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Articles 1 - 30 of 34
Full-Text Articles in Medicine and Health Sciences
Supervision Needs Of Novice Behavioral Health Providers In Integrated Primary Care Settings: A Delphi Study, Nicholas D. Schmoyer
Supervision Needs Of Novice Behavioral Health Providers In Integrated Primary Care Settings: A Delphi Study, Nicholas D. Schmoyer
Counseling & Human Services Theses & Dissertations
The integration of behavioral health providers (BHPs, i.e., clinical mental health counselors, clinical psychologists, clinical social workers, marriage and family therapists) into primary care settings has developed as a healthcare practice associated with enhanced patient clinical outcomes, enhanced patient satisfaction, reduced healthcare expenditures, and enhanced provider wellness and satisfaction, known together as the Quadruple Aim. For BHPs practicing in integrated primary care (IPC) settings, researchers have highlighted a variety of challenges they experience when integrating in these settings, with a consistent challenge being a lack of satisfactory training and supervision. Clinical supervision has been hailed as the “signature pedagogy” for …
The Lived Experiences Of Counselors-In-Training Completing Practicum And Internship During Covid-19, Shelby Lauren Dillingham
The Lived Experiences Of Counselors-In-Training Completing Practicum And Internship During Covid-19, Shelby Lauren Dillingham
Counseling & Human Services Theses & Dissertations
COVID-19’s classification as a pandemic in March 2020 changed numerous professions as they adjusted to social distancing expectations. Mental health providers particularly encountered transitions that included higher acuity caseloads, working different hours, and increased exposure to COVID-19. Counselors-in-training (CIT) faced the dilemma of earning their clinical hours in a safe manner, especially CITs working within integrated healthcare settings, such as hospitals or clinics. Despite some research with licensed professional counselors, limited research exists examining CITs' experiences working during the COVID-19 pandemic. This study sought to understand the lived experiences of CITs who completed their clinical hours in an integrated behavioral …
Partners In Crisis: A Phenomenological Exploration Of Collaboration Between Crisis Intervention Team Officers And Mental Health Professionals, Jessica L. Huffman
Partners In Crisis: A Phenomenological Exploration Of Collaboration Between Crisis Intervention Team Officers And Mental Health Professionals, Jessica L. Huffman
Counseling & Human Services Theses & Dissertations
Law enforcement officers (LEOs) are often the first responders to crisis situations, which increasingly include mental health crises. Collaborating with mental health professionals and organizations increases the likelihood that individuals will receive a response that is contextually and culturally informed by an understanding of mental health needs and considerations. For this reason, Crisis Intervention Teams (CIT) have been established to train LEOs and to unite efforts with mental health professionals, advocates, and community constituents. While there is existing and ongoing literature exploring the responses provided by CIT, there is limited research on the experiences of CITs related to their unique …
The Impact Of Mandatory Substance Abuse Counselor Reporting Requirements On Child Maltreatment Reporting Outcomes, Bilgé Özgé Yilmaz
The Impact Of Mandatory Substance Abuse Counselor Reporting Requirements On Child Maltreatment Reporting Outcomes, Bilgé Özgé Yilmaz
Psychology Theses & Dissertations
The present study sought to examine how state-level mandatory reporting policies are associated with child maltreatment reporting through analysis of the National Data Archive on Child Abuse and Neglect (NDACAN, 2021). This study aimed: 1) to examine how the implementation of substance abuse counselor reporting requirements is associated with the reporting process, including the disposition of reports and the presence of substance abuse; and 2) to examine differences in the above outcomes based on associations between non-specific reporting requirements and specific requirements that mention substance use counselors. A quasi-experimental approach with repeated cross-sectional data was utilized, as it is a …
The Lived Experiences Of 911 Dispatchers With Compassion Fatigue: An Interpretive Phenomenology, Angela Johnson
The Lived Experiences Of 911 Dispatchers With Compassion Fatigue: An Interpretive Phenomenology, Angela Johnson
Counseling & Human Services Theses & Dissertations
911 dispatchers are the “first” first responders in an emergency and play an intrinsic role in the public safety continuum. 911 dispatchers are exposed to daily and cumulative stress from the repeated empathic engagement of those they serve, and from shift work, staffing shortages, and inability to make mistakes. However, there is a dearth of peer reviewed literature on 911 dispatchers and compassion fatigue (CF). CF is described as the emotional and physical exhaustion experienced due to the constant exposure to the trauma of others. CF symptomology in 911 dispatchers has far reaching implications for not only the citizens …
