Sustaining the Utilization and High Quality Implementation of Tested and Effective Prevention Programs Using the Communities That Care Prevention System

This paper describes the extent to which communities implementing the Communities That Care (CTC) prevention system adopt, replicate with fidelity, and sustain programs shown to be effective in reducing adolescent drug use, delinquency, and other problem behaviors. Data were collected from directors of community‐based agencies and coalitions, school principals, service providers, and teachers, all of whom participated in a randomized, controlled evaluation of CTC in 24 communities. The results indicated significantly increased use and sustainability of tested, effective prevention programs in the 12 CTC intervention communities compared to the 12 control communities, during the active phase of the research project when training, technical assistance, and funding were provided to intervention sites, and 2 years following provision of such resources. At both time points, intervention communities also delivered prevention services to a significantly greater number of children and parents. The quality of implementation was high in both conditions, with only one significant difference: CTC sites were significantly more likely than control sites to monitor the quality of implementation during the sustainability phase of the project.     

Sound support: intermodal information facilitates infants' perception of an occluded trajectory

In a visual occlusion task, 4-month-olds were given a dynamic sound cue (following the trajectory of an object), or a static cue (sound remained stationary). Infants' oculomotor anticipations were greater in the Dynamic condition, suggesting that representations of visual occlusion were supported by auditory information.     

Genetic Counseling and the Ethical Issues Around Direct to Consumer Genetic Testing

Over the last several years, direct to consumer(DTC) genetic testing has received increasing attention in the public, healthcare and academic realms. DTC genetic testing companies face considerable criticism and scepticism,particularly from the medical and genetic counseling community. This raises the question of what specific aspects of DTC genetic testing provoke concerns, and conversely,promises, for genetic counselors. This paper addresses this question by exploring DTC genetic testing through an ethic allens. By considering the fundamental ethical approaches influencing genetic counseling (the ethic of care and principle-based ethics) we highlight the specific ethical concerns raised by DTC genetic testing companies. Ultimately,when considering the ethics of DTC testing in a genetic counseling context, we should think of it as a balancing act. We need careful and detailed consideration of the risks and troubling aspects of such testing, as well as the potentially beneficial direct and indirect impacts of the increased availability of DTC genetic testing. As a result it is essential that genetic counselors stay informed and involved in the ongoing debate about DTC genetic testing and DTC companies. Doing so will ensure that the ethical theories and principles fundamental to the profession of genetic counseling are promoted not just in traditional counseling sessions,but also on a broader level. Ultimately this will help ensure that the public enjoys the benefits of an increasingly genetic based healthcare system.     

Essential Elements of Genetic Cancer Risk Assessment, Counseling, and Testing: Updated Recommendations of the National Society of Genetic Counselors

Updated from their original publication in 2004, these cancer genetic counseling recommendations describe the medical, psychosocial, and ethical ramifications of counseling at-risk individuals through genetic cancer risk assessment with or without genetic testing. They were developed by members of the Practice Issues Subcommittee of the National Society of Genetic Counselors Familial Cancer Risk Counseling Special Interest Group. The information contained in this document is derived from extensive review of the current literature on cancer genetic risk assessment and counseling as well as the personal expertise of genetic counselors specializing in cancer genetics. The recommendations are intended to provide information about the process of genetic counseling and risk assessment for hereditary cancer disorders rather than specific information about individual syndromes. Essential components include the intake, cancer risk assessment, genetic testing for an inherited cancer syndrome, informed consent, disclosure of genetic test results, and psychosocial assessment. These recommendations should not be construed as dictating an exclusive course of management, nor does use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care provider's professional judgment based on the clinical circumstances of a client.     

Respect and Types of Injustice

Jonathan Wolff and Timothy Hinton have criticized a version of liberal egalitarianism, often associated with Ronald Dworkin, for promoting an account of social justice that fails to treat everyone with respect. This paper analyses Wolff’s and Hinton’s critiques, particularly with regard to how notions of self-respect and respect-standing are deployed. The paper argues that the analyses of both Wolff and Hinton display affinities with a dualist approach to social justice. A dualist approach theorizes respect as an aspect of both distributive, socioeconomic injustice and cultural injustice, rather than of the former only, which is typical of liberal egalitarianism. Nancy Fraser is widely associated with such a dualist framework, so her version is used to assess Wolff’s and Hinton’s work. The paper argues that both make use of ideals and commitments from the dualist approach to justice in their respect objection. However, despite their evident sympathy for the notion of cultural injustice, both continue to theorize respect primarily as an aspect of distributive justice. Thus, for cultural justice theorists, Wolff’s and Hinton’s critiques of Dworkinian justice may leave something to be desired. Thanks to Anne Phillips, Kathy King, Tamara Jugov, Neal Razzell and reviewers for Res Publica for comments on an earlier draft of the paper. Thanks to Itai Rabinowitz for insightful conversations about the issues touched on here. Thanks to the Commonwealth Scholarship Commission and the Social Sciences and Humanities Research Council of Canada for making this research possible.     

