Fielding Graduate University
  • Santa Barbara, United States
Recent publications
Transgender and gender diverse (TGD) individuals experience minority stress that includes internalizing the negative attitudes that exist in society about those whose identities rest outside of the gender binary. The purpose of this study was to gain a better understanding of the experience of internalized stigma and associated coping methods among six TGD adults utilizing photovoice. Thematic and iconographic analysis of 35 works produced by the participants revealed themes involving metaphors for internalized transphobia, internalized social messages, the psychological debt or emotional cost of internalized transphobia, and a range of coping strategies. Specifically, invisibility was a common metaphor used to suggest that a TGD person’s experience may be associated with actively hiding, masking their identity, or failing to be seen as their true self. Participants expressed concern with being accepted by others and noted anxiety about outward expressions of their gender and personal characteristics. The results also revealed that participants experienced loneliness, fear of rejection, and low self-esteem related to internalized transphobia and their TGD identities. Participants reported receiving messages that TGD individuals are often viewed negatively and generally lack support from society and close relations. Coping strategies utilized by participants included withdrawing from others, hiding their TGD identity to avoid rejection or violence, self-exploration, accepting self and others, and connecting to a community of TGD persons and/or allies. Focus group feedback revealed benefits to participants, including an enhanced sense of community and self-esteem, as well as recommendations for future group structure. Implications and future research directions are discussed.
Although illegal, sexual harassment is endemic in US schools, with students perceiving that school officials ignore complaints of harassment. Research findings have linked school climate tolerant of sexual harassment to peer sexual harassment (PSH) and school outcomes, yet there is a need to better understand these relationships. This cross‐sectional study examined whether there was an indirect effect of school climate tolerant of sexual harassment on disengagement from school, individually and serially, through experiences of PSH victimization and feeling safe at school in a sample of 171 predominantly Black and White girls (14–19 years old) attending high school in the wider Memphis, Tennessee area. The findings supported that a climate tolerant of sexual harassment was indirectly related to school disengagement through PSH and feeling less safe. These findings add to the literature by demonstrating that a climate tolerant of sexual harassment, PSH victimization, and perceptions about personal safety are associated with harm to students’ academic outcomes in the form of school and academic disengagement. Further, the current findings suggest that a national agenda for school safety needs to consider school climate tolerant of sexual harassment in order to be effective in responding to sexual harassment and supporting student engagement.
Objective The COVID-19 pandemic has strongly influenced psychological and physical health worldwide. The aim of this study was to examine the impact of the pandemic on women with fibromyalgia. Methods This mixed methods pilot study explored measures of pain severity and interference, as well as pain catastrophizing and level of fibromyalgia impact among women with fibromyalgia before and during the COVID-19 pandemic in the USA. Fibromyalgia patients completed demographic, pain-related, and other validated psychosocial questionnaires prior to the onset of the COVID-19 pandemic, and then were re-assessed with those questionnaires, as well as a pandemic-related questionnaire assessing the impact of the pandemic on the patients’ life, during the pandemic. Results When comparing data reported before the pandemic to data collected 3–6 months into the pandemic, women with fibromyalgia reported a general worsening of their pain and pain-related symptoms. During the pandemic, pain catastrophizing (p ≤ 0.05) and fibromyalgia impact (p ≤ 0.05) increased significantly compared to before the pandemic. The increase in pain catastrophizing scores was highly correlated with the impact of the pandemic on the participants’ ability to cope with pain and on their mental health. Qualitative analysis corroborated the significant impact of the pandemic on patients’ mental health, with the vast majority reporting a worsening of their mood. Other impacted domains included anxiety, level of activity and sleep. Conclusions Collectively, the pandemic appears to have produced a substantive worsening of pain-related symptomatology among women with fibromyalgia, which should be addressed by targeted interventions.
