Recent Submissions

  • Explorations of intergenerational healing, resilience, and post-traumatic growth by helpers and healers on the Blackfeet Nation

    Hoyt, Tyler J.; Gifford, Valerie M.; Whipple, Jason; Topkok, Sean; David, Eric John (2019-12)
    This project explored intergenerational healing, resilience, and post-traumatic growth within the context of the Blackfeet Nation in Montana, the roles of helpers and healers in this setting, and community experiences of familial trauma and the idiosyncratic healing and resilience processes according to their worldview. The central goal of this study was to provide a contemporary public narrative surrounding healing and resilience as these topics related to historical and intergenerational trauma in this specific community. This exploratory study was composed of the narratives of 14 co-participants working as helpers and healers on the Blackfeet Nation. Indigenous narrative and a cosmic relationality were honored and a phenomenological method of Gadamerian hermeneutics was utilized. Seven central themes arose in the process of data analysis including Spirituality, Trauma, Healing, Resilience, Helping Role, Community, and Blackfeet Worldview. Co-participants explored contemporary experiences of collective intergenerational trauma of those they served as well as personal and familial processes of healing and resilience. The centrality of spirituality, cultural immersion and personal cultural identity were discussed as aspects of intergenerational healing and resilience. A holistic and culturally idiosyncratic understanding of personal and intergenerational healing was emphasized including spiritual, emotional, mental, and physical modes of healing. Patterns of healing experienced collectively and synergistically within family systems and between community members were also identified.
  • Attributions of blame and social reactions to scenarios of sexual assault of adult women

    Skanis, Marie L.; Lopez, Ellen; Rivkin, Inna; Gifford, Valerie; Worrall, John (2019-08)
    Alaska consistently has the highest rate of sexual assault in the nation, yet research within the state has focused on stranger rape or assaults which were reported to medical or law enforcement professionals. National research suggests these characteristics are not representative of most victims. The current study fills a gap in research by examining the attitudes and reactions towards victims of stranger and acquaintance rape who have disclosed their assault to friends rather than authorities. Attribution theory was hypothesized to underlie relationships between attributions, emotional reactions, and social behaviors that victims encounter. Using an experimental design, participants were randomly assigned to read either a scenario of realistic acquaintance (common) or stereotypical (rare) stranger rape. The stereotypical assault scenario depicted a victim who was attacked outdoors by a stranger in a physically violent manner. The acquaintance rape scenario, in which a woman experiences assault inside her home by a known acquaintance who uses coercive verbal tactics, reflects characteristics of sexual assault that are experienced by most victims. The influences of type of rape, modern sexism, rape myth acceptance, expected peer rape myth acceptance, gender, training, or experience responding to disclosures of sexual assault on participant reactions were explored. It was hypothesized that participants reading the acquaintance rape scenario, participants with higher acceptance of negative attitudes (rape myths and modern sexism) and expectations that peers accept high levels of rape myths, male participants, and those who lack training or experience responding to disclosures would report more negative attributions (high fault and blame), emotional reactions (low empathy and high anger), and social reactions to the victim and positive reactions towards the perpetrator (low attributions of fault and blame, high empathy and low anger). Results revealed that acceptance of modern sexism, rape myths, and expecting that friends accept rape myths were associated with higher attributions of fault and blame to the victim, more anger towards the victim, more empathy felt for the perpetrator, and increased likelihood of offering the victim negative social responses. When asked what would improve response to sexual assault at UAF, participants indicated that changes in training, the UAF community, Title IX processes, awareness, resources, and demonstrating trustworthiness are important. Given these results, recommendations for stakeholders include communicating that most students do not accept modern sexism or rape myths to combat pluralistic ignorance and targeting the most prevalent rape myths in training. Changes to education and awareness efforts are recommended, including conducting sessions in-person, over several sessions, within single-gender groups, and utilization of pre- and post-training outcomes assessments to measure a variety of biases (such as rape myths). Stakeholders are encouraged to use existing research as a framework for teaching students about different types of reactions to disclosures of sexual assault, emphasizing which reactions victims experience as helpful and hurtful. Limitations and strengths of the study are also discussed.
  • Moderators of bicultural self-efficacy and mental health among Asian Americans

