Clinical intervention to address violent radicalization: The Quebec model

Author(s):  
Cécile Rousseau ◽  
Christian Savard ◽  
Anna Bonnel ◽  
Richard Horne ◽  
Anousheh Machouf ◽  
...  

Radicalization to violence is a world social phenomenon that is related to mental health in multiple ways, not only because psychological factors and psychopathology are determinants of violent radicalization, but also because psychological distress, grief, and trauma are significant public health consequences of this form of violence. The complexity of violent radicalization manifestations and its increasing association with severe psychopathology in lone actors suggests that there is an important role for clinicians to play in supporting and complementing the work of frontline psychosocial services, as well as contributing to the transdisciplinary network needed to develop effective intervention models. However, given the risks of medicalizing forms of social suffering and of being co-opted by ideologically driven political interests, this professional involvement cannot take place without continuous ethical reflection and systemic evaluation. This chapter will describe the clinical model of intervention developed in Quebec (Canada), and discuss some of the organizational, clinical, and ethical challenges encountered.

2003 ◽  
Vol 25 (3) ◽  
pp. 53-57 ◽  
Author(s):  
Janie Simmons ◽  
Kim Koester

Ethnographic research with impoverished, often homeless, street drug users commonly involves the direct and indirect witnessing of various kinds of violence. Numerous methodological and ethical challenges related to the witnessing of violence have been explored in the ethnographic literature on drug use. In addition, drug-use researchers like Bourgois and Inciardi have written, at least tangentially, about the myriad emotions that come into play when especially egregious forms of interpersonal violence, such as rape, forced prostitution or gang initiations, are described by perpetrators or victims. Apart from experiencing a range of emotions, other researchers have made note of emotional difficulties experienced by researchers studying violence. For example, Dunn described the physical and emotional problems she experienced after interviewing women who had been battered. Alexander and colleagues reported parallel reactions in rape victims and rape researchers. In this paper, we draw upon our own experience as ethnographers in order to raise concerns about the emotional risks of witnessing accounts of past and current violence in the lives of street drug users who are participants in our research projects.


Author(s):  
Denise Lussier

We live in a world where many countries are at war, where religious and ethnic conflicts tend to intensify in spite of sustained effort from governments and inter-governments, where solitudes and tensions between linguistic communities still prevail. In a context where geo-political interests predominate, how do we view cultural and intercultural issues? How can we promote values and attitudes that recognize experiences of diversity and openness to other cultures? Can institutions such as schools and universities promote social cohesion through education? These issues are essential to mankind but they have to be looked upon with logical coherence.This article reviews existing theories, definitions and a conceptual framework to the development of ICC which involves cognitive, affective and psychological factors, and intends to capture the interrelations that are embedded in language, thought and culture. It argues that language competence needs to address not only the linguistic, sociolinguistic and pragmatic/discourse elements of langue but should also integrate (inter)cultural interactions, the development of (inter)cultural representations and transactions between individuals in the learning process. Nous vivons dans un monde dans lequel plusieurs pays sont en guerre ; dans lequel les conflits religieux et ethniques tendent à s’intensifier en dépit des efforts constants des gouvernements et des agences intergouvernementales ; un monde dans lequel les isolements et tensions entre les communautés linguistiques persistent encore. Alors, dans un contexte où les intérêts géopolitiques dominent, comment voyons-nous les problèmes culturels et interculturels ? Comment pouvons-nous promouvoir des valeurs et attitudes qui reconnaissent l’expérience de la diversité et l’ouverture sur les autres cultures ? Des institutions telles que les écoles et les universités peuvent-elles exhorter à une cohésion sociale à travers l’éducation ? Ces questions sont essentielles à l’humanité ; cependant, elles doivent être considérées avec une cohérence logique. Cet article passe en revue des théories existantes, des définitions et un cadre conceptuel au développement des CIC qui implique des facteurs cognitifs, affectifs et psychologiques ; et projette de capter l’essence des interrelations qui sont incorporés au langage, à la pensée et à la culture. Cet article soutient que la compétence linguistique doit se pencher non seulement sur les éléments linguistiques, sociolinguistiques et pratiques/ discursives de la langue ; mais devrait également intégrer des interactions (inter)culturelles, le développement des représentations et transactions (inter)culturelles entre les individus en processus d’apprentissage.


