A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated that more than 60% of patient
visits to primary care physicians (PCPs) include mental health concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint (Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986; Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other researchers and practitioners have
written books that serve as a guide to other mental health practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn et al., 1996).
The specialty of family medicine, which arose in the 1960s, embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of caring for the whole person
within his or her family, social context, and life cycle stage (Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat their patients’ mental health
problems. By definition of their specialty, FPs are trained to integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et al., 1996) as well as to manage
Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle, Maine; Deanna Linville, PhD, Couples and
Family Therapy .
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
This document summarizes and analyzes research on family presence during CPR and invasive medical procedures. It discusses a study by Jensen and Kosowan that surveyed 169 medical professionals on their attitudes towards family presence. The study found that while acceptance of family presence was under 50%, most supported developing policies around it. Other research presented had mixed findings. The document concludes by discussing how nurses can advocate for developing family presence policies based on the evolving research.
Prepared by louise kaplan, ph d, arnp, fnp bc, faanp senior pamit657720
This document provides a framework for critiquing research studies. It outlines 14 key aspects of a research article to evaluate, including the title, abstract, introduction, literature review, methods, analysis, results, discussion, limitations and conclusion. It recommends determining the level and quality of evidence using an appropriate scale. Finally, it asks the reader to decide if the study is applicable to their own practice. The overall purpose is to provide guidance on thoroughly reviewing and assessing the strengths and weaknesses of a research article.
Tangible Needs and External Stressors Faced by Chinese Ameri.docxperryk1
Tangible Needs and External Stressors
Faced by Chinese American Families with
a Member Having Schizophrenia
Winnie Kung
This article examines the tangible needs and external stressors experienced by Chinese
American families with a member living with schizophrenia, in the context of a six-month
pilot study of family psychoeducation. Therapists’ notes from 117 family and group sessions
were analyzed. The families expressed concerns regarding housing, finance, work, study, and
the shortage of bilingual psychosocial services. Interacting with government offices and
social services agencies caused anxiety and frustration, partly due to the high stakes involved
given their low socioeconomic status, and partly due to the bureaucracy. As immigrants,
study participants had needs for language translation, knowledge about resources, and advo-
cacy by case managers. This study also highlights the importance of interventions beyond
the micro individual level to the mezzo and macro levels, where changes in organizations
and policies are necessary.
KEY WORDS: caregivers; Chinese Americans; environmental stressors; ethnic sensitivity;
schizophrenia
This study aims to address the knowledge gap in understanding the challenges faced by Chinese American families with a member
living with schizophrenia in relation to their tangible
needs and external stressors from the environment. I
conducted this research in the context of an interven-
tion study of family psychoeducation that I previously
developed and pilot-tested as an ethnic-sensitive pro-
gram for Chinese Americans ( Kung, Tseng, Wang,
Hsu, & Chen, 2012). Family psychoeducation has
been proven effective in reducing caregiver stress and
the relapse rate of individuals with schizophrenia
( Jewell, Downing, & McFarlane, 2009; Lefley, 2010;
McFarlane, Dixon, Lukens, & Lucksted, 2003). The
intervention protocols focus on educating the fami-
lies about the nature of the illness, promoting better
communication, and helping family members re-
solve conflicts ( Anderson, Reiss, & Hogarty, 1986;
McFarlane, 2002) to reduce “expressed emotions”
such as criticism and overinvolvement, which highly
predict relapses ( Butzlaff & Hooley, 1998; Hooley,
2007; Leff & Vaughn, 1985; Marom, Munitz, Jones,
Weizman, & Hermesh, 2005). Few studies had been
conducted with Chinese American families, many of
whom face unique challenges due to their immigrant
status and cultural values ( Kung, 2003).
To more thoroughly understand the stresses ex-
perienced by these families so as to better meet their
needs and to refine the family psychoeducation pro-
tocol, a qualitative inquiry was conducted using the
clinicians’ session notes from the intervention study.
Whereas the family psychoeducation model in its
original design focused on resolving the psycho-
logical and relational issues within the families, this
investigation noted that these families’ struggles were
closel.
Fact Sheet onFact Sheet onFact Sheet onFact Sheet onFact Sheet on
End-of-Life CareEnd-of-Life CareEnd-of-Life CareEnd-of-Life CareEnd-of-Life Care
WHAT ARE OLDER ADULTS’ MENTAL HEALTH NEEDS
NEAR THE END OF LIFE?
The US Supreme Court agreed that Americans should expect palliative care,
which combines active and compassionate therapies to comfort and support
individuals and families nearing the end of life. End of life is defined as that
time period when health care providers would not be surprised if death
occurred within about 6 months. Older Americans with chronic illness think
about how they would prefer their lives to end, and want a “good death”
without burdensome pain, symptoms and technology.
Most deaths (70%) occur in those aged 65 and older. Older adults want better discussions,
information, and a chance to influence decisions about their care—whether to be at home
or in the hospital and to have CPR (cardiopulmonary resuscitation) (Foley, 1995). Most
Americans die in hospitals (63%), and another 17% die in institutional settings such as
long-term care facilities (Foley, 1995; Isaacs & Knickman, 1997). In addition, most
people are referred too late to hospice or palliative care, so they are unable to get the most
benefit possible from these specialized services.
WHAT DO OLDER ADULTS FEAR MOST?
People fear that their pain, symptoms, anxiety, emotional suffering, and family
concerns will be ignored. Many critically ill people who die in hospitals still receive
unwanted distressing treatments and have prolonged pain. Many fear that their
wishes (advance directives) will be disregarded and that they will face death alone
and in misery. Physicians may use confusing or vague medical terms and talk briefly
about treatment options when the patients are too sick to participate. Most people
want to discuss advance directives when they are healthy and often want their
families involved.
Caregivers reported that a third of 1227 elderly individuals were in unnecessary pain
during the 24 hours before their death. Studies show that two thirds of elderly patients have
pain in the last month of life (Foley, 1995). Although palliative/comfort care could relieve
most of this pain and suffering, patients typically spend 8 days in ICU (an intensive care
unit) comatose or on a ventilator and 30% of patients spend at least 10 days in ICU
before they die (Isaacs & Knickman, 1997).
When discussing a good end of life with a patient, physicians in one study talked about 5-6
minutes, spoke for 2/3 of this time, and did not consider the patient’s values or preferences
(Tulsky, Fischer, Rose & Arnold, 1998). If patients were too sick to make decisions, most
wanted their family to be given choices about treatment and only 41% wanted the
physician to make treatment decisions without consulting them. In 91% of cases in which
physicians discussed end of life treatment options, they did so in scenarios in which most
patients would not want to be treated, whereas o ...
A Survey Of Autism Knowledge In A Health Care SettingAmy Cernava
This study surveyed 111 professionals from various healthcare fields about their knowledge of autism. It found that while all groups accurately understood the DSM-IV diagnostic criteria for autism, primary healthcare providers and specialists differed from experts at an autism center (CARD) in their beliefs about autism's prognosis, course, and treatment. Primary providers showed the greatest number of differences from CARD. The study aims to increase understanding of knowledge and beliefs that influence autism diagnosis across healthcare settings.
This document describes a study that evaluated the effectiveness of a culturally adapted cognitive behavioral therapy (CBT) treatment protocol for Māori clients in New Zealand diagnosed with major depression. The treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. It was administered to 16 Māori clients and resulted in large, significant reductions in depressive symptomatology and negative cognition based on standardized assessments. This was the first study to examine individual psychotherapy outcomes for an indigenous population using an effectiveness design. The findings provide support for culturally adapting psychological treatments for ethnic minority groups.
This study investigated the needs of relatives of surgical patients according to relatives themselves and hospital staff. Both groups ranked assurance and anxiety reduction as the most important needs. While their overall rankings were similar, some differences emerged in the importance assigned to specific needs like information and proximity. Assurance of quality care for patients was seen as the top need by relatives, whereas staff prioritized being informed of patient progress details. Both groups agreed on the least important needs.
Family Therapy CourseUsing the brief case description below, pre.docxssuser454af01
Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
This document summarizes and analyzes research on family presence during CPR and invasive medical procedures. It discusses a study by Jensen and Kosowan that surveyed 169 medical professionals on their attitudes towards family presence. The study found that while acceptance of family presence was under 50%, most supported developing policies around it. Other research presented had mixed findings. The document concludes by discussing how nurses can advocate for developing family presence policies based on the evolving research.
Prepared by louise kaplan, ph d, arnp, fnp bc, faanp senior pamit657720
This document provides a framework for critiquing research studies. It outlines 14 key aspects of a research article to evaluate, including the title, abstract, introduction, literature review, methods, analysis, results, discussion, limitations and conclusion. It recommends determining the level and quality of evidence using an appropriate scale. Finally, it asks the reader to decide if the study is applicable to their own practice. The overall purpose is to provide guidance on thoroughly reviewing and assessing the strengths and weaknesses of a research article.
Tangible Needs and External Stressors Faced by Chinese Ameri.docxperryk1
Tangible Needs and External Stressors
Faced by Chinese American Families with
a Member Having Schizophrenia
Winnie Kung
This article examines the tangible needs and external stressors experienced by Chinese
American families with a member living with schizophrenia, in the context of a six-month
pilot study of family psychoeducation. Therapists’ notes from 117 family and group sessions
were analyzed. The families expressed concerns regarding housing, finance, work, study, and
the shortage of bilingual psychosocial services. Interacting with government offices and
social services agencies caused anxiety and frustration, partly due to the high stakes involved
given their low socioeconomic status, and partly due to the bureaucracy. As immigrants,
study participants had needs for language translation, knowledge about resources, and advo-
cacy by case managers. This study also highlights the importance of interventions beyond
the micro individual level to the mezzo and macro levels, where changes in organizations
and policies are necessary.
KEY WORDS: caregivers; Chinese Americans; environmental stressors; ethnic sensitivity;
schizophrenia
This study aims to address the knowledge gap in understanding the challenges faced by Chinese American families with a member
living with schizophrenia in relation to their tangible
needs and external stressors from the environment. I
conducted this research in the context of an interven-
tion study of family psychoeducation that I previously
developed and pilot-tested as an ethnic-sensitive pro-
gram for Chinese Americans ( Kung, Tseng, Wang,
Hsu, & Chen, 2012). Family psychoeducation has
been proven effective in reducing caregiver stress and
the relapse rate of individuals with schizophrenia
( Jewell, Downing, & McFarlane, 2009; Lefley, 2010;
McFarlane, Dixon, Lukens, & Lucksted, 2003). The
intervention protocols focus on educating the fami-
lies about the nature of the illness, promoting better
communication, and helping family members re-
solve conflicts ( Anderson, Reiss, & Hogarty, 1986;
McFarlane, 2002) to reduce “expressed emotions”
such as criticism and overinvolvement, which highly
predict relapses ( Butzlaff & Hooley, 1998; Hooley,
2007; Leff & Vaughn, 1985; Marom, Munitz, Jones,
Weizman, & Hermesh, 2005). Few studies had been
conducted with Chinese American families, many of
whom face unique challenges due to their immigrant
status and cultural values ( Kung, 2003).
To more thoroughly understand the stresses ex-
perienced by these families so as to better meet their
needs and to refine the family psychoeducation pro-
tocol, a qualitative inquiry was conducted using the
clinicians’ session notes from the intervention study.
Whereas the family psychoeducation model in its
original design focused on resolving the psycho-
logical and relational issues within the families, this
investigation noted that these families’ struggles were
closel.
Fact Sheet onFact Sheet onFact Sheet onFact Sheet onFact Sheet on
End-of-Life CareEnd-of-Life CareEnd-of-Life CareEnd-of-Life CareEnd-of-Life Care
WHAT ARE OLDER ADULTS’ MENTAL HEALTH NEEDS
NEAR THE END OF LIFE?
The US Supreme Court agreed that Americans should expect palliative care,
which combines active and compassionate therapies to comfort and support
individuals and families nearing the end of life. End of life is defined as that
time period when health care providers would not be surprised if death
occurred within about 6 months. Older Americans with chronic illness think
about how they would prefer their lives to end, and want a “good death”
without burdensome pain, symptoms and technology.
Most deaths (70%) occur in those aged 65 and older. Older adults want better discussions,
information, and a chance to influence decisions about their care—whether to be at home
or in the hospital and to have CPR (cardiopulmonary resuscitation) (Foley, 1995). Most
Americans die in hospitals (63%), and another 17% die in institutional settings such as
long-term care facilities (Foley, 1995; Isaacs & Knickman, 1997). In addition, most
people are referred too late to hospice or palliative care, so they are unable to get the most
benefit possible from these specialized services.
WHAT DO OLDER ADULTS FEAR MOST?
People fear that their pain, symptoms, anxiety, emotional suffering, and family
concerns will be ignored. Many critically ill people who die in hospitals still receive
unwanted distressing treatments and have prolonged pain. Many fear that their
wishes (advance directives) will be disregarded and that they will face death alone
and in misery. Physicians may use confusing or vague medical terms and talk briefly
about treatment options when the patients are too sick to participate. Most people
want to discuss advance directives when they are healthy and often want their
families involved.
Caregivers reported that a third of 1227 elderly individuals were in unnecessary pain
during the 24 hours before their death. Studies show that two thirds of elderly patients have
pain in the last month of life (Foley, 1995). Although palliative/comfort care could relieve
most of this pain and suffering, patients typically spend 8 days in ICU (an intensive care
unit) comatose or on a ventilator and 30% of patients spend at least 10 days in ICU
before they die (Isaacs & Knickman, 1997).
When discussing a good end of life with a patient, physicians in one study talked about 5-6
minutes, spoke for 2/3 of this time, and did not consider the patient’s values or preferences
(Tulsky, Fischer, Rose & Arnold, 1998). If patients were too sick to make decisions, most
wanted their family to be given choices about treatment and only 41% wanted the
physician to make treatment decisions without consulting them. In 91% of cases in which
physicians discussed end of life treatment options, they did so in scenarios in which most
patients would not want to be treated, whereas o ...
A Survey Of Autism Knowledge In A Health Care SettingAmy Cernava
This study surveyed 111 professionals from various healthcare fields about their knowledge of autism. It found that while all groups accurately understood the DSM-IV diagnostic criteria for autism, primary healthcare providers and specialists differed from experts at an autism center (CARD) in their beliefs about autism's prognosis, course, and treatment. Primary providers showed the greatest number of differences from CARD. The study aims to increase understanding of knowledge and beliefs that influence autism diagnosis across healthcare settings.
This document describes a study that evaluated the effectiveness of a culturally adapted cognitive behavioral therapy (CBT) treatment protocol for Māori clients in New Zealand diagnosed with major depression. The treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. It was administered to 16 Māori clients and resulted in large, significant reductions in depressive symptomatology and negative cognition based on standardized assessments. This was the first study to examine individual psychotherapy outcomes for an indigenous population using an effectiveness design. The findings provide support for culturally adapting psychological treatments for ethnic minority groups.
This study investigated the needs of relatives of surgical patients according to relatives themselves and hospital staff. Both groups ranked assurance and anxiety reduction as the most important needs. While their overall rankings were similar, some differences emerged in the importance assigned to specific needs like information and proximity. Assurance of quality care for patients was seen as the top need by relatives, whereas staff prioritized being informed of patient progress details. Both groups agreed on the least important needs.
This document provides an overview of medical family therapy, which integrates mind, body, and family in treating illness. It discusses the biopsychosocial framework, collaborative treatment model, and scope of medical family therapy. The document also presents a case study example and discusses applications of medical family therapy, such as personal development and family interventions.
Reply to the following two posts. In your replies, discuss what su.docxaudeleypearl
Reply to the following two posts. In your replies, discuss what surprised you about the theory your peers wrote about, and how it’s integrated into the study? What other type of research might this theory be useful in?
There is not an amount of words required. Just reply to post 1, and post 2.
FREE OF PLAGIARISM.
Post # 1: Michelle
The article I chose to analyze was “Making a connection: Family experiences with bedside rounds in the intensive care unit. The article examined the experience of families with a loved one in the intensive care unit and whether or not the families' participation in daily rounds decreased their anxiety and increased their overall positive perspective. The theoretical framework utilized by the authors Cody, Sullivan-Bolyai, and Reid-Ponte was the Family Management Style Framework.
The Family Management Style Framework was developed by Knafl and Deatrick in 1990 in order to better understand the coping style of families with children who had chronic health conditions (Knafl & Deatrick, 2003). The FMSF looked at the management behaviors and patterns of response to childhood chronic illness (Knafl & Deatrick, 2003). There are three major components in the FMSF, Definition of the situation, Management behaviors, and Sociocultural context (Knafl & Deatrick, 2003). The framework also describes five family management styles, thriving, accommodating, enduring, struggling and floundering (Knafl & Deatrick, 2003). The relationship between the family members, healthcare professionals, and their coping strategies is the basis for the framework.
The research study used the FMSF to look at which families participated in bedside rounds and which opted not to and the overall result. The framework looks specifically at the intersection of the management of chronic illness and the impact on family life (Knafl, et al., 2012). The finding was that the inclusion and willingness of families to participate in bedside rounds ultimately reduced their fear of the unknown and distrust in the healthcare providers. In the end, the families that attended the bedside rounds were better prepared for their loved one's discharge. The concept of the FMSF was woven throughout the study. The targeted areas of familial response to chronic illness were based on the three identified components of the definition of the situation or illness, management and coping behaviors of the individuals, and the perceived outcomes. The overarching finding of the study was that clear, consistent communication by the healthcare team to the families significantly decreased anxiety, and fear and increased trust in the healthcare professionals. The end result was an improved experience for the family.
King’s theory of Goal Attainment cis another framework that would be effective in this study. King’s theory examines individuals as they relate to personal, interpersonal and social systems (Petiprin, 2016). King noted that human beings function as dy ...
CLINICAL SCHOLARSHIPParents’ Perspectives on Supporting Th.docxclarebernice
CLINICAL SCHOLARSHIP
Parents’ Perspectives on Supporting Their Decision Making
in Genome-Wide Sequencing
Karen C. Li, MSN, RN1, Patricia H. Birch, MSc, RN2, Bernard M. Garrett, PhD, RN3, Maura MacPhee, PhD, RN4,
Shelin Adam, MSc5, & Jan M. Friedman, PhD, MD6
1 Graduate Student Researcher, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
2 Clinical Associate Professor, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
3 Associate Professor, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
4 Xi Eta, Associate Professor, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
5 Clinical Assistant Professor, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
6 Professor, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
Key words
Decision making, decision support, exome
sequencing, genetic counseling, genome
sequencing, genome-wide sequencing, nursing,
parent perspective
Correspondence
Karen C. Li, Box 153, Children’s and Women’s
Hospital, 4500 Oak Street, Vancouver, BC V6H
3V4, Canada. E-mail: [email protected]
Accepted: February 27, 2016
doi: 10.1111/jnu.12207
Abstract
Purpose: The purpose of this study was to explore parents’ perceptions of
their decisional needs when considering genome-wide sequencing (GWS) for
their child. This is a partial report and focuses on how parents prefer to receive
education and information to support their decision making about GWS.
Design: This study adopted an interpretive description qualitative method-
ological approach and used the concept of shared decision making and the
Ottawa Decision Support Framework.
Methods: Participants were parents who had already consented to GWS, and
had children with undiagnosed conditions that were suspected to be genetic in
origin. Fifteen parents participated in a focus group or individual interview.
Transcriptions were analyzed concurrently with data collection, iteratively,
and constantly compared to one another. Repeat interviews were conducted
with five of the parents to confirm, challenge, or expand on the developing
concepts.
Findings: Participants felt that their decision to proceed with GWS for their
child was an easy one. However, they expressed some unresolved decisional
needs, including a lack of knowledge about certain topics that became rele-
vant and important to them later and a need for more support and resources.
Participants also had ongoing informational and psychosocial needs after the
single clinical encounter where their decision making occurred.
Conclusions: Participants expressed unmet decisional needs, which may have
influenced the quality of their decisions. The strategies that participants sug-
gested may help create parent-tailored education, counseling, decision sup-
port, ...
Barriers to Practice and Impact on CareAn Analysis of the P.docxrosemaryralphs52525
This document summarizes barriers to practice for psychiatric mental health nurse practitioners (PMHNPs) in New York State. It discusses how statutory collaborative agreements requiring oversight from psychiatrists disrupt continuity of care for patients and limit PMHNPs' autonomous practice. National statistics show a significant need for more mental healthcare providers. While PMHNPs are well-positioned to address this need, barriers like restrictive regulations prevent them from doing so. The document calls for reforms to expand PMHNPs' scope of practice and reduce barriers that impede access to mental healthcare.
MayJune 2021 Volume 39 Number 3 111Nursing Economic$AbramMartino96
May/June 2021 | Volume 39 Number 3 111
Nursing Economic$
Developing a well-prepared and geographically
distributed mental health
workforce is a crucial goal of
healthcare workforce planning
initiatives and contributes to
health systems’ ability to
improve population health
(Beck et al., 2020). Before the
SARS COV-2 global pandemic,
sharp increases in suicide,
substance abuse, opioid crises,
gun violence, and severe
depression among young
people were increasing
demands on mental and
behavioral health professionals,
including nurses (Substance
Abuse and Mental Health
Services Administration, 2020).
