Digital Commons Network^™

Symmetry And Psychosocial Adaptation To Trauma, Illness And Disability Part I: Views From Physics, Medicine And Psychology, Hanoch Livneh

Leadership, Learning and Counseling Faculty Publications and Presentations

The aim of this two-part paper is to discuss the concept of symmetry and its derivatives, symmetry breaking and asymmetry, and the role they assume in elucidating the structure and processes that underlie psychosocial adaptation to traumatic experiences. To achieve this aim, in Part I, first, a cursory review of symmetry is undertaken as it applies to physics, including conservation laws, the forces of nature, and leading theories of nature. Second, the paper addresses how symmetry is perceived in biology and medicine, including symmetry within biochemical and genetic structures, the human body, and the onset of disease processes. Third, the …

Association Between The Combined Herbal Medicines And Risk Of Dental Diseases In Patients With Rheumatoid Arthritis: Insight From A Nationwide Database, Chiu-Hui Ling, Wei-Jen Chen, Ying-To Hsu, Hanoch Livneh, Ming-Chi Lu, Tzung-Yi Tsai

Leadership, Learning and Counseling Faculty Publications and Presentations

Background and Objectives:

Patients with rheumatoid arthritis (RA) are found to have a higher risk of dental diseases. Although herbal medicines (HMs) have long been used to treat various conditions, few studies focus on its impact on dental diseases. In this longitudinal cohort study, we assessed the correlation between HM use and risk of dental diseases in RA groups.

Materials and Methods:

A total of 2359 persons with RA aged 20–80 who were free of dental diseases between 2001 and 2010 were retrospectively enrolled from nationwide register-based data. They were then classified into HMs and non-HMs groups based on whether …

Influence Of Depressive Symptoms On Disease Activity In Patients With Rheumatoid Arthritis: The Mediating Effect Of Self-Efficacy, Wen-Wei Lin, Chieh-Tsung Yen, Hua-Lung Huang, Hanoch Livneh, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai

Leadership, Learning and Counseling Faculty Publications and Presentations

Background and Objectives:

Rheumatoid arthritis (RA) is a lifelong autoimmune disease in which joint inflammation is caused by a dysfunctional immune system. Synchronous depressive symptoms have been identified as determinants of disease progression, especially disease activity as measured using the 28-joint Disease Activity Score (DAS28). Although growing evidence suggests the interplay between depression and DAS28 in RA, related findings remain inconsistent, implying that a pivotal underlying mechanism is overlooked. Hence, we aimed to examine whether self-efficacy, the belief in one’s ability to manage health, could mediate the association between depressive symptoms and DAS28.

Materials and Methods:

Between January and October …

Real-World Evidence For Herbal Medicine Benefit In 9728 Type 2 Diabetes Patients-Peridonotitis Risk And Ambulatory Care Utilization., Wen-Wei Lin, Chieh-Tsung Yen, Hanoch Livneh, Hua-Lung Huang, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai

Leadership, Learning and Counseling Faculty Publications and Presentations

Recent evidence manifests that individuals with type 2 diabetes (T2D) are increasingly affected by oral disorders. Although medicinal herbs have shown promise in managing T2D, their benefit in managing periodontitis risk and subsequent healthcare utilization remains uncertain.

The Addition Of Chinese Herbal Medicines Is Effective As A Prophylactic Treatment Against Dental Diseases For Sjögren’S Syndrome Patients: Insight From Real-World Database, Ching-Ya Juan, Wei-Jen Chen, Hanoch Livneh, Ming-Chi Lu, Tzung-Yi Tsai

Leadership, Learning and Counseling Faculty Publications and Presentations

Background and Objectives:

Sjögren’s syndrome (SS) is a chronic autoimmune disease that affects the salivary glands and increases the risk of developing dental diseases (DDs). Chinese herbal medicines (CHMs) represent a promising alternative strategy for SS treatment; however, the association between CHMs and DD risk has not been confirmed. In this retrospective, cohort-based, nested case-control study, we explored whether or not combining CHMs with routine treatments for SS can reduce the chance of DDs.

