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Anderson JC, Boakye MD, Feinstein Z, Miller-Walfish S, Jones KA, Chugani CD, Schmulevich A, Jackson R, Miller E. College students' experiences of sexual violence and reasons for seeking care in campus health and counseling centers. J Am Coll Health 2024; 72:753-760. [PMID: 35380934 PMCID: PMC9532461 DOI: 10.1080/07448481.2022.2057189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/01/2021] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Examine associations between care seeking reasons in college health and counseling centers and sexual violence (SV). PARTICIPANTS College students (n = 2,084 baseline, n = 1,170 one-year follow up) participating in a cluster randomized controlled trial of an SV reduction intervention on 28 campuses. METHODS Computer-based survey data gathered during students' clinic visit and one-year follow up. RESULTS Despite high prevalence of SV, students almost never sought care specifically for SV (0.5% of reported visits). Gender differences emerged for reasons students sought care generally, but were not associated with differences in care seeking among those who experienced SV. At baseline and one-year, students who reported SV were more likely to state mental or sexual and reproductive health as their reason for care seeking. CONCLUSION Many students seeking care have experienced SV yet present with other health needs. Providers need to recognize this and have a low threshold for providing SV resources routinely. Supplemental data for this article can be accessed online at https://doi.org/10.1080/07448481.2022.2057189.
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Affiliation(s)
- Jocelyn C. Anderson
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Michelle D.S. Boakye
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Zoe Feinstein
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Summer Miller-Walfish
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Kelley A. Jones
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Carla D. Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Alexandra Schmulevich
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Reesha Jackson
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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2
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Coulter RWS, Szoko N, Frankeberger J, Adams B, Jones KA, Chugani CD, Anderson J, Talis J, McCauley HL, Miller E. Gender and Sexual Orientation Differences in Sexual Violence Knowledge, Prevention Behaviors, and Care-Seeking Behaviors. Prev Sci 2024:10.1007/s11121-023-01640-z. [PMID: 38214789 DOI: 10.1007/s11121-023-01640-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
Sexual violence (SV) on college campuses disproportionately affects cisgender (nontransgender) women, sexual minorities (e.g., gays/lesbians, bisexuals), and gender minority (e.g., transgender/nonbinary) people. This study investigates gender and sexual behavior differences in common SV intervention targets-SV-related knowledge, prevention behaviors, and care-seeking. We analyzed cross-sectional survey data, collected in 9/2015-3/2017, from 2202 students aged 18-24 years attending college health and counseling centers at 28 Pennsylvania and West Virginia campuses. Multivariable multilevel models tested gender and sexual behavior differences in SV history; recognition of SV; prevention behaviors (self-efficacy to obtain sexual consent, intentions to intervene, positive bystander behaviors); and care-seeking behaviors (knowledge of, self-efficacy to use, and actual use of SV services). Adjusting for lifetime exposure to SV, compared with cisgender men, cisgender women had higher recognition of SV and reproductive coercion, prevention behaviors, and care-seeking self-efficacy (beta range 0.19-1.36) and gender minority people had higher recognition of SV and intentions to intervene (beta range 0.33-0.61). Cisgender men with any same-gender sexual partners had higher SV knowledge (beta = 0.23) and self-efficacy to use SV services (beta = 0.52) than cisgender men with only opposite-gender partners. SV history did not explain these differences. Populations most vulnerable to SV generally have higher SV knowledge, prevention behaviors, and care-seeking behaviors than cisgender men with only opposite-gender sexual partners. Innovative SV intervention approaches are necessary to increase SV-related knowledge among heterosexual cisgender men and may need to target alternative mechanisms to effectively reduce inequities for sexual and gender minority people.
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Affiliation(s)
- Robert W S Coulter
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA.
