Development and initial validity and reliability of the Rural Practice Awareness and Skills Scale.

PURPOSE: The purpose of this study was to develop and provide initial evidence of the validity and reliability of the Rural Practice Awareness and Skills Scale (RPASS). METHODS: A pool of 63 items was reviewed by an expert panel, subjected to 2 additional face validity checks, and reduced to 39 items. The scale was then completed by 333 participants, and an exploratory factor analysis and confirmatory factor analysis were conducted. FINDINGS: Results revealed a 3-factor, 20-item scale with evidence of reliability and convergent validity. CONCLUSIONS: RPASS has utility for advancing research to support recruitment and retention of rural health providers and ultimately enhance rural health care delivery.

Examining collaborative leadership through interprofessional education: findings from a mixed methods study.

Collaborative leadership is essential as recent trends in healthcare service delivery necessitate interprofessional collaboration and care. Interprofessional education (IPE) efforts, therefore, have to prepare students for this type of leadership. The purpose of this study was to understand how students' perceptions of leadership change as a result of embedding a collaborative leadership model, the Social Change Model (SCM) of leadership, in an IPE course. Data were collected from 30 students participating in an interprofessional course through two interprofessional course reflections, pre/post leadership posters and poster reflections, and a pre/post survey. Results from paired sample t-tests suggested students significantly improved in their perceptions of leadership efficacy. These data also indicated improvements to the three group-level values of the SCM: collaboration, common purpose, and controversy with civility. Findings from the qualitative data suggest that students learned to view leadership as more of a team effort than the actions of a single individual and as more of a process than a role. Findings also revealed the benefits and challenges of using a visual process of poster development as a way of examining students' changes in perceptions of leadership over the course of the semester. Implications are discussed in relationship to the utility of the SCM in promoting students' shifts in conceptualizations of leadership that emphasizes collaboration and helps prepare students to engage in these ways within interprofessional teams in their practice.

Substance abuse treatment engagement among mothers: Perceptions of the parenting role and agency-related motivators and inhibitors.

This qualitative study explored 1) the parenting role as a motivator and inhibitor to engaging in substance abuse treatment and 2) parenting-related, agency-imposed barriers and facilitators to substance abuse treatment engagement. Nine focus groups (n=45) were conducted with current and former male and female recipients of treatment services in one south eastern state. Using inductive thematic analysis, transcripts were analyzed to identify key themes related to parenting. Females were overrepresented in our groups and were more vocal than males regarding issues of parenting as these related to treatment. Among mothers, motivations for treatment related to parenting included involvement with child protective services and the desire to be a better parent. Inhibitors for treatment included anxiety over separation from child, debilitating guilt, and parenting demands. Facilitators for participation included mother-child residential programs, services for children, concrete support, and advocacy and emotional support. Barriers for participation included decreased access to the child and barriers specific to mother-child residential programs. To enhance treatment engagement among parents, providers can address agency-level barriers and draw upon the parenting role as intrinsic motivation for change. Policies and services are needed that promote flexibility, choice, and support parents to engage in treatment services.

Evaluating the association between childhood sexual abuse and attempted suicide across the lifespan: Findings from a nationwide study of women in jail.

Previous studies have found childhood sexual abuse to predict suicidal behavior in adulthood. Women in jail suffer disproportionately high rates of childhood sexual abuse and attempted suicide relative to women in the general population. Thus, better understanding the association between childhood sexual abuse and attempted suicide among women in jail may inform prevention, assessment, and treatment initiatives for this at-risk population. This study examined the association between childhood sexual abuse and the onset of attempted suicide across the life span in a nationwide sample of women in jail. Participants included a randomly selected subsample of women (N = 115), drawn from a larger probability sample (N = 491), who completed Life History Calendars, which were coded for the presence/absence of attempted suicide and childhood sexual abuse across life history stages. Survival analysis and Cox regression indicated that women with histories of childhood sexual abuse perpetrated by an adult or a peer were significantly more likely to have attempted suicide across the life span, including increased risk for the onset of attempted suicide in adulthood. This study demonstrates the salience of childhood sexual abuse as a predictor of suicidal behavior among women in jail, and extends previous research by demonstrating the temporal sequence of childhood sexual abuse relative to attempted suicide across the life span. Given these findings, researchers, clinicians, and policymakers should consider further the influence of childhood sexual abuse with regard to the high rates of attempted and completed suicide among women in jail. (PsycINFO Database Record

An Exploratory Study Examining Risk Communication among Adolescent Children, Their Incarcerated Mothers, and Their Caregivers.

