Publications (9)25.81 Total impact
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Article: Adding positive reinforcement in justice settings: acceptability and feasibility.
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ABSTRACT: Although contingency management (CM) approaches are among the most promising methods for initiating drug abstinence (S. T. Higgins, S. M. Alessi, & R. L. Dantona, 2002; S. T. Higgins, S. H. Heil, & J. P. Lussier, 2004), adoption and implementation of CM protocols into treatment programs are both challenging and infrequent. In criminal justice agencies, where roughly 70% of clients report substance abuse issues (F. S. Taxman, K. L. Cropsey, D. W. Young, & H. Wexler, 2007), CM interventions are virtually nonexistent. The Justice Steps (JSTEPS) study uses a longitudinal, mixed-method design to examine the implementation of a CM-based protocol in five justice settings. This article presents qualitative data collected during Phase 1 of the JSTEPS project regarding the acceptability and feasibility of CM in these justice settings. The study finds a level of acceptability (find CM tolerable) and feasibility (find CM suitable) within justice agencies, but with some challenges. These challenges are reflected in the following: (a) incorporating too many desired target behaviors into CM models; (b) facing intraorganizational challenges when designing CM systems; and (c) emphasizing sanctions over rewards despite the evidence-base for positive reinforcers. These findings have implications for advancing the dissemination, adoption, and implementation of evidence-based treatments (and CM in particular) in criminal justice settings.Journal of substance abuse treatment 09/2011; 42(3):260-70. · 2.90 Impact Factor -
Article: Money boys, HIV risks, and the associations between norms and safer sex: a respondent-driven sampling study in Shenzhen, China.
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ABSTRACT: Money boys (MBs) are male sex workers who sell sex to men who have sex with men (MSM). This study estimates the proportion of MBs in the Chinese MSM, compares HIV risks between MBs and non-MB MSM, and examines the associations between practicing safer sex and peer norms of condom use. Respondent-driven sampling (RDS) was used to sample 351 MSM in the city of Shenzhen in 2007. The RDS-adjusted proportion of MBs among MSM was 9%. Compared to non-MB MSM, more MBs reported having had multiple male and female sexual partners. Half of MBs and non-MB MSM had consistently used condoms. Both descriptive and subjective norms were positively associated with condom use. The MB proportion of 9% in MSM implies a relatively large population of MBs in China. The association between peer norms and consistent condom use can assist with the development of culturally competent HIV interventions that promote safer sex.AIDS and Behavior 11/2008; 13(4):652-62. · 3.49 Impact Factor -
Article: Age-sex differences in medicinal self-poisonings: a population-based study of deliberate intent and medical severity.
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ABSTRACT: Deliberate self-harm (DSH) is related to suicide and DSH repetition is common. DSH hospital presentations are often self-poisonings with medicinal agents. While older age and male sex are known risk factors for suicide, it is unclear how these factors are related to the nature and severity of medicinal self-poisoning (SP). Such knowledge can guide prevention strategies emphasizing detecting and treating mental illness and controlling access to means. Medicinal SP presentations by 18,383 residents of Ontario, Canada, aged 12 years and older, who presented to a hospital emergency department in that province between April 1, 2001-March 31, 2002 were characterized by the agents taken, identification of deliberate intent and medical severity. We found distinct age-sex differences in the nature and severity of medicinal SP. In youths, aged 12-17, about 40% of presentations involved analgesics, typically not prescribed and most often the acetaminophen agent-group. Females aged 12-64 were identified as deliberate more often than their male counterparts and this pattern occurred in most agent-groups, even among those who took antidepressants. The acetaminophen agent-group was most consistently associated with medical severity and this effect was strongest among female youths. Although medicinal SP was less frequent in the elderly, these presentations tended to be more medically serious and less often identified deliberate. The high proportion of medicinal SP in youths involving agents typically not prescribed and the medical severity of the acetaminophen agent-group underscore how prevention strategies must extend beyond controlling access to antidepressants. Despite a higher risk for suicide, males and the elderly may not have their deliberate intent detected and therefore, may not receive appropriate treatment. The emergency department can serve as important link to mental health care and usage patterns can provide feedback about the need for system-level enhancements and DSH surveillance.Social Psychiatry 06/2008; 43(8):642-52. · 2.05 Impact Factor -
Article: The National Criminal Justice Treatment Practices survey: multilevel survey methods and procedures.
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ABSTRACT: The National Criminal Justice Treatment Practices (NCJTP) survey provides a comprehensive inquiry into the nature of programs and services provided to adult and juvenile offenders involved in the justice system in the United States. The multilevel survey design covers topics such as the mission and goals of correctional and treatment programs; organizational climate and culture for providing services; organizational capacity and needs; opinions of administrators and staff regarding rehabilitation, punishment, and services provided to offenders; treatment policies and procedures; and working relationships between correctional and other agencies. The methodology generates national estimates of the availability of programs and services for offenders. This article details the methodology and sampling frame for the NCJTP survey, response rates, and survey procedures. Prevalence estimates of juvenile and adult offenders under correctional control are provided with externally validated comparisons to illustrate the veracity of the methodology. Limitations of the survey methods are also discussed.Journal of Substance Abuse Treatment 05/2007; 32(3):225-38. · 3.14 Impact Factor -
Article: Differential experiences during the holocaust and suicidal ideation in older adults in treatment for depression.
