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Editor's Comments

Welcome. Visitors to this website will find new offerings since Conscience Works made its debut in March of 2001. There are recent contributions located in each of our sections: Theory and Research, Conscience Sensitive Moral Education and Conscience and Ethics. None of this would be possible without the ongoing contributions of the "webmaster" for Conscience Works , Ms. Sue London of the Ruth Lilly Medical School Library. Ms. London and the editorial staff will be assisted by Ms. Angie Baker, Mr. Jonathon Thompson, and Ms. Colleen Method whom we are very glad have joined the project. The Editor's Column now enjoys its own section, which allows for more room to provide not only comment on the electronically published works which appear here but also a periodic update on The I.U.Conscience Project itself. Much merits comment in theory, research, clinical application, teaching, and ethics.

Barbara Stilwell, M.D. has been active in presenting research findings and theory. On 5/31/02, she joined with Matthew Galvin, M.D. at the Fifth Annual Mental Health Symposium: Mental Health In Troubled Times for an invited presentation on conscience development and developmental psychopathology. The symposium is a collaborative effort between the I.U. Department of Psychiatry and the Mental Health Association of Indiana. More recently she was invited to Dartmouth Medical School to contribute to Investigating the Social, Moral, and Spiritual Foundations of Child Well-Being. Here she contributes issue number 2, which concludes Volume I of Conscience Works, in the section entitled Theory and Research. In response to frequent requests for the research instruments she has pioneered and to fulfill our promise to make these available on this website, Dr. Stilwell provides an overview of the most recent semistructured and structured versions of the Stilwell Conscience Interview (SCI). The instruments themselves appear in appendices. These are freely available for downloading and distribution with our usual proviso that the SCI not be altered and that appropriate attribution is made to their creator.

Dr. Stilwell also introduces The Global Assessment of Psychopathological Interference in Conscience. This instrument, also appended, culminated from a year-long collaboration 1998-1999 among conscience sensitive professionals who gathered regularly at Dr. Stilwell's home where they divided into what came to be known as the 'Upstairs and Downstairs' crews. The Upstairs crew consisted of Margaret Gaffney, M.D. (Indiana University School of Medicine), Matthew Galvin, M.D. and Maroline Ritter, Clinical Nurse Specialist (then at Pleasant Run Children's Home). The Downstairs crew consisted of Tom Battocletti, PhD. (then at Pleasant Run Children's Home) and Barbara Stilwell, M.D. Jill Abram, M.D. was engaged in study of conscience interviews of psychiatrically hospitalized adolescent girls conducted by Ms. Sue (McKasson) Goldfarb in the late 1980's. Dr. Abram's interest occasioned our efforts to produce a measure of psychopathological interference (PI) in conscience formation apart from Dr. Stilwell's scoring criteria for stages of conscience development, which had served the earlier studies of normal conscience. Dr. Abram prepared blinded, identical copies of transcribed conscience interviews for all present. The first pass at scoring was conducted individually. The initial P. I. ratings were bare-boned: "none", "mild", "moderate", or "severe". Discussion by crew produced more and more detail and illustration and finally Upstairs and Downstairs crews then met to establish the scoring rationale. Inter-rater reliability improved considerably in the process. Dr. Stilwell reflected upon the efforts and ideas of all involved and produced the scale. In its current form, we think it provides useful benchmarks to conscience sensitive clinical assessment. It seems clinically meaningful to distinguish the concepts of developmental competency, delay or acceleration in conscience formation, on the one hand and psychopathological interference in conscience functioning, on the other. The Global Assessment of P.I. in Conscience used together with the Conscience Developmental Stage Score may provide weight to the distinction and a conscience sensitive problem list as well as the foundation for a competency based treatment plan. However, the psychometric properties of the Global Assessment of P.I. have not been rigorously studied and, at least sometimes we have found P.I. in conscience functioning of severity sufficient to make developmental scoring of conscience formation highly problematic.

Research correlating conscience sensitive psychiatric evaluations scored for P.I. with established dimensional ratings of psychopathology (along the lines of the work conducted by Walsh et al. cited in Conscience Works volume I issue 1), may help statistically strengthen validity. In this regard it is a pleasure to formally acknowledge Ms. Sandy Larimore who is the first recipient of the I.U.Conscience Project's Barbara M. Stilwell Scholarship. Ms. Larimore is matriculating in the Master's Degree in Psychology Program at University of Indianapolis and has recently become a co-investigator in our IRB approved study. We are reserving future space on our website for her findings.