Adolescent children of incarcerated mothers (ACIM) are typically left in the care of adults (primary caregivers) who play a crucial role in children's care and guidance, as well as in the facilitation of contact and communication with incarcerated mothers. The purpose of this study was to explore the nature of relationships and communication among adolescent children of incarcerated mothers, primary caregivers, and incarcerated mothers using pilot data. Semi-structured individual interviews were conducted with youth aged 12-17 (n=7) and caregivers (n=6) recruited through a non-profit organization working with incarcerated mothers and their children. Incarcerated mothers and primary caregivers represent an important family unit for ACIMs and may play a role in preventing risk behavior. A conceptual framework is offered for further consideration of mother and caregiver communication with youth and youth risk.

Trauma experiences and mental health among incarcerated women.

OBJECTIVE: Female offenders have different risk factors for offending than do male offenders, and elevated rates of interpersonal victimization such as physical, emotional, and sexual abuse, and family and community violence, are common in histories of incarcerated women. We used factor analysis to examine patterns of traumatic events experienced by women in jail and explored how these patterns were associated with 4 psychiatric disorders (posttraumatic stress disorder [PTSD], major depression, bipolar disorder, and substance use disorder) observed in this sample. METHOD: A total of 464 women from 9 jails in 4 geographic regions in the United States comprised the sample. Women participated in diagnostic interviews to assess trauma exposure and psychiatric disorders. RESULTS: Three factors described the observed patterns of trauma exposure: family dysfunction (FD), interpersonal violence (IPV), and external events (EE). Life events were analyzed as a separate group of items. FD and IPV each contributed independently to the odds of having each of the 4 mental disorders studied; significant odds ratios were in the range of 1.38-2.05. All 3 factors contributed to the diagnosis of bipolar disorder. The only diagnosis to which stressful life events made a unique contribution was to the likelihood of having PTSD. CONCLUSION: This work provides further support for the importance of assessing trauma exposure of women in jail, especially the family context, as well as mental health. Implementation and testing of evidence-based treatment approaches that address trauma-related distress in correctional settings are warranted. (PsycINFO Database Record

Poly-victimization among girls in the justice system: trajectories of risk and associations to juvenile offending.

Life History Calendars and the Juvenile Victimization Questionnaire were used to collect data from 100 delinquent girls to (a) examine range and co-occurrence of different types of violence over the life span, (b) examine independent and cumulative trajectories of risk for varied types of victimization, and (c) examine the relationship of victimization to girls' offending. Risk trajectories demonstrate critical risk periods for different forms of violence exposure. Cox regression was used to examine the predictive value of different forms of violence exposure for the onset of delinquent and criminal behavior. Findings illuminate the need for programs addressing substance use and alternative coping mechanisms.

A multisite study of the prevalence of serious mental illness, PTSD, and substance use disorders of women in jail.

