Wellness in the Helping Professions: Historical Overview, Wellness Models, and Current Trends

Introduction Wellness and the concept of holism have rich histories throughout the helping professions. However, Westernized medical models often promote the concept of treatment rather than prevention, limiting the helper’s ability to focus on wellness when working with clients/patients. Therefore, in order to support a re-integration to holistic wellness and the prevention of illness, and re-focus on a wellness ideology, we conducted a thorough theoretical overview of wellness in the helping professions to: (a) provide a historical overview of wellness in helping professions, (b) discuss prominent wellness models, (c) review wellness assessments, (d) present wellness supervision models, and (e) offer implications for helping professionals, helping educators, and helping-professionals-in-training (HPITs) who would like to implement or re-integrate wellness techniques across occupational and personal realms. Discussion The history of healthcare is rich with wellness undertones and holistic foundations for practice. However, the helping professions have been shifting away from traditional wellness ideologies with the emphasis on current healthcare trends and the philosophical struggle of balancing both wellness tenets and a popular medical model for practice. Following a thorough discussion of historical implications of wellness, wellness models, wellness assessments, and wellness supervision, implications for a re-integration of a wellness ideology are highlighted for (a) helping professionals, (b) healthcare educators, and (c) HPITs. In regard to practicing healthcare providers, helping professionals are only as helpful as they are well. We suggest that helping professionals refocus their practice to include wellness and integrate such practices into their daily routine to combat compassion fatigue and/or burnout (which are common occurrences among helpers). Wellness practices may include meditation; breathing exercises; reflection; journaling; and other avenues to reflect, respond, and re-center throughout the day to remain within their own window of tolerance, reducing potential for burnout. Helping professional educators, on the other hand, are tasked with training the next wave of helpers. As such, they are responsible for assessing personal levels of wellness in order to ensure they are modeling wellness-behaviors for their HPITs. Regarding healthcare training programs and curriculums, administrators may introduce wellness courses or infuse wellness throughout the life of the program/training experience so HPITs are learning about wellness education and how to implement it across diverse situations. Furthermore, consistent wellness infusion in curricula could promote wellness behaviors and practices beyond the training experience. Finally, HPITs (similar to practicing professionals and healthcare educators) are not insulated from the effects of unwellness. As such, HPITs are encouraged during their clinical experiences to assess their own wellness and partake in activities to increase their wellness awareness. HPITs can formally (see the section on wellness assessments) or informally assess (refer to the wellness models section) their current levels of functioning and learn of potential wellness discrepancies early on in their careers, which in turn can help mitigate negative effects of being a helper in the future. Conclusion With the influence of Westernized viewpoints and a medical model symptom-reduction focus, a re-orientation to wellness could benefit helpers. Furthermore, as helpers continue to face heavy caseloads, high stress environments, and increased propensity for burnout and related issues, increasing wellness and wellness awareness can serve as a protective factor against the deleterious effects of helping for both helpers and the individuals they serve. By reviewing the literature on wellness (e.g., models, assessments, supervision) in the helping professions and applying wellness perspectives in personal and professional endeavors, helping can once again be at the fore-front of wellness-based treatment, training, and living

Investigating developmental delay in South Africa: A pragmatic approach

Global developmental delay and intellectual disability are common disorders in every population, with a prevalence of 1 - 5%. Although a specific cause is not always immediately identifiable, for many affected people the aetiology is genetic or the result of secondary insult to the developing brain. Investigating children with intellectual developmental disorders (IDD) may be a significant challenge, especially in resource-limited settings. Comprehensive clinical evaluation is the first step and frequently determines the direction of further investigations. Hearing and vision screening and thyroid function tests should be performed in most patients. Children with neurological findings should undergo brain imaging, and careful consideration should be given to potential metabolic disorders in all children with IDD, a number of whom are amenable to treatment. Most children in whom a specific direction is not suggested after history-taking and examination, should be tested for chromosomal abnormalities, ideally with chromosomal microarray, which has a diagnostic detection rate of 8 - 20% in IDD. Additional tests may be indicated in particular settings, including broad-based testing for single-gene disorders, such as next-generation sequencing gene panels or exome analysis. All genetic testing has the potential of finding variants of uncertain significance, particularly when there are limited population data, such as in Africa. Making a specific diagnosis in IDD is of benefit to patients, their families and society. Therefore, a rational approach to investigating this group of patients is essential to maximise the health benefit in a cost-effective way

Modelling Nitrous Oxide Emissions from Grazed Grasslands in New Zealand

Spatial and temporal variability are major difficulties when quantifying annual N2O fluxes at the field scale. New Zealand currently relies on the IPCC default methodology (National Inventory Report, 2004). This methodology is too simplistic and generalised as it ignores all site-specific controls, but is also not sufficiently flexible to allow mitigation options to be assessed. Therefore, a more robust, process-based approach is required to quantify N2O emissions more accurately at the field level. Denitrification-decomposition (DNDC) is a process-based model originally developed (Li et al., 1992) to quantify agricultural nitrous oxide (N2O) emissions across climatic zones, soil types, and management regimes. This has been modified to represent New Zealand grazed grassland systems (Saggar et al., 2004). More recent modifications include measured biomass C and N parameters in perennial pasture and compaction impacts on the soil water dynamics. Further validation tests have been conducted against observed soil moisture and gas fluxes. Here we i) assess the ability of a modified DNDC model NZ-DNDC to simulate N2O emissions; ii) compare the measured, modelled and IPCCestimated N2O emissions from dairy- and sheep-grazed pastures; and iii) give preliminary results for upscaling the model to provide preliminary regional emissions estimates

The osmo-metabolic approach: a novel and tantalizing glucose-sparing strategy in peritoneal dialysis.

