Skills and knowledge therapists need to work with foster youth and families: According to key stakeholders in child welfare.

The current study relied on community-based participatory action research and qualitative methodology to explore the necessary skills and knowledge psychotherapists need to work effectively with foster youth and their families. In this study, the research team conducted interviews and focus groups with stakeholders (n = 48) in child welfare to learn how to support therapeutic relationships with foster youth clients. Using qualitative content analysis, the research team identified eight categories for needed knowledge and/or skills, such as collaboration with and inclusion of others in a client's system; flexibility and open-mindedness to individualize care follow the client's lead; and a solid understanding of trauma and attachment supported by therapist training and regular consultation specifically around foster care. These findings offer tangible suggestions for skills that psychotherapists can learn and practice in order to support beneficial mental health services for foster youth.

Ingredients of successful therapeutic relationships with foster youth according to key stakeholders in child welfare: A grounded theory analysis.

Foster youth reportedly have a significant need for mental health services and the quality of the therapeutic relationship can influence service engagement. We employed grounded theory methods to conduct interviews and focus groups with 48 key stakeholders in child welfare to deepen our theoretical understanding of therapeutic relationships with foster youth. The central theory that emerged was that a successful therapeutic relationship is an essential ingredient of the healing process for current and former foster youth. Participants identified hindrances to a successful therapeutic relationship, such as when therapist mishandles countertransference or inappropriately uses self-disclosure, as well as what therapists can do to build a successful therapeutic relationship, such as when a therapist fosters a secure attachment and promotes client agency. The findings offer insight into some of the important facets of building and maintaining a trusting and successful therapeutic relationship with current and former foster youth.

Food security and feeding behaviours in low-income, Latinx families with preschool-aged children.

OBJECTIVE: To examine the association between food security and feeding practices in Latinx parents of pre-school-aged children and examine possible effect modification by parental self-efficacy. DESIGN: Cross-sectional assessment using the US Department of Agriculture screener for food insecurity as the exposure and sub-scales of the Comprehensive Feeding Practices Questionnaire as the outcome with the General Self-Efficacy Scale as an effect modifier. Non-parametric descriptive statistics were used to compare groups based on food security status. SETTING: Two Latinx communities with low-socioeconomic status in Texas in 2017 and in Oregon in 2018-2019. PARTICIPANTS: Latinx parents of preschool aged children, English and Spanish speaking. Dyads were excluded if they had moderate-severe developmental disabilities, a seizure disorder with a restrictive diet or taking medications known to influence typical growth. RESULTS: Of the 168 families in Oregon, 65 (38 %) reported food insecurity, and 10 (21 %) of the 48 families in Texas reported food insecurity. Food security was associated with greater parental monitoring practices in both the Texas and Oregon samples. We observed no differences in creating a healthy home food environment by food security status in either sample. Parental general self-efficacy showed evidence of effect modification in Oregon - only parents with lower self-efficacy showed a significant association between food security and feeding practices. CONCLUSIONS: Latinx parents of preschool children experience high levels of food insecurity, which are associated with maladaptive parental feeding practices. Greater parental general self-efficacy moderates this association and could buffer the effects of food insecurity on children's health.

Experiences during COVID-19: Needs of college students with a history of foster care.

The effects of the coronavirus disease 2019 (COVID-19) have been nothing short of profound, with disparate impact among historically marginalized and under-resourced populations. Eighty undergraduate college students, with a history of foster care placement, describe their experiences during Shelter in Place due to COVID-19. Former and current foster youth already experience challenges in accessing and completing higher education; these challenges were exacerbated by the measures taken to deal with risks associated with the pandemic. Study findings build upon previous studies that indicated that former and current foster youth have unique and significant pandemic related financial, physical and psychosocial concerns, by using conventional content analysis methods to describe what participants identified as needed resources. Findings have implications for future research and policy development, as well as resource provision during ongoing remote learning, and in preparation for the eventual transition back to in-person instruction.

Experiences of young adults with a history of foster care during COVID-19.

