Those Who Hesitate are Lost: The Case for Setting Behavioral Health Treatment and Disability Standards, Part II

In the first article of this three-part series, an overview of systematic problems related to behavioral health (BH) treatment and disability was discussed. In this second article of the series, I discuss a number of factors that contribute to the lack of standardization regarding the work of all professionals in the area, including those in the BH field, which serve to introduce imprecision into the BH treatment and disability determination processes. From how professionals are trained and continuing to those who are providing clinical treatment, it is essential to understand how the lack of standardization impacts the treatment itself as well as treatment outcomes. This lack of standardization contributes to poorly identified mental health (MH) conditions, no identification of psychosocial issues, and an overreliance on subjective information, including professional clinical opinion, which leads to poorly defensible professional decision-making as well as poorer outcomes in treatment. In this litigious age, it is not sufficient to employ clinical opinion alone as the basis for treatment decisions. The more sophisticated professional recognizes the importance that one's assessment and treatment decisions may later be questioned in court or in a disability determination hearing. The importance of standardization and utilizing the current scientific standards has become imperative in today's professional evaluation and treatment in the area.     

NGOs and advocacy: How well are the poor represented?

There is a widespread perception that Southern non-governmental organizations (NGOs) best represent the authentic voices of the Southern poor. This article challenges this perception, arguing that poor people in general, and children and women in particular, continue to be disenfranchised, while NGOs-both Northern and Southern-offer a poor imitation of their voices. It argues that what is needed, given the current global economic paradigm, is an authentic 'joint venture' between NGOs in the North and the South and the authentic voices of poor people themselves, that would bring the poor into the mainstream; and a new approach to capacity-building that would seek to empower them better to advocate for themselves. It concludes that, to achieve this, economic advocacy should perhaps take greater precedence over political advocacy.     

Good Governance and Bermuda’s Public Access to Information Act

Abstract

This paper examines the context surrounding, and debates concerning, freedom of information-type legislation in the British Overseas Territory of Bermuda. It situates the law within a wider push by the British Government for good governance in the British Overseas Territories. It explores the expectation for more ‘open and transparent’ government held by international government organisations, the British Government, and the Bermudian electorate. It analyses the resultant political debates, which are framed by traditions of governance that encouraged secrecy and legacies of distrust between political parties formed soon after universal suffrage was introduced in the 1960s. It investigates the implementation of the Act in response to global, metropolitan and local pressures.     

Incorporating a Healthy Living Curriculum within Family Behavior Therapy: A Clinical Case Example in a Woman with a History of Domestic Violence,Child Neglect,Drug Abuse,and Obesity

Women reported to child protective service agencies frequently report problems that significantly interfere with the health and well-being of their children and themselves. Behavioral treatment programs appear to be effective in managing these co-existing problems, such as domestic violence and substance abuse. However, evidence-supported interventions are rarely exemplified in complicated clinical cases, especially within child welfare settings. Therefore, in this case example, we describe the process of adapting an evidence-supported treatment to assist in managing significant co-existing health-related problems in a mother who was referred due to child neglect and drug abuse. At the conclusion of therapy, the participant reported improvements in perceived family relationships, illicit drug use, child maltreatment potential, whereas other health-related outcomes were mixed. Most improvements were maintained at 4-month follow-up. Issues relevant to implementing evidence-based treatments within community contexts are discussed, including methods of increasing the likelihood of valid outcome assessment, managing treatment integrity, and adjusting standardized treatments to accommodate co-occurring problems.     

A comparative evaluation of the disulfur dinitride process for the visualisation of fingermarks on metal surfaces

The disulfur dinitride process for fingermark visualisation was first reported a decade ago, with promising results obtained for a range of materials including metals. However, the friction sensitive nature of the material and difficulty of synthesis made routine use difficult. Many of these issues have since been addressed, making equipment and chemicals available to build an understanding of how the effectiveness of disulfur dinitride compares to other fingermark visualisation processes currently used on metal surfaces. This enables more informed advice to be given on selection of processes for treatment of metal items, an area of operational interest that encompasses weapons used in violent crime and the increasing incidence in metal theft. This paper reports a comparative study into the effectiveness of disulfur dinitride, cyanoacrylate fuming, vacuum metal deposition, gun blueing and wet powder suspensions on brass, bronze, copper and stainless steel. Experiments were conducted with the surfaces exposed to a range of environments including long term ageing, water/detergent washing, acetone washing and high temperature exposure. The results indicate that disulfur dinitride is an effective process for fingermark visualisation on metal surfaces, including those exposed to adverse environments, and may offer potential improvements over existing processes for those surfaces. Further work, including pseudo-operational trials, is recommended.     

A Person-centered Approach to Risk and Need Classification in Drug Court

A sample of 265 New York City drug court participants completed the Level of Service Inventory—Revised (LSI-R) and Texas Christian University Drug Screen II (TCUDS). Three participant clusters were identified through a person-centered analysis of their LSI-R and TCUDS responses: low risk (LR), criminogenic risk (CR), and complex behavioral health needs (CBHN). Although CBHN scored higher than CR and LR on the LSI-R and TCUDS, they were no more likely to be re-arrested at 24 months and no higher in their rate of positive drug tests. The CR cluster predicted re-arrest beyond the LSI-R and rate of positive drug tests beyond the LSI-R and TCUDS. CBHN participants placed in a residential (vs. non-residential) setting were disproportionately likely to be re-arrested. Results point to a sub-population of drug court participants not captured in variable-centered summary risk scores, who might require intensive case management or referral to suitable treatment.     

DEREGULATION: THE PRINCIPAL INCONCLUSIVE ARGUMENTS1

The authors suggest that most arguments in favor of deregulation are really double-edged swords which render the debate over deregulation inconclusive at best. They challenge the following positions as inconclusive: (1) that deregulation per se is good; (2) that it protects rights; (3) that deregulation removes uncertainties concerning the marketplace; (4) that it reduces “nitpicking” and coercive regulation; (5) that deregulation promotes greater productivity and efficiency; (6) that it combats inflation; (7) that regulations often cannot be justified by benefits over costs; and (8) there are serious problems of attaining optimum levels of regulation. Special interest groups in favor of deregulation are seen to bear a remarkable resemblance to groups opposed to deregulation.