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Articles 1 - 30 of 450
Full-Text Articles in Mental and Social Health
Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West
Providing End-Of-Life Counseling: A Narrative Inquiry, Carol Hecht, Sibyl West
Adultspan Journal
This qualitative study aimed to address the gap in the research related to end-of-life counseling by exploring the experiences of counselors working with clients at end of life. While counseling literature and education are lacking regarding end of life, many counselors will work alongside clients approaching death. The purpose of this study was twofold: (a) to better understand the nuanced experiences of counselors providing end-of-life counseling and (b) to explore the supports and preparations helpful for counselors to provide end-of-life counseling. A narrative approach, using the Listening Guide (Gilligan, 2015), was employed to analyze and present the stories of three …
Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego
Considerations Of Medicare Telehealth Services With Older Adults, Sonah Kho, Amanda Dediego
Adultspan Journal
The onset of the COVID-19 pandemic set in motion a rapid expansion of mental health services offered via telehealth. With this rapid expansion came the need to examine how policy and practice should be shaped in a future where telehealth is considered common in counseling practice. For counselors to understand how to support older adult clients in using telehealth services, they must understand telehealth policy. Following the eligibility of licensed counselors to participate in Medicare, counselors need to stay abreast of regulatory changes regarding restrictions and regulations on use of telehealth for mental and behavioral health services, including video and …
Counseling In Virtual Spaces And Into The Metaverse: A Framework For Reflection, Conversation, And Future Scholarship, Staci Hayes, Yahyahan Aras, Kathy Caputo, James Hoag, Lindsay Ibos, Sania Khan, Kelly Smith
Counseling In Virtual Spaces And Into The Metaverse: A Framework For Reflection, Conversation, And Future Scholarship, Staci Hayes, Yahyahan Aras, Kathy Caputo, James Hoag, Lindsay Ibos, Sania Khan, Kelly Smith
Journal of Technology in Counselor Education and Supervision
Given the success of Virtual Reality (VR) in the gaming community and strides in mental health, both VR and the Metaverse provide limitless opportunities and possibilities in the field of counseling. This article aims to provide important definitions, an overview of the use of VR in clinical counseling, clinical supervision, counselor education and its potential emergence into the Metaverse. Implications are presented in hopes of prompting conversation on how we may accept technological and cultural shifts and remain true to our counseling roots. Specifically, how to maximize the potential benefits with counseling specific rationale and address the limitations and potential …
Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald
Bridging The Gap: Psychopharmacologic Education And Side Effect Screening For Non-Prescribing Mental Health Professionals, Elaine Fitzgerald
Dissertations
Abstract
Problem: The United States is experiencing a growing demand for pediatric mental health support. Surges in mental health diagnoses and psychotropic medication prescriptions have occurred, compounded by a shortage of psychiatric providers. Non-prescribing mental health professionals are well-positioned to recognize psychotropic medication side effects. However, psychologists and counselors lack formal pharmacology education.
