Intimate Partner Violence Screening in the Prenatal Period: Variation by State, Insurance, and Patient Characteristics
Objective To measure the proportion of women screened for IPV during prenatal care; to assess the predictors of prenatal IPV screening. Methods We use the CDC’s 2012 Pregnancy Risk Assessment Monitoring System, representative of births in 24 states and New York City (N = 28,581). We calculated descriptive and logistic regressions, weighted to deal with state-clustered observations. Results 49.2% of women in our sample reported being screened for IPV while pregnant. There were higher screening rates among women of color, and those who had not completed high school, never been married, received WIC benefits, initiated prenatal care in the first trimester, and were publicly insured. State screening rates varied (29.9–62.9%). Among states, mandated perinatal depression screening or training was positively associated with IPV screening. 3.6% of women in our sample reported prenatal IPV but were not screened during pregnancy. Conclusions for Practice Current efforts have not led to universal screening. We need to better understand when and why providers do not screen pregnant patients for IPV.
Observed communication and relationship quality in female same-gender couples
Relationship interventions typically focus on reducing destructive communication patterns between partners. However, a dearth of research exists regarding communication dynamics within female same-gender (FSG) couples. The current study sought to expand basic science on communication dynamics within FSG couples with the overarching goal of informing relationship interventions. Participants included 102 adult FSG couples who provided self-report data and participated in observational communication tasks. Actor–partner interdependence models (Kenny, Kashy, & Cook, 2006) were used for analyses predicting relationship adjustment, dedication, and psychological aggression. Findings suggest that actors’ negative and positive communication patterns were associated with relationship quality outcomes. Negative communication demonstrated stronger associations with relationship quality and psychological aggression compared with positive communication, and partner’s positive communication was associated with psychological aggression. Overall, results suggest that communication processes traditionally addressed by relationship interventions would likely be beneficial to focus on with FSG couples. Clinical implications are discussed, including how to incorporate cultural competence into relationship interventions for FSG couples.
Using the Consolidated Framework for Implementation Research to examine implementation determinants of specialty mental health probation
Background: Specialty mental health probation (SMHP) is designed to improve outcomes for the large number of people with serious mental illnesses who are on probation and/or parole. The evidence for specialty mental health probation is promising; however, little is known about the implementation challenges and facilitators associated with SMHP. To address this gap, we used the consolidated framework for implementation research (CFIR) to analyze 26 interviews with stakeholders representing multiple agencies involved in the implementation of SMHP. Results: Results indicate a number of challenges and facilitators related to the inner setting, outer setting, implementation process, and characteristics of individuals. Conclusions: Findings suggest that complex and cross-sectoral interventions are context-dependent and introduce a number of challenges and facilitators related to multiple CFIR domains. Consequently, agency administrators implementing these types of interventions should consider small pilot studies and develop implementation strategies tailored to the local implementation context.
Characteristics and Factors Associated With Intimate Partner Violence–Related Homicide Post-Release From Jail or Prison
Intimate partner violence (IPV) victimization and perpetration are common experiences among incarcerated people. Despite knowledge regarding the challenges of re-integrating post-release from jail or prison, including an increased risk of homicide victimization, there is a dearth of research focused on IPV-related homicides post-release from a correctional facility. To address this gap, the current study used 2003-2015 data from the National Violent Death Reporting System from 27 states to examine the characteristics and circumstances surrounding IPV-related homicides soon after the homicide victim was released from jail or prison. Of the 126 post-release homicides, 13.5% were related to IPV. Post-release homicides involving either a female victim or perpetrator were more likely to be IPV-related. In the case of many of the IPV-related homicides, there was evidence of prior IPV as well as potential bystanders (including formal and informal supports) who were aware of the risk for IPV escalation and possible lethality. Compared with non-IPV post-release homicides, those related to IPV were more likely to occur in the victim’s home, have been immediately preceded by a physical fight, and have occurred by means other than firearm. These findings highlight the importance of enhancing the capacity of correctional facilities and community-based services to assess for and respond to risk of IPV and IPV-related lethality for individuals leaving correctional institutions.