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA.
| | - Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Jessica Frankeberger
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Brian Adams
- Department of Infectious Diseases and Microbiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Carla D Chugani
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Jocelyn Anderson
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
- College of Nursing, Pennsylvania State University, University Park, PA, 16802, USA
| | - Janine Talis
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
| | - Heather L McCauley
- School of Social Work, Michigan State University, East Lansing, MI, 48824, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Ave, Pittsburgh, PA, 15213, USA
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, USA
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3
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Chugani CD, Mazza JJ, Fuhrman BJ, Lavage DR, Murphy C, Talis J, Miller E, Coulter RWS. A multisite, quasiexperimental trial of a college course to support student mental health during the COVID-19 pandemic. J Clin Psychol 2023; 79:2781-2797. [PMID: 37578213 DOI: 10.1002/jclp.23578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the acceptability, appropriateness, feasibility, and preliminary effectiveness of a three-credit college Wellness and Resilience Course (WRC) for improving student mental health and well-being outcomes in the context of the coronavirus disease 2019 (COVID-19) pandemic. METHOD Undergraduate students aged 18-24 years old on five campuses in Western Pennsylvania or West Virginia who had either enrolled in the WRC (n = 81) or were attending university as usual (i.e., not enrolled in the WRC; n = 171) participated in surveys at baseline (beginning of semester), end of semester, and 3-month follow-up during the Spring and Fall 2020 semesters. RESULTS Overall, students rated the WRC as acceptable, appropriate, and feasible. From baseline to the end of semester, students who received the WRC reported significant improvements in psychological flexibility (d = 0.30), mindfulness (d = 0.42), distress tolerance (d = 0.36), and use of dysfunctional and adaptive coping skills (d = 0.32), compared with students who did not receive the WRC. At follow-up, all gains remained statistically significant and students who received the WRC additionally reported significant improvements in stress (d = 0.44) and life satisfaction (d = 0.35) compared with students who did not receive the WRC. CONCLUSIONS These findings offer preliminary evidence that college courses focused on mental wellness may be an important component of campus strategies to increase universal access to mental health support and skills. This study was registered on clinicaltrials.gov on April 8, 2020.
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Affiliation(s)
- Carla D Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
- Mantra Health, New York, New York, USA
| | - James J Mazza
- College of Education, University of Washington, Seattle, Washington, USA
| | - Barbara J Fuhrman
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Daniel R Lavage
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Courtney Murphy
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Janine Talis
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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4
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Szoko N, Dwarakanath N, Miller E, Chugani CD, Culyba AJ. Psychological empowerment and future orientation among adolescents in a youth participatory action research program. J Community Psychol 2023; 51:1851-1859. [PMID: 36095077 PMCID: PMC10008464 DOI: 10.1002/jcop.22935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 06/14/2023]
Abstract
Youth participatory action research (YPAR) empowers youth to address challenges in their environment. Empowerment is associated with prosocial behaviors; however, understanding of how empowerment may serve as a protective factor and promote emotional health remains limited. We sought to characterize protective factors (future orientation and resilience) and emotional health (difficulties regulating emotion and psychological distress) among youth engaged in YPAR and examine associations with psychological empowerment. We administered cross-sectional surveys to 63 youth in YPAR programming. Multivariable linear regression examined relationships between psychological empowerment, protective factors, and emotional health. Participants had high future orientation and resilience with high psychological distress. Empowerment was significantly associated with higher future orientation. There was no significant relationship between empowerment and measures of emotional health. We demonstrate the importance of evaluating protective factors and emotional health constructs in empowerment frameworks, calling for strategies that incorporate such protective factors and more directly address emotional health.
