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Mental and Social Health

Nova Southeastern University

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Articles 1 - 30 of 148

Full-Text Articles in Medicine and Health Sciences

Stressed Fracture: The Relationship Between Coping Strategies And Workload In Secondary School Athletic Trainers, Andrew Gallucci, Katherine M. Lee, Leslie W. Oglesby, Anna Porter, Leslee Funderburk, Jeff S. Forsse Dec 2023

Stressed Fracture: The Relationship Between Coping Strategies And Workload In Secondary School Athletic Trainers, Andrew Gallucci, Katherine M. Lee, Leslie W. Oglesby, Anna Porter, Leslee Funderburk, Jeff S. Forsse

Internet Journal of Allied Health Sciences and Practice

Purpose: The work environment for an athletic trainer (AT) working in a secondary school is typified by heavy workloads and job-related stress. Occupational stress can have negative effects on productivity, absenteeism, employee turnover, and quality of life. Research suggests that personal and situational factors can influence the coping process adopted by an individual. The approach-avoidance framework suggests that people cope with a stressor by either attempting to reduce it or removing oneself from that stressor. Previous research on other healthcare professionals suggested that use of avoidance coping was correlated with higher levels of job stress and those who perceived greater …


Hearing Loss As A Risk Factor For Cognitive Decline In The Elderly: A Rapid Review, Natalie Large, Nannette Nicholson Dec 2023

Hearing Loss As A Risk Factor For Cognitive Decline In The Elderly: A Rapid Review, Natalie Large, Nannette Nicholson

Internet Journal of Allied Health Sciences and Practice

Purpose: The aim of this rapid review was to identify and evaluate evidence exploring hearing loss as a risk factor for cognitive decline in the elderly population. Methods: A literature search was performed in three databases: CINAHL, Cochrane Central, and PubMed. The PRISMA template was used to record the search and selection process. Search criteria included older adults aged 65 and up with diagnosed or self-reported hearing loss and no previous diagnosis of dementia or Alzheimer’s disease. Participants were excluded if they had been diagnosed with dementia or tested for it before the study began. Hearing loss was categorized using …


Trauma, Identity, And Vietnamese Diaspora: Using The Medicine Wheel As A Healing-Focused Conflict Analysis Framework, Ha B. Dong Nov 2023

Trauma, Identity, And Vietnamese Diaspora: Using The Medicine Wheel As A Healing-Focused Conflict Analysis Framework, Ha B. Dong

Peace and Conflict Studies Journal Conference

No abstract provided.


The Effectiveness Of Serotonin And Tricyclic Antidepressants In Tinnitus Management: A Rapid Review, Dr. Emilie Vos, Dr. Nannette Nicholson, Melinda Johnson, Dr. Karah Gottschalk Sep 2023

The Effectiveness Of Serotonin And Tricyclic Antidepressants In Tinnitus Management: A Rapid Review, Dr. Emilie Vos, Dr. Nannette Nicholson, Melinda Johnson, Dr. Karah Gottschalk

Internet Journal of Allied Health Sciences and Practice

Background: Tinnitus can be defined as a health condition characterized by the perception of sound, either in the head and/or ears, in the absence of any external acoustic stimulus. Perception is often quantified by self-report, or the use of patient reported outcome measures (PROMs). The purpose of this rapid review was to evaluate the level and quality of evidence regarding the use of serotonin and norepinephrine reuptake inhibitors (SNRI), selective serotonin reuptake inhibitors (SSRI), and tricyclic antidepressants as measured by tinnitus patient-reported outcome measures (PROMs) and/or Visual Analog Scales (VAS). Methods: The Cochrane Rapid Review guidelines were followed. The PICO …


Perceptions Of Mental Health Among Pakistani Women With Micro-Finance Loans: An Interpretive Descriptive Study, Farhana Irfan Madhani, Catherine Tompkins, Susan Jack, Carolyn Byrne Aug 2023

Perceptions Of Mental Health Among Pakistani Women With Micro-Finance Loans: An Interpretive Descriptive Study, Farhana Irfan Madhani, Catherine Tompkins, Susan Jack, Carolyn Byrne