Providing Family Centered Care Within Pediatric Integrated Care Settings, Emily D. Bebber
Providing Family Centered Care Within Pediatric Integrated Care Settings, Emily D. Bebber
Counseling & Human Services Theses & Dissertations
Parent engagement remains critical to pediatric care. Both pediatric medical and mental health care remains dependent upon parent/guardian engagement to support successful outcomes for children and adolescents. Efforts to enhance Family Centered Care (FCC) has been spotlighted within pediatric care since the 1950s and the inclusion of counselors within integrated behavior health (IBH) teams ushers a need for an evolved understanding of the implementation of FCC, including parent/guardian engagement across professional roles. Using an explanatory mixed-method design, I examined team implementation of Family Centered Care (FCC) among different provider types (e.g., physicians, nurses, licensed mental health providers, social workers, technicians) …
Fear And Trembling While Working In A Pandemic: An Exploratory Meta-Analysis Of Workers’ Covid-19 Distress, William P. Jimenez, Ian M. Katz, Elissa A. Liguori
Fear And Trembling While Working In A Pandemic: An Exploratory Meta-Analysis Of Workers’ Covid-19 Distress, William P. Jimenez, Ian M. Katz, Elissa A. Liguori
Psychology Faculty Publications
The global COVID-19 pandemic has disrupted the lives of workers and taken its toll on health and well-being. In line with recent calls for more inductive and abductive occupational health science research, we exploratorily meta-analyzed workers’ COVID-19 distress, defined as psychological and psychosomatic strain contextualized to experiencing the virus and pandemic broadly. We identified many existing COVID-19 distress measures (e.g., Fear of COVID-19 Scale by Ahorsu et al., 2020; Coronavirus Anxiety Scale by Lee, 2020a) and correlates, including demographic variables (viz., gender, marital status, whether worker has children), positive well-being (e.g., quality of life, perceived social support, resilience), negative well-being …
An Investigation Of Healthcare Professionals’ Perspectives On The Tasks Of Mental Health Counselors In Hospital Settings, Suelle Micallef Marmara
An Investigation Of Healthcare Professionals’ Perspectives On The Tasks Of Mental Health Counselors In Hospital Settings, Suelle Micallef Marmara
Counseling & Human Services Theses & Dissertations
With the global mental health implications reported by the spread of COVID 19 (Javed et al., 2020) and the amplified mental health illnesses reported by the State of Mental Health in America (Reinert et al., 2021), there is an increased need to address psychological and emotional health along with physical health. Mental Health Counselors (MHCs) can be the next professional body to support the multidisciplinary teams within hospital settings to complement holistic care focusing on physical and emotional well-being. Researchers have demonstrated addressing the psychological needs of patients from their first admissions to the hospital has significant positive implications on …
Complex Thought For Complex Work: Preparing Cognitively Complex Counselors For Work In Diverse Settings, Alexandra C. Gantt
Complex Thought For Complex Work: Preparing Cognitively Complex Counselors For Work In Diverse Settings, Alexandra C. Gantt
Counseling & Human Services Theses & Dissertations
Counselor education researchers have explored the need for high levels of cognitive complexity (CC) in mental health counselors due to its relationship with high quality counseling skills and counselor ways of being (e.g., Castillo, 2018; McAuliffe & Lovell, 2006; Ridley et al., 2011; Welfare & Borders, 2010b). In these studies, researchers have called for continued study of means of enhancing CC in counselors in training (CITs) through andragogical efforts (e.g., Castillo, 2018; Duys & Hedstrom, 2000; Welfare & Borders, 2010a). However, we do not have an understanding of minimally acceptable CC for graduating CITs. In this study, I explored counselor …
The Role Of Athletic Identity In General Mental Health And Alcohol-Related Help-Seeking Intentions Of College Students, Michael Grant Young
The Role Of Athletic Identity In General Mental Health And Alcohol-Related Help-Seeking Intentions Of College Students, Michael Grant Young
Psychology Theses & Dissertations
Young adults are vulnerable to a range of mental health concerns and tend to drink in high quantities and tend to not seek help for these concerns. Specifically, college students involved in athletics tend to have low help-seeking rates—though help-seeking research for this population is relatively limited. Athletic identity (i.e., identification with the athlete role) is a relevant construct for examining this population, however little is known about its association with help-seeking beliefs and ideas. This study examines: (1) the association between athletic identity and help-seeking intentions for both mental health and alcohol use concerns, (2) the association between …