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Affiliation(s)
- Nicholas Szoko
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Namita Dwarakanath
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Carla D. Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Alison J. Culyba
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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5
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Salk RH, Moses-Kolko EL, Chugani CD, Mastruserio S, Wentroble E, Blackburn V, Poling K, Sakolsky D, Brent D, Goldstein TR. An intensive outpatient program for suicidal college students. J Am Coll Health 2023; 71:24-29. [PMID: 33759707 PMCID: PMC8826932 DOI: 10.1080/07448481.2021.1879814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 10/28/2020] [Accepted: 01/08/2021] [Indexed: 06/12/2023]
Abstract
Objective: College counseling centers (CCCs) have limited capacity to accommodate high-risk students who need more intensive care than traditional outpatient treatment. We describe an Intensive Outpatient Program (IOP) to meet the specialized needs of suicidal undergraduates. Participants: Suicidal undergraduates aged 18-24. Methods: Fact-gathering meetings with local universities confirmed high need for prompt access to IOP care for students presenting in crisis at CCCs and emergency rooms, and post-inpatient discharge. We thus iteratively designed and implemented the College Option Services for Teens at Risk (COSTAR) IOP. Results: The 6-week program includes initial diagnostic evaluation and risk assessment followed by weekly skills groups, individual therapy, and medication management. Between September 2017 and January 2020, 148 students (M age = 19.7) attended an average of 5.7 COSTAR group sessions (SD = 4.7). Conclusions: A specialty IOP for suicidal college students holds promise in a stepped care approach for at-risk college students.
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Affiliation(s)
- Rachel H Salk
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eydie L Moses-Kolko
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carla D Chugani
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Susan Mastruserio
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Erin Wentroble
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Vint Blackburn
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kimberly Poling
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dara Sakolsky
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David Brent
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Tina R Goldstein
- Western Psychiatric Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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6
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Anderson JC, Richter RK, Hawk M, Egan J, Miller E, Lampe K, Van Dusen CR, Chugani CD. Exploring Definitions of Consent and Healthy Relationships Among College Students with Disabilities: "I think it's fuzzy". J Fam Violence 2022; 37:1353-1366. [PMID: 36300014 PMCID: PMC9590619 DOI: 10.1007/s10896-021-00322-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 06/16/2023]
Abstract
Purpose College students with disabilities (SWDs) experience elevated rates of sexual violence and intimate partner violence compared with their non-disabled peers. While tailored interventions for these pressing health issues are needed, current research lacks investigation into how SWDs conceptualize relevant key concepts, such as consent and healthy relationships. Method This descriptive qualitative study explored these concepts through semi-structured interviews with college SWDs (n=49), 18-24 years old, in Pennsylvania and West Virginia. Results The results culminated in six rich, descriptive themes addressing: 1) interpersonal and intrapersonal skills necessary for relationship health; 2) normalization of unhealthy treatment by a partner due to manipulation, denial, and love for the partner; 3) how dichotomous definitions of consent interfere with practical application in lived experiences; 4) how active consent can be both facilitated and hindered within the context of a romantic relationship; 5) perceptions that healthcare providers aim to elicit disclosures of abuse rather than initiate a discussion about relationship health; and 6) students' reticence to disclose abuse to healthcare providers due to mistrust and fear over loss of agency. Conclusions These results contradict historic narratives that SWDs do not have the same sexual and relationship beliefs and experiences as other students and highlight the perspectives of this marginalized population. Implications for campus prevention programming and healthcare practices include incorporating intersections of disability and violence, discussing the nuances of consent and substance use, and creating conversations about relationship health that are transparent, non-judgmental, and include a broad range of types of abuse.
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Affiliation(s)
| | | | - Mary Hawk
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
| | - James Egan
- Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Kelli Lampe
- Counseling Academic Unit, Oregon State University
- University Counseling Center, Division of Student Affairs, University of Pittsburgh
| | | | - Carla D. Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine
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7
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Anderson JC, Feinstein Z, Edwards C, Jones KA, Van Dusen C, Kehr V, Burrell C, Coulter RW, Miller E, Chugani CD. Provider perspectives on implementing a student health and counseling center intervention for sexual violence. J Am Coll Health 2022; 70:1363-1371. [PMID: 32721195 PMCID: PMC7855319 DOI: 10.1080/07448481.2020.1797752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/20/2019] [Accepted: 02/29/2020] [Indexed: 06/11/2023]
Abstract
Objective: To describe provider experiences with implementation of the GIFTSS (Giving Information for Trauma Support and Safety) intervention. Participants: Health and counseling center staff from participating campuses attended trainings between August 2015 and August 2016. Interviews were conducted between May and August 2017. Methods: Providers (n = 230) completed surveys prior to and six months following a 3-hour training on the intervention. Structured phone interviews were conducted with a purposively selected subset of 14 providers. Results: Overall, staff found the intervention acceptable. Implementation barriers noted were time and competing patient priorities. Providers noted variation based on patient and visit characteristics. Clinic commitment, particularly in adopting strategies for universal dissemination of the GIFTSS card, was seen as helpful. Conclusion: Implementation of a brief trauma-informed intervention in campus health and counseling centers was feasible and acceptable to most providers. Opportunities to change organizational culture regarding ensuring adequate time and safety for patients are discussed.
