Experiences of mental health professionals counseling young survivors of sexual abuse in the Cayman Islands

OBJECTIVE: To explore the experiences of mental health professionals counseling young survivors of sexual abuse in the Cayman Islands; how they navigated challenges in their experiences and sustained themselves through their work with young survivors of sexual abuse. DESIGN AND METHODS: The present study incorporated a qualitative approach using a phenomenological design to elicit a description of the experiences of mental health professionals who counseled young survivors of sexual abuse in the Cayman Islands. Five mental health professionals were recruited using purposive sampling methods. Semi-structured interviews were facilitated to answer the research questions centered on describing their experiences in counseling young survivors of sexual abuse in the Cayman Islands. Data analysis resulted in four core themes that described their lived experiences as notably punctuated with both significant systemic challenges and significant posttraumatic growth. RESULTS: The findings indicated that mental health professionals compensated for the systemic influences such as patriarchal belief systems and oppressive and complicit attitudes objectifying children by diversifying and expanding their interventions. CONCLUSION: The present study supported recent literature from the Caribbean region that described the embedded oppressive belief systems and traditional patriarchal attitudes that have perpetuated abusive treatment of children. Furthermore, the study provided a greater understanding of mental health professionals’ experiences in the Cayman Islands that also supported expanding the scope of the mental health professions to include social justice and advocacy efforts.

Communication and adherence in the Caribbean: teaching skills for concordant management of care

Effective treatment of contemporary chronic and communicable illnesses can require increasingly complex degrees of adherence. This means that new approaches should be developed to manage the age old problem of adherence or, as it is often called, compliance with medical protocols. Promotion of care-giver and patient concordance as a partnership to address these contemporary concerns must include the development of the requisite communication skills. Within the Caribbean culture, lack of adherence may be exacerbated by a number of issues, including patients' literacy levels, religious and cultural beliefs, perceptions of health care providers, and even attitudes to generic medications. The differences that exist among individual patients/clients, and among the health care providers require the identification and management of the psychosocial factors and communication skills influencing adherence in the Caribbean context. Unfortunately, the exploration of these issues and the teaching of communication skills have not been a standard part of traditional educational programmes for health care providers in the Caribbean. In the introduction to Medical Practice curriculum and as part of the personal and professional development theme, medical students at the University of the West Indies (UWI), Mona, Faculty of Medical Sciences, are asked to examine their experiences of adherence to medical treatment in order to identify common issues as well as those unique to certain patient populations. The issues commonly identified as affecting compliance with medical protocols include the personality of the provider, misunderstanding of instructions, the impact of side effects, and the cost of the medication. Students are then taught four key communication skills geared to increase their competencies in communicating with their patients. These are organizational skills, rapport building skills, data gathering skills, and patient education and management skills. The factors affecting adherence to therapy are examined, such as the patient's condition, treatment prescribed, the clinician, the patient and socioeconomic conditions. The importance of the relationship (including the level of trust and confidence shared) and the quantity and quality of the communication between the patient and the provider are stressed. This chapter makes recommendations on how to improve communication competencies and techniques for effective adherence management. It addresses, in particular, opportunities within the curriculum for supervised communication skills training especially with clinical settings.

Counselling, culture and communication for change

The contemporary landscape of mental health services is changing rapidly with a proliferation of training programmes in counseling and psychotherapy based primarily on North American/Eurocentric theories and cultures. With culture acting as an interpretive frame for behavior and given the multicultural nature of Caribbean society, there is therefore the need for a culturally relevant review of therapeutic communication if practitioners are to successfully engage Caribbean people in the therapeutic process. This chapter addresses some of the cultural factors in the Caribbean which influence this communication process, particularly, how people engage or avoid engaging in the process of counseling and therapy, and suggests strategies and skills for facilitating the needed engagement. Issues examined include clients' past experiences of helping relationships, belief about how change occurs, expectations of counseling/psychotherapy as providing a "quick fix", expectations that the therapist will play a primarily didactic role and that they will be passive learners, the impact of religious beliefs on clients' decisions whether or not to seek help and the challenges of dual relationships (circumstances whereby the therapist and the client interact with each other outside of the therapy context). Concepts are based on a series of presentations made at case conferences at the University Counselling Service at the UWI, Mona, and the authors' thirty-odd years of experience in various clinical settings. The University Counselling Service provides counseling and psychotherapy to a diverse range of clients within the university community, inclusive of students, staff at all levels, faculty members and administrators.