However, the growing demand
for behavioral health services,
let alone treating the 44 million
American adults who have a
diagnosable mental health
condition, is being met by a
potential shortage of
professionals, which the Health
Resources and Services
Administration (2016) projects
will worsen to as many as
250,000 workers by 2025.
Access to mental health care is
crucial given the societal
upheaval brought about by the
SARS COV-2 global pandemic.
To address the growing
demand for mental health
services, many communities and
healthcare systems are exploring
novel ways to integrate mental
health treatment into primary
care delivery, for example, using
the Collaborative Care Model
(Vanderlip et al., 2016). Nurses
often contact people living with
mental or behavioral health
conditions while being treated
for physical and medical
conditions in both community
and hospital settings. A recent
focus on mental health care,
particularly in outpatient
settings, has been an emphasis
in team-based models,
telehealth, and integration of
mental health and primary care
with contributions from
physicians, nurses, social
workers, peer support, and
community health workers – all
of which can be beneficial
relative to more traditional and
often siloed models of mental
health treatment (Reiss-Brennan
et al., 2016).
Characteristics of Registered Nurses
and Nurse Practitioners Providing
Outpatient Mental Health Care
David I. Auerbach
Max C. Yates
Douglas O. Staiger
Peter I. Buerhaus
The growing demand for mental
health services, together with
current and increasing shortages
of mental health professionals
and increasing adoption of
integrated models of care
delivery, suggest nurses will
become increasingly needed to
provide mental health services.
Analysis of a national survey
finds registered nurses and
nurse practitioners working in
outpatient mental health settings
are older than those in other
settings. Most would benefit
from additional training. Provision
of team-based care was
associated with higher job
satisfaction.
May/June 2021 | Volume 39 Number 3112
The growing demand for
mental health services, together
with current and increasing
shortages of mental health
professionals and increasing
adoption of integrated models
of care delivery, suggest nurses
will b ...
Identifying the support needs of fathers affected bypost-par.docxwilcockiris
Identifying the support needs of fathers affected by
post-partum depression: a pilot study
N . L E T O U R N E A U 1 , 2 , 3 p h d r n , L . D U F F E T T- L E G E R 4 , 5 p h d ( c ) r n ,
C . - L . D E N N I S 6 , 7 p h d , M . S T E WA R T 8 , 9 p h d f r s c f c a h s &
P. D . T RY P H O N O P O U L O S 1 0 b n r n p h d s t u d e n t
1Canada Research Chair in Healthy Child Development, 2Professor, 4CIHR Allied Health Professional Doctoral
Fellow, 5Research Associate, 10Project Director, Faculty of Nursing, and 3Research Fellow, Canadian Research
Institute for Social Policy, University of New Brunswick, Fredericton, NB, and 6Canada Research Chair in
Perinatal Community Health, 7Associate Professor in Nursing and Psychiatry, University of Toronto, Toronto,
ON, and 8Health Senior Scholar, Alberta Heritage Foundation for Medical Research, and 9Professor, Faculty of
Nursing and School of Public Health, University of Alberta, Edmonton, AB, Canada
Keywords: barriers to accessing
support, fathers, men’s mental health,
men’s support needs, pilot study, post-
partum depression
Correspondence:
N. Letourneau
University of New Brunswick
PO Box 4400
Fredericton
NB E3B 5A3
Canada
E-mail: [email protected]
Accepted for publication: 9 August
2010
doi: 10.1111/j.1365-2850.2010.01627.x
Accessible summary
• The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had experienced
post-partum depression (PPD).
• Telephone interviews were conducted with a total of 11 fathers. We interviewed
seven fathers from New Brunswick and four fathers from Alberta.
• The fathers we spoke with experienced a number of depressive symptoms including:
anxiety, lack of time and energy, irritability, feeling sad or down, changes in
appetite, and thoughts of harm to self or baby. The most common barriers to
accessing support included not knowing where to look for PPD resources and
difficulty reaching out to others.
• This study demonstrated the feasibility of a larger-scale exploration of fathers’
experiences in supporting their spouses affected by PPD.
Abstract
The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had post-partum depres-
sion (PPD) in preparation for a larger study. Qualitative methods and community-
based research approaches were used in this exploratory/descriptive multi-site study,
conducted in New Brunswick and Alberta. Telephone interviews were conducted with
a total of 11 fathers in New Brunswick (n = 7) and Alberta (n = 4). Fathers experienced
a number of depressive symptoms including: anxiety, lack of time and energy, irrita-
bility, feeling sad or down, changes in appetite, and thoughts of harm to self or baby.
The most common barriers for fathers were lack of information regarding PPD
resources and difficulty seeking support. This pilot study establishes the fea.
Addressing the needs of fertility patientsLauri Pasch
This study examined the mental health of 352 women and 274 men undergoing fertility treatment. The researchers found high rates of depressive and anxiety symptoms among participants, with over half of women and a third of men experiencing clinical depression, and over 75% of women and 60% of men experiencing clinical anxiety. However, only 21% of women and 11.3% of men received mental health services, and about a quarter were provided information about such services by their fertility clinic. Those with the most severe or prolonged distress were no more likely to receive services or information. The researchers concluded that while psychological distress is common among fertility patients, most do not receive mental health support, and services are not targeted to those most in need.
Journal of Counseling Psychology1999, Vol. 46, No. 1,92-98.docxpriestmanmable
Journal of Counseling Psychology
1999, Vol. 46, No. 1,92-98
Copyright 1999 by the American Psychological Association, Inc.
0022-0167/99/$3.00
Research on Religion-Accommodative Counseling:
Review and Meta-Analysis
Michael E. McCullough
National Institute for Healthcare Research
The present meta-analysis examined data from 5 studies (N = 111) that compared the efficacy
of standard approaches to counseling for depression with religion-accommodative ap-
proaches. There was no evidence that the religion-accommodative approaches were more or
less efficacious than the standard approaches. Findings suggest that the choice to use religious
approaches with religious clients is probably more a matter of client preference than a matter
of differential efficacy. However, additional research is needed to examine whether religion-
accommodative approaches yield differential treatment satisfaction or differential improve-
ments in spiritual well-being or facilitate relapse prevention. Given the importance of religion
to many potential consumers of psychological services, counseling psychologists should
devote greater attention to religion-accommodative counseling in future studies.
The United States is a highly religious country; 92% of its
population are affiliated with a religion (Kosmin & Lach-
man, 1993). According to a 1995 survey, 96% of Americans
believe in God or a universal spirit, 42% indicate that they
attend a religious worship service weekly or almost weekly,
67% indicate that they are members of a church or syna-
gogue, and 60% indicate that religion is "important" or
"very important" in their lives (Gallup, 1995).
In addition, many scholars acknowledge that certain
forms of religious involvement are associated with better
functioning on a variety of measures of mental health.
Reviews of this research (e.g., Bergin, 1991; Bergin, Mas-
ters, & Richards, 1987; Larson et al., 1992; Pargament,
1997; Schumaker, 1992; Worthington, Kurusu, McCul-
lough, & Sandage, 1996) suggested that several forms of
religious involvement (including intrinsic religious motiva-
tion, attendance at religious worship, receiving coping
support from one's religious faith or religious congregation,
and positive religious attributions for life events) are posi-
tively associated with a variety of measures of mental health.
For example, various measures of religious involvement
appear to be related to lower degrees of depressive symp-
toms in adults (Bienenfeld, Koenig, Larson, & Sherrill,
1997; Ellison, 1995; Kendler, Gardner, & Prescott, 1997)
and children (Miller, Warner, Wickramaratne & Weissman,
1997) and less suicide (e.g., Comstock & Partridge, 1972;
Kark et al., 1996; Wandrei, 1985).
Koenig, George, and Peterson (1998) reported that de-
pressed people scoring high on measures of intrinsic reli-
giousness were significantly more likely to experience a
remission of depression during nearly a 1-year follow-up
than were depressed people with lower intrinsic relig ...
The document describes a study that analyzed video recordings of standard hospice interdisciplinary team meetings and meetings that included family caregiver participation via videoconferencing (ACTIVE meetings). Standard meetings were shorter and more task-focused, while ACTIVE meetings emphasized biomedical education, relationship-building, and increased socioemotional talk from social workers and chaplains. The inclusion of family caregivers in team meetings via videoconferencing led to longer, more collaborative meetings that addressed psychosocial needs in addition to medical issues.
Running head ADVANCED NURSING PRACTICE .docxSUBHI7
Running head: ADVANCED NURSING PRACTICE 1
ADVANCED NURSING PRACTICE 6
Advanced Nursing Practice Role
Student’s Name: Alien R Perez
Institution: South University
Professor: Dawn Julian
Date: 09/06/2016
Introduction
An advanced practice-nursing role in the specialty area is that of a family nurse practitioner (FNP). Typically, FNPs practice in primary care settings. The National Patient Safety Goals (NPSGs), the family nurse practitioner’s role is clinical in nature since the practitioner must possess clinical skills to carry out important functions such as management and assessment of chronic and acute conditions. The role of FNP enhances patient safety since it places immense emphasis on health promotion, disease prevention and interdisciplinary collaboration to improve patient care outcomes. The FNP also fosters patient safety through emphasizing on the provision of holistic and culturally congruent care. Conducting further research on the role of the FNP will help in providing greater understanding of the scope of this advanced practice role. Apart from exploring the FNP role, this discussion also highlights insights gained from an expert opinion article and two scholarly research articles that have scrutinized different aspects of the role.
Discussion
FNPs play an indispensable role in the health care system, particularly in the primary care settings where the mainly practice. The NPSGs affirm that the FNP role is clinical in nature. To this end, it recognizes these practitioners as clinical experts with an obligation of implementing holistic interventions that focus on both cure and care. According to Hamric, Hanson, Tracy, & O'Grady (2014), FNPs offer comprehensive, continuing and client-centered care to individual patients as well as members of their families. Therefore, they must have the desired academic expertise and clinical skills needed for guaranteeing the success of disease prevention initiatives, and health promotion efforts. The clinical skills are also critical for ensuring the FNPs are effective in dispensing their duties of assessing, managing and treating acute as well as chronic illness in populations of interest (Hamric et al., 2014).
Distler (2013) acknowledges that apart from diagnosing and treating illnesses, FNPs additionally provide preventive care services that often include routine check-ups, immunizations, screening tests, personalized counseling and health risk assessments in the target populations. As such, these nurse practitioners play a central role in promotion of patient safety. Moreover, through emphasis on providing holistic care, FNPs are able to build strong, lasting relationships with patients, families and communities. These relationships empower the family nurse practitioners to dispense culturally sensitive care. Eventually, the strong rela ...
Volume 39 n um ber 2a pril 2017pages i l6 l3 ld o iio .iojas18
This article provides an introduction to narrative family therapy techniques. It discusses the theoretical foundations of systems theory and social constructionism that influence this approach. The article then illustrates various NFT techniques through a case study, such as eliciting family stories, externalizing problems, and reauthoring narratives. It concludes by recommending further development of competence in NFT.
A Naturalistic Study Of Dissociative Identity Disorder And Dissociative Disor...Sara Alvarez
This study aimed to describe community treatment of dissociative disorders and determine if it is as effective as treatment for related conditions like PTSD. Analyses found that patients later in treatment engaged in less self-harm, had fewer hospitalizations, and higher functioning than early patients. Later patients also reported lower dissociation, PTSD, and distress symptoms than early patients. The effectiveness was comparable to treatments for chronic PTSD and depression with borderline personality disorder. This suggests extended dissociative disorder treatment may be beneficial.
Three key barriers to the diagnosis and treatment of depression in Jordan were identified from focus groups with primary health care providers:
1) Lack of education about depression among providers which hinders proper identification, diagnosis, and treatment.
2) Limited availability of appropriate therapies like counseling services and antidepressant medications at primary care clinics.
3) Social stigma surrounding mental illness that prevents patients from accepting depression diagnoses due to beliefs that it reflects poorly on themselves or their families.
Addressing these barriers through provider education, expanding mental health services, and destigmatizing depression could improve rates of recognizing and treating depression in Jordan's primary care system according to the researchers.
Development and evaluation of an intervention to support family caregivers of...beatriz9911
This study aimed to develop and evaluate an intervention to support family caregivers of cancer patients providing home-based end-of-life care. In Phase 1, interviews with 29 caregivers identified their needs for practical information and support skills. Based on these findings, the researchers created an informational booklet as the preferred format. In Phase 2, 31 caregivers and 14 nurses evaluated the booklet. Caregivers reported feeling more positive, reassured, and competent in their caregiving role after using the booklet. Nurses found the booklet useful and received fewer calls from caregivers who used it. However, caregivers indicated they would have benefited from receiving the booklet earlier in the care trajectory. The researchers concluded the
The document discusses barriers to interpersonal communication, including language barriers, cultural medical mistrust, psychological barriers, and differing cultural beliefs that can affect communication. It also describes the procedures used in a physical exam, such as inspection, percussion, palpation, auscultation, and manipulation. Finally, it explains the SOAP method for documenting patient data, where subjective data comes from the patient, objective data from observations and exams, assessment is the provider's analysis, and planning is the treatment plan.
2011 08 Hooker Everett Primary Care Pa Reviewrodhooker
Physician assistants can contribute significantly to primary care systems. Studies show that PAs can provide comprehensive care, maintain accessibility and accountability comparable to physicians. While PAs perform many of the key
State Tested Nursing Aides’Provision of End-of-LifeCare in.docxdessiechisomjj4
State Tested Nursing Aides’
Provision of End-of-Life
Care in Nursing Homes
Implications for Quality Improvement
Emma Nochomovitz, MPH
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN
Mary Dolansky, PhD, RN
Mendel E. Singer, PhD
Peter DeGolia, MD, CMD
Scott H. Frank, MD, MS
v An increasing prevalence in deaths occurring
within nursing homes has led to a growing
concern surrounding quality issues in end-of-life
(EOL) nursing home care. In addition, prior
research has failed to emphasize the importance
of state tested nursing aides (STNAs) in
providing this type of care. The purpose of this
study was to examine quality issues in EOL
nursing home care within the context of STNAs’
comfort in providing this care. A convenience
sample of 108 STNAs from four nursing homes
in the Cleveland, Ohio area used PDAs to
provide answers to an audio questionnaire.
Questions included emergent themes from the
literature pertaining to EOL care in nursing
homes, as well as materials from a national
education initiative to improve palliative care.
Findings demonstrated lack of comfort in
discussing death with nursing home residents
and their families and insufficient knowledge
surrounding EOL decisions and certain types
of EOL care. Overall, the level of comfort
providing EOL care was found to be associated
with STNAs’ perceived importance of EOL
care, understanding of hospice, and spiritual
well-being.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255
Author Affiliations: Emma Nochomovitz, MPH, is
Research Analyst, National Quality Forum,
Washington, DC and Case Western Reserve
University, Cleveland, OH.
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN,
is Assistant Professor, Frances Payne Bolton School of
Nursing, Case Western Reserve University, Cleveland, OH.
Mary Dolansky, PhD, RN, is Assistant Professor,
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, OH.
Mendel E. Singer, PhD, is Associate Professor,
Department of Epidemiology and Biostatistics, Case
Western Reserve University, Cleveland, OH.
Peter DeGolia, MD, CMD, is Director, Center for
Geriatric Medicine, University Hospitals Case
Medical Center and Associate Professor, Family
Medicine, Case Western Reserve University School of
Medicine, Cleveland, OH.
Scott H. Frank, MD, MS, is Director, Master of
Public Health Program, Department of Epidemiology
and Biostatistics, Department of Family Medicine,
Case Western Reserve University, Cleveland, OH.
Address correspondence to Emma Nochomovitz,
MPH, National Quality Forum, 601 13th St
NW, Suite 500 North Washington, DC 20005
([email protected]).
K E Y W O R D S
end-of-life care
hospice
nursing aides
nursing home
I
n recent years, the growth of the older segment of
the population and the prevalence of chronic illness
have led to increased institutionalization of the frail
and elderly prior to their deaths. In particular, nursing
homes have been identified as a place in which end-of-
life .
The document summarizes a research article about clinical judgment in nursing. It discusses how clinical judgment is influenced by a nurse's background, experience with patients, and the context of each situation. It also explores the role of intuition and how nurses develop their clinical reasoning abilities over time. The document reviews nearly 200 studies on clinical judgment and identifies that a nurse's inferences are more influenced by what they bring to a situation than objective data alone. Experience with individual patients and reflection are important for developing strong clinical judgment.
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
A critical review of research on psychosocial treatment of schizophrenia.pdfKathryn Patel
This document provides a review of research on psychosocial treatments for schizophrenia. It summarizes evidence for several approaches:
- Family treatments have been shown to significantly reduce relapse rates, especially for patients living with highly critical families. However, they have not clearly improved social adjustment.
- Assertive community treatment (ACT) programs, which provide intensive community-based support from multidisciplinary teams, have consistently reduced hospitalization times and improved housing stability. However, they have shown more mixed results for improving social and occupational functioning.
- While psychosocial treatments have reduced relapses, they have not convincingly improved other aspects of schizophrenia beyond symptom control. Further research is still needed to develop more effective psychosocial interventions.
Zoe is a second grader with autism spectrum disorders. Zoe’s father .docxransayo
Zoe is a second grader with autism spectrum disorders. Zoe’s father recently passed away in a tragic car accident. Zoe, her mom, and two older brothers have temporarily relocated from out-of-state and are now living in her grandparents’ house in a small, rural community.
Because the family had been living out-of state, Zoe has never interacted with her grandparents. She has challenges responding to social cues, including her name and in understanding gestures. She also engages in repetitive body movements. She is fond of her set of dolls and likes lining them up. When Zoe is agitated, her mother plays Mozart, which seems to have a calming effect. Zoe also enjoys macaroni and cheese.
Her grandparents do not understand Zoe’s attempts at communicating. Zoe does not respond well to crowded and noisy environments. Zoe’s mom is working outside the home for the first time.
Because of the move, Zoe has transferred to a new school, which does not currently have any students with ASD. Although her mom is generally very involved with Zoe’s education, she is away from the home much of the time due to a long commute for her new job is a neighboring city.
Zoe’s grandparents are eager and willing to help in any way they can.
Imagine you are serving as an ASD consultant at Zoe’s new school. Using the COMPASS model, create a COMPASS Action Plan for Zoe by complete the following tasks:
Identify the personal challenges for Zoe;
Identify the environmental challenges for Zoe;
Identify potential supports; and
Identify and prioritize teaching goals.
In addition, include a 250-500-word rationale that explains how your action plan for Zoe demonstrates collaboration in a respectful, culturally responsive way while promoting understanding, resolving conflicts, and building consensus around her interventions.
.
Zlatan Ibrahimović – Sports Psychology
Outline
Introduction:
· General Info
· Nationality, Birthplace, Parents
· Childhood What he wanted to do growing up?
· When did he start playing professionally?
· Which teams did he play for?
· Give some of his career statistics and maybe records?
· What trophies has he won with club football and national team of Sweden?
· Style of Play
· What is his personality like? How do people see him in the media?\
·
Body Paragraphs
Connect the following Sports Psychology Concepts (or even those not listed) to Zlatan Ibrahimović
What is his personality type? Type A, B C, or D?
Give examples through research of where he shows this.
CATASTROPHE THEORY… OCCURS WHEN? WHAT DOES THE GRAPH LOOK LIKE
· Arousal: is a blend of physiological and psychological activity in a person and it refers to the intensity dimensions of motivation at a particular moment. It ranges from not aroused, to completely aroused, to highly aroused; this is when individuals are mentally and physically activated.
· Performance increases as arousal increases but when arousal gets too high performance dramatically decreases. This is usually caused by the performer becoming anxious and sometimes making wrong decisions. Catastrophes is caused by a combination of cognitive and somatic anxieties. Cognitive is the internal worries of not performing well while somatic is the physical effects of muscle tension/butterflies and fatigue through playing.
· The graph is an inverted U where the x line is the arousal and the y is the performance. Performance peaks on the top of the inverted U and the catastrophe happens in the fall of the inverted U
HIGH TRAIT ANXIETY ATHLETES… HOW DO THEY PERCEIVE COMPETITION?
· Anxiety: is a negative emotional state in which feelings of nervousness, worry and apprehension are associated with activation or arousal of the body
· Trait Anxiety: is a behavioral disposition to perceive as threatening circumstances that objectively may not be dangerous and to then respond with disproportionate state anxiety.
· Somatic Trait Anxiety: the degree to which one typically perceived heightened physical symptoms (muscle tension)
· Cognitive Trait Anxiety: the degree to which one typically worries or has self doubt
· Concentration Disruption: the degree to which one typically has concentration disruption during competition
People usually with high trait anxiety usually have more state anxiety in highly competitive evaluative situations than do people with lower trait anxiety. Example two athletes are playing basketball and both are physically and statistically the same both have to shoot a final free throw to win the game. Athlete A is more laid back which means his trait anxiety is lower and he doesn't view the final shot as a overly threatening. Athlete B has a high trait anxiety and because of that he perceives the final shot as very threatening. This has an effect on his state anxiety much more than.
