Methods of visual assessment in children with cortical visual impairment
Purpose of review: Cortical visual impairment (CVI) is the leading cause of pediatric visual impairment in developed countries. Currently, there is no standardized method of visual assessment in these children, who usually cannot participate in tests designed for typically developing children. A reproducible method of visual assessment that accurately reflects the multitude of visual deficits in CVI is critical to evaluate proposed therapies for this disorder. This review analyzes current research on methods of visual assessment in children with CVI. Recent findings: Earlier studies focused on measuring visual acuity in children with CVI. More recent studies have emphasized other aspects of visual function, such as contrast sensitivity, motion detection, and visual search. Current research topics include questionnaires, functional vision assessment (CVI Range), neuropsychological tests of visual perception, and eye tracking. Eye tracking shows promise for visual assessment in both clinical and research settings because it is objective and quantitative, with the ability to assess diverse visual parameters. Summary: Current research on visual assessment in children with CVI focuses on measuring deficits of visual function beyond visual acuity. This research represents an important step toward designing clinical trials to identify effective therapeutics for this increasingly prevalent disorder with heterogeneous manifestations.
What Gets Measured in Reentry Research? A Scoping Review on Community Reentry From Jail and Prison for Persons With Mental Illnesses
Research on reentry for individuals with mental illnesses leaving jails and prisons lacks outcome specificity and standardization needed to advance knowledge about the efficacy and effectiveness of interventions. This scoping review aims to provide clarity about reentry outcomes by: (a) ascertaining what outcomes are a focus in reentry research, (b) explicating how outcomes are defined, and (c) identifying commonalities or gaps in outcomes reported. A search of multiple databases yielded 415 articles for potential inclusion. After independent document review by two of the authors, 61 articles were included in the review. Recidivism was the most used construct, accounting for 58% of total outcomes and 95% of criminal legal outcomes. Behavioral health indicators were reported the second most frequently and other outcomes were rarely reported. Increasing the specificity of commonly used concepts while also expanding the breadth of outcomes considered is needed to build an evidence base this area of research.
Parents’ Cannabis-Related Attitudes and Emerging Adult Offspring Cannabis Use: Testing the Mediating Effect of Perceived Parental Approval
Background: Contrary to parental alcohol use and expectancies work, little is known about how parent’s cannabis use (CU) and expectancies influence offspring CU. This is a notable gap in the literature given increasing acceptability and use of cannabis, especially among emerging adults (EA). Moreover, limited work has tested mechanisms of transmission of risk from these parent factors. This study addresses these gaps by testing prospective associations of parental CU and expectancies with offspring CU and CU problems, and perceived parental approval of offspring CU as a potential mediator. Method: A community sample of 314 EA and caregiver dyads completed three annual assessments (mean age = 19.13). The sample was 54% female and majority White/non-Hispanic (76%). Caregivers reported on their cannabis expectancies and use, and EA reported on their CU, CU-related problems, and perceived parental approval of CU. Results: Longitudinal structural equation modeling supported a mediated pathway such that high parental positive cannabis expectancies were associated with perceived parental approval of CU, which in turn, predicted increases in EA CU and CU problems. Parental negative expectancies had a significant indirect effect but in the opposite direction. Indirect effects were found above and beyond parental CU, which was not associated with offspring CU. Conclusions: This is the first study to test prospective indirect effects of parental cannabis expectancies on offspring CU. Findings suggest parents’ attitudes, even in the absence of parental use, confer risk for offspring use by shaping perceived acceptance of CU, suggesting parental expectancies as targets for parent-based CU interventions.
