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Articles 31 - 60 of 89

Full-Text Articles in Clinical and Medical Social Work

Barriers To The Use Of Palliative And Hospice Care Among The Latino Population, Diana Ramirez May 2022

Barriers To The Use Of Palliative And Hospice Care Among The Latino Population, Diana Ramirez

Electronic Theses, Projects, and Dissertations

Patients suffering from irreversible and terminal illnesses may benefit from the services provided by Palliative and Hospice Care to control any symptom burden and assist in navigating complex medical decisions. Many patients may express hesitation in accepting and enrolling to this service due to misconceptions. Language barriers may add an additional layer of complexity. This study explored the challenges Palliative Care providers encounter when introducing concept of hospice to Spanish-speaking patients their families for the first time. This study implemented qualitative research methods by using semi-structured one-on-one interviews. Ten members of an In-patient Palliative Care Team at a University Hospital …


Substance Use Disorders, Cognitive Dysfunction, And Neurodivergence In Emerging Adulthood, David Posada, Jordyn Hebert Apr 2022

Substance Use Disorders, Cognitive Dysfunction, And Neurodivergence In Emerging Adulthood, David Posada, Jordyn Hebert

Symposium of Student Scholars

Substance Use Disorders, Cognitive Dysfunction, and Neurodivergence in Emerging Adulthood

Posada, D., Herbert, J., Weingast, L., Holliday, E.

Cognitive functioning in college students with substance use disorders (SUD) has been widely researched, however, discussions have largely concentrated on executive functions (EF) such as working memory, flexible thinking, and self-control. Literature on the relationship between cognitive dysfunction and SUD has largely underreported the influence of Attention Deficit/Hyperactivity Disorders (ADD/ADHD) and other neurodivergent characteristics. The current review explores the state of the literature on the relationship between neurodivergence, cognitive dysfunction, and SUD in emerging adulthood. More specifically, it speculates whether college students …


The Gender Freedom Model: A Framework For Helping Transgender, Non-Binary, And Gender Questioning Clients Transition With More Ease, Rae Mcdaniel, Laurel Meng Jan 2022

The Gender Freedom Model: A Framework For Helping Transgender, Non-Binary, And Gender Questioning Clients Transition With More Ease, Rae Mcdaniel, Laurel Meng

Journal of Counseling Sexology & Sexual Wellness: Research, Practice, and Education

Transgender/non-binary experiences and identities are often represented in academic literature through narratives of distress and are often pathologized through a medical lens. This holds implications for the field of psychotherapy, as interventions aimed to support transgender/nonbinary individuals often focus solely on risk mitigation. This article presents a therapeutic framework that rests on three pillars—Play, Pleasure, and Possibility—as the focal points for reimagining work with transgender/non-binary clients. This model aims to help this population explore gender transition with more ease through building practical skills, cultivating personal and collective pride, and centering pleasure equity.


A Pathway For Inclusive Innovation In Pediatric Mental Health: Prevention And Intervention Using Technology, Kate Corinne Bennett Jan 2022

A Pathway For Inclusive Innovation In Pediatric Mental Health: Prevention And Intervention Using Technology, Kate Corinne Bennett

DSW Capstone Projects

It is no secret that access to quality healthcare is difficult for citizens to achieve in the United States. Racism, discrimination, and oppression further exist at the root of compounding social problems, including limits in minority access to mental health services. The COVID-19 pandemic has also exacerbated mental health problems for young children, especially those who are already underserved and at risk. For these reasons, it is imperative that the social work profession emphasizes innovative approaches to equitable treatment access, including a focus on early intervention and the use of technology. Product one of this capstone engages a systematic review …


Transforming Hurt Boys Into Restored Men: The Lack Of Mental Health Treatment For Black Male Trauma Survivors, Shericka Danielle Smith Jan 2022

Transforming Hurt Boys Into Restored Men: The Lack Of Mental Health Treatment For Black Male Trauma Survivors, Shericka Danielle Smith

DSW Capstone Projects

Trauma affects individuals differently, but the prevalence of trauma and its impact on Black males is detrimental. Black males are at higher risk for posttraumatic stress disorder (PTSD), depression, substance abuse, and violent crimes when trauma is left untreated by a mental health professional. As the number of traumatic events experienced by Black males continues to rise, the number of these males who seek mental health treatment remains stagnant and painfully low. Many factors play into these behaviors, yet very little data exists on what is being done to change them.

