Affirmative Stances in Training Programs Toward Sexual and Gender Minority Clients: Views From Clinical and Counseling Psychology Graduate Students.

Despite training recommendations to address mental health disparities among sexual and gender minority (SGM) individuals, the current state of SGM affirmative training in clinical and counseling doctoral psychology programs remains unclear. The present study surveyed 147 clinical and counseling psychology graduate students in the United States. Participants completed surveys on affirmative training stances in their graduate program for sexual minority clients, gender minority clients, and self-reported perceptions of their attitudes, knowledge, and skills related to SGM clients. Results revealed that current graduate students reported more affirmative stances for sexual minority clients compared to gender minority clients. SGM graduate students reported fewer affirmative stances in their programs for both sexual and gender minority clients compared to their heterosexual cisgender peers. Lastly, SGM identity was a significant predictor of perceived SGM clinical competency beyond years of training, program model, or type of graduate program. Implications for training and future research are discussed.

Diffusion tensor imaging findings and neuropsychological performance in adults with TBI across the spectrum of severity in the chronic-phase.

PRIMARY OBJECTIVE: To examine associations between neuroimaging indicators of cerebral tract integrity and neurocognitive functioning in traumatic brain injury (TBI). RESEARCH DESIGN: Between-Groups design with two TBI groups and controls. METHOD AND PROCEDURES: Forty-four participants with TBI and 27 matched controls completed diffusion tensor imaging and neuropsychological measures of processing speed, attention, memory, and executive function. Multivariate analyses were conducted to examine group differences in white matter integrity (fractional anisotropy) for 11 regions of interest and cognitive performance among adult males with chronic phase, mild, moderate, or severe TBI. Correlational analyses investigated associations between white matter integrity, brain injury severity, and cognitive status. MAIN OUTCOMES AND RESULTS: Participants with moderate or severe TBI exhibited reduced white matter integrity in 8 of 11 ROIs and worse performance on most cognitive measures, relative to control participants. Persons with mild TBI did not differ from controls on white matter integrity values and differed on one measure of processing speed. Significant correlations were found between injury severity ratings and 10 ROIs, most notably between ROIs and measures of processing speed or memory. CONCLUSIONS: These findings provide nuanced information regarding white matter connectivity as it relates to neurocognitive abilities across the TBI severity spectrum.

Assessing Psychometrists' Practices to Inform Neuropsychological Services.

OBJECTIVE: Quality of life (QOL) is a broad-ranging concept affecting an individual's physical health, psychological state, social relationships, and relationship to their environment. Although the role of psychometrists in clinical neuropsychology is integral to the delivery of services, little is known about their QOL. The current study assessed psychometrists' workload and aspects related to work QOL (e.g., physical and emotional exhaustion, social and work satisfaction). METHOD: Psychometrists (N = 164) from 38 states completed a nationally distributed survey. Participants averaged eight years of experience, ~29% completed board certification, and worked primarily in general hospitals (~36%), academic medical centers (~21%), private practice (~15%), veterans/military hospitals (~13%), and rehabilitation hospitals (~12%). RESULTS: Respondents saw 5.6±2.4 (Mean±Standard Deviation) patients and spent 18.8±6.9 and 9.4±4.9 hours administering and scoring, respectively, per week. Although the majority of respondents felt satisfied with their work QOL, approximately 49% experienced emotional exhaustion, 42% experienced burnout, and 62% reported that fatigue interfered with work, family, or social life. Correlational analyses found a significant relationship between QOL variables and professional activities, particularly with time spent scoring. Additionally, patient load, time spent administering/scoring, and QOL factors varied depending on work setting. CONCLUSION: The current study provides a novel characterization of psychometrists' QOL. Specifically, the prevalence of emotional exhaustion and fatigue appears to be higher than in the general working population in the United States. In addition, these findings highlight the current variability of job responsibilities and QOL across work settings. Ongoing advocacy and practice adjustments for this field are indicated.

Neuropsychologists' practice adjustments: The impact of COVID-19.

