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Dementia, Advance Directives, And Second-Order Volitions, Rand Hirmiz

Research Collection School of Social Sciences

This paper contributes to the ongoing debate over the authority of advance directives in cases where patients with dementia express desires that conflict with their earlier wishes. Drawing on Harry Frankfurt’s concept of second-order volitions, I argue that the preferences of the pre-dementia self (the “then-self”) should, in most cases, take precedence over those of the post-dementia self (the “now-self”) –  particularly in instances where the now-self has lost the capacity to form second-order volitions and is no longer able to meaningfully repudiate prior values and commitments.

Initial Injury Type And Violent Reinjury, Nicholas Szoko, Daphne Lew, Taylor Kaser, Zoe M Miller, Matt Vogel, Michael A Mancini, Lindsay M Kranker, Christopher Behr, Vicki Moran, Rachel Ancona, Kristen Mueller

2020-Current year OA Pubs

IMPORTANCE: Violent injuries are the leading cause of death among children and young adults in the United States. Violent injury may increase the risk of subsequent injury (ie, violent reinjury), but it is unclear how this risk varies across different injury types (eg, blunt assault, stabbing, firearm).

OBJECTIVE: To describe patterns of violent reinjury across different injury types to inform tailored prevention strategies.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study included patients who presented with violent injuries to 2 adult and 2 pediatric level I trauma centers in St Louis, Missouri, from January 2016 to December 2023.

EXPOSURES: Violent …

Trends Of Pediatric Psychotropic Polypharmacy In Massachusetts Before And During The Covid-19 Pandemic, Gianna D'Ambrozio

Graduate Doctoral Dissertations

Youth in the U.S. and internationally are increasingly being diagnosed with depression and related psychiatric conditions (Murthy, 2021) many of whom are being subjected to non-evidence-based, or what has been termed irrational, psychotropic polypharmacy (Barnett & Concepcion Zayas, 2019). Psychotropic polypharmacy can be defined as “the use of 2 or more psychiatric medications in the same patient,” (Zito et al., 2021) though definitions can vary. Using data from the Center for Health Information Analysis’ Massachusetts All-Payer Claims Database, this study examined the sociodemographic factors associated with high rates of polypharmacy, a hypothesized increase in pediatric psychotropic polypharmacy rates in Massachusetts …

Enhancing Physiological Complexity Through Mindfulness: A Wearable-Based Intervention For First Responders And Their Partners, Thurmon Lockhart, Rahul Soangra, Christopher W. Frames, Sun-Kyung Lee, Amberlee Martin, Susanne Lee, Abigail H. Gewirtz

Physical Therapy Faculty Articles and Research

Background/Objectives: First responders frequently encounter high-stress environments that challenge physiological resilience and autonomic regulation. Heart rate variability (HRV) complexity is a critical marker of adaptive capacity and stress regulation. This study assessed the impact of a wearable-based mindfulness intervention on HRV complexity among first responders using a smartwatch. Methods: A total of 87 first responders participated in a one-month wearable-based intervention. Participants wore Garmin Vivosmart 5 devices to continuously collect PPG data (photoplethysmogram), focusing on beat-to-beat intervals (BBIs). The intervention involved daily Ecological Momentary Assessments (EMAs) and individual randomization to either a mindfulness message, a prompt to access an audio …

A Call To Action: Towards A Compendium For Culturally Responsive And Inclusive Pain Management, Arvie Vitente, Rob Sweet, Lester Jones

Philippine Journal of Physical Therapy

Introduction: Pain is a pervasive global health problem, yet its assessment and management remain shaped by biomedical, monolingual, and culturally narrow assumptions that do not fully reflect the lived realities of diverse populations. Although contemporary pain science recognizes pain as a personal experience influenced by biological, psychological, and social factors, inequities persist across racial, ethnic, linguistic, and cultural groups.

