This chapter discusses comprehensive school crisis interventions, identifies the characteristics that define a crisis, finds ways to assess for the level of traumatic impact, and determines what interventions can be provided to help with response and recovery. It highlights the PREPaRE Model of crisis prevention and intervention. There are six general categories of crises: acts of war and/or terrorism; violent and/or unexpected deaths; threatened death and/or injury; human-caused disasters; natural disasters; and severe illness or injury. Children are a vulnerable population and in the absence of quality crisis interventions, there can be negative short- and long-term implications on learning, cognitive development, and mental health. Evidence-based interventions focusing on physical and psychological safety may be implemented to prevent a crisis from occurring or mitigate the traumatic impact of a crisis event by building resiliency in students. Crisis risk factors are variables that predict whether a person becomes a psychological trauma victim.
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- Go to chapter: Evidence-Based Interventions for Major Depressive Disorder in Children and Adolescents
Depression is a chronic, recurring disorder that impacts children’s academic, interpersonal, and family functioning. The heritability of major depressive disorder (MDD) is likely to be in the range of 31% to 42%. This chapter begins with a brief overview of the etiology of depression. It presents a description of a cognitive behavioral therapy (CBT) intervention designed to be delivered in a group format, an individual interpersonal intervention, and an individual behavioral activation (BA) intervention that includes a great deal of parental involvement. The ACTION program is a manualized program that is based on a cognitive behavioral model of depression. There are four primary treatment components to ACTION: affective education, coping skills training (BA), problem-solving training, and cognitive restructuring. The chapter concludes with a brief discussion of universal therapeutic techniques to be incorporated into work with depressed youth regardless of the therapeutic orientation or treatment strategy.
Divorce is a lengthy developmental process and, in the case of children and adolescents, one that can encompass most of their young lives. This chapter explores the experience of divorce from the perspective of the children, reviews the evidence base and empirical support for interventions. It provides examples of three evidence-based intervention programs, namely, Children in Between, Children of Divorce Intervention Program (CODIP), and New Beginnings, appropriate for use with children, adolescents, and their parents. Promoting protective factors and limiting risk factors during childhood and adolescence can prevent many mental, emotional, and behavioral problems and disorders during those years and into adulthood. The Children in Between program is listed on the Substance Abuse and Mental Health Services Administration (SAMHSA) National Registry of Evidence-Based Programs and Practices. The CODIP and the New Beginnings program are also listed on the SAMHSA National Registry of Evidence-Based Programs and Practices.
Children and youth with serious emotional, behavioral, and social difficulties present challenges for teachers, parents, and peers. Youth who are at risk for emotional and behavioral disorders (EBD) are particularly vulnerable in the areas of peer and adult social relationships. The emphasis on meeting academic standards and outcomes for children and youth in schools has unfortunately pushed the topic of social-emotional development to the proverbial back burner. This chapter emphasizes that social skills might be considered academic enablers because these positive social behaviors predict short-term and long-term academic achievement. Evidence-based practices are employed with the goal of preventing or ameliorating the effects of disruptive behavior disorders (DBD) in children and youth. An important distinction in designing and delivering social skills interventions (SSI) is differentiating between different types of social skills deficits. Social skills deficits may be either acquisition deficits or performance deficits.
Eating disorders (EDs) are a complex and comparatively dangerous set of mental disorders that deeply affect the quality of life and well-being of the child or adolescent who is struggling with this problem as well as those who love and care for him or her. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) outlines specific criteria for the diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding or ED. Treatment of eating disordered behavior typically involves a three-facet approach: medical assessment and monitoring, nutritional counseling, and psychological and behavioral treatment. Cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are also evidence-based approaches to treatment for AN. The treatment of EDs should be viewed as a team effort that integrates medical, nutritional, and mental health service providers.
Asthma, a pulmonary condition, is a chronic respiratory disorder typified by persistent underlying inflammation of tissues, airway obstruction, congestion, hyperresponsive airways, and the narrowing of smooth airway muscle. Asthma is one of the most common chronic medical conditions in children and is the leading cause of school absenteeism. This chapter describes childhood asthma, including its causes and triggers. It elucidates the extant research supporting treatment of the disorder and provides step-by-step empirically based interventions to ameliorate asthmatic symptomatology in children. The psychological underpinnings of asthma have been investigated in the field of psycho-neuroimmunology (PNI), which examines the interplay of the central nervous system, neuroendocrine, and immune system with psychological variables and their relation to physical health. Researchers have shown that relaxation and guided imagery (RGI), written emotional expression, yoga, and mindfulness therapy improve pulmonary lung functioning, decrease rates of absenteeism, and improve overall quality of life.
This chapter reviews the empirical support for such a multifaceted approach by considering selected neurodevelopmental concerns and medical variables that present as obstacles to healthy neurodevelopment. It discusses select neuro-developmental prenatal complications that can be prevented or ameliorated through behavioral interventions with the pregnant mother. The chapter addresses the deleterious effects of legal substances on the developing fetus, but professionals should be vigilant about preventing or reducing intrauterine exposure to illicit substances as well. Tobacco is a legal substance that, when used during pregnancy, has the potential to harm both the mother and fetus. Of particular concern with tobacco use are the detrimental health risks, such as hypertension and diabetes, which adversely affect the cerebrovascular functioning of pregnant women. The process of neurodevelopment is complex and represents a dynamic interplay among genetics, behavior, demographics, the environment, psychosocial factors, and myriad physiological factors.
An individual’s identity development, including his or her preferred gender identity, is a lifelong process, which starts with the earliest interactions with the world. The concepts of gender identity have been explored, studied, debated, and discussed for decades and are currently going through a resurgence of examination, especially in Western cultures. This chapter provides an overview of gender identity development, beginning with an explanation of terms, followed by an exploration of theoretical perspectives which includes cognitive developmental theory, social learning theory, gender schema theory and feminist theory. Topics include current research and perspectives on how gender identity evolves in children and recent shifts in understanding atypical gender identities, including transgender, gender neutral, and gender fluid identification. Finally, implications and strategies for mental health professionals are discussed, especially related to counseling those who are experiencing conflict or distress surrounding issues of gender and gender identity.
Traumatic brain injury (TBI) causes two injury types: primary and secondary. In infants and young children, nonaccidental TBI is an important etiology of brain injury and is commonly a repetitive insult. TBI is by far the most common cause of acquired brain injury (ABI) in children and is the most common cause of death in cases of childhood injury. In 2009, the Pediatric Emergency Care Applied Research Network (PECARN) issued validated prediction rules to identify children at very low risk of clinically important TBI, which is defined as TBI requiring neurosurgical intervention or leading to death. The range of outcomes in pediatric TBI is very broad, from full recovery to severe physical and/or intellectual disabilities. Children and adolescents who have suffered a TBI are at increased risk of social dysfunction. Studies show that these patients can have poor self-esteem, loneliness, maladjustment, reduced emotional control, and aggressive or antisocial behavior.
This chapter includes information related to the clinical evaluation of a concussion that a child might receive in a medical setting. It discusses guidelines for appropriate use of smartphone concussion evaluation apps. This chapter examines a brief section on the future of concussion assessment. The Acute Concussion Evaluation (ACE) can help the school concussion team obtain information regarding the injury, including the cause, severity, any amnesia, loss of consciousness (LOC), and any early signs. The computerized neurocognitive assessment typically measures player symptoms, verbal/visual memory, attention span, working memory, processing speed, response variability, nonverbal problem solving, and reaction time. Neurocognitive tests, sideline assessments, and smartphone apps can help district staff and parents determine the severity of a student’s symptoms. A neuropsychological assessment to assess cognitive functioning, memory, speed, and processing time may also be administered.
One of the most important findings from the original battered woman syndrome (BWS) research was the existence of a three-phase cycle of violence that could be described and measured through careful questioning of the battered woman. This chapter describes the cycle, updates it by adding information from the courtship period, and divides the third phase into several different sections where appropriate so that there may not be any loving contrition or even respites from the abuse at times during the relationship. Teaching the woman how her perception of tension and danger rises to an acute battering incident after which she experiences feelings of relief and then gets seduced back into the relationship by the batterer’s loving behavior, often similar to what she experienced during the courtship period, has been found to be helpful in breaking the cycle of violence that keeps the woman in the relationship.Source:
- Go to chapter: Stabilization Phase of Trauma Treatment: Introducing and Accessing the Ego State System
This chapter aims to help clinicians learn stabilization interventions for use in the Preparation Phase of eye movement desensitization and reprocessing (EMDR) treatment. Using these interventions will aid clients in developing readiness for processing trauma, learning how to manage symptoms of dissociation, dealing with affect regulation, and developing the necessary internal cohesion and resources to utilize the EMDR trauma-processing phase. Earlier negative experiences stored dysfunctionally increase vulnerability to anxiety disorders, depression, and other diagnoses. When assessing a client with a complex trauma history, clinicians need to view current symptoms of post-traumatic stress disorder (PTSD) or depression as reflections of the earlier traumas. The chapter outlines the strategies dealing with dissociative symptoms, ego state work, and internal stability that help clinicians to develop an individualized treatment plan to successfully guide the client through the EMDR phases of treatment.