Banking for all: Why financial institutions need to offer supportive banking features
Financial institutions are missing out on an opportunity to effectively serve the millions of Americans who live with a mental health disability.1 According to the National Alliance on Mental Illness, approximately one in five adults in the U.S. experiences mental illness in a given year. For the 43.8 million of us who experience a mental health issue annually, financial situations can be more complicated than they are for the rest of the population.
Towards a Biopsychosocial Psychiatry
Objective: Constructing a meaningful biopsychosocial model for the mental health field has been extremely elusive. Identifying the linkages between the biological, psychological and social domains has been especially daunting. There has been important progress in clarifying general correlations of certain social factors related to the mental health of individuals and in developing training programs to recognize these social factors. However, efforts have usually focused on broad correlations and there have been serious deficiencies in developing methods for understanding and dealing with the specific processes happening at the psychological and social interface. For this reason, it would be important to be able to do such things as for example have a means to clarify the processes that connect the individual’s mental health and its specific interactions with his or her social class. In this report we suggest two approaches that can contribute to solving this problem. Methods: We will describe approaches from the fields of anthropology and microhistory that link the specific experiences of the individual and the nature of the social context in which he or she finds him/herself. Results: Careful application of certain anthropological and history study methods that “take seriously” the specific interactions between the environmental situation and the individual can provide approaches to improved understanding of the relevant variables and the causal links between “psycho” and “social” in the biopsychosocial model. Conclusions: Teaching and applying these principles in treatment and research can contribute to a more effective model of biopsychosocial interactions in the mental health field.
“That’s My Number One Fear in Life. It’s the Police”: Examining Young Black Men’s Exposures to Trauma and Loss Resulting From Police Violence and Police Killings
Black males are disproportionately the victims of police killings in the United States, yet few studies have examined their personal narratives of trauma and bereavement resulting from police violence. Informed by critical race theory and stress and coping theory, we used a modified grounded theory approach to conduct and analyze in-depth, semistructured life history interviews with 40 young Black men (aged 18-24 years) in Baltimore, Maryland. Study participants were recruited from a GED and job readiness center serving Baltimore youth. Study results offer a nuanced understanding of the patterning and mental health consequences of police violence for young Black men. Participant disclosures of witnessing and experiencing police violence began in childhood and spanned through emerging adulthood, met Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition criteria for trauma exposure, and embodied theoretical conceptualizations of racial trauma. Exposures to police violence fostered distrust of police and informed participants’ appraisals of their vulnerability to police violence across the life course. Six study participants disclosed losing loved ones to police killings. Injustice and hypervigilance accompanied grief. Implications for research, policy, and practice are discussed.
The Dehumanization of Black Males by Police: Teaching Social Justice—Black Life Really Does Matter!
Despite the contemporary public’s discourse regarding the embrace of human diversity within the United States, Black males still are perennially brutalized, killed, and negatively stereotyped. Recent events regarding police killings underscore the reality that even though Black males have the same constitutional and civil rights as all other citizens, in practice their rights are often violated or denied. The negative stereotypes of Black males is problematic because it creates an environment and negative perception of them that causes some police officers to claim that they feared for their life before shooting. In this article the authors discuss the history of police oppression and killing of Black males and offer critical race theory as a theoretical perspective that helps to explain this pervasive social inequity. More important, the authors provide practical classroom narratives, assignments, and strategies that may hold promise in addressing the problem of police brutality and the killing of Black males.
Optimism/hope associated with low anxiety in patients with advanced heart disease controlling for standardized cardiac confounders
Anxiety is an under-investigated comorbidity in heart disease patients. Optimism/hope is a character strength that indicates confidence or favorable expectation about the future. Previous research has consistently reported optimal health outcomes among optimists. However, many studies have lacked adjustment for medical confounders and/or used small clinical samples. To bridge this gap, we tested the hypothesis that optimism/hope was inversely related to anxiety in 400+ patients with advanced heart disease during the stressful waiting period prior to open-heart surgery. The findings supported the hypothesis after controlling for general health, illness impact, behavioral risks, and cardiac medical indices used by surgeons.