Main Body: These inequities affect how pain is expressed, interpreted, documented, and treated, particularly among Indigenous peoples, migrants, refugees, and patients with limited English proficiency. In this perspective, we call for the development of a comprehensive compendium on culturally responsive and …

Lessons From Adults Who Lived Through Parental Divorce As Adolescents, Nirav M. Patel

Pacific Journal of Health

Experiencing parental divorce during adolescence is a significant life event that can have long-term emotional and psychological effects [1]. This qualitative study focuses on how adults who experienced parental divorce between the ages of 10 and 17 reflect on their emotional, social, and academic experiences during that time. Nine adults participated in semi-structured interviews, which were transcribed, coded, and analyzed by the researcher using Dedoose software. Key findings that emerged from the interviews include emotional struggles, coping strategies, family support, the impact on school, and advice for today’s youth who are currently experiencing divorce. The findings emphasize that open communication, …

Lessons Learned In Providing Infant And Early Childhood Mental Health Consultation During The Covid-19 Pandemic, Rashele Wade

Journal of Global Awareness

Access to quality childcare is a protective factor from lifelong issues such as school failure, school drop-out, and incarceration. Conversely, preschool suspension and expulsion are significant risk factors. Evidence-based interventions, such as Infant and Early Childhood Mental Health Consultation, aim to reduce and eliminate the incidence of preschool suspensions and expulsions. The COVID-19 pandemic disrupted access to quality childcare for many children across the country and globally. This study utilized a qualitative action research approach and generic qualitative inquiry to examine the research question, “How can we improve Infant and Early Childhood Mental Health Consultation through lessons learned during the …

Caring For The Carers: Exploring The Mental Wellbeing Of Informal Palliative Caregivers Of Cancer Patients In Kenya, James Kariuki, Rose Njiraini

Journal of Global Awareness

Cancer cases have been on the increase globally, and this has led to economic burden on the affected households. One way of reducing the cost of care is through home-based care by informal palliative caregivers who include family members, friends, and other people assigned by the family members to take care of the patient. The objectives of this study were to assess the status of the mental wellbeing of palliative caregivers of cancer patients; to examine the relationship between the ability of the patient to cope with cancer diagnosis and the mental wellbeing of the caregiver; and to investigate the …

Navigating Burnout: The Role Of Workplace Support For Social Work Clinicians, Melanie Fulton

Journal of Global Awareness

The shortage of mental health workers is a growing concern in the United States, and social workers a substantial portion of employees who work with individuals with mental health concerns. This shortage stresses the importance of studying factors that impact burnout for mental health clinicians, particularly social work clinicians. While burnout among social workers in some settings have been documented in the literature, less research has focused on independently licensed clinical social workers in private practice. This study had participants complete a survey to examine the relationship between workplace support, burnout, and professional fulfillment among this population (N = 57). …

Geauxhealth.Org: A Technological Approach To Community Resources In New Orleans, Madelin Mlynczak

Journal of the Louisiana Public Health Association

Background: Connecting patients to appropriate community resources remains a significant challenge for healthcare providers in New Orleans. Existing resource guides have limitations in clinical workflows, highlighting the need for a tool tailored to healthcare professionals. The primary objective of this study was to evaluate the effectiveness of the GeauxHealth.org website in improving medical residents’ and fellows’ knowledge of community resources and decreasing perceived struggle in referring patients to community resources. Methods: We conducted a pre- and post-intervention survey among residents and fellows at two academic institutions in New Orleans. Participants were introduced to GeauxHealth.org, a locally developed and searchable online …

Vol 6. May '26 Full Issue, Donna L. Williams

Journal of the Louisiana Public Health Association

No abstract provided.

Psychological Impact Of Career Roles On African American Women: A Qualitative Study On The Long-Term Effects On Behavioral Health Providers' Field, Yolanda Seals-Stewart

Doctoral Dissertations and Projects

There is an untold narrative regarding the levels of stress, anxiety, and depression. This leaves a gap in researchers understanding systemic, cultural, and social factors that shape mental health outcomes in a unique way. There is also a deeper need for exploration of resiliency and coping skills strategies utilized by African American women in the behavioral health field, as well as how behaviors such as discrimination, workplace dynamics, and microaggression impact the overall psyche. By addressing these gaps, a more thorough understanding of the long-term psychological effect can be addressed, and these women can receive support mechanisms and interventions that …

A Qualitative Job Posting Analysis From Missouri To Guide Competency-Based Curriculum In Slp Education, Megan Batzer

