Financial Instability in the Earned Income Tax Credit Program: Can Advanced Periodic Payments Ameliorate Systemic Stressors?
The Earned Income Tax Credit (EITC) serves more than 26 million U.S. tax filers every year. The EITC is distributed annually at tax time; however, past research suggests that lump-sum disbursements leave households with a lack of funds to deal with financial emergencies throughout the year. Drawing upon the data from a pilot program conducted in 2014–2015 in Chicago, this study analyzes how advanced periodic payments help mitigate financial instability for EITC recipients. Interview participants relate that advanced periodic payments result in a reduction in perceived stress, lower levels of debt, fewer unpaid bills, and the ability to engage youth in extracurricular activities. The findings provide a unique perspective on the ways in which low-income households cope with financial instability and stress and suggest that payment frequency options can play a small but important role in the way in which the EITC operates as a support mechanism.
Institutional capacity to provide psychosocial care in cancer programs: Addressing barriers to delivering quality cancer care
This study investigates barriers and promoters to delivering quality psychosocial services in 58 cancer programs across North America. Oncology care providers (n = 2008) participated in a survey in which they identified barriers and promoters for delivering psychosocial care at their respective institutions. Multilevel modeling was used to examine (a) the extent to which provider and institutional characteristics were associated with the most common barriers, and (b) associations between perceived barriers and institutional capacity to deliver psychosocial services as measured by the Cancer Psychosocial Care Matrix. Across 58 Commission on Cancer‐accredited programs in North America, the most frequently reported barriers were inadequate number of psychosocial care personnel, lack of funding, inadequate amount of time, lack of systematic procedures, and inadequate training for oncology providers. Overall, there were few significant differences in reported barriers by type of institution or type of provider. In general, the most frequently reported barriers were significantly associated with the institution’s capacity to deliver quality psychosocial care. In particular, the lack of a systematic process for psychosocial care delivery significantly predicted lower levels of institutional capacity to deliver quality psychosocial care. When identifying barriers, respondents reported a greater number of institutional barriers than barriers related to individual provider or patient characteristics. These results present a compelling case for cancer programs to implement and monitor systematic procedures for psychosocial care and to integrate these procedures in routine clinical practice.
Dignity at the end of life
Debt, Incarceration, and Re-entry: a Scoping Review
People involved with the criminal justice system in the United States are disproportionately low-income and indebted. The experience of incarceration intensifies financial hardship, including through worsening debt. Little is known about how people who are incarcerated and their families are impacted by debt and how it affects their reentry experience. We conducted a scoping review to identify what is known about the debt burden on those who have been incarcerated and their families and how this impacts their lives. We searched 14 data bases from 1990 to 2019 for all original research addressing financial debt held by those incarcerated in the United States, and screened articles for relevance and extracted data from pertinent studies. These 31 studies selected for inclusion showed that this population is heavily burdened by debt that was accumulated in three general categories: debt directly from criminal justice involvement such as LFOs, preexisting debt that compounded during incarceration, and debts accrued during reentry for everyday survival. Debt was generally shown to have a negative effect on financial well-being, reentry, family structure, and mental health. Debts from LFOs and child support is very common among the justice-involved population and are largely unpayable. Other forms of debt likely to burden this population remain largely understudied. Extensive reform is necessary to lessen the burden of debt on the criminal justice population in order to improve reentry outcomes and quality of life.
Can Precision Medicine Actually Help People Like Me? African American and Hispanic Perspectives on the Benefits and Barriers of Precision Medicine
To better understand African American and Hispanic perspectives on the potential benefits of precision medicine, along with the potential barriers that may prevent precision medicine from being equally beneficial to all. We also sought to identify if there were differences between African American and Hispanic perspectives. Six semi-structured focus groups were conducted between May 2017 and February 2018 to identify benefits and barriers to precision medicine. Three groups occurred in Nashville, TN with African American participants and three groups occurred in Miami, FL with Hispanic participants. At community-based and university sites convenient to community partners and participants. A total of 55 individuals participated (27 in Nashville, 28 in Miami). The majority of participants were women (76.5%) and the mean age of participants was 56.2 years old. Both African Americans and Hispanics believed precision medicine has the potential to improve medicine and health outcomes by individualizing care and decreasing medical uncertainty. However, both groups were concerned that inadequacies in health care institutions and socioeconomic barriers would prevent their communities from receiving the full benefits of precision medicine. African Americans were also concerned that the genetic and non-genetic personal information revealed through precision medicine would make African Americans further vulnerable to provider racism and discrimination in and outside of health care. While these groups believed precision medicine might yield benefits for health outcomes, they are also skeptical about whether African Americans and Hispanics would actually benefit from precision medicine given current structural limitations and disparities in health care access and quality.
