This study explored the predictors of community supervision failures amongst female offenders in the United States criminal justice system. Female offenders have, in comparison with male offenders, particular challenges for community reintegration. This study used the relational theory and Maslow's hierarchy of needs theory to investigate the effects of childhood trauma on adult female offenders' behaviors, including substance use disorder and mental health issues. Secondary archival data were obtained from the Court Services and Offender Supervision Agency's AUTO Screener and Supervision and Management Automated Record Tracking System; this data pool included information on 1,085 female offenders who had served at least one year on probation, supervised released, and/or parole. Hierarchical logistic regression was used to examine childhood trauma, adult substance use, and substance use and mental health treatments received for the study population. Additional demographic variables were also tested as predictors of community supervision failures. Age, marital status, and caregiving for dependent children were identified as significant predictors of community supervision failures. Results indicated that community supervision failures among female offenders are predicted by relational activities. Positive social change is implicated through programmatic changes offered to female offenders. It is recommended that criminal justice agencies equip female offenders with effective strategies that address relational needs such as childcare, parenting, and life skills assistance. Through these changes, female offenders are able to promote healthier lifestyles for themselves, families, and become productive members of their communities.

The increased prevalence of cognitive deterioration has increased the challenges of caring for older adults. This study's project site offers a psychiatric program for older adults with customized care for complex geriatric mental health patients. Clinical assessment and care management are often overlooked in geriatric mental health patients diagnosed with behavioral and psychological symptoms of dementia (BPSD). The purpose of this project was to deliver an education program developed from the Staff Training in Assisted Living Residences-Veterans Administration, P.I.E.C.E.S model and the Castle framework to 42 nursing and allied health staff of the project site. The project question explored whether an education program on care of patients with BPSD increased staff members' perceived knowledge and competence in providing care to these patients. This education program focused on comprehensive assessment, individualized care planning, and individualized nonpharmacological interventions to manage older adults with dementia. Descriptive statistics were used to analyze performance outcomes data before and after staff education. In addition, care plans of patients were reviewed. Results included a 100% increase in recognition of core concepts of the education program; a 48% to 86% increase in staff willingness to use interdisciplinary care plans; and a 6.6% to 95% increase in documentation of key interventions in care plans for 6 behaviors of dementia. The results of this project might bring about social change by improving the skills and competence of nursing staff in managing the patients with dementia, thus positively impacting the quality of life of patients with BPSD by benefiting from nonpharmacological interventions.

Symptom severity among veteran survivors with partial or full posttraumatic stress disorder (PTSD) continues to increase, with approximately 40% of U.S. veterans reporting significant symptomology 10 years after initial onset of the condition. Veteran survivors often struggle to find therapeutic interventions that meet their specific needs and have a difficult time maintaining a therapy that is both equitable and evidenced based. Grounded in the Rogerian, client-centered theory, the purpose of this qualitative collective exploratory case study was to explore the effects of equine-facilitated psychotherapy with 3 veteran survivors with partial or full PTSD. A 4-stage process was used to collect data, including initial semistructured interviews, observations, photo-interviews, and researcher interpretations of photo-interviews. Data were transcribed, analyzed, and coded into within-case themes and cross case-themes. The principle findings revealed that veteran survivors with partial or full PTSD engaged in an equine-facilitated psychotherapy program had both here-and-now experiences and relational connection experiences with the horse. Many other significant details provided insight into the veteran participants' experiences with equine-facilitated psychotherapy, such as trust, connection, nonverbal communication, awareness, peace, decompression, communication, empathic reflection, congruence, reciprocity, concern, respect, and selflessness. These findings provide social change implications that may inform mental health professionals and counselor educators about the benefits of equine-facilitated psychotherapy with veteran survivors with partial or full posttraumatic stress disorder; the findings also provide structure to the use of equine-facilitated psychotherapy as an adjunct and/or alternative to traditional posttraumatic stress disorder treatments.

