CC102 Lecture Notes - Lecture 7: Toronto Police Service, Robert Pickton, Gun Buyback Program

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2 Feb 2016

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This is a step us from the way policing used to be done. Compstat (computer statistics) - a strategy designed to increase the effectiveness and efficiency of police services while holding police personnel accountable for achieving crime reduction objectives: looking at the patterns where offences occur. Environmental scans- studies designed to identify community, legislative, policy, and other forces in the community that will result in demands on the police: summary that is influencing the situation, affecting why the decision is being made. Vancouver is color- coated system to show where the most crimes happen. Primary- programs that identify opportunities for criminal offences and alter those conditions to reduce the likelihood that a crime will be committed. Trying different models to see which is more effective. The public isn"t aware of police crime prevention. Broken window theory- idea that if you have a house with a broken window, it shows that you don"t care to fix it.

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Medical History:
Mrs. KY is a 45 yr old Caucasian female, married with two teenage sons. She is employed as a senior manager at a large bank and reports experiencing an âabove averageâ level of tension and stress. She presents at the referral of her primary care physician, who has observed that the client has elevated blood pressure and cholesterol levels that may be attributed to her stressful and highly sedentary job. In addition, the client admits that she would like to lose 30 to 40 lb (14 to 18 kg) and improve her fitness so that she can ride her bike with her husband on a community rail trail recently installed by her neighborhood.

Diagnosis:
Mrs. KY is a sedentary but otherwise healthy middle-aged female with significant risk factors for cardiovascular disease including obesity, dyslipidemia, and psychosocial stress. At the request of her physician she seeks to start exercising as part of a disease prevention program.

Exercise Test Results:
The client is 5 feet 6 in. tall (168 cm) and weighs 196 lb (89 kg), with a body mass index of 31.7. She has a resting heart rate of 85 beats Â· minâ1 and a resting blood pressure of 136/89 mmHg. Her total cholesterol is 198 mg Â· dlâ1 untreated, and her high-density lipoproteins are 34 mg Â· dlâ1. Her graded treadmill stress test revealed that she has a V.O2max of 20.5 ml Â· kgâ1 Â· minâ1, which is normal for an unfit woman of her age range. Her electrocardiogram was also unremarkable at rest, as well as during and following her test. In addition, she reported smoking from ages 17 to 40. She also complains of occasional joint stiffness in her hands and ankles. The client describes herself as nonathletic and admits to never participating in an organized sport or exercise setting. She is aware of the benefits of exercise but did not feel an incentive to begin a formal program until her doctorâs recommendation. The client jokes that although her workday is highly organized and structured, the rest of her life is chaotic and that it is due only to the support of her husband and kids that anything gets done at home. She laments that her eating habits are atrocious and that she is so tired when she gets home from work that she has only enough energy to make dinner before crashing in front of the television. She presents to you to start a workout program that will help achieve her goals.

Exercise Prescription:
The exercise plan including the traditional componentsâfrequency, intensity, duration, and modality (discussed in detail in later chapters)âmay be tailored to address specific risk factors. The subjectâs medical history, however, clearly indicates that this person had not prioritized exercise participation until she received her doctorâs recommendation. Moreover, she presents with numerous potential barriers to engaging in a physically active lifestyle, as well as behaviors that contribute to her overweight status. The clinician should assist the participant in establishing awareness and developing strategies to address those barriers. Furthermore, the clinician should consider tailoring strategies for motivating the participant toward the adoption of a healthy, physically active lifestyle.

Questions:
1. Applying the transtheoretical model, at what stage of exercise adoption is this client?

2. Based on your response to question 1, what types of interventions are most appropriate for this stage of change and why?

3. If you used the health belief model, what factors would you emphasize to achieve optimal exercise adherence?

4. How would Banduraâs social cognitive theory be relevant to fostering exercise adherence for this client?

There are sometimes conflicts within the same code, between the code and the __________ and between the code and a counselor's value system.

		Judgment
		Ethics
		Law
		Value

2 points

Question 2

Section A of the ACA Code of Ethics highlights important issues within the __________________________________.

		Privacy Act
		Confidentiality Act
		Professional's Responsibility
		Counseling relationship

2 points

Question 3

______________________ in a code sometimes lag behind the values of society and of professional associations.

		Laws
		Attitudes
		Values
		Beliefs

2 points

Question 4

Which section was added to the latest edition of the ACA Code of Ethics (2014)?

		Resolving Ethical Issues
		Advocacy and Social Justice
		Distance Counseling, Technology, and Social Media
		Research and Publication

2 points

Question 5

Which of the following is not one of the ethical "hot spots" identified in this chapter?

		Gatekeeping
		Social and Cultural Issues
		Informed Consent
		Technology

2 points

Question 6

Which of the following is not a type of ethical decision-making model discussed in the text?