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Affiliation(s)
- Jocelyn C. Anderson
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
- Pennsylvania State University, College of Nursing, State College, PA
| | - Zoe Feinstein
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | | | - Kelley A. Jones
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Courtney Van Dusen
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Vanessa Kehr
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | | | - Robert W.S. Coulter
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
- University of Pittsburgh Graduate School of Public Health, Department of Behavioral and Community Health Sciences, Pittsburgh, PA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Carla D. Chugani
- University of Pittsburgh School of Medicine, Department of Pediatrics and UPMC Children’s Hospital of Pittsburgh, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
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8
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Chugani CD, Jones KA, Coulter RW, Anderson JC, Talis J, Goldstein TR, Chung T, Miller E. Increased risk for binge drinking among college students with disability who report sexual violence. J Am Coll Health 2022; 70:691-697. [PMID: 32407169 PMCID: PMC7666107 DOI: 10.1080/07448481.2020.1760281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/19/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveThis study investigated binge drinking in college students with and without disabilities and sexual violence (SV). Participants: This analysis includes 2,113 college students recruited from campus health or counseling centers between 2015 and 2017, aged 18-24. Method: Multinomial logistic regression procedures were used to estimate adjusted odds ratios (AOR) for past month binge drinking days (BDD). Results: Among students with disabilities, 68% endorsed SV, compared with 53% of those without disability. Disability was not significantly associated with BDD; SV was significantly associated with BDD (p < .0001). Students with SV, regardless of disability status, had 1.7- to 2.1-fold greater odds of having 4+ past month BDD. Conclusions: While disability alone is not a risk factor for binge drinking, novel findings include that students with disabilities binge drink at similarly high rates to their nondisabled peers, and are at elevated risk for SV, which is closely associated with binge drinking.
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Affiliation(s)
- Carla D. Chugani
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelley A. Jones
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Robert W.S. Coulter
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Graduate School of Public Health, Department of Behavioral and Communit Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jocelyn C. Anderson
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Janine Talis
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tina R. Goldstein
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Tammy Chung
- School of Medicine, Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania, USA
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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9
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Chugani CD, Murphy CE, Talis J, Miller E, McAneny C, Condosta D, Kamnikar J, Wehrer E, Mazza JJ. Implementing Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A) in a Low-Income School. School Ment Health 2021; 14:391-401. [PMID: 34377215 PMCID: PMC8339697 DOI: 10.1007/s12310-021-09472-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 12/30/2022]
Abstract
Adolescents living in low-income areas often have high need for mental health supports due to experiences of poverty and trauma, coupled with limited access and availability of such supports. This study investigated the implementation of a socio-emotional learning curriculum titled, “Dialectical Behavior Therapy Skills Training for Emotional Problem Solving for Adolescents (DBT STEPS-A),” which was integrated into health classes in a low-income high school. While preliminary evidence suggests that DBT STEPS-A can be effective in reducing mental health symptoms in high school students, this study is the first to explore the program’s acceptability, appropriateness, and feasibility when implemented in a low-income school. The implementation presented here also diverged from recommended training protocols due to time and cost limitations. Quantitative and qualitative data were collected from 29 school stakeholders prior to implementation and from 23 school stakeholders post-implementation. Our results indicate that DBT STEPS-A is acceptable and feasible for teachers involved in offering the program and that more work is needed to address appropriateness of the content for racially and socio-economically diverse students, ease of implementing lessons, and support for teachers using DBT STEPS-A skills outside of class. We conclude with a discussion of key implementation challenges and solutions generated.