Disparities exist in the recognition and treatment of depression among Hispanics in the United States, creating a social, ethical, economic, and public health burden. This study was designed to generate an improved understanding of the causes of and/or contributors to depression within this population. It was specifically designed to 1) assess the prevalence and severity of depression among Hispanic adults in the United States relative to adults of other race/ethnicities in the United States; 2) clarify the inconsistent results in the literature concerning the relationship between acculturation and depression among Hispanic adults in the United States; and 3) fill a gap in the literature by evaluating the potential for inflammation to mediate the relationship between acculturation and depression among Hispanic adults in the United States. The biopsychosocial model was used as a theoretical foundation for this study. Data from the 2009-2010 National Health and Nutrition Examination Survey were analyzed descriptively and via logistic regression. Findings confirmed higher prevalence of depression among Hispanic adults compared with non-Hispanic White adults, and that a lower degree of acculturation was consistently associated with a decreased likelihood of depression among Hispanics. No mediating effect of inflammation on the relationship between acculturation and depression was observed. The findings from this study are intended for use by health care providers, health educators, and public health practitioners to improve depression prevention, diagnosis, and treatment opportunities within this population and to accordingly to affect positive social change.

Deaf individuals typically have access to 2 types of therapeutic services: interpretive (with an interpreter) and noninterpretive (with a sign-fluent therapist). Previous research indicates that the presence of an interpreter may hinder development of working alliance and attachment. There is a lack of empirical evidence assessing the effect of working alliance and attachment based on whether or not therapy incorporates an interpreter. The working alliance theory and the attachment theory were the theoretical foundations for this study. This study examined the difference between the strength of working alliance and attachment to the therapist given the presence or absence of an interpreter in therapy for Deaf individuals (N = 39) utilizing the Working Alliance Inventory and the Client Attachment to Therapist Scale. A multivariate analysis of variance was utilized to examine the differences between interpretive and noninterpretive services. The results indicated that individuals who received noninterpretive services had stronger working alliance and attachment with their therapist, which suggests that the type of therapy services Deaf individuals receive should strongly be considered. Accordingly, an increase of sign-fluent therapists would promote social change by providing more appropriate services that would remove barriers that hinder working alliance and attachment to the therapist.

The United States experiences opioid addiction at epidemic levels. In 2012, the National Institute of Drug Abuse reported that 23.1 million Americans were in need of addiction treatment services, although only 2.5 million were enrolled in treatment. Following an amendment to the Drug Addiction Treatment Act of 2000 (Public Law 106-310), advanced practice nurses were qualified as providers who could bridge the healthcare gap in treatment access. The purpose of this project was to determine the interest of advanced practice nurses in (a) prescribing buprenorphine and (b) establishing guidelines that would allow them to do so. This quantitative project used a 10-question Internet-based survey with a convenience sample of 95 nurses (recruited online) who were currently practicing in advanced nursing roles. Social media platforms, including Facebook, were used to recruit participants. The survey included questions about expanding the scope of practice in addiction treatment and establishing guidelines that would allow nursing knowledge and expertise to be used in outpatient opiate addiction treatment. Critical social theory and Kingdon's theory of policy analysis were applied to support the project. The Survey Monkey data analysis tool was used to generate descriptive statistics, which demonstrated respondents' support for an expanded scope of practice. If the recommendations of this project are adopted by national legislation, increased accessibility to addiction treatment services will save millions of dollars in justice system, healthcare system, employment, and societal costs. Nursing policy advocates nationally can apply these results to support efforts to expand scope of practice to include prescribing buprenorphine.

Research has shown that individuals' willingness to believe a disclosure of childhood sexual abuse (CSA) is related to just-world beliefs, ambivalent sexism, and defensive attribution. However, researchers do not know whether these variables relate to posts made in response to online articles describing CSA. Negative or disbelieving posts may impact not only the author, but also readers who view these comments via hindrance of disclosures, increased self-blame, and avoidance of help seeking. In this quantitative study, just-world, ambivalent sexism, and defensive attribution theories provided the theoretical basis used to determine whether just-world beliefs, ambivalent sexism, and defensive attribution influenced comments made in response to an online article about CSA disclosure. Eight-hundred twenty participants read the article where the author discloses she was sexually abused as a child. Response comments were coded negative, neutral, or positive. Participants also completed demographic questions, the Global Belief in a Just World Scale, the Ambivalent Sexism Inventory, and questions regarding their similarity to the offender and victim. Multinomial logistic regression analysis showed relationships between negative posts and hostile sexism, perceived similarity to the perpetrator, frequent involvement in online discourse, and, to a lesser extent, belief in a just world. Parenthood and perceived similarity to the author increased one's odds of posting positively. Responses of CSA survivors resulted in unexpected findings. Study findings may be used to challenge stereotypes and vitriol often used to silence survivors in public discourse, for thought challenging in psychotherapeutic settings, and for future public education and research to increase support for CSA survivors.

