A Mixed Methods Approach to Using Collaborative and Proactive Solutions with Students with Emotional and Behavioral Disorders while Applying the Self-Determination Theory

Students with emotional and behavioral disorders (EBD) that lack social skills and problem solving have stronger features of depression, higher drop-out rates and struggle with peer relations. With such an emphasis on academics in high school, students still need strategies taught to compensate for skill deficits in problem solving, relationship- building and choice making. This pragmatic mixed methods study used pre-and post-assessment data from the self-determination theory and examined the implementation of collaborative and proactive solutions through focus groups of teachers and mental health practitioners that work with students with EBD in a special education high school. While quantitative data was not significant, focus group findings specified changes in restructuring the current schedule, trust, time, buy-in and predominantly leadership implications. Recommendations for future studies include additional data sets to be included in the study; choosing elementary or middle school student populations; and applying a leadership frameworks at the onset of implementing collaborative and proactive solutions. Limitations of this study consisted of a small sample size and typical limitations of a focus group. This study adds to current gaps in high-school students with EBD, self-determination, and collaborative and proactive solutions

Eye quietness and quiet eye in expert and novice golf performance: an electrooculographic analysis

Quiet eye (QE) is the final ocular fixation on the target of an action (e.g., the ball in golf putting). Camerabased eye-tracking studies have consistently found longer QE durations in experts than novices; however, mechanisms underlying QE are not known. To offer a new perspective we examined the feasibility of measuring the QE using electrooculography (EOG) and developed an index to assess ocular activity across time: eye quietness (EQ). Ten expert and ten novice golfers putted 60 balls to a 2.4 m distant hole. Horizontal EOG (2ms resolution) was recorded from two electrodes placed on the outer sides of the eyes. QE duration was measured using a EOG voltage threshold and comprised the sum of the pre-movement and post-movement initiation components. EQ was computed as the standard deviation of the EOG in 0.5 s bins from –4 to +2 s, relative to backswing initiation: lower values indicate less movement of the eyes, hence greater quietness. Finally, we measured club-ball address and swing durations. T-tests showed that total QE did not differ between groups (p = .31); however, experts had marginally shorter pre-movement QE (p = .08) and longer post-movement QE (p < .001) than novices. A group × time ANOVA revealed that experts had less EQ before backswing initiation and greater EQ after backswing initiation (p = .002). QE durations were inversely correlated with EQ from –1.5 to 1 s (rs = –.48 - –.90, ps = .03 - .001). Experts had longer swing durations than novices (p = .01) and, importantly, swing durations correlated positively with post-movement QE (r = .52, p = .02) and negatively with EQ from 0.5 to 1s (r = –.63, p = .003). This study demonstrates the feasibility of measuring ocular activity using EOG and validates EQ as an index of ocular activity. Its findings challenge the dominant perspective on QE and provide new evidence that expert-novice differences in ocular activity may reflect differences in the kinematics of how experts and novices execute skills

Does quantitative research in child maltreatment tell the whole story? The need for mixed-methods approaches to explore the effects of maltreatment in infancy

Background and Aims. Research on child maltreatment has largely overlooked the under-five age group and focuses primarily on quantitative measurement. This mixed-methods study of maltreated children (N = 92) entering care (age 6–60 months) combines a quantitative focus on the associations between care journey characteristics and mental health outcomes with a qualitative exploration of maltreatment in four different families. Methods. Care journey data was obtained from social care records; mental health and attachment assessments were carried out following entry to care; qualitative data comprised semistructured interviews with professionals, foster carers, and parents. Results. Significant associations were found between suspected sexual abuse and increased DAI inhibited attachment symptoms (p = 0.001) and between reported domestic violence and decreased DAI inhibited (p = 0.016) and disinhibited (p = 0.004) attachment symptoms. Qualitative results: two themes demonstrate the complexity of assessing maltreatment: (1) overlapping maltreatment factors occur in most cases and (2) maltreatment effects may be particularly challenging to isolate. Conclusions. Qualitative exploration has underscored the complexity of assessing maltreatment, indicating why expected associations were not found in this study and posing questions for the quantitative measurement of maltreatment in general. We therefore suggest a new categorisation of maltreatment and call for the complimentary research lenses of further mixed-methods approaches