Teaching and Learning in Communication Sciences & Disorders

Competency-based education is a major trend for health professions education and one of the topics the Ad Hoc Committee to Plan Next Steps to Redesign Entry-Level Education for Speech-Language Pathologists (SLPs) recently explored. Competency-based education is an outcomes-based educational model where the focus is on development and mastery of specific knowledge and skills through instruction, assessment, and feedback. Competency-based education encompasses multiple educational theories including the self-determination theory, self-directed learning, self-assessment, and self-efficacy. Understanding the perspectives of key constituents, such as employers, on the setting-specific and across-setting knowledge, skills, and attributes required for the clinical fellowship (CF) experience could guide …

Thoughts From The Pit: Can Raving Change The World? A Literature Review Exploring Rave Culture As Expressive Arts Healing, Marissa Rose Renella

Expressive Therapies Theses

This literature review examines the structural and philosophical commonalities between expressive arts therapy (EXA) and rave culture. Drawing on scholarship from anthropology, cultural studies, health sciences, transpersonal psychology, neuroscience, and expressive arts therapy, this review identifies five core principles shared between the two fields: transformational experiences, multimodality, entrainment and flow, containment and ritual, and community and social action values. Across each principle, the literature reveals not surface-level similarity but deep convergence — two fields that have, independently and through different lineages, arrived at the same understanding of what human beings need in order to heal, grow, and connect. To the …

The Academic Workplace Climate Measure: A New Instrument To Measure Counselor Education Faculty Climate, Ryan Holliman, Ryan D. Foster, Pedro Blanco

Journal of Counselor Preparation and Supervision

Research indicates that between 32% and 62% of faculty in higher education have experienced some form of incivility (Cassell, 2011; Fox, 2010; Heffernan & Bosetti, 2020; Hollis, 2012; Keashly & Neuman, 2008; McKay et al., 2008). Incivility among faculty can be associated with declining health, decreased faculty retention, diminished self-esteem, and lowered psychological well-being (McClendon et al., 2021; Miner et al., 2012; Raskauskas & Skrabec, 2011). Although counselor educators are presumably experts in effective communication and conflict negotiation, anecdotal reports of conflict in counselor education departments are frequent. This study developed an instrument called the Academic Workplace Climate Measure. In …

Understanding Counselor Burnout From An Ecological Systems Perspective, Stephanie Thorson-Olesen, Lisa Belknap, Emily Velidow, Jessica Gaul, Phoenix Rosewood, Nayara Aparecida Da Costa Silva Beall

Journal of Counselor Preparation and Supervision

Using Bronfenbrenner’s Ecological Systems Theory as a guiding framework, this study explored the experiences of licensed counselors who self-identified as having recovered from burnout. Burnout was conceptualized as a prolonged response to chronic occupational stress, while participants were invited to describe their experiences based on their own lived understandings of the phenomenon. A qualitative thematic analysis was conducted using data collected through an anonymous online survey featuring open-ended prompts. Participants included 32 licensed counselors who graduated from CACREP-accredited programs and reported previously experiencing burnout and no longer identifying as currently burned out. Thematic analysis yielded nine interrelated themes encompassing contributors, …

Conceptualizing Professional Identity Development In Art Therapy Supervision With Post-Graduate Art Therapists Who Are Pre-Licensed, Christine S. Atkinson

Expressive Therapies Dissertations

This study explored how art therapy supervisors conceptualize professional identity development (PID) in supervision with postgraduate art therapists who were pre-licensed. There was limited empirical research on how art therapy supervisors understood and support PID within art therapy supervision, particularly during the transitional period between graduate training and professional licensure. This study addressed the research question: How do art therapy supervisors conceptualize PID in supervision with postgraduate art therapists who are pre-licensed?

Fourteen art therapy supervisors participated in the study (86% female; 14% non-binary), ranging in age from 25 to over 65 years old. All participants identified their race or …

“There Was Nothing Left To Give”: Experiences Of Compassion Fatigue Among Former In-Patient Psychiatric Clinicians, Katie Ladner

Counseling and Psychology Dissertations

Compassion Fatigue (CF) is a state of emotional and physical exhaustion resulting from prolonged exposure to stressful or traumatic experiences, specifically among healthcare workers, and it negatively impacts their ability to provide care to their patients and perform their jobs effectively (Singh et al., 2020). The purpose of this qualitative study is to explore the lived experiences of compassion fatigue in mental health clinicians who previously worked in in-patient psychiatric hospitals and their subsequent resignations. This phenomenological research explored participants' understanding and descriptions of their CF experiences in their roles within psychiatric hospitals and how CF contributed to their leaving …

