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A Longitudinal Study to Determine the Effects of Mentoring on Middle School Youngsters By Nursing and Other College Students

December 6, 2007

By Whiting, Sylvia M A Mallory, James E

PURPOSE: This study aims to utilize nursing and other college students in conducting a mentoring project aimed at determining outcomes of behavior and attitude of high-risk middle school students over a 5-year period. METHOD: A quasi-experimental study with a sample of fifth and sixth graders was conducted in which mentored subjects were tested using multiple instruments and school data to identify behavioral and attitudinal outcomes. Statistical analyses were conducted using chi-square and one-way analysis of variance.

FINDINGS: Academically below-average males in the treatment group were the only cohort demonstrating significant change across all measures. The magnitude of change in this cohort, however, did significantly affect treatment group outcomes overall. Females in both treatment and control groups reflected similar changes.

CONCLUSIONS: Mentoring of schoolchildren is difficult to accomplish using college mentors because of time and schedule commitments. When college mentors are used, grade allocation seems to be a stronger incentive than when payment is the sole reward. Males whose grades are below average demonstrated positive outcomes from the mentoring experience.

Search terms: Adolescent depression, acting-out, high risk, mentoring, middle school youth, nursing students, school dropouts, self-concept, violence

Schools often are unable to meet demands sufficiently when needy children come to their classrooms, and there is limited opportunity to impact and improve the welfare of such children and create circumstances that promote healthy physical, emotional, mental, and spiritual growth and development. It is an assumption that impoverished children are not likely to succeed and will contribute increasingly to problems of social disruption and chaos.

Literature Review

In a review of the literature prior to 1997 when the project began, there was a very limited amount of research related to mentoring in the middle school years. There was a more limited review available relating to mentoring of youth by college-age students and even more restricted information regarding the involvement of nursing students in mentoring roles. At that time, the need for mentoring in middle schools had been well documented (Dohrn, 1997; Heller, 1996; Keiffer-Barone, Hendricks-Lee, & Soled, 1999; Lunenburg, 2000; Riley, 2000). A recent literature review continues to cite research mostly conducted during and prior to the 1990s. One study (Rutherford et al., 1999) reported a project where university students in health sciences served as mentors training for work in underserved areas. More recent articles tend to refer to adults as mentors to adolescents, rather than refer to college students or, more specifically, nursing students.

Mentoring experiences typically have not been considered as a clinical placement site for nursing students, although Rutherford et al. (1999) reported on the mentoring project for students in the health professions in Seattle, Washington. These authors reported that the classroom is underutilized for addressing healthcare issues of concern to adolescents, and that there is a high degree of mistrust in adolescents toward their teachers. They described mentors as the “beacon of hope” for young people. Another study (Tierney & Branch, 1992) reported that in a project involving student mentors from six different universities, 45% of the participants formed successful youth-driven relationships where both mentors and their mentees were benefited. A mentoring project at Auburn University (Jackson & Matthews, 1999) indicated that the mentoring project helped to retain at-risk African American males in the public schools. A mentoring project (Burkey, Franzen, & Leitz, 2000) involving female college mentors and African American high- risk middle school girls revealed uneven results with significant improvement in some, no improvement in others, and decline in others. Murray (2002) states that change is possible in children in dire circumstances when new experiences and encounters with people give meaning to their lives. However, Jekielek, Moore, Hair, and Scarupa (2002) recommend long-term and intensive mentoring if it is to be effective. It is clear that mentoring is considered a valuable approach to enhance learning for mentors and valuable outcomes for the children who are mentored.

In this era when clinical agencies and settings are diminished, other suitable ways must be found to bring nursing students in contact with clients across the lifespan. A nursing exploratory study (Grindel, Bateman, Patsdaughter, Babington, & Medici, 2001) was completed in 2001 and the authors recommended that nurse educators document the various ways in which students enhance the clinical placement, although their study was concerned with inpatient adults rather than community pediatric settings. In a project (Jekielek et al., 2002) designed to evaluate effectiveness of mentoring programs, seven studies were conducted on five programs using an experimental design for program evaluation. Researchers concluded that mentoring programs can be effective in the positive development of youth but cautioned the avoidance of mentoring relationships that were too short in duration and that augmentation with other supportive services was desirable. They also stressed the need for structure in order to enhance the quality of the experience.