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This document provides an overview of medical family therapy, which integrates mind, body, and family in treating illness. It discusses the biopsychosocial framework, collaborative treatment model, and scope of medical family therapy. The document also presents a case study example and discusses applications of medical family therapy, such as personal development and family interventions.
Reply to the following two posts. In your replies, discuss what su.docxaudeleypearl
Reply to the following two posts. In your replies, discuss what surprised you about the theory your peers wrote about, and how it’s integrated into the study? What other type of research might this theory be useful in?
There is not an amount of words required. Just reply to post 1, and post 2.
FREE OF PLAGIARISM.
Post # 1: Michelle
The article I chose to analyze was “Making a connection: Family experiences with bedside rounds in the intensive care unit. The article examined the experience of families with a loved one in the intensive care unit and whether or not the families' participation in daily rounds decreased their anxiety and increased their overall positive perspective. The theoretical framework utilized by the authors Cody, Sullivan-Bolyai, and Reid-Ponte was the Family Management Style Framework.
The Family Management Style Framework was developed by Knafl and Deatrick in 1990 in order to better understand the coping style of families with children who had chronic health conditions (Knafl & Deatrick, 2003). The FMSF looked at the management behaviors and patterns of response to childhood chronic illness (Knafl & Deatrick, 2003). There are three major components in the FMSF, Definition of the situation, Management behaviors, and Sociocultural context (Knafl & Deatrick, 2003). The framework also describes five family management styles, thriving, accommodating, enduring, struggling and floundering (Knafl & Deatrick, 2003). The relationship between the family members, healthcare professionals, and their coping strategies is the basis for the framework.
The research study used the FMSF to look at which families participated in bedside rounds and which opted not to and the overall result. The framework looks specifically at the intersection of the management of chronic illness and the impact on family life (Knafl, et al., 2012). The finding was that the inclusion and willingness of families to participate in bedside rounds ultimately reduced their fear of the unknown and distrust in the healthcare providers. In the end, the families that attended the bedside rounds were better prepared for their loved one's discharge. The concept of the FMSF was woven throughout the study. The targeted areas of familial response to chronic illness were based on the three identified components of the definition of the situation or illness, management and coping behaviors of the individuals, and the perceived outcomes. The overarching finding of the study was that clear, consistent communication by the healthcare team to the families significantly decreased anxiety, and fear and increased trust in the healthcare professionals. The end result was an improved experience for the family.
King’s theory of Goal Attainment cis another framework that would be effective in this study. King’s theory examines individuals as they relate to personal, interpersonal and social systems (Petiprin, 2016). King noted that human beings function as dy ...
CLINICAL SCHOLARSHIPParents’ Perspectives on Supporting Th.docxclarebernice
CLINICAL SCHOLARSHIP
Parents’ Perspectives on Supporting Their Decision Making
in Genome-Wide Sequencing
Karen C. Li, MSN, RN1, Patricia H. Birch, MSc, RN2, Bernard M. Garrett, PhD, RN3, Maura MacPhee, PhD, RN4,
Shelin Adam, MSc5, & Jan M. Friedman, PhD, MD6
1 Graduate Student Researcher, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
2 Clinical Associate Professor, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
3 Associate Professor, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
4 Xi Eta, Associate Professor, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
5 Clinical Assistant Professor, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
6 Professor, Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
Key words
Decision making, decision support, exome
sequencing, genetic counseling, genome
sequencing, genome-wide sequencing, nursing,
parent perspective
Correspondence
Karen C. Li, Box 153, Children’s and Women’s
Hospital, 4500 Oak Street, Vancouver, BC V6H
3V4, Canada. E-mail: [email protected]
Accepted: February 27, 2016
doi: 10.1111/jnu.12207
Abstract
Purpose: The purpose of this study was to explore parents’ perceptions of
their decisional needs when considering genome-wide sequencing (GWS) for
their child. This is a partial report and focuses on how parents prefer to receive
education and information to support their decision making about GWS.
Design: This study adopted an interpretive description qualitative method-
ological approach and used the concept of shared decision making and the
Ottawa Decision Support Framework.
Methods: Participants were parents who had already consented to GWS, and
had children with undiagnosed conditions that were suspected to be genetic in
origin. Fifteen parents participated in a focus group or individual interview.
Transcriptions were analyzed concurrently with data collection, iteratively,
and constantly compared to one another. Repeat interviews were conducted
with five of the parents to confirm, challenge, or expand on the developing
concepts.
Findings: Participants felt that their decision to proceed with GWS for their
child was an easy one. However, they expressed some unresolved decisional
needs, including a lack of knowledge about certain topics that became rele-
vant and important to them later and a need for more support and resources.
Participants also had ongoing informational and psychosocial needs after the
single clinical encounter where their decision making occurred.
Conclusions: Participants expressed unmet decisional needs, which may have
influenced the quality of their decisions. The strategies that participants sug-
gested may help create parent-tailored education, counseling, decision sup-
port, ...
Barriers to Practice and Impact on CareAn Analysis of the P.docxrosemaryralphs52525
This document summarizes barriers to practice for psychiatric mental health nurse practitioners (PMHNPs) in New York State. It discusses how statutory collaborative agreements requiring oversight from psychiatrists disrupt continuity of care for patients and limit PMHNPs' autonomous practice. National statistics show a significant need for more mental healthcare providers. While PMHNPs are well-positioned to address this need, barriers like restrictive regulations prevent them from doing so. The document calls for reforms to expand PMHNPs' scope of practice and reduce barriers that impede access to mental healthcare.
MayJune 2021 Volume 39 Number 3 111Nursing Economic$AbramMartino96
May/June 2021 | Volume 39 Number 3 111
Nursing Economic$
Developing a well-prepared and geographically
distributed mental health
workforce is a crucial goal of
healthcare workforce planning
initiatives and contributes to
health systems’ ability to
improve population health
(Beck et al., 2020). Before the
SARS COV-2 global pandemic,
sharp increases in suicide,
substance abuse, opioid crises,
gun violence, and severe
depression among young
people were increasing
demands on mental and
behavioral health professionals,
including nurses (Substance
Abuse and Mental Health
Services Administration, 2020).
However, the growing demand
for behavioral health services,
let alone treating the 44 million
American adults who have a
diagnosable mental health
condition, is being met by a
potential shortage of
professionals, which the Health
Resources and Services
Administration (2016) projects
will worsen to as many as
250,000 workers by 2025.
Access to mental health care is
crucial given the societal
upheaval brought about by the
SARS COV-2 global pandemic.
To address the growing
demand for mental health
services, many communities and
healthcare systems are exploring
novel ways to integrate mental
health treatment into primary
care delivery, for example, using
the Collaborative Care Model
(Vanderlip et al., 2016). Nurses
often contact people living with
mental or behavioral health
conditions while being treated
for physical and medical
conditions in both community
and hospital settings. A recent
focus on mental health care,
particularly in outpatient
settings, has been an emphasis
in team-based models,
telehealth, and integration of
mental health and primary care
with contributions from
physicians, nurses, social
workers, peer support, and
community health workers – all
of which can be beneficial
relative to more traditional and
often siloed models of mental
health treatment (Reiss-Brennan
et al., 2016).
Characteristics of Registered Nurses
and Nurse Practitioners Providing
Outpatient Mental Health Care
David I. Auerbach
Max C. Yates
Douglas O. Staiger
Peter I. Buerhaus
The growing demand for mental
health services, together with
current and increasing shortages
of mental health professionals
and increasing adoption of
integrated models of care
delivery, suggest nurses will
become increasingly needed to
provide mental health services.
Analysis of a national survey
finds registered nurses and
nurse practitioners working in
outpatient mental health settings
are older than those in other
settings. Most would benefit
from additional training. Provision
of team-based care was
associated with higher job
satisfaction.
May/June 2021 | Volume 39 Number 3112
The growing demand for
mental health services, together
with current and increasing
shortages of mental health
professionals and increasing
adoption of integrated models
of care delivery, suggest nurses
will b ...
Identifying the support needs of fathers affected bypost-par.docxwilcockiris
Identifying the support needs of fathers affected by
post-partum depression: a pilot study
N . L E T O U R N E A U 1 , 2 , 3 p h d r n , L . D U F F E T T- L E G E R 4 , 5 p h d ( c ) r n ,
C . - L . D E N N I S 6 , 7 p h d , M . S T E WA R T 8 , 9 p h d f r s c f c a h s &
P. D . T RY P H O N O P O U L O S 1 0 b n r n p h d s t u d e n t
1Canada Research Chair in Healthy Child Development, 2Professor, 4CIHR Allied Health Professional Doctoral
Fellow, 5Research Associate, 10Project Director, Faculty of Nursing, and 3Research Fellow, Canadian Research
Institute for Social Policy, University of New Brunswick, Fredericton, NB, and 6Canada Research Chair in
Perinatal Community Health, 7Associate Professor in Nursing and Psychiatry, University of Toronto, Toronto,
ON, and 8Health Senior Scholar, Alberta Heritage Foundation for Medical Research, and 9Professor, Faculty of
Nursing and School of Public Health, University of Alberta, Edmonton, AB, Canada
Keywords: barriers to accessing
support, fathers, men’s mental health,
men’s support needs, pilot study, post-
partum depression
Correspondence:
N. Letourneau
University of New Brunswick
PO Box 4400
Fredericton
NB E3B 5A3
Canada
E-mail: [email protected]
Accepted for publication: 9 August
2010
doi: 10.1111/j.1365-2850.2010.01627.x
Accessible summary
• The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had experienced
post-partum depression (PPD).
• Telephone interviews were conducted with a total of 11 fathers. We interviewed
seven fathers from New Brunswick and four fathers from Alberta.
• The fathers we spoke with experienced a number of depressive symptoms including:
anxiety, lack of time and energy, irritability, feeling sad or down, changes in
appetite, and thoughts of harm to self or baby. The most common barriers to
accessing support included not knowing where to look for PPD resources and
difficulty reaching out to others.
• This study demonstrated the feasibility of a larger-scale exploration of fathers’
experiences in supporting their spouses affected by PPD.
Abstract
The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had post-partum depres-
sion (PPD) in preparation for a larger study. Qualitative methods and community-
based research approaches were used in this exploratory/descriptive multi-site study,
conducted in New Brunswick and Alberta. Telephone interviews were conducted with
a total of 11 fathers in New Brunswick (n = 7) and Alberta (n = 4). Fathers experienced
a number of depressive symptoms including: anxiety, lack of time and energy, irrita-
bility, feeling sad or down, changes in appetite, and thoughts of harm to self or baby.
The most common barriers for fathers were lack of information regarding PPD
resources and difficulty seeking support. This pilot study establishes the fea.
Addressing the needs of fertility patientsLauri Pasch
This study examined the mental health of 352 women and 274 men undergoing fertility treatment. The researchers found high rates of depressive and anxiety symptoms among participants, with over half of women and a third of men experiencing clinical depression, and over 75% of women and 60% of men experiencing clinical anxiety. However, only 21% of women and 11.3% of men received mental health services, and about a quarter were provided information about such services by their fertility clinic. Those with the most severe or prolonged distress were no more likely to receive services or information. The researchers concluded that while psychological distress is common among fertility patients, most do not receive mental health support, and services are not targeted to those most in need.
Journal of Counseling Psychology1999, Vol. 46, No. 1,92-98.docxpriestmanmable
Journal of Counseling Psychology
1999, Vol. 46, No. 1,92-98
Copyright 1999 by the American Psychological Association, Inc.
0022-0167/99/$3.00
Research on Religion-Accommodative Counseling:
Review and Meta-Analysis
Michael E. McCullough
National Institute for Healthcare Research
The present meta-analysis examined data from 5 studies (N = 111) that compared the efficacy
of standard approaches to counseling for depression with religion-accommodative ap-
proaches. There was no evidence that the religion-accommodative approaches were more or
less efficacious than the standard approaches. Findings suggest that the choice to use religious
approaches with religious clients is probably more a matter of client preference than a matter
of differential efficacy. However, additional research is needed to examine whether religion-
accommodative approaches yield differential treatment satisfaction or differential improve-
ments in spiritual well-being or facilitate relapse prevention. Given the importance of religion
to many potential consumers of psychological services, counseling psychologists should
devote greater attention to religion-accommodative counseling in future studies.
The United States is a highly religious country; 92% of its
population are affiliated with a religion (Kosmin & Lach-
man, 1993). According to a 1995 survey, 96% of Americans
believe in God or a universal spirit, 42% indicate that they
attend a religious worship service weekly or almost weekly,
67% indicate that they are members of a church or syna-
gogue, and 60% indicate that religion is "important" or
"very important" in their lives (Gallup, 1995).
In addition, many scholars acknowledge that certain
forms of religious involvement are associated with better
functioning on a variety of measures of mental health.
Reviews of this research (e.g., Bergin, 1991; Bergin, Mas-
ters, & Richards, 1987; Larson et al., 1992; Pargament,
1997; Schumaker, 1992; Worthington, Kurusu, McCul-
lough, & Sandage, 1996) suggested that several forms of
religious involvement (including intrinsic religious motiva-
tion, attendance at religious worship, receiving coping
support from one's religious faith or religious congregation,
and positive religious attributions for life events) are posi-
tively associated with a variety of measures of mental health.
For example, various measures of religious involvement
appear to be related to lower degrees of depressive symp-
toms in adults (Bienenfeld, Koenig, Larson, & Sherrill,
1997; Ellison, 1995; Kendler, Gardner, & Prescott, 1997)
and children (Miller, Warner, Wickramaratne & Weissman,
1997) and less suicide (e.g., Comstock & Partridge, 1972;
Kark et al., 1996; Wandrei, 1985).
Koenig, George, and Peterson (1998) reported that de-
pressed people scoring high on measures of intrinsic reli-
giousness were significantly more likely to experience a
remission of depression during nearly a 1-year follow-up
than were depressed people with lower intrinsic relig ...
The document describes a study that analyzed video recordings of standard hospice interdisciplinary team meetings and meetings that included family caregiver participation via videoconferencing (ACTIVE meetings). Standard meetings were shorter and more task-focused, while ACTIVE meetings emphasized biomedical education, relationship-building, and increased socioemotional talk from social workers and chaplains. The inclusion of family caregivers in team meetings via videoconferencing led to longer, more collaborative meetings that addressed psychosocial needs in addition to medical issues.
Running head ADVANCED NURSING PRACTICE .docxSUBHI7
Running head: ADVANCED NURSING PRACTICE 1
ADVANCED NURSING PRACTICE 6
Advanced Nursing Practice Role
Student’s Name: Alien R Perez
Institution: South University
Professor: Dawn Julian
Date: 09/06/2016
Introduction
An advanced practice-nursing role in the specialty area is that of a family nurse practitioner (FNP). Typically, FNPs practice in primary care settings. The National Patient Safety Goals (NPSGs), the family nurse practitioner’s role is clinical in nature since the practitioner must possess clinical skills to carry out important functions such as management and assessment of chronic and acute conditions. The role of FNP enhances patient safety since it places immense emphasis on health promotion, disease prevention and interdisciplinary collaboration to improve patient care outcomes. The FNP also fosters patient safety through emphasizing on the provision of holistic and culturally congruent care. Conducting further research on the role of the FNP will help in providing greater understanding of the scope of this advanced practice role. Apart from exploring the FNP role, this discussion also highlights insights gained from an expert opinion article and two scholarly research articles that have scrutinized different aspects of the role.
Discussion
FNPs play an indispensable role in the health care system, particularly in the primary care settings where the mainly practice. The NPSGs affirm that the FNP role is clinical in nature. To this end, it recognizes these practitioners as clinical experts with an obligation of implementing holistic interventions that focus on both cure and care. According to Hamric, Hanson, Tracy, & O'Grady (2014), FNPs offer comprehensive, continuing and client-centered care to individual patients as well as members of their families. Therefore, they must have the desired academic expertise and clinical skills needed for guaranteeing the success of disease prevention initiatives, and health promotion efforts. The clinical skills are also critical for ensuring the FNPs are effective in dispensing their duties of assessing, managing and treating acute as well as chronic illness in populations of interest (Hamric et al., 2014).
Distler (2013) acknowledges that apart from diagnosing and treating illnesses, FNPs additionally provide preventive care services that often include routine check-ups, immunizations, screening tests, personalized counseling and health risk assessments in the target populations. As such, these nurse practitioners play a central role in promotion of patient safety. Moreover, through emphasis on providing holistic care, FNPs are able to build strong, lasting relationships with patients, families and communities. These relationships empower the family nurse practitioners to dispense culturally sensitive care. Eventually, the strong rela ...
Volume 39 n um ber 2a pril 2017pages i l6 l3 ld o iio .iojas18
This article provides an introduction to narrative family therapy techniques. It discusses the theoretical foundations of systems theory and social constructionism that influence this approach. The article then illustrates various NFT techniques through a case study, such as eliciting family stories, externalizing problems, and reauthoring narratives. It concludes by recommending further development of competence in NFT.
A Naturalistic Study Of Dissociative Identity Disorder And Dissociative Disor...Sara Alvarez
This study aimed to describe community treatment of dissociative disorders and determine if it is as effective as treatment for related conditions like PTSD. Analyses found that patients later in treatment engaged in less self-harm, had fewer hospitalizations, and higher functioning than early patients. Later patients also reported lower dissociation, PTSD, and distress symptoms than early patients. The effectiveness was comparable to treatments for chronic PTSD and depression with borderline personality disorder. This suggests extended dissociative disorder treatment may be beneficial.
Three key barriers to the diagnosis and treatment of depression in Jordan were identified from focus groups with primary health care providers:
1) Lack of education about depression among providers which hinders proper identification, diagnosis, and treatment.
2) Limited availability of appropriate therapies like counseling services and antidepressant medications at primary care clinics.
3) Social stigma surrounding mental illness that prevents patients from accepting depression diagnoses due to beliefs that it reflects poorly on themselves or their families.
Addressing these barriers through provider education, expanding mental health services, and destigmatizing depression could improve rates of recognizing and treating depression in Jordan's primary care system according to the researchers.
Development and evaluation of an intervention to support family caregivers of...beatriz9911
This study aimed to develop and evaluate an intervention to support family caregivers of cancer patients providing home-based end-of-life care. In Phase 1, interviews with 29 caregivers identified their needs for practical information and support skills. Based on these findings, the researchers created an informational booklet as the preferred format. In Phase 2, 31 caregivers and 14 nurses evaluated the booklet. Caregivers reported feeling more positive, reassured, and competent in their caregiving role after using the booklet. Nurses found the booklet useful and received fewer calls from caregivers who used it. However, caregivers indicated they would have benefited from receiving the booklet earlier in the care trajectory. The researchers concluded the
The document discusses barriers to interpersonal communication, including language barriers, cultural medical mistrust, psychological barriers, and differing cultural beliefs that can affect communication. It also describes the procedures used in a physical exam, such as inspection, percussion, palpation, auscultation, and manipulation. Finally, it explains the SOAP method for documenting patient data, where subjective data comes from the patient, objective data from observations and exams, assessment is the provider's analysis, and planning is the treatment plan.
2011 08 Hooker Everett Primary Care Pa Reviewrodhooker
Physician assistants can contribute significantly to primary care systems. Studies show that PAs can provide comprehensive care, maintain accessibility and accountability comparable to physicians. While PAs perform many of the key
State Tested Nursing Aides’Provision of End-of-LifeCare in.docxdessiechisomjj4
State Tested Nursing Aides’
Provision of End-of-Life
Care in Nursing Homes
Implications for Quality Improvement
Emma Nochomovitz, MPH
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN
Mary Dolansky, PhD, RN
Mendel E. Singer, PhD
Peter DeGolia, MD, CMD
Scott H. Frank, MD, MS
v An increasing prevalence in deaths occurring
within nursing homes has led to a growing
concern surrounding quality issues in end-of-life
(EOL) nursing home care. In addition, prior
research has failed to emphasize the importance
of state tested nursing aides (STNAs) in
providing this type of care. The purpose of this
study was to examine quality issues in EOL
nursing home care within the context of STNAs’
comfort in providing this care. A convenience
sample of 108 STNAs from four nursing homes
in the Cleveland, Ohio area used PDAs to
provide answers to an audio questionnaire.
Questions included emergent themes from the
literature pertaining to EOL care in nursing
homes, as well as materials from a national
education initiative to improve palliative care.
Findings demonstrated lack of comfort in
discussing death with nursing home residents
and their families and insufficient knowledge
surrounding EOL decisions and certain types
of EOL care. Overall, the level of comfort
providing EOL care was found to be associated
with STNAs’ perceived importance of EOL
care, understanding of hospice, and spiritual
well-being.
JOURNAL OF HOSPICE AND PALLIATIVE NURSING v Vol. 12, No. 4, July/August 2010 255
Author Affiliations: Emma Nochomovitz, MPH, is
Research Analyst, National Quality Forum,
Washington, DC and Case Western Reserve
University, Cleveland, OH.
Maryjo Prince-Paul, PhD, APRN, AHPCN, FPCN,
is Assistant Professor, Frances Payne Bolton School of
Nursing, Case Western Reserve University, Cleveland, OH.
