Fielding Graduate University

Scant research has addressed how maximizing, or the tendency to seek the ‘best’ alternative and not settle (Schwartz et al., 2002; Simon, 1955), relates to adolescents’ vocational behavior. In this exploratory study, high school seniors completed measures of maximizing, choice/commitment anxiety, career decidedness, and career exploration time. Seniors also expressed why they considered themselves maximizers or not and described reasons behind feelings of anxiety about career selection. Results showed that adolescents high in maximizing tendency also had heightened choice/commitment anxiety, higher decidedness, and had spent less time exploring careers. Adolescents explained reasons behind maximizing tendencies, such as finding stable careers and challenging themselves. They also provided reasons behind their career choice anxiety, including fear of failure or regret, inadequate work environments, and lack of opportunities. Overall, these findings clarify cognitive and emotional aspects influencing career decision-making in adolescents. Career counseling services can use this information to anticipate concerns and develop prevention programs.

Objectives The diagnosis of autism spectrum disorder (ASD) in adulthood is a growing area of research and practice as the number of adults seeking a first-time diagnosis has increased. Informants are often utilized to aid in the evaluation of ASD in childhood. Little is known regarding the convergence of self- and informant-report measures of ASD in adults and whether gender differences exist. We explored the convergence of self-report and informant ratings on two commonly used rating scales and a clinician observation measure for the diagnosis of ASD. Methods The present study explored the convergence of two commonly used measures (SRS-2 & AQ) and a clinician observation measure for the diagnosis of ASD in adulthood 155 pairs of adults (41.3% female; mean age = 33.19, SD = 11.46) and their informants (total sample, n = 310). Results Overall, self-report AQ and SRS-2 scores were significantly higher than informants. Gender was the most important predictor of poor convergence on AQ and SRS-2, with informants of females reporting significantly fewer ASD symptoms compared to males with a first-time diagnosis of ASD in adulthood. Informant report also did not significantly predict key functional outcomes (i.e., employment, living situation) over and above self-report alone. The present study also found no significant differences in measures regardless of the informant utilized (e.g., parents, spouses). Conclusions Gender is an important factor in the assessment of ASD in adulthood. Thus, practitioners assessing female adults ought to interpret discrepant informant-report results with caution. Researchers ought to continue to examine how ASD measures perform for females and ensure they are normed appropriately with females and males. A wider variety of informants such as a sibling or a friend may be appropriate if a parent or spouse is unavailable.

Objective This systematic review aimed to compile existing evidence examining the effects of mindfulness-based interventions (MBIs) for chronic low back pain (CLBP). CLBP leads to millions of disabled individuals in the US each year. Current pharmacologic treatments are only modestly effective and may present long-term safety issues. MBIs, which have an excellent safety profile, have been shown in prior studies to be effective in treating CLBP yet remained underutilized. Design Ovid/Medline, PubMed, Embase, and the Cochrane Library were searched for, randomized controlled trials (RCTs), pilot RCTs and single-arm studies that explored the effectiveness of MBIs in CLBP. Methods Separate searches were conducted to identify trials that evaluated MBIs in reducing pain intensity in individuals with CLBP. A meta-analysis was then performed using R v3.2.2, Metafor package v 1.9-7. Results Eighteen studies used validated patient-reported pain outcome measures and were therefore included in the meta-analysis. The MBIs included Mindfulness Meditation, Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, Mindfulness Oriented Recovery Enhancement, Acceptance and Commitment Therapy, and Dialectical Behavioral Therapy, Meditation-CBT, Mindfulness-Based Care for Chronic Pain, Self-Compassion course and Loving-Kindness course. Pain intensity scores were reported using a numerical rating scale (0-10) or an equivalent scale. The meta-analysis revealed that MBIs have a beneficial effect on pain intensity with a large-sized effect in adults with CLBP. Conclusion MBIs seem to be beneficial in reducing pain intensity. Although these results were informative, findings should be carefully interpreted due to the limited data and the high variability in study methodologies. More large-scale RCTs are needed to provide reliable effect size estimates for MBIs in persons with CLBP.