In 1997, research literature related to outcomes of mentoring with middle school students was limited, and there was not a great deal more in 2005. Hagen (2004), in North Carolina, identified the growing problem of violence in middle school students citing National Center for Education Statistics that there were 25% more violent crimes in middle school students than in high school students; a $9.7 million contract was awarded to test different violence prevention programs in schools nationwide. Jergensen (2005) reports the success of Nebraska Congressman Tom Osborne’s mentoring program for sixth to twelfth grade students begun in 1991 as TeamMates and costing $300-$400 per year to mentor a single student. In Massachusetts, a middle school mentoring project aims at teaching self-confidence, respect, and leadership skills (Alspach, 2005). Waits (2003) reported on Project SOAR, a mentoring project for at- risk youth and families in Arizona, which demonstrated that when there are two or more interacting risk factors such as poverty, substance abuse, teen pregnancy, truancy, illiteracy, and others, school dropout rates increase. Mentoring was viewed as a pathway of change by influencing adolescent academic adjustment (Rhodes, Grossman, & Resch, 2000) where there were reductions in unexcused absences and improved perceived scholastic competence.

Background for the Study

A mentoring project (Whiting & Mallory, 2003) conceived to address issues related to the need for beneficial interventions among high-risk youngsters and to provide an opportunity for nursing students to participate in a clinical experience allowing for exposure to a nonhospitalized but high-risk pediatric population over a year’s time, was begun in 1997. The experience also was intended to allow for review of mental health concepts and practice learned in the previous year and to participate in an actual nursing research project.

The project was seen as one of the ways to deal with the changing clinical environment and to orient students to the nature of nursing in populations where health promotion is the goal. It was believed that nursing students would serve as healthy role models to their young charges with whom they would meet weekly over a full academic year.

When there were not enough nursing students to serve as mentors, it became necessary to recruit college students from other disciplines because of the number of participants needed for the study. These additional mentors would be those who were studying to serve children after graduation (Table 1). The school principal was interested because although there were many mentors at his school, no project existed that required the type of structure and continuity presented in this study (C. Spell, personal communication, 1997).

The theoretical model Reconnecting At-Risk Youth was utilized for the study (Eggert, Thompson, Herring, & Nicholas, 1994). The model provided direction for assessment and intervention within the following four phases: Background Variables (demographics, risk factors, and protective factors); Interventions (social support, peer group support, skills training, personalized information/ feedback, motivation to change, skills building, skills application, and skills transfer); Intervention Outcomes (self-esteem enhancement, decision-making, personal control, interpersonal communications, social resources, network bonding, perceived social support, time with friends, and time spent in pleasant activities); and Proximal Outcomes (academic performance, school deviance, drug involvement, depression, suicide behaviors, other violent behaviors, school dropout, teen pregnancy, and incarceration). Informed Consent

Permission to conduct the study was obtained from the university research review board in the spring prior to initiating contact with school personnel and obtaining their approval for the study. Informed consent forms were presented for use with mentors, with parents, and with fifth and sixth grade students who were to be mentored. All were required to give informed consent before entering the study. Upon approval, project staff began contacting various school officials who were to be involved in providing permission and arranging contact at the school selected by the school superintendent. Discussion of the sample size and type and need for obtaining informed consents took place with the school principal in August of the initial year.

Methodology

First Year

As mentors and subjects were recruited in the fall of school year 1997-1998, informed consents were obtained. In addition, mentor/ mentee agreement forms were completed. These forms were jointly signed in the first meeting.

A small part of the Pediatric course grade was allocated to the first year mentoring group along with a stipend in order to provide participation incentives. The use of students in research projects at the university is required, and research credit may be allocated in certain courses where appropriate.

Second Year

School personnel requested that the project continue over a second year. However, there were fewer mentors with a greatly limited number of nursing students available because of a curriculum change. A new group of students was recruited requiring larger stipends without grade allocation due to a different set of student course circumstances, but the nursing students were young and far less prepared than those from the previous year and proved to be less reliable and consistent than the senior students in the first year. The younger students were sometimes less able to identify and respond to certain behaviors; however, the aspect of connection and relationship, when present in either year, was equally as effective. Intervention was provided, as needed, by project staff who were present during all aspects of the mentoring process. All mentors were required to take the same training before the mentoring experience.

