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  • Publication
    The Impact of the Therapeutic Alliance, Therapist Empathy and Perceived Coercion on Engagement in Outpatient Therapy for Individuals with Serious Mental Health Conditions
    (2020-05-18) Mallonee, Jason R
    Purpose: Individuals with serious mental health conditions disengage from treatment at a higher rate than other populations. Factors associated with treatment engagement for this population in other contexts, or in outpatient therapy for other populations, include the therapeutic alliance, therapist empathy, and perceived coercion. This study tested the hypothesis that a stronger therapeutic alliance, a greater degree of therapist empathy, and a lower degree of coercion will be associated with a higher degree of engagement in outpatient therapy for individuals with SMHC when controlling for other factors found to be associated with engagement. Methods: 131 participants completed an anonymous web-based survey measuring the study’s constructs with established scales. The relationship between variables was tested using hierarchical multiple regression analysis. Results: After separating the therapeutic alliance and therapist empathy in the multivariate analysis due to multicollinearity, both the therapeutic alliance and therapist empathy were found to be significant predictors of change in client engagement. Perceived coercion was not found to be a significant predictor of change in client engagement. It was also found that participant treatment utilization at the time of survey completion was significantly less intensive than their historical treatment utilization, and that participants reflect a range of symptoms and levels of impairment. Conclusions and Implications: The therapeutic alliance and the quality of therapist-client interactions are the most important factors in maintaining engagement in outpatient therapy for individuals with SMHC. Individuals with SMHC are managing their conditions with less intensive and less restrictive treatments, despite a varying range of symptom severity and functional impairment. Additional research is needed to better understand engagement in therapy for individuals with SMHC and to develop more sensitive measures for evaluating these constructs.
  • Publication
    Effectiveness of an Intergenerational Service-Learning Program on Increasing Knowledge on Aging, Creating Attitude Change Regarding Older Adults, and Reducing Ageism
    (2020-12-22) Bartlett, Sara
    Background and Purpose. This study evaluated the efficacy of an intergenerational service-learning program administered to undergraduates to determine if it would increase knowledge about aging, improve attitudes about older adults, and reduce ageism more than a predominately didactic course with limited service activity. An important goal of effective intergenerational service-learning is to generate interest in pursuing social work careers in aging with the underserved older adult population. Methods. The sample consisted of students in an undergraduate Psychology of Aging course. A quasi-experimental design using a convenience sample compared pre-test and post-test scores between an experimental intervention (N=68) and a comparison (N=71) group over the course of two academic quarters. The Facts on Aging Quiz (FAQ) Multiple Choice version, Aging Semantic Differential (ASD), and Fabroni Scale on Ageism (FSA) were administered before and after a service-learning intervention and comparison predominantly didactic course with limited service activity. Participants also answered open-ended experiential questions. Analysis included descriptive statistics, within group equivalence between quarters, and equivalence of intervention and comparison groups using T-tests or Chi-square tests. No significant differences were found between intervention and comparison groups at pre-test other than relationship to grandparents. Hypotheses were tested using multiple regression analyses to determine significant difference in outcome scores between intervention and comparison groups, controlling for relationship to grandparents. Qualitative analysis consisted of thematic analysis. Results. The hypothesis was partially supported. The intervention group had a significantly higher reduction in Net Bias on the FAQ and a significantly lower score than the comparison group on the FSA Antilocution sub-scale. On other outcome measures, the two groups did not significantly differ. Qualitative analysis showed those in the experimental intervention placed more emphasis on intergenerational relationships and expressed more behavioral intentions related to aging. Conclusions and Implications. There was a significant effect for the intervention on the outcome of bias and ageism. Programs that are more relational, in-depth, and longer than didactic courses may be useful for consideration in undergraduate psychology or social work programs in reducing ageism. Such courses may have the potential for increasing interest in careers in the fields of aging and social work.
