The Parable of the Sower: a case study examining the use of the Godly Play® method as a spiritual intervention on a psychiatric unit of a major children’s hospital

This case study examines the use of Godly Play® as a pastoral intervention on a psychiatric unit at Children’s Health – Children’s Medical Center in Dallas, Texas. The chaplain adapts Godly Play®, more typically used as a programme of Christian formation in churches and schools, for this setting, leading a ‘Purpose and Meaning’ group weekly whose goal is to provide inpatients with a developmentally appropriate way of reflecting on and expressing their own sense of identity, purpose and meaning within the personal, social and spiritual milieu in which they identify themselves as members. The case study examines how the method is adapted as a spiritual intervention in a clinical setting, and analyses its effectiveness in meeting the stated goals of the group.     

Global cognitive function before,surrounding, and after ischemic stroke: the role of risk and protective factors varies with time among ischemic stroke survivors

An estimated 65% of individuals demonstrate multidomain cognitive impairment poststroke, although little is known about the varying role of cognitive risk and protective factors in preischemic, peri-ischemic, and postischemic stroke phases. Longitudinal changes in global cognitive function after ischemic stroke are not well characterized, especially in older adults over age 80. We examined global cognitive function trajectories in these three phases across a mean follow-up of 8.12 (2.30) years in 159 female stroke survivors aged 65–79 at baseline using linear mixed models with change points. In separate models controlling for demographic variables, we tested the interaction of baseline risk and protective factors with stroke phase on global cognitive function. None of the prestroke global cognitive function means or trajectories differed significantly. At the time of ischemic stroke, higher body mass index (BMI), the presence of hypertension (HTN), low optimism, and higher physical function were all associated with significantly greater mean decreases in global cognition (all p’s <.0.0001), but were not significantly different from the contrasting level (all p’s >0.05). Higher BMI, the presence of HTN, low optimism, and higher physical function were in turn protective of global cognitive decline postischemic stroke (all contrasting p values <.01). Baseline factors may play either a risk or a protective role in global cognitive function depending on the phase of ischemic stroke.     

Religious Involvement and Health Over Time: Predictive Effects in a National Sample of African Americans

In this study, two telephone interviews that assessed both religious involvement and health‐related quality of life were conducted approximately 2.5 years apart in a national sample of 290 African Americans. Religious involvement was assessed with an instrument that measured both personal religious beliefs (e.g., having a personal relationship with God) and more public religious behaviors (e.g., attending church services). Health‐related quality of life was measured with version 2 of the Medical Outcomes Study 12‐item short form (SF‐12v2). Structural equation models indicated that higher religious beliefs at baseline predicted better physical and mental health 2.5 years later. Higher religious behaviors at baseline contributed smaller, complementary suppression effects. Physical and mental health indicators from the SF‐12v2 at baseline did not predict changes in either religious beliefs or religious behaviors over time. These findings indicate that, for African Americans, personal religious beliefs lead to beneficial health effects over time, whereas individual differences in health do not appear to predict changes in religious involvement.     

Teachers’ awareness in identifying microaggressive behaviors within the K-12 classroom

In the field of education, teachers are sentries for maintaining proper decorum, upholding school policies, and maintaining a social justice classroom, free of adversarial behaviors. While the premise of proper social and academic student engagement is expected, teachers are not always aware of or able to respond to inappropriate social interactions. This qualitative study using a narrative inquiry approach investigates and portrays the levels of awareness and decision-making processes teachers possess when addressing microaggression and microaggressive behaviors. Five public school teachers from varying grade levels in a culturally diverse school district participated in semi-structured, in-depth interviews for this study. Emergent themes included: (a) awareness and recognition of microaggression as related to bullying, (b) microaggression as denigrating behavior directed toward others, and (c) microaggression with the school discipline framework. Findings suggest that teachers often lack awareness of microaggression as a concept distinct from bullying. But when the distinction is evident, teachers understand how microaggression can be a precursor to bullying which, if proactively addressed within the school discipline framework, may result in preventing bullying incidents before they start. Teachers were interested in receiving targeted professional development and adjusting school discipline policy to consider microaggression a unique concept. Guidance is offered to support educators, schools, and districts as clear guidelines and policies are established pertaining to identifying and addressing microaggression within the school community, thereby ensuring social and behavioral awareness.