    Shah, Dhara; David, E.J.R.; Lopez, Ellen; Campbell, Kendra; Buckingham, Sarah (2019-08)
    The relationship between acculturation and mental health among Asian Americans has been established. For example, the integration strategy, often associated with bicultural competence, has been shown to positively predict well-being and self-esteem, and negatively predict various indicators of distress (Nguyen, Messe, & Stollak, 1999; Oh, Koeske, & Sales, 2002; Yoon, Lee, & Goh, 2008). Further, biculturalism (Chen, Benet-Martinez, & Bond, 2008) and bicultural self-efficacy (David, Okazaki, & Saw, 2009) have been associated with positive mental health outcomes among Asian Americans. That is, perceiving oneself as capable of navigating various domains (e.g., values, behaviors) within two cultures is associated with better mental health. Little is known, however, regarding the factors that may influence the strength of this relationship. Thus, the present study aimed to identify some moderating factors of the relationship between bicultural self-efficacy and mental health among Asian Americans. Considering previous research examining the factors associated with acculturation and mental health (Berry, 1980; Nguyen & Benet-Martinez, 2007; Padilla, 2006), it was hypothesized that bicultural identity integration, cognitive flexibility, psychological flexibility, and resilience would each moderate the relationship between bicultural self-efficacy and satisfaction with life, and between bicultural self-efficacy and psychological distress. Results indicated that bicultural identity integration approached significance, indicating that of all the hypotheses presented in this study, it may be the only moderator of the relationship between bicultural self-efficacy and life satisfaction. Thus, viewing two cultures as compatible may act as a protective factor, or buffer, against the negative effects of low bicultural self-efficacy on some aspects of mental health. Further, the null findings suggest that the relationships between the measured variables may be more complex than simple moderation. It is recommended that future research continue to explore and test moderation and mediation models, while considering alternative measures and specific subscales. Recommended service implications for Asian Americans include interventions geared to increase one's level of bicultural identity integration or bicultural selfefficacy, as well as to encourage systems or communities to provide the appropriate resources needed to do so.
  • The looking glass effect: the influences of clinical supervision on student attitudes toward evidence based practices

    Leonard, Hugh D.; Campbell, Kendra; Rivkin, Inna; Gonzales, Vivian M.; Fitterling, Jim (2019-08)
    The current study explored how graduate students' attitudes toward evidence-based practices (EBPs) are influenced through clinical supervision. Despite being widely endorsed by professional entities, such as the American Psychological Association, members of the profession have mixed attitudes toward the EBP approach. Mixed attitudes toward EBPs have potentially detrimental effects, such as resulting in clinicians simply dismissing the notion of evidence-based treatment decision making and instead utilizing interventions that are without scientific support and potentially ineffective and even harmful. Resistance toward EBPs has been studied, but largely unstudied is how negative attitudes toward EBPs are developed and propagated to others. Professional identity solidifies in graduate school by way of clinical supervision. The goal of this study was to illuminate underlying influences of clinical supervision on graduate student attitudes toward EBPs, as clinical supervision may be the root cause of resistance toward EBPs. Perceived supervisor credibility influences professional identity development and may be influenced by a positive supervisory working alliance, theoretical orientation match, and overall acquiescence to a clinical supervisor; and these factors may affect attitudes toward EBPs. However, no previous research exists to directly confirm this notion. This study sampled from Ph.D. and Psy.D. clinical psychology graduate students who had started seeing patients (n = 157). Participants completed an online survey battery measuring perceived supervisor credibility, supervisory working alliance, student attitudes toward EBPs, perceived supervisor attitudes toward EBPs, and dispositional psychological reactance. It was predicted that students would perceive their supervisor as credible when their theoretical orientations matched, a positive supervisory working alliance existed, and students' psychological reactance was low. It was also predicted that supervisor attitudes toward EBPs would predict student attitudes toward EBPs when perceived supervisor credibility is high, students' dispositional psychological reactance is low, supervisory alliance is high, and theoretical orientations matched. Simultaneous linear regression and hierarchical regression was used to test the study hypotheses. The results partially supported the study hypotheses. It was found that a positive supervisory alliance predicted perceived supervised credibility. However, the remaining hypotheses were unsupported. Results contribute to the sparse research base on supervisor credibility in that preliminary support is provided that perceived credibility occurs when students and supervisors have a good relationship. Noteworthy are that results yielded from correlations suggested that students' global appreciation for research was related to theoretical orientation match of their clinical supervisor, supervisors' and graduate program's favorable attitudes toward EBP's, and to multi-faceted supervisory relationships such as having a clinical supervisor also as a research supervisor. These findings suggest that student internalization of supervisor attitudes may have less to do with perceived credibility and more to do with attitudes toward research. Future research should consider exploring attitudes toward research in the context of development of attitudes toward EBPs.
  • A humble guest: a phenomenological exploration of success and competence in rural Alaskan mental health care

