DOCSLIB.ORG

Interventions Targeting HIV-Infected Risky Drinkers

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Interventions Targeting HIV-Infected Risky Drinkers 33.3_9.1.10.qxd:32(1).qxp 9/8/10 11:44 AM Page 267 Interventions Targeting HIV­Infected Risky Drinkers Drops in the Bottle Jeffrey H. Samet, M.D., M.A., M.P.H., and Alexander Y. Walley, M.D., M.Sc. Alcohol use is common among people infected with HIV and may contribute to adverse consequences such as reduced adherence to treatment regimens and increased likelihood of risky sexual behaviors. Therefore, researchers and clinicians are looking for treatment approaches to reduce harmful alcohol consumption in this population. However, clinical trials of existing treatment models are scarce. A literature review identified only 11 studies that included HIV­infected patients with past or current risky alcohol use and which targeted alcohol use and other health behaviors. Four studies focusing on HIV­infected participants with alcohol problems found mixed effects on adherence and on alcohol use. Five clinical trials included at least 10 percent of HIV­infected subjects who use alcohol; of these, only one reported significant evidence of a favorable impact on alcohol consumption. Finally, two trials targeting alcohol users at high risk for HIV infection identified treatment effects that were not sustained. Taken together, these findings provide limited evidence of the benefit of behavioral interventions in this population. Nevertheless, these studies give some guidance for future interventions in HIV­infected patients with alcohol problems. KEY WORDS: Alcohol and other drug use; alcohol consumption; alcohol use disorder; human immunodeficiency virus; HIV­infected patients; sexually transmitted disease; unsafe sex; treatment method; treatment outcome; intervention; clinical trial; literature review n the United States, people infected • Lack of a health care provider for the 1 According to the National Institute on Alcohol Abuse and HIV infection (Metsch et al. 2009); Alcoholism (2007), women who drink more than 3 drinks per with the human immunodeficiency day or more than 7 drinks per week and men who drink more virus (HIV) drink more alcohol than 4 drinks per day or more than 14 drinks per week are at increased risk for alcohol­related problems. Alcohol consumption I • Delayed linkage to HIV medical levels above these limits are considered risky drinking. than people in the general population. Specifically, a higher proportion drink care (Samet et al. 1998); risky amounts1 or have an alcohol use • Increase in risky sexual behaviors JEFFREY H. SAMET, M.D., M.A., disorder (i.e., abuse or dependence) (Kalichman et al. 2002; Metsch M.P.H., is a professor in the Clinical (Conigliaro et al. 2003; Galvan et al. et al. 2009); Addiction Research and Education 2002; Lefevre et al. 1995; Samet et (CARE) Unit, Section of General • Increased transmission of sexually Internal Medicine, Department of al. 2003a,b, 2004). Risky alcohol transmitted infections (Kalichman Medicine, Boston University School of use in HIV­infected people has been et al. 2000); and Medicine, and in the Department of associated with the following range Social and Behavioral Sciences, Boston of adverse effects: • Progression of HIV disease University School of Public Health, (Conigliaro et al. 2003; Miguez both in Boston, Massachusetts. • Reduced adherence to medication et al. 2003; Samet et al. 2007). LEXANDER Y. WALLEY, M.D., M.SC., regimens for treatment of HIV A Given the spectrum of problems is an assistant professor in the CARE infection (Chander et al. 2006; associated with such alcohol use among Unit, Section of General Internal Conen et al. 2009; Cook et al. HIV­infected patients, one important Medicine, Department of Medicine, 2001; Golin et al. 2002; Halkitis avenue to improving the health of this Boston University School of Medicine, et al. 2003; Samet et al. 2004); population is to develop interventions Boston, Massachusetts. Vol. 33, No. 3, 2010 267 33.3_9.1.10.qxd:32(1).qxp 9/8/10 11:44 AM Page 268 that target alcohol use and its associated (e.g., cognitive–behavioral coping • HIV risk behaviors; consequences. Accordingly, interventions skills, motivational enhancement, have been designed to both decrease 12­step facilitation) can be effective • Acquisition of sexually transmitted alcohol consumption and address the (Project MATCH Research Group infections; and specific adverse health consequences. 