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.     

Patients’ Views of Treatment-Focused Genetic Testing (TFGT): Some Lessons for the Mainstreaming of <Emphasis Type="Italic">BRCA1</Emphasis> and <Emphasis Type="Italic">BRCA2</Emphasis> Testing

This paper explores patients’ views and experiences of undergoing treatment-focused BRCA1 and BRCA2 genetic testing (TFGT), either offered following triaging to clinical genetics (breast cancer) or as part of a mainstreamed care pathway in oncology (ovarian cancer). Drawing on 26 in-depth interviews with patients with breast or ovarian cancer who had undergone TFGT, this retrospective study examines patients’ views of genetic testing at this point in their care pathway, focusing on issues, such as initial response to the offer of testing, motivations for undergoing testing, and views on care pathways. Patients were amenable to the incorporation of TFGT at an early stage in their cancer care irrespective of (any) prior anticipation of having a genetic test or family history. While patients were glad to have been offered TFGT as part of their care, some questioned the logic of the test’s timing in relation to their cancer treatment. Crucially, patients appeared unable to disentangle the treatment role of TFGT from its preventative function for self and other family members, suggesting that some may undergo TFGT to obtain information for others rather than for self.     

Creation and Implementation of an Environmental Scan to Assess Cancer Genetics Services at Three Oncology Care Settings

An environmental scan (ES) is an efficient mixed-methods approach to collect and interpret relevant data for strategic planning and project design. To date, the ES has not been used nor evaluated in the clinical cancer genetics setting. We created and implemented an ES to inform the design of a quality improvement (QI) project to increase the rates of adherence to national guidelines for cancer genetic counseling and genetic testing at three unique oncology care settings (OCS). The ES collected qualitative and quantitative data from reviews of internal processes, past QI efforts, the literature, and each OCS. The ES used a data collection form and semi-structured interviews to aid in data collection. The ES was completed within 6 months, and sufficient data were captured to identify opportunities and threats to the QI project’s success, as well as potential barriers to, and facilitators of guideline-based cancer genetics services at each OCS. Previously unreported barriers were identified, including inefficient genetic counseling appointment scheduling processes and the inability to track referrals, genetics appointments, and genetic test results within electronic medical record systems. The ES was a valuable process for QI project planning at three OCS and may be used to evaluate genetics services in other settings.     

Functional Communication Training and Demand Fading Using Concurrent Schedules of Reinforcement

Demand fading, a schedule thinning procedure for escape-maintained behaviors, typically includes an escape extinction component. The purpose of this study was to examine the effectiveness of demand fading with alternative reinforcement utilizing concurrent reinforcement schedules without extinction. During demand fading, aggression and requests emitted prior to meeting the task completion criterion were reinforced with short, low-quality breaks, but requests emitted following the task completion criterion were reinforced with long, high-quality breaks. Results suggest that concurrent schedules of reinforcement may be an effective alternative to extinction as a component of demand fading.     

Cross-Age Peer Tutoring and Fluency-Based Instruction to Achieve Fluency with Mathematics Computation Skills: A Randomized Controlled Trial

The current study employed a randomized controlled trial to evaluate the use of peer tutoring and fluency-based instruction to increase mathematics fluency with addition and subtraction computation skills. Forty-one elementary school students between the ages of eight and 12 years participated in the 8-week study using cross-age peer tutoring, Say All Fast Minute Every Day Shuffled, frequency building, and the morningside math facts curriculum (Johnson in Morningside mathematics fluency: math facts (vol 1–6; curriculum program), Morningside Press, Seattle, 2008). Pre- and post-test measures of mathematics fluency and calculation were conducted with all participants. A measure of social skills and competing problem behaviors was also conducted at pre- and post-testing to evaluate any additional effects of the peer tutoring model. The results demonstrated a statistically significant difference between groups on measures of mathematics fluency, with the experimental group demonstrating significantly higher scores than the control group at post-testing. There were no significant differences between groups on measures of social skills and competing problem behaviors or calculation. The findings indicate that cross-age peer tutoring and fluency-based instruction resulted in positive outcomes for tutees in the mathematics domain, specifically mathematics fluency.     

A Comparison of the Taped Spelling Intervention and Cover,Copy, and Compare for Students with Learning Disabilities

This study evaluated the effectiveness and compared the efficiency of two interventions on the spelling performance of four fifth-grade students with learning disabilities in reading and writing. The first intervention, Cover, Copy, and Compare (CCC), is an established, evidence-based procedure, while the second, the Taped Spelling Intervention (TSI), is a new procedure with only one published article establishing its effectiveness at the time of this study. Although both interventions resulted in spelling performance gains, learning speed was higher in the CCC condition and students overwhelmingly reported preferences for CCC over TSI. Spelling gains were maintained on assessments administered approximately two weeks following the final intervention sessions for both interventions. Discussion focuses on the importance of easily implemented, socially acceptable, time- and resource-efficient interventions for increasing the academic performance of students, and the value of comparative analyses for choosing appropriate interventions.     

