Little is known about the effectiveness of HIV testing and counseling programs to inspire behavior change among patients seen at US clinics for Sexually Transmitted Diseases (STDs). We studied changes in gonorrhea incidence from 1989 through 1993 in a historical cohort of 4,031 patients seen at a public STD clinic in New Orleans, Louisiana. To determine if HIV testing and counseling promote risky behaviors, we designed a pretest-posttest observational study which included a treatment group and an untreated comparison group. The frequency, timing, and results of the HIV tests performed during follow-up were taken into account in the analysis. We used Cox's proportional hazard regression techniques for multivariate failure time data to model the occurrence of gonorrhea infections over time. The models adjusted the comparisons for history of gonorrhea, and HIV testing and counseling, as well as important confounding factors. We found that being tested and learning about a negative test result may have prevented up to 1,318 gonorrhea infections (34.7 percent of the expected total number of infections) among individuals who never tested HIV positive. The risk of gonorrhea remained constant at a low level among 911 individuals who were not tested during follow-up (22.6 percent of all patients). The risk of gonorrhea decreased markedly after HIV testing among 2,041 individuals at low baseline risk (50.6 percent of all patients), decreased moderately after each of the first two HIV tests among 672 subjects at intermediate baseline risk (16.7 percent of all patients), but increased after the first test among 358 subjects at high baseline risk (8.9 percent of all patients). Posttest counseling was associated with a marginally significant decline in risk of gonorrhea among subjects at low baseline risk, but had no apparent effect on the other patients. No disinhibition effect was observed after posttest counseling. Our study suggests that HIV testing and counseling promote safer behaviors in most patients diagnosed with gonorrhea in a public clinic for sexually transmitted diseases. Nevertheless, a possible rebound effect was observed after HIV testing among patients who had the highest baseline risk of gonorrhea / acase@tulane.edu

This work seeks to construct and implement in two Baptist churches a viable congregational model for doing youth ministry, which can be used to improve positive self-esteem in Black children, ages ten thru eighteen. Positive self-esteem is examined in the congregational settings by posing and answering six (6) questions: What is Self-Esteem? Who is God? Who am I? Who are you? Who are we in Christ? and What ought we do? These six (6) questions form the essence of positive self-esteem. The model uses family relationships between adult presenters and the intended youth, adult presentations on Christian identity and action in the congregation, field trips, Black history materials in the homes, and visual aids as the vehicles to accomplish the improvement in the positive self-esteem of the youth. The model responds to the threat to positive self-esteem of many of the youth as evidenced by racism and discrimination in American society, the presence of several indicators of negative or low self-esteem, problems in the very institutions that influence positive self-esteem, and adult perceptions of the social environment. It is based on the premise that the church must provide the family with the tools to help our children survive in this society. This will be accomplished by preparing our youth to affirm positive actions that build and affirm positive self-esteem and to reject the negative actions that counter it. This project seeks to use the extended family system and the conjugal family system of the children in their quest for positive self-esteem because of its potential as a positive influence. Finally, this work seeks to place the responsibility of the children in the hands of the entire church family, which is called to actively work to nurture them in this crucial and critical time in their lives.

This dissertation offers an interdisciplinary model of pastoral counseling with 'interdependence' as its organizing principle. This interdisciplinary model relies on the theological concept of Community, according to Howard Thurman, and the psychological issue of dependence as articulated in the Object Relations theory of W. R. D. Fairbairn. Interdependence as a norm for this interdisciplinary Community/Mature Dependence model of pastoral counseling is helpful in that it responds to a need in the field of pastoral counseling for relevant input concerning norms, values and criteria for effective pastoral counseling with persons, particularly those from bi-cultural communities, such as African Americans. In this respect, the African American cultural values of Collective Identity, Family life and Resiliency in Struggle and Suffering form an integral part of this interdisciplinary model. Interwoven with the theological and psychological concepts and the African American cultural values are the clinical cases of two African Americans, a female and a male. These concepts and the cultural values chosen to bring to bear on the counseling relations with these persons are especially helpful due to their focus on the value of communal interrelating and the processes of whole-making. Prominent issues raised in conjunction with the clinical cases are: (1) the fragmentation, splitting and distorted self images that can occur due to improper nurturing in childhood and/or as a result of racism and oppression, (2) the effects of racism and discrimination on personal and familial value systems, and (3) the pain and suffering caused by unresolved conflict involved in the status of being bi-cultural. Howard Thurman, as an African American theologian who, from outside the majority culture and some of its theoretical and cultural constrictions brings to this discussion his unique perspective of Community which grounds all persons and all dimensions of personhood in an Ultimate unity. Thurman, speaking with the insights of one who has suffered racial oppression and discrimination, lifts his voice of sensitive concern and caring to all persons bound in the human condition and outlines the task for the reconciliation of all of creation. Unity, Actualization of Potential, Love and Reconciliation are the four major components of Thurman's concept of Community addressed in this dissertation. My analysis also brings the object relations theory of W. R. D. Fairbairn into dialogue with Thurman, the cultural factors and the clinical data from the two case studies. Fairbairn, deviates from psychoanalytic tradition in that he formulated an alternative interpretation of the core of personality than that advocated by Sigmund Freud. Fairbairn's assertion is that the libidinal ego is first and foremost in need and in search of an satisfying object, i.e., a meaningful and positive relationship with another person. With the help of Thurman, Fairbairn, the clinical cases and African American cultural factors, I highlight the illusory or at best transient nature of independence and the process I demonstrate the need for an appreciation of the nature of dependency, particularly in the context of Interdependence. A three dimensional model of pastoral counseling is presented which elaborates upon the importance of (1) the client's historical situation and cultural values; (2) identification, a proper sense of self and differentiation; and, (3) shared suffering, actualization of potential and liberating and reconciling love.

