This chapter discusses comprehensive school crisis interventions, identifies the characteristics that define a crisis, finds ways to assess for the level of traumatic impact, and determines what interventions can be provided to help with response and recovery. It highlights the PREPaRE Model of crisis prevention and intervention. There are six general categories of crises: acts of war and/or terrorism; violent and/or unexpected deaths; threatened death and/or injury; human-caused disasters; natural disasters; and severe illness or injury. Children are a vulnerable population and in the absence of quality crisis interventions, there can be negative short- and long-term implications on learning, cognitive development, and mental health. Evidence-based interventions focusing on physical and psychological safety may be implemented to prevent a crisis from occurring or mitigate the traumatic impact of a crisis event by building resiliency in students. Crisis risk factors are variables that predict whether a person becomes a psychological trauma victim.

Depression is a chronic, recurring disorder that impacts children’s academic, interpersonal, and family functioning. The heritability of major depressive disorder (MDD) is likely to be in the range of 31% to 42%. This chapter begins with a brief overview of the etiology of depression. It presents a description of a cognitive behavioral therapy (CBT) intervention designed to be delivered in a group format, an individual interpersonal intervention, and an individual behavioral activation (BA) intervention that includes a great deal of parental involvement. The ACTION program is a manualized program that is based on a cognitive behavioral model of depression. There are four primary treatment components to ACTION: affective education, coping skills training (BA), problem-solving training, and cognitive restructuring. The chapter concludes with a brief discussion of universal therapeutic techniques to be incorporated into work with depressed youth regardless of the therapeutic orientation or treatment strategy.

Divorce is a lengthy developmental process and, in the case of children and adolescents, one that can encompass most of their young lives. This chapter explores the experience of divorce from the perspective of the children, reviews the evidence base and empirical support for interventions. It provides examples of three evidence-based intervention programs, namely, Children in Between, Children of Divorce Intervention Program (CODIP), and New Beginnings, appropriate for use with children, adolescents, and their parents. Promoting protective factors and limiting risk factors during childhood and adolescence can prevent many mental, emotional, and behavioral problems and disorders during those years and into adulthood. The Children in Between program is listed on the Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-Based Programs and Practices. The CODIP and the New Beginnings program are also listed on the SAMHSA National Registry of Evidence-Based Programs and Practices.

Children and youth with serious emotional, behavioral, and social difficulties present challenges for teachers, parents, and peers. Youth who are at risk for emotional and behavioral disorders (EBD) are particularly vulnerable in the areas of peer and adult social relationships. The emphasis on meeting academic standards and outcomes for children and youth in schools has unfortunately pushed the topic of social-emotional development to the proverbial back burner. This chapter emphasizes that social skills might be considered academic enablers because these positive social behaviors predict short-term and long-term academic achievement. Evidence-based practices are employed with the goal of preventing or ameliorating the effects of disruptive behavior disorders (DBD) in children and youth. An important distinction in designing and delivering social skills interventions (SSI) is differentiating between different types of social skills deficits. Social skills deficits may be either acquisition deficits or performance deficits.

Eating disorders (EDs) are a complex and comparatively dangerous set of mental disorders that deeply affect the quality of life and well-being of the child or adolescent who is struggling with this problem as well as those who love and care for him or her. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for the diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or ED. Treatment of eating disordered behavior typically involves a three-facet approach: medical assessment and monitoring, nutritional counseling, and psychological and behavioral treatment. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are also evidence-based approaches to treatment for AN. The treatment of EDs should be viewed as a team effort that integrates medical, nutritional, and mental health service providers.

Asthma, a pulmonary condition, is a chronic respiratory disorder typified by persistent underlying inflammation of tissues, airway obstruction, congestion, hyperresponsive airways, and the narrowing of smooth airway muscle. Asthma is one of the most common chronic medical conditions in children and is the leading cause of school absenteeism. This chapter describes childhood asthma, including its causes and triggers. It elucidates the extant research supporting treatment of the disorder and provides step-by-step empirically based interventions to ameliorate asthmatic symptomatology in children. The psychological underpinnings of asthma have been investigated in the field of psycho-neuroimmunology (PNI), which examines the interplay of the central nervous system, neuroendocrine, and immune system with psychological variables and their relation to physical health. Researchers have shown that relaxation and guided imagery (RGI), written emotional expression, yoga, and mindfulness therapy improve pulmonary lung functioning, decrease rates of absenteeism, and improve overall quality of life.

This chapter reviews the empirical support for such a multifaceted approach by considering selected neurodevelopmental concerns and medical variables that present as obstacles to healthy neurodevelopment. It discusses select neuro-developmental prenatal complications that can be prevented or ameliorated through behavioral interventions with the pregnant mother. The chapter addresses the deleterious effects of legal substances on the developing fetus, but professionals should be vigilant about preventing or reducing intrauterine exposure to illicit substances as well. Tobacco is a legal substance that, when used during pregnancy, has the potential to harm both the mother and fetus. Of particular concern with tobacco use are the detrimental health risks, such as hypertension and diabetes, which adversely affect the cerebrovascular functioning of pregnant women. The process of neurodevelopment is complex and represents a dynamic interplay among genetics, behavior, demographics, the environment, psychosocial factors, and myriad physiological factors.

This chapter presents the anatomy review of the human heart. The human heart is a hollow four-chambered muscle that is responsible for pumping blood throughout the body. The heart lies in the mediastinum in the thorax, pointing toward the left of the midline. The heart consists of four main layers: the pericardium, epicardium, myocardium, and endocardium. The epicardium is the outermost layer of the heart muscle. The middle layer of the heart is called the myocardium. The innermost layer of the heart is the endocardium. The heart is divided into right and the left side. The right side of the heart contains the right atrium and right ventricle. The left side of the heart contains the left atrium and left ventricle. The heart has four valves: tricuspid valve, mitral valve, aortic valve, pulmonary valve; acting as tiny doors that keep the blood moving in one direction.

The chapter explores how to measure the electrical direction for the P wave, the QRS complex, and the T wave, as well as for other forces. It provides a method for determining the direction of the electrical force for any of these waves, or complexes, on the electrocardiograph (EKG). The heart produces electrical and mechanical energy on a continuous basis. Both forms of energy come from specialized cardiac muscle fibers. These fibers provide electrical signals and mechanical energy that physically pumps the blood. Although the EKG does not show that mechanical energy, it can be used to measure a variety of electrical events. When a force is abnormal in size or direction, it may indicate that the specific part of the heart producing the force is abnormal. Therefore, learning the normal electrical direction of forces in the heart provides a simple and scientific way of understanding and interpreting an EKG.

This chapter explains various types of heart blocks such as premature atrial contraction, sinus arrest and asystole. It explains various types of pacemakers such as ventricular pacemaker and artrial pacemakers. Junctional rhythm is a regular rhythm. A P wave is frequently not seen because the rhythm originates in the AV junctional node. Junctional rhythm may be a manifestation of digitalis toxicity, sick sinus syndrome, and acute inferior wall infarction. Pauses are most commonly caused by premature atrial contractions (PACs) that do not conduct down to the ventricle and generate a QRS complex. These are called nonconducted PACs (NCPACs). Asystole is a prolonged period of no electrical activity. Cessation of function of the sinus node is called sinus arrest. Normally, when sinus arrest occurs, another pacemaker must take over, such as the junction or the ventricles. Ventricular pacemaker rhythm demonstrates a vertical electrical artifact (EA) at the beginning of the QRS.

This chapter presents the case examples of pressure and volume overload on the left ventricle and provides list of criteria for the diagnosis of Left Ventricular Hypertrophy (LVH) on the electrocardiogram (EKG). It also describes and explains how to identify ST changes in LVH and LVH simulating anterior wall infarction on the EKG. LVH refers to an increase in the wall thickness or dilation of the left ventricle. LVH is often the result of increased pressure, or volume, within the left ventricular chamber. Mitral regurgitation (MR) occurs when the mitral valve allows the backflow of blood from the left ventricle into the left atrium. The most common cause of pressure overload is hypertension (HTN). Hypertrophy of the left ventricle increases the amplitude of the left ventricular forces, because more mass generates more electricity. In LVH, the frontal plane, the horizontal plane, or both may show increased QRS amplitude.

This chapter presents an overview of the restorative justice movement in the twenty-first century. Restorative justice, on the other hand, offers a very different way of understanding and responding to crime. Instead of viewing the state as the primary victim of criminal acts and placing victims, offenders, and the community in passive roles, restorative justice recognizes crime as being directed against individual people. The values of restorative justice are also deeply rooted in the ancient principles of Judeo-Christian culture. A small and scattered group of community activists, justice system personnel, and a few scholars began to advocate, often independently of each other, for the implementation of restorative justice principles and a practice called victim-offender reconciliation (VORP) during the mid to late 1970s. Some proponents are hopeful that a restorative justice framework can be used to foster systemic change. Facilitation of restorative justice dialogues rests on the use of humanistic mediation.