    Herman, Daniel John; Gifford, Valerie M.; Whipple, Jason; David, Eric John; Swift, Joshua (2018-12)
    Objective: Rural communities in Alaska face a long list of mental health disparities that are exacerbated by the other challenging factors inherent within the rural context. Rural Alaskan mental health care providers are faced with the tremendous task of providing clinically and culturally competent care to underserved and marginalized populations, with limited personal and professional resources, all while balancing the needs of the community, their own personal boundaries, and the pressure of remaining accountable to the larger system of professional ethics and guidelines. The aim of this study was to explore, identify, and understand from the perspective of rural Alaskan providers what it means to be successful and competent mental health care providers in rural Alaska. The ultimate goal of this study was to develop a deeper understanding of what being successful and competent means from the perspective of providers who have been successful in rural Alaskan practice. Methods: This study utilized an exploratory qualitative methodology grounded in the interpretive/constructivist paradigm. Semi-structured interviews were used to explore the perspectives of 12 mental health providers who have practiced successfully and competently with rural Alaskan patients. Furthermore, a phenomenological-hermeneutic approach was applied in order to work collaboratively with participants to reach a deeper understanding of mental health care success and competence in a rural Alaskan context. Results: Ten contextual themes and 27 subthemes emerged from the interviews that illuminate the experience of success and competence as experienced by rural Alaskan mental health care providers. The implications of this study serve to deepen the current understanding of what it means to practice in rural Alaska with communities and Indigenous people. Furthermore, the findings provide a culture and context specific understanding of success and competence that will help current providers, employers, and communities to better serve rural Alaskan people. The findings contribute to the literature by promoting a salient perspective of practice that is within a context of mental health that is generally disregarded, overlooked, and rarely considered.
  • Historical trauma and approaches to healing among Choctaw American Indians

    Woods, Ashley; Rivkin, Inna; Gifford, Valerie; Lardon, Ce'cile; David, E.J.R. (2018-08)
    Native Americans have experienced a number of historically traumatic events that are believed to contribute to the development of behavioral health symptoms that negatively affect Native American quality of life across generations. Despite the trajectory of trauma experienced in some Native American communities, Native Americans exhibit extraordinary resilience and cultural strengths. Stress and coping models have been developed to explain how historical trauma is related to current health disparities among Native Americans and how enculturation may serve as a buffer against the negative effects of historical trauma. However, these models apply meta-theories to understanding historical trauma rather than tribally specific conceptualizations of historical trauma and historical trauma responses. Therefore, it is important to understand tribally specific manifestations of historical trauma so that intervention and prevention efforts are culturally appropriate. Choctaws are one of the largest Native American groups in the United States. They have experienced a history of forced removal and relocation from traditional homelands, yet the Choctaw Nation itself exhibits continuous growth and success as a tribe. This study used a qualitative, phenomenological, and community based participatory research (CBPR) approach to explore how Oklahoma Choctaw American Indians experience historical trauma and define well-being and enculturation. Interviews and focus groups were conducted with Choctaw American Indians in three different age categories 18-29; 30-49; and 50 and over to examine generational differences in how concepts of historical trauma, enculturation, and well-being are conceptualized. The theoretical construct of historical trauma was informed by themes of assimilation and colonization; resurgence of the Choctaw identity; awareness of historical losses and affective responses; forms of coping; current barriers to accessing Choctaw Nation services; and varying degrees of cultural involvement among tribal members. The theoretical construct of well-being was described in terms of physical health, faith, family, and culture. The theoretical construct of enculturation included pride in heritage, having Choctaw blood, being involved, and social connectedness. Choctaw participants reported social problems related to substance abuse and a sense of diminishing social connectedness to other tribal members. Recommendations on how to upscale behavioral health treatment and strengthen community ties are described. Adapted measures of historical trauma and enculturation for use in future research endeavors with Oklahoma Choctaw American Indians are also provided.
  • Concurrent Validation Of Alaska's Juvenile Justice Suicide Risk Screening Measure

    Gonzales, Jaymes; Boeckmann, Robert; Allen, James; Gonzalez, Vivian; Sandberg, Patricia (2012)
    Incarcerated youth face elevated rates of mental health problems and are at greater risk for suicide. The Alaska Division of Juvenile Justice (AKDJJ) uses the Mental Health/Suicide Screening (MHSS) measure to screen incoming youth for mental health problems and current suicide risk. This research examined the concurrent validity of the MHSS, exploring the relationships of the MHSS with the Beck Depression Inventory 2nd Edition (BDI-II; Beck, Steer, & Brown, 1996) and a measure of current suicidal ideation, the Positive and Negative Suicidal Ideation Inventory (PANSI; Osman, Guiterrez, Kopper, Barrios, & Chiros, 1998b). Statistically significant correlations were found between the MHSS, BDI-II, and negative ideation subscale of the PANSI; however, the effect sizes were not large enough to suggest concurrent validation within the study sample or to advise the continued use of the MHSS as a suicide risk measure. Future research directions and practical implications are provided.
  • Secondary Trauma In Mental Healthcare Providers In Alaska

