Family Caregiver Communication in the ICU: Toward a Relational View of Health Literacy

We interviewed 18 family caregivers about their communication experiences in the ICUs at an urban hospital. Analysis of their narratives suggests health literacy is important in family caregiver/healthcare provider communication, especially as complicated illnesses move the caregiver deeper into decision making. Using the domains of Yuen et al.’s conceptual model of caregiver health literacy (2015), we identified three themes within the context of ICU communication: agency, coordinated communication, and caregiver’s evolving role. We saw family caregivers negotiating domains of health literacy as they built upon knowledge of the patient’s needs, their rights as family caregivers, and the hierarchy of the professional staff. We found that these narratives represent co-created, or relational communication, rather than individual health literacy skills. Conceptualized in the transaction of relationship, health literacy is enacted; it is socially constructed and is the scaffolding upon which family caregivers make decisions, care for their loved one, and care for themselves.     

Developing an undue influence screening tool for Adult Protective Services

The study purpose was to develop and pilot an undue influence screening tool for California’s Adult Protective Services (APS) personnel based on the definition of undue influence enacted into California law January 1, 2014. Methods included four focus groups with APS providers (n = 33), piloting the preliminary tool by APS personnel (n = 15), and interviews with four elder abuse experts and two APS administrators. Social service literature—including existing undue influence models—was reviewed, as were existing screening and assessment tools. Using the information from these various sources, the California Undue Influence Screening Tool (CUIST) was developed. It can be applied to APS cases and potentially adapted for use by other professionals and for use in other states. Implementation of the tool into APS practice, policy, procedures, and training of personnel will depend on the initiative of APS management. Future work will need to address the reliability and validity of CUIST.     

The Development of a Reliable Change Index and Cutoff for the Revised Dyadic Adjustment Scale

The Revised Dyadic Adjustment Scale (RDAS; Busby, Crane, Larson, & Christensen, 1995) is a measure of couple relationship adjustment that is often used to differentiate between distressed and non‐distressed couples. While the measure currently allows for a determination of whether group mean scores change significantly across administrations, it lacks the ability to determine whether an individual's change in dyadic adjustment is clinically significant. This study addresses this limitation by establishing a cutoff of 47.31 and reliable change index of 11.58 for the RDAS by pooling data across multiple community and clinical samples. An individual whose score on the RDAS moves across the cutoff changes by 12 or more points can be classified as experiencing clinically significant change.     

What Is Valued in Gay and Lesbian Specific Alcohol and Other Drug Treatment?

Little is known about what gay and lesbian clients value about culturally specific alcohol and other drug treatment programs. This study involves a sample of clinical staff and former clients (N = 40) of four culturally specific alcohol and other drug treatment programs to clarify what is addressed and deemed valuable for the specific needs of gay and lesbian clients. Through the lens of the recovery capital conceptual framework, this qualitative research emphasizes resiliency and the supports necessary for long-term recovery. Results indicate three major themes that make this type of treatment valuable: (1) a separate treatment unit or facility, (2) a safe and supportive therapeutic milieu, and (3) specific tailored treatment approaches. Findings are discussed to include implications for ways to improve services for this all too often understudied population of potentially vulnerable individuals who can benefit from culturally sensitive care.     

Relationships between Economics,Welfare, Social Network Factors,and Net Migration in the United States

By using economics, welfare and social network factors as frames of reference, this study aims to explore the relationship between these three factors and net migration to various US states. Adopting related variables collected from official aggregate data, this study first utilizes Logit Regression analysis to draw out seven variables that best explain net migration to the various states, then employs these variables in LISREL analyses to build a model explaining the factors influencing net migration to the various US states. Concretely, this research obtained the following findings: (1) the seven variables ‐‐ the average rate of net migrants of 2002–2005, Medicaid, federal aid, employment rate, non‐poverty population rate, and SSI subsidy ‐‐ all significantly affected (p < 0.01 or p < 0.05) net migration in 2006; (2) the main influences on net migration for the various states are, from highest to lowest, social network, economic, and welfare factors. More specifically, a better explanation is that, through the social network factor, economic and welfare factors exert an increased influence on the net number of migrants; and (3) as for the influence of social network factors on the number of net migrants, the social network factor for the previous year was found to best explain domestic migration flows, while the social network factor for the previous three‐to‐four years best explained international migration flows.     

Lesbian Identity Management at Various Stages of the Coming Out Process: A Qualitative Study

This qualitative study is designed to explore how women at various stages of lesbian identity development make decisions about managing their identities. Management of identity was studied in terms of how women came out or stayed hidden and how they made decisions both to disclose and to conceal. The Cass (1984) Stage Allocation Measure was used as a means to categorize women at various stages of lesbian identity development. Twenty-five adult women were individually interviewed using a semi-structured interview schedule. A journal was kept by each woman for one month. The major findings indicated that women at different stages of lesbian identity development use both disparate and similar identity-management and decision-making strategies. Underlying and connecting lesbian identity management and development was the need to maintain self-esteem and safety.     

Vicarious traumatization,secondary traumatic stress,and burnout in sexual assault and domestic violence agency staff

This study investigated three occupational hazards of therapy with trauma victims: vicarious trauma and secondary traumatic stress (or "compassion fatigue"), which describe therapists' adverse reactions to clients' traumatic material, and burnout, a stress response experienced in many emotionally demanding "people work" jobs. Among 101 trauma counselors, client exposure workload and being paid as a staff member (vs. volunteer) were related to burnout sub-scales, but not as expected to overall burnout or vicarious trauma, secondary traumatic stress, or general distress. More educated counselors and those seeing more clients reported less vicarious trauma. Younger counselors and those with more trauma counseling experience reported more emotional exhaustion. Findings have implications for training, treatment, and agency support systems.