• 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.
    • 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.
    • Healing from within: the wellness team concept

      Burnham, Violet (2006-08)
      This project was created to chronicle one community's effort to stem the tide of alcohol abuse and address issues of trauma that had plagued the community for many years despite services provided by the State. It is the story of a group of people who came together despite differences to form a team of service providers that would begin a journey of healing for themselves and the community. The results are coming slowly, but indicate less drinking, less tolerance for any form of abuse, and a healthier lifestyle. Although the journey has not ended, there are many more indicators showing that the community is taking responsibility for their problems. The team members as well choose a healthier lifestyle maintaining sobriety, eating healthier, and exercising regularly.
    • 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.
    • 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.
    • 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.
    • 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 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.
    • 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.
    • Becoming adults in a rural Yup'ik community: a longitudinal qualitative study exploring resilience

      Ford, Tara J.; Allen, James; Whipple, Jason; David, Eric John; Henry, David; Rasmus, Stacy M. (2013-08)
      The aim of this study is to explore strategies for navigating challenges in a rural Alaskan Yup'ik community among youth and young adults. This qualitative study captures a longitudinal perspective as youth (N=25; 11 -18 years old) were originally interviewed in January 2010. For the current study, participants were re-interviewed in December 2012. Follow-up interviews addressed life challenges over the past three years and resources that helped them with their hard times. To reinforce the multifaceted nature of growing-up in a rural Yup'ik community, scholarly literature along with observations, conversations with local residents, and local wisdom captured in anthropological work are featured throughout this paper. Fifteen youth (14 years old - 20 years old) agreed to be re-interviewed. Developmental changes were noted regarding challenges and protective resources. Youth emphasized challenges as sources of vulnerabilities around lack of employment and interpersonal relationship strain. Similar to findings from the original study, interpersonal relationship distress was discussed in three distinct contexts including antagonist "girl drama," family discord, and partner relations conflicts. Youth identified personal strengths such as re-framing challenges, seeking personal space, and family support to overcome challenges. Contemporary understanding of emergent young adults' role and responsibilities in a rural Yup'ik setting warrants further study as it was found to be a source of vulnerability. Findings can inform clinical and prevention work in the community. For example, targeted community activities can address reported challenges including job fairs and workshops on healthy relationships with specificity to the experience of becoming an adult in rural Alaska.
    • A validity study of the reasons for life scale with emerging adult college students

      Curns, Daniel B.; Gonzalez, Vivian M.; Swift, Joshua K.; Skewes, Monica C.; Ashdown, Brien K. (2014-12)
      This study examined the validity of the Reasons for Life Scale (RFLS) with emerging adult college students. The RFLS measures "reasons for life." It was developed for use with Alaska Native youth as a way to assess potential risk of suicide without directly questioning about suicidal ideation or history of suicide attempts. This study sought to adapt the RFLS for use with emerging adult (age 18-25) college students, and to examine its factor structure and convergent validity with this population. First, a focus group was conducted to assist in rewording two Alaska Native-specific items from the RFLS for non-Natives. Then, with the additional items from the focus group, the revised version of the RFLS (RFLS-R) and other suicide-related measures were administered to a sample of 116 emerging adult college students. Exploratory factor analysis indicated a unidimensional factor structure for the RFLS-R with this sample. The RFLS-R showed a significant and strong correlation with the Reasons for Living Inventory (RLI; r = .70), which, like the RFLS-R, measures reasons for living but makes direct reference to suicide. There also were significant moderate negative correlations with the Suicidal Behavior Questionnaire - Revised (SBQ-R; r = -.36) and the Adult Suicidal Ideation Questionnaire (ASIQ; r = -.29). There was a significant moderate correlation between the RFLSR and a measure of socially desirable responding, the Balanced Inventory of Desirable Responding (BIDR; r = .31), with similar correlations found between the BIDR and other suicide-related measures included in this study. The results suggest that socially desirable responding did not strongly affect participants' responding or explain the associations found among the measures. The high correlation with the RLI suggests that the RFLS-R measures a similar construct, providing evidence of convergent validity; however, the RLI was more highly correlated with measures of suicidality than the RFLS-R -- suggesting that while the RFLS was moderately associated with measures of suicidality, it is a weaker predictor of suicide risk than the RLI. Although the RFLS-R was not as highly correlated with measures of suicidality as the RLI, which directly mentions suicide, the RFLS-R is the only known suicide measure that completely avoids items and instructions that mention suicide, therefore it may be useful in contexts where directly discussing suicide is not acceptable or appropriate.
    • Parental perceptions of play: the influences of parent gender, gender role attitudes, and parenting styles on parent attitudes toward child play

      Horwath-Oliver, Courtney; Campbell, Kendra; Rivkin, Inna; Webster, David; McGee, Jocelyn (2015-08)
      The literature overwhelmingly demonstrates that play supports healthy social, emotional, physical, and cognitive development. Efforts to understand parents' support of child play seek to identify parent attitudes toward play, ways in which parents facilitate play for their children, and how they participate in play. Previous findings indicate parent valuation of play is an important factor for childhood play time and finds differences between mothers and fathers in parent-child play. While much research has been done to understand how mothers and fathers play with their sons and daughters, few studies have investigated what factors influence parent valuation of play or facilitate certain types of play. This study used a moderated mediation model to explore how parental attitudes about gender roles influence perceptions of play through parenting style and how this effect may be different for fathers and mothers. Analyses were also performed to understand the relationships between parent attitudes and parent play behaviors. The findings suggested egalitarian gender role attitudes predicted a higher valuation of play and more permissive mindsets toward cross-gender play for both mothers and fathers. Conversely, traditional gender role attitudes were predictive of less permissive mindsets toward cross-gender play for both mothers and fathers. A moderated mediation was found for fathers with traditional gender role attitudes and a permissive or authoritarian parenting style. Fathers with traditional gender role attitudes and a permissive parenting style were less likely to value play for child development. Fathers with traditional attitudes and an authoritarian parenting style had less permissive mindsets toward cross-gender play. Additionally for both mothers and fathers, authoritative parenting was correlated with increased parent play behaviors, while authoritarian parenting was correlated with decreased parent play behaviors. These findings support previous literature in that parent gender and gender role attitudes do appear to influence parent attitudes toward play. They also contribute to our understanding of parent gender differences and the way that parenting style influence this relationship. In addition, parenting style was found to be a facilitator of parent-child play. These findings contribute to an understanding of what kind of parents value play and can be used to inform family psychotherapy and parent education about play.
    • 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.
    • 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.
    • 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.
    • 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
    • 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.
    • 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.
    • 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.