Trends in Telehealth versus On-site Clinical Genetics Appointments in Manitoba: A Comparative Study

Telehealth involves the use of information and communications technology to deliver health services to patients over distance. Canada is well suited to benefit from telehealth since many individuals live in remote, rural and isolated locations. Manitoba is the easternmost prairie province and MBTelehealth is an active Canadian program that currently has 105 sites in 73 communities. Although studies of patient satisfaction comparing telehealth to on-site clinical visits have been conducted, a comparative study of the types of genetics patients seen via these two modalities has not been performed previously. In this study we: (1) examined the uptake of telehealth in Genetics in Manitoba; (2) contrasted telehealth usage in Genetics with other clinical programs; and (3) performed a comparative study of the types of Genetics referrals seen in 2008 on-site versus via telehealth. Results indicate the uptake of telehealth is increasing and has made genetics outreach clinics unnecessary. The Program of Genetics and Metabolism is consistently one of the top ten utilizers of telehealth within the province. With respect to discipline, chi square analysis revealed the trends were not significantly different for on-site and telehealth encounters, with prenatal referrals being the most common and Hereditary Breast and Ovarian Cancer referrals being the least common. Referrals within each discipline varied depending on the need for fetal assessment and physical examination. Telehealth was utilized regularly for test results sessions across all disciplines.     

Immigrant Youth and Employment: Lessons Learned from the Analysis of LSIC and 82 Lived Stories

Finding a job has become a critical challenge to many youth. Immigrant youth, who have been a key part of the global migrants, are particularly vulnerable when entering the job market of the host country due to various structural barriers. However, in both public policy discourse and research, their labour market experience tends to be overlooked. In this paper, we report the employment experience of recently arrived immigrant youth based on an analysis of the LSIC and findings of in-depth interviews of 82 immigrant youth in four cities in Canada. Our results reveal that recently arrived immigrant youth tend to work in lower-skilled employment, experience significant delays in finding employment, have difficulties with foreign credential recognition, and have fewer means to access to job markets.     

Six-Year Sustainability of Evidence-Based Intervention Implementation Quality by Community-University Partnerships: The PROSPER Study

There is a knowledge gap concerning how well community-based teams fare in implementing evidence-based interventions (EBIs) over many years, a gap that is important to fill because sustained high quality EBI implementation is essential to public health impact. The current study addresses this gap by evaluating data from PROSPER, a community-university intervention partnership model, in the context of a randomized-control trial of 28 communities. Specifically, it examines community teams' sustainability of implementation quality on a range of measures, for both family-focused and school-based EBIs. Average adherence ratings approached 90% for family-focused and school-based EBIs, across as many as 6 implementation cohorts. Additional indicators of implementation quality similarly showed consistently positive results. Correlations of the implementation quality outcomes with a number of characteristics of community teams and intervention leaders were calculated to explore their potential relevance to sustained implementation quality. Though several relationships attained statistical significance at particular points in time, none were stable across cohorts. The role of PROSPER's continuous, proactive technical assistance in producing the positive results is discussed.     

Maternal Depressive Symptoms and Child Social Preference During the Early School Years: Mediation by Maternal Warmth and Child Emotion Regulation

This longitudinal study examined processes that mediate the association between maternal depressive symptoms and peer social preference during the early school years. Three hundred and fifty six kindergarten children (182 boys) and their mothers participated in the study. During kindergarten, mothers reported their level of depressive symptomatology. In first grade, teachers rated children’s emotion regulation at school and observers rated the affective quality of mother-child interactions. During second grade, children’s social preference was assessed by peer nomination. Results indicated that mothers’ level of depressive symptomatology negatively predicted their child’s social preference 2 years later, controlling for the family SES and teacher-rated social preference during kindergarten. Among European American families, the association between maternal depressive symptoms and social preference was partially mediated by maternal warmth and the child’s emotion regulation. Although the relation between maternal depressive symptoms and children peer preference was stronger among African American families than Europrean American families, its mediation by the maternal warmth and child’s emotion regulation was not found in African American families.     

What is Happening With Bill and Jane?

