2.5 million people sustain a traumatic brain injury (TBI) annually in the United States. Although there is potential for functional recovery following TBI, there is no definitive treatment to improve recovery after TBI. Our lab has shown that TBI enhances an endogenous neurogenic response in the subventricular zone and hippocampus. TBI-induced neural stem cells (NSCs) can integrate into regions such as the hippocampus and olfactory bulb. Although the mechanism behind TBI-enhanced neurogenesis remains unknown, the Notch signaling pathway has been implicated as a regulator in the maintenance and survival of NSCs. This thesis explores the effects of Notch pathway manipulation on functional recovery following TBI. We hypothesize that Notch signaling plays a critical role in recovery after TBI. Activation of this pathway via a Notch agonist (Notch1) will facilitate post-injury recovery while inhibition of this pathway via a Notch antagonist (recombinant Jagged-1 Fc) will deter post-injury recovery. Functional recovery was assessed within 30 days or 60 days post-injury in two different cohorts of animals. The behavior assays conducted in this study included motor, cognitive, and olfactory assessment. In the 30-day phase, Notch pathway manipulation following TBI did not affect functional performance. In the 60-day study, significant group differences were found. While the FPI+Vehicle animals exhibited a functional recovery in Morris water maze, injured animals with Notch inhibition failed to show this cognitive recovery, indicating the involvement of the Notch pathway in cognitive recovery at the chronic stage following TBI. Motor and olfaction were not significantly affected by Notch pathway manipulation.

Social workers in child protective services often handle hundreds of cases regarding children traumatized by abuse and/or neglect. In time, social workers' experiences can become emotionally and psychologically challenging. A problem for supervising child protection social workers (SCPSWs) is that they might experience the same challenges; however, there was no research that described the lived experiences of SCPSWs. This phenomenological study explored the lived experiences of SCPSWs. Conceptually, constructivist self-development theory (CSDT) provided the framework for understanding how SCPSWs managed their lived experiences and the issues related to them. Ten SCPSWs volunteered their time for face-to-face interviews and provided data for this study. Saldana's coding manual was used to guide the identification and coding of key words and phrases. SCPSWs experienced occupational trauma in the form of vicarious trauma, compassion fatigue, secondary traumatic stress, and/or burnout similar to that experienced by front line workers. SCPSWs' experiences required them to set boundaries, stop taking work home and support each other in the workplace. Enhanced resources for training on self-care plus increased administrative and peer support could potentially improve the lives of these SCPSWs and increase their longevity and effectiveness in the workplace. Retaining experienced supervisors also has the potential to promote positive social change by improving the support supervisors can provide to front line staff, thus indirectly helping children, families, and communities they serve.

Compassion fatigue is a secondary stress reaction that results from providing care to those undergoing traumatic life events. Frequent exposure to dying patients with complex medical concerns has been identified as a contributing factor to compassion fatigue and resultant turnover among hospice nurses. The purpose of this project was to assess whether the provision of education to hospice nurses regarding compassion fatigue resulted in a demonstrable improvement in their levels of compassion fatigue. Watson's theory of human caring and Roy's adaptation model provided the theoretical foundation for this project. The practice-focused question for this project asked whether a reduction in compassion fatigue among hospice nurses would result after providing them with educational material focused on compassion fatigue. Twenty-three hospice nurse participants were administered Stamm's Professional Quality of Life Scale to measure their compassion fatigue levels before and after being presented with an educational booklet. Scores for this project were compared using a before-and-after quality improvement design and percent difference to measure the impact of the educational offering. Results demonstrated an 8.6% reduction in compassion fatigue among the hospice nurse participants, indicating that educational interventions support a positive effect in reducing compassion fatigue. Positive social change might result from this project by improving nurses' awareness of the need for self-care that contributes to resiliency and prevention of compassion fatigue.

Few existing studies have examined compassion fatigue among emergency responders even though firefighters and emergency medical service (EMS) professionals have repetitive direct exposure to traumatic events. This study focused on identifying predictor variables for the development of compassion fatigue in firefighters. Karasek's demand-control model, a commonly used work stress model, was the study's theoretical framework as it focuses on specific construct interactions that predict employee well-being. Accordingly, this correlational study examined the predictive nature of EMS license level, years of service, and personality type on the development of compassion fatigue in career firefighters. Data collection occurred with surveys incorporating the Professional Quality of Life Scale and the Big Five Inventory. Mid-Michigan fire departments participated with 129 career firefighters returning completed surveys with results analyzed using logistic regression. Findings revealed a significant predictive relationship between personality traits and the development of compassion fatigue. These findings can inform preventative measures that protect the psychological well-being of these emergency responders by informing and educating the professionals and organizations as to who is at greatest risk and ultimately providing opportunity for risk mediation.

