A systems analysis of a failure to test the effectiveness of waiting-list group therapy.

This nonexperimental effectiveness study attempted to evaluate the utility of a brief waiting-list group. The setting was a university clinic providing treatment for an inner-city population. Health delivery and staff dynamics made it difficult to conduct clinical research in this treatment-oriented setting. The nonrandom design allowed for patient choice, with few clients attending more than two group sessions, thus decreasing its impact. Managed-care pressures decreased staff cooperation with our research objectives, resulting in very low return rates in testing and follow-up data. A social systems analysis, highlighting staff and institutional ambivalence, is used to understand the failure to adequately test the effectiveness of waiting-list group therapy. Recommendations are offered to investigators who contemplate conducting clinical research with limited resources.     

The Assessment of Goal Commitment: A Measurement Model Meta-Analysis

Goals are central to current treatments of work motivation, and goal commitment is a critical construct in understanding the relationship between goals and performance. Inconsistency in the measurement of goal commitment hindered early research in this area but the nine-item, self-report scale developed by Hollenbeck, Williams, and Klein (1989b), and derivatives of that scale, have become the most commonly used measures of goal commitment. Despite this convergence, a few authors, based on small sample studies, have raised questions about the dimensionality of this measure. To address the conflicting recommendations in the literature regarding what items to use in assessing goal commitment, the current study combines the results of 17 independent samples and 2918 subjects to provide a more conclusive assessment by combining meta-analytic and multisample confirmatory factor analytic techniques. This effort reflects the first combined use of these techniques to test a measurement model and allowed for the creation of a database substantially larger than that of previously factor analyzed samples containing these scale items. By mitigating sampling error, the results clarified a number of debated issues that have arisen out of previous small sample factor analyses and revealed a five-item scale that is unidimensional and equivalent across measurement timing, goal origin, and task complexity. It is recommended that this five-item scale be used in future research assessing goal commitment. Copyright 2001 Academic Press.     

Daily hassles,ethnic identity and psychological adjustment among Lebanese‐Canadians

Acculturation, as a process of cultural change, has been related to a number of consequences including psychological distress. While some research has demonstrated how post‐migration stressors influence the adjustment of immigrants, it has been proposed that daily hassles—irritants in daily interactions—such as minor chronic problems with the in‐group and the out‐group have an even greater impact on adjustment than major life events. Furthermore, research has shown that ethnic identification profiles and discrimination are two factors closely associated with adjustment among immigrant populations. This study was, therefore, meant to further investigate the relationships among ethnic identity, discrimination (personal and collective), and adjustment (self‐esteem and depression) through a model proposing daily hassles as a mediator among these factors. There were 100 first‐ and second‐generation Lebanese‐Canadians who participated in the study. They completed a questionnaire measuring ethnic identification to their in‐ and out‐group, discrimination, hassles experienced with their in‐ and out‐group, depression, and self‐esteem. Path analyses revealed the mediating role of daily hassles between identity and discrimination, on the one hand, and indices of depression and self‐esteem, on the other. The results also demonstrated that greater experienced personal discrimination was associated with higher levels of experienced out‐group hassles and more out‐group hassles related to lower levels of adjustment. Processes of identity revealed that a higher level of Lebanese identity was associated with less experienced in‐ and out‐group hassles, which positively related to better adjustment. However, Canadian identity directly and positively related to depression. These results are discussed, first, with respect to their implications for current theorizing regarding the process of acculturation. Daily hassles would indeed now stand as a key mediating factor in the explanation of adjustment among immigrants. Second, the findings are deemed to have practical implications in term of the direction of programmes aimed at alleviating acculturative stress.     

Addressing Relationship Health Needs in Primary Care: Adapting the Marriage Checkup for Use in Medical Settings with Military Couples

The overall objective of this study was to pilot the Marriage Checkup (MC), a brief intervention for enhancing marital resiliency tailored to a military population, for use by internal behavioral health consultants (IBHCs) working in an integrated primary care clinic. The MC was revised to fit into the fast-paced environment of primary care (e.g., streamlined to fit within three 30-min appointments), and military-relevant material was added to the content. IBHCs working in primary care were then trained to offer the intervention. Thirty participants were enrolled in the study and completed a relationship checkup and one-month follow-up questionnaires. Analysis of post-test and one-month follow-up data showed statistically significant improvements in participants’ marital health compared to pre-treatment. The MC intervention appeared to be well received by both couples and IBHCs.     

Therapy Expectations of Adolescents with Depression Entering Psychodynamic Psychotherapy: A Qualitative Study

Patient expectations about therapy have been regarded as a common factor affecting the course and outcome of psychotherapy. However, little is known about the expectations of adolescents. We aimed to explore the therapy expectations of young people (YP) with depression prior to psychotherapy. We conducted semi-structured interviews with six YP (5 female, 15–19 years old) entering psychodynamic outpatient treatment. Interviews were transcribed verbatim and analyzed using Interpretative Phenomenological Analysis. The careful analysis of the YPs’ accounts yielded the following four key themes: not knowing but being cautiously hopeful; therapy as a long and difficult process; therapy as a place to understand oneself and to develop; and the importance of the professional and interpersonal skills of the therapist. The findings suggest to foster realistic treatment and outcome expectations while at the same time individual therapists should pay careful attention to the specific expectations that YP bring into therapy.     

Describing Trajectories of Homeless Service Use in Hawai‘i Using Latent Class Growth Analysis

The State of Hawai‘i, like many other areas across the United States, has large numbers of individuals and families experiencing homelessness, many of whom seek support through statewide shelters and services. This study explored the diversity of ways in which individuals and families moved through Hawai‘i's homeless service system. Using administrative data, a cohort of new service users was tracked across time to trace the developmental trajectories of their homeless service use. The sample consisted of adults who had entered the service system for the first time in the fiscal year (FY) of 2010 (N = 4655). These individuals were then tracked through the end of FY 2014, as they used emergency shelter, transitional shelter, and outreach services. A latent class growth analysis was conducted and identified four distinct patterns of service use: low service use (n = 3966, 85.2%); typical transitional shelter use (n = 452, 9.7%); atypical transitional use (n = 127, 2.7%), and potential chronic service use (n = 110, 2.4%). Multinomial logistic regression models were then used to determine if select demographic, family, background experience (e.g., education, employment), or health variables were associated with class membership. The distinct profiles for class membership are discussed.     

Cognitive and attentional functioning in adolescents and young adults with Tetralogy of Fallot and d-transposition of the great arteries

The objective of this study is to investigate cognitive and attentional function in adolescents and young adults with operated congenital heart disease. Previous research has indicated that children with congenital heart disease have deficits in broad areas of cognitive function. However, less attention has been given to survivors as they grow into adolescence and early adulthood. The participants were 18 non-syndromic adolescents and young adults with tetralogy of Fallot and d-transposition of the great arteries that required cardiac surgery before the age of 5 years, and 18 healthy, unaffected siblings (11–22 years of age for both groups). Cases with congenital heart disease and their siblings were administered Wechsler Intelligence scales and reported attention problems using the Achenbach System of Empirically Based Assessments. Cases were compared to both healthy siblings and established norms. Cases performed significantly lower than siblings on full scale IQ and processing speed, and significantly lower than norms on perceptual reasoning. Cases also reported more attention problems compared to both siblings and norms. Effect sizes varied with medium-to-large effects for processing speed, perceptual reasoning, working memory, and attention problems. Findings suggest that neurocognitive function may continue to be affected for congenital heart disease survivors in adolescence and young adulthood, and that comparisons to established norms may underestimate neurocognitive vulnerabilities.