Differentiating crisis incidents: A replication study using the action systems model

Crisis incidents are volatile situations that can pose significant risk to those involved and to law enforcement. The idiosyncratic conditions that lead to such incidents, as well as their volatility, often militate against consistent explanatory models. However, the application of overarching paradigms, such as the action systems model, has shown some promise in imposing order in the domain. Recent research has successfully differentiated crisis incidents into the four distinct modes of the action systems model: conservative, adaptive, integrative, and expressive. The purpose of this paper is to attempt to replicate this recent study using 242 cases from the United States, Ireland, Canada, and Sweden. Data analysis involves smallest space analyses and constrained multidimensional scaling. Although the results supported the underlying structure of original proposed behavioural model, there are a few deviances. These differences along with the potential influence of cultural variations, offence variable selection, the type of incident, and the sample under scrutiny are discussed. It is evident that there remain several challenges, and further research is required, prior to developing a unified framework.     

Revisiting the Psychoanalytic Object: Introduction

Senior analysts from different theoretical orientations are invited to express their conceptions of the nature of the psychoanalytic object and its place in their clinical approaches. I provide the rationale for this updated survey on the object, drawing on recent procedural notions of its formation, and on the broader range of patients now seeking help whose difficulties foreground use of the analyst-as-object. Certain common themes among the writers emerge, including concern with the dialectic of the separability and unity of subject and object. Most strongly, the object’s personalized meaning for each writer, as for all analysts, confirms its robustness and generativity as a psychoanalytic concept and entity.     

Intersectional experiences of discrimination in a low‐resource urban community: An exploratory latent class analysis

There have been increasing calls for the application of an intersectionality framework to understand and address discrimination and health inequities among diverse communities. Yet there have been theoretical debates regarding to whom intersectionality applies and how intersectional experiences of discrimination are associated with health outcomes. The current study aimed to contribute to these theoretical debates and inform practical applications to reduce health inequities. Data were drawn from a community health survey in New Haven, CT (N = 1,293 adults) and analysed using latent class analysis. Results yielded 4 classes. Members of the 4 classes were similar sociodemographically. Three classes of participants reported experiencing discrimination, and members of these classes had greater stress, higher rates of smoking and sleep disruption, and worse overall health than members of the class reporting no discrimination. Members of 2 classes made multiple, or intersectional, attributions for discrimination, and members of these classes reported the most frequent discrimination. Findings suggest that community members who are sociodemographically similar may have diverse discrimination experiences. Multilevel interventions that address multiple forms of discrimination (e.g., racism and sexism) may hold promise for reducing discrimination and, ultimately, health inequities within low‐resource urban community settings.     

Utilization of the Tablet Application Proband in Pedigree Construction and Assessment

Many medical institutions have converted to a digital model for record keeping due to the Health Information Technology for Economic and Clinical Health Act. This Act provides incentives to health care systems to accelerate and encourage the adoption of electronic health record (EHR) systems. The pedigree as a tool in medicine provides an efficient method to assess and represent an individual’s health and family health risks that may otherwise not be apparent in the medical record in a clearly identifiable way (Schuette, J. L., & Bennett 2009). Many clinicians continue to construct pedigrees using pen and paper method despite findings of improved identification of at risk patients with similar electronic intake tools (Arar et al. in Personalized Medicine 2011 8:523–32). The goal of this study was to explore the patient and practitioner experience with electronic pedigree programs using Proband, an application developed at The Children’s Hospital of Philadelphia for genetic counselors to construct pedigrees during genetic counseling sessions directly on iPads. The first part of this study looked at the patient experience and assessed time to take the pedigree and the impact of using an electronic pedigree tool on the relationship between participant and genetic counselor. This involved 50 participants and was compared with the traditional paper method of taking a pedigree. There was no statistical significance found between the two different mediums in accuracy, speed, and rapport with provider. The second part of the study assessed the usability of Proband by ten genetic counselors. Overall, the application received a system usability score of 90/100 with a majority (7/10) of counselors agreeing that they would use this application in their clinic. The positive outcome of this study encourages future work to assess the impact and usability of programs on a larger scale as they continue to integrate into current electronic health records.     

Differential Effects of Family Stress Exposure and Harsh Parental Discipline on Child Social Competence

Low family socioeconomic status (SES) is a robust risk factor for adverse child outcomes, yet the specific processes that account for this risk are not fully understood. This study examines whether and how variation in two adverse factors, stressful life events and harsh parental discipline, affect children’s social competence within a high-risk environment, and whether some children are more vulnerable to these effects than others. Data were collected from 207 families of kindergarten children at risk for behavioral maladjustment. Children’s physiological regulation (respiratory sinus arrhythmia; RSA) measured during rest was examined as a moderator of risk exposure. Results indicate that both greater exposure to life stress and harsh discipline were correlated with lower social competence. Although children’s resting RSA was not a direct predictor of their social competence, it moderated the association between life stress and social competence. Greater exposure to life stress was more strongly associated with lower social competence among children with lower resting RSA. Higher RSA may help to buffer the effects of stress and facilitate appropriate social development. RSA did not moderate the effects of harsh discipline. This differential pattern of findings suggests that children’s physiological regulation can facilitate an effective response to situational stressors, but may be less efficacious in buffering against stress in the context of the parent-child relationship.     