Missed Appointments by Hypertension Patients in Transitional Care: Race and Insurance Correlates
Missed outpatient appointments represent a barrier to continuity of care. Little evidence exists on the relationship between health insurance status and missed appointments at a transitional care clinic (TCC) for underserved hypertensive patients. High blood pressure is the leading risk factor for stroke. This study examined associations between payment status and race with missed first appointments after discharge following hypertension-based hospitalization. We conducted a retrospective study using an appointment database during the first three years at a TCC that serves underserved patients. Nearly two-thirds of eligible patients (n=144) self-identified as Blacks. Three types of insurance and demographics were used to predict the missed first appointment in three two-step logistic regression models. We also examined the interaction between race and appointment status. The role of race in appointment status varied across three models. Privately insured patients had fewer missed appointments. However, the interaction analyses showed that privately insured Black patients were more likely to miss their first appointments than patients of other races or patients with other insurance types. Black patients without insurance were more likely to appear at appointments, though neither being publicly insured nor being uninsured was independently related to missed appointments. Further investigation into vulnerable populations should address mechanisms underlying these relationships.
Anxiety, Depression, and the Interpersonal Theory of Suicide in a Community Sample of Adults with Autism Spectrum Disorder
The present study examines occurrence of depression, anxiety, and suicidality in adults with autism spectrum disorder (ASD), relationships between social difficulties and mental health, and application of the Interpersonal Theory of Suicide in this population. Ninety-eight adults with ASD completed an online survey. Data were analyzed using bivariate correlations, independent samples t-tests, and simple mediational analyses. A substantial proportion reported a lifetime history of anxiety (63%), depression (55%), and suicide attempts (19%), as well as recent suicidal ideation (12%). Social difficulty was associated with higher psychiatric concerns. Thwarted belongingness and perceived burdensomeness were associated with social dissatisfaction, current suicidal ideation, and history of depression. Results suggest the need for widespread screening and intervention services for co-occurring psychiatric conditions in this population.
Perceptions of belongingness and social support attenuate PTSD symptom severity among firefighters: A multistudy investigation
Firefighters experience high rates of posttraumatic stress disorder (PTSD). It is imperative to identify malleable factors that protect against the development of PTSD symptoms among this population. We examined whether perceptions of belongingness broadly (Study 1) and social support from supervisors, coworkers, and family/friends specifically (Study 2) are associated with lower PTSD symptom severity among firefighters. Study 1 included 840 U.S. firefighters (91.1% male); participants completed the Interpersonal Needs Questionnaire and PTSD Checklist—Civilian Version. Study 2 included 200 U.S. women firefighters exposed to a Criterion A traumatic event; participants completed the Generic Job Stress Questionnaire, Life Events Checklist for Diagnostic and Statistical Manual of Mental Disorders–5, and PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders–5. Linear regression analyses were conducted, adjusting for the number of years participants served as firefighters. Greater belongingness broadly (Study 1; b = −0.740, p < .001) as well as social support specifically (Study 2) from supervisors (b = −4.615, p < .001), coworkers (b = −4.465, p = .001), and family/friends (b = −3.206, p = .021) were associated with less severe PTSD symptoms. When all sources of social support were entered into a single model, only support from supervisors was significantly associated with lower overall PTSD symptom severity (b = −4.222, p = .004). Belongingness and social support may protect against the development of PTSD among firefighters. Supervisor social support may be particularly salubrious, suggesting that top-down mental wellness promotion within the fire service may be indicated to protect firefighters against PTSD.
The Systemic Therapy Inventory of Change (STIC) Initial Scales: Are they sensitive to change?
The Systemic Therapy Inventory of Change (STIC) is a multisystemic and multidimensional feedback system that provides therapists feedback about systemic domains of client change in individual, couple, and family therapy over time. The goal of the present study is to investigate the sensitivity to change of the scores of the STIC Initial Scales. In total, 583 clients who voluntarily sought individual, couple, or family therapy services and participated in a randomized controlled trial study were included in the study. Their pre- and posttherapy responses to the STIC Initial measures and corresponding validation measures for individual functioning, couple relationship, child adjustment, and family functioning were compared. The results support the sensitivity to change of the scores of the four STIC Initial Scales investigated: Individual Problems and Strengths (IPS), Relationship with Partner (RWP), Family/Household (FH), and Child Problems and Strengths (CPS). Of particular note, the IPS demonstrated even greater change over time than the BDI-II, BAI, and OQ-45. The discriminant validity of measuring change with the CPS was not supported. Thus, the STIC Initial IPS, RWP, and FH can be usefully employed to measure multisystemic changes in both research and clinical work.
