From the Director
From Research to Practice: The CDISC in Clinical Services
Evaluation of a Protocol for Identification of Woman Abuse in Families with Allegations of Child Abuse or Neglect
Center Activities & AnnouncementsGrandparents Raising Grandchildren: A Group Intervention
The Empirical Development of an Early Child Maltreatment Prevention Program
A Study of Suicidal Ideation and Behavior in Preadolescents
Practitioner-Researcher Partnerships: Building Knowledge From, In, and For Practice Is Published
From the Director
This issue of Practice & Research is longer than previous issues. It features the Center's current research studies. The articles provide useful summaries of the Center's research programs and give relevant references for those who wish to pursue the topics in further detail. Four new studies are described and one ongoing study is updated: From Research to Practice: The CDISC (Diagnostic Interview Schedule for Children in Clinical Services; Evaluation of a Protocol for Identification of Woman Abuse in Families with Allegations of Child Abuse or Neglect; The Empirical Development of an Early Child Maltreatment Prevention Program; Grandparents Raising Grandchildren: A Group Intervention; and A Study of Suicidal Ideation and Behavior in Preadolescents.
A fifth study, The Odyssey Project: A Descriptive and Prospective Study of Children and Youth in Residential Treatment, Group Homes and Therapeutic Foster Care will be implemented in 1995. This national study is being conducted by the Child Welfare League of America, Inc. (CWLA) with the cooperation and support of its members. Patnck A. Curtis, PhD, Director of Research, CWLA, is Principal Investigator; Cynthia Papa- Lentini, PhD, Director of Research and Program Evaluation, Berkshire Farm Center for Children and Youth, and Gina Alexander, MS, MSW, Vice President, the Villages of Indiana, Bloomington, Indiana are Co- Principal Investigators; and Lisa A. Lunghofer, PhD, is Project Director. All CWLA member agencies with residential treatment, group home or therapeutic foster care programs have been invited to form a consortium that will provide data on their respective programs. JBFCS has agreed to participate under the aegis of the Center. Bruce A. Grellong, PhD, JBFCS Chief Psychologist, is Research Coordinator and Neil B. Guterman, PhD, CUSSW Assistant Professor and Center faculty affiliate, is Research Director. The JBFCS Jerome M. Goldsmith Center, Hawthorne Cedar Knolls and Linden Hill programs are potential sites. The study seeks to describe what types of children and youth are being treated in which types of settings and with which types of services, and to examine a variety of outcomes.
The Center has had an active and productive year, thanks to the contributions of the Center's Development Council, Professional Advisory Committee, faculty and staff affiliates, and students. I am pleased to welcome Seymour R. Askin, Jr, JBFCS President, as a new member of the Development Council, and Dr. Annaclare van Dalen, as a new member of the Professional Advisory Committee. New Center faculty affiliates are Drs. Kathryn Conroy Idns Andrew Hamid, Andre Ivanoff, Randy Magen, Lawrence Martin and Barbara Simon.
In September, Ms. Jennifer Magnabosco returned to her previously held position as the Center's Administrative Coordinator. Ms. Magnabosco most recently was a Research Associate at the University of Chicago Center for Psychiatric Rehabilitation. Ms. Magnabosco serves as Managing Editor for this issue of the newsletter. All of the Center affiliates thank Mr. Karun Singh for his excellent service as Administrative Coordinator during 1993-94. And, I am pleased to welcome CUSSW doctoral students Dara Kerkonan and Steve Scher to the Center.
A description of recent Center activities is included in this issue. We are pleased to announce the recent publication of Practitioner-Researcher Partnerships: Building Knowledge From, In, and For Practice, which contains original chapters and revised papers presented at the Center's March 3, 1993 Conference, "Knowledge for Practice: Practitioners and Researchers as Partners. " Excerpts from the Foreword and Table of Contents are reproduced.
We are eager to hear from our readers and welcome suggestions for areas of study or collaboration.
From Research to Practice: The CDISC (Diagnostic Interview Schedule for Children) in Clinical Services
Prudence Fisher, MS, CSW and Helene Jackson, Ph.D.
The comprehensive and systematic assessment of symptoms is an essential part of any clinical evaluation of children and adolescents. Although reliable and valid standardized diagnostic instruments have been developed, in most clinical out patient services such measures are rarely part of the evaluation process. The use of the unstructured clinical interview has many drawbacks (Kendell, 1975), including its variable structure and limited information upon which to base a diagnosis. The clinician's tendency to focus on data that will confirm a diagnosis, ignore con flicting evidence (Simon et al., 1971; Elstein et al., 1972; Kendell, 1973), and frequently overlook rare or socially embarrassing items (Greist et al., 1973; Bec1: et al., 1988; Levine et al., 1989; Lucas et al., 1977; Bagley & Genius, 1991) is a serious concern.
Personal characteristics of the clinician Jackson & Nuttall, 1993; Jackson &r Nuttall, 1994) and the nonclinical characteristics of a patient, such as race, gender and age, can affect how clinicians conduct a clinical inter view, leading them to focus on certain issues or, more importantly to avoid others (Gauron & Dickinson, 1966b; Burgoyne, 1977; Jackson & Nuttall, 1994). Clinicians often have very little idea of the "true" probabilities of symptom-disease relationships (Gauron & Dickinson, 1966a; Leaper et al., 1972). The advent of frequently changing criterion-based diagnostic systems, such as the DSM-III (APA, 1980), DSM-111-R (APA, 1987) and DSM-IV (APA, 1994) and ICD-10 (WHO, 1993), may also have introduced new sources of clinical unreliability It is not surprising then that even the most able and diligent clinicians find it extremely challenging to organize and retain diagnostic logic, eliminate bias, and use diagnostic labels in the way they were intended.
Research studies show that many of these problems have been obviated by the use of standardized interviewing techniques. Epidemiological research in particular uses reliable measures that can be given to a large number of subjects at low cost. These benefits are consistent with the needs of under staffed clinical services for children and adolescents. Other research has explored whether a combination of a comprehensive automated assessment of symptomatology with a subsequent sensitive exploration of presenting complaints by a clinician might represent an optimal approach (Williams et al., 1975; Farrell et al., 1987; Yokley Reuter, 1989; Sawyers et al., 1992).
Although these findings are products of uncontrolled naturalistic studies, they strongly support the notion that when made avail able to clinicians, computer-generated reports can inform and guide diagnostic impressions and decisions.
More research is needed to better under stand the implications of using this procedure. The need is therefore urgent to address scientifically the impact of the introduction and use of such standardized assessment procedures on clinical services using appropriate controls and design safeguards. This need led to the current study
The Current Study: The CDISC in Clinical Services
This three-year NlMH-funded study examines the impact of introducing a standardized assessment procedure, the NIMH DISC, on clinical practice in community-based child mental health. It is funded with a budget of approximately one million dollars.
The DISC is a highly structured diagnostic interview designed to be administered by lay interviewers to assess most of the commonly occurring mental disorders of children and adolescents included in the DSM diagnostic system (APA, 1994). Parallel parent and child versions of the instrument exist, the DISC- P (parent self-report about their child, age 6 to 17) and the DISC-C (child self-report about himself, age 9 to 17 ). The DISC is probably the most extensively tested of all the child and adolescent diagnostic interviews. Its performance has been evaluated using both clinical and community samples (Shaffer, et al., submitted; Schwab-Stone et al., submitted; Jensen et al., in press; Fisher et al., 1993).
