The Laboratory-Clinician Team: A Professional Call to Action to Improve Communication and Collaboration for Optimal Patient Care in Chromosomal Microarray Testing

The International Standards for Cytogenomic Arrays (ISCA) Consortium is a worldwide collaborative effort dedicated to optimizing patient care by improving the quality of chromosomal microarray testing. The primary effort of the ISCA Consortium has been the development of a database of copy number variants (CNVs) identified during the course of clinical microarray testing. This database is a powerful resource for clinicians, laboratories, and researchers, and can be utilized for a variety of applications, such as facilitating standardized interpretations of certain CNVs across laboratories or providing phenotypic information for counseling purposes when published data is sparse. A recognized limitation to the clinical utility of this database, however, is the quality of clinical information available for each patient. Clinical genetic counselors are uniquely suited to facilitate the communication of this information to the laboratory by virtue of their existing clinical responsibilities, case management skills, and appreciation of the evolving nature of scientific knowledge. We intend to highlight the critical role that genetic counselors play in ensuring optimal patient care through contributing to the clinical utility of the ISCA Consortium's database, as well as the quality of individual patient microarray reports provided by contributing laboratories. Current tools, paper and electronic forms, created to maximize this collaboration are shared. In addition to making a professional commitment to providing complete clinical information, genetic counselors are invited to become ISCA members and to become involved in the discussions and initiatives within the Consortium.     

Are Genetic Counselors and GLBT Patients “on the Same Page”? an Investigation of Attitudes, Practices, and Genetic Counseling Experiences

Gay, lesbian, bisexual, and transgender (GLBT) individuals comprise a growing patient population in genetic counseling, yet literature on working with this population is scarce. This study sought to investigate GLBT patient experiences in genetic counseling and genetic counselor attitudes and practices when counseling GLBT patients. Twenty-nine GLB individuals who had previously participated in genetic counseling, and 213 genetic counselors completed online surveys. No individuals identifying as transgender participated. The patient survey assessed disclosure of orientation, discrimination in genetic counseling, and quality of services received. The counselor survey assessed comfort with and attitudes about counseling GLBT patients, disclosure of counselor orientation, and whether they counsel differently with this population. Every patient denied experiencing discrimination during their session, but 17% reported their genetic counselor assumed they were heterosexual, and 45% indicated intake forms were not GLBT-inclusive. A majority of counselors (91%) reported having counseled GLBT patients and indicated they were comfortable doing so (86%), and 72% indicated no differences in their counseling approaches with GLBT patients. Few counselors (17%) received training in GLBT issues, and most (61%) desired such education. Additional findings and practice and research recommendations are presented.     

Assessing and Managing Risk With Suicidal Individuals

The University of Washington Risk Assessment Protocol (UWRAP) and Risk Assessment and Management Protocol (UWRAMP) have been used in numerous clinical trials treating high-risk suicidal individuals over several years. These protocols structure assessors and treatment providers to provide a thorough suicide risk assessment, review standards of care recommendations for action, and allow for subsequent documentation of information gathered and actions taken. As such, it is a resource for providers treating high-risk populations across multiple contexts (e.g., primary care, outpatient psychotherapy, emergency department). This article describes both the UWRAP and UWRAMP. Taken together, these assessment and risk management tools include (a) assessment questions for gathering information to determine the level of risk, (b) action steps that can be taken to ensure safety, and (c) a companion therapist note where providers document their assessment and actions.     

Modifying CBT for Perinatal Depression: What Do Women Want?: A Qualitative Study

The evidence for the efficacy of CBT for depression during the perinatal period is mixed. This was a qualitative study that aimed to understand the perinatal-specific needs of depressed women in an effort to inform treatment modifications that may increase the relevance and acceptability of CBT during this period. Stratified purposeful sampling resulted in 23 participants selected by pregnancy, socioeconomic, and depression status. Participants completed semistructured interviews exploring their experiences of pregnancy and the postpartum period and its relationship to mood, and perspectives on ideal treatment content. Thematic analysis revealed a number of perinatal-specific themes that were relevant to CBT in three key domains: self, motherhood, and interpersonal. Mothers particularly struggled with: internalization of “motherhood myths,” self-sacrifice, and managing social support during this period. Shifts in women's themes across the perinatal period, and between racial and socioeconomic groups are discussed as are implications for modification of CBT to improve relevance for perinatal depression.     