Since 9/11 over 2.77 million U.S. service members have deployed 5.4 million times to a theater of war with the majority serving in the U.S. Army. The increased stress inherent in a single combat deployment grows exponentially with each subsequent deployment, resulting in behavioral issues and suicide attempts and ideations. This study's purpose, following resilience theory, was to explore the associations of military life experiences (permanent changes of station, promotions, retirements, etc.) and deployment characteristics (number of deployments, operational specialties, combined lengths of deployments, etc.) to postdeployment resilience in U.S. military personnel. The study's design was a quantitative correlational research design; 102 participants were recruited through social media. Protective factors associated with resilience served as the dependent variable. The independent variables were time and transitions. Covariates included demographic data (age, gender, ethnicity, marital status, rank, branch of service, years of service, etc.), number of combat deployments, and combined length of deployments. The target population consisted of military service members with at least one combat deployment and had been redeployed for a minimum of one year. Results of this study may provide positive social change by identifying points and periods in the redeployment and post redeployment timeline service members can focus on to improve protective factors. Additionally, as Global War on Terror (GWOT) veterans begin leaving the service at an increased rate data focused on resilience may assist military mental health providers with developing treatment strategies that reinforce affect protective factors.

Traumatic death survivors are an at-risk population that could benefit from social work interventions. This action research study explored social work perspectives on crisis practice with traumatic death survivors in acute medical settings. The research questions focused on whether early crisis interventions by social workers would benefit traumatic death survivors, which interventions were recommended in crisis practice with this population, the potential effects of repeated trauma exposure on the social workers providing the crisis interventions, and recommendations to manage this professional exposure to trauma. The purpose of the study was to explore social work perspectives on potential benefits of crisis interventions with traumatic death survivors and potential effects of crisis practice on the social workers providing the services. Crisis theory and family systems theory informed the study. Participants were selected from a convenience sample of licensed social workers, and data were collected in 1 focus group and 3 in-depth interviews. Data were analyzed using descriptive and thematic analysis. Findings supported the benefits of social work crisis interventions for traumatic death survivors and the need for self-care, self-awareness, and support to reduce the risks of negative effects of crisis practice on social workers. Specific crisis interventions recommended for practice include the roles of advocate and guide, grief support, viewing of the body, and explanation of next steps. An increase in knowledge and recommendations for future practice based on study findings might promote positive social change by raising awareness about the problem and improving social work practice with traumatic death survivors.

Thesis (M.A. (Clinical Psychology) --University of Limpopo, 2008 / Police members of the South African Police Service (SAPS) work under constant physical, emotional and psychological stress due to the demands of their work. It is possible to assume that this profession could be more susceptible to trauma, depression and suicide ideation than a less demanding profession. The increase in suicides within the SAPS in the past years has created great concern worldwide. The literature review contributes to the understanding of vicarious trauma by providing evidence of its widespread existence and the impact on all professions that deal with trauma victims, as do the SAPS. A need for further research was highlighted. The aim of the study was to determine the prevalence of vicarious trauma within the SAPS; how rank, marital status, education, duration of service and workload affect the existence of vicarious trauma; and how the experience of vicarious trauma affects the lives of the SAPS member . A quantitative study was done with a sample comprising of 60 SAPS members from the Limpopo Province (Lebowakgomo and Mankweng stations). The inclusion criteria included: participants (both permanent and voluntary) had to be active, field working members of the SAPS and had to be in direct association with trauma victims. The conceptual framework: T rauma Theory guided the description and interpretation of the data. Findings revealed that there exist, at present, high levels of vicarious trauma within the SAPS. The duration of service and the marital status of the individual were found to have an influence on the existence of compassion fatigue, while rank, workload, education level and gender were found to have no direct relationship to the presence of vicarious trauma. Finally , this study concludes with recommendations for future studies into vicarious trauma within the SAPS.