The main thrust of this dissertation is the development and effectiveness of a pastoral counseling center in an African-American church. Prior to the development of this pastoral counseling center, there were none in an African-American church in the southeast. This document seeks to link the need for pastoral counseling centers to the rich history of care offered by the African-American Church. A consideration of theological issues regarding pastoral counseling and developing pastoral counseling centers is offered in this dissertation. Also, a look at liberation as being the aim of theology is presented. In addition, the theology of the pastoral counselor who developed this center can be found in this dissertation. The factors to be considered when developing a pastoral counseling center in an African-American church are offered in this dissertation. The organizational structure and methodology of this center are also elaborated upon in the document. Included is a description of the various individuals who were directly involved in the development of the pastoral counseling center. Additionally, a description of the church where the center was developed is given which includes a demographic study of the community, a historical view of the host church, and a description of the city where the church is located. To ascertain the effectiveness of the pastoral counseling center, interviews with the senior pastor, the ministerial staff, the advisory committee, and selected clients were conducted. A summary of services rendered at the center over a one-year period is presented in the dissertation. Finally, a comprehensive look at the training and the process of certification of a pastoral counselor is documented. The training of a pastoral counselor is linked to the development and effectiveness of the pastoral counseling center. There is also given a general theory of the development of a pastoral counseling center in an African-American church.

The purpose of this research project was to design an alternative ministry for recovering substance abusers and alcoholics during a twelve-week period. This recovery ministry was used in conjunction with Alcoholic Anonymous. The difference between this ministry and Alcoholics Anonymous is the qualitative base upon which this ministry was established and proclaimed. The Christian Church and Alcoholics Anonymous can be used as parallel rehabilitative agencies for substance and alcoholic abusers to a point. This recovery ministry leads the substance abuser and alcoholic to another level of understanding that God is the supreme being that brings deliverance to the addict. The ministry setting is the Third Street Church of God in Washington, D.C. The recovery ministry was developed from the Urban Prayer Breakfast Ministry at this church. The Urban Prayer Breakfast Ministry provides breakfast five days a week to one hundred people who are homeless, substance abusers, and poor. A recovery ministry was established for this particular population. Therefore, it was the writer's intention to organize another way of helping the hurting in this community. Interviews were conducted with one hundred persons of the Urban Prayer Breakfast Ministry who would be interested in participating in the recovery ministry. There were thirteen adult clients (twelve males and one female) from the treatment group who expressed an interest. The clients were given a screening interview prior to acceptance into the recovery ministry. A post-interview evaluation was given at the end of the twelve-week ministry. Five male clients completed the twelve-week recovery ministry. This dissertation includes a twelve-week outline for a spiritually-based program, the interview questionnaire, drug and alcohol testing results, and a daily itinerary of the recovery ministry. One male client did remain drug free during the last six weeks of the recovery ministry. This project was designed to help persons become free of substance abuse. The writer believes that it is possible for a person who desires freedom from substance abuse dependency to gain deliverance in twelve weeks. However, freedom from substance abuse dependency is a one day at a time process. Some substance abusers are delivered instantaneously, others are delivered over a period of time, and some never gain total deliverance from substance abuse. The mission of this project was to create an atmosphere where substance abusers could receive help with their addiction. During the hours of 7:00 p.m. and 9:00 p.m. on Mondays, Wednesdays, and Fridays of the twelve-week recovery ministry, the clients did not engage in substance abuse.

