Kenneth W. Phelps

Enrichment, stress, and growth from parenting an individual with an autism spectrum disorder

Abstract Background Past researchers have focused primarily on the associated negative impact of caring for a child with special needs. In this study, caregivers report the enrichment and stress of caring for a child with an autism spectrum disorder. Method Eighty caregivers completed the Social Communication Questionnaire (SCQ), Effects of the Situation Questionnaire (ESQ), and Posttraumatic Growth Inventory (PTGI). Enrichment and stress scores were compared to symptom severity data and posttraumatic growth scores. Results Consistent with prior research, caregivers reported greater levels of stress than enrichment. On just over half of the stress/enrichment variables, parental ratings of stress and enrichment were negatively correlated. Scores of total stress and enrichment were not correlated to the severity of the individuals symptoms or caregivers’ growth scores. Conclusions These findings suggest that although stress is a major concern for caregivers, enrichment and growth may also occur in varying degrees.

A collaborative care model for patients with Type-2 diabetes.

The research on diabetes has shown the need to move from a traditional medical model to a patient-team orientation. This has led to a number of collaborative programs targeting the patient and familys comprehensive needs. This paper details one collaborative care program for underserved patients with Type-2 diabetes set in rural, eastern North Carolina. Roles of the therapeutic team are incorporated along with a case example highlighting the bio-psychosocial-spiritual model in action. Sustainability, challenges, and strengths are included to facilitate a realistic appraisal of the program.

Advancing Medical Family Therapy Through Qualitative, Quantitative, and Mixed-Methods Research

To survive in today’s healthcare climate, stakeholders across all behavioral health disciplines must work to produce empirical evidence that earns their fields’ regard by educators, providers, and policy makers. As the field of medical family therapy (MedFT) answers this call, it will be important for researchers to clearly define, characterize, and assess MedFT practice across clinical, operational, and financial arenas of care. In this chapter, the authors propose a common lexicon from which to do this, highlighting the following core tenets of MedFT: systems theory, biopsychosocial–spiritual sensitivity in practice, agency, communion, interdisciplinary collaboration, and the three-world model of healthcare. We conclude by offering concrete ways to advance the MedFT research agenda using qualitative, quantitative, and mixed-method approaches.

African American Women’s Recollected Experiences of Adherence to Breast Cancer Treatment

Purpose/Objectives: To explore African American women’s recollected experiences of breast cancer treatment. Research Approach: Qualitative description and narrative analysis. Setting: South Carolina Oncology Associates, an outpatient oncology clinic serving rural and urban populations. Participants: 16 African American women with breast cancer previously enrolled in the control arm (n = 93) of a completed randomized, controlled trial. Methodologic Approach: Feminist narrative analysis of in‐depth individual interviews. Findings: The authors identified three themes within the African American breast cancer survivors’ recollected experiences of treatment adherence: Embarking With Trust, Moving on Down the Road, and Being Actively Involved in Decision Making. Interpretation: Although little evidence was presented of shared decision making with providers, patients were committed to completing the prescribed therapies. The narratives highlighted the value of in‐depth examination of patients’ perspectives, particularly among minority and underserved groups. With the exception of voicing personal choice of surgical treatment, the women trusted providers’ recommendations with a resolve to “just do it.” Although trust may enhance treatment adherence, it may also reflect power differentials based on gender, race, education, and culture. Implications for Nursing: Nurses should listen to patients describe their experience with cancer treatment and compare the themes from this study with their patients’ story. This comparison will help nurses support patients through various aspect of diagnosis and treatment.

Building Strengths with the Six Es of Medication Management

The authors provide a template of focused skills drawn from various psychotherapy modalities for integration into follow-up psychopharmacology appointments. Titled the Six E model, this approach includes strategies to elicit an agenda, externalize the presenting problem, seek exceptions, engage empathetically, utilize enactments, and offer education. The template was trialed in a child and adolescent outpatient residency clinic under the guidance of two attendings. Qualitative feedback was solicited from fellows following utilization of the template. The Six E model was felt to improve structure and subjective satisfaction of patient, family, and provider participating in the brief appointments.

