Patterns of Psychotropic Prescription and Use in Youth Prison 2: Thematic Analysis

2.50
Hdl Handle:
http://hdl.handle.net/10755/157696
Type:
Presentation
Title:
Patterns of Psychotropic Prescription and Use in Youth Prison 2: Thematic Analysis
Abstract:
Patterns of Psychotropic Prescription and Use in Youth Prison 2: Thematic Analysis
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:Cloyes, Kristin G., PhD, RN
P.I. Institution Name:University of Utah, College of Nursing
Title:Assistant Professor
Contact Address:6523 SE 41st Ave, Portland, OR, 97202, USA
Contact Telephone:801-557-3808
Background and Significance. As more at-risk youth are incarcerated in the U.S., juvenile justice secure facilities (youth prisons) have become critical sites for mental health intervention including psychopharmacology, which remains controversial in correctional, clinical and political discourse. The complexities of using psychotropic medications to treat youth are manifold and well documented. Few clinical trials for psychotropic medications in youth means that prescription for this population is largely ?off label?. No widely recognized national or international standards of practice for psychopharmacologic treatment of youth currently exist, and states are individually responsible for policies and protocols related to incarcerated youth. Neither mental health disorders nor psychotropic medications are well understood by laypersons, including families, prison officials and legislators. These issues become even more complicated in settings permeated by a ?custody vs. care? dynamic, where the dividing lines between ?mental illness?, ?behavioral disorders? and ?delinquency? are hotly contested. Purpose: This multiple methods study was conducted in 6 secure care facilities administered by the Utah Division of Juvenile Justice Services. Statistical analysis of retrospective clinical data for all youth receiving psychotropic meds at the time of the study was combined with inductive analysis of interview data to describe patterns related to psychotropic medication prescription and use. The aim of the interpretive arm of the study was to explore how psychiatric providers, nursing staff, therapists and youth counselors working in the 6 facilities understood mental illness and psychotropic medication use, including practices, attitudes and beliefs related to psychopharmacological treatment of the youth in their care. Methods: A set of 25 semi-structured in-depth interviews were conducted with providers and staff directly involved in prescribing, administering, documenting, or monitoring psychotropic medications at each site. Participants included APRNs, psychiatrists, psychologists, nurses, social workers and youth counselors. Systematic inductive analytic techniques were performed on each interview and across the set, to generate a thematic analysis. Themes were judged to be credible representations of these data in terms of how well they described overarching ideologies and constructs that seemed to shape the pervasive yet culturally bound sense-making activities at work in these settings. Results: Two intersecting themes describe much of the ideological activity running through the interviews: attribution of responsibility and the primacy of internal vs. external realities in guiding psychopharmacologic practices. First, much of the participants? talk centered on 3 major aspects of responsibility: who should be responsible for treating mentally disordered youth; worries about liability and problematic administration policies; and whether psychotropics, by affecting their brains, enable youth to dodge responsibility to ?cowboy up? or do ?good time?. The second and highly iterative theme represents numerous recurring attempts to assert particular realities, understood as being either internal or external, as adequate justifications for practice. Distinctions between internal and external realities propped up further divisions between ?mental? and ???behavioral?, perceptions of locus of control (on several levels) and correctional and community practice. Implications: In youth prison, patterns of psychotropic prescription and use are informed as much by culture and context as scientific theory and formal standards of practice. Nurses and APRNs who work in these settings and who advocate for incarcerated and mentally disordered youth must be aware of such ideologies and cultural constructs, ad how these influence the clinical decisions and correctional practices that affect these youth.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePatterns of Psychotropic Prescription and Use in Youth Prison 2: Thematic Analysisen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157696-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Patterns of Psychotropic Prescription and Use in Youth Prison 2: Thematic Analysis</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Cloyes, Kristin G., PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">University of Utah, College of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Assistant Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">6523 SE 41st Ave, Portland, OR, 97202, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">801-557-3808</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">kristin.cloyes@nurs.utah.edu</td></tr><tr><td colspan="2" class="item-abstract">Background and Significance. As more at-risk youth are incarcerated in the U.S., juvenile justice secure facilities (youth prisons) have become critical sites for mental health intervention including psychopharmacology, which remains controversial in correctional, clinical and political discourse. The complexities of using psychotropic medications to treat youth are manifold and well documented. Few clinical trials for psychotropic medications in youth means that prescription for this population is largely ?off label?. No widely recognized national or international standards of practice for psychopharmacologic treatment of youth currently exist, and states are individually responsible for policies and protocols related to incarcerated youth. Neither mental health disorders nor psychotropic medications are well understood by laypersons, including families, prison officials and legislators. These issues become even more complicated in settings permeated by a ?custody vs. care? dynamic, where the dividing lines between ?mental illness?, ?behavioral disorders? and ?delinquency? are hotly contested. Purpose: This multiple methods study was conducted in 6 secure care facilities administered by the Utah Division of Juvenile Justice Services. Statistical analysis of retrospective clinical data for all youth receiving psychotropic meds at the time of the study was combined with inductive analysis of interview data to describe patterns related to psychotropic medication prescription and use. The aim of the interpretive arm of the study was to explore how psychiatric providers, nursing staff, therapists and youth counselors working in the 6 facilities understood mental illness and psychotropic medication use, including practices, attitudes and beliefs related to psychopharmacological treatment of the youth in their care. Methods: A set of 25 semi-structured in-depth interviews were conducted with providers and staff directly involved in prescribing, administering, documenting, or monitoring psychotropic medications at each site. Participants included APRNs, psychiatrists, psychologists, nurses, social workers and youth counselors. Systematic inductive analytic techniques were performed on each interview and across the set, to generate a thematic analysis. Themes were judged to be credible representations of these data in terms of how well they described overarching ideologies and constructs that seemed to shape the pervasive yet culturally bound sense-making activities at work in these settings. Results: Two intersecting themes describe much of the ideological activity running through the interviews: attribution of responsibility and the primacy of internal vs. external realities in guiding psychopharmacologic practices. First, much of the participants? talk centered on 3 major aspects of responsibility: who should be responsible for treating mentally disordered youth; worries about liability and problematic administration policies; and whether psychotropics, by affecting their brains, enable youth to dodge responsibility to ?cowboy up? or do ?good time?. The second and highly iterative theme represents numerous recurring attempts to assert particular realities, understood as being either internal or external, as adequate justifications for practice. Distinctions between internal and external realities propped up further divisions between ?mental? and ???behavioral?, perceptions of locus of control (on several levels) and correctional and community practice. Implications: In youth prison, patterns of psychotropic prescription and use are informed as much by culture and context as scientific theory and formal standards of practice. Nurses and APRNs who work in these settings and who advocate for incarcerated and mentally disordered youth must be aware of such ideologies and cultural constructs, ad how these influence the clinical decisions and correctional practices that affect these youth.</td></tr></table>en_GB
dc.date.available2011-10-26T20:07:02Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:07:02Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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