- Go to chapter: ACT-AS-IF and ARCHITECTS Approaches to EMDR Treatment of Dissociative Identity Disorder (DID)
This chapter describes key steps, with scripts, for the phases of therapy with a dissociative identity disorder (DID) client, and for an eye movement desensitization and reprocessing (EMDR) session with a DID client. In brief, the method employs the artful use of EMDR and ego state therapy for association and acceleration, and of hypnosis, imagery, and ego state therapy for distancing and deceleration within the context of a trusting therapeutic relationship. It is also endeavoring to stay close to the treatment guidelines as promulgated by the International Society for the Study of Trauma and Dissociation. The acronym ACT-AS-IF describes the phases of therapy; the acronym ARCHITECTS describes the steps in an EMDR intervention. Dual attention awareness is key in part because it keeps the ventral vagal nervous system engaged sufficiently to empower the client to sustain the painful processing of dorsal vagal states and sympathetic arousal states.
One way of thinking about procrastination is to regard it as a form of addiction; an addiction to putting things off. As with other addictive patterns, the client will choose a short-term gratification instead of going for a long-term result that might, in the end, be more satisfying or empowering. As with other addictions, a procrastinating client often suffers ongoing erosion of her self-esteem. Quite often, procrastination may function as a defense as a way to avoid other life issues that are disturbing. With this type of problem, we can use a variation of Popky’s addiction protocol, and the level of urge to avoid (LoUA) procedure. It is also important to use resource installation procedures to help the client develop an image of the benefits that would come with being free of this problem.
The important elements of the Eye Movement Desensitization and Reprocessing (EMDR) and Phantom Pain Research Protocol are client history taking and relationship building, targeting the trauma of the experience, and targeting the pain. This protocol is set up to follow the eight phases of the 11-Step Standard Procedure. This chapter presents a case series with phantom limb patients obtained a few before and after EMDR magnetoencephalograms (MEGs) at the University of Tübingen, Germany on arm amputees that show the presence of phantom limb pain (PLP) in the brain images before EMDR and the absence of it after EMDR. In these case series, it is found that PLP in leg amputations is much easier to treat than arm amputations, likely due to the much more extensive and complex arm and hand representation in the sensory-motor cortex compared to the leg and foot representation.
This chapter presents an overview of the restorative justice movement in the twenty-first century. Restorative justice, on the other hand, offers a very different way of understanding and responding to crime. Instead of viewing the state as the primary victim of criminal acts and placing victims, offenders, and the community in passive roles, restorative justice recognizes crime as being directed against individual people. The values of restorative justice are also deeply rooted in the ancient principles of Judeo-Christian culture. A small and scattered group of community activists, justice system personnel, and a few scholars began to advocate, often independently of each other, for the implementation of restorative justice principles and a practice called victim-offender reconciliation (VORP) during the mid to late 1970s. Some proponents are hopeful that a restorative justice framework can be used to foster systemic change. Facilitation of restorative justice dialogues rests on the use of humanistic mediation.
This chapter describes some of the recent restorative justice innovations and research that substantiates their usefulness. It explores developments in the conceptualization of restorative justice based on emergence of new practices and reasons for the effectiveness of restorative justice as a movement and restorative dialogue as application. Chaos theory offers a better way to view the coincidental timeliness of the emergence of restorative justice as a deeper way of dealing with human conflict. The chapter reviews restorative justice practices that have opened up areas for future growth. Those practices include the use of restorative practices for student misconduct in institutions of higher education, the establishment of surrogate dialogue programs in prison settings between unrelated crime victims and offenders. They also include the creation of restorative justice initiatives for domestic violence and the development of methods for engagement between crime victims and members of defense teams who represent the accused offender.
This chapter aims to give the behavioral health specialist (BHS) a basic understanding of pain, knowledge about how to effectively evaluate chronic pain, and a description of effective pain management techniques. Knowledge of the biological and psychological basis of pain is important to understanding the experience of chronic pain. A biopsychosocial assessment is the foundation for providing behavioral health treatment to the chronic pain patient. Chronic pain is less responsive to treatments commonly used for acute pain such as opioid analgesia and avoiding physical activity. A multidisciplinary team approach can substantially improve outcomes in chronic pain treatment. Whatever the format of service provision, utilizing multiple interventions such as physical therapy/exercise, emotional management, pacing, and medication, rather than a single modality can substantially improve outcomes for chronic pain. Providing psychoeducation about chronic pain can be an important strategy.
The “Image Director Technique” was developed to target recurring nightmares or bad dreams and those targets that are directly related to a traumatic experience. This technique is a special module that is embedded in the Standard Eye Movement Desensitization and Reprocessing (EMDR) Protocol. The technique begins with the worst image of the dream and then accesses and measures it as in Phase 3 of the Standard EMDR Protocol that includes the image, cognitions, emotions, and sensations. Clients are more likely to work with short clips or films if the subjective units of disturbance (SUD) of the target image is low. This technique can also be considered an imagery exposure method that is based in systematic desensitization, a behavioral approach. Often, clients prefer the tactile bilateral stimulation (BLS) because they can close their eyes in order to be visually undisturbed during the creation of the new images.
This chapter focuses on office automation and systems that are useful in the mental health field, along with principles to be aware of when considering the use or purchase of such systems. Most managers have to rely on input from outside in order to form an opinion about how to resolve complex issues. The complexity of the issue increases significantly when the current federal health care laws are incorporated into the task of choosing appropriate clinical information management software. The significance of Health Insurance Portability and Accountability Act (HIPAA) would seem to dictate at least a brief foray into its content because it lays the foundation for virtually everything that is happening in the clinical information management (CIM) realm. The information provided in the chapter can give a backdrop by which current practices can be examined for goodness of fit with the available client information management systems.
Many developmental models view human growth from a space of lack or abundance, a perpetual fulcrum swinging from the word survive at one end to thrive at the other. This chapter discusses Urie Bronfenbrenner’s bioecological theory of human development to conceptualize female adolescent and young adult development. The contextual focus of this theory provides a global framework for counselors to view young women as individuals who both influence, and are influenced by, their surroundings. Customs, beliefs, and the government all play a role in the development of children and adolescents. When young females overcome the stigma associated with mental health services, they typically seek treatment in one of two primary settings: community mental health centers and schools. Relational-cultural theory (RCT) is an evolving feminist model of human development that views connection to others as essential to growth and disconnection as a major cause of disrupted functioning.
The concept of risk behaviors became a model for public health interventions in the late 1970s and 1980s. This chapter describes contemporary knowledge on the risk behaviors of gender and sexual minority (GSM) persons. It highlights research findings, with particular attention paid to studies of different GSM subgroups, and evaluates interventions that have sought to modify behaviors in the pursuit of better health outcomes. The chapter then focuses on the potential contributions of other theoretical frameworks to the study of GSM risk behaviors, including opportunities to incorporate disclosure, resilience, intersectionality, and minority stress theories. It also presents recommendations for future directions for researching health risk behaviors among GSM persons, addressing the risk of harming GSM populations, and diverting attention and resources from addressing justice and social determinants of GSM health. The chapter concludes with suggestions for future research and interventions in support of more equitable health outcomes.
As in the non-lesbian, gay, bisexual, and transgender (LGBT) community, gender and sexual minority (GSM) individuals who are also members of one or more racial/ethnic minority populations face unique sociocultural dynamics that impact the ability to achieve and maintain health. This chapter describes the literature that has examined racial/ethnic disparities in a variety of outcomes, and describes what is known regarding the actual impact of intersectionality whenever possible. Reflective of the current literature, the chapter centers on the African American and Hispanic sexual minority male population, HIV, substance use, and mental health as outcomes. It begins with an exploration of barriers to health that reach across outcomes and populations and discusses four specific outcomes with more developed bodies of literature (HIV/sexual health, substance use, mental health/suicide, and victimization). Finally the chapter summarizes the initial evidence from three emerging lines of inquiry (chronic conditions, incarceration, and women’s health).
Using Bronfenbrenner’s Ecological Systems Theory, this chapter highlights the unique strengths and challenges faced by gender and sexual minority (GSM) youth and highlights future directions for research that we believe hold promise in promoting the health and well-being of this special population. It presents a review of the research as applied to physical and mental health disparities that impact GSM youth and discusses the two dominant psychosocial models that explain the contributing factors to these disparities. Notably, public opinion has been shifting toward greater acceptance and inclusion of the lesbian, gay, bisexual, and transgender community, and the 21st century has seen a large increase in the number of protections and rights afforded to GSM individuals. Future research should continue to examine and replicate the impact of minority stress in more recent cohorts of GSM adolescents to determine whether improvements in the social environment result in decreases in health disparities.
- Go to chapter: Recommendations for Practitioners for Providing Competent Care to Gender and Sexual Minority Individuals
Recommendations for Practitioners for Providing Competent Care to Gender and Sexual Minority Individuals
Research on the health and health care needs of gender and sexual minority (GSM) people is burgeoning, in part due to increased awareness of the importance of identifying the health care needs of these long-neglected populations. This increase in knowledge related to GSM health is a critical part of improving the quality of GSM people’s health and health care. This chapter considers how practitioners might integrate existing knowledge about GSM health into their clinical work to establish an affirmative context for GSM patients. More contemporary approaches take a more process-oriented view, focused on the appreciation of cultural differences at personal, professional, organizational, and societal levels. These approaches place greater emphasis on training clinicians to think critically about how patients’ cultural backgrounds and identities impact their life experiences. The authors draw on these approaches to provide practical recommendations for providers to deliver competent care to GSM individuals.
