocampal
volume reduction in adults with post-traumatic
stress disorder: A meta-analysis of structural
MRI studies", Hippocampus, 2005
Publicat ion
etd.lib.f su.edu
Int ernet Source
digital.library.adelaide.edu.au
Int ernet Source
cdn.govexec.com
Int ernet Source
Yelena Bogdanova. "Cognitive Sequelae of
Blast-Induced Traumatic Brain Injury: Recovery
and Rehabilitation", Neuropsychology Review,
02/17/2012
Publicat ion
Nanda, U., H. L. B. Gaydos, K. Hathorn, and N.
Watkins. "Art and Posttraumatic Stress: A
Review of the Empirical Literature on the
Therapeutic Implications of Artwork f or War
Veterans With Posttraumatic Stress Disorder",
Environment and Behavior, 201.
Information interventions for injury recovery: a reviewAlex Collie
This presentation reports the results of a systematic review of information based interventions for injury recovery. It was presented at the Canadian Association for Research on Work and Health (CARWH) conference in 2012. The study has since been published in the Journal of Rehabilitation Medicine. A link to the study is here:
http://www.ncbi.nlm.nih.gov/pubmed/22674232
Research Paper Assignment – Waste Management Purpose .docxverad6
Research Paper Assignment – Waste Management
Purpose: This assignment supports the following objective for the course: define waste
management and the strategies for achieving it.
Key Dates: The topic for your research paper is one that you can begin work on immediately.
While the final paper is not due until the end of the term, it is recommended from a time
management standpoint that you start early.
Key due dates are:
Detailed outline, including key conclusions, due by the end of Week 6.
Final report, containing all the elements below, due by the end of Week 8.
[Note an appendix is optional; it is not required for the paper to be complete.]
Research Topic: Should container deposit laws (bottle bills) be expanded to include
noncarbonated drinks?
Format: The paper must be submitted as a Word document using the APA format and
headings. It should be 1500 to 2500 words in length, written in 12 point font and double
spaced. For full credit it must contain each of the following elements:
Title Page.
Body of Paper - Based on your research:
o Briefly describe the history of container deposit laws.
o Describe how container deposit laws work.
o Explain why proponents believe bottle laws should be updated to include bottled
water, sports drinks, teas, and other noncarbonated beverages.
o Explain the position of those that oppose changing the law.
Conclusions (minimum 2 paragraphs): Based on the above state and defend your
position on whether states should expand their container deposit laws to include
noncarbonated beverages.
Bibliography: Include at least three sources not in the weekly reading assignments that
you used in this paper. (Wikipedia is not an acceptable source.)
Appendices (optional): Include appropriate charts, graphs, or other documents for extra
credit. (Note: Appendices do not count as part of the overall length requirement).
Psychological Services
Treatment Choice Among Veterans With PTSD Symptoms
and Substance-Related Problems: Examining the Role of
Preparatory Treatments in Trauma-Focused Therapy
Laura D. Wiedeman, Susan M. Hannan, Kelly P. Maieritsch, Cendrine Robinson, and Gregory
Bartoszek
Online First Publication, November 26, 2018. http://dx.doi.org/10.1037/ser0000313
CITATION
Wiedeman, L. D., Hannan, S. M., Maieritsch, K. P., Robinson, C., & Bartoszek, G. (2018, November
26). Treatment Choice Among Veterans With PTSD Symptoms and Substance-Related Problems:
Examining the Role of Preparatory Treatments in Trauma-Focused Therapy. Psychological
Services. Advance online publication. http://dx.doi.org/10.1037/ser0000313
Treatment Choice Among Veterans With PTSD Symptoms and Substance-
Related Problems: Examining the Role of Preparatory Treatments in
Trauma-Focused Therapy
Laura D. Wiedeman
Edward Hines Jr. Veterans Affairs Hospital, Hines, Illinois, and
Veterans Affairs Northern California Health Care System,
Martinez, Califor.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxrtodd599
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Yoan Collado
Carlos Albizu University
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and c.
Running head VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEM.docxjenkinsmandie
Running head: VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 1
VETERANS PTSD CAUSES, TREATMENTS, AND SUPPORT SYSTEMS 3
Veterans PTSD Causes, Treatments, and Support systems
Veterans PTSD Causes, Treatments, and Support systems
Evaluations on Post Traumatic Stress Disorder (PTSD) among veterans is imperative for a positive health outcome. The evaluations and analysis of the results ensure that barriers to treatment are addressed and have access to the available support systems. Studies carried out have depicted the successes of the treatments and support programs in the health systems to veterans. Modifications on the systems have also been recommended to combat and control PTSD. Alternative approaches such as computerized systems, natural treatment methods, and home-based systems are also essential in providing a holistic approach in PTSD treatments. Treatment methods success ensures that veterans do not fall victim to depression, which can result in chronic diseases. This can be as a result of negative health behaviors and lifestyles. Understanding the consequences of PTSD among veterans will ensure that approaches utilized offer not only treatment methods but also offer support systems for general wellbeing.