A Meta-Analysis Of Group Treatment Outcomes For Veterans With Substance Use Disorders, Robert “Tony” Dice
A Meta-Analysis Of Group Treatment Outcomes For Veterans With Substance Use Disorders, Robert “Tony” Dice
Counseling & Human Services Theses & Dissertations
Group therapy is commonly used in the treatment of substance use disorders (SUD). Many studies exist related to the efficacy of group interventions for veterans with SUDs. A meta-analysis and systematic review of the literature addressing the use of group therapy, specifically psychoeducational groups, cognitive behavioral therapy (CBT) groups and support groups, in the treatment of SUDs with veterans was conducted. The following questions guided the research: What are viable treatment outcomes for psychoeducational, CBT, and support groups of veterans with SUDs? and What are the measures that capture outcomes related to psychoeducational, CBT, and support groups of veterans with …
Minority Counselor Multicultural Competence In The Current Sociopolitical Climate, Kathleen Brown
Minority Counselor Multicultural Competence In The Current Sociopolitical Climate, Kathleen Brown
Counseling & Human Services Theses & Dissertations
A key component of professional orientation in the field of mental health is the ability to provide counseling that is culturally competent. Counselor preparatory education, ethical codes, professional organizations and regulating bodies recognize cultural competence as a cornerstone of clinical practice. It is especially important during a time in which cultural and racial minorities combat a tumultuous sociopolitical climate. American society has seen an exponential rise in anxiety, depression, and helplessness secondary to the 2016 Presidential Election. For minority counselors, providing multiculturally competent counseling in the face of extreme oppression, and during a period of apparent resurgence in overt systemic …
Mental Health Counselors' Perceptions On Preparedness In Integrated Behavioral Healthcare In Underserved Areas, Kyulee Park
Mental Health Counselors' Perceptions On Preparedness In Integrated Behavioral Healthcare In Underserved Areas, Kyulee Park
Counseling & Human Services Theses & Dissertations
Integration of behavioral and primary healthcare (IBH) has been increasingly suggested as a model approach in serving historically marginalized populations, including rural, Healthcare Provider Shortage (HPSA), and Medically Underserved (MUA) communities (Coleman & Patrick, 1976; Wong et al., 2019). However, there is no evidence-based practices in interprofessional education and training for professional mental health counselors to serve as competent practitioners in integrated behavioral healthcare. This study examined the gap in interprofessional and counselor education literature by identifying the lived experiences and perceptions of mental health professionals in integrated settings and assessed the need areas in current counselor education. A phenomenological …
Intersectional Identities And Microaggressions: The Experience Of Transgender Females, Cory Daniel Gerwe
Intersectional Identities And Microaggressions: The Experience Of Transgender Females, Cory Daniel Gerwe
Counseling & Human Services Theses & Dissertations
Historically, attention given to privileged LGBT minorities such as white LGBT individuals, renders those who experience multiple minority identities as unacknowledged. There is a scarcity of research exploring the intersectional experiences of transgender individuals and how these experiences impact their mental health and well-being. For that reason, the intent of this study was to learn more about transgender females who hold additional minority statuses, their transition experiences, their circumstances, and the nature of their social environment. Specifically, I investigated trans female experiences of transitioning with a specific focus on the intersection of gender identity, race, socioeconomic status (SES), and age. …
The Relationship Between Childhood Adversity And Adult Relationship Health For Economically Marginalized, Racially And Ethnically Diverse Individuals, Sandy-Ann M. Griffith
The Relationship Between Childhood Adversity And Adult Relationship Health For Economically Marginalized, Racially And Ethnically Diverse Individuals, Sandy-Ann M. Griffith
Counseling & Human Services Theses & Dissertations
Childhood adversity is prevalent and significantly influences an individual’s life. Adverse Childhood Experiences (ACEs) are linked to chronic physical and mental health issues, as well as maladaptive and abusive patterns of behavior in adult relationships such as unhealthy problem-solving strategies, poor ability at conflict resolution, and intimate partner violence (IPV). The current study explored the relationship between ACEs and adult relationship health outcomes. Controlling for the effect of average individual yearly income on adult relationship health, the extent to which demographic factors (i.e., gender, race and ethnicity, and children status) moderate the relationship between ACEs and adult relationship health and …
