A Mixed Methodological Analysis of the Role of Culture and Diagnostic Variance Among Counselors and Counselor Trainees

As the U.S. population continues to diversify, counselors are challenged to respond to the interface of culture and mental health concerns of clients (Gushue, Constantine, & Sciarra, 2008). It is important for counselors when making clinical decisions to reflect on the diverse needs of clients as well as the potential impact of cultural factors on mental health (Sue & Sue, 2008). Accordingly, this study sought to investigate the clinical decision-making process among counselors and counselor trainees and how, if at all, cultural factors influence the case conceptualization of clients. The study also investigated how counselors and counselor trainees collect and process client data when making clinical decisions to include: diagnostic decisions, current level of functioning, and prognosis. The concurrent mixed methods study tests and revises a grounded theory of clinical decision-making and degree of match between counselors, counselor trainees, and clients (Hays, McLeod, & Prosek, 2009; Hays, Prosek, & McLeod, 2010). Participants viewed 1 of 6 mock client videos representing identical symptomology, but differing on cultural variables of race/ethnicity and gender. After viewing the video, participants diagnosed the client and completed an electronic survey packet of both qualitative open-ended survey questions and quantitative survey instruments. Demographic information was collected from participants to determine degree of cultural match with client. Results indicate counselors and counselor trainees arrive at different diagnostic decisions when provided identical clinical data. However, counselors and counselor trainees utilize similar cognitive tools when conceptualizing information from clients. Diagnostic variance was identified to account for differences in diagnoses. Cultural factors such as race/ethnicity and gender are considered within the presenting problem and/or diagnostic decision; but cultural bias also influences the clinical decision-making process. There is a statistically significant relationship between the degree of racial/ethnic match between counselor/counselor trainee and client and the consideration of race/ethnicity in the presenting problem and/or diagnostic decision. However, there was no statistically significant relationship between the degree of gender match between counselor/counselor trainee and client and the consideration of gender in the presenting problem and/or diagnostic decision. Lastly, there were no statistically significant relationships between cultural bias and perceptions of client functioning; although the small sample size limits the quantitative findings of the study. The developing theory of the clinical decision-making process of counselors and counselor trainees is presented. Implications of the theory for counselor educators and future research are discussed

The Relationship Between Counseling Students’ Theoretical Orientation and Treatment Outcomes

A MANCOVA was conducted to determine differences in client treatment outcomes based on counseling students’ theoretical orientations. Results indicated that at a training clinic, clients demonstrated statistically significant improvement and, students’ theoretical orientation did not significantly affect client outcomes. Pedagogical strategies are suggested for counselor educators and supervisors

Effective Remediation in Master’s-Level Counseling Students

Despite evidence that remediation is effective, little is known about counselor educators’ experience with remediation. In this consensual qualitative study, authors interviewed counselor educators (N=11) to better understand remedial practices and identify effective strategies. Findings have implications for the remediation of master’s-level students in counselor education

Acute kidney injury in patients treated with immune checkpoint inhibitors

Background: Immune checkpoint inhibitor-associated acute kidney injury (ICPi-AKI) has emerged as an important toxicity among patients with cancer. Methods: We collected data on 429 patients with ICPi-AKI and 429 control patients who received ICPis contemporaneously but who did not develop ICPi-AKI from 30 sites in 10 countries. Multivariable logistic regression was used to identify predictors of ICPi-AKI and its recovery. A multivariable Cox model was used to estimate the effect of ICPi rechallenge versus no rechallenge on survival following ICPi-AKI. Results: ICPi-AKI occurred at a median of 16 weeks (IQR 8-32) following ICPi initiation. Lower baseline estimated glomerular filtration rate, proton pump inhibitor (PPI) use, and extrarenal immune-related adverse events (irAEs) were each associated with a higher risk of ICPi-AKI. Acute tubulointerstitial nephritis was the most common lesion on kidney biopsy (125/151 biopsied patients [82.7%]). Renal recovery occurred in 276 patients (64.3%) at a median of 7 weeks (IQR 3-10) following ICPi-AKI. Treatment with corticosteroids within 14 days following ICPi-AKI diagnosis was associated with higher odds of renal recovery (adjusted OR 2.64; 95% CI 1.58 to 4.41). Among patients treated with corticosteroids, early initiation of corticosteroids (within 3 days of ICPi-AKI) was associated with a higher odds of renal recovery compared with later initiation (more than 3 days following ICPi-AKI) (adjusted OR 2.09; 95% CI 1.16 to 3.79). Of 121 patients rechallenged, 20 (16.5%) developed recurrent ICPi-AKI. There was no difference in survival among patients rechallenged versus those not rechallenged following ICPi-AKI. Conclusions: Patients who developed ICPi-AKI were more likely to have impaired renal function at baseline, use a PPI, and have extrarenal irAEs. Two-thirds of patients had renal recovery following ICPi-AKI. Treatment with corticosteroids was associated with improved renal recovery

Research of Teaching in Counselor Education: A Collective Effort of Improved Rigor

This special issue in Teaching and Supervision in Counseling offers several perspectives of teaching, pedagogy, and learning theory in counselor education. In this article, the author conceptualizes signature pedagogies: surface, deep, and implicit structures in terms of research questions. Methodological design considerations are discussed to broaden the scope and rigor of research on teaching in counseling. Finally, strategies for improving a favorable review of research manuscripts for publication are provided

The Relationship Between Counseling Students’ Theoretical Orientation and Treatment Outcomes

A MANCOVA was conducted to determine differences in client treatment outcomes based on counseling students’ theoretical orientations. Results indicated that at a training clinic, clients demonstrated statistically significant improvement and, students’ theoretical orientation did not significantly affect client outcomes. Pedagogical strategies are suggested for counselor educators and supervisors