There are two new additions to Conscience Sensitive Moral Education.The first is the Conscience Celebration Study Guide, authored by M. Galvin as an educator's companion to the work, which first appeared in 1998 as a contribution to the Riley Child Psychiatry Special Needs library. Dr. Galvin is grateful to his colleagues for their reviews and comments. The Conscience Celebration itself became the initial focus of a special interest work/study group convened by Dr. Tom Battocletti at Pleasant Run Children's Home in March of 2000. The purpose was to review the ideas in the story and explore how they might be adapted for psychoeducational and therapeutic use in the continuum of care provided at the time at Pleasant Run, Inc. (PRI). The group concluded its task by generating recommendations for a dramatic treatment of conscience more relevant to the lives of children and adolescents who reside in treatment facilities. The I.U. Conscience Project joined with PRI in commissioning dramatist Rita Kohn to create a script. The working title is How Does Your Garden Grow? Maroline Ritter, Clinical Nurse Specialist, maintained close liaison with Ms. Kohn early in the project until Ms. Ritter's departure from Pleasant Run to return to academia at Anderson University. We are anticipating a debut performance of Ms. Kohn's original play within the next twelve months. As clinical director of Pleasant Run, Kim Haga, PhD, directed that Dr. Battocletti's Work/Study Group be reorganized to consider how conscience could be incorporated in treatment. Participants in these various groups included I.U. Conscience Project members and several PRI clinical, administrative and support staff united in their interest in conscience, in alphabetical order: Tom Battocletti, Janet Carlson, Kanesha Crawford, Meg Gaffney, Matt Galvin, Gayle Harrell, Cynthia Holloway, Erron Kelly, Rae Lynn Kelly, Rita Kohn, Kinzua LeSuer, April McWilliams, Brenda Melton, Mary Jean Pies, Maroline Ritter, Deborah Stamper, Monte Stevenson, Barb Stilwell, Sue Walker and Neal Wilkey. The nursing contingent among these participants, Ms. Stamper, CNS, Ms. Kelly, RN and Ms. Harrell, RN, and Dr. Wilkey, a fourth year psychiatry resident at I.U. began with Dr. Galvin the task of developing a format for conscience sensitive psychoeducational group therapy. The first group was brought to premature closure when, after 134 years, Pleasant Run was obliged to close its doors. However in the tradition of Johnny Appleseed, it is hoped that former participants are nurturing conscience sensitivity in interview techniques, assessments and treatments wherever they are now working with youth and adults with special needs. With the support of Paul Lefkovitz, PhD., M.D. Dr. Galvin has had the good fortune to continue conscience sensitive psychiatric assessment and to refine conscience sensitive group treatment at St Vincent's Stress Centers. He pairs with seasoned therapists interested in conscience theory and the clinical applications. These clinicians are Bev Berger, Youth Day School, Mimi Brittingham, Meridian Youth Outpatient, Marjorie Cline, Partial Hospitalization Program and Julie Martin, Adolescent Intensive Outpatient Program. Dr.Galvin has also conducted groups at Children's Bureau Inc. Retreat Program. As an introduction to interested parties, The Conscience Project has developed half and full day workshops, entitled Conscience Sensitive Psychiatric Treatment of Children and Adolescents. These have been conducted at New Perspectives, 9/24/99, PRI, 9/29/00, St Vincent's Stress Center, 5/21/01 and most recently Children's Bureau Incorporated, 1/30/02.

The second addition to Conscience Sensitive Moral Education is a fantasy sequel to The Conscience Celebration, entitled Rachel and the Seven Bridges of Conscience-Berg. Like all of our works, it is freely available for downloading and distribution with the proviso that it not be altered and that appropriate attribution is given to its creators. Many real-life contributors to the study of moral development are honored for their labors in fictitious Conscience-Berg. With the help of an Imp, Rachel, the fictitious protagonist, finds something else: how each domain of conscience is linked with a bedrock value and how all the domains and bedrock values are inextricably connected. The creators of the work are grateful for the review and comments on earlier versions provided by Ms. Rita Kohn. We hope you enjoy it.

In Conscience Works volume II issue number 1, Meg Gaffney, M.D. and her colleagues inaugurate Conscience and Ethics with the article, Conscience Sensitive Medical Education. The article provides an account of how introduction to clinical medicine courses can be conscience sensitive. It is based upon direct teaching experience with first year medical students and with psychiatric residents over several years. The material has been shaped by presentations to: The I.U. Department of Psychiatry 5/9/97, and 9/25/98, The Annual Meeting of the I.U. School of Social Workers, 11/5/99, The Association for Practical and Professional Ethics, 3/2/01; and in our workshops conducted at: The American Psychiatric Association 151st Annual Meeting 6/4/98, Pleasant Run Incorporated/Hamilton Center Alliance Family Services, 2/15/99, the Academy of Child and Adolescent Psychiatry Annual Meeting 10/23/99, the Annual Meeting of the Association for Moral Education, 11/18/99, and the I.U. School of Medicine Program in Medical Ethics Workshops for Faculty 8/28/98, 12/5/00 and 12/7/00. The paper was substantively presented in an invited discussion at the I.U. Poynter Center for the Study of Ethics and American Institutions, 1/31/02. The authors are grateful to the following persons for their reviews: Dr. David H. Smith, Dr. Gary Mitchell, Dr. Steven Ivy, Fr. Charles Shelton, Dr. Robert Payton, and Dr. David Moller.