The Qualitative Report

Mental health has gained significant recognition and importance as a crucial aspect of overall well-being. An individual's mental health is influenced by the intersection of individual, social, cultural, and systematic sources of stress and resilience. It is important to include subjective conceptualizations of mental health and well-being to develop culturally sensitive approaches to mental health promotion. This qualitative study aimed to understand how urban-dwelling women living in Pakistan who are micro-finance loan recipients conceptualize the meaning of mental health. Using interpretive description methodology, data were collected and analyzed through in-depth, semi-structured interviews conducted in Urdu with a purposeful sample of …


Geriatric Interest Plan For Individuals With Dementia: Improved Quality Of Life, Alexis T. Francois Aug 2023

Geriatric Interest Plan For Individuals With Dementia: Improved Quality Of Life, Alexis T. Francois

Department of Occupational Therapy Entry-Level Capstone Projects

The purpose of this Capstone experience was to identify the specific needs to improve the quality of life for individuals with Dementia and Alzheimer’s. According to the Alzheimer’s Association (2022a), 1 in 9 people aged 65 and older have dementia. It is imperative for people living with this disease to be actively involved in meaningful activities that can reduce their negative symptoms. People with dementia constitute 40% of patients with significant depression (Alzheimer’s Association, 2022a). The common risk factors that increase the likelihood of depression in these adults include social isolation and loneliness, lack of exercise, and functional limitations that …


The Efficacy Of Group-Based Acceptance And Commitment Therapy For Decreasing Post-Stroke Depression To Improve Functional Outcomes, Lindsay Marie Folsom Aug 2023

The Efficacy Of Group-Based Acceptance And Commitment Therapy For Decreasing Post-Stroke Depression To Improve Functional Outcomes, Lindsay Marie Folsom

Department of Occupational Therapy Entry-Level Capstone Projects

No abstract provided.


Understanding Athletes’ Experience When Transitioning To Life Beyond Sport, Mary L. Dell'arciprete, M Lauren Dell'arciprete Jul 2023

Understanding Athletes’ Experience When Transitioning To Life Beyond Sport, Mary L. Dell'arciprete, M Lauren Dell'arciprete

Department of Occupational Therapy Entry-Level Capstone Projects

Discontinuation may be by choice or may be due to an injury; however most collegiate athletes’ sports engagement ends due to graduation causing them to shift their role in an occupation that played a crucial role in their self-identity. Athletes of all levels are challenged in their transition beyond sport and in the adjustment to the various role changes that occur. A significant life event, such as the end of one’s athletic engagement, can cause a loss of identity, purpose, and mental health decline. Former athletes may experience occupational disruption, a temporary inability to adequately engage in meaningful tasks due …


Incorporating Poi As A Therapeutic Modality For Preschool Aged Children In The Care Clinic, Danielle Zirkle Jul 2023

Incorporating Poi As A Therapeutic Modality For Preschool Aged Children In The Care Clinic, Danielle Zirkle

Department of Occupational Therapy Entry-Level Capstone Projects

No abstract provided.


Physical Therapy Students Experience Reductions In Physical Activity And Social Interaction During Coronavirus-Related Curricular Changes: A Cohort Study, Daniel W. Flowers, Amanda Bernard, Erin Mccallister, Lauren Rachal Sant Jun 2023

Physical Therapy Students Experience Reductions In Physical Activity And Social Interaction During Coronavirus-Related Curricular Changes: A Cohort Study, Daniel W. Flowers, Amanda Bernard, Erin Mccallister, Lauren Rachal Sant

Internet Journal of Allied Health Sciences and Practice

Purpose: The Coronavirus disease 2019 (COVID-19) pandemic challenged physical therapy students and faculty. The faculty at this institution implemented a modular curriculum progressing from in-person to remote learning to parallel a predicted autumn COVID-19 surge. This study compares the effect of varying educational models on physical therapy students’ physical activity and social isolation outcomes during their program’s response to the COVID-19 pandemic. We hypothesized that changes in students’ physical activity and social interaction would be observed throughout the semester as the curriculum became more distance based. Methods: This prospective cohort investigation of 42 students from a single physical therapy program …


Understanding Mental Health As Public Health, Christi M. Navarro Jun 2023

Understanding Mental Health As Public Health, Christi M. Navarro

Faculty Proceedings, Presentations, Speeches and Lectures

In this interactive workshop, we will utilize a multi-level public health framework to illustrate factors of risk and prevention that influence mental health and well-being. We will discuss shifting the narrative of mental health as an individual issue to the responsibility of society, culture, and environment. Participants will reflect on their role and level of influence in this model as well as their potential for action and positive impact.


