5 research outputs found
The primary prevention of sexual violence against adolescents in Racine County and the Community Readiness Model
Sexual violence affects tens of thousands of people annually in the United States. The majority of sexual assault victims are under the age of 18. Victims of sexual violence often experience severe, long-lasting ramifications, including post-traumatic stress disorder, depression, anxiety, interpersonal problems, suicidal ideation, self-harm behaviors, and eating disorders. As a result of these effects, it is imperative that communities provide effective primary prevention of sexual violence programs. However, it is challenging to effectively implement sexual violence primary prevention strategies for a variety of reasons. One challenge is because it is difficult to construct a prevention program that changes the social norms and cultural beliefs that both contribute to sexual violence and are reinforced on a daily basis through society\u27s social structures and media influences. A second, and related, challenge is the difficulty of implementing effective prevention strategies that specifically address the cultural norms and belief systems of a particular community. These challenges are addressed in this study through the Community Readiness Model (CRM). The CRM is a qualitative model of community assessment used to match a prevention strategy to the social norms and culture of a specific community. The CRM assesses a community along six Dimensions and nine Stages of Readiness. This study was completed in rural and urban Racine County, Wisconsin. Results indicated that both the rural and urban Racine County communities were at the Vague Awareness stage of readiness to implement primary prevention strategies to reduce the incidence of sexual violence against adolescents. Implications of the study are provided including possible primary prevention implementation strategies that match the levels of readiness within the communities. Theoretical and methodological limitations of this research are presented, as well as the study\u27s implications for future research
Can Boundary Crossings in Clinical Supervision be Beneficial?
Published studies have addressed boundary violations by clinical supervisors, but boundary crossings, particularly those deemed positive by supervisees, have not received much attention. Eleven trainees in APA-accredited doctoral programs in clinical and counseling psychology were interviewed regarding positive boundary crossings (PBCs) they experienced with clinical supervisors. Interview data were analyzed using Consensual Qualitative Research. Examples of PBCs included socializing with supervisors outside the office, sharing car rides, and supervisor self-disclosure. Typically, supervisees did not discuss the PBC with their supervisors because they were uncomfortable doing so, felt that the PBC was normal, or felt that processing such issues was not part of the supervisor’s style. Most supervisees viewed the PBCs as enhancing the supervisory relationship and their clinical training; however, some participants reported that the PBCs created role confusion. The results suggest that there are legitimate reasons for supervisors to be scrupulous about their boundaries with supervisees; however, supervisors who hold rigid boundaries can deprive supervisees of deeper mentoring relationships or a more authentic emotional relationship that can be valuable to supervisees learning how to provide psychotherapy
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CureGN Study Rationale, Design, and Methods: Establishing a Large Prospective Observational Study of Glomerular Disease
Glomerular diseases, including minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and immunoglobulin A (IgA) nephropathy, share clinical presentations, yet result from multiple biological mechanisms. Challenges to identifying underlying mechanisms, biomarkers, and new therapies include the rarity of each diagnosis and slow progression, often requiring decades to measure the effectiveness of interventions to prevent end-stage kidney disease (ESKD) or death.
Multicenter prospective cohort study.
Cure Glomerulonephropathy (CureGN) will enroll 2,400 children and adults with minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, or IgA nephropathy (including IgA vasculitis) and a first diagnostic kidney biopsy within 5 years. Patients with ESKD and those with secondary causes of glomerular disease are excluded.
Clinical data, including medical history, medications, family history, and patient-reported outcomes, are obtained, along with a digital archive of kidney biopsy images and blood and urine specimens at study visits aligned with clinical care 1 to 4 times per year.
Patients are followed up for changes in estimated glomerular filtration rate, disease activity, ESKD, and death and for nonrenal complications of disease and treatment, including infection, malignancy, cardiovascular, and thromboembolic events.
The study design supports multiple longitudinal analyses leveraging the diverse data domains of CureGN and its ancillary program. At 2,400 patients and an average of 2 years’ initial follow-up, CureGN has 80% power to detect an HR of 1.4 to 1.9 for proteinuria remission and a mean difference of 2.1 to 3.0mL/min/1.73m2 in estimated glomerular filtration rate per year.
Current follow-up can only detect large differences in ESKD and death outcomes.
Study infrastructure will support a broad range of scientific approaches to identify mechanistically distinct subgroups, identify accurate biomarkers of disease activity and progression, delineate disease-specific treatment targets, and inform future therapeutic trials. CureGN is expected to be among the largest prospective studies of children and adults with glomerular disease, with a broad goal to lessen disease burden and improve outcomes