bluuebunny/crossref_metadata_2025 huggingface dataset:
Introduction to This Workbook
Authors: Steffen Ann M. , Dick-Siskin Leah P. , Bilbrey Ann Choryan , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

This culturally responsive workbook uses the evidence-based methods of cognitive behavioral therapy to help middle-aged and older adults build on existing strengths and reduce symptoms of depression, whether they are feeling “a little blue” or are very depressed. The culmination of more than four decades of research, this empirically supported and effective treatment program helps clients learn how to develop and use healthy habits to improve mood and quality of life. This workbook is intended to be used as an adjunct to clinician-provided CBT and is not a self-help book to be used on its own. The personalized approach used in this workbook means that, together with their clinician, individuals decide which of the modules are a good fit for their specific life circumstances. Each module includes easy to read, large-print Learn pages that therapists can use to help clients learn specific depression management skills, along with Practice forms to use between sessions to practice, remember, and use these skills. Complete with information and practical strategies for improving depression and related concerns (e.g., anxiety, sleep, chronic pain, brain health, caregiving, grief and personal relationships), this thoroughly revised second edition of Treating Later-Life Depression: A Cognitive-Behavioral Therapy Approach provides indispensable resources to help culturally diverse aging individuals thrive in a daily life that is true to their values and personal strengths.
Skills for Doing
Authors: Steffen Ann M. , Dick-Siskin Leah P. , Bilbrey Ann Choryan , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

Decreases in the frequency of positive activities, along with poor problem solving skills, play especially strong roles in perpetuating depressive symptoms in middle-aged and older adults. For that reason, increasing daily rewarding, meaningful, and valued activities is a priority in treatment for depression. This workbook module of Treating Later-Life Depression: A Cognitive Behavioral Therapy Approach promotes the application of behavioral activation and problem-solving strategies that are consistent with clients’ personal values and strengths. Easy-to-read, large-print Learn pages are selected by behavioral health providers to help aging clients understand the role of activities in depression, engage in positive daily activities, and apply the steps of problem solving to anticipate and remove barriers. Practice forms are provided for clients’ use between sessions to develop and use skills. Clinicians must attend to the ways that cultural and generational norms and beliefs influence clients’ attitudes and choice of language used to describe rewarding and meaningful activities. Practitioners are encouraged to apply strategies that are responsive to the needs of culturally diverse aging clients.
Skills for Brain Health
Authors: Steffen Ann M. , Dick-Siskin Leah P. , Bilbrey Ann Choryan , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

Behavioral health clinicians should be aware that the science and practice of brain health is developing at a rapid pace. We now understand that there are many things middle-aged and older adults can do that make a difference in their cognitive health and functioning. This personalized workbook module of Treating Later-Life Depression: A Cognitive Behavioral Therapy Approach promotes skills to manage age-related changes in cognitive functioning and support daily living that is consistent with personal values and life goals. Easy-to-read, large-print Learn pages are selected by psychotherapists and other providers to help aging clients understand cognitive aging, engage in brain-healthy habits, navigate health care, manage medications, and consider whether to complete a cognitive evaluation. Practice forms are provided for practitioners and clients to collaboratively select for use between sessions to practice, remember, and use these skills. The experience of cognitive aging is embedded within social contexts and environments. Practitioners are encouraged to apply strategies that are responsive to the needs of culturally diverse aging clients.
Skills for Caregiving
Authors: Steffen Ann M. , Dick-Siskin Leah P. , Bilbrey Ann Choryan , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

Middle aged and older adults often experience considerable distress when providing extensive caregiving (e.g., to parents, partners, grandchildren, disabled children, other members of chosen family). Several decades of research have found that depression – at either the clinical or subsyndromal level – is a very commonly reported negative impact of being a caregiver. This personalized workbook module of Treating Later-Life Depression: A Cognitive Behavioral Therapy Approach provides flexible clinical tools for mental health interventions with aging clients who are experiencing caregiver burden. Easy-to-read, large-print Learn pages are selected by behavioral health clinicians to support psychoeducation and the clinical tasks of self-compassion, coping with caregiving stressors, problem solving, cognitive reappraisal, planning positive activities with the care recipient, and self-care. Practice forms are provided for use between sessions to practice, remember, and use these skills. Caregiving is embedded within social contexts and environments. Practitioners are encouraged to apply strategies that are responsive to the needs of culturally diverse aging clients.
Skills for Relating
Authors: Steffen Ann M. , Dick-Siskin Leah P. , Bilbrey Ann Choryan , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