2012 ◽  
Vol 40 (1) ◽  
pp. 85-98 ◽  
Author(s):  
Lisa M. Lee

For over 100 years, the field of contemporary public health has existed to improve the health of communities and populations. As public health practitioners conduct their work – be it focused on preventing transmission of infectious diseases, or prevention of injury, or prevention of and cures for chronic conditions – ethical dimensions arise. Borrowing heavily from the ethical tools developed for research ethics and bioethics, the nascent field of public health ethics soon began to feel the limits of the clinical model and began creating different frameworks to guide its ethical challenges. Several public health ethics frameworks have been introduced since the late 1990s, ranging from extensions of principle-based models to human rights and social justice perspectives to those based on political philosophy. None has coalesced as the framework of choice in the discipline of public health. This paper examines several of the most-known frameworks of public health ethics for their common theoretical underpinnings and values, and suggests next steps toward the formulation of a single framework.


Proceedings ◽  
2021 ◽  
Vol 77 (1) ◽  
pp. 11
Author(s):  
Cécile Rousseau

The place of clinical, medical, or health professional interventions in addressing violent radicalization is a topic of ongoing debate. Although violent radicalization is primarily a social phenomenon with significant psychological dimensions, the high prevalence of mental health “issues” and past psychiatric diagnosis in lone actors suggests that it may be useful to distinguish socialized actors who have strong ties to structured extremist organizations from relatively socially isolated actors who claim, and even boast about, virtual affiliation to extremist groups. For the latter, the potential efficacy of mental health interventions should be considered. However, because of the risk of profiling, stigmatization of minorities, pathologizing social dissent, and resistance, clinical intervention may cause harm and should be carefully evaluated. Until the effectiveness of clinical interventions in reducing radical violence is improved through evaluative research, exchanges about existing clinical models can be useful to support practitioners in the field and provide initial insights about good and potentially harmful practices. The Quebec model of clinical services to mitigate violent radicalization (secondary and tertiary prevention) is structured around three pillars: multiple access points to facilitate outreach and decrease stigma; specialized teams to assess and formulate treatment plans based on existing best evidence in forensic, social, and cultural psychiatry; and collaborative involvement with primary care services, such as community mental health, education, and youth protection institutions, which are in charge of social integration and long-term management. Beyond the initial assessment, the program offers psychotherapy and/or psychiatric interventions services, including mentorship to foster clients’ social integration and life-skill development. Artistic programs offering a semi-structured, nonjudgmental environment, thus fostering self-expression and creativity, are very well received by youth. A multimedia pilot program involving young artists has been shown to provide them with alternative means of expressing their dissent. Three years on from its inception, the preliminary evaluation of the Quebec clinical model by its partners and clinicians suggests that it could be considered a promising approach to address the specific challenges of individuals who present as potential lone actors at high risk of violent radicalization. The model does not, however, appear to reach many members of extremist groups who do not present individual vulnerabilities. While initial signs are positive, a rigorous evaluation is warranted to establish the short, medium, and long-term efficacy of the model, and to eventually identify the key elements which may be transferable to other clinical settings. In 2020, a five-year evaluative research project began to examine these questions. It is important to consider that any intervention can be harmful if due attention is not paid to structural discrimination and violence stemming from associated marginalization and exclusion. Clinical care can in no way replace social justice, equity, and human rights—all key pillars in primary prevention against violent radicalization. In the meantime, however, providing empathy and care in the face of despair and rage may prove most beneficial in decreasing the risk of violent acts.


2004 ◽  
Vol 44 (6) ◽  
pp. 731-738 ◽  
Author(s):  
Sharon R. Kaufman ◽  
Janet K. Shim ◽  
Ann J. Russ

Abstract Developments in the realms of medical innovation and geriatric clinical intervention impact our understanding of the nature of late life, the possibilities for health in advanced age, medical decision making, and family responsibility in ways that could not have been predicted 15 years ago. This essay begins to map new forms of biomedicalization in the U.S. and to underscore their emergence in a new ethical field. We suggest that a new kind of ethical knowledge is emerging through “routine” clinical care, and we offer examples from the following interventions: cardiac procedures, kidney dialysis, and kidney transplant. This new ethical knowledge is characterized by the difficulty of saying “no” to life-extending interventions, regardless of age. We explore the intensification of the biomedicalization of old age through a discussion of three features of the new ethical field: (a) the ways in which routine medical care overshadows choice; (b) the transformation of the technological imperative to a moral imperative; and (c) the coupling of hope with the normalization and routinization of life-extending interventions. We argue that societal expectations about longevity and standard medical care come together today in a shifting ethics of normalcy, with unexplored socio-cultural ramifications.