  • Publication
    Technology as the Third Spouse - The Impact of Smartphones on Newlywed Couples
    (2021-05-15) Mandel, Sarah
    Background Recent research has explored the impact of technology and smartphone use on relationships. This is the first study to address smartphone use in the newlywed stage of marriage. The newlywed time period is the foundational phase of a marital relationship. Technological changes have become part of our culture and smartphone technology has become central to individuals’ lives. The accessibility and size of the smartphone, along with the features it provides, is different from all other devices, thus creating a more intimate and dependent relationship with it. Methods The aim of this study was to expand upon the existing research related to smartphone technology by addressing the gap in the literature on smartphone use during the newlywed time period. This qualitative study explored the experiences of smartphone use in newlywed couples when in each other's presence and how smartphones were part of a newlywed couple’s interaction. Twenty newlywed couples, married between one and four years were interviewed separately, totaling a sample of 40 participants. Data were collected from June 2020 through July 2020 until saturation was met. Results The five themes that were illuminated in this study were, Vehicle, Mindset, Phone Rules, Interface, and Circular Use. The themes were developed based on the appreciation of the common experience of all the participants within their newlywed marriage in relation to their smartphone use (n=40). The results indicated that the smartphone is a neutral reflection of its user and is a vehicle that can be used to either magnify or minimize the value of the couple’s interaction when together. The user’s needs and mindset drive the use of the smartphone. Depending on the spouse’s mindset, the smartphone was used to either enhance bonding or to create a momentary outlet within the relationship. The unexpected finding that a person’s mindset effected their smartphone use informed the reason why individuals used their smartphone object in the moment when with their spouse. Discussion These findings support that when the newlywed couple either employed rules or made quality time a priority by putting the brakes on their smartphone consumption, smartphone use did not have a negative effect on their feelings of attachment to each other. This study suggests the importance of understanding a spouse’s mindset as a motivating factor for smartphone use during shared interactions in order for the couple to better acknowledge each other’s needs and support their developing marital bond. This research has provided information that stresses the importance of helping couples exchange their seeking of connection to their devices in exchange for live and conscious connection to their partner.
  • Publication
    THE RELATIONSHIP OF ADULT ATTACHMENT TO THE WILLINGNESS OF SOLDIERS TO SEEK HELP FOR BEHAVIORAL HEALTH CONCERNS
    (2022-05-16) Barton, Richard A
    Statement of Problem: This study sought to determine the influence of attachment styles and stigma on the willingness of soldiers to seek help for mental health concerns and the degree to which stigma mediates the relationship between attachment style and help-seeking. Methods: This study utilized data gathered from an anonymous survey of U.S. Army soldiers (N=538) used in a mixed-methods Epidemiological Consultation (EPICON). Participants responded to validated items measuring depression, anxiety, post-traumatic stress, and alcohol use. Measures also included stigma, attachment types, and help-seeking. Analysis assessed the mediating effect of stigma on the willingness of insecure attachment styles to seek help across formal and informal helping categories. Results: Attachment avoidant soldiers were found more resistant to the idea of help-seeking than attachment anxious soldiers. Comparisons of insecure attachment styles (anxious and avoidant) found attachment avoidance predicted increases in stigma, corresponding with declines in help-seeking willingness, with the most significant decrease linked to unit peers and leaders. However, while stigma negatively influenced attachment anxious soldiers’ willingness to seek help from both military and civilian sources, it only mediated a decline in attachment avoidant soldiers’ willingness to seek help from military sources, not civilian. Conclusion: Findings align with prior research indicating anxious attachment adult hesitation can delay help-seeking, and under certain conditions, attachment avoidant adults can be open to help-seeking. Results also suggest when promoting help-seeking with service members and veterans, understanding the intersections between adult attachment types, stigma, and help-seeking is essential to effective clinical and community outreach practice.
  • Publication
    COMING HOME: a narrative exploration of parent experiences in the Post 9/11-era veteran community reintegration process
    (2021-07-22) Callahan, Michael J
    COMING HOME: a narrative exploration of parent experiences in the Post 9/11-era veteran community reintegration process Michael Callahan, MSW, LCSW Dissertation Chair: Irene Wong, PhD BACKGROUND: For many Post 9/11-era service members, their home of record and parents will be the first space and persons assisting their transitions to civilian life through a process known as community reintegration (CR). Parents of Post 9/11-era veterans report encountering many challenges in supporting their veteran child during the CR process. This study explored the parenting strategies and coping mechanisms developed by parents of Post-9/11 veterans, the resources they accessed to support that process, and determined characteristics that impact the parent’s experience of CR. METHODS: This study employed a qualitative approach using the processes and procedures of narrative inquiry during data collection, analysis, and interpretation of findings. Twelve semi-structured interviews were conducted via Zoom with individuals who self-identified as parents of a Post 9/11-era veterans. RESULTS: Concepts related to understanding the parent of a veteran identity, the CR process, resource seeking behaviors, and meaningful connections and parent-child relationship seeking emerged from the data. These insights revealed ways in which the CR process can be transformative for established parent/child relationships. Themes uncovered during data analysis included perceptions of parent identity, the concept of home, relationship with adult veteran child, community connection, growth through re-attachment, and significance of service. DISCUSSION: Research findings suggest the need for culturally appropriate and community-grounded psychoeducational support groups for parents of Post 9/11-era veterans to mitigate psychosocial and psychoeducational challenges associated with CR. Interventions related to parent understanding of military culture and veteran resources, culturally appropriate supportive resources, and community building should be considered to address the challenges and opportunities of the CR process. In areas where access to professional treatment is limited, telehealth options should be considered to assist parents.