Depression creates difficulties with interpersonal communication and relationships, especially for middle-aged and older adults. This personalized workbook module of Treating Later-Life Depression: A Cognitive Behavioral Therapy Approach provides flexible clinical tools for aging clients who are socially isolated and wish to reach out to people, or who are in conflict and want to re-establish stronger connections. Easy-to-read, large-print Learn pages are selected by behavioral health clinicians to help their aging clients learn specific communication and interpersonal skills. Together with their provider, clients choose which Practice forms they will use between sessions to practice, remember, and use these skills. Communication and other interpersonal skills are embedded within social contexts and environments. Practitioners are encouraged to apply strategies that are responsive to the needs of culturally diverse aging clients.
How to Use This Treatment Approach
Authors: Steffen Ann M. , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

This chapter provides a general overview of the modular cognitive-behavioral therapy program for later-life depression that is described in this clinician guide. The flexibility of this approach enhances the personalized application of change strategies, including behavioral activation, problem solving, relaxation training, attention to personal strengths and positive emotional experiences, self-compassion, cognitive reappraisal, and communication skills training. Compatible with individual and group psychotherapy, this approach is also appropriate for briefer interventions within integrated primary care and within telehealth practice. This chapter summarizes the core modules and the personalized modules that make up this treatment. It also provides practical suggestions for using the program with culturally diverse middle-aged and older adults and summarizes the risks and benefits of this treatment approach.
Assessment with Aging Individuals
Authors: Steffen Ann M. , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

This chapter provides an overview of assessment issues for practitioners working with aging clients. The chapter covers three core practices for assessment in the context of clinical interventions: basic intake assessment (depression, anxiety, suicide risk, medical history and medications taken, functional and cognitive impairment, elder abuse, abuse of alcohol and other substances, and strengths); eligibility for treatment and need for additional referrals; and ongoing practices for feedback-informed treatment. Optional assessment tools and practices may be applicable for specific clients (enhancing daily functioning, caregiving issues, and grief). This process of conducting a careful intake assessment, followed by routine monitoring of targeted outcomes for each client, is often very interesting to clients, and they benefit from the clinician’s feedback about their responses. Use of standardized assessment strategies can also increase clients’ confidence in the therapeutic relationship and lead to a stronger alliance.
Cognitive-Behavioral Therapies 101
Authors: Steffen Ann M. , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

This chapter serves as a brief orientation to cognitive-behavioral therapies across problem areas and populations. At its heart, cognitive-behavioral therapy is a theoretical orientation to behavioral health and wellness that prioritizes scientific evidence while also being deeply humanistic in emphasizing transparency and collaboration between clients and therapists throughout treatment. The chapter covers concepts that unify behavioral and cognitive therapies (conceptual model, “think” rules, developing and maintaining a therapeutic relationship), outlines the three phases of therapy (early, middle, ending), and describes key clinical skill domains (session structure and pacing; “describe, demonstrate, do, and discuss”; overcoming common barriers to home practice assignments; using validation and metaphors effectively).
Module 6: Skills for Managing Chronic Pain: Improving Daily Life
Authors: Steffen Ann M. , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

There are a number of health conditions experienced by middle-aged and older adults that lead to persistent pain. This chapter supports providers as they help aging clients manage chronic pain and engage in daily living that is consistent with personal values and life goals. The material provided in this chapter can help aging clients apply the gate control theory of pain to regulate emotions, thoughts, and behaviors that increase pain perceptions and disrupt value-based living. This chapter describes the Practice forms provided in the workbook for clients’ use between psychotherapy and integrated primary care sessions to remember and use these skills. This chapter directs clinicians to apply recommended strategies that are responsive to the needs of culturally diverse aging clients, including within the context of telehealth.
Module 8: Skills for Caregiving: Reducing Stress While Helping Others
Authors: Steffen Ann M. , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

Depression—at the clinical or subsyndromal level—is a commonly reported outcome of informal caregiving (e.g., for parents, partners, grandchildren, disabled children, other members of chosen family). This chapter guides providers as they help middle-aged and older adults who experience caregiver burden. The material supports psychoeducation and the clinical tasks of self-compassion, coping with caregiving stressors, problem solving, cognitive reappraisal, planning positive activities with the care recipient, and self-care. This chapter also describes the Practice forms provided in the workbook for aging clients’ use between psychotherapy and integrated primary care sessions to remember and use these skills. Clinicians are directed to apply recommended strategies that are responsive to the needs of culturally diverse aging clients, including within the context of telehealth.
Module 10: Skills for Relating: Getting Along and Communicating Your Needs
Authors: Steffen Ann M. , Thompson Larry W. , Gallagher-Thompson Dolores
Published: February 2022

Depression creates difficulties with interpersonal communication and relationships, especially for middle-aged and older adults. This chapter suggests flexible clinical tools for providers to use with aging clients who are socially isolated and wish to reach out to people, or who are in conflict and want to re-establish stronger connections. Clinicians can use the material in this chapter to help aging clients learn specific communication and interpersonal skills. This chapter also describes the Practice forms provided in the workbook for aging clients’ use between psychotherapy and integrated primary care sessions to remember and use these skills. Clinicians are encouraged to apply recommended strategies that are responsive to the needs of culturally diverse aging clients, including within the context of telehealth.
Introduction: Overview of the Program
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

