A Pandemic’s Potential to Haunt: A Longitudinal Look at the Professional Wellbeing of TN’s Infant and Early Childhood Mental Health (IECMH) Workforce

Infant and Early Childhood Mental Health (IECMH) providers engage in uniquely relational work with high-risk families that expose them to the full advantages (i.e., compassion satisfaction [CS]) and disadvantages (e.g., burn-out [BO]) of a helper role. Though the pandemic seemed poised to escalate disadvantage, most early pandemic studies found high CS alongside elevated BO. Unfortunately, as COVID-19 has continued, CS has declined while BO has increased. Given the delayed COVID-19 impact on children, these changes may be particularly acute for IECMH providers. Using a longitudinal cohort of 27 IECMH providers, this study aimed to describe and quantify changes in professional wellbeing and contributing factors over a 12-month period (T1 – T12) from early to mid-pandemic. Little changed from T1 to T12 for IECMH provider CS (M = 41.33 vs. M = 41.08) or BO (M = 22.22 vs. M = 22.65) scores. Variables known to contribute to CS similarly held when T1 was compared to T12, but they fluctuated considerably and non-linearly between these time points. Variable relationships with CS also changed over time necessitating an adjusted hierarchal regression model. This model accounted for 20% of variance in T12 CS. Pandemic experiences like loss are reported; needs/supports are summarized using content analysis. Results underscore the importance of cohort, multi-time point design and the need for non-linear analysis to contextualize the interplay of shared and individual experiences within COVID-19. Implications for maintaining IECMH professional wellbeing moving forward and improving the health of other fields are discussed

Intrinsic and Extrinsic Factors of Illicit Prescription Drug Use: Where You Spend Your College Years Matters

With college students\u27 rates of illicit prescription drug use higher than any other groups, it is imperative that factors associated with use be explored. The current study aims to expand and integrate a currently disjointed literature that is predominately focused on individual characteristics. Social development model and social control theory are discussed throughout as theoretical support. A national sample of 454 college students took an anonymous web-based survey assessing intrinsic and extrinsic factors. Intrinsic factors were perceptions of harm, gender, stress and depressive symptoms. Extrinsic factors were type of institution, living situation, sense of school community and peer norms. Those attending private institutions or living on-campus used illicit prescription drugs significantly less and those living on-campus also had higher perceptions of harm. Multiple regression analyses and Sobel tests showed perceived peer norms fully mediated the relationship between type of institution and use, living situation and use, and living situation and perceptions of harm. Implications for these and other findings for prevention and future research in the area of illicit prescription drug use in college populations are discussed

In the Wake of a Veto: What Do Oregon Psychologists Think and Know about Prescription Privileges for Psychologists?

Clinical psychology continues to grapple with a contentious debate surrounding prescriptive authority. With over half of all states having considered legislating prescriptive authority, an immense amount of time and money has been invested. This study aims to assess knowledge and attitudes of licensed psychologists in Oregon following a veto that prevented it from becoming the third state with prescription privileges for psychologists. From a list of 1,318 licensed Oregon clinical psychologists, 60% were randomly selected to participate. Of the 130 participants invited thus far, 83 have completed the survey, yielding a respectable response rate (64%). Perceived familiarity with current training models revealed lacking awareness with 75.2% and 72% expressing they were not familiar with the DOD and APA models, respectively. Only 5% knew which three states/territories currently have prescriptive authority and 77% were unfamiliar with any of the three prerequisites for postdoctoral training in psychopharmacology. Arguments in favor of prescription privileges garnering the most support related to perceptions of improved access and treatment enhancement. In contrast, the strongest arguments against prescription privileges involved professional issues (e.g., altered identity). Reflecting division, 43.9% were in favor, 20.7% were undecided, and 36% were in opposition to broadening privileges for psychologists. However, only 15.9% expressed interest in completing training and only 7.2% plan to pursue training and become a prescriber. Overall, these findings suggest legislative efforts should be mindful of the controversy within the field and the low numbers of professionals interested in pursuing prescription privileges, which undercut arguments for improved access and care

