Employers' Perceptions of Occupational Therapy in Community Mental Health

ABSTRACT

This paper explores the nature of occupational therapy practice from the perspective of community mental health agency directors currently employing occupational therapists. Directors were interviewed using a semi-structured format. Retrospective content analysis produced a systematic detailed summary of six major and eight minor themes separating into process themes or how the occupational therapist practised, and content themes, or what the occupational therapist practised. The process themes included a holistic approach, client centredness, and a practical, outcome oriented focus. The content themes included the use of activity, focus on individual functioning, and specific vocational and living skill training. In addition, some directors identified inadequacies including insufficient medical background and the need for education in community practice. Themes were compared against two additional data sources; expert occupational therapists and current literature in occupational therapy in mental health. There was agreement on the major themes. Implications of these results are discussed.     

Stakeholders’ Opinions on the Implementation of Pediatric Whole Exome Sequencing: Implications for Informed Consent

Advances in whole genome and whole exome sequencing (WGS/WES) technologies have led to increased availability in clinical settings. Currently, there are few guidelines relating to the process and content of informed consent for WGS/WES, nor to which results should be returned to families. To address this gap, we conducted focus groups to assess the views of professionals, parents, and adolescents for the future implementation of WES. The discussions assessed understanding of the risks and benefits of WES, preferences for the informed consent discussion, process for return of results, and the decision-making role of the pediatric patient. Professional focus group participants included bioethicists, physicians, laboratory directors, and genetic counselors. Parent focus groups included individuals with children who could be offered sequencing due to a potential genetic cause of the child’s condition. On-line discussion groups were conducted with adolescents aged 13–17 who had a possible genetic disorder. We identified discrepancies between professionals and patient groups regarding the process and content of informed consent, preference for return of results, and the role of the child in decision-making. Professional groups were concerned with the uncertainty regarding professional obligations, changing interpretation in genomic medicine, and practical concerns of returning results over time. Parent and adolescent groups focused on patient choice and personal utility of sequencing results. Each group expressed different views on the role of the child in decision-making and return of results. These discrepancies represent potential barriers to informed consent and a challenge for genetic counselors regarding the involvement of pediatric patients in decision-making and return of results discussions.     

Training Methods for Delivering Difficult News in Genetic Counseling and Genetics Residency Training Programs

Genetic counselors and clinical geneticists are often in the position of delivering difficult news (DDN) to patients and families. Many studies show that healthcare providers require major improvement in the skills needed in DDN in a manner that is satisfactory to their patients. The purpose of this study was to assess the amount and methodology of DDN training received by genetic counselors and medical genetics residents in their training programs, such as observations of DDN or attending didactic lectures. To our knowledge, there is no previous assessment or study of DDN training in genetic counselor and medical genetics residency programs; therefore, we aim to both assess and compare the training in DDN received by genetic counselors and by genetics residents and determine whether there is a desire for recommendations on DDN training. We invited genetic counseling (GC) and genetics residency program directors to participate in an online survey designed to assess coursework, clinical experiences, and directors’ attitudes toward teaching DDN. Response rate was 85% (28/33) for GC program directors and 26% (14/53) for genetics residency program directors. One hundred percent of GC and genetics residency directors who responded to the survey agreed that it is important for genetic counselors and medical geneticists to be able to deliver difficult news effectively and that training programs should formally teach students how to deliver difficult news. Six of the eight common teaching methods are used by at least 75% of GC programs while two of eight are used by at least 75% of genetics residency programs. Seventy-nine percent of GC and 93% of genetics residency program directors agree that there should be recommendations on how to teach students to deliver this news. Our results show that techniques for DDN are integrated more fully into GC program curricula than genetics residency curricula. Directors of both types of programs desire recommendations and more standardized education for training students to deliver difficult news.     

Impairment in risk-sensitive decision-making in older suicide attempters with depression