The first source focuses on the treatment and success of three-week outpatient program by “evaluating patterns and predictors of symptom change during a three-week intensive outpatient treatment for veterans with PTSD.” The study is evidence-based on statistics drawn from the program and modifications for optimal success rates. 191 veterans were the participants in the research comprising of a daily group and individual Cognitive Processing Therapy (Zalta et al., 2018). The data was analyzed from the sample cohorts in accordance with military and demographic characteristics. Measures in the study involved treatment engagement as well as comparison of pre-treatment and post-treatment changes (Zalta et al., 2018). The results showed progress in the evaluation of predictors and patterns in treatment changes. Procedures utilized involved group sessions with daily activities for the development of the treatment program. Self-report metrics were also applied in the procedures as control groups were challenging in the study. Modified and intensive outpatient (IOP) treatment to veterans showed high success levels in the program (Zalta et al., 2018).
The second source examines a new treatment in exploring the feasibility of computerized, placebo-controlled, and home-based executive function training (EFT) on psychological and neuropsychological functions. The source titled “Computer-based executive function training for combat veterans with PTSD” shows trials in assessing feasibility and predictors output. The study shows how the functions can be useful in brain activation combating PTSD in veterans. Symptoms experienced after treatment on PTSD cases are stimulated through neural and cognition reactivity, which can be contr.
O R I G I N A L P A P E RCharacteristics of Patients Refer.docxcherishwinsland
O R I G I N A L P A P E R
Characteristics of Patients Referred to Psychiatric Emergency
Services by Crisis Intervention Team Police Officers
Beth Broussard • Joanne A. McGriff •
Berivan N. Demir Neubert • Barbara D’Orio •
Michael T. Compton
Received: 29 September 2009 / Accepted: 20 January 2010 / Published online: 7 February 2010
� Springer Science+Business Media, LLC 2010
Abstract The Crisis Intervention Team (CIT) program
trains police officers in crisis intervention skills and local
psychiatric resources. Because the safety and appropriate-
ness of any new intervention is a crucial consideration, it is
necessary to ensure that CIT training does not result in
excessive or inappropriate referrals to psychiatric emer-
gency services (PES). Yet, aside from one prior report by
Strauss et al. (2005) in Louisville, Kentucky, little is known
about the comparability of patients referred to PES by CIT-
trained officers in relation to other modes of referral. The
research questions driving this retrospective chart review
of patients referred to PES were: (1) What types of patients
do CIT-trained officers refer to PES?, and (2) Do mean-
ingful differences exist between patients referred by family
members, non-CIT officers, and CIT-trained officers?
Select sociodemographic and clinical variables were
abstracted from the medical records of 300 patients during
an eight-month period and compared by mode of referral.
Differences across the three groups were found regarding:
race, whether or not the patient was held on the locked
observation unit, severe agitation, recent substance abuse,
global functioning, and unkempt or bizarre appearance.
However, there were virtually no differences between
patients referred by CIT-trained and non-CIT officers.
Thus, while there were some expected differences between
patients referred by law enforcement and those referred by
family members, CIT-trained officers appear to refer
individuals appropriately to PES, as evidenced by such
patients differing little from those referred by traditional,
non-CIT police officers. Trained officers do not have a
narrower view of people in need of emergency services
(i.e., bringing in more severely ill individuals), and they do
not have a broader view (i.e., bringing in those not in need
of emergency services). Although CIT training does not
appear to affect the type of individuals referred to PES,
future research should examine the effect of CIT training
on the frequency of referrals or proportion of subjects
encountered that are referred, which may be expected to
differ between CIT-trained and non-CIT officers.
Keywords Crisis intervention team � Law enforcement �
Police officers � Psychiatric emergency services
Introduction
As first responders in crisis situations involving persons
with serious mental illnesses, law enforcement officers are
often the principal source of referral to psychiatric emer-
gency services (PES) and play an .
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Immunity to Veterinary parasitic infections power point presentation
2014 apa convention_presentation_08-07-14
1. TBI and Substance Abuse
Correlates Within a Prison
Therapeutic Community
2014 APA Convention
Washington, D.C.
Paper Session
Scott R. La Point, MA, Doctoral Candidate
Joseph Francis, Psy.D. and Linda Baum, Ph.D.
8/7/2014 1
2. Acknowledgments:
Lakeview NeuroRehabilitation Center
American Psychological Association
Regent University
Joseph Francis, Psy.D.
Linda Baum, Ph.D.
John Corrigan, Ph.D.
George Parkerson, Ph.D.
James Brockington, Ph.D.
My family - wife Amy and our three sons
(Luke, Joshua & Samuel)
8/7/2014 2
3. Introduction
• Between 1.5 million to 2 million individuals are
presently incarcerated in U.S. prisons and jails.