The role of elementary school and home quality in supporting sustained effects of pre-K
Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (NICHD SECCYD), we used 2-level random effects models to examine whether the quality of school and home environments during elementary school moderated associations between pre-K quality and math, reading, and vocabulary achievement from first through fifth grade. Results showed that the quality of the home environment moderated the association between pre-K quality and children’s vocabulary achievement. Supportive home environments during elementary school had an additive effect over and above the positive effects of pre-K quality in predicting children’s vocabulary achievement. In contrast, when children experienced high levels of pre-K quality and lower quality home learning environments, the positive effects of pre-K were less likely to be sustained. Findings suggest the importance of considering programs and policies to support home-based learning as one potential mechanism to sustain early effects of pre-K.
Cognitive behavioral intervention for trauma in adolescent girls in child welfare: A randomized controlled trial
Objective This study tested the effectiveness of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in adolescent girls involved in the child welfare system. Three outcomes were evaluated: symptoms of posttraumatic stress disorder (PTSD), depression, and social problem-solving skills. Method A randomized controlled trial was utilized to compare the effects of an adapted version of CBITS with usual care (UC) services. Participants were ages 12 to 19 (N = 249), the majority of whom (69.5%) were African American. Participants’ symptoms of PTSD, depression, and social problem-solving skills were evaluated at pre, post (3 months), and follow-up (6 months) assessments. Linear mixed models were used to compare condition by time interactions using all available data. Control variables were demographics, service use, and number of types of traumas. Treatment fidelity, participant acceptability, and satisfaction with the intervention were also examined. Results Analyses indicated that participants in the CBITS condition showed significantly greater increases in social problem-solving than the UC condition. For both PTSD and depression symptoms, there were no significant differences between the two conditions. Both the CBITS and UC participants showed significant reductions in symptoms. Results also indicated that this intervention is an acceptable model for this population. Conclusions Despite the growth of trauma-focused, evidence-supported interventions for reducing PTSD and depression, knowledge of effective interventions in child welfare youth lags behind. Because CBITS is more effective than UC in increasing social problem-solving skills, this intervention may be an important treatment option for this population.
Characterizing the predictive validity of measures of susceptibility to future use of combustible, vaporized and edible cannabis products in adolescent never-users
Background and aims: The construct of susceptibility to substance use initiation (i.e. cognitive proclivity to future use) is critical for prevention efforts in adolescent populations. This study aimed to provide empirical evidence for the validity of the susceptibility construct for different cannabis products (i.e. combustible, edible or vaporized cannabis), and evaluate whether susceptibility measures are predictive of subsequent initiation. Design: Prospective cohort study including baseline data (Spring 2015) and four follow-up surveys administered every 6 months through Spring 2017. Setting: Ten schools in the Los Angeles, California metropolitan area. Participants: Adolescents [n = 2100; mean age = 16.1; standard deviation (SD) = 0.41; 54% female] who reported never having used any cannabis product at baseline.Measurements: We assessed five indices of a susceptibility to use cannabis composite index at baseline, adapted from a validated tobacco use index (intention to use, willingness, curiosity and positive/negative cannabis use outcome expectancies, with four response categories, definitely not  to definitely yes ), by cannabis product (combustible, edible or vaporized). A composite index was created for each product by averaging responses across the five susceptibility items. Subsequent initiation of use of each cannabis product was assessed at each follow-up wave. Findings: Factorial validity for unidimensionality for each five-item index (by product) was confirmed. The composite index for susceptibility to cannabis use was greatest for combustible (mean = 1.44; SD = 0.58), moderate for edible (mean = 1.37; SD = 0.53) and lowest for vaporized cannabis (mean = 1.30; SD = 0.44). The associations of each composite susceptibility index with subsequent initiation of that product and each of the other cannabis products over follow-up (i.e. cross-product associations) were statistically significant, with hazard ratios ranging from 2.30 to 2.80 across 24 months of follow-up (all Ps < 0.05). Conclusions: A five-item susceptibility to cannabis use composite index (by product) appears to be useful for characterizing and predicting youth at risk for cannabis use initiation across a spectrum of cannabis products.