This concluding chapter summarizes the major points regarding elder abuse (EA) presented in the preceding chapters. It concludes the chapter by taking one last opportunity to encourage exploration and initiation of system-level efforts to solve a major public health problem. The socioecological framework for violence prevention utilized within domestic and global public health work is applicable and extendable to EA. Throughout this book, the authors have argued that EA is a public health problem and that EA may well be among the most under-recognized and under-resourced population health problems of the early 21st century. Public health has frameworks, tools, approaches, relationships, structures, systems, and a variety of agents and organizations poised to address the problem of EA. The imprimatur of the growing population of older adults and the character of demographic transitions occurring globally provide the perfect rationale for action—now.
The obesity epidemic is even more pronounced in rural America, and is a growing concern as rural adults and children are now more likely to be obese than urban adults and children. People who are overweight or obese are at increased risk for chronic disease and conditions such as hypertension, coronary heart disease, stroke, gallbladder disease, osteoarthritis, and some types of cancers. For women, obesity also is associated with complications of pregnancy, menstrual irregularities, hirsutism, and psychological disorders such as depression. Stress has been linked to obesity in adults and in children, and rural residents are continually subject to the stresses of poverty, limited access to health care, and geographical and social isolation. In rural communities, community organizations and families need to come together to identify common goals related to obesity prevention and identify and mobilize human and community assets to implement strategies they believe will work for their community.
Concurrent with the release of Education and Identity in 1969, the United States was at the nexus of social unrest and expanding funding and support for educational initiatives. The decades of the 1950s and 1960s saw a great increase in research and practice focused on developmental theorists working in the area of higher education. At the forefront of this work was theorist Arthur Chickering. The primary construct of Chickering’s (1969) work is the Seven Vectors of Development. The vectors are: (a) developing competence, (b) managing emotions, (c) moving through autonomy toward interdependence, (d) developing mature interpersonal relationships, (e) establishing identity, (f) developing purpose, and (g) developing integrity. This vector addresses competence across three domains: intellectual, physical and manual, and interpersonal. This chapter briefly outlines Chickering’s life work, and ways in which practitioners can apply his theory to their daily interactions with college students.
This chapter describes the relevance of critical thinking and the related process and philosophy of evidence-based practice (EBP) to cognitive behavior therapy and suggests choices that lie ahead in integrating these areas. Critical thinking in the helping professions involves the careful appraisal of beliefs and actions to arrive at well-reasoned ones that maximize the likelihood of helping clients and avoiding harm. Critical-thinking values, skills and knowledge, and evidence-based practice are suggested as guides to making ethical, professional decisions. Sources such as the Cochrane and Campbell Collaborations and other avenues for diffusion, together with helping practitioners and clients to acquire critical appraisal skills, will make it increasingly difficult to mislead people about “what we know”. Values, skills, and knowledge related to both critical thinking and EBP such as valuing honest brokering of knowledge, ignorance and uncertainty is and will be reflected in literature describing cognitive behavior methods to different degrees.
This chapter describes the Coping Skills Program, an innovative, school-based, universal curriculum for elementary-school aged children that is rooted in cognitive behavior theory. Rooted in cognitive behavior theory, the Coping Skills Program consists of carefully constructed metaphorical fables that are designed to teach children about their thinking; about the connections among their thoughts, feelings, and behavior; and about how to change what they are thinking, feeling, and doing when their behavior causes them problems. The chapter provides a thorough description of the Coping Skills Program and how it is implemented through a discussion of relevant research-based literature, and the theoretical underpinnings underlying this cognitive behavior approach with school-aged children. It also includes the results of preliminary testing of the Coping Skills Program. The research-based literature shows that cognitive behavior approaches are among the interventions commonly used by social workers to help young children in school settings.
This chapter describes many of the theories that involve taxonomies. Most taxonomies of love begin in the same place: The language of love is examined, whether through an examination of film, literature, music, or firsthand accounts of people about their love life. The three primary love styles are eros, storge, and ludus. Eros is a passionate kind of love that is characterized by strong emotions and intense physical longing for the loved one. With storge, should the lovers break up, there is a greater chance than with other love styles that they remain friends. Ludus commonly is displayed by people who prefer to remain single and who see love as a game of conquest and numbers. A pragmatic lover hesitates to commit to a relationship until he or she feels confident of finding the right partner. The different love styles also correlate with some other personality traits.Source:
This chapter provides new data and a critical look at the comparative assessment of different ethnic groups’ overall levels of savings given their different experiences in the labor market. It focuses on how employers differentially treat minorities to their disadvantage with a multiple regression analysis that identifies the independent negative impact of being a minority on retirement sponsorship and pension plan participation. Minorities have lesser access to employer-sponsored retirement plans because they are particularly affected by the substitution of defined benefit (DB) plan coverage for less secure and less comprehensive defined contribution (DC) plans. Social Security is an important source of retirement income for all Americans. Minorities are disproportionately employed in lower-paid industries and occupations, which have lower rates of retirement account coverage. Qualitative research and interdisciplinary collaborative studies of minority retirement behavior have emerged.
Migrant farmworkers are a distinct population within rural public health. This chapter considers the demographics, health behaviors, health conditions, access barriers, and programs and resources for the mobile poor population. Migrant and seasonal farmworker health issues that warrant special consideration include those related to occupational and environmental health, infectious diseases, mental and behavioral health, food insecurity, housing, and oral health. Present programs in health and education available to migrant farmworkers reach only a minority of farmworker families and need expansion as well as enhancement. Primary care services will be most effective when patient-centered care is coupled with outreach efforts and preventive health coverage. Cancer care, palliative care, and end-of-life care are areas in need of thoughtful program implementation. Public health practitioners and planners will be assisted by understanding the agricultural labor force in their region of concern, and the available resources for social and health services.
This chapter focuses on an area that has been at the center of the debate between the approaches: processing ambiguous words and sentences. Interestingly, an important factor for ambiguity resolution appears to be the frequency of the different meanings of the ambiguous words. Subordinate- bias effect is as follows: in a neutral, nonbiasing context, words that are balanced cause longer reading times than words that are either unbalanced or unambiguous. Different languages impose different rules about how grammatical categories may be combined. In the garden path model, sentence processing happens in two stages: an initial structure building stage in which the only information that is used is syntactic, and then a second stage in which the structure is checked against semantic and pragmatic information. Constraint-based models take a very different approach to how sentences are initially parsed and how mistakes are sometimes made.
- Go to chapter: What Does Knowing About Genetics Contribute to Understanding the Health of Minority Elders?
This chapter discusses the identification of individual differences in health behaviors and health status among minorities. Sickle cell disease (SCD), a genetic disorder, may serve as an optimal model for understanding issues of aging in minority populations. SCD is an important model of multifactorial conceptualization of genetic-based chronic disease among aging populations. Generally, molecular genetic methodologies are called to mind when people consider the role of genetic factors in health and disease. Behavioral genetic methods will be particularly useful if one begins studying minorities from the perspective that there is significant heterogeneity within populations of minorities. Conceptual and methodological discussions of heterogeneity within minority populations are particularly timely given the changing sociodemographic features of ethnic/racial populations related to health disparities. Socioeconomic status and education have been found to be important variables associated with the development of chronic illness.
Delirium, also known as acute confusional state, organic brain syndrome, brain failure, and encephalopathy, is a common occurrence among medical and surgical patients and causes extensive morbidity and mortality. This chapter provides an updated review of delirium, including pathophysiological correlates, clinical features, diagnostic considerations, and contemporary treatment options. The defining features of delirium include an acute change in mental status characterized by altered consciousness, cognition, and fluctuations. The chapter explores the risk factors for delirium. These can be divided into two categories: predisposing factors and precipitating factors. Imbalances in the synthesis, release, and degradation in gamma-aminobutyric acid (GABA), glutamate, acetylcholine, and the monoamines have also been hypothesized to have roles in delirium. GABA is the primary inhibitory neurotransmitter in the central nervous system (CNS) and medications such as benzodiazepines and propofol have known actions at GABA receptors and have been associated with delirium.
Traditionally, there has been a division of labor in higher education between academics and student affairs. This chapter is designed to focus on the plausibility of using theory to facilitate communication across the many departments and divisions of higher education. It is important to remember that the student affairs profession “grew from the campus up, not from theory down”. Early institutions of higher education followed the Oxbridge model with historically based residential living systems in which educators resided in residence halls with the students. This concept of faculty–student integration remains a valuable component in student success today, and is discussed in greater detail in this chapter. One useful “language” for student affairs practitioners is found in Erikson’s stages of psychosocial development. Erik Erikson pioneered a theoretical framework and proposes an eight-staged life-span model through which developing individuals permeate starting at birth and eventually ending with death.