     

Evaluation of a Safe Sleep Training for Home Visitors and Their Clients

Sleep-related deaths are a common preventable cause of death, and such deaths occur disproportionately in families of color. Home visitors provide families with education about infant safe sleep guidelines; however, families face many barriers to engaging in safe sleep practices. This study evaluated the efficacy of a program to train home visitors to talk to clients about infant safe sleep using Motivational Interviewing and cultural sensitivity. We examined the effects of the intervention on home visitors’ (n?=?23) knowledge, MI skill use, and cultural sensitivity using a single group pre-post design. We also examined home visiting clients’ (n?=?78) knowledge, attitudes, and behaviors using a quasi-experimental design. Home visitors were primarily female (97%), had a college degree (86%), and were primarily white (50%) or African American (43%). The home visiting clients were all female and were primarily African American (43%) and Caucasian (36%). Most clients (59%) earned less than 30,000 dollars per year. Home visitors showed significant improvement in MI skill use and cultural sensitivity from pre- to post-test. Regarding client outcomes, our results indicate a significant group by time interaction when predicting changes in client knowledge such that the treatment group showed larger gains than the control group. There were no significant differences between groups when predicting changes in client attitudes or behavior. MI may be an effective technique for home visitors to help increase families’ safe sleep knowledge. Additional research is needed to examine whether such training can translate to changes in families’ safe sleep behavior.

     

Parenting Characteristics Protective Against Substance Use and Deviant Peer Involvement in High-Risk Neighborhoods

Robust research shows that poor parenting practices are related to adverse outcomes among adolescents; however, few have examined the interaction between parenting variables and adolescent outcomes within the context of exposure to relentless crime. The current study examined the combined effects of parental monitoring and discipline on marijuana involvement and deviant peer affiliation among adolescent males living in Los Angeles neighborhoods with concentrated crime. For this study, areas with higher-than-average crime rates were selected based on census data, published statistics, and law-enforcement data. The study included 349 males between 13 and 17 years of age, mostly Latino (70.2%) and African American (28.4%). Data were collected using questionnaires to interview participants and analyzed using logistic regression. Results suggest that among adolescent males in geographic areas of high violence and crime, the interaction between parental monitoring and discipline was significantly related to marijuana involvement and deviant peer affiliation. Follow-up analyses showed parental monitoring was only an effective tool at higher levels of consistent parental discipline. In the absence of consistent discipline, good parental monitoring was ineffective at preventing marijuana involvement and affiliation with deviant peers. Results suggest that if time and resources are limited, clinicians should consider focusing on the use of consistent discipline with parents residing in high-crime neighborhoods.

     

Performance gains from directed training do not transfer to untrained tasks

Given the increasing complexity of the tasks and skills needed in modern society, developing effective training strategies is of tremendous practical importance. Furthermore, training that improves performance of both trained and untrained tasks would be highly efficient. In the present study, we examined how directed training contributes to skill acquisition, and more importantly, to engendering transfer of training to untrained tasks. Participants learned a complex video game for 30 h (Space Fortress, Donchin, Fabiani, & Sanders, 1989) using one of two training regimens: Hybrid Variable-Priority Training (HVT), with a focus on improving specific skills and managing task priority, or Full Emphasis Training (FET) in which participants simply practiced the game to obtain the highest overall score. We compared game performance, retention of training gains, and transfer of training to untrained tasks as a function of the training regimen. Compared to FET, HVT learners reached higher levels of mastery on the game and HVT was particularly beneficial for initially poor performing participants. This benefit persisted seven months after training. However, contrary to expectation, both HVT and FET were unsuccessful in producing transfer to untrained tasks compared to a group that received limited game experience, suggesting that directed training and practice can produce task-specific improvements, but improvements do not necessarily transfer from trained to untrained tasks.     

Her own decision: impairment and authenticity in adolescence

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development of agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient's decisions in relation to her identity.     

Health Behavior Theories and Research: Implications for Suicidal Individuals’ Treatment Linkage and Adherence

Treatment linkage and adherence to psychotherapeutic interventions can be challenging with suicidal individuals. Health behavior theories, specifically the Health Belief Model, Stages of Change, and Theory of Planned Behavior, focus on individuals' beliefs, their readiness to change, their perceptions of illness severity and "threat," their perceptions of significant others' attitudes toward illness and treatment, and their behavioral intentions to change. These constructs have relevance both for understanding suicidal individuals' behaviors related to treatment utilization and for understanding cultural variations in these behaviors. Furthermore, these theories have implications for clinical practices aimed at facilitating improved treatment follow-through and adherence. After describing the theories and their constructs, clinical examples are provided to illustrate applications to practice with suicidal individuals.     

Why women of lower educational attainment struggle to make healthier food choices: The importance of psychological and social factors

Women of lower educational attainment are more likely to eat unhealthy diets than women of higher educational attainment. To identify influences on the food choices of women with lower educational attainment, 11 focus groups (eight with women of lower, and three with women of higher educational attainment) were held. Using a semi-structured discussion guide, environmental, social, historical and psychological factors known to be associated with food choice were explored. Audio recordings were transcribed verbatim and thematically analysed. Compared to women of higher educational attainment, women of lower educational attainment had less control over their families’ food choices, less support for attempts to eat healthily, fewer opportunities to observe and learn good food-related practices, more negative affect, more perceived environmental constraints and more ambiguous beliefs about the consequences of eating a nutritious diet. These findings provide a starting point for taking forward the design of an intervention to improve the diets of young women.