Collective Threat: Conceptualizing Blumer’s Threat as a Collective Emotion
This manuscript lays the groundwork for considering racial threat as a collective emotion. Although sociologists regularly study racial threat, a disconnect exists between Blumer’s theoretical framework (1958) and modern empirical measurement. Research has largely measured racial threat as perceptions of competition or increases in racism. Neither, however, squarely fits the symbolic interactionist framework that Blumer championed. This manuscript frames racial threat as an affective group response that is generated through sustained interaction with social groups and group representations. After showing how Blumer’s threat conceptualization fits the parameters of a collective emotion, I demonstrate how quantitative measurement and experimental research design can be used to capture threat as Blumer outlines it. Then, using factor analyses and regression, I illustrate that collective threat is distinct from other collective emotions and operates according to Blumer’s theoretical predictions. The manuscript concludes with a discussion of how ongoing attempts to measure collective threat and the evolution of racism in the United States highlight the continued relevance of Blumer’s work.
Putting Quality Metrics in Context: A Novel Index Approach to Measuring Inpatient Utilization
To determine the preliminary feasibility and reliability of a novel health plan‐level quality index reflecting multiple aspects of inpatient utilization currently measured by separate quality metrics. Analysis of three Healthcare Effectiveness Data and Information Set (HEDIS) measures: Acute Hospital Utilization (AHU), Hospitalizations for Potentially Preventable Conditions (HPC), and Plan All‐Cause Readmissions (PCR). Proportion of plans able to report these measures were examined within and between measurement years. Individual measure performance was scored on the observed‐to‐expected (O/E) ratio: O/E = 1 “as expected” (score of 0), O/E < 1 “better than expected” (score of +1), and O/E > 1 “worse than expected” (score of ‐1). Measure scores were summed to create an index (‐3 to +3). Performance variation was examined. Index unidimensionality and reliability were evaluated using coefficient omega (total and hierarchical) and explained common variance (ECV). Medicare Advantage (MA) plans reporting HEDIS in measurement years (MY) 2017 (505 plans) and 2018 (525 plans). To align reporting strata across the three metrics, analysis was restricted to beneficiaries age 65 and older. A majority of plans were able to report measures in both MY2017 and MY2018 (AHU: 67.0%, HPC: 65.7%, PCR: 60.7%). In MY2018, 71.4% of plans reported all three measures. The strongest correlation in O/E ratios was observed between AHU and HPC (Pearson: 0.29, Spearman: 0.64), the weakest between AHU and PCR (Pearson: 0.19, Spearman: 0.17). A moderate correlation was observed between PCR and HPC (Pearson: 0.31, Spearman: 0.36). “Better than expected” (+1) was the most common measure‐level score on AHU (48.0%) and HPC (51.4%). “As expected” (0) was the most common score (58.5%) on PCR. The most common index score was +2 (25.1%), and mean score was 0.3. HPC performance scores were most likely to contribute to an increased index score (52.4% of cases), and AHU performance was most likely to contribute to a decreased index score (42.1% of cases). PCR performance was as likely to increase (20.5%) as decrease (21.1%) the index score. When the original O/E ratio for each measure was retained, moderate‐to‐good reliability was observed. Omega hierarchical approached the minimum 0.50 threshold (0.49), and ECV met the 0.85 threshold for unidimensionality. Omega hierarchical decreased significantly (0.33), and ECV no longer achieved the 0.85 threshold when the composite was scored as an ordinal index (‐3 to +3). A composite inpatient utilization index is feasible and demonstrates meaningful variation. Index‐style scoring is useful for visualization and identification of trends; however, composite reliability is achieved only when original O/E ratios are maintained. Alternative scoring approaches should be examined. Inpatient utilization is a primary driver of health care costs and critical target for quality improvement. Current health plan accountability metrics focus on different components of utilization separately and may miss the relationships between them. Interventions to improve one metric may overlap into another, while over‐focusing on one aspect in isolation may lead to perverse incentives (eg, keeping total hospitalizations high to make readmission rates appear low). The proposed composite approach provides a more complete representation of inpatient care, improving transparency and accountability.
