This thesis covers the background and history of cultural attitudes towards body art, scarification and tattoos, the history of street gangs and their influence and impact on Southern California communities, and an in-depth program analysis of the "Gang Tattoo Removal Program" established at the Arrowhead Regional Medical Center (ARMC).

This paper examines the correspondence, manuscripts, and speeches of ex-mental patient activists. I chronicle the activities of the emergent psychiatric survivors movement from its beginnings in the early 1970’s focusing on the work of the Boston based activist, Judi Chamberlin (1944-2010). This paper examines how mental patients in post-war America began to organize in order to have their voices included in the process of their own recovery. I present Chamberlin’s experience as a mental patient as being representative of the “rootlessness” that many post-war women experienced. Chamberlin’s work as an ex-patient activist presented one aspect of the overall struggle on the part of mental patients to claim their place in a wider society. I also pay attention to interdisciplinary scholarly analyses of madness to investigate how discussion of the subject influenced ex-patient activists, as well as whether or not the ex-patients’ narrative reciprocally influenced the scholarly discussion about madness. In the final chapters, I also look at how the successes of this social movement ironically led to the prevalence of today’s diagnostic models of treatment that rely heavily on pharmacological methods and highly regimented evidence-based psychotherapies while still excluding patients’ voices. The voices of mental patients both in the asylum era and today have been excluded from the treatment process.

Background: The Veterans Health Administration (VHA) encourages depression screening and treatment for pregnant veterans; however, rates of depression symptoms and treatment utilization during pregnancy have not been well-studied. Methods: We used data from the Maternity Care Coordination for Women Veterans cohort study. Specifically, our aims were to: 1) examine rates and correlates of depression symptoms in a sample of pregnant veterans; 2) understand mental health care treatment utilization and explore the experiences of veterans accessing mental health care at the VHA during pregnancy; and 3) examine VHA mental health provider's perspectives on depression screening and treatment in the perinatal period. Findings: Depression symptoms were present in 28% of pregnant veterans in our sample. Social support and employment decreased odds of symptoms; history of anxiety, antidepressant use, and active duty service resulted in increased odds of symptoms. Nearly 70% of women veterans with prenatal depression symptoms received at least one mental health visit or antidepressant prescription during pregnancy. However, symptomatic pregnant women without a history of depression were less likely to receive care. Mental health providers identified absence of screening protocols and referral procedures and variability in risk/benefit conversations surrounding antidepressant use as areas of weakness for VHA mental health care during the perinatal period. Conclusions: Depression symptoms were present in nearly one in every three pregnant veterans. Depression treatment during pregnancy is complex, requiring individualized care. Policies for depression screening, referrals to providers, and medication review could be better encouraged to improve standardized care across the VHA.

This research explores the experiences and practices of Medical Art Therapists; specifically, how working with clients in a medical setting, often as a part of a multidisciplinary team, impacts the work of an Art Therapist. Researchers reviewed the general literature regarding children and adults’ experiences of hospitalization and utilization of psychosocial services. Medical Art Therapy literature is reviewed next, emphasizing work with children, families, and adults. Informed by the literature, researchers invited Medical Art Therapists to participate in a focus group and/or follow-up survey. Researchers conducted a focus group in which participants discussed their experiences and created response art. A survey was then sent to focus group participants and other respondents who were unavailable for the focus group. Researchers identified four categories that emerged from the survey data: “art as self-expression,” “categorization of Art Therapy,” “considerations specific to the medical setting,” and “range of utility” of Medical Art Therapy. Researchers used these categories to analyze data from the focus group and response art. An additional category emerged from these two data sets: “personal experience.” The response art naturally offered another category for analysis: “features of the art.” Researchers compared findings across all data sets and discovered meanings by setting these findings in the context of the general and Medical Art Therapy literature. Further research is warranted to support expansion in the field of Medical Art Therapy.