  • Publication
    EXPLAINING THE LONG-DISTANCE PARENT CAREGIVING BURDEN OF THE UNITED STATES FOREIGN SERVICE AND MILITARY
    (2022-08-05) Holmes, Christine D
    Purpose: To respond to global trends in aging, healthcare, technology and mobile labor markets, this cross-sectional, correlational study examined the burden of long-distance parent caregivers, or adults coordinating parent care remotely, by using a convenience sample of U.S. active-duty military personnel and Foreign Service Officers. Methods: 79 respondents completed an anonymous online survey containing standardized scales. The relationship between variables was tested using multiple regression analysis and One-way Analysis of Variance (ANOVA). Results: Preparedness for caregiving was negatively correlated with subjective and objective caregiving burden in multiple regression analysis. One-way ANOVA revealed a statistically significant difference in subjective burden based on caregiving intensity. There was also a significant difference in objective burden based on the reason the recipient needed care, but post-hoc analysis found no inter-group differences that passed the Bonferroni adjusted cutoff for significance. Multiple regression analysis demonstrated that the gender of the caregiver, availability of a sibling support network and instrumental support were not significantly correlated with burden. Conclusions and Implications: Preparedness for caregiving had the strongest relationship to distance caregiving burden in this study. Findings may inform intervention strategies to limit the strains of caregiving and support other distance caregiver subgroups, such as other U.S. Government employees and other Americans living overseas. Future longitudinal research is needed to understand causality and the relationship between variables in the long-distance caregiving trajectory over time.
  • Publication
    REMEMBERING THOSE WE HAVE LOST; COLLEGE STUDENTS’ USE OF SOCIAL MEDIA AND THE CONTINUING BONDS OF GRIEF
    (2020-12-22) Black, Suzanne R
    This dissertation is an exploratory study of grieving college students and their usage of social media and if this usage creates a continuing bond. In this mixed method study, the researcher explored grieving undergraduate and graduate students ages 18-24 who had experienced a death within the last 24 months, their use of social media and their understanding and creation of continuing bonds. Students received an email and self-selected to answer a survey and two instruments describing how grief and continuing bonds are experienced and how social media influences their ability to cope with loss. The data did not support that college students use social media to create or maintain a continuing bond, however exploratory data indicates that students do find a continuing bond important. In this sample, descriptive analysis indicated that college students do use social media to express and cope with their grieving experience and are often ambivalent about sharing their grief and loss experience over social media. Further research is needed to explore how students use the ever-evolving platforms on social media to express their emotions and thoughts during the grieving process.
  • Publication
    Understanding Medication Adherence Among Individuals with Severe Mental Illness: Relationship to Treatment Approaches
    (2020-12-22) Ben Avraham, Lior
    Purpose: The use of coercion in public mental health programs as a means to promote adherence to psychotropic medication is a subject of significant debate. Programs that rely on coercion, such as involuntary outpatient commitment, are growing, while programs that reject coercion, such as recovery-based services, present an alternative agenda. Yet, scholarship has not examined recovery-oriented services and coercion together, as a way of explaining medication adherence. Thus, study tested the hypothesis that among consumers with SMI, the greater the degree of perceived recovery-oriented practices and the lower the degree of perceived coercive practices, the greater the degree of adherence to medication treatment. Method: Using an online survey, the study was completed by 111 adults who self-reported a primary psychiatric diagnosis of a severe mental illness and received psychiatric medication prescriptions from a community mental health clinic. The survey included measures of perceived autonomy, perceived organizational recovery-oriented services, perceived coercion, and adherence to medication. The research employed an explanatory mixed-methods (quantitative and qualitative) design. Hypothesis was tested using multiple regression and open-ended questions were analyzed using directed content analysis. Results: Autonomy was found to be a significant predictor of adherence to medication, while perceived organizational culture of recovery-oriented practices and perceived coercion were not significant predictors of adherence to psychotropic medications. Qualitative analysis demonstrated that participants viewed autonomous decision-making and person-centered care as effective methods to encourage adherence. Conclusion: Elements of recovery-oriented treatment that increase consumers’ sense of autonomy in decisions about medications will likely enhance their adherence.