This chapter describes the current trends toward greater gender equality in couple relationships, what keeps old patterns of gendered power alive, and why equality is so important for successful relationships. Relationship vignettes like the ones just described are common. Sharing family and outside work more equitably is only part of the gender-equality story. Gender ideologies are replicated in the way men and women communicate with each other and influence the kind of emotional and relational symptoms men and women present in therapy. Stereotypic gender patterns and power differences between partners work against the shared worlds and egalitarian ideals that women and men increasingly seek. The concept of relationship equality rests on the ideology of equality articulated in philosophical, legal, psychological, and social standards present today in American and world cultures. The four dimensions of the relationship equality model are relative status, attention to the other, accommodation patterns, and well-being.
- Go to chapter: F.I.T. Camp: A Biopsychosocial Model of Positive Youth Development for At-Risk Adolescents
Adolescence is a particularly intense stage of development. During the time of life between prepubescence and young adulthood, youth are challenged by accelerated mental, emotional, cognitive, and physical changes. The ordinary biopsycho-social stressors of adolescence, in conjunction with extraordinary environmental conditions, harmful external stimuli, and the dearth of resources that are associated with lower class and ethnic social status, tend to disrupt homeostasis and thwart positive youth development (PYD). Poor, ethnic minority youth are at disproportionate risk of negative social outcomes. The majority of these disparities involve externalizing factors, such as teen pregnancy, academic underachievement, and antisocial peer-group affiliation, as well as violent victimization and offending. The basic mission of F.I.T. an acronym for Focus, Initiative, and Tenacity Camp is to empower disadvantaged, ethnic minority youth by means of fostering positive social and emotional development.
This chapter focuses on the following topics: demography, gender, age at diagnosis/onset of cardiovascular disease (CVD), Medicare usage, work and retirement, social support, social context and neighborhoods, ethnography of families, qualitative research, and social policy. These topics constitute some of the key areas that should be the focus of future research on the sociology of minority aging. The chapter provides a rich description of trends in the ethnic and racial composition of older cohorts to illustrate the dramatic changes that have taken place in the United States in the past century. The rising costs of health care and the increasing older minority population, additional reform will be needed to maintain the sus-tainability of the program. Additional work examining within-race group differences is key to understanding minority aging issues given the large amount of cultural diversity in the United States.
This chapter provides an overview of working with clients who present with more complex trauma. Many of the clients that come for Eye Movement Desensitization Reprocessing (EMDR) will have a history of complex trauma or a chaotic childhood. Clients who have experienced complex trauma may lack basic life skills or have missed out on developmental stages due to a chaotic childhood, for example, parents who were absent, neglectful, or abusive. Clients may not have been taught how to regulate their emotions in early childhood. They may present with impulsive, risk-taking, or suicidal behaviors. Before carrying out the desensitization phase of EMDR, individuals need to have an adequate level of resilience and be sufficiently resourced. Clients with Dissociative Identity Disorder (DID) display at least two distinct and enduring “alters” or identity states that recurrently take control of their behavior.
This chapter explores the relationship between gender and power. Gendered power in couple relationships arises from a social context that has given men power over women for centuries. When practitioners fail to take account of social context, however, they may run the risk of inadvertently pathologizing clients for legitimate responses to oppressive experiences. The term gender is a socially created concept that consists of expectations, characteristics, and behaviors that members of a culture consider appropriate for males or females. Consequently, an individual’s ideas about gender may feel deeply personal even though they are a product of social relationships and structures. Strong social forces work to keep social power structures, including gender inequality, in place. The continued presence of gendered power structures in economic, social, and political institutions still limits how far many couples can move toward equality. Today, ideals of equality compete with the institutional practices that maintain gender inequality.
Rural America may seem an unlikely setting for new trends in substance abuse. This chapter compares rural and urban areas and the rural continuum for prevalence of substance use and abuse, efforts to prevent substance abuse, treatment availability and accessibility, and continuing care and long-term support for abstinence. It also presents models of service delivery that address resource limitations common to rural areas. Van Gundy also found that substance abuse rates vary across racial and ethnic groups, though rates differ when socioeconomic status and other factors are considered. Nonmedical use of prescription drugs is a growing national problem and one that heavily impacts rural areas. Societal effects include the strain and economic costs absorbed by emergency rooms, treatment agencies, social service agencies, and the legal and criminal justice systems in coping with the consequences of meth abuse. Treatment models with relevance for rural providers address the shortcomings of existing services.
The researchers were specifically interested in whether they would get more incorrect responses depending on the type of sentence. From a certain perspective, passive sentences are more complicated than active sentences and so perhaps it is the case that passives are more difficult simply because they are more complicated. It appears that the important difference between subject cleft and actives on one hand, and passives on the other, is that the order of the roles is reversed between them: in active sentences, the agent comes first. Indeed, there is a growing body of evidence that languages allow English speakers to structure their utterances in a way that can flag certain parts of the sentence as particularly important or worthy of special attention. Recently, psycholinguists have been interested, too, in how information structure influences language processing.
- Go to chapter: Integrating Theories of Developmental Psychology Into the Enactment of Child Psychotherapy
Child psychotherapy requires case conceptualization through the lens of developmental psychology in a multimodal approach to assessment, diagnosis, treatment planning, and clinical interventions. This chapter outlines a blueprint for therapists to provide treatment for children by integrating these fundamental principles while collaborating with the other people in the child’s life. The chapter guides the therapist through case conceptualization that integrates the most efficacious treatment interventions into the eight-phase template of eye movement desensitization and reprocessing (EMDR). Adaptive information processing (AIP) theory drives treatment with EMDR throughout the eight phases of that protocol and provides a template for case conceptualization and treatment planning. The use of the EMDR approach to psychotherapy is well documented and approved as evidence-based practice in Substance Abuse and Mental Health Administration (SAMHSA) and California Evidence-Based Clearinghouse for Child Welfare (CEBC).
- Go to chapter: Introduction: Psychology—Rising as a Discipline to Meet the Challenges of an Aging, Increasingly Diverse Society
Introduction: Psychology—Rising as a Discipline to Meet the Challenges of an Aging, Increasingly Diverse Society
This chapter presents an illustration of the complexities involved in studying ethnic and racial influences on psychosocial processes and how they are intimately tied to physical outcomes in later life. It focuses on psychology as a discipline, minority aging research during the last several decades has revealed the need for multidisciplinary and intersectional conceptual and research approaches. The chapter also focuses on the age, gender, socioeconomic, cultural, and racial and ethnic graded influences on life course development that eventuate in unequal burdens of psychological and physical health morbidity and mortality for certain groups in late life. No section on psychology could be complete without a discussion of religion and spirituality among racial and ethnic minorities. Generational processes are clearly implicated in ideas about the cyclical nature of poverty and health behaviors that are intricately linked with environmental factors and social influence.
This chapter examines the Older Americans Act (OAA) through the prism of the coming nexus of aging and ethnic/racial diversity. It explains that the OAA can serve as a foundation for building a home- and community-based set of services for all older adults and persons with disabilities and for addressing aging in the 2lst century. The OAA is the primary federal program providing a host of services that enable older persons and their families to live in their homes and communities with a measure of dignity and independence. The OAA, Administration on Aging (AOA), and aging network today provide five major categories of services: access to social and legal services, nutrition, home- and community-based long-term social and supportive services, disease prevention and health promotion, and vulnerable elder rights protections. The OAA and the AOA remain secondary players in national agenda setting for an aging population.
This chapter examines the cultural and relational contexts of postpartum depression. Postpartum depression (PPD) is a debilitating, multidimensional mental health problem that affects 10"-15” of new mothers and has serious consequences for women, children, families, and marriages. Although women’s experience of postpartum depression has been the subject of considerable recent study, nearly all of this work has been interpreted within a medical or psychological frame. The chapter looks at a social constructionist lens to this body of research through a meta-data-analysis of recent qualitative studies of PPD. Though hormonal changes as a result of childbirth are related to depressive symptoms after childbirth, biological explanations alone cannot explain postpartum depression. A social constructionist approach to postpartum depression focuses on how the condition arises in the context of ongoing interpersonal and societal interaction. Climbing out of postpartum depression is an interpersonal experience that requires reconnection with others.
Clinical social workers have an opportunity to position themselves at the forefront of historic, philosophical change in 21st-century medicine. As is so often true for social work, the opportunity is associated with need. For social workers, in their role as advocates and clinicians, this unmet need would seem to create an obligation. This chapter argues that, if choosing to accept the obligation, social workers can become catalysts for vitally needed change within the medical field. While studies using the most advanced medical technology show the impact of emotional suffering on physical disease, other studies using the same technology are demonstrating Cognitive behavior therapy’s (CBT) effectiveness in relieving not just emotional suffering but physical suffering among medically ill patients. While this chapter discusses the clinical benefits and techniques of CBT, it also acknowledges the likelihood that social work will have to campaign for its implementation in many medical settings.
This chapter focuses on informal caregiving among minority groups. It also focuses on context of caregiving and discuss the various specific challenges caregivers of minority older adults face. The chapter examines some of the specific caregiving interventions tailored for families of color and discuss the implications for practice, policy, and research. Medical advances and greater longevity point to healthier and longer lives for many, but both formal and informal caregiving remain a concern as individuals age and develop conditions that require care. Caregivers are often able to realize the positive aspects of caregiving when they are not struggling with financial or social support challenges. Despite the vast literature on caregiving in general, research pertaining to the needs and experiences of racial/ethnic minority older adults and their caregivers is limited, particularly for American Indians, Pacific Islanders, specific Asian American and Latino subgroups, and religious minorities groups such as Muslim Americans.