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Affiliation(s)
- Carla D Chugani
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Courtney E Murphy
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Janine Talis
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | | | | | | | | | - James J Mazza
- University of Washington College of Education, Seattle, WA USA
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10
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Richter RK, Anderson JC, Miller E, Bonomi AE, De Genna NM, Feinstein Z, Kass G, Lampe K, Mathier A, Chugani CD. Campus Service Use Among Students With Disabilities Who Have Experienced Sexual Violence: A Conceptual Model. Qual Health Res 2021; 31:1222-1233. [PMID: 33709816 PMCID: PMC8320804 DOI: 10.1177/1049732321998054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Students with disabilities are one student group with elevated risk of sexual violence. Although they would benefit from streamlined access to campus support, little is known about their patterns of campus service use. This qualitative analysis includes data from semi-structured interviews with 51 students with disabilities who experienced sexual violence focused on service use across campus. The resultant conceptual model shows that greater accessibility is associated with positive experiences, and lower accessibility is associated with negative experiences. Students with disabilities who experienced or expected negative reactions (e.g., judgment) were less likely to use services and were less satisfied. Advocacy and support in connecting students with disability or sexual violence services was associated with positive experiences and increased accessibility. These findings highlight key facilitators and barriers to campus service use for students with disabilities with sexual violence histories and suggest key intervention points for increasing accessibility, reducing stigma, and improving student experiences with campus providers, staff, and faculty.
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Affiliation(s)
| | | | | | - Amy E Bonomi
- Michigan State University, East Lansing, Michigan, USA
| | | | - Zoe Feinstein
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gabriel Kass
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kelli Lampe
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Oregon State University, Corvallis, Oregon, USA
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11
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Coulter RWS, Mitchell S, Prangley K, Smallwood S, Bonanno L, Foster EN, Wilson A, Miller E, Chugani CD. Generating Intervention Concepts for Reducing Adolescent Relationship Abuse Inequities Among Sexual and Gender Minority Youth: Protocol for a Web-Based, Longitudinal, Human-Centered Design Study. JMIR Res Protoc 2021; 10:e26554. [PMID: 33843601 PMCID: PMC8076986 DOI: 10.2196/26554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/31/2021] [Accepted: 02/25/2021] [Indexed: 01/23/2023] Open
Abstract
Background Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a dearth of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel web-based methodology leveraging the field of human-centered design to generate multiple ARA intervention concepts with SGMY. Objective This paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness of using web-based human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. Methods We are conducting a longitudinal, web-based human-centered design study with 45-60 SGMY (aged between 14 and 18 years) recruited via social media from across the United States. Using MURAL (a collaborative, visual web-based workspace) and Zoom (a videoconferencing platform), the SGMY will participate in four group-based sessions (1.5 hours each). In session 1, the SGMY will use rose-thorn-bud to individually document their ideas about healthy and unhealthy relationship characteristics and then use affinity clustering as a group to categorize their self-reported ideas based on similarities and differences. In session 2, the SGMY will use rose-thorn-bud to individually critique a universal evidence-based intervention to reduce ARA and affinity clustering to aggregate their ideas as a group. In session 3, the SGMY will use a creative matrix to generate intervention ideas for reducing ARA among them and force-rank the intervention ideas based on their potential ease of implementation and potential impact using an importance-difficulty matrix. In session 4, the SGMY will generate and refine intervention concepts (from session 3 ideations) to reduce ARA using round robin (for rapid iteration) and concept poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, the SGMY will complete validated measures about the feasibility, acceptability, and appropriateness of the web-based human-centered design methods (a priori benchmarks for success: means >3.75 on each 5-point scale). Results This study was funded in February 2020. Data collection began in August 2020 and will be completed by April 2021. Conclusions Through rigorous testing of the feasibility of our web-based human-centered design methodology, our study may help demonstrate the use of human-centered design methods to engage harder-to-reach stakeholders and actively involve them in the co-creation of relevant interventions. Successful completion of this project also has the potential to catalyze intervention research to address ARA inequities for SGMY. Finally, our approach may be transferable to other populations and health topics, thereby advancing prevention science and health equity. International Registered Report Identifier (IRRID) DERR1-10.2196/26554
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Affiliation(s)
- Robert W S Coulter
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Shannon Mitchell
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kelly Prangley
