When the Topic is You: Genetic Counselor Responses to Prenatal Patients’ Requests for Self-Disclosure

A limited amount of research indicates patient requests play a major role in genetic counselors’ self-disclosure decisions and that disclosure and non-disclosure responses to patient requests may differentially affect genetic counseling processes. Studies further suggest patient requests may be more common in prenatal settings, particularly when counselors are pregnant. Empirical evidence is limited however, concerning the nature of patient requests. This study explored genetic counselors’ experiences of prenatal patients’ requests for self-disclosure. Four major research questions were: (1) What types of questions do prenatal patients ask that invite self-disclosure?; (2) Do pregnant genetic counselors have unique experiences with prenatal patient disclosure requests?; (3) How do genetic counselors typically respond to disclosure requests?; and (4) What strategies are effective and ineffective in responding to disclosure requests? One hundred seventy-six genetic counselors completed an online survey and 40 also participated in telephone interviews. Inductive analysis of 21 interviews revealed patient questions vary, although questions about counselor demographics are most common, and patients are more likely to ask pregnant counselors questions about their personal pregnancy decisions. Participants reported greater discomfort with self-disclosure requests during pregnancy, yet also disclosing more frequently during pregnancy. Counselor responses included personal self-disclosure, professional self-disclosure, redirection, and declining to disclose. Factors perceived as influencing disclosure included: topic, patient motivations, timing of request, quality of counseling relationship, patient characteristics, and ethical/legal responsibilities. Disclosure practices changed over time for most counselors. Additional findings, practice implications, and research recommendations are discussed.     

Child-Related Interparental Conflict in Infancy Predicts Child Cognitive Functioning in a Nationally Representative Sample

While associations between exposure to marital conflict and child development have been documented extensively in middle childhood and adolescence, few studies have examined the developmental consequences of conflict exposure in infancy. Moreover, those that have examined marital conflict in infancy tended to focus on consequences of conflict exposure on infants’ attachment security, and various aspects of infants’ physiological and emotion regulation. Virtually nothing is known about the longitudinal links between exposure to interparental conflict in infancy and later cognitive development. Using longitudinal data on a subsample of infants (N = 6,019) and their parents who participated in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), this study examined links between the frequency of interparental conflict at 9 months and child cognitive development 15 months later. Combining data from parent interviews, birth certificates, in-home assessments of child cognitive development, and videotaped parent–child interactions, results showed significant negative associations between the frequency of child-related interparental conflict at 9 months of age and child cognitive ability at 24 months. The negative association reflects a direct effect that was not mediated by parental support or child attachment security measured at 24 months. Associations were calculated while considering children’s prior cognitive functioning (at 9 months), and a wide range of child, parent and household characteristics.     

Yoga in an Urban School for Children with Emotional and Behavioral Disorders: A Feasibility Study

Increasingly, school-aged children present with challenging emotional and behavioral problems and may be resistant to traditional special education approaches (Smith et al., Behav Disorders 36(3):185–194, 2011). These programs do not take into consideration the specific needs of students with emotional and behavioral disorder (EBD). We examined the feasibility and potential for positive effects of yoga sessions within a school setting for children with EBD at an urban elementary school. Thirty-seven children with EBD in an urban school completed a yoga intervention in small groups (7–10 students) twice per week for 3 ½ months. Teachers, parents, and students completed a systematic pre- and post-intervention assessment, and yoga instructors completed attendance and behavior checklists. Average attendance for the yoga sessions was 90 %. Eighty percent of responders described being very satisfied with the intervention. Teachers reported improved attention in class (p = 0.01) and adaptive skills (p = 0.03) and reduced depressive symptoms (p = 0.03), behavioral symptoms (p = 0.01), and internalizing symptoms (p = 0.04). No significant changes were found in the parent data and no discernable trend was found in student reports. These data suggest that yoga administered in small groups in an urban school setting is a feasible school intervention for children with emotional and behavioral disorders and may be effective in reducing symptoms.     

Motivation and Problem Solving (MAPS): Motivationally Based Skills Training for Treating Substance Use

Over 10 years ago, Baer and colleagues proposed the integration of skills training and motivational strategies for the treatment of substance abuse. Since that time, several studies evaluating the efficacy of such hybrid approaches have been published, but few have been efficacious. Motivation and Problem Solving (MAPS) is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework, and has been demonstrated to be effective in a randomized clinical trial focused on the prevention of postpartum smoking relapse. MAPS was designed to be applicable to not only relapse prevention but also the cessation of substance use, and is relevant for individuals regardless of their motivation to change. MAPS views motivation as dynamically fluctuating from moment to moment throughout the behavior change process, and comprehensively addresses multiple issues important to the individual and relevant to change through the creation of a wellness program. As a result, we believe that MAPS enhances the likelihood that individuals will successfully achieve and maintain abstinence from substance use, and that its comprehensive focus on addressing diverse and salient issues enhances both engagement in treatment and its applicability in modifying other health risk behaviors. The current paper introduces MAPS, distinguishes it from other hybrid and stage-based substance use treatments, and provides detailed information and clinical text regarding how MAPS is specifically and uniquely implemented to address key mechanisms relevant to quitting smoking and maintaining abstinence.     