The Influence of Implicit Theories of Depression on Treatment-Relevant Attitudes
Implicit theories (beliefs about the malleability of self-relevant traits) of emotion are associated with various motivational and emotional responses. Less is known about implicit theories of depression. The present study examined the effects of a manipulation of implicit theories of depression on depression symptom severity, engagement in a self-help task, and treatment-relevant attitudes. Participants experiencing clinically significant levels of depression (N = 142) were randomly assigned to receive education about depression emphasizing either the malleability of depression (incremental condition) or depression as a chronic condition (entity condition). Participants subsequently completed a self-help task for depression. Symptom severity, stigma, prognostic pessimism, psychotherapy and antidepressant credibility, psychological flexibility, and time spent on the self-help task were assessed. Participants in the incremental condition endorsed a greater incremental theory of depression than did those in the entity condition. To the extent that the experimental condition was associated with the adoption of an incremental theory of depression, depression symptom severity and stigma decreased, and treatment-relevant attitudes were more favorable. The experimental condition had no effect on self-help task persistence. Presenting depression as malleable may be associated with more positive attitudes towards treatment, although the impact on actual treatment engagement warrants future investigation.
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.
Utilizing Crisis Intervention Teams in Prison to Improve Officer Knowledge, Stigmatizing Attitudes, and Perception of Response Options
People with mental illness (MI) are overrepresented in prisons, in part, because people with MI stay in prison longer. Correctional officers (COs) use discretion in force, violations, and segregation. Crisis intervention teams (CITs) are being used in corrections to reduce disparities in sanctioning and improve safety. This quasi-experimental, mixed-methods study includes 235 CIT COs who were surveyed before and after training on knowledge of MI, stigmatizing attitudes, and perception of response options. Non-CIT (n = 599) officers completed the same survey. Randomly selected CIT COs completed interviews 6 to 9 months following training (n = 17). CIT COs had significantly lower stigmatizing attitudes, more mental health knowledge, and better perceptions of options following CIT training compared with non-CIT COs. This preliminary work on CIT use in prison is promising; additional work is needed to determine whether these changes result in behavior change among COs and improvements in outcomes for people with MI.
Intimate partner violence victimization among college students with disabilities: Prevalence, help-seeking, and the relationship between adverse childhood experiences and intimate partner violence victimization
Intimate partner violence (IPV) is a major public health issue. Almost one third of college students in the U.S. experience IPV victimization. However, existing studies have focused primarily on college students without disabilities with little to no attention to college students with disabilities. In addition, few studies have explored the patterns of help-seeking and the relationship between adverse childhood experiences (ACEs) and IPV victimization among college students with disabilities. This study aimed to explore the prevalence of IPV victimization, ACEs, and help-seeking, the patterns of survivors’ help-seeking behaviors, and the relationship between ACEs and IPV victimization. Data from a cross-sectional online survey, which was conducted with samples from six universities in the U.S. and Canada (N = 3,308) between March 2016 and June 2017, were used. Descriptive bivariate and multivariate regression analyses were performed. The results show clear evidence that compared to college students without disabilities, college students with disabilities experienced higher rates of IPV victimization and ACEs. In addition, 42% of the survivors with disabilities sought some sort of support and they sought more formal support than their counterparts without disabilities. Furthermore, the associations between ACEs and IPV victimization among college students with disabilities were substantial after controlling for other risk factors. Specific, targeted university policies and programs as well as increased investment in programs that prevent ACEs are urgently needed to reduce violence against college students with disabilities.
Youth involvement in food preparation practices at home: A multi-method exploration of Latinx youth experiences and perspectives
Youth are frequently involved in preparing meals for themselves and family members. Latinx youth may be more likely to be involved in food preparation compared to youth from other ethnic backgrounds. Involvement in food preparation has been linked to various positive health outcomes, such as better diet quality and higher self-esteem. However, little is known about how youth come to be involved in food preparation at home. In addition, previous research has failed to explore the perspectives of youth regarding their role in food preparation. The objective of the present study was to qualitatively explore the food preparation practices of youth from im/migrant Latinx families. A multi-method study consisting of participatory focus groups embedded within an ethnographic fieldwork period was conducted. Participatory focus groups with Latinx youth featured inclusive discussions and participatory techniques, such as draw-write-tell activities, photo-elicitation activities, a decision-making chart activity, and listing activities. Twenty-three youths ages 9–17 years participated in this study. A thematic analysis uncovered themes related to gender norm expectations, specific cooking skills bound by age and food type, and food preparation as an important household contribution. Findings illustrate the diverse experiences of Latinx youth in food preparation. The investigation of youth involvement in food preparation in the home environment may identify potential targets for obesity prevention and dietary health promotion.