Product one is a systematic literature review in which …


The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor Jan 2022

The Program To Reduce Implicit Bias In Carroll Hospital Center Using The Implicit Association Test, Katherine E. Traynor

Capstone Showcase

Natural brain processes make all individuals susceptible to unconscious bias; however, stressful, fearful, or anger-evoking situations as well as the negative influence of media and social surroundings increase the risk of holding obstructive bias, and there is a greater risk of being negatively impacted by this phenomenon when belonging to a minority population (Rose & Flores, 2020). As a result, high rates of infant mortality (10.2 deaths per 1,000 live births for the Non-Hispanic Black population compared to 4.1 in the White population) and cardiovascular related diseases (190.0 cases per 1,000 in the Non-Hispanic Black population compared to 161.3 in …


The Biopsychosocial Model And Clinical Decision Science In The Age Of Black Lives Matter: A Clinical Reflection, Abdul-Rahman M. Suleiman, Samer Ilayan May 2021

The Biopsychosocial Model And Clinical Decision Science In The Age Of Black Lives Matter: A Clinical Reflection, Abdul-Rahman M. Suleiman, Samer Ilayan

Clinical Research in Practice: The Journal of Team Hippocrates

The author reflects on the biopsychosocial considerations of elevated blood pressure in teenage African American youth during the era of Black Lives Matter (BLM). Parallels are drawn between Dr. Engel’s biopsychosocial model and clinical decision science.


Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos May 2021

Treatment Access For Dual Diagnosis Substance Use And Mental Health Disorders, Pedro Banuelos

Electronic Theses, Projects, and Dissertations

In 2018, of 1.3 million Latinx adults in the United States facing concurrent issues with substance use disorders (SUD) and mental health disorders (MHD) 93% remained untreated for either diagnosis. This is concerning since Substance Abuse and Mental Health Services Administration (SAMHSA) data reveals that this population is at greater risk for suicidal thoughts, plans, and attempts. They also face structural barriers such as employment, housing, legal involvement, and insurability that further impede access to treatment.

This study’s purpose was to examine barriers to accessing treatment for Latinx populations confronting co-occurring SUDs and MHDs. This study used a qualitative design …


Assisted Reproductive Technologies And Health-Related Issues Among Women And Children: A Research Review, Laura Maria Corradi Mar 2021

Assisted Reproductive Technologies And Health-Related Issues Among Women And Children: A Research Review, Laura Maria Corradi

Dignity: A Journal of Analysis of Exploitation and Violence

From their first use in the late 1970s until the mid-1990s, Assisted Reproductive Technologies (ART) gave rise to serious concerns by feminists internationally. Their questions ranged from asking about health risks to ethical and political problems inherent in these technologies. However, over the last 25 years, interest in women’s health which used to be central to feminist theory and politics, progressively decreased and with it concerns about ART. Today, while the medical literature about health risks in ART is increasing, the topic of women’s health in relation to reproductive technologies remains marginal in feminist discourse, social sciences, and the mainstream …


The Rise In Use Of Emotional Support Animals By College Students: The Impact Of Parenting Styles, Misty G. Smith, Samantha Ballard, Jill Willis Jan 2021

The Rise In Use Of Emotional Support Animals By College Students: The Impact Of Parenting Styles, Misty G. Smith, Samantha Ballard, Jill Willis

Journal of Higher Education & Student Affairs

As the generational context of higher education shifts, a rise of Emotional Support Animals (ESA) and mental health concerns are present for students on college campuses. While previous studies have aimed to address the relevancy and controversy of ESAs in higher education as well as their effectiveness in supporting individuals, less research has explored underlying factors that contribute to the use of an ESA. The purpose of this study was to explore the parenting behaviors of parents/caregivers of students with ESAs in comparison to parents/caregivers of students without ESAs. An embedded mixed methods design was used. Participants completed the Parenting …


Historical Trauma Response Scores As A Function Of Unresolved Grief And Substance Use Disorder In American Indian Populations, Andrew R. Saunders Nov 2020

Historical Trauma Response Scores As A Function Of Unresolved Grief And Substance Use Disorder In American Indian Populations, Andrew R. Saunders

