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Cet article est centré sur l’analyse de filtres garnis de fragments de coco utilisés en France en assainissement non collectif. La qualité des rejets des trois dispositifs développés (V0, V1 et V2) mesurée en conditions de plateforme d’essais et in situ est comparée. Des études précédentes utilisant une méthodologie d’analyse similaire ont qualifié d’« acceptable » la qualité des rejets in situ de V0 et V2 mais pas celle de V1. L’objectif est d’évaluer l’impact des évolutions techniques (matériau filtrant, surface réduite et distribution) sur les différences observées et de déterminer comment les performances sur plateforme peuvent prédire ces résultats de terrain. Tant pour les résultats recueillis sur plateforme qu’ in situ, les outils statistiques déployés concluent que les meilleures qualités de rejet sont obtenues avec le dispositif V0 et les moins bonnes avec le dispositif V1, le dispositif V2 étant intermédiaire. La comparaison entre la qualité des eaux usées brutes utilisées sur plateforme et celle observée in situ montre des différences de concentrations, mais des charges organiques appliquées plutôt homogènes. Ainsi, il est possible de déterminer les rendements requis sur plateforme, assurant l’atteinte des exigences de rejets in situ. L’article fournit des valeurs de rendement applicables aux dispositifs de configuration équivalente. La distribution améliorée à l’aide de l’auget bidirectionnel explique en partie les meilleures performances de V0 et V2 comparativement à V1. Les diminutions des surfaces de filtration n’ont pas d’impact sur les abattements de composés carbonés. Enfin, bien que sur plateforme les charges surfaciques journalières en azote Kjeldahl (NK) soient plus grandes qu’en conditions in situ, ce type d’essais ne permet pas d’apprécier le vieillissement des dispositifs par l’analyse des différentes concentrations azotées du rejet. La poursuite du suivi in situ apparaît donc pertinente.

In this article, we offer a primer on “classical” frequentist statistics. In doing so, we aim to (1) provide social workers with a nuanced overview of common statistical concepts and tools, (2) clarify ways in which these ideas have oft been misused or misinterpreted in research and practice, and (3) help social workers better understand what frequentist statistics can and cannot offer. We begin broadly, starting with foundational issues in the philosophy of statistics. Then, we outline the Fisherian and Neyman–Pearson approaches to statistical inference and the practice of null hypothesis significance testing. We then discuss key statistical concepts including α, power, p values, effect sizes, and confidence intervals, exploring several common misconceptions about their use and interpretation. We close by considering some limitations of frequentist statistics and by offering an opinionated discussion on how social workers may promote more fruitful, responsible, and thoughtful statistical practice.

The macro landscape shaping antidepressant use is marked by uncertain and contested research and vigorous pharmaceutical promotion to doctors and (in the U.S.) patients. While prior studies have investigated antidepressant users’ firsthand experiences of the impacts of medication use on their lives and identities, these studies do not explicitly situate users’ experiences within the macro realities that shape the larger system of care. The aim of this Internet-based qualitative study was to advance a uniquely social work perspective on psychotropic medications by thematically examining the everyday experiences of antidepressant users and framing emergent themes within the broader macro context. The largest sample to date (n = 3243) of user reviews of four antidepressants (escitalopram, duloxetine, vilazodone, and vortioxetine) were downloaded from popular patient-reporting websites and analyzed line-by-line by two independent coders in a general inductive coding process. Antidepressant experiences were characterized by trial-and-error experimentation, limited relief, drug cocktails, uncertainty about causes of change, and unforeseen drug withdrawal challenges. Individual-level experiences are contextualized within the larger landscape of publication bias in clinical drug trials and persistent drug industry promotion of newer, costlier, and add-on drugs. Based on the profession’s systems perspective and social justice commitment, social workers should recognize how macro factors contextualize individual experience and strive to support users in cultivating more informed, empowering relationships with psychiatric drugs. Exploring the meaning of medications, validating users’ firsthand experiences, and monitoring changes throughout treatment and discontinuation are appropriate, critical roles that social workers should consider adopting.

A significant treatment gap exists for incarcerated men with lifetime traumatic experiences. A small research base for trauma interventions for incarcerated women is emerging, but incarcerated men have largely been ignored. Men comprise 90% of the incarcerated population and are at the greatest risk

Peer caregivers are specially-trained incarcerated persons who support the needs of patients in correctional health care settings. Their role is of particular importance in light of the growing population of older adult prisoners with complex health problems in U.S. prisons. The purpose of the current study was to examine the disparity between patient and peer caregiver ratings of patient quality of life (QoL) in a sample of correctional health dyads (n = 52) in a state prison system. The current study also aimed to identify which patient and caregiver characteristics were most closely associated with emerging disparities. The sample and measures were described using frequencies and descriptive statistics. Patient QoL was measured using the McGill Quality of Life Scale-Cardiff Short Form and rater disparity was calculated at the individual- and group-level. Potential correlates were identified using bivariate statistics. Main results indicate group-level disparities were smallest among psychological and physical QoL (d = .06), and largest regarding existential QoL (d = .22). Few bivariate relationships were meaningful in effect, though patient characteristics accounted for 79% of emerging associations (viz. primary diagnosis). Though disparities emerged, peer caregivers in correctional health settings have unique strengths regarding assessment of patient QoL. Implications related to reducing dyadic disparities and targeting caregiver training regarding the importance of patient existential QoL are discussed.

Self-directed care (SDC) is a service delivery model in which individuals diagnosed with a severe and persistent mental illness (SPMI) direct their behavioral healthcare by managing an individual b...

The prescription of psychotropic drugs to children in the child welfare system has rightfully attracted increased public and institutional attention. Significant challenges include (1) the integrity of the scientific literature that concerns the use of psychotropic drugs; (2) the nature and scope of the influence of pharmaceutical companies on prescribing patterns; (3) the regulatory rigor of the U.S. Food and Drug Administration (FDA); (4) the accuracy of psychiatric diagnosis that provides the basis for prescribing decisions; and (5) the efficacy of psychotropic drugs and their long-term impacts on children. This article describes the extant knowledge on these crucially important issues from the perspective of child welfare researchers and practitioners. In particular, a disconnect often exists between the scientific data and the routine psychiatric treatment of youth involved in the child welfare system. Such issues represent significant challenges for the implementation of evidence-informed clinical practice. Recommendations are made for improving the current situation at the levels of child welfare practice, policy, and education.