Background Pediatric brain tumor (PBT) survivors are at risk for developing sleep disturbances. While in other pediatric populations sleep disturbance has been associated with worse cognitive functioning, it is unclear to what extent this relationship generalizes to PBT survivors. The aim of the current study was to assess the relationship between sleep disturbance and aspects of cognition, including sluggish cognitive tempo (SCT) as well as attention and working memory.Materials and Methods Eighty-three PBT survivors 6–18 years of age who were at least 3 months post-treatment were included in the present cross-sectional study. Level of sleep disturbance was measured as a composite score reflecting various sleep problems as rated by caregivers. Cognitive measures included caregiver-ratings of sluggish cognitive tempo and attention problems, as well as performance-based cognitive measures assessing attention and executive functioning. Hierarchical regression analysis was used to assess associations between sleep and cognition.ResultsOf all caregivers, 32.5% reported one or more sleep disturbances as “very/often true” and over 68% of caregivers rated at least one sleep-related item as “somewhat true.” Of all cognitive variables, scores were most frequently impaired for SCT (30%). A higher level of sleep disturbance was associated with worse SCT and parent-rated attention problems. Associations between sleep and performance-based cognitive measures assessing attention and working memory were not statistically significant.Conclusion Findings of the current study highlight the importance of further investigation into the relationship between sleep and cognition in PBT survivors, which may assist efforts to maximize cognitive outcome and health-related quality of life in PBT survivors. The current study additionally suggests further investigation of SCT in this population is warranted, as it may be more sensitive to detecting possible associations with sleep disturbance relative to discrete measures that assess cognitive performance under ideal circumstances.
Climate change, violence against women (VAW), and modern slavery are significant human rights crises to which women are disproportionately vulnerable. Our research examined the complex relationship between indicators of climate change, VAW, and the estimated prevalence of modern slavery across 180 countries. Regression analysis revealed significant results suggesting that countries where climate change and VAW are prevalent may support conditions that exacerbate vulnerability to exploitation. Results are placed within a gender framework, highlighting ecofeminism theory for an examination of patriarchal and capitalistic systems and their relationship to the oppression of women, the degradation of the environment, and modern slavery.
Rationale Occupation-based practice in the neonatal intensive care unit may be impacted by a plethora of contextual factors. There is limited literature of the lived experience mothers have with mothering occupations for the care of premature infants in a Level-IV neonatal intensive care unit. Methodology A phenomenological design was used to interview mothers of premature infants in a Level-IV neonatal intensive care unit. The eight participants were mothers who had been in the neonatal intensive care unit for at least 1 month. Data was obtained via demographic form, two individual semi-structured interviews for each mother, and fieldnotes. Results Thematic analysis yielded five themes and two subthemes which were: unanticipated journey to becoming a mother, emotional rollercoaster, mother’s lost voice, subtheme cultural influences, roadblocks to mothering, unexpected layer to mothering occupations and subtheme support for mothering occupations. Each theme described a mother’s experience with mothering. Conclusion There is an importance for neonatal occupational therapists to provide support for mothering occupations for mothers from a variety of demographic and cultural backgrounds. Occupation-based practice in the neonatal intensive care unit continues to need attention for inclusion of all mothers. The findings showed that cultural humility should be practiced in family-centred care in the neonatal intensive care unit.
Introduction and hypothesis: Atorvastatin (ATO) and its siblings in the statin drug class are widely prescribed as a lipid lowering agent. However, ATO in high doses can induce renal toxicity via oxidative stress. Thymoquinone (TQ), an extractive of Nigella sativa,is a natural antioxidant that has been shown to protect the kidney via its anti-inflammatory effects. The aim was to study the anti-inflammatory effect of posttreatment TQ and whether it could reverse the ATO-induced oxidative injury to the rat kidney. Methods: We used 4 groups of adult male Sprague Dawley rats (control; TQ-treated; ATO-post treated; ATO- post treated plus TQ-treated). Each group was formed of 10 rats. Ultrastructural, and morphometric analyses of the rat kidneys were performed. Statistical analysis was done using SPSS. One-way analysis of variance (ANOVA) and post hoc tests (Bonferroni test) were used to compare the means of different groups, expressing data as mean ± standard deviation (SD) and P values of less than 0.01 were expected to be significant. Results: Morphometric analyses of the ultrastructural examination revealed that the histopathological changes induced by post treatment ATO has improved in the ATO/TQ-treated group compared to the ATO- post treated group. Conclusion: Posttreatment TQ appears to reduce and reverse renal injury due to ATO-induced oxidative stress. TQ can potentially play a role in alleviating side effects in patients with kidney disease who are being treated with high dose of atorvastatin.