Exploring The Variant Experiences Through Which Racial/Ethnic Minorities Select Art Therapy As A Career, Mary Ritchie Roberts
Exploring The Variant Experiences Through Which Racial/Ethnic Minorities Select Art Therapy As A Career, Mary Ritchie Roberts
Counseling & Human Services Theses & Dissertations
This study implemented a phenomenological approach to the inquiry of the career decisions of racial/ethnic minorities leading to selection of art therapy as a career. Gottfredson’s Career Theory was used to design interview questions to elicit the perspectives of ten racial/ethnic minority members about their career choice of art therapy. This study used post-intentional phenomenological qualitative coding of data to understand the decisions and contributing factors to racial/ethnic minorities selecting a career in art therapy. The findings suggest factors including: personal characteristics, interests, personal and professional beliefs, cultural beliefs, influential people, social contexts, experiences, and encounters contributed to racial/ethnic minority …
Breaking The Silence: A Phenomenological Exploration Of Secondary Traumatic Stress In U.S. College Student Affairs Professionals, Robert Jason Lynch
Breaking The Silence: A Phenomenological Exploration Of Secondary Traumatic Stress In U.S. College Student Affairs Professionals, Robert Jason Lynch
Educational Leadership & Workforce Development Theses & Dissertations
Breaking the Silence: A Phenomenological Exploration of Secondary Traumatic Stress in U.S. College Student Affairs Professionals is a qualitative-intensive mixed methods study using phenomenology and art-based research techniques to uncover the essence of secondary traumatic stress in U.S. college student affairs professionals. Researchers in the fields of psychology, counseling, social work and other helping professions suggest that repeated exposure to individuals experiencing trauma, or hearing repeated details of an individual’s trauma, have negative outcomes on professional helpers. Coined secondary traumatic stress, this phenomenon may be defined as “the stress resulting from helping or wanting to help a traumatized or suffering …
An Exploratory Factor Analysis Examining Experiences And Perceptions Of Campus Safety For International Students, Sonia H. Ramrakhiani
An Exploratory Factor Analysis Examining Experiences And Perceptions Of Campus Safety For International Students, Sonia H. Ramrakhiani
Counseling & Human Services Theses & Dissertations
Although international students make up a significant percentage of the college population and contribute to higher education institutions in multiple ways, a lack of attention is paid to their safety needs. This dissertation examined the experiences and perceptions of campus safety among international college/university students in the United States. The researcher sampled participants from different institutions around the country, who self-identified as international students. A researcher-developed 53-item Likert scale questionnaire, International Students’ Safety Questionnaire (ISSQ), was administered to the sample. Findings from the exploratory factor analysis (EFA) provided evidence for the four-factor solution for the 26-item ISSQ accounting for 48.65% …
Establishing The Psychometric Properties Of The Understanding Mental Health Scale: A Dissertation Study, Michael Thomas Kalkbrenner
Establishing The Psychometric Properties Of The Understanding Mental Health Scale: A Dissertation Study, Michael Thomas Kalkbrenner
Counseling & Human Services Theses & Dissertations
The purpose of this dissertation study was to validate the Understanding Mental Health Scale (UMHS). The UMHS is a 50-item questionnaire that was designed to measure college students’ awareness of mental health issues. To test the psychometric properties of the UHMS, a principal axis factor (PAF) analysis with an oblique rotation was conducted using an existing data set of 350 college students. Results revealed a two-factor structure underlying college students’ understanding of mental health issues. The factors were named risk-factor awareness (familiarity with warning signs of mental health issues) and resource awareness (knowledge of resources for mental health issues). A …
Understanding The Experiences Of Women With Anorexia Nervosa Who Complete An Exposure Therapy Protocol In A Naturalistic Setting, Gina B. Polychronopoulos
Understanding The Experiences Of Women With Anorexia Nervosa Who Complete An Exposure Therapy Protocol In A Naturalistic Setting, Gina B. Polychronopoulos
Counseling & Human Services Theses & Dissertations
Anorexia Nervosa (AN) is a serious mental health concern in the United States, with the highest mortality rate of all mental disorders. Females comprise the vast majority of people with AN, although the number of males with the condition is rising. Anorexia Nervosa has a high relapse rate and is often enduring, which makes it challenging to treat successfully; therefore, the mental health profession is in need of innovative therapeutic approaches. Exposure therapy has a growing evidence base for the treatment of eating disorders, including AN; however, there are very few studies that explore body image/mirror exposure specifically in patients …
