Childhood sexual abuse among males has been associated with many negative psychological outcomes. Studies have attempted to identify which sexual abuse characteristics (e.g., duration, age of onset) are associated with mental health difficulties. While informative, this research has been mostly limited to variable-centered analyses, which do not capture the heterogeneity in males’ abuse experiences and psychological presentations. This two-part dissertation advances our understanding of how best to measure childhood sexual abuse and how to account for the diversity of sexual abuse experiences and outcomes among men using a person-centered approach. Given that there are few validated measures of childhood sexual abuse, the first study examined the psychometric properties of a commonly-used measure in the sexual abuse literature, the Sexual Victimization Survey (SVS; Finkelhor, 1979). Once the validity and reliability of the SVS were established, the SVS was used to generate profiles on the basis of abuse characteristics (Study 2). Data for both studies were drawn from a sample of 302 males (85% Caucasian) aged 18 to 65 years seeking support for childhood sexual abuse. Participants completed a modified version of the SVS as well as the sexual abuse subscale of the Childhood Experiences of Violence Questionnaire-Short Form (CEVQ-SF; Tanaka et al., 2012). Twenty-one males completed the SVS again one week later for test-retest purposes. The SVS showed high inter-rater reliability on sexual abuse status and sexual abuse characteristics. Most males (85%) who endorsed sexual abuse on the SVS did so on the CEVQ-SF, resulting in fair concurrent validity. The SVS showed perfect one-week test-retest reliability on abuse status, as well as good to excellent agreement on sexual abuse characteristics between the initial and one week time points. Given the strong psychometric properties of the modified SVS, it was then used to generate childhood sexual abuse profiles in Study 2. Once participants with significant missing data were deleted, 215 men remained and were included in the generation of profiles. Latent profile analyses revealed three distinct profiles which varied in the severity of abuse experiences. The Severe profile (n = 56, 26%) depicted sexual abuse which began in mid-childhood and consisted of a one or two time fondling by an unfamiliar extrafamilial perpetrator. Men in the More Severe profile (n = 71, 33%) also experienced abuse in mid-childhood by an extrafamilial perpetrator, but experienced more severe sexual acts that spanned several months to several years. Men in this profile were emotionally closer to their perpetrators prior to abuse onset than males in the Severe profile. The Most Severe profile (n = 88, 41%) depicted abuse which began in early childhood and consisted of very severe sexual acts by trusted individuals both within and outside of the family. Men in the Most Severe were significantly more likely to concurrently have experienced child emotional and physical abuse as well as a greater number of non-victimization adversities, compared with men in the other two profiles. Profiles varied with respect to psychological outcomes. Males in the More Severe and Most Severe profiles reported significantly more internalizing problems than men in the Severe profile, and men in the Most Severe profile reported significantly more trauma symptoms than men in the Severe profile. Certain contextual variables were also associated with greater psychological difficulties, namely greater present-day use of avoidant coping predicted more internalizing and externalizing problems, as well as greater trauma symptoms. Worse childhood family functioning was associated with more internalizing and externalizing problems, and disclosure of the abuse (compared to non-disclosure) was associated with more externalizing problems and trauma symptoms. These results have several research and clinical implications, including tailoring assessment and treatment to meet the individual needs of male survivors.

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Most physical rehabilitation services are not person-centered. Occupational therapy practitioners (OTPs) are vested in person-centered approaches, thereby they are optimally positioned to take leading roles in these quality improvement (QI) activities. Yet, there is a lack of OTPs-led QI activities on person-centered rehabilitation, and seminally, a lack of a QI guide informing these activities. To shape the evidence- and theory-based QI guide, we engaged a small international sample (n= 8) of potential end-users, i.e., OTPs in practice or management roles. The process involved three rounds of mixed-methods surveys, which helped in the design, refinement, and preliminary evaluation of the QI guide. Informed by theory, evidence and participants’ feedback, the final guide followed a “why, what, and how” structure. Six out of the eight participants rated the QI guide as one they are “very likely” to use. Also, the median rated value of the guide was “9” in a “0-10” scale. The QI was also well appraised by being an all-in-one resource to enable OTPs close the gap in person-centered rehabilitation practices and its improvement. The final version of the QI guide is ready to use and freely available in the Open Science Framework platform: http://osf.io/xzgpe/.

