Racial Dynamics in Counselor Training: The Racial Identity Social Interaction Model

Counselors frequently receive their initial training about the dynamics of race and culture in the counseling process in didactic group settings, such as multicultural courses and experiential skills-building labs. Whereas multicultural and diversity courses reportedly have been growth promoting for students, counselor educators describe several difficulties that arise as they attempt to teach these courses. Yet virtually no research has focused on examination of instructors’ difficulties from a theoretical perspective. To examine the complex, intersecting dynamics that occur when teaching groups of counselor trainees about race and culture, we used Directed Content Analysis with theoretical guidance from the Racial Identity Social Interaction Model. We analyzed interviews obtained from instructors (n = 8) who had led small-group counseling skills labs with a multicultural and social justice perspective. Problematic dynamics occurred in three major domains, group, leader, and institutional dynamics. Implications for teaching about race and culture in group settings are discussed

A realist evaluation of the role of communities of practice in changing healthcare practice

<p>Abstract</p> <p>Background</p> <p>Healthcare organisations seeking to manage knowledge and improve organisational performance are increasingly investing in communities of practice (CoPs). Such investments are being made in the absence of empirical evidence demonstrating the impact of CoPs in improving the delivery of healthcare. A realist evaluation is proposed to address this knowledge gap. Underpinned by the principle that outcomes are determined by the context in which an intervention is implemented, a realist evaluation is well suited to understand the role of CoPs in improving healthcare practice. By applying a realist approach, this study will explore the following questions: What outcomes do CoPs achieve in healthcare? Do these outcomes translate into improved practice in healthcare? What are the contexts and mechanisms by which CoPs improve healthcare?</p> <p>Methods</p> <p>The realist evaluation will be conducted by developing, testing, and refining theories on how, why, and when CoPs improve healthcare practice. When collecting data, context will be defined as the setting in which the CoP operates; mechanisms will be the factors and resources that the community offers to influence a change in behaviour or action; and outcomes will be defined as a change in behaviour or work practice that occurs as a result of accessing resources provided by the CoP.</p> <p>Discussion</p> <p>Realist evaluation is being used increasingly to study social interventions where context plays an important role in determining outcomes. This study further enhances the value of realist evaluations by incorporating a social network analysis component to quantify the structural context associated with CoPs. By identifying key mechanisms and contexts that optimise the effectiveness of CoPs, this study will contribute to creating a framework that will guide future establishment and evaluation of CoPs in healthcare.</p

Elevated protein concentrations in newborn blood and the risks of autism spectrum disorder, and of social impairment, at age 10 years among infants born before the 28th week of gestation

Among the 1 of 10 children who are born preterm annually in the United States, 6% are born before the third trimester. Among children who survive birth before the 28th week of gestation, the risks of autism spectrum disorder (ASD) and non-autistic social impairment are severalfold higher than in the general population. We examined the relationship between top quartile inflammation-related protein concentrations among children born extremely preterm and ASD or, separately, a high score on the Social Responsiveness Scale (SRS total score ≥65) among those who did not meet ASD criteria, using information only from the subset of children whose DAS-II verbal or non-verbal IQ was ≥70, who were assessed for ASD, and who had proteins measured in blood collected on ≥2 days (N = 763). ASD (N = 36) assessed at age 10 years is associated with recurrent top quartile concentrations of inflammation-related proteins during the first post-natal month (e.g., SAA odds ratio (OR); 95% confidence interval (CI): 2.5; 1.2–5.3) and IL-6 (OR; 95% CI: 2.6; 1.03–6.4)). Top quartile concentrations of neurotrophic proteins appear to moderate the increased risk of ASD associated with repeated top quartile concentrations of inflammation-related proteins. High (top quartile) concentrations of SAA are associated with elevated risk of ASD (2.8; 1.2–6.7) when Ang-1 concentrations are below the top quartile, but not when Ang-1 concentrations are high (1.3; 0.3–5.8). Similarly, high concentrations of TNF-α are associated with heightened risk of SRS-defined social impairment (N = 130) (2.0; 1.1–3.8) when ANG-1 concentrations are not high, but not when ANG-1 concentrations are elevated (0.5; 0.1–4.2)

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

4. Toward A Methodology For Measuring And Assessing Racial As Distinguished From Ethnic Identity

In the 1970s, as an offshoot of the civil rights movements of that era, applied psychologists began to grapple with the issues of how to measure racial and ethnic identity. Given the increased emphasis on improving the life circumstances of disenfranchised peoples in the United States, practitioners and applied social and behavioral scientists sought pragmatic strategies for determining how best to intervene in the environments primarily of peoples of color in order to contribute to positive mental health outcomes for them as well as society more inclusively (Sue, 1992). However, as Helms (1990a) noted, the sophistication of theoretical models and formulations used to explain the psychological effects of being socialized in racially oppressed and culturally distinct social groups far out-shipped efforts to develop strategies for assessing the relevant psychological aspects of racism and ethnocentrism. Thus, in her overviews of existing theoretical models that purported to address aspects of racial or ethnic identity, Helms (1990a, 1990b) located 11 models for African Americans, six for White Americans, two for Asian Americans, two for Latino/Hispanic Americans, and four for Native Americans. She also noted that some of the theorists that she reviewed considered that they had developed models of ethnic or cultural identity, whereas others contended that they had developed models of racial identity, although each seemed to be addressing aspects of the same societal dynamics of in-group/out-group oppression. In general, it seemed to be the case that theorists who believed that their own discomfort with race or ethnicity was due to racism and the resulting racial discord developed theories of racial identity, whereas theorists who felt that their societal disempowerment was due to cultural mismatch of some sort developed theories of ethnic identity. However, problems with this language of convenience are that it helped to perpetuate the imprecision in terminology in psychological research when matters of race, ethnicity, or culture are discussed. Furthermore, such imprecise usage makes it difficult to operationally define any of the relevant constructs. Consequently, Helms (1994a, 1994b) recommended that identity models be considered racial models if they describe reactions to societal dynamics of racial oppression (i.e., domination or subjugation based on racial or ethnic physical characteristics commonly assumed to be racial or genetic in nature). She suggested that identity models be considered ethnic models if acquisition or maintenance of cultural characteristics (e.g., language, religious expression) are defining principles

