Dads and Dyads: stress and coping when a child has Retinoblastoma

Child psychosocial oncology research offers limited examination of fathers’ and dyadic stress and coping. Retinoblastoma (Rb) is a rare genetic eye cancer occurring at birth or early childhood. This qualitative sociological study examines individual and dyadic stress and coping across 4 fatherhood role categories when their child is diagnosed/treated for Retinoblastoma. Using purposive sampling, 23 Canadian Rb couples and 7 unmatched parents completed individual in-depth, semi-structured interviews. Findings confirm fatherhood role identity is diverse, influenced by the current situation, elements of discourse, and cultural references. Often contested in public and private spheres, fathering roles show transitional or permanent change tied to circumstance and dyadic support. In a stress process model, fathers primarily relied on problem-oriented and instrumental coping. Partners were the primary mediator of stress for all fathers, providing extensive emotional and informational supports. Using a systemic-transactional model of coping, most study dyads used positive coping strategies and were often supported by the extended clinical team and Social Worker. These dyads showed symmetrical coping that enhanced short and long term well-being. A life course perspective emerges for individuals with heritable Rb. Mothers focused on their child’s future health risk and Rb transmission to future generations. Fathers focused on possible socioeconomic disadvantage for their child. A disease-treatment matrix impacts the life course experience. Heritable Rb is referred to the single tertiary treatment centre in Canada. Regular travel from home and the absence of common social supports increases individual and dyadic stress for many affected parents. Implications for clinical practice include the importance of face-to-face meetings with clinicians as a primary parent coping strategy. Fathers should be actively encouraged to attend Rb appointments with their partner and child whenever possible. Those that did so enhanced both individual coping and positive dyadic coping outcomes. After clinician information, parents preferred brief, plain language pamphlets and brochures for take-away information. These were commonly lacking and internet resources were the default information source for parents. Some Rb parents gain substantial informal informational and social support from peer parents. Social media is the emerging channel among younger parents for that informal peer support

Integrating Interpersonal Neurobiology in Healthcare Leadership and Organizations

Interpersonal Neurobiology (IPNB) is an interdisciplinary, science-based field that seeks to understand human reality including the nature of mind, brain, and relationships. IPNB has been used extensively by mental health practitioners as well as child development and parenting experts. While practitioners and scholars have described ways that IPNB can be used in leadership and organizations, there has been no systematic inquiry into the practical and phenomenological experience of this application. IPNB offers an alternative to dominant models of care and leading in healthcare settings and fields, which are characterized by disconnection, objectification, and separation. It offers a relationally centered approach that honors people’s subjective experience and seeks to advance whole-person and whole-system wellness through the promotion of integration. As a living and dynamic systems approach, IPNB has the potential to influence the quality of leaders’ presence, perception, and practice while upholding the interconnectedness within and between the functional elements of organizational structures and processes. This narrative inquiry sought to explore how leader and leader consultants approach their work from an IPNB perspective. It centers around two research questions: How, if at all, have healthcare leaders integrated IPNB in their leadership practices, and what impact has this integration had on their development and identity? Secondly, what, if any, implications might their experiences hold for leadership in health and mental health organizations? Using the Listening Guide (LG; Gilligan, Spencer, et al., 2006) methodology this inquiry explores the experiences of twelve leaders and leadership consultants in order to understand the implications IPNB has had for their practices, development, and identity. It takes a broad and deeply phenomenological dive into each person’s IPNB leadership experience across time, space, and place to understand the implications this framework has had for leading and organizations. This inquiry identifies what themes and IPNB principles have been significant to the participants, the counterpoints that have propelled their development forward, and the multiple and relationally positioned identities that signify leader’s relational embeddedness in the organizations and systems they serve. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu)

Benefits of Nonpharmacological and Pharmacological Treatments in Autistic Children

Autism is a disorder that affects one in 59 children in the United States. The spectrum disorder affects individuals in early childhood and daily functioning. They may display limited spontaneous language and play and have difficulty in processing social messages. The literature review examines the benefits of non-pharmacological and pharmacological interventions in children with autism spectrum disorder (ASD). The proposed study will be guided by the phenomenology theory. Based on this theory, semi-structured interviews will focus on caregiver’s perceptions of their children’s reactions, needs, and care in healthcare settings. The literature review reveals how certain interventions and treatments have helped this population