Adverse effects (AEs) are an important factor in antidepressant treatment decision-making, though common AE profiles from clinical trial research highlight physical AEs to the neglect of emotional and behavioral AEs. First-hand accounts of antidepressant users on the Internet can supplement AE profiles with information gained from real-world treatment experiences. We examined online user reviews of two older (escitalopram; duloxetine) and two newer (vilazodone; vortioxetine) antidepressants for differences in their AE profiles and determined which categories of AEs were associated with users' satisfaction. A codebook of 60 physical, emotional, and behavioral AEs was used for line-by-line coding of effects reported among 3243 user reviews from three popular health websites. Emotional and behavioral effects were commonly reported (41%), followed by sleep (31.9%) and gastrointestinal (25.0%) effects. Specific AEs statistically significantly varied across drugs, creating potentially meaningful differences in AE profiles. Users of newer drugs more often reported emotional instability, while users of older drugs reported more emotional blunting. Emotional and behavioral AEs demonstrated moderate to substantial relationships with users' satisfaction, whereas gastrointestinal, metabolic, or sexual AEs were minimally related. More specific and systematic assessment of a broader range of AEs is needed in both research and practice.

As youth near the transition to adulthood and aging out of the foster care system, exposure to stress increases, especially for youth who have less-than-adequate support systems. Although mental health problems among foster youth often continue into adulthood, service use decreases dramatically within a year of turning age 18. Understanding how foster youth experience mental health services as they transition from care provides social workers and other mental health professionals important insight that can lead to specific, targetable strategies. This study sought to explore what situations were helpful in supporting mental health as foster youth transitioned to adulthood. Focus groups and interviews with former foster youth and professionals informed the development of a quantitative instrument, which was used to identify the most supportive and frequently encountered situations former foster youth experienced. Findings indicate the most helpful situations were those in which professionals and me...

Social workers’ unique skills and professional perspective can contribute to improved practices in psychopharmacology, yet it is unclear how social work programs prepare students for this area of practice. This study examined instruction of psychopharmacology through a national Web-based survey of MSW program directors and instructors of psychopharmacology content (n = 171). Nearly two-thirds (63.7%) reported their program integrates psychopharmacology usually into one or two existing courses, whereas 20.5% indicated their program offers a stand-alone course. Lack of faculty expertise and having no room in the current curriculum structure were identified as the top barriers for programs not offering any psychopharmacology content. The profession’s critical, social justice, empowerment, client-centered, and systems perspective appears to ground the teaching of psychopharmacology in social work programs.

With all the emphasis on havingmoreconversation about mental health, remarkably little attention has been paid tohow exactlywe want to be having it. In what follows, we review five areas about which sharp differences currently exist: (a) Biology—how are physiological contributors to mental distress being framed? (b) Symptoms—how should we best work with distressing signs in the body? (c) Action steps—what needs to happen to improve mental health in the nation? (d) Barriers—what are the primary barriers that need to be overcome in improving public mental health? (e) Lifestyle—what role do lifestyle choices play in mental health? After illustrating the different positions being taken on each of these questions, we then consider the diverging implications for individuals and families facing these problems. We conclude with recommendations as to how the larger dialogue on mental health could become more inclusive and productive.

This study reports on a mixed-methods evaluation of the impacts of an educational curriculum designed to engage psychosocial professionals in child welfare in critical thinking about psychotropic medication-related issues. Caseworkers in two counties (n = 20) received the curriculum and were compared at baseline and 30-day follow-up to caseworkers (n = 46) in non-intervention counties on general attitudes toward medication. Follow-up focus groups with 13 caseworkers examinined self-reported changes in practice behaviors and the broader contexts shaping medication-related practices for youth in foster care. The CriticalThinkRx curriculum resulted in modest changes in attitudes toward greater perceived harms, with a small-to-medium effect size. Following the curriculum, caseworkers reported asking more questions about medications, increasing their advocacy roles, and adopting a systemic perspective on the use of medications. Across counties, caseworkers described a practice context characterized by a systemic reliance on medications, uncertain roles and lack of education of caseworkers, poor client education about medications, inflexible professional hierarchy, and lack of time or options. Despite nationwide calls for improved psychotropic medication practices in child welfare, myriad professional and systemic barriers exist that perpetuate the primacy of drugs for treating youths’ emotional and behavioral distress.

This qualitative study examined the client experience of psychiatric medication among an unusual and under-studied subpopulation, individuals diagnosed with SMI who eventually experienced functional recovery. Four themes emerged from in-depth qualitative interviews with 16 such individuals: (1) primacy of medication, (2) informed consent, (3) self-determination, and (4) clinical engagement. Participants reported that psychiatric medication was the primary, and sometimes the only, intervention offered to them. Some described substantial delays in receiving psychosocial services, or that they were not informed of their availability. Participants also identified deficiencies in the process of informed consent, with some receiving information on adverse effects belatedly, or not at all. Coercive medication practices (e.g., court-ordered medication) were described negatively. Good clinical engagement from prescribers (e.g., good listening and a respectful relationship) was highly appreciated by the par...

Public conversation about biological contributors to mental disorder often centers on whether the problem is “biological or not.” In this paper, we propose moving beyond this bifurcation to a very different question:how exactlyare these problems understood to be biological? Specifically, we consider four issues around which different interpretations of the body’s relationship to mental disorder exist:1. The body’s relationship to day-to-day action; 2. The extent to which the body is changeable; 3. The body’s relationship to context; 4. The degree to which states of the body directly cause mental disorder.Drawing on the work of Merleau-Ponty and other phenomenologists, we examine different responses to these questions and associated implications for how mental health treatment and recovery come to be experienced. Finally, we consider broader questions these patterns raise, including why certain portrayals of the brain dominate public attention and how to foster more deliberation in this regard.

Mental health services are provided to people diagnosed with mental disorders to foster rehabilitation by enhancing emotional and behavioral functioning. The purpose of this project was to understand from the perspective of service recipients what aspects of services they found most helpful in facilitating the process of recovery. Using a sequential explanatory design, a quantitative screening tool was used to identify a criterion sample of people who had been diagnosed with serious mental illness and reported they achieved functional recovery. A sample of 16 adults who met study criteria participated in qualitative interviews to understand what aspects of mental health services they felt contributed to their recovery. Thematic analysis uncovered 7 themes that emerged from their stories of service experiences describing both the content and process of services they found most beneficial. Although some descriptions of services were consistent with recovery-oriented practice principles, others contr...

