It takes a village to break up a match: a systemic analysis of formal youth mentoring relationship endings

BACKGROUND Although early closure of formal youth mentoring relationships has recently begun to receive some attention, more information about factors that contribute to premature endings, and how those factors interact, is needed so that empirically-based program practices can be developed and disseminated to prevent such endings and to ensure that youth reap the benefits mentoring can provide. OBJECTIVE This qualitative interview study applies a systemic model of youth mentoring relationships (Keller in J Prim Prev 26:169–188, 2005a) to the study of mentoring relationship endings in community-based mentoring matches to understand why these matches ended. METHOD Mentors, parents/guardians and program staff associated with 36 mentoring matches that had ended were interviewed about their experiences of these relationships and their understanding of why they had ended. Thematic analysis of the interview transcripts and mentoring program case notes for each match followed by systemic modeling of the relationships yielded three major findings. RESULTS A strong mentor–youth relationship is necessary but not sufficient for match longevity. The mentor–youth relationship, even when relatively strong, is unlikely to withstand disruptions in other relationships in the system. Agency contextual factors, such as program practices and policies and staffing patterns, have a critical role to play in sustaining mentoring matches, as they directly influence all of the relationships in the mentoring system. CONCLUSION These findings highlight the importance of considering not just the mentoring dyad but also the parent/guardian and program context when trying to prevent match closures. They also point to several program practices that may support longer mentoring relationships.Accepted manuscrip

Concordance of Illness Representations: The Key to Improving Care of Medically Unexplained Symptoms

How can effective patient-provider relationships be developed when the underlying cause of the health condition is not well understood and becomes a point of controversy between patient and provider? This problem underlies the difficulty in treating medically unexplained symptoms and syndromes (MUS; e.g., fibromyalgia, chronic fatigue syndrome), which primary care providers consider to be among the most difficult conditions to treat.1 This difficulty extends to the patient-provider relationship which is characterized by discord over MUS.1 In this article, we argue that the key to improving the patient provider relationship is for the patient and provider to develop congruent illness perceptions about MUS

Do program practices matter for mentors?: How implementation of empirically supported program practices is associated with youth mentoring relationship quality

This study investigates how the implementation of program-level practices by formal youth mentoring programs is associated with the quality of youth mentoring relationships as contexts for youth development and also examines whether this connection is mediated by the mentor-staff working alliance. Using data from mentors (n = 542) participating in multiple programs (n = 55), multilevel path models examined hypothesized direct and mediated effects. Parallel analyses were conducted with assessments of program practices from staff (n = 219). Greater exposure to program practices was associated with higher ratings of mentoring relationship satisfaction, commitment, and security and lower mentor-youth relationship negativity. The mentor-staff working alliance either partially or fully mediated these associations. Staff-reported practices predicted mentoring relationship satisfaction and commitment without mediation by the working alliance. This study suggests program practices contribute to stronger youth mentoring relationships. The findings also highlight the mentor-staff working alliance in supporting the development of positive mentoring relationships

(Not) Minding the Gap: A Qualitative Interview Study of How Social Class Bias Can Influence Youth Mentoring Relationships.

This study sought to examine how social class bias may be enacted by mentors and mentoring program staff within community-based youth mentoring relationships and how these biases may influence the mentoring relationship. A narrative thematic analysis was conducted with interviews from mentors, mentees\u27 parents/caregivers, and mentoring program staff representing 36 matches participating in a larger, prospective, mixed-methods study examining factors associated with early match closures. Findings indicate that although some mentors were able to partner with the youth and family to effectively navigate challenges related to the family\u27s economic circumstances, other mentors and some mentoring program staff held deficit views of the youth and their family that appeared to be at least partially rooted in negative social class-based assumptions about attitudes and behaviors. Specifically, we observed tendencies on the part of some mentors and program staff toward (a) deficit-based views of families and youth, (b) individual-level attributions for the family\u27s economic circumstances and blaming of caregivers, and (c) perceiving mentors as being underappreciated by the youth\u27s caregiver. These deficit perspectives contributed to the minimization of parent/caregiver voice in the mentoring process and negative interpretations of parent/caregiver and, in some cases, youth attitudes and behaviors

Medically Unexplained Physical Symptoms: Why Counseling Psychologists Should Care About Them

Medically unexplained symptoms and/or syndromes (MUS) affect the health of 20% to 30% of patients seen in primary care. Optimally, treatment for these patients requires an interdisciplinary team consisting of both primary care and mental health providers. We propose that counseling psychologists may develop expertise to improve the care of patients with MUS who are already in their practice, expand the number of patients they help, and enhance the integration of counseling psychology into the broader medical community. Additionally, counseling psychologists’ expertise in culture, attunement to therapeutic processes, and focus on prioritizing patients’ perspectives and quality of life can fill the gap in research on MUS. By focusing on MUS, counseling psychologists can provide unique contributions to health service delivery