Peritoneal dialysis (PD) is a viable but under-prescribed treatment for uremic patients. Concerns about its use include the bio-incompatibility of PD fluids, due to their potential for altering the functional and anatomical integrity of the peritoneal membrane. Many of these effects are thought to be due to the high glucose content of these solutions, with attendant issues of products generated during heat treatment of glucose-containing solutions. Moreover, excessive intraperitoneal absorption of glucose from the dialysate has many potential systemic metabolic effects. This article reviews the efforts to develop alternative PD solutions that obviate some of these side effects, through the replacement of part of their glucose content with other osmolytes which are at least as efficient in removing fluids as glucose, but less impactful on patient metabolism. In particular, we will summarize clinical studies on the use of alternative osmotic ingredients that are commercially available (icodextrin and amino acids) and preclinical studies on alternative solutions under development (taurine, polyglycerol, carnitine and xylitol). In addition to the expected benefit of a glucose-sparing approach, we describe an 'osmo-metabolic' approach in formulating novel PD solutions, in which there is the possibility of exploiting the pharmaco-metabolic properties of some of the osmolytes to attenuate the systemic side effects due to glucose. This approach has the potential to ameliorate pre-existing co-morbidities, including insulin resistance and type-2 diabetes, which have a high prevalence in the dialysis population, including in PD patients

Acute inhibition of MEK suppresses congenital melanocytic nevus syndrome in a murine model driven by activated NRAS and Wnt signaling

Congenital melanocytic nevus (CMN) syndrome is the association of pigmented melanocytic nevi with extra-cutaneous features, classically melanotic cells within the central nervous system, most frequently caused by a mutation of NRAS codon 61. This condition is currently untreatable and carries a significant risk of melanoma within the skin, brain, or leptomeninges. We have previously proposed a key role for Wnt signaling in the formation of melanocytic nevi, suggesting that activated Wnt signaling may be synergistic with activated NRAS in the pathogenesis of CMN syndrome. Some familial pre-disposition suggests a germ-line contribution to CMN syndrome, as does variability of neurological phenotypes in individuals with similar cutaneous phenotypes. Accordingly, we performed exome sequencing of germ-line DNA from patients with CMN to reveal rare or undescribed Wnt-signaling alterations. A murine model harboring activated NRASQ61K and Wnt signaling in melanocytes exhibited striking features of CMN syndrome, in particular neurological involvement. In the first model of treatment for this condition, these congenital, and previously assumed permanent, features were profoundly suppressed by acute post-natal treatment with a MEK inhibitor. These data suggest that activated NRAS and aberrant Wnt signaling conspire to drive CMN syndrome. Post-natal MEK inhibition is a potential candidate therapy for patients with this debilitating condition

Investigating developmental delay in South Africa: A pragmatic approach

Global developmental delay and intellectual disability are common disorders in every population, with a prevalence of 1 - 5%. Although a specific cause is not always immediately identifiable, for many affected people the aetiology is genetic or the result of secondary insult to the developing brain. Investigating children with intellectual developmental disorders (IDD) may be a significant challenge, especially in resource-limited settings. Comprehensive clinical evaluation is the first step and frequently determines the direction of further investigations. Hearing and vision screening and thyroid function tests should be performed in most patients. Children with neurological findings should undergo brain imaging, and careful consideration should be given to potential metabolic disorders in all children with IDD, a number of whom are amenable to treatment. Most children in whom a specific direction is not suggested after history-taking and examination, should be tested for chromosomal abnormalities, ideally with chromosomal microarray, which has a diagnostic detection rate of 8 - 20% in IDD. Additional tests may be indicated in particular settings, including broad-based testing for single-gene disorders, such as next-generation sequencing gene panels or exome analysis. All genetic testing has the potential of finding variants of uncertain significance, particularly when there are limited population data, such as in Africa. Making a specific diagnosis in IDD is of benefit to patients, their families and society. Therefore, a rational approach to investigating this group of patients is essential to maximise the health benefit in a cost-effective way

Clinical Practice: Direct-to-consumer genetic testing: To test or not to test, that is the question

In direct-to-consumer (DTC) genetic testing, laboratory-based genetic services are offered directly to the public without an independent healthcare professional being involved. The committee of the Southern African Society for Human Genetics (SASHG) appeals to the public and clinicians to be cautious when considering and interpreting such testing. It is important to stress that currently, the clinical validity and utility of genetic tests for complex multifactorial disorders such as type 2 diabetes mellitus and cardiovascular diseases is questionable. The majority of such tests are not scientifically validated and are based on a few preliminary studies. Potential consumers should be aware of the implications of genetic testing that could lead to stigmatisation and discrimination by insurance companies or potential employers of themselves and their family members. Guidelines and recommendations for DTC genetic testing in South Africa (SA) are currently lacking. We provide recommendations that seek to protect consumers and healthcare providers in SA from possible exploitation

The Experiences of Counselors-in-Training in a School-based Counseling Practicum

Counselor education programs often must choose between providing in vivo faculty supervision or a community-based setting. Programs that combine both elements have shown positive preliminary findings related to counselor development; however, the in-depth experiences of students in such programs have not been explored. This phenomenological study examined the lived experiences of counselors-in-training who participated in a school-based counseling practicum with in vivo faculty supervision. Researchers identified six themes, including continuum of support within relationships, operational challenges and concerns, needs and challenges of the community, working with children, expectations and realities, and counselor identity development. Implications for counselor education and research are provided