Deciding in the best interest of clients with dementia: the experience of public guardians

We conducted an in-depth interview study of public guardians in three local jurisdictions in the state of Maryland to explore the decision-making process utilized by court-appointed public guardians making medical and EOL care decisions on behalf of their clients with dementia. Overall, public guardians appeared to make their decisions in the context of relevant ethical principles and relevant case law and state statute, and the basis upon which they made informed decisions was dependent on their training and experience. The stated goal of public guardians is to make decisions that they believe are in the best interest of their clients. In the case of a healthcare decision, their goal is to maximize quality of life; and in the case of an EOL care decision, their goal is to minimize pain and suffering. In general, public guardians gathered information in order to identify previous preferences of their now-incapacitated clients, so that they could develop a preference profile to assist both an initial decision on whether an individual ought to have a court-appointed public guardian, and with healthcare and EOL decisions once an appointment was made. When guardians were unable to develop a preference profile for a particular client, they relied on past decisions in similar situations. Healthcare and EOL decisions were most often triggered by a recommendation by the client's healthcare provider. Once a decision-point was identified, the public guardian considered the risks and benefits of the proposed intervention in light of the client's current condition. At times the guardians reviewed informational resources such as textbooks and the Internet. In addition, most guardians sought advice from a medical consultant who is available to all public guardians in Maryland. Some guardians sought the advice of this medical consultant only when faced with more complex decisions. Guardians challenged physicians' recommendations when they believed the physicians were recommending an intervention that was not in the best interest of the client--that is, they advocated against either overtreatment or undertreatment. Ultimately, guardians took particularly difficult issues to the court and obtained a judge's opinion.     

Dimensionality and Validity of a Structured Telephone Reference Check Procedure

A structured telephone reference check (STRC) was developed to assess three job-relevant personality/interpersonal dimensions (Conscientiousness, Agreeableness, customer focus) for a family of entry-level, customer-contact jobs within a service organization. The procedure was designed to be brief (a 10–15 minute telephone call with each referee) and easy to administer by untrained recruitment staff. Confirmatory factor analyses on referee ratings for 223 applicants indicated that referees were able to adequately discriminate between dimensions of applicants' past performance. A predictive, criterion-related validation study on those applicants who were hired demonstrated that the STRC predicted supervisory ratings of job performance (   r = .25, p < .01,  uncorrected; .36 corrected for range restriction and criterion unreliability). No evidence was found that referees with shorter working relationships with applicants provided less valid ratings.     

Computer- and internet-based psychotherapy interventions

Computers and Internet-based programs have great potential to make psychological assessment and treatment more cost-effective. Computer-assisted therapy appears to be as effective as face-to-face treatment for treating anxiety disorders and depression. Internet support groups also may be effective and have advantages over face-to-face therapy. However, research on this approach remains meager.     

Ministry-Related Burnout and Stress Coping Mechanisms Among <Emphasis Type="Italic">Assemblies of God</Emphasis>-Ordained Clergy in Minnesota

Clergy members suffering from burnout face both personal and professional complications. This study assessed occupational burnout and stress coping mechanisms among ministers affiliated with the Assemblies of God, a denomination that has received little attention in previous burnout-related studies. A cross-sectional design was employed using two instruments with acceptable psychometric properties. Approximately 65 % of those surveyed were either suffering from burnout or on the verge of burnout. Statistical differences in coping mechanism use were found between those who were and were not experiencing some level of burnout. The results of this study add to the existing understanding of occupational burnout among clergy members and ways in which burnout may be alleviated.     

Resilient teenagers: Explaining the high educational aspirations of visible-minority youth in Canada

While previous studies show that visible minority and immigrant students are disadvantaged within the school system, findings from a national Canadian survey of 15-year old students and their parents indicate that visible-minority immigrant students nevertheless have higher educational aspirations than Canadian-born nonvisible minority students. Using the 2000 Youth in Transition survey, this paper examines sociodemographic, social psychological, and school performance factors that help explain much of the difference in aspirations between these groups. We conclude by identifying areas of future research that could further uncover the family, school, and community processes that shape aspirations and the relationships between aspirations and future educational and occupational attainment.     

Change in maternal criticism and behavior problems in adolescents and adults with autism across a 7-year period

In a previous study, high levels of maternal criticism predicted increased behavior problems in adolescents and adults with autism spectrum disorders (ASD) over an 18-month period (Greenberg, Seltzer, Hong, & Orsmond, 2006). The current investigation followed these families over a period of 7 years to examine the longitudinal course of criticism and behavior problems, to assess the association between their trajectories, and to determine the degree to which change in each of these factors predicted levels of criticism and behavior problems at the end of the study period. A sample of 118 mothers coresiding with their adolescent and adult children with ASD provided open-ended narratives about their children and reported on the children's behavior problems at 4 waves. Maternal criticism was derived from expressed emotion ratings of the narratives. Criticism exhibited low but significant stability over the 7-year period, and behavior problems exhibited high stability. Through latent growth curve modeling, (a) criticism was found to have increased over time, but only for the group of families in which the sons or daughters transitioned from high school services during the study period; (b) individual changes in criticism and behavior problems were positively correlated over the 7-year period; and (c) changes in criticism predicted levels of behavior problems at the conclusion of the study. Changes in behavior problems were not predictive of end levels of criticism. Implications for intervention and prevention efforts are discussed.