Foreign‐Born Therapists: How Acculturation and Supervisors' Multicultural Competence Are Associated With Clinical Self‐Efficacy

The authors examined the associations between acculturation, supervisors' multicultural competence, and clinicians' self‐efficacy in a sample of 153 immigrant therapists currently practicing in the United States. Participants completed a demographic questionnaire and 3 additional questionnaires that examined their levels of acculturation, perceived supervisors' multicultural competence, and clinical self‐efficacy. Results suggested that perceived prejudice, not level of acculturation, was significantly associated with foreign‐born therapists' clinical self‐efficacy. Perceived supervisors' multicultural competence was significantly associated with therapists' clinical self‐efficacy. Recommendations for supervisors working with foreign‐born therapists are provided. Los autores examinaron las asociaciones entre aculturación, competencia multicultural de los supervisores y autoeficacia de los profesionales clínicos en una muestra de 153 terapeutas inmigrantes actualmente en activo en los Estados Unidos. Los participantes completaron un cuestionario demográfico y tres cuestionarios adicionales que examinaron sus niveles de aculturación, la competencia multicultural percibida de sus supervisores y la autoeficacia clínica. Los resultados sugieren que los prejuicios percibidos, no el nivel de aculturación, están asociados de forma significativa con la autoeficacia clínica de los terapeutas nacidos en el extranjero. La competencia multicultural percibida de sus supervisores está asociada significativamente con la autoeficacia clínica de los terapeutas. Se proporcionan recomendaciones para supervisores que trabajan con terapeutas nacidos en el extranjero.     

Clarifying Heterogeneity of Daytime and Nighttime Symptoms of Posttraumatic Stress in Combat Veterans With Insomnia

Daytime and nighttime symptoms of posttraumatic stress disorder (PTSD) are common among combat veterans and military service members. However, there is a great deal of heterogeneity in how symptoms are expressed. Clarifying the heterogeneity of daytime and nighttime PTSD symptoms through exploratory clustering may generate hypotheses regarding ways to optimally match evidence-based treatments to PTSD symptom profiles. We used mixture modeling to reveal clusters based on 6 daytime and nighttime symptoms of 154 combat veterans with insomnia and varying levels of PTSD symptoms. Three clusters with increasing symptom severity were identified (n1 = 50, n2 = 70, n3 = 34). These results suggest that, among veterans with insomnia, PTSD symptoms tend to exist on a continuum of severity, rather than as a categorical PTSD diagnosis. Hypotheses regarding possible targeted treatment strategies for veterans within each identified cluster, as well as ways to generalize these methods to other groups within the military, are discussed.     

The School Assessment for Environmental Typology (SAfETy): An Observational Measure of the School Environment

School safety is of great concern for prevention researchers, school officials, parents, and students, yet there are a dearth of assessments that have operationalized school safety from an organizational framework using objective tools and measures. Such a tool would be important for deriving unbiased assessments of the school environment, which in turn could be used as an evaluative tool for school violence prevention efforts. The current paper presents a framework for conceptualizing school safety consistent with Crime Prevention through Environmental Design (CPTED) model and social disorganization theory, both of which highlight the importance of context as a driver for adolescents’ risk for involvement in substance use and violence. This paper describes the development of a novel observational measure, called the School Assessment for Environmental Typology (SAfETy), which applies CPTED and social disorganizational frameworks to schools to measure eight indicators of school physical and social environment (i.e., disorder, trash, graffiti/vandalism, appearance, illumination, surveillance, ownership, and positive behavioral expectations). Drawing upon data from 58 high schools, we provide preliminary data regarding the validity and reliability of the SAfETy and describe patterns of the school safety indicators. Findings demonstrate the reliability and validity of the SAfETy and are discussed with regard to the prevention of violence in schools.     