Materials and Methods:

In the beginning, we recruited subjects aged 20–80 years with newly diagnosed SS who were free of DDs between 2001 and …

Mediating Role Of Self-Efficacy In The Association Between Fatigue And Depressive Symptoms In Females With Rheumatoid Arthritis, I-Yu Hsiao, Hanoch Livneh, Chieh-Tsung Yen, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background and Objectives: Extant research on the relationship between fatigue and depression in people with rheumatic diseases portrays a divergent picture. While caring for persons with this medical condition, one issue that represents individual confidence in carrying out specific tasks, namely self-efficacy level, has attracted significant attention. Yet, the information regarding whether self-efficacy may pose a clue linking these two major symptoms is still unknown. The aim of this study, therefore, is to examine whether self-efficacy mediates the association between fatigue and depressive symptoms among persons with rheumatoid arthritis (RA). Materials and Method: A cross-sectional study of 224 …

The Combined Treatment Of Chinese Herbal Medicines Is Correlated With A Lower Risk Of Rheumatoid Arthritis In Patients With Depression: Evidence From A Population-Based Patient–Control Study, Chieh-Tsung Yen, Hanoch Livneh, Hui-Ju Huang, Ming-Chi Lu, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background: Major depression places psychological strain on the individual that may increase the risk of developing rheumatoid arthritis (RA). Though the use of Chinese herbal medicines (CHMs) is widespread in clinical practice, its effect on the prevention of RA incidents is still unknown. This study aimed to evaluate the association between CHMs use by patients with depression and their subsequent risk of being diagnosed with RA.

Integrating Rehabilitation Services Into Routine Care Of Rheumatoid Arthritis May Reduce The Inflammatory Response: A Hospital-Based Follow-Up Study In Taiwan, Hui-Ju Huang, Wei-Jen Chen, Hanoch Livneh, Hua-Lung Huang, Ming-Chi Lu, Tzung-Yi Tsai, Multiple Additional Authors

Counselor Education Faculty Publications and Presentations

Background and Objectives:

For persons with rheumatoid arthritis (RA), the accompanying systemic inflammatory conditions often insidiously damage extra-glandular organs, causing poor outcomes. Despite evidence manifesting the application of rehabilitation services (RSs), the association between RSs use and changes in the inflammatory response among persons with RA has not yet been established. With that in mind, this study aimed to evaluate changes in C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) before and after long-term RSs use.

Materials and Methods:

For this two-group pre and posttest study, medical data of 4505 persons with RA aged 20–70 years between 2012 and 2017 …

An Exploration Of Self-Efficacy And Its Associated Factors Among Rheumatoid Arthritis Patients In Taiwan, I-Yu Hsiao, Hanoch Livneh, Wei-Jen Chen, Ming-Chi Lu, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Self-efficacy is an important ingredient in successful disease management, especially in patients with chronic conditions such as rheumatoid arthritis (RA). However, the information on self-efficacy and its influencing factors among RA patients is scarce. This study investigated the level of self-efficacy and its pertinent predictors among RA patients in Taiwan. This cross-sectional study recruited patients with RA from a hospital in Taiwan between January and October 2023. A structured questionnaire was used to collect data on respondents’ demographic and job characteristics and included a Chinese version of the Arthritis Self-Efficacy Scale (ASES). Multiple linear stepwise regression analysis was employed to …

Decreased Risk Of Osteoporosis Incident In Subjects Receiving Chinese Herbal Medicine For Sjögren Syndrome Treatment: A Retrospective Cohort Study With A Nested Case-Control Analysis, Chieh-Tsung Yen, Hanoch Livneh, Hua-Lung Huang, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Sjögren syndrome (SS) is a long-lasting inflammatory autoimmune disease that may cause diverse manifestations, particularly osteoporosis. Though usage of Chinese herbal medicine (CHM) can safely manage autoimmune disease and treatment-related symptoms, the relation between CHM use and osteoporosis risk in SS persons is not yet recognized. With that in mind, this population-level nested case-control study aimed to compare the risk of osteoporosis with and without CHM use. Potential subjects aged 20–70 years, diagnosed with SS between 2001 and 2010, were retrieved from a national health claims database. Those diagnosed with osteoporosis after SS were identified and randomly matched to those …

