Sex Offender Treatment Programming (SOTP) is a specific treatment intervention aimed at reducing recidivism through cognitive behavioral modification of known risk factors for sexual offending. SOTP provided in criminal justice or correctional settings and contexts presents unique ethical challenges and experiences for traditionally trained mental health counselors due to competing and differing roles, priorities, and stakeholders. SOTP in criminal justice or correctional settings is in some instances provided by professionally licensed or certified and traditionally trained mental health practitioners; and such settings can challenge traditional ethical standards and practices. A study was conducted utilizing qualitative phenomenology in order to investigate the ethical experiences of mental health practitioners providing SOTP in criminal justice settings. Semi-structured phone interviews were conducted with six professionally licensed or certified practitioners who were currently providing (or had recently provided) SOTP in criminal justice settings. Analysis of the data revealed thirty codes and six prevailing themes: unexpected entrance into the field of SOTP; ethical limits; role incongruence; competing obligations; imbalance between rehabilitation and community safety; and line of demarcation (“the line”). The essence of participant experiences was determined to be: who is the client? Meaning, participants identified ethical experiences that at their core indicated difficulty identifying to whom ethical obligations were owed. A model depicting the process of ethical experiences described by participants providing SOTP in criminal justice settings is offered. Future research questions and potential, related research projects are described. Implications for practice, counselor preparation, and research are summarized. The results of the present study may provide greater insight into a subject with limited research, while providing information for practitioners that may aid their ability to navigate complex ethical situations.

Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting up to 18% of all women, yet only 1.5% have been formally diagnosed. Untreated, PCOS is associated with the early onset of diabetes mellitus type II, heart disease, and cancer. One of the most common clinical symptoms of PCOS is mental health illness. The estimated lifetime prevalence of mental illness in women with PCOS is 80%. Therefore, mental health professionals may be especially poised to screen, refer, and address PCOS in their practices. This study was used to develop a survey tool as well as a brief educational intervention using framing theory to boost PCOS knowledge of diagnostic criteria and clinical symptoms, screening practices, and referrals for PCOS evaluation. The survey assessed mental health providers' knowledge about PCOS, estimates of PCOS prevalence in their practices, and evaluated attitudes about screening for PCOS in order to identify other potential barriers and facilitators to screening. This study was conducted using a randomized, two-group (experimental vs. attention control) design with three measurement periods: pre-intervention, 4-weeks, and 12-weeks. Participants were stratified by whether or not they had medical degrees. One-hundred and sixty three (N=163) participants completed the first survey and were randomized and completed one of the two educational interventions (PCOS related or attention control). Knowledge outcomes included number of correctly identified PCOS diagnostic criteria and clinical symptoms. Behavior outcomes included whether or not participants screened or referred clients for PCOS in the last 3 months. Fourteen attitude measures and two confidence measures were also separately evaluated as potential influencing factors of knowledge and behavior. The study resulted in no change in PCOS knowledge of diagnostic criteria or clinical symptoms or behavior based on intervention assignment in medical professionals; however, baseline knowledge in this group was high. Confidence in PCOS knowledge was associated with screening behavior. The PCOS educational intervention appears to have potential efficacy at increasing non-medical professional clinical symptom knowledge of PCOS (Chi-square(1)=5.341, p=0.021) but did not improve screening or referring behavior. The PCOS intervention resulted in greater confidence in PCOS knowledge in the PCOS intervention group than in the attention control group (p=.003). Framing theory appears to be a promising framework for messaging designed to increase knowledge about PCOS only in non-medical mental health practitioners. Results of this study should be interpreted with caution because sample size goals were not met and there was high attrition among medical mental health practitioners. Future intervention strategies should consider the inherent differences in the type of professional that are targeted (i.e. medical vs. non-medical) and the presence of specific barriers to screening and referral behavior. These strategies should improve upon the intensity of the intervention and the timing of the intervention to occur during provider training (i.e. during residency or early internships) in order to increase screening and referring behaviors for PCOS. / Public Health