    Johnson, Erin L.; Lampman, Claudia; Petraitis, John; David, EJR; Lower, Tim (2012)
    Secondary trauma (ST) is vicarious traumatization caused by empathetic engagement with another's trauma, which may lead to burnout/turnover for mental healthcare providers (MHPs). ST and associated risk or protective factors have not been studied in Alaska. This research explored the prevalence and predictors of ST. The study population was 450 licensed MHPs and 14 Behavioral Health Aides (BHAs) who were randomly selected to complete the Secondary Traumatic Stress Scale (STSS) and a questionnaire created for this research, which inquired into aspects of their work. Bivariate analyses, mediator analyses, and multiple regressions tested which variables were associated with levels of overall ST and three sub-types of ST labeled Intrusion, Avoidance, and Arousal. 4 of the MHPs who responded to the survey also participated in a focus group to explore the survey results in greater detail. In total, 232 (50% response rate) licensed professionals and BHAs (47.08% urban and 48.15% rural) responded to the online survey. The Total STSS score across all participants indicated a "mild" level of ST among the MHPs. Approximately 20% of the sample met criteria for posttraumatic stress disorder as a result of their work; 47.6% experienced intrusion, 32.9% experienced arousal, and 29.9% experienced avoidance symptoms. As hypothesized, MHPs who reported working in rural locations, treating long-term and casual acquaintances, being less satisfied with their social support and self-care levels, and feeling more embarrassed to discuss ST reported higher levels of ST. Spending a higher percentage of one's workweek providing direct client services, however, was associated with less ST. Other hypothesized predictors of ST, including being younger, time spent debriefing, having a trusted supervisor, hours spent in self-care, treating a family member or friend, having a similar trauma history as a client, and gender were not associated with ST. Focus group participants shared that all clinicians may be susceptible to ST, that MHPs cope with ST by emotionally withdrawing, and that organizations can help reduce ST by providing support that reduces overall job-related stress. The information obtained can assist training programs, organizations, and providers in addressing ST, which may help reduce burnout/turnover rate.
  • Factors Contributing To Weight Gain Among College Freshman And Beyond

    Chipp, Cody L.; Brems, Christiane; Johnson, Mark; Metzger, Jesse; Rivkin, Inna (2012)
    Background: Linked with a higher risk of life threatening illnesses, obesity in the United States has become an epidemic, with a prevalence rate of overweight and obese adults of nearly 68%. Obesity rates have accelerated over the past two decades and one crucial developmental period for weight gain is among emerging adults attending college. Using an explanatory mixed-method design, this study examined contributing factors to weight gain among college students, including eliciting university stakeholders' perceptions of supports and barriers to exercising and healthy eating among students. Method: Data collection for the quantitative phase of the study consisted of two waves, baseline and 2-year follow-up. Students completed psychosocial and anthropometric measures (height, weight, and body fat percentage). Data collected for the qualitative phase of the study consisted of key informant interviews with university administrators (n=15) and seven student focus groups (n=34 students). Qualitative analyses were conducted with NVivo software and multiple coders, using a grounded theory approach to elicit major themes. Results: Students gained 1.5lbs (p>.05), with 34% of participants gaining over 5 lbs and 17% over 10 lbs. Participants who gained weight were men, ate more calories from sweets or desserts, and consumed fewer calories from fats. Increase in calories from desserts or sweets increased odds of weight gain (OR=1.075, CI=1.01-1.14) and body fat (OR=1.106, CI=1.036-1.181). Contextualizing the quantitative findings, students and administrators identified several themes that support healthy living, including access to nutritious food and physical amenities. Both groups also identified barriers, including easy access to high-calorie foods, limited recreation facilities, and policy challenges. Administrators spoke of extant health promotion efforts; however, students did not perceive active health promotion initiatives on campus. Conclusions: Dietary habits were identified drivers of weight gain among students. Extant campus supports and barriers to exercise and healthy eating among students were equally identified by students and administrators with great reliability. Implications for future health promotion efforts, food availability, recreation, and physical amenities are discussed in the context of clears sets of recommendations for stakeholder groups. Future research should explore specific dietary foods that are increasing weight and develop targeted preventions/interventions for individuals at risk.
  • Meeting The Needs Of Breast Cancer Survivors In Alaska: Survivors' And Healthcare Providers' Perspectives