Suicidal behavior is a potentially lethal complication of late-life depression. In younger adults, suicide has been linked to abnormal decision-making ability. Given that there are substantial age-related decreases in decision-making ability, and that older adults experience environmental stressors that require effective decision-making, we reasoned that impaired decision-making may be particularly relevant to suicidal behavior in the elderly. We thus compared performance on a probabilistic decision-making task that does not involve working memory ("Cambridge Gamble Task") in four groups of older adults: (1) individuals with major depression and a history of suicide attempt (n = 25), (2) individuals with major depression with active suicidal ideation but no suicide attempt (n = 13), (3) individuals with major depression without suicidality (n = 35), and (4) nondepressed control subjects (n = 22). There was a significant effect of group on quality of decision-making, whereby the suicide attempters exhibited poorer ability to choose the likely outcome, compared with the nonsuicidal depressed and nondepressed comparison subjects. There were no group differences in betting behavior. The suicide attempters differed in several aspects of social problem-solving on a self-report scale. Quality of decision-making was negatively correlated with the score on the impulsive/careless problem-solving subscale. These data suggest that older suicide attempters have a deficit in risk-sensitive decision-making, extending observations in younger adults. More specifically, older suicide attempters seem to neglect outcome probability and make poor choices. These impairments may precipitate and perpetuate suicidal crisis in depressed elders. Identification of decision-making impairment in suicidal elders may help with designing effective interventions.     

Women Surviving an Abusive Relationship: Grief and the Process of Change

The authors briefly survey the literature about women in abusive relationships and discuss key issues about the change process that arise from that work and are consistent with the grieving process. The constructs of depression, guilt, and decision-making difficulty among women abused by an intimate partner are examined and compared with the perspective of the normal grieving of a major loss. Implications for counseling practice are considered.     

A systematic approach to planning a careers education course

The nature of careers education is discussed and a design framework proposed in which careers education is witnessed in terms of process. Five major process skills used by students in choosing a career are identified: discovering, selecting, responding, implementing, and assessing/evaluating. These mediate eight major components each characterised by elements accepted in the literature as impinging upon vocational development and career decision-making. An analysis of the aims, general objectives and specific objectives of careers education is undertaken, and suggestions are made for ways in which the process skills might be used to provide a rationale for programme development and improved classroom interaction.     

Value of interviews for admission to clinical training programs: Perspective of program directors

Abstract: The interview has a long history of being used to select individuals for positions in industry, professional occupations, and for a variety of specialised educational programs. Despite its widespread popularity, the selection interview is often criticised for its potential bias and unreliability, which in turn has led to its decreasing use in some settings. The purpose of the present study was to explore the views of the directors of 21 Australian clinical training programs as to the value of interviews as part of the admission process for their clinical psychology postgraduate training candidates. Three programs reported not conducting interviews at all, expressing reservations concerning their validity. Most other directors saw interviews as having at least some value, with the opportunity to evaluate interpersonal skills being one of the most commonly mentioned advantages. A variety of methods was used for the final admission decisions, with substantial variation in acceptance rates by candidates who survived the interview process. Implications for selection processes in the future are discussed.     

驾驶决策的研究现状与展望

驾驶决策是驾驶员对不同交通场景进行判断、选择,并产生驾驶行为的过程。驾驶决策的研究起源于人因工程学,并随着认知心理学的发展而逐渐受到关注。驾驶决策的研究范式主要采用心理测量与实验法;并与年龄、性别、风险感知、情绪以及决策风格相关;为了有效防止交通事故的发生,驾驶决策的改善逐步成为研究的新热点。今后的研究可以从认知与情绪角度综合探讨适合中国国情的驾驶决策的结构与特征,以提高驾驶员的决策能力。     

中国情境下团队伦理决策的过程机制及影响因素

尽管绝大多数商业伦理决策都是由团队而非个人所做出的,但目前对团队伦理决策的研究还很少,尤其缺乏基于理论的深入研究。在前人研究的基础上,借鉴个体伦理决策和团队决策方面的研究成果,结合中国文化强调反省、中庸、威权领导等特点,我们对团队伦理决策的过程机制及影响因素的作用模式展开理论驱动的深入研究。具体来讲,将综合利用多种方法来进行两个方面的4项子研究。在团队伦理决策的过程机制方面,拟开展团队伦理决策的过程机制模型构建研究,然后聚焦于团队伦理决策和个体伦理决策的核心区别,展开基于社会决策图式理论的团队伦理决策观点整合机制研究;在团队伦理决策的影响因素作用模式方面,拟从成员和领导两个方面来进行:基于信息加工和团队冲突的成员多样性对团队伦理决策的影响机制研究,基于信息取样模型的领导特征对团队伦理决策的影响机制研究。     

Learning algorithm for an intelligent decision making system based on multi-agent neurocognitive architectures

The paper presents the formalism of an intelligent decision-making system based on multi-agent neurocognitive architectures, which has an architectural similarity to the human brain. An invariant of the organizational and functional structure of the intellectual decision-making process based on the multi-agent neurocognitive architecture is developed. An algorithm for teaching intelligent decision-making systems based on the self-organization of the invariant of multi-agent neurocognitive architectures is presented. Using this algorithm, an intelligent agent was trained and the architecture of the learning process was built on the basis of an invariant of neurocognitive architecture. Further research is related to training an intelligent agent in more complex behavior and expanding the capabilities of an intelligent decision-making system based on multi-agent neurocognitive architectures.     