This study examined health/mental health status, family functioning, and resiliency among a sample of bereaved parents ( N = 503). Participants were recruited from an online support community to complete an online survey instrument (response rate = 51.75%). The questionnaire contained an array of self-report instruments, such as the Hopkins Symptoms Checklist-25 (HSCL-25), the Impact of Event Scale-Revised (IES-R), and the Family Assessment Device (FAD), as well as open-ended questions. Many respondents scored over the clinical cut-off for the HSCL-25 (51.3%, n = 258) and IES-R (42.3%, n = 213). IES-R scores were negatively correlated with years-since loss ( r = −0.24, p < .05). In narrative responses, participants described a wide range of deeply impactful mental and physical health problems. The results indicate significant clinical distress in this sample of bereaved parents, with many reporting enduring psychological, familial, and health consequences following the death of a child.

To examine psychiatric prescribing in response to perinatal/neonatal death, we analyzed data from a cross-sectional survey of 235 bereaved parents participating in an online support community. Of the 88 respondents prescribed medication, antidepressants were most common (n = 70, 79.5%) followed by benzodiazepines/sleep aids (n = 18, 20.5%). Many prescriptions were written shortly after the death (32.2% within 48 hr, 43.7% within a week, and 74.7% within a month). Obstetrician/gynecologists wrote most prescriptions given shortly after loss. Most respondents prescribed antidepressants took them long-term. This sample is select, but these data raise disturbing questions about prescribing practices for grieving parents.

This article examines the economic consequences associated with the death of a child. The economic costs (funeral and medical expenses and productivity losses) of child death 6 months following the death were estimated based on 213 parents who had experienced the death of a child (usually unexpectedly and predominantly mothers). Findings suggest that productivity losses associated with child death comprise most of the costs and that the economic effects are substantial. Costs associated with on-the-job productivity losses ("presenteeism") outweigh the costs associated with absenteeism. To date, no research has empirically measured both absenteeism and presenteeism following bereavement.

This article documents one woman's experience of mental health recovery using a case study approach. Specifically, qualitative data collected through a semistructured interview were triangulated with the medical record to understand more about how this woman experienced a transition from a period of her life marked by severe psychological and emotional impairment to an extended period of time during which she was thriving and did not experience symptoms consistent with her former diagnosis of severe mental illness. This case study offers important implications regarding the importance of trauma-informed care in the field of mental health.Keywords: mental health recovery; case study; psychiatric rehabilitation; clinical depressionThe process of mental health recovery is complex. Moving from a diagnosis of serious mental illness (SMI) toward a state of recovery can take years and involves a complicated set of experiences as people navigate both the mental health system along with their own emotional and psychological distress. This article presents a case study documenting one woman's journey from adolescence and early adulthood marked with ongoing and serious psychological impairment to an extended period of time during, which she did not experience symptoms indicative of SMI. This case study offers important implications regarding what is helpful and not helpful in fostering the process of recovery. This case study also illustrates that mental health recovery is possible, challenging the notion that SMI has to be lifelong and debilitating.LITERATURE REVIEWMental health recovery is a topic of great interest to both researchers and practitioners. Mental disorders, including affective and personality disorders, are often considered to be chronic, lifelong medical conditions that require ongoing psychiatric intervention, usually medication. Paradoxically, long-term recovery among those diagnosed with mental disorder is relatively common; for instance, in a 10-year longitudinal study, 88% of those diagnosed with borderline personality disorder achieved remission (Zanari, Frakenburg, Hennen, Reich, & Silk, 2006). Intriguingly, some studies show that being off psychiatric medication is associated with better outcomes (e.g., Harding, 1987; Harrow & Jobe, 2007; Whitaker, 2010).Mental health recovery is difficult to define and there are several different narratives defining what recovery means (Hess, Gantt, Lacasse, & Vierling-Claassen, 2014; Hess, Lacasse, Harmon, Williams, & Vierling-Claassen, 2014). For instance, a mental health consumer may embrace their diagnostic label, along with biological explanations of its etiology and treatment with psychiatric medications. These consumers may receive disability payments, live in an assisted housing facility, and work in a sheltered workshop setting. They may receive recovery-oriented services and self-identify as "in recovery" or "recovered" from mental disorder despite their continued reliance on services. At the other end of the continuum lie former mental health clients who reject their diagnostic labels and do not accept a medical view of their problems. These former mental health consumers are functioning well without the need for psychiatric intervention. Although many variations exist and stark distinctions are difficult to draw on the individual level, some such former clients may identify with the "psychiatric survivor" movement (see Adame, 2013; Adame & Knutson, 2007).This article focuses on the latter version of recovery. This version of functional recovery includes the initial diagnosis of a severe mental disorder followed by an eventual resumption of a productive life in terms of relationships, employment or school, and general functioning. Because people who experience success often drop out of the mental health system, such individuals are rarely studied. Given the centrality of psychiatric medications in the current mental health system (Gomory, Wong, Cohen, & Lacasse, 2011) and the ongoing debate regarding their impact on outcomes (Whitaker, 2010), individuals who have attained functional recovery without continuing to take psychiatric medication are of particular interest. …