Integrative Systemic Therapy: Lessons on Collaboration and Training for the 21st Century
The field of couple, marital, and family therapy (CMFT) is at an important juncture of identity development and synthesis. Integrative Systemic Therapy (IST) is a problem‐centered metaframeworks approach that meets the growing needs of family therapists working with diverse and complex family systems and restores the field to its original focus on collaboration. This paper describes the process by which IST developed featuring anecdotes from live interviews with the founders. We briefly outline IST’s theoretical pillars and the essential way IST practitioners deliver treatment including a blueprint for therapy. Finally, we propose that IST is a comprehensive, systemic guide uniquely beneficial to CMFT training and discuss our approach to integrating IST into our training of students in a COAMFTE accredited program.
Deconstructing racial essentialism in the classroom : The impact of social constructionist curricula on student diversity interaction
This study aims to examine how change in white college students’ beliefs about race over the course of a semester impacted their interactions with diverse others. While there is an increasing interest in understanding people’s beliefs about race, there has been limited research examining how people’s beliefs about race can and do change over time and how education can facilitate this change. White students (N = 98) at a predominantly white college completed a multidimensional racial essentialism measure and measures of both self-report and behavioral interactions with diversity, at the beginning and end of a semester. Multilevel modeling with time-varying predictors was used to examine how change in beliefs about race related to change in diversity interactions. The impact of racial essentialism on student diversity interaction varied considerably depending on the type of racial essentialism. Higher levels of speciation and genotypic essentialism at Time 1 were related to lower interaction with diversity at Time 2. Decreases in phenotypic essentialism were concurrent with increases in diversity interaction over the duration of the semester. For a subgroup of students enrolled in a race and diversity course, unexpectedly, decreases in genotypic essentialism were concurrent with decreases in diversity interaction. By using a multidimensional model of beliefs about race with a longitudinal assessment, this study contributes to our understanding of how specific components of beliefs about race change over time and how change in these beliefs occurs concurrently with students’ diverse interactions. The findings are discussed in relation to the impact of education on students’ peer interactions with diverse others, with specific implications for race and diversity pedagogy.
Hope Springs: Moderating the Link Between Racial Discrimination and Depressive Symptoms for African American Emerging Adults
To better understand the moderating effect of coping mechanisms (distraction and rumination) and internal assets (hope) on the relationship between perceived discrimination and depressive symptoms, a sample of 363 African American students (65.3% female; mean age = 20.25 years; SD = 2.39) from two large Midwestern universities were surveyed using self-report measures. Hierarchical multiple regressions were used to explore the relationships among the variables and depressive symptoms. Results indicated that discrimination (B = 0.10, p < .001) and ruminative coping (B = 1.05, p < .001) were positively related to depressive symptoms, while hope was negatively related to depression (B = −0.33, p < .001). Further, the relationship between discrimination and depressive symptoms was moderated by hope (B = 0.01, p = .02). The interaction between discrimination and depressive symptoms suggested that participants who reported low levels of hope also reported more depressive symptoms regardless of level of discrimination, compared with those who reported high hope. For these African American emerging adults, the results bring to light the potential of an internal asset that aids in reduction of depressive symptoms in response to constant, potential harm such as racial discrimination.
A comparison of patients managed in specialist versus non-specialist inpatient rehabilitation units in Australia
To compare the rehabilitation of patients with brain and spinal cord injury in specialist rehabilitation units and non-specialist rehabilitation units in Australia over a 10-year period. A retrospective cohort study design was used. Epidemiological descriptive analysis was used to examine inpatient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database at four discrete time points: 2007, 2010, 2013 and 2016. Data sets included patient demographics, length of stay and the Functional Independence Measure. Data sets were examined for differences between specialist and non-specialist rehabilitation units. Over the 10-year study period, compared to patients admitted to non-specialist rehabilitation units patients admitted to specialist rehabilitation units: (1) were younger and more likely to be male; (2) had a longer time between onset of illness/injury and rehabilitation admission; (3) had a longer median rehabilitation length of stay; (4) had a higher burden of care on admission to rehabilitation; however (5) had a greater functional gain. Patients in specialist rehabilitation units had a lower relative functional efficiency per day of rehabilitation, but higher percentage of Functional Independence Measure gain. In 2016, 66% of brain injury and 51% of spinal cord injury patients were not rehabilitated in specialist rehabilitation units.There are differences in the characteristics of patients admitted to specialist versus non-specialist rehabilitation units. Patients admitted to specialist rehabilitation units have greater functional gain. A noteworthy proportion of brain and spinal cord injury patients are not being rehabilitated in specialist rehabilitation units, particularly patients with non-traumatic injuries.