This chapter describes some of the recent restorative justice innovations and research that substantiates their usefulness. It explores developments in the conceptualization of restorative justice based on emergence of new practices and reasons for the effectiveness of restorative justice as a movement and restorative dialogue as application. Chaos theory offers a better way to view the coincidental timeliness of the emergence of restorative justice as a deeper way of dealing with human conflict. The chapter reviews restorative justice practices that have opened up areas for future growth. Those practices include the use of restorative practices for student misconduct in institutions of higher education, the establishment of surrogate dialogue programs in prison settings between unrelated crime victims and offenders. They also include the creation of restorative justice initiatives for domestic violence and the development of methods for engagement between crime victims and members of defense teams who represent the accused offender.

This chapter explores traumatic grief and loss and discusses various treatments for it. It focuses on mindfulness-based interventions for specific use in traumatic grief with bereaved parents. Traumatic grief appears relatively responsive to the psychosocial approach, particularly when it includes exposure elements, such as retelling the story of the loss, reutilization, and building tolerance to the emotions associated with loss. More recently, Thieleman, Cacciatore, and Hill have presented evidence for a mindfulness-based, psychosocial approach for specific use in traumatic grief with bereaved parents. Western culture’s interest in mindfulness has grown exponentially, and practices have been integrated into a variety of general, psychotherapeutic treatment approaches including acceptance and commitment therapy (ACT), dialectical behavioral therapy (DBT), mindful- ness-based cognitive therapy (MBCT), and mindfulness-based stress reduction (MBSR). Of all mindfulness practices, one of the most cost-effective strategies to help providers working with bereaved parents is meditation.

This chapter highlights key elements of adolescent growth and development and outlines communication strategies to serve as a guide for health care clinicians. It provides a summary of research findings on the adolescent female bereavement response to an early pregnancy loss prior to 20 weeks gestation like miscarriage, ectopic pregnancy, or elective termination. To gain a greater understanding of the adolescent response to pregnancy loss, it is helpful to review normal adolescent emotional and psychological development. Erik Erikson’s classic developmental theory offers an outline of the psychosocial tasks of adolescents. Blos described three separate phases of adolescence: early, middle, and late, which evolve throughout the transition from childhood to adult hood. Sanders’s integrated bereavement theory has been used to organize grief responses and the bereavement process. When adolescents have experienced an early pregnancy loss they will experience grief responses that are physical, emotional, social, and cognitive in nature.

This chapter aims to give the behavioral health specialist (BHS) a basic understanding of pain, knowledge about how to effectively evaluate chronic pain, and a description of effective pain management techniques. Knowledge of the biological and psychological basis of pain is important to understanding the experience of chronic pain. A biopsychosocial assessment is the foundation for providing behavioral health treatment to the chronic pain patient. Chronic pain is less responsive to treatments commonly used for acute pain such as opioid analgesia and avoiding physical activity. A multidisciplinary team approach can substantially improve outcomes in chronic pain treatment. Whatever the format of service provision, utilizing multiple interventions such as physical therapy/exercise, emotional management, pacing, and medication, rather than a single modality can substantially improve outcomes for chronic pain. Providing psychoeducation about chronic pain can be an important strategy.

Multiple physical changes can impair the mental health of the aging individual. These changes include: acid-based imbalances, dehydration, electrolyte changes, hypothermia or hyperthermia, and hypothyroidism. This chapter reviews the most common mental health disorders affecting the elderly population and trends affecting care delivery. Moreover, chronic, unresolved pain has been associated with an increased risk of a mental health disorder such as depression, suicide, or anxiety. The aging individual may exhibit signs and symptoms of insomnia such as sleeping for short periods during the night, sleeping during times of normal social activities, arising early in the morning while others sleep, and experiencing daytime sleepiness. The chapter concludes by applying the nursing process from an interpersonal perspective to the care of an elderly patient with a mental health disorder.

Respiratory disorders are the most common causes of illness and hospitalization in children. Respiratory disorders range from mild and self-limiting to life-threatening. Pediatric respiratory health is promoted through prevention, early detection, treatment of disorders, and education efforts. This chapter reviews common pediatric respiratory disorders, explores etiology of pediatric respiratory disorders, and discusses specific care of pediatric clients with respiratory disorders. Newborns have less mucous production, making them more susceptible to infection. Throughout childhood, infants/preschoolers have larger tongues, tonsils, and adenoids, which can cause airway obstruction even in the absence of disease. The common cold is the most common upper respiratory infection (URI) or nasopharyngitis. The causes of a URI include rhinoviruses, parainfluenza, and the respiratory syncytial virus (RSV). Pediatric disorders that affect the lower respiratory tract can be short- or long-term conditions depending upon the cause.

Musculoskeletal disorders are some of the most common causes of illness and hospitalization in children due to their active nature. This chapter reviews common pediatric musculoskeletal disorders, etiology of pediatric musculoskeletal disorders, and pediatric-specific care of musculoskeletal disorders. The musculoskeletal system supports the body structure and provides for client movement. Skeletal growth is most rapid during infancy and adolescence. Injury to the epiphysis can affect bone growth. The most common pediatric musculoskeletal disorders involve pediatric trauma. Torticollis is a symptom that causes a child’s chin to be rotated to one side and the head to the other side. The two most common disorders that can cause torticollis include: Congenital muscular torticollis, and Acquired torticollis. Osteomyelitis is an infection of the bone that occurs most often in infancy or between the ages of 5 and 14 years.

The endocrine or ductless glands work with the nervous system to regulate the body’s metabolic processes. Hormones interact with specific target organs to create an effect on the body. This chapter reviews the pathophysiology behind the metabolic system in pediatric clients. It describes nursing care required for pediatric clients with various metabolic conditions. The chapter explores instruction necessary for families of clients with metabolic conditions. Most of the glands and structures of the endocrine system develop during the first trimester of fetal development. Hormonal control is immature until approximately 18 months of age, leaving the infant prone to dysfunction of the endocrine system. Hundreds of hereditary biochemical disorders affect the metabolism. As the infant adjusts to life, symptoms can rapidly emerge that are life-threatening. The most common endocrine dis.

The Senior House Calls program (SHC) was started as a component of the Texas Tech University Health Sciences Center School of Nursing (TTUHSC SoN) practice program through a 2-year grant from a local foundation. Operated as part of the Larry Combest Community Health and Wellness Center (LCCHWC), it primarily serves the needs of vulnerable elders in the area. SHC is a nurse-managed clinical service for homebound elders that provides comprehensive primary care through advanced practice nurses who are employees of the SoN. The goal of this program is to provide access to a continuum of community-based services for the elderly population in the city of Lubbock, as an alternative to institutional care. Family therapy services are provided in the SHC program; those needing more intensive therapy are referred to appropriate services. SHC is largely funded through Medicare since almost 99” of its patient volume is covered by Medicare.

Nurse-managed wellness centers (NMWC) are practice settings that are community based, directed by an advanced practice nurse, and staffed by public health nurses, advanced practice nurses, and other members of an interdisciplinary health care team. The wellness center model stresses primary prevention and facilitates self-care of the individual with regard to health care strategies and decision making. Freestanding NMWC services include health promotion and disease prevention activities that focus on primary and secondary prevention strategies as well as wellness programs. Students from various health care disciplines, such as nursing, pharmacy, social work, physical therapy, and nutrition, actively participate in NMWC activities. Students benefit in multiple ways because clinical assignments at NMWCs expose them to real-life situations that individuals, families, and groups experience beyond the boundaries of the acute care setting. Wellness centers complement existing primary care services. NMWCs are effective and achievable models of health care delivery.

The 19130 Zip Code Project at the Community College of Philadelphia (CCP) started as a curriculum innovation: the CCP Department of Nursing’s response to the national shift toward community-based health care. The project resulted in the refocusing of the nursing curriculum and the development of partnerships with CCP’s neighbors in the 19130 zip code. It also is an excellent example of a nurse-managed wellness center without walls. The Zip Code Project has put down deep roots in the neighborhood and in the nursing curriculum. It has produced a community-based model for educating local health professionals and a service-learning model for enhancing health service delivery by local agencies. The faculty arranged community-based clinical experiences for nursing students in the neighborhood surrounding CCP. Although CCP sits in the middle of the zip code, faculty knew little about community-based health care services in the community.