The Racial School Climate Gap: Within-School Disparities in Students’ Experiences of Safety,Support, and Connectedness

This study used student and teacher survey data from over 400 middle schools in California to examine within‐school racial disparities in students’ experiences of school climate. It further examined the relationship between a school’s racial climate gaps and achievement gaps and other school structures and norms that may help explain why some schools have larger or smaller racial disparities in student reports of climate than others. Multilevel regression results problematized the concept of a “school climate” by showing that, in an average middle school, Black and Hispanic students have less favorable experiences of safety, connectedness, relationships with adults, and opportunities for participation compared to White students. The results also show that certain racial school climate gaps vary in magnitude across middle schools, and in middle schools where these gaps are larger, the racial achievement gap is also larger. Finally, the socioeconomic status of students, student–teacher ratio, and geographic location help explain some cross‐school variation in racial climate gaps. These findings have implications for how school climate in conceptualized, measured, and improved.     

The Genetic Counselor in the Pediatric Arrhythmia Clinic: Review and Assessment of Services

There are minimal data on the impact of genetic counselors in subspecialty clinics, including the pediatric arrhythmia clinic. This study aimed to describe the clinical encounters of a genetic counselor integrated into a pediatric arrhythmia clinic. In the 20 months between July 2015 and February 2017, a total of 1914 scheduled patients were screened for indications relevant for assessment by a genetic counselor. Of these, the genetic counselor completed 276 patient encounters, seeing 14.4% of all patients in clinic. The most expected and common indications for genetic counselor involvement were related to suspicion for primary heritable arrhythmia conditions, though patients seen in this clinic display a wide range of cardiac problems and many additional indications for genetic evaluation were identified. Roughly 75% (211/276) of encounters were for personal history of confirmed/suspected heritable disease, including cardiac channelopathies, cardiomyopathies, ventricular arrhythmias, and congenital heart defects, and 25% (65/276) were for family history of disease, including long QT syndrome and sudden unexplained death. Overall, this study shows that about 1 in 7 patients seen in a pediatric arrhythmia clinic have indications that likely benefit from genetic counselor involvement and care. Similar service delivery models embedding genetic counselors in pediatric arrhythmia clinics should be encouraged, and this model could be emulated to increase patient access to genetic counseling services.     

SBNR Identity: The Role of Impersonal God Representations,Individualistic Spirituality,and Dissimilarity With Religious Groups

We conducted two studies investigating the extent to which self-identification as Spiritual but not Religious (SBNR) was associated with (H1) the development of idiosyncratic religious beliefs and exposure to religious diversity and/or (H2) negative attitudes toward organized religion and being hurt by members of a religious group. In Study 1, SBNRs scored higher than religious and nonreligious participants on belief in God as an impersonal cosmic force (but not as a personal being) and individualistic spirituality. Although SBNRs had positive attitudes toward religion, they were less positive than those identifying as religious. Exposure to religious diversity and hurt by religious groups were not significant predictors of SBNR. We replicated these results in Study 2 using a multi-item measure of God representations and also found that SBNRs’ attitudes toward religion were predicted by a perceived dissimilarity with religious groups over and above individualism, secular group participation, perceptions of Christianity as too structured, and liberalism.     

Using the Linehan Risk Assessment and Management Protocol With a Chronically Suicidal Patient: A Case Report

The Linehan Risk Assessment and Management Protocol (LRAMP) is an empirically supported, comprehensive framework used to assess suicide risk and protective factors, and provide a guide for the therapist to consider reasonable options for intervening on suicidal behavior. This protocol includes a structured checklist for assessing, managing, and documenting suicide risk. It also structures the documentation to clearly describe the presentation, assessment, in-session interventions, decision-making process, and follow-up to other members of the treatment team. This paper describes a case in which the LRAMP was used to guide the assessment, intervention, and documentation of the suicidal behavior of a patient, “Ann,” being treated with outpatient Dialectical Behavioral Therapy in a community mental health clinic. Each section of the LRAMP is discussed as it was used with this complex patient, who had history of high utilization of acute psychiatric services. Application of the LRAMP included the assessment of risk and protective factors, and the use of an individualized crisis plan that engaged the patient, her family, the therapist, and the clinical team, to decrease acute risk, continue outpatient treatment, and avoid inpatient hospitalization. The considerations for documenting clinical decision-making with chronically suicidal patients are discussed.