Exploring Dimensions of Culturally Sensitive Clinical Styles with Latinos

Abstract

This study sought to identify dimensions of culturally sensitive clinical practice by comparing the personal clinical styles of Latino and non-Latino clinicians, and their clinical decisions in respect to Latino immigrant clients. A combination of qualitative and quantitative methods were used. Sixty Latino American clinicians and 47 non-Latino (White) clinicians in Northern California completed the Achieving Styles Inventory (ASI) which yields information on direct, instrumental and relational styles. Demographic data were obtained as well as information on language proficiency and years of clinical experience. Statistical analysis included uses of t-test, ANOVA, and multiple regression analysis and revealed significant differences between the two groups in personal achieving styles within all three domains. There were no significant differences on the demographic variables. Nine clinician members of each ethnic group were interviewed in-depth through non-directive interviewing styles to assess their clinical decision making via use of a case vignette. Content analysis pointed to similarities and differences in proposed assessment and intervention strategies. The Latino group displayed more culturally relevant interpretations. The non-Latino clinicians were more directive and instrumental than the Latinos who put more emphasis on self disclosure, case management, use of Spanish with the client, and crisis intervention. This finding is consistent with both the quantitative data analysis of ASI hypotheses and the expected linguistic/cultural findings of the qualitative content analysis. Bilingual non-Latino White clinicians showed more cultural sensitivity and competence than the monolingual non-Latino clinicians. These findings suggest that linguistic/cultural match and linguistic/cultural compatibility are important in cross-cultural clinical practice.     

MARRIAGE ROLE EXPECTATIONS OF DIVORCED MEN AND WOMEN

Marriage role expectations of divorced men and women were compared to those of married men and women. Six dimensions of expectations were examined along the continuum of traditionalism versus equalitarianism in sex roles: (I) authority patterns. (2) household tasks, (3) childcare, (4) personal characteristics, (5) social participation, and (6) finances and employment. The data suggest that women, more than men, view marriage role responsibilities as evenly applying to both sexes. Divorce appears to have a liberalizing effect on men's perceptions of marriage roles, but divorced women express a significantly higher level of equalitarianism in their marriage role perceptions than any other comparison group. Differences in expectations regarding authority, finances, and employment appear to be broadened between men and women as a result of divorce.     

Couples' Facilitative Communication Skill as a Dimension of Marital Therapy Outcome*

This study examined the relationships between three dimensions of patients' perceptions of their spouses' empathic understanding, warmth, and genuineness, and marital co-therapy outcome. The relationships between selected therapist and treatment factors and couples' communication skill was also investigated. Results indicated (a) a positive relationship between patient-rated outcome and final levels of rated Total Facilitative Conditions (TFC), but not initial levels; (b) a near-zero relationship between pre- and post-therapy TFC similarity and outcome; (c) positive relationships between changes in perceived TFC and outcome, but no relationship between outcome and symmetry of TFC change; (d) no relationship between treatment length and either outcome or TFC change; and (e) a significant negative relationship between co-therapists' experience level differences and two dimensions of rated TFC change. Discussion of these findings focused on implications for the clinical practice of conjoint couples' therapy.     

Divorced Fathers and Their Daughters: A Review of Recent Research

This study examined single mothers' concerns about the effects of father absence on boys. A two-pan questionnaire covering 11 dimensions of parent role and child development was administered to a group of single and a group of nonsingle mothers. Subjects rated the "importance" of a father and a mother and the effects of a father's absence on a boy. It was found that singles rated a father more important than nonsingles did, but singles also rated a mother more important-this was called the "parenting effect." All subjects rated a father as more important than a mother; the two most significant dimensions, especially for single mothers, were "sex role" and "play activity," substantiating previous research' and observation. The findings were discussed in terms of single mothers' psychosocial conditions, and clinical implications were offered.     

Investment in Innovation: An Historical Appraisal of the Fund for the Advancement of Education,Paul Woodring. Boston: Little,Brown and Company, 1970. 323 Pages, $7.50 Hardbound

Abstract

An exploratory study of the role of “faculty field liaison” was conducted, utilizing a national survey of 88 MSW degree-granting programs. Respondents were program directors of field practicums. Their perceptions were solicited regarding: (1) criteria for selection, (2) liaison expectations, (3) methods of evaluation, and (4) perceptions of the importance of liaison duties compared to other job responsibilities. Many more liaison responsibilities were identified than were heretofore reported in the literature or other documented research. The study confirmed that the role is more complex and diverse than anticipated. The need for some form of uniform understanding and training of liaisons seems evident.     