Undergraduate Research Symposium

Abstract

Researchers are interested in the outcomes of interventions, specifically, measuring historical trauma (HT) among American Indian/Alaska Native communities and the long-term distress and substance abuse as a result of historical trauma response (HTR). Previous literature has implicated limitations in the clinical conceptualization of the relationship between intergenerational transfer of HTR and substance abuse. The aim of the current study is to examine treatment efficacy of 50 homosexual, American Indian males randomized to a culturally-adapted juxtaposition of (1) Group Interpersonal Psychotherapy (IPT), (2) Cognitive Processing Therapy (CPT), and (3) Historical Trauma and Unresolved Grief Intervention (HTUG), or (4) waitlisted on …


Application Of Self-Efficacy Training In Group Aural Rehabilitation: An Interprofessional Collaborative Model, Stephen D. Roberts, Nancy A. Delich Aug 2020

Application Of Self-Efficacy Training In Group Aural Rehabilitation: An Interprofessional Collaborative Model, Stephen D. Roberts, Nancy A. Delich

JADARA

Few studies have explored self-efficacy training with persons with hearing loss (PHLs), yet alone with their communication partners (CPs). The purpose of this mixed-method study was to examine the impact of self-efficacy training as a framework for an Interprofessional Psychosocial Group Aural Rehabilitation (IPGAR) workshop with PHLs and their CPs. Four PHLs and their four CPs consented to participate in the IPGAR workshop that employed interventions including short lectures, psychosocial exercises, communication strategies training, speech perception training, adaptive/stress reduction exercises, and group discussions relevant to mutually established shared goals for each couple. The participants reported improved communication abilities in the …


Bridging The Gap: Understanding Non-Offending Parental Responses To Their Children's Sexual Abuse., Jennifer Latreill, Psy.D. Jun 2020

Bridging The Gap: Understanding Non-Offending Parental Responses To Their Children's Sexual Abuse., Jennifer Latreill, Psy.D.

Dissertations

The parental response to children's disclosure of childhood sexual abuse (CSA) is the most critical and important factor regarding the child's post trauma trajectory and overall trauma resolution. Understanding parental responses and the factors that prompt acceptance versus disbelief among the non-offending parent (NOP) is vital to children's success following disclosure given the weight of the NOPs response and its impact on long-term consequences of CSA. This literature review provides a comprehensive summary of what may deter the NOP from recognizing intrafamilial sexual abuse, factors that may contribute to the NOPs disbelief following disclosure, and possible clinical implications of such …


From Isolation To Communication: Connecting Adults Who Have Hearing Loss With Their Communication Partners, Stephen D. Roberts, Nancy A. Delich Apr 2020

From Isolation To Communication: Connecting Adults Who Have Hearing Loss With Their Communication Partners, Stephen D. Roberts, Nancy A. Delich

JADARA

As Baby Boomers enter the late adulthood stage of life, hearing loss continues to be one of the most prevalent, chronic, and isolating conditions facing older adults today. Research has focused on the negative consequences of hearing loss on the health and the person’s well-being, but it is equally important to recognize that hearing loss also leads to communication loss. The resulting social isolation and the collateral effects of hearing loss on the communication partner are the focus of this mixed-method study that explored the hearing loss-related quality of life for both parties. Five overarching themes emerged from the analysis, …


Access To Autism Spectrum Disorder Services For Rural Appalachian Citizens, Angela Scarpa, Laura S. Jensen, Denis Gracanin, Sharon L. Ramey, Angela V. Dahiya, L. Maria Ingram, Jordan Albright, Alyssa J. Gatto, Jen P. Scott, Lisa Ruble Jan 2020

Access To Autism Spectrum Disorder Services For Rural Appalachian Citizens, Angela Scarpa, Laura S. Jensen, Denis Gracanin, Sharon L. Ramey, Angela V. Dahiya, L. Maria Ingram, Jordan Albright, Alyssa J. Gatto, Jen P. Scott, Lisa Ruble

Journal of Appalachian Health

Background: Low-resource rural communities face significant challenges regarding availability and adequacy of evidence-based services.

Purposes: With respect to accessing evidence-based services for Autism Spectrum Disorder (ASD), this brief report summarizes needs of rural citizens in the South-Central Appalachian region, an area notable for persistent health disparities.