Mentor Recruitment and Training

Preparation for the mentoring experience included the mentor recruitment process, training and orientation planning for mentors, contacting the school district and establishing relationships in the assigned school, and obtaining informed consent releases from parents. One of the project faculty (Mallory) had held a position in the school system and was well known in the district, facilitating access and activity within the assigned school more easily than might have occurred without such a person. Each prospective mentor was interviewed and instructed about what the project entailed, provided with a schedule of events, and signed necessary forms prior to the first training session. Training began in seminar sessions where human development theories, problems of high-risk students, and assistance with testing and documentation were presented prior to meeting the subjects. Videos, didactic sessions, and class discussion were the training modes used.

Sample Selection

Project staff met with the doctorally prepared principal, who agreed to assign a homogeneous group of subject participants using a random selection method. The method he used was to request student names from all teachers in the respective fifth and sixth grade classes who could benefit from mentoring. Selection was based on an every-other-student assignment to either the treatment or the control group. Project staff did not select the sample and the study was considered as quasi-experimental. As subjects were selected, parents were contacted by letter and requested to sign informed consents for their children’s participation in the project. The school principal, after selecting the sample, contacted the parents if the forms were not returned within the time period before the arrival of the mentors. It was late October in the fall semester when all consents were returned and mentors could begin meeting with subjects.

Sample Characteristics

Treatment and experimental groups were drawn from a population of 105 fifth graders and 96 sixth graders until a total of 82 students were selected for random placement into their respective groups. The total number of youngsters who actually began the project was 79 because of attrition before the mentoring actually began. The treatment group selection included a total of 19 fifth graders and 23 sixth graders, for a total of 42. The control group selection included a total of 19 fifth graders and 18 sixth graders, for a total of 37. Gender of the groups was ultimately reflected as 40 boys and 39 girls.

The Mentoring Experience

The mentoring project began in the fall of 1997. Orientation to the school and the initial meeting between mentors and mentees took place in the third week of October 1997, because the recruitment and preparation of mentors and mentees was not fully complete until that time. Mentors were required to commit to weekly sessions with their mentees at the school and to attend weekly seminars for the purpose of learning or reviewing confidentiality issues, appropriate communication and interaction techniques, and developmental and other theories. They participated in discussion, reporting, and recording activities and in planning regarding their mentees. Mentors were also expected to assist with data collection. Because the pretesting activity had to be done during the first contact and before any actual relationship was established, the mentor supervision of mentees with this task was considered a helpful structure for making them acquainted before agreeing to work together. At the time of agreement, both parties signed a form which served as their contract.

Recording and Reporting

Weekly reports were written on forms specifically provided for the purpose and enhanced the reports given during seminars. These recordings have proved valuable in ongoing tracking of the mentees who have progressed to the fifth year and were in ninth and tenth grades (except for one who was retained in eight grade). Mentors were required to document attitudes, behaviors, and themes that emerged during their sessions. These were then reviewed each week by project staff. If there were notable problems or concerns, these were discussed with the mentors in order to gain pertinent information. Any information that gave cause for concern was then discussed with the school guidance counselors. Observations were also possible as mentees attended annual trips to campus to visit mentors’ classrooms and learning labs and to experience other areas of the university environment with a variety of experiences from year 1 to year 4. This included such things as trips to the planetarium, radio broadcast studio, a play on campus, and ROTC demonstrations along with lunch in the student center. The campus trip was suspended in year 5 because of the difficulty in getting the group together as class schedules were so varied and complex.

Data Collection

The instruments used in the study consisted of a researcher- designed demographic tool, the PiersHarris Self-Concept Scale, and the Achenbach measures obtained from mentor observers, parents, teachers, and the mentees themselves. At the end of the second year, the mentoring aspect was concluded; however, the collection of data continued on an annual basis to complete a total of 5 years and concluded in September 2002. Project staff continued to have two to three contacts with subjects at annual testing periods once the mentoring process was ended.