1997). In addition, several medica­ The concept that negative conse­ tions (i.e., disulfiram, naltrexone, and • Alcohol use. quences of alcohol use can be reduced acamprosate) are approved for the in patients with HIV infection is treatment of alcohol dependence, and To be included in the review, the based on research demonstrating the other medications (e.g., topiramate) studies had to report alcohol­specific impact of clinical interventions on are being further evaluated (Anton et outcomes. Beyond that, the studies alcohol consumption and associated al. 2006; Garbutt et al. 2005; Kranzler were classified into three categories of negative consequences in patients and Van Kirk 2001; Olmsted and specificity. The most specific category without HIV infection (Institute of Kockler 2008; Rubio et al. 2001). comprised clinical trials that included Medicine 1990; Kristenson et al. 1983). Given the strong evidence that only HIV­infected people with past Alcohol research over the past three alcohol consumption is an important or current unhealthy alcohol use. The decades has demonstrated that behav­ health issue for many people with second category comprised clinical ioral interventions can be effective, HIV infection, efforts to potentially trials that included only HIV­infected with benefits varying based on setting, ameliorate these problems by addressing people but in which not all of the severity of alcohol problems, and alcohol use are of great interest. The participants exhibited unhealthy alcohol patient characteristics. For example, studies in non–HIV­infected people use. For a study to be included in this meta­analyses of randomized controlled reviewed above suggest that interven­ category, at least 10 percent of partic­ trials (RCTs)2 of interventions to tions among HIV­infected people with ipants had to report current alcohol reduce risky alcohol use demonstrated alcohol problems could be beneficial. use. The third category of studies decreased drinking for patients in pri­ However, the wide range of results comprised trials that were aimed at mary care settings (Beich et al. 2003; in these intervention studies based on preventing alcohol use and sexual Kaner et al. 2007). However, no such setting and disease severity argues for behaviors that put people at risk of effects were found in meta­analyses of the need to carefully assess efforts to HIV infection among alcohol­using interventions delivered in hospital mitigate alcohol’s deleterious impact on people. Although these studies did settings (Emmen et al. 2004), possi­ health in HIV­infected patients. As not include HIV­infected participants bly because inpatients typically have an important step in this direction, this or did not report the HIV status of greater severity of alcohol problems article summarizes the findings of a the participants, they were reviewed because they may inform future research (i.e., most are alcohol dependent) (Saitz review of the clinical trial literature on on people at risk of HIV transmission et al. 2007, 2008). Several high­quality interventions addressing alcohol con­ in the setting of alcohol use. RCTs of brief interventions delivered sumption and its consequences among Initially, the review intended to in emergency departments also detected HIV­infected patients. After describing include only RCTs. However, very no or limited benefit (D’Onofrio and the design of the literature search and few studies were identified that met Degutis 2002; Daeppen et al. 2007; evaluation, the article reviews the findings Longabaugh et al. 2001; Monti et al. this criterion in the first two categories. of the studies identified and discusses Therefore, the search was expanded 1999). The influence of the patient’s the implications of those findings. consumption levels also was demon­ to include nonrandomized and non­ strated in several studies. For example, controlled clinical intervention trials in two separate RCTs in the primary­ Design of the Literature in categories 1 and 2. care setting (Fleming et al. 1997; Review To identify relevant studies, the Ockene et al. 1999), where patients literature database MEDLINE was were seeking medical care but not The literature review sought to identify searched through September 30, necessarily for an alcohol problem, clinical trials of interventions among 2009, using the search terms “HIV, implementation of a 5­ to 15­minute HIV­infected people with past or current alcohol, hazardous drinking, risky discussion reduced alcohol consump­ unhealthy alcohol use (i.e., the spectrum drinking, problem drinking, counseling, tion in patients who met the criteria from risky drinking to alcohol dependence brief intervention, 12 step, pharma­ for risky drinking. Studies of such [Saitz 2005]) that reported effects on cotherapy, naltrexone, acamprosate, brief interventions among patients who any of the following outcomes: disulfiram, topiramate, and clinical met the criteria for alcohol dependence, trial.” For all articles identified using however, have shown no benefit • HIV disease progression; this approach, the reference lists also (Kaner et al. 2007; Whitlock et al. 2004; Wutzke et al. 2002). • Receipt of HIV treatment; 2 RCTs are clinical studies in which
