Nurses working in an acute psychiatric setting within a veterans' administration hospital must maintain a therapeutic milieu by recognizing and managing aggressive behaviors before violence ensues to reduce injuries to staff nurses and patients. The purpose of this project was to develop an evidence-based and theoretically grounded educational program that will help staff nurses manage escalating aggression, violence, and acting out behaviors to provide a safe environment for patients and staff through high risk identifier recognition and intervention training. During the data and information gathering stage, 23 articles were reviewed, rated, and graded to provide the most significant information used to complete the project. The project is a workshop made up of a 6-module curriculum that will be used to train staff nurses. This workshop will be shared with the partnering organization including the recommendation that it is adopted and implemented at a later date. The educational training program will have the potential to become a practice standard for other acute psychiatric settings within the Veterans Integrated Service Network to provide a tool that will assist the nurses as they care for the patient and maintain safety. Social change will occur through the empowerment of nurses who interact with veterans to bring them better and safer care.

Concerned that depression might be a common malady among youth who are placed in treatment centers for delinquents, we undertook an exploratory study to determine the validity of this premise. The authors of this study have all worked with youth who, for various reasons, have been placed in residential treatment centers. The authors have observed that symptoms of depression seem to be more prevalent in these youth than in non-institutionalized adolescents, and that these symptoms are often perceived as individual pathology rather than emotional responses common to institutionalized youth. We thus began questioning if these were common emotional responses, and if they were common in males and females in a number of treatment centers. We were interested in knowing if the youth do in fact become more, depressed after being admitted to a treatment center, and if they do, at what point in their stay at the center this occurs.

This study examined the relationship between performance in a leveled token economy for emotionally disturbed adolescents and posttreatment level of functioning six months after discharge from the target program. The target program for the study is an acute care psychiatric hospital which specialized in the treatment of adolescents with both emotional and substance abuse problems. Previous literature on the outcome of token economy treatment programs however for they adolescents have generally been favorable have typically not examined level of functioning as an outcome criteria.

Perceived quality of care and burnout affects psychiatric care workers profession-ally and physically. Psychiatric caregivers working in forensic facilities encounter negative changes with perceived quality of care and burnout when working with offender patients. Recognizing the variables that lead to burnout and perceived quality of care may assist professionals and organizations with the information needed to prevent burnout and poor perceived quality of care among psychiatric caregivers. Using self-efficacy theory as a framework, this correlational design examined whether years of experience, self-efficacy, and caseload complexity predict burnout and perceived quality of care. A total of 148 psychiatric caregiver participants completed questionnaires comprised of the Maslach Burnout Inventory-HSS, General Self-efficacy Scale, and Quality of Care Measures (staff-form), along with demographic questions. Multiple regression determined that self-efficacy and years of experience significantly predicted personal accomplishment, which is a subscale of burnout. However, self-efficacy did not predict of depersonalization or emotional exhaustion the other 2 subscales of burnout. Self-efficacy was also found to be a positive predictor of perceived quality of care. The research findings have the potential to influence social change by providing professionals and organizations a better under-standing of the factors that influence burnout and perceived quality of care when work-ing with offender patients. In relation, improvements in trainings, interventions, and strat-egies for positive employee well-being and increased patient care could possibly reduce burnout and increase perceived quality of care.

People with intellectual disabilities (ID) experience trauma and posttraumatic stress disorder (PTSD) in similar ways as individuals in the general population. The purpose of this phenomenological study was to explore and describe clinicians perceptions of trauma treatment for people with ID. Theories of trauma, PTSD, and stigma were part of the conceptual framework from which interview questions were developed. Purposive and snowball sampling were used to recruit 8 participants in the Denver, Colorado area. Four participants had experience working with people with ID, and 4 participants did not have this experience. Participants sat for semi structured open-ended recorded interviews, which were used to gather data for interpretation. Eight essential themes were identified: (a) chosen field, (b) lack of training, (c) stigma and stereotypes, (d) they're just folks like us, (e) preying on their vulnerabilities, (f) PTSD and trauma symptoms are the same with people with ID, (g) EMDR and the adaptive information processing theory, and (h) mindfulness interventions. The participants dispelled myths such as people with ID do not experience trauma and PTSD, and people with ID cannot participate in trauma therapy such as EMDR. Participants who had experience working with people with ID wanted more training on adaptations for treatment interventions, and participants without this experience welcomed advanced training on trauma treatment for people with ID. This study adds to the research on trauma treatment for people with ID and may affect social change by inspiring more conversations among clinicians on appropriate trauma treatment for people with ID. Clinicians with experience can build stronger relationships with community mental health centers, and continue to educate, clients, families, direct care providers, and agency personnel on trauma-informed care.

Military sexual trauma (MST) has been associated with poor emotional and psychological well-being, less overall life satisfaction, and poorer health in general as well as higher rates of posttraumatic stress disorder (PTSD). The Department of Veterans Affairs provides treatment for veterans who experienced MST and recommends cognitive processing therapy (CPT) as a preferred treatment modality. Quantitative studies have shown that CPT can decrease symptoms of PTSD; however, a neglected area of study concerns the experiences of veterans who receive CPT for MST-related PTSD. In this generic qualitative study, the perceptions and experiences of female veterans who were survivors of MST and received CPT from a VA provider through a feminist lens were explored. Twenty-one female veterans who were survivors of MST and who sought treatment at the VA and received CPT were asked to complete a written questionnaire. The research questions explored the participants' experiences with CPT, changes in their symptoms, social lives and relationships, and general functioning and well-being after receiving CPT. Thematic analysis was used to identify 3 themes. Findings revealed that although participants described their experience of deciding whether to participate in CPT and receiving CPT as difficult, they reported increased quality of life and improved well-being after CPT. The results from this study will increase understanding of the experiences of veterans with CPT. Finally, scholar practitioners may be able to use findings from this study to enhance awareness of perceptions of clients, improve practice, and better serve clients who have experienced MST.