(Bureau of Justice Statistics, 2012; Torrey et al., 2010)
• TBI is an unrecognized problem in prisons and jails
nationwide, with 25% to 87% of offenders reporting a
history of TBI as compared to 8.5% of the general
population. (Slaughter, Fann, & Ehde, 2003)
• An estimated 155.9 million individuals identify as
illicit drug users or drinkers of alcohol.
(National Survey on Drug Use and Health, 2011)
2
8/7/2014 3
4. New Mexico
2 Million
New
Hampshire
1.3 Million
Wyoming 0.5 Million
8/7/2014 4
6. Background on TBI, SA
• Alcohol and accidents
– 50% of all TBI-related accidents involve alcohol use
(Allen et al., 2010; Sparadeo, Strauss, and Barth, 1990)
• TBI and Substance Abuse
– Cognitive decline; TBI or SA? (Iverson, Lange, and Franzen, 2005)
• Comorbidity
– Major Depressive Disorder, anxiety, substance use disorders,
impulsivity, and problems with executive functions (attention,
memory, initiation) (CDC, 2010; Rimel et al.,1981)
• Screening for TBI < SA or psychiatric disorders
• Affect of TBI on functioning in a TC population
3
8/7/2014 6
7. Background on TBI
• Controversies about TBI
– Level of impairment not always representative of injury
severity
• mTBI and PCS
– Small percentage of individuals with mTBI experience
long-term deficits (McCrea, 2008)
• Technology not the answer
– Advancements have not led to better identification
(Zhou et al., 2013)
• Study rationale
– Group parings: mTBI and no TBI
4
8/7/2014 7
8. Purpose of the Study
• The lack of research among offenders within a prison
therapeutic community means that an exploratory
study could yield important findings with
implications on the importance of screening for TBI.
• Improved identification of offenders with a history of
TBI could enhance understanding of TBI-related
problems within a prison TC.
• This study sought to explore if having a TBI has an
effect on offenders’ health, cognition, and prison
performance.
5
8/7/2014 8
9. Hypotheses
• Hypothesis 1: Among offenders with a history of substance-related
problems, measures of program compliance will be
higher for those without a history of moderate/severe TBI.
• Hypothesis 2: Among offenders with a history of substance-related
problems, offenders with moderate/severe TBI will
show evidence of greater problems with physical health and
mental health as measured by the Duke Health Profile
(DUKE) than will offenders without a history of
moderate/severe TBI.
• Hypothesis 3: Among offenders with a history of substance-related
problems, offenders with moderate/severe TBI will
perform less well on the Trail Making Test (TMT) than will
offenders without a history of moderate/severe TBI. 6
8/7/2014 9
10. Hypotheses (cont.)
• Hypothesis 4: Offenders who lack both a diagnosis of
substance abuse/dependence and moderate/severe TBI will
show better health indices on the DUKE, better program
compliance, and perform better on the TMT than offenders
with history of moderate/severe TBI and/or substance
abuse/dependence.
• Hypothesis 5: A higher percentage of offenders with a history
of TBI will be identified through the use of a structured
interview (Ohio State University TBI Identification Method)
than indicated by self-report methods upon admission to the
prison TC.
7
8/7/2014 10
11. Methodology
• Participants
– 213 offenders aged 18 to 65
• Procedures
• Measures
– Demographic Form
– Prison TC Compliance Rating
– Duke Health Profile (DUKE)
– Trail Making Test (TMT)
– Ohio State University TBI
Identification Method (OSU TBI-ID)
– Addiction Severity Index (ASI)
8
8/7/2014 11
12. Demographics
• Age
– Mean: 37 years
• Date of birth
• Ethnicity
• Educational level
• Marital status
8/7/2014 12
13. Data Analysis
• Between-group design
• SPSS Statistics 20 for Windows
• Prior to Analysis
– Preliminary examination included assessment of normality,
outlier analysis, and descriptive statistics.
– All assumptions met
• Eager participants
– Unexpected number
10
8/7/2014 13
14. Results
• Hypothesis 1
– Level of TBI not predictive of TC compliance
• Virtually the same TC performance rating
• Hypothesis 2
– Level of TBI predictive of physical and mental health
• Moderate/severe TBI reported more problems
• Hypothesis 3
– Level of TBI significantly affected less cognitively
demanding task but not more difficult one
• Moderate/severe TBI accounted for 3.4% of variance on TMT-A
11
8/7/2014 14
15. Results (cont.)
• Hypothesis 4a
– Cognitive Processing Speed (TMT)
• Level of TBI significantly affected TMT-A but not TMT-B
• Level of SA significantly affected TMT-B but not TMT-A
• Hypothesis 4b
– Physical and Mental Health (DUKE)
