abstract: The purpose of this study was to examine the association between characteristics of the symptomatology change curve (i.e., initial symptomatology, rate of change, curvature) and final treatment outcome. The sample consisted of community clients (N = 492) seen by 204 student therapists at a training clinic. A multilevel approach to account for therapist effects was followed. Linear, quadratic, and cubic trajectories of anxiety and depression symptomatology, as assessed by the Shorter Psychotherapy and Counseling Evaluation (sPaCE; Halstead, Leach, & Rust, 2007), were estimated. The multilevel quadratic trajectory best fit the data and depicted a descending curve (partial “U”-shaped). The quadratic growth parameters (intercept, slope, quadratic) were then used as predictors of both symptom change and reliable improvement in general symptomatology (pre- to post-treatment), as assessed by the Outcome Questionnaire-45.2 (OQ-45.2; Lambert, Hansen, Umpress, Lunen, Okiishi et al., 1996). The quadratic growth parameters of depression and anxiety showed predictive power for both symptom change and reliable improvement in general symptomatology. Patterns for two different successful outcomes (1-change in general symptomatology and 2-reliable improvement) were identified. For symptom change, successful outcomes followed a pattern of low initial levels of depression and anxiety, high initial rates of change (slope), and high (flattening after initial drop) curvature, and the pattern applied to both within- and between-therapist levels. For reliable improvement at within-therapist level, successful outcomes followed a pattern of high initial rate of change (slope) and high curvature. For reliable improvement at between-therapist level, successful outcomes were associated with a pattern of low initial levels of depression and anxiety. Implications for clinical practice are discussed. / Dissertation/Thesis / Doctoral Dissertation Counseling Psychology 2018

<p>With the current emphasis on evidence-based physical therapy practice, there is a need to understand how published research is translated into practice and utilized by clinicians (Hudon, Gervais, & Hunt, 2015; Jewell, 2018). Knowledge translation (KT), the process of moving research evidence into day-to-day practice, encompasses awareness of new evidence, modifications of existing beliefs and changes in clinical behaviors. The process of KT may be affected by factors associated with the practice environment, the new knowledge or the individual (Logan & Graham, 1998; Rogers, 2003d). Engagement in KT helps to ensure that practitioners are maintaining currency with the research evidence and narrowing the knowledge-to-practice gap (Rogers & Martin, 2009b; Sudsawad, 2007). There is a paucity of research examining physical therapists? experiences with acquiring and utilizing research evidence for practice in early intervention (Sudsawad, 2007). The purpose of this study was to explore the process of knowledge translation for physical therapists in early intervention through a theory-driven approach adapted from the Diffusion of Innovations Theory and Ottawa Model of Research Use. A qualitative exploratory study was conducted with 36 practicing physical therapists from early intervention programs in New York State. The therapists were asked to describe their practice patterns and how they acquire and utilize new knowledge. The conceptual model captured data relevant to the process of KT. The model enabled the researcher to understand the important role that social networks have for this group of physical therapists, identified therapists based on their utilization of research-informed interventions, and identified contributing factors that exist within the individual, the practice environment and the knowledge itself that impact the utilization of research evidence. The findings indicate variability in practice patterns among the physical therapists in this study. Some of the therapists reported using research-informed treatment interventions and others did not. The factors that influenced variability include level of professional education, membership in professional organizations and opportunities to network with professionals that have adopted an evidence-based approach to practice. The results of this study provide important information related to how physical therapists are acquiring their knowledge in early intervention and how they are practicing. Next steps would be to gather data clarifying the steps that move therapists from acquiring research evidence to implementation. Interpretation of physical therapists? experiences in knowledge translation is an important step in closing the knowledge-to-practice gap.