Diverse Spirituality Revisited: Lessons Learned
Chapters included in this volume highlight the vibrancy of research into diverse spiritualities. As shown by many of the book’s chapters, culturally specific measures enhance our ability to explain and understand the complexities of spiritual phenomena and help us appreciate religious traditions other than our own and humanize “the other.” The book includes chapters describing measures of Eastern forms of meditation, spiritual Jihad, afterlife beliefs associated with the three main religious worldviews, spirituality among Latin American youth, and Muslim religiousness. The case for particularism is not in conflict with that for universalism as some of the measures have been used cross-culturally. The challenge is to productively fuse these two research traditions. A second set of chapters explores the complex spiritual terrain of the Western world in the post-1960s era. These chapters illuminate a common theme of spirituality decoupled from traditional religiousness—all measures reflect a belief in interconnectedness between the person and the world at large—and articulate differences dependent on socio-cultural and historic contexts (e.g., the U.S. versus Western Europe) and field of inquiry (e.g., the psychology of religion versus transpersonal psychology). Other chapters demonstrate the empirical utility of assessing spirituality related concepts including spiritual support, modeling, struggle, well-being, as well as, prayer coping, faith, and meaning making. The new tools described in this book expand the understanding of the role played by spirituality in our rapidly changing and interconnected world while, at the same time, highlighting the aspects of spirituality common among all peoples and cultures.
The Perceived Spiritual Support Scale (PSSS): Measuring Support from the Deep Connection with Diverse Sacred Entities
The concept of perceived spiritual support (PSS) centers on an internalized resource derived from perception of an intimate relationship with a higher power, be it God, Jesus, a cosmic force, ancestral spirits, or a psychologically functional equivalent. The literature has indicated the increasing importance of spiritual support in crises and medical care, but previous assessments tended to focus on mainstream religions with inadequate validation. To meet the gap and based on related scientific theories, three crises-based studies were conducted to develop and validate a 12-item scale of perceived spiritual support (the PSSS) for assessing the spiritual resource of individuals with diverse belief systems. This endeavor was also a response to a long-standing call for measuring consciousness-related faith experience and to an assessment problem—the use of simple frequency measures in large-scale epidemiological or sociological surveys. Participants in the three studies reflect varied makeups of age, gender, generation, race, belief systems, and cultural backgrounds. The findings provide the adequate psychometric information for the PSSS and its predictive value for various outcomes. Multivariate analyses demonstrated the indirect mediating or pathway effect of the PSSS, simultaneously evaluated the effects of other established factors, and tested an explanatory mechanism underlying its predictive value. The results suggest that the PSSS, as a short and easy to use tool, can be used to predict important outcomes in crises and across different populations. More cross-cultural studies are warranted for further validation.
“We’re just two people in a relationship”: A qualitative exploration of emotional bond and fairness experiences between transgender women and their cisgender partners
Trans‐including couples experience systemic marginalization impacting their relationships, yet studies on these relationships or narratives of strength are few. The purpose of this qualitative study was to explore emotional bonding and perceptions of fairness between transgender women and their cisgender partners. Interpretative Phenomenological Analysis was utilized to answer the research question: What are the experiences of emotional bond and fairness between transgender women and their cisgender partners? This research was situated within frameworks of minority stress, romantic attachment, and contextual therapy. Seven couples of transgender women and cisgender partners were interviewed. Three themes emerged: Minority Stress Contexts and Relational Strengths; The Experience of Emotional Bond; and Negotiating Balance. Processes of boundary creation, attunement, affirmations, and balance of care were noted. Findings reframe partner relationships as opportunities to construct transphobia‐resistant and resilient narratives. Recommendations for clinicians include prioritizing the couple subsystem as an avenue for building resilience against minority stress.