This special issue of Research on Social Work Practice focuses on a critical assessment of the Diagnostic and Statistic Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association, 2013). This is the first substantial revision of the DSM since 1994. Given the major impact of the DSM on the field of mental health and beyond, it stands to reason why clinicians, scholars, and the general public are interested in the newest edition of the ‘‘psychiatric bible.’’ However, the development and release of the DSM-5 has been accompanied by an unprecedented level of public debate and protest (Kirk, Cohen, & Gomory, in press). In just a few short years, a sizeable literature assessing and criticizing DSM-5 has emerged (e.g., Frances, 2013a, 2013b; Greenberg, 2013; Kirk, Gomory, & and Cohen, 2013). A public petition asking for an independent scientific review of the DSM-5 was endorsed by at least 47 mental health organizations (Frances, 2012a). Jack Carney, DSW, a longtime clinical social worker, organized a boycott of the DSM-5 and asked ‘‘Where are the Social Workers?’’ (Frances, 2012b; Frances & Jones, 2014). However, the National Association of Social Workers has not taken a stand on DSM-5 (Littrell & Lacasse, 2012a). This special issue seeks to add to this emerging literature by critically examining the DSM-5 from the perspective of social work (see also Wakefield, 2013a, 2013b). The DSM-5 has created controversy for a variety of reasons. Some are specific to the DSM-5, while others are issues that would apply to previous editions of the DSM as well. While objections to the DSM-5 are detailed in the scholarly literature (both in this special issue and beyond), a brief catalog of the perceived problems with the new DSM provides useful context: The reliability and the validity of the DSM-5 are challenged based on the empirical data (Kirk et al., 2013; Mallett, 2014; Spitzer, Endicott, & Williams, 2012). The DSM-5 continues the reification of disorders despite compelling counterevidence (Wong, 2014). While the creators of the DSM-IV were concerned with false-positive diagnoses, DSM-5 has expanded the boundaries of mental disorder and medicalized many more human problems (Frances, 2013a, 2013b; Gambrill, 2014; Jacobs, 2014; see also Thyer, 2014). The removal of the bereavement exclusion (Thieleman & Cacciatore, 2014; Wakefield & Schmitz, 2014) and the creation of binge-eating disorder and mild neurocognitive disorder are examples of potential medicalization (Frances, 2013a, 2013b; Myers & Wiman, 2014). Changes to the autism spectrum disorder (ASD) have caused significant controversy (Greenberg, 2013; Linton, Krcek, Sensui, & Spillers, 2014). The DSM-5 developers also removed the multiaxial system, including Axis IV, sometimes called the ‘‘social work axis’’ (Probst, 2014). Accompanying these and many other DSM-5 controversies (Frances, 2013a, 2013b; Wakefield, 2013b), there is a general impression that the American Psychiatric Association has bungled the development and release of DSM-5. The sources of these criticisms included prominent psychiatrists Robert Spitzer (Chair of DSM-III and DSM-III-R) and Allen Frances (Chair of DSM-IV and DSM-IV-TR). They publicly objected to the lack of transparency within the DSM-5 process (e.g., Spitzer, 2009). While the original hope was that developments in neuroscience would uncover specific brain lesions allowing DSM mental disorder categories to ‘‘map onto the brain,’’ providing for an integration of neuroscience and psychiatry under DSM-5, no such scientific findings appeared. This has raised the question of why a new DSM is needed at this time (Frances, 2009). To make matters worse, publication of the DSM-5 was rushed, leading to copyediting errors in the printed edition, some of which could impact clients (Frances, 2013c). At times, it has seemed that the APA has behaved very much like a corporation seeking profit and influence rather than a scientific organization charged with the crucially important task of defining mental disorders. Some have argued that the motivations of the APA are not scientific but primarily financial (e.g., Frances, 2012c, 2012d). Rather than engaging with the scholarly criticisms of the DSM-5 and mounting a credible defense of their scientific work, the APA worked to suppress critical discussion (see Greenberg, 2013, pp. 282–283, 292– 295, 338). For example, the APA claimed that anyone writing a narrative account of the DSM-5 needed their permission. This led Gary Greenberg to compare the APA to ‘‘bumbling Kremlin bureaucrats’’—and to question whether a private guild with close ties to the pharmaceutical industry should be entrusted by

Objectives: To test the potential impact of a critical curriculum on psychiatric medications designed for child welfare workers. Method: In a quasiexperimental, longitudinal study, the monthly proportion of medicated foster children and the average number of prescriptions per medicated child at Agency 1 (669 clients) exposed to the CriticalThinkRx curriculum were compared to Agencies 2–9 (3,346 clients) in the same two-county service network. Data were collected during 6 months of preintervention, 1 month of intervention, and 9 months of postintervention. Practitioners were not informed of data collection. Results: During postintervention months 1–8, the proportion of medicated children declined from 17.5% to 11.0% at Agency 1, while the mean proportion rose slightly at Agencies 2–9, statistically significant effects. At 9 months, the proportion at Agency 1 rose again though not reaching preintervention level. Average numbers of prescriptions per child remained unchanged. Conclusion: Use of CriticalThinkRx may reduce psychiatric prescribing in foster care.

Questions regarding the efficacy of antidepressant drugs have been a recent focus of attention in the national news both in print and in the television media. Many clients will have questions regarding what they can believe and how they can address mood problems. Social workers constitute a greater percentage of the mental health work force than any other profession. Thus, social workers will probably be asked by clients about these issues. This article presents information on the efficacy of antidepressants for both the short and long term. It covers adverse effects and withdrawal symptoms. Clients' self-determination should be honored. However, social workers can be of assistance in supplying facts relevant to decision making.

This essay addresses recent controversies surrounding the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5—the first major revision of the DSM since 1994), as well as questions regarding the safety and efficacy of psychotropic medications discussed in the public domain. Mental health professionals across a wide range of professions have signed a petition to the DSM-5 Task Force protesting changes in the new edition, and critiques of psychiatric medications are increasingly disseminated in the media. These issues have particular relevance for children in foster care, who receive diagnoses and medication at high rates. The general public is increasingly exposed to information on these topics through the media; as advocates and clinicians, it is important that social work practitioners be informed regarding these issues.

Given the importance of journal rankings to tenure, promotion, and other professional decisions, this study examines a new method for ranking social work journals. The Google Scholar h-index correlated highly with the current gold standard for measuring journal quality, Thomson Institute for Scientific Information (ISI) impact factors, but provided data for more than 4 times as many disciplinary journals. Eighty disciplinary periodicals are identified and ranked using the Google Scholar h-index. The vast majority of these were ranked higher than the lowest ranked social work journal indexed by Thomson ISI. Although the results hold salience for many professional stakeholders, they may be of particular interest to faculty who publish in disciplinary journals not indexed by Thomson ISI. The Google Scholar h-index provides faculty with an additional tool to document the quality of the venues in which they publish.

