Clinical practice guidelines (CPGs) for Attention Deficit Hyperactivity Disorder (ADHD) recommend documentation of symptom scales and comorbidity screenings at the time of diagnosis and routinely throughout care. Rates of documentation for these tools in pediatric primary care are consistently low, creating a gap in care that impairs diagnosis, management, and patient outcomes. The purpose of this quality improvement project was to implement an online ADHD portal that emails, collects and scores these tools. The aims of the project are to improve utilization of CPGs by increasing documentation rates of symptom scales and comorbidity screenings for pediatric patients with ADHD. One primary care pediatrician located in Middle Tennessee piloted the project, with the goal to expand this practice change to additional partners in the future. Following submission to the IRB, the committee determined this type of quality improvement project to not require their oversight. A six-month retrospective chart review was conducted to determine baseline rates of documentation for the two outcomes. During the ten-week project, the portal was activated and evaluation tools were sent. A second chart review will be conducted at the conclusion of the project to determine if utilization of CPGs for the two outcomes has improved. Limitations included small sample size and accessibility barriers. The expected outcomes of this project include successful implementation of the online portal with improved rates of documentation for symptom scales and comorbidity assessments. This project could potentially improve CPG utilization and ultimately impact the quality of care for pediatric patients with ADHD.

This manuscript provides a critical review of the literature on parent–child physiological synchrony—the matching of biological states between parents and children. All eligible studies found some evidence of physiological synchrony, though the magnitude and direction of synchrony varied according to methodological factors, including the physiological system examined (i.e., parasympathetic or sympathetic nervous system activity, adrenocortical functioning) and the statistical approach used (e.g., multilevel modeling, correlation). The review underscores the need to consider the context in which physiological synchrony occurs (e.g., family risk) to best understand its significance. Furthermore, the review delineates vital avenues for future research, including the need to assess synchrony across multiple physiological systems and the importance of documenting continuity/change in physiological synchrony across developmental periods. Such research is crucial for understanding how the parent–child relationship unfolds at a physiological level and, in turn, how this relationship can facilitate or hinder parent, child, and family adjustment.

Many young adult African American men living in urban areas adopt a style of self-presentation known as the gangsta image in an attempt to earn and maintain what they may perceive to be respect, self-esteem, and social status. While these young men succeed in earning the respect of their peers, they also may jeopardize their chances of succeeding in mainstream society by engaging in an alienating lifestyle related to their alternative form of status. The purpose of this case study was to explore the concepts of respect and self-esteem as defined by a culture-sharing group of young African American men living in an urban environment. Using the theoretical lens of Goffman's dramaturgical model of social interactions, case studies of 4 young African American males' experience of self-esteem and respect as components of social acceptance were explored. Their sources of teachings about respect and social position received from the authority figures in their environment, as well as the contextual factors that shaped their self-concept, were also delineated. The research used a qualitative, case study design. Data were collected from observations, interviews, participatory photography, and document review and analyzed by coding and concept mapping using Atlas.ti software. The key finding was that perceptions of self-respect were connected to ongoing negative relationships with mainstream society and law enforcement. This study contributes to social change by helping human services professionals to comprehend the meaning and significance of respect and self-esteem for this population. This understanding can then inform practices related to engaging and supporting the mainstream success of this important group.

The Centers for Disease Control and Prevention reported that African American women had the lowest recorded number of suicide completions among all ethnic and gender groups in the United States. In addition, the number of suicides among African American women continued to soar without a clear reason or understanding of their lowest completion rates. Further research in the area of spirituality among African American women may be critical in understanding why African American women's rates of completed suicides are statistically lower than other ethnic groups and how to prevent future rate increases. A phenomenological framework was used to examine the thoughts and opinions of African American Christian women on whether or not religion plays a vital part during the contemplation phase of suicidal ideations and on their reasons for living. The study explored the low rates of suicide completions among African American women from a religious and spiritual perspective. Fifteen African American Christian women who had contemplated suicide were recruited via flyers posted at a local church campus. Participants were individually interviewed about their lived experiences during suicidal behaviors. After the interviews were transcribed, data were coded by assigning numbers to common themes and placing the common themes into categories. The results indicated that among the small sample of 15 participants, religion and spirituality are highly considered as being a protective factor against repeated suicidal behavior, followed by family relationships, when compared to other reasons for living. The least likely protective factor was financial status. The findings suggest that spirituality can be used as a preventative measure to lower the risk of suicide completions among African American Christian women.

Violence in mental health care continues to be a problem. The incidence of violent episodes in healthcare settings with aggressive behavior of patients aimed at staff members or other patients is almost four times greater in healthcare than in other industries. Reducing violent episodes enhances the quality of care and improves safety for staff members and for patients. The project focused on development of a staff education program exploring the practice-focused question: Will this program effectively guide staff member approaches to mental health patients with challenging behaviors? The purpose of this project was to address the identified gap in practice in one mental health unit at a Florida correctional facility. A comprehensive literature review was completed using 30 sources from 2012-2017 and included peer-reviewed research and government resources to guide the development of this program, called TAPOUT. Sources of evidence emerged from a systematic review of the literature and an expert panel in mental health. Using the Delphi technique, all 5 panel members came to consensus after 2 rounds, agreeing to implement the TAPOUT program. The findings demonstrated the TAPOUT program may effectively guide staff member approaches to mental health patients with challenging behaviors and showed the benefits of using the TAPOUT program for reduction of violence. The DNP project has demonstrated TAPOUT can address the identified practice gap. The educational program's goal was to reduce violence and positively impact social change by providing staff members with tools to prevent and to deescalate emerging violent behaviors and episodes, preventing injury among staff members and patients alike.

