The current study investigated the prevalence and impact of exposure to school violence using a cross-sectional design with a sample of 132 low-income, African American fifth graders (mean age = 10.20). Additionally, hope was examined in relation to adjustment and as a potential resilience factor in the context of school violence. Students completed self-report measures for exposure to school violence frequencies, self-concept, and hope. Teachers completed a teacher-rated survey assessing levels of problem behaviors, social skills, and academic competence. Results indicated that the majority of youth had been personally victimized or witnessed violence during a 3-month period. Exposure to school violence was positively associated with problem behaviors, and negatively associated with social skills, self-concept, and academic competence; hope was inversely related to externalizing behaviors and positively related to self-concept. Hope buffered the effects of personal victimization and witnessing violence on self-concept. Gender differences were observed for a number of the analyses. The implications of both the prevalence and impact of exposure to school violence, as well as the moderating effects of hope, are discussed.
Research in late life mental health has not kept pace with the rapidly aging population of the U.S. Older adults (over age 65), more specifically the "baby boomer" cohort, are likely to pose unique challenges to mental health care providers. This report describes the case of Geoffrey, a 66-yearold African American male who presented with a complex range of psychiatric conditions (e.g., major depressive disorder, social anxiety disorder, and a history of polysubstance dependence), and challenging life circumstances (e.g., limited financial and social resources, and poorly controlled medical illness). Because Geoffrey also evidenced impairment in several cognitive domains (attention, memory, executive functions), a combined intervention of executive skills training (Sohlberg, Johnson, Paule, Raskin, & Mateer, 2001) and cognitive behavior therapy (CBT) was selected. Furthermore, because time for conducting therapy was limited (fourteen, 90-minute sessions over a ten-week period), a "transdiagnostic" approach was taken to maximize efficiency. Results suggest the utility of augmented, transdiagnostic therapies to achieve optimal response with older clients. Although Geoffrey's intervention progressed well, an event occurring late in treatment changed the course of therapy and led to an unexpected outcome. Several noteworthy aspects of the intervention, including the relevance of Geoffrey's case to the current aging trend in the U.S., the use of a combined transdiagnostic intervention, and aspects of the therapy process are discussed throughout.
This is a response to the commentaries by Dr. Knight (2008) and Dr. Hyer (2008) on "The Case of Geoffrey" (Mohlman et al., 2008). The response focuses on three major themes: the notion of cultural competence in the psychotherapeutic setting; possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults; and the growing use of cognitive remediation in the treatment of psychiatric disorders. We also address some of the other excellent issues raised by Drs. Knight and Hyer regarding cohort effects in the study of older therapy clients and missing elements in the case of Geoffrey.Keywords: African American; aging; comorbidity; transdiagnostic approach; augmenting cognitive behavior therapy (CBT); baby boomers _____________________________________________________________________________________ RESPONSE TO KNIGHT AND HYER COMMENTARIESThe commentaries on Deconstructing Demons: The Case of Geoffrey (Mohlman et al., 2008) by Dr. Knight (2008) and Dr. Hyer (2008) were thoughtful and comprehensive. We appreciate Dr. Knight's observation that there are few didactic resources for psychologists whose clients have multiple diagnoses (e.g, psychiatric, cognitive, medical), which is the rule rather than the exception with aging adults. Dr. Hyer points out the usefulness and appropriateness of the transdiagnostic approach, especially with clients who have a range of symptoms and poor prognostic indicators. The empirical case study is one way to begin to amass the necessary documentation for mental health practitioners to make informed choices about treatment planning when working with older adults with multiple problems. This response will address three major themes raised in the commentaries: the notion of cultural competence in the psychotherapeutic setting, possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults, and the growing use of cognitive remediation in the treatment of psychiatric disorders.
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