		Problem-solving model
		Advocacy model
		Social constructivist model
		Developmental model

2 points

Question 7

_______________ has to do with protecting the independences, self-determination and freedom of choice for client.

		Nonmaleficence
		Beneficence
		Justice
		Autonomy

2 points

Question 8

People who have this view of the world, see things in black and white, are very concrete, rigid, and authoritarian.

		Dualistic
		Modern
		Post-modern
		Flexible

2 points

Question 9

Which section of the ACA Ethical Code (2014) offers guidelines on how to report an ethical violation?

		Section B
		Section I
		Section E
		Section A

2 points

Question 10

.__________ is the responsibility under the law for a violation of federal or state criminal statute.

		Beneficence
		Nonmaleficence
		Civil liability
		Criminal liability

2 points

Question 11

To prove that they are following the best practices of their professions, counselors should:

		Know relevant laws
		Maintain good records
		Stay professional with clients
		All of the above.

2 points

Question 12

______________ is the most rigorous form of credentialing.

		Accreditation
		Licensure
		Certification
		Registration

2 points

Question 13

Theories help counselors and other helping professionals in the following way(s):

		conceptualizing clients' problems
		necessary to become a licensed psychotherapist
		offer specific techniques to apply
		both a and c

2 points

Question 14

What is a paradigm shift?

		A change like a universe.
		A change in the way information is perceived.
		A change in theory.
		A change in human nature.

2 points

Question 15

Do psychodynamic theories consider which of the following to be important in understanding a person's functioning?

		Child-rearing practices
		The unconscious and conscious
		Examining the past
		All of the above

2 points

Question 16

Sigmund Freud was trained as a:

		Physician
		Counselor
		Caseworker
		Social worker

2 points

Question 17

Freud believed that there are ____________ structures that make up personality.

		1
		2
		3
		4

2 points

Question 18

Freud, and later his daughter Anna Freud, identified a number of _______________ that help people to cope with anxiety.

		Defense skills
		Coping mechanisms
		Coping skills
		Defense mechanisms

2 points

Question 19

___________ believed that each of us has a unique psychological type which includes the attitudes of extraversion and introversion.

		Freud
		Rogers
		Jung
		Cattell

2 points

Question 20

_______________________ believed that every child was born with innate and unique capabilities and is inherently moving toard the future, not determined by the past.

		Adler
		Freud
		Rogers
		Jung

2 points

Question 21

Existential-humanistic approaches embrace a phenomenological perspective, stressing all but which of the following?

		The subjective reality of the client
		the role of the unconscious
		How the counselor uses his or her personal qualities in counseling
		the importance of consciousness and/or awareness

2 points

Question 22

Although Ludwig Binswanger is generally acknowledged as being the first existential therapist, who is seen as the person who popularized this approach through "logotherapy"?

		Irvin Yalom
		Carl Rogers
		Alfred Adler
		Viktor Frankl

2 points

Question 23

____________________ developed client-centered therapy.

		Carl Jung
		Viktor Frankl
		Carl Rogers
		Ludwig Binswanger

2 points

Question 24

Today, most Gestalt therapists believe that from birth, the individual is in a constant state of ______________ through a process of need identification and need-fulfillment.

		Self-regulation
		Self-actualization
		Existential crisis
		Emotional distress

2 points

Question 25

This therapy was developed by Albert Ellis during the 1950s.

		Psychodynamic therapy
		Behavioral therapy
		Cognitive therapy
		Rational emotive therapy

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While the concepts of screening and surveillance are intertwined there are subtle distinctions between the two ideas. The main goals are data collection to measure magnitude, changes, and trends in populations. The objective is to create interventions in defined populations. On the contrary, testing to identify individuals with infection or disease is the main goal of screening. The area of breast cancer screening and breast cancer surveillance has been a point of contention. Please read the following article and weigh in on which side seems most convincing:

There is a heated debate in this country about the risks and benefits associated with screening mammography. Proponents on both sides of the debate feel equally as strongly for or against annual breast cancer screening. Despite oneâs opinions regarding the utility of screening mammography, it is difficult to deny that the rates of false-positive exams, the rates of overdiagnosis, and the cost of annual screening are too high. We can do better. It is time to stop devoting energy to arguing about data from studies performed decades ago and start working toward gathering new evidence. In late 2015, we will initiate the WISDOM study to investigate the safety and effectiveness of a personalized breast cancer screening model. This model will use a comprehensive risk assessment process to determine individualized screening regimens for women in the interventional arm. The data collected in this study will better inform the screening debate and will allow us to shed more light and less heat on the issue.

There is a great debate in this country about the risks and benefits of screening mammography. On one side of the debate are those in favor of the one-size-fits-all model of performing annual mammograms starting at the age of 40 for women who are not known to be at greatly elevated risk of developing breast cancer. The radiology community argues that this model reduces the rates of interval cancers, aids early detection, and should not be changed. On the other side of the debate are those who support the United States Preventive Services Task Force (USPSTF) recommendations to screen women biennially starting at age 50, and to screen women in their 40s based on personal preferences regarding the potential benefits and harms of screening.¹ Specialists on this side of the debate believe that annual screening results in unacceptably high rates of false-positive recalls, overdiagnosis, and overtreatment.