    Parret, Virginia Cress; Brems, Christiane; Dulin, Patrick; Johnson, Mark E.; Rivkin, Inna (2011)
    Cancer is the leading cause of death in the state of Alaska and female breast cancer ranks second highest for incidence and mortality compared to all other cancers. Due to high incidence rates of women diagnosed with breast cancer each year and a growing number of survivors, it is important to examine the unmet needs of breast cancer survivors living in Alaska. The purpose of this study was to gather data about the needs of Alaskan breast cancer survivors across the continuum of breast cancer care. Study goals were accomplished via an explanatory mixed methods research design involving three distinct phases; namely, a quantitative, qualitative, and application phase. In the quantitative phase, the study drew upon an existing needs assessment dataset collected from breast cancer survivors living in Alaska to identify and bring awareness to the physical, psychological, and daily living challenges secondary to diagnosis and treatment for breast cancer. Augmenting secondary data analyses of this dataset, key informant interviews were used to elicit information from healthcare providers about their perception of breast cancer survivors' needs and how to meet these needs in Alaska. Results based on the survey responses from 309 breast cancer survivors and interviews with 31 healthcare providers revealed key barriers and services gaps along with ways to improve services for Alaskan breast cancer survivors. Broad recommendations based on all data included: 1) addressing service gaps and improving communication; 2) meeting psychosocial needs; 3) attending to needs specific to rural breast cancer survivors; 4) improving coordination of care; and 5) implementing established survivorship care plan(s) within Alaska's healthcare system. Many challenges and obstacles identified by interviewees are beyond individual providers' control and need to be addressed not only as independent practice issues, but as larger medical education and healthcare systems issues. Given these realities and findings, the study concludes with recommendations aimed toward providers serving the oncology community, hospital groups, and other key community stakeholders with the goal of providing comprehensive medical and support services to breast cancer survivors living in Alaska.
  • Identifying and working with non-responsive and deteriorating patients within the process of supervision: methods of practicing supervisors

    Rast, Katrina Anne; Gifford, Valerie; David, Eric John; Geist, Charles; Lardon, Cecile; Whipple, Jason (2018-05)
    Clinical supervision is widely considered to be an essential part of psychotherapy training, encouraging trainee growth, and ensuring the best possible outcome for patients. The use of routine outcome monitoring (ROM) systems in clinical practice has been shown to be beneficial in improving patient outcome within psychotherapy. In addition to its utility in clinical practice, research has suggested that the use of ROM systems and patient feedback within the supervisory process may also have a positive impact on patient outcome. Despite these potential benefits, there is no existing literature about how supervisors identify and work with patients at risk for deterioration within the supervision process. This study aimed to explore the influence on regulatory focus and the use of ROM systems within supervision. Additionally, this study sought to explore two questions: 1) How do supervisors currently identify supervisee patients who are unresponsive to treatment or deteriorating? and 2) How do supervisors currently work with unresponsive or deteriorating patients in supervision? Using a quantitative approach, results suggest that the majority of supervisors rely heavily on clinical judgment in order to identify treatment non-responders and irregularly use ROM systems in order to identify these patients. In addition, the results suggest that the majority of supervisors respond to deteriorating patients in a way that coincides with existing literature pertaining to common practices within psychotherapy. Furthermore, there appears to be a prominent lack of understanding of the purpose and use of ROM systems within supervision. Finally, results indicate that promotion scores are a predictor of the use of ROM within supervision. Implications for research and clinical practices are discussed, in addition to limitations and future directions of the study.
  • "We did listen": Successful aging from the perspective of Alaska Native Elders in Northwest Alaska