- Go to chapter: Minority Aging Before Birth and Beyond: Life Span and Intergenerational Adaptation Through Positive Resources
Minority Aging Before Birth and Beyond: Life Span and Intergenerational Adaptation Through Positive Resources
This chapter presents an integrative approach to the psychological study of minority populations and the reduction of health disparities through positive nonmaterial resources. It provides a brief introduction to positive psychology and to the concept of early life origins of disease, highlighting the value of integrating these seemingly disparate literatures as a lens for studying health and broader aging processes among minority populations. Minority status whether based on ethnicity, gender, socioeconomic status (SES), citizenship, religion, or other factors is a robust determinant of health, well-being, and success across the life span and intergenerationally. Positive psychology is relevant to health and development particularly physiological and psychological adaptation to stress across the life span, and even across multiple generations among humans in general and among minority populations in particular. Health inequalities are the result of unique challenges to successful psychological and physiological adaptation faced by minority group members.
- Go to chapter: A Developmentally Grounded and Integrative Clinical Approach for Treating Complex Trauma and Dissociative Disorders in Children
A Developmentally Grounded and Integrative Clinical Approach for Treating Complex Trauma and Dissociative Disorders in Children
Children are exposed to distress, violence, and trauma even before they are born. In-utero and early childhood exposure can contribute to severe medical and psychological consequences. Children who have been exposed to such traumatic events often arrive at the psychotherapist’s office with emotional and behavioral symptoms suggestive of reactive attachment disorder (RAD), post-traumatic stress disorder (PTSD), and dissociation. This chapter reviews relevant theories of dissociation integrated with theories of development to provide a summary of how attachment impacts dissociation. With a developmentally grounded theory of dissociation, the chapter describes clinical interventions for treating the dissociative sequelae of attachment trauma in children. This theoretical framework offers a developmentally grounded and integrative framework for working with children with complex trauma and dissociation. Symptoms of dissociation are common with PTSD, but an extreme response to trauma can be dissociation and dissociative disorders.
This chapter discusses current thinking in the field of social support and social relationships, and physical and mental health among older racial and ethnic minorities. Social relationships are an important predictor of health and psychological well-being across the life course. Many minority older adults will face the continued challenges of declining functional status due to physical and mental health conditions over the course of their lives. Most empirical studies on social support among older racial and ethnic minority adults explore the association between social support and both physical and mental health. The wealth of studies on social support among minority older adults has much to offer with respect to understanding the correlates of emotional support and patterns of assistance. The biological mechanisms explaining the link between social support and physical health outcomes have been largely unexplored among older racial and ethnic minority groups.
The study of the properties of language can be divided up into roughly five, somewhat overlapping categories: sound system, word structure, sentence structure, meaning, and real-world use. In spoken languages, segments are sounds—each language has a set of sounds that are produced by changing the positions of various parts of the vocal tract. The sound system of language is actually studied in two main parts: phonetics, phonology. Phonemes can be combined to make words, and words themselves have an internal structure and can even be ambiguous based on this structure. Syntax is the study of how sentences are formed. There are two noun phrases (NPs) in the sentence—the artist and a paintbrush. The field of semantics is concerned with meaning in language and can be divided into two major parts: lexical and propositional.
One of the most trying aspects of training professionals to work with couples using solution-focused therapy is expecting professionals to go slowly and to develop a connection with their couples before moving on. In fact, the therapist is working to uncover the positive aspects of the couple’s life, and how they were living before their problem. Lipchik calls this process listening with a constructive ear probing for evidence of strengths, resources, and past success, learning what life was like before or without the problem, what the clients want, or anything at all that can be reinforced as a positive aspect of the client’s lives going forward. Every couple comes from a past when the relationship was working much better. The therapist listens for clues about how the relationship was built to understand what worked in the past and continues to work today.
This chapter includes the guiding tenets of solution-focused therapy (SFT). Solution-focused (SF) practice differs from other therapeutic approaches in its use of solution building rather than problem solving. The solution-building process is about creating what is most desired by the couple, and not about problem solving. For a couple to be seeking therapy together, there has to have been a time in the past when the relationship was working better for both the parties. By focusing on the relationship and the skills that each partner uses to contribute to the relationship, the therapist conveys a level of hope to the couple. Solution-building conversations must be co-constructed with input from all participants. Motivation should never be in doubt, even if one member of the couple claims that he or she is only there because the other partner “made” them come to therapy.
This chapter examines disability identity as a unique area in which the clinician working with individuals with brain injuries must become culturally competent. It begins with an overview of the disability rights movement and its influence on disability identity as a construct. Legislative and regulatory scaffolding for societal responsiveness to and acceptance of individuals with disability exists, but it requires further refinement. Social agencies have been created to support the process of adaptation to disability culture and are attempting to foster development of disability identity through networking resources for employment and socialization. The chapter then discusses critical issues in cultural competence and how these intersect with ethical practice in working with individuals and families with neurorehabilitation needs. It concludes with suggestions regarding cultural competence that transcend individual diagnoses.
This chapter presents reasons for why many individuals prefer receiving mental health care in a primary care setting. In fact, more persons with a mental health problem or illness are treated by a primary care provider than by a specialty mental health care provider. The chapter also presents the background for integration, including definitions, models, barriers, and evidence from the general integration literature. It describes the history of integration in rural areas and best practices of integrating care in rural areas. The chapter presents practical strategies for integrating care in rural areas. It provides case studies of integrated care in rural communities. The chapter reviews the experience and lessons learned by four rural primary care providers who have successfully integrated care. A number of national trends and policy initiatives are likely to influence access to rural mental health care in the years ahead.
Primary progressive aphasia (PPA) is the term applied to a clinical syndrome characterized by insidious progressive language impairment that is initially unaccompanied by other cognitive deficits. This chapter describes several variants of PPA and more than one etiology. It explains three main variants of PPA, namely, semantic Variant of PPA (svPPA), nonfluent/agrammatic variant of PPA (nfvPPA) and logopenic variant of PPA (lvPPA), and also describes criteria for their diagnoses. The defining symptom of PPA is the presence of a language impairment for at least 2 years in the absence of any other significant cognitive problem. Assessment of other cognitive domains is challenging because many tests of memory, attention, executive functioning, and visual-spatial skills rely on language processes in some manner. There are no drug therapies proven to arrest progression of signs and symptoms of PPA due to frontotemporal lobar dementia (FTLD) or Alzheimer’s disease (AD) pathologies.
This chapter examines racial and ethnic differences in disability in the United States with a focus on their patterns, trends, and determinants. Disability is responsible for massive social and economic costs to individuals, families, and health care systems. Racial and ethnic differences in health are one of the most widely studied topics in U.S. health disparities research. The risk of disability among older Asians is an understudied area, despite the growth of this population subgroup in recent years due to increased volume of immigration from Asia to the United States. There is an ongoing interest in measuring and understanding the patterns and causes of racial/ethnic differences in disability in the United States. Rising obesity may play an important role in the findings for Hispanic women and for the trend in disability for all race/ethnic groups.
This chapter talks about questions related to how speakers and hearers influence each other. It looks at research on dialogue, and especially how a dialogue context influences speakers. Speakers have an impact on their listeners. The goal of a dialogue is successful communication and so it would make sense that a speaker would pay careful attention to the needs of a listener and do things like avoid ambiguity and package information in a way that flags particular information as important or new to the listener. Ambiguity may be avoided depending on the speaker’s choice of words and so a natural question is whether, and when, speakers appear to avoid ambiguous language. In terms of pronunciation, speakers reduce articulation and intelligibility over the course of a dialogue. There are some constraints and preferences on how to interpret pronouns and other coreferring expressions that appear to be structural or syntactic in nature.
Dementia is an umbrella term for conditions such as Alzheimer’s disease (AD), dementia with Lewy bodies (DLB), vascular dementia (VaD), and frontotemporal dementia (FTD). Under that umbrella, FTD, also known as frontotemporal lobar degeneration (FTLD), can be further categorized to define a group of neurodegenerative disorders resulting from a progressive deterioration of the cells in the anterior temporal and/or frontal lobes of the brain. More specifically, ventromedial-frontopolar cortex is identified with metabolic impairment in FTD. This chapter elaborates on the history, epidemiology, pathophysiology, clinical features, treatment, and outcomes of FTD. The history and background section of each of the FTD categories highlights the evolution of the disease conceptualization. The FTD subtypes are conceptualized in three categories: neurobehavioral variant, motor variant, and language variant. The chapter illustrates the features of all three categories of FTD.
This chapter describes the role of supplementary education–typically, a form of additional structured education that takes place outside of the school classroom–and how it can prepare learners for high academic achievement and effective engagement in the process of learning that is key to academic success. The idea of supplementary education is based on the premise that beyond exposure to the school’s formal academic curriculum, high academic achievement is closely associated with exposure to family and community-based activities and learning experiences that occur outside of school. The chapter presents the rationale and need for supplementary education. Related types of supplementary education include those that are implicit parenting, nutrition, family talk, parental employment, decision making, reading along with the children, socialization and acculturation, social networks, travel, and environmental supports, and those that are explicit (academic development, tutorials, advocacy, remediation, one-on-one tutoring SAT preparation, Saturday academies, specialized services, socio-cultural and child-centered social groups).