This chapter talks about monitoring equipment, and procedural sedation and analgesia (PSA). In addition to respiratory suppression, the medications used for PSA may suppress the autonomic nervous system’s ability to adequately respond to hypovolemia; therefore, close monitoring of vital signs is important for the well-being of patients. PSA medications promote a rapid recovery stage with minimal postprocedure impairment. Patients need to be observed until there is no risk of cardiorespiratory depression or compromise; monitoring vital signs, including level of consciousness (LOC), with ability to intervene quickly with resuscitation efforts if needed. The rapid response system (RRS) provides critical care expertise when intensive care unit (ICU) level care is needed for compromised patients outside of the ICU, including radiology. The RRS is the radiology nurse’s resource when patients have adverse reactions to sedation, procedures, or diagnostic tests.

The learning landscape continues to evolve as new technological tools enable teachers to deliver robust learning experiences. It is important to help teachers, administrators, and students know where to begin so that the transition to virtual learning is smooth, without educational loss. This chapter consists of two sections: current trends and issues in technology integration and technological pedagogical content knowledge. The first section briefly reviews the trends in instructional or educational technologies that are causing administrators, teachers, and students to reflect on and modify their thinking about learning and educational content delivery. The second section explores constructivism, the scientific underpinnings of nursing informatics, and ethics. Nurse educators must also address the ethical challenges brought about by this evolving learning landscape. After reading this chapter, one can understand current trends and issues, as well as the influence of nursing informatics and ways to approach new ethical dilemmas.

Healthcare is in a state of rapid change. Although practice environments have become more complex, educational delivery methods have remained stagnant. Innovative technologies provide opportunities to enhance nursing student learning and help nursing programs become more responsive to changes in the practice environment; however, obstacles may hinder successful implementation. With the increasing complexity of today’s health care environment, innovations in nursing curricula are necessary. This chapter explores some of the general challenges associated with the integration of innovative educational technologies, as well as some challenges unique to virtual simulation. It helps the reader to analyze the challenges of integrating educational technologies into nursing education associated with faculty, administrators, and students. It also helps the reader to examine practical and philosophical barriers related to technology integration and explores challenges unique to the adoption of virtual simulation.

Simulation has many advantages for nursing education, some of which include creating safe learning environments for students and reinforcing information learned in the classroom; it also has the advantage of being available in inclement weather as well as 24 hours a day for student access. Simulation in nursing is one of many methods used for teaching students. Teaching and learning in a virtual learning environment has many advantages for administrators, faculty, and students. One of the advantages includes the use of other disciplines to help create or participate in a virtual world learning experience. The virtual learning environment can be created to look similar to real communities, disaster areas, or homes, with avatars populating that environment. The advantage to using virtual reality, rather than a real-life experience, is that in real life, students could be immersed in an environment that could cause them harm.

This chapter provides practical strategies for nursing care related to sleep promotion and prevention and treatment of sleep disorders in pediatric primary care settings, acute care settings, and schools. In children with sleep disorders, inadequate sleep does not often result in excessive daytime sleepiness, but in behavioral difficulties such as inattention, hyperactivity, cognitive dysfunction, and/or scholastic problems. Nurses who see children in the primary care setting can take an active role in the evaluation and assessment of all children’s sleep health and provide follow-up care and ongoing treatment monitoring for children who have sleep disorders. In the acute care setting, nurses can incorporate regular treatment plans for a child’s sleep disorder during hospitalization and should be aware of potential for obstructive sleep apnea (OSA)-related perioperative complications for children undergoing adenotonsillectomy. School nurses have the opportunity to promote healthy sleep and improve behavior and school performance in children at risk.

This chapter describes the relevance of critical thinking and the related process and philosophy of evidence-based practice (EBP) to cognitive behavior therapy and suggests choices that lie ahead in integrating these areas. Critical thinking in the helping professions involves the careful appraisal of beliefs and actions to arrive at well-reasoned ones that maximize the likelihood of helping clients and avoiding harm. Critical-thinking values, skills and knowledge, and evidence-based practice are suggested as guides to making ethical, professional decisions. Sources such as the Cochrane and Campbell Collaborations and other avenues for diffusion, together with helping practitioners and clients to acquire critical appraisal skills, will make it increasingly difficult to mislead people about “what we know”. Values, skills, and knowledge related to both critical thinking and EBP such as valuing honest brokering of knowledge, ignorance and uncertainty is and will be reflected in literature describing cognitive behavior methods to different degrees.

This chapter describes the Coping Skills Program, an innovative, school-based, universal curriculum for elementary-school aged children that is rooted in cognitive behavior theory. Rooted in cognitive behavior theory, the Coping Skills Program consists of carefully constructed metaphorical fables that are designed to teach children about their thinking; about the connections among their thoughts, feelings, and behavior; and about how to change what they are thinking, feeling, and doing when their behavior causes them problems. The chapter provides a thorough description of the Coping Skills Program and how it is implemented through a discussion of relevant research-based literature, and the theoretical underpinnings underlying this cognitive behavior approach with school-aged children. It also includes the results of preliminary testing of the Coping Skills Program. The research-based literature shows that cognitive behavior approaches are among the interventions commonly used by social workers to help young children in school settings.

This chapter describes nursing care for sleep disorders in the primary care setting. The most prevalent sleep disorders in adults and older adults, and those most commonly seen in primary care settings are insomnia, sleep-disordered breathing, and restless legs syndrome. There is a compelling need for widespread access to sleep assessment and treatment among the large population of primary care clients who have sleep disorders-many of which are currently undetected. Primary care providers, especially nurses, are in an ideal position to assess, implement, and evaluate sleep promotion and sleep disorders treatment in primary care clients. The reach, adoption, implementation, and long-term maintenance of sleep promotion and sleep disorders treatment is most likely to be successful if implemented at the practice/organizational level. Nurses, especially advanced practice nurses play a pivotal role in implementing and evaluating policies and procedures to assure the translation and uptake of these important services.

This chapter describes the current trends toward greater gender equality in couple relationships, what keeps old patterns of gendered power alive, and why equality is so important for successful relationships. Relationship vignettes like the ones just described are common. Sharing family and outside work more equitably is only part of the gender-equality story. Gender ideologies are replicated in the way men and women communicate with each other and influence the kind of emotional and relational symptoms men and women present in therapy. Stereotypic gender patterns and power differences between partners work against the shared worlds and egalitarian ideals that women and men increasingly seek. The concept of relationship equality rests on the ideology of equality articulated in philosophical, legal, psychological, and social standards present today in American and world cultures. The four dimensions of the relationship equality model are relative status, attention to the other, accommodation patterns, and well-being.

Adolescence is a particularly intense stage of development. During the time of life between prepubescence and young adulthood, youth are challenged by accelerated mental, emotional, cognitive, and physical changes. The ordinary biopsycho-social stressors of adolescence, in conjunction with extraordinary environmental conditions, harmful external stimuli, and the dearth of resources that are associated with lower class and ethnic social status, tend to disrupt homeostasis and thwart positive youth development (PYD). Poor, ethnic minority youth are at disproportionate risk of negative social outcomes. The majority of these disparities involve externalizing factors, such as teen pregnancy, academic underachievement, and antisocial peer-group affiliation, as well as violent victimization and offending. The basic mission of F.I.T. an acronym for Focus, Initiative, and Tenacity Camp is to empower disadvantaged, ethnic minority youth by means of fostering positive social and emotional development.

This chapter explores the relationship between gender and power. Gendered power in couple relationships arises from a social context that has given men power over women for centuries. When practitioners fail to take account of social context, however, they may run the risk of inadvertently pathologizing clients for legitimate responses to oppressive experiences. The term gender is a socially created concept that consists of expectations, characteristics, and behaviors that members of a culture consider appropriate for males or females. Consequently, an individual’s ideas about gender may feel deeply personal even though they are a product of social relationships and structures. Strong social forces work to keep social power structures, including gender inequality, in place. The continued presence of gendered power structures in economic, social, and political institutions still limits how far many couples can move toward equality. Today, ideals of equality compete with the institutional practices that maintain gender inequality.

Child psychotherapy requires case conceptualization through the lens of developmental psychology in a multimodal approach to assessment, diagnosis, treatment planning, and clinical interventions. This chapter outlines a blueprint for therapists to provide treatment for children by integrating these fundamental principles while collaborating with the other people in the child’s life. The chapter guides the therapist through case conceptualization that integrates the most efficacious treatment interventions into the eight-phase template of eye movement desensitization and reprocessing (EMDR). Adaptive information processing (AIP) theory drives treatment with EMDR throughout the eight phases of that protocol and provides a template for case conceptualization and treatment planning. The use of the EMDR approach to psychotherapy is well documented and approved as evidence-based practice in Substance Abuse and Mental Health Administration (SAMHSA) and California Evidence-Based Clearinghouse for Child Welfare (CEBC).