Load more

Recommended publications
  • Best Practice Guides for Behavioral Intervention
    Best Practice Guidelines for Behavioral Interventions Developed by PATRICIA BACH, PHD STANLEY G. MCCRACKEN, PHD, LCSW Developed for Behavioral Health Recovery Management Project An Initiative of Fayette Companies, Peoria, IL and Chestnut Health Systems, Bloomington, IL The project is funded by the Illinois Department of Human Services’ Office of Alcoholism and Substance Abuse. Authors: Dr. Bach is a trainer at the University of Chicago Center for Psychiatric Rehabilitation. She received her doctorate in clinical psychology from the University of Nevada, Reno. She has provided mental health services with a behavioral focus to individuals with serious mental illness, substance abuse, and/or developmental disabilities for over 10 years in varied settings. Dr. McCracken is currently Co-Director of Training for the University of Chicago Center for Psychiatric Rehabilitation (CPR) and the Illinois Staff Training Institutes. He holds joint appointments at the University of Chicago as Associate Professor of Clinical Psychiatry and as Senior Lecturer in the School of Social Service Administration. He has conducted research at the CPR and with the University of Chicago Human Behavioral Pharmacology Research Group in a variety of areas, including the influence of mood on drug preference and the effects of training on staff interest and burnout. He has published two books and a number of articles in the areas of psychiatric rehabilitation, chemical dependency, behavioral medicine, staff training, and implementation of evidence based practice. He also is a respected clinician with twenty five years experience providing services to individuals with mental illness, physical illness, and chemical dependence. 1 Behavioral Interventions Several behavioral approaches, when combined with medication, have been shown to reduce symptoms or the impact of symptoms of serious mental illness (Corrigan, 1997).
    [Show full text]
  • Behavioral Health Integration Policy Brief Prepared for the Bipartisan Policy Center Stephanie Gold, MD, Perry Dickinson, MD, Larry Green, MD
    Brief 7, April 2020 Behavioral Health Integration Policy Brief Prepared for the Bipartisan Policy Center Stephanie Gold, MD, Perry Dickinson, MD, Larry Green, MD The need for behavioral health integration (BHI): The aim of health care is to help people solve or live with their health-related problems. There are constant and unavoidable interactions of mental, emotional, behavioral and physical problems that require integration of primary care and behavioral health. What is the current landscape of primary care delivery of behavioral health services? • Integrated care is being implemented in practices of all types • Payment and workforce shortages remain significant barriers to scaling implementation of integrated care • More integration in urban, larger practices compared to rural and smaller practices, but rural-urban difference may be mostly explainable by practice size1 o ~ 45% PCPs are co-located with a BH provider (with the rates in urban areas close to twice that of rural areas). No significant change in these numbers 2010 – 2018.2,3 • Some states are more advanced than others. The State Innovation Model (SIM) has been a mechanism for advancing BHI in several states:4 o Practice facilitation and multipayer support for BHI into primary care settings (CO) o Implementation of behavioral health homes (ME, MN) o ACOs requiring or incentivizing BHI (MN, VT, MA) o Inclusion of BH metrics in payment and delivery models (OR, MA, VT, MN, ME) o Invested in technical assistance for BH (OR, ME, MN, VT, MA) How do the delivery of care and challenges
    [Show full text]
  • AOK Early Childhood Network Mental Health Resource Guide 2016
    AOK Early Childhood Network Mental Health Resource Guide 2016 Program Name Description of Services Eligibility Locations Contact Information • General youth Ages 3 – Adult ABC Counseling 7820 N. University Phone: counseling Private insurance Adoption & Family • Youth sexual abuse Suite 101 Peoria office (309) 689-2990 Counseling Services DCFS Medicaid Peoria, IL 61614 counseling Pekin office (309) 349-3866 clients • Adoption services Negotiated fee 359 Margaret St. Website: Pekin, IL 61554 www.abccounseling.org Scholarships available for sexual abuse victims • Coaching AEON • Cognitive Behavioral 0 years – Adult 5016 N University Ste Phone: Social Emotional • EMDR 101 (309) 573-4834 Health Insurance accepted Peoria, Illinois 61614 • Family / Marital • Family Systems Sliding scale fee • Interpersonal • Play