Cystic Fibrosis Prenatal Screening in Genetic Counseling Practice: Recommendations of the National Society of Genetic Counselors

For over a decade, prenatal screening for cystic fibrosis (CF) has been considered a model for the integration of genetic testing into routine medical practice. Data from pilot studies and public policy discourse have led to recommendations by some professional organizations that CF screening should be offered or made available to pregnant women and their partners, and to couples planning a pregnancy. It is crucial that genetic counselors gain thorough understanding of the complexities of CF and the implications of positive test results, so that they may serve as a reliable, educated referral base and resource for health care providers and their patients. While not all pregnant women will be referred for genetic counseling prior to CF carrier testing, genetic counselors often will be asked to counsel clients after they have a positive test result, or who are found to be at increased risk. Genetic counselors can play an important role in providing accurate and current information as well as support for patients informed decisions. These recommendations were created by a multicenter working group of genetic counselors with expertise in CF and are based on personal clinical experience, review of pertinent English language medical articles, and reports of expert committees. The recommendations should not be construed as dictating an exclusive course of management, nor does the use of such recommendations guarantee a particular outcome. These recommendations do not displace a health care providers professional judgment based on the clinical circumstances of a particular client.     

Spatial probability as an attentional cue in visual search

We investigated the role of spatial probabilities in target location during participants' performance of a visual search task. Experiments 1 and 2 demonstrated that spatial probabilities could serve as a powerful attentional bias that produced faster detection of targets in high-probability locations than of those in low- or random-probability locations. The effect could not be explained by repetition priming alone. Moreover, responses to targets in low-probability locations were slowed only when a distractor was present in the high-probability location. In Experiments 3-5, we compared the effects of spatial probability with an explicit endogenous cue and a salient exogenous cue. Facilitation due to spatial probability was independent of any benefit afforded by the explicit endogenous cue but interacted with the salient exogenous cue, such that the exogenous cue validity effect was compressed for targets in the high-probability location. Together, these results suggest that the spatial probabilities governing target location constitute a potent bias of visual processing and, as such, can be considered an attentional cue that differs from both typical explicit endogenous and salient exogenous cues.     

A Recursive Frame Qualitative Analysis of MFT Progress Note Tipping Points

Medically oriented psychotherapists typically record progress notes by articulating client symptoms, diagnoses, functional status, progress, and adherence to treatment plans. This orientation can challenge marriage and family therapists working from discursive or post-modern perspectives. Although there are discursive therapy friendly treatment planning guides, no published research on such practice exists. To address this gap the researchers conducted a recursive frame qualitative analysis of 206 de-identified progress notes from 30 completed cases seen by MFT master’s students learning discursive approaches to therapy in a university-based training clinic. Researchers found students noted problem to solution-focused discourse tipping or turning points in 20 cases with positive outcomes and no comparable shifts in 10 cases with negative or unclear outcomes.     

Clinical Supervision Dilemmas Related to Child Abuse in Wraparound Treatment

We conducted two separate, exploratory studies to evaluate the differences between the supervision of wraparound (in-home) and outpatient (office) child treatment interventions. Study one (n = 96) examined the structure and norms of supervision between groups as well as rates of general disclosure to direct supervisors. Study two (n = 116) specifically examined the frequency of child abuse and neglect encountered in each intervention setting, and the level of disclosure in supervision of these mandatory reporting events. Findings from the first study suggest that wraparound clinicians received significantly less individual supervision and colleague consultation than their office-based counterparts. Additionally, wraparound clinicians were significantly more likely to withhold information about client cases from their direct supervisors. In the second study, wraparound clinicians endorsed significant increases for observed child abuse, observed child neglect, and verbally reported child neglect compared to their office-based counterparts. In regards to mandatory reporting issues with children, wraparound clinicians were found to be significantly less likely to disclose issues pertaining to child neglect to their direct supervisors than office-based clinicians. Our studies show preliminary evidence for a needed increase of individual supervision in wraparound practice, in addition to a greater focus on clinician disclosures related to incidents of child abuse and neglect.     

Moderators of the Relationship Between Maternal Substance Abuse Symptoms and Preschool Children’s Behavioral Outcomes

While maternal substance use problems increase the likelihood of behavior problems in children, child outcomes are varied, leading to interest in understanding additional family factors that contribute to the development of behavior problems in children impacted by maternal substance abuse. The purpose of this study is to examine harsh parenting and family conflict as potential moderators of the relationship between symptoms of maternal substance use problems and child externalizing behavior problems. The non-clinical sample for this study included 250 low-income parents whose preschool age children were enrolled in Head Start programs in a Southern state. This study utilized data collected during two home visits, an average of 10 months apart, with data on family functioning and maternal symptoms of substance use problems collected at the first time point and child externalizing behavior collected at the second time point. Over one-third of the children (38.1 %) had clinically elevated externalizing behavior scores. We used regression analysis to examine whether harsh parenting or family conflict moderated the relationship between maternal substance use symptoms and child externalizing behavior. In this community sample, we found that in the absence of family risks related to harsh parenting and family conflict, maternal symptoms of substance use problems did not have a significant impact on child externalizing behavior in preschool children. However, when high levels of family conflict or harsh parenting were present, symptoms of maternal substance use problems increased the risk of externalizing behavior problems in children.     

The child as held in the mind of the mother: The influence of prenatal maternal representations on parenting behaviors

Using a longitudinal design, this study examined the relationship of a mother's prenatal representation of her child and her parenting behavior with that child at 1 year of age in a sample of women who were either exposed or not exposed to intimate partner violence (IPV) (N = 164; M child age = 1.1 years, SD = .11 years; 52% male). Controlling for prenatal IPV, a MANCOVA analysis revealed that prenatal representational typology was significantly related to parenting behavior 1 year postpartum. Mothers whose representations were affectively deactivated (disengaged) were more behaviorally controlling with their children. Mothers whose representations were affectively overactivated (distorted) were more hostile with their children. Mothers with balanced representations demonstrated more positive parenting. Exposure to IPV did not moderate this relationship. There was no direct association between prenatal or postnatal IPV and parenting behavior. These findings suggest that prenatal representations influence postnatal parenting behavior in significant and theoretically consistent ways and that this relationship functions similarly for both abused and nonabused women. Results add to the growing literature that internal representations serve to guide behavior throughout development and suggest that maternal working models may be one important link in the intergenerational transmission of attachment relationships.     

An Event History Analysis of First-Term Soldier Attrition

The study of attrition has largely focused on identifying demographic or biographic characteristics that predict whether soldiers complete their enlistment term. As a result, much is known about who attrites. Less is known about why soldiers attrite. This research assessed the influence of two psychological factors on U.S. Army soldier attrition: self-reported confidence that one could complete one’s term of service and ambivalence regarding the decision to enlist. The study sample consisted of first-term enlisted soldiers (N = 14,808) who were respondents to Army surveys. Results of fitting three longitudinal models indicated that confidence in being able to complete one’s term of obligation was more predictive of attrition for those reporting greater ambivalence regarding the decision to enlist. This effect was significant throughout a 3-year period. This work adds to our understanding of attrition by highlighting the role of confidence and ambivalence. Implications for strategies to reduce attrition are discussed.