OBJECTIVES: This multisite study aimed to answer the following research questions about women in urban and rural jails. First, what is the current and lifetime prevalence of serious mental illness (major depressive disorder, bipolar disorder, and psychotic spectrum disorders) of women in jail? Second, what level of impairment is associated with their serious mental illness? Third, what is the proportion of incarcerated women with serious mental illness who also have posttraumatic stress disorder (PTSD), a substance use disorder, or both? METHODS: Participants were 491 women randomly sampled in jails in Colorado, Idaho, South Carolina, and the metropolitan area of Washington, D.C. Structured interviews assessed lifetime and 12-month prevalence of disorders and level of impairment. RESULTS: Forty-three percent of participants met lifetime criteria for a serious mental illness, and 32% met 12-month criteria; among the latter, 45% endorsed severe functional impairment. Fifty-three percent met criteria for ever having PTSD. Almost one in three (29%) met criteria for a serious mental illness and PTSD, 38% for a serious mental illness and a co-occurring substance use disorder, and about one in four (26%) for all three in their lifetime. CONCLUSIONS: The prevalence of serious mental illness and its co-occurrence with substance use disorders and PTSD in this multisite sample suggest the critical need for comprehensive assessment of mental health at the point of women's entry into the criminal justice system and the necessity for more programs that offer alternatives to incarceration and that can address the complexity of female offenders' treatment needs.

Institutional responses to self-injurious behavior among inmates.

To date, little research has systematically investigated perceptions of mental health professionals regarding motivations for self-injury among prison inmates. To help fill this gap, the authors used descriptive techniques to examine self-injurious behavior among inmates from the perspective of correctional mental health professionals. A quantitative survey assessed perceptions of mental health staff regarding etiology, motivations, and manifestations of self-injury. A qualitative interview component was used to explicate responses from the survey. Inmate cutting, scratching, opening old wounds, and inserting objects were the most commonly witnessed behaviors. Findings suggest that self-injury occurred regularly and that a subset of inmates are responsible for recurrent events. Mental health professionals perceived the motivation for inmate self-injury to be both manipulative and a coping mechanism. They described current management strategies and corresponding needs for training and resources.

Pathways to prison: impact of victimization in the lives of incarcerated women.

This study examines ways in which victimization may contribute to criminal involvement among incarcerated women. The authors conduct interviews with 60 women in a maximum-security prison to gather each woman's perspective on psychological, physical, and sexual victimization in her life. Qualitative analyses indicate ways that victimization relates directly to women's crimes as well as influences health, psychosocial functioning, or systemic involvement to create difficult situations with which the women struggle. Case histories are used to illustrate pervasive impacts of victimization, and the roles of multiple traumas and cumulative impact are discussed.

Breast health behavior among lesbians: the role of health beliefs, heterosexism, and homophobia.

The Health Belief Model was used as a conceptual framework for exploring how health beliefs and perceptions of heterosexism and homophobia in health care related to lesbians' breast health behaviors, including use of breast exams and mammograms, visits to health care providers, and use of complementary/alternative care. A total of 173 exclusively homosexual women completed survey measures assessing health beliefs, experiences of heterosexism/homophobia, and health maintenance behaviors as these related to breast health. Findings indicated that women perceived heterosexism and homophobia from providers to influence the amount of discussion they had with providers and, to a lesser extent, care received, frequency of service use, and health outcomes. Perceptions of heterosexism and homophobia in health care settings significantly contributed, beyond routine health beliefs, to women's use of breast self-exams, visitation to health care providers, and use of complementary/alternative care. Implications for culturally competent care are discussed.

Psychologists' judgments of psychologically aggressive actions when perpetrated by a husband versus a wife.

Research literature suggests that clinical judgments of men's versus women's behavior and symptoms typically rate the men as more pathological and dangerous. To determine whether this view would extend to assessments of psychologically aggressive actions, two separate versions of a survey listing potentially psychologically abusive behaviors perpetrated by either a wife toward her husband or the identical actions perpetrated by a husband toward his wife were sent to a nationwide sampling of practicing psychologists. Results indicated that psychologists, irrespective of demographics, rated the husband's behavior as more likely to be psychologically abusive and more severe in nature than the wife's use of the same actions. Psychologists did not differentially rely on any of the three contextual factors (i.e., frequency/duration, intent of the perpetrator, and perception of the recipient) to influence their determination that a behavior was "psychological abuse" dependent upon whether the initiator of the psychological actions was the husband or the wife. Future research could assess more directly the rationale for the psychologists' differing views of male versus female behavior. In addition, more normative information is needed to inform mental health professionals as to the prevalence and severity of psychologically aggressive actions in the general population.