School social workers provide direct treatment for a multitude of problems that affect child and adolescent development and learning; these problems include mood disorders, attention deficit hyperactive disorder (ADHD), disruptive behavior disorders, and learning disorders, as well as child abuse and neglect, foster care, poverty, school drop out, substance abuse, and truancy, to name but a few. This chapter examines four constructs that are important when working with students. These constructs include: assessment and cognitive case conceptualization, the working alliance, self-regulated learning, and social problem solving. The chapter discusses the development of attainable and realistic goals is a critical component both of self-regulated learning and social problem solving. The chapter examines the problem of academic underachievement and four constructs that are critically important when working with children and adolescents in school settings. Academic underachievement is a serious problem affecting the lives of many children.
- Go to chapter: Use of Meditative Dialogue to Cultivate Compassion and Empathy With Survivors of Complex Childhood Trauma
Use of Meditative Dialogue to Cultivate Compassion and Empathy With Survivors of Complex Childhood Trauma
This chapter offers a review of selective literature on complex childhood trauma. It explains a case study demonstrating the use of meditative dialogue, a collaborative practice through which client and therapist are able to work together to develop empathy and compassion toward self and others during psychotherapy sessions. Thompson and Waltz described an inverse relationship between exposure to trauma and subsequent posttraumatic stress disorder symptom severity, and self-compassion. Recent neuroscience research has begun examining the effects of meditation practices on specific areas of the brain through neuroimaging studies. Clinical trials on the use of meditative dialogue in psychotherapy with survivors of complex childhood trauma, looking at the brains of the clients, and using magnetic resonance imaging (MRI) to measure changes, would help to demonstrate its efficacy and move it into the realm of evidence-based practices.
Neurorehabilitation has become more of a global phenomenon and is not necessarily limited to industrialized or Westernized societies. Culture often connotes concepts of race and ethnicity when discussed in the context of health care disparities. Socioeconomic and other demographic variables make up the majority of the balance on discussion regarding culture in health care. Multicultural neurorehabilitation must emphasis “multiple”, and do so in a dynamic manner. In other words, at any given time, multiple cultures operate in each interaction and in each therapy delivered in the neurorehabilitation setting. Recently, there has been increased interest and research into the newly developing field of cultural neuroscience. Several models are available to conceptualize the influence of culture in human functioning. The most persuasive model is one that mirrors a dynamic, ecological system.
- Go to chapter: Structural and Cultural Issues in Long-Term Services and Supports for Minority Populations
This chapter examines the history of long-term services and supports (LTSS) programs to document their racially and ethnically disparate impact, and explain the current research on the access and quality of LTSS used by older adults in communities of color. LTSS are a set of health and social services delivered over a sustained period to people who have lost or never acquired some capacity for personal care. The high costs of LTSS have led a smaller number of low-income older adults to consume a large share of Medicaid expenditures. Cultural beliefs about family responsibility to care for older adults as well as attitudes toward the use of formal and/or public health and long-term care services can shape older adults’ use of LTSS. The coming sociodemographic shift of older minority adults calls attention to other structural and cultural issues that facilitate or inhibit the appropriate use of LTSS.
This chapter explains a set of guidelines to help mental health professionals and clients move away from the gender stereotypes that perpetuate inequality and illness. Identifying dominance requires conscious awareness and understanding of how gender mediates between mental health and relationship issues. An understanding of what limits equality is significantly increased when we examine how gendered power plays out in a particular relationship and consider how it intersects with other social positions such as socioeconomic status, race, ethnicity, and sexual orientation. To contextualize emotion, the therapist draws on knowledge of societal and cultural patterns, such as gendered power structures and ideals for masculinity and femininity that touch all people’s lives in a particular society. Therapists who seek to support women and men equally take an active position that allows the non-neutral aspects of gendered lives to become visible.
This chapter presents how eye movement desensitization and reprocessing (EMDR) therapy and Theraplay can be used together when treating children with a history of complex trauma. Theraplay focuses on the parent-child relationship as the healing agent that holds within it the potential to cultivate growth and security in the child. The chapter shows some core concepts that help define and illuminate the application of Theraplay. Now that a clear review of basic Theraplay principles has been provided, people need to look at EMDR therapy and the adaptive information processing (AIP) model in conjunction with Theraplay and Theraplay core values. Early in its development, Theraplay integrated parental involvement into its therapeutic model. During the reprocessing phases of EMDR therapy, Theraplay can be very helpful in providing different avenues for emotion regulation and for the repairing of the attachment system.
A growing body of research documents racial and ethnic disparities in physical and mental health among older Americans. This chapter discusses larger stress process literature and reviews research on discrimination as a source of stress that is an influential determinant of racial and ethnic differences in the health status of older Americans. It provides a brief overview of disparities in health among older Americans. The chapter discusses the biology of stress, elaborates on key elements of the general stress process framework, and highlights findings pertinent to the health of older minorities. It reviews the research on personally mediated discrimination and health that includes findings from both age-diverse samples and those specific to older adults. The chapter also reviews the literature on coping with discrimination and the contribution of institutionalized discrimination to health inequalities. Lacking are investigations on the joint impact of perceived discrimination and residential segregation.
- Go to chapter: Ethnic/Racial Disparities in Gay-Related Stress and Health Among Lesbian, Gay, and Bisexual Youths: Examining a Prevalent Hypothesis
Ethnic/Racial Disparities in Gay-Related Stress and Health Among Lesbian, Gay, and Bisexual Youths: Examining a Prevalent Hypothesis
Lesbian, gay, and bisexual (LGB) individuals are more likely than their heterosexual peers to experience a variety of mental health and health-related problem behaviors, including emotional distress, suicidality, substance use, and sexual risk behaviors. This chapter investigates potential ethnic/racial differences in gay-related and non-gay-related stress among a sample of Black, Latino, and White LGB youths in New York City. It further examines whether ethnic/racial disparities exist in various mental health and health-related behaviors of LGB youths. The chapter then examine whether gay-related stress may account for the potential ethnic/racial disparities among LGB youths. The chapter reviews the research on sexual orientation disparities in health among LGB youths, followed by a review of what is currently known about potential ethnic/racial disparities in stress and health among LGB youths.
The concept of Mild cognitive impairment (MCI) makes a lot of sense in that individuals are typically not “normal” one day and “demented” the next. In theory, especially for progressive neurodegenerative conditions, such as Alzheimer’s disease (AD), frontotemporal dementia (FTD), the development of dementia may take months or years. The clinical syndrome of MCI due to AD can be identified via a neuropsychological evaluation or less-sensitive cognitive screening measures. Much of what we are learning about MCI, and therefore refining its diagnostic criteria, is coming from two large-scale studies of cognition and aging: Alzheimer’s Disease Neuroimaging Initiative (ADNI) and Australian Imaging, Biomarkers and Lifestyle (AIBL). According to the most recent research diagnostic criteria for MCI due to AD, evidence of beta-amyloid deposition, neuronal injury, and/or other biochemical changes needs to be seen to increase confidence of the etiology of MCI. Cholinesterase inhibitors remain the primary pharmacological treatment for AD.
This chapter provides new insights, direction, and applicability of qualitative research methods in social network analysis, with special emphasis on the minority elder population. It describes how specific qualitative approaches may be applied and contribute to increased understanding in social network analysis. The chapter provides a list of suggested future directions to address issues that are void in the literature on social networks and minority elders. The social networks of older adults provide them with the greatest amount of care and support. Any definition of social networks needs to be grounded in both microstructural and macro-structural perspectives. The social networks of minority elders are uniquely shaped by the cultural norms and values associated with the diverse racial and ethnic groups with which they identify. The conceptual guidance from the life course perspective can also inform understanding the structure and function of social networks among minority elders.
Informal and loosely generated models of White identity development began to emerge in the late 1970s and early 1980s; however, the first formal White identity development model, or typology, was proposed by Helms in 1984. This chapter describes her model, followed by an application of the model to the opening vignette. It identifies strategies for educators and student affairs practitioners to work with students like Craig to begin to more fully understand his Whiteness, the sociopolitical realities of race on campus and, in general, increase his multicultural competence, and engage in healthy interracial interactions. The chapter also discusses the summary of the literature examining the steps educators and student affairs practitioners can take to promote their own cross-cultural interactions and multicultural knowledge in order to more effectively work with students struggling with their own racial identity, followed by the strategies to promote healthy interracial interactions among students.