Introduction and hypothesis: In recent years, medical schools have modified their approaches to pre-clinical education to accommodate constantly evolving changes in science and medicine. As part of such effort, anatomy educators are leaning into novel teaching methods that support diverse learners beyond the traditional cadaver dissection. At the California University of Science and Medicine, School of Medicine (CUSM-SOM), a system-based active-learning curriculum has been designed and implemented. Howard Gardner's Theory of Multiple Intelligence proposes that human intelligence consists of at least eight modalities, suggesting that individual differences exist in their ways of learning. Developing active-learning laboratory sessions that support multiple intelligences - specifically, the visual-spatial, logical-mathematical, and bodily-kinesthetic knowledge - within anatomy education is critical. The aim of this study is to explore the effect of multidisciplinary, hands-on "Art in Anatomy" laboratory sessions, with an emphasis on visual learning, student engagement, wellbeing, creativity, and successful understanding of complex anatomical concepts. Methods: Each "Art in Anatomy" session has its own session learning objectives (SLOs) that align with course learning objectives (CLOs) of the system-based curriculum courses of first- and second-year medical students. Each one-hour session is composed of three twenty-minute phases: (1) didactic presentation, (2) model building in small groups, and (3) an interactive showcase where groups present and teach their models to other groups. During Phase 1, a professor presents the anatomical concepts relevant to the SLOs. In phase 2, five to six students explore one of the SLOs introduced in phase 1 by building a "craft" model of an anatomical structure, with appropriate arts and craft materials provided (i.e., construction paper, pipe cleaners, paper cups, etc.). The inter-group discussion in phase 3 reinforces student comprehension of the material. By the end of the hour-long session, students would have been exposed to the same anatomical topics from multiple perspectives. Moreover, students are asked to complete one pre- and two post- quizzes. The first post-quiz occurs just after the session, and the second post-quiz takes place four weeks after the session to assess the long-term memory retention of the SLOs. Results: The pre- and post-lab quizzes revealed that students have improved in their visual learning, class engagement, wellbeing, creativity, and content understanding of complex anatomical concepts. Furthermore, the small group discussion and critical thinking have reinforced students' comprehension of the SLOs as they fine-tuned their models to better reflect their understanding. Conclusion: "Art in Anatomy" could be an effective method to support knowledge acquisition of medical students in their pre-clinical years by incorporating visual arts and peer-to-peer collaboration. Increased engagement with anatomical content in a novel and creative environment may further encourage medical students to demonstrate their understanding of SLOs to other classmates.
The implementation of Person-Centred Care (PCC) by primary care teams is complex. Framed through the Quadruple Aim, successful healthcare system redesigns result in improved health outcomes of individuals and populations, reduce costs, and ensure an engaged and productive workforce. However, how can primary care teams achieve the Quadruple Aim? This article provides a learning and performance framework to support PCC through a Team-Based Care (TBC) ecosystem approach. We developed our approach using action research to improve TBC orientations, workshops, and consultations for teams and their leaders in Urgent Primary Care Centres and Primary Care Networks in Canada. This paper provides a synthesis of our experience in the context of the relevant evidence. We aim to share our efforts and acknowledge that our experience is still ongoing and complemented by ongoing improvement activities by others in the TBC ecosystem.
In the current healthcare climate, reimbursement for services is increasingly linked to the ability to demonstrate beneficial patient outcomes. Neuropsychology faces some unique challenges in outcomes research, namely, that neuropsychologists often do not follow patients over time and the effect of neuropsychological services on patient outcomes may not be fully realized until under another provider's care. Yet there is an urgent need for empirical evidence linking neuropsychological practice to positive patient outcomes. To provide a framework for this research, we define a core set of patient-centered outcomes and neuropsychological processes that apply across practice settings and patient populations. Within each area, we review the available existing literature on neuropsychological outcomes, identifying substantial gaps in the literature for future research. This work will be critical for the field to demonstrate the benefit of neuropsychological services, to continue to advocate effectively for reimbursement, and to ensure high-quality patient care.