    Boyd, Keri M.; Gifford, Valerie M.; Whipple, Jason; Lewis, Jordan; David, Eric John (EJ) (2018-05)
    Alaska's older adults are growing faster in proportion to the overall population creating concern regarding how adequate care will be provided in the coming years. Statewide, rural community members are looking for innovative, culturally appropriate ways to promote successful aging for their growing population of elders, allowing them to age in their home communities. This qualitative, phenomenological study sought to establish a deeper understanding of how Alaska Native Elders in Northwest Alaska understand and experience successful aging to inform program development and service delivery. The present project was embedded within a larger community-based participatory research study and conducted in collaboration with community members and an Alaska Native Elder Advisory Committee. The 14 community-nominated Elder participants universally identified engagement with family and community, self-awareness and care, and a sense of gratitude as essential elements of successful aging. Elders who age successfully listened to and learned from their Elders, enact their traditional values and practices, and pass their wisdom and knowledge to future generations. The results provide a culture and context specific understanding of successful aging that will help communities develop Elder-centered programs and service delivery and contributes to field of successful aging by presenting a perspective of successful aging that is not currently represented in the literature. Finally, by recording the Elders' knowledge and stories of successful aging this project also helped preserve some of the traditional cultural knowledge held by Elders in this region to be shared with generations to come.
  • A comparison between talking circles and mainstream student support groups for college life adjustment with Alaska Native students

    Woods, Tina Marie; David, E. J. R.; Petraitis, John; Lampman, John; Allen, James (2013-05)
    Alaska Native college students are less likely to graduate within a four year time span, have higher drop-out rates, and have lower grade point averages compared to other students. In addition to the typical life adjustments, challenges, and stressors that come along with college life, Alaska Native college students also commonly face conflicts between their heritage culture and the Westernized systems of colleges and universities, which might make it more difficult for Alaska Native college students to successfully adjust to college life, perform well academically, and remain committed to completing their education. Thus, this study used an experimental design to compare two similar student support groups (Talking Circles or TC and Mainstream Support Groups or MSG) that were administered during an academic semester to determine which works better with Alaska Native college students for facilitating their adjustment to college life, academic performance, and commitment to completing college. Using an experimental, pre-/post-test comparison group design with 24 Alaska Native college students (TC n=10; MSG n=14), the results revealed that neither TCs nor MSGs increased levels of adjustment to college life and commitment to completing college. Furthermore, although the results showed that students who participated in TCs felt more satisfied and felt that they were heard better by their group compared to students in the MSGs., no evidence was found to support the effectiveness of TCs in improving adjustment to college life, academic success, and commitment to college. Along with the study limitations, future research and service implications regarding the use of TCs among Alaska Native college students -- and among Alaska Native Peoples more generally -- are discussed.
  • Factors that contribute to rural provider retention, service utilization, and engagement in mentorship by cultural experts

    Gifford, Valerie M.; Rivkin, Inna; Lower, Timothy; Koverola, Catherine; Brems, Christiane (2012-05)
    A substantial amount of time, money, and other resources are expended on recruiting behavioral health providers to fill vacant positions in rural Alaska. This exhaustive drain on resources is perpetual due to the high turnover rates of providers. This exploratory qualitative study utilized grounded theory methodology to investigate personal qualities of providers and other factors contributing to long-term retention of providers relocating to Alaska's Bering Strait Region from elsewhere, community members utilizing the provider's services, and the provider's engagement in cultural mentorship to facilitate the integration of culture into their practice. Furthermore, factors contributing to local provider retention were examined. Key informant interviews were conducted with 21 healthcare providers living and working in the region long-term. A theory emerged that connected provider retention to community member service utilization and cultural mentorship. Results indicated that providers who are open, willing to learn, good listeners, calm, friendly, respectful, flexible, compassionate, genuine and possess a sense of humor, humility, and ability to refrain from imposing personal values, beliefs and worldviews upon others are a good fit for living and work in rural Alaska. Such qualities facilitate a provider achieving professional and personal satisfaction through building relationships and creating opportunities for cultural mentorship, professional support, and social support. These opportunities enhance the delivery of quality services that are culturally appropriate and well-utilized by community members, which, in turn, increase provider satisfaction and retention. Recommendations are made to healthcare organizations regarding recruitment and retention strategies. Recruitment strategies include careful screening of potential applications for specific qualities and enlisting local community members and students into the healthcare field. Retention strategies include professional support by way of a comprehensive orientation program, clinical supervision, cultural mentorship, and continuing education training opportunities that focus on cultural competency. Recommendations for retention of local providers include professional development incentives and opportunities that qualify local providers for positions typically held by outside providers.
  • TEST Older Theses Not Clearly Affiliated with a Current College 9/25/17

    CHISUM (2017-09)
    TEST Older Theses Not Clearly Affiliated with a Current College 9/25/17
  • Routine outcome monitoring and clinical supervision: do therapists really care about their patients?

