Does Receiving Genetic Counseling Impact Genetic Counselor Practice?

This study was an investigation of whether genetic counselors have received genetic counseling and if so, how they believe it affects their practice. One thousand genetic counselors were mailed surveys about the nature of genetic counseling services received, impact on their clinical practice, frequency and reasons for disclosing about their receipt of counseling to their clients, and demographics. Ninety-three of the 510 respondents reported receiving genetic counseling. Of these, almost three-fourths were practicing genetic counselors while receiving services. Reasons for services include prenatal concerns, family history of cancer, and history/risk of other genetic conditions. Frequently endorsed effects on practice include increased empathy and understanding of client decisions, feeling more connected with clients, greater emphasis on psychosocial support, and sympathy. Forty-six respondents disclosed to clients about their receipt of genetic counseling. Prevalent reasons include client asked, help clients feel they are not alone, demonstrate counselor understanding, decrease client anxiety, build rapport, and normalize client feelings. Practice and research recommendations are given.     

Memory enhancement of classical fear conditioning by post-training injections of corticosterone in rats

There is extensive evidence that post-training administration of the adrenocortical hormone corticosterone facilitates memory consolidation processes in a variety of contextual and spatial-dependent learning situations. The present experiments examine whether corticosterone can modulate memory of auditory-cue classical fear conditioning, a learning task that is not contingent on contextual or spatial representations. Male Sprague-Dawley rats received three pairings of a single-frequency auditory stimulus and footshock, followed immediately by a post-training subcutaneous injection of either corticosterone (1.0 or 3.0mg/kg) or vehicle. Retention was tested 24h later in a novel test chamber and suppression of ongoing motor behavior served as the measure of conditioned fear. Corticosterone dose-dependently facilitated suppression of motor activity during the 10-s presentation of the auditory cue. As corticosterone administration did not alter responding after unpaired presentations of tone and shock, tone alone, shock alone or absence of tone/shock, the findings indicated that corticosterone selectively facilitated memory of the tone-shock association. Furthermore, injections of corticosterone given 3h after training did not alter motor activity during retention testing, demonstrating that corticosterone enhanced time-dependent memory consolidation processes. These findings provide evidence that corticosterone modulates the consolidation of memory for auditory-cue classical fear conditioning and are consistent with a wealth of data indicating that glucocorticoids can modulate a wide variety of emotionally influenced memories.     

Does class size in first grade relate to children's academic and social performance or observed classroom processes?

This study evaluated the extent to which first-grade class size predicted child outcomes and observed classroom processes for 651 children (in separate classrooms). Analyses examined observed child-adult ratios and teacher-reported class sizes. Smaller classrooms showed higher quality instructional and emotional support, although children were somewhat less likely to be engaged. Teachers in smaller classes rated typical children in those classes as more socially skilled and as showing less externalizing behavior and reported more closeness toward them. Children in smaller classes performed better on literacy skills. Larger classrooms showed more group activities directed by the teacher, teachers and children interacted more often, and children were more often engaged. Lower class sizes were not of more benefit (or harm) as a function of the child's family income. First-grade class size in the range typical of present-day classrooms in the United States predicts classroom social and instructional processes as well as relative changes in social and literacy outcomes from kindergarten to first grade.     

Post-exercise pulse pressure is a better predictor of executive function than pre-exercise pulse pressure in cognitively normal older adults

Exercise “stress tests” are widely used to assess cardiovascular function and to detect abnormalities. In line with the view of exercise as a stressor, the present study examined the relationship between cognitive function and cardiovascular activity before and after light physical exercise in a sample of 84 non-demented community-dwelling older adults. Based on known relationships between hypertension, executive function and cerebral white matter changes, we hypothesized that greater post-exercise reactivity, as indexed by higher pulse pressure, would be more related to worse performance on frontal-executive tasks than pre-exercise physiologic measures. All participants were administered a comprehensive neuropsychological battery and underwent a Six Minute Walk Test (6MWT), with blood pressure (BP) measures obtained immediately before and after the walk. Pulse pressure (PP) was derived from BP as an indicator of vascular auto-regulation and composite scores were computed for each cognitive domain assessed. As predicted, worse executive function scores exhibited a stronger relationship with post-exercise PP than pre-exercise PP. Results suggest that PP following system stress in the form of walking may be more reflective of the state of vascular integrity and associated executive dysfunction in older adults than baseline physiologic measures.     