Chapter 1 (session 1) introduces the Brief Behavioral Therapy (BBT) program to youth and families as a program that might help kids and teens who feel stressed, worried, nervous, scared, sad, or overwhelmed. The chapter describes what kinds of kids and teens this program is meant for, and what participation is like. It also discusses how families can best use this Workbook as part of sessions with your BBT therapist.
Session 1: Understanding Stress and Mood
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

In this first chapter of the workbook, youths and their families will learn how the Brief Behavior Therapy (BBT) treatment program is structured and what to expect. In addition, youth will begin to learn about stress and how stress can be a call to action when we are feeling scared, stuck, or down. Last, youths will learn how to begin keeping track of mood and stressed feelings each day as way to help them learn about patterns in their behavior in response to events and feelings. This chapter includes a number of simple handouts that will help youths understand facts about feelings (for example, why do we feel stress, anxiety, and sadness?) and worksheets to help youths monitor their feelings each day between sessions.
Session 5, Onward: Implementing the Master Plan
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

Chapter 5 focuses on carrying out the Master Plan that you started to make goals for in Session 4, and will keep working on in Session 5 for the remainder of treatment. The content of this session covers Session 5 until the second to last session of treatment. In each session from this point forward, youth will work with their therapist to complete tasks from their Master Plan and will also work with the therapist to make a detailed plan for completing tasks between sessions (i.e., outside of the treatment setting). This chapter will review why Master Plans are important, and it provides worksheets to help youths keep track of and successfully complete these tasks, as well as worksheets to continue mood monitoring and other ongoing exercise (e.g., relaxation practice).
Introduction: Background for Therapists
Authors: Weersing V. Robin , Gonzalez Araceli , Rozenman Michelle
Published: February 2022

This Introduction provides background information that contextualizes the development, rationale, and scientifically-supported outcomes of the Brief Behavioral Therapy (BBT) intervention. It provides details about why this program was developed and its clinical outcomes in a large-scale two-site randomized controlled trial, and how and why it makes sense to treat internalizing problems (anxiety and depression) together as a cluster of related concerns. This introductory chapter then turns to the theoretical model underlying BBT, as well as considerations for clinicians in regards to which clinicians might be best suited to administer the intervention, the types of youth for whom this program might be a good fit, and the importance of assessment prior to and throughout treatment. The chapter ends with a discussion of the necessary clinician preparation and youth active participation for success in the BBT program.
Psychological Therapies for Adults with Autism
Authors: Spain Debbie , Musich Francisco M. , White Susan W.
Published: February 2022

Many adults with autism spectrum disorders (ASD) experience mental health conditions, including anxiety and depression. A range of short- to medium-term psychological therapies have shown promise, although research is limited for most comorbid conditions. The first of its kind, Psychological Therapies for Adults with Autism is an edited volume with contributions from an internationally recognized group of clinical experts. Service-user voices are viewed as central to the book, and the second chapter documents adults’ with ASD and parents’ experiences of, and thoughts about, engaging in psychological therapy. Subsequent chapters follow a similar format, presenting an overview of the psychological therapy covered, the main strategies used, and the research evidence regarding its use in individuals with ASD. This is followed by a case vignette linking theory to practice and outlining extensive examples of adaptations to enhance the accessibility and acceptability of interventions. Psychological therapies covered include transition-focused approaches, education- and employment-focused approaches, systemic therapy, social skills interventions, positive behavior support (PBS), mindfulness-based interventions, cognitive behavior therapy (CBT), schema therapy, eye movement desensitization and reprocessing (EMDR), dialectical behavior therapy (DBT), compassion-focused therapy (CFT), group interventions, and offender-focused interventions. Reflecting the fact that adults can benefit from a multidisciplinary approach, one chapter focuses on pharmacological interventions. The concluding chapter outlines considerations for developing effective psychological therapies services for adults with ASD.
Systemic Therapy
Authors: Dallos Rudi , Stancer Rebecca
Published: February 2022

The provision of systemic therapy in the context of autistic has been somewhat limited. Some attempts have been made to develop models for families focusing on children with the diagnosis but there has been very little attention paid to the needs of adults with a diagnosis of autism and their needs in the context of their relationships and families. This chapter adopts a broadly systemic view embracing both the challenges and opportunities that autistic presents and more broadly considers the needs of others who are in relationships with them. The chapter looks at how systemic therapeutic approaches and techniques can be adapted and applied in the context of autism. Two approaches based on an integration of systemic and attachment theory are outlined alongside their clinical illustrations.
Social Skills Interventions
Authors: D’Agostino Cynthia I. , Musich Francisco M.
Published: February 2022

