A barreira de contacto em sujeitos toxicodependentes, através da sua expressão no Rorschach

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Situação de risco com impacto em toda a família: gravidez na adolescência

Introdução: A gravidez na adolescência constitui uma situação de risco com impacto em toda a família, podendo gerar crises não apenas na jovem que engravida - em virtude da inexperiência e consequente dificuldade que surge para cuidar de um filho - , como do ponto de vista transgeracional. Objetivos: Aplicar o Modelo Dinâmico de Avaliação e Intervenção Familiar (MDAIF) Figueiredo (2009) e avaliar o impacto dos cuidados de enfermagem numa família em contexto clínico. Métodos: Estudo de caso qualitativo realizado com base no MDAIF em contexto clínico nos Cuidados de Saúde Primários. Este estudo focou-se no processo de intervenção familiar desenvolvido com uma família de uma adolescente de 16 anos que engravida, fruto de uma relação fugaz com um rapaz 9 anos mais velho que conheceu através das redes sociais (Facebook). Instrumentos: Genograma, Ecomapa, Apgar familiar e Escala de Graffar. Resultados: Família extensa, com diferentes subsistemas e limites rígidos. A família encontra-se na etapa do ciclo vital – família com filhos adolescentes, segundo Duvall (1977). Família de classe média. Com a gravidez não desejada da adoelscente, e apesar da relação conflituosa com a sua mãe, esta torna-se um apoio importante no percurso da vida da adolescente e no desenvolvimento do recém-nascido. Conclusões: A utilização do MDAIF permitiu o desenvolvimento das habilidades dos enfermeiros para uma abordagem familiar, contribuindo assim para dar resposta às necessidades da família, enquanto unidade alvo de cuidados. Além disto, permitiu à adolescente prosseguir com a realização do seu projeto de vida, com o apoio familiar e social. Sugere-se a continuidade da utilização do MDAIF.

Crianças e jovens em acompanhamento na Comissão de Proteção de Crianças e Jovens Almada

O presente trabalho tem como principal objetivo caraterizar o acompanhamento processual realizado até à aplicação de medida de acolhimento residencial em crianças/jovens com processo de promoção e proteção em Almada. Para tal, através da elaboração de uma grelha de análise, composta por dados sociodemográficos e aspetos referentes à situação de perigo das crianças/jovens, procedeu-se à consulta de 82 processos na CPCJ de Almada. Os resultados obtidos indicam que há uma predominância de rapazes aos quais foi aplicada tal medida, sendo que na totalidade da amostra a maioria iniciou o processo de promoção e proteção em vigor entre os 10 e os 13 anos, seguindo-se a faixa etária entre os 14 e os 17 de idade. Quanto às tipologias de perigo, encontramos a negligência como a mais comum, tendo as situações de perigo sido sinalizadas maioritariamente por familiares próximos. No que diz respeito ao contexto familiar, verificamos que estas crianças/jovens estavam inseridas predominantemente num agregado monoparental feminino, tendencialmente caraterizado por conflitos relacionais e ausência de suporte familiar, factos que constituíram fatores de decisão para aplicação da medida de acolhimento residencial. No que diz respeito ao acompanhamento dos processos, constatamos que a CPCJ de Almada realizou várias diligências envolvendo vários dos intervenientes participantes na situação de perigo em que a criança/jovem se encontrava, assim como cooperações frequentes com as entidades que conhecem a família. Sugere-se, futuramente, o estudo do impacto da aplicação e execução da medida de acolhimento residencial e do consequente processo de institucionalização de tais crianças/jovens.

The extent and nature of family alcohol and drug use: Findings from the Belfast Youth Development Study

Using data from an ongoing longitudinal study of adolescent drug use, this study examines the proportion of teenagers living with parents who are problem alcohol or drug users. Around two percent of parents report high levels of problem drinking and one per cent report problem drug use. If a broader definition of hazardous drinking is used, the proportion of teenagers exposed increases to over 15 per cent. When substance use is examined at a family level (taking account of alcohol and drug use amongst dependent children in addition to that of parents), the proportion of families experiencing some form of substance use is considerable. These findings add further support to the call for increased recognition of the needs of dependent children within adult treatment services when working with parents. Likewise, the reduction of harm to children as a result of parent substance use should be an increasingly important priority for family support services. This is likely to be achieved through the closer integration of addiction and family services.