A book, paper, or speech that involves an author who is notgiven credit is considered ghostwritten, at least according tomost dictionary definitions. This straightforward and seem-ingly commonsense definition has yet to be accepted withinacademic medicine. Over the past 15 years, the academicmedical community has quietly tolerated the presence ofghostwriters in the medical literature, a practice that no othersegment of the university community has allowed. A medicalresearch paper containing a subtle endorsement for amedication carries more weight with clinicians and patientsif the pharmaceutical company that wrote the paper is notmentioned in the authorship byline, especially if it listsprominent university professors from prestigious institutions.The practice of ghostwriting is neither rare nor harmless.Alleged ghost authors haunt the clinical trial literature ofvirtually all the recent blockbuster drugs, including medi-cines like Vioxx, Avandia, Paxil, Zoloft, Zyprexa, hormone-replacement therapy, and Fen-phen. As the makers of thesedrugs are embroiled in product liability lawsuits from theirproduct’s tendency to cause harm, the involvement ofghostwriters in the production of scientific evidence tosupport their use has raised eyebrows.Recently, a public dialogue on ghostwriting has emerged,with public advocacy organizations and some medicaljournal editors, practicing physicians and bioethicistsvoicing their perspectives and calling for reform. As thisdialogue continues, we have noted a critically importantissue often overlooked by many of those involved: Whenexactly should a scientific paper be considered ghostwrit-ten? Medicine aside, most people who hear the term“ghostwriter” think of a paid writer who authors an article,book, or speech without credit. While discussions ofghostwriting have some complexities, it seems there isone, and only one, criterion to determine whether ascientific paper has been ghostwritten: If a person whoshould have been listed as an author was left off the byline,then the paper has been ghostwritten.Whiter Shades of PaleInstead, because of supposedly offsetting circumstances,various authors, companies, reporters, and universityadministrators have taken the stance that some scientificpapers, which admittedly did involve a ghost author, should

Examinations of highly cited articles are common in professions such as medicine as a way to enhance professional self-reflection. Yet, little research has examined influential articles in social work. In light of the emergence of a distinct disciplinary knowledge base over the past few decades, this study identifies the 100 most cited articles in disciplinary social work journals (N ¼ 79) published during 2000–09. Analysis revealed twelve citation classics spanning a relatively diverse array of subjects. Among the various topics that appeared among the 100 most cited articles, the results suggest that evidence-based practice/social work research plays a particularly important role in professional discourse. Also notable is the fact that some two-thirds of the most highly cited articles were published in just four journals.

As public and professional attention to outcome and evaluation research grows, focus commonly remains centered on the question, “Does this treatment work or not?” Consequently, much less emphasis is given to what exactly it means for a treatment to be effective. This article examines 5 issues relevant to whether an intervention is deemed successful or not: (a) Sponsorship: Who generates the empirical evidence? (b) Sensitivity: How deep does the evidence gathering go? (c) Scope: Over what time period does the evidence span? (d) Source: According to which data is a determination reached? (e) Fairness: How seriously are negative cases examined? After exploring each issue, larger implications for youth treatment are discussed. Ultimately, we propose that current trends warrant more thoughtful deliberation and education among citizens and practitioners about treatment outcomes generally.

Objectives: This article reports the first estimated h-index values for social work faculty. Methods: Multiple raters blindly assessed two samples of faculty (1) tenure-track faculty at institutions listed in the U.S. News and World Report top 10 (n = 337) and (2) tenure-track editorial board members of 5 highly ranked social work journals (n = 215). Results: Intraclass correlation coefficients for h-index values among the multiple raters ranged from .83 to .92, indicating good reliability. For faculty at top 10 institutions, mean estimated h-index values were 3.97 (SD = 2.87) for assistant professors; 8.59 (SD = 3.72) for associate professors; and 16.14 (SD = 8.35) for full professors. Values for editorial board members were generally similar. Conclusions: These are the first such published data; further research is needed.

This article subjects a randomized controlled trial (RCT) published in the American Journal of Psychiatry to a methodological and statistical critique, including a reanalysis of the effect size statistics presented. The published trial tested the use of combination antidepressants (mirtazapine coprescribed with either bupropion, venlafaxine, or fluoxetine) at treatment initiation as compared with fluoxetine monotherapy. The authors report that combination therapy was effective, with a number-needed-to-treat (NNT) statistic of 3-5, a strong effect size. Scrutiny of the methodology and clinical trial registration shows that 4 of 6 preregistered outcomes were statistically nonsignificant, 1 outcome was not reported, and 1 unregistered outcome was published. The well-critiqued Hamilton Depression Inventory was the only positive outcome measure. Calculating confidence intervals for the reported NNT demonstrates substantial uncertainty (95% CI for NNT 5 2.3-18.0). In an era of evidence-based psychiatric practice, there is insufficient evidence to recommend combination therapy at initiation of treatment. Keywords: evidence-based practice; mirtazapine; antidepressant; statistical reform The limitations of antidepressant monotherapy in the treatment of major depression are well established (Leventhal & Antonuccio, 2009). No more than 30% of depressed patients will have full remission of their depression in response to a single antidepressant (Pigott, 2011; Trivedi et al., 2006). Given these acknowledged limitations, there is a need for treatments that have demonstrated evidence of superiority over antidepressant monotherapy. In a recent issue of the American Journal of Psychiatry, Blier and colleagues (2010) reported a randomized controlled trial (RCT) sponsored by Organon Pharmaceuticals, the manufacturer of mirtazapine. The investigators claim that combining mirtazapine with fluoxetine, venlafaxine, or bupropion is more effective in the treatment of major depression than fluoxetine monotherapy 1 placebo. The clinical implication is that prescribers should consider prescribing two antidepressants (one of them mirtazapine) at treatment initiation. This is a reasonable conclusion given the findings as presented, in that combination treatment "yielded a number needed to treat of 3 to 5 over fluoxetine monotherapy, which is similar to the advantage of clozapine over conventional antipsychotics" (Blier et al., 2010, p. 286). An editorial in the same issue states, while noting limitations, "The results are striking, and the message is encouraging" (Rush, 2010, p. 241). As reported, these are robust findings, and given the potential ramifications of these findings for clinical practice,1 they warrant detailed consideration. METHODOLOGICAL CRITIQUE Antidepressant trials have been frequently critiqued for methodological problems ( Moncrieff, 2001), and this trial is no exception. The dosing of fluoxetine monotherapy was not optimized, and most of the patients had depression with melancholic features, both of which may have disadvantaged fluoxetine monotherapy (Rush, 2010). Unsurprisingly, this type of confound favors mirtazapine, the drug manufactured by the sponsor of the trial (see Smith, 2005). The basic design of this trial has been questioned. A letter to the editor published in response to this study (El-Mallakh, Kaur, & Lippman, 2010) argues that because the trial lacked a mirtazapine 1 placebo group, the authors' conclusions are invalid. This argument is critically important-if it is correct, other analyses may be beside the point. This trial was preregistered, as is required of all contemporary trials (De Angelis et al., 2005). Trial registration consists of the investigators preregistering their outcome variables, so that the selective reporting so common in psychiatric trials (e.g., Turner, Matthews, Linardatos, Tell, & Rosenthal, 2008) can be prevented or at least identified. …