Vicarious trauma impacts counselors in various ways: by diminishing their feelings of importance in the profession, hindering their completion of adequate work with clients, and negatively affecting their personal life choices. Although numerous qualitative and quantitative studies have been conducted on vicarious trauma over the past 20 years, there is a rarity of research investigating the implications of trauma for counseling supervisors. The purpose of this study was to examine the lived experiences and perceptions of tertiary trauma among 11 counselor supervisors from Oklahoma and Missouri who were providing active supervision. This study was approached through a hermeneutic phenomenological methodology. The overarching research question investigated how counseling supervisors defined tertiary trauma. Interviews were transcribed and uploaded into NVivo 10, and constructs were identified via an exploratory and inductive analysis. Codes and sub-themes were categorized then deductively divided into 6 primary themes that demonstrate participant perceptions of tertiary trauma. These themes included: (a) what it means to be a supervisor, (b) the understanding of vicarious trauma, (c) the base knowledge of tertiary trauma, (d) the symptoms of tertiary trauma, (e) the meaning of supervisor wellness, and (c), the and role of the supervisor. Findings from the study offer the counseling profession a working definition of tertiary trauma based in counseling supervisors' perception of the phenomenon. The study outcomes are unique because counseling supervisors are vital to the continued growth of both the profession and new counseling professionals, acting as gate keepers to the counseling profession.

Counselor education and supervision (CES) faculty members are responsible for adequately preparing counselors-in-training (CIT) for their work with diverse populations. Current literature explains traditional multicultural counseling education in this way; however, little research is available exploring faculty members' personal and professional experiences with intersectionality and how those experiences contribute to their pedagogy. In this dissertation, CES faculty members' experiences with intersectionality theory and how they could use this theory in their multicultural pedagogy were explored. Research questions exploring CES faculty use of intersectionality in their multicultural coursework, how their personal experiences contribute to their pedagogy, and their experiences with privilege and oppression were used to guide the study. The method of inquiry used to collect and analyze data was heuristic in nature due to the focus on contextual experiences of the participants as well as the researcher. The results showed how 7 CES faculty members' personal and professional experiences influence their incorporation of intersectionality in their multicultural pedagogy. There were for themes identified in this study: Privilege and Oppression and the use of Intersectionality in Pedagogy, Intentionality and Responsibility to the Students, and Intersectionality for Empowerment and Building Bridges in the Classroom. Based on the themes and findings, the current study could lead to change regarding how multicultural issues are taught and supervised by CES faculty members at CACREP accredited institutions.

In recent years, the percentage of incarcerated individuals with mental illness has dramatically increased. It is very hard to provide treatment and care for these defendants in jails or prisons. Currently, there are more mentally ill individuals incarcerated than in psychiatric hospitals. Furthermore, as budget cuts are being decided, urban and rural communities in America are looking at ways to help the mentally ill by initiating a mental health court (MHC) or continuing to fund an already existing MHC. Guided by the therapeutic jurisprudence theory, the purpose of this study was to elicit the opinions from MHC professionals regarding the strengths and weaknesses of MHCs in addressing the needs of defendants, their victims, and the communities in which they live, in order to gain the recommendations for program improvement from the professionals who have knowledge of the impact of public safety, recidivism rates, and quality of life for mentally ill defendants. Study participants answered questions about several aspects of MHCs, such as length of incarceration, application of the therapeutic jurisprudence theory, treatment planning, and institutional budget constraints. The interviews were coded using NVivo, looking for common words, statements, and themes across responses. Mental health courts have been shown to save thousands of dollars to local community budgets, provide professional support and complete the judicial system requirements. This study furthers social change by supporting the rationale for MHCs: to help prevent defendants with mental illness involved in the criminal justice system from reoffending, thereby improving community safety and reducing justice system costs over the long term.

Building Resiliency and Coping Effectiveness (BRACE): A Program for Military Families by Linda Zarrett MSN, University of Cincinnati, 2012 BSN, Minnesota State University, Moorhead, 1985 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University August 2015 Veterans returning from combat report significant family strain and Post Traumatic Stress Symptoms (PTSS) yet have limited access to care resources. Family members, including children, report very similar symptoms to those of veterans and have yet fewer health care resources. The purpose of this project was to apply principles from existing research on post-traumatic stress and secondary trauma to providers as the basis for a curriculum for families of combat veterans with PTSS. The health beliefs model and Orem's self-care deficit theory were used to guide development of this curriculum. Long-term goals of this initiative are increased resiliency in families of combat veterans with PTSS, decreased family conflict, diminished incidence of secondary trauma in children, and reduced productivity losses and education losses in this population. The project was designed as the first stage of a long-term quality improvement initiative. Products of the project include a curriculum and plans for implementing and evaluating the curriculum. Products were developed in collaborative meetings with stakeholders, including the grant administrator, a social services representative, a military member, and a military family member. The curriculum was reviewed for content validity by sending sections to nurse scholars with relevant context expertise, after which revisions were made in accordance with feedback. Implementation and evaluation plans suggest use of a web-based program hosted by the Minnesota Association of Children's Mental Health. Increasing resources for combat veterans and their families has important implications for positive social change. This project may also address the reluctance of this population to engage in treatment by applying principles of military culture and concern for confidentiality, and may aid cost reduction through prevention of complications of secondary trauma.