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Paperwork, Paradox, and PRN: Psychotropic Medication Deficiencies in Assisted Living
Journal of Applied Gerontology, Ahead of Print.
Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure and processes of care. Policymakers might consider how regulations unintentionally incentivize task-oriented versus person-centered care practices.
Individual state approaches to assisted living/residential care (AL/RC) licensing and oversight in the United States result in different practice standards and requirements, including psychotropic medication use. We examined 170 psychotropic medication deficiency citations issued to 152 Oregon AL/RC settings from 2015 to 2019. Applied thematic analysis resulted in the following themes: (1) documentation issues are primarily responsible for noncompliance, (2) unclear parameters place direct care workers in a role paradox, and (3) there is a persistent disconnect about when to seek qualified expertise before requesting psychotropic medications. AL/RC-specific mechanisms for medication prescription and administration are necessary to improve the structure and processes of care. Policymakers might consider how regulations unintentionally incentivize task-oriented versus person-centered care practices.
A-Methodological Saturation: A Grounded Theory Analysis
The Counseling Psychologist, Volume 51, Issue 7, Page 933-969, October 2023.
The purpose of this qualitative study was to develop an abstracted theoretical model concerning how counseling and counselor education researchers utilize saturation in their qualitative research. Given the importance of rigor and trustworthiness in qualitative research, this study addresses saturation, a method for ensuring methodological rigor and trustworthiness. The qualitative study included 23 participants from a range of social locations, methodological expertise, and research agendas. The findings from this qualitative study were analyzed and presented using Straussian grounded theory and resulted in the development of an abstracted theoretical model, which included the following: causal conditions, contextual factors, intervening conditions, actions, consequences, and a core category. The abstracted theoretical model can aid researchers in the process and practice of saturation. Advances in saturation can support the development of rigorous qualitative research design and methodological integrity. Discussion and implications are discussed across the areas of practice, education, advocacy, and research.
The purpose of this qualitative study was to develop an abstracted theoretical model concerning how counseling and counselor education researchers utilize saturation in their qualitative research. Given the importance of rigor and trustworthiness in qualitative research, this study addresses saturation, a method for ensuring methodological rigor and trustworthiness. The qualitative study included 23 participants from a range of social locations, methodological expertise, and research agendas. The findings from this qualitative study were analyzed and presented using Straussian grounded theory and resulted in the development of an abstracted theoretical model, which included the following: causal conditions, contextual factors, intervening conditions, actions, consequences, and a core category. The abstracted theoretical model can aid researchers in the process and practice of saturation. Advances in saturation can support the development of rigorous qualitative research design and methodological integrity. Discussion and implications are discussed across the areas of practice, education, advocacy, and research.
An Integrated Behavioral-Neuropsychiatric Treatment Plan Reduces Severe Challenging Behavior in an Adolescent With Neurobehavioral Complications of Neonatal Brain Injury
Clinical Case Studies, Ahead of Print.
We present the case of a 15-year-old adolescent boy with a neurobehavioral disorder who experienced a brain injury during the first month of life. The forms of challenging behaviors were severe and included aggression, property destruction, volitional incontinence, and suicidal statements, and had resulted in two psychiatric hospitalizations and multiple emergency evaluations prior to intervention. The intervention was preceded by a functional behavior assessment suggesting that a differential reinforcement intervention could be designed to minimize reinforcement of challenging behaviors while maximizing reinforcement of adaptive, positive behaviors. The intervention was introduced following the baseline phase and there was an immediate decrease in the rate of challenging behaviors and in the utilization of emergency psychiatric services. Improvements continued for 6 weeks, after which a medication was added to promote sleep onset (to decrease sleep onset latency) along with behavioral guidelines, which led to further improvements for an additional 12 weeks. A follow-up phase of 3 months showed sustained results. The study illustrates the value of an integrated approach utilizing applied behavior analysis and sequenced neuropsychiatry, and a neurobehavioral formulation where components of the participant’s brain injury history are integrated with an operant formulation as circumstances that explain the problem behavior while effectively suggesting strategies for behavioral treatment. Because the intervention was implemented by support staff in a group home, it illustrates the ability of support staff to work therapeutically with severe behavior presentations using structured behavioral interventions.
We present the case of a 15-year-old adolescent boy with a neurobehavioral disorder who experienced a brain injury during the first month of life. The forms of challenging behaviors were severe and included aggression, property destruction, volitional incontinence, and suicidal statements, and had resulted in two psychiatric hospitalizations and multiple emergency evaluations prior to intervention. The intervention was preceded by a functional behavior assessment suggesting that a differential reinforcement intervention could be designed to minimize reinforcement of challenging behaviors while maximizing reinforcement of adaptive, positive behaviors. The intervention was introduced following the baseline phase and there was an immediate decrease in the rate of challenging behaviors and in the utilization of emergency psychiatric services. Improvements continued for 6 weeks, after which a medication was added to promote sleep onset (to decrease sleep onset latency) along with behavioral guidelines, which led to further improvements for an additional 12 weeks. A follow-up phase of 3 months showed sustained results. The study illustrates the value of an integrated approach utilizing applied behavior analysis and sequenced neuropsychiatry, and a neurobehavioral formulation where components of the participant’s brain injury history are integrated with an operant formulation as circumstances that explain the problem behavior while effectively suggesting strategies for behavioral treatment. Because the intervention was implemented by support staff in a group home, it illustrates the ability of support staff to work therapeutically with severe behavior presentations using structured behavioral interventions.
Assessment of implicit COVID-19 attitudes using affective priming for pro-vaccine and vaccine-hesitant individuals
Journal of Health Psychology, Ahead of Print.