A New Christmas Eve: Match Day Eve, Gehan A. Pendlebury Apr 2023

A New Christmas Eve: Match Day Eve, Gehan A. Pendlebury

be Still

The transition of medical student to resident physician represents the student becoming the teacher -- a teacher that will continue to evolve over time. Residents teach medical students, yet residents are taught by their attending physicians. In many ways, Match Day is a milestone marking the beginning of that incremental learning process. The word "doctor" derives from the Latin word “docere” meaning "to teach" as doctors should be teaching their patients good health in their practice of medicine. Likewise, it is an inherent responsibility of all physicians to pass on their knowledge and skills for the betterment of the next …


“Chains Weigh Heavy”: Body Mapping Embodied Experiences Of Anxiety, Priya Vaughan Dr, Anna Tewson, Patricia Morgan Dr, Katherine M. Boydell Professor Feb 2023

“Chains Weigh Heavy”: Body Mapping Embodied Experiences Of Anxiety, Priya Vaughan Dr, Anna Tewson, Patricia Morgan Dr, Katherine M. Boydell Professor

The Qualitative Report

Anxiety has both cognitive and somatic dimensions as is ubiquitous at a population level. We report on an arts-based research workshop gathering data on embodied experiences of anxiety and non-anxiety. We developed an innovative short body mapping workshop to collect data and undertook thematic analysis to analyse textual and visual data. 35 body maps were produced. “Tightness,” “pain,” and “heaviness” were the most frequently expressed embodied sensations of anxiety. By contrast, when not feeling anxious, participants’ bodies primarily felt “energetic,” “ordered,” and “open.” Anxiety was most frequently felt in the stomach, head and heart. 35 Participants mostly used an abstracted, …


State Level Mental Health Education Compared To Suicide-Related Behavior In Adolescents, 2019, Sonia Rao Jan 2023

State Level Mental Health Education Compared To Suicide-Related Behavior In Adolescents, 2019, Sonia Rao

Honors Theses

Objective: Determining correlations between state level mental and emotional health (M&E) education and suicide prevention (SP) education to suicide-related behaviors (I.e. feeling sad or hopeless, suicide ideation, making a suicide plan, suicide attempt, suicide attempt treated by medical personnel, and death by suicide) within high school adolescents aged 15-19 within the United States in 2019.

Methods: State level education policies, M&E and SP, were retrieved from the National Association of State Boards of Education (NASBE). Self-reported adolescent suicide related behaviors were retrieved from the 2019 Youth Risk Behavior Surveillance System (YRBSS). Data on deaths by suicide of youth aged 15-19 …


“We Live On An Island:” Perspectives On Rural Family Caregiving For Adults With Alzheimer’S Disease And Related Dementias In The United States, Heather J. Williamson, Andria B. Begay, Dorothy J. Dunn, Rachel Bacon, Mark Remiker, Yolanda E. Garcia, Michael J. Mccarthy, Julie A. Baldwin Oct 2022

“We Live On An Island:” Perspectives On Rural Family Caregiving For Adults With Alzheimer’S Disease And Related Dementias In The United States, Heather J. Williamson, Andria B. Begay, Dorothy J. Dunn, Rachel Bacon, Mark Remiker, Yolanda E. Garcia, Michael J. Mccarthy, Julie A. Baldwin

The Qualitative Report

As the United States’ aging population grows, there will be increased prevalence of individuals living with Alzheimer’s Disease and related dementias (ADRD), who largely rely on the support of their family caregivers. Family caregivers residing in rural areas face additional challenges with managing caregiving responsibilities and navigating support services. The purpose of this multilevel phenomenological qualitative study was to explore the assets, unique needs, and resources of rural-residing ADRD caregivers from the caregiver, provider, and policy influencers’ perspectives. The study took place between 2019 through 2021 in northern Arizona, a largely rural and geographically vast area home to caregivers from …


Medicine And Motherhood: The Silent Loads, Gehan A. Pendlebury Oct 2022

Medicine And Motherhood: The Silent Loads, Gehan A. Pendlebury

be Still

This poem articulates the challenging and often misunderstood experience of being a mother in medical school It describes a silent load that often takes a toll on mothers in medicine It describes the feeling of simultaneously being pulled in opposing directions, the pain of missing on special family moments and events The poem offers hope and solidarity for mothers who are enduring this unique experience.