Exploring the effect of therapists' treatment practices on client attendance in community-based care for children

Sustained treatment attendance has been reported to be poor in publicly funded community-based clinic settings serving children and families. Several child and family characteristics have been shown to predict attendance in community-based care, but virtually no research has been conducted to examine how experiences in care, including psychotherapists' within-session practices, influence client attendance. The goal of this exploratory study was to examine how observed practice within sessions, in particular the extent to which therapists delivered elements consistent with evidence-based practices, impacts total number of sessions attended, while accounting for an array of other potential predictors. Participants include 181 children ages 4-13 and their parents entering a new episode of care for disruptive behavior problems in publicly funded clinics. Data sources include administrative billing records on treatment attendance; coded videotaped treatment sessions; and self-reports from children, parents, and therapists. Results indicate that parent education, service funding source, parent alliance with therapist, and therapist experience predicted number of sessions attended; intensity of evidence-based treatment techniques delivered to children was marginally associated with attendance (p = .059). Implications for improving engagement in community-based care are discussed.     

A telehealth intervention for veterans on antiviral treatment for the hepatitis C virus

The standard treatment for chronic hepatitis C (pegylated interferon and ribavirin) causes challenging physical and psychological side effects. The current pilot study evaluated the efficacy of a brief, telephone-based, cognitive-behavioral self-management intervention designed to address mood and quality of life within a sample of veterans on antiviral treatment for hepatitis C. Results from this pilot study support the feasibility of this telehealth intervention, showing that veterans were highly satisfied with the content of the intervention and compliant with the telephone calls. Findings further indicate that symptoms of depression and anxiety and mental health quality of life either remained stable or improved in those participants who received the brief telephone intervention, while those receiving usual care showed significant declines in mood and mental health quality of life. The findings from this study provide evidence that a brief, clinician-administered phone intervention may help individuals on antiviral therapy for hepatitis C to cope more effectively with the negative treatment side effects.     

Recognizing prosody across modalities, face areas and speakers: examining perceivers' sensitivity to variable realizations of visual prosody

Prosody can be expressed not only by modification to the timing, stress and intonation of auditory speech but also by modifying visual speech. Studies have shown that the production of visual cues to prosody is highly variable (both within and across speakers), however behavioural studies have shown that perceivers can effectively use such visual cues. The latter result suggests that people are sensitive to the type of prosody expressed despite cue variability. The current study investigated the extent to which perceivers can match visual cues to prosody from different speakers and from different face regions. Participants were presented two pairs of sentences (consisting of the same segmental content) and were required to decide which pair had the same prosody. Experiment 1 tested visual and auditory cues from the same speaker and Experiment 2 from different speakers. Experiment 3 used visual cues from the upper and the lower face of the same talker and Experiment 4 from different speakers. The results showed that perceivers could accurately match prosody even when signals were produced by different speakers. Furthermore, perceivers were able to match the prosodic cues both within and across modalities regardless of the face area presented. This ability to match prosody from very different visual cues suggests that perceivers cope with variation in the production of visual prosody by flexibly mapping specific tokens to abstract prosodic types.     

Implicit Science Stereotypes Mediate the Relationship between Gender and Academic Participation

While the gender gap in mathematics and science has narrowed, men pursue these fields at a higher rate than women. In this study, 165 men and women at a university in the northeastern United States completed implicit and explicit measures of science stereotypes (association between male and science, relative to female and humanities), and gender identity (association between the concept “self” and one’s own gender, relative to the concept “other” and the other gender), and reported plans to pursue science-oriented and humanities-oriented academic programs and careers. Although men were more likely than women to plan to pursue science, this gap in students’ intentions was completely accounted for by implicit stereotypes. Moreover, implicit gender identity moderated the relationship between women’s stereotypes and their academic plans, such that implicit stereotypes only predicted plans for women who strongly implicitly identified as female. These findings illustrate how an understanding of implicit cognitions can illuminate between-group disparities as well as within-group variability in science pursuit.     

A factor analytic investigation of the BASC-2 Behavioral and Emotional Screening System Parent Form: psychometric properties, practical implications, and future directions

The Behavior Assessment System for Children, Second Edition (BASC-2) Behavioral and Emotional Screening System Parent Form (BESS Parent; Kamphaus & Reynolds, 2007) is a recently developed instrument designed to identify behavioral and emotional risk in students. To describe the underlying factor structure for this instrument, exploratory (EFA) and confirmatory factor analyses (CFA) were conducted utilizing two subsets of a large, nationally-representative sample. The results of the EFA suggested that the BESS Parent contained a four-factor latent structure (i.e., Externalizing, Internalizing, Adaptive Skills, and Inattention), which was supported by CFA. Results support further investigation into utilizing four subscales in addition to an overall risk score; distributional and reliability information for the BESS Parent subscales is provided. Practical implications for school psychologists interested in early identification and directions for future research are discussed.