Objective: The field of neuropsychology's response to the COVID-19 pandemic was characterized by a rapid change in clinical practice secondary to physical distancing policies and orders. The current study aimed to further characterize the change in neuropsychologists' professional practice, specifically related to teleneuropsychology (TNP) service provision, and also provide novel data regarding the impact of the pandemic on providers' emotional health. Method: This study surveyed 142 neuropsychologists between 3/30/2020 and 4/10/2020, who worked within a variety of settings (e.g., academic medical centers, general hospitals, Veterans Affairs medical centers, rehabilitation hospitals) across all four U.S. geographic regions. Mixed-model analyses of variance (ANOVAs) were conducted to assess for differences in neuropsychological practice (i.e., total number of patients and proportion of TNP seen per week) across time points (i.e., late February and early April) by practice setting and region. Descriptive statistics were conducted to describe respondents' perceptions of TNP, emotional responses to the pandemic, and perceptions of institutional/employers'/practices' responses. Results: Nearly all respondents (∼98%) reported making practice alterations, with ∼73% providing at least some TNP. Neuropsychologists across all settings and regions reported performing a higher proportion of TNP evaluations by April 2020. On average, respondents reported a medium amount of distress/anxiety related to COVID-19, which had a "somewhat small impact" on their ability to practice overall. Conclusions: The current study further elucidated neuropsychologists' provision of TNP services and offered initial data related to their emotional response to the pandemic. Future research is needed to examine the viability and sustainability of TNP practice.

Mental Health Practitioners' Immediate Practical Response During the COVID-19 Pandemic: Observational Questionnaire Study.

BACKGROUND: The COVID-19 pandemic has been associated with increased psychological distress, signaling the need for increased mental health services in the context of stay-at-home policies. OBJECTIVE: This study aims to characterize how mental health practitioners have changed their practices during the pandemic. The authors hypothesize that mental health practitioners would increase tele-mental health services and that certain provider types would be better able to adapt to tele-mental health than others. METHODS: The study surveyed 903 practitioners, primarily psychologists/doctoral-level (Psych/DL) providers, social workers/master's-level (SW/ML) providers, and neuropsychologists employed in academic medical centers or private practices. Differences among providers were examined using Bonferroni-adjusted chi-square tests and one-way Bonferroni-adjusted analyses of covariance. RESULTS: The majority of the 903 mental health practitioners surveyed rapidly adjusted their practices, predominantly by shifting to tele-mental health appointments (n=729, 80.82%). Whereas 80.44% (n=625) were not using tele-mental health in December 2019, only 22.07% (n=188) were not by late March or early April 2020. Only 2.11% (n=19) reported no COVID-19-related practice adjustments. Two-thirds (596/888, 67.10%) reported providing additional therapeutic services specifically to treat COVID-19-related concerns. Neuropsychologists were less likely and Psych/DL providers and SW/ML providers were more likely than expected to transition to tele-mental health (P<.001). Trainees saw fewer patients (P=.01) and worked remotely more than licensed practitioners (P=.03). Despite lower rates of information technology service access (P<.001), private practice providers reported less difficulty implementing tele-mental health than providers in other settings (P<.001). Overall, the majority (530/889, 59.62%) were interested in continuing to provide tele-mental health services in the future. CONCLUSIONS: The vast majority of mental health providers in this study made practice adjustments in response to COVID-19, predominantly by rapidly transitioning to tele-mental health services. Although the majority reported providing additional therapeutic services specifically to treat COVID-19-related concerns, only a small subset endorsed offering such services to medical providers. This has implications for future practical directions, as frontline workers may begin to seek mental health treatment related to the pandemic. Despite differences in tele-mental health uptake based on provider characteristics, the majority were interested in continuing to provide such services in the future. This may help to expand clinical services to those in need via tele-mental health beyond the COVID-19 pandemic.

Examining the relationship between neuroticism and post-concussion syndrome in mild traumatic brain injury.