The COVID-19 pandemic has resulted in the introduction of pharmaceutical and non-pharmaceutical interventions such as precautionary behaviours. The current study used affective priming to evaluate COVID-19 attitudes in vaccine-hesitant and pro-vaccine participants. Explicitly, both groups rated their overall perception of risk associated with contracting COVID-19 significantly lower compared to their perception of necessary precautions and overall adherence to public health measures. Pro-vaccine participants rated their perception of necessary precautions higher compared to vaccine-hesitant participants. During baseline measures, both groups classified COVID-19 affiliated words as unpleasant. Affective priming was observed for congruent prime-target pleasant and unpleasant word pairs but was not observed for COVID-19 related word pairs. Differences between groups in the perception of necessary public health precautions points to different underlying pathways for reduced perceived risk and lack of affective priming. These results refine previous findings indicating that implicit attitudes towards COVID-19 can be measured using the affective priming paradigm.
The COVID-19 pandemic has resulted in the introduction of pharmaceutical and non-pharmaceutical interventions such as precautionary behaviours. The current study used affective priming to evaluate COVID-19 attitudes in vaccine-hesitant and pro-vaccine participants. Explicitly, both groups rated their overall perception of risk associated with contracting COVID-19 significantly lower compared to their perception of necessary precautions and overall adherence to public health measures. Pro-vaccine participants rated their perception of necessary precautions higher compared to vaccine-hesitant participants. During baseline measures, both groups classified COVID-19 affiliated words as unpleasant. Affective priming was observed for congruent prime-target pleasant and unpleasant word pairs but was not observed for COVID-19 related word pairs. Differences between groups in the perception of necessary public health precautions points to different underlying pathways for reduced perceived risk and lack of affective priming. These results refine previous findings indicating that implicit attitudes towards COVID-19 can be measured using the affective priming paradigm.
Validation and psychometric properties of the Word Choice Test-10 as an abbreviated performance validity test
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Age effects on Wechsler Memory Scale–Fourth Edition (WMS–IV) indexes and subtests
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Experiences of meaning in life in urban and rural Zambia
Archive for the Psychology of Religion, Ahead of Print.
Meaning in life has become an important topic in empirical research in the psychology of religion. Although it has been studied and found applicable in many different contexts, research on meaning in life and sources of meaning in African countries is scarce. This study qualitatively investigates understandings and experiences of meaning in life and sources of meaning among urban and village dwellers with different educational backgrounds in Zambia. Seven focus group interviews (total N = 52) were conducted and analysed, drawing on Schnell’s model of meaning in life and sources of meaning. The results indicate that the concept of meaning in life is relevant to both urban and village dwellers in Zambia. Meaning experiences and sources of meaning are associated with certain life domains: relationships; religion; education and work; leisure activities; and health and survival. Each life domain includes several fundamental sources of meaning, which can be related to Schnell’s four dimensions of sources of meaning: self-transcendence, self-actualisation, order and well-being and relatedness. The results are discussed in light of extant studies on meaning and cultural characteristics in Africa.
Meaning in life has become an important topic in empirical research in the psychology of religion. Although it has been studied and found applicable in many different contexts, research on meaning in life and sources of meaning in African countries is scarce. This study qualitatively investigates understandings and experiences of meaning in life and sources of meaning among urban and village dwellers with different educational backgrounds in Zambia. Seven focus group interviews (total N = 52) were conducted and analysed, drawing on Schnell’s model of meaning in life and sources of meaning. The results indicate that the concept of meaning in life is relevant to both urban and village dwellers in Zambia. Meaning experiences and sources of meaning are associated with certain life domains: relationships; religion; education and work; leisure activities; and health and survival. Each life domain includes several fundamental sources of meaning, which can be related to Schnell’s four dimensions of sources of meaning: self-transcendence, self-actualisation, order and well-being and relatedness. The results are discussed in light of extant studies on meaning and cultural characteristics in Africa.
Measuring attentional blink magnitude: Reliability and validity of a novel single-target rapid serial visual presentation task index in a psychiatric sample
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Hope, quality of life, and psychological distress in patients on peritoneal dialysis: A cross-sectional study
Journal of Health Psychology, Ahead of Print.
Hope is a goal-directed thought that reflects the sense of control over uncertainties and can promote adjustment to chronic illness. This study aimed to assess the level of hope among patients on peritoneal dialysis and evaluate the association of hope with health-related quality of life and psychological distress. This cross-sectional study included 134 Chinese patients receiving peritoneal dialysis in Hong Kong. Patients’ level of hope was assessed using the Adult Trait Hope Scale. Participants who were employed, had a higher income, and received automated peritoneal dialysis reported a higher hope score. Hope was found to have significant correlations with age and social support. A higher hope score was associated with better mental well-being and less severe depressive symptoms. Specific relationships between agency/pathway thinking and these outcomes were identified. The patient subgroups at risk for losing hope need to be identified and received early interventions to prevent adverse outcomes.
Hope is a goal-directed thought that reflects the sense of control over uncertainties and can promote adjustment to chronic illness. This study aimed to assess the level of hope among patients on peritoneal dialysis and evaluate the association of hope with health-related quality of life and psychological distress. This cross-sectional study included 134 Chinese patients receiving peritoneal dialysis in Hong Kong. Patients’ level of hope was assessed using the Adult Trait Hope Scale. Participants who were employed, had a higher income, and received automated peritoneal dialysis reported a higher hope score. Hope was found to have significant correlations with age and social support. A higher hope score was associated with better mental well-being and less severe depressive symptoms. Specific relationships between agency/pathway thinking and these outcomes were identified. The patient subgroups at risk for losing hope need to be identified and received early interventions to prevent adverse outcomes.