Multimethod Formative Research to Improve the Training and Delivery of Tobacco-cessation Interventions in Behavioral Health Settings.

INTRODUCTION: Despite progress in reducing tobacco use within the general population, high prevalence of tobacco use continues in individuals with mental health and substance use disorders ("clients"). Tobacco use persists as the leading cause of premature mortality in this population. While behavioral health providers have frequent contacts with this population, they lack training in tobacco cessation counseling. METHODS: We conducted multimethod formative data collection consisting of key informant interviews with providers, field observations at clinical sites, and structured group interviews with behavioral health providers, and, separately, clients. Activities were conducted at 4 behavioral health agencies with 9 behavioral health clinic sites in southern Arizona. Recurring phrases and level of repetition were quantified to identify themes. These themes were then used to adapt the method of training delivery and revise the curriculum content for providers at the participating sites. RESULTS: Results indicated that providers had "training fatigue" and low satisfaction with multiple, online trainings. Further, providers noted issues including time constraints, competing clinical priorities, and low access to tobacco-cessation materials. Clients demonstrated high self-awareness around the importance of quitting smoking and professed frustration at being unable to quit, despite multiple attempts. Finally, both providers and clients agreed that a personal, supportive approach to cessation counseling was preferred. CONCLUSIONS: Using results from this formative research to revise delivery and content of existing smoking-cessation training for behavioral health providers may address barriers to assisting clients with smoking cessation. Additional research to determine the efficacy of the adapted training is needed.

A statewide initiative to train behavioral health providers in smoking cessation.

Individuals with mental health and substance use disorders smoke at rates two to four times higher than the general population and account for over half of smoking-related deaths. Building capacity of behavioral health providers to provide smoking cessation treatment may decrease smoking prevalence in these groups. The present study evaluated a statewide rollout of a capacity building training program to teach behavioral health providers to deliver a manualized smoking cessation group intervention for patients with mental health and substance use disorders. Behavioral health treatment providers (N = 333) participated in a day-long training. Pretraining and posttraining evaluations were conducted on the day of training to assess changes in confidence, attitudes, and knowledge regarding smoking cessation and possible barriers to implementing the smoking cessation curriculum in treatment programs. These constructs were reassessed in follow-up surveys conducted online 2 and 6 months posttraining. A subset of providers participated in follow-up telephone calls to discuss implementation of smoking cessation programming. Posttraining evaluations indicated that trainees' confidence, attitudes, and knowledge of smoking interventions improved. Follow-up surveys indicated that these gains decreased but were maintained above baseline. Over one-half of survey respondents reported taking at least one implementation step. Interviewees reported that agency and staff-level barriers such as difficulty coordinating a group, staff turnover, and inadequate time with clients precluded more widespread implementation. Training for behavioral health providers is effective in improving confidence, attitudes, and knowledge regarding smoking cessation interventions. Consistent implementation requires ongoing support and agency problem solving to address common barriers.

Errors of commission and omission in novice group counseling trainees' knowledge structures of group counseling situations.

This study investigated how novice group counseling trainees' knowledge structures about group situations differed from experts.' Eight highly experienced group therapists and 54 novice trainees indicated which of the 19 leader interventions they would consider using to respond to the 21 group situations described in the Group Therapy Questionnaire (GTQ, Wile, Bron, & Pollack, 1970). Pathfinder Network Analysis (Schvaneveldt, 1990) was used to generate knowledge structures (cognitive maps) about group situations based on the aggregated response of experts and each trainee's response to GTQ. Comparing trainees' maps with the referent expert map, we found no common errors of commission, that is, relationship between situations in trainees' knowledge maps but not in experts' knowledge maps, but 10 common errors of omission, that is, relationships among group situations in experts' knowledge maps but not in trainees' knowledge maps. Cluster analysis identified 2 subgroups of trainees. Neither of these trainee subgroups incorporated the group's developmental stage into their map of group situations as experts did: experts saw the situations during the beginning and ending phases of the group as similar but different from situations in the middle phase of the group. The first group of trainees had a holistic approach to group situations but tended to make errors in dealing with group situations involving a problematic member. The second group had an atomistic approach to group situations but lacked a clearly differentiated and structured general organization for the situations. They tended to make errors in dealing with challenging situations where the group is avoidant and lacks engagement.