When children are removed from their parents due to child maltreatment, the goal remains to reunite families whenever possible. Although extensive research exists regarding barriers to reunification, little is known about the families who are successfully reunited. The aim of this study was to examine the strengths families found helpful in the process of achieving and maintaining reunification. In-depth, qualitative interviews were conducted with 15 reunified families. Thematic coding of these narrative interviews was completed, uncovering the ways the families perceived intrafamilial and external social support that was given and received played an important role in their stories of reunification.

Objectives: This study evaluates the utility of a new measure—the h-index—that may provide a more valid approach to evaluating journal quality in the social work profession. Method: H-index values are compared with Thomson ISI 5-year impact factors and expert opinion. Results: As hypothesized, the h-index correlates highly with ISI 5-year impact factors; but exhibits closer agreement with expert opinion, particularly with high familiarity disciplinary journals. Conclusions: This evidence of convergent and discriminatory validity suggests that the h-index may have some utility in assessing social work journals. Notable advantages of the h-index include its compatibility with the profession’s applied research culture and its ability to be used with essentially all journals in which social workers publish.

The Mental Illness Beliefs Inventory (MIBI) measures the extent to which an individual subscribes to the medical model of mental illness. This article reports the results of two preliminary validation studies. The first study establishes the initial psychometric properties for the MIBI, based on a sample of 222 students in the helping professions; the second study tests the model established in the first study with an additional 270 students. The MIBI performs well as a composite instrument measuring belief in the medical model of mental illness. This instrument shows promise for examining the extent to which individual beliefs affect mental health practice. Keywords: medical model; mental disorder; social work In helping professions such as psychology, social work, counseling, and psychiatry, the medical model is commonly used to explain disturbed or disturbing behavior (Lacasse & Gomory, 2003). Medical model terminology such as "mental illness," "mental disorder," and "biologically based brain disease" are often used interchangeably to describe both the putative cause and the nature of disturbing human behavior (Boyle, 2002; Leo, 2004). However, critics have argued that in contrast to well-validated medical diagnoses such as cancer and hypertension, mental disorders are accorded disease status without meeting the classic Virchowian criteria for disease (Szasz, 2001). This lack of objective criteria for mental disorders is made clear in the U.S. Surgeon's General Report on Mental Health, which states that "there is no definitive lesion, laboratory test, or abnormality in brain tissue that can identify [mental] illness" (U.S. Department of Health and Human Services, 1999, p. 44). Given unknown etiology and the absence of valid and reliable measurement of mental disorders (Kutchins & Kirk, 1992), a wide range of beliefs regarding mental disorder are possible. Possible beliefs range from that of mental disorder as scientifically established brain disease (Andreason, 1985, 2001) to mental disorder as deviance (Scheff, 1999) to mental disorder as metaphorical rather than genuine bodily disease (Szasz, 1987). Despite its potential importance, there is a paucity of research measuring belief in the medical model among mental health professionals (although see Colombo, Bendelow, Fulford, & Williams, 2003). Measurement of this belief could yield important information for mental health practice. This belief may impact how helping professionals treat their clients, view their behavior, and decide when and if medical intervention is necessary (e.g., when a referral for psychotropic medication is appropriate). Furthermore, since some of the beliefs inherent in the contemporary medical model may have flimsy empirical underpinnings (Lacasse & Leo, 2005), such measurement has the potential to identify problem areas in knowledge development within the field of mental health. BACKGROUND Instruments have been developed to measure attitudes and beliefs regarding mental illness, but only a few have focused on the medical model. Golding, Becker, Sherman, and Rappaport (1975) developed the Behavioral Expectations Scale (BES) to measure adherence to the medical model, but the BES has lackluster psychometric properties. Morrison (1979) developed the Client Attitude Questionnaire (CAQ), which measured belief in the psychosocial model, partially characterized by a lack of belief in the medical model. Nevid and Morrison (1980) improved on the CAQ by developing the Libertarian Mental Health Ideology Scale (LMHIS). The LMHIS appears to measure the degree of belief in the Szaszian viewpoint (Szasz, 1987) but may be inaccessible to those not already familiar with this point of view (e.g., asking respondents to agree or disagree with the statement "Mental illness is a myth" without context may be problematic in a modern context). Milling (1981) critiqued previous efforts, such as the CAQ, by pointing out that these efforts included flawed items with poor construct validity. …

We report on the accelerated ageing of cellulose based insulating paper by means of pulsed UV laser irradiation (λ = 248 nm) under various experimental conditions including paper composition, background gas (He, N2 and air) and moisture content of the paper. The temperature reached by the paper samples during their laser irradiation was monitored by means of real-time IR imaging. It is shown that the equilibrium temperature (Teq) reached by the paper increases from ~30 to ~270 °C when the laser energy density was raised from 15 to 550 mJ cm−2. The laser irradiated samples were systematically characterized by means of scanning electron microscopy (SEM) observations and degree of polymerization (DPv) measurements. Interestingly, it is found that, for a given moisture content, the degradation level of the cellulose is mainly triggered by the Teq value reached during the laser irradiation. Moreover, their moisture content was found to influence significantly the number of laser produced bond scissions (it doubles when the moisture content is increased from 0.5 to 6%); the paper degradation is apparently not affected by the presence of oxygen as the background gas. These results suggest that the laser induced cellulose degradation occurs through a direct photolysis (i.e. direct breakage of C–C, C–O and C–H bonds), leading to radicals formation, which, in turn, are believed to induce the acid hydrolysis degradation mechanism, the latter being moisture dependent. The activation energy (Ea) of each gaseous species collected after the laser degradation was estimated. Their Ea values were found to be in good agreement with the one associated to the laser depolymerisation of cellulose (i.e. ~56 kJ mol−1), suggesting thereby a direct correlation between the cellulose degradation and the formation of the detected gaseous species. Finally, the pulsed laser irradiation can be seen as an attractive tool to identify primarily generated molecules, on a very short time scale, that can be used as relevant chemical markers for the monitoring of the ageing of transformers materials with cellulose.