<p> A central challenge in California is how best to provide speech and language services to linguistically and culturally diverse (CLD) populations, given that only a small percentage of speech-language pathologists (SLPs) identify as bilingual. The present thesis investigated whether bilingual speech-language pathology assistants (SLPAs) can serve as suitable collaborators with SLPs in the process of carrying out screenings and assessments of CLD students/clients. A survey was administered to 6 bilingual SLPAs who reported that they currently assist with bilingual assessment. The results revealed that these participants expressed confidence in their ability to assist in assessments of CLD students/clients. This confidence seems to stem from their linguistic fluency, as well as from their cultural competency. Moreover, these SLPAs reported making use of materials and procedures identified as best practices. However, training for assisting in CLD assessments was largely obtained during work experience, not from formal coursework. Future research will be needed to identify how SLPA training programs can best train bilingual SLPAs to competently assist in CLD assessments in California schools and clinics.</p><p>

<p> The purpose of this study was to explore how listeners perceived adults who use speech modification techniques for stuttering and how these techniques affect listener comfort. Eighty-nine university undergraduate students completed Likert-type scales and answered descriptive questions to rated four audio samples presenting stuttered speech, prolonged speech, speech with pull-outs, and speech with preparatory-sets.</p><p> The results of the scales reveled that listeners perceived the use of preparatory-sets to be a significantly more natural and less handicapping form of speech than the other experimental conditions. No significant differences were found in personality judgments of the speaker. However, all four conditions were rated to have an overwhelmingly negative impression, which was primarily described with negative communication and personality attributes.</p><p> Listener comfort was significant more positive in the preparatory-set condition than the other conditions and in the stuttered speech condition compared to the prolonged speech condition. Most participants reported that listener comfort was influenced by the negative speech attributes of each condition, which varied across conditions. The participants were significantly less willing to socially interact with the speakers using prolonged speech. </p><p> The results of this investigation supported the use of preparatory-sets to increase perceived speech naturalness, listener comfort, and to decrease perceived handicap. The use of prolonged speech at reduced speech rates should be used with caution as it can lead to increased negative socially interaction and listener comfort. However, all the speech conditions were rated more negatively than the norms for fluent speech. Therefore, counseling and desensitization techniques should be incorporated in interventions for stuttering.</p><p>

<p> This study focused on the experience of stigma in adults who self-identify as having a lisp. Data were gathered and analyzed using a mixed-methods methodology. This research design allowed for multiple data collection procedures, including quantitative surveys and rating scales, completed by both listeners and self-identified adults who lisp (SIAWLs) and qualitative semi-structured interviews of SIAWLs. These combined procedures allowed for the adherence to the theoretical appropriateness of qualitative approaches to stigma and disability and for the incorporation of quantitative objectivity. </p><p> The results of the quantitative data yielded varied conclusions regarding listener ratings of SIAWLs compared to SIAWLs&rsquo; ratings of themselves. These results also yielded varied conclusions regarding listener and SIAWL ratings of lisping stigma awareness, lisping stereotype agreement, and (SIAWLs only) stigma self-concurrence. Applied thematic analysis of the qualitative semi-structured interview responses yielded eleven superordinate themes. Each theme was examined for its possible association with public and self-stigma in the creation of a new model of reinforcement of structural stigma. These emergent themes supported Goffman&rsquo;s stigma theory and the consideration of lisping as a minor bodily stigma. The integration of the qualitative and quantitative approaches allowed for in-depth illustrations of each interviewed individual SIAWL. This study emphasized the importance of considering the experience of the SIAWL as a highly personal one. These research findings have important implications for the value of using mixed-methods research designs to investigate, acknowledge, illuminate, and legitimize this personal and variable experience of stigma or lack thereof in adults who self-identify as speaking with a lisp.</p><p>

The client of this case study was a twenty two year old female in her first year at university. The client had come into therapy because she had felt depressed, lonely and riddled with selfdoubt. The author used a Narrative Therapy approach with the client and was focussed on helping the client generate new meanings and stories that were more useful and empowering for the client. In this case study, the author was interested in exploring the process of change that the client underwent during the therapy process and he would rely on identifying innovative moments to track these changes. This interest informed the research question; what is the process of change in narrative therapy as tracked through the therapeutic dialogue? How does the change process in this case study track with the heuristic model of change put forward by Gonçalves and his colleagues? The author chose to use a pragmatic hermeneutic case study method in order to analyse the data and the results were organised into a coherent narrative. The data was collected from twenty two therapy sessions and these were grouped together into themes, namely a quick start, the beginning of change, thickening the innovative moments and lighting the fire. The results of this study reveal that despite being considered a good outcome case by the author, the process of change differed somewhat to that proposed by the heuristic model of change.