Stormy weather: testing “stealing thunder” as a crisis communication strategy to improve communication flow between organizations and journalists

An experiment was conducted to examine the effectiveness of a highly proactive approach to crisis communication called “stealing thunder.” Reporters and journalism students were asked to read one of two fictitious crisis scenarios: one in which the organization’s public relations practitioner stole thunder (broke the news about the crisis) by contacting the journalist, and one in which the journalist learned about the crisis from another party. When the organization stole thunder, journalists rated the practitioner as more credible, but also indicated greater interest in the story. No differences were found across the two conditions in terms of perceptions of crisis severity or framing in reporters’ news leads. Implications for crisis communication and the ongoing journalist–practitioner relationship are discussed.     

Perceptions of cross-sex and same-sex nonreciprocal touch: It is better to give than to receive

Observers' perceptions of actors engaged in cross-sex and same-sex nonreciprocal touch vs. no-touch interactions were assessed. Touchers were rated significantly higher than recipients on dimensions of status/dominance, instrumentality/assertiveness, and warmth/expressiveness. Furthermore, touchers were rated higher, and recipients were rated lower, on these dimensions than no-touch controls. Female observers rated actors involved in touch interactions as more attractive than those involved in no-touch interactions, whereas male observers did the reverse. Results suggest that nonreciprocal touch conveys several messages, and appears to benefit the toucher more than the recipient. Implications of these results for evaluations of the nonverbal communication patterns of women and men were discussed.     

How beliefs about substance use differ by socio-demographic characteristics,individual experiences,and neighborhood environments among urban adolescents

In this article, we tested a series of Item Response Theory (IRT) models to examine the individual and neighborhood variation in perceived risk along dimensions of substance use (alcohol, marijuana, and hard drugs) and usage patterns (light/experimental use, moderate use, heavy/regular use). Data were gathered from 2266 adolescents aged 9, 12, and 15 residing in 79 Chicago neighborhoods. Developmental patterns for age and amount of use were observed whereby older respondents rated alcohol and marijuana as less harmful compared to the younger respondents, but rated hard drugs as more harmful. Risk perceptions were found to be more closely tied to one's direct experience with drugs rather than a general constellation of beliefs. Neighborhood variation in risk perceptions was also observed for hard drugs and three patterns of use, controlling for characteristics of individual residents. Neighborhoods did not vary in risk perceptions toward alcohol use. Individual-level factors rather than characteristics of the neighborhoods explained the observed neighborhood variation in perceptions toward marijuana use. These findings illustrate the complex links between individual and contextual factors in the development of beliefs about the health risks associated with substance use.     

The use of node-link mapping in the chemical dependency treatment of adolescents.

The current study examined treatment perceptions of youth adjudicated to an eight-month residential treatment facility. Participants were randomly assigned to standard or mapping-enhanced counseling. They completed established questionnaires assessing group sessions, program features, treatment motivation, and number of program infractions. Mapping residents rated group sessions as deeper over time. Mapped sessions appeared to also maintain residents' arousal over time. Mapping residents rated themselves as more motivated to get along with staff, and also tended to be more motivated to engage in the treatment process. In addition, mapping residents had fewer program infractions thirty days after the beginning of the experiment compared to standard residents. These findings extend previous research on node-link mapping in adult treatment settings.     

Physical,social, and personal factors in the perception of crowding

This study investigated the effects of density, posters, sex of subject, and group composition on anagram solving and also the perception of oneself and the physical and social environment. There were four major findings: (1) The addition of posters to a room in a high density nonsocial situation led to enhanced perceptions of crowding for males but not for females. These results were interpreted in terms of sensory overload. (2) Females rated themselves more positively in high density while males rated themselves more positively in low density. (3) Subjects rated the physical environment more negatively in high density than in low density. (4) There was no density effect on anagram solving.     