Questions for the current study include: Is the DISC a useful tool in clinical settings? Is important information discovered by the DISC? Do clinicians find the DISC reports helpful in their evaluation of new intakes? Does clinical practice change if the DISC is used? How do clients/parents feel about the use of the DISC in their intake assessments? Does the CDISC save time? Is use of lay interviewers economical?
The study is being conducted in collaboration (and under subcontracts) among the New York State Psychiatric Institute, the Center for the Study of Social Work Practice and the University of Medicine and Dentistry of New Jersey (UMDNJ) at Newark. English-speaking children aged 9 to 18, and their parents, who come for an initial evaluation at the JBFCS Madeleine Borg Community Services and the UMDNJ Community Mental Health Center, and their intake cliniciansó 800 parent/caretaker-child pairs and 80 cliniciansóare expected to participate. The study will use a repeated-measures, matched-group design in which secular trends and seasonal changes in diagnoses will be controlled to examine the impact of the CDISC on clinicians' diagnostic and clinical practice, and on patient satisfaction.
Lay interviewers will administer the CDISC, a computerized user-friendly version of the DISC, to child and parent/caretaker participants. The CDISC corresponds exactly to the official paper version of the interview, but has the following advantages: it simplifies administration; it has database properties; and, most importantly, it can produce diagnostic reports immediately at completion of the interview.
Diagnosing clinicians will be provided reports from the CDISC prior to their first interview. During the first 12-month period of the project, the original subject group,
Group A, will receive the CDISC and a contrast group, Group B, will be observed and recorded. Dunug a second 12-month period, Group B will receive the CDISC and Group A will be observed and recorded.
With increasing pressure on clinical services, it is expected that a diagnostic tool such as the CDISC will help focus scarce resources quickly, more cost- effectively and with greater accuracy to children and adolescents in need of mental health intervention. Objective and quantifiable baseline measures also will provide a basis for evaluating treatment effects and lead to expert systems that will allow evaluators to determine the appropriateness of given interventions.
New York State Psychiatric Institute: Principal Investigator: David Shaffer, MD Co-lnvestigators: Prudence Fisher, MS, CSW and Christopher Lucas, MD Center for the Study of Social Work Practice: Principal Investigator: Ed Mullen, DSW (CUSSW) Co-lnvestigators: Bruce Grellong, PhD OBFCS); Robert Abramovitz, MD OBFCS) and Helene Jackson, PhD (CUSSW)
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8. Farrell, A. D., Camplair, P S. & McCullough, L. (1987). Identification of target complaints by computer interview: Evaluation of a computerized assessment system for psychotherapy evaluation and research. J Consult Clin Psychol, 55, 691-700.
9. Fisher, P, Shaffer, D., Piacentini, J. C., Lapkin, J., Kafantaris, V, Leonard, H., Herzog, D. B. (1993). Sensitivity of the Diagnostic Interview Schedule for Children, 2nd edition (DISC 2.1) for specific diagnoses of children and adolescents. J Am Acad Child Adolesc Psychiatry, 32, 666-673.
10. Fisher, P, Blouin, A., Shaffer, D. (1993b). The C-DISC: A computerized version of the NIMH Diagnostic Interview Schedule for Children, Version 2.3. Poster Presentation at SRCAP, Santa Fe, New Mexico.
11. Gauron, E.F, Dickinson,J.K. (1966a). Diagnostic decision making in psychiatry. ll. Diagnostic styles. Arch Gen Psychiatry, 14, 233-237.
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(1966b). Diagnostic decision making in psychiatry 1. Information usage. Arch Gen Psychiatry, 14, 225-232.
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15.Jackson, H. & Nuttall, R. (1993). Clinician responses to sexual abuse allegations. Child Abuse & Neglect, 17, 127-143.
16. Jensen, P, Roper, M., Fisher, P, Piacentini, J., Canino, G., Richters, J., Rubio-Stipec, M., Dulcan, M., Goodman, S., Davies, M., Rae, D., Shaffer, D., Bird, H., LaheY B., SchwabStone, M. (in press). Test-Retest reliability of the Diagnostic Interview Schedule for
Children (ver. 2.1): Parent, child and combined algorithms. Arch Gen Psychiatry.
17. Kendell, R.E. (1973). Psychiatric diagnoses: a study of how they are made. Br J Psyche, 122, 437-445.
18. Kendell, R. E. (1975). The role of diagnosis in psychiatry: Diagnosis as a practical decision making process, pp. 49-59. Blackwell: Oxford.
19. Kintz, B.L., Delprato, DJ., Mettee, D.R., Persons, C.E., Schappe, R.H. (1965). The experimenter effect. Psychological Bull, 63, 223-232.
20. Leaper, D. J., Horrocks, J. C., Staniland, J. R., de Dombal, F T (1972). Computer- assisted diagnosis of abdominal pain using "estimates" provided by clinicians. Br Med J, 1y 350-354.
21. Levine, S., Ancill, R. J., Roberts, A. P (1989). Assessment of suicide risk by computer delivered self-rating questionnaire: preliminary findings. Acta Psych Scand, 80, 216-220.
22. Lucas, R.W, Mullin, PJ., Luna, C.B.X., Mclnroy D. C. (1977). Psychiatrists and a computer as interrogators of patients with alcohol-related illnesses: a comparison. Br J Psych, 131, 160-167.
23. Sawyer, M. G, Sarris, A., Baghurst, P (1992). The effect of computer-assisted interviewing on the clinical assessment of children. Australian and New Zealand J Psychiatry, 26, 223-231.
24. Schwab-Stone, M., Shaffer, D., Dulcan, M., Jensen, P, Eisher, P, Bird, H., Goodman, S., Lahey, B., Lichtman, J., Canino, G., RubioStipec, M., Rae, D. (submitted for publication). Criterion validity of the NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC 2.3).
25. Setterberg, S., Ernst, M., Rao, U., Campbell, M., Carlson, G.A., Shaffer, D., Staghezza, B.M. (1991). Child psychiatrists' satisfaction and usage of DSM IIIR. J Am Acad Child Adolesc Psychiatry, 30, 652-658.
26. Shaffer, D., Fisher, P, Dulcan, M., Davies, M., Piacentini, J., Schwab-Stone, M, Lahey B., Bourdon, K., Jensen, P, Bird, H., Canino, G., Regier, D. (submitted for publication). The NIMH Diagnostic Interview Schedule for Children (DISC-2): Description, acceptability prevalence, and performance in the MECA study
27. Simon, RJ., Gurland, BJ. Fleiss, J.L., Sharpe, L. (1971). Impact of a patient history interview on psychiatric diagnosis. Arch Gen Psychiatry, 24, 437- 440.
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29. WHO (1993). International Classification of Diseases - Diagnostic Criteria for Research, 10th Edition, World Health Organization: Geneva.
30. Yokley J.M., Reuter, J. M. (1989). The computer assisted child diagnostic system: a research and development project. Computers in Human Behavior, 5, 277-295.
Evaluation of a Protocol for Identification of Woman Abuse in Families with Allegations of Child Abuse or Neglect
Randy Magen, PhD
The recognition of child abuse as a modern social problem occurred in the 1960s, while the acknowledgment of the problem of woman abuse emerged in the 1970s. For the most part, social activists, social scientists, and social workers have focused on either the problem of child abuse or the problem of woman abuse. Very little research or direct practice has centered on the coexistence o; the problems.
The literature on family violence illustrates what Martin (1983) calls, "an interesting division of labor." Men are described as perpetrators of woman abuse while women traditionally are viewed as responsible for child abuse. While clear evidence exists that a significant proportion of abusive parents are male (Martin, 1983), mothers often are treated as complicit in allowing children to be abused or witness their own abuse (Stark & Flitcraft, 1988).