Mary Dolansky, PhD, RN, is Assistant Professor,
Frances Payne Bolton School of Nursing, Case
Western Reserve University, Cleveland, OH.
Mendel E. Singer, PhD, is Associate Professor,
Department of Epidemiology and Biostatistics, Case
Western Reserve University, Cleveland, OH.
Peter DeGolia, MD, CMD, is Director, Center for
Geriatric Medicine, University Hospitals Case
Medical Center and Associate Professor, Family
Medicine, Case Western Reserve University School of
Medicine, Cleveland, OH.
Scott H. Frank, MD, MS, is Director, Master of
Public Health Program, Department of Epidemiology
and Biostatistics, Department of Family Medicine,
Case Western Reserve University, Cleveland, OH.
Address correspondence to Emma Nochomovitz,
MPH, National Quality Forum, 601 13th St
NW, Suite 500 North Washington, DC 20005
([email protected]).
K E Y W O R D S
end-of-life care
hospice
nursing aides
nursing home
I
n recent years, the growth of the older segment of
the population and the prevalence of chronic illness
have led to increased institutionalization of the frail
and elderly prior to their deaths. In particular, nursing
homes have been identified as a place in which end-of-
life .
The document summarizes a research article about clinical judgment in nursing. It discusses how clinical judgment is influenced by a nurse's background, experience with patients, and the context of each situation. It also explores the role of intuition and how nurses develop their clinical reasoning abilities over time. The document reviews nearly 200 studies on clinical judgment and identifies that a nurse's inferences are more influenced by what they bring to a situation than objective data alone. Experience with individual patients and reflection are important for developing strong clinical judgment.
Multiple Chemical Sensitivities - A Proposed Care Model v2zq
Multiple Chemical Sensitivities - A Proposed Care Model - Resources for Healthy Children www.scribd.com/doc/254613619 - For more information, Please see Organic Edible Schoolyards & Gardening with Children www.scribd.com/doc/254613963 - Gardening with Volcanic Rock Dust www.scribd.com/doc/254613846 - Double Food Production from your School Garden with Organic Tech www.scribd.com/doc/254613765 - Free School Gardening Art Posters www.scribd.com/doc/254613694 - Increase Food Production with Companion Planting in your School Garden www.scribd.com/doc/254609890 - Healthy Foods Dramatically Improves Student Academic Success www.scribd.com/doc/254613619 - City Chickens for your Organic School Garden www.scribd.com/doc/254613553 - Huerto Ecológico, Tecnologías Sostenibles, Agricultura Organica www.scribd.com/doc/254613494 - Simple Square Foot Gardening for Schools - Teacher Guide www.scribd.com/doc/254613410 - Free Organic Gardening Publications www.scribd.com/doc/254609890 ~
A critical review of research on psychosocial treatment of schizophrenia.pdfKathryn Patel
This document provides a review of research on psychosocial treatments for schizophrenia. It summarizes evidence for several approaches:
- Family treatments have been shown to significantly reduce relapse rates, especially for patients living with highly critical families. However, they have not clearly improved social adjustment.
- Assertive community treatment (ACT) programs, which provide intensive community-based support from multidisciplinary teams, have consistently reduced hospitalization times and improved housing stability. However, they have shown more mixed results for improving social and occupational functioning.
- While psychosocial treatments have reduced relapses, they have not convincingly improved other aspects of schizophrenia beyond symptom control. Further research is still needed to develop more effective psychosocial interventions.
Similar to A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docx (20)
Zoe is a second grader with autism spectrum disorders. Zoe’s father .docxransayo
Zoe is a second grader with autism spectrum disorders. Zoe’s father recently passed away in a tragic car accident. Zoe, her mom, and two older brothers have temporarily relocated from out-of-state and are now living in her grandparents’ house in a small, rural community.
Because the family had been living out-of state, Zoe has never interacted with her grandparents. She has challenges responding to social cues, including her name and in understanding gestures. She also engages in repetitive body movements. She is fond of her set of dolls and likes lining them up. When Zoe is agitated, her mother plays Mozart, which seems to have a calming effect. Zoe also enjoys macaroni and cheese.
Her grandparents do not understand Zoe’s attempts at communicating. Zoe does not respond well to crowded and noisy environments. Zoe’s mom is working outside the home for the first time.
Because of the move, Zoe has transferred to a new school, which does not currently have any students with ASD. Although her mom is generally very involved with Zoe’s education, she is away from the home much of the time due to a long commute for her new job is a neighboring city.
Zoe’s grandparents are eager and willing to help in any way they can.
Imagine you are serving as an ASD consultant at Zoe’s new school. Using the COMPASS model, create a COMPASS Action Plan for Zoe by complete the following tasks:
Identify the personal challenges for Zoe;
Identify the environmental challenges for Zoe;
Identify potential supports; and
Identify and prioritize teaching goals.
In addition, include a 250-500-word rationale that explains how your action plan for Zoe demonstrates collaboration in a respectful, culturally responsive way while promoting understanding, resolving conflicts, and building consensus around her interventions.
.
Zlatan Ibrahimović – Sports Psychology
Outline
Introduction:
· General Info
· Nationality, Birthplace, Parents
· Childhood What he wanted to do growing up?
· When did he start playing professionally?
· Which teams did he play for?
· Give some of his career statistics and maybe records?
· What trophies has he won with club football and national team of Sweden?
· Style of Play
· What is his personality like? How do people see him in the media?\
·
Body Paragraphs
Connect the following Sports Psychology Concepts (or even those not listed) to Zlatan Ibrahimović
What is his personality type? Type A, B C, or D?
Give examples through research of where he shows this.
CATASTROPHE THEORY… OCCURS WHEN? WHAT DOES THE GRAPH LOOK LIKE
· Arousal: is a blend of physiological and psychological activity in a person and it refers to the intensity dimensions of motivation at a particular moment. It ranges from not aroused, to completely aroused, to highly aroused; this is when individuals are mentally and physically activated.
· Performance increases as arousal increases but when arousal gets too high performance dramatically decreases. This is usually caused by the performer becoming anxious and sometimes making wrong decisions. Catastrophes is caused by a combination of cognitive and somatic anxieties. Cognitive is the internal worries of not performing well while somatic is the physical effects of muscle tension/butterflies and fatigue through playing.
· The graph is an inverted U where the x line is the arousal and the y is the performance. Performance peaks on the top of the inverted U and the catastrophe happens in the fall of the inverted U
HIGH TRAIT ANXIETY ATHLETES… HOW DO THEY PERCEIVE COMPETITION?
· Anxiety: is a negative emotional state in which feelings of nervousness, worry and apprehension are associated with activation or arousal of the body
· Trait Anxiety: is a behavioral disposition to perceive as threatening circumstances that objectively may not be dangerous and to then respond with disproportionate state anxiety.
· Somatic Trait Anxiety: the degree to which one typically perceived heightened physical symptoms (muscle tension)
· Cognitive Trait Anxiety: the degree to which one typically worries or has self doubt
· Concentration Disruption: the degree to which one typically has concentration disruption during competition
People usually with high trait anxiety usually have more state anxiety in highly competitive evaluative situations than do people with lower trait anxiety. Example two athletes are playing basketball and both are physically and statistically the same both have to shoot a final free throw to win the game. Athlete A is more laid back which means his trait anxiety is lower and he doesn't view the final shot as a overly threatening. Athlete B has a high trait anxiety and because of that he perceives the final shot as very threatening. This has an effect on his state anxiety much more than.
Zia 2Do You Choose to AcceptYour mission, should you choose.docxransayo
Zia 2
Do You Choose to Accept?
Your mission, should you choose to accept it, is to go out and see Mission: Impossible-Fallout. As I sat back in my red-cushioned seat, accompanied by my brothers, I knew I was in for something special. The film takes place two years after two-thousand fifteens hit movie, Mission: Impossible-Rogue Nation. While I had no clue what to expect, I knew I was going to be in for an incredible ride as soon as the movie began with the intense dialogue between Ethan Hunt (Tom Cruise) and Solomon Lane (Sean Harris). From beginning to end, Mission: Impossible- Fallout delivers crazy action-thriller scenes, inventive special effects, and creative cinematography.
Mission: Impossible-Fallout is based on a story of an American agent who must retrieve nuclear weapons from an enemy terrorist organization with help of his specialized IMF team. The film was consistent the first hour with it involving the audience in the mission of the secret organization and trying to figure out the next move of the evil organization known as the Apostles. However, towards the middle of the movie it was revealed that one of the CIA agents was playing the role of a double spy and was on the side of the Apostles. The plot delivered intense action-packed scenes between the opposing groups that personally had me at the edge of my seat. Whether it was a chase on motorcycles, cars, speedboats, or helicopters, each scene had Ethan Hunt running for his life to save the world. Even though I was only viewing the movie from a comfortable movie theater, Hunt zigzagging through the traffic of France on a motorcycle had my fists clenched and adrenaline pumping. However, that was not even the best thriller of the movie. Ethan Hunt trailing Agent Walker in a helicopter with heavy rounds of artillery being fired at each other through the snowcapped mountains of Kashmir may very well be one of the best action scenes in cinematic history. Mission: Impossible-Fallout can be appreciated and enjoyed by all audiences because of its action-packed scenes that keep everyone extremely engaged in the plot.
Mission: Impossible-Fallout brilliantly illustrates the amazing special effects that serve to create the theme and style of the film. From creating bloody wounds to spectacular backgrounds, special effects are abundant throughout the movie. For instance, as Hunt is jumping off an airplane, the special effects of this scene include wind, rain, thunder, and clouds that make the film visually appealing and almost realistic. The thunder striking him as he is skydiving had my jaw wide open simply because of how incredible the illusion was displayed. In almost every fight between Hunt’s team and the Apostles, multiple types of special effects were utilized. Fighting sequences with Hunt angrily running towards Lane and delivering devastating punches accompanied by “POWs” and “AAAHs” seemed so realistic that it had me feeling queasy in my stomach. The gunfire during these fight.
Ziyao LiIAS 3753Dr. Manata HashemiWorking Title The Edu.docxransayo
Ziyao Li
IAS 3753
Dr. Manata Hashemi
Working Title:
The Education Gap
Research Question:
How did the youth of Iran make up the education gap resulted from the Cultural Revolution from 1980 to 1982?
This is a critical question because it involves both education and the youth of Iran. Education and the youth are both very fundamental perspectives for a society to thrive. During the cultural revolution, the education system was shut down, which would undermine the overall quality of a generation. Research of this issue will lead us to the methods used to make up the education gap. It is possible to help other countries suffering similar issues.
Thesis Statement:
After the Iran’s cultural revolution during 1980 to 1982, the youth of Iran made up the education gap caused during the revolution by promoting student movements.
Outline:
· Introduction:
· Cultural Revolution happened in Iran during 1980 to 1982. The education institutions like universities were shut down for the 3-year period. And this gap in education brought significant influence on the youth of Iran at that time. However, the education gap was made up successfully after the revolution.
· State the thesis statement:
· The education gap is made up by the youth in Iran. They promoted the student movement to help the society recover from the revolution.
· The scars left from the revolution
· The revolution lasted 3 years, young people who were supposed to be students had to quit school. The government forced schools to close. The chain of delivering knowledge was broken. And young people cannot find proper things to do when quitting school.
· Student movements
· After the cultural revolution, people in Iran realized they need to correct the current education situation recover the damages resulted from the revolution. Since Iran’s youth has a great number in the society, their power was not to be ignored. They started to fight for their own rights and profits. They were looking for ways to make up the damage has been down. Then the student movement eventually worked for recovering Iran’s education level.
· Conclusion
· The cultural revolution in Iran hurt its education continuity. However, the youth of Iran managed to make up for the damage caused by the cultural revolution. Student movements played the dominant role in this recovering process.
Bibliography:
Khosrow Sobhe (1982) Education in Revolution: is Iran duplicating the Chinese Cultural Revolution?, Comparative Education, 18:3, 271-280, DOI: 10.1080/0305006820180304
Mashayekhi M. The Revival of the Student Movement in Post-Revolutionary Iran. International Journal of Politics, Culture & Society. 2001;15(2):283. doi:10.1023/A:1012977219524.
Razavi, R. (2009). The Cultural Revolution in Iran, with Close Regard to the Universities, and its Impact on the Student Movement. Middle Eastern Studies, 45(1), 1–17. https://doi-org.ezproxy.lib.ou.edu/10.1080/00263200802547586
ZABARDAST, S. (2015). Flourishing of Occid.
Ziyan Huang (Jerry)
Assignment 4
Brand Positioning
Professor Gaur
Target audience:
HR in Ping An Bank Co., Ltd. HRs (interviewers who hire people) from Ping An Bank are usually female, aged 30-40, who look friendly and easy-going. They are sophisticated and skeptic when checking people’s resumes and asking questions during interview. Usually, HRs care about four things: 1. Graduate school ranking. 2. Working experience in bank 3. Oral expression. 4. Personal character. They prefer people who are enthusiastic, energetic and hard-working.
Q1:
Compared to other people who also look for jobs in Ping An Bank, my points of parity would be: 1. I have earned a master degree in a Top 40 U.S. graduate school. 2. I have some intern experience in another bank. My points of differentiation would be: 1. I am confidence in speaking and self-expression. I can serve both Chinese and American clients because I speak fluent Mandarin and English. 2. I am energetic and hard-working. I always have passion in learning something new, which is a key for me to develop working skills.
Q2:
My brand essence: “Energetic, hard-working and modest.”
Q3:
Positioning statement:
Ziyan Huang is for employers from bank,
Who look for excellent employees.
Ziyan Huang is an energetic, hard-working NYU graduate student,
That has passion in developing new working skills.
Because he can speak fluent Mandarin and English,
And have one year working experience in China Merchant Bank,
So that employers can trust him as a reliable candidate.
.
Zhtavius Moye
04/19/2019
BUSA 4126
SWOT Analysis
Dr. Setliff
PORSCHE
Strengths
· Brand Recognition
Not only a brand, but a status symbol for wealth and luxury
· Lean Factory Production
Manpower is low compared to the use of raw materials and supplies
· High Profit Share
The reputation is well-known for good treatment
Weaknesses
· Small automotive manufacture
Porsche has offered the same line of cars for years before extending.
· Limited Customer Sector
Not everyone can afford a Porsche
· Location
Since beginning of time, Porsche has been in Stuttgart, Germany. No space to expand
Opportunities
· Expansion
Deliveries increased in China by 12% but needs more in Asia, Japan, and Indonesia.
· Electric Mobility
A chance to expand Porsche name to many more industries and markets with top competitors such as Tesla.
· S1, O2: Brand recognition extends the range for profitability for the 2020 fully electric Porsche Taycan.
· S3, O1: The annual profitability of the company will encourage others to become a part of the business.
· S2, O1: The cost of a Porsche effects expansion, but by expanding to China could significantly increase rates.
· S3, O1: The location in Germany is a problem for expansion due to limited space of Stuttgart.
Threats
· Technology
Modern technology is advancing to lower cost vehicles.
· Market Competition
Vehicles with similar characteristics at lower cost.
· S3, O2: Weighing heavily on the market Porsche’s reputation will continue to stand abroad its competitors.
· S2, O1: Limited labor will call for more software developers in the more modern technology, especially introducing the fully electric Porsche Taycan.
· S1, O1: Porsche is a company that believes in staying at its classic and luxury perception to their buyers. Still giving all newly updated technology certain things such as an automatic start engine will not be an asset.
· S2, O2: Combined leaves Porsche at a limitation of customers making it hard to expand the market.
VIOLATION OF CIVIL RIGHTS ACT IN ELECTIONS 1
VIOLATION OF CIVIL RIGHTS ACT IN ELECTIONS 2
Violation of Civil Rights Act in Elections
Jake Bookard
Savannah State University
Violation of Civil Rights Act in Elections
Introduction
Despite the assurance of minority voter’s rights by the constitution and the fourteenth amendment, cases of rights violation with regards to the voting process are still on the rise in the US. Minority groups are often discriminated or blocked from participating in the voting process both in ways that they can discern and through cunning plans that can involve the voting process. Some of the main reasons why minorities’ constitutional rights are violated include racial discrimination by majority races, and to manipulate the outcome of the elections so as to keep minority groups out of the political leadership structure. The fourteenth amendment and the constitution do not sufficiently safeguard the rights of minority groups during elections beca.
Zichun Gao Professor Karen Accounting 1AIBM FInancial Stat.docxransayo
Zichun Gao Professor Karen Accounting 1A
IBM FInancial Statement Analysis
Financial Ratios 2019 2018 Formula
Current Ratio 1.02 1.29 CA/CL
Profit Margin 12.22% 12.35% Net Income/Total Revenue
Receiveables Turnover 9.80 10.71 Revenue/Average AR
Average Collection Period 36.72 33.62 365/Receiveables Turnover
Inventory Turnover 25.11 25.36 COST/Average Inventory
Days in Inventory 14.53 14.39 365/Inventory Turnover
Debts to Asset Ratio 0.86 0.86 Total Debts/Total Assets
IBM's days in inventory is around two weeks and this means that goods in the inventory
as efficnetly distributed and that there is a consitantly good inventory control for the
company.
The company's debts to assets ratio is the same for two years and this means that the
company has less debt than asset. However, it is still a relatively poor ratio because this
might show that there are potential problems for the company to generate sufficient
revenue.
The current ratio of the company has decreased over the year, and this means that the
company has less liquid assets to cover its short term liabilities. Since the ratio is
currently approaching 1, the company might be having liquidation problem.
The profit margin for IBM is very stable and it has been about 12% for two years. The
company is performing the profit-generating ability at an average level and it is having
an average profit margin in the industry.
The receiveables turnover is good for the company while between these two years, there
is a decline. As the company is collecting its accounts receiveables around 10 times per
year, the collection is frequent.
The company has been collecting money from customers on credit sales approximately
once every month, and the company usually has fast credit collection, which means that
the risk for credit sales is relatively low.
Inventory turnover measures how many times a company sells and replaces inventory
during a year and for IBM, the number of times is stable and it is constantly around 25.
This means that the company has an efficient control of its goods in the inventory.
Free Cash Flow 11.90 11.90 CF_Operation-Capital Expenditures
Return on Assets 0.06 0.08 Net Income/Total Assets
Asset Turnover 0.51 0.65 Revenue/Assets
Figures From Financial Statement
From Income Statement pg.68
Net Income 9431 9828
Total Revenue 77147 79591
Cost 40657 42655
From Consolidated Balance Sheet pg.70
Current Assets 38420 49146
Current Liabilities 37701 38227
Accounts Receiveables 7870 7432
Inventory 1619 1682
Total Assets 152186 123382
Total Liabilities 131202 106452
From Cash Flow Overview pg.59
Net Cash From Op 14.3 15.6
Capital expenditures 2.4 3.7
The company currently has 11.9 billion dollars free cash flow for two years and this is a
relatively high level of free cash flow. With the high free cash flow, the company can
have more oportunity to expand, invest in new projects, pay dividends, or invest the
money into Resea.
Zheng Hes Inscription This inscription was carved on a stele erec.docxransayo
Zheng He's Inscription
This inscription was carved on a stele erected at a temple to the goddess the Celestial Spouse at Changle in Fujian province in 1431. Message written before his last voyage.
The Imperial Ming Dynasty unifying seas and continents, surpassing the three dynasties even goes beyond the Han and Tang dynasties. The countries beyond the horizon and from the ends of the earth have all become subjects and to the most western of the western or the most northern of the northern countries, however far they may be, the distance and the routes may be calculated. Thus the barbarians from beyond the seas, though their countries are truly distant, "have come to audience bearing precious objects and presents.
The Emperor, approving of their loyalty and sincerity, has ordered us (Zheng) He and others at the head of several tens of thousands of officers and flag-troops to ascend (use) more than one hundred large ships to go and confer presents on them in order to make manifest (make it happen) the transforming power of the (imperial) virtue and to treat distant people with kindness. From the third year of Yongle (1405) till now we have seven times received the commission (official permission) of ambassadors to countries of the western ocean. The barbarian countries which we have visited are: by way of Zhancheng (Champa Cambodia), Zhaowa (Java), Sanfoqi (Palembang- Indonesia) and Xianlo (Siam/Thailand) crossing straight over to Xilanshan (Ceylon- Sri Lanka) in South India, Guli (Calicut) [India], and Kezhi (Cochin India), we have gone to the western regions Hulumosi (Hormuz Between Oman and Iran), Adan (Aden), Mugudushu (Mogadishu- Somalia), altogether more than thirty countries large and small. We have traversed more than one hundred thousand li (distance of 500 meters) of immense water spaces and have beheld in the ocean huge waves like mountains rising sky-high, and we have set eyes on barbarian regions far away hidden in a blue transparency of light vapours, while our sails loftily unfurled like clouds day and night continued their course (rapid like that) of a star, traversing those savage waves as if we were treading a public thoroughfare. Truly this was due to the majesty and the good fortune of the Court and moreover we owe it to the protecting virtue of the divine Celestial Spouse.