Socio-Contextual Influences on the Korean News Media's Interpretation of Samsung's $847.6 Million Donation

This study investigates the role of leadership in facilitating strategic communication management and effective public relations practice by proposing a set of dimensions measuring corporate communication executives’ perceptions on leadership. A measurement methodology was applied and suggested to facilitate empirical investigation. Data from two groups of senior corporate communicators and public relations executives (N = 384) nationwide were used to assess the validity and reliability of proposed leadership dimensions that contribute to effective communication management. Results from both groups demonstrated strong support for the proposed higher-order measurement model. The analysis suggested that 6 major dimensions (self-dynamics, team collaboration, ethical orientation, relationship building, strategic decision making capability, and communication knowledge management capability) are crucial for communication executives to expand their influence in the institutional context and generate desired communication outcomes. The findings offer insights on both leadership and corporate communications that may account for significant nonfinancial indictors of organizational effectiveness.     

Clinicians' Experiences of a Podcast Series on Implementing a Manualized Treatment

The purpose of this qualitative study was to explore clinicians' experiences of using Podcasts to assist with implementing an evidence-based practice (EBP). Twelve clinicians, including eight student interns, at a human service organization were interviewed about their perceptions of using Podcasts about implementing an EBP called Grief and Trauma Intervention (GTI) for Children. Major themes included that the Podcasts were helpful, liked the short length, fit their learning styles, useful teaching tool, wanted more clinical content and more engaging material, and that administrative support was important for use. Technological difficulties were a major barrier to use. There were some differences in experiences of the Podcasts between post-masters professionals and interns. Podcasts may be a useful technology to help clinicians implement EBPs, and future research on Podcast use is warranted.     

Client narratives about experiences with a multicouple treatment program for intimate partner violence

A handful of clinical trials have concluded that conjoint couples treatment for intimate partner violence is safe and at least as effective as conventional batterer intervention programs, yet very few researchers have explored couples' perspectives on conjoint treatment. Using qualitative narrative analysis methodology, the researchers conducted 48 client participant interviews and five staff interviews to better understand couples' experiences of a conjoint treatment program for intimate partner violence. Themes that recurred throughout participants' narratives included (a) perceptions of safety, (b) benefits received, (c) attitudinal change, (d) behavioral change, and (e) important learning. Research directions and training implications are discussed.     

Associations between Students’ Perceptions of the Psychosocial School Environment and Indicators of Subjective Health in Finnish Comprehensive Schools

The study examined how far students’ perceptions of the psychosocial school environment are associated with self‐rated health, life satisfaction and subjective health complaints. Students’ perceptions were associated with one or more indicators of subjective health. Perceived health was better in direct proportion to positive perceptions. Student relations and school strain were the factors that stood out in both genders, with regard to all the health indicators. School engagement, parental support and educational aspiration were found to be important for overall perceived health of the students. This study indicates the importance of the psychosocial school environment for students’ health.     

Stealing thunder: Analysis of the effects of proactive disclosure of crisis information

An organization has several options when releasing information about a crisis. These options include the use of various types of explanations and justifications for the crisis as well as the timing of information release. An experiment investigated a self-disclosure strategy called “stealing thunder.” When an organization steals thunder, it breaks the news about its own crisis before the crisis is discovered by the media or other interested parties. Stealing thunder in a crisis situation, as opposed to allowing the information to be first disclosed by another party, was found to result in higher credibility ratings. A path analysis also linked stealing thunder and previous involvement with the organization and product to perceptions of the crisis as less severe and to higher levels of intent to purchase the product involved in the crisis.     

Marital treatment following early infant death

In recent years, clinicians have become increasingly more aware of the high risk of psychiatric disability when parents are unable to mourn the loss of a stillborn baby or a neonate. The literature discussing the psychodynamic functions of this mourning process and the social as well as intrapsychic defenses against it is examined. A clinical illustration suggests how difficulty in acknowledging the ongoing significance of the infant's death can have major ramifications within both the marital relationship and the treatment context. Countertransference issues are found to be particularly important.     