The separate research traditions have failed to recognize that their focus often is on the same family member, the mother. Child abuse literature's focus on the mother as the abuser and the spouse abuse literature's examination of the woman as the survivor result in sets of separate studies purporting to explain the behavior of the same person. The focus of the collaborative study with the New York City Child Welfare Administration is on the intersection of child abuse and woman abuse within families.
A variety of research methods examine the extent of coexistence of child abuse and woman abuse. These approaches have included case studies, surveys of clinical populations, large-scale random population samples and crossnational comparisons. While the quality has waned, together they paint a vivid picture. Studies from the field of child abuse are consistent in finding a relationship between woman abuse and child abuse. They are found to coexist even though the studies involved different populations, settings and methodologies. But, estimates of the degree to which child abuse and woman abuse coexist vary from 11% of families reported for child maltreatment (Daro & Cohn, 1988) to 45% (Stark & Flitcraft, 1988). In New York City, an investigation by the Child Welfare Administration Fatality Review Panel found that 1% of mothers of murdered children had been abused by a partner (Task Force on Family Violence, 1993). Literature from the field of woman abuse provides further evidence of coexistence. An early study on the experience of battered women found that 37_h had abused children while 54% of batterers had been abusive (Gayford, 1975). Fifty-six percent of Giles-Sims' (1985) sample of battered women recounted using violence against their children. These women reported that 63% of their abusive partners had engaged in child abuse. Significant in Giles-Sims ' study was that abuse toward the child was six times more frequent from abusive men than from battered women.
Straus and his colleagues (e.g., Straus, Gelles, & Steinmetz, 1980) are the only investigators who have conducted studies focused on the coexistence of woman abuse and child abuse in non clinical samples. Their national surveys show that in families where women are subjected to violence, child abuse is double that of families with no violence. When woman abuse becomes more severe and more frequent, the rate of child abuse also seems to double.
Some argue (e.g., Straus, 1983) that services to battered women should be separated from assistance to abused children. However, Cummings and Mooney (1988) point out that child protective service workers and battered women's advocates both ". . . share an interest in stopping the violence, their perspectives and approaches are frequently in conflict." Child protective service agencies typically adopt a family-centered approach and follow the principle of working "in the best interests of the child." Battered women's advocates adopt a woman-centered approach and follow the goal of empowering women. In spite of the commonalties of these two kinds of abuse, risk indices for child abuse do not screen parents for the presence of woman abuse (Nelson, 1984) and services to battered women often are developed without considering the needs of children (McKay, 1994). This traditional division of services may not be the most effective means of intervention.
New York City
Abused women in New York City are assisted through the Crisis Intervention Services of the Human Resources Administration and children are assisted through the Child Welfare Administration.
In April 1993 the Task Force on Family Violence published, " Behind Closed Doors: The City's Response to Family Violence." Subsequently, several members of the New York City Interagency Task Force on Domestic Violence joined with faculty affiliates of the Center to form a Program Work Group. With cooperation from the Child Welfare Administration, the Group developed a 15-item interview protocol to identify and serve battered women. The protocol was implemented in one service zone in Manhattan on a pilot basis to test effectiveness and examine questions about coexistence of child abuse/neglect and violence against women. The Center was invited to lead research development and evaluation.
The study's primary objective is to describe the incidence and characteristics of cases in which domestic violence and child abuse are found to coexist as well as the actions taken in those cases. It also will identify beneficial outcomes of the protocol, effectiveness and any obstacles to implementation.
At this writing, the study is in the final phases of pilot testing. Information is being collected from two sources. A volunteer sample of Child Welfare Administration staff, responsible for protocol implementation, is being interviewed. Case data from child protective service caseworkers and supervisors, which documents the process and outcome of all child abuse/neglect investigations, also is being collected.
Initial results of the pilot study, available in the Spring of 1995, will be used to design a subsequent study to examine the coexistence of child abuse and domestic violence. Results also will be used to design protocols for locating families in which the problems coexist. Such protocols will be useful for public and private social agencies to rapidly identify families in need of services for child abuse and domestic violence.
Co-lnvestigators: Kathryn Conroy, DSW; Peg Hess, PhD; Randy Magen, PhD and Barbara Simon, PhD (CUSSW). With the cooperation of the New York City Child Welfare Administration.
1. Cummings, N. and Mooney, A. (1988). Child protective workers and battered women's advocates: a strategy for family violence intervention. Response, 11 (2), 4-9.
2. Daro, D. and Cohn, A.H. (1988). Child maltreatment evaluation efforts: what have we learned? In G T Hotaling, D Finkelhor, J T Kirkpatnck, & M A. Straus (Eds.). Coping with Family Violence: Research and Policy Perspectives, pp. 275- 287 Newbury Park, CA: Sage.
3. Gayford, JJ. (1975). Wife battering: a preliminary survey of 100 cases. Brit Med J, 25, 194-197.
4. Giles-Sims, J. (1985) A longitudinal study of battered children of battered wives. Family Relations, 34 (2), 205- 210.
. Martin, J. (1983). Maternal and paternal abuse of children: theoretical and research perspectives In D Finkelhor, R J. Gelles, G. T Hotaling, M. A Straus (Eds.). The Dark Side of Families: Current Family Violence Research, pp. 293-304 Beverly Hills, CA Sage.
6. McKay, M M. (1994) The lini between domestic violence and child abuse: assessment and treatment considerations. Child Welfare, 73 (1), 29-39.
7. Nelson, K G. (1984) The innocent bystander: the child as unintended victim of domestic violence involving deadly weapons Pediatrics, 73 (2), 251- 252.
8. Rosenberg, M S. and Rossman, s.s.R. (1990) The child witness to marital violence. in R Ammerman & M Hersen (Eds.). Treatment of Family Violence, pp. 183210 New York: John Wiley & Sons, Inc.
9. Stark, E. and Flitcraft, A. (1988). Women and children at risk: a feminist perspective on child abuse. International Journal of Health Services, 18 (1), 97-118.
10. Straus, M A. (1983). Ordinary violence, child abuse and wife- beating: what do they have in common? In D. Finkelhor, R J Gelles, G T Hotaling, M A. Straus (Eds.). The Dark Side of Families: Current Family Violence Research, pp. 213-234 Beverly Hills, CA Sage.
11. Straus, M A., Gelles, RJ. and Steinmetz, S K. (1980). Behind Closed Doors: Violence in the American Family New York: Doubleday/Anchor.
12 Task Force on Family Violence (1993) Behind Closed Doors: The City's Response to Family Violence. Office of New York Manhattan Borough President.
Center Activities & Announcements
New Research Development Fund Established
The Center has established a new Research Development Funding Program (RDFP). Funding is now available to support a limited number of small-scale research studies (under the auspices of the Center) that will lead to subsequent application for external funding. CUSSW faculty and JBFCS staff are eligible to submit applications. Priority will be given to proposed studies involving collaboration between CUSSW faculty and JBFCS staff. Proposed budgets should not exceed $5,000. Priority areas are: research outcomes in social work practice; assessment of practice in a managed care context; examination of ways to use research in practice; and research on family violence and social work practice. The intent of the RDFP is to stimulate research that faculty and staff identify as important. Therefore, applications in other research areas are also welcome.
Center Conference on Outcome Measurement Planned During the past decade considerable attention has been given to development and use of outcome measures in social work practice. Most recently, the emphasis on accountability in the human services and the movement toward managed care in the health and mental health fields, have further added to interest in this topic. The Center has convened a planning committee to consider sponsorship of this topic at a 1995 conference. Conference participants will be asked to consider the implications of outcome measurement for social work practice as the profession enters the next millennium.