Bakgrund: Ett personcentrerat arbetssätt är en grund inom arbetsterapeutiska verksamheter, där varje person har ett unikt utgångsläge inom sina sociodemografiska faktorer och personliga preferenser, vilket kan påverka personers utförande av aktiviteter och delaktighet i det vardagliga livet. Syfte: Att granska och sammanställa hur personer som har deltagit i arbetsterapeutiska interventioner samt arbetsterapeuter upplever ett personcentrerat arbetssätt, för att få förståelse för svårigheter och möjligheter med detta arbetssätt. Metod: En kvalitativ litteraturöversikt av tidigare forskning. Resultat: Resultatet presenteras under rubrikerna och underrubrikerna: Hur personer som har deltagit i arbetsterapeutiska interventioner upplever ett personcentrerat arbetssätt; Svårigheter och möjligheter i samarbetet, Arbetsterapeuters upplevelser av ett personcentrerat arbetssätt; Svårigheter och möjligheter i samarbetet samt:Organisatoriska svårigheter och möjligheter med ett personcentrerat arbetssätt. Slutsats: En ökad förståelse för begreppet personcentrering behövs genom ytterligare studier, detta skulle bidra till mer kunskap om begreppets innebörd och hur det bör implementeras i svenska arbetsterapeutiska verksamheter. / Background: A person-centered approach is a foundation in occupational therapy activities, where each person has a unique starting point within their sociodemographic factors and personal preferences, which can affect people's performance of activities and participation in everyday life. Aim: To examine and compile how people who have participated in occupational therapy interventions and occupational therapists experience a person-centered approach, to gain an understanding of difficulties and opportunities with this approach. Method: A qualitative literature review of previous research. Results: The result are presented under the headings and subheadings: How people who have participated in occupational therapy interventions experience a person-centered approach; Difficulties and opportunities in the collaboration, Occupational therapists' experiences of a person-centered approach; Difficulties and opportunities in the collaboration and: Organizational difficulties and opportunities with a person-centered approach. Conclusion: An increased understanding of the concept of a person-centered approach is needed through further studies, this would contribute to more knowledge about the meaning of the concept and how it should be implemented in Swedish occupational therapy.

The purpose of this study was to explore how the therapist-provided conditions of congruence, unconditional positive regard, and empathic understanding were experienced and conveyed in child-centered play therapy (CCPT). Although the therapist-provided conditions are considered essential to the therapeutic process in CCPT, a gap exists between child-centered theory and empirical exploration of the process and dynamics of these relational variables in CCPT. Due to the limited research in this area, a grounded theory approach was utilized to explore how the three variables emerge in CCPT. Participants included four advanced doctoral students, all Caucasian females with extensive training in CCPT, and 12 children ranging from 4 to 8 years of age receiving weekly, individual CCPT. One individual CCPT session was observed and video-recorded for each therapist-child dyad (n = 12). Following each observation, play therapists were interviewed regarding the observed play session (n = 12). During each interview, the researcher and therapist watched the recorded play session in its entirety and discussed noteworthy interactions between the child and therapist. The video-recorded play therapy sessions and therapist interviews were analyzed using a multiphasic, constant comparative method. Results of the analysis included a process-model of the therapist-provided conditions in CCPT, examples of play therapists’ internal experiences and external behaviors associated with the presence and absence of the therapist-provided conditions, and a model of the process play therapists utilize to respond to breaks and barriers to congruence, unconditional positive regard, empathic understanding, and unconditional positive self-regard in CCPT. Implications for clinical practice, training, supervision, and research are discussed.

Half of the students who begin college do not complete a degree or certificate. The odds of completing a degree are decreased if a student has a low socio-economic status (SES), is the first in a family to attend college (first-generation), attends multiple institutions, stops out multiple times, reduces credit loads over time, performs poorly in major-specific coursework, has competing family obligations, and experiences financial difficulties. Stopping out of college does not always indicate that a student is no longer interested in pursuing an education; it can be an indication of a barrier or several barriers faced. Institutions can benefit themselves and students by utilizing person-centered statistical methods to re-engage students they have lost, particularly those near the end of their degree plan. Using demographic, academic, and financial variables, this study applied latent class analysis (LCA) to explore subgroups of seniors who have stopped out of a public four-year Tier One research intuition before graduating with a four-year degree. The findings indicated a six-class model was the best fitting model. Similar to previous research, academic and financial variables were key determinants of the latent classes. This paper demonstrates how the results of an LCA can assist institutions in the decisions around intervention strategies and resource allocations.

