“Meeting Someone at the Edge”: Counselors’ Experiences of Interpersonal Stress

Using consensual qualitative research, the authors explored the factors that contribute to counselors’ experiences of interpersonal stress and how counselors respond to interpersonal stressors within therapeutic settings. Thirteen professional counselors representing a variety of counseling contexts and settings participated in semistructured interviews. Through consensus building, the authors identified 4 domains within the data: client characteristics, relationship dynamics, counselor response, and personal vs. professional self. The findings suggest that client characteristics and relationship dynamics are catalysts to counselor interpersonal stress responses, which shape their conscious awareness of the experience. Implications for clinical practice, clinical supervision, and counselor wellness are discussed.     

Understanding how engagement in a self‐managed shelter contributes to empowerment

Participant empowerment is a foundational goal of self‐organised homeless care. We aim to understand how a self‐organised setting contributes to participants' empowerment. The data we analysed (56 interviews, both open and semi‐structured) were generated in a longitudinal participatory case study into Je Eigen Stek (Your own place, JES), a low‐cost shelter for people experiencing homelessness in the Netherlands. JES participants experienced the freedom of choice and influence on their living environment. JES' fluid structure allowed participants to adapt the program to their desires and needs, though participants were sometimes negative about having to live together. Most participants preferred JES over regular shelters. Unlike empowerment literature, participants mostly emphasised freedom of choice over capacity development. JES offered opportunities for social and organisational engagement, through which participants developed roles, skills and self‐image. However, a limited number of participants developed leadership roles through self‐management. Literature suggests setting aspects to be either enabling or entrapping. We found some aspects (e.g., size, freedom of choice) could be entrapping or enabling, depending on personal factors. Our analysis revealed individual freedom of choice, balancing freedom of choice with support, offering opportunities for engagement and maintaining fluidity in program management as core aspects of how JES contributed to participants' empowerment.     

The long‐term effects of institutional rearing,foster care intervention and disruptions in care on brain electrical activity in adolescence

Exposure to early psychosocial deprivation as a result of institutional care disrupts typical brain development. The Bucharest Early Intervention Project (BEIP) is the first longitudinal study to investigate the neurodevelopment of institutionalized infants randomized to a foster care (FCG) intervention versus care as usual (CAUG). Here, we present findings from a follow‐up assessment of brain electrical activity as indexed by resting EEG at age 16 years. In addition, we examined the effects of disruption of foster care placement (e.g. the number of moves among foster care placements) on brain electrical activity. Resting‐state EEG was collected from 48 CAUG, 46 FCG and 48 never institutionalized (NIG) control participants. Absolute (µV²) and relative (proportion) power were computed from eyes closed, resting EEG data for theta, alpha and beta frequency bands. The CAUG displayed higher relative theta and lower relative alpha power compared to the FCG at 16 years of age. The FCG showed brain activity comparable to the NIG. The results further showed that disruptions following the original foster care placement had an adverse effect on brain electrical activity. Within the foster care group, there were no effects of age of placement on EEG power. Placement of children who have experienced early institutional rearing into stable foster care settings ensure long‐term improvement in brain functioning.     

理智而现实的选择--面临新世纪的卫生保健服务

新世纪的卫生保健服务,面临的将是不断增长的健康需求、日益昂贵的费用和难于对付的现代文明病的客观形势,因而必须全面把握卫生保健改革的目标,将满足健康需求,所有制费用的过快增长和控制现代文明病的蔓延三者有机地结合起来,融资、医疗保险和提供服务等方面推行多层或多层体制,才能收到较为理想的效果。任何只考虑某一方面的需求和机能（如市场）的做法,都可能使卫生保健服务陷入更严重的困境。     

Future Issues in Pediatric Psychology: Delphic Survey

Using a Delphic poll procedure, we surveyed pediatric psychologists who were established in either clinical practice or empirical research in pediatric psychology. Three rounds of expert responses were logically combined in order to identify domains of importance to the future of pediatric psychology and to determine to what extent research and clinical aims concur. Overall, researchers and clinicians did not differ in the types of issues deemed important to the field. The top three domains for the next decade are concerned with pediatric psychology's ability to demonstrate viability, to integrate psychologists into primary care settings, and to demonstrate need for changes in reimbursement systems within managed care. Implications of the ten priority issues are discussed.     

Self-guided behavioral skills training: A public health approach to promoting nurturing care environments

The World Health Organization identified the promotion of “Nurturing Care Environments” as a global health priority. Responsive caregiving, 1 of 5 domains describing nurturing care, is critical for healthy child development. Relatively little research has evaluated population-level interventions aimed to increase responsive caregiving during the first 1,000 days of an infant's life. In this pilot study, we evaluated an intervention designed for population-level dissemination that targeted responsive caregiving. The self-guided behavioral skills training aimed to teach mothers to imitate infant vocalizations. The intervention was delivered within an on-line asynchronous training. All 3 mothers increased vocal imitative behavior following training without receiving coaching or behavior-specific feedback from an implementer. The results offer a preliminary proof of concept with implications for population-level intervention design and evaluation.     

Impact of skin-to-skin contact on the autonomic nervous system in the preterm infant and his mother

Before, during and after mother-newborn skin-to-skin contact (SSC), parasympathetic activity was evaluated by heart rate variability (HRV) analysis. SSC had a favorable impact on maternal and premature infant parasympathetic activities with a more pronounced response for neonates when the basal HRV values were lower, without modifications of EDIN scores, temperatures or oxygen saturation.     

The ABLe Change Framework: A Conceptual and Methodological Tool for Promoting Systems Change

This paper presents a new approach to the design and implementation of community change efforts like a System of Care. Called the ABLe Change Framework, the model provides simultaneous attention to the content and process of the work, ensuring effective implementation and the pursuit of systems change. Three key strategies are employed in this model to ensure the integration of content and process efforts and effective mobilization of broad scale systems change: Systemic Action Learning Teams, Simple Rules, and Small Wins. In this paper we describe the ABLe Change Framework and present a case study in which we successfully applied this approach to one system of care effort in Michigan.