This chapter describes the characteristics, epidemiology, pathophysiology, and treatment of movement disorders: periodic limb movement disorder (PLMD) and restless legs syndrome (RLS) and suggests implications for nursing practice. Parasomnias and movement disorders are associated with many behaviors that occur in proximity to the sleep period during sleep stage transitions, or during REM or NREM sleep. Movement disorders, in particular, are associated with significant impairment in quality of life and possibly negative cardiovascular consequences. Both groups of conditions occur in adults and children. Although some conditions are occasional, benign, and self-limiting, others are persistent and associated with significant sleep loss and/or the risk of injury to self and others. Nursing care for movement disorders and parasomnias is focused on patient education, providing appropriate reassurance regarding benign and self-limiting behaviors, a safe environment, and symptom control where necessary. Sleep hygiene, avoiding caffeine, and regularly scheduled sleep-wake cycle often reduces negative consequences.

This chapter examines the cultural and relational contexts of postpartum depression. Postpartum depression (PPD) is a debilitating, multidimensional mental health problem that affects 10"-15” of new mothers and has serious consequences for women, children, families, and marriages. Although women’s experience of postpartum depression has been the subject of considerable recent study, nearly all of this work has been interpreted within a medical or psychological frame. The chapter looks at a social constructionist lens to this body of research through a meta-data-analysis of recent qualitative studies of PPD. Though hormonal changes as a result of childbirth are related to depressive symptoms after childbirth, biological explanations alone cannot explain postpartum depression. A social constructionist approach to postpartum depression focuses on how the condition arises in the context of ongoing interpersonal and societal interaction. Climbing out of postpartum depression is an interpersonal experience that requires reconnection with others.

Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. As is so often true for social work, the opportunity is associated with need. For social workers, in their role as advocates and clinicians, this unmet need would seem to create an obligation. This chapter argues that, if choosing to accept the obligation, social workers can become catalysts for vitally needed change within the medical field. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating Cognitive behavior therapy’s (CBT) effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients. While this chapter discusses the clinical benefits and techniques of CBT, it also acknowledges the likelihood that social work will have to campaign for its implementation in many medical settings.

Children are exposed to distress, violence, and trauma even before they are born. In-utero and early childhood exposure can contribute to severe medical and psychological consequences. Children who have been exposed to such traumatic events often arrive at the psychotherapist’s office with emotional and behavioral symptoms suggestive of reactive attachment disorder (RAD), post-traumatic stress disorder (PTSD), and dissociation. This chapter reviews relevant theories of dissociation integrated with theories of development to provide a summary of how attachment impacts dissociation. With a developmentally grounded theory of dissociation, the chapter describes clinical interventions for treating the dissociative sequelae of attachment trauma in children. This theoretical framework offers a developmentally grounded and integrative framework for working with children with complex trauma and dissociation. Symptoms of dissociation are common with PTSD, but an extreme response to trauma can be dissociation and dissociative disorders.

School social workers provide direct treatment for a multitude of problems that affect child and adolescent development and learning; these problems include mood disorders, attention deficit hyperactive disorder (ADHD), disruptive behavior disorders, and learning disorders, as well as child abuse and neglect, foster care, poverty, school drop out, substance abuse, and truancy, to name but a few. This chapter examines four constructs that are important when working with students. These constructs include: assessment and cognitive case conceptualization, the working alliance, self-regulated learning, and social problem solving. The chapter discusses the development of attainable and realistic goals is a critical component both of self-regulated learning and social problem solving. The chapter examines the problem of academic underachievement and four constructs that are critically important when working with children and adolescents in school settings. Academic underachievement is a serious problem affecting the lives of many children.

This chapter offers a review of selective literature on complex childhood trauma. It explains a case study demonstrating the use of meditative dialogue, a collaborative practice through which client and therapist are able to work together to develop empathy and compassion toward self and others during psychotherapy sessions. Thompson and Waltz described an inverse relationship between exposure to trauma and subsequent posttraumatic stress disorder symptom severity, and self-compassion. Recent neuroscience research has begun examining the effects of meditation practices on specific areas of the brain through neuroimaging studies. Clinical trials on the use of meditative dialogue in psychotherapy with survivors of complex childhood trauma, looking at the brains of the clients, and using magnetic resonance imaging (MRI) to measure changes, would help to demonstrate its efficacy and move it into the realm of evidence-based practices.

This chapter explains a set of guidelines to help mental health professionals and clients move away from the gender stereotypes that perpetuate inequality and illness. Identifying dominance requires conscious awareness and understanding of how gender mediates between mental health and relationship issues. An understanding of what limits equality is significantly increased when we examine how gendered power plays out in a particular relationship and consider how it intersects with other social positions such as socioeconomic status, race, ethnicity, and sexual orientation. To contextualize emotion, the therapist draws on knowledge of societal and cultural patterns, such as gendered power structures and ideals for masculinity and femininity that touch all people’s lives in a particular society. Therapists who seek to support women and men equally take an active position that allows the non-neutral aspects of gendered lives to become visible.

This chapter presents how eye movement desensitization and reprocessing (EMDR) therapy and Theraplay can be used together when treating children with a history of complex trauma. Theraplay focuses on the parent-child relationship as the healing agent that holds within it the potential to cultivate growth and security in the child. The chapter shows some core concepts that help define and illuminate the application of Theraplay. Now that a clear review of basic Theraplay principles has been provided, people need to look at EMDR therapy and the adaptive information processing (AIP) model in conjunction with Theraplay and Theraplay core values. Early in its development, Theraplay integrated parental involvement into its therapeutic model. During the reprocessing phases of EMDR therapy, Theraplay can be very helpful in providing different avenues for emotion regulation and for the repairing of the attachment system.

One of the emerging approaches to explaining the normative spike in adolescent risk-taking, with delinquent/antisocial behavior as one expression, is based on recent advances in developmental neuroscience. Brain imaging studies have identified two main processes for which co-occurrence in the healthy adolescent brain directly impacts delinquent behavior. The first neuropsychosocial process implicated in heightened risk-taking involves sudden and dramatic changes in activity in the limbic system that coincides with puberty. The second process is associated with a developing ability to self-regulate behavior that continues to mature into the early 20s. Mindfulness meditation may be an effective method for reducing delinquency in juvenile justice involved youth because of its association with increases in self-regulation. The juvenile justice system was built on the argument that children and youth are less culpable for criminal and delinquent behavior than adults, making adolescence a mitigating circumstance in determining the state’s response to youth criminality.

Most Behavioral Group Therapy (BGT) with children and adolescents include aspects of problem solving or social skills training or both. This chapter describes group workers can make an important contribution to children, families, and schools through preventive and remedial approaches. Social skills training grew out of the clinical observation and research that found a relationship between poor peer relationships and later psychological difficulties. The social skills program taught the following four skills: participation, cooperation, communication, and validation/support. The chapter focuses on the unique application of behavioral treatment using groups with an emphasis on assessment, principles of effective treatment, and guidelines for the practitioner. It also focuses on the use of the group in describing these aspects of BGT. The primary goal of using BGT with children is enhancing the socialization process of children, teaching social skills and problem solving, and promoting social competence.

This chapter describes the toxic stress often experienced by young homeless children and the effect that this type of stress can have on brain development, behavior, and lifelong health. Mental health and cognitive challenges are abundant among homeless families. Stress can affect maternal cardiovascular function and restrict blood supply to the placenta, potentially reducing fetal nutritional intake or oxygen supply, and lead to reduced fetal growth, increased risk of placental insufficiency, preeclampsia, and preterm delivery. Trauma in early childhood has clear neurological and developmental consequences, especially with regard to brain development and executive functioning. The chronic release of two stress hormones glucocorticoids and cortisol can have damaging effects on neurological functioning and lifelong health. Similarly, exposure to high levels of cortisol inhibit neurogenesis in the hippocampus, further impacting executive functioning and the ability to distinguish safety from danger, a symptom of posttraumatic stress disorder (PTSD).

The case for major depression being an inflammatory condition has been advanced in the literature on neuroscience as well as in the literature on psychiatry. The correlational data suggested that depressed persons exhibit signs of systemic inflammation. One way to induce inflammation in the blood is to place a piece of the wall of a bacterium in the paw of an animal. There are other ways to induce systemic inflammation besides introducing fragments of a bacterial cell wall. Consistent with the view that behavioral depression involves inflammation, particular alleles for genes involved in the immune system have been identified as risk factors for depression. Mediterranean diets are associated with lower levels of inflammatory factors and lower levels of depression. Parasympathetic nervous system (PNS) releases factors that will inhibit the release of inflammatory factors from white blood cells and from the liver.