The Interpersonal and Psychological Impacts of COVID-19 on Risk for Late-Life Suicide
Older adults experience increased risk for suicide compared to the general population, and the circumstances surrounding the Coronavirus Disease 2019 (COVID-19) may potentiate this risk. We discuss how current COVID-19 pandemic-related policies are likely to harm older adults disproportionately. COVID-19 pandemic social distancing policies and ethical guidelines for COVID-19 treatment may exacerbate experiences of social isolation, perceived expendability, and exposure to suffering, which are related to the 3 main components of the Interpersonal Theory of Suicide (i.e., thwarted belongingness, perceived burdensomeness to society, and capability for suicide). The COVID-19 pandemic poses a drain on services and has drawn ethical debates about policies around treating younger adults first. These experiences may lead older adults to have reduced access to needed medical and psychiatric services and may convey damaging messages of expendability. Furthermore, the potential prolonged stress associated with the COVID-19 pandemic may affect neurological, immunological, and health functioning—exacerbating suicide risk. Potential venues to increase treatment options and decrease social isolation are discussed. We acknowledge optimistic effects as well, such as “pulling together” as a society and the many valuable ways older adults may contribute during this crisis.
The impact of a diversity intervention on White college students’ colour-blind racial attitudes
This research explored the impact a 3-day pre-college diversity intervention had on incoming White college students’ (N = 63) colour-blind racial attitudes (COBRAS), or their unawareness of racial privilege, blatant racial issues, and institutional discrimination. Repeated measures analysis of variance tests indicated that students reported a greater awareness of racial privilege and blatant racial issues immediately after the programme. Students’ awareness of institutional discrimination – a potentially more abstract and complex understanding of racism – did not change after the program. To isolate the effects of the intervention, independent sample t-tests between White college students who did not undergo the intervention and intervention participants were conducted. Results indicated that both samples did not have significantly different COBRAS before the intervention, providing evidence that the intervention likely contributed to changes in intervention participants’ COBRAS. These results suggest that the pre-college diversity intervention impacted forms of COBRAS differently. Implications for diversity interventions on predominantly White college campuses are discussed.
“It really presents a struggle for females, especially my little girl”: Exploring father’s experiences discussing body image with their young daughters
Body dissatisfaction in children, particularly young girls, is a growing concern around the world. The home environment can have a strong influence on children’s well-being, and parents may contribute to their children’s positive or negative body image development. Nearly all research on parent influence on body image has focused on mothers, leaving fathers’ attitudes and experiences poorly-understood. To address this gap in the literature, we interviewed 30 fathers (Mage = 40.30; SD = 7.48) of girls between the ages of 5 and 10 about the conversations they have with their daughters regarding body image. Through thematic analysis, we identified three primary themes: barriers to effective communication, combatting negative influences, and strategies for discussing body image. Fathers recognized the importance of talking about body image with their daughters, yet many did not feel confident or competent to do so effectively. They engaged in a variety of strategies to combat adverse cultural influences and encourage self-expression, character development, and mental and physical health in their daughters. However, messages about health were sometimes conflated with messages about thinness or food restriction. Implications for families and future research are discussed.
“Don’t Know where to Go for Help”: Safety and Economic Needs among Violence Survivors during the COVID-19 Pandemic
The COVID—19 pandemic and related quarantine has created additional problems for survivors of interpersonal violence. The purpose of this study is to gain a preliminary understanding of the health, safety, and economic impacts of the COVID-19 pandemic on people that are experiencing or have previously experienced violence, stalking, threats, and/or abuse. An online survey, open from April to June 2020, was taken by people with safety concerns from interpersonal violence. Participants were recruited from IPV and sexual assault-focused agencies, state coalitions, and social media. Quantitative data were summarized using descriptive methods in SPSS and coding methods from thematic and content analysis was used to analyze qualitative data from open-ended questions. A total of 53 participants were recruited for the survey. Individuals with safety concerns have experienced increased challenges with health and work concerns, stress from economic instability, difficulties staying safe, and access resources and support. Over 40% of participants reported safety had decreased. Use of social media and avoidance strategies were the most common safety approaches used. Participants reported mixed experiences with virtual services. The COVID-19 pandemic has exacerbated existing structural concerns for survivors of violence like IPV and sexual assault. Increased support and economic resource access, coupled with modified safety planning and improved virtual approaches, would better help meet survivor needs.