A Remedy for the Black-White Test-Score Disparity [Comment]

Sackett, Schmitt, Ellingson, and Kabin (April 2001) analyzed the effectiveness of strategies for reducing the disparities in average scores on high-stakes tests of cognitive abilities (CATs) of (especially) African or Black and Latino and Latina Americans as compared with White Americans. They argued that decision makers in the domains of education, employment, and licensure and certification are becoming increasingly dependent on test scores as the primary criteria for making high-stakes decisions. Consequently, these two socioracial groups, as well as Native and Asian Americans (with respect to tests of verbal skills), who are already underrepresented in many selective educational institutions and professions, may disappear from them entirely if the disparities in test scores cannot be eliminated or rendered meaningless for making high-stakes decisions involving them. Sackett et al.'s proposed solutions to the problem are to either "dumb down" (i.e., remove cognitive content of) the tests or alter the testing process so that it appears to be fair to Black and Hispanic test takers, even, as if the authors' analysis suggested, it is not. In what seems to be an effort to prove that the test performance disparities between groups reflect actual irremediable cognitive deficiencies of the adversely affected test takers, Sackett et al. (2001) cited DeShon, Smith, Chan, and Schmitt's (1998) "unique study" (Sackett et al., 2001, p. 309) as disproving a "social relations and social context" (p. 309) argument, which they misattributed to me (Helms, 1992). I did not recommend that CAT items be modified to include social content. Most CATs already include such content. Instead, I discussed the absence of empirical evidence that CATs are culturally equivalent for African American test takers and proposed a strategy for quantifying the effects of racial and cultural variables on African, Latino and Latina, Asian, and Native American (ALANA) test takers' CAT scores. DeShon et al. allegedly collected the type of cultural data (e.g., racial identity attitudes) that could be used for trying the strategy but did not analyze it appropriately

Racism and Ethnoviolence as Trauma: Enhancing Professional Training

In trauma theory, research, and practice, post traumatic stress disorder (PTSD), a syndrome of psychobiological reactions to events perceived as cataclysmic or life threatening, often has been the focus of mental health interventions and research. Yet virtually missing from contemporary trauma literature is consideration of racism and ethnoviolence as catalysts for PTSD and related symptoms. The stress inducing effects of obviously life threatening racist or ethnoviolent events may be readily apparent to service providers and researchers although they have not been treated or investigated. However, observers seem not to view other types of racism and ethnoviolence as life-threatening (e.g., vicarious experiences, exposure to microaggressions) because the historical roots of the trauma are invisible. Such events may arouse immediate or delayed PTSD and related symptoms in the experiencing person if the experienced event(s) serves as a catalyst for recalling previous personal memories or identity-group histories of extreme threat. Current PTSD assessment schedules are critiqued for their inappropriateness for assessing stress reactions to racism and ethnoviolence specifically; quantitative scales are criticized because of developers' thoughtless application of traditional psychometric principles of scale development, such as maximizing the magnitude of internal consistency reliability coefficients. We recommend that researchers and practitioners conduct culturally responsive and racially informed assessment and interventions with African Americans, Latina/Latino Americans, Asian/Pacific Islander Americans, Native Americans, and related immigrant groups when they present with symptoms of trauma, particularly when their trauma responses are atypical or the precipitating stressor is ambiguous

Racism and Ethnoviolence as Trauma: Enhancing Professional and Research Training

In trauma theory, research, and practice, post traumatic stress disorder (PTSD), a syndrome of psychobiological reactions to events perceived as cataclysmic or life threatening, often has been the focus of mental health interventions and research. Yet virtually missing from contemporary trauma literature is consideration of racism and ethnoviolence as catalysts for PTSD and related symptoms. The stress inducing effects of obviously life threatening racist or ethnoviolent events may be readily apparent to service providers and researchers although they have not been treated or investigated. However, observers seem not to view other types of racism and ethnoviolence as life-threatening (e.g., vicarious experiences, exposure to microaggressions) because the historical roots of the trauma are invisible. Such events may arouse immediate or delayed PTSD and related symptoms in the experiencing person if the event(s) serves as a catalyst for recalling previous personal memories or identity-group histories of threats to life or psychological integrity. Current PTSD assessment schedules are critiqued for their inappropriateness for assessing stress reactions to racism and ethnoviolence specifically; quantitative scales are criticized because of developers' thoughtless application of traditional psychometric principles of scale development, such as maximizing the magnitude of internal consistency reliability coefficients. We recommend that researchers and practitioners conduct culturally responsive and racially informed assessment and interventions with African Americans, Latina/Latino Americans, Asian/Pacific Islander Americans, Native Americans, and related immigrant groups when they present with symptoms of trauma, particularly when their trauma responses are atypical or the precipitating stressor is ambiguous