This study assessed the needs, concerns, and strengths of young adults (ages 18-26), previously placed in foster care, in response to coronavirus disease 2019 (COVID-19). One hundred and twenty-seven participants completed the survey in May and June, offering a preliminary description of the impact of Shelter in Place (SIP) due to COVID-19 on their well-being. The mixed-methods, cross-sectional survey assessed participants' perspectives regarding (1) changes in physical, financial, professional, social, relational, and psychological levels of concern and (2) the general impact of SIP due to COVID-19, as well as the unique impact as a current or former foster youth. Participants reported significant increases in their level of concern in each domain from before SIP orders to during SIP, which was maintained in anticipation of the year following SIP. Participants also described their experiences with SIP and COVID-19 as unique, due to their lived experience as a former foster youth. Findings highlight a need for a coordinated short and long-term response to address the needs and concerns of this vulnerable population.

Preliminary Effects of Tailoring an Obesity Prevention Intervention Program for Latino Immigrant Families.

An obesity preventive intervention program for preschool families, Healthy Balance, was tested in 2 sequential pilot trials. The first pilot tested the original and translated group intervention in a heterogeneous population (65 families), and the second tested the feasibility of a culturally adapted version for Latinx immigrant families (27 families). No significant study 1 intervention effects were found. However, in study 2, there were significant improvements in parent body mass index, neck circumference, and blood pressure. These studies suggest that targeting family system change and tailoring the intervention for Latinx immigrant populations is feasible and has the potential to improve obesity-related biomarkers.

Latinx Immigrant Farmworker Community Health Promotion: A Needs Assessment.

The present study examined the health promotion intervention needs of Latinx immigrant farmworker families residing in Oregon. Grounded theory qualitative procedures were used to analyze the needs assessment data from 31 Latinx immigrant farmworker residents and key informant interviews as well as four focus groups with resident youth and parents. A theoretical model of how key family-based health behaviors can both confer risk for and protection against negative physical, mental, and social health outcomes among Latinx farmworking communities emerged. Six primary areas of concern emerged from these data, leading to the identification of primary health promotion intervention needs with three foci: (a) the provision of sustainable supports and resources, (b) skill development so that individuals could successfully negotiate identified challenges, and (c) greater community efficacy. Findings underscore the importance of social support and resource accessibility for Latinx immigrant populations.

Understanding the dining experience of individuals with dysphagia living in care facilities: A grounded theory analysis.

BACKGROUND AND OBJECTIVES: Person-directed care in nursing homes, also known as the 'culture-change movement', aims to enhance dining-related quality of life. However, for residents with dysphagia, it is unclear how to best support this enhancement while balancing eating-related safety/risks. Thus, the purpose of this study was to explore the experience of and to define successful, person-centered dining for residents with dysphagia. RESEARCH DESIGN AND METHODS: Grounded theory methodology guided twenty-one 60-90 minute semi-structured interviews with participants across 7 stakeholder groups including residents, family members, and nursing, dietary, and therapy staff. We used a systematic and iterative approach for all data collection, analysis, and generation of theory. RESULTS, DISCUSSION, AND IMPLICATIONS: A theory emerged from the data that highlighted how individualization and socialization are the central tenants for improving residents' dining experiences and success, or 'focusing on the person: individualization and socialization during mealtimes'. We identified multiple facilitators and barriers to successful dining for residents with dysphagia such as the importance of positive social connections and invested, knowledgeable, and aware care team members. The focus of care was a salient theme suggesting that individualization of care that promotes residents' quality of life is a key facilitator of successful dining experiences. A social-ecological model for successful dining with dysphagia is ultimately proposed: optimizing health and well-being for these residents through successful dining experiences requires collaborative and coordinated care to address a variety of interrelated individual-, interpersonal-, and organizational-level facilitators and barriers.

Reciprocal Influence of Couple Dynamics and Eating Disorders.

Little research has focused on the ways that eating disorder processes and adult couple dynamics influence one another. The purpose of this study was to investigate the reciprocal influence of couple dynamics and eating disorder illness and recovery processes. We conducted 51 interviews with 17 couples where one member identified as currently suffering or having recovered from an eating disorder. Using grounded theory analytical methods, findings include the systemic interplay of the eating disorder and relationship, both partners' perspectives on the eating disorder and its role in the relationship, the noneating disorder partner's impact on the eating disorder, and coping strategies for recovery as a couple. Clinical implications for supporting couples experiencing eating disorder illness and recovery are discussed.

Effectiveness of an eating disorder preventative intervention in primary care medical settings.