Researchers have suggested that jails and prisons in the United States are becoming the new mental health clinics, contributing to the phenomenon of mass incarceration and costing upwards of $15 billion per year in public revenue. The problem is no conclusive evidence exists that treatment in these custodial environments is more effective than that provided by noncustodial programs; especially for substance users. Additionally, the continuing incarceration of people with mental health problems by the hundreds of thousands poses a difficult ethical dilemma regarding why this population does not receive noncustodial or hospital treatment instead. The study addressed the research question of whether there is a significant difference in individual patient treatment plan completions that points to differences in the effectiveness of custodial and noncustodial mental and substance use disorder treatment programs. The study was guided by self-determination theory. Archival data reported through the Statewide Maryland Automated Tracking System comparing the number of complete and incomplete treatment plans of 1 custodial (n = 940) and 1 noncustodial (n = 534) mental health treatment program in Maryland, were analyzed using a Pearson's chi-square test of independence .The analysis showed that while custodial treatment plans were more effective, both custodial and noncustodial had high failure rates, and custodial plan success may be limited to the period within custody. This study may impact social change by informing justice policy and lawmakers about the need for continued research to provide effective interventions for substance users that transcends custodial boundaries.

The rise in diagnosable mental illness disorders in the United States is a major concern. However, researchers indicate that African Americans are far less likely to seek mental health treatment than Caucasian Americans. This qualitative, phenomenological study addressed a research gap regarding the beliefs, perceptions, stigmas, and practices of African American clergy regarding their promotion of mental health services. Two conceptual frameworks consisting of the sociocultural theory and the social learning theory guided the study. There were two research questions used to guide the exploration of the purposive sampling of 6 African American clergy from major African American denominations across the southeastern United States. Responses from the in-depth, semistructured interviews, after being analyzed, coded, and categorized, were grouped into 3 main themes: (a) stigmas African American clergy have regarding mental illness, (b) African American clergy's promotion of secular counseling for mental health treatment, and (c) clergy's personal experiences with mental illness and secular counseling. The results were that African American clergy had stigmas regarding the use and promotion of mental health services and relied more on prayer as the first line of defense. Social change implications include bringing awareness to African American clergy at large and how their perceptions, beliefs, stigmas, and practices affect their congregations and communities. An increased knowledge of mental illness and interventions, with sensitivity to African Americans culturally and spiritually, may improve the rates of African Americans help-seeking behaviors and minimize the risk of stigmatization.

It is increasingly important to understand the factors associated with individuals struggling with addiction and their quality of life, especially with those struggling with co-occurring diagnoses (CODs). The purpose of this study was to explore the extent to which meaning, and CODs of anxiety and depression predict an individual's attitudes and beliefs about addiction among persons receiving treatment for substance use disorders (SUDs). The theoretical foundation used to guide this study was logotherapy, which emphasizes the importance of increasing meaning in life through choices, while also centering on being able to find meaning in all situations. A cross-sectional correlation design was employed, using a sample of patient admission records from a dual diagnosis treatment center in the western United States. The responses on 4 assessments related to meaning, symptoms of anxiety and depression, and attitudes about substances were analyzed using a multiple linear regression. There was no statistically significant relationship between an individual's attitudes and beliefs about addiction as predicted by that individual's meaning and CODs symptoms of anxiety and depression. A significant negative correlation existed between depression and meaning (p < .01), while a significant positive correlation existed between the depression and anxiety (p < .05) as well as the anxiety and attitudes about substances (p < .01). The findings from this study can assist counselor educators in understanding the correlation between SUD, increased depressive symptoms, and low personal meaning.

Researchers have found that African American men are one of the most marginalized, targeted, and disenfranchised groups of people. In the past, African American men were less likely to attend psychotherapy compared to other ethnicities. Barriers to treatment includes the following: distrust in the mental health system, self-reliant behaviors, religious ideologies, cultural stigmas, and the ideology of what it means to be a man and an African American man in America. This study addressed the lack of qualitative studies on the experiences of African American men who attend psychotherapy by exploring the lived experiences of 10 African American men who voluntary attended psychotherapy 2 or more times in their adult lives. Sites of resilience, a theoretical framework for this study, provided an understanding of African American men's resilience and a clinical model for engaging African American men in mental health services. Handcoding was used to organize data by developing categories and later establishing common themes expressed during semistructured interviewing. Five themes emerged from the data: (a) stigmatization, (b) self-awareness, (c) self-realization, (d) emotions, and (e) transition between prepsychotherapy and postpsychotherapy experiences. The understanding of experiences of African American men who have chosen psychotherapy contributes to positive social change by identifying appropriate therapeutic strategies, including emotional regulation and distress tolerance skills. Furthermore, the lived experiences provided by this study's participants can provide direction for additional research to improve the experiences of African American men and mental health services.

Hurricane Katrina devastated the U.S. Gulf Coast and subjected the city of New Orleans to disastrous flooding, which resulted in numerous after effects that impacted the children and adolescents of the city. The disaster contributed to high levels of stress, increased risk of psychological disorders, and was associated with an increased percentage of New Orleans children presenting symptoms of post traumatic stress disorder (PTSD). To help address these problems associated with hurricanes and other disasters, the current study investigated how age, gender, race, and pre-existing conditions increased or decreased the likelihood of a child being diagnosed with PTSD following Hurricane Katrina. A binary logistical regression was utilized in this study. Bronfenbrenner's ecological systems theory formed the framework of the study, based on the functionality of an individual's life and development in his or her environment. The findings revealed age to be a significant predictor on PTSD. As children's ages increase, the likelihood of having PTSD increases. The result can promote positive social change by providing mental healthcare professionals with comprehensive information regarding possible health risk of developing PTSD and the possibilities of getting treatment with evidence-based therapeutic support, medicine, and psychotherapy.