This chapter integrates elements and strategies of internal family systems (IFS) psychotherapy into eye movement desensitization and reprocessing (EMDR) therapy with complexly traumatized children. It shows a description of healing a part using in-sight with a child. In-sight involves having the client look inside to find and work with parts that he or she sees or senses and describes to the therapist. The IFS therapist starts by ensuring the client’s external environment is safe and supportive of the therapy. In a self-led system, polarizations are absent or greatly diminished, leaving more harmony and balance. However, when and how the self is formed may be seen and conceptualized through different lenses in adaptive information processing (AIP)-EMDR and IFS. According to the AIP model, the human brain and biological systems are shaped by the environmental experiences they encounter.

This chapter provides insight into the dilemmas couples face when ideals of equality intersect with societal structures that maintain gendered power. It examines how Iranian couples construct gender and negotiate power within their culture, political structure, and Islamic values. Gender equality may express itself differently in a culture such as Iran that not only emphasizes collective goals and achievements, strong feelings of interdependence, and social harmony. Collectivism typically maintains social order through a gender hierarchy. Contemporary Iranian couples draw from diverse cultural legacies. Although some couples seemed to accept the traditional gender hierarchy and a few others appeared to manage relatively equally within it, other couples were quite aware of gendered-power issues and attempted to address them in their personal lives. Some couples describe trying to maintain an equal relationship in their personal lives despite men’s greater legal authority.

This chapter examines how 12 White, middle-class couples negotiated the issue of equality in their relationships during their first year of marriage. The social context both supports and inhibits the development of marital equality. To be included in the present study, complete transcripts with both the husband and wife present had to be available, both members of the couple had to express ideals of gender equality, and both had to express commitment to careers for wives as well as husbands. Most of the couples classified as creating a myth of equality, spoke as though their relationships were equal but described unequal relationship conditions. The other couples classified in the myth-of-equality category described similar contradictions between their ideals of gender equality and their behavior. Gender-equality issues raise political and ethical concerns for all of us who are family practitioners and teachers.

This chapter presents advances in the understanding of adolescent brain development that can inform and improve social work practice with youth leaving foster care. Foster care populations have a high rate of mental health disorders, and the association of types of child maltreatment with elevated risk for such disorders is well known; discussion of specific mental health problems and their treatment can be found elsewhere. Conventional mental health approaches have often targeted the innervated cortical or limbic neural systems, rather than the innervating source of the dysregulation. Psychotherapy, whether psychodynamic or cognitive, acts on and has measurable effects on the brain, its functions, and metabolism in specific brain areas. The ethical response is a sharing of the dilemma, and of information about the neurobiology of the client’s struggle, to enable the client to make as informed a decision as possible. In addition, neuroimaging techniques themselves lead to other ethical dilemmas.

The inclusion of parents and family caregivers throughout the phases of eye movement desensitization and reprocessing (EMDR) therapy is essential for best treatment outcome with highly traumatized and internally disorganized children. Parental responses that create dysregulation in the child’s system also appear to be related to the parent’s capacity to reflect, represent and give meaning to the child’s internal world. This chapter shows a case that exemplifies how the caregiver’s activation of maladaptive neural systems perpetuates the child’s exposure to multiple and incongruent models of the self and other. Helping parents arrive at a deeper level of understanding of their parental role using the adaptive information processing (AIP) model, attachment theory, regulation theory and interpersonal neurobiology principals will create a solid foundation. The thermostat analogy is designed to assist parents in understanding their role as external psychobiological regulators of the child’s system.

This conclusion presents some closing thoughts on key concepts discussed in the preceding chapters of this book. The book attempts to contribute to improving children’s lives by providing a comprehensive and effective treatment protocol. To enhance treatment efficacy and improve the trajectory for children’s lives, case conceptualization in child psychotherapy must integrate developmental theory, neuroscience, and best practice models into clinical practice. The book reviews some of the latest research on attachment and neuroscience that impacts case conceptualization in child psychotherapy. In 1989, Shapiro proposed a new treatment approach she entitled eye movement desensitization (EMD) and, later, eye movement desensitization reprocessing (EMDR) to treat trauma. After reviewing the major theories of attachment and Schore’s current rendition that he labels self-regulation theory, the book offers a foundation for therapists to use develop-mentally grounded theory through the lens of adaptive information processing (AIP) to treat attachment issues in clients of all ages.

There is abundant evidence of the importance of sleep and sleep disorders in nursing practice. This chapter provides a perspective on future directions in nursing research, practice, and education relative to sleep promotion and prevention and treatment of sleep disorders. It also provides an opportunity to examine some of the exciting possibilities and challenges for advancing sleep science and the implementation of this evidence in the discipline of nursing. While the contributions of nurses to sleep science are growing, the application of science to practice and pedagogy lags behind scientific progress. The chapter presents an overview of opportunities and possible directions for nursing scholarship related to sleep, and also presents an overview of current trends that intersect with the need for evidence-based practice in sleep promotion, and suggest implications for nursing curricula. The effort will require creativity, dedication, strategic planning and successful interdisciplinary collaboration, as well as collaborations within nursing.

This chapter provides a summary of the social-cognitive neuroscience conceptualization of empathy. It discusses the application of neuroscience research to social work education, practice, and research. Empathy activates neural networks, groups of nerve cells that are connected by synaptic junctions. These three cognitive abilities, self-other awareness, perspective-taking, and emotion regulation, are critical components in the inductive process that results in the experience of affective empathy. Without these three cognitive abilities, people are more likely to be overwhelmed by the effects of the Shared representation System (SRS) and experience emotional contagion rather than affective empathy. Underlying the cognitive empathy appraisal process is the concept known as theory of mind (ToM). The affective empathy induction process relies heavily on a part of the brain known as the limbic system, which is near the center of the brain and evolved first in early mammals.

This chapter focuses on mirror neurons, which were discovered in the 1990s in Italy. It describes the relevance of mirror neurons for social work practice and addresses some research implications of this topic. The chapter explains the functions of the mirror neuron system (MNS), which includes a discussion of imitation, action understanding, intention understanding, theory of mind (ToM), and empathy. It includes sections on the neuroscience contributions to attachment theory, the concept of the social brain, micro-practice and policy implications, and research implications. Mirror neurons are a specialized kind of brain cells that form a network located in the temporal, occipital, and parietal visual areas, and two additional brain regions that are mainly involved with motor actions. The auditory motor neurons found in the high vocal center (HVC) of swamp sparrows are considered to be very similar to the visual motor mirror neurons that have been discovered in primates.

The clinical social worker typically interfaces with older adult clients and their families in a variety of settings, providing diverse services ranging from assessment to clinical treatment to referral. This chapter discusses the ways in which cognitive behavior therapy (CBT) techniques can be used by social workers across different milieu to assist elderly clients who may be suffering from depression. These settings include the client’s home, an inpatient or outpatient mental health facility, a hospital or medical setting, a long-term care facility, or a hospice setting. The chapter provides an overview of how cognitive behavior techniques can be integrated throughout the range of services social workers may provide to elderly clients. Clinical examples demonstrate the use of CBT in a variety of settings. For many older adult clients, issues related to the need for increasing dependence on family, friends, and paid caretakers may become the central focus of counseling.

This chapter presents several strategies, analogies, and metaphors to address dissociation from different angles and perspectives. Clinicians will have a wide range of methods of introducing and explaining dissociation to children. Analogies and stories that help children understand the multiplicity of the self may be presented during the preparation phase of eye movement desensitization and reprocessing (EMDR) therapy. A good way of introducing the concept of dissociation is by using the dissociation kit for kids. Stimulating interoceptive awareness is a fundamental aspect of the work needed during the preparation phase of EMDR therapy with dissociative children. Visceral, proprioceptive, as well as kinesthetic-muscle awareness should be stimulated. The installation of present resolution (IPR) was inspired by an exercise developed by Steele and Raider. In this exercise, the child is asked to draw a picture of the past traumatic event followed by a picture of the child in the present.

During the installation phase, the child can experience a felt positive belief about himself or herself in association with the memory being reprocessed. Children with history of early and chronic trauma have difficulty tolerating positive affect. Enhancing and amplifying their ability to tolerate and experience positive emotions and to hold positive views of the self are pivotal aspects of eye movement desensitization reprocessing (EMDR) therapy. This chapter shows a script that may be used with children during the body scan phase. Assisting children in achieving emotional and psychological equilibrium after each reprocessing session as well as ensuring their overall stability are fundamental goals of the closure phase of EMDR therapy. The reevaluation phase of EMDR therapy ensures that adequate integration and assimilation of maladaptive material has been made. The future template of the EMDR three-pronged protocol is a pivotal aspect of EMDR therapy.