Imposter Phenomenon And Dunning-Kruger Effect: Leveraging Internal Conflicts For Professional Growth And Wellness, Arkene Levy, Algevis Wrench, Maria Padilla, Vijay Rajput Md Oct 2022

Imposter Phenomenon And Dunning-Kruger Effect: Leveraging Internal Conflicts For Professional Growth And Wellness, Arkene Levy, Algevis Wrench, Maria Padilla, Vijay Rajput Md

be Still

Working together as a team, we all came to realize that addressing uncomfortable topics such as imposter phenomenon is important to build resilience among faculty and students.


An Examination Of Emotional Resilience Among Athletic Trainers Working In The Secondary School Setting, Shaine Henert, William Pitney, Bethany Wood, Nicholas E. Grahovec, Tyler A. Wood Sep 2022

An Examination Of Emotional Resilience Among Athletic Trainers Working In The Secondary School Setting, Shaine Henert, William Pitney, Bethany Wood, Nicholas E. Grahovec, Tyler A. Wood

Internet Journal of Allied Health Sciences and Practice

Purpose: Athletic training is a demanding profession that is a stressor for many practitioners. Emotional resilience allows Athletic Trainers (ATs) to persist in their roles and benefit from long and successful careers. The purpose of this study was to explore the level of emotional resilience of ATs working in secondary school settings and identify factors perceived to contribute to or mitigate one's emotional resilience. Method: A sequential explanatory mixed-method design using a cross-sectional online survey followed by in-depth interviews was used to gather information from 160 (16% response rate) secondary school NATA members - 97 (60.6%) female; 63 (39.4%) male …


Assessment And Diagnostic Practices Relating To Autism Spectrum Disorder In The United States And Mexico, Maria Valdez, Jessica R. Stewart, Wan-Lin Chang, Ruth Crutchfield, Ralph Carlson Sep 2022

Assessment And Diagnostic Practices Relating To Autism Spectrum Disorder In The United States And Mexico, Maria Valdez, Jessica R. Stewart, Wan-Lin Chang, Ruth Crutchfield, Ralph Carlson

Internet Journal of Allied Health Sciences and Practice

Purpose: The present study examined and compared professional assessment and diagnostic practices relating to autism spectrum disorder (ASD) in Mexico and the United States (U.S.). This information is of great importance because there is an extremely limited amount of information pertaining the assessment and diagnostic practices for ASD in Mexico and little is known about how these practices compare to those in the U.S. Methods: Archival data from a survey investigating ASD in the U.S. and Mexico was used for this study. Participants included 29 professionals from the U.S. and 7 professionals from Mexico. Professionals were from a variety of …


Correlates Of Caffeinated Energy Drinks, Substance Use, And Behavior Among Adolescents, Lauren N. Maziarz, Lauren A. Dial, Bradley Fevrier, William Ivoska Sep 2022

Correlates Of Caffeinated Energy Drinks, Substance Use, And Behavior Among Adolescents, Lauren N. Maziarz, Lauren A. Dial, Bradley Fevrier, William Ivoska

Internet Journal of Allied Health Sciences and Practice

Background: Caffeinated energy drinks (CCEDs) are frequently consumed by adolescents aged 10-19, yet the effects of consumption on adolescent behavior are not well understood. Previous research has identified positive associations between CCED use and other substances such as alcohol and marijuana but studies among adolescents are lacking. Methods: We conducted a secondary analysis using data collected from the 2019 Alcohol, Drug Addition, and Mental Health Services (ADAMHS) Board/Wood County Educational Service Center’s youth survey. Ten public schools in Wood County, Ohio participated (n=6,152). Results: CCED use was common among our sample (43.4% overall). Reported consumption increased with age and was …


Occupational Therapy Program For Pace Center For Girls, Natalie Vish Aug 2022

Occupational Therapy Program For Pace Center For Girls, Natalie Vish

Department of Occupational Therapy Entry-Level Capstone Projects

An occupational therapy handbook was created for future occupational therapy students and occupational therapy assistant students to utilize when completing fieldwork rotations at Pace Center for Girls. The handbook was created to address core occupations through a trauma-informed and gender-sensitive perspective. An occupational therapy program utilizing mindfulness and sensory-based approaches at Pace Center for Girls may provide alternative and effective solutions for this at-risk female adolescent population as literature reveals that survivors of complex trauma often do not respond to traditional psychiatric treatment approaches.