Social skills impairments in autism spectrum disorder (ASD) persist in adult life. There are different individual and group interventions for adults with ASD, designed to improve their instrumental social skills, that are comprised of several behavioral, narrative, and cognitive techniques. Decisions about which interventions might be more appropriate are informed by a thorough evaluation that includes individual and contextual variables, goals of the patient, and their preferred learning style. There is still much to research and learn about one of the most challenging and core areas of ASD. Future studies should ensure that samples who may be under-represented (e.g., women and nonbinary gender identities), are also recruited since these groups might present with different needs and require different supports”
Cognitive Behavior Therapy
Authors: Chew Xie Yin , Ozsivadjian Ann , Hollocks Matthew J. , Magiati Iliana
Published: February 2022

Cognitive behavior therapy (CBT) is a goal-focused, usually short-term therapy that integrates cognitive and behavioral modalities. CBT aims to change unhelpful thinking patterns and behaviors and develop more balanced ways of thinking about, and responding to, distressing experiences and situations. As rates of mental health difficulties are high in autistic people, the highly structured, practical, and present-focused CBT approach has been adapted for autistic people, with emerging, but still limited, evidence of effectiveness. This chapter outlines CBT’s theoretical and empirical basis, common strategies and techniques, the modifications/adaptations of CBT for use with autistic adults and a case study illustrating the CBT formulation and intervention with an autistic adult.
Mindfulness-Based Interventions
Authors: Beck Kelly B.
Published: February 2022

Mindfulness-based interventions (MBIs) are emerging as an empirically supported treatment for adults with autism spectrum disorder (ASD). There is evidence supporting the feasibility, acceptability, and efficacy of MBIs for improving co-occurring psychiatric symptoms and quality of life in samples of adults with ASD. However, the current research consists of mostly pilot trials and a few randomized controlled trials (RCTs), posing an outstanding need for large-scale effectiveness trials. MBIs may improve outcomes in ASD due to direct changes in emotion regulation impairment, which underlies many high-impact problems such as suicidality, anxiety, and depression in autism. Adults with ASD have unique needs that often pose clinical challenges that require small adjustments and additional supports during mindfulness delivery. As such, this chapter provides a resource to current and future clinicians serving adults with ASD. Mindfulness, meditations, and MBIs as a psychotherapy approach are introduced and followed by a summary of empirical evidence supporting MBIs in samples of adults with ASD. Common clinical delivery challenges and strategies are described in the context of a case study for clinicians interested in using MBIs with adults with ASD.
Group-Based Interventions
Authors: Langdon Peter E. , Robertson Adam , Fellas Thecla
Published: February 2022

Group-based psychological interventions for autistic adults have tended to focus upon teaching social skills or helping with mental health problems, such as anxiety or depression, or a combination of the two. There are a variety of factors associated with outcomes from group-based interventions, mainly centered around group dynamics, such as cohesion. Issues with negative attitudes, stigma, and discrimination may interfere with participation within group-based interventions, and specific adaptations are required to promote inclusion and ensure the needs of autistic people are met. Two types of groups are described within this chapter. The first is a social group developed with and run collaboratively with adults, where the theoretical foundation is based upon theories associated with behavioral activation, while the barriers faced by autistic people are minimized because of the collaborative and “self-help” nature of the group. The second is a cognitive-behavioral group for anxiety. The strengths and weaknesses of these approach are discussed as reported by the participants who took part in the groups.
Pharmacological Interventions
Authors: Hirota Tomoya , King Bryan H.
Published: February 2022

While there are no medications that have yet been identified as effective for addressing core features of autistic, there is a general consensus that some adults with autistic may benefit from access to psychopharmacotherapy for a variety of other clinical indications. Psychiatric disorders occur more commonly in autistic than in the non-autistic general population, and some medicines have well-established indications for conditions like irritability specifically in autistic. While it is generally the case that psychosocial therapies should be part of every treatment plan, medication should not be viewed as a last resort. Virtually all of the common classes of psychotropic medication have been explored in autistic, and antidepressant medications are among the most commonly used. Additional studies will be important in informing the practice of psychopharmacotherapy in autistic, particularly with respect to the common practice of combining different classes of medication.
Group SCM Sessions
Authors: Mitchell Stuart
Published: February 2022

This chapter outlines the content of group sessions, the processes of delivery, and offers some guidance on how practitioners may overcome frequently seen problems that occur. The group component of structured clinical management (SCM) is a key ‘socializing’ element to the model along with fostering a sense of social connectivity. Motivational work, alliance formation, understanding group issues, exploring crises, and agreeing progress monitoring (general therapeutic strategies) can all be employed here. The content includes problem-solving, managing emotions, increasing awareness of their own and other people’s minds (mindfulness, mentalizing), managing impulsivity and alternatives to self-harm, and fostering safe and secure relationships skilfully. It is recommended that SCM group practitioners agree roles and responsibilities so that ‘managing the group’ and SCM therapy tasks are distinguished.
Models of SCM Implementation— United Kingdom
Authors: Sampson Mark , Berry Christopher , Jerry Allyson , Gray Catriona
Published: February 2022