The Parenting and Family Adjustment Scales (PAFAS): an Indonesian Validation Study

Understanding parenting risk and protective factors can help clinicians and researchers to develop effective family interventions. To have knowledge of these risk and protective factors, validated assessment tools are required. Validation studies for parenting measures with Indonesian parents are lacking, despite the need for access to parenting interventions among Indonesian families. This study aimed to validate the Parenting and Family Adjustment Scales (PAFAS), a brief parenting and family adjustment measure developed in Australia that has been validated with Panamanian and Chinese parents. A sample of 210 Indonesian parents with children aged 2–12 years old completed the Indonesian version of the PAFAS and Child Adjustment and Parent Efficacy Scale (CAPES). Confirmatory Factor Analysis (CFA) and Structural Equation Modelling (SEM) were used for analyses. CFA resulted a four-factor PAFAS Parenting scale (15 items) and three-factor PAFAS Family adjustment scale (8 items). SEM analyses with PAFAS and CAPES revealed a good fit of the model of relationships between parent, family and child constructs to the data. The internal consistencies of PAFAS were good or acceptable, with the exception of Parental consistency. Overall, PAFAS had satisfactory psychometric properties. It is a promising measure that can potentially be used to study parenting risk and protective factors among Indonesian families. Item improvement and further validation with more diverse samples are suggested.     

Daily Peer Hassles and Non-Suicidal Self-Injury in Adolescence: Gender Differences in Avoidance-Focused Emotion Regulation Processes

This study aimed to examine the mediating role of rumination, experiential avoidance, dissociation and depressive symptoms in the association between daily peer hassles and non-suicidal self-injury among adolescents. Additionally, this study explored gender differences in these associations and tested whether the proposed model was invariant across genders. The sample consisted of 776 adolescents, of them 369 are males (47.6%) and 407 are females (52.4%), aged between 12 and 18 years old from middle and high schools in Portugal. Participants completed self-report questionnaires to assess daily peer hassles, rumination in its severe component (i.e., brooding), experiential avoidance, dissociation, depressive symptoms and non-suicidal self-injury. Path analysis showed that daily peer hassles indirectly impact on non-suicidal self-injury through increased levels of brooding, experiential avoidance, dissociation, and depressive symptoms. Results indicated significant gender differences in mean scores and path analysis. Male adolescents were more likely to engage in brooding and experiential avoidance in response to external distress (particularly, daily peer hassles), whereas female adolescents were more likely to engage in non-suicidal self-injury in response to internal distress (particularly, depressive symptoms). These findings suggest relevant preventive and intervention actions to address emotion dysregulation in adolescence, by teaching them acceptance and mindfulness skills as a way of coping with stressful experiences and internal distress.     

The Role of Reflective Functioning in Predicting Marital and Coparenting Quality

Reflective functioning (RF) is a measure of mentalization—the capacity to think about one’s own and others’ thoughts and feelings and to understand the connections between mental states and behaviors. Previous research indicates a decline in marital quality across the transition to parenthood, and some studies have found that parents are less happy than non-parents. Thus, researchers have called for research into possible moderators of these patterns. RF may help couples navigate this transition by more easily taking each other’s (and the infant’s) perspective and understanding each other’s behaviors. Much of the research on RF has focused on mothering behavior; research has not yet examined associations between RF and other family interactions. We examined associations between RF and marital and coparenting quality for both wives and husbands. Reflective functioning was coded from Adult Attachment Interviews conducted during pregnancy. We assessed marital quality at 3.5 months, and coparenting quality at 13 months, after the birth of the target child. Wives’ higher RF was associated with higher levels of positive—and lower levels of negative—marital and coparenting interactions. Wives who were better able to reflect on their early experiences with their parents were involved in marital interactions that were more positive and supportive and less conflicted and undermining. Husbands’ RF did not predict marital or coparenting quality. These findings highlight the importance of reflective functioning in understanding family functioning.     

Adjustment Profiles of Low-Income Caregivers from the United States and South Africa: Contrasts and Commonalities

Although low-income parents living in under-resourced communities in the United States and around the world face challenges, many do well while others struggle in one or more areas of functioning. The present study examined patterns of adjustment among maternal caregivers living in the United States (US) (N?=?320) and South Africa (SA) (N?=?324). Cluster analyses across four domains of functioning representing both positive and negative adjustment and conducted within country revealed similar patterns of adjustment, with a majority of caregivers (37.8% in the US; 47.5% in SA) landing in a “holding steady” pattern, exhibiting good but not exceptional adjustment. Other patterns of adjustment (three additional in the US sample; two additional in the SA sample) showed elevated impairment in somatic complaints, problems with alcohol, or life satisfaction. In both the US and SA, support from family, friends, and neighbors differentiated the adjustment profiles. Further, both current stressors within and outside of the family and previous stressors including direct and indirect exposure to violence discriminated caregivers who were “holding steady” from those who were struggling in one or more domains. Additionally, across both countries, caregivers who were “holding steady” evidenced less avoidant coping. Implications of this work for fostering resilience among caregivers and their children are discussed.