Methods: The quality improvement (QI) initiative was guided by the Plan-Do-Study-Act (PDSA) model. The evidence-based psychopharmacologic education for non-prescribers utilized a quasi-experimental pre- and post- test design. Data collected from clinicians included knowledge, confidence, and skill concerning psychotropic medications. The Psychotropic Medication Monitoring Checklist (PMMC) screen clients …
The Hidden Impact Of Sociocultural Determinants In Adolescence, Lauren B. Robins, Nicholas Schmoyer, Atiya Smith, Krystal L. Clemons, Jill Kivikoski
The Hidden Impact Of Sociocultural Determinants In Adolescence, Lauren B. Robins, Nicholas Schmoyer, Atiya Smith, Krystal L. Clemons, Jill Kivikoski
Journal of Human Services Scholarship and Interprofessional Collaboration
This study, guided by the Social Determinants of Health framework and Social Ecological Model, examined how SDOH impact the presence of anxiety during adolescence. This study set out to understand what sociocultural determinants predict anxiety, using the 2018 National Survey of Children’s Health dataset. The analysis included a logistic regression to determine the predictability of SDOH on anxiety in adolescence. The results indicated that various SDOH are significant predictors of anxiety, while also indicating that the absence of adverse SDOH predicts the lack of anxiety. Further, unique findings related to race/ethnicity, age, and gender set the stage for additional research …
A Qualitative Exploration Of Well-Being In Cancer Survivorship: Implications For Counselors, Hallie M. Sylvestro, Lindsey K. Umstead, Heather Delgado, Christopher Lawrence, Keith Mobley, Kelly L. Wester, Andrew Wood
A Qualitative Exploration Of Well-Being In Cancer Survivorship: Implications For Counselors, Hallie M. Sylvestro, Lindsey K. Umstead, Heather Delgado, Christopher Lawrence, Keith Mobley, Kelly L. Wester, Andrew Wood
Adultspan Journal
Adult cancer survivors represent an important–and growing–population that could benefit from counseling services. This study employed consensual qualitative research to examine the well-being experiences of eight cancer survivors. Findings suggest a broad range of changes to individual well-being following cancer diagnosis and treatment, and indicate counseling can provide an ideal setting for processing such changes. Recommendations for counseling practice and future research are provided.
One Stitch At A Time: Examining The Self-Care Of Art Therapists And The Potential Of Fiber Arts For Wellbeing, Elaine Chippero
One Stitch At A Time: Examining The Self-Care Of Art Therapists And The Potential Of Fiber Arts For Wellbeing, Elaine Chippero
Expressive Therapies Capstone Theses
The goal of this thesis was to understand why art therapists are particularly at risk for burnout, why it is essential for art therapists to engage artmaking for their own self-care, and why fiber crafts are particularly suited for self-care. The literature was collected and organized using reflective journaling and visual–tactile coding and then presented in the following review. The first two sections of the literature review include comprehensive definitions of burnout and self-care and how both concepts have been discussed in literature relating to the helping professions and specifically art therapists. The third section covers the historical context of …
Exploring Attachment Through Clay-Based Therapy: A Parent-Child Community Engagement Project, Hilari Stahler
Exploring Attachment Through Clay-Based Therapy: A Parent-Child Community Engagement Project, Hilari Stahler
Expressive Therapies Capstone Theses
This research project explores the therapeutic potential of clay, particularly as a creative, sensory-rich process that facilitates access to pre-verbal memories. Grounded in attachment theory and the innovative approach to trauma healing by Cornelia Elbrecht, known as Trauma Healing at the Clay Field®, the study investigates clay's regressive and healing qualities. It examines how its smooth, skin-like texture can activate our implicit memories through sensory experiences. Utilizing a community engagement format, this study aimed to assess the effectiveness of parent-child clay field sessions in addressing intergenerational attachment trauma and unmet attachment needs. The research revealed that the unique properties of …
A Trauma-Informed Socially Just Approach To Working With Juvenile Justice-Involved Youth Utilizing Expressive Arts Therapy, Ciara Carr
Expressive Therapies Capstone Theses
Youth involved with the juvenile justice system often have a history of trauma and oppression resulting from their positionality and circumstances. Most juvenile justice-involved youth are boys, youth of color, low-income, LGBTQIA2S+, disabled, and traumatized. This literature review explores the history of the juvenile justice system, issues with the present-day model, and trauma-informed and transformative justice approaches to practice. The implementation of socially just, trauma-informed expressive arts therapy programs is proposed as a more equitable practice to replace commonly used punitive practices across the United States. More research is needed to understand the impact of such programs on this population …
Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou
Emotion Regulation Strategies And Perceived Emotional Intelligence: The Effect Of Age., Iwanna Sepiadou