Does The Nurse-Led Case Management Benefit Rheumatoid Arthritis Patients In Reducing Distressing Symptoms And C-Reactive Protein: A 2-Year Follow-Up Study In Taiwan, Wei-Chiao Chang, Hanoch Livneh, Hua-Lung Huang, Hsin-Hua Li, Ming-Chi Lu, Miao-Chiu Lin, Wei-Jen Chen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background: Rheumatoid arthritis (RA) is a chronic disease and may worsen over time. Today, nurse-led case management (NLCM) has been recommended to improve clinical outcomes for chronic disease patients, yet little is known regarding its impact on pain, fatigue, and C-reactive protein (CRP) among RA patients. We aimed to explore this issue among such groups via a two-group pre- and post-test approach.

Methods: All subjects were recruited from one hospital in Taiwan from January 2017 to June 2018 and assigned to either a 6-month NLCM program in addition to usual care or to a control group that received usual care …

Effect Of Company-Driven Disability Diversity Initiatives: A Multi-Case Study Across Industries, Brian N. Phillips, Teresa A. Granger, Chase Ochrach, Kathryn A. Thomas, Antonio Reyes, Rachel F. Kesselmayer, Catherine A. Anderson, Katherine B. Friedman, Multiple Additional Authors

Counselor Education Faculty Publications and Presentations

OBJECTIVE: In this article, we share insights emerging from case studies conducted across seven companies.We illustrate the motives, processes, and outcomes of these initiatives. METHODS: This study is built on the previously published case studies conducted across seven companies. We applied elements of consensual qualitative research (CQR) for the data collection and analyses before performing an in-depth qualitative content analysis using the data coded for each company, looking for commonalities and differences. RESULTS: Although practices differed, all companies experienced noted benefits. Committed leadership and complementary company values facilitated successful outcomes for initiatives. The strength or salience of disability-inclusive actions and …

A Call To Action For Disability And Rehabilitation Research Using A Discrit And Disability Justice Framework, Toni Saia, Rana Yaghmaian, Rachel Cuesta, Carlyn Mueller, Roxanna N. Pebdani

Counselor Education Faculty Publications and Presentations

Purpose: Disability and ableism exist within a societal context that does not ignore the many facets of a person’s identity, however often our disability research does not recognize how experiences vary based on the intersecting identities individuals hold. This article utilizes Intersectionality, Dis/ability Critical Race Studies (DisCrit), and Disability Justice to identify ways for rehabilitation researchers to adapt their research practices for maximum inclusivity and representation.

Materials and Methods: Using these three frameworks, we have developed a call to action including recommendations for rehabilitation researchers to consider as they design and implement research projects.

Results: Incorporating these frameworks provides an …

Relationship Between Chinese Herbal Medicine Use And Risk Of Sjögren’S Syndrome In Patients With Rheumatoid Arthritis: A Retrospective, Population-Based, Nested Case-Control Study, Hou-Hsun Liao, Hanoch Livneh, Miao-Chiu Lin, Ming-Chi Lu, Ning-Sheng Lai, Hung-Rong Yen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background and Objectives: Sjögren’s Syndrome (SS) is a common extra-articular feature among subjects with rheumatoid arthritis (RA). While Chinese herbal medicine (CHM) has been used to treat symptoms of RA for many years, few studies have examined its efficacy in guarding against the SS onset. This study aimed to compare risk of SS for RA patients with and without use of CHM. Materials and Methods: Data obtained for this nested case-control study were retrieved from Taiwanese nationwide insurance database from 2000–2013. Cases with SS claims were defined and matched to two randomly selected controls without SS from the recruited RA …

How Domestic Violence Affects Incarcerated Women, Michelle Ryman

University Honors Theses

The incarceration of women has grown seven times since the 1980s, with up to 90% of incarcerated women being survivors of domestic violence. Women are five times more likely to be abused by an intimate partner. Intimate partner violence leads to unhealthy coping mechanisms like drug abuse and violence against perpetrators. While coercion in IPV can contribute to violent retaliation and drug abuse, it can also lead to criminal behavior prompted by the perpetrator. Whether IPV shows itself as violent attacks, sexual assault, coercion, financial withholding, threats, isolation, psychological abuse, or any other behavior that allows one person to control …