Introduction: Improving the quality of contraceptive care that youth receive improves the patient-provider relationship, satisfaction with care, and contraceptive method use and continuation. In recent years, high-quality contraceptive care for youth has shifted away from tiered effectiveness counseling and toward youth-friendly, person-centered contraceptive counseling (YFPCCC). Rooted in the reproductive justice movement, YFPCCC requires that counseling encourages youth to say what matters to them in their contraceptive method, respects youth’s preferences in their contraceptive method, provides youth with the information necessary to make the best choice for them, and is respectful of youth’s choices. YFPCCC is especially important for minor youth and youth of color who have historically received biased care and for youth in the United States South where restrictive policies may prevent youth from receiving care. This study examined youths’ perspectives of YFPCCC at safety-net clinics in two states in the U.S. South. Methods: Between 2018 and 2022, a survey measuring patient perspectives of their contraceptive counseling was collected from youth (ages 16 to 24) who received care at federally qualified health centers (FQHCs) and health departments (HDs) in Alabama (AL) and South Carolina (SC). A total of 1,052 youth were included in the study (AL n=513 and SC n=539). Four survey items measuring the four components of person-centered counseling and two survey items measuring youth-friendliness (knowledgeable and trustworthy providers) were dichotomized into Yes/No responses and combined to create two new variables measuring PCCC and providers’ youth-friendliness. PCCC and youth friendliness were compared across clinic type, state, age, race/ethnicity, and insurance coverage using logistic regression. P-values less than 0.05 were considered significant. Results: Overall, 56% of youth in the study reported that they received all four components of PCCC and 71% reported that their providers were youth-friendly. Minor youth (ages 16 and 17) were 34% less likely than older youth (ages 20-24) to report receipt of PCCC (aOR 0.66, 95% confidence interval (CI) [0.45, 0.98]). Minor youth were also 39% less likely than older youth to report that their provider was youth-friendly (aOR 0.61, 95% CI [0.40, 0.93]). Non-Hispanic Black youth were 45% less likely than non-Hispanic White youth to report PCCC (aOR 0.55 95% CI [0.40, 0.70]). Similarly, non-Hispanic Black youth were 44% less likely than non-Hispanic White youth to report that their provider was youth-friendly (aOR 0.56 CI [0.41, 0.77]). Discussion: Providing contraceptive care that is both person-centered and youth-friendly is essential in improving the quality of care that youth receive. In this study, minors and non-Hispanic Black youth were the least likely to report that their care was both person-centered and youth-friendly. This gap in the quality of care that non-Hispanic Black youth receive may contribute to lower satisfaction with care which may contribute to lower contraceptive use rates and higher unintended teen birth rates for this group. Clinics can improve their ability to provide YFPCCC by ensuring providers are trained in youth-friendly and person-centered contraceptive care.

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Past research on the impacts of acculturation gaps among immigrant family members has yielded inconclusive results potentially due to inconsistent analytical methods, lack of consideration of family processes, and discrepant conceptualizations of acculturation. With a sample of 161 Chinese Canadian immigrant families, the current study adopted a person-centred approach with a family lens to examine the nature of acculturation gaps and how these gaps were associated with family functioning and individual psychological adjustment. Latent profile analyses were utilized to generate mother-father-child acculturation profiles based on individual reports of acculturation (in the domains of cultural identity and value, separately) from mothers, fathers, and children in the same family. The results identified five family acculturation profiles in the identity domain and four family acculturation profiles in the value domain. Parents’ cultural disengagement was linked to the most positive psychological wellbeing and family relationships for all family members. The expected acculturation gaps in the Canadian host dimension were not found to be associated with the most depressive symptoms or family conflicts, suggesting that acculturation gaps where adolescents were more acculturated to the host culture than their parents may be normative in immigrant families and thus not linked to youth maladjustment. In contrast, the reversed acculturation gaps in the host dimension and the expected acculturation gaps in the heritage dimension were consistently found to be associated with family conflicts and individual psychological distress. The results also revealed an undifferentiated acculturation style that was not outlined in Berry’s model. An undifferentiated style was characterized by average acculturation levels on both the heritage and host dimensions, and it was the most prevalent individual acculturation style in the identity domain and the second most prevalent style in the value domain. Directions for future research and the benefits of using a person-centered approach in the research of acculturation gaps are discussed. / Graduate / 2023-09-06