    Dexter, Kyle Raymond Kwon; Whipple, Jason; David, Eric John (EJ); Gifford, Valerie; Lardon, Cecile (2017-08)
    Psychotherapy has repeatedly been shown to be an acceptable form of treatment for a variety of psychiatric conditions. However, despite the success of psychotherapy, not all patients improve during a course of treatment. In fact, research has suggested that some patients actually become worse while engaged in psychotherapy. Thus, it becomes important to identify patient deterioration and provide this information back to therapists. Additionally, the ability to detect patient deterioration cannot be solely the result of clinician judgment. Research has shown that utilizing actuarial methods of identifying patient non-responders is superior to that of clinician judgment alone. In turn, the field has moved toward implementing routine outcome monitoring tools/management systems to assist in the process of identifying patients who are failing to respond to treatment. The present study explored potential relationships between routine outcome monitoring, deliberate practice, and routine clinical supervision. Results suggest that the vast majority of practicing therapists do not utilize routine outcome monitoring tools/management systems as part of their daily practices of psychotherapy, and most do not incorporate feedback results into their personal clinical supervision experiences. Additionally, results suggest that therapists who have received formalized training with routine outcome monitoring tools and/or are required to engage in weekly supervision, are more likely to monitor their patient outcome as part of their daily practices of psychotherapy. Moreover, self-assessment bias seems to be present within the sample in regards to identifying patient improvement, non-response, and deterioration. Implications for clinical practice and research are discussed, along with limitations and future directions.
  • Differences in reasons for living between Alaska Native and Euro-American college students

    Simmons, Teisha Marie (2003-05)
    The purpose of this study was to explore the differences in reasons for living between Alaska Native and Euro-American college students, to determine which are important as protective factors against suicide for these two groups. A sample of 106 students at the University of Alaska Fairbanks, matched on age, sex, race, marital status, and recent suicide or suicide attempt by a family member or friend, were surveyed using a demographic instrument, the College Students Reasons for Living Inventory, and the Orthogonal Cultural Identification Scale. Results appear to indicate that Alaska Native college students report more reasons for living than Euro-American students.
  • Dance/movement therapy (DMT) for cancer survivors and caregivers in Fairbanks, Alaska

    Sharma, Dinghy Kristine B.; Lopez, Ellen D. S.; Rivkin, Inna D.; Swift, Joshua K.; Goodill, Sharon W. (2016-08)
    Worldwide, the burden of cancer continues to grow and impact the quality of life of patients, their families, and caregivers. Aside from the physical effects and financial costs of cancer and its treatment, a significant portion of cancer patients and their caregivers experience emotional, social, and psychological distress throughout the trajectory of their illness and extending to long-term survivorship. Despite medical advances in cancer treatment, a cancer diagnosis is still often considered to be synonymous with death, pain, and suffering. It has been established that engaging in the creative arts could promote quality of life (QOL) especially for those suffering from chronic illnesses such as cancer. Specifically, studies on dance/movement therapy (DMT) have indicated its efficacy as a complementary and holistic intervention in providing social support, decreasing fatigue and stress, increasing mobility, and enhancing overall wellbeing of cancer survivors. Results from a pilot DMT study that explored the cultural suitability, feasibility, and benefits of using DMT in the post-treatment QOL of Alaska Native cancer survivors indicated positive impacts on participants' mobility, body awareness, emotional expression, self-care, and wellbeing. Participants from the pilot study highlighted the need for providing DMT in the community and opening the DMT group to both cancer survivors and caregivers. This suggestion was in consideration of the lack of support groups available to both cancer survivors and caregivers that focus on cancer survivorship and promotion of quality of life. Existing locally available cancer support groups emphasize cancer education but are limited in meeting the psycho-social, emotional and physical needs of both cancer survivors and caregivers. The encouraging results and feedback from participants not only supported existing studies on DMT's cross-cultural benefits in promoting QOL among cancer survivors but also provided the rationale for a larger dissertation study for survivors and caregivers in Fairbanks, Alaska. It was in this context that DMT's significance in increased survivorship and QOL among cancer survivors and caregivers in Alaska was examined. The study employed a sequential, mixed methods small-N design in investigating the therapeutic benefits of DMT among cancer survivors and caregivers (N = 16) in a practice-based setting in Fairbanks, Alaska. Adhering to the principles of community-based partnership research (CBPR), the study established a collaborative partnership with the Fairbanks Memorial Hospital as it piloted a 12- week, open DMT group intervention for cancer survivors and caregivers. The study was conducted in two phases: Phase 1: DMT Intervention (12 weeks) and Phase 2: Follow-up and Findings Meeting (3 months after the last offered DMT session), which assessed DMT’s lasting effects on participants. Quantitative and qualitative data were employed to examine DMT’s effects on participant’s mental health functioning, body awareness, subjective QOL, and sense of group cohesiveness and engagement with the DMT group. Quantitative findings indicated significant improvements in participants’ mental health functioning with a moderate effect size after participation in the DMT program. Although no significant pre- to post-change was found on participants’ subjective QOL, cancer survivors reported significantly better QOL (social, emotional and functional wellbeing) at the three-month follow-up, suggesting that DMT can offer late, but possibly lasting, positive changes. Additionally, participants’ ability for selfregulation and use of avoidance as a coping tool for pain were found to increase after their DMT participation. No significant changes were noted in participants’ level of cohesion with the DMT group. However, qualitative findings indicate that participants found that the DMT program was extremely beneficial in promoting their physical, psychological, social and spiritual wellbeing and expressed overall strong positive feelings toward their DMT group. Implications for research and clinic practice were discussed as informed by the study’s strengths and limitations. One the study’s strengths is its adherence to the principles of community-based participatory research (CBPR) as an over-arching framework in guiding all aspects of the research process. By establishing a collaborative partnership between the UAF academic community and the local community hospital (Fairbanks Memorial Hospital), this study was able to build on the community’s strengths and resources in an effort to help promote cancer survivorship for cancer survivors and caregivers. Future recommendations include further strengthening collaborative community partnerships with a larger, DMT confirmatory study using a Randomized Control Trial (RCT) design, while integrating a mixed-methods approach. Implementing these strategies would help establish DMT’s efficacy as a holistic and ecologically valid intervention for cancer survivors and caregivers in Fairbanks, Alaska.
  • Developing a patient-driven, substantive definition of office-based opioid treatment success