Exploring Direct Support Professionals' (Dsps) Attitudes Regarding Trauma Informed Care And Its Impact On Turnover Intention, Lorraine D'Sylva-Lee

Seton Hall University Dissertations and Theses (ETDs)

The relationship between Direct Support Professionals’ (DSPs’) attitudes toward trauma-informed care (TIC) and their turnover intention has remained empirically untested, despite DSPs’ exposure to primary and secondary trauma. An estimated 8.38 million Americans with intellectual and developmental disabilities (IDD) depend on this workforce, yet 2024 turnover rates reach 53.7%. This convergent mixed methods study examined TIC attitudes, turnover intention, and their relationship among 109 DSPs in IDD provider agencies in New Jersey. Grounded in the Theory of Planned Behavior (TPB), the cross-sectional design used the ARTIC-10, TIS-6, and two open-ended items. DSPs with more favorable TIC attitudes were significantly less …

Postpartum Depression Protocols In A Neonatal Intensive Care Unit: Benefits And Outcomes, Myrnnda Miller

UNLV Theses, Dissertations, Professional Papers, and Capstones

This capstone project aimed to reduce postpartum depression symptoms in mothers with infants admitted to the University Medical Center (UMC) of Southern Nevada’s neonatal intensive care unit (NICU) by integrating early screening with occupation-based, trauma-informed support. The intervention combined the Edinburgh Postnatal Depression Scale (EPDS) for early detection with occupational therapy–facilitated maternal support sessions, providing emotional validation, education, and strategies for coping and parent–infant bonding. Guided by Trauma-Informed Care and Backwards Design frameworks, the project prioritized maternal safety, empowerment, and confidence. A paired sample t-test was conducted to compare pre and posttest EPDS scores and showed that the participant’s EPDS …

Golden Steps: A Dance-Based Program To Improve Balance In Older Adults — A Feasibility And Acceptability Study, Ramyr Bognot, Sophia Botelho, Nolan Caberto, Lauren Valerio, Joshua Yu, Jason Zeidman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Background

Falls are a leading cause of injury and loss of independence among older adults. Evidence-based programs such as Otago and Tai Ji Quan reduce fall risk, yet barriers to access and adherence remain. Dance-based interventions may offer a practical, enjoyable approach to engage older adults in balance training.

Purpose

This formative pilot study aimed to develop four dance routines grounded in evidence- based balance principles and evaluate their feasibility and acceptability among older adults, including factors influencing enjoyment and willingness to continue participation, to inform future clinical and community implementation.

Methods

Four routines (Polka, Country, Rockabilly, Salsa) were developed …

Associations Between Father–Mother Food Parenting Practices And Children’S Dietary Intake, Brian K. Lo, Natalie Grafft, Mariane Helen De Oliveira, Sebastien Haneuse, In Young Park, Alejandra Cantu-Aldana, Katherine W. Bauer, Rebekah Levine Coley, Jorge E. Chavarro, Kirsten K. Davison, Jess Haines

Human Genetics Publications

Objective: To examine whether the number of parents using high levels of structure or coercive control food parenting practices is associated with children’s dietary intake.

Design: Cross-sectional analysis of father–mother dyads from the Fathers & Families cohort study. Fathers and mothers independently reported their food parenting practices and child’s dietary intake. Multivariate logistic regression models estimated associations between the number of parents (0, 1 or 2) using high structure or coercive control practices and children’s intake of fruit, vegetables, fast food and sugar-sweetened beverages (SSB), adjusting for demographics and recruitment site.

Setting: United States

Participants: 474 father–mother dyads with a …

Keeping Families Together: Companion Animals As A Public Health Imperative, Lori R. Kogan, Rebecca Niemiec

Journal of One Health Systems

Contemporary US public health frameworks emphasize social, economic, and environmental determinants of health, yet largely overlook the reality that most households include companion animals regarded as family members. This omission has tangible consequences during crises such as housing instability, illness, domestic violence, or disasters, when families are often forced to choose between their own safety and the safety of their animals. We argue that this represents a significant public health failure. Drawing on interdisciplinary evidence, we propose that companion animals function as a social determinant of health, that forced separation constitutes a public health harm, and that Human-Animal Support Services …