Methods: A mixed-methods approach was used to collect quantitative and qualitative data during focus groups with 33 service providers and 15 caregivers of children with ASD in rural southwest Virginia.

Results: Results supported the barriers of availability and affordability of ASD services in this region, especially relating to the need for more ASD-trained providers, …


Creative Arts-Based Parents Training Program For Parents Of Children With Autism Spectrum Disorder, Jung Eun Park Dec 2019

Creative Arts-Based Parents Training Program For Parents Of Children With Autism Spectrum Disorder, Jung Eun Park

Expressive Therapies Dissertations

This study evaluated the impact of the Creative Arts-based Parents’ Training (CAPT) program. The 6-week long, creative arts therapy-based program and its impact on parental stress and sense of competence for parents of children with Autism Spectrum Disorder (ASD) was examined. Korean Parenting Stress Index Short-Form (K-PSI-SF) and Korean-Parenting Efficacy Test (K-PET) were used as quantitative measurements. Qualitative data were also collected for the experimental group (n = 17) using questionnaires, art journaling, and a 30 min focus group interview. The control group (n = 15) only participated in quantitative measurements. There was no difference in age between …


Chapter 12: Dementia: Detection, Assessment, And Intervention, Sally Pelon Dec 2019

Chapter 12: Dementia: Detection, Assessment, And Intervention, Sally Pelon

Books and Contributions to Books

This chapter considers various forms of dementia as well as the assessment and diagnosis process from a uniquely social work perspective. It also explores various psychosocial and practical interventions that may utilized by social workers as they support and assist both those with a dementia diagnosis and their loved ones.


Power In The Counseling Relationship: The Role Of Ignorance, Izaak L. Williams, Peg O'Connor Oct 2019

Power In The Counseling Relationship: The Role Of Ignorance, Izaak L. Williams, Peg O'Connor

Journal of Human Services: Training, Research, and Practice

This article explores the role of therapist self-disclosure in clinical settings. Distinctions are made between the enmeshed concepts of privacy, secrecy, and confidentiality to elucidate the role of ignorance in maintaining the power dynamics in therapeutic relationships. While some measure of privacy is essential to counseling practice, secretive behavior (in which the counselor divulges too little about themselves) can have a negative impact on the therapeutic relationship and the client’s therapeutic outcomes. There is, therefore, an under-appreciated and delicate balancing act between withholding information to protect the client and the counselor and revealing enough personal details to empower the client’s …


Does Ethnic Identity, In-Group Preference, And Acculturation Protect Latinas With A History Of Interpersonal Trauma From Developing Symptoms Of Ptsd?, Evelyn M. Ramirez Sep 2019

Does Ethnic Identity, In-Group Preference, And Acculturation Protect Latinas With A History Of Interpersonal Trauma From Developing Symptoms Of Ptsd?, Evelyn M. Ramirez

Dissertations, Theses, and Capstone Projects

Previous research suggests ethnic identity, a sense of belonging to a particular cultural group, may be protective against symptoms of post-traumatic stress disorder (PTSD). However, the role of ethnic identity, in-group preference (i.e., an individual’s preference for interactions with members of their own ethnic group) and acculturation (i.e., the level of comfort with the mainstream culture) have not been investigated as protective factors for Latinas with a history of interpersonal and sexual trauma. In this study, ethnic identity, in-group preference and acculturation were assessed via self-report on the Scale of Ethnic Experience in two samples of undergraduate Latina and non-Latina …


Efficacy Of Integrated Mental Health Care With Dual Diagnosis Patients And Their Utilization Of Psychiatric Emergency Services, Denton Scott May 2019

Efficacy Of Integrated Mental Health Care With Dual Diagnosis Patients And Their Utilization Of Psychiatric Emergency Services, Denton Scott

Doctoral Dissertations

Historically, patients with dual diagnosis have been subjected to ineffective treatment and negative attitudes from healthcare providers. Further, these patients are plagued with myriad afflictions that exist beyond substance abuse and mental illness. The treatments and collateral damage associated with the diagnosis impose excessive healthcare costs and can be of significant detriment to society. Largely, patients suffering from dual diagnosis do not receive adequate treatment. As such, psychiatric emergency services are frequently utilized as an alternate treatment, wherein the main focus of care is on the substance abuse alone. This study argues that solely treating the substance abuse is not …