Medical Family Therapy in Psychiatry

The term “Psychiatry,” named first in 1808 by physician Johann Christian Reil, is derived from two Greek words: psyche (soul) and iatros (healer) (Marneros, 2008). Over the years, psychiatry has remained a specialty of medicine focused on the complexities of the human mind. While understanding the etiologic and remediating factors of mental illness has been a mainstay of psychiatric practice, clinical methods have varied over time. Psychiatry has seen shifts from Freudian psychoanalysis to more structured, manualized therapeutic approaches. Emerging science has taken the profession further away from its therapeutic roots, in favor of psychopharmacologic and neurologic discovery. Nevertheless, psychiatry continues to be a practice defined by interdisciplinary collaboration as well as conceptualization sensitive to familial and cultural factors. This is demonstrated through the American Psychiatric Association’s (American Psychiatric Association, 2016a) values of “prevention, access, care and sensitivity for patients and compassion for their families; respect for diverse views and pluralism within the field; and respect for other health professionals” (para 3).

Medical Family Therapy in Obstetrics and Gynecology

The combined disciplines of obstetrics and gynecology (Ob-Gyn) are committed to the reproductive physiology of women’s health throughout the lifespan and include an integration of medical and surgical care. Ob-Gyn providers attend to the social, physiological, environmental, and genetic factors that influence or exacerbate health conditions in women. As such, Ob-Gyns’ expertise in and attention to diverse factors that influence the physical health of women makes medical family therapists (MedFTs) a logical partner for integrated behavioral healthcare (IBHC). Both disciplines train providers to recognize and care for the unique biopsychosocial-spiritual (BPSS) health needs (Engel, 1977, 1980; Wright, Watson & Bell, 1996) of each patient over the lifespan and in the context of her family system. Furthermore, both disciplines include training in their respective areas across prevention, health education, assessment, diagnostics, and intervention.

Expectations and reality: perceptions of support among African American breast cancer survivors

ABSTRACT Objective: The experience of an illness such as breast cancer is not a static event. Just as physiological needs change as a patient transitions through diagnosis, treatment, to long-term survivorship, so too will their needs for social support. We applied a transitions theory framework to explore how African American women with breast cancer conceptualized and experienced support along their breast cancer journey. Design: We recruited 16 African American women with breast cancer from a regional cancer center in South Carolina to complete qualitative, semi-structured interviews. We iteratively examined verbatim transcripts using thematic analysis. Results: Three core themes emerged: ‘I guess she was supposed to’: When support meets patient expectations; ‘I wasn’t expecting that and that just made me feel so good’: When reality exceeds expectations; and ‘Don’t try to make an invalid out of me’: When support given wasn’t what was desired. Survivors shared how their family, friends and clergy met their needs for emotional (e.g. prayer, sharing affirmations about God) and instrumental support (e.g. cooking meals, house cleaning). They emphasized how receiving emotional support from their healthcare providers was a pleasant surprise. However, survivors also described unexpected disappointments when family members offered support that was un-needed or un-desired. Conclusions: Applying transitions theory, we found that social support is a process of bidirectional negotiation where African American women with breast cancer perceive support as helpful and acceptable depending on who offers support, what type of support is offered, and when it is offered. Members of their social support network (e.g. family, friends, providers) should periodically assess the survivor’s evolving needs to ensure the social support harmonizes with the needs and expectations of the survivor.

Clinical Reasoning in the Assessment and Intervention Planning for Major Depression

Accurate assessment and effective treatment of mood disorders, particularly depression, is critically important for the millions of youth who are experiencing such symptomatology and who are at risk for a multitude of deleterious outcomes. Although the extant empirical literature provides substantial guidance for the assessment and treatment of depression, real-life complexities necessitate the inclusion of sound clinical judgment throughout the diagnostic, treatment planning and intervention phases. The purpose of this article is to present an example of a real-life case study reliant on evidence-based practices and sound clinical judgment in the assessment and treatment of depression. We first review the extant diagnostic, epidemiological, assessment, and treatment literature. The case study is intended to highlight the therapist’s use of evidence-based treatment (i.e., Cognitive Behavioral Therapy), while also considering points during treatment at which the therapist was required to use clinical judgment. Outcomes of the case are described and limitations reviewed.

Location of care for patients with borderline personality disorder: Challenges and opportunities in finding a home.

Patients with borderline personality disorder (BPD) represent a population with increased care needs and high provider demand, even in the best cases of quality integrated primary care. The current article outlines the complexities of working with patients with BPD in primary care, including when the transition to the specialty mental health sector may be warranted. Core factors around transitions of care (between integrated primary care and the specialty mental health sector) have been identified. These factors included suicidal ideations, psychiatric hospitalizations/conditions, physician consultation availability, behavioral provider availability, supervision availability, finances, and patient preferences. (PsycINFO Database Record