Developmental disabilities (DEVDIS) such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorders (ASD), developmental delay (DD), and learning disabilities, affect 14% of US youth, who also experience higher rates of obesity, approximately 19%, than youth without these conditions. Screen time is a risk factor for obesity, though it is not well-studied among youth with developmental disabilities. Youth with developmental disabilities experience challenges with learning, have underdeveloped social skills, and problematic behaviors. These predispositions can often result in peer rejection. The resulting social isolation may make these youth particularly vulnerable to engaging in solitary activities such as screen time. The objectives of this dissertation were to compare screen time rates among youth with developmental disabilities to typically developing youth and to examine the associations between social and family engagement with screen time among youth with developmental disabilities. Data from the 2007 National Survey of Children’s Health (NSCH), a national cross-sectional study that assesses the physical and emotional health of US children (N = 91,642), were used. Youth 6-17 years, with ADHD (n = 7,024), ASD (n = 1,200), DD (n = 3,276), LD (n = 7,482), and without special health care needs (n = 44,461) were studied. Unadjusted analyses found that children with DEVDIS engage in higher rates of screen time than youth without special health care needs. For youth with DEVDIS who were medicated for their ADHD, these associations attenuated. Thus ADHD symptoms, a common comorbidity across developmental disabilities, drove associations between the other developmental disabilities and screen time. Across all developmental disability groups, television in the bedroom was a significant screen time risk factor in both children and adolescents. Among children with ADHD, additional screen time risk factors included lack of caregiver knowledge of the child’s friends and any social engagement outside of the household. Among adolescents with ADHD, additional screen time risk factors included lower frequency that caregiver attends adolescent’s events and sport social engagement. Findings of this dissertation elucidate modifiable screen time risk factors that could potentially be adapted to decrease screen time among youth with developmental disabilities.

Background: Major depression is one of the most prevalent, disabling, and costly illnesses worldwide. Despite a 400% increase in antidepressant medication use since 1988, fewer than half of treated depression patients experience a clinically meaningful reduction in symptoms and uncertainty exists regarding how to successfully obtain symptom remission. Identifying homogenous subgroups based on clinically observable characteristics could improve the ability to efficiently predict who will benefit from which treatments. Methods: Latent class analysis and latent transition analysis (LTA) were applied to data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study to explore how to efficiently identify subgroups comprised of the multiple dimensions of depression and examine changes in subgroup membership during treatment. The specific aims of this dissertation were to: 1) evaluate latent depression subgroups for men and women prior to antidepressant treatment; 2) examine transitions in these subgroups over 12 weeks of citalopram treatment; and 3) examine differences in functional impairment between women’s depression subgroups throughout treatment. Results: Four subgroups of depression were identified for men and women throughout this work. Men’s subgroups were distinguished by depression severity and psychomotor agitation and retardation. Severity, appetite changes, insomnia, and psychomotor disturbances characterized women’s subgroups. Psychiatric comorbidities, especially anxiety disorders, were related to increased odds of membership in baseline moderate and severe depression subgroups for men and women. After 12 weeks of citalopram treatment, depression severity and psychomotor agitation were related to men’s chances of improving. Severity and appetite changes were related to women’s likelihood of improving during treatment. When functional impairment was incorporated in LTA models for women, baseline functional impairment levels were related to both depression subgroups at baseline and chances of moving to a different depression subgroup after treatment. Conclusion: Depression severity, psychomotor disturbances, appetite changes, and insomnia distinguished depression subgroups in STAR*D. Gender, functional impairment, comorbid psychiatric disorders, and likelihood of transitioning to subgroups characterized by symptom improvement differed between these subgroups. The results of this work highlight how relying solely on summary symptom rating scale scores during treatment obscures changes in depression that might be informative for improving treatment response.

The purpose of this study was to examine parents’ management styles when caring for adult children with serious mental illness (SMI), as well as parents’ perspectives on what type of community-based mental health interventions would support and/or enhance overall family functioning. This qualitative descriptive study was undergirded by Knafl and Deatrick’s Family Management Style Framework. Thirty parents (N = 30) caring for adult children with SMI over age 18 were recruited as participants. Demographic data included age, gender, ethnicity, educational level, annual income, and National Alliance on Mental Illness membership. Parents were interviewed in their homes or other private setting. Verbal informed consent was obtained. Audio-recorded, individual, semistructured interviews were conducted until redundancy was achieved. Data were analyzed using qualitative content analysis. Four major themes emerged from the data. These themes described prolonged, difficult, and confusing phases that parents and the family undergo in caring for an adult child with SMI. These phases have a progressive nature, moving from parents recognizing that their child has a SMI to redefining family life as a result of caring for an adult child with SMI. Successful management of these phases must include increasing access to mental health information, mental health screening, early interventions, violence prevention, and various treatment options for adult children and their families.