Adultspan Journal
The aim of this study was to investigate the relationship between perceived emotional intelligence and the reported use of cognitive reappraisal and expressive suppression. We also investigated the possible effects of age on the aforementioned variables. The total sample consisted of 379 people (158 men, 220 women, 1 unreported). Across participants, 273 were young (20-39 years old) and 106 were middle-aged (40-65 years old). We found statistically significant positive correlations between the dimensions of perceived emotional intelligence and the reported use of cognitive reappraisal and negative primarily correlations between the dimensions of perceived emotional intelligence and the reported use of …
Expressive Therapies And Resiliency – Resistance In Mental Health: A Literature Review, Gabrielle Lopez
Expressive Therapies And Resiliency – Resistance In Mental Health: A Literature Review, Gabrielle Lopez
Expressive Therapies Capstone Theses
This review evaluates the current literature on psychological resistance amongst human service professionals experiencing burnout and the effect of Expressive Arts interventions on resiliency. Concepts include identifying the main symptoms, risk factors, causes, and treatments for burnout in education faculty, medical staff, and clinicians. Qualitative, quantitative, and meta-analysis studies are included to identify the most prevalent intervention frameworks for reducing stress including Arts-Based and Mindfulness-compassion based techniques. The effectiveness of Arts-based tools on strengthening identity, self-esteem, emotional regulation, and meaning-making in combating burnout is presented. Based on analysis of the literature, the author proposes a three-step intervention framework for utilizing …
The Role Of Acculturation In The Professional Identity Of Art Therapy And Counseling International Students, Ana Marcela Tobar Chavez
The Role Of Acculturation In The Professional Identity Of Art Therapy And Counseling International Students, Ana Marcela Tobar Chavez
Art Therapy Counseling Final Research Projects
In a country of immigrants, the concept of acculturation needs to be familiar to almost any professional in the mental health field and it is a reality for immigrants and international students. As international and immigrant students continue to join the Art Therapy Counseling profession, it is important to understand how acculturation plays a role in the development of their counseling professional identity. Unlike most master’s students in the art therapy counseling profession, international and immigrant students go through unique experiences such as being born and raised in a different country with difference in cultures, languages, and immigration statuses that …
Behavioral Health Professionals’ Perception Of Anxiety Disorders Amongst African American Clients, Chantel K. Gant
Behavioral Health Professionals’ Perception Of Anxiety Disorders Amongst African American Clients, Chantel K. Gant
University of New Orleans Theses and Dissertations
Abstract
Anxiety disorders are frequent and increasing across the United States including for ethnically diverse populations (Carter et al., 2012). There is a need for education in the community on anxiety disorders about indicators of anxiety, severity and therapeutic approaches that would be beneficial (Johnson & Coles, 2013). It is imperative to know the variation in anxiety for African Americans to aid in therapeutic resources and counseling designed for this population (Hopkins & Shook, 2017). Prior research includes more of a focus on behavioral health professionals’ perspectives in conjectural situations rather than actual clinical practice (Joy & Bartholomew, 2021; Lawrence …
Art Therapy For Bereaved Siblings After Pediatric Cancer Death, Daniela Ramirez-Ibarra
Art Therapy For Bereaved Siblings After Pediatric Cancer Death, Daniela Ramirez-Ibarra
Electronic Theses, Projects, and Dissertations
Children and adolescents whose siblings die due to pediatric cancer are at an increased risk for several mental health issues and high risky behavior engagement. There is currently very little literature on the topic of a sibling’s grief despite its potentially critical and persisting consequences. Through qualitative research in analyzing art projects made by bereaved siblings, this is an exploratory study of how an art program may help bereaved or grieving children access their feelings using a non verbal modality of expression. The research study was conducted at a community-based non-profit organization which focuses on supporting families of children with …
Multicultural Gerotranscendence: A Theoretical Approach To Working With Older Adults, Whitney George, Danielle Schlittler
Multicultural Gerotranscendence: A Theoretical Approach To Working With Older Adults, Whitney George, Danielle Schlittler
Adultspan Journal
With the growing number of the aging population, the call for counselors to understand the developmental processes of all clients is essential. The theories of gerotranscendence and multicultural counseling and therapy are central to the understanding of adult development in later life. The use of these two theories together provides a theoretical basis for counselors wishing to provide services to diverse older adults.