This chapter describes three structured care pathways from different UK organizations, all of which have implemented structured clinical management (SCM). SCM and structured care pathways are one way to enable services to address exclusion, variability, and inconsistency. The SCM approach enables generalist (non-specialist) mental health practitioners to deliver care for people diagnosed with borderline personality disorder (BPD) in a way that is structured, organized, and focused on recovery. The pathways are provided as case examples. The services are contextualized, their implementation process described, and their pathways illustrated. The chapter concludes by identifying commonalities across the three pathways, along with the shared ‘key enablers’ that have helped in their successful implementation.
Teamworking, System, and Service Interfaces in SCM
Authors: Mitchell Stuart , Harrison Julia
Published: February 2022

This chapter outlines how mental health services can ensure effective integrated team and service interface working within a structured clinical management (SCM) pathway for borderline personality disorder (BPD). It then reviews some of the problems experienced across the whole healthcare system and how these can be understood within the SCM approach. Finally, it illustrates these issues through several practical examples of service-related problems and suggests practical solutions based on the SCM approach. Integration of clinical teams and services within a comprehensive healthcare system is an essential part of the care and treatment of people diagnosed with personality disorder, yet there are many different elements of treatment teams or services which do not always work in synchrony or follow agreed care plans and strategies.
Prescribing in SCM: United Kingdom and Europe
Authors: Nair Rajesh , Björling Peder , Abdul-Rahman Muhammad , Turkington Gordon
Published: February 2022

This chapter provides guidelines on how to integrate pharmacological treatment for service users diagnosed with borderline personality disorder (BPD) in structured clinical management (SCM) treatment. It examines current international and national guidelines on pharmacological treatment, discusses the importance of service user–practitioner alliance, distinguishes between crisis-driven symptoms and co-occurring disorders, setting goals, and evaluating any pharmacological interventions. Finally, it integrates clinical decision-making about drug treatment into the SCM team model. Drug treatments are often used despite the lack of research evidence underpinning this approach. Further complications for effective prescribing often arise over the course of treatment itself with high rates of non-attendance and complications arising from co-occurring substance misuse and ruptures in the therapeutic alliance between service user and practitioner.
Managing Transitions and Endings
Authors: Quayle Genevieve , Mitchell Stuart
Published: February 2022

This chapter discusses how transitions and endings fit into the structured clinical management (SCM) treatment pathway, key factors in the ending and transition process, and the therapeutic implications of these for what makes a good or poor transition or ending. Clinical examples of good and poor transitions are used to illustrate principles. Managing endings and transitions in care for people who have experienced trauma and who are diagnosed with personality disorder is a key aspect of the SCM pathway in order to promote safe and effective care and treatment. The National Institute for Health and Care Excellence (NICE) recommends that for all people diagnosed with personality disorder a structured and phased approach is used before their services are changed or withdrawn.
Adaptations of SCM
Authors: Graham Simon , Robinson Jon , Juma-Smith Rachael , Kayes Sharron
Published: February 2022

This chapter focuses on adapting structured clinical management (SCM) in order to improve care pathways and treatment for people diagnosed with borderline personality disorder (BPD). It describes and outlines two adaptations to SCM as a treatment model for BPD. The first describes a specialist SCM Case Management Service based on SCM principles for service users who present with complex and severe personality disorder and are high risk to themselves or others. The second adaptation focuses on the training of some mental health professionals as personality disorder linkworkers who provide individual SCM informed sessions in adapted form to the system of care surrounding the service user. Case management and linkwork are integrated in service provision when complexity, severity, and systemic risk are high.
SCM Supervision in the United Kingdom
Authors: Harrison Julia , Watts Robert , Quayle Genevieve , Hanmer Sarah , Line Rachael , Ellis Darren , Maher Amy , MacDonald Louise
Published: February 2022

This chapter outlines the key principles of clinical supervision for structured clinical management (SCM), illustrated by data from experiences of SCM supervisors, supervisees, and team managers from two contributing National Health Service (NHS) trusts in the United Kingdom. SCM is an evidence-based approach that enables generalist mental health practitioners to work effectively with people diagnosed with borderline personality disorder (BPD). It is important that supervision structures are considered an essential part of the implementation of the SCM approach, and that experienced supervisors with adequate understanding of the model are identified at an early stage. It will describe how supervisory arrangements have been implemented and give an overview of how SCM can be delivered and supervised according to the skill mix and resources of services.
On Opacity: Toni Morrison’s and Paule Marshall’s Narrative Vision Therapy
Authors: Morris Johnson Nicole
Published: February 2022