Recently, the USPSTF published a draft update to the 2009 breast cancer screening recommendations, and the debate has once again intensified. The solution to this problem is not to continue the debate with repetitious reviews of studies that were performed more than 30 years ago, but to focus ahead on how to make breast cancer screening safer and more effective. The time has come to put the debate to rest by conducting a modern-era screening trial.

Before focusing on the future, let us first take a moment to review the current state of breast cancer screening in the United States. The majority of providers in this country continue to recommend annual screening starting at age 40.² Proponents of annual screening mammography cite a resulting relative reduction in breast cancer mortality of 21%, which is based on data from randomized screening trials performed in the 1970s and 1980s.³ However, this estimated benefit comes with significant drawbacks. After 10 years of annual screening, over one-half of women screened will receive a false-positive recall, and 7% to 9% will undergo a benign biopsy.^4,5 False-positive recalls and benign biopsies can cause long-lasting psychological distress that can negatively impact a womanâs willingness to undergo screening for breast cancer in the future. Additionally, false-positive recalls and overdiagnosis cost the United States an estimated $4 billion per year,⁶ and screening in aggregate is estimated to cost between $8 and 10 billion per year.⁷ This estimate is based on a screening mammogram costing between $135 and $195. If the cost of mammography increases, the overall cost of breast cancer screening increases proportionally. As a country and as healthcare professionals, we can and should do better.

Breast cancer screening should harness the advances that have been made in breast cancer risk assessment and our understanding of breast cancer tumor biology. Screening should be more effective at finding relevant and consequential cancers, and should result in fewer benign biopsies. Screening should also be better integrated with prevention. Lastly, screening should be more cost-effective. A personalized screening model could potentially achieve all of these goals.

The aim of a personalized screening model would be to focus resources on those women who are most likely to benefit. The foundation of the model would be a comprehensive risk assessment that would take into consideration a womanâs classical risk factors for breast cancer, such as her personal and family history of breast disease. This comprehensive risk assessment would also include an evaluation of breast density and germline genetic testing. These risk factors would then be placed into a breast cancer risk model that would estimate the womanâs 5-year risk of developing breast cancer, and personalized screening recommendations would be made according to this risk. Women at high risk of developing breast cancer would be screened more frequently, and women at low risk would be screened less frequently. This risk estimation could also be used to make recommendations regarding chemoprevention, thereby integrating screening and prevention, which is the real key to reducing mortality from breast cancer.

This model has the potential to optimize the benefits of mammography in the context of modern systemic therapy while minimizing harms. Using a similar risk model in 3 independent study populations, it has been shown that 50% of cancers occur in women with the top 20% predicted risk.⁸ This model is also practical because these risk factors are easy to assess, and it is estimated to be more cost-effective than annual screening, despite the use of genetic testing, which has decreased in cost significantly since the Supreme Court ruling in June 2013 that stated that the human genome could not be patented.

Personalized screening may be the way forward, but this can only be determined in the setting of a randomized controlled trial. In the fall of 2015, a randomized controlled trial comparing personalized breast cancer screening with annual screening will be initiated within the Athena Breast Health Network that spans the University of California and the Sanford Health system in the Midwest. This study will be called the WISDOM study (Women Informed to Screen Depending on Measures of Risk). We have received a large grant from the Patient-Centered Outcomes Research Institute to perform this trial, and are also working with payers and self-insured employers, such as Blue Shield of California and UC Health, to create a Coverage with Evidence Development policy that will cover the medical costs of the trial. Using surrogate endpoints and long-term follow-up, we aim to determine whether personalized screening is as effective, less morbid, more preferred by women, and enables prevention more as compared with annual screening. Our hope is that this trial will provide us with the information we need in order to determine the safest and most effective way to screen women for breast cancer. Then, and only then, will we be able to put âThe Great Mammography Debateâ to rest.

As we move toward a more biology-based approach to the treatment of diseases, our approach to screening for and preventing those diseases should follow suit. The opportunity before us is to learn who is at risk for which type of breast cancer, and to optimize our screening and prevention strategies for each individual according to her personal risk. Over the last 20 years, many advances have been made in our understanding of the risk factors that contribute to a womanâs risk of developing breast cancer. The time has come for us to harness this knowledge and apply it in an evidence-generating fashion to shed more light and less heat on the screening controversy.

Do you believe that US Preventive Services Task Force (USPSTF) recommendations should be followed or do you believe screening should start at age 40? Why or why not?

CC102 Lecture Notes - Lecture 7: Toronto Police Service, Robert Pickton, Gun Buyback Program

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