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Closing the research-practice gap: factors affecting adoption and implementation of a children's mental health program.

Despite the availability of effective interventions, they are not widely used in community mental health centers. This study examined the adoption and implementation of The Arson Prevention Program for Children (TAPP-C), a program for juvenile firesetters developed at a teaching hospital and disseminated to community settings. Questionnaire data from mental health professionals were used to evaluate the roles of adopter, innovation, and dissemination characteristics in TAPP-C adoption and implementation. Results indicate that different factors are important at different diffusion stages. Moreover, they suggest that innovation characteristics may be particularly important to adoption, whereas adopter and dissemination characteristics may be more influential in implementation.

Adolescent↗

The criminal careers of arsonists.

This paper replicates a 1973 study of the criminal careers of arsonists (Soothill and Pope, 1973). It compares the original series of those convicted at the high court of arson in England and Wales in 1951 (n=74) with three new series of all those convicted in any court in England and Wales in 1963-5 (n=1352), in 1980-1 (n=5584) and in 2000-1 (n=3335). The profile of convicted arsonists has significantly shifted over the years, with an increasing proportion of females and a rise in the average age of both males and females. Previous convictions for violence and criminal damage (including arson) are much more evident in the later series. The proportion of medical disposals has declined, while the 1:2 ratio for custodial/non-custodial sentences has remained constant. With a 20-year follow-up the proportion reconvicted for arson has more than doubled--from 4.5% in the 1951 series to 10.7% for the 1980-1 series. The indications are that the situation in relation to arson has deteriorated significantly over the past forty years.

Crime↗

Arson: a growing inferno.

In a series of 34 arsonists, our survey compares the changing trends in arson to an earlier study carried out ten years ago in the same region in the UK by Rix (1994). The survey is based on pre-trial court reports done by the second author only. Fire-setting offending was predominantly seen in the young male (18-32). Fire-setting started as early as age seven and was seen as late as 63 years of age. More than half of the subjects received some form of family support. At least one third had an ICD-10 (WHO, 1992) diagnosable mental disorder and more than half were diagnosed with a psychiatric disorder during the time of reporting. A third of the subjects had a personality disorder diagnosis prior to reporting and another third had disordered personality traits established during the time of reporting. More than half had a psychological motive. Eleven per cent started a fire for excitement with only one for revenge. A third of the subjects were first time arsonists. Sixty-five per cent of arson involved building damage and all the 34 subjects were under the influence of alcohol prior to and during the act of arson. Additionally, there was cannabis use in nearly half of the subjects. Opioids and poly substance abuse were seen in a third of subjects. With the extent of financial and social burden along with risks, attention should be focused on accessing these individuals early to preventing recidivism. More research needs to be undertaken to identify the psychological motives behind fire-setting and to look into the drugs and alcohol problems amongst the younger age groups.

Adolescent↗

Painless ischemia provoked by mental stress in the coronary care unit.

A 30-year-old man suffered a cardiac arrest after setting fire to his home. Continuous ST segment electrocardiographic monitoring in the Coronary Care Unit detected painless ST segment depression during an interview with a police officer. At angiography, the patient proved to have severe three-vessel coronary artery disease. This case demonstrates the clinical value of continuous ST segment monitoring in the ICU. In addition, the case illustrates that mental stress is a potential trigger for acute myocardial ischemia in the ICU.

Adult↗

Primal scene derivatives in the work of Yukio Mishima: the primal scene fantasy.

This article discusses the preoccupation with fire, revenge, crucifixion, and other fantasies as they relate to the primal scene. The manifestations of these fantasies are demonstrated in a work of fiction by Yukio Mishima. The Temple of the Golden Pavillion. As is the case in other writings of Mishima there is a fusion of aggressive and libidinal drives and a preoccupation with death. The primal scene is directly connected with pyromania and destructive "acting out" of fantasies. This article is timely with regard to understanding contemporary events of cultural and national destruction.

Famous Persons↗

Retroductive reasoning in a proposed subtype of partial seizures, evoked by limbic "kindling".