Dissemination of Family-Centered Prevention for Military and Veteran Families: Adaptations and Adoption within Community and Military Systems of Care

In response to the needs of military families confronting the challenges of prolonged war, we developed Families OverComing Under Stress (FOCUS), a multi-session intervention for families facing multiple deployments and combat stress injuries adapted from existing evidence-based family prevention interventions (Lester et al. in Mil Med 176(1): 19–25, 2011). In an implementation of this intervention contracted by the US Navy Bureau of Medicine and Surgery (BUMED), FOCUS teams were deployed to military bases in the United States and the Pacific Rim to deliver a suite of family-centered preventive services based on the FOCUS model (Beardslee et al. in Prev Sci 12(4): 339–348, 2011). Given the number of families affected by wartime service and the changing circumstances they faced in active duty and veteran settings, it rapidly became evident that adaptations of this approach for families in other contexts were needed. We identified the core elements of FOCUS that are essential across all adaptations: (1) Family Psychological Health Check-in; (2) family-specific psychoeducation; (3) family narrative timeline; and (4) family-level resilience skills (e.g., problem solving). In this report, we describe the iterative process of adapting the intervention for different groups of families: wounded, ill, and injured warriors, families with young children, couples, and parents. We also describe the process of adopting this intervention for use in different ecological contexts to serve National Guard, Reserve and veterans, and utilization of technology-enhanced platforms to reach geographically dispersed families. We highlight the lessons learned when faced with the need to rapidly deploy interventions, adapt them to the changing, growing needs of families under real-world circumstances, and conduct rigorous evaluation procedures when long-term, randomized trial designs are not feasible to meet an emergent public health need.     

Midstream Modulation in Biotechnology Industry: Redefining What is ‘Part of the Job’ of Researchers in Industry

In response to an increasing amount of policy papers stressing the need for integrating social and ethical aspects in Research and Development (R&D) practices, science studies scholars have conducted integrative research and experiments with science and innovation actors. One widely employed integration method is Midstream Modulation (MM), in which an ‘embedded humanist’ interacts in regular meetings with researchers to engage them with the social and ethical aspects of their work. While the possibility of using MM to enhance critical reflection has been demonstrated in academic settings, few attempts have been made to examine its appropriateness in industry. This paper describes the outcomes of a case study aiming to find out firstly whether MM can effectively be deployed to encourage and facilitate researchers to actively include social and ethical aspects in their daily R&D practice, and secondly to what extent the integration activities could form an integral part of the engaged industrial researchers’ professional activities. Our data show that after MM, researchers display increased reflexive awareness on the social and ethical aspects of their work and acknowledge the relevance and utility of such aspects on their daily practice. Also, all participants considered actively reflecting on social and ethical aspects to be part of their work. Future research on the role of MM in industrial settings could focus on how to embed social and ethical integration as a regular part of innovation practice. We suggest that one possibility would be through aligning social and ethical aspects with innovation Key Performance Indicators.     

Pragmatic reasoning from multiple points of view: A response

Abstract

In our response we consider several broad sets of issues raised in the commentaries on our target article. We provide an elaboration of the general theory of pragmatic reasoning schemas and of the mechanisms posited to explain pespective effects and other contextual influences on reasoning. We consider the strengths and limitations of a number of alternative proposals offered by the commentators. Finally, we discuss possible links between pragmatic schemas and more elementary “building blocks” for human reasoning     

No effects of eye movements on the encoding of the visuospatial sketchpad and the phonological loop in healthy participants: Possible implications for eye movement desensitization and reprocessing therapy

Horizontal eye movement is an essential component of the psychological intervention “eye movement desensitization and reprocessing” (EMDR) used in posttraumatic stress disorder. A hypothesized mechanism of action is an overload of the visuospatial sketchpad and/or the phonological loop of the working memory.     

Identifying trajectories of adolescent smoking: an application of latent growth mixture modeling.

The goal of the current study was to identify discrete longitudinal patterns of change in adolescent smoking using latent growth mixture modeling. Five distinct longitudinal patterns were identified. A group of early rapid escalators was characterized by early escalation (at age 13) that rapidly increased to heavy smoking. A pattern characterized by occasional puffing up until age 15, at which time smoking escalated to moderate levels was also identified (late moderate escalators). Another group included adolescents who, after age 15, began to escalate slowly in their smoking to light (0.5 cigarettes per month) levels (late slow escalators). Finally, a group of stable light smokers (those who smoked 1-2 cigarettes per month) and a group of stable puffers (those who smoked only a few puffs per month) were also identified. The stable puffer group was the largest group and represented 25% of smokers.