Instruments

Achenbach

The standardized instruments used in the study were the Achenbach System of Empirically Based Assessment (ASEBA) with four subset tests, Observer Behavior Checklist (OBCL), Youth Self Report (YSR), Child Behavior Checklist (CBCL), and Teacher’s Report Form (TRF). These were completed by the mentor, child, parent, and the primary teacher once each year during the 5 years of the project in addition to the pretest. The profiles and norms of the ASEBA are designed for use with children ages 6-18 for the CBCL, 11-18 for the YSR, and 6- 18 for the TRF. Many CBCL and TRF items have counterpart questions on the YSR. The ASEBA has been in use since the 1960s to assess conduct problems, depression, and the way in which children function under different situations with different interaction partners. There are eight syndrome scales designated as Anxious/Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior. High scores on the syndrome scales indicate clinically important deviance since they imply the presence of problems. The behavioral ranges include normal, borderline, and clinical aspects. Validity of the competence, adaptive, and problem item (syndrome) scores has been supported for four decades of research, consultation, feedback, and revision as well as findings that all items discriminated significantly (p

Piers-Harris Children’s Self-Concept Scale

The Piers-Harris Children’s Self Concept is a frequently used measure of self-concept in children and proved to be the least complicated of the measures used in the study. It is a simple 80- item test requiring a “Yes” or “No” response. There are six subsections and a total score revealing perception of self in terms of behavior, intellectual and school status, physical appearance and attributes, anxiety, popularity, and happiness and satisfaction. As with the ASEBA, the Total Score for the PCHSCS is considered the most important. Discrepant responses are identified on the Inconsistency Index determined by random response patterns. Validity of the instrument was determined by a number of empirical studies for criterion-related and construct validity. Levels of intercorrelation between the six subsection clusters ranged from .21 to .59. Construct validity correlations ranged from .32 to .85 (Piers, 1984). Reliability has been established by numerous studies to determine test-retest stability with both normal and special samples. Reliability coefficients ranged from .42 (with an interval of 8 months) to .96 (with an interval of 3-4 weeks. The median test- retest reliability was .73 (Piers). A variety of culturally based studies took place (Lefley; 1974; Henggler & Tavorima, 1979), in which researchers reported reliability coefficients of .73 (sample of 40 American Indian students with a 10-week test-retest interval) and .51 (Mexican American migrant children with a 1-year interval). Children’s Depression Inventory

The Children’s Depression Inventory (CDI) consists of 27 items and was developed to measure the level of depression in children ages 7-17 years. Validity was determined using a number of techniques in hundreds of clinical and experimental research studies. The inventory was found to assess important constructs with strong explanatory and predictive ability in the characterization of depressive symptoms in children and adolescents. Tests of reliability were conducted and reported for internal consistency, item total score correlations, and test-retest reliability. Alpha coefficients of reliability were reported for the CDI in nine various samples and ranged from .71 to .89, indicating an acceptable level of consistency. The CDI measures state rather than trait; therefore, it may be necessary to reassess more often with a symptom- oriented instrument such as the CDI.

Demographics

The demographic sheet was designed to assess, in addition to the usual, such conditions as length of time at present address, current family configuration, areas of interest (a list of 10 items was provided), number of siblings/nonsiblings within the household, additional persons living within the household, preferred/least preferred academic subjects, perceived health problems, and medications. These data were collected annually because of frequent changes in the subjects’ lives.

Achenbach Observer, Parent, Teacher, and Youth Self-Reports

The Achenbach is an instrument that lends itself to interrater reliability analysis since it includes observations of the parent, teacher, observer (mentor), and the child him- or herself. Mentors were expected to complete Achenbach Observer (OBCL) forms each year while mentoring took place and to assist mentees, wherever needed, by overseeing the completion of the Youth Self-Report forms. They were taught the proper procedure for assisting in psychometric data collection during seminars. Teachers were asked to complete their forms for each child, and so were parents; often a second or even a third form had to be supplied when forms were not returned as requested. Incentives were offered to all participants in advance, but it was obvious by year 3 that more stringent attempts had to be made to obtain forms, especially from parents. Project staff arranged to be present during report card days when parents were expected to come to school for conferences regarding their children. This ultimately improved the collection of parent forms to above 50% and finally to 78% in year 5 while also providing an opportunity to meet and communicate with parents regarding their children. A considerable number of parents did not come for the parent-teacher conferences at these times.