Severe traumatic brain injury (TBI) is a pervasive and devastating condition, often resulting in permanent alterations in cognition, behavior, and personality. As such, survivors of severe TBI usually rely on the assistance of caregivers to navigate situations of daily living throughout their life span. Spouses of individuals with TBI have been shown to experience greater levels of burden than parental caregivers of TBI survivors (Kreutzer et al., 1994; Mauss-Clum & Ryan, 1981) and subsequently rates of divorce and separation have been documented within the research literature to be high (Thomsen, 1984; Wood et al., 2005). Although marital breakdown has been frequently studied, research on marital satisfaction and coping within long-term marriages where one spouse has survived a severe TBI remains insufficient. The purpose of this study was to provide a descriptive analysis of long-term spousal caregivers of individuals with severe TBI. First, demographic variables of caregiving spouses of individuals with severe TBI, who remained married at least 10 years post injury, were described and comparisons to other spousal caregiver samples were addressed. Second, the relationship between marital adjustment and demographic variables, coping, and quality of life was examined. Finally, an analysis of primary stressors was conducted to better understand the caregiving spouses' continued experience of stressors. Twenty-one spousal caregivers who remained married for at least 10 years post injury to their spouse who sustained a severe TBI participated in the study. Analyses revealed that spouses had remained married an average of 19 years post-injury and in general were mildly dissatisfied within their marriages. Furthermore, marital adjustment (Dyadic Adjustment Scale total score) of long-term spousal caregivers of severe TBI was not significantly different than spousal caregivers of individuals with chronic illness. Higher marital satisfaction scores were associated with higher endorsement of emotion-focused coping strategies and greater mental health quality of life. In addition, marital satisfaction was positively associated with the longevity of the marital relationship, the age of the spouse at the time of the injury, and the length of the marriage at the time when the injury was sustained. As expected, higher scores of marital satisfaction were associated with higher levels of mental health quality of life. There were no significant relationships between physical health quality of life and marital satisfaction. An analysis of primary stressors show that long-term caregiving spouses continue to report similar types of stressors as indicated in the research literature from caregiving spouses during the first 5 to 8 years post injury. Findings were discussed in relation to implications for practice and additional research.

Philosophiae Doctor - PhD / HIV/AIDS has made a huge impact on human development and sexual reproductive habits in this century in the world and especially in sub-Saharan Africa. It has only recently been acknowledged that HIV/AIDS has an equal if not greater effect on or threat to people with disabilities. Survivors of traumatic spinal cord injury (TSCI) with resultant disability are incorrectly believed to be sexually inactive, unlikely to use drugs or alcohol and at less risk of violence or rape than their non-disabled peers. This group can thus be described as economically, educationally and socially disadvantaged, which in itself, suggest that they are a high-risk group for HIV infection. The overall aim of this study is to examine the factors that could contribute to the risk and vulnerability to HIV/AIDS among individuals with spinal cord injuries in South Africa. The specific objectives of the study are to assess the behavioral and protective factors that could contribute to risk and vulnerability to HIV infection among individuals and spinal cord injuries; and to explore the socio-cultural issues that might increase individuals with spinal cord injuries’ vulnerability to HIV/AIDS. The design of this study was a mixed methods design, particularly the sequential explanatory strategy was used will used in this study. The study was conducted in four (4) conveniently selected provinces (highest prevalence of SCI). The Quad-Para Association of South Africa’s (QASA) provincial databases was used to invite individuals with SCI to participate in the study. Data for quantitative part of the study was collected by means of self-administered questionnaires. The questionnaire consisted of various sections requesting for information on: Demographics; HIV-Knowledge (HIV- KQ-18); Sexual behaviours; Sexual communication and negotiation skills; Self-efficacy to refuse sex. Separate binary logistics analysis was done to assess which of the selected factors are associated with risky sexual behaviour. The forced entry method approach was used to determine which of these factors have the greatest productive power to predict sexual risk behaviour. No “a priori” sample size was developed for the qualitative part, but participants were recruited until saturation has been reached of all the categories. Consenting participants were visited by the researcher for data collection in the environment indicated by the participant. Permission to conduct the study was obtained from the Research Ethics Committee at the University of the Western Cape (UWC). The study was conducted according to ethical practices pertaining to the study of human subjects as specified by the UWC and Faculty of Community and Health Sciences Research Ethics Committee of the UWC.

The focus of this thesis is to investigate the use of art therapy in the treatment of an individual diagnosed with schizophrenia. In this qualitative narrative single case study, eleven art therapy sessions are described using non-directive spontaneous art making with a 37-year-old man residing in a psychosocial rehabilitation program. The research study describes this client�s delusional world, and explores the struggle of making sense of his traumatic experiences in early childhood. The themes that emerge in this exploratory study are many and grief and bereavement are the focus as the client uncovers the connections between the past and the present. The process of the art therapy sessions and the progression in the imagery from chaos to serenity is described as the client moves from darkness into light, and as we witness his exploration of space in the images of the whirlwind that reappear throughout the sessions.