Teaching Social Work Practice in the Shared Trauma of a Global Pandemic
Unique clinical dynamics occur when both clinician and client are exposed to the same community traumatic event or reality. This reflection explores the applicability of the concept of shared trauma for social work educators in the context of the COVID-19 pandemic. The author describes her experiences shifting suddenly to teaching social work direct practice courses online, against the backdrop of a rapidly escalating coronavirus pandemic. Several parallels to the clinical concept of shared trauma are described, including a stronger emphasis on the mutuality of the teaching relationship, heightened emotional identification with students, and blurred professional boundaries in the student-teacher relationship. The author also describes significant differences between her own experiences and those of her students, recognizing that shared trauma is not always shared proportionately in environments of persistent racial and economic inequality. The chapter concludes with implications for educators working in shared trauma contexts, including the importance of self-care and administrative support. Teaching in a shared traumatic reality requires social work educators to stay cognizant of our connections to our students, as well as the disproportionate tolls of this pandemic.
“Mental Health Is for Crazy People”: Perceptions and Barriers to Mental Health Service Use among Refugees from Burma
Good mental health is essential to successful integration for refugee populations that resettle in the U.S. We explored perceptions of mental illnesses and barriers to mental health service use as well as solutions to current mental health problems from the perspective of refugees. The interviews with a convenience sampling of 11 community leaders (6 men and 5 women) from various Burmese ethnic communities revealed three major categories, including sources of mental illnesses (e.g. traumatic experiences and post-resettlement challenges), barriers to service use (e.g. lack of understanding about mental health, linguistic challenges, cultural stigma, alternative treatments, and unresponsive system), and proposed community solutions (e.g. community education, culturally-competent providers, and beyond mental health treatment). The findings suggest that the ethnic community can be a source of potential solutions to mitigate barriers to mental health service use.
“Gambling Can’t Be Positive, Can it?”: Gambling Beliefs and Behaviors Among Older Korean Immigrants
After migrating to the United States, older Korean immigrants may increase their gambling participation and be at higher risk for problem gambling. However, not much is known about their experiences and beliefs on gambling. The purpose of the present study was to explore gambling behaviors and shared beliefs about gambling among older Korean immigrants residing in New York City. A total of 20 semi-structured in-depth interviews (10 men and 10 women) were conducted in Korean. Interviews were transcribed verbatim and analyzed using a thematic analysis approach. The findings revealed three major categories among older Korean immigrants. The first category, cultural beliefs, has three subcategories (i.e., gambling is unethical, fear of addiction, and losing everything) and refers to negative beliefs about gambling. The second category, adaptation, refers to positive attitudes they acquired as they adjusted to the new gambling environment (i.e., harmless leisure, coping strategies, and excitement in life). Last, they revealed ambivalence about gambling (i.e., changes in gambling environment, ‘my gambling’ is different, and gambling in secrecy). Overall, older Korean immigrants have retained their cultural beliefs about gambling, even as they have embraced the legalized gambling environment and changed social norms of the U.S. However, they have trouble reconciling the differences between their beliefs, behaviors, values, and newly acquired norms. Findings point to a need for healthy and affordable leisure pursuits, and for culturally appropriate intervention programs to help problem gamblers.