Community-based epidemiological studies find that when grouped together, anxiety disorders are the most common mental health conditions in the United States apart from substance use disorders. Anxiety disorders are also associated with substantial impairments in overall health and well-being, family functioning, social functioning, and vocational outcomes. This chapter includes a brief description of the anxiety disorders followed by a more detailed review of the cognitive behavior interventions indicated for these conditions. Social phobia is the most common anxiety disorder in the United States. Panic attacks are sudden surges of intense anxiety that reach their peak with 10 minutes and involve at least 4 of a list of 13 symptoms. Another somewhat less common anxiety disorder is obsessive compulsive disorder. The chapter discusses the posttraumatic stress disorder (PTSD). Two anxiety management procedures, breathing retraining and deep muscle relaxation, have been subject to some level of empirical investigation for certain anxiety disorder.

This introduction presents an overview of key concepts discussed in the subsequent chapters of this book. The book serves as a practice resource for social workers by making accessible the vast territory covered by the social, cognitive, and affective neurosciences over the past 20 years, helping the reader actively apply scientific findings to practice settings, populations, and cases. It helps readers gain a deeper understanding of how neuroscience should and can help the design, development, and expansion of therapeutic interventions, social programs, and policies for working with our most vulnerable populations. The book considers the neuroscientific implications for social work practice in child welfare and educational settings across system levels. It highlights the neuroscientific literature that can inform social work practice in health and mental health. The book concludes by discussing the neuroscientific implication of social work practice in the criminal justice system.

This chapter focuses on six maladaptive processes that underlie a wide range of emotional and behavioral problems commonly addressed by social work practitioners in the mental health field. First, it explicates how a focus on transdiagnostic processes differs from traditional views of psychopathology and accords more closely with neuroscientific evidence. Next, the chapter reviews current research in the fields of experimental psychopathology and neuroscience to detail the cognitive, emotional, and neurobiological features of these six core transdiagnostic processes: automaticity, attentional bias, memory bias, interpretation bias, suppression, and stress reactivity. Then it discusses how these processes may be assessed by clinical social workers in the field, and offer six case vignettes that depict how they manifest in human suffering and impaired psychosocial functioning. Finally, the chapter discusses mindfulness-based interventions as a means of targeting transdiagnostic processes in clinical practice.

Cognitive behavioral therapy (CBT) with children addresses four main aims: to decrease behavior, to increase behavior, to remove anxiety, and to facilitate development. Each of these aims targets one of the four main groups of children referred to treatment. This chapter suggests a route for applying effective interventions in the day-to-day work of social workers who are involved in direct interventions with children and their families. An effective intervention is one that links developmental components with evidence-based practice to help enable clients to live with, accept, cope with, resolve, and overcome their distress and to improve their subjective well-being. CBT offers a promising approach to address such needs for treatment efficacy, on the condition that social workers adapt basic CBT to the specific needs of children and design the intervention holistically to foster change in children. Adolescent therapy covers rehabilitative activities and reduces the disability arising from an established disorder.

The primary goals of the assessment phase are to access the memory network containing traumatogenic material and to access and activate the cognitive, affective, and somatic aspects of the memory. Since the reprocessing phases of eye movement desensitization and reprocessing (EMDR) therapy follow immediately after the assessment phase, the clinician should have prepared potential interweaves in case the child’s processing of the memory gets blocked. Children with complex trauma histories may already have sensitized sympathetic systems that make them prone to being in fight flight mode even in the face of safety. The chronically traumatized children present with sensitized dorsal vagal systems. Current caregiving and attachment behaviors have the potential for activating the attachment system, and with it past dysfunctional attachment experiences. One of the best adjunct approaches that can be used within a comprehensive EMDR treatment is sandtray therapy.

This chapter discusses the impact of trauma and its treatment through discussion of posttraumatic stress disorder (PTSD) and its neurological components-especially those affecting memory, evidence-based therapies (EBTs) for the treatment of PTSD, and the implications for practice, policy, and research. Two primary predictors exist for a person developing PTSD. The first one is experiencing dissociation during the trauma. The second predictor is the person developing acute stress disorder. Specifically, neuroimaging shows how PTSD affects neurological functioning in the brain. The primary regions of the brain affected by PTSD are the medial prefrontal cortex, the left anterior cingulate cortex, the thalamus, the medial temporal and hippocampal region, and the amygdala. The different regions of the brain associated with memory encoding are: left prefrontal cortex, left temporal/fusiform, anterior cingulate, and hipocampal formation. Cognitive-behavioral therapy (CBT) has been used extensively to treat PTSD.

The incorporation of a skill-building phase and eye movement desensitization reprocessing (EMDR) games can greatly enhance and facilitate the utilization of EMDR therapy with children who have a history of complex trauma. Some EMDR games work with cognitive skills, others work with emotional skills, while others work with the body and the language of sensation. The use of positive cognition cards offers a great opportunity to play and use a wide range of card games. This chapter exemplifies how to use negative cognition games. Feeling cubes contain different basic emotions appropriate for children. Clinicians can purchase plain wooden cubes and write different feelings on the cube. A wide range of card games can be used with the feeling cards. The memory wand offers another playful approach to the process of identifying traumatic events with children. The chapter shows a playful way of exploring and identifying parent-child interactions.

The basic goals of phase one are to develop a working relationship and a therapeutic alliance and to determine if the level of expertise of the eye movement desensitization and reprocessing (EMDR) clinician is adequate for the complexity of the case. Other goals are to develop a comprehensive treatment plan and case formulation. EMDR therapy was developed as a form of treatment to ameliorate and heal trauma. Clinicians working with complex trauma must have substantial understanding of the adaptive information processing (AIP) model and the EMDR methodology. During phase one, the clinician works on creating an atmosphere of trust and safety so a therapeutic alliance can be formed with the child and the caregivers. This chapter shows an example of how medical issues can affect the quality of the parent-child communications. The adult attachment interview (AAI) gives us the view of the presence of the experiences in the parent’s life.

Social work professionals are in key roles for providing effective education, treatment, training, and services for adult survivors. This chapter helps the social workers to equip with an evidence-based treatment framework to effectively enhance their work with this population of adult survivors. A community study of the long-term impact of the sexual, physical, and emotional abuse of children concluded that a history of any form of abuse was associated with increased rates of psychopathology, sexual difficulties, decreased self-esteem, and interpersonal problems. There is well-established and increasing empirical evidence that cognitive and cognitive behavior therapies are effective for the treatment of disorders that are typical among adult survivors of sexual and physical abuse. The chapter presents some basic cognitive behavior therapy (CBT) strategies that social workers can use in whatever roles they play in working with the multidisordered adult survivor. There are three types of schema avoidance: cognitive, emotional and behavioral.

This chapter discusses the characteristics of sleep, factors associated with sleep, and evidence-based strategies to promote sleep in acute and critical care settings. It discusses implications for nursing practice and research. Disordered sleep is common in patients hospitalized in demographical and clinically diverse acute and critical care settings. Careful assessment for factors that increase the risk for sleep disturbance and its consequences during hospitalization is needed. Although randomized clinical trials are sparse, the available evidence suggests the promise of multimodal interventions that reduce environmental stimuli or their impact. Given the high prevalence of obstructive sleep apnea (OSA) in the general population and its underdiagnosis, there is a compelling need for assessment and preventative interventions for this condition. Research is needed on the short- and longer-term outcomes of sleep-promoting interventions on patients’ function, quality of life, and morbidity.

When Charles, a 46-year-old divorced male with an extensive psychiatric history of depression, substance abuse, and disordered eating resulting in a suicide attempt, erratic employment, and two failed marriages, began treatment with a clinical social worker trained in dialectical behavior therapy (DBT), he was an angry, dysphoric individual beginning yet another cycle of destructive behavior. This chapter provides the reader with an overview of the standard DBT model as developed by Linehan. Dialectical behavior therapy, which engages vulnerable individuals early in its treatment cycle by acknowledging suffering and the intensity of the biosocial forces to be overcome and then attending to resulting symptoms, appears to be the model most congruent with and responsive to the cumulative scientific and theoretical research indicating the need for the development of self-regulatory abilities prior to discussions of traumatic material or deeply held schema.