Parkinson’s Disease: Patients’ Knowledge,Attitudes, and Interest in Genetic Counseling

The objective of this study was to assess the genetics knowledge of patients with Parkinson’s disease (PD), and to explore their attitudes on genetic testing and interest in genetic counseling. We surveyed 158 patients from the University of Maryland Parkinson’s Disease and Movement Disorders Center. Patients averaged a score of 63% on general genetics knowledge and 73% on PD genetics knowledge. Participants had an overall positive attitude toward genetic testing: 80% believed that the use of genetic tests among people should be promoted, and 83% would undertake genetic test for PD if it was available. Patients reported a high interest to discuss the benefits, risks, and impacts of genetic testing for PD (mean sum score?=?26, range?=?9–35), and 43% patients expressed interest in meeting with a genetic counselor. Multivariate regression analysis showed that patients who had more positive attitudes toward genetic testing for PD were more interested in meeting with a genetic counselor (β?=?0.6, p?<?0.001). This study is the first to demonstrate an interest in genetic counseling among patients with PD. Our findings demonstrate a new niche for genetic counselors to support patients in clarifying gaps or misconceptions in knowledge about PD genetics as well as the possible risks, benefits, and limitations of genetic testing.     

Agents of Prosociality: Agency Affirmation Promotes Mutual Prosocial Tendencies and Behavior Among Conflicting Groups

Members of conflicting groups are motivated to restore their ingroup's agency, leading to antisocial tendencies against the outgroup. The present research tested the hypothesis that affirming conflicting groups' agency would increase their members' mutual prosociality. The effectiveness of agency affirmation was demonstrated in three contexts of conflict between groups: Switzerland and the EU following the 2014 referendum (Study 1), Israelis and Palestinians (Study 2), and Israeli rightists and leftists (Study 3). Study 1 found that in a nonconflictual context Swiss participants prioritized their moral (prosocial) over agentic goals, yet in the context of conflict with the EU, they prioritized their agentic over moral goals. This “primacy‐of‐agency” effect, however, was eliminated once their ingroup's agency was affirmed. Studies 2 and 3 demonstrated the positive effect of agency affirmation on prosociality among Israelis referring to Palestinians and Israeli rightists and leftists referring to the adversarial political camp. This effect was mediated by group members' readiness to relinquish some power for the sake of morality. Pointing to the importance of the affirmation's specific content, Studies 2 and 3 demonstrated that morality affirmation failed to increase prosociality. As such, the present research puts forward a promising strategy to reduce hostility and promote prosociality between conflicting groups.     

Acceptability,Feasibility, and Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York

Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive–compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen’s d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.     

Predictive Relationship Between Parental Beliefs and Accommodation of Pediatric Anxiety

Behavior performed by parents to assist a youth in avoiding or alleviating anxiety, known as accommodation, is ubiquitous among pediatric anxiety disorders and strongly related to poor treatment outcome. According to cognitive-behavioral theory, the beliefs parents hold regarding accommodation should predict parental accommodating behavior. Unfortunately, little is known about the beliefs parents hold regarding accommodation, as there exists no validated measure of this construct. First, the psychometric properties were examined for the Parental Accommodation Scale (PAS), a novel measure of parental accommodating behavior frequency (PAS-Behavior scale) and parental beliefs about accommodation (PAS-Belief scale). Second, the relationship between parental beliefs about accommodation and accommodation frequency was examined. Results provide preliminary evidence of the internal consistency and convergent validity of the PAS. Stronger positive beliefs about accommodation significantly predicted accommodation frequency, even after controlling for youth anxiety severity. Specifically, beliefs that accommodation prevents youth from losing behavioral and emotional control significantly predicted accommodation frequency. Therefore, efforts to decrease accommodation in clinical settings should involve correcting maladaptive parental beliefs about accommodation, with a particular emphasis on beliefs regarding the necessity of accommodation in preventing a youth from losing behavioral and emotional control.     

Guidelines to Integrate Spirituality and Spiritual Care in Occupational Therapy Education: A Modified Delphi Study

This modified Delphi study aimed to develop educational guidelines for integrating spirituality and spiritual care into occupational therapy education. The first round comprised a self-administered questionnaire, the second round used a face-to-face workshop, and last round reviewed the developed educational guidelines, which reached the highest agreement and median values greater than 3.25. A panel of 18 comprised occupational therapy educators, clinicians, and nursing experts were recruited. A total of 126 out of 142 items reached the highest agreements from the panel participants, categorized based on the content knowledge-based, importance, skills, ethics, pedagogical approaches, teaching and learning strategies, and assessment of student learning.