The Phased Integrated Community (PIC) Model: A Framework for Care and Child Protection
Global cases of child abuse and neglect highlight the need to generate improved frameworks of care, support and child protection. A number of models exist globally, albeit with limitations. This paper draws from the evidence base and a Ugandan study which sought to understand the existing mechanisms of support for orphans and vulnerable children (OVC) including the availability, efficacy and limitations of these support systems. Building on the limitations of the existing interventions, this paper proposes the Phased Integrated Community (PIC) model, a hybrid framework that draws from existing models in the fields of social sciences and epidemiology to provide solutions for OVC care and support.
The PIC model critiques the inherent limitations of existing frameworks and adapts their unique strengths. The model also highlights that the notion of child agency is under-developed in most OVC interventions, arguing that this could partly explain their marginal impact, and then makes a case for incorporating child agency in childcare and child protection.
The proposed model challenges dominant discourses on childhood and focuses on the agency, aspirations and expressed needs of OVC. A key argument is that nuanced and accurate representations of OVC are critical to their support. This framework positions OVC at the heart of their communities, highlighting the limitations of some cultural and structural aspects. It is cognizant of the strained community capacity (rupture theory), in spite of its willingness to provide quality care and support. The framework also aligns itself with, and supports, national policy and cherished cultural values in Uganda that the extended family and community should be the first line of response for OVC.
Do Psychiatry and Family Medicine Residents Differ with Regard to Attitudes towards Treating Substance Use Patients
Background and Objective: Substance use disorders are a major health issue affecting many who present for treatment for psychiatric and medical problems. Substance use is associated with employment problems, relational difficulties, child abuse, stress and percentages of untimely deaths. Training and exposure has been shown to lessen negative stigmatizing attitudes towards the treatment of people suffering from substance abuse problems. In the current study, we investigated whether psychiatry and family medicine residents would have different attitudes towards these patients.
Methods: 23 psychiatry residents and 19 family medicine residents consented were asked write about the last substance abuse patient they treated to prime their memory and then complete a self-report that measures clinicians feelings about their patients.
Results: We found no statistical difference between the family medicine and psychiatry residents with regard to their attitudes and feelings toward SUDs patients they treat. Our results also showed that experience or year of training in the residency program was not linked with any significant different in scores on the CTQ scales.
Conclusion: This result is interesting given that psychiatry residents often have much more training and exposure to this population than their peers in this family medicine residency. But less family medicine departmental hostility towards substance abuse patient as a whole, extra training in the field of addiction for the substance abuse treatment could be possible for this result.
Dental Graduates Awareness of Child Abuse and Neglect (CAN)
Aims: To assess the knowledge and attitude of dental graduates regarding identification of child abuse and neglect (CAN).
Study Design: This study included Dental graduates from Krishna and West Godavari districts of Andhra Pradesh, India. A questionnaire with 15 questions about Dentists’ attitudes, Dentists’ knowledge on “Child Abuse and Neglect” was made. Two hundred randomly selected dentists who have minimum five years of clinical experience were selected from the Indian Dental Association database and questionnaire was sent to them by post with return postage paid.
Place and Duration of Study: Department of Pedodontics & Preventive Dentistry, St. Joseph Dental College, Duggirala, Eluru. Between June 2014-November 2014.
Methodology: In an effort to understand the dental graduates’ mindset in an ever changing scenario so that children can be identified and rendered proper care at the right time in the right way. Questionnaires were sent via post to two hundred dental graduates with the minimum of five years working experience, working in both public and private sectors. The questionnaire contained three sections with a total of 15 questions. The response formats were tabulated and analyzed statistically.
Results: Hundred and seventy dental graduates responded to the questionnaire.
Conclusion: The dentists who responded demonstrated an overall poor understanding about the problem of Child Abuse and Neglect, despite a very high level of interest showed by them for further information about their responsibilities.
DISSOCIATIVE (CONVERSION) DISORDER FOLLOWING SERIAL SEXUAL ABUSE OF A 16 YEAR OLD GIRL CHILD: A CASE REPORT
Introduction: Conversion disorder resulting from the developmental history of many years of sexual abuse in adolescent females who are never heard, is often a rare feature in our cultures. Consequently, they explain themselves in unusual symptoms. This is the rationale for this report which is an original case report of interest to a particular clinical speciality of mental health but it will have a broader clinical impact across medicine especially for general practitioners, on the need to reduce cases of missed diagnosis. The findings in this study therefore, will significantly advance our knowledge of conversion disorders and the different ways it can present, to cause diagnostic puzzles.
Case Presentation: A 16-year-old high school female student in Rivers State, Nigeria, presented to a primary care private clinic in August 2015, with the history of seizures with abnormal behaviour. She was consequently referred to a mental health physician for evaluation. On psychiatric interview and mental health examination, it was found out that the patient had pseudoseizures following serial sexual abuse by caregivers. Bio-psycho-social Model was employed in the management of this patient with a good outcome.
Conclusions: The psychological factor of child abuse triggering this peudoseizure, points to the fact that parents should be more proactive and careful with their children in the guardianship of family members or friends and emphasizes the need for medical practitioners, to raise their index of suspicion in order to reduce cases of missed diagnosis.
Treatment strategies for ADHD: an evidence-based guide to select optimal treatment
Attention-deficit/hyperactivity disorder (ADHD) is a common and impairing disorder affecting children, adolescents, and adults. Several treatment strategies are available that can successfully ameliorate symptoms, ranging from pharmacological to dietary interventions. Due to the increasing range of available options, an informed selection or prioritization of treatments is becoming harder for clinicians. This review aims to provide an evidence-based appraisal of the literature on ADHD treatment, supplemented by expert opinion on plausibility. We outline proposed mechanisms of action of established pharmacologic and non-pharmacologic treatments, and we review targets of novel treatments. The most relevant evidence supporting the efficacy and safety of each treatment strategy is discussed. We review the individualized features of the patient that should guide the selection of treatments in a shared decision-making continuum. We provide guidance for optimizing initiation of treatment and follow-up of patients in clinical settings.