Antenatal voluntary counselling and testing for HIV in Barbados. Success and barriers to implementation

Objective. To determine the success of voluntary counseling and testing (VCT) for HIV and to identify the barriers to implementation when VCT is offered as a package integrated with antenatal care. Methods. In this descriptive study we investigated antenatal VCT and HIV testing in all post-parturient women at the Queen Elizabeth Hospital, Bridgetown, Barbados, who gave birth between April and September 2002. Data were collected retrospectively from the antenatal care record and by recall during one-on-one interview. Results. Of 1, 342 women surveyed, 954 (71.1 percent) received antenatal counseling and were offered an HIV test. Of the 954 women offered HIV test after counseling, 914 (95.8 percent) agreed to have the test. Among the women surveyed, 1, 106 (82.4 percent) had a documented HIV test, 914 (85.7 percent) were tested after documented pretest counseling, and another 192 (14.3 percent) were tested without documented pretest counseling. Overall, 822 of the 1, 342 women surveyed (61.2 percent) had a documented HIV test result in their antenatal case record at the time of delivery. Of the 1, 106 women who had a documented HIV test, the test results were unavailable at the time of delivery in only 284 (21.2 percent). Among the reasons for unavailability of a documented HIV test result, the most common (45.0 percent) was that no test was done, followed by unclear documentation of the result. Conclusions. Twenty-nine percent of surveyed women failed to receive antenatal VCT and this is a cause of concern, for both the high coverage and good quality counseling are key to the overall success and cost effectiveness of the VCT program. Fourteen percent of the women surveyed who did not receive VCT were tested for HIV, a situation that is undesirable because some women may be tested without understanding the full implication of this policy, and as a result the overall impact of VCT may be reduced (AU)

Knowledge, beliefs, practices, blood pressure and blood glucose control in women with diabetes mellitus [abstract]

OBJECTIVE: To determine the knowledge, beliefs, practices, blood pressure and blood glucose control among women with diabetes mellitus attending a specialist medical clinic. METHOD: A 43-item pre-tested questionnaire was administered to a purposive sample of 28 (26.4 percent) of women attending the University Hospital of the West Indies Diabetes Clinic in May/June 2001. Weight (wt), height (ht), blood pressure (BP), fasting blood glucose (FBG) and two hour post-prandial blood glucose (2hpp), diet and activity were recorded. Body mass index (BMI, wt/ht2) was calculated. RESULTS: Median age of 57 years, range, 21-85 years; median time since diagnosis was 14.5 years, range, 0.5-51 years. Only 27 percent of patients had BP controlled to ó135/85 mm/Hg. There was an association between systolic BP and BMI (r= 0.43, p<0.05). The majority of the patients were inactive, overweight or obese: median BMI, 30.3 kg/m2. The majority did not follow a diabetic diet and had no recent contact with a dietitian. There was an association between reported intake of sucrose and 2hpp (r= 0.75, p<0.001). The majority (82 percent) did not take alcohol; 14 percent smoked cigarettes. Only 28.6 percent were controlled to FBG ó 8 mmol/l and 2 hpp ó10 mmol/l. Sixty-seven percent of the patients were on insulin; 21.3 percent used a glucometer. Medications were missed a median of two days per month. There were inverse associations between years since diagnosis and number of days per month that medications were missed (r= -0.39, p<0.05) and knowledge scores and age (r= -0.47, p<0.01). There were associations between knowledge, practice and educational level (p<0.01). The doctor was the main source of information. The majority reported having had ECG (57 percent), blood cholesterol and renal function tests (64 percent) in the past year. The majority (57 percent) reported never having had a foot examination; 32 percent reported never having had an eye examination. CONCLUSION: The majority of these patients were inactive and obese with limited control of blood glucose and blood pressure. Although fairly compliant with medication, there was little adherence to therapeutic guidelines regarding diet, exercise and maintenance of normal weight. Closer attention should be given to foot and eye examinations for early detection of complications. Closer monitoring and counselling of patients in these areas is recommended. (AU)