Despite the abundance of literature regarding potentially effective treatment modalities for Native American clients, researchers have been unable to identify an empirically proven effective treatment modality for this population. Common recommendations/considerations for therapists working with Native clients have been identified throughout literature; however, such findings were gathered by insiders (i.e., Native researchers or trained Tribal staff), which has left questions regarding the efficacy of such recommendations when applied by non-Native therapists. Due to Native American history, elaborate IRB requirements were put in place to ensure ethical research with this population but impedes the research process. I conducted an analytic autoethnography to explore my experiences of working on an Indian reservation as an outsider/Whitegirl marriage and family therapist. Experiences were explored contextually and explanatorily through a postmodern epistemology to determine similarities/differences to common recommendations/considerations in literature. Themes that emerged from the analysis of this study reflected common factors of psychotherapy and MFT rather than aspects of a specific MFT modality. This study contributes to the expansion of knowledge regarding effective practices and therapeutic considerations for Native American clients.

Background Up to 34% of perinatal individuals experience childbirth as traumatic. These individuals are at increased risk for developing depression, anxiety, and posttraumatic stress disorder (PTSD) after the traumatic event. The objective of this study was to elicit the perspectives of individuals with a traumatic birth experience on barriers and facilitators to receiving mental health support in the postpartum period after a traumatic delivery. Methods Individuals who delivered within the last three years and perceived their birth experience to be traumatic (n=32) completed an hour-long semi-structured phone interview. The interview included screening for PTSD, depression, and anxiety with validated instruments including the Posttraumatic Stress Disorder Checklist for DSM-V (PCL-5), the Patient Health Questionnaire depression scale (PHQ-8), and the Generalized Anxiety Disorder scale (GAD-7), respectively. Qualitative data was analyzed using a modified grounded theory characterizing participants’ barriers and recommendations for mental health support after traumatic births. Results Among participants, 34.4% screened positive for PTSD, 18.8% screened positive for major depressive disorder, and 34.4% screened positive for anxiety. Qualitative themes revealed multi-level barriers involving lack of communication, education, and resources which prevented obstetric professionals from recognizing and supporting patients’ mental health needs after a traumatic birth. Recommendations from participants included that 1) obstetric professionals should acknowledge trauma experienced by any individual after childbirth, 2) providers of multiple disciplines need to be integrated into postpartum care, and 3) mental health support is needed before the ambulatory postpartum visit. Conclusions There are multi-level barriers toward detecting and responding to individuals’ mental health needs after a traumatic birth. Obstetric professionals need to use a trauma-informed approach and proactively follow-up and assess mental health care in the postpartum period.

This paper describes an empirical approach to assessing pediatric residents' attitudes, knowledge and skills in primary care behavioral health. Outcomes from that assessment approach are presented from two pediatric residency training programs in the northeastern United States. Thirty-six pediatric residents completed attitudes, knowledge and skills surveys. The survey was developed to align with the American Academy of Pediatrics’ Policy Statement in 2009 citing aspirational competencies for pediatricians in primary care behavioral health. This alignment addressed both learner variables (attitudes, knowledge, and skills) as well as clinical presentations (ADHD, anxiety, depression, and suicide) highlighted in the policy statement. The survey specifically inquired about self-reported confidence and comfort in managing behavioral health concerns using evidence-based practice parameters (attitudes and knowledge) and their measured ability to deliver evidence-based care in response to clinical vignettes (skills). Findings largely revealed no statistically significant differences in attitudes, knowledge or skills between interns and upper-level residents. Training programs can use the approach described in this paper and the assessment instrument with some possible modifications to monitor annual progress and evaluate any changes in didactic and clinical training.