• Level of TBI predictive of health problems
– Moderate/severe TBI reported more problems
• Level of SA not predictive of health problems
• Hypothesis 4c
– TC Compliance
• TBI and SA not predictive of program participation
12
8/7/2014 15
16. Results (cont.)
TC, DUKE and TMT Performance by Substance Use and TBI Status
Substance Use History of TBI
SU
Problem
(n = 165)
(n = 151)1
No
SU Problem
(n = 48)
(n = 43)1
Moderate/
Severe
(n = 54)
(n = 50)1
No Moderate/
Severe
(n = 159)
(n = 144)1
Domain M SD M SD F p η² M SD M SD F p η²
TC Compliance 2.78 .433 2.75 .438 .25 .62 .001 2.76 .432 2.77 .435 .15 .69 .001
DUKE Physical 70.42 21.31 70.83 21.31 .097 .76 .00 65.00 22.38 72.52 21.77 4.21 .04* .020
DUKE Mental 68.24 23.50 71.04 22.99 .005 .95 .00 63.15 25.24 70.82 22.45 5.14 .02* .024
TMT-A 49.56 10.21 49.79 10.47 .020 .89 .00 46.40 10.13 50.72 10.08 4.75 .03* 0.24
TMT-B 47.62 9.48 44.42 11.78 3.94 .048* .02 44.82 9.82 47.64 10.12 3.38 .07 .017
TBI: Traumatic Brain Injury; TC: Therapeutic Community; DUKE: Duke Health Profile; TMT: Trail Making
Test; 1Results for TMT-A and TMT-B only include participants whose ethnicity is African American and
Caucasian; Note: * p < .05
13
8/7/2014 16
17. Results (cont.)
• Hypothesis 5
– TBI identification
• Higher percentage of offenders reported history of TBI on
structured interview than indicated in prison records
– 69.5% on OSU TBI-ID
– 84.5% indicated “possible TBI,” “mild TBI,” and
“moderate/severe TBI”
14
8/7/2014 17
18. Discussion
• Prison TC Compliance
– Regardless of TBI history or substance abuse, rating
virtually the same
• Physical and Mental Health
– TBI severity predictive of lower estimates of physical and
mental health
• Individuals with more severe TBI may experience long-term
comorbid disorders or lifelong physical, cognitive,
behavioral, and emotional disturbances.
(Cohen, et al., 1999; Lucas & Addeo, 2006)
15
8/7/2014 18
19. Discussion (cont.)
• Cognitive Processing Speed
– Group differences; unexpected directions
– Substance Abuse
• No ready explanation for why offenders with SA performed
better on the more demanding task
• Practice effect? Concept formation practice (Corrigan, 2012)
• TBI identification
– Findings congruent with previous research
– Prison records revealed only 11.3% of offenders indicated
a history of TBI
16
8/7/2014 19
20. Limitations
• Volunteer participants
– Results cannot be generalized as broadly
– “I’ve had a concussion, but…”
– Participants in better health
• Reliability of Duke Health Profile
– Evidence of actual health problems?
• Accuracy of offenders’ self-reporting
– Health, TBI history (Schofield et al., 2010), and addiction severity
• Validity and reliability of ASI
– Systemic bias of ISRs
17
8/7/2014 20
21. Future Research
• mTBI as its own category
– Results possibly distorted by study’s grouping
– A “no” TBI group?
• PCS among offenders with moderate/severe TBI
– Cognitive rehabilitation as an alternative treatment
• Studying female offenders
– Insights into prevalence, health of incarcerated women
• More specific measure to rate offender compliance
– Organic factors vs. personality characteristics
18
8/7/2014 21
23. References
Allen, D., Frantom, L., Forrest, T., & Strauss, G. (2006). Neuropsychology of Substance Use
Disorders. In P. Snyder (Ed.), Clinical neuropsychology: A pocket handbook for
assessment (p. 649-673). Washington, DC: American Psychiatric Publishing.
Bigler, E., & Maxwell, W. (2012). Neuropathology of mild traumatic brain injury:
Relationship to neuroimaging findings. Brain imaging and behavior, 6(2), 108- 136.
Bureau of Justice Statistics (2012, December). Prisoners in 2011. U.S. Department of Justice,
Office of Justice Programs.
Centers for Disease Control and Prevention (2010). Traumatic brain injuries in prisons
and jails: An unrecognized problem. Retrieved November 13, 2010, from Centers for
Disease Control and Prevention Web site:
http://wwww.cdc.gov/traumaticbraininjury/pdf/Prisoner_TBI_Prof-a.pdf
Cohen, R., Rosenbaum, A., Kane, R., Warnken, W., & Benjamin, S. (1999).
Neuropsychological correlates of domestic violence. Violence and Victims, 14(4), 397-
411.
Corrigan, J., & Bogner, J. (2007). Initial reliability and validity of the Ohio State University TBI
Identification Method. Journal of Head Trauma Rehabilitation, 22(6), 318-329. 20
8/7/2014 23
24. References (cont.)
Heaton, R., Miller, S., Taylor, M., & Grant, I. (2004). Revised Comprehensive Norms for an
Expanded Halstead-Reitan Battery: Demographically Adjusted Neuropsychological
Norms for African American and Caucasian Adults Scoring Program. Lutz, FL:
Psychological Assessment Resources.