Objective: To build upon existing recommendations on best practices for chiropractic management of children by conducting a formal consensus process and best evidence synthesis. Design: Best practice guide based on recommendations from current best available evidence and formal consensus of a panel of experienced practitioners, consumers, and experts for chiropractic management of pediatric patients. Methods: Synthesis of results of a literature search to inform the development of recommendations from a multidisciplinary steering committee, including experts in pediatrics, followed by a formal Delphi panel consensus process. Results: The consensus process was conducted June to August 2022. All 60 panelists completed the process and reached at least 80% consensus on all recommendations after three Delphi rounds. Recommendations for best practices for chiropractic care for children addressed these aspects of the clinical encounter: patient communication, including informed consent; appropriate clinical history, including health habits; appropriate physical examination procedures; red flags/contraindications to chiropractic care and/or spinal manipulation; aspects of chiropractic management of pediatric patients, including infants; modifications of spinal manipulation and other manual procedures for pediatric patients; appropriate referral and comanagement; and appropriate health promotion and disease prevention practices. Conclusion: This set of recommendations represents a general framework for an evidence-informed and reasonable approach to the management of pediatric patients by chiropractors.

Background Through our work, we have demonstrated how clinical decision support (CDS) tools integrated into the electronic health record (EHR) assist providers in adopting evidence-based practices. This requires confronting technical challenges that result from relying on the EHR as the foundation for tool development; for example, the individual CDS tools need to be built independently for each different EHR. Objective The objective of our research was to build and implement an EHR-agnostic platform for integrating CDS tools, which would remove the technical constraints inherent in relying on the EHR as the foundation and enable a single set of CDS tools that can work with any EHR. Methods We developed EvidencePoint, a novel, cloud-based, EHR-agnostic CDS platform, and we will describe the development of EvidencePoint and the deployment of its initial CDS tools, which include EHR-integrated applications for clinical use cases such as prediction of hospitalization survival for patients with COVID-19, venous thromboembolism prophylaxis, and pulmonary embolism diagnosis. Results The results below highlight the adoption of the CDS tools, the International Medical Prevention Registry on Venous Thromboembolism-D-Dimer, the Wells’ criteria, and the Northwell COVID-19 Survival (NOCOS), following development, usability testing, and implementation. The International Medical Prevention Registry on Venous Thromboembolism-D-Dimer CDS was used in 5249 patients at the 2 clinical intervention sites. The intervention group tool adoption was 77.8% (4083/5249 possible uses). For the NOCOS tool, which was designed to assist with triaging patients with COVID-19 for hospital admission in the event of constrained hospital resources, the worst-case resourcing scenario never materialized and triaging was never required. As a result, the NOCOS tool was not frequently used, though the EvidencePoint platform’s flexibility and customizability enabled the tool to be developed and deployed rapidly under the emergency conditions of the pandemic. Adoption rates for the Wells’ criteria tool will be reported in a future publication. Conclusions The EvidencePoint system successfully demonstrated that a flexible, user-friendly platform for hosting CDS tools outside of a specific EHR is feasible. The forthcoming results of our outcomes analyses will demonstrate the adoption rate of EvidencePoint tools as well as the impact of behavioral economics “nudges” on the adoption rate. Due to the EHR-agnostic nature of EvidencePoint, the development process for additional forms of CDS will be simpler than traditional and cumbersome IT integration approaches and will benefit from the capabilities provided by the core system of EvidencePoint.

This chapter provides an overview of the anti-oppressive resilience-enhancing stress model’s methodology and its application with clients and constituencies who are facing stressful transitions or adverse critical events. The guide outlines content that informs the social worker’s use of a narrative interview in the four phases of the social work helping process. It spells out steps social workers can take to assist clients and constituencies in ameliorating problems of daily living encountered during challenging person-environment encounters. The guide covers how social workers gather data that individualizes a client’s varying responses to stress or risks. Tables and a toolkit provide a further understanding of these procedures.