    Hewell, Valerie Marie; Gonzalez, Vivian M.; Lopez, Ellen D. S.; Fitterling, James; Rivkin, Inna (2016-08)
    Patients in office-based opioid treatments’ definitions of treatment success and recovery are not well understood. This is important because traditional ways of defining and measuring success focus on consumption, and usually abstinence. This definition does not encompass medication-assisted treatment, such as office-based opioid treatment, which do not necessitate abstinence. Moreover, there is evidence to support the efficacy of office-based opioid treatment in reducing the harm associated with opioid misuse, which is important as opioid misuse has increased and leads to serious consequences for individuals, families, and society. To address this gap in the literature, using a qualitative design, this dissertation explored patients’ ideas on defining office-based opioid treatment success, recovery, facilitators and barriers to treatment success, and recommendations for measuring success. This was achieved by conducting a focus group with seven participants and subsequent interviews with seven participants, two of whom were also in the focus group, for a total of 12 office-based opioid treatment patients in rural Alaska. Grounded theory, directed content analysis, and a community-based participatory research approach were used to collect and analyze focus group and interview data. Findings suggest that patients’ definitions of office-based opioid treatment success extend beyond consumption and include four main themes: functioning, such as contributing to society and living a functional lifestyle; accomplishing, such as reappraising life goals and having an intrinsic belief that one can accomplish success; relationships, such as family, friendships, and restoring relationships; and psychological factors, such as emotional wellbeing and addiction. Recovery was understood as a construct that was related to success, yet distinct, and involved healing and growth, a process, and a recovery attitude. Facilitators and barriers to treatment success include treatment factors, contextual factors, and psychological factors. Participants also recommended measuring success in a way that is individualized and flexible. This study suggests that providers should take a multifaceted and patient-driven approach when attempting to define and measure office-based opioid treatment success. Specifically, findings suggest that patients experience success in office-based opioid treatment in ways that extend beyond substance consumption. Findings also suggest that contextual barriers, such as availability and accessibility of treatment, should be addressed on a systemic level.
  • Therapeutic multi-faceted relationships in rural Alaska

    Hensley, Lara Sue (2003-12)
    In rural Alaska, avoidance of dual relationships is impossible and may be culturally inappropriate; Alaska Native counselors live and work in communities where they are reared, educated, married, had children, and built their homes. These counselors have layers of relationships with relatives, friends and coworkers outside of the therapeutic alliance. In this study I interviewed six Alaska Native rural counselors and three clinical supervisors regarding the nature of their multi-faceted relationships, stressors of these on the counselor and ways of managing these stressors. Counselors stated that the multi-faceted relationships are a part of their daily life. They primarily manage these stressors through self-care techniques ranging from establishing clear boundaries to prayer and mediation to debriefing with a supervisor. Most Euro-American mental health professionals will never know the experience of counseling only their family and friends in the hometown where they were born and raised. However, for those counselors who live and practice in rural America this study should offer encouraging strategies for managing multi-faceted relationships.

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