OBJECTIVE: To conduct a pilot effectiveness trial of a brief dissonance-based eating disorder preventative program, the Body Project, when implemented at primary care medical clinics. METHOD: Sixty-six female adolescents between the ages of 13 and 17 who reported at least some body image dissatisfaction were recruited at two primary care clinics and randomized to Body Project groups or an educational video control condition; eating disorder risk factors and symptoms were measured at pretest, posttest, and 3-month follow-up. RESULTS: Body Project versus educational video control participants showed significantly greater reductions in thin-ideal internalization, pressure to be thin, dieting, and eating disorder symptoms at posttest, which were medium to large effect sizes. Body Project participants also showed greater decreases in body dissatisfaction and negative affect at posttest, though these moderate sized effects were not significant. Effects persisted through 3-month follow-up. CONCLUSION: Average pre-post effect sizes (d = 0.58) compare favorably to those observed in past Body Project efficacy (average d = 0.59) and effectiveness trials (average ds of 0.43 and 0.69), suggesting that primary care clinics may represent a novel venue for offering and extending the reach of this eating disorder prevention program.

Client beliefs about a multicouple group service for intimate partner violence: a narrative analysis.

Despite the ongoing debate about intervention best practices for intimate partner violence (IPV), few researchers have elicited the perspectives of clients themselves about what interventions most effectively decrease violence and increase safety. Using qualitative narrative analysis methodology, the researchers conducted 48 client participant interviews and 5 staff interviews to better understand couples' perspectives of a multicouple conjoint treatment program for IPV. Several recurring themes included (a) group purpose and general service characteristics, (b) motivation for participation, (c) comparison with other services, (d) benefits of, (e) disadvantages of, and (f) suggestions for Couples Achieving Relationship Enrichment. Important research implications for community intervention are discussed.

Client narratives about experiences with a multicouple treatment program for intimate partner violence.

A handful of clinical trials have concluded that conjoint couples treatment for intimate partner violence is safe and at least as effective as conventional batterer intervention programs, yet very few researchers have explored couples' perspectives on conjoint treatment. Using qualitative narrative analysis methodology, the researchers conducted 48 client participant interviews and five staff interviews to better understand couples' experiences of a conjoint treatment program for intimate partner violence. Themes that recurred throughout participants' narratives included (a) perceptions of safety, (b) benefits received, (c) attitudinal change, (d) behavioral change, and (e) important learning. Research directions and training implications are discussed.

Eating disorders and social support: perspectives of recovered individuals.

Eating disorder researchers have focused more on the etiology and treatment and less on what happens for individuals during the recovery process from an eating disorder. For this qualitative study, we examined how social supports were helpful and hurtful during the eating disorder recovery process and learned about varying experiences with social supports from the perspectives of 22 recovered women. Participants reported that eating disorder recovery is largely influenced by the individual's sense of connection to self and others. In addition, participants shared that the focus of care from providers influenced their recovery process in powerful ways. Clinical implications and future research ideas are presented for clinicians and researchers working in the area of eating disorders.

Outness and relationship satisfaction in same-gender couples.

Self-disclosure of sexual orientation, or outness, is a fundamental feature of gay, lesbian, and bisexual (GLB) experience, yet little is known about how outness impacts same-gender relationship satisfaction. Through a qualitative analysis of interviews with 15 same-gender couples, the complexities of navigating a stigmatized identity in a homonegative society emerged, including (a) characteristics of outness, (b) the influence of coupling on an individual's outness, and (c) the impact of outness on same-gender relationship satisfaction. Findings suggest that for GLB persons, outness is a developmental skill, an expression of identity and values, as well as a resilience strategy for managing discrimination and gay-related stress that influences, though does not singularly determine, relationship satisfaction. Implications for clinical practice and future research suggestions are presented.

Medical providers' self perceived knowledge and skills for working with eating disorders: a national survey.

Research indicates that individuals suffering from an eating disorder (ED) consult their general practitioners more frequently than those without an eating disorder (Mond, Myers, Crosby, Hay, & Mitchell, 2010). However, little is known about medical providers' existing knowledge of and training in ED detection, intervention, and treatment. This study aimed to examine national medical providers' self-perceived knowledge, skills, and needs around eating disorder screening and intervention strategies. Utilizing survey design, a randomized sample of national medical providers responded to a 23-question survey. Sixty-eight percent of respondents indicated that they did not think to screen for an eating disorder because it was not the presenting concern and nearly 59% of providers did not feel like they had the skills necessary to intervene with eating disorders. Training implications and future research directions are discussed.