Colloquia on Domestic Violence Co-Sponsored
A two-part colloquium series on domestic violence was jointly sponsored by JBFCS and CUSSW staff in April and October 1994 at CUSSW The first part featured Kathryn Conroy CUSSW Assistant Dean/Director of Field Work, "The History of Battered Women," and Janet Geller, JBFCS Director, The Center for the Prevention of Family Violence, "Multi-Modality Approach to Treatment of Partner Abuse." The second part featured CUSSW Professor Randy Magen, "Child Abuse and Woman Abuse: One Problem or Two?" and Dr. Annaclare van Dalen, JBFCS Senior Supervisory/Clinical Social Worker, Madeleine forg Community Services, "Impact of Family Violence on Children." The series was planned by CUSSW Professors Helene Jackson, Neil Guterman and Ada Mui, and JBFCS staff Mr. Morris Black and Ms. Jackie Miller.
Symposium on Multicultural Issues and Practice with Geriatric Clients PlannedA half-day symposium on "Practice with Ethnic Minority Elders" will be held on March 23, 1995 at Columbia University Developed for the Columbia University Center for Geriatrics and Gerontology's 1993-1994 education program, the symposium is specifically designed to focus on multicultural issues JBFCS practitioners face in caring for geriatric clients. CUSSW Professors Denise Burnette, Ada Mui and Abraham Monk are developing and organizing the program to be offered under the sponsorship of the Center for the Study of Social Work Practice.
Helen Rehr and Ruth Fizdale Professorship in Health and Mental Health Announced
Dean Ronald A. Feldman has announced the establishment at CUSSW of the Helen Rehr and Ruth Fizdale Professorship in Health and Mental Health. This endowed professorship honors the contributions of Dr. Rehr and Ms. Fizdale to the fields of social work, health and mental health. Dr. Rehr is a member of the Center's Development Council.
Willma and Albert Musher Professorship Announced
Dean Ronald A. Feldman announced the establishment at CUSSW of the Willma and Albert Musher Professorship. This professorship honors the Willma and Albert Musher family It has been fully endowed by Mr. Albert Musher through a single gift which is the largest such gift received by CUSSW It is the only professorship in the field of social work in the United States exclusively focused on the examination of ways in which science and technology can be used to advance human betterment. Mr. Musher previously funded the development of two Center studies.
Ed Mullen Honored
The Catholic University of America honored Dr. Ed Mullen with The National Catholic School of Social Service 75th Anniversary Award for Distinguished Service on October 21, 1994. Dr. Mullen was recognized "as one of the pioneers in advocating for the practitioner-scholar model... [and] for his contribution to the knowledge development of social practice."
Grandparents Raising Grandchildren: A Group Intervention
Denise Burnette, PhD, MSSW
It is 5:30 a.m., and the housing projects of Brooklyn form a dim silhouette against the breaking day. The lights have been on in Mrs. S.'s apartment for half an hour, illuminating her strong, tender hands as they bathe and dress her 7-year-old granddaughter, who has cerebral palsy. The ritual is second nature; the child has been with Mrs. S. since birth. The routine is carefully timed, for two other grandchildren, ages 10 and 12, need to get to school, and a six-month old infant will soon wake.
Mrs. S. is special, but she is not alone. In 1980, the Bureau of the Census estimated that 2.0 million children lived with a grandparent (U.S. Bureau of the Census, 1991). In 1990, 3.4 million children 5% percent of all children under age 18-lived with a grandparent (U.S. Bureau of the Census, 1991).
This upward trend is due to a combination of structural changes in multigenerational families, such as longer lifespans and fewer children per generation; the outbreak of tragic social health problems, notably the crack: cocaine and HIV/AIDS epidemics; and the changing sociocultural norms and public policies that govern familial responsibility (Burnette, forthcoming).
Previous studies show that caregiving grandparents are at increased risk for emotional and physical health problems, social isolation, family conflict, and legal and financial obstacles. In a study of 74 African-American grandmothers canny for young kin due to the crack addiction of adult children in Oakland, California, Minkler and Roe (1992) found extraordinary dedication to childrearing commitments, but at enormous personal costs such as anger, despair and frustration. In a study of 60 grandparent caregivers in two urban African-American communities, Burton (1992) found that parenting grandchildren was emotionally rewarding, but at considerable psychological, physical and economic costs.
Family assistance for grandparents in their role as surrogate parents was sparse in both of these studies--only 3% of Burton's respondents reported having consistent familial support. Johnson and Barer (1990) found that older African-Americans in San Francisco who lacked adequate kin support tended to generate "fictive kin" (distant or nonfamilial support) to fill this gap.
Issues of private versus public responsibility for family welfare are complex, emotional and highly politicized. Empirical data on informal and formal support needs of grandparent caregivers and the efficacy of programmatic responses to these needs are limited. More research is needed to provide useful data, and more attention must be paid to the types of assistance that exist to fulfill the multifaceted needs associated with parenting grandchildren.
Support groups are the most common intervention for helping these grandparents cope with multiple life stresses. These rapidly proliferating groups are now tracked by a National Grandparent Information Center funded by the American Association of Retired Persons and the Brookdale Foundation Group. The content, format and usefulness of these groups appear to be quite variable. Only a few specific examples are documented in the literature. Vardi and Buchhok (1994) described a year- long psychotherapy group for eight grandmothers in which a psychoanalytic developmental orientation was employed.
Consistent with this approach to intervention and the need to conduct research and evaluation in this area, CUSSW Assistant Professor Denise Burnette and a group of JBFCS staff launched a structured, time-limited group intervention and a study to assess its efficacy in 1994. Partial funding for the development of the gmap and the study was provided by the Willma and Albert Musher Fund (see Musher Professorship Announced, page 5). Although it was originally designed as a quasi- experimental pretest-posttest study with a wait-list comparison group, time constraints prohibited recruitment of a comparison group. Outreach was targeted to all grandparent caregivers of children at a New York: City elementary school through its JBFCS on-site mental health program.
Eleven grandparents were selected. Group members, 10 African-American grandmothers and one Latino grandfather, were found to be similar to the "typical" profile of previous studies. Mean age was 57 and over half were widowed. Three- fourths reported that they were "doing okay" financially while the others were "barely getting by" Group members were canny for 2.67 grandchildren on average (range 1-5). About one-third of children had special physical, social, emotional and/or educational needs. Reasons given for caregiving were substance abuse, HIV/AIDS, incarceration and/or death of grandchildren's parents.
The nine sessions that comprised intervention were based on principles of psychoeducation and mutual aid. Educational material on designated topics were combined with discussion of the members' own experiences. Session topics included: 1. introductions/overview; 2. sodal supports: family friends and community; 3. stress and coping; 4. interpersonal family issues; 5. parent skills training; 6. Iegal and social services: rights, responsibilities, and entitlements; and 7. community-based initiatives.
Standardized instruments were used to gather data on venous dimensions of the group members' physical and mental health, well being, stress and coping, and social support. Pretest data suggest that group members were functioning quite well despite many challenges. Scores on the General Health Questionnaire (Goldberg & Hillier, 1979) were in the "nominal" range with none above the clinical cutting score. On the subscales, members showed highest scores for "anxiety and insomnia," "social dysfunction," and "somatic symptoms." Scores on "severe depression" were extremely low.