A Conceptualisation Of Resilience Among Cancer Surviving Employed Women In Malaysia, Melati Sumari, Nordinah Mohd Kassim, Nor Safatul Aznin A.Razak Aug 2022

A Conceptualisation Of Resilience Among Cancer Surviving Employed Women In Malaysia, Melati Sumari, Nordinah Mohd Kassim, Nor Safatul Aznin A.Razak

The Qualitative Report

This study examines the experiences faced by employed female cancer survivors when developing resilience. We used a phenomenological approach to understand these experiences and challenges. A total of ten participants with different types of cancer participated in this research, which was carried out using semi-structured interviews. Social media was used for triangulating the data collected. The meanings of resilience were monitored through the particpants’ social media accounts (namely, Facebook and Instagram) from the time of diagnosis until they returned to work. Data were analysed using thematic analysis. Five themes emerged from the data collected: (a) resilience through painful experience, (b) …


Coping Strategies For Inner Conflicts Between Gay Bear Identity And Health Concerns, Chichun Lin, Darren D. Moore Jul 2022

Coping Strategies For Inner Conflicts Between Gay Bear Identity And Health Concerns, Chichun Lin, Darren D. Moore

The Qualitative Report

Gay bear refers to a burly gay man with a hirsute body and face. Chinese gay bear men are highly homogeneous and strictly emphasize a uniform bear appearance; however, obesity is an obvious health issue in this population. This study aims to explore the Chinese gay bear men's inner conflicts between bear identity and health concerns. Eleven Chinese gay bear men including four Taiwanese, two mainland Chinese, two Hong Kong, two Malaysian, and one Singaporean were interviewed. The study used a thematic analysis approach and found three coping strategies including (a) Eat healthy but maintain a minimal bear standard; (b) …


The Lived Experience Of Postpartum Anxiety During Covid-19: A Hermeneutic Phenomenological Study, Walker Ladd Phd, Jenny De Decker Jul 2022

The Lived Experience Of Postpartum Anxiety During Covid-19: A Hermeneutic Phenomenological Study, Walker Ladd Phd, Jenny De Decker

The Qualitative Report

The experience of pregnancy and postpartum anxiety disorders results in adverse birth outcomes and the disrupted development of infants and children. Since the COVID-19 Pandemic, the Centers for Disease Control and Prevention (CDC) has designated pregnant and postpartum women as more vulnerable to COVID-19 (CDC, 2021), and perinatal mood and anxiety disorders rates have increased. However, research regarding the lived experience of women with postpartum anxiety (PPA) during a global pandemic remains lacking. Using van Manen’s hermeneutic phenomenological research method, we interviewed eight women self-identifying as having had PPA during the COVID-19 pandemic. Analysis revealed five themes describing the lived …


Influences On The Attachment Style Of Deaf Adults With Hearing Parents, Ellen Schaefer-Salins Jul 2022

Influences On The Attachment Style Of Deaf Adults With Hearing Parents, Ellen Schaefer-Salins

JADARA

The current study explored variables that could contribute to the development of a secure or insecure attachment style of 15 deaf adults between the ages of 30 and 50 with hearing parents. There is a paucity of information on the relationship of deaf adults to their hearing parent and how that relationship may influence attachment. For the current study, quantitative methods were used to explore both childhood and adulthood variables, such as type of communication used with parents, type and level of schooling, and current attachment style. Variables also studied include age, gender, race, birth order, marital status, the hearing …


Self-Portraits For Social Change: Audience Response To A Photovoice Exhibition By Women With Disability, Diane Macdonald, Angela Dew, Karen Fisher Assoc Prof, Katherine Boydell Apr 2022

Self-Portraits For Social Change: Audience Response To A Photovoice Exhibition By Women With Disability, Diane Macdonald, Angela Dew, Karen Fisher Assoc Prof, Katherine Boydell