Increasing Staff Knowledge and Screening Practices for Adverse Childhood Experiences in Primary Care

Adverse childhood experiences (ACE) are important to future health outcomes. Many health care providers lack the knowledge or training to assess for ACE. Purpose. The purpose of this quality improvement project is to increase the identification of ACE among adult clients in a primary care clinic in Saint John New Brunswick Canada, through the delivery of an education session for the health care team members and patient screening for ACE. Methods. Staff at one clinic attended an educational program about ACE. Staff completed a pre and post education survey questionnaire (N = 8). Additionally, clinic patients (N= 32) were screened for childhood trauma using the ACE questionnaire. Post-screening surveys were completed by the clinicians who screened for ACE. Results. Most staff (85.7%) reported inadequate training/knowledge of ACE pre-education session; improvement in knowledge/understanding of ACE post session; and better prepared to discuss/screen patients for ACE. Nearly all of the 32 clinic patients reported a positive ACE score, and 62.7% had a score of four or more. Time to screen was not reported as a barrier by clinicians, and 10.0% of patients who screened positive were referred for counselling or booked a follow-up appointment. Conclusion. Health care providers lack education/training on ACE and patients are not regularly screened for ACE. To do this effectively, a trauma informed care approach must be used. A history of ACE in the patient sample was found to be high, yet previously unknown to the clinicians. This information has implications for primary care practice, community programming and policy development

Mental health nurses’ attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder:systematic, integrative literature review

Aims and objectives To establish whether mental health nurses responses to people with borderline personality disorder are problematic and, if so, to inform solutions to support change. Background There is some evidence that people diagnosed with borderline personality disorder are unpopular among mental health nurses who respond to them in ways which could be counter-therapeutic. Interventions to improve nurses’ attitudes have had limited success. Design Systematic, integrative literature review. Methods Computerised databases were searched from inception to April 2015 for papers describing primary research focused on mental health nurses’ attitudes, behaviour, experience, and knowledge regarding adults diagnosed with borderline personality disorder. Analysis of qualitative studies employed metasynthesis; analysis of quantitative studies was informed by the theory of planned behaviour. Results Forty studies were included. Only one used direct observation of clinical practice. Nurses’ knowledge and experiences vary widely. They find the group very challenging to work with, report having many training needs, and, objectively, their attitudes are poorer than other professionals’ and poorer than towards other diagnostic groups. Nurses say they need a coherent therapeutic framework to guide their practice, and their experience of caregiving seems improved where this exists. Conclusions Mental health nurses’ responses to people with borderline personality disorder are sometimes counter-therapeutic. As interventions to change them have had limited success there is a need for fresh thinking. Observational research to better understand the link between attitudes and clinical practice is required. Evidence-based education about borderline personality disorder is necessary, but developing nurses to lead in the design, implementation and teaching of coherent therapeutic frameworks may have greater benefits. Relevance to clinical practice There should be greater focus on development and implementation of a team-wide approach, with nurses as equal partners, when working with patients with borderline personality disorder

Perceptions and Outcomes of Occupational Therapy Students Participating in Community Engaged Learning: A Mixed-Methods Approach

Today’s health care system requires therapists to acquire a level of confidence, flexibility, and personal growth that enables them to treat a diverse and complex clientele. Occupational therapy programs need to ensure that clinical placements can best prepare students for these demands. Community engaged learning (CEL) offers a distinctive opportunity both to meet the curricular requirements of fieldwork and to afford students the chance to develop unique sets of skills. The purpose of this mixed-methods study was to examine the experiences of graduate occupational therapy students participating in CEL fieldwork placements. The study explored the students’ self-efficacy before and after placements and the transformative learning process that occurred. Data were collected from semi-structured interviews, pre/post surveys, and reflective journals. The findings resulted in eight major themes that revealed growth in self-efficacy and personal and professional development. The results indicated the influential impression CEL leaves on the development of the student and provides a potential solution for programs to meet the demands of the current health care climate