Acknowledging an ongoing atmosphere of Black death, assault, and pain, and its relationship to a kind of ocular and imaginative distress, this article highlights the urgency of revisiting the lessons embedded in the writing of Toni Morrison (The Bluest Eye [1970]), Beloved [1987]) and Paule Marshall (“Reena” [1962], and Praisesong for the Widow [1983]). I join robust conversations in Black and literary studies in examining Marshall’s and Morrison’s crucial lessons on healing Black vision—work necessary for full command of the imagination. These lessons become more pronounced when viewed through the lens of Marshall’s and Morrison’s literary “dark sousveillance,” which Simone Browne defines as the charting of possibilities and coordination of “modes of responding to, challenging, and confronting a surveillance that [is] all encompassing.” I argue that through the use of narrative vision therapy, or the use of narrative as a healing device that realigns readers with their power to imagine and craft narratives that decenter anti-Blackness, Morrison and Marshall demonstrate that imagining otherwise futures requires intentional returns to and ongoing vigilance from opaque spaces—wherein the embrace of Black flesh, sounds, movement, and memory can help reverse distortions that our hyper-seeing of various violent forms of anti-Blackness have wrought.
Blockchain and population health
Authors: Gaynor Mark , BeLue Rhonda , Tuttle-Newhall J E , Martin Maxwell , Patejdl Frank , Vogt Clare
Published: February 2022

Background

Blockchain technology has made great strides in many industries but has yet to impact the world of public health. Population health issues such as outbreak surveillance and controlled substance tracking during emergencies all require a secure, easily accessible database. While the healthcare industry is typically slow to adapt to change, blockchain technology lends itself well to many healthcare issues.

Methods

We utilized a 3D framework using difficulty, novelty and necessity to examine the adoption of blockchain technology in population health, based on the 2D framework of difficulty and novelty as driving factors for the development of foundational technologies in the world of business by Iansiti and Lakhani in The Harvard Business Review.

Results

We find that by implementing the third dimension of necessity into an evaluation framework, we can better predict the adoption of technology. We found how different areas of population health fit into the evaluation framework and how necessity can eliminate barriers from implementing novel technologies.

Conclusion

The byproduct of this paper will be the extension of the Iansiti and Lakhani framework. We will show that blockchain, in all of these domains, shows promise to improve population health as we move past COVID-19 and into the future of healthcare.
Psychological impact of lung cancer screening using a novel antibody blood test followed by imaging: the ECLS randomized controlled trial
Authors: Hancox J , Ayling K , Bedford L , Vedhara K , Roberston J F R , Young B , das Nair R , Sullivan F M , Schembri S , Mair F S , Littleford R , Kendrick D
Published: February 2022

Background

The Early CDT®-Lung antibody blood test plus serial computed tomography scans for test-positives (TPGs) reduces late-stage lung cancer presentation. This study assessed the psychological outcomes of this approach.

Methods

Randomized controlled trial (n = 12 208) comparing psychological outcomes 1–12 months post-recruitment in a subsample (n = 1032) of TPG, test-negative (TNG) and control groups (CG).

Results

Compared to TNG, TPG had lower positive affect (difference between means (DBM), 3 months (3m: −1.49 (−2.65, − 0.33)), greater impact of worries (DBM 1m: 0.26 (0.05, 0.47); 3m: 0.28 (0.07, 0.50)), screening distress (DBM 1m: 3.59 (2.28, 4.90); 3m: 2.29 (0.97, 3.61); 6m: 1.94 (0.61, 3.27)), worry about tests (odds ratio (OR) 1m: 5.79 (2.66, 12.63) and more frequent lung cancer worry (OR 1m: 2.52 (1.31, 4.83); 3m: 2.43 (1.26, 4.68); 6m: 2.87 (1.48, 5.60)). Compared to CG, TPG had greater worry about tests (OR 1m: 3.40 (1.69, 6.84)). TNG had lower negative affect (log-transformed DBM 3m: −0.08 (−0.13, −0.02)), higher positive affect (DBM 1m: 1.52 (0.43, 2.61); 3m: 1.43 (0.33, 2.53); 6m: 1.27 (0.17, 2.37)), less impact of worries (DBM 3m: −0.27 (−0.48, −0.07)) and less-frequent lung cancer worry (OR 3m: 0.49 (0.26, 0.92)).