Internal and External Factors Associated with Illicit Prescription Drug Use in College Students

With data suggesting emerging adulthood is a time of increased risk for illicit prescription drug use, it is essential that factors contributing to this be understood to guide prevention efforts. Internal factors (stress, GPA, gender) and external factors (type of institution, living situation) were assessed in tandem with perceptions of harm and illicit prescription drug use. In accordance with nationwide research (SAMSHA, 2006), 14% of our sample of Oregon college students reported illicitly using prescription drugs. While rates of use did not vary by gender, females held higher perceptions of harm. Perceived harm was high for our sample and inversely correlated with use. Those living on campus reported higher perceptions of harm and less use than those living off campus. Those attending private academic institutions reported higher perceptions of harm and less use than those attending public institutions. Previous studies suggest a heightened sense of community within schools, comparatively present within private institutions, can reduce drug use (Battistich, & Hom, 1997). Stress was positively correlated with use and GPA was negatively correlated with use. While numerous studies have examined various correlates of prescription drug use, few have sampled beyond a single institution, most within public universities. Thus, the inclusion of private institutions offers unique and a more holistic insight. As drug use continues to increase in college populations even with prevention programs in place, it is imperative to translate these findings into prevention targeting both genders, at times of stress, particularly those living off campus, at public universities, with lower GPAs

Data-Driven Change in Oregon Psychologists’ Knowledge and Attitudes about Prescriptive Authority

With over half of all states having considered legislating prescriptive authority, an immense amount of time and money has been invested. The literature is limited in terms of understanding if opinions toward prescriptive authority are grounded in knowledge and what implications that has for altering these opinions. Following a veto of a prescriptive authority bill in Oregon, 160 licensed Oregon clinical psychologists were surveyed regarding their attitudes and knowledge. In terms of knowledge, only 5.6% knew which three states/territories currently have prescriptive authority and 70.4% were unfamiliar with any of the prerequisites for postdoctoral training in psychopharmacology. Reflecting division, 42.8% were in favor, 20.1% were undecided, and 37.1% were in opposition to broadening privileges for psychologists. Further, only 15.1% expressed interest in pursuing training or 6.4% in becoming a prescriber. Data on access, training, and legislative costs were presented to participants in the education condition. These participants showed significant gains in their knowledge across all domains and their opinions shifted only in these specific areas leaving their general stance on the issue unchanged. In contrast to ardent supporters who argue that their “data should provide reassurance to psychologists spearheading legislative initiatives” because of high approval ratings (Sammons et al., 2000, p. 608), our data suggest disagreement amongst a group of professionals who are not particularly well-informed, nor interested in becoming prescribers. Future work should investigate whether expanding the data relevant to other facets of the argument contributes to further targeted change or an overall change in opinion toward prescriptive authority

Oregon Psychologists on Prescriptive Authority: Divided Views and Little Knowledge

With over half of all states having considered legislating prescriptive authority, an immense amount of time and money has been invested. The literature is limited in terms of understanding if opinions toward prescriptive authority are grounded in knowledge and what implications that has for altering these opinions. Following a veto of a prescriptive authority bill in Oregon, 399 licensed Oregon clinical psychologists were surveyed regarding their attitudes and knowledge. In terms of knowledge, only 6.5% knew which three states/territories currently have prescriptive authority and 70.4% were unfamiliar with any of the prerequisites for postdoctoral training in psychopharmacology. Reflecting division, 43.4% were in favor, 25.4% were undecided, and 31.2% were in opposition to broadening privileges for psychologists. Further, only 15.2% expressed interest in pursuing training or 6.7% in becoming prescribers. Data on access, training, and legislative costs were presented to participants in the education condition. These participants showed significant gains in their knowledge across all domains and their opinions shifted only in these specific areas leaving their general stance on the issue unchanged. In contrast to ardent supporters who argue that their “data should provide reassurance to psychologists spearheading legislative initiatives” because of high approval ratings (Sammons et al., 2000, p. 608), our data suggest disagreement amongst a group of professionals who are not particularly well-informed, nor interested in becoming prescribers. Future work should investigate whether expanding the data relevant to other facets of the argument contributes to further targeted change or an overall change in opinion toward prescriptive authority