Enhancing Access Through Integrated Behavioral Healthcare: Expanding Counselor Identity And Social Determinants Of Health Competency, Tiffany N. Snow

Dissertations, 2020-current

Abstract

The counseling profession has historically differentiated its identity by emphasizing a wellness-oriented approach. However, this has often led to the exclusion of counselors from integrated behavioral healthcare (IBH). With the 2024 enactment of the Mental Health Access Improvement Act, counselors now have unprecedented opportunities to serve as behavioral health providers in federal medical settings. This three-manuscript dissertation explores the intersection of counselor professional identity, social determinants of health (SDoH) competency, and interprofessional collaboration within IBH.

Manuscript 1 presents a conceptual framework for reconciling traditional counselor identity with the "medical model" of Primary Care Behavioral Health (PCBH), arguing that this …

Staff Education To Improve Psychiatric Nurses’ Knowledge On The Identification And Management Of Malignant Hyperthermia After Electroconvulsive Therapy, Grace Nwawuihe

Walden Dissertations and Doctoral Studies

No abstract provided.

The Impact Of Trump Administration Immigration Policies On Connecticut Educators And Families, Elena C. Bielesz

Honors Scholar Theses

Anti-immigrant rhetoric, policies, and practices, which have grown increasingly prevalent due to the current national political climate, have adverse effects on the mental health of immigrant families and the teachers that support them in Connecticut. This study seeks to represent the opinions of Connecticut K-12 MLL (Multilingual Learners) Education Teachers and Administrators whose daily lives are impacted by the anti-immigrant and anti-refugee policies and procedures. The study employed a human subjects-based approach supported by a review of related literature. MLL Educators from around the state of Connecticut were interviewed. These interviews found that while immigration-based trauma and stressors are common …

Preparing A Qualified Workforce To Support The Disability Community Through The Lend Interprofessional Learning Experience, Megan K. Roberts, Beth W. Degrace, Mark J. Fisher, Sandra H. Arnold

Developmental Disabilities Network Journal

Leadership and workforce preparation are vital roles of the nation’s academic institutions to advance health care services for the members of our communities. Leadership Education in Neurodevelopmental and other Related Disabilities (LEND) programs aim to prepare leaders in health care services and advocacy to improve systems and the quality of care and supports for the disability community, specifically children with developmental disabilities. LEND programs enhance standard health care pre-service training by providing interdisciplinary learning experiences for student trainees from a minimum of ten disciplines in 300 hours of learning activities over one academic year. An innovative feature of LEND programs …

Clinical Practice Guideline To Reduce Lgbtq+ Disparities In Health Care, Angel Lb Ambrose

Walden Dissertations and Doctoral Studies

No abstract provided.

From Exploitation To Healing: Mental Health And Resilience Among Native American Survivors Of Sex Trafficking, Katelin A. Stoebner

Honors Thesis

The mental health impacts of sex trafficking on Native American survivors and pathways to resilience are important to understanding healing. Native Americans are disproportionately affected by sex trafficking due to systemic inequities, historical trauma, and socioeconomic vulnerability. Using interviews with 47 Native survivors conducted as part of a larger Office on Violence Against Women project, this study analyzes the mental health challenges and recovery strategies identified by participants. Findings reveal that survivors commonly experience significant psychological effects, including post-traumatic stress disorder (PTSD), depression, and anxiety. Among participants, PTSD emerged as the most frequently reported condition, followed by depression and anxiety, …

Left Out And At Risk: Post-Pandemic Continuation Of Organizational Service Reduction In Metropolitan New York City Coincides With Rise In Opiate Use And Mental Health Problems For Latinos, Ruth Lin Campbell, Smita Ekka Dewan

Publications and Research

Increasing opiate use and mental health problems among younger and older Latinos in urban US contexts prompted this investigation into the organizational resources that facilitate help-seeking efforts of Latinos in New York State (NYS). Guided by a Vulnerability Model and a framework of organizational enabling resources, this study used complementary longitudinal and cross-sectional designs. The longitudinal component examined changes in levels of organizational facilitators for Latino substance use disorder (SUD) help-seeking in Downstate NYS across three time periods, while the cross-sectional component compared post-pandemic facilitator levels across service types and regions. A convenience sample of 241 SUD clinicians participated in …