  • Publication
    Addressing Barriers to College Completion for BIPOC First Generation Students: Recommendations to Improve Students’ Sense of Belonging and College Persistence Outcomes
    (2021-05-16) Kabalkin, Nicole P
    Abstract Addressing Barriers to College Graduation for BIPOC First-Generation Students; Recommendations to Improve Students’ Sense of Belonging and Persistence Outcomes Dr. Nicole Kabalkin DSW, LCSW Background The topic of college persistence outcomes for first-generation college students (FGCS) of color has garnered increased academic inquiry in recent years. While universities throughout the nation have professed a commitment to equity, often equating college admission to guaranteed social mobility, research indicates that access to university life does not translate to inclusion. Universities and colleges alike cite a history of engaging in concrete efforts to embrace and support BIPOC FGCS. Yet, poor college outcomes for this distinct population, along with student accounts of exclusionary practices on campus, indicate that universities must do more to combat inequality on their campuses in order to promote a sense of belonging for all students. Methods This exploratory study explores the voices of FGCS, channeling their recommendations into institutional changes at the university level. The study aims to develop a strengths-based approach that encourages universities to not only nurture their BIPOC FGCS, but to seek out and include their voices throughout all levels of the institution. The goal of this study is to support FGCS of color, along with administrators, faculty, and the greater university community to reform the exclusionary culture of academia and, in turn, ensure that university life mirrors the lives of all those in attendance, regardless of their racial or socio-economic background. Qualitative interviews in the form of focus groups were conducted with a sample of 50 KIPP NYC, AF NYC, and HVA alumni who are currently between the ages of 18 to 25 and who enrolled in college within a year of high school graduation. Participants represented the variety of schools that this population attends i.e. community colleges, public universities, Ivy League universities and other private institutions. Focus groups of 6-8 participants were held in January of 2021. Groups were recorded, transcribed and the researcher conducted a thematic analysis. Results Student narratives can serve as an important resource for institutions throughout the country who are committed to fostering a culture of equity and belonging for all students. Seven prominent themes surfaced: Sense of Belonging and Community; Effects of Imposter Syndrome and Code Switching; White Saviorism; Tokenism and Emotional Labor of Educating Others; Financial and Familial Stressors; Experiences with Racism and Microaggressions; and Access to Mental Health. Student narratives illuminated the legacy of institutionalized oppression that continues to operate at the highest levels of education. Students recommend a number of changes to university life, including a strengths-based approach to FGCS grounded in resiliency variables rather than risk factors; increased hiring of faculty of color and mental health practitioners of color at counseling centers; a designated center embedded on campus for FGCS of color w/ peer to peer supports; mandatory trainings for faculty and students on equity and inclusion; and increased accountability for both faculty and staff who engage in racist practices.
  • Publication
    Brief Mindfulness Intervention with Women in an Inpatient Substance Use Treatment Setting
    (2020-06-10) Colbert, Kay
    Objective: There is a critical need for effective, economical, and brief interventions for individuals who struggle with substance use disorders in inpatient treatment settings. Mindfulness-based interventions have facilitated increases in days of sobriety, decreases in number and intensity of cravings to use substances, decreases in stress, and decreases in adverse consequences related to substance use; however, there is limited research to guide such interventions in inpatient treatment settings. This pilot study explores the feasibility, acceptability, and potential benefits of teaching brief mindfulness-based practices as an ancillary treatment with a diverse population of women at an inpatient substance use treatment center. Methods: A sample of sixty-one participants (N=61) were randomized to two conditions. Thirty participants were taught mindfulness approaches to cope with stressors of early sobriety in addition to treatment as usual and thirty-one participants were assigned to a benign control condition in addition to treatment as usual. Ten self-report instruments were administered to measure addiction severity, use of substances, trait mindfulness characteristics, psychological distress, stress, adverse consequences of substance use, posttraumatic stress disorder (PTSD), disability, quality of life, acceptability of the intervention, and other support services received. The instruments were administered at baseline, end of the intervention, and at four weeks post-discharge. Analyses were conducted for all demographic variables, equivalency of groups, effects of the novel delivery of mindfulness training, and mean differences between treatment and control groups on post-test and follow-up levels of mindfulness. Results: Descriptive data analysis indicated the intervention had a high degree of acceptability among participants. Statistically significant differences in mindfulness traits, frequency or severity of substance use cravings, psychological distress, PTSD, and quality of life were not found; however, post hoc analyses indicated that treatment effects varied in relation to PTSD symptoms. Conclusion and Implications: Discussion of strengths, challenges, and lessons learned in this research is provided. Future research that further examines the effectiveness of brief inpatient mindfulness training is needed.