In this comment I applaud Goldner’s ability to capture couple experience and dynamics while emphasizing that coupling involves more than attachment. In my view, couple conflict and therapy involves attending not only to attachment, which involves closeness and the threat of separation, but also to issues of identity, self-definition, and shame. I point out how some of the interactions and dynamics in the case discussed involve a threat to identity through invalidation more than to attachment by abandonment. As Goldner notes, mutual recognition between people is the cornerstone of the relational ideal, and it is for recognition through being seen, and validated for which Bill and Jane fight so hard, not closeness. In my view not everything in couples is about regulating attachment; rather everything is probably about regulating affect. Attachment is one, but only one, of the ways couples regulate their affect.     

Using Coaching to Support Teacher Implementation of Classroom-based Interventions

Despite the growing evidence base for the efficacy of preventive interventions, the level of implementation of these interventions in schools is often less than optimal. One promising approach to supporting teachers in implementation of interventions is the use of coaching. In this study, teachers were trained in a universal classroom management intervention and provided ongoing coaching. The association between the type and amount of coaching activities and teacher implementation of proactive classroom management over time were investigated. Results indicated that teachers who received more performance feedback had higher levels of implementation over time in comparison with teachers who received less feedback. In addition, a significant interaction between the amount of coaching a teacher received and his or her implementation of proactive classroom management was found. Increased implementation over time was observed for teachers with lower initial levels of implementation who received more coaching, whereas implementation decreased over time for teachers who received less coaching. The importance of coaching as a support system for enhancing implementation quality of classroom-based preventive interventions is discussed.     

Leaving the Church Behind: Applying a Deconversion Perspective to Evangelical Exit Narratives

The motivating factors and structural processes of religious exits have been important inquiries in the sociology of religion and are increasingly important to the field of non-religious studies. Based on qualitative research with 20 former post-Boomer Evangelical Christians, this article takes a phenomenological–hermeneutical approach to understanding religious exiting by examining narratives of deconversion. The narrative data presented in this article depict Evangelical exits from a deconversion perspective where exiters emphasize breaking away from the constraints of hegemonic Christianity rather than turning to secularity. The findings suggest that framing the intentional rejection of faith as ‘deconversion’ transforms exit narratives into a necessary cultural repertoire that encourages individuals to challenge religious domination and makes finding acceptance and validation easier in an established community of non-believers. By emphasizing the negative impact of religion, even after non-religious worldviews have been adopted, deconverts come to know who they currently are in the light of who they once were.     

Comparing Holographic Reprocessing and Prolonged Exposure for Women Veterans with Sexual Trauma: A Pilot Randomized Trial

This pilot study compares an emerging evidence-based treatment, holographic reprocessing (HR) to prolonged exposure (PE) versus a person-centered (PC) control group to treat symptoms of distress in female Veterans with sexual trauma. In contrast to PE, HR does not include exposure to a target event of trauma. Instead, HR focuses on healing the internal working model or type of attachment style that may form as a result of interpersonal trauma or maltreatment. The model reveals how people perceive themselves and others. These perceptions set in motion emotional, cognitive, and behavioral tendencies wherein people unconsciously replicate similar types of relationships that reinforce their worldview. Fifty-one female Veterans with sexual trauma were randomly assigned to one of three treatments and completed pre- and post-treatment measures of psychiatric symptoms (anxiety, depression, and PTSD) and post-traumatic cognitions. ANOVAs found significant decreases on all variables. Post-hoc comparisons revealed that HR and PE treatments demonstrated significantly greater decreases in symptoms compared to the PC control group. Chi square analyses revealed that HR produced a significantly lower dropout rate 1 (6 %) compared to PE 7 (41 %) and PC 6 (35 %). These initial results are promising and further investigation of HR is warranted.     

Adapting Parent–Child Interaction Therapy for Deaf Families That Communicate via American Sign Language: A Formal Adaptation Approach

While our field has made positive strides in adapting psychotherapeutic interventions for diverse groups of people, considerable work is still needed in this area. We present our formal adaptation procedure for parent–child interaction therapy (PCIT) with Deaf persons. This includes a review of the cultural adaptation process for psychological interventions, including PCIT, as well as an introduction to Deaf culture. Details regarding the specific adaptation of PCIT for Deaf persons are outlined. We found that the utilization of a clear framework to guide the cultural adaptation process facilitated careful consideration of the numerous linguistic and cultural variables involved, while maintaining integrity of the treatment model. While the current focus was on adapting PCIT for Deaf families who communicate via American Sign Language, this framework can also be applied to other populations and/or interventions.