Music As A Coping Mechanism: Clinical Implications Of How College Students Utilize Music To Cope With Anxiety, Depression, And Daily Stressors, Karly Pikel
Senior Theses
Many college students face stress, anxiety, and/or depression in their daily lives which they cope with in their own ways. Listening to music or playing an instrument are particularly powerful forms of coping that can have a plethora of positive effects on an individual. The purpose of this study was to conduct a survey amongst the University of South Carolina student body to determine how they utilize music to cope in their daily lives. Of 847 respondents, almost all of them reported experiencing some extent of anxiety and/or stress and listening to music to help them cope. Respondents agreed that …
Exploring The Experiences Of School Counselors Advocating For Social Justice Within Urban Pk-12 Charter Schools, Betsy Marina Perez
Exploring The Experiences Of School Counselors Advocating For Social Justice Within Urban Pk-12 Charter Schools, Betsy Marina Perez
Counseling & Human Services Theses & Dissertations
School counselors serve students’ academic, career, and social/emotional needs through a comprehensive school counseling program, and center their work on concepts of equity, advocacy, social justice, and systemic change, to remove barriers and increase opportunities for all PK-12 students. Charter schools are also unique public school settings as they offer flexibility, innovation, and autonomy to staff to create individualized experiences for their students. Held in common by these two educational services is the commitment to serving the needs of historically marginalized populations (Black, Indigenous, People of Color [BIPOC] and those from low socioeconomic backgrounds) and the opportunity to advocate for …
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 …
Consensus On Best Practices In Neuroscience-Informed Treatment Of Combat-Related Posttraumatic Stress In Military Veterans: A Delphi Study Of Experts In The Field Of Mental Health, Danielle Lauren Winters
Consensus On Best Practices In Neuroscience-Informed Treatment Of Combat-Related Posttraumatic Stress In Military Veterans: A Delphi Study Of Experts In The Field Of Mental Health, Danielle Lauren Winters
Counseling & Human Services Theses & Dissertations
The purpose of this study was to capture consensus among mental health professionals who work with combat trauma-afflicted veterans and/or utilize a neuroscience-informed counseling approach, about a set of best practices for uniting neuroscience-informed treatment modalities with the treatment of veterans who present with Post Traumatic Stress (PTS). A multi-round Delphi study was used to elicit information from mental health professionals, which led to the proposition of ways in which mental health professionals may more efficiently work with combat veterans while utilizing neuroscience-informed treatments such as Prolonged Exposure Therapy, Eye Movement Desensitization and Reprocessing (EMDR) neuro-informed Cognitive Behavioral therapy (nCBT), …
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 …
Addressing Weight In Primary Care: Perspectives Of African American Young Adults With Serious Mental Illness, Sang Qin, Lindsay Sheehan, Janis Sayer, Kristin S. Williams, Julius Mercer, Ashley Scott, Tevin Anderson
Addressing Weight In Primary Care: Perspectives Of African American Young Adults With Serious Mental Illness, Sang Qin, Lindsay Sheehan, Janis Sayer, Kristin S. Williams, Julius Mercer, Ashley Scott, Tevin Anderson
Journal of Human Services Scholarship and Interprofessional Collaboration
Young adults with serious mental illness (SMI) experience disproportionate rates of physical illness. Morbidity and mortality are even worse for young African Americans with SMI, especially those who are overweight. Primary care physicians (PCPs) have an important role in addressing weight management. Current research explored these young patient’s perceptions of weight management and how PCPs can best address their weight concerns. Using community-based participatory research, we interviewed 25 African American aged 18-30 who were overweight and had a SMI. Results revealed 1) patient perceptions around weight and 2) patient preferences. Participants identified both positive and negative aspects of being overweight, …
Clinical Supervisors Competency And Readiness To Supervise Telehealth Practices, Myriam Buitrago
Clinical Supervisors Competency And Readiness To Supervise Telehealth Practices, Myriam Buitrago