Therapy • Relational • Solution Focused Brief • • Counseling Ages 3 – Adult • Play, art, & sand 75 E. Queenwood Rd. Phone: Agape therapy Fees based on each Morton, IL 61550 Counseling • Premarital & marital therapist’s degree Morton office (309) 263-5565 counseling and experience • Dialectal behavior 2001 W. Willow Knolls Peoria office (309) 692-4433 • Eye Movement Accepts most major Rd. Desensitization insurances-no Suite 110 Bloomington office Reprocessing (EMDR) Medicaid Peoria, IL 61614 (309) 663-2229 • Group therapy • Sexual recovery Deductibles and co- Hours: groups pay due at time of 211 N. Veterans 9:00am – 5:00pm • Psychological service Parkway assessments Suite 1 Website: • Forensics evaluation Accept sliding scale Bloomington, IL 61704 www.agapecounselors.net fees for certain • Mediation services therapist • Mental health Open to everyone 405 W. John Gwynn Jr. Phone: American Red Cross services Ave. (309) 677-7272 Crisis Counseling • Blood donations Peoria, IL 61605 Website: • Charity services www.redcross.org/il/peoria • Disaster relief • Education services • Child clinic Ages 0 years – Adult 6615 N.
    [Show full text]
  • Columbia University School of Nursing
    Psychiatric Care: What America Can Learn from Jamaican Practices Gabrielle Ranger-Murdock, MSN, RN, Andrea McDade, MSN, RN Columbia University School of Nursing Introduction & Purpose Where are Psychiatric Patients Being Treated? Mental health disorders continue to be a leading cause of disability in the United States. United States Jamaica Thus, the improvement of psychiatric care is imperative. An immersive experience in the Jamaican psychiatric system incited research to compare and contrast mental health care in both countries. • Where is America lacking in psychiatric care? ▹ Continuing difficulty with patient autonomy and community based treatment following discharge ▹ Deinstitutionalization has failed to provide adequate access to patient-centered mental healthcare8 ▹ High mental health care expenditures that include correctional services funding5 • What has Jamaica done differently? ▹ Collectivist values to promote patient centered care ▹ Community mental healthcare has expanded access, expenditures have been reduced, and inpatient hospital stays are shorter5 How can we use global perspectives to guide improvement to patient centered care in the US mental health system? Conclusions & Future Directions Mental Healthcare Facilities Collectivist values promote holistic support of psychiatric patients, as well as community reintegration. Investing in this integration, educating communities on severe mental illness, and Jamaica promoting family-centered care contributes to improved patient outcomes and reduces need United States for
    [Show full text]
  • Psychiatry and Behavioral Medicine Clerkship Rotation Purpose
    Bethel University Physician Assistant Program Course: PHAS 710, 720, 730 (Clinical Field Placements I, II, & III) This clerkship module is a part of the Clinical Field Placement (CFP) series of courses over the clinical year of the Bethel PA program. The Student Clerkship Handbook and CFP syllabi expectations and requirements will be followed for grading requirements. Psychiatry and Behavioral Medicine Clerkship Rotation Purpose The purpose of this 4-week rotation is to educate the physician assistant student in the evaluation, diagnosis, management, and treatment of acute and chronic psychiatric problems encountered in Behavioral Medicine. This is a clinical rotation emphasizing the behavioral and bio-psychosocial aspects of common mental disorders. Inpatient and outpatient settings allow students to participate in practical clinical work, seminars, and case presentations. The development of clinical interviewing, diagnostic and treatment planning skills are stressed. Clinical experiences are intended to assist the student’s transition from didactic to integrated clinical evaluation, decision-making, and management of patients with psychiatric problems. In addition to gaining specific skills in Behavioral Medicine during this rotation, the student should also continue to develop skills in systematic problem solving and patient management abilities, establish or reinforce patterns of independent learning, self-evaluation, inter-professional relationships and communication skills. Preceptor Requirements Board Certified Psychiatrist, Clinical Psychologist, Licensed Therapist, or Certified PA/NP working with a Board Certified Psychiatrist (B3.05 & B3.06) Clinical Field Placement Courses Objectives / Learning Outcomes At the end of this course, the PA student will be able to: 1. Develop the competencies for clinical practice and knowledge acquisition in all clinical settings (B3.02, B3.03a-d, B3.04a-d, B3.07a-f & 2, 3, 8, 9) 2.