Iverson, G., Lange, R., & Franzen, M. (2005). Effects of mild traumatic brain injury cannot be
differentiated from substance abuse. Brain Injury, 19(1), 15-25.
Lucas, J., & Addeo, R. (2006). Traumatic brain injury and postconcussion syndrome. In P.
Snyder (Ed.), Clinical neuropsychology: A pocket handbook for assessment (p. 351-
380). Washington, DC: American Psychiatric Publishing.
McCrea, M. (2008). Mild traumatic brain injury and postconcussion syndrome. New
York: Oxford University Press.
McLellan, A., Luborsky, L, Woody, G., & O’Brien, C. (1980). An improved diagnostic
evaluation instrument for substance abuse patients: The addition severity index. The
Journal of Nervous and Mental Illness, 168(1), 26-33
Parkerson, G., Broadhead, W., & Tse, C. (1990). The Duke Health Profile: A 17-item
measure of health and dysfunction. Medical Care, 28(11), 1056-1072.
21
8/7/2014 24
25. References (cont.)
Rimel, R., Giordani, B., Barth, J., Boll, T., & Jane, J. (1981). Disability caused by minor
head injury. Neurosurgery, 9(3), 221-228.
Schofield, P., Butler, T., Hollis, S., Smith, N., Lee, S., & D’Este, C. (2010). Are prisoners
reliable survey respondents? A validation of self-reported traumatic brain injury (TBI)
against medical records. Brain Injury, 20(5), 1-9.
Slobounov, S., Gay, M., Zhang, K., Johnson, B., Pennell, D., Sebastianelli, W. … & Hallett, M.
(2011). Alteration of brain functional network at rest and in response to YMCA
physical stress test in concussed athletes: rsFMRI study. NeuroImage, 55(4), 1716-
1727.
Sparadeo, F., Strauss, D., & Barth, J. (1990). The incidence, impact, and treatment of
substance abuse in head trauma rehabilitation. Journal of Head Trauma
Rehabilitation, 5(3), 1-8.
Zhou, Y., Kierans, A., Kenul, D., Ge, Y., Rath, J., Reaume, J. … & Lui, Y. (2013) Mild
traumatic brain injury: Longitudinal regional brain volume changes. Radiology.
22
8/7/2014 25
Editor's Notes
TBI and Substance Abuse Correlates within a Prison Therapeutic Community:
While previous research has assessed offenders in a prison population, this is the first known study that examined the problem of TBI and substance abuse within a prison therapeutic community (TC).
TBI and Substance Abuse Correlates within a Prison Therapeutic Community:
While previous research has assessed offenders in a prison population, this is the first known study that examined the problem of TBI and substance abuse within a prison therapeutic community (TC).
Between 1.5 million to 2 million individuals are presently incarcerated in U.S. prisons and jails.
TBI is an unrecognized problem in prisons and jails nationwide, with 25% to 87% of offenders reporting a history of TBI as compared to 8.5% of the general population.
Of the close to 2 million prison offenders, a half million to 1 and a quarter million report a history of TBI.
In regards to substance use, according to the National Survey on Drug Use and Health, an estimated 155.9 million individuals identify as illicit drug users or drinkers of alcohol.
What makes this figure noteworthy is the fact that problems with memory and nonverbal learning resolve slowly after cessation of drinking. However, difficulties with abstraction and problem-solving, perceptuomotor abilities, visual learning/visual memory, and contextual memory often persist. Furthermore, various drugs have different long-term effects on people, but whatever problems they experience are usually reversible.
Between 1.5 million to 2 million individuals are presently incarcerated in U.S. prisons and jails.
TBI is an unrecognized problem in prisons and jails nationwide, with 25% to 87% of offenders reporting a history of TBI as compared to 8.5% of the general population.
Of the close to 2 million prison offenders, a half million to 1 and a quarter million report a history of TBI.
In regards to substance use, according to the National Survey on Drug Use and Health, an estimated 155.9 million individuals identify as illicit drug users or drinkers of alcohol.
What makes this figure noteworthy is the fact that problems with memory and nonverbal learning resolve slowly after cessation of drinking. However, difficulties with abstraction and problem-solving, perceptuomotor abilities, visual learning/visual memory, and contextual memory often persist. Furthermore, various drugs have different long-term effects on people, but whatever problems they experience are usually reversible.
Between 1.5 million to 2 million individuals are presently incarcerated in U.S. prisons and jails.
TBI is an unrecognized problem in prisons and jails nationwide, with 25% to 87% of offenders reporting a history of TBI as compared to 8.5% of the general population.
Of the close to 2 million prison offenders, a half million to 1 and a quarter million report a history of TBI.
In regards to substance use, according to the National Survey on Drug Use and Health, an estimated 155.9 million individuals identify as illicit drug users or drinkers of alcohol.