Conclusions

Negative psychological effects in TPG and positive effects in TNG were short-lived and most differences were small.
Three decades of organic wheat improvement: Assessing the impact and returns on investment
Authors: Grovermann Christian , Weiner Mareike , Levy Lilia , Locher Michael , Manuel Herrera Juan , Winter Eva
Published: February 2022

A changing regulatory environment and growing awareness are driving the need for crop improvement in organic agriculture. Contrary to conventional breeding, evidence on the economic effects of research and development in organic breeding is lacking. This study assesses adoption, economic impact, and rates of return to organic crop improvement research. The economic surplus method is used to quantify the impact of the Wiwa winter wheat variety. The standard model is enhanced by considering the economic benefits of improvements in crop nutrient and processing quality as well as resilience gains. Results show substantial economic returns of 18.6 per cent for the period from 1988 to 2019. The reduced downside risk of the organic cultivar is a key distinguishing factor in the analysis as organic breeding aims at providing farmers with resilient cultivars. Further investment in organic breeding appears as a promising element in the strategy for resilient and sustainable food systems.
Optimizing the implementation of a multisite feasibility trial of a mind–body program in acute orthopedic trauma
Authors: Bakhshaie Jafar , Doorley James , Reichman Mira , Mace Ryan , Laverty David , Matuszewski Paul E , Elwy A Rani , Fatehi Amirreza , Bowers Lucy C , Ly Thuan , Vranceanu Ana-Maria
Published: February 2022

The Toolkit for Optimal Recovery (TOR) is a mind–body program for patients with acute orthopedic injuries who are at risk for persistent pain/disability. In preparation for a multisite feasibility trial of TOR at three orthopedic trauma centers, we aim to qualitatively identify barriers and facilitators to study implementation and strategies to mitigate the implementation barriers and leverage facilitators.We conducted 18 live video focus groups among providers and three one-on-one interviews with department chiefs at Level 1 trauma centers in three geographically diverse sites (N = 79 participants). Using a content analysis approach, we detected the site-specific barriers and facilitators of implementation of TOR clinical trial. We organized the data according to 26 constructs of the Consolidated Framework for Implementation Research (CFIR), mapped to three Proctor implementation outcomes relevant to the desired study outcomes (acceptability, appropriateness, and feasibility). Across the three sites, we mapped six of the CFIR constructs to acceptability, eight to appropriateness, and three to feasibility. Prominent perceived barriers across all three sites were related to providers’ lack of knowledge/comfort addressing psychosocial factors, and organizational cultures of prioritizing workflow efficiency over patients’ psychosocial needs (acceptability), poor fit between TOR clinical trial and the fast-paced clinic structure as well as basic needs of some patients (appropriateness), and limited resources (feasibility). Suggestions to maximize the implementation of the TOR trial included provision of knowledge/tools to improve providers’ confidence, streamlining study recruitment procedures, creating a learning collaborative, tailoring the study protocol based on local needs assessments, exercising flexibility in conducting research, dedicating research staff, and identifying/promoting champions and using novel incentive structures with regular check-ins, while keeping study procedures as nonobtrusive and language as de-stigmatizing as possible. These data could serve as a blueprint for implementation of clinical research and innovations in orthopedic and other medical settings.
Understanding barriers and facilitators to voluntary medical male circumcision and Spear and Shield uptake in Zambian community health centers
Authors: Cristofari Nicholas V , Rodriguez Violeta J , Jones Deborah L , Weiss Stephen M
Published: February 2022

Voluntary medical male circumcision (VMMC) has been an effective method for reducing the risk of HIV transmission by 50%–70% in Eastern and Southern Africa. The Spear and Shield (S&S) program is a community health center (CHC)-based biobehavioral VMMC HIV prevention intervention that increased VMMC uptake in male CHC attendees in Lusaka, Zambia. Qualitative data organized using the Consolidated Framework for Implementation Research (CFIR) has been used to characterize factors that may impact S&S/VMMC implementation. This manuscript uses the CFIR to examine S&S implementation across 96 CHCs in four Zambian provinces using a mixed-methods approach to (a) quantify successful S&S implementation; (b) understand how CFIR domains might provide insight into the degree of implemental success; (c) identify major themes among least and most successful CHCs; and (d) help guide future prevention efforts and policy related to VMMC promotion in the Zambian CHC context. In contrast with CFIR quantitative analyses, 12 major qualitative themes associated with the least and most successful CHCs provided unique insight into S&S and VMMC implementation and guidance for future implementation studies. Themes included lack of resources (staff, space, transportation) for the former and strong staff relationships and active community engagement for the latter. The CFIR framework appears extremely useful for the identification of qualitative themes related to intervention implementation, and reduction of qualitative data for quantitative analyses may sacrifice more nuanced information. Consideration of CFIR themes may be useful to inform HIV prevention strategies in Zambia and similar contexts.
Applying the Nightingale Pledge in Reducing Health Disparities: A Hospital-Acquired Pressure Injury Case Study
Authors: Green Cheryl
Published: February 2022

Professional nurses, by virtue of their training, pledge to care for individuals who are sick or infirm. This commitment is confirmed via the Nightingale Pledge, which focuses on public health and equity and deems the nurse to be a missioner of health. Health disparities exist in direct conflict with the nursing responsibility of caritas, or love. Accordingly, it is imperative that nurse educators create learning environments that are conducive to comfortably discussing differences in physical assessments performed on diverse populations as part of their work to eliminate health disparities and in accordance with the Nightingale Pledge.
Consistent Practices in Pressure Injury Prevention at Long-term Care Facilities
Authors: Haavisto Elina , Kielo-Viljamaa Emilia , Hjerppe Anna , Puukka Pauli , Stolt Minna
Published: February 2022

OBJECTIVE

To examine the use of consistent practice in pressure injury (PI) prevention based on international guidelines at long-term care facilities in Finland.