    [Show full text]
  • Reducing Disparities in Psychiatric Care North Carolina Psychiatric Association Annual Conference 2015 October 4, 2015
    Mental Health Disparities & Health Policy: Reducing Disparities in Psychiatric Care North Carolina Psychiatric Association Annual Conference 2015 October 4, 2015 Rahn Kennedy Bailey, M.D., D.F.A.P.A. Wake Forest School of Medicine Chair Department of Psychiatry and Behavioral Medicine Wake Forest Baptist Medical Center Executive Director Behavioral Medicine Wake Forest Baptist Medical Center 1 DISCLOSURES National Institute Minority Health Disparities Translational Health Disparities Training August 2014 The course provides an introduction to the principles and practice of health disparities research. Focusing on concepts, methods, key issues, and applications, the course aims to provide the knowledge and research tools needed to conduct and develop translational and transdisciplinary research and interventions to eliminate health disparities. The course content is developed in the context of the history of health and health disparities in the United States, and addresses biological and non-biological determinants of health and a range of social, political, economic, cultural, and legal theories related to health disparities. Wake Forest Baptist Medical Center 2 DISCLOSURES The Health Policy Writing Collaborative is sponsored in part by the Robert Wood Johnson Foundation for Health Policy at Meharry, and the Department of Health and Human Services Health Resources and Services Administration (HRSA), D76HP0862 grant award. It was also funded in part by the Substance Abuse and Mental Health Services Administration (SAMHSA). The content is solely the responsibility of the author and does not necessarily represent the official view of the Robert Wood Johnson Foundation, the Department of Health and Human Services, or the Substance Abuse and Mental Health Services Administration. Wake Forest Baptist Medical Center 3 OBJECTIVES 1.
    [Show full text]
  • ICANA-4 1 4Th International Conference on Applications Of
    ICANA-4 4th International Conference on Applications of Neuroimaging to Alcoholism ICANA-4 July 19-21, 2019 Yale School of Medicine The Anlyan Center (TAC) 300 Cedar Street, New Haven, CT Sponsored by: With additional support from: 1 ICANA-4 CONFERENCE FUNDING Funding for this conference was made possible (in part) by 1 R13 AA 27710-01 from the National Institute on Alcohol Abuse and Alcoholism (NIAAA). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention by trade names, commercial practices, or organizations imply en- dorsement by the U.S. Government. 2 ICANA-4 Dear Colleagues, Welcome to the 4th International Conference on Applications of Neuroimaging to Alcoholism (ICANA-4). ICANA-4 is part of the NIAAA Center for the Translational Neuroscience of Al- coholism (CTNA) based at the Yale University Department of Psychiatry. Our goal is to build on the success of past ICANA conferences and continue to foster interest, career development, research, and collaboration in this ever-expanding area of neuroscience technology. We have brought together neuroimagers with ex- pertise in a wide variety of imaging techniques and with clinical expertise to discuss the numerous ways of applying imaging to alcoholism research. Distinct to ICANA-4 is our focus on the use of multiple imaging techniques to approach the same topical issue within the field of alcohol research. We are delighted to welcome you to Yale. We look forward to our discussions and con- tinuing to foster growth and advances in this exciting area of research.