Forgotten Children & Bonds That Heal: The Critical Nature Of Attachment, August Ashbaker Mar 2019

Forgotten Children & Bonds That Heal: The Critical Nature Of Attachment, August Ashbaker

Lesley University Community of Scholars Day

Human attachment is one of the most critical factors in proper neurological and physiological development. Attachment is built through the mutuality of emotional impact, as well as the regular reception of physical touch. Infants and children who have been deprived of these vital necessities through the lacking initiatives of their caregivers—through neglect—display visible signs of its physiological, cognitive, emotional, and behavioral impact. Research has found neglect to be the highest risk factor for permanent damage to brain development in comparison to other forms of complex trauma (i.e. chronic caregiver interpersonal trauma in childhood); it is also the most prevalent …


A Multicase Study Exploring Women’S Narratives Of Infertility: Implications For Counselors, Staci L. Born, Christin L. Carotta, Kristine Ramsay-Seaner Dec 2018

A Multicase Study Exploring Women’S Narratives Of Infertility: Implications For Counselors, Staci L. Born, Christin L. Carotta, Kristine Ramsay-Seaner

The Qualitative Report

Infertility affects 6.7 million women in the United States (Chandra, Copen, & Stephen, 2013). Women’s experiences with infertility are not only influenced by biological health factors, but also by social, cultural, and personal variables. Given the prevalence and complexity of infertility, additional research is needed to further examine the nuances of women’s experiences. The purpose of this multicase study, as informed by four individual cases, was to explore how women construct their infertility narratives. Review of reflective journals found five common elements: (1) Emotional Rollercoaster, (2) Mind-Body (Dis)Connection, (3) Secret Identity, (4) Supportive vs. Constrained Communication Patterns, and (5) Fatalistic- …


The Critical Need For Mental Health Education To Be Mandated In New Mexico's Public Schools, Bonnie L. Murphy Nov 2018

The Critical Need For Mental Health Education To Be Mandated In New Mexico's Public Schools, Bonnie L. Murphy

Shared Knowledge Conference

Based on a review of research and best practices in mental health awareness and skills, this inquiry project argues for state legislative policies that would require mental health awareness and skills in the K-12 curriculum. Mental health affects individual accomplishments in every stage of people’s lives beginning in early childhood and throughout the life cycle. Prevention and treatment of mental illness plays a key role in the ability of an individual to cope with loss and develop resiliency and perseverance in challenging times and to make better decisions that improve the individual’s life and the lives of those around them. …


An Examination Of The Impact Traumatic Events Has On Psychosocial Impairment In Eating Disorder Patients, Jennifer Parker Hackett Jun 2018

An Examination Of The Impact Traumatic Events Has On Psychosocial Impairment In Eating Disorder Patients, Jennifer Parker Hackett

Electronic Theses, Projects, and Dissertations

Research suggests that trauma has an impact on eating disorders. While prior research has demonstrated that the trauma from abuse has a significant impact on eating disorders, research has failed to explore other types of trauma. In addition, previous studies have stopped short of examining the impact trauma has on functioning among individuals with an eating disorder. This study aimed to address that gap in the literature. The purpose of this study is to examine whether traumatic life events impact psychosocial functioning among individuals living with an eating disorder. Furthermore, this study aimed to identify which traumas are shown to …


Social Work Trauma Interventions: Dialectical Behavioral Therapy, Kassie Baumann May 2018

Social Work Trauma Interventions: Dialectical Behavioral Therapy, Kassie Baumann

Senior Honors Theses

According to Lynne Weilart (2013), in her article on the reasons why people seek out therapy, trauma is the number one reason people attend counseling. Many different trauma-informed approaches are designed specifically to address the consequences of trauma and to facilitate healing. Some of these approaches are as follows: Cognitive Behavioral Therapy (CBT); Dialectical Behavioral Therapy (DBT);Mentalization Based Therapy (MBT); Trauma Systems Therapy (TST); Trauma Assessment Pathway (TAP); and Attachment, Self-Regulation, and Competency (ARC) (de Arellano, Danielson, Ko, & Sprauge, 2008). The effectiveness of each trauma intervention will be examined. DBT is one of these trauma interventions that is growing …


