Fight,Flight, or Remain Silent? Juggling Multiple Accountabilities throughout the Formative Stage of a Neighborhood Revitalization Initiative

This paper describes the experiences of a research team as they navigated uncertain ethical and political terrain throughout the formative stage of a public housing redevelopment project. Specifically, we discuss the challenges related to balancing multiple accountabilities and the tensions among the various roles and responsibilities that emanated from different accountabilities. Due to contractual obligations to our funding source, established relations with community partners, and an ethical imperative to align with those holding the least power, we grappled with embodying multiple and often conflicting roles. Without oversight provided by our university institutional review board or a clear ethical framework for community psychology research and action, our team was left to negotiate the challenges that emerged through critical reflection and financial considerations. Throughout the case example presented in this paper, we highlight our difficulty in ethical decision‐making with respect to the principles of obligation, disclosure, consent, commitment, and professionalism. Community psychologists often straddle the realms of academia, community partnerships, and conscious engagement with little guidance in navigating often conflicting roles and value systems. We present our narrative to highlight the complexity of scholar‐activism in the context of community psychology and the necessity for developing ethical standards and guidelines tailored to meet the unique needs of community psychologists.     

Psychometric Properties of a Social Skills Assessment using a Virtual Environment

Social Anxiety Disorder (SAD) is a marked and persistent fear of social and/or performance situations in which embarrassment or scrutiny from others may occur. One form of behavioral assessment is a Role Play Task (RPT). However, RPTs often are not feasible in clinical settings due to the common obstacles in implementation. Thus, the current study examines the feasibility, acceptability and psychometric properties of a virtual environment based social skills assessment compared to the traditional RPT. Forty-six children, ages 7 to 14, participated in two assessment conditions: RPT and a virtual environment behavioral assessment (VE BAT). Participants reported self-ratings of anxiety and acceptability, while blinded observers rated social skills and overall social anxiety. An ANCOVA, covarying for age, revealed (a) no significant task difference for voice volume, speech latency, number of words spoken, effectiveness, and SAM ratings; (b) that the VE BAT was more feasible to implement in terms of personnel time and costs and; (c) more overall anxiety during the RPT task than during the VE BAT task. In addition, the VE BAT demonstrated moderate concurrent validity when correlating the self-report ratings of anxiety with the Social Phobia and Anxiety Inventory for Children (SPAI-C). The current study addresses many of the impediments to conducting RPTs in a clinical setting and, overall, supports the utilization of VE BATS as a viable alternative for the behavioral assessment of social skills in children. Further implications address the potential for the armamentarium for social skills training with children with SAD.     

Understanding Barriers to Initial Treatment Engagement among Underserved Families Seeking Mental Health Services

This mixed method study examined factors associated with parents not attending their child’s mental health treatment after initially seeking help for their 2–5 year old child. It was part of a larger study comparing two evidence-based treatments among low-income racial/ethnic minority families seeking child mental health services. Of 123 parents who initiated mental health treatment (71?% African American or multi-racial; 97.6?% low-income), 36 (29.3?%) never attended their child’s first treatment session. Socio-demographic characteristics, parenting stress, depression, severity of child behavior problems, and length of treatment delay from intake to first scheduled treatment session were compared for families who did and did not attend their first treatment session. Parents who never attended their child’s first treatment session were more likely to live with more than four adults and children (p?=?.007) and have more depressive symptoms (p?=?.003). Median length of treatment delay was 80 days (IQR?=?55) for those who attended and 85 days (IQR?=?67.5) for those who did not attend their child’s first treatment session (p?=?.142). Three themes emerged from caregiver interviews: (a) expectations about the treatment, (b) delays in getting help, and (c) ambivalence about research participation. Findings suggest the need to develop better strategies for addressing risk factors early in the treatment process and reducing the length of time families with adverse psychosocial circumstances must wait for child mental health treatment.     

Perceptions of Stress,Coping, and Intervention Preferences among Caregivers of Disadvantaged Children with Asthma

Asthma remains the most prevalent chronic illness among children. Despite the substantial body of literature examining children with asthma, few studies have examined parents’ perspectives of the condition and experiences of caregiver stress. Parents of children with chronic illnesses experience elevated stress and may have limited opportunities to cope with complex emotions while caring for children with asthma. Drawing from focus groups and interviews with African American and Hispanic parents of children with asthma, this qualitative study was conducted as part of a patient-centered engagement process to inform the refinement of an intervention aimed at reducing stress among parents of children with asthma. All data were transcribed and underwent three waves of inductive analysis. The content analysis indicated that the unpredictable nature of asthma and the caregiving burden associated with managing children’s asthma contributed to parents’ stress, and external contexts compounded the impact of these stressors. Parents also reported having difficulty identifying how they coped with stress and employed approaches to coping with stress that they applied intermittently but encountered several barriers to enacting known or available coping strategies. Analyses also revealed that parents desired a multimodal stress reduction intervention that emphasized building relationships, allowed for flexibility, and encouraged staff-parent communication. Whereas African American and Hispanic parents’ experiences of stress and coping strategies were similar, their preferences differed in regards to incorporating technology into the intervention, the credentials of facilitators, and the salience of language preferences. Understanding the complexities of stressors facing caregivers is important for developing interventions to support parents and children coping with asthma, and in particular when working with families from diverse backgrounds.     