Sex-role stereotypes and clinical judgments of mental health: The Brovermans' findings reexamined

This study attempted to evaluate the progress of mental health professionals regarding sex-role stereotyping in clinical functioning, identified as a problem over 10 years ago by Broverman et al. (Journal of Consulting and Clinical Psychology, 1970, 34, 1–7). A comparable format and questionnaire were used in order to replicate faithfully the earlier study and facilitate past-present comparisons. One hundred four psychiatrists, psychologists, and social workers were randomly assigned to three instruction-set conditions in completing the Stereotype Questionnaire: sexunspecified adult instruction set, female instruction set, and male instruction set. No significant differences were found related to sex of clinician. A significant effect (p<.001) was found for social desirability and what was judged as healthy for sex-unspecified adults. No significant relationship was found, however, for social desirability of traits and conventional sex-role stereotypes. Based on the results of this study it is possible to speculate either that the Boverman results were primarily an artifact of their forced-choice methodology or that progress has been made in a more nonsexist direction among mental health professionals. Limitations of this research are presented and considered relative to the Brovermans' study. The basically attitudinal nature of this work is noted and the question is raised as to whether nonsexist attitudes are translated into nonsexist clinical functioning.     

Biobanks: Importance,Implications and Opportunities for Genetic Counselors

Biobanks are collections of human biological tissue specimens and related health data. Biobank research hopes to provide novel insights into the genetic component of disease, ultimately leading to a more personalized approach to healthcare. However, biobanks have sparked debate due to the ethical, legal, and social implications surrounding utilization of population samples and data. These controversies include issues of consent, privacy and confidentiality, return of results and data-sharing. This paper provides an overview of the different types and scope of biobanks and an examination of the most pertinent ethical, legal and social considerations surrounding such research, as well as how some of these concerns are being addressed. The paper finishes with a discussion of the relevance of biobanks to the genetic counseling field and concludes that genetic counselors are in a position to make a unique, educated and practical contribution to the ongoing dialogue and direction of biobank research.     

Sleep disturbance in intentional self-awakenings: behavior-genetic and transient factors

Unaided self-awakenings were studied, using a baseline vs treatment comparison with 84 undergraduate subjects serving as their own controls. The data suggest that situational constraints related to time and sleep environment affect successful awakenings, that the subjects' instructional set produces a temporary sleep disturbance, and that chronically sleep satisfied or dissatisfied groups respond differently to the procedures used here.     

A STAFF MANAGEMENT SYSTEM FOR MAINTAINING IMPROVEMENTS IN CONTINENCE WITH ELDERLY NURSING HOME RESIDENTS

We developed a staff management system for maintaining treatment gains achieved on a specialized continence unit located in a geriatric nursing home. Geriatric assistants learned to use a prompted voiding procedure to maintain improved dryness for 4 elderly residents. The staff management system included self-monitoring and recording of prompted voiding activities and supervisory monitoring and feedback based on group performance of these activities. Results show that the system was effective in maintaining prompted voiding activities with corresponding maintenance of improved patient continence. However, a gradual decline in staff performance was noted 4 to 5 months after the initiation of the system. During a subsequent phase of the study, provision of individual feedback restored staff performance to previous levels. Results are discussed in relation to the practicality of prompted voiding interventions in nursing home environments and the applicability of staff management systems in this setting.     

Rhythm and the timing of movement sequences

Summary Many motor skills involve a sequence of movements phased over a period of time. The present study investigated the importance of rhythmic timing structures in the acquisition and control of a serial key-pressing task. Four groups of subjects received extensive practice on 9-element finger sequences varying in the form of the inherent temporal structure. Following a training period, the stability of the various timing patterns was examined by requiring subjects to perform the key-pressing task concurrently with a verbal memory task. The memory task involved reporting back a sequence of visually-presented words with a lag of one word. A comparison was made of performance on the two tasks under dual task and control (single task) conditions. The results suggested that natural rhythmic timing structures require less attention for production than unnatural temporal patterns. A breakdown of the temporal patterns into within-group and between-group intervals showed that patterns containing within-group intervals that related as 1:1 or 1:2 evidenced good stability under dual-task conditions. These results were taken as support for the suggestion by Fraisse (1946) that the perception and production of rhythms can be understood by an internal representation that allows only two distinct durations that relate as 1:2. Furthermore, it was suggested that relative timing may become an invariant property of motor program representation only in those instances in which the timing sequence completely fits the internal timing structure.