What makes this figure noteworthy is the fact that problems with memory and nonverbal learning resolve slowly after cessation of drinking. However, difficulties with abstraction and problem-solving, perceptuomotor abilities, visual learning/visual memory, and contextual memory often persist. Furthermore, various drugs have different long-term effects on people, but whatever problems they experience are usually reversible.
Before getting into the study, I want to provide more background on TBI and SA,
Among people with TBI, alcohol use is involved in more than 50% of all accidents. In fact, individuals with TBI are often intoxicated at the time of injury and have more chronic problems with alcohol than the general population.
In regards to TBI and Substance Abuse, Iverson et al. (2005) reported that brain injuries are “two-to-four times more prevalent in alcohol abusers than in the general public and reflect a significant risk factor for cognitive decline independent of the effects of alcohol”
In short, this study asks: Are offenders’ problems because of mTBI or Substance Abuse – or both?
There is a High rate of comorbidity among people with TBI and/or substance abuse.
Associated disorders that are more prevalent in the offender population than the general population include Major Depressive disorder, an anxiety disorder, impulsivity, Substance Abuse, and problems with Executive functions, such as attention, memory, initiation, judgment.
It’s interesting that Problems being identified today by the CDC are the same ones that were first talked about by Rimel et al. as well as others more than 30 years ago.
In regards to screening offenders for problems, Screening for psychiatric problems is routinely done, while screening for TBI is not.
In light of the prevalence of TBI in prison, A central question becomes: How much does TBI affect areas of functioning in a prison TC, and will offenders with a history of TBI in addition to substance abuse perform less well on outcome variables than those with SA alone?
In the literature, controversies about TBI exist.
For example, the level of impairment is not always consistent with the degree of an individual’s injury severity. Someone does not need to lose consciousness to have sustained a TBI of mild severity.
Also, psychiatric problems typically follow those with moderate/severe TBI and less frequently following mTBI; and yet, someone with mTBI can have lasting deficits while someone with a moderate/severe TBI does not have any
mTBI and PCS
A small percentage of individuals with mTBI go on to experience long-term deficits or post-concussion symptoms, a condition commonly referred to postconcussive syndrome.
McCrea reported that only 1% to 5% of individuals with mTBI end up having a neurologic explanation for their deficits. Other factors explain these problems better. Environmental, individual, familial, and the way someone was raised, among others, interact with neurologic factors to effect outcome from mTBI.
Technology not the answer
Advancements in neuroimaging have not always led to better identification of TBI. Zhou et al. (2013) found measurable global and regional brain atrophy in a small sample of concussed individuals one year after injury following a single concussion. MRI results revealed structural changes to the brain in regions associated with cognitive changes in attention, memory, and anxiety.
Slobounov et al. (2011) reported that the brain might remain injured even after symptoms of a concussion have resolved and that neuropsychological tests might not detect these putative injuries.
All of this bring us to a rationale for the groupings of the Predictor Variables for the Present Study
Because of the fact that approximately 90% to 95% of individuals with mTBI do not suffer long-term deficits or dysfunction, this study separated those offenders with mTBI from those with moderate/severe TBI. In other words, the mTBI was group included those offenders who did not report a history of TBI, as it was believed that this group would not report more problems than those with a history of moderate/severe TBI.
The lack of research among offenders within a prison therapeutic community means that an exploratory study could yield important findings with implications on the importance of screening for TBI.
Numerous studies have examined the prevalence of TBI within a prison population and called for better screening of TBI among offenders because of the emotional-behavioral challenges associated with brain injury.
There has been no research, however, into how TBI affects an offender’s program compliance within a Prison TC. Thus, a study examining offenders with TBI could enhance understanding of TBI-related problems within a prison TC.
Does having a TBI have an effect on health, cognition, and prison performance? That’s what this study attempted to find out.
It should be noted that the first three hypotheses have to do with substance-related problems, as opposed to substance abuse or dependence. For purposes of this study, offenders with a history of substance-related problems refers to those convicted of committing a drug-involved crime (1) while under the influence of a substance, such as driving under the influence, (2) that involved an illegal substance, such as possession, or (3) in order to obtain an illegal substance (i.e., breaking and entering).
In short, these 3 groups included those both with and without substance abuse or dependence.
Hypothesis 5: A higher percentage of offenders with a history of TBI will be identified through the use of a structured interview (Ohio State University TBI Identification Method (OSU TBI-ID) than indicated by self-report methods upon admission to the prison TC.
With Hypothesis 5, it was a qualitative study of a structured interview (Ohio State University TBI Identification Method) vs. recording of TBI history in prison records.
Participants
In regards to participants, 21% of ICCC prison population volunteered to participate; 213 male offenders, aged 18 to 65
Procedures
Regent Human Subjects Review Committee and the Virginia Department of Corrections Human Subjects Research Review Committee
After the author obtained HSRC and DOC approval, offenders were solicited in groups of 60+ from the six housing units. Self-report measures were administered individually. The process of data collection took place over a six-month period.
Consent was obtained and participants were told that they would not be paid and that their sentences would not be reduced. They were also informed that they could withdraw from the study at any time.