Decreased Risk Of Low Back Pain During Pregnancy Associated With The Use Of Orthopedic Manual Therapy: A Nested Case-Control Study, Wei-Chiao Chang, Hanoch Livneh, Chieh-Tsung Yen, Min-Chih Hsieh, Ming-Chi Lu, Wei-Jen Chen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background: Recent evidence suggests that the use of orthopedic manual therapy (OMT) may lessen the subsequent risk of low back pain (LBP), but this association has not been examined among pregnant women who are at higher risk of LBP. This study aims to determine whether the addition of OMT to conventional LBP treatment before pregnancy could decrease the subsequent risk of LBP during pregnancy.

Methods: From Taiwan's National Health Insurance Research Database, we identified 68,960 women, 20–55 years of age, with first pregnancy between 2001 and 2012. We then performed a nested case-control study in which 3,846 women with newly …

Perspectives Of Students With Intellectual And/Or Developmental Disability In College Inclusion Programs On Their Preparation For Working In Competitive Integrated Employment, Eva R. Blixseth

Dissertations and Theses

Individuals with intellectual and developmental disabilities have a history of being isolated, marginalized, and excluded from employment that is competitive and integrated. Policy makers, disability advocates, and self-advocates have made efforts to center inclusive education and employment opportunities for individuals with intellectual disability. Employment is a valuable outcome for students with intellectual and developmental disabilities exiting college inclusion programs (Lee & Colleagues, 2022). However, from 2017 through 2021, not all students with intellectual and/or intellectual disability exiting college inclusion programs were employed. This is concerning as O'Brien et al. (2019) pointed out students' primary goal for completing college inclusion programs …

Adjusting To Change: Learning American Sign Language Online During A Global Pandemic, Kara Gournaris

Northwest Journal of Teacher Education

Second language acquisition of American Sign Language (ASL) requires opportunities for engagement with native language models (Krashen, 1988). The shift to online instruction due to the impact of COVID-19 presented unique challenges for ASL programs across the United States. With little time to redesign courses, instructors and students had to navigate the experience of online learning together. The students who participated in this 2020 study at Western Oregon University (WOU) shared their raw experiences related to this transition, and unfortunately, one year later, many of the same barriers reported by students persist. The purpose of this article is to share …

Parecoxib Reduced Postsurgical Pain And Facilitated Movement More Than Patient Controlled Analgesia, Szu-Ching Chiu, Hanoch Livneh, Jin-Cheng Chen, Chia-Ming Chang, Honda Hsu, Tsay-I Chiang, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background: Postoperative pain management is an imperative issue for patients undergoing lumbar spinal fusion surgery. Delayed pain relief is associated with poor clinical outcomes. This study compared the effects of intravenously administered patient-controlled analgesia (PCA) with intravenous parecoxib, both commonly used methods for analgesic pain control after surgery.

Methods: A non-randomized study was used to recruit 68 patients who were scheduled to receive lumbar spinal fusion surgery at a hospital in Taiwan from April through December of 2020. The group treated with parecoxib received an initial perioperative dose of parecoxib 40 mg during a 30-min period and then postoperative intravenous …

A Comparison Of The Risk Of Fracture In Rheumatoid Arthritis Patients With And Without Receiving Chinese Herbal Medicine, Hou-Hsun Liao, Hanoch Livneh, Yu-Jung Chung, Ching-Hsing Lin, Ning-Sheng Lai, Hung-Rong Yen, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Objective: Patients with rheumatoid arthritis (RA) often suffer from bone complications due to persistent joint inflammation, especially incident fracture. Nowadays, Chinese herbal medicines (CHMs) have provided safe and effective therapy for treating skeletal conditions, but it is unclear whether CHMs can prevent fracture onset among RA individuals. This study aimed to determine the association between the use of CHMs and the risk of fracture among them.