Dignity at the end of life
Measuring the ‘dose’ of person‐centred care in aged care: Development of staff and family questionnaires
Aims: To develop a theoretically and psychometrically sound instrument to measure the ‘dose’ of person‐centred care practice in long‐term care. Background: Although person‐centred care has been adopted for long‐term care across the world, there is a lack of theory‐based instruments to measure its impact. Two questionnaires were developed to measure person‐centred care from the perspectives of staff and family based on current person‐centred care frameworks: Kitwood, Nolan, and Eden Alternative. Methods: Phase I: literature review and focus groups identified potential items for the questionnaires. Phase II: academic experts, local staff, and family members of residents assessed content validity. Phase III: psychometric testing. Results: A 34‐item staff questionnaire (Cronbach’s Alpha = 0.942) with two factors “Making person‐centredness real” and “Making the environment meaningful for life and work”. A 30‐item family questionnaire (Cronbach’s Alpha = 0.947), with three factors “Staff care about what is meaningful to my family member”, “Staff know and respect my family member”, and “We are all part of a family”. The factors did not directly reflect the theoretical constructs from Kitwood’s and Nolan’s work. Conclusion: Two instruments, capturing the ‘dose’ or active practice of delivering person‐centred care, have demonstrated sound psychometric properties. The study contributes to understanding the theoretical components of person‐centred care. Impact: The study addressed the lack of robust tools to measure how much person‐centred care is taking place in aged care facilities. Staff and family questionnaires were produced based on strong theoretical foundations combining concepts of prominent person‐centred theories and rigorous psychometric testing. The instruments can be used to determine if person‐centred care makes a difference, to compare if person‐centred care changes or develops over time or between facilities. Ultimately residents, families, and staff will benefit from the ability to measure how much person‐centred care residents receive.
Co-occurring risk factors among U.S. high school students at risk for suicidal thoughts and behaviors
Background: Suicidal thoughts and behaviors (STBs) are increasing among adolescents in the United States and are challenging to predict and prevent. The current study identifies subtypes of youth at risk for suicidal thoughts and behaviors (STBs) in school-based settings. Method: Data are from the CDC’s 2015 and 2017 National Youth Risk Behavior Survey of US high school students. Among students reporting depression symptoms, latent class analysis is used to identify subtypes at risk for STBs based on personal characteristics, risk behaviors and environments. Results: Two distinct subtypes of youth were found to be at high risk for STBs: The first, larger subtype (22%) is predominately females in early high school, many of whom identify as bisexual, experienced past-year bullying, and are likely to have experienced sexual victimization. These students have low levels of externalizing risk behaviors making them difficult to detect. The second high-risk subtype (7%) is characterized by students with significant social integration challenges, with extremely high levels of substance abuse, fighting, physical and sexual victimization and poor academic performance. Many of these students have low English fluency, and identify as sexual minority. Limitations: Due to attrition or language barriers, experiences of some students at high-risk for STBs may not have been captured by this survey. Conclusion: Universal screening in clinical settings, and universally focused suicide prevention programs in school-based settings are needed and should be introduced early on. Interventions should be tailored to reach high-risk students with language, cultural and social integration challenges.
A pilot study of a group-based perinatal depression intervention on reducing depressive symptoms and improving maternal-fetal attachment and maternal sensitivity
To conduct a pilot study of a group-based perinatal depression intervention, the Mothers and Babies Course, on depressive symptomatology, maternal-fetal attachment, and maternal sensitivity, 60 pregnant women with moderate to severe depressive symptomatology were randomized to a 6-week intervention or usual care group at their initial prenatal care visit. Measures of depressive symptomatology and maternal-fetal attachment were collected at baseline and 36 weeks gestation. At 12 weeks postpartum, participants completed a measure of depressive symptomatology, and an objective measure of maternal sensitivity was collected. Participants randomized to the intervention group completed an average of 5.2 sessions, and 70% of women completed all six sessions. Exploratory analyses showed that at 12 weeks postpartum, participants randomized to the intervention group had an 8.32-point decrease from baseline on the Edinburgh Postnatal Depression Scale (EPDS) as compared to a 4.59-point decrease among participants randomized to usual care. Participants randomized to the intervention group had a mean change score of 12.60 in maternal-fetal attachment via the Maternal Fetal Attachment Scale (MFAS) as compared to 4.60 among participants in usual care. Maternal sensitivity scores, assessed via the Nursing Child Assessment Satellite Training-Feeding Scale (NCAST-Feeding), were higher at 12 weeks postpartum for women in the intervention group as compared to women in usual care (59.2 and 51.8, respectively). Our pilot study findings provide preliminary support for the benefits of a perinatal depression intervention, delivered in a group setting, on reducing depressive symptomatology, and improving maternal-fetal attachment and maternal sensitivity. Further research, conducted with larger samples, is necessary to determine the effect of this intervention on indicators of maternal attachment.