The power of the goddess having indeed been manifested in previous times has been abundantly revealed in the present generation. When we arrived in the distant countries we captured alive those of the native kings who were not respectful and exterminated those barbarian robbers who were engaged in piracy, so that consequently the sea route was cleansed and pacified (to make someone or something peaceful) and the natives put their trust in it. All this is due to the favours of the goddess.
We have respectfully received an Imperial commemorative composition (essay/piece of writing) exalting the miraculous favours, which is the highest recompense and.
Zhou 1Time and Memory in Two Portal Fantasies An Analys.docxransayo
Zhou 1
Time and Memory in Two Portal Fantasies: An Analysis of Alice’s Adventure in Wonderland and "Windeye"
Life is a collection of moments, and some memories last forever. Brian Evenson
demonstrated this in “Windeye,”a story of a man who faces mental challenges because of the
life-long memory of his sister. In spite of the fact that his mother insists that the sister did not
exist, the protagonist stuck to this belief until his old age. The basis of the protagonist’s
problems is the intense love and unforgettable memories he shared with his imagined sister.
A great portion of his childhood memories is centered around his sister and their exploration
of the windeye. Windeye, the corruption of the word window, is a portal that causes the
disappearance of the protagonist’s sister. The popular portal fantasy, Alice’s Adventure in Wonderland, illustrates a similar story in the same sub-genre where a girl travels through a
rabbit hole and experiences a fantasy world which chronicles her changes from naive child-
like responses to more adult-like problem solving reactions. In “Windeye,” Brian Evenson
utilizes the portal trope to develop conflict and outcomes while exploring the themes of time
and memory. In both stories, the use of the portal trope creates a distinct world that is
separate from reality; however, the outcomes are different, and ultimately, Alice’s Adventure in Wonderland presents the theme of growth while “Windeye” explores time and memories.
The use of time factors allows the reader to travel back to the origin of the story in “Windeye” and experience the beginning of the central conflict. It is in his past that the
protagonist develops strong childhood memories of a sister, which is the cause of his future
mental challenges. In the present, the narrator is old and rickety as he uses a cane to walk but
is still reminiscent of the past (Evenson). He holds firm to the belief that he might have a
chance of meeting his sister again and thus contemplates the future and the sister’s
appearance. The plot of “Windeye” is composed of distinctive life moments: the past, the
present, and the future, which offer a clear and complete description of the events. The theme
Zhou 2
of time allows the reader to understand why the protagonist profoundly feels that his sister exists. In essence, it is time travel that gives the story a picture of the events that lead to the current situation.
The portal fantasy is a fictional literary device where a character enters into a
fantastical world through a portal or a hole. In Alice’s Adventures in Wonderland, Carroll
uses a rabbit hole as a physical portal to move through time. Comparably, Evenson utilizes
the windeye, a window that can only be seen from one side, as a physical portal. When the
sister touches the windeye, her brother believes that she enters into another reality through
the portal as Alice does. In contrast, the protagonist also experiences a new reality as he is.
Zhang 1
Yixiang Zhang
Tamara Kuzmenkov
English 101
June 2, 2020
Comparing Gas-Powered Cars and Electric Cars
Electric cars have become increasingly popular in the past century. These cars use
electric motors instead of conventional gasoline engines. Electric cars pollute less and utilize
energy more efficiently than gas-powered vehicles; therefore, modern research is focusing on
improving electric vehicles, such as increasing the storage capacity of the batteries. This essay
seeks to identify the differences and similarities between the two types of cars focusing on their
performance, price, and convenience.
An electric car is a car that is primarily powered by electricity. The conventional gas-
powered cars require diesel or gasoline to power the engines. These cars have gas tanks that store
fuel and the engine converts the gas to the energy that powers the motor. Similarly, electric cars
have batteries, or fuel cells that store and convert electricity to energy used to propel electric
motors (What Are Electric Cars?). Four components present in electric cars distinguish it from
the gas-powered cars (Alternative Fuels Data Center: How Do All-Electric Cars Work?). The
first is the charge port. Since electricity powers an electric car, there has to be a port to connect
to an external power source when charging the battery. The second is an electric traction motor
that propels the vehicle. The third is a traction battery pack. This battery serves the same purpose
as the gas tank; thus, it stocks electric power to propel the motor. The forth is a direct current
converter. This component converts the current to low voltage power that is needed to power the
electric engine.
Tamara Kuzmenkov
90000001730094
You need to watch the panapto session for this paper assignment and FOLLOW the instructions I give there. Your topic sentence must follow the patterns set forth by your thesis. So, this first paragraph must have a topic sentence about GAS POWERED cars and PRICE. That is what you have set forth in your thesis. Watch the panapto session. And ask me questions if you do not understand what I mean.
Tamara Kuzmenkov
90000001730094
No, you cannot 'announce' what your essay will do. And this is NOT the thesis I approved. What I approved:"Both gas-powered cars and electric cars are now in use, but their price, performance and convenience may vary, which may influence people's decisions about which type to use."
Zhang 2
Differences between gas-powered cars and electric cars
The initial purchase price of an electric car is much higher than that of a gas-powered car.
Consumers intending to own a vehicle have the option of buying or leasing. The initial cost of a
car depends on an individual's disposable income and savings. Knez et al. noted that "When it
comes to financial features, the most important thing seems to be the total price of the vehicle"
(55). The difference in price between electr.
Zhang �1
Nick Zhang
Mr. Bethea
Lyric Peotry
13 November 2018
Reputation by Taylor Swift
After Taylor Swift fell into disrepute, she was truly reborn. As a creative singer
who reveals a lot of real life emotions and details in her works, she constantly refines
and shares her emotional connection with her audience. In her new album, people find
resonance in her work, connect it with their own lives. "Reputation" is not only the
original efforts of Taylor Swift, but also means that she turned gorgeously and
dominated. This album is like a swearing word from her to the world. Revenge fantasy,
sweet love, painful growth... all the good and bad things that happened in these stages
of life, her music seems to have gone through with us all over again.
But last August, the now 28-year-old singer declared that "the old Taylor is
dead" in her eerie single "Look What You Made Me Do," the beginning of a new era for
Swift (Weatherby). The disclosure of the society, the accusations of rumor makers,
these straight-forward lyrics shred the ugly face of those unscrupulous people. Taylor
Swift did not endure the rumors in the society, but created this rock album after the
silence. If 1989 is still what Taylor hopes to gain the understanding of the public, this
album is really a matter of opening up the past concerns, saying goodbye to the past
as well as being a true Taylor Swift. No longer caring about the so-called "reputation ",
preferring to be burned to death by those ridiculous "images." This air of newfound
jadedness is one of the many ways in which Swift broadcasts her long-overdue loss of
Zhang �2
innocence on “Reputation,” an album that captures the singer during the most
turbulent but commercially successful period of her career. (Primeau)
The cover is black and white, the picture is Taylor's head, and the side is the
newspaper's article and title words. The cover of the album may be a metaphor, it
reveals that Taylor can no longer stand the report of the gossip media, and the chain on
the neck represents depression and breathlessness. The theme and style of the album
are all refined from their own lives. The emotions and themes interpreted in her songs
make the audience feel more deeply that her album is her life. Without even using any
real words, fans can surmise what this means — a reference to the endless headlines
and stories the singer has spurred in recent years. (Primeau) Reputation, come to diss
the past and all opponents.
The lyrics and MV are full of real stalks in Taylor Swift's life , with Taylor's
resentment for circles and industry since his debut. In the era of streaming singles, she
is the rare young star who still worships at the altar of the album, an old-fashioned
instinct that serves her surprisingly well. (Battan) "Look What You Made Me Do" is a
counterattack against Kanye West and Kim Kardashian, Katy Perry and numerous
online "black mold". And .
Zero trust is a security stance for networking based on not trusting.docxransayo
The document provides an assignment to research and write a report on the zero trust security model. The report should describe the purpose of zero trust and how it differs from other models, provide an overview of how zero trust works in a network environment, and explain how zero trust incorporates least privilege access through role-based access control and attribute-based access control. The report should be around 2 pages and 600 words.
Zero plagiarism4 referencesNature offers many examples of sp.docxransayo
Zero plagiarism
4 references
Nature offers many examples of specialization and collaboration. Ant colonies and bee hives are but two examples of nature’s sophisticated organizations. Each thrives because their members specialize by tasks, divide labor, and collaborate to ensure food, safety, and general well-being of the colony or hive.
In this Discussion, you will reflect on your own observations of and/or experiences with informaticist collaboration. You will also propose strategies for how these collaborative experiences might be improved.
Of course, humans don’t fare too badly in this regard either. And healthcare is a great example. As specialists in the collection, access, and application of data, nurse informaticists collaborate with specialists on a regular basis to ensure that appropriate data is available to make decisions and take actions to ensure the general well-being of patients.
Post
a description of experiences or observations about how nurse informaticists and/or data or technology specialists interact with other professionals within your healthcare organization. Suggest at least one strategy on how these interactions might be improved. Be specific and provide examples. Then, explain the impact you believe the continued evolution of nursing informatics as a specialty and/or the continued emergence of new technologies might have on professional interactions.
.
Zero plagiarism4 referencesLearning ObjectivesStudents w.docxransayo
Zero plagiarism
4 references
Learning Objectives
Students will:
Develop diagnoses for clients receiving psychotherapy*
Analyze legal and ethical implications of counseling clients with psychiatric disorders*
* The Assignment related to this Learning Objective is introduced this week and
submitted
in
Week 4
.
Select a client whom you observed or counseled this week. Then, address the following in your Practicum Journal:
Describe the client (without violating HIPAA regulations) and identify any pertinent history or medical information, including prescribed medications.
Using the
Diagnostic and Statistical Manual of Mental Health Disorders
, 5th edition (DSM-5), explain and justify your diagnosis for this client.
Explain any legal and/or ethical implications related to counseling this client.
Support your approach with evidence-based literature.
.
Zero Plagiarism or receive a grade of a 0.Choose one important p.docxransayo
Zero Plagiarism or receive a grade of a 0.
Choose one important police function: Law enforcement, order maintenance or service, etc.
OR
Choose one important police strategy: Traditional Policing, Community Policing, Data Driven Policing, etc.
Write a research paper describing the strateugy or function in detail and discussing the significance of the strategy or function with respect to the roles in society.
Format: Title Page, Outline, Text, and References
Must have 3 sources
You can use your textbook: Cox, Steven M., et al. (2020). Introduction to Policing. Fourth Edition. Thousand Oaks, CA: SAGE Publications, Inc.
Paper must by 6 pages long
APA Style
.
ZACHARY SHEMTOB AND DAVID LATZachary Shemtob, formerly editor in.docxransayo
ZACHARY SHEMTOB AND DAVID LAT
Zachary Shemtob, formerly editor in chief of the Georgetown Law Review, is a clerk in the US District Court for the Southern District of New York. David Lat is a former federal prosecutor. Their essay originally appeared in the New York Times in 2011.
Executions Should Be Televised
Earlier this month, Georgia conducted its third execution this year. This would have passed relatively unnoticed if not for a controversy surrounding its videotaping. Lawyers for the condemned inmate, Andrew Grant DeYoung, had persuaded a judge to allow the recording of his last moments as part of an effort to obtain evidence on whether lethal injection caused unnecessary suffering.
Though he argued for videotaping, one of Mr. DeYoung’s defense lawyers, Brian Kammer, spoke out against releasing the footage to the public. “It’s a horrible thing that Andrew DeYoung had to go through,” Mr. Kammer said, “and it’s not for the public to see that.”
We respectfully disagree. Executions in the United States ought to be made public.
Right now, executions are generally open only to the press and a few select witnesses. For the rest of us, the vague contours are provided in the morning paper. Yet a functioning democracy demands maximum accountability and transparency. As long as executions remain behind closed doors, those are impossible. The people should have the right to see what is being done in their name and with their tax dollars.
This is particularly relevant given the current debate on whether specific methods of lethal injection constitute cruel and unusual punishment and therefore violate the Constitution.
There is a dramatic difference between reading or hearing of such an event and observing it through image and sound. (This is obvious to those who saw the footage of Saddam Hussein’s hanging in 2006 or the death of Neda Agha-Soltan during the protests in Iran in 2009.) We are not calling for opening executions completely to the public — conducting them before a live crowd — but rather for broadcasting them live or recording them for future release, on the web or TV.
When another Georgia inmate, Roy Blankenship, was executed in June, the prisoner jerked his head, grimaced, gasped, and lurched, according to a medical expert’s affidavit. The Atlanta Journal-Constitution reported that Mr. DeYoung, executed in the same manner, “showed no violent signs in death.” Voters should not have to rely on media accounts to understand what takes place when a man is put to death.
Cameras record legislative sessions and presidential debates, and courtrooms are allowing greater television access. When he was an Illinois state senator, President Obama successfully pressed for the videotaping of homicide interrogations and confessions. The most serious penalty of all surely demands equal if not greater scrutiny.
Opponents of our proposal offer many objections. State lawyers argued that making Mr. DeYoung’s execution public raised safety concerns..
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The document is a reflective essay written by Jiawen Zeng about improving their writing skills during their English 3001 writing proficiency course over 10 weeks. The essay discusses the most serious problems Zeng previously faced with their writing, including issues with grammar, verb tenses, and content quality. It describes Zeng's initial strategy of only focusing on highlighted mistakes, but then realizing this was not enough and starting to read more books in English and write more diverse essays. The essay reflects on Zeng meeting the university's writing requirements being just the beginning, and the need to continue improving editing skills and focusing on content, evidence, and meeting further targets.
zClass 44.8.19§ Announcements§ Go over quiz #1.docxransayo
This document summarizes a lecture on the social organization of Hindustani music. It discusses key terms like gharana (musical lineage), khandan (musical family), and the distinction between soloists and accompanists. Socially, soloists came from higher castes than accompanists. Musically, the performance structure involved a soloist leading with accompanists following. Over time, accompanists gained more prominence and independence, filling important musical roles and occasionally challenging the traditional hierarchy. Lineage and pedigree (gharana/khandan) became important for musicians' social and musical identities.
zClass 185.13.19§ Announcements§ Review of last .docxransayo
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Class 18
5.13.19
§ Announcements
§ Review of last class
§ Finish lecture on Qawwali, begin intro to Pakistan
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Announcements
§ Keshav Batish senior recital, June 5 – Extra credit
§ Exam #1 results posted
§ 2 perfect scores, 25 A’s, 46 B’s, 37 C’s, 17 D and lower
§ Summer course on Indian rhythm (second session)
§ Learn tabla and dholak!
§ Enrollment open now!
z
Last class review
§ Qawwali – “Food for the soul”
§ Sufi devotional poetry set to music
§ Performed at dargah
§ ‘Urs
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Terms
§ Mehfil – small, intimate gatherings that involve entertainment of
various sorts, including music, poetry, dance etc.
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Tum Ek Gorakh Dhandha Ho
§ “You are a baffling puzzle”
§ Written by Naz Khialvi (1947-2010)
§ Pakistani lyricist and radio broadcaster
§ Popularized by Ustad Nusrat Fateh Ali Khan (1948-1997)
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Tum Ek Gorakh Dhandha Ho
kabhi yahaan tumhein dhoonda
kabhi wahaan pohancha
tumhaari deed ki khaatir kahaan
kahaan pohancha
ghareeb mit gaye paamaal ho
gaye lekin
kisi talak na tera aaj tak nishaan
pohancha
ho bhi naheen aur har ja ho
tum ik gorakh dhanda ho
At times I searched for you here,
at times I traveled there
For the sake of seeing You, how
far I have come!
Similar wanderers wiped away
and ruined, but
Your sign has still not reached
anyone
You are not, yet You are
everywhere
You are a baffling puzzle
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Bhar Do Jholi Meri
§ Traditional song
§ Popularized in movie “Bajrangi Bhaijaan” (2015)
z
Bhar Do Jholi Meri
Tere Darbaar Mein
Dil Thaam Ke Woh Aata Hai
Jisko Tu Chaahe
Hey Nabi Tu Bhulata Hai
Tere Dar Pe Sar Jhukaaye
Main Bhi Aaya Hoon
Jiski Bigdi Haye
Nabi Chaahe Tu Banata Hai
Bhar Do Jholi Meri Ya Mohammad
Lautkar Main Naa Jaunga Khaali
They come into Your court
clenching their hearts
Those people whom You desire to
see , O Prophet!
I’ve also come to Your door with
my head bowed down
You’re the One who can fix
broken fates, O Prophet!
Please fill my lap, O Prophet!
I won’t go back empty handed
z
Ustad Nusrat Fateh Ali Khan
(1948-1997)
§ Pakistani vocalist
§ Sang classical (khyāl) but more famous as a Qawwali singer
§ Brought classical performance techniques to Qawwali
§ Visiting artist at University of Washington from 1992-93
§ Legacy carried on through his nephew, Rahat Fateh Ali Khan
z
Introduction to Pakistan
Badshahi Mosque, Lahore
Built in 1671 by Emperor Aurangzeb
z
Pakistan
§ Prominent Bronze Age (3000-1500BCE) settlements of Mohenjo
Daro and Harrapa along Indus River Valley
§ Hinduism widespread during Vedic Age (1500-500BCE)
§ Ruled by series of Hindu, Buddhist, and eventually Muslim
(Persian) dynasties
§ Islam introduced by Sufi missionaries from 7th to 13th centuries
§ Ethnically and linguistically diverse
z
Indus Valley civilization
z
Pakistan ethnicities
z
Modern India and Pakistan
§ By the end of 19th century British rule was in effect over much of
old Mughal Empire territory
§ The Hindu and Muslim divide among this territory was be.
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A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docx
1. A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and
family therapy (MFT),
members of both fields have made significant advances in
collaborative health research
and practice. To add to this work, we surveyed a nationwide
random sample of 240 family
physicians (FPs) and asked about their perspectives and
experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their
patients to receive MFT-
related care, but their referral to and collaboration with MFTs
were limited. Through
responses to an open-ended question, we gained valuable
information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing
integrative, collaborative
2. healthcare, we know little about how commonly family
physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our
knowledge, there have been
no studies published from the perspective of the FP that
describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware
of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude
toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common
occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated
that more than 60% of patient
visits to primary care physicians (PCPs) include mental health
concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint
(Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams
have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986;
Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other
researchers and practitioners have
written books that serve as a guide to other mental health
practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn
et al., 1996).
The specialty of family medicine, which arose in the 1960s,
embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of
caring for the whole person
within his or her family, social context, and life cycle stage
3. (Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat
their patients’ mental health
problems. By definition of their specialty, FPs are trained to
integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et
al., 1996) as well as to manage
Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle,
Maine; Deanna Linville, PhD, Couples and
Family Therapy Program, Department of Counseling Psychology
and Human Services, University of Oregon;
Karen H. Rosen, EdD, Marriage and Family Therapy Program,
Department of Human Development, Virginia
Polytechnic Institute and State University, Northern Virginia
Center.
Address correspondence to Rebecca Clark, Lifespan Family
Healthcare, 80 River Road, Newcastle, Maine
04553; E-mail: [email protected]
Journal of Marital and Family Therapy
April 2009, Vol. 35, No. 2, 220–230
220 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
psychotropic medication. The American Academy of Family
Physicians (AAFP, 2000) recom-
mended curriculum guidelines delineate how family medicine
residents must understand the
4. individual in the context of his or her family, as well as the
emotional impact of illness, and be
able to evaluate and diagnose mental health disorders from a
biopsychosocial perspective. For
decades, authors in family medicine and collaborative
healthcare journals have published
literature regarding the use of MFT techniques such as family
systems thinking, the use of gen-
ograms, meeting with the entire family, brief therapy
techniques, and when to refer patients for
family therapy (Bader, 1990; Bloom & Smith, 2001; Bullock &
Thompson, 1979; Christie-Seely,
1981; Davis, 1988; Frank, 1985; Lang et al., 2002; Mayer et al.,
1996; Tomson & Asen, 1987).
Additionally, organizations such as the Collaborative Family
Healthcare Association (CFHA;
see http://www.cfha.net) and the Society for Teachers of Family
Medicine (STFM; see http://
www.stfm.org) continue to promote research, education, and
practice in collaborative health-
care. Given family medicine’s emphasis on family systems, the
family as the unit of care, and
biopsychosocial perspective, it seems that MFTs would be a
logical, and even sought-after,
complement to FPs in providing comprehensive patient care.
As a specialty of MFT, medical family therapy (MedFT) has
already made significant
advances in this area. Particularly helpful for chronic illness,
MedFT has enabled MFTs to
skillfully integrate the biopsychosocial-spiritual perspective, a
systemic integration of physical
and emotional health, familial ⁄ social relationships, and
spiritual belief systems, with a family
systems framework (McDaniel, Hepworth, & Doherty, 1992a;
Rolland, 1994; Weihs, Fisher, &
5. Baird, 2002). Specifically trained medical MFTs have
effectively collaborated with medical prac-
titioners to provide care for families struggling with chronic
medical illnesses such as infertility
(Burns, 1999; McDaniel, Hepworth, & Doherty, 1992b), cancer
(Yeager et al., 1999), childhood
asthma and diabetes, cardiovascular and neurological disorders
(Campbell & Patterson, 1995),
obesity (Campbell & Patterson, 1995; Flodmark, Ohlsson,
Ryden, & Sveger, 1993), somatoform
disorder (McDaniel, Hepworth, & Doherty, 1995), dual
diagnosis (Harkness & Nofziger, 1998),
and anorexia nervosa (Dare & Eisier, 1995).