Randy Tanzer, CSW (JBFCS) Group Leader and Grandparents Group
The Ways of Coping (revised) instrument (Folkman et al., 1986) was used to assess the relative use of eight styles of coping with problems in caregiving. Group members used positive reappraisal most often, followed by (in descending order): seeking social support, problem solving, distancing, confrontation, accepting responsibility, and escape-avoidance.
The Social Support Behaviors (SS-B) Scale (Vaux, Riedel, & Stewart, 1987) was used to assess support from family and friends. Members' scores were generally very high. On a scale of 1-4, support from friends averaged 3.7, from family 3.9. With respect to specific dimensions of support, highest ratings from family were on emotional support, followed by financial, practical, advice, and socializing types of support. Emotional support also ranked highest for friends, with practical, advice, socializing, and financial support following. Knowledge of and need for 14 different types of services also were assessed. Members expressed both lack of knowledge about the special needs of their grandchildren, and the need for such services. Other services needed by at least half of group members were education/counseling for special emotional needs of children, counseling for self, respite childcare services, stress management techniques and education about social problems. Posttest measures of the standardized scales are being analyzed to determine if specific areas of knowledge and/or functioning improved with group sessions.
Qualitative data will be examined to further assess group outcomes. Audiotapes of the nine sessions will be analyzed for content and process. During the last group meeting, members convened congenially about the flow of everyday lifeólooking back, forward and living today As they prepared to disband for the summer, Mrs. S. was networking among members to seek support for her work during the next school year as President of the Parent Teacher Association. Clearly, much repetition exists in this cycle of life that revolves around child-rearing for three, four, even five decades. Yet, continual learning and growth also are possible, as evidenced in this group.
Principal Investigator: Denise Burnette, PhD, MSSW (CUSSW) Group Leader and Project Facilitator: Randy Tanzer, CSW aBFCS) Project Facilitators: Jennifer Crumpley, CSW; Jonathan Katz, CSW; Vickie Rosenstreich, ACSW and Ruby Thompson, CA (JBFCS)
1. Burnette, D. (forthcoming). One more time with (mixed) feelings: Grandmothers parenting grandchildren. In B.L. Simon PH. Mayhew (Eds.). Single women in America since 1945. New York: Greenwood Press.
2. Burton, L.M. (1992). Black grandparents rearing children of drug- addicted parents: Stressors, outcomes, and social service needs. The Gerontologist, 32 (6), 744-751.
3. Folkman, S., Lazarus, R.S., DunkelSchetter, C., DeLongis, A. & Gruen, RJ. (1986). Dynamics of a stressful encounter: Cognitive appraisal, coping, and encounter outcomes. J Personality and Social Psychol, 50 (5), 992-1003.
4. Goldberg, D.P & Hillier, VF (1979). A scaled version of the General Health Questionnaire. Psychological Med, 9, 139-145.
5. Johnson' C.L. & Barer, B. (1990). Families and networks among older inner city blacks. Gerontologist, 30 (6), 726-733. . Minkler, M. & Roe, K. (1992). Forgotten Caregivers: Grandmothers Raising the Children of the Crack Cocaine Epidemic. Newbury Park, CA: Sage.
. . U.S. Bureau of the Census (1991). Current population reports: Mental status and living arrangements: March 1990. (Series P-20 No. 450). Washington, DC: U.S. Government Printing Office.
8. Vaux, A, Riedel, S. & Stewart, D. (1987). Modes of social support: The Social Support Behaviors (SS-B) Scale. Am J Comm Psychol, 15 (2), 209-237.
The Empirical Development of an Early Child Maltreatment Prevention Program
Neil B. Guterman, PhD
Despite the ongoing struggle over the past several decades to stem the tide of child abuse and neglect in the U. S., all signs suggest that the problem continues to rise. As compared to the 1.2 million reports of suspected child abuse and neglect in 1982, 1992 saw more than double that figureó 2.9 million reports. More than three children each day die because of child maltreatment, and 87% of these are under five years of age (McCurdy Daro, 1993; Cohn Donnelly 1991).
The typical service path in child maltreatment begins after maltreatment has been suspected. However, by this point children frequently have suffered significant if not disastrous consequences. Family problems typically are entrenched and at a crisis point, and intervention, via the child protective services system, is usually involuntary, stigmatizing and often insufficient to overcome the depth of family problems associated with the maltreatment.
A host of clinical interventions aimed at ameliorating child maltreatment and its effects, after families have already been identified as maltreating, has shown questionable empirical efficacy (Shuerman, et al., 1993; Rossi, 1992; Cohn & Daro, 1987). All the more concerning are the great social and economic costs of such "after the fact" services, particularly when the need arises to place a child out of the home.
Preventive interventions, initiated before maltreatment occurs, offer the promise of servicing families proactively while at the same time alleviating the underlying conditions which appear to breed abuse and neglect. Early child maltreatment prevention programs typically service families in the home, targeting parenting skills and knowledge, and assisting families to link up with necessary resources and services, like health care for the young child or professional counseling for the parent(s). Early reports from Hawaii's "Healthy Start" program, currently considered the dominant program model in early child maltreatment prevention, have touted promising results: "Not a single case of abuse among the project's 241 high risk families (seen between 1985- 1988) had been reported since the demonstration began" (Breaky & Pratt, 1991).
Despite such reports and the intrinsic attractiveness of early child maltreatment programs in general, the existing empirical evidence raises many questions. For example, while parenting and formal supports are addressed in programs like Healthy Start, several risk factors remain largely untargeted by current intervention modelsómost particularly those associated with client powerlessness, such as poverty, social isolation, and minority group status (Garbarino, & Kostelny, 1992; Hampton, 1987; Spearly & Lauderdale, 1983; Cazenave & Straus, 1979; Pelton, 1979).
A more careful look at the most complete and recent (unpublished) data of the Healthy Start model provides a less sanguine picture than originally presented: Of 1,204 high- risk families serviced by the program (in 19871990), 10 were confirmed for abuse or neglect (99.2% nonabuse rate). In a comparison (uncontrolled) group of 337 high-risk families not receiving services, 9 were confirmed for abuse or neglect (97.3% nonabuse rate). In short, this initial nonexperimental data indicate a 1.9% difference in maltreatment rates between high-risk families receiving the Hawaii Healthy Start services and those that do not (State of Hawaii Department of Health, 1991).
Of the more controlled studies that utilize randomly assigned control groups and specific child maltreatment outcome measures (e.g., Brayden, et al., 1992; Barth, 1991; Siegel, et al., 1980; Olds, 1986), only one (Olds, et al., 1986) demonstrates clinical effectiveness. All controlled studies that reported nonsignificant findings had key inadequacies in the intervention designs employed.
No work has attempted to systematically and empirically ground the design and development of an optimal primary prevention model, prior to controlled evaluation. An approach that integrates both clinical research and practice methods can increase the likelihood of determining what optimally prevents maltreatment, and can significantly enhance the reliable transfer of effective services to a range of other sites.
Encouraged by earlier collaborative applications of a "developmental research" methodology (Rothman & Thomas, 1994) to other child welfare innovations (Guterman et al., 1989; Hodges, et al., 1989), CUSSW Assistant Professor Neil Guterman maintains that this approach has great potential to yield an effective innovation in early child maltreatment prevention. Developmental research methods draw upon empirical procedures to develop social work technologies which are clearly specified, clinically effective and transferable to a range of other sites.
In the past year, the Center and the JBFCS provided funding to initiate such a study. Using a developmental research methodology U?othman Thomas, 1994), the study seeks rigorous intervention knowledge to answer: How can we best prevent child maltreatment before it occurs? The study will examine the design and development of an early child maltreatment prevention program.