This chapter discusses the intergenerational transmission of resilience from a sociocultural and structural point of view. It highlights anti-oppressive intervention strategies used in the resilience-enhancing stress model (RESM) that address the fact that the large-scale societal risks that may lead to environmental injustice are disproportionately distributed across subpopulations of US society. As a result, vulnerable individuals and social groups may experience discrimination-related stress and a decrease in resilient social functioning. At the same time, societal and sociocultural environmental influences can act as protective factors that can contribute to the enhancement of resilience, growth, and transformation. As social workers come to understand a client’s or constituency’s meaning of sociocultural events, this knowledge can inform their choice of RESM assessment and intervention skills that ameliorate discriminatory stress.

This chapter provides an overview of the resilience-enhancing stress model (RESM), an anti-oppressive human behavior and practice model intended to prepare social workers to serve clients and constituencies who are facing difficult life transitions, challenging environmental demands, or adverse critical events. It synthesizes four theories that constitute the RESM including risk and resilience theory, systems theory, ecological theory, and narrative theory. It also describes the four overlapping phases of practice consisting of engagement, assessment, intervention, and evaluation. The RESM model is suitable for working with diverse individuals, families, groups, organizations, and communities. Chapter 2 continues with an overview of the anti-oppressive practice methodology of the RESM.

This chapter is the first of three chapters that explore content related to the anti-oppressive approach to social work practice embedded in the resilience-enhancing stress model (RESM). It discusses the central person–environment focus, terms, and assumptions of the anti-oppressive approach, illustrating them with practice examples. Finally, the chapter describes how practitioners can combine traditional, RESM, and anti-oppressive skills and techniques to cocreate a client narrative during the four practice phases of the RESM. By referring to theory and skills in the RESM and the literature on AOP, social workers can expand the narrative interview, making it even more responsive to societal inequities.

At the height of the COVID-19 pandemic, many nursing home residents across the United States experienced numerous inordinate risks. News reports of residents’ strict social isolation and multiple untimely deaths heightened people’s awareness of the crisis in nursing home care. This chapter discusses how social workers can try to ameliorate this crisis by applying strategies from the anti-oppressive resilience-enhancing stress model to deliver quality care to nursing home residents and their families. The chapter also suggests resilience-enhancing functions and skills nursing home social workers can aspire to use to retain their residents’ social functioning and social identity in a multilayered nursing home environment by reducing risk and bolstering protective factors.

As US society grows increasingly diverse and polarized by civil strife, there is a greater need for social workers to give attention to protective factors that contribute to a positive cultural climate. This chapter continues to address anti-oppressive social work practice strategies embodied in the resilience-enhancing stress model (RESM). It offers social workers an understanding of how culture acts as a protective factor for clients making difficult life transitions or overcoming an adverse critical event. It explains how strong cultural identity and ties are positively related to a client’s or constituency’s resilient response to stress. Practice examples illustrate how social workers can use the helping process to identify and support cultural ties that enhance client resiliency during the RESM helping process.

This chapter discusses how social workers who practice with military personnel and their families can address issues important to sustaining resiliency. It provides tools and strategies social workers can use to explore a family’s communication and organizational patterns, belief systems that impact deployment-related stress, and maintenance of effective social functioning. The social worker’s role is to help the family reduce the stress brought about by multiple deployments and/or geographic relocations and improve overall family functionality. Social work family coaching skills in the resilience-enhancing stress model are provided to illustrate how a family coconstructed and reconstructed its grand narrative by joining in positive family conversations.

This chapter builds on previous chapters that have described the anti-oppressive social work practice approach of the resilience-enhancing stress model. It illustrates how interventions to combat societal inequities and exclusion can ameliorate clients’ and constituencies’ distress and increase their capacity to maintain resilience at multiple systems levels. Two practice examples illustrate social workers’ use of the model to counter human rights abuses and historical trauma that may stand in the way of resilient social functioning. They also shed light on strategies that can be used to help clients and constituencies adopt pathways that attempt to overcome the injustices of adverse critical events.