A gap in research on cyberbullying intervention strategies exists. The purpose of this study was to identify effective coping strategies for cyberbullying by interviewing cyberbullying survivors. The study used grounded theory qualitative methodology to allow data to fully emerge from participants’ perspectives. When analyzing the data, the researchers found that youth engaged in three types of coping: online coping, offline coping, and intrinsic coping. Online coping involved online interventions to stop active cyberbullying and prevent future cyberbullying; for example, youth limited who had access to their online accounts or blocked and reported cyberbullies. Offline coping included strategies that participants engaged in offline to minimize, tolerate, or cope with the effects of cyberbullying, such as talking about their experiences or reframing the way that they think about things. Finally, intrinsic coping described survivors’ personality traits or ways of being that aided them in developing such resilient coping strategies; for instance, possessing self-awareness and self-love contributed to survival. Accordingly, the findings contribute to the literature on effective coping strategies by confirming previously identified strategies, like online coping, and highlighting new ones, like intrinsic coping. The findings also help inform future counseling practices within schools.
This longitudinal study examined associations between at‐home TV watching and the biological stress response (cortisol) during a laboratory infant cognitive challenge task in 240 3‐ and 5‐month infants and their mothers. Cortisol levels were lower in mothers of 5‐month‐old infants whose infants were exposed to TV at home, compared to mothers of infants that were not TV‐exposed. Cortisol patterns were different across three laboratory sampling intervals for 3‐month‐old infants as a function of TV watching, revealing a sharp increase in laboratory cortisol only for infants who were exposed to TV at home. In contrast, there was no effect of TV exposure in 5‐month‐old infants’ cortisol. Infant temperament and demographic measures were included as control variables in regression models to predict maternal and infant cortisol. At 3 months, for the T3 cortisol sampling interval, and at 5 months across all three sampling intervals, maternal cortisol levels were significantly predicted by infant TV exposure after accounting for variance due to these control variables. Our findings show the strong influence of the infant TV‐exposure factor in the biological stress response of mothers of young infants, and suggest that infant TV exposure may influence self‐regulation in 3‐month‐old infants.
Background: Flourishing is considered an optimal state of well-being and is associated with positive psychological outcomes. Although, individual, family, and social factors may either facilitate or impede flourishing, their unique influence on flourishing outcomes is not well-understood among youth. Objective: Using data from the 2016–2017 National Survey of Children's Health (NSCH), this study investigated cross-sectional associations among adverse family experiences (AFE), community safety, family resilience, parental aggravation, and flourishing among youth. Participants and setting: Data from the 2016–2017 NSCH (N = 51,156) were analyzed. Participants included males (n = 26,124) and females (n = 25,032) whose ages ranged from 6 to 17 years old (M = 12.14, SD = 3.45). Methods: After controlling for relevant demographics, adjusted odds ratios (AORs) using a singleblock logistic regression determined the relative likelihood of flourishing. Results: Youth who experienced zero to one AFE (AOR = 2.10; 95% CI [1.95, 2.26]) and two to three AFEs (1.32 [1.20, 1.45]) were more likely to flourish than youth with four or more AFEs. Youth whose parents endorsed low parental aggravation (6.80 [6.41, 7.22]) and moderate parental aggravation (3.70 [3.51, 3.89]) were more likely to be flourishing than youth whose parents endorsed high parental aggravation. Conclusions: Findings suggest that high parental aggravation is related to poorer flourishing outcomes, after considering community safety, family adversity, family resilience, and demographic characteristics. Providers should consider interventions to support the emotional regulation of parental systems as a means of maximizing developmental outcomes among youth.