Methods: This retrospective, population-based study retrieved administrative health data from the Taiwan National Health Insurance (NHI) database to identify patients with newly diagnosed RA between 2000 and 2009. Of the 6178 incident …

Creating Academic-Community Partnerships To Jointly Enhance Advocacy And Research On Violence And Disability: Two Case Examples, Emily M. Lund, Rosemary B. Hughes, Katherine E. Mcdonald, Sandra Marie Leotti, Marsha Katz, Leanne Beers, Christina Nicolaidis

School of Social Work Faculty Publications and Presentations

Objective: This article describes the use of community-based participatory research (CBPR) to foster bidirectional and equitable academic-community partnerships in two studies related to interpersonal violence and disability. Method: We analyzed our methods and experiences in conducting these studies to focus on the ways in which CBPR methodology was used to jointly promote and enhance research and advocacy surrounding violence and disability in the research processes themselves and the resulting assessment and intervention products. Results: Our use of CBPR methodology allowed us to identify and address critical issues related to violence in the disability community, such as disability-related forms and experiences …

Adding Pay-For-Performance Program To Routine Care Was Related To A Lower Risk Of Depression Among Type 2 Diabetes Patients In Taiwan, Wei-Cheng Lian, Hanoch Livneh, Hui-Ju Huang, Ming-Chi Lu, How-Ran Guo, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Background: Patients with type 2 diabetes (T2DM) often experience depression during treatment, negatively influencing their treatment compliance and clinical outcomes. Recently, the pay-for-performance (P4P) program for chronic diseases, with high-cost and high-risk feature, such as T2DM, has been implemented and has been operational for several years. Nevertheless, its effect on the risk of developing depression among T2DM cases is unknown. This study aims to explore the association of P4P use with the subsequent risk of developing depression among these patients.

Methods: This cohort study used a nationwide health insurance database to identify patients 20–70 years of age newly diagnosed with …

The Relationship Of Acupuncture Use To The Endometriosis Risk In Females With Rheumatoid Arthritis: Real-World Evidence From Population-Based Health Claims, Hanoch Livneh, Wei-Jen Chen, Chien-Hui Hsu, Ying-To Hu, Ning-Sheng Lai, How-Ran Guo, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Objectives: Women affected by rheumatoid arthritis (RA) have a higher risk of endometriosis, an estrogen-dependent, chronic inflammatory disease. Though acupuncture has long been a safe and effective therapy for treating inflammatory conditions, it is unclear whether it could prevent the onset of endometriosis. This study aims to determine the effect of acupuncture on the subsequent risk of endometriosis in female RA patients.

Methods: Between 1998 and 2010, female subjects with RA were recruited from a nationwide database (5,736 patients; age ≥20 years). Enrolled patients included 2,407 acupuncture users and 2,407 nonusers randomly selected using propensity scores. The occurrence of endometriosis …

Use Of Chinese Herbal Medicines Is Related To A Reduction In Depression Risk Among Patients With Insomnia: A Matched Cohort Study, Yun-Wen Chiao, Hanoch Livneh, How-Ran Guo, Wei-Jen Chen, Ming-Chi Lu, Miao-Chiu Lin, Chia-Chou Yeh, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Objective: Subjects with insomnia have a higher risk of depression, thus possibly making them live with serious health conditions. To date, information regarding the effect of Chinese herbal medicines (CHMs), a commonly used complementary and alternative medicine, on depression risk among people with insomnia is still unknown. This study aimed to investigate the effect of CHMs on the risk of depression among individuals with insomnia.

Methods: This cohort study used a national health insurance database to identify 68,573 subjects newly diagnosed with insomnia, aged 20–70 years, who received treatment between 1998 and 2010. Using propensity score matching, we …

Reduced Stroke Risk Among Patients With Atrial Fibrillation Receiving Chinese Herbal Medicines Treatment: Analysis Of Domestic Data In Taiwan, Li‐Cheng Zheng, Hanoch Livneh, Wei‐Jen Chen, Miao‐Chiu Lin