The Multicultural Communication Bridge Program, an ongoing project at the Broward Correctional Institution, utilizes creative movement, writing, and drawing as treatment modalities with long-term incarcerated women. This type of programming is new in the prison system thus literature and research supporting the outcomes with this population are lacking. Therefore, a qualitative study was conducted to determine the efficacy of the program. Nine inmates, who have been involved in the program for at least one year, were interviewed to gather information about their personal experiences as a result of their participation. Common themes that were noted include an increase in trust, the expression of emotions, an increase in self esteem, and an improvement in interactions with others. These attributes are believed to be beneficial to these women to ensure a successful community reintegration upon their release from prison.

The current study assessed the effects of participation in an Arthritis Foundation sponsored water exercise program on self-reported functioning and health status. Nine older community living women with various forms of arthritis took part in this pre to post-test design study, along with a comparison group of eleven older women also regularly engaged in differing forms of exercise. Both groups completed a standardized questionnaire, the Arthritis Impact Measurement Scales 2, twice over an eight week period. Twelve scales and additional questions measured physical, social, and psychological aspects of daily functioning. Aquacize participants reported significant improvements in the Physical Component area of functioning from pre to post-test, as well as more improvements in Arm Function and Household Tasks than the comparisons. Occupational therapists need to be aware of the efficacy of programs to which they refer their arthritic clients. Findings support, regular participation in aquacize has a positive influence on health.

The purpose of this study was to compare age-related differences in self-reported health and self-reported functional abilities from 1971 individuals surveyed in the Comprehensive Needs Assessment Survey of Elders 60 years and Older in Dade County. The responses were divided into four age groups: (a) 60 to 64 years, (b) 65 to 74 years, (c) 75 to 84 years, and (d) 85 years and older and results compared. The study found that self-reported health ratings were significantly different across the four age groups and exhibited a gradual decrease in favorable health ratings with age. For all ages, at least 60% of the respondents rated their health as either "excellent" or "good", but this percentage decreased from 68.10% in the youngest group to 60.7% in the oldest. The study also found significant differences across age groups in functional abilities as measured by reported difficulties with eight activities of daily living (ADLs) and eight instrumental activities of daily living (IADLs). For all ADLs and IADLs, the percentage of respondents reporting difficulty increased with age, but this increase was most dramatic in the oldest age group (85+ years). There was a positive relationship between self-reported health and functional ability in the four age groups and as the number of difficulties with ADLs or IADLs increased, self-reported health became poorer. However, the relationship between self-reported health and functional ability tended to weaken with age. Pearson correlation coefficients between self-reported health and difficulties with ADLs decreased from the youngest age group (r=.463) to the oldest group (r=.310). Similarly, the correlation between self-reported health and difficulties with IADLs was higher in the two younger age groups (r=.326 and r=.420) than the two older groups (r=.249 and r=.215). Pairwise z-tests revealed that the correlations of the oldest age group were significantly different from the other age groups. The study also found gender differences across age groups. The findings from this study suggest that there is a relationship between self-reported health and functional abilities and this relationship tends to weaken with age. The implications of these findings for occupational therapy with elderly clients are discussed.

A study was conducted in order to describe and understand the occupational role behavior of gay men with particular interest on understanding the impact of an HIV diagnosis on their roles and life satisfaction. A 137- item questionnaire was developed for this study and distributed through various gay community groups in south Florida. The process resulted in ranked description of 24 valued occupational roles of gay men (n = 80) along with a general understanding of potential shifts that may occur in those roles as a result of becoming infected with HIV. The study concludes that a diagnosis of HIV infection impacts gay men both by altering their value for particular roles and by darkening the images they hold of their future. The study also identified key factors which may contribute to the greater life satisfaction of gay men including greater confidence in personal knowledge of HIV, a more optimistic outlook on life, the use of stronger coping styles, and perceiving stronger social support and lower stress.