The Relationship Between Counselors' Multicultural Counseling Competence And Poverty Beliefs, Madeline Elizabeth Clark
The Relationship Between Counselors' Multicultural Counseling Competence And Poverty Beliefs, Madeline Elizabeth Clark
Counseling & Human Services Theses & Dissertations
The relationship between increased levels of poverty and decreased levels of psychological wellbeing and overall wellness is well documented. Although poverty clearly impacts mental health and wellness, little research in counseling has been conducted exploring the poverty attitudes of counselors. This study explored the relationship between professional counselors’ multicultural counseling competence (MCC), poverty beliefs, and select demographic factors (i.e. counseling specialty, gender, age, ethnocultural identity, poverty counseling experience, and personal poverty experience). Data were collected using survey-based methods from professional counselors of all specialties. Results of a hierarchical linear regression indicate that increased MCC, adjusted for select demographic factors, is …
Examining Changes In College Counseling Clients’ Symptomology And Severity Over An Eight Year Span, Caroline Lee Bertolet
Examining Changes In College Counseling Clients’ Symptomology And Severity Over An Eight Year Span, Caroline Lee Bertolet
Counseling & Human Services Theses & Dissertations
The current college counseling literature has conflicting findings regarding the extent to which the severity of mental health symptoms has increased for college students. Some researchers claim that over time student’s mental health symptoms have become more complex rather than more severe. This study examined archival data to analyze both the severity and complexity of symptoms in an eight year time span. The study also examined how disruptiveness and treatment demand have changed over the eight year period. The data were analyzed using multiple regression. The results of the study supported perspectives found in the current literature indicating little increase …
An Exploration Of Health Providers' Responses To Intimate Partner Violence (Ipv) In Malaysia, Kee Pau
An Exploration Of Health Providers' Responses To Intimate Partner Violence (Ipv) In Malaysia, Kee Pau
Counseling & Human Services Theses & Dissertations
This grounded theory study aimed to examine factors that influence Malaysian health providers' attitudes, knowledge, and responses to IPV survivors, including health providers' perceptions of IPV, factors that influenced the ways they work with IPV survivors, factors they perceived toward influencing IPV survivors' help-seeking behaviors, and their recommendations for improving IPV training. Seventeen (N = 17) participants were recruited using snowball sampling and theoretical sampling was utilized to ensure the data was saturated. The results found nine superordinate themes that highlights health providers' perceptions of IPV in general, conceptualization of IPV, institutional factors, health providers' personal factors, sociocultural factors, …
A Grounded Theory Of Suicidality In Children Ten And Younger, Katherine Angela Heimsch
A Grounded Theory Of Suicidality In Children Ten And Younger, Katherine Angela Heimsch
Counseling & Human Services Theses & Dissertations
Once every two days in the United States, a child aged 5 to 14 years old dies by suicide (World Health Organization, 2010). When viewed on a spectrum that includes suicidal ideation, verbalizations, behaviors, and attempts, the problem of youth suicidality is actually far greater than the numbers of completed suicides suggest (Cheng, Tao, Riley, Kann, Ye, Tian...Hu, 2009). This study examined suicidality in children ages 10 and younger, and included the characteristics of suicidal children, factors that influence childhood suicidality, and treatment implications. The researcher conducted 12 semi-structured qualitative interviews with experienced treatment providers and performed a content analysis …
College Health And Mental Health Outcomes On Student Success, Daniel Joseph St. John
College Health And Mental Health Outcomes On Student Success, Daniel Joseph St. John
Counseling & Human Services Theses & Dissertations
This study explores the relationship between college students' utilization of university counseling services and university health services, and student academic performance. Data was collected using an archival data set including university counseling center records, health center records, and academic reports from institutional research at a large, public southeastern university. The primary variables of this study included: number of sessions in the university counseling center and/or university health center, instances of new initiated contacts, treatment variables, GPA, and degree completion. The overarching hypothesis of this study is that students who receive mental health services are significantly more likely to experience student …