2021 ◽  
pp. medhum-2021-012194
Author(s):  
Yoshiko Iwai ◽  
Sarah Holdren ◽  
Leah Teresa Rosen ◽  
Nina Y Hu

While COVID-19 brings unprecedented challenges to the US healthcare system, understanding narratives of historical disasters illuminates ethical complexities shared with COVID-19. In 2005, Hurricane Katrina revealed a lack of disaster preparation and protocol, not dissimilar to the challenges faced by COVID-19 healthcare workers. A case study of Memorial Hospital during Hurricane Katrina reported by journalist-MD Sheri Fink reveals unique ethical challenges at the forefront of health crises. These challenges include disproportionate suffering in structurally vulnerable populations, as seen in COVID-19 where marginalised groups across the USA experience higher rates of disease and COVID-19-related death. Journalistic accounts of Katrina and COVID-19 offer unique perspectives on the ethical challenges present within medicine and society, and analysis of such stories reveals narrative trajectories anticipated in the aftermath of COVID-19. Through lenses of social suffering and structural violence, these narratives reinforce the need for systemic change, including legal action, ethical preparedness and physician protection to ensure high-quality care during times of crises. Narrative Medicine—as a practice of interrogating stories in medicine and re-centering the patient—offers a means to contextualise individual accounts of suffering during health crises in larger social matrices.


1992 ◽  
Vol 4 (4) ◽  
pp. 509-527 ◽  
Author(s):  

AbstractThis paper presents a developmental and a clinical model for the treatment of conduct disorder through the strategy of preventive intervention. The theoretical principles and clinical strategies utilized in the FAST Track (Families and Schools Together) Program are described. We indicate how the clinical model is derived from both our developmental model and previous findings from prevention trials. The FAST Track Program integrates five intervention components designed to promote competence in the family, child, and school and thus prevent conduct problems, poor social relations, and school failure. It is our belief that testing the effects of such a comprehensive approach is a necessary step in developing new intervention models for this population.


2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Espen W. Haugom ◽  
Torleif Ruud ◽  
Torfinn Hynnekleiv

Abstract Background Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion. Methods This study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis. Results The main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff’s sincere desire to provide good treatment and the patients’ behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice. Conclusion Ethical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.


2019 ◽  
Vol 50 (4) ◽  
pp. 562-578 ◽  
Author(s):  
Dawna Duff

Purpose Vocabulary intervention can improve comprehension of texts containing taught words, but it is unclear if all middle school readers get this benefit. This study tests 2 hypotheses about variables that predict response to vocabulary treatment on text comprehension: gains in vocabulary knowledge due to treatment and pretreatment reading comprehension scores. Method Students in Grade 6 ( N = 23) completed a 5-session intervention based on robust vocabulary instruction (RVI). Knowledge of the semantics of taught words was measured pre- and posttreatment. Participants then read 2 matched texts, 1 containing taught words (treated) and 1 not (untreated). Treated texts and taught word lists were counterbalanced across participants. The difference between text comprehension scores in treated and untreated conditions was taken as a measure of the effect of RVI on text comprehension. Results RVI resulted in significant gains in knowledge of taught words ( d RM = 2.26) and text comprehension ( d RM = 0.31). The extent of gains in vocabulary knowledge after vocabulary treatment did not predict the effect of RVI on comprehension of texts. However, untreated reading comprehension scores moderated the effect of the vocabulary treatment on text comprehension: Lower reading comprehension was associated with greater gains in text comprehension. Readers with comprehension scores below the mean experienced large gains in comprehension, but those with average/above average reading comprehension scores did not. Conclusion Vocabulary instruction had a larger effect on text comprehension for readers in Grade 6 who had lower untreated reading comprehension scores. In contrast, the amount that children learned about taught vocabulary did not predict the effect of vocabulary instruction on text comprehension. This has implications for the identification of 6th-grade students who would benefit from classroom instruction or clinical intervention targeting vocabulary knowledge.


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