从对框架效应的分析看风险决策的神经基础

对风险决策的研究近年来一直是微观经济学和心理学的热门,但是从传统的决策理论到主张有限理性的预期理论大多是对决策行为的研究,决策的心理机制一直是无法解释的黑箱子。令人兴奋的是近几年来神经科学家及其他领域的学者开始用先进的神经心理学的方法来研究风险决策,试图理解神经过程调节风险决策行为的方式。文章从分析违背“不变性”原则的框架效应入手,从正反框架、确定选择和风险选择、风险规避和风险寻求、高估小概率事件几个方面,全面分析风险决策可能的神经基础。在总结已有研究的基础上提出了把风险决策研究扩展到不确定决策,把风险决策中的一次决策研究扩展到多次决策的研究思路     

Behaviorally-based decision-making training for children

A seven-step, behaviorally based, decision-making process was taught to 17 children, age 9–10 years. Each child's decision-making ability was measured before and after training, using two audiotaped stories that described problem situations typically encountered in the school or home. The children were asked to identify the problem, generate alternative solutions, think of positive and negative consequences for each solution, and offer a personal value supporting their decision. As compared to a no-treatment control group, the children receiving the decision-making training obtained significantly greater scores on four of five dependent measures. Implications for teaching decision-making as a self-management skill are offered.     

Success and Gender: Determining the Rate of Advancement for Intercollegiate Athletic Directors

Since the demise of the Association for Intercollegiate Athletics for Women (AIAW), female sport administrators have continued their struggle to reestablish their place as athletic directors. The purpose of this study was to assess the rate of advancement (success ratio) of intercollegiate athletic directors, with a primary focus on gender. Athletic directors from 157 NCAA (National Collegiate Athletics Association) member institutions participated in the study. The preliminary results confirmed the expected findings that hegemonic masculinity was entrenched within intercollegiate athletics. The success ratio of male athletic directors differed from that of female athletic directors, and the difference was significant (p ≤ .05). The success ratio for men was higher than the ratio for women. Further analyses, however, showed that female athletic directors had higher success ratios than their male peers at lower level institutions. Although parity in numbers has not yet been achieved across the NCAA, the glass ceiling at Division I institutions may begin to crack as more women achieve success at the lower level institutions.     

揭秘经济管理中的行为异象：心理账户理论的应用启示

2017年Richard H. Thaler获得诺贝尔经济学奖, 其重要的研究贡献之一是催生并发展了心理账户理论。心理账户理论被广泛用于解释经济管理中的行为异象。文章以消费决策、金融管理决策两大领域的应用研究为外在逻辑, 以心理账户的设立、运算和关闭过程的特点为内在逻辑, 重点探讨了消费决策中的“标签效应”、“预算效应”、“价格幻觉”、“解耦效应”和“效用偏差”; 金融管理决策中的“粘蝇纸效应”、“薪酬感知之谜”、“税收-投资之谜”、“会计信息披露之谜”和“处置效应”十大行为异象。文章进一步提出未来可能的两个研究方向, 一是通过眼动技术和认知神经科学方法揭示心理账户影响行为决策的内在过程及神经机制; 二是将心理账户理论应用于“以小拨大”的行为助推, 助力政府公共管理和企业管理决策。     

The relationship of mathematics self-efficacy expectations to the selection of science-based college majors

The major purpose of the present study was to investigate the relationship of mathematics self-efficacy expectations to the selection of science-based majors in college males and females. Based on results obtained from a pilot sample of college students, an instrument assessing mathematics self-efficacy expectations was developed. The items used in the mathematics self-efficacy scale included everyday math tasks, math problems, and math-based college courses. Subjects, 153 female and 109 male undergraduates, completed the mathematics self-efficacy scale, the Bem Sex Role Inventory, an adapted version of the Fennema-Sherman Mathematics Attitudes Scales, and a questionnaire concerning their college major choices. Results indicated that mathematics self-efficacy expectations were significantly related to the extent to which students selected science-based college majors, thus supporting the postulated role of cognitive mediational factors in educational and career choice behavior. In addition, the math-related self-efficacy expectations of college males were significantly stronger than were those of college females. Implications of the findings for the process of educational and career decision-making are discussed.     