Dissertations
The growing effectiveness of telehealth as an alternative practice is gaining acceptance not only by professionals in the healthcare field but also by people who have benefited from this approach. New training and supervision practices are required to meet the new telehealth approach. Clinical supervision is a new profession identifying the competencies that define their best practices. However, telehealth is forcing us to evaluate and redefine them to meet the new telehealth requirements. This study used two assessments, the Supervisor competence self assessment and the supervisor evaluation and the Supervisor Competence Scale, to measure supervisors' self-evaluation of their performance as …
Counseling And Mental Health Awareness In Higher Education Institutions: A Phenomenological Exploration Of Mental Health And How It Affects Degree Completion Among Black Undergraduate College Women, Shaquina D. White, Desirae N. Williams
Counseling And Mental Health Awareness In Higher Education Institutions: A Phenomenological Exploration Of Mental Health And How It Affects Degree Completion Among Black Undergraduate College Women, Shaquina D. White, Desirae N. Williams
Dissertations
The purpose of this qualitative study was to explore Black undergraduate women’s lived experiences with mental health management and pursuance of degree completion. This study used a phenomenological approach, guided by the following research questions: 1) What barriers are Black undergraduate college women facing regarding their accessibility to counseling services on their campus? and 2) How do Black undergraduate college women with mental health issues effectively manage stressful situations while pursuing and completing a college degree? The current literature that examined Black women’s utilization of counseling is limited, especially among Black women enrolled in college. This study aimed to fill …
Digital Phobia: An Inquiry For Mapping The Unseen Dimension Of New Digital Anxiety, The ‘Digiphobia’, Amarjit Kumar Singh ,Library Assistant, Md. Arshad Ali , Professional Assistant, Dr. Pankaj Mathur, Deputy Librarian,
Digital Phobia: An Inquiry For Mapping The Unseen Dimension Of New Digital Anxiety, The ‘Digiphobia’, Amarjit Kumar Singh ,Library Assistant, Md. Arshad Ali , Professional Assistant, Dr. Pankaj Mathur, Deputy Librarian,
Library Philosophy and Practice (e-journal)
Background: As technology continues to advance, individuals' interactions with digital platforms have become integral to daily life. Amidst this technological evolution, a novel concern emerges—Digital Phobia, hereafter referred to as “Digiphobia.” This phenomenon, although not previously explored in scholarly literature, necessitates an in-depth investigation due to its potential impact on individuals' well-being. Our research employs a two-step methodology to investigate its existence, implications, and manifestations.
Introduction: This research paper introduces and proposes the term "Digiphobia" as a comprehensive conceptualization of anxiety arising from interactions with digital spaces, applications, and environments. The proliferation of digital technologies has led to the emergence …
Acculturation And Immigrant Parental Perceptions Concerning Sexual Communication, Kwame Owura Frimpong
Acculturation And Immigrant Parental Perceptions Concerning Sexual Communication, Kwame Owura Frimpong
Journal of Human Services Scholarship and Interprofessional Collaboration
Abstract:
Acculturation presents challenges to many immigrant parents that are adjusting to new lives in the United States. The rationale for conducting this study stemmed from the effects that acculturation can have on the wellbeing of immigrants, adversely affecting their health outcomes. The purpose of this study was to explore the perceptions of Sub-Saharan African immigrant parents concerning having a conversation with their pre-adolescent children about sexuality and sexual practices. Findings revealed communication barriers due to cultural beliefs, cultural taboos, and shame. The findings from this study are beneficial to behavioral healthcare providers that work with immigrant families, parents, and …
Understanding The Experience Of Mothers In Higher Education During The Covid-19 Era, Shannan L. Engel
Understanding The Experience Of Mothers In Higher Education During The Covid-19 Era, Shannan L. Engel
Antioch University Dissertations & Theses