Personality tests are frequently administered during the process of hiring police officers. The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is one of the most widely used instruments in the selection of candidates. Pre-employment MMPI-2 scores have also been used to predict police misconduct and early termination of police officers. This study looked at the predictive ability of the immaturity index for the early termination of officers. The immaturity index is a composition of three scales from the MMPI-2 that includes the Lie scale, Hypomania, and Psychopathic Deviate. Results showed the immaturity index as a significant predictor of officers being terminated for cause and no longer being employed by the department within one year of hire. This data supports the utility of the index for predicting potentially problematic behavior in police officer recruits. In addition, because the MMPI-2 is a common assessment given during the onboarding psychiatric evaluation of police officers, potential candidates for hire with elevated immaturity index scores may be reconsidered or warrant further evaluation.
Trauma is a growing public health concern as global crises increase. Trauma can result in significant adverse psychological outcomes such as posttraumatic stress disorder (PTSD). Past research indicates that forgiveness may buffer the adverse psychological effects of trauma. We hypothesized that restoring individual and collective sense of meaning promotes forgiveness toward self and others and enables posttraumatic growth (PTG). Established PTG models posit that meaning can be found in surviving a traumatic event. We propose that PTG manifests as forgiveness in the face of both natural and humanmade disasters. Data were collected from individuals ( N = 3,534) in 11 countries from diverse global regions that have experienced collective traumas. Our study examined the predictive nature of meaning in life and PTSD symptoms on forgiveness. Hierarchical regression analysis indicated that trauma and meaning significantly predicted forgiveness, with a larger effect for humanmade disasters. Results indicated that presence of meaning, but not search for meaning, plays a role in PTG as measured by the ability to forgive after experiencing trauma, thus demonstrating its possible centrality to the healing process. Interventions and community-based programs that foster meaning-making following trauma may be part of an effective multicultural approach for enhancing community-wide PTG and resilience following disasters.
Background Young children living with a depressed parent are at risk for developing social, behavioral, and emotional problems. The purpose of this study was to evaluate whether an increase in subclinical caregiver depression scores was associated with increases in internalizing and externalizing behavior in children who are high risk for maltreatment. Methods The 1,019 U.S. based dyads consisted of predominantly single (45.53%) and Black/African American (53.29%) caregivers and high-risk 4-year-olds from the LONGSCAN study. Multivariate regression analyses were used to evaluate the relationship between caregiver Center for Epidemiological Studies-Depression (CES-D) scores, above and below the at-risk for depression CES-D score, and preschooler internalizing, externalizing, and total problem behaviors, measured with the Child Behavior Checklist (CBCL). Results Caregiver CES-D score increases, above and below the at-risk for depression score, were significantly associated (p < 0.05) with increased child internalizing, externalizing, and total problem behaviors. After adjusting for covariates, among dyads whose caregivers had subclinical (CES-D <16) scores, a one-unit score increase was significantly associated with a 0.43 increase (p < 0.01) in children's CBCL internalizing score. Limitations These findings are restricted to preschool children who are at risk for maltreatment, limiting generalizability. Conclusions Low and moderate levels of caregiver depressive symptomatology was associated with negative influence on preschooler's adjustment. Practitioners should consider that the link between caregiver depression and child wellbeing may lie on a continuum. With consideration of the full continuum of symptoms, early intervention and anticipatory guidance may decrease the impact of depression on the caregiver, child, and system.
In this chapter, Warren discusses the multidimensional role of culture to understand the significance of hair combing interaction (HCI) for parent–child relationships. Culture is a powerful source of belonging—belonging to a family, a group of people, and/or to a place. How parents care for children—and their hair—can become a battle to belong or an easy opportunity to learn family cultural norms. This chapter discusses how the act of hair combing routines serves a cultural function in the development of children and their relationships with caregivers. The daily routines of living together, keeping house, feeding, and clothing family members all establish the family’s culture. Often, these routines are passed down intergenerationally. Warren then describes the general ways that children are socialized into their family culture, and the individual ways that they establish their sense of self within the family’s culture. The chapter ends with a series of pragmatic questions the helper might ask a family that will help broaden the understanding of culture and potential points of risk or resilience.
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Karen E Dill-Shackleford
  • School of Psychology
Debra Bendell
  • School of Psychology
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  • The School of Leadership Studies
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  • School of Psychology
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  • School of Psychology
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