The cause of mental disorders such as depression remains unknown. However, the idea that neurotransmitter imbalances cause depression is vigorously promoted by pharmaceutical companies and the psychiatric profession at large. We examine media reports referring to this chemical imbalance theory and ask reporters for evidence supporting their claims. We then report and critique the scientific papers and other confirming evidence offered in response to our questions. Responses were received from multiple sources, including practicing psychiatrists, clients, and a major pharmaceutical company. The evidence offered was not compelling, and several of the cited sources flatly stated that the proposed theory of serotonin imbalance was known to be incorrect. The media can play a positive role in mental health reporting by ensuring that the information reported is congruent with the peer-reviewed scientific literature.

This chapter addresses potential barriers to good clinical decision-making, found at all levels of practice. It begins with decision-making at the micro-level—that is, at the level of the individual clinician, who faces a series of decisions with each new case: how to frame problems, what outcomes to pursue, when to stop collecting information, what risks to take, what criteria to use to select practice methods, and how to evaluate progress. The flexible and diverse nature of clinical practice, while allowing for consideration of specific client needs, also leaves room for many kinds of error. These errors can be avoided, or at least minimized, by the use of evidence-informed assessment practices as outlined in the chapter. At the mezzo-level, requirements of the practice setting (such as mission and funding source) can shape and constrain the way assessment takes place; the media, professional literature, and structure of professional training also exert a powerful influence. Macro-level influences include the widespread medicalization of human behavior; the pharmaceutical companies and managed care institutions comprising the “biomedical industrial complex;” and entities such as the National Institute of Mental Health, the American Psychiatric Association, and the welfare and legal systems. The chapter concludes by urging students to consider the biases that may be inherent in the information on which they base their decisions, as well as how the environment they work in may affect their ability to make sound clinical decisions.

OBJECTIVE Self-directed care (SDC) is a mental health service delivery model in which participants budget the state dollars allotted for their care to purchase the goods and services they deem most appropriate for achieving their recovery goals. This study examines the demographic characteristics, service utilization patterns, and outcomes of individuals enrolled in the Florida Self-Directed Care (FloridaSDC) program, which is the oldest and most established SDC program in the United States for individuals diagnosed with a severe and persistent mental illness. METHOD This is a naturalistic descriptive study in which demographic, service utilization, and outcome data (i.e., Functional Assessment Rating Scale (FARS) scores, days in the community, days worked, monthly income, discharge status) were collected from the clinical and fiscal records of 136 FloridaSDC participants. RESULTS Key findings suggest that FloridaSDC participants had very little income and largely utilized their budgets to subsidize their living expenses. Though most participants did not work or earn income and very few left the program due to employment, participants' FARS scores improved modestly and nearly all participants remained in the community throughout the study period. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Participants' service purchases were rational given the poverty in which they live, and their outcomes did not suffer when they controlled decisions regarding their service needs. These findings highlight the utility and value of the personalized budgeting and individualized planning components of SDC. Findings also point to the need for practitioners to implement innovative strategies to enhance participants' employment readiness and supported employment opportunities. (PsycINFO Database Record

In the United States, antidepressant medications are heavily promoted through direct-toconsumer advertising, which is regulated by the Food and Drug Administration (FDA). Advertisements for selective serotonin reuptake inhibitors frequently contain information inconsistent with the scientific evidence on the treatment of depression with antidepressants. The information presented serves to promote the use of antidepressants by biasing the public against nonpharmacological treatment of depression. While the FDA enforces regulations requiring fair and balanced presentation when comparing one medication to another, there appears to be no action taken against pharmaceutical companies that distort scientific evidence in order to disparage nonmedical approaches to depression. Keywords: consumer advertising; antidepressant; depression; psychotherapy; sertraline The United States is one of two countries in the world that permit direct-to-consumer advertising of prescription-only medications. (New Zealand is currently attempting to phase out such advertising.) Most Americans have become accustomed to having their prime-time television shows interrupted by commercials that advise them to request medications from their doctors that will treat their heartburn, allergies, or erectile dysfunction. Of specific interest to the readers of this journal, advertisements for psychiatric medications are becoming increasingly common. As part of its mission of protecting consumers, the U.S. Food and Drug Administration (FDA) is responsible for regulating consumer advertising. Advertisements are required to contain fair balance, disclose major side effects, and to "present information that is not inconsistent with the product label" (United States General Accounting Office, 2002). If manufacturers violate these rules, they may receive a warning letter from the FDA. For instance, Pfizer received such a letter for a recent Zoloft advertisement published in the New York Times without a required advisory warning of the link between suicide and selective serotonin reuptake inhibitors (SSRIs; Food and Drug Administration, 2005a). Unfortunately, there is a programmed bureaucratic delay between the identification of objectionable ads and the issuance of warning letters. This means that when pharmaceutical companies run ads that violate FDA regulations (which happens with great regularity), they often do not receive warning letters until after the advertising campaign has run its course. Direct-to-consumer advertising has received much attention of late, including sharp criticism from two books authored by physicians, Marcia Angell (former editor-in-chief of the New England journal of Medicine) and John Abramson (a clinical faculty member at Harvard University). They have pointed out that the popularity of some recent blockbuster drugs has been significantly driven by direct-to-consumer advertising, rather than any empirically demonstrated additional therapeutic utility (Abramson, 2004; Angell, 2004). In the case of Nexium, for instance, the result has been increased costs to consumers, as less costly medications exist that are nearly identical (Prilosec), and in most cases, just as effective. Drug manufacturers are under no obligation, however, to inform consumers that there are alternatives to their product available, even if they are less risky or costly. Indeed, it would be foolish of them to do so, if they are concerned about profit. The FDA regulations for consumer advertising do require that advertisements tread carefully when comparing their own product to that of a competitor. Before claiming that their prescription medication is superior to another, drug companies must have solid evidence. Claims made without such evidence will be classified as misleading and issued a FDA warning letter. For example, after AstraZeneca Pharmaceuticals disseminated a television ad claiming that its cholesterol-lowering drug, Crestor, was superior to other similar drugs, the FDA issued a warning letter (FDA, 2005b). …