Predictive effects of mother and peer influences on increases in adolescent eating disorder risk factors and symptoms: a 3-year longitudinal study.

OBJECTIVE: To investigate the relation of maternal and peer attitudes and behaviors to changes in eating disorder risk factors and symptoms in adolescent females. METHOD: We tested whether maternal and peer eating attitudes, behaviors, and deficits in social support at baseline predicted subsequent increases in eating disorder risk factors and symptoms among 483 late adolescent females followed over 3 years. RESULTS: Data provide partial support for hypotheses, as eating disorder risk factors and symptoms increased over time and maternal thin ideal internalization significantly predicted a future increases in adolescent bulimic symptoms. There were no significant predictors of adolescent thin ideal internalization or body dissatisfaction. DISCUSSION: Findings only partially support the hypothesis that unhealthy attitudes and behaviors of mothers increase risk for eating disorder symptoms in their late adolescent daughters. These results underscore why eating disorder prevention programs should be based on risk factor research that has used prospective and rigorous designs.

A longitudinal analysis of parenting practices, couple satisfaction, and child behavior problems.

This longitudinal study examined the relationship between couple relationship satisfaction, parenting practices, parent depression, and child problem behaviors. The study participants (n = 148) were part of a larger experimental study that examined the effectiveness of a brief family-centered intervention, the Family Check-Up model. Regression analysis results indicated that our proposed model accounted for 38% of the variance in child problem behavior at Time 2, with child problem behavior and couple relationship satisfaction at child age 2 years each accounting for a significant portion of the variance in child problem behavior at age 3. Couple relationship satisfaction directly predicted child behavior problems over time. Clinical and research implications are discussed.

Medical providers' screening, training and intervention practices for eating disorders.

Individuals struggling with an eating disorder are typically first seen by their family physician, yet little is known about how medical providers are trained to work with eating disorders or about their screening and intervention practices (Clarke & Polimeni-Walker, 2004). This study sought to examine frontline medical providers' eating disorder screening and intervention practices as well as their training needs. Medical providers' perspectives were elicited through survey data and semi-structured interview data. Seventy-eight percent of survey respondents reported that they had patients with eating disorders who they were unsure how to treat and 54% reported either moderately or strongly supporting universal screening for eating disorders with all patients regardless of presenting issue. Qualitative themes including challenges and barriers to effective screening, desire for increased eating disorder trainings, and fear of incompetence emerged from the interviews. Training implications and future research directions are discussed.

Using mock trials to teach students forensic core competencies in marriage and family therapy.

This article provides a description of a university-based project that used mock trials to train both practicum-level marriage and family therapy and law students in forensic work, and a qualitative investigation of student experiences with the training. The content of the training focused on American Association for Marriage and Family Therapy (AAMFT) core competencies that relate specifically to the legal aspects of therapy. This article describes the didactic training the students received to prepare for the mock trials, the structure and protocol of the mock trials themselves, and the specific AAMFT core competencies addressed in the project. The results of an analysis of focus group interviews with participating law school (n = 15) and marriage and family therapy (n = 19) students are presented as well as the results of a 36-item Knowledge, Skills, and Comfort Level Questionnaire completed by participating marriage and family therapy students. Participants discussed the value of the training with regard to preparation for mock trial procedures, preparation for testimony, importance of documentation, and cross-discipline collaboration issues. The article concludes with a discussion of how this type of training may be used in developing students' skills with regard to forensic and legal core competencies, and future research directions.

Sexual assault support services and community systems: understanding critical issues and needs in the LGBTQ community.

Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals encounter social conditions that create important considerations for LGBTQ sexual assault victims. This exploratory, mixed-methods study examines the relationship between community attitudes toward LGBTQ persons and associated community responses to LGBTQ sexual assault victims. An online and paper-and-pencil survey (n = 130) and four focus group interviews (n = 14) are analyzed using frequency distributions and grounded theory methods. The central theme that emerged in focus group interviews, titled "low community awareness and support for sexual violence in the LGBTQ community," was corroborated by survey participants. Participants' views of unique considerations for LGBTQ sexual assault victims are presented, including causal factors, consequences, and recommended strategies.