Roadblocks to Identifying and Managing Patient Psychosocial
Concerns
There is a range of limitations to the quantity and quality of
psychosocial care FPs can
deliver to their patients. Researchers have identified lack of
training (Christie-Seely, 1981;
Fosson, Elam, & Broaddus, 1982), time (Glied, 1998; Rost,
Humphrey, & Kelleher, 1994;
Tomson & Asen, 1987), patient reluctance (Kainz, 2002;
Williams et al., 1999), managed care
(DeGruy, 1997; Fisher & Ransom, 1997), and lack of
confidence (Gerdes, Yuen, & Frey, 2001;
Williams et al., 1999) as roadblocks to FPs and other PCPs
identifying and treating patient
mental health needs.
Roadblocks to referral. Regardless of to whom they refer,
physicians identify several road-
blocks when referring patients to mental health professionals.
These have included patient
reluctance, the unavailability of appropriate mental health
6. professionals in rural communities,
lack of affordability of mental health, significant lag time
between referral and appointment
availability, lack of adequate feedback from mental health
professionals, the stigma patients
attach to mental healthcare, and poor communication from the
mental health professional
(Kainz, 2002; Kushner et al., 2001; McCulloch et al., 1998;
Reust, Thomlinson, & Lattie, 1999;
Rost et al., 1994; Williams et al., 1999).
The purpose of this exploratory study was to discover FPs’
views of MFTs as potential
collaborators on the healthcare team. Specifically, this study
seeks to answer three research
questions:
(1) Do FPs view MFTs as a resource for patients with
psychosocial needs?
(2) Are FPs interested in collaborating with MFTs?
(3) What would make MFTs more helpful collaborators?
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
221
METHODS
This study was a national survey of 240 FPs. A questionnaire
was mailed to 240 board cer-
tified FPs who were randomly selected from the AAFP
directory. The inclusion criteria were
engagement in the practice of family medicine, graduation from
a U.S. medical school, comple-
tion of residency after 1969, and residence within a U.S. zip
7. code.
Participants and Procedures
After obtaining IRB approval, a randomly selected mailing list
was obtained from the
AAFP. Questionnaires were mailed along with an introductory
letter describing the study,
a brightly colored sticky note with a brief hand-written note,
and a self-addressed stamped
envelope. Each questionnaire was numbered to enable a follow-
up mailing to nonrespondents.
During the first wave, 104 questionnaires were returned. After 4
weeks the same material
was re-mailed to nonrespondents. After two mailings we
received 153 responses, representing
a 64% response rate. Of those responses, 16 questionnaires were
excluded from analyses
because respondents were no longer practicing family medicine
full time. Consequently, there
were a total of 137 usable questionnaires (57%). We received
responses from FPs in 37 out of
42 states as well as an FP in Puerto Rico and a deployed
military FP. Respondents had been
in practice for an average of 12 years and were an average age
of 46. Table 1 depicts demo-
graphic data such as gender and geographical distribution of
respondents. The four major
census regions of the United States as well as U.S. territories
and military were represented in
the sample. Based on the AAFP 2002 census of their members
(AAFP, 2003), the sample
appears representative of both the gender and regional
distribution of FPs throughout the
United States.
8. Table 1
Demographics
Variable
Percentage
of respondents
Percentage
of random
sample
Percentage
of 2002
National
AAFP
Censusa
Region
Northeast 15 13 15
South 35 33 33
Midwest 27 33 28
West 21 20 21
U.S. territory ⁄ Army Post Office 2 2 3
Gender
Male 66 71b
Female 34 29b
Note. n = 137. aMembership (U.S., U.S. Territories, and
Military; AAFP, 2003). bActive
AAFP members (this percentage includes 138 Canadian
members and 350 foreign members
that were not part of the sampled population). AAFP =
American Academy of Family
9. Physicians.
222 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
The questionnaire, which contained both closed and open-ended
questions, was based on a
review of literature and in consultation with MFTs and FPs. In
the development phase, the
questionnaire was administered to five FPs and revised based on
their feedback.
Analysis
Quantitative data analyses were completed using SPSS for
Windows, v10.0 (Norusis, 2000).
Qualitative data were analyzed using a modified version of the
constant comparative method
described by Strauss and Corbin (1990). Each segment of the
written responses to the open-
ended questions was coded independently by both authors to
identify and name major themes.
Once a list of major themes was developed, content analysis
(Patton, 2002) was used to deter-
mine how frequently each theme was mentioned by respondents.
RESULTS
In this section, each research question is addressed in turn.
When qualitative data gene-
rated noteworthy themes, the themes are identified and quotes
provided for illustration.
Do FPs View MFTs as a Resource for Patients With
10. Psychosocial Needs?
This research question was addressed by five questions on our
questionnaire. Respondents
were asked to estimate the percentage of their patients with
identified psychosocial concerns
who they believed could benefit from marital and ⁄ or family
therapy. Respondents were also
asked to estimate their referral practices. On average,
respondents estimated that 48% of their
patients could benefit from marital and ⁄ or family therapy and
that they referred 12% of their
patients for mental health services. However, respondents
estimated that they referred 5% of
their patients specifically for marital and ⁄ or family therapy–
related care. We specified marital
and ⁄ or family therapy–related care rather than MFT because at
that time several states did not
license MFTs (three of the states represented in this survey did
not).
Additionally, respondents were asked to check all that applied
from a list of potential
roadblocks encountered when referring patients for MFT-related
care. As can be seen in
Figure 1, ‘‘Patient reluctance’’ was checked by 85% of the
respondents, ‘‘HMO ⁄ Insurance’’ by
65%, ‘‘unavailability of appropriate therapists’’ by 40%,
‘‘time’’ by 34%, ‘‘lack of awareness of
appropriate therapists’’ by 33%, and ‘‘don’t feel this type of
therapy is helpful’’ by 4%.
Although 24 respondents provided written answers in response
to ‘‘other please specify,’’ no
new categories of roadblocks to referral emerged.
Figure 1. Roadblocks encountered by FPs when referring
11. patients for marriage and family
therapy–related care (n = 136).
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
223
Finally, respondents were asked if they were aware that MFTs
are licensed mental health
professionals ‘‘trained in psychotherapy and family systems and
licensed to diagnose and treat
mental and emotional disorders within the context of marriage,
couples, and family systems.’’
While 83% of respondents checked ‘‘yes’’ to this question, 64%
reported that prior to receiving
our survey they did not recognize the initials ‘‘LMFT’’ as
credentials for a Licensed Marriage
and Family Therapist.
Are FPs Interested in Collaborating With MFTs?
This research question was addressed by five questions on our
questionnaire. Respondents
were asked, ‘‘Have you ever consulted with a mental health
professional regarding a patient
case?’’ All of the respondents checked ‘‘yes’’ to this question.
When respondents were asked
whether or not they had ever consulted with an LMFT regarding
a patient or family, 47% of
the respondents checked ‘‘yes,’’ while 53% of the respondents
indicated they either had not or
were not sure if they had consulted with an LMFT.
Additionally, respondents were given a list of collaborative
modes and asked to check all
12. that applied to their experience of collaborating with MFTs or
comparable mental health pro-
fessionals in their community. ‘‘Infrequently receive reports’’
was checked by 49% of the FPs,
‘‘phone call ⁄ email with a MFT’’ by 43%, ‘‘informal
consultation with a MFT’’ by 40%, ‘‘no
patient-care contact with MFTs’’ by 20%, ‘‘regularly receive
reports’’ by 19%, and ‘‘regular
meetings with MFTs’’ by 3%.
Respondents were asked to describe how helpful they found
patient-care consults with
MFTs. The collaborative interactions with MFTs were indicated
by 82% of the respondents to
be either ‘‘very helpful’’ or ‘‘somewhat helpful.’’ Five percent
checked either ‘‘somewhat
unhelpful’’ or ‘‘very unhelpful,’’ while 12% checked ‘‘not
applicable.’’
Finally, respondents were asked to describe their interests in
collaborating with LMFTs or
comparable mental health professionals when identifying
patients’ psychosocial needs by check-
ing all that applied from a list of collaborative approaches. The
mode of collaboration pre-
ferred by most of the respondents was ‘‘referral out with
continuing collaborative
communication’’ (84%). Some respondents also indicated that
they would be interested in
‘‘inviting a family therapy provider to a patient’s appointment’’
(15%) or ‘‘meeting regularly
with a MFT regarding complex patients’’ (11%). Only 7% of the
respondents indicated they
were ‘‘not interested’’ in collaborating with MFTs.
What Would Make MFTs More Helpful Collaborators?
13. This research question was addressed by an open-ended
question. Respondents were asked
to ‘‘briefly describe what would make MFT providers a more
helpful resource when treating
patients with psychosocial issues, OR if you don’t consult with
an MFT, why not?’’ Eighty-nine
respondents (65% of sample) answered this question, offering a
total of 141 coded responses. A
content analysis produced six primary themes: (a) ideal
collaborative practices, (b) barriers to
referral, (c) MFT specialty awareness, (d) let us know who you
are, (e) barriers to collaboration,
and (f) attitudes toward MFTs. Quotes are included to better
illustrate the themes and
subthemes.
Ideal collaborative practices. Fifty-four responses were coded
as relating to collaborative
practices that would make MFTs more helpful resources. These
included proximity (‘‘I wish I
had a family therapist in my office’’), ease of referral (‘‘Be
available to my patients within
2 weeks of the request’’), collaborative communication (‘‘More
communication after [patient]
evaluation,’’ ‘‘Regular feedback’’), topical ⁄ specialty
information (‘‘Suggestions on what I can do
to help further the therapeutic goals,’’ ‘‘A specialist who could
incorporate issues related
to aging’’), and religious ⁄ faith-based (‘‘Faith-based, a plus!’’
‘‘I would like to work with a
Christian marriage and family therapist’’).
224 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
14. Barriers to referral. We coded 33 comments as barriers
respondents face when making
referrals to MFTs, including patient reluctance (‘‘Difficulty
convincing patients that therapy can
help them and sometimes even that there is a problem’’),
managed care (‘‘Many patients don’t
have mental health coverage,’’ ‘‘I do use other therapists when
driven by insurance’’), do not
know the therapist (‘‘hard to refer when don’t know
therapist’’), and lack of availability (‘‘Ther-
apists not available in my rural area,’’ ‘‘If one were more
readily available, this would be an
excellent resource’’). Only one of the responses indicated that
the respondent encountered no
barriers to referral.
MFT specialty awareness. We coded 15 responses as relating to
respondents’ awareness of
MFT as a specialty. Many of these respondents indicated they
were either completely unaware
of MFT as a distinct field or were unclear about the professional
role of an MFT (‘‘I didn’t
know there was a family ⁄ marriage therapy specialist’’). Other
respondents asked for more infor-
mation about MFTs and the types of services they provide.
Some indicated that they had not
differentiated between the various mental health professionals
with whom they worked (whether
they be MFTs, social workers, or psychologists).
Let us know who you are. We coded 14 responses as indicating
respondents wanted to be
able to identify the MFTs in their communities. Responses
placed in this category suggested
15. that respondents were either unaware of MFTs, had no
professional contact with MFTs in
their communities, or were less likely to work with therapists
they had not met (‘‘Probably
meeting face to face [would be helpful]’’).
Barriers to collaboration. We coded 13 responses as describing
barriers to collaboration.
Subcategories of this theme are the following: time
(‘‘Unfortunately we seem to have less time
to [collaborate]’’), managed care (‘‘HMO . . . typically listed an
800# to call . . . made commu-
nication very difficult between the anonymous therapist and
I’’), lack of therapist feedback
(‘‘Helpful to get reports back from therapists, but it often
doesn’t happen’’), and interest (‘‘I
like to refer but don’t necessarily feel I need to receive
reports’’).
Attitudes toward MFTs. We coded 12 responses as relating to
FPs’ attitudes regarding
MFTs. Seven responses had positive overtones (‘‘They are
already a helpful resource for me—I
can’t think of any way to improve this presently’’). Two
responses suggested an uncertain or
even negative mind-set toward MFTs (‘‘most of the MFT people
only have a Master’s . . . for
more complex cases, I might choose psychiatry or doctoral
psychology background’’). Three
responses made reference to the importance of a philosophical
fit.
DISCUSSION
The primary theme emerging from this study is that FPs are
interested in referral and col-
16. laboration, in some form, but face barriers. This theme is
illustrated by the quantitative and
qualitative data. The data suggest that there is a considerable
gap between the percent of
patients FPs identified as potentially needing MFT (48%) and
the percent of patients actually
referred for MFT (5%). This may, in part, be understood by the
roadblocks to referral (e.g.,
patient reluctance, HMO restrictions, unavailability of
appropriate therapist, and time) faced
by FPs in this study as well as in previous research studies
(Kainz, 2002; Orleans, George,
Houpt, & Brodie, 1985; Rosenthal, Shiffner, & Panebianco,
1990; Rost et al., 1994; Williams
et al., 1999).
Secondly, FP respondents in this study reported that they are
often unaware of MFTs in
their community or unfamiliar with the discipline of MFT.
Likewise, Kainz (2002) found that
physicians would be more likely to refer to the mental health
providers with whom they had
met and developed a good relationship or of whom they had
heard a good report from either
colleagues or patients. It may be that FPs are also uncertain of
the scope of MFTs’ training
and practice.
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
225
Thirdly, the FPs in this study appeared receptive to referring to
and collaborating with
MFTs, but collaboration is limited in its occurrence. In this
17. study, HMOs, time limitations,
and lack of therapist-initiated communication have been
identified as significant barriers to col-
laboration. These barriers that were identified by FPs are
similar to the collaboration barriers
identified by MFTs. Research articles and books written on
collaboration give considerable
attention to the issues around HMO-related barriers (e.g.,
DeGruy, 1997; McCulloch et al.,
1998; Seaburn et al., 1996). Other potential barriers to
collaboration may be attributed to
patient reluctance to accepting a mental health referral. Reust et
al. (1999) found that patient-
identified barriers to following through with a physician-
initiated mental health referral are
comparable to the barriers identified by FPs in this study.
Finally, FP respondents reported that they want feedback from
MFTs to whom they refer
a patient. This finding is consistent with the findings of other
studies on collaboration (Kainz,
2002; Rosenthal et al., 1990; Rosenthal, Shiffner, Lucas, &
DeMaggio, 1991) which have identi-
fied regular feedback to be essential, with the majority
describing this feedback ideally to be a
brief intake report or progress note. With these themes in mind,
we make suggestions for
enhancing collaboration between FPs and MFTs.
Suggestions for MFTs
Specific training in MedFT will facilitate MFTs’ ability to
collaborate and provide compre-
hensive, biopsychosocial care in conjunction with a client’s FP
or other medical practitioner
(McDaniel et al., 1992a). As with any relationship, it is
18. important to take a learning stance in
order to begin forging collaborative relationships with FPs.
Researchers and practitioners in
healthcare collaboration underscore the importance of
understanding how the cultural and
structural differences between the two professions present
unique challenges for collaboration
(McDaniel et al., 1992a; Patterson, Peek, Heinrich, Bischoff, &
Scherger, 2002). Knowledge of
the culture of family medicine or other medical specialties will
add to MFTs’ abilities to
approach collaboration with sensitivity and confidence. To
build mutual respect, MFTs should
communicate a desire to understand the needs of FPs and their
patients. Overall, constant
investments of time, communication, respect, and goal
clarification are important for develop-
ing successful collaborative relationships (McDaniel et al.,
1992a; Seaburn et al., 1996).
We found that some FPs are either unaware of MFT as a unique
discipline within the
mental health field or unaware of MFTs’ availability in their
community. In response to this
finding, MFTs might introduce themselves to local FPs,
especially those whose patients they
are already counseling. Recognizing that it may be intimidating
to make the initial contacts,
McDaniel et al. (1992a) suggested finding venues for
introduction such as through another
medical colleague or inviting the medical practitioner to lunch.
At this time it may be helpful
to offer a business card, rolodex insert, and brochure describing
areas of specialty in order to
facilitate future contact or referral from the FP.
19. As MFTs learn about the types of patient psychosocial concerns
that FPs commonly
encounter, it may be helpful to create fact sheets addressing
these concerns, offer brief work-
shops, or even participate on grand rounds in local hospitals.
FPs in this study suggested that
information on specific psychosocial issues would be helpful.
They most commonly requested
suggestions for reducing patient reluctance to MFT care. MFTs
might consider American Asso-
ciation for Marriage and Family Therapy (AAMFT) brochures
addressing specific mental
health issues as a resource to offer FPs or referred patients.
These brochures have a space for
professional contact information and are available for purchase
from AAMFT (see http://
www.aamft.org/store/shop/category.asp?catid=9). Also, MFTs
can regularly participate on
healthcare teams by obtaining releases from clients to exchange
information with the referring
physician. If a client declines to release his or her information,
the MFT may want to send a
brief note acknowledging and thanking the FP for the referral
and discuss with the client the
goals and potential benefits of a team approach.
226 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
Beyond the routine collaborative communication, MFTs can
look for ways to maintain con-
tact and develop the relationship. For instance, MFTs might
locate current journal articles or
other brief materials for FPs that may pertain to collaboration,
20. mental health issues, or behavioral
health techniques. Due to the demands of patient care, FPs have
limited time for researching
issues in mental health and may appreciate this collaborative
gesture (E. Ng, MD, personal
communication, December 3, 2003). Experienced collaborators
underscore the importance of the
long-term efforts necessary to maintain collaborative
relationships. MFTs may also be interested
in joining a collaborative healthcare organization such as the
CFHA (which includes a subscrip-
tion to the journal Families, Systems, and Health) or
participating in other like-minded events such
as the Conference on Families and Health sponsored by the
STFM and CFHA.
Implications for Clinical Training and the MFT Field
Professionals in the field of MFT must continue to look for
ways to bridge the gap
between these two compatible fields. Based on our findings, it
seems that MedFT and collabo-
rative training programs offer skills necessary to collaborate
with FPs in comprehensive,
systemic care. These trainings are offered in academic settings,
in fellowship training programs,
professional associations, professional journals, and community
interactions (for information
on training programs, see www.cfhcc.org/pages/education-and-
training/; see also a list of pro-
grams in Seaburn et al., 1996, pp. 270–272). It may be
necessary for MFT training programs to
add collaboration training or MedFT to their curriculum.
William Doherty (personal communi-
cation, March 22, 2003) stated that professionals most often
collaborate with whom they train
21. or know personally. Since most MFTs do not have the
opportunity to know FPs personally, a
collaborative component early in MFT training would offer an
opportunity for students to
interact with health professionals from other disciplines and for
medical health professionals in
the community to learn about MFT and meet future MFTs.
Students could be encouraged to
seek internships in medical settings or to conduct research
relevant to both fields and to publish
in family medicine journals.
Numerous associations (such as the AAFP, AAMFT, Health
Psychology Division of the
American Psychology Association, CFHA, and STFM) offering
workshops and conferences
provide additional opportunities for MFTs and FPs to interact
and increase their collaboration
skills. As MFTs learn to connect with FPs, it is possible that
MFTs and FPs will find ways to
work together to promote marketing and to advocate for
managed care policy change. Man-
aged care corporations may respond to pressure placed on them
by organized, collaborating
FPs and MFTs to ensure reimbursement for mental healthcare.
Limitations
When interpreting the results of the study, it is important to be
mindful of the following
limitations. First, the questionnaire has not been tested for
reliability or validity. While the sur-
vey method is an efficient mode for data collection,
questionnaires are self-administered tools
in uncontrolled settings. Thus, it is possible for the participants
to misinterpret questions. To
22. address these limitations, this survey was scrutinized by several
FPs, and qualitative questions
were included to add depth and clarity to the findings.
Secondly, although the size of our sample is sufficient to
produce a confidence interval of
about ±6% (Rea & Parker, 1997), it is still a relatively small
sample compared to a population of
over 53,000 FPs. Readers are encouraged to consider the margin
of error when interpreting results.
However, this study’s response rate (64%) is remarkable when
compared with physician response
rates to other surveys with and without incentives (VanGeest,
Wynia, Cummins, & Wilson, 2001).
Suggestions for Future Research
More research is needed to enhance our understanding of what
increases the likelihood of
successful collaboration between FPs and MFTs. One approach
to this may be for researchers
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
227
to examine collaborative relationships that are working. What
types of training in an MFT
program or FP residency are linked to increased collaboration?
What current practices of col-
laboration are most effective and why? Additionally, another
member of the collaborative triad,
the patient, could be a valuable source of information about the
helpfulness of FP ⁄ MFT col-
laboration. The patient’s perspective of the risks ⁄ benefits of
23. his or her FP and MFT working
together may be useful in establishing a link between
psychosocial care and cost-effective
healthcare that would interest managed care companies.