Counselor Education Faculty Publications and Presentations

Background and objectives: Patients with atrial fibrillation (AF) reportedly have a much higher risk of death due to stroke. Faced with this heavy burden, it remains unclear if the Chinese herbal medicines (CHMs), the most common form complementary and alternative medicine, can lower the risk of stroke for them. This study aimed to evaluate the association of CHMs use with stroke risk among them. Materials and Methods: From a nationwide database, 11,456 AF patients aged ≧ 20 years between 1998 and 2007 were identified. Afterwards, we enrolled 2670 CHMs users and randomly selected 2670 non-CHMs users using the propensity score …

Exploring The Use Of An Occupational Interests Card Sort With Young Adults With Intellectual Disability: A Preliminary Stud, Sarah R. Carlson, Mary E. Morningstar, Arpita Ghosh, Vidya D. Munandar

Special Education Faculty Publications and Presentations

Transition planning is the foundation for addressing post-secondary goals leading to improved outcomes. Transition assessments guide the transition planning process. Given the importance of transition assessment results, practitioners need access to measures supporting the active involvement of youth with intellectual disability. One such method is the occupational interests card sort. This study investigated the use of an occupational interests card sort with youth with intellectual disability, assessing its impact on their career decision self-efficacy. Results indicated that the occupational interests card sort influenced young adults’ ability to select career goals, as well as identify career themes beyond occupational interests.

Association Of Use Of Rehabilitation Services With Development Of Dementia Among Patients With Rheumatoid Arthritis: Analysis Of Domestic Data In Taiwan, Ming-Chi Lu, Hanoch Livneh, Chieh-Tsung Yen, Hua-Lung Huang, Miao-Chiu Lin, Shu-Wen Yen, Ning-Sheng Lai, Tzung-Yi Tsai

Counselor Education Faculty Publications and Presentations

Objectives: Rheumatoid arthritis (RA) was found to trigger the higher risk of dementia. Limited information, however, is available on whether the use of rehabilitation services (RS), an integral part of healthcare programs, can lessen dementia risk for RA subjects. The aim of this study was to determine the relationship of RS use to the development of dementia in RA patients.

Methods: We identified 2,927 newly diagnosed patients with RA, 20–70 years of age between 1998 and 2007, from a national health insurance database. 965 patients from this sample received RS, and 1,962 patients were designated as a control group (non-RS …

Upstream Predictors Of The Need For Developmental Education Among First-Year Community College Students, Mathew C. Uretsky, Stacey L. Shipe, Angela K. Henneberger

School of Social Work Faculty Publications and Presentations

Objective/Research Question. How do student- and school-level factors measured in the final year of high school contribute to the odds of a student being assessed to need remediation in Math during the students’ first community college enrollment? Methods. The present study draws on five years of linked secondary and post-secondary administrative records and includes the academic records for 18,814 students attending 228 high schools across 24 jurisdictions in Maryland. We used a series of multilevel models (MLM) to address the research question. Results. Using MLM, we identified both student and school-level factors, drawn from the final year of high school, …

Engaging In A Rural Deaf Community Of Practice, Kara Gournaris

Dissertations and Theses

The number of students taking American Sign Language (ASL) at the post-secondary level continues to increase as more Deaf-related graduate programs and employment settings require fluent ASL skills. Western Oregon University (WOU) is one of the few existing programs in the United States that offers four years of ASL instruction; however, as a rural university it has limited access to a Deaf community. The problem of practice is that students often have little exposure to rich language models who are fluent in ASL, which impacts their legitimate peripheral participation (LPP) in the local Deaf communities of practice (CoPs) and reduces …

Training Needs Of Peer And Non-Peer Transition Service Providers: Results Of A National Survey, Pauline Jivanjee, Leigh Grover, Kristin Thorp, Brie Masselli, Johanna Bergan, Eileen Brennan

School of Social Work Faculty Publications and Presentations

Participatory action research processes guided a national online survey of service providers working with transition age youth with mental health challenges. The survey investigated transition service providers’ ratings of the importance of competencies and skills, self-assessed need for training in these competencies and skills, their preferred training modalities, and obstacles to engaging in training. The 254 participants identified trauma-informed care, understanding youth culture, promoting natural supports, and using culturally responsive practices as most important training needs. Age, years in current job, years in transition work, and race/ethnicity predicted training needs regarding some competencies and skills. Peer providers expressed preferences for …