    [Show full text]
  • Challenges and Opportunities in Neuroimaging
    DOI: 10.103711040-3590.19.1.58 Innovative Clinical Assessment Technologies: Challenges and Opportunities in Neufoimaging Gregory A. Miller Thomas Elbert University of Illinois at Urbana-Champaign University of Konstanz Bradley P. Sutton and Wendy HelIer University of Illinois at Urbana-Champaign The authors review the reasons for the contrast between the remarkable advances that hemodynamic and electromagnetic imaging of the human brain appear capable of delivering in clinical practice in psychology and their very limited penetration into practice to date. Both the heritages of the relevant technologies and the historical orientation of clinical psychology away from biological phenomena are factors. Discussion of some technical aspects and prospects of these methods and recommendations for facilitating clinical use are provided, with an emphasis on fostering the participation of and contribution by practicing clinical psychologists and professionals in related fields lacking a strong grounding in biological measurement. Keywords: electroencephalography, functional magnetic resonance imaging, magnetoencephalography, neuroimaging, optical imaging Adaptive or not, a change in the brain's software can-because psychological phenomena are driving the brain (sometimes medi­ of neuroplastic alterations of the neural substrate-prompt changes ated by psychological factors tuning gene expression, sometimes in the brain's hardware (Montague, Hyman, & Cohen, 2004) in more directly) and vice versa, it is not feasible to cast any of these ways that may contribute fundamentally to psychopathology (Hy­ players as "underlying" the others (Miller, 1996). Rather, all of man, 2005). Neuroimaging methods can assess many such func­ these measurement domains should be considered in clinical prac­ tional and structural changes that occur in mental illness as a tice, as has been advocated for decades (e.g., Davis & Lang, 2003; prelude to treatment or as a means of tracking its impact.
    [Show full text]
  • Balint Groups in Cognitive Behavioral Supervision
    Activitas Nervosa Superior Rediviva Volume 62 No.1 2020 This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. ORIGINAL ARTICLE Balint groups in cognitive behavioral supervision Jan Prasko 1,2,3, Marie Ociskova 1, Jakub Vanek 1, Darius Dicevicius 4, Julius Burkauskas 5, Ilona Krone 6, Milos Slepecky 2, Marija Abeltina 7, Alicja Juskiene 5,8, Lina Bagdonaviciene 9 1 Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Czech Republic, 2 Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Slovak Republic, 3 Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, Czech Republic, 4 MB Saules miesto medicine and psychotherapy centre, Lithuania, 5 Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania, 6 Riga`s Psychiatry and Narcology centre, Latvian Association of CBT, Latvia, 7 University of Latvia, Latvian Association of CBT, Latvia, 8 Behavioral Medicine Clinic, Faculty of Nursing, Lithuanian University of Health Sciences, Behavioral Medicine Laboratory, Neuroscience Institute, Lithuanian University of Health Sciences, 9 Institute of Neuromedicine, Lithuania Correspondence
    [Show full text]
  • Innovative Models of Collaborative Care for Indiana Residents with Severe Mental Illness in Long Term Care
    Innovative Models of Collaborative Care for Indiana Residents with Severe Mental Illness in Long Term Care John J. Wernert, MD, MHA Executive Medical Director – Behavioral Medicine Norton Medical Group Jerry Sheward, MD Chief Medical Officer Indiana State Mental Hospitals Unique Challenges of Elderly Psychiatric Patients: • Scope of the Problem • Indiana’s History of Transinstitutionalization • Prodrome and Clinical Course • Similarities and differences – Dementia and SMI • Indiana’s Transformation Playbook • Integrative Approaches to Treatment - Telepsychiatry • Team-Based Care Reimagined • Examples Fragmentation of the Service Delivery System for Older Persons • Primary care • Multiple medical subspecialties • Specialty mental health • Aging network services • Home care • Skilled Nursing Facilities • Nursing Homes – long term care • Assisted Living • Family caregivers “The advantages of a decisive shift away from mental hospitals and nursing homes to treatment in community-based settings today are in jeopardy of being undermined by fragmentation and insufficient availability of services.” (Admin. on Aging, 2000) Geriatric Mental Health Care reimagined • No secret that current models of care not supporting our patients or families in recovery or end of life care • Field of psychiatry has lagged behind in understanding the value of team-based care, integrative medicine and video technology • Our geriatric SMI patients are least able to advocate for their needs and silently suffer from ineffective treatment • Families are exhausted by their experiences with the complexities of the HC system and are seeking more individualized care Nursing Facilities need to be prepared • “As little as 5 years ago, we said that those with chronic mental illness died 25 years before those without. That isn’t true anymore.
