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Essential nonmedical perinatal services for multiple birth families.
Parents of multiples suffer unique stresses which can severely impair family health and welfare. Access to information, counseling, and community resources increase parents' abilities to cope, and reduce the risk of child and spousal abuse. Twinline, a social service agency in California, provides a variety of free and low-cost nonmedical perinatal services to meet the needs of a heterogeneous population of over 1,000 multiple birth families and parents expecting multiples in the urban and rural counties of the San Francisco Bay Area.
Quitline in smoking cessation: a cost-effectiveness analysis.
OBJECTIVES: The cost-effectiveness of the Swedish quitline, a nation-wide, free of charge service, is assessed. METHODS: The study was based on data of a sample of 1131 callers enrolled from February 1, 2000 to November 30, 2001. Outcome was measured as cost per quitter and cost per year of life saved. Cost per quitter was based on a calculation of the total cost of the quitline divided by the number of individuals who reported abstinence after 12 months. The cost per life year saved (LYS) was calculated by the use of data from the literature on average life expectancy for smokers versus quitters, the total cost of the quitline, and the cost of pharmacological treatment. RESULTS: The number of smokers who used the quitline and reported abstinence after 1 year was 354 (31 percent). The accumulated number of life years saved in the study population was 2400. The cost per quitter was 1052-1360 USD, and the cost per life year saved was 311-401 USD. A sensitivity analysis showed that, for outcomes down to an abstinence rate of 20 percent, the cost per LYS rose modestly, from 311 to 482 USD. Discounting the cost per LYS showed the cost to be 135 USD for 3 percent and 283 USD for 5 percent. CONCLUSIONS: The Swedish quitline is a cost-effective public health intervention compared with other smoking cessation interventions.
Randomized, controlled trial of three levels of critical incident stress intervention.
BACKGROUND: Stress debriefing following exposure to a critical incident is becoming more prevalent. Its aim is to prevent or minimize the development of excessive stress response symptoms that lead to loss of productivity or effectiveness in the workplace or at home. There is little evidence that any form of psychological debriefing is effective. This study evaluated the effectiveness of three intervention strategies, and attempted to correlate the symptoms with the severity of the incident and level of intervention. METHODS: A randomized, controlled trial of three levels of critical stress intervention was conducted in the British Columbia Ambulance Service (BCAS), in British Columbia, Canada, among paramedics and emergency medical technicians (EMTs), reporting critical incident stress. Outcomes were measured at one week (Stanford Acute Stress Reaction Questionnaire (SASRQ), the Life Impact Score (LIS), and Schedule of Recent Events (SRE)), and at three months and six months following the intervention (Impact of Events (IE), Coping Mechanisms, LIS, and SRE). RESULTS: Fifty calls were received during the 26-month study period (<1 per 10,000 BCAS response calls): 23 were by third parties, but the involved EMT did not call; nine were placed by crew unwilling to participate in the study; 18 subjects enrolled, but six completed no forms. No correlation was found between severity of the incident and scores on the SASRQ, IE, or LIS, or between any of these scores. There was no consistent pattern in the stress scores over time. CONCLUSION: Requests for critical incident stress intervention were uncommon. The need for intervention may not be as great as generally is assumed. Further randomized trials, ideally multicenter studies, are indicated.
Effects of different telephone intervention styles with suicidal callers at two suicide prevention centers: an empirical investigation.
To determine the relative effectiveness of telephone intervention styles with suicidal callers, researchers listened unobtrusively to 617 calls by suicidal persons at two suicide prevention centers and categorized all 66,953 responses by the 110 volunteer helpers according to a reliable 20-category checklist. Outcome measures showed observer evaluations of decreased depressive mood from the beginning to the end in 14% of calls, decreased suicidal urgency ratings from the beginning to the end in 27% of calls, and reaching a contract in 68% of calls, of which 54% of contracts were upheld according to follow-up data. Within the context of relatively directive interventions, a greater proportion of "Rogerian" nondirective responses was related to significantly more decreases in depression. Reduction in urgency and reaching a contract were related to greater use of Rogerian response categories only with nonchronic callers.
An analysis of calls to a Vietnam veterans' telephone counselling service.
The pattern of calls to an after-hours crisis telephone service for Vietnam veterans was surveyed over a 9-week period. Not including prank and administrative calls, 274 calls were made to the service. Domestic conflict, substance abuse, traumatic memories, depression, and anger at government represented the major problems requiring counselling. Crisis intervention was required for 18% of calls because of suicide threats or threatened violence to others. The survey findings indicate that telephone counselling can be an appropriate means to provide support for many veterans who may avoid conventional counselling agencies.
Befriending mental patients: experience in the Ukraine.
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Telephone crisis intervention skills: a simulated caller paradigm.
Counseling skills were evaluated in a telephone counseling service for Vietnam veterans. Thirty simulated crisis calls were made to telephone counselors by experienced clinical psychologists. The counselors' responses were rated on dimensions that indexed general counseling skills, knowledge of veteran needs, and provision of appropriate advice. Whereas the majority of callers demonstrated adequate counseling skills, many lacked knowledge of veterans' posttraumatic stress, common veteran terminology, and the nature of veterans' experiences. The findings suggest that telephone counseling services that target specific populations should employ comprehensive training to ensure that counselors possess adequate and relevant knowledge about callers and their presenting problems. The simulated caller paradigm appears to be an effective paradigm for training and evaluation of telephone counselors.
Education and debriefing: strategies for preventing crises in crisis-line volunteers.
Telephone crisis lines offer an important service to individuals in crisis. The accessibility as well as a lack of other means of support leads many individuals to call the line. The role of the volunteer is to listen and support the caller as well as provide information and referrals to other agencies. Agencies are presented with a high turnover of volunteers and are then faced with the task of recruiting and training replacements. Volunteers are often exposed to horrific accounts of human pain and suffering which may affect their personal thoughts, feelings, beliefs and actions and influence the decision to quit. Compassion fatigue is one term used for this inherent "cost of caring." Many factors contribute to this cost including the nature of crisis calls, the repeat caller, and personal coping mechanisms. Educating and debriefing the volunteer are two strategies that may prevent the onset of compassion fatigue and volunteer resignation. Debriefing is viewed as an effective strategy for volunteers as it has been found to be successfull in assisting other helpers in many different contexts to cope and deal with the traumatic events that they experience or hear about.
Befriending in cyberspace--challenges and opportunities.
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Nodus informis leti--"The most infamous death" (Virgil).
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Repeat callers and the Samaritan telephone crisis line--a Canadian experience.
Telephone crisis lines are increasingly providing a much needed service in the community to the lonely, the depressed, and the suicidal. The Samaritan volunteer crisis line discussed here is open to any person at any time, day or night. The instant availability of such an anonymous service attracts callers who use the line inappropriately; these people are often referred to as repeat callers. The Samaritans discovered that repeat callers were creating serious problems for both staff and volunteers. The difficult task was to develop a policy to restrict the repeat callers, but at the same time ensuring that the mandate of the crisis line was offered to them. This article examines the characteristics of repeat callers, and makes suggestions about the management of the chronic caller.
Befriending the suicidal in Yugoslavia.
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Reaching the suicidal: the volunteer's role in preventing suicide.
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Preventing teenage suicide in New York.
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The posttotalitarian pattern of suicidal behavior: impact on youth.
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