METHODS

A correlational cross-sectional design was used. The authors collected data from 84 contact persons within 62 participating long-term care facilities in Finland using the Pressure Ulcer Prevention Practice instrument.

RESULTS

According to the respondents, the PI prevention strategies practiced most often were skin assessment and skin care; nutrition was the prevention used least often. Consistent practices relating to repositioning were most frequently agreed upon, whereas those relating to risk assessment were least frequently agreed upon. Some of the demographic factors of respondents, including knowledge level and reading of PI prevention guidelines and articles, were associated with the frequency of prevention practices.

CONCLUSIONS

Although respondents reported a moderate level of PI prevention based on international guidelines, there were often no consistent practices in the units. Further education about PI prevention might improve the consistent practice of evidence-based PI prevention.
Patient Characteristics Associated With Phone Versus Video Telemedicine Visits for Substance Use Treatment during COVID-19
Authors: Chang Ji Eun , Lindenfeld Zoe , Thomas Tatiana , Waldman Justine , Griffin Judith
Published: February 2022

Objectives

Although video visits may offer some benefits over the telephone, not all patients may be equipped to access video telemedicine, raising questions surrounding access disparities. The aim of this study is to examine patient characteristics associated with the use of phone versus video-enabled tele-medication for opioid use disorders (MOUD) during COVID-19.

Methods

This study uses data from a nonurban integrated substance use disorder treatment site in New York to examine patient characteristics associated with the modality of tele-MOUD care. The provider did not offer in-person care. Multivariable regression models were used to assess the association between patient’s primary mode of tele-MOUD and patient demographic characteristics. Additional analysis of new patient inductions examined associations between mode of tele-MOUD induction and 30-day follow-up receipt.

Results

Of the 4557 tele-MOUD encounters, 76.92% were video and 23.08% were telephone visits. Older patients had significantly higher odds of primarily using telephone (odds ratio [OR]: 0.580; 95% confidence interval [CI]: 0.045, 1.115). Patients with higher education (OR: –0.791; 95% CI: –1.418, –0.168), recent overdose (OR: –0.40; 95% CI: –0.793, –0.010), and new patients (OR: 0.484; 95% CI: –0.945, 0.023) were significantly less likely to rely on telephone. Of 336 new patient initiations, 31 were conducted by telephone while 305 were conducted through video. The mode of new patient initiation was not associated with a follow-up visit within 30 days of initiation.

Conclusions

Telemedicine may increase access to MOUD, though certain patients may rely on different forms of telemedicine. Attention must be paid to policies that promote equitable access to both video and telephone tele-MOUD visits.
Verification of Resectability Status for Pancreatic Cancer
Authors: Makino Isamu , Tajima Hidehiro , Kitagawa Hirohisa , Gabata Ryosuke , Okazaki Mitsuyoshi , Shinbashi Hiroyuki , Ohbatake Yoshinao , Nakanuma Shinichi , Saito Hiroto , Yamaguchi Takahisa , Terai Shiro , Okamoto Koichi , Sakai Seisho , Kinoshita Jun , Nakamura Keishi , Ninomiya Itasu , Fushida Sachio , Ohta Tetsuo
Published: February 2022

Objectives

Resectability status is considered an important indicator for progression of pancreatic cancer. We verified the superior mesenteric artery (SMA) factors of resectability status by radiological and pathological analysis in patients who underwent pancreatoduodenectomy with combined resection of the SMA.

Methods

We enrolled 22 patients who underwent pancreatoduodenectomy with combined resection of the SMA. Patients were divided into 3 groups according to the contact angle between the tumor and the SMA in preoperative computed tomography images (no contact, R-sma; contact within 180 degrees, BR-sma; contact more than 180 degrees, UR-sma). We pathologically evaluated cancer progression toward the SMA.

Results

There were 3 patients with R-sma, 12 with BR-sma, and 7 with UR-sma. The median distance (mm) between the cancer and the SMA was 7.0 with R-sma, 1.0 with BR-sma, and 0 with UR-sma (P = 0.0003). Invasion to the superior mesenteric nerve plexus was positive in none with R-sma, 11 with BR-sma, and 7 with UR-sma (P < 0.0001). Invasion to the SMA was positive in none with R-sma and BR-sma, and 7 with UR-sma (P < 0.0001).

Conclusions

Superior mesenteric artery factors of resectability status are reliable indicator for cancer progression toward the SMA.