Enhancing vocational training in corrections: A type 1 hybrid randomized controlled trial protocol for evaluating virtual reality job interview training among returning citizens preparing for community re-entry
The Michigan Department of Corrections operates the Vocational Villages, which are skilled trades training programs set within prisons that include an immersive educational community using virtual reality, robotics, and other technologies to develop employable trades. An enhancement to the Vocational Villages could be an evidence-based job interview training component. Recently, we conducted a series of randomized controlled trials funded by the National Institute of Mental Health to evaluate the efficacy of virtual reality job interview training (VR-JIT). The results suggested that the use of VR-JIT was associated with improved job interview skills and a greater likelihood of receiving job offers within 6 months. The primary goal of this study is to report on the protocol we developed to evaluate the effectiveness of VR-JIT at improving interview skills, increasing job offers, and reducing recidivism when delivered within two Vocational Villages via a randomized controlled trial and process evaluation. Our aims are to: (1) evaluate whether services-as-usual in combination with VR-JIT, compared to services-as-usual alone, enhances employment outcomes and reduces recidivism among returning citizens enrolled in the Vocational Villages; (2) evaluate mechanisms of employment outcomes and explore mechanisms of recidivism; and (3) conduct a multilevel, mixed-method process evaluation of VR-JIT implementation to assess the adoptability, acceptability, scalability, feasibility, and implementation costs of VR-JIT.
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.
“Let Me Be Bill-free”: Consumer Debt in the Shadow of Incarceration
Low-income U.S. households are increasingly burdened by unaffordable debt, with profound long-term economic and health consequences. Households of color are disproportionately negatively affected. This article examines the nexus of this rising indebtedness and mass incarceration through the experiences of a particularly marginalized group, people with mental illness. Drawing on qualitative research with 31 individuals with mental illness and recent incarceration in the city of New Haven, Connecticut, we show how carceral institutions and predatory financial practices intersect to create complex entanglements for poor and vulnerable people. While a growing body of scholarship focuses on criminal justice fines and fees, we highlight other types of debt that add to the overall burden, describing how incarceration deepens people’s existing debts of poverty and adds new debts from in-prison costs and identity theft. After release, those debts complicate the search for housing, employment, and financial stability, leading to further debt, stressing social relationships and reproducing social and economic inequality. The experiences of people with mental illness illuminates structures of marginalization and disadvantage that affect many others involved with the criminal justice system.
The measurement of interpersonal interactions with continuous spatiotemporal data: Application to a study of the effects of resource competition on racial group interactions
We describe a sequential qualitative ➔ quantitative mixed-method procedure used to construct conceptually grounded quantitative metrics of interpersonal behavior from continuous spatiotemporal data. Metrics were developed from data collected during an experiment in which racially diverse participants interacted with self-resembling avatars at social events hosted in the virtual world Second Life. In the qualitative stage, the researchers conceptualized four distinct patterns of movement from overhead video recreations of participants interacting during the social events. In the quantitative stage, these patterns of movement were operationalized into metrics to reflect each type of observed interpersonal behavior. The metrics were normalized through a series of transformations, and construct validity was assessed through correlations with self-report measures of intergroup behavior. Finally, the metrics were applied to an analysis of the virtual-world study examining the influence of resource competition on racial group interactions. The findings contribute to our understanding of the influence of resource competition on Blacks’, Asians’, and Whites’ group dynamics. Applications of these metrics for the future of the psychological study of interpersonal behavior are discussed.
Sleep coach intervention for teens with type 1 diabetes: Randomized pilot study
Teens with type 1 diabetes (T1D) experience increased sleep disturbances, which have been linked to problems with adherence and glycemic control. As such, sleep represents a novel target to improve outcomes in teens. To evaluate the feasibility, acceptability, and preliminary efficacy of a sleep-promoting intervention in teens with T1D. Teens aged 13 to 17 with T1D (n = 39) completed measures of sleep quality and diabetes management and wore actigraphs to obtain an objective measure of sleep. Hemoglobin A1C (HbA1c) was collected from medical records. Teens were randomized to Usual Care (n = 19) or the Sleep Coach intervention (n = 20). Teens in the Sleep Coach group received educational materials on healthy sleep habits and completed three individual telephone sessions. Follow-up data were collected at 3 months, including exit interviews with teens and parents. Feasibility of the study was excellent; 80% of teens in the Sleep Coach group completed all three sessions, and retention was high (90%). Based on actigraphy data, a significant improvement in sleep efficiency and sleep duration was observed (48-minute increase) among teens randomized to the Sleep Coach intervention, and teens in the control group were 7.5 times more likely to report poor sleep quality after 3 months than intervention participants. No change in HbA1c was observed. The Sleep Coach intervention for teens with T1D is a feasible and acceptable program that increased sleep duration and improved sleep quality for this high-risk population.