    [Show full text]
  • Workforce Development to Enhance the Cognitive, Affective, and Behavioral Health of Children and Youth: Opportunities and Barriers in Child Health Care Training
    DISCUSSION PAPER Workforce Development to Enhance the Cognitive, Affective, and Behavioral Health of Children and Youth: Opportunities and Barriers in Child Health Care Training Thomas F. Boat, MD, University of Cincinnati College of Medicine; Marshall L. Land, MD, University of Vermont College of Medicine; Laurel K. Leslie, MD, MPH, American Board of Pediatrics; Kimberly E. Hoagwood, PhD, New York University; Elizabeth Hawkins-Walsh, PhD, CPNP, PMHS, FAANP, The Catholic University of America; Mary Ann McCabe, PhD, George Washington University School of Medicine; Mark W. Fraser, PhD, University of North Carolina at Chapel Hill; Lisa de Saxe Zerden, MSW, PhD, University of North Carolina at Chapel Hill; Brianna M. Lombardi, MSW, University of North Carolina; Gregory K. Fritz, MD, American Academy of Child and Adolescent Psychiatry; Bianca Kiyoe Frogner, PhD, Univer- sity of Washington; J. David Hawkins, PhD, University of Washington; Millie Sweeney, MS, Family-Run Executive Director Leadership Association November 29, 2016 Responsibility for cognitive, affective, and behavioral innovation in this area has been carried out by pre- (CAB) health of children and adolescents (hereafter vention scientists who have created evidence-based “youth”) has traditionally been shared among fami- interventions, primarily targeting activities in commu- lies, education systems, communities, and the health nity settings, and has not focused on opportunities care delivery system. Within routine child health care, within primary or subspecialty child health care set- increasing but spotty attention is paid to early cogni- tings. Preventive interventions adapted for child health tive, emotional, and behavioral development. Those care settings and training programs are nascent and most intensively trained in emotional development will require a revision of training goals and curricula and the clinical behavioral sciences (e.g., child and as well as a reorganization of practice for successful adolescent psychiatrists and psychologists, behavioral implementation.
    [Show full text]
  • An Integrative Approach to Counseling 1St Edition Pdf Free
    AN INTEGRATIVE APPROACH TO COUNSELING 1ST EDITION PDF, EPUB, EBOOK Robert G Santee | 9781452245478 | | | | | An Integrative Approach to Counseling 1st edition PDF Book Strategic Family Therapy. The Therapeutic Process in Feminist Therapy. Up to date and easy to read, the book engages readers with inner reflection questions that help them apply the theories to the lives of their clients and shows them how to develop their own integrative approach to psychotherapy. Anti-psychiatry Behavioral medicine Clinical neuroscience Imaging genetics Neuroimaging Neurophysiology Philosophy of psychiatry Political abuse of psychiatry Insulin shock therapy Electroconvulsive therapy Pentylenetetrazol Biopsychiatry controversy Controversies about psychiatry Psychiatrist Psychiatric epidemiology Psychiatric genetics Psychiatric hospital Psychiatric survivors movement Psychosomatic medicine Psycho-oncology Psychopharmacology Psychosurgery Psychoanalysis. Integrated Psychopharmacology. Lesley L. Categories : Integrative psychotherapy. The advantage of technical eclecticism is that it encourages the use of diverse strategies without being hindered by theoretical differences. The generic term, integrative psychotherapy, can be used to describe any multi-modal approach which combines therapies. Various psychotherapies typically ground themselves in one these four foundational perspectives, often minimizing the others. After being trained in an existing school of psychotherapy, the therapist begins to practice. New Forms of Psychoanalysis. Co-therapy Couples therapy
    [Show full text]