The role of emotion in decision-making: evidence from neurological patients with orbitofrontal damage

Most theories of choice assume that decisions derive from an assessment of the future outcomes of various options and alternatives through some type of cost-benefit analyses. The influence of emotions on decision-making is largely ignored. The studies of decision-making in neurological patients who can no longer process emotional information normally suggest that people make judgments not only by evaluating the consequences and their probability of occurring, but also and even sometimes primarily at a gut or emotional level. Lesions of the ventromedial (which includes the orbitofrontal) sector of the prefrontal cortex interfere with the normal processing of "somatic" or emotional signals, while sparing most basic cognitive functions. Such damage leads to impairments in the decision-making process, which seriously compromise the quality of decisions in daily life. The aim of this paper is to review evidence in support of "The Somatic Marker Hypothesis," which provides a systems-level neuroanatomical and cognitive framework for decision-making and suggests that the process of decision-making depends in many important ways on neural substrates that regulate homeostasis, emotion, and feeling. The implications of this theoretical framework for the normal and abnormal development of the orbitofrontal cortex are also discussed.     

A national survey of hospital directors' views about the importance of various chaplain roles: differences among disciplines and types of hospitals

A national random sample of hospital directors was asked to rate the importance of seven categories of chaplain roles and functions: 246 nursing directors, 267 social services directors, 307 medical directors, and 611 pastoral care directors. All four groups rated end-of-life care, prayer, and emotional support as being between very important and extremely important. Other roles, including consultation, advocacy, community outreach, and religious services and rituals were rated significantly less important. Significant differences were found across disciplines and hospital settings (general, psychiatric, etc.). Medical directors rated most chaplain roles lower than other directors did, and directors in psychiatric hospitals rated all roles, except religious services/rituals, lower than their counterparts in other types of hospitals. The importance that directors accorded to all the chaplain roles examined was also influenced by their own spirituality and religiosity, as well as the religious affiliation of their institution.     

Batterer Program Directors' Views on Substance Abuse and Domestic Violence

This article reports on a national survey of batterer intervention program (BIP) directors (N?=?150). The beliefs of these directors on the relationship of substance abuse and domestic violence is reported and discussed. BIP director's opinions are important because they make programmatic and treatment decisions. Most BIP directors believe that for many of their clients, both men and women, perpetrator and victim, violence and substance abuse is related. Treatment and methodological considerations are discussed.     

Exploring the retirement from sport decision-making process based on the transtheoretical model

ObjectivesThe purpose of this study was to complement and extend the current knowledge of the particular stages of athletes’ career transition process through employing the transtheoretical model (Prochaska & DiClemente, 1984) as a theoretical framework. More specifically, the current study aimed to explore Korean elite tennis players’ career transition process through focusing on their retirement decision-making process, including their cognitive and behavioral changes and internal and external influences for their decisions during the final stages of their sport careers and the retirement decision-making process.DesignWe employed focus groups.MethodsA total of 12 participants took part in one of three focus groups (i.e., four current players, five retired players, and three coaches) that focused on the process of athletes' retirement decision-making. All participants (seven males and five females; Mean age = 31.25, SD = 3.49 years) were either current or former Korean elite-level tennis players. The data were thematically content analyzed.ResultsThe results revealed three themes: (a) readiness for retirement, (b) psychological and emotional responses during the decision-making process, and (c) coping strategies; and showed that athletes’ decision-making at the end of their sports careers is a dynamic process, accompanied by various emotional responses requiring different coping strategies at different stages.ConclusionFindings indicated that the transtheoretical model helped to explain athletes’ decision-making in retiring from sport and suggested to the need to provide different interventions at different stages. Identifying detailed aspects of readiness for retirement and examining the effectiveness of interventions grounded in the transtheoretical model are recommended as future research directions.     

决策信心的认知机制与神经基础

决策信心是指在进行判断或决策时, 个体对其决策最优性或正确性的信心程度。决策信心的单过程理论认为决策与信心评估是并行的同一加工过程; 而决策后理论认为决策和信心评估是串行的两个加工过程。决策信心存在两种典型的偏差效应：过分自信和信心不足。决策信心的神经机制研究指出, 信心评估可能是决策过程中最基本并且普遍存在的一个成分; 对决策信心评估敏感的脑区包括扣带回、背外侧前额叶和顶上小叶等。未来研究应该在决策信心产生的机制、信心与决策如何交互的心理及神经机制等领域展开大量研究。