While not yet field tested, the intervention design draws from earlier program models such as the Healthy Start model, and includes support components that explicitly address parents' empowerment. Program components include a differential screening and assessment prior to or at birth of a first child, provision of home and group-based services, coordination with medical support for referral and services, parenting support, mutual support, and case management. In the "developmental" or field testing phase, the program will provide prototype services to families residing in the Upper West Side and Central Harlem areas of Manhattan, a cachement area that includes neighborhoods among the highest risk for child maltreatment and poor early childhood outcomes in the state of New York (New York State Department of Health, 1994). The JBFCS Preventive Services programs, directed by Rhona Triggs, CSW, will participate in this phase. The project is seeking larger scale funding to support full field testing and summative evaluation.
Principal Investigator: Neil B. Guterman, PhD (CUSSW)
Project Steering Committee Members: Robert Abramovitz, MD; Bruce Grellong, PhD; Jackie Miller, MSW, CSW; Alan Siskind, PhD (JBFCS)
1. Barth, R. (1988). Preventing child abuse: An experimental evaluation of the child parent enrichment project. J Primary Prev, 8, 4, 201-215.
2. Brayden, R. M., Altemeier, W A., Dietrich, Ms, Tucker, D. D, Christensen, M J., Mclaughlin, E J, & Sheffod, K B (1993). A prospective study of secondary prevention of child maltreatment. Pediatrics, April, 5,11-516.
3. Breakey, G. &r Pratt, B (1991) Healthy Growth for Hawaii's "Healthy Start": Toward a Systematic Statewide Approach to the Prevention of Child Abuse and Neglect. Zero to Three, 11 (4), 16-22.
4. Cazenave N &: Straus, M (1979). Race, class, network embeddedness and family violence: A search for potent support systems. J Comparative Family Studies, 10, 3, 282-300.
5. Cohn, A. (z Daro, D (1987).1s treatment too late: What ten years of evaluative research tell us. Child Abuse and Neglect, 1, 433-442.
6. Cohn DonneHY A. (1992). Investing in Prevention: Healthy Families in America, Testimony presented before the Select Committee on Children, Youth and Families, Apnl 2, 1992.
7 . Cohn Donnelly A. (1991). What we have reamed about prevention: What we should do about it, Child Abuse and Neglect, 15, 1, 99-106.
8. Daro, D. (1990). Prevention of child physical abuse. In R. T Ammemlan & M. Hersen (Eds.) Treatment of Family Violence: A Sourcebook, NY: John Wiley & Sons, pp. 331-353.
9. Daro, D. (1988). Intervening with New Parents: An Effective Way to Prevent Child Abuse. Working Paper of the National Center on Child Abuse Prevention Research, Chicago: NCPCA.
10. Garbanno, J. & KostelnY K. (1992). Child maltreatment as a community problem, Child Abuse and Neglect, 16, 455-462.
11. Gutemman, N. B., Hodges, V G., Blythe, B. J., &: Bronson, D. E. (1989). Aftercare service development for children in residential treatment. Child and Youth Care 2uarterly, 18 (2), 119-130.
12. Hampton, R. L. (1987). Race, class and child maltreatment. J Comparative Fam Studies, 18, 1,113-126.
13. Hodges, V G., Gutemlan, N. B., Blythe, B. J. &: Bronson, D. E. (1989). Intensive aftercare services for children. Social Casework, 70(7), 3974-4.
14. McCurdy K. & Daro, D (1993). Current trends in Child Abuse Reporting and Fatalities: The Results of the 1992 Annual Fiity State Survey, National Committee to Prevent Child Abuse (Chicago, IL), April.
15. Olds, D. L., Henderson, C. R., Chamberlin, R. & Tatelbaum, R. (1986). Preventing child abuse and neglect: A randomized tnal of nurse home visitation. Pediatrics, 78, 65-78.
16. New York State Department of Health (1994). Request for proposals: Pennatal networks, community health worker program and regional outreach and education, August 16.
17. Pelton, L. (1978). Child abuse and neglect: The myth of classlessness. Amencan Journal of Orthopsychiatry, 48, 4, 608-617.
18. Rothman, J. & Thomas, E. J. (Eds.) (1994). Intervention Research: Design and Development for Human Services. Binghamton, NY: Hawthorne Press.
19. Rossi, P H. (1992). Assessing family preservation programs. Children and Youth Services Rev, 14, 77-97.
20. Schuemman, J. R., Rzepnicki, T L., Littnell, J. H., & Chak, A. (1993). Evaluation of the Illinois Family First Placement Prevention Program: Final Report. Chicago, IL: Chapin Hall Center for Children.
21. Siegel, E., Bauman, K., E., Schaefer, E. S., Saunders, M. M. & Ingram, D. D. (1980). Hospital and home support during infancy: Impact on matemal attachment, child abuse and neglect, and health care utilization. Pediatrics, 66, 2, 183-190.
22. Spearly, J. & Lauderdale, M. (1983). Community charactenstics and ethnicity in the prediction of child maltreatment rates. Child Abuse and Neglect, 7, 91-105.
23. State of Hawaii Department of Health (1991). Healthy Start/Family Support Programs: Evaluation Results.
24. Willis, D. J., Holden, E. W & Rosenberg, M (Eds.) (1992) Prevention of Child Maltreatment Developmental and Ecological Perspectives, NY: John Wiley & Sons.
A Study of Suicidal Ideation and Behavior in Preadolescents
Helene Jackson, PhD
Available data suggest that preadolescent suicidal ideahon may be one of the most common symptomsfound in senously mentally ill young children (Brent et al, 1986; Hendin, 1986; Pfeffer et al, 1979; Pfeffer, 1978; Plutchik and van Pruag, 1990; Shaffer, 1974). Despite reports of a high prevalence of suicidal activity in psychiatnc outpatient children (60%) (Carlson & Cantwell, 1982), few systematic studies of suicidal ideation and behaviors in this population have been conducted.
Awareness of the prevalence and correlates of suicidal thoughts and behaviors among preadolescents is of particular concem to social workers who provide most of the mental health services to children and their families. identified factors that place children at risk for suicidal behavior include mood disorders (Brent et al.,1986; Harnngton et al.,1993; Pfeffer et al.,1988; Pfeffer et al., 1991), prior suicide attempts (Eisenberg, 1984; Weissman, 1974), age (Bolger, Downey, Walker, & Steininger, 1989; Hoberman & Garfinkel, 1988), substance abuse (Hoberman & Garfinkel, 1988), gender (Hendin, 1986), concept of death as transient (Pfeffer et al., 1993), a history of physical and sexual abuse (Briere, 1989; Browne & Finkelhor, 1986; Wozencraft et al., 1991), preoccupation with death (Pfeffer and Trad, 1988), running away (RotheramBorus & Bradley, 1991), assaultive behavior (Pfeffer et al., 1979) conduct disorders (Apter, Bleich, Plutchik, Mendelsohn, & Tyano, 1988), and a broad range of additional psychopathology (Brent et al., 1986).
Parental factors associated with a child's suicidal ideation and/or behavior include parental conflict, major mental illness, separation, substance abuse and death (Dorpat, Jackson and Ripley 1965). Garbanno (1993) proposes that environmental factors such as neighborhood violence, poverty and cultural expectations also can affect an individual's motivation for suicide (Hendin, 1986). Despite these associations, it remains unclear if suicidality is a result of these nsk hctors or the consequence of a combination of other dysfunctional variables such as family structure, the nature and quality of familial and peer relationships, environmental factors and the like. It continues to be difficult to accurately identify or predict the probability of attempted suicide or suicide (Hendin, 1986).