This chapter helps readers to understand the main characteristics of the three major types of eating disorders: anorexia nervosa, bulimia nervosa, and binge eating. It also examines each disorder from a neurobiological perspective, including genetic factors when known, neuroimaging results, the understanding of neurotransmitter dysregulation, cognitive performance, and various types of treatment. The chapter then presents the consideration of the unique challenges associated with comorbidity, societal pressure, and medical implications. Eating disorders are increasingly common, debilitating, and potentially life-threatening disorders that are clearly linked in their neurobiological basis. Mental health professionals should be aware of the signs and symptoms of eating disorders, as individuals might not disclose their eating habits as readily as their mood, anxiety level, or other symptoms. Treatment is complex, as no medication has been shown to be consistently effective, and each eating disorder will bring with it specific goals.Source:
This chapter describes four specific minority groups within rural areas namely African American; Hispanic; lesbian, gay, bisexual, and transgender (LGBT); and American Indian/Alaskan Native. It also describes leading health issues such as diabetes, heart disease, stroke, hypertension, and cancer among rural Hispanics, contributing factors to health disparities among rural Hispanics. The chapter offers recommendations to improve health and eliminate disparities among rural Hispanic populations. For rural African American communities, community-based settings like churches have been found to engender higher participation and retention rates for health promotion programs. Factors such as poverty, health insurance, and having a health care provider contribute to the health disparities among rural Hispanics. Innovations such as telehealth and community-based participatory research hold much promise for advancing health within rural minority groups such initiatives should be encouraged, supported, and appropriately funded to begin to address health inequity in the doubly underserved populations.
One of the emerging approaches to explaining the normative spike in adolescent risk-taking, with delinquent/antisocial behavior as one expression, is based on recent advances in developmental neuroscience. Brain imaging studies have identified two main processes for which co-occurrence in the healthy adolescent brain directly impacts delinquent behavior. The first neuropsychosocial process implicated in heightened risk-taking involves sudden and dramatic changes in activity in the limbic system that coincides with puberty. The second process is associated with a developing ability to self-regulate behavior that continues to mature into the early 20s. Mindfulness meditation may be an effective method for reducing delinquency in juvenile justice involved youth because of its association with increases in self-regulation. The juvenile justice system was built on the argument that children and youth are less culpable for criminal and delinquent behavior than adults, making adolescence a mitigating circumstance in determining the state’s response to youth criminality.
Holland theorized six distinct worker personalities (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional). This is often referred to as RIASEC. The theory includes six work environments that correspond to the same personality types (Realistic, Investigative, Artistic, Social, Enterprising, and Conventional). Although people possess aspects of each type, the general thesis of the theory is that salient types (work personalities) will emerge in each individual. Holland’s work represents a significant contribution to career development and counseling. Understanding Holland’s focus on interests as expressions of personality aids career counselors and student development specialists in helping students gain critical self-understanding. Exploring the match between personalities and work environments is a fundamental aspect of applying this theory to student development. Helping students to explore and learn about different careers that may be of interest to them is congruent with the goals of higher education institutions and student development theories.
- Go to chapter: New Paradigms for Inclusive Health Care: Toward Individual Patient and Population Health
This chapter presents new paradigms for inclusive health care, articulating the need for both individual patient and population health approaches, while highlighting the role of home-based interactive computer technology in having a wide impact. It describes the high costs of health and mental health behaviors. The chapter explains science’s and health care practices low impact on health and mental health behaviors. It describes higher impact paradigms that can complement current paradigms of research and practice. Integrated health care paradigm is an innovative approach to population health, which would integrate services across biological and behavioral disciplines. The chapter discusses in detail clinician and computer paradigms, clinician and computer-based clinical trials, from single to multiple behavior change paradigms, high specificity vs. high generality, and higher impact science and service.
Most Behavioral Group Therapy (BGT) with children and adolescents include aspects of problem solving or social skills training or both. This chapter describes group workers can make an important contribution to children, families, and schools through preventive and remedial approaches. Social skills training grew out of the clinical observation and research that found a relationship between poor peer relationships and later psychological difficulties. The social skills program taught the following four skills: participation, cooperation, communication, and validation/support. The chapter focuses on the unique application of behavioral treatment using groups with an emphasis on assessment, principles of effective treatment, and guidelines for the practitioner. It also focuses on the use of the group in describing these aspects of BGT. The primary goal of using BGT with children is enhancing the socialization process of children, teaching social skills and problem solving, and promoting social competence.
Integral to theories of moral development is the matter of not only what individuals think but also how they think. Across the life span, moral development is shaped by challenging events that prompt individuals to question the frameworks they have created for finding ways to determine what is good and what is bad. College students encounter new ideas and values that differ from those of their families, in the classroom, in the residence hall, in the dining facility, in the student union, and sometimes on the athletic field or court. In order to illustrate how moral development unfolds within a college student population, this chapter introduces a fictitious character who displays each stage of moral development for two theories–Lawrence Kohlberg’s (1963, 1984) and Carol Gilligan’s (1982) models of moral development. The chapter discusses the underpinnings of two specific moral development theories.
This chapter suggests that the dysexecutive syndrome associated with vascular dementia (VaD) is caused by impairment in separate but related cognitive concepts; that is, pathological inertia, mental bradyphrenia, disengagement, and temporal reordering. During the late 19th and early 20th centuries, cerebrovascular dementia was a well-established clinical syndrome. Multi-infarct dementia (MID) generally became associated with all types of vascular syndromes. Recent research suggests the presence of considerable overlap between the neuropathology underlying Alzheimer’s disease (AD) and VaD. Patients diagnosed with VaD tend to produce hyperkinetic/interminable perseverations, suggesting an inability to appropriately terminate a motor response. Other aspects of the dysexecutive syndrome associated with VaD revolve around constructs related to interference inhibition, flexibility of response selection, and sustained attention. From the view point of diagnosis, the neuropathology of VaD often differentially impacts the frontal lobes, whereas the neuropathology associated with AD revolves more around circumscribed temporal lobe involvement.
The multicultural movement in counseling and psychology has begun to provide scholars and practitioners with contextually relevant, systems-based ecological approaches to counseling as alternatives to the traditional theoretical models of human behavior and intervention that are based on Western dominant culture. This chapter provides awareness of the complexity of multicultural issues among individuals with disabilities and discusses culturally sensitive strategies to work with people with disabilities (PWDs). It reviews legislative mandates related to diversity and multiculturalism in rehabilitation and addresses the relationship between disability and culture in the scope of rehabilitation practice. The chapter introduces multiculturalism and multicultural counseling models as a therapeutic framework and provides guidelines to help psychologists increase their cultural sensitivity. It also provides strategies to work with individuals with disabilities from minority backgrounds.
This chapter describes the toxic stress often experienced by young homeless children and the effect that this type of stress can have on brain development, behavior, and lifelong health. Mental health and cognitive challenges are abundant among homeless families. Stress can affect maternal cardiovascular function and restrict blood supply to the placenta, potentially reducing fetal nutritional intake or oxygen supply, and lead to reduced fetal growth, increased risk of placental insufficiency, preeclampsia, and preterm delivery. Trauma in early childhood has clear neurological and developmental consequences, especially with regard to brain development and executive functioning. The chronic release of two stress hormones glucocorticoids and cortisol can have damaging effects on neurological functioning and lifelong health. Similarly, exposure to high levels of cortisol inhibit neurogenesis in the hippocampus, further impacting executive functioning and the ability to distinguish safety from danger, a symptom of posttraumatic stress disorder (PTSD).
The case for major depression being an inflammatory condition has been advanced in the literature on neuroscience as well as in the literature on psychiatry. The correlational data suggested that depressed persons exhibit signs of systemic inflammation. One way to induce inflammation in the blood is to place a piece of the wall of a bacterium in the paw of an animal. There are other ways to induce systemic inflammation besides introducing fragments of a bacterial cell wall. Consistent with the view that behavioral depression involves inflammation, particular alleles for genes involved in the immune system have been identified as risk factors for depression. Mediterranean diets are associated with lower levels of inflammatory factors and lower levels of depression. Parasympathetic nervous system (PNS) releases factors that will inhibit the release of inflammatory factors from white blood cells and from the liver.
This chapter describes maneuvers to access the internal system of the patient as well as means to accelerate or decelerate the work in that process of accessing the self-system. Eye movement desensitization and reprocessing (EMDR), ego state therapy, and somatic therapy fit together like hand and glove. An extended preparation phase is often necessary before trauma processing in complex traumatic stress presentations and attachment-related syndromes, particularly when dealing with the sequelae of chronic early trauma. Clinical practice suggests that the adjunctive use of body therapy and ego state interventions can be useful, during stabilization and later on in increasing the treatment response to EMDR. Traditional treatment of complex posttraumatic stress disorder (PTSD) and dissociative disorders has usually included hypnoanalytic interventions, during which abreaction is considered an important part of treatment.
- Go to chapter: Two Approaches to Developing Health Interventions for Ethnic Minority Elders: From Science to Practice and From Practice to Science
Two Approaches to Developing Health Interventions for Ethnic Minority Elders: From Science to Practice and From Practice to Science
This chapter focuses on more integrated approach or process for developing a health intervention for ethnic minority groups that incorporates accepted principles of medicine and scientific methodology. The changing demographic has led to complex challenges in the U.S. health care system. The delivery of effective health care services hinges on health care professionals’ ability to recognize varied understandings of and approaches to health care across cultures. Health care providers may employ different strategies to increase participation of service users by bridging barriers to communication and understanding that stem from these racial, ethnic, cultural, and linguistic differences. In the context of health or health care improvement, little debate exists concerning the recognized need to help ethnic minority patients maintain and restore health. There are two general approaches for developing culturally appropriate health interventions. The first approach is from science to practice and the second approach is from practice to science.