Early childhood interventionists' perspectives on serving maltreated infants and toddlers

A 2003 amendment to the Child Abuse Prevention and Treatment Act (CAPTA) required states to create developmental screening programs for maltreated infants and toddlers. Programs authorized under Part C of the Individuals with Disabilities Education Act (IDEA) were directed to work with state and local child welfare authorities to develop the screening program. They were also to ensure that additional assessment and intervention was provided when needed. The degree to which this mandate has been implemented varies widely between state and local programs. Some early intervention experts and Part C program administrators have expressed concerns about providers' willingness to serve families referred from child welfare, but there has been no systematic research on this issue. The Professional Interventionist CAPTA Survey (PICS) is a newly developed measure of early childhood intervention providers' perceptions of their responsibilities under CAPTA. The first aim of this study was to conduct analysis of the PICS using a national sample of providers. This study also reports the perceptions of early childhood interventionists about their responsibilities under CAPTA and examines the relationship between worker characteristics and how they perceive these responsibilities. The PICS appears to be useful for examining early childhood intervention providers' responses to CAPTA.     

An Empirical Assessment of the Goals of Family Therapy*

This study is an empirical assessment of the goals of family therapists. A list of goals was developed based on a theoretical clustering of the family therapy literature into the dimensions of communication, cohesion, and adaptability. Three hundred ten clinical members of the American Association for Marriage and Family Therapy (AAMFT) responded to a questionnaire about their use of these goals in family therapy. The findings indicate that the goals employed by this sample seem to reflect ideas from the literature which are not the property of any one “school” of family therapy. The goals that were rated and ranked highest included encouraging family members to relate caringly, responsibly, and creatively in negotiating their differences. Goals that were rated and ranked lowest included the more advanced or technical communication skills and some cohesion goals that may be interpreted as related to institutional aspects of family life.     

Estimating Pain and Disability in Virtual Patients with Low Back Pain: The Contribution of Nonverbal Behaviors

It is well recognized that chronic low back pain (cLBP) can be estimated from nonverbal pain behaviors. However, only a few studies examined how clinicians rely on those when estimating specific outcomes, such as pain intensity and pain disability. Therefore, the present study examines (1) if facial expressions and guarding behaviors (including speed of the movement and lifting strategy) contribute to the prediction of pain intensity and disability in patients with cLBP; and (2) if these pain behaviors have been given the same importance according to the outcome. Twenty-five experienced clinicians and thirty-one novice clinicians were asked to estimate low back pain intensity and disability from a realistic virtual character performing a lifting lowering task. The studied pain behaviors were manipulated across different conditions. Pain intensity and disability were judged higher when the character moved more slowly and displayed painful facial expression. Speed of the movement and facial expressions explained a greater portion of variance when related to pain intensity assessment than to pain disability assessment. Results also showed a significant interaction between the lifting strategy, the speed of the movement and facial expressions, but only when estimating the character’s pain-related intensity. Novice clinicians rated pain disability higher than experienced clinicians did. Although pain-related concepts, pain intensity and related disability are not estimated through the same pain behaviors by clinicians. Clinical experience does not contribute to clinical judgments through the use of nonverbal pain behaviors when estimating pain outcomes but contributes to pain disability rating overall.     

Analysis of perception of training in graduates of the Faculty of Medicine at Universidad de Castilla-Mancha

IntroductionProblem-based learning has been a key component of the teaching method employed at the Faculty of Medicine at the University of Castilla La Mancha (UCLM) in Albacete, Spain since its creation. The aim of this study was to evaluate perceptions of training among residents who graduated from the first three years of the UCLM Degree in Medicine.MethodsUsing the Jefferson Medical College postgraduate rating form, residents rated their performance in four areas of clinical competency (medical knowledge, data gathering skills, clinical judgment, and professional attitudes) at the beginning of residency training in comparison with colleagues from other faculties. The construct validity of responses was evaluated using Cronbach's alpha and exploratory factor analysis.ResultsOver half the respondents (57.8%) considered that they had received better training than peers from other medical schools, and 98.5% felt that their general performance in the four competencies analyzed was similar or superior to that of their colleagues. Factor analysis revealed two major factors: “the physician as scientist” and “the physician as manager and communicator”.ConclusionsOur study shows that graduates from the UCLM Faculty of Medicine perceive their training, which is largely based on problem-based learning, as satisfactory.