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Seth Smallwood
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Leyna Bonanno
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Elizabeth N Foster
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Abby Wilson
- LUMA Institute, Pittsburgh, PA, United States
| | - Elizabeth Miller
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Carla D Chugani
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
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Chugani CD, Anderson JC, Richter RK, Bonomi AE, DeGenna NM, Feinstein Z, Jones KA, Miller E. Perceptions of College Campus Alcohol and Sexual Violence Prevention Among Students with Disabilities: "It Was A Joke". J Fam Violence 2021; 36:281-291. [PMID: 34083871 PMCID: PMC8168969 DOI: 10.1007/s10896-020-00150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
PURPOSE The purpose of this study was to understand perceptions of campus-based alcohol and sexual violence (SV) prevention programming among college students with disabilities to inform future development of prevention programs appropriate for the needs of these students. METHOD The study included semi-structured, qualitative interviews with 51 college students with disabilities who reported histories of SV recruited from a larger parent study investigating a brief universal intervention to reduce alcohol related SV involving 28 campuses across Western Pennsylvania and West Virginia. Interviews focused on college-related experiences of prevention programming, and experiences of health, disability, alcohol use and violence victimization. Data were analyzed using thematic analysis. RESULTS Three themes emerged: (1) Students with disabilities described campus prevention programming as ineffective and irrelevant to their experiences, including referring to programs as "a joke," (2) Students wanted multi-dose, developmentally relevant content that directly addresses the complexities of their experiences with disability, alcohol, and violence, and (3) Students called for programing focused on engaging their interests. CONCLUSIONS Our results point to the need to augment campus-based programming, with attention to the unique needs and relevant concerns of students with disabilities, within the broader context of campus prevention programming.
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Affiliation(s)
- Carla D Chugani
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | | | - Rachael K Richter
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Amy E Bonomi
- Children and Youth Institute, Michigan State University
| | - Natacha M DeGenna
- Department of Psychiatry, University of Pittsburgh School of Medicine
| | - Zoe Feinstein
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Kelley A Jones
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
| | - Elizabeth Miller
- Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine
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Kannan D, Chugani CD, Muhomba M, Koon K. A Qualitative Analysis of College Counseling Center Staff Experiences of the Utility of Dialectical Behavior Therapy Programs on Campus. J College Stud Psychother 2021; 35:53-59. [PMID: 33718945 DOI: 10.1080/87568225.2019.1620662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Dialectical behavior therapy (DBT) is an evidence-based practice for suicidal and self-injuring behavior with growing popularity in college counseling centers (CCCs). With the exception of a single, quantitative study, no research to date investigates how DBT is used in CCCs or what factors influence program implementation. We conducted qualitative interviews with 15 CCC staff that were delivering DBT programs in order to inform a more richly detailed understanding of the process of developing and implementing a DBT program housed in a CCC.
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Affiliation(s)
- Divya Kannan
- Psychological and Counseling Center, Vanderbilt University, Nashville, TN
| | - Carla D Chugani
- University of Pittsburgh, Children's Hospital of Pittsburgh of UPMC, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA
| | - Monicah Muhomba
- Psychological and Counseling Center, Vanderbilt University, Nashville, TN
| | - Kimberly Koon
- Psychological and Counseling Center, Vanderbilt University, Nashville, TN
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Gulamani T, Uliaszek AA, Chugani CD, Rashid T. Attrition and attendance in group therapy for university students: An examination of predictors across time. J Clin Psychol 2020; 76:2155-2169. [PMID: 32830326 PMCID: PMC7666048 DOI: 10.1002/jclp.23042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/20/2020] [Accepted: 07/17/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVES There exists a dearth of research focused explicitly on predictors of attrition, particularly in the area of group therapy, where both attrition and attendance becomes of primary concern. The present study examined both pretreatment and treatment-specific variables in the prospective prediction of attendance and attrition in group therapy. METHOD Fifty-two participants were randomized to one of two 12-week group treatments. Participants completed baseline interviews and questionnaires, as well as weekly assessments of treatment-specific factors. RESULTS No pretreatment factors predicted attendance or drop out, although men attended a larger amount of sessions and were less likely to drop out. Cross-lagged panel analyses supported bidirectional, causal relationships both treatment-specific predictors (therapeutic alliance and number of therapeutic techniques) and attendance. CONCLUSIONS Successful retention in group therapy may be less predictable from pretreatment factors and instead lie in increasing alliance and fostering the practice of therapeutic strategies.
