PurposeThe aim is to determine whether staff ratings of service user attachment style are associated with service user misconduct during inpatient treatment in a medium secure mental health unit; also, to gauge whether staff can evaluate attachment style reliably.Design/methodology/approachRetrospective case note analysis on 55 inpatient treatment episodes were supplemented with staff ratings of service user attachment style. Records of untoward incidents were centrally retrieved. Kappa statistics were used to analyse levels of staff agreement regarding service user attachment style.FindingsAttachment style was associated with hostile episodes, treatment non‐compliance and service user aggression. Post hoc analysis on a subset of data yielded poor overall agreement in ratings of attachment style (Kappa=0.2). Further analysis revealed a sex‐based asymmetry with high consistency in ratings of female service users (Kappa=0.79) and very low inter‐rater reliability for male service users (Kappa=−0.05). It is important to note that the staff included in the interrater reliability analysis were female.Research limitations/implicationsThe sample was small, the observation period was short and staff conducting the ratings had no special training in the rating tool.Practical implicationsAttachment style per se played a significant part in the success and/or failure of service user treatment (when measured by misconduct). However, the validity of staffs' ratings of attachment style may interact systematically with the sex of staff and service users. These findings have important implications for the application of the concept of attachment in clinical settings.Social implicationsMental health professionals place central importance on the establishment of therapeutic relationships between clinicians and service users. Service user attachment style is assumed to play a role in mediating the success, or failure, of relationships with clinicians.Originality/valueThis study makes a novel contribution to the application of attachment theory to secure mental health care, it also demonstrates that gender is an important factor in staff appraisals of service users' approach to treatment.
This article aims to explore and report on violent thinking and alcohol misuse; how these factors may predict self-reported violence. The role of violent thinking in violent behavior is both well established in theoretical models, yet there are few measures that explain this role. One measure that has been identified is the Maudsley Violence Questionnaire (MVQ). This is the first study to explore the use of the MVQ with a general (nonoffender) adult sample, having already been shown to be valid with young people (under 18 years old), adult male offenders, and mentally disordered offenders. This study involved 808 adult participants—569 female and 239 male participants. As figures demonstrate that around half of all violent crime in the United Kingdom is alcohol related, we also explored the role of alcohol misuse. Regression was used to explore how these factors predicted violence. The results demonstrate the important role of violent thinking in violent behavior. The MVQ factor of “Machismo” was the primary factor in regression models for both male and female self-reported violence. The role of alcohol in the regression models differed slightly between the male and female participants, with alcohol misuse involved in male violence. The study supports theoretical models including the role of violent thinking and encourages those hoping to address violence, to consider “Machismo” as a treatment target. The study also provides further validation of the MVQ as a helpful tool for clinicians or researchers who may be interested in “measuring” violent thinking.
Kincaid score for readability, and inclusion of a link to a reputable abortion service on the website. Results:We evaluated 89 websites with information about medical abortion. We found 41 (46%) websites to be fully accurate and complete, with 12 (13%) websites containing outright inaccurate information and an additional 14 (16%) missing pertinent information. There were 29 (33%) sites that reported an incorrect upper limit gestational age and 10 (11%) did not report at all. The average readability score was 43.5 (95% CI: 40.3-46.6) among all websites, which is considered "difficult" and intended for college educated readers. While 41 (46%) websites provided links to abortion providers, 7 (8%) websites gave referrals to abortion reversal services. In total, 19 (21%) websites mentioned abortion reversal, and 11 (58%) of those indicated it was possible. Conclusions: We found medical abortion information on the web varied widely in accuracy and completeness. While most websites contained inaccuracies related to gestational age, many websites also supported an abortion reversal option. Providers should be aware of medical information on the web and more data on patient interpretation of websites is needed.
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