The Qualitative Report

Negative attitudes about and behaviours towards women with disability are harmful and exclusionary, contributing to poorer health, income, educational, and employment outcomes. Our study focused on what audiences learnt, felt, and did (what changed) after viewing self-portraits and stories by women with disability. We questioned whether a public exhibition of their artworks, created through photovoice methodology, could be an effective platform to provoke social change and increase inclusion for people with disability. We collected audience response to our exhibition to address a research gap and to provide an example for other photovoice researchers. We employed interpretive thematic analysis through a …


Access, Engagement, And Experiences With Critical Incident Response Resources In Athletic Training, Karen L. Holmes, Elizabeth R. Neil, Kelcey C. Granger, Lindsey E. Eberman Mar 2022

Access, Engagement, And Experiences With Critical Incident Response Resources In Athletic Training, Karen L. Holmes, Elizabeth R. Neil, Kelcey C. Granger, Lindsey E. Eberman

Internet Journal of Allied Health Sciences and Practice

Purpose: Experiencing an event that involves actual or threatened death or serious injury is a critical incident and produces serious emotional responses. Athletic trainers (ATs) experience critical incidents in their day-to-day work. The purpose of this study was to explore how ATs experience a critical incident during the course of clinical practice. Methods: We used one-on-one, web-based, semi-structured interviewing with a criterion sample of ATs who experienced a critical incident and used any critical incident response resources in the last year (n=17; age=32±8; years of experience=9±7; years in current position=4±5). We used a 3-person team with a multi-phase process to …


A Systematic Review To Propose An Evidence-Based Nutrition Protocol In Depression, Camilla A. Mirkin, Nicole Koci Feb 2022

A Systematic Review To Propose An Evidence-Based Nutrition Protocol In Depression, Camilla A. Mirkin, Nicole Koci

NSU REACH and IPE Day

Background: Rates of depression have been rising steadily over the last several decades with more than 264 million people affected, making it one of the top three burdens globally. The pandemic has brought on a greater risk of depression. Forty-two percent of individuals surveyed in December 2020 by the US Census Bureau reported depressive symptoms. Many factors, including poor diet quality, play a role in the development of depression during traumatic events like the pandemic. A low-quality dietary pattern has been associated with obesity, low-grade chronic inflammation, dysbiosis, increased cortisol levels and monoamine neurotransmitter deficiency. Among others, these factors have …


African-American Lay Pastoral Care Facilitators’ Perspectives On Dementia Caregiver Education And Training, Nik M. Lampe, Nidhi Desai, Tomeka Norton-Brown, Alexandra C. H. Nowakowski, Robert L. Glueckauf Feb 2022

African-American Lay Pastoral Care Facilitators’ Perspectives On Dementia Caregiver Education And Training, Nik M. Lampe, Nidhi Desai, Tomeka Norton-Brown, Alexandra C. H. Nowakowski, Robert L. Glueckauf

The Qualitative Report

The African-American Alzheimer’s Caregiver Training and Support Project 2 (ACTS 2) is a faith-integrated, skills-training and support program for distressed African American family caregivers of persons living with dementia across Florida. Caregivers participate in a 12-week, telephone-based, skills-building and support program led by faith community workers (i.e., lay pastoral care facilitators) who provide volunteer services to their denominations. In this case study, we examined facilitators’ perspectives and recommendations for supplementary audiovisual and written training materials to optimize group process and goal-setting skills. Utilizing a qualitative approach, we explored facilitators’ needs, experiences in using current training materials, and recommendations for supplementary …


The Role Of Social Work In Residential Aged Care Facilities: Evaluation Of A Pilot Program In Australia, Jodie L. Lee Ms, Michael Splawa-Neyman Mr, Fiona Mcdermott Associate Professor Jan 2022

The Role Of Social Work In Residential Aged Care Facilities: Evaluation Of A Pilot Program In Australia, Jodie L. Lee Ms, Michael Splawa-Neyman Mr, Fiona Mcdermott Associate Professor

The Qualitative Report

In some international settings, social workers are employed within aged care settings. However, in Australia, social workers rarely work in residential aged care facilities. In an innovative program, an Australian health network employed a social worker in an aged residential care facility from 2010 to 2011. In this research we examine and evaluate this program. Qualitative semi-structured interviews with nine key stakeholders and data extraction from medical records were conducted. Data from medical records and interview transcripts were coded and themes extracted using thematic analysis. Thematic analysis identified five key themes reflecting the roles performed by the social worker. These …