Results

To initially analyze data from this quasi-experimental study, the researchers examined the characteristics of the two groups at baseline. Basic descriptive statistics and bar charts were utilized to examine the data for both groups during the duration of the study. To assess changes in the characteristics of students in both treatment and control groups, chi-square tests were utilized. Trend analyses to determine if changes occurred over the entire study period were performed using chi-square tests. Also, in looking at mean differences wherever the data were reported as averages, a one- way analysis of variance was utilized. All results were considered significant at p

Achenbach

Parent comparisons on the Achenbach pretest and fifth year revealed that treatment group males demonstrated significant improvement in five areas (anxiety/depression, social, attention, aggressive, and total score) while treatment group females demonstrated significant change in the area of social only. Control group males showed no change and control group females changed at significant levels in the areas of anxiety/ depression and aggression. There were no changes reported by the youth themselves in any group except for Treatment group males, where changes were noted for withdrawn/depression, attention, aggression, and total score. Teacher reports reflected no significant changes.

Piers-Harris Self-Concept Scale

The Piers-Harris Self-Concept Scale is an instrument used in youngsters ages 5-18 years. The instrument was administered annually to observe for differences between each of the years and over the five years. Table 2 reflects changes that occurred in total scores between pretest to fifth year of the study.

In the area of Behavior, treatment group improvement effects were mainly noted for the academically below-average males, while these scores actually dropped for the control group academically below- average cohort. No effects were noted in any cohort for the attribute of Intellectual and School Status, nor were there any for Physical Appearance and Attitudes. There were no significant effects noted for Happiness and Satisfaction, although some variation existed. The Total Score, considered as the most important of all the scales, revealed a significant improvement effect (p > .095) for the treatment group, whereas scores dropped in the control group.

Academic, Attendance, Tardiness, and Discipline Data

Academic, attendance, and discipline data were obtained each year throughout the study. These were analyzed for group variances.

Academics

As students moved to higher grade levels, there was more subject diversity and the N decreased across certain subjects. Average scores across six different subject areas dropped in both groups, except for the category known as Other and the Arts. Subject averages in the control group dropped to a greater extent than in the treatment group, except for the Arts, where the reverse was true. Table 3 depicts the subject area percentage decreases between treatment and control groups.

Attendance

The average number of attendance incidents decreased 23% for the treatment group and increased for the control group. Comparisons between year 1 and year 5 revealed that the treatment group dropped from 115.7 to 88.8 attendance incidents, and the control group increased from 67.8 to 95.4 attendance incidents. During the first two years of the study, two cohorts became evident within each of the treatment and control groups and were categorized as ‘Troubled” and “Nontroubled.” Analysis of these cohorts demonstrated a 2% increase in attendance incidents for the Troubled Treatment cohort as compared to an 83% increase for the Troubled Control cohort.

Tardiness

When Troubled vs. Nontroubled youngsters were considered, there was a 94% increase in tardiness for the treatment group Troubled cohort as opposed to a 172% increase for the control group Troubled group cohort. Nontroubled youngsters reflected increases in both treatment and control groups, but they were greater in the control group; the treatment group increases for the 5 years went from 8.4 to 10.7 average incidents, while the control group increases went from 4.8 to 14.4 average incidents.

Discipline

Discipline was considered to have multiple components. Categories for discipline were collapsed in order to manage an inordinate number of complaints. The total number of disciplinary incidents decreased from years 1 to 5 from 240 to 197 in the treatment group and increased in the control group from 105 to 232 for the same period. Table 4 identifies nine separate categories and number of offenses for first and fifth year.

Children’s Depression Inventory

The CDI was used in the fifth year of the study. The Achenbach had a depression measures component, and the CDI allowed for a validity check of the Achenbach data. Most interestingly, academically belowaverage youth did not produce high depression scores whereas academically average/above-average youth registered at higher levels when scores were divided into low, moderate, and high levels of depression. When analyzed for Troubled/Nontroubled cohorts, the percentage of control group depressives was higher than in the treatment group (Table 5).

Youth Response Survey

A researcher-developed instrument, the Youth Response Survey, was developed for determining attitudes and opinions related to violence, acting-out, and perceived parental responses or involvement toward their children during their adolescence. Collected data may be found in a future publication or available from the authors by request.

Demographics

There were no great differences noted in either group. There was considerable mobility of students throughout the project with some moving back and forth from home to home, up to three times in a given year. Other students claimed to live in more than one household at the same time, going from one to the other according to personal whim or parental decision. In the summer between years 1 and 2, seven treatment group participants and one control group participant had moved to different schools in the district. Summary

Sample

The study was longitudinal and the mentoring process involved multiple and various types of student mentors who worked with a group of mentees over a 2-year period. There was a lack of diversity in the mentee sample as all were African American youth with the exception of one Caucasian child in the control group. The makeup of the sample provided for two groups that were further subdivided into cohort groups of academically average/above average and below average. In addition, there was some grouping into troubled and nontroubled categories based on the observation of certain behavioral manifestations.