Despite the barriers and limitations to FP ⁄ MFT collaboration
identified in this study, our
findings suggest that FPs think many of their patients could
benefit from MFT and are inter-
ested in collaborating with MFTs. It is our hope that this study
will encourage interdisciplinary
discussion that continues to bridge the gap between FPs and
MFTs and ultimately promote
more effective care for the patient ⁄ client.
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32. TRAINING FOR COLLABORATION: COLLABORATIVE
PRACTICE SKILLS FOR MENTAL HEALTH
PROFESSIONALS
Richard J. Bischoff, Paul R. Springer, Allison M. J. Reisbig
University of Nebraska-Lincoln
Sheena Lyons
Devereux
Adriatik Likcani
Kansas State University
The purpose of the study was to identify skills that mental
health practitioners need for
successful collaborative practice in medical settings. Known
experts in the field of collabo-
rative health care completed a survey designed to elicit their
suggestions about what is
needed for successful collaborative care practice. Through
qualitative analysis, a set of 56
skills was developed. These skills are organized into three
general categories of compe-
tency: (a) skills for working in a medical setting; (b) skills for
working with patients;
and (c) skills for collaborating with healthcare providers.
In their landmark text, Medical Family Therapy, McDaniel,
Hepworth, and Doherty (1992)
introduced an approach to health care delivery based on the
Engel’s (1977) biopsychosocial
(BPS) model. The foundation of medical family therapy
(MedFT) is an acknowledgment that
‘‘all human problems are BPS systems problems: there are no
33. psychosocial problems without
biological features and no biomedical problems without
psychosocial features’’ (McDaniel
et al., 1992, p. 26). The authors reasoned that treatments will be
more effective and outcomes
more positive when biological and psychosocial dimensions of
functioning are considered and
addressed simultaneously. This is facilitated by maximizing the
collaboration between physi-
cians and mental health therapists.
While the scholarship of the practice of collaborative health
care predates the publication
of this text, it has increased dramatically since 1992. Other
texts promoting the practice of
MedFT have been written (e.g., Blount, 1998; Patterson, Peek,
Heinrich, Bischoff, & Scherger,
2002; Prouty-Lyness, 2003; Seaburn, Lorenz, Gunn, Gawinski,
& Mauksch, 1996), giving stu-
dents of the approach a library of literature on the practice.
While started in 1983, the journal
Families, Systems, and Health has since become a premiere
journal in this specialty area of
mental health care. Research has established the link between
biological, social, and psychologi-
cal systems (see Campbell & Patterson, 1995) and the positive
impact of psychotherapy, espe-
cially relational approaches to treatment, on health outcomes
(Cambell, 1996; Crane &
Christenson, 2008; Law, Crane, & Berge, 2003). The
Collaborative Family Healthcare Associa-
tion, an association devoted to collaborative care practices that
are characteristic of MedFT,
has matured into a multidisciplinary association giving those
interested in collaborative care
practices a place to come together to share ideas and advance
34. the practice, research, and theory
of medical family therapy (Bloch & Doherty, 2001). It would be
difficult to imagine that one
could graduate from a clinical training program in marriage and
family therapy, psychology, or
Richard J. Bischoff, PhD, is a Professor and Director in the
Marriage and Family Therapy Program at
University of Nebraska-Lincoln; Paul R. Springer, PhD and
Allison M. J. Reisbig, PhD, are Assistant Professors in
the Marriage and Family Therapy Program at University of
Nebraska-Lincoln; Sheena Lyons, MS, Devereux,
Arizona; Adriatik Likcani, MS, is a Doctoral candidate in the
Marriage and Family Therapy Program at Kansas
State University.
Address correspondence to Richard J. Bischoff, Marriage and
Family Therapy Program, University of
Nebraska-Lincoln, PO Box 830800, Lincoln, Nebraska 68583-
0800; E-mail: [email protected]
Journal of Marital and Family Therapy
doi: 10.1111/j.1752-0606.2012.00299.x
June 2012, Vol. 38, No. s1, 199–210
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
199
social work without an understanding of the BPS model,
collaborative care practice, and Med-
35. FT. However, even with the existence of several degree granting
and postdegree training pro-
grams in MedFT and many more programs that have emphases
in medical family therapy and
collaborative health care, little is known about the competencies
needed to practice MedFT.
It is clear from reading any of the several texts on the subject
that MedFT is different from
the traditional mental health care practice. Those practicing
MedFT need to have the same
skills that are needed for traditional practice environments as
well as many other skills unique
to the collaborative health care environment. However, as yet,
these skills have not been orga-
nized nor explicitly identified. The development of a succinct
set of skills, similar to that of the
American Association for Marriage and Family Therapy
(AAMFT) core competencies (Nelson
et al., 2007), would be a step in the direction of developing
training and practice guidelines for
this rapidly developing approach to health care. This is
particularly important in this age of
outcomes-based educational standards (Maki, 2004; Miller,
Todahl, & Platt, 2010; Nelson
et al., 2007).
The purpose of this study was to develop a set of skills that
would aid educators and train-
ers interested in preparing mental health therapists for practice
in collaborative health care set-
tings. This was achieved through a qualitative design that began
with inductive qualitative
inquiry with leaders of collaborative care practice in an effort to
understand the competencies
that mental health therapists need to work effectively in
36. collaborative health care settings.
METHODOLOGY
Participants
After receiving Institutional Review Board approval, a
purposive sampling strategy was
used to invite experts in MedFT to participate in this study. To
be identified as an expert, indi-
viduals had to meet one of the following criteria: (a) the person
was an author on a minimum
of two peer-refereed journal articles directly related to
collaborative care practice or training or
(b) the person was identified as an expert by someone meeting
the two publication criterion.
The first criterion allowed for the inclusion of those identified
as experts because they were
advancing the field through publication. The second criterion
allowed for the inclusion of prac-
titioners who have influence on the development of the practice
of MedFT through clinical
practice. Thirty-three experts were invited to participate, and 25
contributed data for the study
(a response rate of 76%). Sixty percent of the participants were
men and 80% were over
35 years old. Sixty-eight percent reported that they had more
than 5 years of experience work-
ing collaboratively in a medical setting practicing the principles
identified in the research, and
24% reported more than 15 years of experience. Sixty percent
reported their primary place of
employment as a medical setting (11 respondents worked in a
medical residency program, three
in a medical school, and one in a primary care medical setting).
The remainder reported that
37. their primary employment setting was a university-based mental
health training program. Fif-
teen respondents identified their primary professional affiliation
as MFT. Other respondents
were primary care physicians (5), psychiatrists (2),
psychologists (2), and one nurse.
Survey
A survey consisting of 13 questions was developed for the
purposes of this study. Six open-
ended questions were designed to elicit skills needed for
successful collaborative practice. These
questions elicited data about knowledge (biomedical and mental
health) and clinical skills
needed for successful practice in medical settings. Participants
were also asked to relate an inci-
dent that exemplifies successful medical, mental health
collaboration. Six closed-ended questions
elicited demographic information. The final question requested
that the respondent identify oth-
ers who they would consider to be experts on collaborative care
practice and who might be able
to provide useful information. In an effort to facilitate
participation, participants either could
choose to complete the survey on-line through a secure,
password-protected website or through
a paper version that was mailed to them. Potential respondents
were contacted both by email
(if an email address was available) and by a letter sent via US
mail requesting participation in
the survey.
200 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
38. Data Analysis
Data were initially analyzed using a process similar to the
constant comparison qualitative
data analysis method (Miles & Huberman, 1994) by the primary
researcher and a research
assistant. Using this method, content analyses were performed,
and a preliminary codebook of
themes or skills was inductively identified. Specifically, each
participant’s response was read in
its entirety to understand the skills being emphasized by each
respondent. Each reader kept a
list of skills that emerged from the data. They then met to
review and compare their separate
lists and come up with a consensus list. No skills identified by
readers were eliminated from the
list. Both the primary researcher and the research assistant then
separately returned to the data
to carefully examine the responses to each question. All
responses to question number one were
read, identifying support for the skills identified on the list and
adding new skills to the list by
comparing incidents in the data with all others. Question
number two was then analyzed simi-
larly, and so on. Subsequent responses were compared with
those preceding them in the analy-
sis, with the result being the addition of new skills or the
addition of evidence for skills already
noted, as appropriate.
The validity, or substantive significance, of the data was
established through analyst trian-
gulation (Patton, 2002). Using a deductive method, three
secondary coders reviewed and vali-
39. dated the presence and salience of each theme identified by the
primary coder and his research
assistant. Skills that lacked clear support in the data were
discussed and compared with all
other skills that had been identified. This process helped
establish the validity of the primary
researcher’s and the graduate assistant’s preliminary coding of
the data. The primary researcher
and secondary coders then collapsed and sorted each theme or
skill into categories and subcate-
gories. The result of this process ensured that all categories and
subcategories were examined
and agreed upon by all coders. In addition, this process ensured
that the interpretation of the
data was comprehensive and accurate.
RESULTS
Qualitative analysis of the survey responses resulted in a set of
56 skills that uniquely char-
acterize MedFT. It is evident from the data that while the
practice of MedFT includes compe-
tence in the practice of psychotherapy, it also includes skills
unique to working in medical
settings and to collaborating with medical providers and other
professionals. Consequently, the
identified skills have been clustered into three categories that
represent logical groupings of
these skills: (a) skills for working in a medical setting; (b)
unique skills for working with
patients in medical settings; and (c) skills for collaborating with
healthcare providers. Skills
within each category are further broken down into
subcategories. The skills are presented by
category in Tables 1–3. Each category is described below.
40. Skills for Working in a Medical Setting
Participants were careful to explain that working in medical
settings is different from work-
ing in traditional mental health practice settings. In describing
this difference, one respondent
explained that the medical setting is ‘‘a fast paced environment
that has an organizational
structure entrenched in traditional biomedical influence.’’
Others created lists such as: ‘‘differ-
ences in language, pace, communication styles, confidentiality
expectations, team roles, and
documentation.’’ Differences such as these require those
practicing MedFT to demonstrate
competence in working within this unique practice environment.
These skills can be organized
according to those relating to (a) the unique practice culture of
the medical setting, (b) medical
knowledge, (c) accommodating to the medical setting, and (d)
nurturing one’s professional
identity.
The unique practice culture of the medical setting. When
stepping into a medical setting,
one is stepping into a unique culture; one that is different from
traditional mental health care
practice. Those practicing MedFT recognize this work to
understand the culture, and to prac-
tice in culturally sensitive ways. One respondent counseled that
‘‘It is important for the mental
health professional to recognize that he or she is entering a
different culture.’’ Another respon-
dent explained that ‘‘a medical setting is part of the culture of
medicine. It has a language, a
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
41. 201
history, a set of shared myths and archetypes like any culture.’’
The data suggest that it is par-
ticularly important for mental health therapists to attend to the
following characteristics of this
unique culture.
Language. Respondents explained that the language of medical
settings has been devel-
oped to facilitate the work of medicine and that this language is
unique and different from that
found in traditional mental health care settings. One respondent
explained,
Bridging the language barrier is [important]. Many MHPs
[Mental Health Providers]
enter into a medical setting speaking therapy and not
understanding medicalease.
[Developing a common language] means abandoning the terms
that we learned in
graduate school for more user friendly words that medical
professionals understand.
Another respondent explained that ‘‘The language is
instrumental and action oriented. [It]
mirrors the kind of expectations that the [medical provider] may
have of mental health provid-
ers (what can you do rather than what do you think).’’ Another
respondent succinctly wrote
that there is a ‘‘preference for concreteness over abstractions.’’
The importance of the language
used applies equally to verbal and written (e.g., charting)
communication. Several respondents
42. explained that mental health therapists ‘‘should understand the
abbreviations for medication
Table 1
Skills for Working in a Medical Setting
The unique practice culture of medical settings
Medical family therapists . . .
Recognize that medical settings have a unique practice culture
Recognize and respect the professional hierarchy in medical
settings
Respect the differences between medical and mental health
providers in scope of
practice, practice patterns and strategies, approach to patient
care, etc.
Know the difference between primary, secondary, and tertiary
care
Respect and value the contributions of the biomedical approach
to care
Are curious and willing to learn about unfamiliar, new, and
nontraditional approaches
to healing and promoting wellness
Know the services that are available and how to utilize them
Are visible within the medical environment as an active
participant of the care team
Medical knowledge
Medical family therapists . . .
Speak the language of the medical setting (e.g., medical terms,
abbreviations, jargon)
Access and use medical and pharmacological information from
reliable sources
43. Know the diagnostic tests and treatments that are commonly
used for patient medical
care
Accommodations to the medical setting
Medical family therapists . . .
Match the pace of the medical setting
Are comfortable with frequent interruptions by medical staff
during treatment sessions
Are flexible in working with patients and families in
examination rooms and
other nontraditional settings
Accommodate to how confidentiality is handled in medical
settings
Document patient progress consistent with medical setting
protocols
Have the ability to be an excellent short-term interventionist
Nurturing professional identity
Medical family therapists . . .
Are willing to be shaped in professional identity and role
Stay connected with mental health colleagues
202 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
(e.g., QID, QD, PO)’’ and should be able to document
psychotherapy consistent with medical
charting protocols and in a way that will make this information
useful to medical providers.
44. Time management. It is important to attend to the pacing of the
medical setting and in
how medical providers manage time with patients. One
respondent explained that ‘‘MDs
[Medical Doctors] carry a case load of several thousand and see
a minimum of [four] patients
per hour.’’ Another explained that ‘‘The medical clinician is
usually working with [two] patients
at one time.’’ This use of time can be disconcerting for the
naı̈ ve mental health therapist. But,
echoing the sentiment of others, one respondent wrote, ‘‘MDs
must be action oriented. This
time crunch should never be interpreted as evidence that the MD
does not care about his ⁄ her
patients.’’
The team approach to patient care. Contrary to the independence
and autonomy that are
hallmarks of traditional mental health practice, treatment in
medical settings is typically charac-
terized by a team approach where health care providers from
various specialties and disciplines
work together in caring for a patient. There are two noteworthy
consequences of this approach
for mental health therapists. First, the mental health care is
often not the primary focus of the
treatment. As one part of the overall care plan, the mental
health treatment must support and
complement the other parts of the care plan, some of which have
greater immediacy and
demand more attention than the mental health concerns. Second,
the therapist may not occupy
a primary role in direct patient care and may at times not even
see the patient. There is a
Table 2
45. Skills for Working with Patients
The practice lens
Medical family therapists . . .
Conceptualize pathology from the biopsychosocial perspective
Medical knowledge
Medical family therapists . . .
Have a basic understanding of biochemical processes and
pharmacology
Have a basic understanding of anatomy and physiology
Know about the biological processes of diseases
Know the medical conditions that commonly have psychosocial
comorbidity
Know mental health conditions that commonly manifest through
physical symptoms
Know common psychiatric medications, names and
abbreviations, doses, and side effects
Patient care
Medical family therapists . . .
Are skillful in working with a wide variety of treatment
modalities (e.g., couple, family,
individual, group)
Assess and diagnose mental disorders using the current DSM
and ICD
Provide patient psychoeducation in both individual and group
formats
Engage patients who do not see the connection between their
medical conditions and
other areas of functioning
Respond to a wide range of patient responses to illness and
46. medical treatment
Organize and conduct family meetings
Know when and how to effectively intervene in the physician-
patient relationship to
improve treatment outcomes
Facilitate patient groups including psychoeducational groups
Are able to manage chronic illness and stress
Effectively apply evidence-based brief psychotherapies
Effectively apply evidence-based psychotherapies to the
treatment of specific problems
Teach mind–body techniques
Understand that the medical provider may be more invested in
the patient’s mental
health treatment than the patient
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
203
hierarchy within the medical setting that must be respected to
honor the team approach to care.
One respondent simply stated: ‘‘You are part of a team, but
your work is not at the center [of
patient care].’’ Another provider pointed out: ‘‘You are likely
to feel one-down, and you should
not take this personally, but see it in part as part of the culture
of medicine.’’ Third, there is an
expectation that necessary information will be readily shared
among professionals. Each per-
son’s job in patient care is dependent on information obtained
by other members of the care
team. One respondent explained:
It is . . . normal for treatment in medical settings to be done in
47. teams . . . Information
flows freely on the team because life and death matters are
often involved. This may
pose a problem for mental health professionals who have a more
traditional view of
how confidentiality should be dealt with. The mental health
provider must think of
him ⁄ herself as part of a treatment team; that communication
within the team is as
important as anything else the mental health provider may do,
that his ⁄ her role may
be consultative as often as it will be treatment oriented, that he ⁄
she may need to be
flexible with regard to availability.
Table 3
Skills for Collaborating with Medical Providers
Relationship building
Medical family therapists . . .
Understand the importance of relationship building to effective
collaboration
Build relationships with medical providers and office staff
Are available, accessible, and visible to healthcare providers
and flexible in style
of working
Actively collaborate with health care providers as a member of
the care team
Place self in the traffic pattern without getting in the way
Collaborative communication skills
Medical family therapists . . .
Work within multidisciplinary teams, keeping lines of
48. communication open to
coordinate treatment
Communicate with medical providers in an efficient and clear
manner
Fluently use appropriate medical terminology
Talk about mental health problems in a way that is easily
understood by health care
providers and that is respectful of all perspectives
Keep medical providers informed of progress and changes in
care
As invited, feel comfortable to provide feedback on the work of
medical provider
colleagues in the treatment of their patients
Interpersonal expertise
Medical family therapists . . .
Understand that many medical providers become frustrated
when dealing with chronic
mental health problems
Perceive medical provider distress and respond appropriately to
alleviate the distress
Monitor and appropriately respond to emotional reactivity in
oneself and in medical
providers
Think relationally, not just in conceptualizing patients’
experiences, but also in
conceptualizing the relationships among providers
Assess one’s own participation in and contributions to the
relationship with medical
providers
49. Evaluate the effectiveness of the collaborative relationship
among care team members
and among treatment providers and patients
204 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
Many respondents explained that they use their skills as a
family therapist in their interac-
tions in the multidisciplinary team in culturally sensitive ways.
Similar to others, one
respondent wrote that to be successful in the practice of MedFT
‘‘we need to use our
therapeutic skills in order to join with this new system just like
we would with a new family in
therapy . . .’’ Another respondent emphasized: ‘‘MH providers
need to JOIN, JOIN, JOIN with
the culture and the providers.’’
Medical knowledge. Medical knowledge is the foundation of the
language of medical set-
tings. While mental health therapists do not need to be medical
experts, it was consistently
underscored that they need to have enough knowledge that they
can have sufficient conversa-
tional fluency to participate as team members in patient care.
This includes knowing basic
information about diseases, disease processes, course, and
treatments, including pharmacologi-
cal treatments. They should have a basic understanding of
pharmakinetics and psychopharma-
cology and know how and where to access medical and
pharmacological information on an
50. on-going basis. They should be able to discuss the impact of
commonly used medications on
patient functioning and should recognize that medical providers
may want to consult with
them about pharmacological treatments. A few respondents
indicated that it is important to
know the ‘‘difference between primary and tertiary care and
understand the domains of vari-
ous specialties (e.g., neurology, endocrinology, oncology,
obstetrics and gynecology, rheuma-
tology).’’ Familiarity with most commonly used medical terms,
abbreviations, and jargon in
medical settings was also cited as important. One provider
wrote:
I don’t think the person has to be an expert or even very
authoritative in all of these
areas, especially in the beginning of the collaborative
relationship. But an acknowledg-
ment of their importance and a willingness to continue learning
are crucial.
Accommodating to the medical setting. Mental health therapists
trained to work in tradi-
tional mental health care settings need to accommodate their
style of practice to fit the practice
environment of the medical setting. One respondent wrote:
‘‘The medical system is bigger than
us. MHP-s are the ones that need to do the cross-over learning
and bridge the two cultures.’’
Several respondents were careful to point out that not all
medical settings are alike, even
though the culture of medicine is common to each. Medical
settings differ according to spe-
cialty, treatment emphasis, population served, and other factors.
51. The therapist’s ability to adapt
their own way of working to match that of the setting is a key to
success. Most respondents
identified attributes that facilitate adaptability including
‘‘humility, patience, curiosity, non-
judgmental attitude toward physician behavior, empathy, and
willingness to take risks,’’ ‘‘lots
of flexibility,’’ ‘‘self-motivation, persistence,’’ ‘‘openness,’’
and ‘‘a sense of humor.’’ These attri-
butes allow therapists to adapt their approach and apply their
expertise to the unique medical
practice setting within which they are working.
Mental health therapists cannot succeed if they treat it as a
traditional mental health
care practice setting, nor can they succeed if they attempt to
practice traditional psychother-
apy. Two representative examples from the data describe the
types of accommodations that
need to be made. First, the fast-paced nature of the practice of
medicine places constraints
on traditional mental health treatments. Respondents
emphasized the importance of applying
brief focused therapies that match the problem-focused,
outcomes-oriented approach of med-
icine. Second, the respondents pointed out the need to adapt the
traditional role of the
therapist as a treatment provider. A respondent explained that in
these settings, therapists
need to
Be able to expand [their] sense of mental health treatment
beyond the 50-minute ses-
sion, for example, to see the opportunities such as being
available for informal consul-
tations, joining an MD in a medical visit with a challenging
52. patient, considering issues
related to the general mental health of the staff and work
relationships, attending to
the relationship between the health care providers and patients,
etc.