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ABSTRACT: Data were used on 275 Jewish individuals aged 50 and older in outpatient treatment for depression in this retrospective cross-sectional study. Holocaust survivors who were in work camps, in ghettos, or in hiding (HS-WGH) and holocaust survivors who were in concentration camps (HS-CC) were more likely to suffer posttraumatic stress disorder compared to other survivors (HS-OT) and controls. The HS-WGH and HS-CC groups had at least a threefold greater odds of suicidal ideation compared to controls. Suicidal ideation rates did not differ significantly between HS-OT group and controls. Among survivors, HS-WGH had a threefold greater odds of suicidal ideation compared to HS-OT. The results are applicable to survivors of similar atrocities and show that differing types and severities of traumatic experiences have important implications for treatment planning.Journal of Traumatic Stress 07/2006; 19(3):417-23. · 2.72 Impact Factor -
Article: Depression and mental health visits to physicians--a prospective records-based study.
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ABSTRACT: Previous studies of access to care for depression have been based on cross-sectional surveys of self-reported use of mental health service use. As the recall of use may be differentially biased by mood states, inferences about how well persons with depression are accessing services in comparison to other groups may be misleading. Accordingly, we estimated the magnitude of the depression-use associations in relation to key covariates based on prospective records of mental health visits to physicians. The sample, N = 23,063, of persons 12 years and older, was drawn from the 1996/97 Ontario Health Survey and linked to their administrative mental health care records 24 months forward in time. We found that depression-use associations were in the expected direction but similar in magnitude to associations for gender and education unlike previous self-reported use surveys. Female gender was positively related to the use of a primary care physician but negatively related to seeing a psychiatrist as opposed to a primary care physician. Those who had attained higher levels of education were more likely to be seen by physicians than those with lower education levels. The meaning behind these findings bears further study as it may have implications for primary care reform and the design of future studies of access.Social Science [?] Medicine 03/2006; 62(4):828-34. · 2.70 Impact Factor -
Article: Holocaust experience and suicidal ideation in high-risk older adults.
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ABSTRACT: Depression is an identified risk factor for suicidal ideation, a precursor for more serious suicidal behaviors. This risk might be further compounded in individuals who experience negative life events, including traumatic experiences, and those who might have comorbid illnesses. The authors examined the impact of past exposure to the Nazi Holocaust on the development of suicidal ideation in a sample of depressed older adults. Authors conducted a retrospective cross-sectional study. The study sample comprised data on 530 consecutive eligible first admissions of Jewish patients who were referred and admitted to a geriatric psychiatry day hospital program between September 1986 and December 2000. Multiple logistic-regression analyses, controlling for social support, history of suicide attempts, and other negative life events, showed that severity of depression and exposure to the Holocaust were independently associated with suicidal ideation. Those not showing suicidal ideation were slightly more likely to have reported having a confidant. This is the first empirical study to demonstrate an increased likelihood for suicidal ideation in survivors of the Nazi Holocaust. The chronic stress produced by these traumatic events may have predisposed survivors to cope ineffectively as they age, thus resulting in suicidal ideation. Authors highlight the importance of a multifaceted approach when assessing suicidal behaviors in high-risk groups.American Journal of Geriatric Psychiatry 12/2003; 12(1):65-74. · 3.64 Impact Factor -
Article: The Canadian Psychiatric Association practice profile survey: I. Methods and general sample characteristics.
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ABSTRACT: To describe the rationale, methodology, and general sample characteristics of the Canadian Psychiatric Association (CPA) practice profile survey, a national survey of psychiatrists and psychiatric practice. Mail-in interviews were sent to all Canadian psychiatrists listed in their provincial registers and to all active CPA members (total = 3628). Respondents provided general information about their professional activities for one 24-hour day and detailed information for 1 randomly selected hour. Patient information--including sociodemographics, diagnostic profiles, functioning levels, risk of harm to self or others, and disposition--was elicited for 1 patient seen during the random hour as well as for the most seriously ill patient receiving clinical services that day. There was a 45.5% response rate. Questionnaires completed by nonpsychiatrists or with a large percentage of missing or incorrect data were eliminated (107 surveys), resulting in a final sample size of 1570. CPA members and those from Western Canada responded at a higher rate to the survey. The results suggest some cause for concern about future manpower shortages. Most psychiatrists practise eclectically, seeing patients across the life-span, and working in both community and institutional settings. The old and the young appear to be underserviced, compared with adults. This study represents an important step forward in evaluating the profile and activities of the profession.Canadian journal of psychiatry. Revue canadienne de psychiatrie 06/2003; 48(4):237-43. · 2.42 Impact Factor -
Article: The impact of rural residence on medically serious medicinal self-poisonings.
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ABSTRACT: Suicide rates are often high in rural areas. Despite the strong association between deliberate self-harm (DSH) and suicide, few have studied rural residence and DSH. Self-poisonings dominate DSH hospital presentations. We investigate a previously reported association between rural residence and medical severity (defined as a subsequent medical/surgical inpatient stay) among emergency department presentations for medicinal self-poisoning (SP) to determine whether differences in agents taken, mental health service use or hospital-level resources explain the relationship. A cohort of n=16,294 12-64-year olds presenting with SP to hospital emergency departments in Ontario, Canada, in 2001/2002 was linked to their service records over time. The rural-medical severity association was best explained by differences in hospital resources; presenting to hospitals providing inpatient psychiatric services appeared to reduce medical/surgical inpatient stays in favor of psychiatric ones. Among those with a recent psychiatric admission, more intensive ambulatory psychiatric contact may be protective of a psychiatric inpatient stay subsequent to the SP presentation. Compared to nonrural residents, deliberate intent was identified less often in rural residents, particularly males. The rural-medical severity association was best explained by disparities in the delivery systems serving rural and nonrural residents, important to rural suicide prevention efforts.General Hospital Psychiatry 30(6):552-60. · 2.74 Impact Factor
Top co-authors
Top Journals
Institutions
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2006–2008
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St. Michael's Hospital
Toronto, Ontario, Canada
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2003
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University of Toronto
- Department of Psychiatry
Toronto, Ontario, Canada
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