A family-focused randomized controlled trial to prevent adolescent alcohol and tobacco use: The moderating roles of positive parenting and adolescent gender

Four years of longitudinal data from 2,153 families with a 5th- or 6th-grade preadolescent participating in a family-focused pediatric primary-care-based prevention program were used to examine whether prevention effects were moderated by positive parenting and/or adolescent gender. Alcohol and tobacco use, internalizing problems, and externalizing problems were examined. Although findings revealed no main effect of the prevention program, positive parenting and adolescent gender were moderators of internalizing problems and adolescent gender was a moderator of externalizing problems. Clinical implications and future directions for research are discussed.     

Does Happiness Predict Medication Adherence among African Americans with Hypertension?

Poor medication adherence is a leading cause of excessive cardiovascular morbidity among African Americans. Many adherence-promoting interventions have addressed economic barriers, improved the patient-provider relationship, simplified regimens, and used reminder systems; however, the problem of low adherence remains intractable. Meanwhile, positive psychological attributes that might serve to promote medication adherence have not been fully explored. To address this gap, we examined the association between happiness and medication adherence among low-income African Americans with hypertension treated in a safety-net setting. Data were obtained from the Alabama Collaboration for Cardiovascular Equality, 2007?C2008. Happiness was measured using the 4-item scale of Lyubomirsky and Lepper; low, moderate, and high happiness were defined by tertiles because of the non-normal distribution. Medication adherence was assessed with the Morisky Medication Adherence Scale. Associations were quantified with ordinal logistic regression. Our sample of 573 African Americans was 71.6?% female and had an average age?±?SD of 53.6?±?9.7?years and a median happiness score of 5.2. Compared to participants with low happiness, the odds (OR; 95?% CI) of being in a better medication adherence category were greater for those with moderate (1.53; 1.02?C2.27) and high (2.26; 1.52-3.37) happiness, after adjusting for age, sex, income, education, and difficulty paying for medical care. Within this cohort of low-income African Americans with hypertension, participants with greater happiness exhibited better medication adherence. Although one interpretation of our study is that more adherent patients are naturally happier, our findings raise the possibility that adding happiness-boosting components may increase the effectiveness of more traditional adherence interventions.     

The extent of working memory deficits associated with Williams syndrome: exploration of verbal and spatial domains and executively controlled processes

The present study investigated verbal and spatial working memory (WM) functioning in individuals with the neuro-developmental disorder Williams syndrome (WS) using WM component tasks. While there is strong evidence of WM impairments in WS, previous research has focused on short-term memory and has neglected assessment of executive components of WM. There is a particular lack of consensus concerning the profile of verbal WM functioning in WS. Here, WS participants were compared to typically developing participants matched for (1) verbal ability and (2) spatial ability (N = 14 in each of the 3 groups). Individuals with WS were impaired on verbal WM tasks, both those involving short-term maintenance of information and executive manipulation, in comparison to verbal-matched controls. Surprisingly, individuals with WS were not impaired on a spatial task assessing short-term maintenance of information in memory (remembering spatial locations) compared to spatial-matched controls. They were, however, impaired on a spatial executive WM task requiring the manipulation of spatial information in memory. The present study suggests that individuals with WS show WM impairments that extend to both verbal and spatial domains, although spatial deficits are selective to executive aspects of WM function.     

Elevated suicide rates at high altitude: sociodemographic and health issues may be to blame

Suicide rates are higher at high altitudes; some hypothesize that hypoxia is the cause. We examined 8,871 suicides recorded in 2006 in 15 states by the National Violent Death Reporting System, with the victim's home county altitude determined from the National Elevation Dataset through FIPS code matching. We grouped cases by altitude (low<1000m; middle=1000-1999m; high≥2000m). Of reported suicides, 5% were at high and 83% at low altitude, but unadjusted suicide rates per 100,000 population were higher at high (17.7) than at low (5.7) altitude. High and low altitude victims differed with respect to race, ethnicity, rural residence, intoxication, depressed mood preceding the suicide, firearm use and recent financial, job, legal, or interpersonal problems. Even after multivariate adjustment, there were significant differences in personal, mental health, and suicide characteristics among altitude groups. Compared to low altitude victims, high altitude victims had higher odds of having family or friends report of a depressed mood preceding the suicide (OR 1.78; 95%CI:1.46-2.17) and having a crisis within 2weeks before death (OR 2.00; 95%CI:1.63-1.46). Suicide victims at high and low altitudes differ significantly by multiple demographic, psychiatric, and suicide characteristics; these factors, rather than hypoxia or altitude itself, may explain increased suicide rates at high altitude.