HumMod: A Modeling Environment for the Simulation of Integrative Human Physiology

Mathematical models and simulations are important tools in discovering key causal relationships governing physiological processes. Simulations guide and improve outcomes of medical interventions involving complex physiology. We developed HumMod, a Windows-based model of integrative human physiology. HumMod consists of 5000 variables describing cardiovascular, respiratory, renal, neural, endocrine, skeletal muscle, and metabolic physiology. The model is constructed from empirical data obtained from peer-reviewed physiological literature. All model details, including variables, parameters, and quantitative relationships, are described in Extensible Markup Language (XML) files. The executable (HumMod.exe) parses the XML and displays the results of the physiological simulations. The XML description of physiology in HumMod's modeling environment allows investigators to add detailed descriptions of human physiology to test new concepts. Additional or revised XML content is parsed and incorporated into the model. The model accurately predicts both qualitative and quantitative changes in clinical and experimental responses. The model is useful in understanding proposed physiological mechanisms and physiological interactions that are not evident, allowing one to observe higher level emergent properties of the complex physiological systems. HumMod has many uses, for instance, analysis of renal control of blood pressure, central role of the liver in creating and maintaining insulin resistance, and mechanisms causing orthostatic hypotension in astronauts. Users simulate different physiological and pathophysiological situations by interactively altering numerical parameters and viewing time-dependent responses. HumMod provides a modeling environment to understand the complex interactions of integrative physiology. HumMod can be downloaded at http://hummod.or

Iraq and Afghanistan Veterans report symptoms consistent with chronic multisymptom illness one year after deployment

Many Veterans returning from service in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) experience chronic pain. What is not known is whether for some OIF/OEF Veterans this pain is part of a larger condition of diffuse multisystem symptoms consistent with chronic multisymptom illness (CMI). We use data from a prospective longitudinal study of OIF/OEF Veterans to determine the frequency of CMI. We found that 1 yr after deployment, 49.5% of OIF/OEF Veterans met criteria for mild to moderate CMI and 10.8% met criteria for severe CMI. Over 90% of Veterans with chronic pain met criteria for CMI. CMI was not completely accounted for either by posttraumatic stress disorder or by predeployment levels of physical symptoms. Veterans with symptoms consistent with CMI reported significantly worse physical health function than Veterans who did not report symptoms consistent with CMI. This study suggests that the presence of CMI should be considered in the evaluation of OIF/OEF Veterans. Further, it suggests that the pain management for these Veterans may need to be tailored to take CMI into consideration

High healthcare utilization near the onset of medically unexplained symptoms

Objective: Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) soldiers to understand the relationship of increasing physical symptom burden to healthcare utilization. Methods: Data was examined from a prospective study of OEF/OIF soldiers assessed before and one year after deployment (n = 336). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA). Results: Increases in physical symptom burden predicted greater healthcare utilization one year after deployment: primary care practitioner (slope = − 0.26, F = 4.07, p = 0.04), specialist (slope = − 0.43, F = 8.67, p = 0.003), allied health therapy (e.g., physical therapy) (slope = − 0.41, F = 5.71, p = 0.02) and mental health (slope = − 0.32, F = 4.04, p = 0.05). There were no significant difference in utilization between those with consistently high levels and those with increases in physical symptom burden. Conclusion: This is the first prospective study to examine, and show, a relationship between onset of clinically significant physical symptoms and greater healthcare utilization. Our data suggest that patients with increasing physical symptom burden have the same level of healthcare as patients with chronic physical symptom burden. Needed next steps are to better understand the quality of care at inception and determine how to intervene so that recommended approaches to care are provided from the onset

High Healthcare Utilization at the Onset of Medically Unexplained Symptoms

Objective: Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans to understand the relationship of increasing physical symptom burden to healthcare utilization. Methods: Data was examined from a prospective study of OEF/OIF veterans assessed before and one year after deployment (n=335). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA). Results: Increases in physical symptom burden predicted greater healthcare utilization one year after deployment: primary care practitioner (slope = -0.26, F=4.07, p=0.04), specialist (slope = -.43, t=8.67, p=0.003), allied health therapy (e.g., physical therapy) (slope = -.41, t=5.71, p=0.02) and mental health (slope = -.32, F=4.04, p=0.05). There were no significant difference in utilization between those with consistently high levels and those with increases in physical symptom burden. Conclusion: This is the first prospective study to examine, and show, a relationship between onset of clinically significant physical symptoms and greater healthcare utilization. Our data suggest that patients with increasing physical symptom burden have the same level of healthcare as patients with chronic physical symptom burden. Needed next steps are to better understand the quality of care at inception and determine how to intervene so that recommended approaches to care are provided from the onset