The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer Apr 2018

The Predictors Of Juvenile Recidivism: Testimonies Of Adult Students 18 Years And Older Exiting From Alternative Education, La Toshia Palmer

Dissertations

Purpose: The purpose of this descriptive, qualitative study was to identify and describe the importance of the predictors of juvenile recidivism and the effectiveness of efforts to prevent/avoid juvenile recidivism as perceived by previously detained, arrested, convicted, and/or incarcerated adult students 18 years of age and older exiting from alternative education in Northern California. A second purpose was to explore the types of support provided by alternative schools and the perceived importance of the support to avoid recidivism according to adult students 18 years of age and older exiting from alternative education.

Methodology: This qualitative, descriptive research design identified …


Launch-Ing Minnesota Early Childhood Mental Health Into The Future, Molly Abdo, Alyssa Baker, Elizabeth Holz Mar 2018

Launch-Ing Minnesota Early Childhood Mental Health Into The Future, Molly Abdo, Alyssa Baker, Elizabeth Holz

Master of Social Work Student Policy Advocacy Briefs

What is Social-Emotional Development? The foundation for lifelong mental health, including social and emotional development, is established early in life and shaped by children's relationships with parents, caregivers, and peers. This foundation is critical to all aspects of healthy development and growth in early childhood. Social-emotional development can be defined as "the capacity to form secure relationships; experience, express, and manage a range of emotions; and learn and explore one's environment."

Why is it Important? When children fail to develop social-emotionally, mental health symptoms begin to emerge and can "cause distress, interfere with relationships, limit the child's participation in daily …


Psychosocial Correlates Of Post-Traumatic Stress Disorder Symptoms And Well-Being Among Hispanic World Trade Center Rescue And Recovery Workers, Dianne Ciro Feb 2018

Psychosocial Correlates Of Post-Traumatic Stress Disorder Symptoms And Well-Being Among Hispanic World Trade Center Rescue And Recovery Workers, Dianne Ciro

Dissertations, Theses, and Capstone Projects

Thousands of first responders are estimated to have endured extremely distressing experiences during their recovery efforts at the 9/11 World Trade Center (WTC) site. While the effects of 9/11 continue to be studied, few studies have examined how rescue and recovery workers have been coping since 9/11 and how their coping is associated with their psychological well-being. Moreover, we do not know how distinct coping patterns may be associated with post-traumatic growth, experiences of positive emotion, or quality of life among WTC responders.

This study compared coping differences among Hispanic, Non-Hispanic White, and Non-Hispanic Black first responders. In addition, it …


The Hold Me Tight Program For Couples Becoming Parents: A Mixed Methods Study, Debbie Wang Jan 2018

The Hold Me Tight Program For Couples Becoming Parents: A Mixed Methods Study, Debbie Wang

Theses and Dissertations (Comprehensive)

ABSTRACT

Attachment theory has made substantial contributions to the understanding of close relationships. The purpose of this study was to inquire whether an attachment-informed psychoeducational program is a feasible and effective intervention for couples expecting their first child. The overarching question was: Is an attachment-informed relationship enhancement program, such as Hold Me Tight® (HMT), helpful to couples in strengthening their relationship and increasing their confidence in becoming first-time parents? The research question was addressed using a mixed-methods approach.

In the first phase, the Hold Me Tight® program developed by Dr. Sue Johnson was modified for use with couples …


Caring For Caregivers: Challenges Facing Informal Palliative Caregivers In Western Kenya, Hartlee Johnston Oct 2017

Caring For Caregivers: Challenges Facing Informal Palliative Caregivers In Western Kenya, Hartlee Johnston

Independent Study Project (ISP) Collection

Chronic illnesses like cancer, HIV, and other non-communicable disease are increasing globally, especially in developing countries, necessitating development of palliative care and symptom management systems. In Kenya, the burden of care for chronically ill patients often falls to unpaid, informal caregivers like family members or friends. Thirty-five current or past informal caregivers from Kisumu, Kenya were interviewed about their experience, challenges they faced, and interventions they felt would be helpful. Major challenges identified included lack of finances for treatment and other living expenses; inadequate, unaffordable, or interrupted medical care; emotional stress exacerbated by juggling many responsibilities, pressure to emotionally support …