The impact of side effects on family planning use among female clients of the public health services in Jamaica

A one-year longitudal study was undertaken in kingston, Jamaica, to examine (i) the experience of side effects among female contraceptives users, (ii) the role of side effects. The study consisted of 463 women who utilized public health centres in Kingston and were either new users of contraceptives or who were switching contraceptive methods. They were recruited over a two-month period in 1998 and followed up for one year. All follow-up, interviews were done at women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, cotraceptive history, servive factors, experience with method and length of use. Forty eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side efects were irregular bleeding/no period, headaches, nausea; dizziness and weight gain/loss. These side effects occurred mainly among pill and injection users. The occurrence of side effects had a negative impact on continuation rates. Forty seven per cent of the women stated that they had received counselling regarding side effects. The level and impact of side effects among family planning acceptors at public health centres in Jamaica is of significance to the family planning programme. Method options need to be widened and counselling needs to be improved to ensure that women fully understand the issue of side efects and make informed choices about contraception. (AU)

HIV Voluntary Counselling and Testing in Community Health Services

Compares the effectiveness of voluntary counselling and testing for AIDS or reproductive health education among people in Kenya, Tanzania and Trinidad. Changes in sexual behaviour that occured among individuals in the counselling and testing group; Reports in this issue of the Lancet that deal with AIDS vaccines in developing countries and the cost-effectiveness of counselling and testing for HIV and AIDS.(Au)

The impact of contraceptive side effects on family planning use among female clients of the public health services in Jamaica

OBJECTIVES: To examine (i) the experience of contraceptive side effects among women (ii) the role of side effects in method continuation, and (iii) the counselling regarding such side effects. METHODS: The study consisted of 463 women who utilised public health centres and were either new users of contraceptives or were switching contraceptive methods. They attended government health centres in Kingston and were recruited over a two-month period in 1998 and followed for 1 year. All follow-up interviews were done at the women's homes and complete interviews were obtained for 323 women. Information was collected about socio-economic characteristics, contraceptive history, service factors, experience with method and length of use. RESULTS: Forty-eight per cent of the women experienced side effects with the method accepted on recruitment to the study. Common side effects were irregular bleeding/no period, headaches, nausea/dizziness and weight gain/loss. The side effects occurred mainly among pill and injection users. The occurrence of side effects had a significantly negative impact on continuation rates. Forty-seven percent of women stated that they had received counselling regarding side effects. CONCLUSIONS: The level and impact of side effects among family planning acceptees at public health centres in Jamaica is of significance to the public health family planning programme. Method choice needs to be widened and counselling needs to be improved to ensure that women make informed choices about contraception.(Au)

Impact of a six-month intervention project on blood pressure control: preliminary report

OBJECTIVES: To describe the characteristics of uncontrolled hypertensive clients attending the specialist hypertension clinic at the University Hospital of the West Indies. To evaluate the effect of a six-month structured education programme on blood pressure (BP) control in these clients. METHOD: All clients attending the clinic between January 4 and March 29, 1999, with blood pressure >140/90 mmHg (n=80), were divided into Group 1, cases (n=42) and Group 2, controls (n=38). Blood pressure (BP), weight (wt), height (ht), waist (W) and hip (H) circumferences were measured and Body Mass Index (BMI) and W/H ratio calculated. Group 1 attended monthly structured interventions: BP and wt monitoring, videos, group and individual counselling for six months. A 40 item pretested questionnaire, administered to both groups, collected demographic, lifestyle, knowedge and medication data at baseline and at the end of six months. RESULTS: Mean BMI for men was 27.2 (95 percent CI, 25.7-29.6); mean BMI for women was 30.9 (95 percent CI, 26.1-35.7). Although the majority of both men and women recognized diet, inactivity and overweight as contributing to high blood pressure. Reported medication compliance was good with a mean of only 4 days missed per month. In men, there were associations between BMI and WWHR, p<0.05, BMI and diastolic BP and a negative association between BMI and activity level, p<0.05. Following the intervention, BP was reduced overall, p<0.01, except for diastolic BP in male controls. Knowledge improved among the male cases p<0.01. In the female cases activity scores were higher, p<0.001; Wt and BMI, were lower than at baseline, p<0.05. There was no difference in these variables among the controls. CONCLUSION: Structured education and monitoring interventions with personalised counselling in life style management and weight reduction may be an important part of therapy for clients.(Au)