Pocket Ace: Neglect of Child Sexual Abuse Survivors in the ACE Study Questionnaire

Twenty years ago, a seminal study on adverse childhood experiences (ACEs) and subsequent increased health risks catapulted ACEs into the zeitgeist of research and application. Though a validated construct, the questionnaire, particularly the child sexual abuse (CSA) item is not without limitation and yet is used by the Centers for Disease Control and state agencies to quantify need and allocate resources to services accordingly. Currently, CSA is counted only when the perpetrator is 5-years or older than the victim. This requirement makes neglect of sibling and peer assault very likely. Accordingly, this study aimed to assess whether individuals with CSA experiences within an age gap smaller than 5 years are missed by the 5-year modifier embedded in CSA assessment wording and whether this missed group would otherwise qualify for services if detected. The study also aimed to assess whether this missed group has equivalently poor health outcomes to CSA groups currently captured by the 5-year modifier and whether outcomes for all CSA groups were higher than those who did not have a CSA history. An international sample of 974 women aged 18 to 50 completed an online survey hosted by Reddit regarding their substance use, multiple domains of current health, and CSA history using the original ACEs questionnaire and an experimental version of the CSA item without the 5-year modifier. All statistical analyses were completed in R. Results indicated there was a group of survivors with CSA experiences missed by the 5-year modifier and this had implications for reducing their total ACE scores. This group was nearly equal in size to CSA groups captured by the 5-year modifier and demonstrated equivalently poor health and substance use outcomes. On nearly all variables, CSA groups demonstrated poorer health outcomes than those who had never experienced CSA. These findings suggest the language of how CSA is assessed must be thoughtfully revised to include all CSA experiences as all are equally at risk for adverse outcomes and thus all warrant consideration for services currently afforded those with CSA histories and high ACE scores

Pocket ACE: Child sexual abuse survivors missed by the ACEs Study Questionnaire

Background: A 1998 seminal study catapulted adverse childhood experiences (ACEs) into the zeitgeist and shaped assessment of these experiences and long-term health consequences via The ACEs Study Questionnaire (ACE-SQ). However, the ACE-SQ\u27s childhood sexual abuse (CSA) item requires the perpetrator have been 5-years or older than the survivor for endorsement. This may not adequately capture CSA and limit the questionnaire\u27s ability to detect survivors. Objective: This study assessed whether CSA survivors were missed by this 5-year modifier, whether service access was restricted, and whether those missed were at elevated risk for adverse outcomes. Participants and setting: A sample of 974 women (M age = 30.46) completed an online survey. Methods: Histories of CSA were assessed using the original ACE-SQ and an alternative version without the 5-year modifier. Participants were grouped by endorsement (Modifier, No Modifier, No CSA) and compared across numerous physical and mental health outcomes using MANOVA, ANOVA, and logistic regression. Results: Numerous CSA survivors are presently missed by the 5-year modifier (n = 118 of N = 249). This group demonstrated the same elevated depression (t = 3.44, p = .002, d = 0.34), heightened somatic symptom burden (t = 3.34, p = .003, d = 0.35), and poorer subjective health (t = -2.86, p = .012, d = 0.27) as those captured by the modifier. Conclusions: Recommendations for research, practice, and policy include removing the 5-year modifier from CSA assessment, creating an empirically informed CSA definition, and eliminating or adjusting requisite cut-scores for accessing services