Lead researcher trained eight assistants, all of whom were doctoral students in clinical psychology at Regent University. They were trained on how to conduct the various assessments and record the information on the data collections sheet.
Measures
A Demographic questionnaire was created to obtain data on participants’ age, date of birth, ethnicity, educational level, and marital status.
Prison TC Compliance Rating: The Southeastern Virginia Prison TC uses a five-point Likert Scale to rank offenders’ compliance within the TC program. The ratings range from 1 (active resistance) to 5 (most favorable).
Duke Health Profile: a 17-questions instrument that assesses six health domains; the present study utilized the physical and mental health indices; high scores indicate good health status.
OSU TBI-ID: a semi-structured interview to assess lifetime history of TBI. It asks about events that involved a blow to the head or a brain-related trauma or medical event. It also asks about loss of consciousness, alterations in mental status, and age of each injury.
Trail Making Test: A popular and brief test commonly used to measure psychomotor speed, visual scanning, and executive ability. It consists of two parts, with part A consisting of 25 encircles numbers, and Part B consisting of 25 encircled numbers and letters. It requires participants to connect the circles in an ascending pattern as quickly as possible. Raw scores (time to complete) are converted to T-scores based on norms addressing sex, education, age, and ethnicity (Heaton, Miller, Taylor, & Grant, 2004).
Addiction Severity Index: Is an instrument administered as a semi-structured interview and uses a 10-point scale from 0 to 9. It provides two scores: the Interviewer Severity Ratings score and the Composite Score. The IRSs incorporates an Interviewer Rating Scale and a Client Rating Scale, which reflects offenders’ self-report of problems in various areas. In this study, the ASI drug and alcohol indices were used to denote whether offenders had a substance-use problem.
Both Prison TC Compliance Rating and Addiction Severity Index scores were taken from prison records. The TC rating was the most recent, and the ASI scores for the drug and alcohol indices were used.
Demographic data indicated that 131 of the 213 male participants (61.5%) were aged 26 to 45.
212 or 60% identified as African American/Black, and 76 (35.7%) identified as Caucasian/White.
Regarding education level, 3.3% attended only primary school to middle school, while one participant reported not having received any schooling. More than 50% received either their high school diploma (113) or General Equivalency Diploma (GED). Twenty six (12.2%) received some college.
In regards to marital status, a majority was single (135: 63.3%), while 40 (18%) were married and 9 were separated (4.2%).
A between-group subjects design was used in the current study –
Moderate/severe TBI and substance-related problems and those without;
Moderate/severe TBI and substance-use problems (abuse/dependence) and those without (Hypothesis 4)
Hypotheses were tested using quantitative data obtained through SPSS Statistics 20 for Windows.
Preliminary examination included assessment of normality, outlier analysis, and descriptive statistics.
All assumptions were met
Hypothesis 1
Level of TBI not predictive of TC compliance
The presence of TBI did not significantly affect program compliance; offenders with moderate/severe TBI received almost the same TC performance rating as did offenders without moderate/severe TBI
Hypothesis 2
Level of TBI predictive of physical and mental health
Offenders with moderate/severe TBI reported more physical and mental health problems than offenders without severe/moderate TBI.
Hypothesis 3
Level of TBI significantly affected less cognitively demanding task but not more difficult one
History of moderate/severe TBI did not significantly affect the TMT-B scores, but it did have a significant effect on the TMT-A scores, accounting for 3.4% of variance on TMT-A
Results indicated that offenders with moderate/severe TBI performed less well on TMT-A than offenders without moderate/severe TBI.
Hypothesis 4a
Cognitive Processing Speed (TMT)
Level of TBI significantly affected TMT-A but not TMT-B
Level of SA significantly affected TMT-B but not TMT-A
4a: Results indicated that history of TBI had a significant effect on TMT-A, but did not significantly affect TMT-B. Substance use did not have a significant effect on TMT-A, but it did significantly affect TMT-B.
Hypothesis 4b
Physical and Mental Health (DUKE)
Level of TBI predictive of health problems
Moderate/severe TBI reported more problems
Level of SA not predictive of health problems
4b: Results indicated that history of TBI had a significant effect on both physical and mental health. Substance use did not have a significant effect on physical health or mental health. The interaction between history of TBI and substance use did not have a significant effect on either one of the dependent variables individually.
Hypothesis 4c
TC Compliance --
Level of TBI and Substance Use not predictive of program participation
Regardless of TBI history and history of substance use or abuse, rating was virtually the same.
Hypothesis 4: It was hypothesized that offenders who lack both a history of substance abuse or dependence and a moderate/severe TBI will perform better on a measure of processing speed/executive functioning, report better health, and receive better TC program-performance rating, than offenders with a history of moderate/severe TBI and/or substance abuse or dependence problems.
Table of results for Hypothesis 4: 2X2 MANOVA with TBI and Substance Abuse as the independent or predictor variables with TC Compliance, DUKE, and TMT as outcome or dependent variables.