We report on the successful use of a KrF excimer laser as a highly promising tool to investigate the accelerated ageing of wood Kraft papers used as insulating components in high-voltage power transformers. The effects of varying both the laser repetition rate (5 to 180 Hz) and the laser energy density (0.02 to 0.11 J cm-2) on the degradation of wood Kraft paper in air were systematically investigated. During the laser irradiation experiments, the temperature of the paper samples was real-time measured by means of an IR camera. It is shown that the ageing temperature of the paper can be controlled very precisely by simply adjusting the laser parameters. Indeed, levelling-off temperatures in the 25–320 °C range can be reached after only 3 s of laser exposure, by either varying the repetition rate at a fixed energy density or changing the laser fluence at a given pulse rate. By performing both scanning electron microscopy (SEM) observations and measurements of the degree of polymerization (DPv) of the laser irradiated paper samples, we were able to demonstrate that the laser irradiation induces a very rapid degradation of the paper samples (typical laser exposure times are around 35 s to be compared with ∼10 days for standard dynamic heating based ageing tests). Both the DPv of the irradiated paper samples and the average width of the corresponding cellulose fibers as measured from SEM micrographs, are shown to reduce by about 50% following their laser heating at ∼320 °C for 35 s of exposure time. It is pointed out that the observed laser-induced degradation is predominantly a photothermal process. Finally, by using gas chromatography/mass spectrometry (GC/MS), we were able to show that low molecular weight compounds such as acetaldehyde, methyl formate, acetone, and methanol are produced not only by the laser ageing process but also in real on-field transformers that underwent a severe short-circuit.

In this pilot study, concept mapping, a methodological approach combining qualitative and quantitative analytic strategies, was used to identify the therapist qualities, competencies, and skills necessary for effective play therapy outcomes as perceived by a sub-sample of 28 experienced play therapists who are members of the Association for Play Therapy (APT). The clusters associated with the therapeutic relationship and facilitative skills (e.g., empathy, warmth, and genuineness) were rated as the most essential skills to possess and also as the most difficult to develop. In contrast, the clusters associated with play therapy interventions and theories were rated as the least important skills to possess but as the easiest to acquire. The findings are discussed, with implications for therapeutic practice, research, and policy.

A sample of 71 psychopathology course syllabi from 58 different graduate schools of social work was analyzed to determine whether different viewpoints and the concomitant empirical evidence were presented regarding 4 significant mental health topics: concepts of mental disorder, reliability and validity of psychiatric diagnoses, biological etiology, and drug treatment. There is little evidence that graduate psychopathology courses cover viewpoints other than the most conventional and institutional—that of biomedical psychiatry. A small handful of secondary (textbooks) rather than primary (research articles) sources provide the majority of the mental health content in these courses. Implications are discussed. The article includes an overview of both the relevant conventional and critical literature.

Aside from academic medicine, when most people hear theterm “ghostwriter” they think of a paid writer who authoreda speech, article, or book without credit. Over the pastdecade, for virtually every blockbuster medication released,there have been allegations that some of the peer-reviewedpapers essential for their commercial success were ghost-written. The most recent case revolves around two professorsof psychiatry at the University of Pennsylvania who wereaccused of involvement with a ghostwritten paper on the useofthebest-sellingantidepressantmedication,Paxil.Followingthecharges,theuniversity conductedaninternalinvestigationand, last week, announced that the professors were innocent.The most important ramification of the UPenn investigation,though, is that instead of indicating a vigilant response toghostwriting, it (perhaps inadvertently) actually sanctionsghostwriting.As we examined the results of the investigation, we werestruck by the fact that the investigative panel seemed toconfuse honorary authorship with ghostwriting. To be sure,both are problems in academia, but there are importantdifferences. Honorary authorship consists of someone beingplaced on the authorship line who did not truly deserve to belisted as an author- often a department head or well-respected senior researcher in the field. As we have recentlyargued, ghostwriting is a simpler issue to ascertain, byasking the straightforward question: Was there a writerwho contributed significantly to the paper, who was notlisted as an author? If the answer is yes, the paper wasghostwritten. This is not just our perspective. In a recentresearch article on ghostwriting, the editors of JAMA de-fined a paper as ghostwritten when, “An individual who wasnot listed as an author made contributions that meritedauthorship,” or “An unnamed individual participated inwriting the article.”TheprimaryconclusionsoftheUniversityofPennsylvaniainvestigation did not result from scrutinizing the paper for aghostwriter, but were instead explanations for why the listedauthorsdeservedtobeonthebyline.Infact,asreportedinthePhiladelphia Inquirer, “Susan Phillips, a spokeswoman forthe medical school, did not respond to a question aboutwhether the medical writing firm wrote the study or editedthe researchers’ writing.” The final statement concludes thatalthough a medical writer (a subcontractor working for themakers of Paxil) helped write the paper, the listed authors“satisfied all authorship criteria and the publication presentedthe research findings accurately. ” Even if the UPenn profes-sor’s deserved to be on the byline, if the byline omitted adeserving author then the paper was ghostwritten.The statement goes on to say that authorship standardshave changed in the last decade, and that in 2001, theauthors were not breaking any rules. However, regardlessof all the other issues involved with this case, this seems tocontradict a statement in Senator Charles Grassley’s 2010report on ghostwriting which stated: “Penn Medicine doesnot use the term ‘ghostwriting’ in its authorship policies, butstated that it has policies against plagiarism and it considersghostwriting to be the equivalent of plagiarism.” But,regardless of UPenn’s past policy, what is of more concernis their new policy, which calls for acknowledging assistance.According to the results of the recent investigation “…current Perelman School of Medicine policy and journalpractice call for acknowledgment of the assistance of amedical writer…..” Thus, the University of Pennsylvania

This article explores the various characteristics and attributes of a sample of play therapists (N=891). The data were collected using multiple methods, including a web-based survey, to collect information from the membership of the Association for Play Therapy (APT). The survey instrument collected information on various issues such as members' educational background, continuing education experiences and needs, methods of obtaining supervision, work settings, and distribution of play therapy as a portion of their overall workload. Descriptive and inferential statistics (including t-tests, Chi- squares, and ANOVA's where appropriate) were conducted to highlight significant differences in the sample across specific variables (gender and academic discipline). The findings are discussed, with recommendations provided to assist APT in planning strategies to best meet the needs of its members.