A continuum of care: More is not always better.

Bickman, Leonard

doi:10.1037/0003-066x.51.7.689

Cited by 291 publications

(212 citation statements)

References 41 publications

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“…The versions of the DISC used in the current study have been shown to possess acceptable to excellent psychometric properties, especially when used with clinical populations Jensen et al, 1995;Schwab-Stone et al, 1993, 1996Shaffer et al, 1996). Reliability between SA and maternal reports is generally higher for externalizing symptoms, rather than internalizing symptoms .…”

Section: Assessments Emergency Room Assessments Prior To Er Care (Timmentioning

confidence: 98%

“…In particular, we anticipated the program's impact to vary depending on the SA's degree of psychiatric symptomatology at the time of the suicide attempt. Earlier treatment outcome studies have noted that the most seriously disturbed youths are the least likely to improve in response to treatment (Bickman, 1996). In a study by Pfeffer and colleagues (1994), hospitalized SA treated with antidepressant medication for longer periods of time were 17 times more likely to make a suicide attempt over the next 6 to 8 years than those receiving less antidepressant treatment.…”

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confidence: 99%

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The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

Rotheram‐Borus¹,

Piacentini²,

Cantwell³

et al. 2000

Journal of Consulting and Clinical Psychology

158

169

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Following a suicide attempt by female adolescents, the impact of a specialized emergency room (ER) care intervention was evaluated over the subsequent 18 months. Using a quasi-experimental design, this study assigned 140 female adolescent suicide attempters (SA), ages 12-18 years, and their mothers (88% Hispanic) to receive during their ER visit either: (a) specialized ER care aimed at enhancing adherence to outpatient therapy by providing a soap opera video regarding suicidality, a family therapy session, and staff training; or (b) standard ER care. The adjustment of the SA and their mothers was evaluated over 18 months (follow-up, 92%) using linear mixed model regression analyses. SA's adjustment improved over time on most mental health indices. Rates of suicide reattempts (12.4%) and suicidal reideation (29.8%) were lower than anticipated and similar across ER conditions. The specialized ER care condition was associated with significantly lower depression scores by the SA and lower maternal ratings on family cohesion. Significant interactions of intervention condition with the SA's initial level of psychiatric symptomatology indicated that the intervention's impact was greatest on maternal emotional distress and family cohesion among SA who were highly symptomatic. SA's attendance at therapy sessions following the ER visit was significantly associated with only one outcome-family adaptability. Specialized ER interventions may have substantial and sustained impact over time, particularly for the parents of youth with high psychiatric symptomatology. Adolescent suicide attempts are a significant problem, with 7.7% of high school students reporting attempts and 2.6% saying their attempt required medical attention (Centers for Disease Control and Prevention [CDC], 1998). Adolescent suicide attempters (SA) are at increased risk for repeat attempts, long-term psychiatric symptoms, and academic, social, and behavioral problems (Shaffer & Piacentini, 1994). In spite of their great need for mental health intervention, fewer than 50% of adolescent attempters are referred for psychotherapy following their emergency room (ER) visit (Piacentini et al., 1995; Spirito, Brown, Overholser, & Fritz, 1989), and a large proportion of these individuals fail to attend their initial treatment session. Of those who do attend, many do not complete treatment (Piacentini et al., 1995; Spirito et al., 1989). Nonattendance to follow-up treatment by suicidal adolescents is especially disturbing, considering that psychiatric intervention can reduce subsequent attempts and social maladjustment (Rotheram-Borus, Piacentini, Miller, Graae, & Castro-Bianco, 1994; Shaffer & Piacentini, 1994). There are many reasons why individuals fail to attend treatment following an ER visit for a suicide attempt. Repetitive evaluations, lengthy waiting periods, bureaucratic registration procedures, and

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Section: Assessments Emergency Room Assessments Prior To Er Care (Timmentioning

confidence: 98%

mentioning

confidence: 99%

The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

Rotheram‐Borus¹,

Piacentini²,

Cantwell³

et al. 2000

Journal of Consulting and Clinical Psychology

158

169

View full text Add to dashboard Cite

show abstract

“…Specifically, it may protect clinicians from the more anxietyprovoking situation of getting to know their patients personally and thereby feeling responsible for their welfare. Moreover, placing blame for failed initiatives on faulty payment structures (Bickman, 1996;Chang et al, 1998) or information-sharing systems (Kripalani et al, 2007), however warranted, may conveniently detract attention away from the unconscious resistances at play; resistances hitherto unexamined in the current literature.…”

Section: Reassessing "Continuity Of Care"mentioning

confidence: 99%

“…Defined as "an implicit pledge that clinicians will communicate and coordinate across boundaries" (Haggerty et al, 2013, p. 269), continuity of care is a structural intervention seemingly geared towards tackling the very fragmentation Menzies Lyth (1960) documented over a half-century ago. And yet, repeated failure of continuity of care initiatives (Bickman, 1996;Chang et al, 1998) suggests the longstanding discontinuity of care serves some important purpose. Specifically, it may protect clinicians from the more anxietyprovoking situation of getting to know their patients personally and thereby feeling responsible for their welfare.…”

Section: Reassessing "Continuity Of Care"mentioning

confidence: 99%

So Much More Than a Job: A Psychoanalytic Exploration of Healthcare Work

Gerard

2017

European Journal of Environment and Public Health

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This paper explores the utility of psychoanalysis for understanding the underlying meaning of healthcare work. At times deeply fulfilling, while at other times demanding and thankless, the provision of healthcare takes a unique toll on the psyche. Psychoanalysis is particularly suited for highlighting the paradoxical character of healthcare work because of its focus on the unconscious, emotional and irrational aspects of psychic life. Exploring the latent meaning of healthcare work, as well as the complex interplay between work and worker, allows for deeper insight into contemporary issues of healthcare management and organization.

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“…However, this potential bias has not been investigated with children and adolescents. This paper presents data-driven evidence from the Fort Bragg Evaluation Project (FBEP; Bickman, 1996aBickman, , 1996bBickman et al, 1995), which provides a large sample (N=984 youths ages 6-18) for analysis of these topics.…”

Section: Bias In Assigning Formal Diagnosis Based On Informantmentioning

confidence: 99%

Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

Bickman

Wighton

Lambert

et al. 2012

Journal of Methods and Measurement in the Social Sciences

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This paper presents results from a three-part study on diagnosis of children with affective and behavior disorders. We examined the reliability, discriminant, and predictive validity of common diagnoses used in mental health services research using a research diagnostic interview. Results suggest four problems: a) some diagnoses demonstrate internal consistency only slightly better than symptoms chosen at random; b) diagnosis did not add appreciably to a brief global functioning screen in predicting service use; c) low interrater reliability among informants and clinicians for six of the most common diagnoses; and d) clinician diagnoses differed between sites in ways that reflect different reimbursement strategies. The study concludes that clinicians and researchers should not assume diagnosis is a useful measure of child and adolescent problems and outcomes until there is more evidence supporting the validity of diagnosis.

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A continuum of care: More is not always better.

Cited by 291 publications

References 41 publications

The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

The 18-month impact of an emergency room intervention for adolescent female suicide attempters.

So Much More Than a Job: A Psychoanalytic Exploration of Healthcare Work

Problems in Using Diagnosis in Child and Adolescent Mental Health Services Research

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