Fans of college sports embrace the idea of athletes playing sport and, in turn, receiving tuition scholarships that provide them an opportunity to trade athletic talent for a free education. A contradictory body of research using internal colonization theory posits that the trade of education for playing sports is not a fair exchange but is fraught with exploitation that continues to perpetuate subjugation. An accepted narrative in athletic competition is that the recruiting pipeline draws athletes from impoverished inner-city areas engaging young athletes who experience difficulties keeping up scholastically becoming academically resistant as they focus on their sport at the expense of their academics. Biopsychosocial and developmental neuroscience research recognizes outside social factors as variables that affect the development of the brain, thus influencing basic mechanical operations of specific brain structures. This dissertation breaks new ground by utilization of the 10-question Adverse Childhood Experiences (ACE) Inventory to explore a possible relationship between ACE scores and Academic Resistance (AR), ACE scores and Locus of Control, and ACE scores and Identity Foreclosure. Using the T-test to determine a relationship between 194 participants’ ACE scores and AR, the findings showed the probability of Type I error of 5%, to be that the AR of student athletes with an ACE score >=2, n=94, to be significantly higher than the AR of student athletes with an ACE

Similar to other immigrant populations in the United States, Haitians have a migratory history of escaping from political turmoil, natural disasters, and extreme poverty (Zephir, 2004). However, Haitian Americans remain one of the underserved populations in the United States. Marginalized yet resilient, Haitian families in the U.S. continue to display strength in the face of adversity. Second-generation Haitian-American college graduates are the evidence of such strengths. There is very little research focused on second-generation Haitian-American college graduates’ perspective on the possible familial influences pertaining to education. Using an Interpretative Phenomenological Analysis (IPA) design and Bowen’s Family Systems Theory as a theoretical framework, this study explored the lived experiences of seven selected selfidentified second-generation Haitian-American college graduates. The study was driven by three questions: 1. How do second-generation Haitian-American college graduates describe their cultural views on education? 2. How do these cultural views on education inform or influence Haitian families living in South Florida? 3. What are the lived experiences of second-generation Haitian-American college graduates regarding their family of origin’s influences on them as it pertains to education? Six themes emerged as a result: Multigenerational Method of Transmission, Reminiscent Educational Dialogue, Education as Economic Protection, Expected Educational Momentum, Future Multigenerational Method of Transmission, and Broadening the Educational View. It is the hope of the researcher that this study will expand marriage and family therapists’ understanding of the possible cultural/familial concerns, as well as, possible strengths and resources when working with Haitian families.

Transgender individuals go through their intrapersonal differentiation between covert “I” (expressed gender) and overt “I” (assigned gender), often unnoticed by family members before their coming out. Consequently, their coming out rockets anxiety in the family system and the process of differentiation of transgender parents seem to go through its unique path to search for equilibrium. Recent social and clinical studies about transgender parents have paid attention to the experience and challenges of the gender transition process, social pressure, acceptance of transgender individuals in a parenting role, and readiness of families to cope with the transition of a parent (Bischof, Warnaar, Barajas, & Dhaliwal, 2011; Chung, 2016; Di Ceglie, 1998; Freedman, Tasker, & Di Ceglie, 2002; Haines, Ajayi, & Boyd, 2014; Hines, 2006; Theron & Collier, 2013; Veldorale-Griffin, 2014; White & Ettner, 2004, 2007). No research study has attempted to explore the essence of transgender parenting and the related self-differentiation process (Bowen, 1978; Kerr & Bowen, 1988). In this research, I intended to address this gap in knowledge by utilizing a heuristic phenomenological research design to explore the essence of parenting and self-differentiation of transgender parents. I used interviews with ten transgender parents, both females, and males, to embrace the elements of the lived experienced. The first conducted heuristic analysis revealed five emerging themes: Selfish Unselfishness: Becoming Me; Relationship with My Close Family: It is About Respect; Battle of Emotions: Do the Right Thing; Competence, Confidence, and Legacy: This Is How We Do It. Or Not; and Life Satisfaction: Welcome to My World. The second, qualitative data analysis, brought evidence of these qualities of self-differentiation: Balancing Individuality and Togetherness; Balancing Thoughts and Feelings; and Self-differentiation in the Expressed Gender.