The purpose of this study was to examine the predictive and content validity of the Portraits Questionnaire (PQ), a universal values survey, for use with consumers of state-federal rehabilitation services. Convenience samples of Native American and Non-Native American consumers receiving services from Arizona Rehabilitation Services Administration were selected to represent the range of value priorities found in the diverse national population of rehabilitation consumers. A test for predictive validity was established by proposing a null hypothesis that the responses to the PQ by the study groups would not predict group membership. An examination of content validity was based on the logical relationship between the responses to the PQ by the two study groups and the values attributed to the two study groups in the literature. Two null hypotheses were established to test content validity. The first null hypothesis predicted that the Native American group would not assign a higher priority to PQ value types, Benevolence, Tradition, Conformity, and Security, than the Non-Native American group would. The second null hypothesis predicted that the Non-Native American group would not assign a higher priority to value types, Self-Direction, Stimulation, Hedonism, Achievement, Power, and Universalism, than the Native American group would. Copies of the PQ were mailed to 259 Native American and 263 Non-Native American consumers. Usable responses were received from 96 members of the Native American group and 97 members of the Non-Native American group. Discriminant Analysis of the data produced a significant discriminant function (Wilks' Lambda = .856, p = .001) that predicted correct group membership for 65.8% of the cases. The null hypothesis was rejected and predictive validity of the Portraits Questionnaire for the study groups accepted. Univariate analysis of the data revealed two significant (p ≤ .05) discriminant variables, Tradition and Stimulation. The standardized canonical discriminant function coefficients indicated that both variables were predictors of Native American membership. Therefore, both null hypotheses for content validity were retained. Tradition was the only value type that predicted group membership as expected. Interpretations of the results are offered and implications presented. The need for further research is discussed.

This research describes the development and the content validation of the Counselor's Theoretical Orientation Inventory (CTOI). The purpose for developing the CTOI is to: (1) stimulate the critical thinking skills that drive academia and counseling therapy, (2) help rehabilitation counseling students to assess their theoretical orientation, (3) use as an educational instrument for teaching counseling theories, (4) use as an appropriate instrument for practica and internship placement, and (5) use as an ongoing self-evaluation to enhance continuing education. Ten hypothetical case scenarios about individuals with differing disabilities were written by the researcher. Seven expert professional counselors, each representing seven different counseling theoretical orientations, provided rejoinders for each case scenario. The counseling theories represented in the CTOI are: Adlerian, behavioral, cognitive-behavioral, existential, gestalt, person-centered, and reality. Seven rehabilitation counselor educators assessed the CTOI for content validity. Of the theories, the rehabilitation counselor educators identified the person-centered rejoinders at the rate of 97%. The rehabilitation counselor educators identified the remaining theories above the acceptable 70% criterion except for existential theory which received only 69% correct identification. The CTOI was found to have content validity as the overall theory recognition score was 79%. Recognition of counseling theoretical orientations can help rehabilitation counselors to recognize incongruencies between personal and theory-driven beliefs and values and enable them to articulate a personal theoretical approach.

The purpose of this study was to develop a profile of the domestic violence abuser in Pima County during the year 1990. The population for this study consisted of 160 abusers who had been arrested for domestic violence and referred to the Pima County Attorney's Domestic Violence Diversion Program. The profile information was gathered from law enforcement reports, assessment forms, and domestic violence questionnaires. Also presented are conclusions, discussions, and implications. The profile areas of this study include the relationship between the victim and the perpetrator, the length of the relationship between the victim and the abuser, the number of children living in the home, the perpetrator's level of education, the ethnicity of the abuser, the age of the abuser, the employment status of the perpetrator, the income level of the perpetrator, the number of prior arrests and convictions, the abuser's alcohol and drug using behaviors, prior domestic violence events and frequency, the likelihood of repeated domestic violence, the abuser's support system, prior counseling experience, and present counseling received.

<p>This mixed methods, phenomenological study examined how cultural tension influences career development for Asian American community college students. Students initially completed Phinney's (1992) Multigroup Ethnic Identity Measure (MEIM) and an instrument developed for this study called the Cultural Identification Survey. The mean for ethnic identity search was 3.49 and the mean for the ethnic identity commitment was 3.97. High exploration with high commitment corresponds to Phinney's third stage of ethnic identity development, ethnic identity achievement. On the Cultural Identification survey, the mean for "I identify more with my parents' culture" was 3.55, the mean for "I identify more with White culture than my parents' culture" was 2.80, the mean for "I identify with both White culture and my parents' culture" was 3.45, and the mean for "I feel caught between White culture and my parents' culture" was 2.62. Fourteen students who indicated either "often" or "all the time" to the statement "I feel caught between White culture and my parents' culture" participated in the interview portion of the study. The 14 participants received a mean of 3.30 for ethnic identity search and a mean of 3.56 for ethnic identity commitment on the MEIM corresponding with the ethnic achievement stage. Participants described how they experienced cultural tension through their relationships with their parents. The results indicated that through cultural tension, participants were able to move through the stages of ethnic identity development as described by Phinney (1990), Parental influence on career development, including their support, their understanding of careers, and their exposure to careers, was also found to be part of the participants' experiences. Cultural tension and their parental involvement created learning experiences that had an impact on the career decision-making process. </p>

<p> This study utilizes Allan Guggenbuhl's seven-step Mythodrama method of resolving conflict and bullying in a school setting which has proven successful in Europe, applies this to a school setting in the United States, and measure that application to see if this intervention for addressing conflict and bullying is successful in a setting in the United States. Pre- and post-testing was conducted and some statistically significant improvement post-intervention was found. Study results suggest this methodology would have efficacy when applied broadly in US schools.</p>