This exploratory study aimed to understand the experience of mothers in higher education both during the COVID-19 pandemic and toward the end of restrictions. The population included academic mothers with children at home during the pandemic. Data was analyzed thematically by a team of researchers. The results generated six themes: (a) life changed suddenly, (b) remote work, school, and life, (c) unsupported, (d) sense of control, (e) support, and (f) positive aspects of COVID. These findings are important to the field of mental health counseling profession, supervision, and higher education because of the circumstances exemplified by the pandemic that highlight …
Emdr Gaming Recovery And Insight Protocol (E-Grip): An Approach For Treating Video Game Addiction, Manjit Bath
Emdr Gaming Recovery And Insight Protocol (E-Grip): An Approach For Treating Video Game Addiction, Manjit Bath
Antioch University Dissertations & Theses
The prevalence of video game addiction has escalated with the advancement of digital technologies, posing significant psychological and social challenges. This dissertation introduces the eye movement desensitization and reprocessing (EMDR) Gaming Recovery and Insight Protocol (E-GRIP), a novel therapeutic approach designed to address the complexities of video game addiction. Grounded in the principles of EMDR therapy and incorporating insights into video game culture, E-GRIP aims to treat individuals struggling with problematic gaming behaviors by integrating their gaming experiences and preferences into the therapeutic process. The E-GRIP methodology extends the conventional EMDR framework by including an in-depth exploration of the client’s …
Emotions, Self-Efficacy, And Accountability For Antiracism In White Women Counselors, Lisa Wenninger
Emotions, Self-Efficacy, And Accountability For Antiracism In White Women Counselors, Lisa Wenninger
Antioch University Dissertations & Theses
Supporting the development of an antiracist identity in counselors could facilitate change toward equity, justice, and opportunity within the counseling profession and increase awareness of white counselors in working with clients of color. Understanding obstacles to and enablers of antiracist attitudes in white women counselors holds the potential to bring change to the profession as a whole, given their position in the majority. This quantitative study used instruments to assess white racial affects of white fear, anger, and guilt along with antiracist self-efficacy as influencing antiracist accountability in a sample of white women counselors in the United States (N = …
Clinical Practice Guideline For The Management Of Depression In Primary Care, Estrella Catherine Villarreal
Clinical Practice Guideline For The Management Of Depression In Primary Care, Estrella Catherine Villarreal
Doctor of Nursing Practice (DNP) Scholarly Projects
Abstract
Background: The prevalence of depression poses a significant challenge in primary care, emphasizing the urgent need to address this issue during patient visits. Primary care providers are at the forefront of managing depression, yet they encounter difficulties in screening, diagnosing, assessing, and treating this complex condition. Clinical guidelines serve as valuable tools for primary care providers and practices, offering support in identifying and addressing depression effectively. An evidence-based approach to treating depression in primary care, with a focus on collaborative interventions with behavioral health to enhance depression management for American Indian/Alaskan Native (AI/AN) communities.
Methods: The descriptive analysis was …
Career Counselors Addressing Social Determinants Of Mental Health In Rural Communities, Kaprea F. Johnson, Alexandra Gant-Howrey, Bisola E. Duyile, Lauren B. Robins, Natese Dockery
Career Counselors Addressing Social Determinants Of Mental Health In Rural Communities, Kaprea F. Johnson, Alexandra Gant-Howrey, Bisola E. Duyile, Lauren B. Robins, Natese Dockery
Counseling & Human Services Faculty Publications
Career counselors practicing in rural communities must understand and address social determinants of mental health (SDOMH). This conceptual article details the relationships between SDOMH domains and employment and provides evidence-based recommendations for integrating SDOMH into practice through a rural community health and well-being framework. Description of the adaptation of the framework for career counselors in rural communities, SDOMH assessment strategies and tools, and workflow adjustments are included. Conclusions suggest next steps for practice and research.