Clinical and Ethical Considerations for Delivering Couple and Family Therapy via Telehealth

Studies have generally supported telehealth as a feasible, effective, and safe alternative to in‐office visits. Telehealth may also be of particular benefit to couples/families interested in relational treatments, as it addresses some of the barriers that may be more prominent for families, such as childcare and scheduling difficulties. Therapists interested in expanding their practice to include telehealth should understand ethical and practical considerations of this modality. This article discusses areas unique to the delivery of telehealth to couples and families. Each broad domain is then elaborated upon with case examples from actual clinical practice and specific recommendations for addressing potential difficulties. Authors recommend further empirical research examining differences in modality outcome, as well as feasibility of the suggestions proposed here.     

The Mediating Effect of Resilience Between Social Support for Exercise and Resident Satisfaction in Assisted Living

This study examined whether residents' level of resilience mediated the relationship between social support for exercise from staff and resident satisfaction in assisted living. This was a secondary data analysis using baseline data from a function-focused care intervention study including 171 residents from four assisted living facilities. Using structural equation modeling, we found that mood and social support for exercise from staff were the only variables associated with resilience. Mood, gender, cognition, and social support for exercise from staff directly influenced resident satisfaction and explained 31% of the variance in the model. Implications for future research and practice are discussed.     

Demographic differences in response rates for PHQ9 in a university student population

Objective: To examine differences in complete response rates for depression screening questions based on demographic characteristics. Methods: Cross-sectional study examining associations between demographic characteristics and completely responding depression-screening questions. Participants: “Healthy Minds Study” data, collected in a public University in February 2016, where 7,326 students participated. Results: women (AOR: 0.69; 95% CI =0.57–0.83) and gay/lesbian students (AOR: 0.24; 95% CI =0.10–0.60) had better complete response rates. Non-US (AOR: 1.46; 95% CI =1.03–2.07), black (AOR: 3.32; 95% CI =1.92–5.77), and Middle-Eastern students (AOR: 3.73; 95% CI =1.73–8.02) had lower complete response rates. Conclusions: Our study shows sex, gender, citizenship, and race categories have significant differences in complete response rates for the outcome. Our findings have several implications; including recognizing interventions for depression based on responders may not target those that tend to be “partial-responders”. Efforts in survey design, recruiting and completion of surveys should be maximized.     

Disrupting Sexual Norms: An Application of the Critical Interpersonal and Family Communication (CIFC) Framework in the Context of Vulvodynia

This study uses intersectional methodology to critically explore vulvodynia, chronic female genital pain, as it disrupts norms governing gender roles in heterosexual sex and reproduction. Interviews with 26 women with vulvodynia illuminate core tenets of the critical interpersonal and family communication (CIFC) framework, which include power; private and public sphere bidirectionality; the critique, resistance, and transformation of the status quo; and considerations of author reflexivity. As the author is herself a heterosexual woman navigating vulvodynia, reflexivity is particularly salient. Status quo social constructs are explicated. Results demonstrate how participants experience losses of relational power and problematic media depictions establishing standards for “normal” heterosexual sex. Discourses and practices concerning the perpetuation, resistance, and potential transformation of the status quo are described.     

Dual experiences of teenage parenting and homelessness among Native Hawaiian youth: A critical interpretative phenomenological analysis

Teenage parenting is a challenging venture—particularly when parenting while homeless. The present study explores in‐depth through case‐based analysis the lived experiences of three young homeless and parenting teens (one mother and two fathers). It is the first known study of teenage parenting and homelessness among Native Hawaiian youth, a key affected population. Interpretative phenomenological analysis of participants' individual interviews revealed three themes that characterize the experience of parenting as a teen while homeless: (a) They never raised me up (childhood experiences); (b) becoming mommy and daddy (early experiences of teen pregnancy and parenting while homeless); and (c) finding our place (current experiences of teen parenting and perspectives on teen pregnancy and homelessness). Implications for direct practice, social policy, and future research are discussed in the context of this complex reality.     

Bioecological Implications of Narrative Exposure Therapy in Low‐Resource Settings: Individual,Family, Community,and Socio‐Political Contexts

Traumatic stress can have detrimental effects on individuals, families, and communities. Narrative exposure therapy (NET) is an evidence‐based intervention for decreasing individuals’ post‐traumatic stress disorder (PTSD) symptoms and has been tested in some of the most challenging contexts, such as in post‐conflict refugee camps. Although the focus of NET is on reducing individual PTSD symptoms, the impact of NET can be seen beyond the individual level. The purpose of this paper is to examine some of the ecological implications of using NET with trauma‐affected populations in low‐resource settings. We describe the implications of NET at the family, community, and sociopolitical levels using several case examples. Finally, we outline limitations and future directions for improving the delivery of NET in settings with limited resources.     

Modeling population and subject-specific growth in a latent trait measured by multiple instruments over time using a hierarchical Bayesian framework

Psychometric growth curve modeling techniques are used to describe a person’s latent ability and how that ability changes over time based on a specific measurement instrument. However, the same instrument cannot always be used over a period of time to measure that latent ability. This is often the case when measuring traits longitudinally in children. Reasons may be that over time some measurement tools that were difficult for young children become too easy as they age resulting in floor effects or ceiling effects or both. We propose a Bayesian hierarchical model for such a scenario. Within the Bayesian model we combine information from multiple instruments used at different age ranges and having different scoring schemes to examine growth in latent ability over time. The model includes between-subject variance and within-subject variance and does not require linking item specific difficulty between the measurement tools. The model’s utility is demonstrated on a study of language ability in children from ages one to ten who are hard of hearing where measurement tool specific growth and subject-specific growth are shown in addition to a group level latent growth curve comparing the hard of hearing children to children with normal hearing.KEYWORDS: Bayesian hierarchical models, psychometric modeling, language ability, growth curve modeling, longitudinal analysis     

Maternal mortality: What can we learn from stories of postpartum haemorrhage?

Death from pregnancy is rare in developed countries such as Australia but is still common in third world and developing countries. The investigation of each maternal death yields valuable information and lessons that all health care providers involved with the care of women can learn from. The aim of these investigations is to prevent future maternal morbidity and mortality.Obstetric haemorrhage remains a leading cause of maternal death internationally. It is the most common cause of death in developing countries. In Australia and the United Kingdom, obstetric haemorrhage is ranked as the 4th and 3rd most common cause of direct maternal death respectively. In a number of cases there are readily identifiable factors associated with the care that the women received that may have contributed to their death. It is from these identifiable factors that both midwives and doctors can learn to help prevent similar episodes from occurring.This article will identify some of the lessons that can be learnt from the recent Australian and UK maternal death reports. This paper presents an overview of the process and systems for the reporting of maternal death in Australia. It will then specifically focus on obstetric haemorrhage, with a focus on postpartum haemorrhage, for the 12-year period, 1994–2005. Vignettes from the maternal mortality reports in Australia and the United Kingdom are used to highlight the important lessons for providers of maternity care.