Using empowerment theory in collaborative partnerships for community health and development

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development. This work was supported by Kansas Health Foundation Grants 9206032B and 9206032A to support and evaluate community partnerships to prevent adolescent substance abuse. Thanks to Tom Wolff for sharing his wisdom about community coalitions so generously, and to Bill Berkowitz and anonymous reviewers for thoughtful comments on an earlier version of this manuscrpt. We also thank our colleagues from the Kansas Health Foundation, Mary K. Campuzano, Steve Coen, and Marni Vliet, and those from collaborating communities, who continue to teach us about ways to enhance community capacities to address local concerns.     

The effects of varied retrieval cues on reminiscence in eyewitness memory

Eyewitnesses sometimes recall things at later interviews that they did not recall at previous interviews (reminiscence). When these cases are argued in the courtroom, attorneys may claim (and judges may warn jurors) that eyewitnesses who provide reminiscences are necessarily inaccurate witnesses. Consequently, their testimony may be prematurely discredited or dismissed. We examined here the role of varying the retrieval cues across interviews to account for reminiscence. Participants watched a videotaped mock crime and were tested for recall on two occasions using the same or different cues. Results supported the hypothesis that varying retrieval cues increases the amount of reminiscence. Furthermore, nearly all participants exhibited some reminiscence. Finally, reminiscence was not significantly correlated with overall accuracy of testimony. These findings suggest that many of the assumptions underlying legal tactics and judges' instructions regarding reminiscent inconsistencies are erroneous. Copyright © 2006 John Wiley & Sons, Ltd.     

Diagnostic Comorbidity in Adults With Generalized Anxiety Disorder: Impact of Comorbidity on Psychotherapy Outcome and Impact of Psychotherapy on Comorbid Diagnoses

The current study examined the impact of comorbidity on cognitive and behavioral therapies for generalized anxiety disorder (GAD) as well as the impact of these therapies on diagnoses comorbid to GAD. Seventy-six treatment-seeking adults with principal diagnoses of GAD received 14 sessions of therapy. Most (n = 46; 60.5%) of the sample had at least one comorbid diagnosis. Although the presence of comorbid diagnoses was associated with greater severity of GAD symptoms at pretreatment, greater severity of comorbid major depression, simple phobia, and social phobia was associated with greater change in symptoms of GAD in response to treatment, with no effect on maintenance of gains during a 2-year follow-up. Further, psychotherapy for principal GAD led to a reduction in number of comorbid diagnoses and in severity of social phobia, simple phobia, and major depression at posttreatment. At 2-year follow-up severity of social and simple phobia remained below pretreatment levels, whereas severity of depression was no longer significantly below pretreatment levels. These results suggest that although people with comorbid disorders enter treatment with more severe GAD symptomatology, they demonstrate greater change, and therefore such comorbidity does not diminish the efficacy of cognitive and behavioral therapies for GAD. In addition, the impact of these treatments for GAD may generalize to reduced severity of simple phobia, social phobia, and major depression; however, gains in severity of major depression are not maintained.     

Preliminary evidence of the impact of early childhood maltreatment and a preventive intervention on neural patterns of response inhibition in early adolescence

Maltreated youths in foster care often experience negative developmental and psychological outcomes, which have been linked with poor response inhibition. Recent evidence suggests that childhood maltreatment is also associated with alterations in the neural circuitry underlying response inhibition. However, a burgeoning line of research has begun to explore the mitigating effects of preventive interventions on neural functioning. The current study used event‐related functional magnetic resonance imaging to explore the impact of early childhood maltreatment and a preventive intervention on response inhibition in early adolescence. Thirty‐six demographically similar adolescents (ages 9–14 years) completed a Go/NoGo task. The sample included nonmaltreated adolescents (n = 14) and maltreated adolescents who were in foster care as preschoolers and randomly assigned to receive services as usual (n = 11) or a preventive intervention, Multidimensional Treatment Foster Care for Preschoolers (n = 11). The groups demonstrated similar behavioral performance but significantly different neural patterns. The maltreated adolescents who received services as usual demonstrated subcortical hypoactivity during successful response inhibition and subcortical hyperactivity during unsuccessful response inhibition. In contrast, the nonmaltreated adolescents and maltreated adolescents who received the intervention exhibited strikingly similar neural patterns during successful response inhibition, but the maltreated adolescents who received the intervention demonstrated prefrontal hypoactivity during unsuccessful response inhibition. These findings offer preliminary evidence that early childhood maltreatment alters the neural patterns underlying response inhibition in early adolescence and that participating in a preventive intervention could mitigate maltreatment‐related effects on these neural systems.     