What do we know about preventing drug-related harm through social developmental intervention with children and young people

This chapter examines the evidence for the effectiveness of interventions aiming to reduce drug-related harm by improving conditions for healthy develeopment in the earliest years through adolescence. Of the interventions beginning prior to birth, there is efficacy evidence that family home visitation is a feasible strategy for implementation with disadvataged families and can reduce risk factors for early developmental deficits and thereby improve childhood development outcomes. There is efficacy evidence for strategies such as parent education and school preparation through the pre-school age period. Some of the strongest evidence for efficacy in reducing developmental pathways to drug-related harm comes from interventions delivered through the early school years to improve educational environments. Of the interventions targeting the high school age period, school drug education has been the most commonly evaluated. The evidence suggests that short term reduction in both drug use and progression to frequent drug use may be achievable through this strategy, but the prospects for longer-term and population-level behaviour change is still unclear. In overview, a range of prevention strategies have been developed and evaluated. Most of the exisiting evidence is restricted to efficacy studies and there are future challenges to progress evaluation through to studies of effectiveness. In general, prevention programmes appear more successful where they maintain intervention activities over a number of years and incorporate more than one strategy. Much of the existing research has been based in North America and evaluates discrete programmes. Future research should test effects in other countries, in different social contexts and seek to better understand the interrelated effects of combining interventions within the community. Developmental prevention programmes target different age periods and social settings, hence communities have the challenge of coordinating a mixture of programmes that address the local conditions that adversely influence child and youth development. There are opportunities in this work to coordinate prevention activities using funding from different jurisdictions (e.g., crime prevention, health promotion, mental health, education, substance abuse prevention).

Alcohol, tobacco, and other drug use by women in the Illinois child welfare system : prevalence - treatment need - impact on children.

"This report represents a joint effort between the Illinois Department of Alcoholism and Substance Abuse (DASA) and Department of Children and Family Services (DCFS). The study examined alcohol, tobaccco, and other drug abuse (ATODA) and need for treatment among adults involved with the child welfare system in Illinois. The purpose of the study was to provide data on the relationships between ATODA and child abuse and neglect"--P. iii.

Parental Criminal Justice Involvement and Children's Involvement With Child Protective Services: Do Adult Drug Treatment Courts Prevent Child Maltreatment?

BACKGROUND: In light of evidence showing reduced criminal recidivism and cost savings, adult drug treatment courts have grown in popularity. However, the potential spillover benefits to family members are understudied. OBJECTIVES: To examine: (1) the overlap between parents who were convicted of a substance-related offense and their children's involvement with child protective services (CPS); and (2) whether parental participation in an adult drug treatment court program reduces children's risk for CPS involvement. METHODS: Administrative data from North Carolina courts, birth records, and social services were linked at the child level. First, children of parents convicted of a substance-related offense were matched to (a) children of parents convicted of a nonsubstance-related offense and (b) those not convicted of any offense. Second, we compared children of parents who completed a DTC program with children of parents who were referred but did not enroll, who enrolled for <90 days but did not complete, and who enrolled for 90+ days but did not complete. Multivariate logistic regression was used to model group differences in the odds of being reported to CPS in the 1 to 3 years following parental criminal conviction or, alternatively, being referred to a DTC program. RESULTS: Children of parents convicted of a substance-related offense were at greater risk of CPS involvement than children whose parents were not convicted of any charge, but DTC participation did not mitigate this risk. Conclusion/Importance: The role of specialty courts as a strategy for reducing children's risk of maltreatment should be further explored.

Twelve-month effectiveness of a parent-led, family-focused weight-management program for prepubertal children : a randomized, controlled trial

BACKGROUND Parenting-skills training may be an effective age-appropriate child behavior-modification strategy to assist parents in addressing childhood overweight. OBJECTIVE Our goal was to evaluate the relative effectiveness of parenting-skills training as a key strategy for the treatment of overweight children. DESIGN The design consisted of an assessor-blinded, randomized, controlled trial involving 111 (64% female) overweight, prepubertal children 6 to 9 years of age randomly assigned to parenting-skills training plus intensive lifestyle education, parenting-skills training alone, or a 12-month wait-listed control. Height, BMI, and waist-circumference z score and metabolic profile were assessed at baseline, 6 months, and 12 months (intention to treat). RESULTS After 12 months, the BMI z score was reduced by ∼10% with parenting-skills training plus intensive lifestyle education versus ∼5% with parenting-skills training alone or wait-listing for intervention. Waist-circumference z score fell over 12 months in both intervention groups but not in the control group. There was a significant gender effect, with greater reduction in BMI and waist-circumference z scores in boys compared with girls. CONCLUSION Parenting-skills training combined with promoting a healthy family lifestyle may be an effective approach to weight management in prepubertal children, particularly boys. Future studies should be powered to allow gender subanalysis.