, Iron Cage or Paper Cage? The Interplay of Worker Characteristics and Organizational Policy in Shaping Unequal Responses to a Standardized Decision-Making Tool
Studies are largely optimistic about the ability of standardized procedures to constrain decision-makers’ biases and produce more equitable results across fields. However, work that embraces standardization as an equalizing force stands in contrast to research on standardization and street-level bureaucrats, which asserts that standardized procedures are not self-actuating and cannot be understood apart from the environments in which they are used. I examine how frontline workers vary in their approach to an actuarial-based tool intended to standardize judgments. In a highly controlled decision-making environment, child welfare workers whose racial and sex characteristics afford them higher status report subverting the tool; conversely, workers in the same position whose ascriptive characteristics yield them lower status in terms of race and sex describe following the rules. In an environment where the same tool is adopted only ceremonially, all workers experience decision-making as unconstrained, regardless of their ascriptive characteristics. This work fills gaps in knowledge about how social status and organizational context intersect to affect rule abidance. Examining these dynamic relationships advances understanding of how organizations reproduce inequality and the limits and potential for standardization to transform social hierarchies.
Standardizing Biases: Selection Devices and the Quantification of Race
Racial inequality persists despite major advances in formal, legal equality. Scholars and policymakers argue that individual biases (both explicit and implicit) combine with subjective organizational decision-making practices to perpetuate racial inequality. The standardization of decision making offers a potential solution, promising to eliminate the subjectivity that biases consequential decisions. We ask, under what conditions may standardization reduce racial inequality? Drawing on research in science studies and law and society, we argue that standardization must be understood as a heterogeneous practice capable of producing very different outcomes depending on the details of the standard and the organizational infrastructure surrounding its use. We compare selection devices—simple quantified tools for making allocation decisions—in undergraduate admissions and child welfare to highlight the complex relationships between race and standardization. Child welfare agencies adopted a colorblind actuarial device that attempted to predict which children were most at risk and then make decisions based on those predictions. In contrast, the University of Michigan’s points system explicitly considered and valued race, with the goal of increasing minority student enrollments in the context of promoting student body diversity. Comparing these cases demonstrates how actuarial standardization practices, including those adopted with the intention of reducing racial inequality, tend to reinforce an unequal status quo by ideologically reconfiguring mutable social structures into immutable individual risk factors. In contrast, nonactuarial practices that explicitly promote racial equality are vulnerable to political challenges as they violate norms of colorblindness and cannot be defended in terms of their predictive validity.
Innovations in child welfare interventions for caregivers with substance use disorders and their children
Families who enter the Child Welfare System (CWS) as a result of a caregiver’s substance use fare worse at every stage from investigation to removal to reunification (Marsh, Smith, & Bruni, 2011). Intervening with caregivers with Substance Use Disorders (SUDs) and their children poses unique challenges related to the structure and focus of the current CWS. Research demonstrates that caregivers with SUDs are at a greater risk for maladaptive parenting practices, including patterns of insecure attachment and difficulties with attunement and responsiveness (Suchman, Paulo, DeCoste, & Mayes, 2006). Caregivers with SUDs have also often experienced early adversity and trauma. However, traditional addiction services generally offer limited opportunities to focus on parenting or trauma, and traditional parenting programs rarely address the special needs of parents with SUDs. This article details four innovative interventions that integrate trauma-informed addiction treatments with parenting for families involved in the child welfare system. Common mechanisms for change across programs are identified as critical components for intervention. This work suggests the need for a paradigm shift in how cases involving caregivers with substance use disorders are approached in the child welfare system.