Identifying and Addressing Barriers to Treatment Decision‐making in Bipolar II Disorder: Clinicians’ Perspective

Objective

Treatment decision‐making in bipolar II disorder is complex due to limited evidence on treatment efficacy and potentially burdensome side‐effects of options. Thus, involving patients and negotiating treatment options with them is necessary to ensure that final treatment decisions balance both clinician and patient preferences. This study qualitatively explored clinician views on (a) effective treatment decision‐making, unmet patient needs for (b) decision‐support and (c) information.

Method

Qualitative semi‐structured interviews with 20 practising clinicians (n = 10 clinical psychologists, n = 6 general practitioners, n = 4 psychiatrists) with experience treating adult outpatients with bipolar II disorder were conducted. Interviews were audiotaped, transcribed verbatim and analysed thematically using framework methods. Self‐report professional experience, and clinician preferences for patient decision‐making involvement were also assessed.

Results

Qualitative analyses yielded two inter‐related themes: (a) challenges and barriers to decision‐making and (b) facilitators of clinician decision‐making. Symptom severity, negative family attitudes, system‐based factors, and information gaps were thought to pose challenges to decision‐making. By contrast, decision‐making was supported by patient information, family involvement and patient‐centredness, and a strong therapeutic relationship. Clinician views varied depending on their professional background (medical vs clinical psychologist), patient involvement preferences, and whether the clinician was a bipolar specialist.

Conclusions

Whilst clinicians uniformly recognise the importance of involving patients in informed treatment decision‐making, active patient participation is hampered by unmet informational and decision‐support needs. Current findings inform a number of bipolar II disorder‐specific, clinician‐endorsed strategies for facilitating patient decision‐making, which can inform the development of targeted patient decision‐support resources for use in this setting.     

A multicomponent approach to thinning reinforcer delivery during noncontingent reinforcement schedules

We evaluated a noncontingent reinforcement procedure that involved initially providing three subjects with signaled, continuous access to the functional reinforcer for aggression and slowly increasing the amount of time subjects were exposed to the signaled unavailability of the reinforcer. Additionally, alternative potential reinforcers were available throughout the sessions. Results showed immediate and substantial reductions in aggression for all three subjects. The clinical utility of this intervention is discussed, and future research directions are recommended.     

Remote treatment of sleep‐related trichotillomania and trichophagia

We used a biobehavioral treatment consisting of melatonin and a standardized bed and wake time to decrease one girl's head and mouth touches associated with sleep‐related trichotillomania and trichophagia. We remotely coached the girl's caregiver to implement all procedures and monitored response to treatment using a DropCam Pro video camera equipped with night‐vision capabilities. Head and mouth touches decreased, and her sleep pattern improved with the combination of treatment strategies. We discuss our use of a novel mode of service delivery to treat sleep‐related problem behavior.     

Further evaluation of differential exposure to establishing operations during functional communication training

Recent research findings (DeRosa, Fisher, & Steege, 2015 ) suggest that minimizing exposure to the establishing operation (EO) for destructive behavior when differential reinforcement interventions like functional communication training (FCT) are introduced may produce more immediate reductions in destructive behavior and prevent or mitigate extinction bursts. We directly tested this hypothesis by introducing FCT with extinction in two conditions, one with limited exposure to the EO (limited EO) and one with more extended exposure to the EO (extended EO) using a combined reversal and multielement design. Results showed that the limited‐EO condition rapidly reduced destructive behavior to low levels during every application, whereas the extended‐EO condition produced an extinction burst in five of six applications. We discuss these findings in relation to the effects of EO exposure on the beneficial and untoward effects of differential reinforcement interventions.     

The Curse of Expertise: When More Knowledge Leads to Miscalibrated Explanatory Insight

Does expertise within a domain of knowledge predict accurate self‐assessment of the ability to explain topics in that domain? We find that expertise increases confidence in the ability to explain a wide variety of phenomena. However, this confidence is unwarranted; after actually offering full explanations, people are surprised by the limitations in their understanding. For passive expertise (familiar topics), miscalibration is moderated by education; those with more education are accurate in their self‐assessments (Experiment 1). But when those with more education consider topics related to their area of concentrated study (college major), they also display an illusion of understanding (Experiment 2). This “curse of expertise” is explained by a failure to recognize the amount of detailed information that had been forgotten (Experiment 3). While expertise can sometimes lead to accurate self‐knowledge, it can also create illusions of competence.     

Predictors of Mental Health Among College Students in Guam: Implications for Counseling

The authors investigated sociodemographic predictors of the mental health status of college students (N = 308) in Guam. Results indicated prevalence rates of 17.8%, 40.2%, and 25.6% for moderate or more severe levels of depression, anxiety, and stress, respectively. Psychological distress was found to be predicted by gender, ethnicity, living arrangement, and academic level. Comparisons with college students in the U.S. mainland and Hong Kong were also examined. Implications for counseling services and strategies are discussed.