It is difficult for parents to recognize a child's suicidal behavior (Rosenthal & Rosenthal, 1984). Physicians are reluctant to report it, and clinicians hesitate to ask about
suicide directly In the absence of specific instructions and agency support, practitioners may avoid exploring violent behavior, in general, or suicide in particular, as factors that contubute to or are associated with their clients' presenting problem (BreLke, 1987; Jacobson and Richardson, 1987; Post, Willett, Franks, House, Back & Weissberg, 1980; Rotheram-Borus, 1989). Psychiatric evaluations of outpatient psychiatric children do not routinely include assessment of suicide risk or questions about preoccupation with death and self- destructive behavior (Pfeffer et al., 1979). Further, little empincal knowledge exists to guide clinicians in identifiying and assessing this complex, potentially lethal phenomenon. In 1992, Dr Annaclare van Dalen's &BFCS Senior Supervisory/Clinical Social Wor1cer) interest in understanding an observed high rate of suicidal ideation and behaviors among preadolescent clients at one of theJBFCS clinics led her to discussions with Centerfaculty Consistent with the literature, and their similar interests in preadolescent suicidality, Drs. Annaclare van Dalen, HeleneJachson and Peg Hess (CUSSW faculty) collaborated to better understand the observed phenomenon atJBFCS and to develop a study with two main objectives: 1. to test the effects of the routine clinical application of a standardized assessment protocol (Pfeffer 1978) on the identification of preadolescent suicidality and 2. to test the validity of a developmental and ecological model offactors associated with preadolescent suicidality The model that informs the protocol used in the study is derived from developmental and ecological theories. The Mod)fied Pfeffer Suicide Potential Scale (PSPS) (1978; Jackson, Hess, & van Dalen, 1994), designed for use with 6-12 year olds, is an extensive, well developed instrument that generates data on the protective and nsk hctors for, and incidence of, suicidal activity Among hctors expected to be associated with lower risk for preadolescent suicide are positive child attubutes and social and hmily support. The study's sample consists of four groups of 40 preadolescents (total 160) who present for treatment at the JBFCS' Madeleine Borg Community Ser. vices, Pelham and Beatman clinics. At Pelham, data are being obtained using the new assessment procedures. At Beatman, data will be obtained from existing assessment procedures. Baseline data, based on examination of clinic records, will be obtained from both sites and analyzed for the frequency of case finding of suicidal behavior in the designated population.
At this writing, data have been collected on 21 preadolescents and their hmilies. Preliminary analysis shows that approximately half of the preadolescents participating in the study reported suicidal thoughts either currently, or within the six months pnor to their interviews. One had made suicide threats, and one had actually attempted suicide.
The study will examine associations between the independent vanables_childhood traumas, childhood nsk hctors, hmily stressors, child adapative hctors, social supports and hmily supports and suicidal ideation, threats and/or action. It is hypothesized that the independent vanables_childhood traumas, childhood risk factors and family stressors_will be associated with greater nsk for the dependent vanable suicidality Conversely, we hypothesize that the independent vanables_child adaptive hctors, social supports and hmily supports_ will be associated with lesser risk for the dependent vanable suicidality
The literature suggests that the nsk that young children will become suicide "completers" is low. Yet, even conservative estimates of the number of children reported to have suicidal ideation are of concern to all those responsible for the care and protection of preadolescents and their hmilies. This study's findings will have important implications for developing new modes of assessment as well as for implementing prevention and remedial interventions for preadolescent suicide.
Principal Investigator: Helene Jackson, PhD (CUSSW) Co- lnvestigator: Peg Hess, PhD (CUSSW) Clinical Investigator: Annaclare van Dalen, PhD (JBFCS)
1. Apter, A., Bleich, A., Plutchik, R, Mendelsohn, S. and Tyrano, S. (1988). Suicidal Behavior, depression, and conduct disorder in hospitalized adolescents.Journal of the American Academy of Child and Adolescent Psychiatry, 27 (6), 696- 699.
2. Bolger, N., Downey, G., Walker, E., & Steininger, P (1989). The onset of suicidal ideation in childhood and adolescence. J of Youth and Adolescence, 18(2), 175-190.
3. Brekke, J.S. (1987). Detecting wife and child abuse in clinical settings. Social Casework, 68 (6), 332-338.
4. Brent, D.A., Kalas, R., Edelbrock, C., Costello, AJ., Dulcan, M.K. and Conover, N. (1986). Psychopathology and its relationship to suicidal ideation in childhood and adolescence. J Am Acad Child Psychiatry, 25(5), 666-673.
5. Bnere, J. and Runtz, M. (1986). Suicidal thoughts and behaviors in former sexual abuse victims. Can J Behav Sacnces, 18, 413-423.
6. Browne, A. and Finkelhor, D. (1986). Impact of child sexual abuse: A review of the research. Psychological Bull, 99 (1),66-77.
7. Carlson, G.A. and Cantwell, D.P (1982). Suicidal behavior and depression in children and adolescents. J Am Acad of Child Psychiatry, 21, 361-368.
8. Carlson, G.A. and Kashani,J.H. (1988). Phenomenology of major depression from childhood through adulthood: Analysis of three studies. Am J Psychiatry, 145, 1222-1225.
9. Eisenberg, L. (1984). Adolescent suicide: on taking arms against a sea of troubles. Pediatrics, 66, 315-320.
10. Garbarino, J. (1993) Personal Communication. Columbia University School of Social Work, New York.
11. Harrington, R., Fudge, H., Rutter, M., Pickles, A. and Hill, J. (1990). Adult out comes of childhood and adolescent depression. Arch Gen Psychiatry, 47, 465473.
12. Hendin, H. (1986). Suicide: a review of new directions in research Hosp Com Psychiatry, 37 (2), 148-154.
13. Hobennan, H.M. and Garfinkel B.D. (1988). Completed suicide in children and adolescents. J Am Acad Child and Adolescent Psychiatry, 27 (6) 689-695.
14. Jacobson, A. and Richardson, B. ( 1987). Assault experiences of 100 psychiatric inpatients: Evidence of the need for routine inquiry. Am J Psychiatry, 144 (7) 908913.
15. Jackson, H., Hess, P and van Dalen, A. (1994). Modified Pfeffer Suicidal Potential Scale (unpublished)
16. Pfeffer, C.R. (1987). Elements of treatment for suicidal preadolescents. American Journal of Psychotherapy XLT (2), 172-184.
17. Pfeffer, C.R., Conte, H.R., Plutchik, R. and Jerrett, l. (1979). Suicidal Behavior in Latency Aged Children. J Am Acad Child Psychiatry, 18 (4), 679-692.
18. Pfeffer, C.R., Klerman, G.L., Hurt, S.W, Kakuma, f, Peskin, J.R. and Siefker, C.A. (1993). Suicidal children grow up: Rates and Psychosocial risk factors for suicide attempts during follow-up. J Am Acad of Child and Adolescent Psychiatry, 32 (1), 106-113.
l9. Pfeffer, C.R., Klerman, G.L., Hurt, S.W, Lesser, M., Peskin, J.R. and Siefker, C.A. (1991) Suicidal children grow up: Demographic and clinical risk factors for adolescent suicide attempts. J Am Acad of Child and Adolescent Psychiatry, 30, 609- 616.
20. Pfeffer, C.R., Lipkins, R., Plutchik, R. and Mizruchi, M. (1988) Suicidal behavior in latency age children. J Am Acad of Child Psychiatry, 27 (1), 34-41.
