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.     

The value of forgetting suicidal thoughts and behavior

This is a prospective longitudinal study examining recollections of suicidal content and correlates of accurate and inaccurate recollection. A primarily at-risk group of young adults (N = 78) who were initially assessed for suicidal ideation and behavior in adolescence, were asked to recall whether they had reported sui- cidal ideation or behavior about six years earlier. In recalling the previous inter- view, the majority of the participants provided consistent reports. However, with regard to those who had previously reported suicidal ideation or behavior, 38% failed to recall prior adolescent suicidal reports. Those who provided accurate reports of prior suicidal content were more symptomatic and were functioning more poorly than those who failed to recall past suicidal content. The implications for clinical assessment practices, research, and theory development are discussed.     

Establishing and Evaluating the Substantive Adequacy of Positive Behavioral Support Plans

The Individuals with Disabilities Education Improvement Act (2004) renewed the commitment to provide positive behavioral support (PBS) for students that engage in persistent problem behavior. Behavior intervention plans (also known as PBS plans) serve as legal documents that help guide the implementation of intervention strategies to encourage more positive forms of behavior. The purpose of this study was to evaluate the substantive adequacy of PBS plans developed for special education students. This was accomplished by documenting the content of plans developed by two different groups of educators using a rating instrument based on the key concepts of PBS planning. Results revealed that the majority of plans developed by teams without identified training and expertise in PBS were rated as substantively inadequate, lacking critical information related to effective behavioral support planning. The implications of the results for everyday practice in the schools and directions for future research are discussed.     

Change blindness blindness: beliefs about the roles of intention and scene complexity in change detection

Observers have difficulty detecting visual changes. However, they are unaware of this inability, suggesting that people do not have an accurate understanding of visual processes. We explored whether this error is related to participants' beliefs about the roles of intention and scene complexity in detecting changes. In Experiment 1 participants had a higher failure rate for detecting changes in an incidental change detection task than an intentional change detection task. This effect of intention was greatest for complex scenes. However, participants predicted equal levels of change detection for both types of changes across scene complexity. In Experiment 2, emphasizing the differences between intentional and incidental tasks allowed participants to make predictions that were less inaccurate. In Experiment 3, using more sensitive measures and accounting for individual differences did not further improve predictions. These findings suggest that adults do not fully understand the role of intention and scene complexity in change detection.     

Actual and ideal conflict styles and job distress in a health care organization

Employees (N = 176) of a large metropolitan health care corporation completed the Thomas-Kilmann Conflict Mode Inventory (TKI; K. W. Thomas & R. H. Kilmann, 1974), and the authors computed scores on each of 5 characteristic conflict styles (competing, collaborating, compromising, accommodating, and avoiding). Respondents again completed the TKI, this time by identifying their ideal conflict styles. Participants also provided ratings of job distress and demographic information. Compromising and avoiding were the most strongly endorsed actual conflict styles, and avoiding was the most strongly endorsed ideal conflict style. Respondents viewed their ideal conflict style as more competitive, less collaborative, and more avoidant than their actual conflict style. Job distress did not correlate with actual or ideal conflict styles. However, participants whose actual conflict style matched their ideal conflict style reported lower distress, especially if they perceived a high level of destructive conflict in their work environment. Distress was also lowest for respondents in high managerial positions and respondents who had been in the organization for a short time.     

A National Survey of Genetic Counselors’ Personal Values

Personal values are motivational sources for an individual’s actions [Hitlin and Piliavin (Annual Review of Sociology 30:359–393, 2004)]. Genetic counselors’ values may influence their behaviors in clinical practice, but a profile of their personal values has not been identified empirically. In this study, 292 genetic counselors completed the Schwartz Universal Values Questionnaire (SUVQ; Schwartz, S. H. (1992). Universals in the content and structure of values: Theoretical advances and empirical tests in 20 countries. In M. Zanna (Ed.), Advances in experimental social psychology (pp. 1–65). Boston, MA: Academic.), a widely used measure of value types, and provided information about their demographic characteristics. Results indicate that respondents highly valued benevolence, self-direction, achievement, and universalism indicating a strong pattern of concern for the welfare of others. They placed considerably less value on stimulation, tradition, and power, which reflect personal interests. Respondents who reported practicing a religion scored significantly lower on stimulation and hedonism and higher on tradition and spirituality than those not practicing; married respondents and parents scored significantly lower on stimulation and achievement; and males scored higher on power than females. The value types are described, and training and research recommendations are provided.     

Multilevel Perspectives on Community Intervention: An Example from an Indo-US HIV Prevention Project in Mumbai, India

This paper explores the meaning and applicability of multilevel interventions and the role of ethnography in identifying intervention opportunities and accounting for research design limitations. It utilizes as a case example the data and experiences from a 6-year, NIMH-funded, intervention to prevent HIV/STI among married men in urban poor communities in Mumbai, India. The experiences generated by this project illustrate the need for multilevel interventions to include: (1) ethnographically driven formative research to delineate appropriate levels, stakeholders and collaborators; (2) identification of ways to link interventions to the local culture and community context; (3) the development of a model of intervention that is sufficiently flexible to be consistently applied to different intervention levels using comparable culturally congruent concepts and approaches; (4) mechanisms to involve community residents, community based organizations and community-based institutions; and (5) approaches to data collection that can evaluate the impact of the project on multiple intersecting levels.