This chapter illustrates a contemporary postmodern narrative perspective on bereavement associated with an individual’s meaning-making, adjustment to loss, and resilient transformation. The narrative perspective of the resilience-enhancing stress model on a person’s reaction to grief and loss is discussed when a client tells and reconstructs a grand story of loss. The emphasis is on a meaning-making process that facilitates an individual’s or a collective’s transition to a new phase of life. The practice example describes portions of a family grand narrative, and excerpts from narrative interviews illuminate a story of individual and collective grief as a young client and her social worker go through the four phases of the resilience-enhancing stress model.

Pediatric chronic pain is an important public health issue given its notable impact on numerous domains of living. Pediatric chronic pain is also often comorbid with emotional, developmental, or behavioral conditions, which can lead to more severe negative outcomes and an even greater reduction in positive outcomes compared to those without comorbidities. Flourishing is a positive outcome that chronic pain status has been shown to impact. Flourishing in children aged 6–17 years living with chronic pain, as well as those with chronic pain and comorbidities, was explored using data from the 2018/2019 National Survey of Child Health. Chronic pain occurred in 4.0% of our sample, and the prevalence of chronic pain plus comorbidities was 3.9%. There were significant associations between the chronic pain condition status and all demographic variables (sex, age, race/ethnicity, poverty level, parental education, and health insurance status). The results of the hierarchical logistic regression found that the chronic pain condition status significantly predicted flourishing. Children with chronic pain were 2.33 times less likely to flourish, and children with chronic pain plus an emotional, developmental, or behavioral comorbidity were 13 times less likely to flourish than their typical peers. Given their significantly lower likelihood of flourishing, there is an urgent need for interventions targeted at children experiencing chronic pain and mental health comorbidities.

The time from when an ambulance paramedic receives the 911 alarm notification until they have determined the differential diagnosis of a patient is highly stressful. During this time, there is a high demand placed on the paramedic, and they have a low level of control. Recent advances in prehospital care that place more responsibility on paramedics have exacerbated this high-stress phenomenon. Twenty paramedics from across the United States were interviewed and evaluated using descriptive phenomenology to better understand one of the most stressful moments of high-stakes decision-making that paramedics regularly face. Using descriptive phenomenology, we identified six categories in the paramedics' interview responses: pressure, overwhelm, emotional extremes (with sub-categories of adrenaline rush and time-dilation), dissociation, multi-tasking, and disconnect. This analysis of the paramedic's lived experience of this high-stress, high-stakes phenomenon provides insight into how paramedics experience the unique stress of this phenomenon. This understanding is key to elucidating the effects of this acute stress that may impact the judgment and, ultimately, the care performed by the paramedic. Both early- and late-career paramedics from thirteen different states in all regions of the United States were interviewed. Further qualitative data from paramedics from a diverse range of regions and backgrounds are essential to identify ways in which to ameliorate the negative effects of acute stress experienced by paramedics. Addressing such issues will reduce turnover and burnout among paramedics.

Action Leadership for Adolescents (ALA) is a cutting-edge inclusive approach to adolescent leadership development. The Self-Reflection Evaluation Inventory evaluated the growth of 21st-century skills taught through the five principles of ALA. The five principles: Brain Balance, Skill Development, Interdisciplinary Collaboration, Innate Wisdom, and Cultural Responsibility; guided the curriculum of a course for seniors in a traditional high school and validated the hypothesis that the curriculum rooted in these principles ensured growth and empowerment for adolescents. ALA was born from a combination of Positive Youth Development and Transformational Leadership models and the efficacy of the approach was confirmed through the mixed-methods action research study presented in this article. Overall, the participants of the study demonstrated significant growth in the maturation of their 21st-century skills. The next steps for ALA include partnering with social researchers to continue analyzing the efficacy of ALA in all activities for adolescents.