TBI Identification
Higher percentage of offenders reported a history of TBI on the OSU TBI-ID than were found in prison records
69.5% vs. 11.3%
Possibly as many as 84.5% if those with a “possible” (dazed and confused) were included
Prison TC Compliance
Regardless of TBI history or substance abuse, rating virtually the same
The five-point rating scale showed little variation among offenders, and as a result, most offenders either with or without moderate/severe TBI were rated similarly.
With the general nature of rating criteria, staff may be less able to capture any significant differences between offenders by using the current measurement tool.
Another potential reason for the obtained findings is the possibility that offenders with lower compliance ratings did not volunteer for the study. Perhaps they did not volunteer because they were not interested, or were already struggling with demands of the program and did not want to call further attention to their non-compliance.
While it was unclear why offenders with moderate/severe TBI appeared to be performing as well as those without moderate/severe TBI, it is possible that the structure provided within a prison TC helps to ameliorate some of the problems that offenders experience, and that any difficulty they are having socially and/or psychologically is being addressed by the TC’s treatment approach (De Leon, 2000).
Physical and Mental Health
Research supports the finding of more physical and mental health problems among individuals with TBI. Although effect sizes were small, results indicated that offenders with a history of moderate/severe TBI and substance-related problems evidence greater problems with physical and mental health than do offenders without.
As Cohen, et al. and Lucas & Addeo, reported, individuals with more severe TBI may experience long-term comorbid disorders or lifelong physical, cognitive, behavioral, and emotional disturbances.
Regarding Cognitive Processing Speed, there were Group differences BUT IN unexpected directions
Moderate/severe TBI: Better on TMT-A but not TMT-B: Unknown why those with moderate/severe TBI did as well as those without moderate/severe TBI on a measure requiring greater cognitive flexibility
Moderate/severe unexpectedly did not perform worse
In regards to Substance Abuse and TBI
Better performance on TMT-B by SA group
No ready explanation for why offenders with SA performed better on the more demanding task
A possible rationale for this is that offenders experienced a form of “rehearsal” effect on the simpler task. Perhaps they were “Primed” for the more complex task by the relatively easier and unfamiliar portion preceding it. If offenders can’t grasp what you are saying/explaining when telling them the directions seeing the actual paper with the letters on it can help a lot.
Perhaps the novelty of the assessment artificially lowers the Part A score because they are trying to “wrap their head around” the concept. They learn the concept and get some visual feedback from doing the Trails A. So their score on Trails B is not as poor – delayed concept formation.
TBI identification
Findings congruent with previous research
Prison records revealed only 11.3% of offenders indicated a history of TBI
A disproportionate number of offenders are failing to report a history of TBI using the current system
A more structured assessment tool is likely to capture a significantly higher number of offenders who sustained a TBI sometime in their lifetime.
Volunteer participants
Results cannot be generalized as broadly because the participants did not come from a random sample; they signed up to participate
It is also possible that many declined to participate, because, as one offender noted, “I’ve had a few concussions, but I’ve never had a brain injury.” Participants in better health than non-participants. They didn’t believe the study pertained to them.
It’s also possible that Participants in better health than non-participants
It is also possible that those who did not participate actually had a history of TBI or diagnosis of substance abuse/dependence
Reliability of DUKE
Aside from mixed findings for test-retest reliability, the DUKE has strong psychometric support. Still, perhaps a question on the physical health indices, which asked about “physical trouble or difficulty walking up a flight of stairs” is not suitable in an environment where walking up a flight of stairs is not an option of everyday life.
An instrument designed for a prison setting might include content that is more specific to the offender population.
Accuracy of Offender’s self-reporting
As with any psychological assessment in which self-reporting is utilized, there is always the question of reliability of offenders’ reporting of problems. However, Schofield at al., indicated that offenders’ reporting of TBI is highly accurate when compared to medical records.
Systemic Bias
It’s worth noting that Several of the offenders’ ASI scores on the alcohol and drug indices were rated “0,” an indication that the interviewer rated the offender as having no substance-use problem. While such a finding could be accurate, a review of the literature calls into question the validity of the Interviewer Severity Ratings score (ISRs). Because of its subjective nature, the ISRs has been shown to be less valid than the objective Composite Scores.
1 mTBI as its own category
Results possibly distorted by study’s grouping
New groupings might produce different results
Bigler & Maxwell reported that Because of the variability in functional outcomes among individuals with mTBI, some of these individuals may present with symptoms congruent with a more severe injury.
2
It would be worth studying post-concussion symptoms among offenders with moderate/severe TBI
Although not without its critics, cognitive rehabilitation has shown some promise for individuals suffering with memory deficits and other cognitive problems (i.e., impairments of executive functioning, poor impulse control, and communication difficulties).
Studying female offenders
It is possible that they experience prison life differently and experience different problems with men
Also varying Prevalence rates
More specific measure to rate offender compliance
Problems that are brain related vs. personality characteristics