This chapter discusses the history, organization, development, and the future of Medicare and applies Andersen’s Behavioral Model of Health Services Use to understand utilization among the elderly and conduct a systematic literature review. It analyzes racial/ethnic disparities in health care utilization among the elderly using Andersen’s model and discuss the implications of the current proposals for changes in Medicare for health care utilization especially among minority aging. Racial/ethnic differences in seniors’ use of medical care were sizable before the Medicare program. The focus on deficits and controlling the cost of government has in turn increased the focus on health care and entitlement programs like Medicare. Medicare is important to ensure access to health care for the elderly, particularly the poor and minorities. However, with the rising health care costs and changing demographics, it is clear that Medicare needs some type of reform to ensure its continuing viability.
Many adults understand the pressures of having multiple responsibilities that require attention in a variety of life circumstances. Whether giving attention to work, friends, school, religious activities, romantic relationships, family, or even recreation, adulthood requires the ongoing ability to multitask a variety of expectations and responsibilities. Before reaching adulthood, each person has experienced influences that affect how we think, feel, and react to life’s circumstances. This chapter offers professionals and educators one model for understanding these influences and their impact on college students who oftentimes are transitioning to a new world of adult responsibilities for the first time. Ecological theory originally developed out of the work of Urie Bronfenbrenner (1977) within the field of developmental psychology. The concepts described in Bronfenbrenner’s ecological theory offer a number of important implications for supporting students in a college setting.
This chapter provides selective review of research on religion and spirituality across three groups of racial and ethnic minority older adults African American, Asian American, and Hispanic/Latino. It discusses major denomination and faith traditions, as well as information about types and patterns of participation and their sociodemographic correlates. The chapter examines informal social support provisions within faith communities and the types of assistance exchanged. It also examines associations between religion, spirituality and physical/mental health, and psychological well-being. Religion and spirituality, through a variety of psychosocial mechanisms and pathways are thought to have largely beneficial impacts on physical and mental hea.
This chapter integrates elements and strategies of internal family systems (IFS) psychotherapy into eye movement desensitization and reprocessing (EMDR) therapy with complexly traumatized children. It shows a description of healing a part using in-sight with a child. In-sight involves having the client look inside to find and work with parts that he or she sees or senses and describes to the therapist. The IFS therapist starts by ensuring the client’s external environment is safe and supportive of the therapy. In a self-led system, polarizations are absent or greatly diminished, leaving more harmony and balance. However, when and how the self is formed may be seen and conceptualized through different lenses in adaptive information processing (AIP)-EMDR and IFS. According to the AIP model, the human brain and biological systems are shaped by the environmental experiences they encounter.
Dementia pugilistica (DP) is a form of chronic traumatic encephalopathy (CTE) that involves gross impairment of cognitive and motor functioning due to repetitive blows to the head from boxing. Rapidly increasing in popularity among fight fans and fighters is mixed martial arts (MMA). In the area of sport-related concussion, there are two other frequently used terms that are necessary to distinguish from DP and CTE: postconcussion syndrome (PCS) and second impact syndrome (SIS). The classical clinical signs and symptoms of DP include combinations of dysarthria, incoordination, gait disturbance, pyramidal and extrapyramidal dysfunction, and cognitive impairment. Some media reports about concussion and the potential link between repetitive concussions and long-term problems include eye-catching and emotionally provocative titles. This chapter has provided an overview of the many complex issues surrounding the effects of repeat concussive trauma, particularly in sports.
This chapter provides insight into the dilemmas couples face when ideals of equality intersect with societal structures that maintain gendered power. It examines how Iranian couples construct gender and negotiate power within their culture, political structure, and Islamic values. Gender equality may express itself differently in a culture such as Iran that not only emphasizes collective goals and achievements, strong feelings of interdependence, and social harmony. Collectivism typically maintains social order through a gender hierarchy. Contemporary Iranian couples draw from diverse cultural legacies. Although some couples seemed to accept the traditional gender hierarchy and a few others appeared to manage relatively equally within it, other couples were quite aware of gendered-power issues and attempted to address them in their personal lives. Some couples describe trying to maintain an equal relationship in their personal lives despite men’s greater legal authority.
- Go to chapter: HIV/AIDS Risk Reduction With Couples: Implications for Reducing Health Disparities in HIV/AIDS Prevention
HIV/AIDS Risk Reduction With Couples: Implications for Reducing Health Disparities in HIV/AIDS Prevention
Twenty-five years into the epidemic, AIDS remains a significant public health issue that highlights the persistence of health disparities in the United States. This chapter provides an example of the best case scenario outcome: a new emergent evidence-based model for reducing HIV/AIDS risk with serodiscordant couples worthy of dissemination, and adaptation to new culturally distinct populations. It reviews current research on HIV prevention for couples and highlight the rationale for conducting couple-based intervention research. The chapter describes the process of designing Project Connect, a cultural- and gender-specific HIV/STI prevention intervention. It presents theories that guided the study. The chapter describes the content of the intervention and finally discusses the implications of the efficacy of Project Connect for the design and dissemination of culturally-congruent interventions to address the AIDS epidemic among ethnically diverse women and their male partners.
This chapter focuses on aging and health issues in all of America’s major minority populations including African Americans, Hispanics/Latinos, Asian Americans, as well as Native Americans. It addresses the issues of health inequality and health advantage/disadvantage. The chapter introduces relatively new areas of inquiry including long-term care, genetics, nutrition, health interventions, and health policy issues. In addition to possible genetic factors, the literature has emphasized the influence of poverty and socioeconomic status as well as stressors associated with minority group status. The system of long-term care services will need to be restructured to take into account issues affecting minority populations such as health care coverage, housing and income supports, as well as cultural issues as filial piety and trust. The field of minorities, aging, and health has been dominated by a health inequality perspective that has been illustrated by the application of cumulative disadvantage/cumulative inequality theory.
This chapter examines how 12 White, middle-class couples negotiated the issue of equality in their relationships during their first year of marriage. The social context both supports and inhibits the development of marital equality. To be included in the present study, complete transcripts with both the husband and wife present had to be available, both members of the couple had to express ideals of gender equality, and both had to express commitment to careers for wives as well as husbands. Most of the couples classified as creating a myth of equality, spoke as though their relationships were equal but described unequal relationship conditions. The other couples classified in the myth-of-equality category described similar contradictions between their ideals of gender equality and their behavior. Gender-equality issues raise political and ethical concerns for all of us who are family practitioners and teachers.
The general racial/ethnic identity theories offer some insight into possible ways to approach diversity education within all aspects of student affairs. Student affairs professionals and faculty could facilitate educational programs, seminars, and workshops that challenge students to confront issues of prejudice and racism as well as to cultivate racial or ethnic pride. These programs should address the external conditions in which students explore their identity and how to make meaning of shifting thoughts as they progress in their racial or ethnic identity development. By looking at diversity through the lens of racial or ethnic orientation, professionals can meet students where they are and help them not only understand other cultures, but also how they fit into their own race/ethnicity. Practitioners might also use these models as a way to gain insight as to where students might be in their racial/ethnic identity development.
This chapter introduces the scope of this volume by reviewing thirteen guiding principles for a new field of equity in health. The thirteen guiding principles are: The drive for a major paradigm shift, the drive for new models of health care and training, the drive for new theories, perspectives, and identities, the drive for evidence-based approaches, the drive for transdisciplinary teams and community-based participatory research, the drive for globalization and global collaboration, the drive for cultural competence and cultural appropriateness, the drive for health literacy and linguistic appropriateness, the drive to ensure the right to health, the drive for social justice and acknowledgment of forces in the social context, the drive to protect and support the most vulnerable, the drive to repair damage, restore trust, and take responsibility, and the drive to redistribute wealth and access to opportunity. These principles provide hope for a future global transformation in health.
This chapter focuses on the assessment phase and importance of negative cognitions (NCs) drawing heavily on illustrative case vignettes. Janoff-Bulman introduced the notion of an “Assumptive World Theory” to describe how individuals make assumptions about themselves and the world they live in. According to McCann and Pearlman’s Constructionist Self-Development Theory (CSDT), people give meaning to traumatic events depending on how, as individuals, they interpret them. Person-centered counseling refers to “self-concept” describing the individual’s self-image largely based on life experience and attitudes expressed by significant others, such as family, teachers, and friends. Therapists should familiarize the client at an early stage with the mechanics of DAS and allow them some control in choosing the technique to be used. In choosing the target memory, the therapist and client need to determine the touchstone event, that is, the earliest memory linked to the current pathology.
- Go to chapter: The Role of Neurobiology in Social Work Practice With Youth Transitioning From Foster Care
This chapter presents advances in the understanding of adolescent brain development that can inform and improve social work practice with youth leaving foster care. Foster care populations have a high rate of mental health disorders, and the association of types of child maltreatment with elevated risk for such disorders is well known; discussion of specific mental health problems and their treatment can be found elsewhere. Conventional mental health approaches have often targeted the innervated cortical or limbic neural systems, rather than the innervating source of the dysregulation. Psychotherapy, whether psychodynamic or cognitive, acts on and has measurable effects on the brain, its functions, and metabolism in specific brain areas. The ethical response is a sharing of the dilemma, and of information about the neurobiology of the client’s struggle, to enable the client to make as informed a decision as possible. In addition, neuroimaging techniques themselves lead to other ethical dilemmas.