Child psychotherapy is different than any other type of adult-child relationship. A trained mental health professional is using clinical skills to help a child find the answers to the problems he or she has encountered. This chapter outlines the most common symptoms in child psychotherapy. Anxiety is one of the most common symptoms of childhood, but the etiology and manifestation of anxiety varies. Anxiety is a symptom of many other disorders, including generalized anxiety disorder (GAD), separation anxiety, obsessive-compulsive disorder, panic disorder, social phobia and other specific phobias, selective mutism, mood disorders, and post-traumatic stress disorder. Gifted children tend to have higher levels of anxiety because they can think about things they are not yet emotionally prepared to manage. The chapter discusses clinical interventions for common issues of childhood, along with resources for children, directions for parents, and references for parents, caregivers, educators, and therapists alike.

This chapter explores theories of human development, also referred to as developmental psychology, as a knowledge base for professionals to integrate theory into case conceptualization in child psychotherapy. It provides a brief overview of the significant contributions of developmental psychology to the field of child psychotherapy that impact case conceptualization in the clinical treatment of children. Many theorists have shaped the study of human development, including Buford Jeanette Johnson, Anna Freud, Jean Piaget, Lev Vygotsky, Urie Bronfenbrenner, Erik Erikson, Jerome Kagan, John B. Watson, B. F. Skinner, Albert Bandura, Lawrence Kohlberg, Jerome Brunner, Robert J. Havighurst, and Emmy Werner. Collectively, their theories propose explanations of all aspects of human development, including psychosexual, cognitive, social, psychosocial, behavioral, and neurological development, along with memory, information processing theories, and resilience. The chapter includes educational theory in order to understand how children are challenged to learn not only internally, but also externally, as well.

This chapter offers a brief and focused review of human development, with specific emphasis on cognition and emotion. It is essential that the reader distinguishes between cognitive development, cognitive psychology, and cognitive therapy. Both short-term and long-term memory improve, partly as a result of other cognitive developments such as learning strategies. Adolescents have the cognitive ability to develop hypotheses, or guesses, about how to solve problems. The pattern of cognitive decline varies widely and the differences can be related to environmental factors, lifestyle factors, and heredity. Wisdom is a hypothesized cognitive characteristic of older adults that includes accumulated knowledge and the ability to apply that knowledge to practical problems of living. Cognitive style and format make the mysterious understandable for the individual. Equally, an understanding of an individual’s cognitive style and content help the clinician better understand the client and structure therapeutic experiences that have the greatest likelihood of success.

This chapter reviews normal physiological and anatomical changes that occur during pregnancy and discusses common sleep disorders that can occur during pregnancy as well as postpartum. It also discusses the adverse effects of poor sleep on labor and delivery outcomes and reviews postpartum sleep patterns within the context of risk for postpartum depression. The chapter examines the nurses’ role in sleep promotion in relation to sleep hygiene behaviors that can be adapted for pregnant women and new mothers and their families during the first 6 months postpartum. It describes alternative strategies nurses can use to safely promote sleep during perinatal period. Restless legs syndrome (RLS) and sleep-disordered breathing (SDB) or obstructive sleep apnea (OSA) the most critical causes of disturbed sleep during pregnancy and require urgent assessment and referral for effective and non-pharmacologic interventions. The chapter explores sleep during the postpartum period, when women’s experience with sleep deprivation is expected.

International Society for the Study of Trauma and Dissociation (ISSTD)’s professional training institute offers comprehensive courses on childhood dissociation that are taught internationally and online. This chapter briefly cites some of the theories that have emerged in the dissociative field. One system, the apparently normal personality (ANP) enables an individual to perform necessary functions, such as work. The emotional personality (EP) is action system fixated at the time of the trauma to defend from threats. As with the Adaptive Information Processing Model (AIP) in eye movement desensitization and reprocessing (EMDR), each phase brings reassessment of the client’s ability to move forward to effectively process trauma. There are many overlapping symptoms with Attention Deficit Hyperactive Disorder (ADHD) and dissociation that often mask the dissociation. The rate of diagnosis of pediatric bipolar disorder has increased 40 times in the last ten years.

Social workers are committed to the protection and empowerment of weak populations, of those people who are least powerful. Gradually, social work started to rely more on problem-solving methods, client-focused therapy, family theories, and, more recently, cognitive behavior theories, constructivist theories, and positive psychology developments. Clinical social work today operates in a variety of settings in the statutory, voluntary, and private sectors. Clinical social workers have always been interested in helping clients change effectively. The importance of empirical study, valid information, and intervention effectiveness has always been accentuated by the social work field’s central objectives of increasing accountability, maintaining exemplary ethics and norms, and establishing clear definitions and goals. Cognitive behavior theory emphasizes several components. First and foremost, human learning involves cognitive mediational processes. Social workers need to look for effective methods for change, and CBT methods are very promising in this respect.

Research on brain structure and function in white-collar criminals is a notable gap in the neurolaw literature, a gap that was addressed for the first time in one recent research report. Neuroscience is suggesting a link between brain abnormalities and some types of criminal behavior, but it is not yet clear exactly what those abnormalities are. Research on brain function and criminality focuses primarily on levels of hormones and neurotransmitters involved in neuronal communication. The findings regarding connections between the brain and adult criminal behavior, preliminary as they are, have implications for social work practice, including prevention of criminal behavior as well as intervention with offenders. The consistent finding that the likelihood of antisocial behavior is greatest when genetically based brain abnormalities encounter harsh environments has implications for social policy beyond the criminal justice system.

Progress in neuroscience over the past several decades has led to a greater understanding of how the brain functions as a child or adult learns. This chapter focuses on disorders of the brain as applied to school settings. It explores learning disabilities (LD) as they pertain to practice in schools, as well as policy and research implications, and ethical and legal issues. Social workers must understand how the brain develops during various developmental ages and how this affects the learning of individuals. Research by the National Institutes of Mental Health (NIMH) have detected that the causes of LD are diverse and complex. New brain cells and neural networks continue to be produced for a year or so after the child is born. Electroencephalogram (EEG) can provide accurate timing information but provides little impression of where in the brain a particular activity is occurring.

Over the past 25 years there has been a growing recognition of the importance of working with families of persons with severe mental illnesses such as schizophrenia, bipolar disorder, and treatment-refractory depression. Family intervention can be provided by a wide range of professionals, including social workers, psychologists, nurses, psychiatrists, and counselors. This chapter provides an overview of two empirically supported family intervention models for major mental illness: behavioral family therapy (BFT) and multifamily groups (MFGs), both of which employ a combination of education and cognitive behavior techniques such as problem solving training. Some families have excellent communication skills and need only a brief review, as provided in the psychoeductional stage in the handout “Keys to Good Communication”. One of the main goals of BFT is to teach families a systematic method of solving their own problems.

This chapter discusses the treatment of comorbid chronic depression and personality disorders. It then discusses recent treatment advances in the cognitive behavior field relevant to this population. Recently, research has been done comparing schema therapy to Otto Kernberg’s latest model. Because of severe emotional distress, patient often experience suicidal and/or parasuicidal behaviors. The chapter explores the benefits of mode work with these particular difficulties while maintaining a therapeutic approach of connection and compassion; this alliance is crucial for the approach to be effective. It focuses on the five most common modes for those with chronic depression and personality disorders namely the abandoned/abused mode, the detached protector mode, the angry mode, the punitive mode and the healthy adult mode. The interventions described in schema mode therapy have cognitive, experiential, and behavioral components. Identification of the mode the patient is in when suicidal is essential when managing a crisis.

This chapter reviews the basic tenets of evidence-based practice (EBP), and discusses the potential applications of this model of practice and training for the field of clinical social work. It also presents some actual illustrations of its use. The chapter describes the major forms of clinical outcome studies: Anecdotal Case Reports, Single-System Designs With Weak Internal Validity, Quasi-Experimental Group Outcome Studies, Single, Randomized Controlled Trial, Multisite Randomized Controlled Trials and Metaanalyses that comprise the priority sources of information underpinning EBP. As the human services increasingly develop robust evidence regarding the effectiveness of various psychosocial treatments for various clinical disorders and life problems, it becomes increasingly incumbent upon individual practitioners to become proficient in, and to provide, as first choice treatments, these various forms of evidence-based practice. It is also increasingly evident that cognitive behavior therapy (CBT) and practice represents a strongly supported approach to social work education and practice.

Comparison studies have long found that same-sex partners maintain more equal relationships than their heterosexual counterparts, largely because they do not divide roles and responsibilities based on gender. Thus the study of samesex couples offers the ability to examine the processes that create and maintain equality when gender differences do not organize couple relationships. However, same-sex partners emphasize the satisfaction of intimacy needs, rather than moral obligation or societal expectations, as their reason for maintaining the relationship. This primary focus on the relationship itself, which is also becoming more common among heterosexual couples, tends to be associated with egalitarian ideals that are not necessarily easy to translate into practice. A distinguishing characteristic of couples who were classified as demonstrating attuned inequality is the indebtedness that the benefiting partner feels to the other. Attuned couples describe conscious strategies for managing their relationships.