Tratamento grupal psicopedagógico e as cenas temidas na aprendizagem de crianças e adolescentes / Grupo de tratamiento psicopedagógico y escenas temía el aprendizaje de la niñez y la adolescencia / Therapeutic group approach and the fearful scenes of learning in children and adolescents

Esta pesquisa teve por objetivo o estudo das cenas temidas na aprendizagem no atendimento grupal psicopedagógico de crianças e adolescentes de 11 a 13 anos. A partir da identificação das "cenas temidas" no grupo, foi possível refletir sobre os obstáculos que os participantes encontraram. Coube à equipe estruturar atividades lúdicas que provocassem a confrontação do participante com ele mesmo e em relação ao outro, fazendo-o refletir sobre suas dificuldades, e provocando-os a assumirem suas capacidades criativas. Relatamos algumas cenas e de que forma foram pensadas pela equipe. Percebeu-se a importância da intervenção psicopedagógica grupal sobre as manifestações de ocultamento do sujeito criador/autor, que foram as que mais caracterizaram os modos como os participantes se relacionavam com o objeto de conhecimento.

The research aims at studying the fearful scenes of learning in therapeutic groups of children and adolescents between 11 and 13 years old. During the process of the groups and by identifying the "fearful scenes" of learning it was possible to reflect the obstacles of each participant. The authors of the project created play activities to allow the reflection of each one's own difficulties and capacities in order to recognized one's own creative processes. In this article we show how the scenes were thought and performed. The authors point to the importance of the group intervention mainly when the manifestations and recognition of creativity are hidden for the participants of the group.

Esta investigación tubo como objetivo estudiar las escenas temidas en el apredizaje de niños y adolescentes, de 11 a 13 anõs, que estabam en tratamiento psicopedagógico en grupo. A partir de la identificación de las "escenas temidas" en el grupo fué posible pensar sobre los obstáculos encontrados por los participantes. El equipo de psicopedagogos estructuró actividades lúdicas para provocar la confrontación de cada articipante con él mismo y en relación al otro, con el objetivo de hacerlo pensar sobre sus dificultades y permitir que asumieran sus capacidades creativas. Relatamos algunas de las escenas y la forma como fueron pensadas por el equipo de psicopedagogos. Se percibió la importancia de la intervención psicopedagógica grupal sobre las manifestaciones de ocultación del sujeto creador/autor. Estas manifestaciones fueron las que más caracterizaron la forma como los participantes se relacionabam con el objeto del conocimiento.

Estrategias psicopedagógicas para el ejercicio de la autoridad docente en el preescolar / Psycho-pedagogical strategies for the exercise of teaching authority in preschool

Educar, en conjunto con gobernar y psicoanalizar, es ubicada por Freud como una de las profesiones imposibles, lo cual no significa que en la historia de la humanidad, éstas sean desechadas. Al contrario, es precisamente a estas disciplinas a las que las ciencias sociales y humanas le han apostado, en miras de mejorar o re-significar la condición del hombre, siempre en relación a su condición de ser social.

To educate, together with governing and psychoanalyzing, is placed by Freud as one of the impossible professions, which does not mean that in the history of humanity, they are discarded. On the contrary, it is precisely to these disciplines that the social and human sciences have bet, in order to improve or re-signify the condition of man, always in relation to his condition of being social.