Healthcare Providers’ Experiences with Gaps, Barriers, and Facilitators Faced by Family Caregivers of Children with Respiratory Diseases
Purpose: The purpose of this study was to identify healthcare providers’ experiences of the gaps in the healthcare system, barriers to obtaining care, and facilitators that promoted safe, quality care for family caregivers of children with respiratory diseases. Design and methods: A qualitative, descriptive design was used with 13 pediatric healthcare providers. Findings: Gaps included themes of 1) fragmented healthcare system and 2) lack of asthma management knowledge. Barriers included themes of 1) poor access to healthcare and medications, 2) non-adherence, and 3) linguistic diversity and poor health literacy. Facilitators of optimal respiratory management included themes of 1) education, 2) improved communication, and 3) peer support. Conclusions: Through better understanding the gaps, barriers, and facilitators, pediatric nurses will be able to more effectively anticipate and address the needs of the caregivers. Practice implications: The nurse is in a pivotal role to empower caregivers with the skills and resources to address challenges and connect them with providers for optimal respiratory management.
Does mindfulness practice promote psychological functioning or is it the other way around? A daily diary study
Mindfulness-based interventions are commonly used to reduce psychological symptoms and enhance positive qualities of human functioning. However, the influence of mindfulness practice dosage remains poorly understood, limiting dissemination and implementation efforts. The current study examined the association between practice dosage and several constructs related to psychological functioning (positive and negative affect, state mindfulness) over the course of a standardized mindfulness-based intervention (Mindfulness-Oriented Recovery Enhancement). Twenty-five participants completed daily diary assessments for 12 weeks. Two-part gamma regression models examined the dichotomous (did practice occur?) and continuous (how much practice?) components of practice minutes. Practice time and outcomes showed same-day relationships in the expected directions. Lagged models, however, showed no evidence that current day practice time predicts subsequent day outcomes. In contrast, higher current day negative affect predicted less subsequent day practice time, and higher current day mindfulness predicted more subsequent day practice time. In a post hoc analysis, practice time moderated the link between day-to-day affect, strengthening the link for positive affect and weakening the link for negative affect. Collectively, these findings suggest that the causal direction linking practice time and outcome may flow from outcome to practice time, rather than the reverse—with potential recursive relationships between these factors. Further examination of lagged relationships between practice time and outcome as well as random assignment of participants to varying practice dosages (e.g., in within-person microrandomized trials) may help clarify the influence of this central treatment ingredient within mindfulness-based interventions.
Effects of Mindfulness Meditation on Self-Transcendent States: Perceived Body Boundaries and Spatial Frames of Reference
Objectives: Mindfulness training is believed to encourage self-transcendent states, but little research has examined this hypothesis. This study examined the effects of mindfulness training on two phenomenological features of self-transcendence: (1) perceived body boundary dissolution and (2) allocentric spatial frame of reference. Methods: A sample of healthy, young adults (n = 45) were randomized to five sessions of mindfulness training or an active listening control condition. Results: Results indicated that mindfulness training decreased perceived body boundaries (F4,172 = 6.010, p < .001, η2 = .12) and encouraged more allocentric frames of reference (F4,168 = 2.586, p = .039, η2 = .06). The expected inverse relationship was observed between perceived body boundaries and allocentric frames of reference ((β = − .58, p = .001)), and path analysis revealed that the effect of mindfulness training on allocentric frames of reference was mediated by decreased perceived body boundaries (β = .24, se = .17, CI: 0.11 to 0.78). Conclusions: Taken together, study results suggest that mindfulness training alters practitioners’ experience of self, relaxing the boundaries of the self and extending the spatial frame of reference further beyond the physical body. Future studies are needed to explore the psychophysiological changes that co-occur with phenomenological reports of self-transcendence and the behavioral consequences following self-transcendent experiences.