Objective: We sought to examine the relationship between personality traits and post-concussion symptom reporting in individuals with and without a self-reported history of concussion. Methods: Data were collected via a cross-sectional electronic survey from 619 individuals via Amazon Mechanical Turk (mTurk). Participants completed a background demographic questionnaire, as well as both the Post-Concussion Symptom Scale (PCSS) and IPIP-NEO-120 personality inventory. Results: Significant relationships were seen between concussion symptom reporting and personality traits of neuroticism, extraversion, agreeableness, and conscientiousness, but not openness, among both groups. The positive concussion group reported more severe symptoms across nearly all PCSS items, despite being, on average, multiple years removed from their injury. Furthermore, broad personality traits did not differ between concussion groups. Discussion: The positive concussion group reported persisting symptoms many years post-injury, suggesting a small subset of individuals may not become fully asymptomatic following a concussion. While differences among personality traits, including neuroticism, were not seen, psychiatric distress, namely symptoms of depression, accounted for a significant degree of variance in symptom reporting and is likely a strong influencer in recovery trajectory. As such, an increased emphasis on psychotherapeutic treatment following a concussion, especially in cases with prolonged recovery, may be warranted.

Construct validity of the Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES).

BACKGROUND: The Functional Assessment of Verbal Reasoning and Executive Strategies (FAVRES) is a measure of cognitive-communication and executive functions involving everyday tasks. Scores are predictive of employment status; however, the measure's construct validity is unclear. OBJECTIVE: The study's objective was to assess the linear association of FAVRES test performance with performance on a number of neuropsychological measures in a sample of individuals with neurocognitive deficits. METHODS: Twenty-two adults completed the FAVRES, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), Delis-Kaplan Executive Function System (D-KEFS), Color-Word Interference (CWI), Tower and Trail Making (TM). RESULTS: FAVRES Total Accuracy score significantly correlated with CWI Inhibition (r = -0.43) and Tower (r = 0.60). Total Rationale significantly correlated with CWI Inhibition (r = -0.49), TM Number-Letter Switching (r = -0.48) and Tower (r = 0.55). Total Reasoning significantly correlated with CWI Inhibition (r = -0.71), Inhibition Switching (r = -0.50), TM Number-Letter Switching (r = -0.67) and Tower (r = 0.69) but also correlated with a number of measures involving other elements of cognition. CONCLUSION: Results provide evidence of convergent validity for the FAVRES as a measure of executive functions. Accuracy and Rationale scores also appear to have good discriminant validity.

The Clinical Utility of the Conners' Continuous Performance Test-II in Traumatic Brain Injury.

OBJECTIVE: The Conners' Continuous Performance Test Second Edition (CPT-II) is a measure commonly used in persons with suspected attentional deficits. Our study examined the utility of the CPT-II as a measure of attention in adults with traumatic brain injury (TBI) of varying severity. METHOD: As part of a larger investigation, several measures of cognitive functioning, including the CPT-II, were administered to 30 healthy control participants (HCP), 30 mild TBI participants (M-TBI), and 30 moderate to severe TBI participants (MS-TBI). Multivariate and correlational analyses compared group performances and examined convergent and divergent relationships between the CPT-II and various measures, including other tests of attention and neuropsychological function. RESULTS: Group differences were found for four of six CPT-II variables, with the MS-TBI group exhibiting greater impairment, relative to M-TBI and HCP. In addition, the CPT-II commission and detectability variables were found to correlate significantly with TBI severity. The CPT-II variables also demonstrated correlations of varying magnitude between commonly used neuropsychological measures. CONCLUSIONS: These findings support the utility of the CPT-II for assessing attentional abilities in persons with TBI of varying severity, particularly those with moderate to severe status. Moreover, the current study also demonstrates relationships that are consistent with convergent validity but inconsistent findings with regard to divergent validity. As a result, the CPT-II measures components of attention that is unique to other commonly used neuropsychological measures of attentive functioning. Further research examining CPT-II performance in TBI populations is recommended.