Role Ambiguity Of Counseling Supervisors, Aaron Gabriel Shames
Role Ambiguity Of Counseling Supervisors, Aaron Gabriel Shames
Counseling & Human Services Theses & Dissertations
Supervisors often find themselves in the midst of ambiguity seeking clarity of their role and professional identity within the counseling field. Supervisors wear many hats, the most prominent ones being educator, counselor, and gatekeeper for the profession. Counseling supervisors are expected to establish and maintain a complex blend of professional, educational, and therapeutic relationships with their supervisees. This process involving multiple roles often presents conflicts. One such conflict experienced by supervisors has been termed role ambiguity. The purpose of this phenomenological inquiry was to explore what experiences counseling supervisors have with role ambiguity and how they experience role ambiguity. Themes …
Development Of The Profession Of Counseling In Kenya, Uganda, And Tanzania: A Grounded Theory Study, Mueni Joy Maweu Mwendwa
Development Of The Profession Of Counseling In Kenya, Uganda, And Tanzania: A Grounded Theory Study, Mueni Joy Maweu Mwendwa
Counseling & Human Services Theses & Dissertations
The positive mental health of a country's population has a direct correlation to that country's economic and social advancement. As a result, the development of the counseling profession is critical. Even though fewer than half of African member states have an existing mental health policy in place, initiatives to establish mental health policies and develop the counseling profession are underway across the African continent. In general, there is a significant deficit of counseling literature, and specifically, research on the development of the counseling profession in Africa. This grounded theory study sought to explore the experiences of counseling leaders related to …
Investigating Similarities And Differences As Measured By The Durel And Gsq Between Three Subgroups Attending A Local Aa Meeting To Develop A Profile Of Long Term Attendees, Keesha Masean Kerns
Investigating Similarities And Differences As Measured By The Durel And Gsq Between Three Subgroups Attending A Local Aa Meeting To Develop A Profile Of Long Term Attendees, Keesha Masean Kerns
Counseling & Human Services Theses & Dissertations
Alcoholics Anonymous groups are growing in popularity due to their cost effectiveness and history of dependability. Although the program clearly has the numbers to support its popularity, skeptics continually analyze its claims of effectiveness through research. While research pertaining to AA is diverse, very little is presented concerning factors that contribute to retention in the program. The primary purpose for this quantitative study was to investigate the similarities and differences in the various stages of participants of a sample attending a local AA program, identify variables that contribute to retention in the AA sample, and to use Grounded Theory to …
Conditions For Empathy In Medicine: A Grounded Theory Study, Hannah Barnhill Bayne
Conditions For Empathy In Medicine: A Grounded Theory Study, Hannah Barnhill Bayne
Counseling & Human Services Theses & Dissertations
Previous research in the medical setting has credited empathy with improving treatment outcomes and patient satisfaction, though operational definitions of the concept are widely varied and indicate inconsistencies in conceptualization and subsequent assessment. The purpose of this grounded theory study was to examine the role of empathy in the medical setting. A model of conditions for empathy in medicine was developed through in-depth interviews with 21 healthcare professionals, utilizing their professional experiences and perspectives to structure the multi-level model. The seven levels of the model indicate the layers of complexity inherent in facilitating optimal empathy in medicine and add to …
Treating Trauma Survivors With Neurofeedback: A Grounded Theory Study Based On The Practices Of Experienced Mental Health Professionals, Christine L. Currie
Treating Trauma Survivors With Neurofeedback: A Grounded Theory Study Based On The Practices Of Experienced Mental Health Professionals, Christine L. Currie
Counseling & Human Services Theses & Dissertations
Neuroscience, the mental health field, and the concept of trauma as an underlying factor in mental and physical disorders have been inextricably linked since the inception of the mental health professions. Numerous quantitative studies have indicated that neurofeedback may be effective in ameliorating trauma symptoms; however, there is a paucity of research exploring the factors that produce those positive outcomes. The purpose of this qualitative grounded theory study was to explore the factors and processes that influence treatment outcomes when neurofeedback is used with trauma survivors. Thirty interviews were completed with ten experienced mental health and neurofeedback professionals identified through …