Nurturing one’s professional identity. Mental health therapists
working in medical settings
can expect to experience a challenge to their professional
identity, which could result in a redefini-
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
205
tion of how they see themselves as professionals and in how
they see themselves in relation to
their peers who are not working in medical settings. One of the
respondents related the following:
One should expect a redefinition of one’s professional identity.
When I started in this
setting . . . I thought of myself as a family therapist. But over
the years that has
proven to be an inadequate designation. I see individuals as
much as anything else.
Often the main focus of the treatment I provide is to help the
MD ⁄ patient relation-
ship. I consult and educate as much as provide therapy. My
most important interven-
tions often have little to do with what goes on in the therapy
hour (which is often not
an hour!). I think that mental health professionals who want to
work in collaborative
settings must realize that the setting will shape them, and this
53. can be very exciting and
enriching, but it can also be disorienting.
Respondents explained they found it important to stay
connected and involved with other
mental health colleagues and with their professional
organization. Another respondent cau-
tioned: ‘‘Establish a support network with other mental health
folks, either on site or in other
settings. Share experiences. Consult regarding systems issues,
and support each other. Take care
of yourself. Have fun.’’ Staying connected to and grounded in
the mental health discipline
helped these respondents stay oriented and helped them preserve
a coherent sense of professional
identity. It also allowed them to test out their evolving ideas, to
stay abreast of advances in men-
tal health treatments, and to ensure that they were engaging in
ethical mental health practice.
Skills for Working With Patients
All the competencies needed for traditional mental health care
practice are needed for work
in medical settings. Respondents explained that mental health
therapists practicing MedFT
need ‘‘sound therapy skills, including individual, couple, and
family’’ and ‘‘excellent interview-
ing skills.’’ But, working with patients in a medical setting also
requires the use of unique skills
in patient care.
Conceptualizing patient problems. Participants uniformly
identified the BPS model as the
most useful conceptual model when providing direct patient
care. They explained that those
54. practicing MedFT need to recognize that most patients get
mental health treatment only after
seeking help for medical conditions or relief from biological
symptoms. Often the mental health
problem is co-occurring with a biological health problem, and
both must be considered in order
for mental health treatment to be successful. The patient
perspective, like that of the medical
provider, is first biological and then (if at all) psychosocial.
Knowing about the patient’s medical condition. Respondents
acknowledged that patients
expect mental health therapists working in medical settings to
be part of the health care team.
Therapists demonstrate that they are part of the team through
their comfort with biomedical
language and knowledge and curiosity about biomedical
conditions. It is expected that they will
use language that, while it may not be the same as that used by
the medical provider, is at least
consistent with that used by the medical provider. The therapist
should be familiar with the
patient’s medical condition and the diagnostic tests and
treatments associated with that condi-
tion. While they do not need to know everything about it, they
should ‘‘know enough of the
medical condition and treatments in order to explain it to
patients.’’ What the therapist does
not know, they should be willing to learn. One respondent
wrote:
I think that there is a difference between what information a
mental health profes-
sional should know and what they should be willing and able to
learn. . . . So, in a
sense, I believe that would serve the mental health professionals
55. (and the PCP [Primary
Care Providers] and patient) the best to ‘‘know’’ how to access
this information.
Patient care. Respondents wrote that mental health therapists
working in medical settings
are expected to assess and diagnose patients using the approved
nosology found in the current
versions of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) and Interna-
tional Statistical Classification of Diseases and Related Health
Problems (ICD). They are
expected to know the evidence-based protocols and have
competency in applying accepted
206 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
treatments to specific mental health diagnoses. One respondent
described this expectation in the
following way:
Medical providers are interested in problem-based knowledge.
They are not interested
in one’s conceptual framework, they are interested in what
problems you can address.
The biggest problem is depression. Other problems are anxiety,
substance abuse, pain
management, smoking cessation, weight loss, ADHD. I think
that these problems pre-
dominate because they are very challenging for MDs to treat.
All these problems
require an understanding of DSM IV categories. It is fine to
treat these problems in a
56. family systems modality, but it is vital that the mental health
professional feel comfort-
able with traditional diagnostic categories. MDs expect mental
health professionals to
be able to assess, diagnose, treat, and make recommendations to
the physician regard-
ing how to manage these patients in office visits. They expect
the kinds of things they
would expect from any specialist.
Mental health therapists can also expect that they will be asked
to work with the most
difficult patients. One respondent explained that therapists need
to be prepared to work with
‘‘somatically-oriented, drug-seeking, dependent, hopelessly
depressed, and chronically mentally
ill patients.’’ These are patients who are often unwilling to
accept that there are psychosocial
problems co-occurring with (or in some cases, superseding) the
biomedical ones. They should
be able to creatively work with these and other patients who
may not be interested in even
acknowledging a mental health problem, let alone willing to
accept a referral to a mental health
therapist.
It was common for respondents to explain that while this work
with difficult patients is
designed to improve patient functioning, that much of the
mental health therapist’s work with
these patients is to provide relief and support for the medical
provider. One respondent
explained: ‘‘You are a resource to clinicians for their own
development of comfort with
patients.’’
57. Skills for Collaborating With Medical Providers
It is clear from the data that multidisciplinary collaboration is a
hallmark and essential
characteristic of MedFT. Collaboration is facilitated as mental
health therapists (a) build rela-
tionships with medical providers, (b) ensure frequent and
accurate communication about
patients, and (c) objectively attend to relationship processes.
Building relationships with medical providers. Mental health
therapists working in medical
settings must recognize that the relationship among providers is
the foundation for collabora-
tive health care and that they must attend to these relationships
if they are to be successful.
One of the respondents wrote: ‘‘The most important key to
success is the relationship between
providers.’’ Another added that relationships among providers
‘‘are the basis for referral and
collaboration.’’
Respondents emphasized that medical providers are problem-
focused and action-oriented.
Mental health therapists build relationships by being available
to medical providers, by showing
a willingness to accommodate to the pace of the work
environment, and by actively participat-
ing with medical providers in their patient care activities, such
as rounds, care team meetings,
and patient interviews. They should be flexible in their style of
working (e.g., accepting inter-
ruptions during treatment sessions, curbside consultations), and
they should be able to place
themselves in the traffic pattern without getting in the way.
58. Collaborative communication. Frequency, length, and content of
communication character-
ize collaborative relationships in medical settings. Respondents
indicated that medical providers
expect regular communication about patients and treatment
progress and that this communica-
tion should be of sufficient frequency that medical providers
can feel they are included in the
treatment, that they have not lost their patient. ‘‘Once the
collaborative medical professional
refers a patient he or she will also want to be updated regularly
and be included as part of the
treatment process.’’ This level of communication respects the
hierarchy within the medical
setting and acknowledges that the medical provider is ‘‘in
charge’’ of patient care.
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207
Because the use of language in medical settings is instrumental
and action-oriented, the
mental health therapist should match this communication style.
Messages should be efficient
and clear. One respondent explained that ‘‘most collaboration
occurs through interactions that
last <5 min. These are the bumps in the hall.’’ Because of this,
being ‘‘accessible’’ and ‘‘visible’’
were repeatedly mentioned as essential to effective
communication and collaboration.
Several respondents stressed that medical providers expect to
hear ‘‘what works and what
one can do rather than what one thinks.’’ The caution to
59. traditionally trained mental health
therapists is to limit theoretical explanations and to stick to
what is directly relevant to the care
plan. One respondent counseled: ‘‘Don’t bore people with
details that don’t impact patient
management.’’ Similar advice was given by another who wrote:
‘‘Be able to be concise and jar-
gon free about what you believe is going on in a case.’’ Another
wrote: ‘‘willingness to talk the
medical language as much as possible and minimize
psychobabble.’’ Another respondent even
went as far as to caution well-intentioned therapists to be
careful not to ‘‘proselytize’’ or
become too ‘‘psychosocially fixated.’’ Yet another wrote that a
successful mental health thera-
pist is ‘‘one who does not feel he ⁄ she needs to preach systems
to those who work in the setting;
very off- putting.’’
Communicating in this way requires mental health therapists to
be ‘‘comfort[able] with their
own skills [without a] continuous need to prove oneself [and an]
ability to function without a lot
of . . . validation.’’ As participants in the communication
dynamic within a medical setting, thera-
pists are confident, assertive, patient, flexible, and
accommodating. The respondents explained
that this stance leads medical providers to ‘‘confidently value
the role you play.’’
Be relationship experts. It is clear from the data that one of the
roles played by mental
health therapists, as relationship experts, is to attend to the
relationships among providers and
between providers and patients, and to intervene in a way that
improves collaboration and
60. health outcomes.
Respondents explained that medical providers expect the mental
health therapist to objec-
tively observe these relationships and to intervene
appropriately.
DISCUSSION
This study results in a greater understanding of the practice of
MedFT, and the unique
skills needed to engage in this practice. It is clear from the data
that the practice of MedFT is
different from traditional mental health care practice. There
appear to be two primary differ-
ences. First, in addition to requiring competency in the practice
of psychotherapy, MedFT
requires additional competencies unique to working within the
culture of medicine. Second,
some competencies, while perhaps not unique to MedFT, are
noteworthy because they are
uniquely prominent in the practice of MedFT. So, for example,
while all MFTs should have
competency in multidisciplinary collaboration, it is uniquely
prominent in the practice of Med-
FT where therapists must negotiate daily professional
relationships in a multidisciplinary envi-
ronment that is inherently hierarchical.
These two types of unique competencies are most likely an
outgrowth of the application of
the BPS model that requires therapists to consider multiple
systems of functioning simulta-
neously. In the practice of MedFT, the curative work of the
therapist includes both interactions
with the patient and family as well as interactions with medical
61. providers and others involved
in the patient’s care. A true acknowledgment of the biological
system begs multidisciplinary col-
laboration just as a true acknowledgment of the social system
begs family involvement in treat-
ment. Consequently, the application of the BPS model expands
the practice and the treatment
to include interactions with other systems and people. This
requires competencies in addition to
those expected of skilled marriage and family therapists.
Multidisciplinary collaboration appears to be a hallmark of
MedFT. The modern medical
system is inherently collaborative, while the modern mental
health care system is not. Medical
systems generally adopt a leadership model of collaboration that
has a clear hierarchy with
physicians, and in some cases, mid-level medical providers in
the leadership role. It is clear
from the data obtained from those experienced in the practice of
MedFT that if MFTs are to
succeed in a medical system, they must understand and respect
the leadership model of
208 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
collaboration. They may need to change their way of practicing
to accommodate to the system
rather than try to change the system to fit their way of doing
things. This may even include the
way that psychotherapy is practiced. Participants frequently
extolled the importance of flexibil-
ity in practice, curiosity about new ways of doing things, and
62. willingness to learn.
The results of this study are the next step in articulating the
competencies mental health
therapists need to have to practice what has come to be known
as MedFT. It would be a mis-
take to assume that the set of competencies generated through
this study is exhaustive. Perhaps
if we would have returned to the participants to request
additional competencies, others would
have emerged. We know through the literature that other skills
have been identified that were
not mentioned in the data that we obtained. For example, some
authors have expanded the
BPS model to include the spiritual dimensions of patient
functioning (e.g., Prest & Robinson,
2006), yet none of our participants acknowledged the spiritual
dimension nor skills specific to
working within this dimension. Also, while participants
indicated that it was important to be
curious about nontraditional approaches to care, only one
participant made even passing refer-
ence to mind–body techniques. Yet, the literature suggests that
these techniques are particularly
efficacious (Astin, Shapiro, Eisenberg, & Forys, 2003) and
within the scope of practice of mar-
riage and family therapists (McCollum & Gehart, 2010). We are
aware of some therapists
working in medical settings who regularly teach mind–body
techniques to their patients and to
medical students (Saunders et al., 2007). Other skills not
mentioned include the importance of
knowing how patients move through the medical system and
being able to intervene on the
patient’s behalf, skills specifically related to making referrals
so that the biological dimensions
63. of mental health problems are addressed, and understanding
how payment and billing occur
within the medical setting in which one is working (Patterson et
al., 2002).
Emphasized in our data was the importance of cultural
competence in relation to the culture
of the medical system. Given that this was such a prominent
theme, we found it curious that we
were not able to find references to the importance of
demonstrating competency with the culture
of the patient’s system. Similarly, while participants were
careful to identify the importance of
recognizing and negotiating power imbalances in the medical
setting, they did not identify the
importance of being sensitive to how these same power
dynamics impact patients and families
and the role of the therapist in helping them navigate these
power imbalances. That these two
seemingly important skills were not mentioned may be a
function of how the questions were
worded; we specifically asked for unique knowledge and skills
to the practice of MedFT. It may
be that participants see these competencies as important to the
practice of marriage and family
therapy and psychotherapy in general and not unique to the
practice of MedFT.
It is possible that had we asked specifically about these, and
other techniques gleaned from
the literature and experience, that we would have been able to
develop a more comprehensive
list. But, then we might have sacrificed coming to understand
those competencies that are spe-
cifically unique to the practice of MedFT. Additional research
is needed to further refine and
64. expand this list of skills. Specifically, it is possible that the
application of a Delphi methodology
(Stone Fish & Busby, 1996) could be helpful in clarifying those
skills that are particularly
important to the practice of MedFT. This method has been used
successfully by others to
develop lists of skills, most notably the list that has become the
AAMFT core competencies
(Nelson et al., 2007).
Implications for Training and Practice
Identifying competencies is a first step toward developing
learning and assessment activities
that will expedite student learning (Maki, 2004). A logical next
step is to develop learning and
assessment activities, similar to what has been carried out with
regard to the AAMFT core
competencies (Hodgson, Lamson, & Feldhousen, 2007; Miller,
Linville, Todahl, & Metcalfe,
2009; Openshaw et al., 2006; Perosa & Perosa, 2010). The
results of this research will facilitate
the development of these learning and assessment activities.
Developing these activities in light
of learning outcomes will lead to training that is more focused
and efficient and that will better
prepare students for the realities of collaborative care practice.
The results will also help experi-
enced therapists interested in expanding or changing their
practice to include work in medical
settings and medical, mental health collaborations. These
therapists can use this research to
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
209
65. understand the skills unique to the practice of MedFT.
Attending to these unique skills will
help them appropriately incorporate these skills into their
practice, thereby increasing the likeli-
hood that the transition in their practice will be successful.
Those already working in medical
settings will find that these results provide them with literature
that will help to document and
articulate the competencies needed for MedFT. This may be
particularly important in attempt-
ing to described MedFT to those who may not be familiar with
it. It may also help by provid-
ing a useful organization of these skills and practices unique to
MedFT. These and other
implications are important to the advancement of the practice of
MedFT.
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O R I G I N A L P A P E R
‘‘Is Our Daughter Crazy or Bad?’’: A Case Study
of Therapeutic Assessment with Children
Francesca Fantini • Filippo Aschieri • Paolo Bertrando
Published online: 28 March 2013
70. � Springer Science+Business Media New York 2013
Abstract In this paper we present a new model of intervention
with documented efficacy
that combines psychological tests and assessment methods with
therapeutic techniques to
promote change in clients. We will discuss Therapeutic
Assessment of Children and their
families (TA-C) through the case of a 4-year-old girl, Clara, and
her family. Clara’s parents
were distressed by her uncontrollable rage outbursts and feared
she might be ‘‘crazy’’. The
treatment helped to shift the narrative the parents had about
Clara and give new meanings
to her behaviors. We describe in detail the steps of the
assessment and provide a theoretical
discussion of the therapeutic processes involved.
Keywords Assessment � Family � Children � Therapy
Within systemic therapy, skepticism about the tools and
methods typical of psychological
assessment has been fostered both by the social constructionist
stance that prevailed within
the field in recent year, and by prejudices about the very nature
of testing, i.e., the idea that
psychological tests pertain to the domain of naı̈ ve realism and
71. tend to give an account of
clients’ problems framed in a positivistic view. In such a
context, psychological assessment
is viewed as an effort to measure the ‘‘true reality’’ of clients’
problems, thereby mini-
mizing their own experiences, views, and hypotheses (Brown
1972). While this underlying
philosophy may characterize the traditional approach to
psychological assessment, in
recent years new ways have been developed of integrating the
tools and methods of the
assessment practice in a therapeutic and post-modern
framework. This is the case of
Therapeutic Assessment (TA), a semi-structured form of brief
integrative intervention
(Kaslow 2000) developed by Finn and his colleagues (Finn and
Tonsager 1992, 1997; Finn
2007) over the last 20 years. TA combines psychological
assessment with techniques and
F. Fantini � F. Aschieri (&)
European Center for Therapeutic Assessment, Università
Cattolica del Sacro Cuore, Via Nirone 15,
20123 Milan, Italy
e-mail: [email protected]
P. Bertrando
Private practice, Milan, Italy
72. 123
Contemp Fam Ther (2013) 35:731–744
DOI 10.1007/s10591-013-9265-3
principles of interpersonal and systemic psychotherapy. TA has
proved to be effective with
different types of clients such as adult outpatients (Finn and
Tonsager 1992; Newman and
Greenway 1997), couples (Durham-Fowler 2010), families with
children (Tharinger et al.
2009; Smith et al. 2010), and adolescents (Ougrin et al. 2008).
Research has focused on the
effectiveness of TA with different types of problems, i.e., self-
harm (Ougrin et al. 2008);
internalizing symptoms, (Aschieri and Smith 2012);
externalizing symptoms (Smith et al.
2010); disorganized attachment (Smith and George 2012); and
developmental trauma
(Tarocchi et al. in press).
Therapeutic Assessment with Children and Their Families
TA with children and their families (TA-C) involves a
suggested series of steps described
73. in various publications (Aschieri et al. 2013; Smith et al. 2009;
Tharinger et al. 2008a; Finn
2007). In summary, after the initial phone contacts, the assessor
meets the parents to co-
construct assessment questions that capture their main puzzles
and worries about their
child or their relationship with their child (Step 1). By focusing
on the parents’ questions,
the assessor aims to involve parents as active participants from
the beginning of the
process. Assessment questions are used to build an alliance
around parents’ motivations
and goals, and to foster their curiosity about their child. Also,
the clear formulation of the
assessment goals as focused on their puzzles and worries has
the effect to lower the
parents’ anxiety about the assessment. The assessor also works
to gather background
information about the family and uses assessment questions as
guides to chose which
themes the parents are open to discuss and don’t find
threatening. In fact, besides the
explicit goal of collecting parents’ questions, the assessor also
works to build a secure
74. relationship with them, based on experiences of emotional
attunement, collaborative
communication and the repair of possible disruptions (Finn
2012). The creation of a such a
relationship is considered essential for a therapeutic change to
occur. The child being
assessed may have his/her own questions too, and these are
collected in the second session,
usually scheduled with the whole family. Afterwards, the
assessor begins the testing phase
with the child to collect useful information relevant to the
assessment questions. The
parents are usually asked to observe test administration or the
unstructured activities (i.e.
drawings) that are part of this phase from behind a one-way
mirror, over a video link, or
from the corner of the testing room (Step 2). Later, the assessor
and parents discuss their
observations and their relevance to the parents’ assessment
questions (Tharinger et al.
2008b). Different from other systemic collaborative
interventions (see, for example,
Teixeira et al. 2011), in TA-C the parents are involved directly
as co-assessors, observing
75. and interpreting their children’s behaviors during the testing.
Next the assessor schedules
one or more family sessions, the so called intervention sessions;
these represent occasions
to work even more on the systemic aspects of the child’s
problem and to work with the
family members on possible new ways of interacting (Tharinger
et al. 2008a) (Step 3).
Finally, the assessor meets the parents for a summary/discussion
(i.e., feedback) session,
where the main results of the assessment are summarized and
discussed (Finn 2007;
Tharinger et al. 2008b) (Step 4). The assessor also gives
feedback to the child about the
assessment results in the form of an individualized fable
(Tharinger et al. 2008c) (Step 5).
TA-C can be done by one clinician or by two, depending on the
presence of a colleague
trained in the approach and on the financial aspects of the
assessment. Clearly, one of the
main advantages of working with a co-therapist is that during
the testing phase, while one
clinician works with the child, the other can stay behind the
one-way mirror with the
76. 732 Contemp Fam Ther (2013) 35:731–744
123
parents. There, the second clinician can support the parents
emotionally and begin com-
menting with them on what is happening in the assessment room
with the child.
A recent review of the research on TA by Finn et al. (2012)
revealed fewer empirical
studies supporting TA-C than TA with adult clients. However,
the results available so far
are promising. An aggregate group study by Tharinger et al.
(2009) assessed the overall
effectiveness of the TA-C model with 14 families with
preadolescent children referred for
emotional and behavioral problems. The study showed that TA-
C reduced symptoms in
both parents and children, increased communication and
positive emotions, and decreased
negative emotions and conflicts within the family. Also,
participants reported high
engagement in the assessment and satisfaction with the services.
Tharinger and Pilgrim