Over the years, cognitive behavior therapy (CBT) has been applied to a variety of client populations in a range of treatment settings and to the range of clinical problems. This chapter provides a general overview of the cognitive behavior history, model, and techniques and their application to clinical social work practice. It begins with a brief history and description, provides a basic conceptual framework for the approach, highlights the empirical base of the model, and then discusses the use of cognitive, behavior, and emotive/affective interventions. Cognitive behavior therapy is based on several principles namely cognitions affect behavior and emotion; certain experiences can evoke cognitions, explanation, and attributions about that situation; cognitions may be made aware, monitored, and altered; desired emotional and behavioral change can be achieved through cognitive change. CBT employs a number of distinct and unique therapeutic strategies in its practice.

Sex and gender differences occur during normal sleep and at sleep-wake transitions and may influence the prevalence and presentation of sleep disorders across the lifespan. This chapter describes sex and gender differences in normal sleep throughout the lifespan and hormonal changes that affect sleep in women and men that may underlie risk for the development of sleep disorders. Gender refers to gender identity within the context of relationships to the society and culture that may evolve over time. Research on gender and sleep has revealed physiologically based sex differences in sleep and important information on sleep as a behavior embedded in the social environment. Although over the course of the human lifespan gender differences are modest, differences in presentation and prevalence of sleep disorders and their potential impact suggest the importance of sex- and gender-related factors in sleep promotion and assessment and management of sleep disorders.

Desensitization is a complex and important phase of eye movement desensitization reprocessing (EMDR) therapy. This chapter covers child-friendly strategies and interweaves that support and stimulates the social engagement system, maintain dual awareness and kindle children’s integrative capacities. It presents advanced strategies and interweaves that can facilitate the assimilation of memories of trauma and adversity as well as to promote vertical and horizontal integration. Shapiro developed a strategy to jump-start blocked processing that she called ‘the cognitive interweave’. According to Shapiro, clients spontaneously move through the three plateaus of information processing: responsibility, safety, and control/power, to a more adaptive perspective during reprocessing. Most children injured and traumatized in the adult-child relationship carry within the responsibility of the event. Mindful awareness in EMDR is pivotal during the reprocessing phases. The use of nonverbal communication strategies can greatly facilitate the process for children working on memories of events occurring pre-verbally.

Narcolepsy is a potentially disabling hypersomnia of central origin that is associated with dysregulation of sleep and waking states. Although less prevalent than some other sleep disorders, such as sleep apnea and insomnia, narcolepsy is very important because studies of this condition have provided scientists with insight into basic mechanisms of sleep-wake regulation. Although the exact cause of narcolepsy is unknown, causes appear to be multifactorial, for example, genetics, infection, stress, and low levels of the brain neurochemical hypocretin. Effective treatments are available and can improve this chronic condition, as well as its negative consequences. This chapter describes the characteristics and consequences of narcolepsy and strategies for assessment and treatment of this sleep disorder, and discusses implications for nursing practice. Nurses and advanced practice nurses, as members of an interdisciplinary team, play important roles in assessment, diagnosis, treatment, and follow-up care.

This chapter provides information for therapists to integrate theories of neuroscience into the practice of child psychotherapy. Neuroscientists have described how the brain develops, documented the impact of external experiences on the developing brain, and integrated theories of neurodevelopment and neuroplasticity into our understanding of the impact of our interpersonal relationships on our brain. The chapter focuses on developmental trauma disorder and the research on the impact of trauma on children. The majority of the research on trauma in children has focused on the assessment and diagnosis of Post traumatic stress disorder (PTSD); however, there are a limited number of studies that have documented the efficacy of the treatment of PTSD in children. The chapter reviews diagnoses specific to neurodevelopment, including autistic spectrum disorders (ASD) and sensory processing disorders (SPD).

The work directed toward increasing the child’s ability to tolerate and regulate affect, so that the processing of traumatic material can be achieved, is initiated during the preparation phase. The process of providing the neural stimulation to improve the child’s capacity to bond, regulate, explore, and play should begin during the early phases of eye movement desensitization and reprocessing (EMDR) therapy. The Polyvagal theory presents a hierarchical model of the autonomic system. In complexly traumatized children, the development of this system has been compromised due to the early dysregulated and traumatizing interactions with their environments and caregivers. When describing the various forms of bilateral stimulation (BLS), go over the different options and practice with the child. If the child went through the calm-safe place protocol successfully, motivating the child to actually use it when facing environmental triggers is an important goal.

This chapter presents a combined creative-corrective approach to working with the bereaved by emphasizing on cognitive assessment as a tool for social workers. It determines how best to facilitate an adaptive grief process with individuals who experience traumatic loss or complicated grief. Cognitive therapies (CT) and cognitive behavior therapies (CBTs) were found suitable with individuals suffering from posttraumatic stress disorder (PTSD), anxiety, and chronic or traumatic grief. Grief as a process of reorganizing one’s life and searching for a meaning following a loss through death is a painful experience. The Adversity Beliefs Consequences (ABC) model is based on a cognitive theoretical model to be applied in treatment of bereaved individuals. Like other cognitive models, rational emotive behavior therapy (REBT) emphasizes the centrality of cognitive processes in understanding emotional disturbance, distinguishing between two sets of cognitions that people construct, rational and irrational ones and their related emotional and behavioral consequences that differ qualitatively.

The current common combat era casualties have been posttraumatic stress disorder (PTSD), head injuries, hearing loss or impairment, and polytrauma. Common causes of military traumatic brain injuries (TBI) are blasts, falls, vehicular accidents, and penetrating fragments or bullets. Mild TBIs (mTBIs) usually are not detectable by lab tests or scans, which typically show normal results. The most common assessment instrument used for TBI is the Glasgow Coma Scale, which scores eye opening responses, motor responses, and verbal responses. Findings of effectiveness of psychosocial rehabilitation models for civilians with TBI and their families suggest that developing models of supported education and employment for injured veterans may be similarly helpful. Stigma, military stoicism, mTBI-related executive function compromise, and PTSD-related avoidance symptoms are barriers to care for neurological disorders, but disclosure of care is still perceived as possibly leading to loss of career or current employment, both among active duty and veterans.

Eye movement desensitization and reprocessing (EMDR) therapy was independently designated as a psychotherapy approach, and was validated by twenty randomized controlled clinical trials. Results of meta-analyses show EMDR as an effective and efficacious treatment for posttraumatic stress disorder (PTSD) in adults and children. Childhood complex trauma refers to the exposure of early chronic and multiple traumatic events. The adaptive information processing (AIP) model constitutes the central piece and foundation of EMDR therapy. Affective neuroscience brings up the importance of PLAY as a healing agent. The polyvagal theory emerged out of the work of Stephen Porges on the evolution of the autonomic nervous system (ANS). Interpersonal neurobiology (IPNB) brings a viewpoint that integrates objective realms of scientific findings and subjective realms of human knowing. The structural dissociation theory of the personality is based on Pierre Janet’s view of dissociation as a division among systems that constitute the personality of an individual.

This chapter discusses some of the critical issues surrounding culture and cognitive behavioral methods in order to better inform the advancement of culturally responsive social work practice. It focuses on one such treatment modality, cognitive behavior therapy (CBT). The chapter reviews relevant theoretical frameworks, existent empirical studies on CBT with diverse cultural groups, strengths and limitations of this modality across cultures, and suggestions for culturally responsive CBT practice, in order to better inform social work practice. While cognitive behavior therapy was developed with universal assumptions and without consideration to the diversity of the cultural contexts of consumers, it is grounded in theory that is likely to have “some universal basis across populations”. Several studies have described the use of cognitive behavior methods with gay and lesbian clients, particularly the use of rational emotive therapy, cognitive restructuring, and behavior experiments.

The treatment of the suicidal individual is perhaps the most weighty and difficult of any of the problems confronted by the clinical social worker. Some frequent comorbid pathology with suicidal behavior includes alcoholism, panic attacks, drug abuse, chronic schizophrenia, conduct disorder in children and adolescents, impulse control deficits, schizophrenia, and problem-solving deficits. Suicidal harmful behavior appears in all ages and characterizes clients in a large spectrum of life. There are four types of suicidal behavior namely rational suicider, psychotic suicider, hopeless suicider and impulsive or histrionic suicider. This chapter presents some primarily cognitive techniques for challenging suicidal automatic thoughts. Recent reports suggest that individuals suffering from alcohol or substance abuse are at an increased risk both for attempting, and for successfully completing, a suicidal act. The therapist must develop an armamentarium of cognitive techniques, and the skills to use these effectively in ways that are appropriate for each individual client.