Seagrave and Grisso ( 2001) questioned the clinical-forensic utility of tests designed to assess juvenile psychopathy. They discussed potential problems with such tests and some avenues for future research. We agree with the points made by Seagrave and Grisso, but believe their critique did not go far enough. The "state of the art" with respect to the assessment of juvenile psychopathy is like an Impressionist painting: fine from a distance; but the closer you get, the messier it looks. We conclude that although tests of "juvenile psychopathy" measure something, it is impossible to be sure at this time they are actually measuring psychopathy.Seagrave and Grisso (2001) questioned the potential clinical-forensic utility of tests designed to assess "juvenile psychopathy." They discussed out several problems with such tests and discuss some avenues for future research. We agree with the points raised by Seagrave and Grisso, many of which are echoed in other recent or forthcoming reviews (e.g., Edens, Skeem, Cruise, & Cauffman, 2001;Salekin, Rogers, & Machin, 2001;Vincent & Hart, 2002). In our opinion, the biggest problem with the critique by Seagrave and Grisso is that it didn't go far enough. The "state of the art" with respect to the assessment of juvenile psychopathy is like a painting by Monet: fine from a distance; but the closer you get, the messier it looks.Let's take a step closer and have a quick look at three issues. First, does psychopathy as a form of personality disorder exist in childhood or adolescence? Second, even if it does exist, does its presentation in childhood and adolescence mirror that in adulthood? And third, even if it exists and presents in a similar manner, is it possible to measure psychopathy in childhood or adolescence using simple downward extensions of tests designed for use with adults?
BackgroundCultural competence is a broad concept with multiple theoretical underpinnings and conflicting opinions on how it should be materialized. While it is recognized that cultural competence should be an integral part of General Practice, literature in the context of General Practice is limited.The aim of this article is to provide a comprehensive summary of the current literature with respect to the following: the elements of cultural competency that need to be fostered and developed in GPs and GP registrars; how is cultural competence being developed in General Practice currently; and who facilitates the development of cultural competence in General Practice.MethodsWe conducted an integrative review comprising a systematic literature search followed by a synthesis of the results using a narrative synthesis technique.ResultsFifty articles were included in the final analysis. Cultural competence was conceptualized as requiring elements of knowledge, awareness/attitudes and skills/behaviours by most articles. The ways in which elements of cultural competence were developed in General Practice appeared to be highly varied and rigorous evaluation was generally lacking, particularly with respect to improvement in patient outcomes. Formal cultural competence training in General Practice appeared to be underdeveloped despite GP registrars generally desiring more training. The development of most aspects of cultural competence relied on informal learning and in-practice exposure but this required proper guidance and facilitation by supervisors and educators. Levels of critical and cultural self-reflection amongst General Practitioners and GP registrars varied and were potentially underdeveloped. Most standalone training workshops were led by trained medical educators however the value of cultural mentors was recognised by patients, educators and GP registrars across many studies.ConclusionsCultural competency development of GP registrars should receive more focus, particularly training in non-conscious bias, anti-racism training and critical self-reflectiveness. There is a need for further exploration of how cultural competence training is delivered within the GP training model, including clarifying the supervisor’s role.It is hoped this discussion will inform future research and training practices in order to achieve quality and respectful care to patients across cultures, and to remove health inequities that exist between cultural groups.
Efforts to promote systems change frequently involve the creation of councils, coalitions, and other collaborative settings. However, research, to date, reports limited empirical evidence that they achieve desired outcomes (Roussos and Fawcett, Annu Rev Public Health 21:369-402, 2000). The precise nature of this evidence base has received less attention. In particular, formal investigations into council effectiveness (a) rarely highlight the specific nature of collaborative efforts; (b) emphasize fairly distal markers as the "gold standard" for effectiveness; (c) focus largely on formative "outcomes" (e.g., action plan quality); and (d) utilize primarily quantitative research approaches. The current study extends previous research by employing a qualitative approach to investigate the particular activities and proximal outcomes of 41 domestic violence coordinating councils. Study findings suggest that councils engage in six primary activities: discussing issues, sharing information, identifying weaknesses in the system's response, providing training for key stakeholders, engaging in public/community education, and lobbying key stakeholders who are not council members. Three proximal outcomes were consistently identified in council efforts: the promotion of knowledge, relationships, and institutionalized change. Attending more directly to proximal outcomes and concrete activities in our research has important implications for conceptualizing and researching the effectiveness of councils and collaborative settings.
The Static-99 is the most commonly used risk assessment instrument for sexual violence in North America and its results can affect highly consequential decisions made in the criminal and civil justice systems. Despite its influence, few studies have systematically examined how the Static-99 is used by clinicians in practice. The current study compares the Static-99 ratings of clinicians to those of researchers for 100 adult males who completed an outpatient sex offender treatment program and were followed up over an average of about 4 years. Results showed good agreement between the ratings of clinicians and researchers for total scores on the Static-99, as well as for most individual items. Ratings by clinicians tended to be slightly lower than those made by researchers. The predictive validity of ratings made by clinicians and researchers was very similar and moderate in terms of effect size. In 30 cases, clinicians used discretion to "override" or adjust the Static-99 ratings when making final risk judgments, but the predictive validity of the clinical adjusted ratings was worse than that of the original Static-99 ratings made by clinicians. The need for quality assurance and training are discussed along with the need for clear empirically supported guidelines regarding overrides.
IntroductionAn equitable multicultural society requires General Practitioners (GPs) to be proficient in providing health care to patients from diverse backgrounds. This requires a certain set of attitudes, knowledge and skills known as cultural competence. While training in cultural competence is an important part of the Australian GP Registrar training curriculum, it is unclear who provides this training apart from in Aboriginal and Torres Strait Islander training posts. The majority of Australian GP Registrar training takes place in a workplace setting facilitated by the GP Supervisor. In view of the central role of GP Supervisors, their views on culturally competent practice, and their role in its development in Registrars, are important to ascertain.MethodsWe conducted 14 semi-structured interviews with GP Supervisors. These were audiotaped, transcribed verbatim and thematically analyzed using an iterative approach.ResultsThe Supervisors interviewed frequently viewed cultural competence as adequately covered by using patient-centered approaches. The Supervisor role in promoting cultural competence of Registrars was affirmed, though training was noted to occur opportunistically and focused largely on patient-centered care rather than health disparities.ConclusionFormal training for both Registrars and Supervisors may be beneficial not only to develop a deeper understanding of cultural competence and its relevance to practice but also to promote more consistency in training from Supervisors in the area, particularly with respect to self-reflection, non-conscious bias and utilizing appropriate cultural knowledge without stereotyping and assumption-making.
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