Mentors

Since the study period encompassed 2 years and there was a need for switching to new mentors in the second year, repeated training and introduction of new mentors to the subjects in the treatment group were carried out. It often was difficult to mesh schedules of mentors and their mentees, and this necessitated some reassignment as well. This required adjustment on the part of mentees, and project staff frequently served in the mentoring role on a given day. One day per week was allocated for each encounter. It would have been preferable if the interactions could have occurred more frequently. However, this was not possible given the schedules that mentors and mentees had to maintain.

Conclusions

The mentoring project demonstrated effects that were significant in the Treatment Group belowaverage male cohort, and these accounted for the major effects for the treatment group as a whole. The results cannot be generalized since the study began in one racial group of school children in a rural southeastern county and with two different sets of mentors that often proved unreliable. However, the data suggest that males who are academically below average respond to mentoring. College student schedules often conflict with the times when mentees were available during the school day, making it difficult to mesh their times together. In-school requirements often hamper mentoring activity by restricting the times that mentors and mentees can be together, and out-of-school activities are not permitted. Another conclusion is that school mentoring projects cannot succeed without cooperation and collaboration among project staff and school administrators, teachers, and staff. The school counselor is especially significant in helping the process succeed.

Recommendations

The following recommendations for future studies include (a) seeking cooperation of school district administrative officials; (b) recruiting mentors who are at least college juniors or seniors to assure maturity; (c) considering the impact of grades over stipends or in addition to stipends to assure supply and reliability of mentors; (d) selecting a larger sample size; (e) separating treated from nontreated subjects by using separate schools; (f) identifying an individual from within respective schools to coordinate and cooperate in the collection of data and related activities; (g) establishing clear memoranda of agreement between study participants and project staff to maintain a detailed project plan; (h) establishing face-to-face contact with teachers and parents whenever possible; (i) providing attractive incentives to all project participants, including mentees, parents, and teachers; (j) conducting comparative studies using college students and other types of mentors to determine effectiveness of each; and (k) considering two sessions per week instead of one.

Acknowledgments. This paper is under the EvansAllen Cooperative Agricultural Research Program and is supported by the South Carolina State University/ 1890 Research & Extension in cooperation with the U. S. Department of Agriculture. Appreciation is given to Mr. Tyrone Dash for his statistical analysis.

Journal of Child and Adolescent Psychiatric Nursing, Volume 20, Number 4, pp. 197-208

In this era when clinical agencies and settings are diminished, other suitable ways must be found to bring nursing students in contact with clients across the lifespan.

Mentors were required to commit to weekly-sessions with their mentees at the school and to attend weekly seminars for the purpose of learning or reviewing confidentiality issues, appropriate communication and interaction techniques, and developmental and other theories. They participated in discussion, reporting, and recording activities, and in planning regarding their mentees.

The Piers-Harris Self-Concept Scale is an instrument used in youngsters ages 5-18 years. The instrument was administered annually to observe for differences between each of the years and over the five years.

School mentoring projects cannot succeed without cooperation and collaboration among project staff and school administrators, teachers, and staff. The school counselor is especially significant in helping the process succeed.

References

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Whiting, S. A., & Mallory, J. E. (2003). An outcome study relative to adolescent violence and acting-out in ninth and tenth grades following a college student mentoring experience in fifth and sixth grades (Research Bulletin 76). Orangeburg, SC: South Carolina State University, 1890 Research.

Sylvia M. A. Whiting, PhD, APRN-BC, and James E. Mallory, EdD, LPC

Sylvia Whiting, PhD, is a Professor and Interim Program Director in Nursing at South Carolina State University, Orangeburg, SC; and James Mallory, EdD, LPC, is a Research Associate for 1890 Research and Extension and the Department of Nursing at South Carolina State University.

Author contact: sylviawhiting@aol.com, with a copy to the Editor: poster@uta.edu

Copyright Nursecom, Inc. Nov 2007

(c) 2007 Journal of Child and Adolescent Psychiatric Nursing. Provided by ProQuest Information and Learning. All rights Reserved.




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