Surviving to thrive in complexity: a mixed method evaluation of military rehabilitation post lower limb amputation

This cohort of combat casualties from Iraq and Afghanistan should not have survived; but they did. Their survival should now be defined by their disability; yet it is not. Using a mixed method research approach underpinned by complexity science and social theory, this study critically examines military rehabilitation post lower limb amputation and key components required to manage their complex needs. Structured around an adapted MRC evaluation framework for complex interventions, perspectives of clinicians, clinical managers and veterans have been captured and verified using the Nominal Group Technique, interviews, and veteran outcome data (ADVANCE). Clinicians and clinical managers cite the importance of a highly collaborative interdisciplinary team approach where a culture of innovation, creativity, trust, and interdependence is nurtured by leaders. Conversely, the multidisciplinary team structure led to feelings of distrust, inadequacy, isolation, and disempowerment to adapt their circumstance. Veterans highlight the prosthetic limb as a powerful symbol of autonomy and group membership; social bonds with peers, family and trusted clinicians, and the intensive goal centred, functionally based, rehabilitation process are also prized. These components support veterans to acquire the skills needed to feel connected with others and act autonomously – verified in the literature as extrinsic enablers of human thriving. The ADVANCE cohort presented with a high severity of injury, yet remarkably no psychological or social decline when compared to uninjured controls. However, psychosocial outcomes did not depend on prosthetic mobility as previous research has shown. Therefore, both qualitative and quantitative data, point to a social dynamic supporting clinicians and patients to achieve their intrinsic motivational needs – to feel connected, competent, autonomous, and thereby, to thrive. Rehabilitation programmes planned around the proposed model of human thriving should promote high levels of social, psychological, and physical recovery. Future research is suggested on factors impeding thriving, mental health, socket comfort and medication.Open Acces

Evaluation of the Veteran Resilience Project

Posttraumatic Stress Disorder (PTSD) is a daunting concern among the majority of organizations with diverse, or tangential, affiliations to the United States Military and/or its personnel. Unquestionably, the 21 million service-connected individuals, at the time of this writing, (i.e., Active-Duty, Reserve, National Guard, and Veterans) afflicted with this disorder are the catalyst for the intense public and private sector interest and involvement in eradication of this disorder. Prevalence rates of PTSD among this complex classification of persons vary across the relevant literature. Some estimates suggest anywhere from 11 to 20 percent, while other sources indicate that upwards of 40 percent of some military service-connected populations (i.e., those who served in Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], and Operation New Dawn as well as less publicized military actions which have taken place within the same timeframe) demonstrate PTSD or other related mental health disorders. Given the high PTSD prevalence demonstrated among service-connected populations, effective, practical, and accessible treatment of PTSD among this contingent is a primary and salient area of exploration both clinically and empirically. Relevant to this, the Veteran Resilience Project (VRP) of Minnesota utilizes Eye Movement Desensitization and Reprocessing (EMDR) as an intervention to treat veterans with PTSD. Thus, the organization contracted this program evaluator to undertake a program evaluation of their nonprofit organization. The association utilizes Eye Movement Desensitization and Reprocessing (EMDR) as a therapeutic intervention due to their belief that it is the most efficacious treatment for PTSD. Along with the comprehensive evaluation of their program and the establishment of proof of efficacy for their interventions of choice, EMDR, the VRP seeks to increase their capacity through the recruitment of military service-connected clients and retention of treating therapists. Therefore, the achievement of these objects occurs through an implementation program evaluation dissertation, based on both qualitative (i.e., using survey and interview methodologies) and quantitative data (i.e., analyzing accessible collected data from a sample of service-connected clients who had previously utilized services at the VRP). As a part of the program evaluation, the data were used to inform specific recommendations thus refining ameliorative procedures. This dissertation is available in open access at AURA, http://aura.antioch.edu/ and Ohio Link ETD Center, https://etd.ohiolink.edu/etd