This analysis provides a specific example of the generally applicable process of creative delineation of a novel pattern while searching for an explanatory hypothesis for puzzling observations. In so doing, the neglected retroductive form of inference or abduction was used. Central to such a process is the delineation of a specific "generative mechanism" capable of uniting and explaining heretofore unexplained phenomena. Herein the neurophysiologically known mechanism of limbic seizure "kindling" is offered as a unifying explanation for a dozen bizarre phenomena, proposed as a new subtype of partial seizures, "Limbic Psychotic Trigger Reaction." This new syndrome has been proposed over 15 years in 17 male social loners. Upon encounter with an individualized stimulus, which revived in memory prior moderately hurtful experiences, these men suddenly committed motiveless, unplanned acts with flat affect, transient psychosis and autonomic arousal, showing no quantitative impairment of consciousness and so without memory loss for their perplexing homicidal acts (13 cases), firesetting (3 cases), or bank robbery (1 case). Events occurred in three phases reminiscent of seizures: (1) aura-like puzzlement, (2) transient ictus with a limbic release of predatory or defensive aggression (circa 20 min.), and (3) postictal inefficient actions, implicating a transient frontal lobe system dysfunction secondary to the limbic hyperactivation. The 17 men were of diverse backgrounds, but all without history of prior violence or severe emotional trauma. Seven of 17 had some abnormal tests at some time during their lives and eight known histories of typically overlooked closed-brain injury. Brain damage may facilitate seizure "kindling" but has been traditionally observed in mammals and in a few humans without such damage.

Adult↗

Using group work to understand arsonists.

This article looks at the fascination people have with fire and provides a brief overview of classic psychological theories of arson, and a possible cycle of fire setting. The author also describes the achievements of an arson treatment group and some of the personal intra-group experiences of the clients involved.

Firesetting Behavior↗

The burnt male--intentional assault on the male by his partner.

There are few studies which address the burnt male patient who has been intentionally assaulted by his partner. Thirty such patients were admitted to the Somerset Hospital Burns Unit between January 1993 and May 1995. The average age was 37 years and the mean total burn surface area was 19.6% (range 2-55%). A variety of agents had been used to inflict the burn, but throwing hot fluid at the victim was the most common. The head, neck and chest were the most common areas burnt. Five patients developed respiratory burns and 2 required ventilatory support. Three patients died: 1 of respiratory failure and 1 of septicaemia, while 1 committed suicide. The burnt and battered male patient is a real clinical entity which is becoming more common. Treatment should investigate psychosocial factors in addition to ensuring healing of the burn wound.

Adult↗

Four-year retrospective survey of fire incidents in a psychiatric hospital.

This paper describes a four-year retrospective survey of fire incidents in a psychiatric hospital. The results suggest that there were sufficient similarities between a fire incident and a violent incident for the former to be included in a hospital register of violent incidents. The authors recommend that fire incidents should be studied prospectively, and that hospital fire officers should be an integral part of the multidisciplinary team auditing such incidents.

Data Collection↗

Hospital fire training heats up.

The author describes the fire safety training program at Robert Wood Johnson University Hospital, and discusses its benefits. He concludes that the security department's enhanced image because of this program has made other security objectives easier to accomplish.

Fire Extinguishing Systems↗

1996 U.S. fire loss.

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Data Collection↗

Howard University Hospital fire, Washington, D.C.--successful construction and reactions prevent fatalities.

If the arsonist who set fire to the fourth floor of this hospital intended to destroy the whole hospital, his plans were foiled by the hospital's lifesafety systems and the quick action of the hospital staff. Corridor smoke detectors activated the building fire alarm system, notified the hospital fire brigade and staff, notified the fire department, and closed the corridor smokestop doors. Members of the staff immediately closed the doors to all patient rooms in the area of the fire that were exposed to smoke and heat, and then began evacuating patients from the area. There were no fatalities in this fire. Although this fire is four years old, we think it is worth studying for its contrasts with Mississauga.

District of Columbia↗

Coping with fire and arson.

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Disruptive, Impulse Control, and Conduct Disorders↗