The application of Bowen’s family system theory (BFST) to the Malay population in Malaysia

The rapid economic development and social changes in Malaysia recently have led to many psychosocial problems in young people, such as drug addiction, child sexual abuse and mental illness. The Malaysian government is beginning to focus more attention on its social welfare and human service needs in order to alleviate these psychosocial problems. Although counselling is accepted and widespread in Malaysia, the practice of family therapy is not as accepted as it is still a widely held belief that family problems need to be kept within the family. However, changes are imminent and thus the theoretical basis of family therapy needs to be culturally relevant. Bowen‟s Family Systems Theory (BFST) is already one of the major theories taught to tertiary counselling students in Malaysian universities. The main tenet of Bowen‟s theory is that the family as a system may be unstable unless each member of the family is well differentiated. High differentiation levels in the family allow a person to both leave the family‟s boundaries in search of uniqueness and to continually return to the family fold in order to establish a more mature sense of belonging. The difficulty, however, is that while Bowen has claimed that his theory is universal nearly all of the research confirming the theory has been conducted in the United States of America. The only known study outside America, however, did show that Bowen‟s theory applied to a Filipino population but, one of the theory‟s propositions that differentiation is intergenerational was not supported in this non-American sample. The American sample that was compared to the Malay sample was taken from Skowron and Friedlander‟s (1998) study. One hundred and twenty-seven faculty staff in an American university completed the Differentiation of Self Inventory (DSI) to measure level of differentiation of self. This thesis therefore, set out to determine whether Bowen‟s theory applied to another non-American sample, the Malaysian community. The research also investigated if the intergenerational effect was present in the Malaysian sample as well as explored the role of socio-economic status on Bowen‟s theory of differentiation and gender effect. Three hundred and seventy-four families completed four measures to examine these research questions: the Differentiation of Self Inventory (DSI), the Family Inventory of Life Event (FILE), the Depression Anxiety and Stress Scale (DASS) and the Connor-Davidson Resilience Scale (CD-RISC). The results of the study showed that differentiation of self is a valid construct for the Malay population. However, all four subscales of the Differentiation of Self Inventory (DSI); emotional reactivity (ER), emotional cut-off (EC), fusion with other (FO) and I position (IP), showed significant differences compared to the American sample from Skowron and Friedlander‟s (1998) study. The Malay sample scored higher in emotional reaction (ER), fusion with other (FO), but lower on emotional cut-off (EC) and I position (IP) than the American sample. The intergenerational effect was found in the Malay population as the parent‟s level of differentiation correlated with their children‟s level of differentiation. It was found that stress as measured by the Family Inventory of Life Event (FILE) and as measured by the Depression Anxiety and Stress Scale (DASS) were not correlated with the level of differentiation of self in parents. However, gender had a significant effect in predicting the level of differentiation among parents in Malay population with females scores higher on emotional reactivity (ER) and fusion with other (FO) than males. An additional finding was that resilience can be predicted from the level of differentiation of self in children in the Malay sample. There was also a positive correlation between the level of differentiation of self in parents and resilience in their children. Findings from this study indicate that the concept of differentiation of self is applicable to a Malay sample; however, the implementation of the theory should be applied with cultural sensitivity.

A parent-led family-focused treatment program for overweight children aged 5 to 9 years : The PEACH RCT

OBJECTIVE: To evaluate a healthy lifestyle intervention to reduce adiposity in children aged 5 to 9 years and assess whether adding parenting skills training would enhance this effect. PARTICIPANTS AND METHODS: We conducted a single-blinded randomized controlled trial of prepubertal moderately obese (International Obesity Task Force cut points) children, aged 5 to 9 years. The 6-month program targeted parents as the agents of change for implementing family lifestyle changes. Only parents attended group sessions. We measured BMI and waist z scores and parenting constructs at baseline, 6, 12, 18, 24 months. RESULTS: Participants (n = 169; 56% girls) were randomized to a parenting skills plus healthy lifestyle group (n = 85) or a healthy lifestyle–only group (n = 84). At final 24-month assessment 52 and 54 children remained in the parenting skills plus healthy lifestyle and the healthy lifestyle–only groups respectively. There were reductions (P < .001) in BMI z score (0.26 [95% confidence interval: 0.22–0.30]) and waist z score (0.33 [95% confidence interval: 0.26–0.40]). There was a 10% reduction in z scores from baseline to 6 months that was maintained to 24 months with no additional intervention. Overall, there was no significant group effect. A similar pattern of initial improvement followed by stability was observed for parenting outcomes and no group effect. CONCLUSIONS: Using approaches that specifically target parent behavior, relative weight loss of ∼10% is achievable in moderately obese prepubertal children and can be maintained for 2 years from baseline. These results justify an investment in treatment as an effective secondary obesity-prevention strategy.