A propósito de un programa de sicología con énfasis en psicología social / About a psychology program with an emphasis on social psychology

La sicología nació en los consultorios como práctica clínica individual y en los laboratorios como práctica experimental y aún sigue teniendo vigencia en esos escenarios; sin embargo, después de la segunda mitad del siglo XX, los grupos, las entidades educativas, las instituciones y comunidades han dirigido a la psicología demandas de intervención y preguntas que desbordan ese marco en el que nació la joven disciplina en el siglo XIX.

Psychology was born in the offices as an individual clinical practice and in the laboratories as an experimental practice and is still valid in these scenarios; However, after the second half of the twentieth century, groups, educational entities, institutions and communities have addressed intervention psychology and questions that overflow that framework in which the young discipline was born in the nineteenth century.

O setor de grupo na psiquiatria do HUPE/UERJ: relato de experiência do treinamento profissional em psicoterapia de grupo / The group sector in psychiatry of HUPE/UERJ: report of work professional training in psychotherapeutic groups

O trabalho relata o funcionamento de um setor de grupo em uma Instituiçäo Universitária, que veio se estruturando ao longo dos anos, através da modalidade de treinamento profissional a médicos e psicólogos abordando o ensino teórico e prático e atendimento clínico a uma grande maioria da populaçäo que procura o ambulatório de psiquiatria

A família como modelo para instituiçäo: um estudo sobre o luto / The family as model institution, a study on the mourning

O artigo apresenta o trabalho desenvolvido por uma Pedagoga Institucional, num enfoque de Intervençäo Breve, desenvolvido dentro da Instituiçäo. Pretende enfocar as relaçöes entre o grupo de professores da instituiçäo, tendo como modelo a Família. A partir de referências teóricas, a profissional vai relatando as experiências, bem como faz uma avaliaçäo sobre esta modalidade de atendimento, que atualmente vem despertando muito interesse na área especializada

Effectiveness of a training program for enhancing therapists' understanding of the supportive-expressive treatment model for breast cancer groups.

This study evaluated a training program for leaders of supportive-expressive psychotherapy groups for breast cancer patients. Twenty-four mental health/medical cancer care professionals completed two training phases and were tested for their understanding of the treatment model. Participants' understanding was enhanced as a result of the training program. This study demonstrates that a brief training program can improve therapists' understanding of the treatment model and demonstrates an effective method of evaluation. Future research should examine how performance on these tests generalizes to performance when leading a supportive-expressive group.

[Experiences of a psychiatrist in cooperation with ophthalmologists]. / Erfahrungen eines Psychiaters in der Zusammenarbeit mit Ophthalmologen.

This paper reports on cooperation between ophthalmologists and psychiatrists as seen from the latter's standpoint, primarily with regard to psychosomatic medicine and work in Balint groups. Ophthalmological experience both in a general Balint group and in a special Balint group mainly for ophthalmologists is described. The "general" part is mainly devoted to a discussion of everyday language associated with eyes and sight, since everyday language usually gives clues to psychophysical relationships. The main advantage of participating in Balint groups is that the practitioner learns to integrate himself, as a diagnostic instrument, with regard to his feelings and experiences. This results in a new relationship between patient and practitioner which could be defined as "relationship diagnostics" and "relationship therapy".

Técnicas grupais e processos de aprendizagem na formaçäo de psicoterapeutas de grupo / Group technics and learning processes in the group psychotherapeutists training

Salienta-se a importância de se refletir em torno de uma metodologia adequada nos processos de aprendizagem dos psicoterapeutas de grupo. Baseia-se na sua experiência profissional-docente e na sua formaçäo com técnicas operativas e grupos de reflexäo com PICHON-RIVIERE7 e DELLAROSSA4, em Buenos Aires. O recurso a uma metodología de aprendizagem em pequenos grupos, com um referencial teórico que articula a psicanálise, psicologia social e dinâmica de grupos no processo de formaçäo, é a proposta deste trabalho. Esta abordagem é considerada como integradora dos níveis intra-subjetivos, grupais e institucionais, postos em jogo durante a aprendizagem da teoria e técnica psicoanalítica dos grupos