21. Pfeffer, C.R. and Trad, PB. (1988). Sadness and suicidal tendencies in preschool children. Developmental and Behavioral Pediatrics, 9, 86-88.
22. Plutchik, R. and van Praag, H.M. (1990). Psychosocial correlates of suicide and violence risk (37-67). In H.M. van Praag, R. Plutchik and Apter, A. (eds.), Violence and Suicidality New York: Brunner/Maazel.
23. Post, R.D., Willett, A.B., Franks, R.D., House, R.M., Back, S.M. and Weissberg, M.P (1980). A preliminary report on the prevalence of domestic violence among psychiatric inpatients. Am J Psychiatry, 137 (8) 974-975.
23. Rosenthal, PA. and Rosenthal, S. (1984). Suicidal behavior by preschool children. Am J Psychiatry, 141, 520-525.
24. Rotheram-Borus, M.F and Bradley J. (1991). Triage model for suicidal runaways. Am J Orthopsychiatry, 61 (1), 122127.
25. Shaffer, D. (1974). Suicide in childhood and early adolescence. Journal of Child Psychology and Psychiatry, 15, 275-291.
26. Weissman, M. (1974). The epistemology of suicide attempts, 1960-1971. Arch Gen Psychiatry, 32, 1166-1171.
27. Wozencraft, T, Wagner, W and Pellegnn, A. (1991). Depression and suicidal ideation in sexually abused children. Child Abuse and Neglect, 15, 505-511.
Practitioner-Researcher Partnerships: Building Knowledge From, In, and For Practice Is Published
Practitioner-Researcher Partnerships: Building Knowledge From, In, and For Practice will be published in February 1995 by NASW Press. The book includes original chapters as well as papers prepared for the Center's 1993 conference, "Knowledge for Practice: Practitioners and Researchers as Partners" (see Table of Contents, below). It is edited by Peg Hess, CUSSW Associate Professor and Associate Dean, and Ed Mullen, CUSSW Professor and Center Director. Following is an excerpt from its Foreword. Ordering information is provided for your convenience.
Excerpts from the Foreword
For at least three decades, social workers of all typesópractitioners, administrators, researchers and educatorsóhave inveighed about the need to build effective partnerships between the worlds of research and practice. Yet, their actions and accomplishments have lagged far behind their rhetoric, exhortations and hopes. They have not kept pace with the ever accelerating demands for productive partnerships and with the enviable progress made by allied helping professions. The extant literature reveals few examples of effective practice-research collaborations in social work. Nor does it provide practical considerations that need to be pondered if such partnerships are to be realized.
If the worlds of social work practice and research do not soon respond to the growing demands for meaningful collaboration, it is entirely possible that the profession will squander a crucial opportunity to improve its effectiveness, to demonstrate that it merits strong fiscal and moral support, and to sustainómuch less enhanceóits credibility and standing in the eyes of clients, policy makers, funders and fellow professionals.
Publication of [this book] is therefore timely relevant and of overarching importance for all sectors of the social work profession. It does not merely add one more voice to the call for effective linkages between research and practice. Rather, it draws upon the talents of numerous contributors who consider in depth and breath the myriad variables that must be understood to bring about such partnerships. It can reassure doubting skeptics and worried professionals by demonstrating that it is possible, in fact, to forge effective partnerships between social work researchers and practitioners.
In sum the authors promote effective partnerships between social work research and practice by addressing in each detail the complexities that must be considered if true advances are to be made.
Alan B. Siskind, PhD, Executive Vice President Jewish
Board of Family & Children's Services
Ronald A. Feldman, PhD, Dean Columbia University School of Social Work
Practitioner-Researcher Partnerships: Building Knowledge From, in, And For Practice
Edited by Peg Hess and Ed Mullen
Table of Contents
1. Bridging the Gap: Collaborative Considerations in Practitioner
Researcher Knowledge-Building RelationshipsñPeg McCartt
Hess, PhD & Edward J. Mullen, DSW
2. Reflective Inquiry in Social Work PracticeñDonald A. Schön
3. Reflecting In and On Practice: A Role for Practitioners in Knowledge BuildingñPeg McCartt Hess, PhD
4. Promoting Reflective Social Work Practice: Research Strategies and Consulting PrinciplesñIrwin Epstein, PhD
5. Research for Initiatives in Low-income CommunitiesñClaudia Colton, PhD
6. Research as an Act of PracticeñJuliet Cheetham, MA
7. Intersecting the Parallel Worlds of Practice and Research: An Agency Practitioner-Academic Researcher TeamñDenise Burnette, PhD & Audrey Weiner, DSW
8. The Practitioner-Researcher Team: A Case ExampleñRita Beck Black, DSW & Virginia Walter, MSW
9. Agency-University Collaboration: Partnerships for Implementing and Studying Practice InnovationsñArthur Blum, DSW, David E. Biegel, PhD, Elizabeth M. Tracy, PhD & Mary Jane Cole, MSW
10. Research Collaboration Among Hospital Social Work AdministratorsñMildred Mailick, DSW Michael King, DSW James Donnelly, DSW & Sona Euster, ACSW
11. Developing a Research Unit Within A Hospital Social Work DepartmentñGrace H. Christ, DSW & Karolynn Siegel, PhD
12. The Expert System as a Metaphor for Professional Knowledge DevelopmentñWilliam J. Fems, PhD & Manon Reidel, CSW
13. Research, Practice and Expert SystemsñJohn Schuemman, PhD
14. Toward Research Practice DevelopmentñEdward J. Mullen, DSW Peg McCartt Hess. PhD
To order Practitioner-Researcher
Partnerships: Building Knowledge From, In, and For Practice: By
Phone: Call 1-800-227-8590 and use Visa or Mastercard. In
the Washington, DC area call 301-317-8688; By Fax: Send
your orders to us at 301-206-7989: By Mail: Send the order
form printed in the paper issue of Research & Practice and your payment to the NASW Distribution Center, PO. Box 431, Annapolis, JCT, MD 20701, USA
Selected Publications of Center Associates 1994
Burnette, D. & Mui, A.C. (in press). In-home and community-based service use by three groups of elderly Hispanics: A national perspective. Social Work Research.
Ivanoff, A. Blythe, BJ. & Tripodi, T (1994). Involuntary clients in social work practice: A research-based approach. Hawthome, NY: Aldine deGrnyter.
Jackson, H., Hess, P & van Dalen, A. (1994). Preadolescent suicide: How to ask and how to respond (in press). Families in Society Kettner, PM. & Martin, L.L. (1994). Will privatization destroy the traditional nonprofit human services sector? NO! In MJ. Austin and J.I. Lowe (Eds.). Controversial issues in communities and organizations: Perspectives on macro-practice, pp.l64, 166-177. Boston: Allyn & Bacon, .
Mattaini, M.A. & Thyer, B.A. (Eds.) (Forthcoming). Science, Behavior and Social Issues. Washington, DC: American Psychological Association.
Mui, A.C. & Burnette, D. (1994). A comparative profile of frail elderly persons living alone and those living with others. J Gerontological Social Work, 21, (3/4), 5-26.
Mullen, EJ. (1994). Design of social intervention. In J. Rothman
& E. Thomas (Eds.). Intervention research: Design and development
for human services. New York: Hawthorne Press.
The Center for the Study of Social Work Practice is
a joint program of the Columbia University School of Social Work
and the Jewish Board of Family and Children's Services
The purpose of the Center is to advance social work knowledge by linking research skills and practice experience.
Dr. Alan B. Siskind|
Executive Vice President
Jewish Board of Family and Children's Services
|Dr. Ronald A. Feldman|
Columbia University School of Social Work