Enhancing Social Responsibility and Prosocial Leadership to Prevent Aggression,Peer Victimization,and Emotional Problems in Elementary School Children

Testing the theories that form the basis of prevention programs can enhance our understanding of behavioral change and inform the development, coordination, and adaptation of prevention programs. However, theories of change showing the linkages from intervention program components to risk or protective factors to desired outcomes across time are rarely specified or tested. In this 2‐year longitudinal study, we test the theory that increases in two protective factors (i.e., children's prosocial leadership and their teachers’ expectations of social responsibility) targeted by the WITS Programs (Walk Away, Ignore, Talk it Out, and Seek Help) would be associated with declines in peer victimization, aggression, and emotional problems. Participants included Canadian students, in grades 1–4 at baseline (n = 1329) and their parents and teachers. Consistent with our theory of change, variability in program implementation (adherence and integration) and in children's use of program skills (child responsiveness) are related to increases in both protective factors. Increases in these protective factors are associated with subsequent declines in children's aggression, victimization, and emotional problems. We discuss how enhancement of these protective factors may operate to improve child outcomes and the need for theory‐based research to refine and improve the effectiveness of intervention strategies and to improve program scale‐up.     

Developing skills in counselling and psychotherapy: a scoping review of Interpersonal Process Recall and Reflecting Team methods in initial therapist training

The authors conducted a scoping review of the peer-reviewed literature associated with Interpersonal Process Recall (IPR) and Reflecting Team (RT) methods in order to find evidence for their use within skills development in therapist trainings. Inclusion criteria were: empirical research, reviews of empirical research, and responses to these; RT or IPR for skills development in counsellors/psychotherapists undertaking initial training. Six papers were identified (four IPR, two RT), all from the USA. Of the four IPR papers, three were themselves reviews, the fourth empirical paper being of poor methodological quality. There was some evidence that IPR is more valuable in developing reflective practice than in initial skills training. The small number of RT studies, of varying methodological quality, made it difficult to draw any conclusions about the appropriateness of this method for initial skills training. However, the method appeared to have been broadly welcomed by students for its potential to be inclusive and collaborative. The limitations of this current review are acknowledged, and research recommendations made.     

Trauma-Informed Medical Care: Patient Response to a Primary Care Provider Communication Training

Trauma exposure predicts mental disorders and health outcomes; yet there is little training of primary care providers about trauma’s effects, and how to better interact with trauma survivors. This study adapted a theory-based approach to working with trauma survivors, Risking Connection, into a 6-hour CME course, Trauma-Informed Medical Care (TI-Med), to evaluate its feasibility and preliminary efficacy. We randomized four primary care sites to training or wait-list conditions; PCPs at wait-list sites were trained after reassessment. Primary care providers (PCPs) were Family Medicine residents (n = 17; 2 sites) or community physicians (n = 13; 2 sites). Outcomes reported here comprised a survey of 400 actual patients seen by the PCPs in the study. Patients, mostly minority, completed surveys before or after their provider received training. Patients rated PCPs significantly higher after training on a scale encompassing partnership issues. Breakdowns showed lower partnership scores for those with trauma or posttraumatic stress symptoms. Future studies will need to include more specific trauma-related outcomes. Nevertheless, this training is a promising initial approach to teaching trauma-informed communication skills to PCPs.     

Ethical and Professional Challenges Posed by Patients with Genetic Concerns: A Report of Focus Group Discussions with Genetic Counselors, Physicians, and Nurses

Ninety-seven physicians, nurses, and genetic counselors from four regions within the United States participated in focus groups to identify the types of ethical and professional challenges that arise when their patients have genetic concerns. Responses were taped and transcribed and then analyzed using the Hill et al. (1997, Counsel Psychol 25:517–522) Consensual Qualitative Research method of analysis. Sixteen major ethical and professional domains and 63 subcategories were identified. Major domains are informed consent; withholding information; facing uncertainty; resource allocation; value conflicts; directiveness/nondirectiveness; determining the primary patient; professional identity issues; emotional responses; diversity issues; confidentiality; attaining/maintaining proficiency; professional misconduct; discrimination; colleague error; and documentation. Implications for practitioners who deal with genetic issues and recommendations for additional research are given.     

Who Is Referred to Mental Health Services in the Juvenile Justice System?

We describe the mental health referral rate among youth in a correction facility, examine how sociodemographic and criminal history characteristics relate to referral, and explore how these variables and diagnostic class differ by referral source. Data were abstracted from case records. The referral rate was low (6%). Non-Latino youth, repeat offenders, and violent offenders were more likely to be referred compared to all detained youth. Referral source also varied by violent offense history and diagnosis type. Future studies examining access to mental health services should take into account a detained youth's sociodemographic, criminal history, and clinical characteristics.