This paper constitutes the first stage of data analysis in a larger controlled study designed to assess the effect of a forensic psychiatric assessment on legal disposition defined in three ways: 1. the number of days spent in custody prior to trial; 2. the number of sentenced days of incarceration; and 3. the conviction rate. A historical cohort design was used to follow two cohorts of individuals remanded, pretrial, to Southern Alberta Provincial Correctional Centres between 1988 and 1989. The study cohort consisted of all offenders detained who received a forensic psychiatric assessment. The comparison cohort consisted of a random sample of persons detained who did not undergo a forensic assessment. Because of small numbers, individuals below the age of 18 and women were excluded from study. This paper compares socio-legal characteristics of study and comparison subjects in order to better understand forensic psychiatric referral patterns and identify potentially confounding factors that would need to be controlled in subsequent analyses of legal outcomes. No differences were noted with respect to educational level but forensic subjects were found to be slightly older (average of 31 years compared to 29 years). Aboriginal peoples (Native Indian, Inuit and Metis) were three times more common among non-forensic offenders. Forensic patients were more likely to have had a prior forensic assessment but less likely to have a prior criminal detention. In addition, forensic patients were three times more likely to be charged with a crime against a person and counted more offenses in the target episode than comparison subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Sexual abuse allegations directed at one parent can arise in the context of custody and access disputes. The role of the clinician, when such allegations occur, is to provide an assessment of the total situation, taking the allegations into account. To assess the probability that sexual abuse has occurred involves a thorough assessment of the accuser, the accused, the accusation, the child, and different family subsystems. Particular attention should be paid to interviewing the young child with detailed focus on the interviewing process, how the interviews are reported and what conclusions may be drawn from them. Following a thorough assessment, the clinician may reach one of three conclusions: that the sexual abuse has probably occurred, has probably not occurred, or is unsure. A strong caution is given against becoming entangled in an endless process of trying to find out whether the allegations are true or false. Whatever conclusions are reached are but one factor in the recommendation regarding custody and/or access. Ultimately the recommendation will be made according to the best interests of the child, taking into account the child's relationships and attachments, as well as the sexual abuse allegations.
This national study of child custody disputes within the context of child protection investigations confirms and reinforces the perception in the field that child custody disputes are more likely to reopen for investigations, include higher rates of malicious referrals and involve a higher proportion of children with emotional and functioning issues compared to non-custody-related investigations. Future research might consider the reasons for these higher rates so to improve the identification of these cases and to make more informed decisions about how best to respond to these families. The greatest contribution of this study is that it provides important new evidence to reinforce the need to prioritize child custody disputes within the context of child protection services given the unique challenges and opportunities for making well-informed case plan decisions.
The adjustment of pre-school and latency age children, at the time of a custody/access dispute between their parents, was studied in relation to the children's age, sex and whether they were living with a parent of the same or the opposite-sex. Few adjustment problems were noted; however, older children and boys were more vulnerable. Sex of custodial parent did not predict children's adjustment.
OBJECTIVE: This study compares patients referred to chiropractic practices by medical doctors with patients who came directly to the chiropractors offices without referral. BACKGROUND: Because Norway has legislation requiring referral as a precondition for reimbursement by the national social security system, we have a unique opportunity to examine current practice when it comes to musculoskeletal conditions and to compare demographic, diagnostic and other data between the referred and nonreferred groups. METHODS: Questionnaires recorded on a continuous basis by participating members of the Norwegian Chiropractors Association during anamnesis of the first 25 new patients after a preset date. Of 140 chiropractors, 98 participated and returned 2401 questionnaires. RESULTS: Although the referred patients had been on sick-leave an average (mean) of 22.9 days before commencing chiropractic treatment, the corresponding figure for the nonreferred was 8.5 days. Otherwise, the two groups were identical or nearly identical in all tested aspects. There were deficiencies in the medical doctor's examination procedures and referral practices. CONCLUSION: Recent studies have shown chiropractic treatment to be a cost-efficient therapy for back-related conditions. The findings in our study indicate that the result of the present system of referral is substantially longer sick-leave time and delayed onset of chiropractic treatment. It is generally accepted that early, effective intervention is the primary method of preventing chronicity. This is not promoted by the present Norwegian system of referral, which in earlier studies we have shown to be inconsistent and expensive for both the patient and the social security system.
A new policy (patient choice) was introduced in Sweden in the early 1990s to give patients the right to choose their healthcare providers, however, evaluations show that few patients exercise this right. This paper analyses physicians' roles in putting the patient choice policy into effect. To examine attitudes, knowledge and behaviour among physicians, a questionnaire was sent to 960 physicians in one of the most populous counties in Sweden. The results show that the physicians approve of the policy, yet only a minority state that they regularly help patients to choose healthcare providers by giving them information and letting them choose where they will be referred. Instead, referrals are mostly based on medical grounds; the patient's wish to choose a specific provider is considered less important. In summary, we found that more than a decade after the policy was introduced, only a minority of physicians act according to the political intention. This could be one explanation for why many patients still do not exercise their right to choose a hospital.
The current study reviews the personal characteristics of 32 consecutive admissions to a secure custody centre in one southwest Ontario jurisdiction under the Young Offenders Act. Results indicated that there was considerable variability amongst the group regarding court history and the seriousness of the charge on which committal was made. Background history data suggested that the problems of youths committed to secure custody reflect considerable difficulties within families and school. The discussion questions whether the youths in this group are better served through the dispositions emphasizing custody-deterrence or rehabilitation-treatment. Implications for young offender policy are also presented.
Informed consent for surgical procedures requires that the procedures are explained and that the patient understands the procedures and risks and agrees to undergo them. Proxy consent occurs when an individual is provided with the legal right to make decisions on behalf of another. This study was conducted to determine how surgeons communicate information to obtain an informed proxy consent, and to investigate how that information is received and processed by surrogates responsible for providing such consent.
Twenty English-speaking parents or legal guardians and 5 surgeons in an urban pediatric hospital were interviewed before, and 2 to 4 weeks after, the surgical procedure. In addition, the interview between the surgeon and surrogate, when consent was obtained, was audiotaped and subsequently analyzed. Semistructured interviews were used to elicit the motivations and influences on the surrogates to consent to the procedure. The same methodology was used to elicit the corresponding impressions of the surgeons. The data were analyzed using descriptive statistics and crosstabulations.
Demographic data did not influence the results. Although there was concordance between the surrogate's understanding of the procedure and the surgeon's impression of this understanding, only 3 of 17 surrogates could recall any specifics of the explained procedure. Contrary to the stated belief of surgeons, surrogates consulted with a variety of others, including medical and paramedical professionals, family members, and spiritual leaders.
Communication plays an important role within the surrogate-surgeon dyad. Psychologic variables such as expectations, and the perception of both the surrogates and the surgeons, influence the amount of information that is proffered and the manner in which it is received. Improved communication may be achieved by use of visual aids, discussion of anesthesia and the postoperative course, recognition of the circumstances around the discussion, such as timing and location of the discussion, and personalization of the discussion.