Diabetes education for the adult - position statement

There is a fourfold increase in the incidence of major malformations in pregnant diabetic women who have poor metabolic control during the period of organogenesis. The goals of preconception care are: Screening for underlying non-diabetic medical conditions, assessment of diabetes-related complications, obstetric evaluation, intensive education of woman and family, attainment of optimum diabetic control, timing and planning of pregnancy. To achieve these goals, education must be implemented to ensure that the woman understands the effects of diabetes on pregnancy. She must undergo a review of self-management skill; that is nutrition counselling, insulin administration, exercise, blood glucose monitoring. The feasibility and cost-effectiveness of such programmes can be assessed in terms of the successful outcomes for both mother and child.(AU)

Diabetes education for the adult - position statement

Women developing gestational diabetes mellitus (GDM) must be made aware of its definition and incidence, and the risk factors associated with the development of complications in pregnancy. The potential problems inherent in this condition make screening and diagnosis imperative as early as possible during the antenatal period. Affected individuals must be given a simple understanding of the basic pathophysiology of the condition. They must be taught self-management skills involving nutrition counselling, exercise, and monitoring of metabolic status by blood glucose and urine ketone testing. Pharmacological management is usually by insulin administration. The antenatal care programme will monitor foetal movement and provide information about preparation for labour and delivery. Education is also provided on the benefits of breastfeeding. After delivery, pastpartum counselling is mandatory to explain the risk of developing GDM in subsequent pregnancies, the risk of developing type 2 diabetes and the need for establishing healthy life style changes; that is, weight maintenance and increased physical activity. Postpartum evaluation and annual blood glucose testing is important.(AU)

The social worker: a member of the primary care team?

The primary health care team at present does not include social workers as routine members. If however, we, accept the World Health Organisation definition of health, which includes social well being, then it follows that the social worker should be considered as a member of the health team to attend to this aspect of health in the service delivery mix. This paper presents the experience of a social worker assigned to the August Town/Hermitage Type III health centre during the period March 1995 to February 1996 and her contribution to patient welfare. The expected roles of the social worker and his or her contribution to the health team are outlined.(AU)

A study of parasuicide among adolescent and young adult in southern region of Trinidad

This study was an attempt to determine factors which are responsible for the high suicide rate among adolescents and young adults. The census was taken from admission to a Health Institution in South Trinidad - the San Fernando General Hospital. An instrument based on the research questions was designed to yield the necessary data for completion of the research study. Seventy-five clients between the ages 9 years to 24 years were visited at home, interviewed and instruments completed by the researcher. The data was collated and analyzed with the aid of the computer programme SPSS Windows and a manual scientific calculator. The study revealed that East Indians (60 percent) were the most represented Ethnic group and they resided in the rural areas. Male to female ratio was 1:2. The risk and precipitating factors identified are family instability (40 percent) emotional problems (29.6 percent), financial difficulties (24 percent), peer pressure (22.4 percent) and conflict with parents and family members (38.4 percent). Unemployment (12 percent) and lovers quarrel (12 percent) was also prevalent. Ingestion of tablets (50.7 percent) was the most common means of para-suicide, followed by weedicide and insecticide (26.6 percent). The victims identified support from family members/significant others and counselling being the main strategy for healing.(Au)