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Affiliation(s)
- Tahira Gulamani
- Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | - Amanda A. Uliaszek
- Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada
| | - Carla D. Chugani
- Division of Adolescent and Young Adult Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tayyab Rashid
- The Health and Wellness Centre, University of Toronto Scarborough, Toronto, Ontario, Canada
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Affiliation(s)
- Carla D Chugani
- Carla D. Chugani is with the Department of Pediatrics, University of Pittsburgh School of Medicine, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA. Amy Houtrow is with the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Division of Pediatric Rehabilitation
| | - Amy Houtrow
- Carla D. Chugani is with the Department of Pediatrics, University of Pittsburgh School of Medicine, Division of Adolescent and Young Adult Medicine, Pittsburgh, PA. Amy Houtrow is with the Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Division of Pediatric Rehabilitation
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16
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Sang JM, Louth-Marquez W, Henderson ER, Egan JE, Chugani CD, Hunter SC, Espelage D, Friedman MS, Coulter RWS. "It's Not Okay for You to Call Me That": How Sexual and Gender Minority Youth Cope with Bullying Victimization. J Homosex 2020:1-20. [PMID: 33164708 PMCID: PMC8106687 DOI: 10.1080/00918369.2020.1826831] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual and gender minority youth (SGMY) have higher rates of bullying than their heterosexual peers and must disproportionately cope with bullying victimization. The purpose of this research is to highlight various coping strategies employed by SGMY. We conducted 20 cross-sectional, semi-structured online interviews with SGMY about their bullying experiences and coping strategies. We coded interviews with descriptive qualitative research to illustrate a comprehensive summary of bullying-related coping methods. We found SGMY engage in multiple coping strategies that include (1) emotion-focused coping-rumination; self-harm and considering or attempting suicide; seeking social and emotional support; engaging in creative endeavors; self-acceptance and community connectedness-and (2) problem-focused coping-reporting the bully; confronting the bully; conceal orientation; ignoring the bullying; and changing environment. Additionally, most SGMY reported using multiple coping techniques or changing how they coped over time (i.e., coping flexibility). These findings can inform future interventions to promote positive coping mechanisms among SGMY.
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Affiliation(s)
- Jordan M Sang
- Graduate School of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - William Louth-Marquez
- Graduate School of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Emmett R Henderson
- Graduate School of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - James E Egan
- Graduate School of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carla D Chugani
- Department of Pediatrics, Division of Adolescent and Young Adult Health, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Simon C Hunter
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland
| | - Dorothy Espelage
- Department of Psychology, University of Florida, Gainesville, Florida, USA
| | - Mark S Friedman
- Mark S. Friedman Psychotherapy, Pittsburgh, Pennsylvania, USA
| | - Robert W S Coulter
- Graduate School of Public Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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17
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Navratil J, Chugani CD, Golden D, Fuhrman B, Ripper LM, Talis J, Miller E. The Fundamental Ethical Concern Is Lack of School Resources to Ensure Student Well-Being. Am J Bioeth 2020; 20:65-66. [PMID: 32945760 DOI: 10.1080/15265161.2020.1806391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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18
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Anderson JC, Chugani CD, Jones KA, Coulter RWS, Chung T, Miller E. Characteristics of precollege sexual violence victimization and associations with sexual violence revictimization during college. J Am Coll Health 2020; 68:509-517. [PMID: 30908164 PMCID: PMC6761049 DOI: 10.1080/07448481.2019.1583237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/21/2018] [Accepted: 02/08/2019] [Indexed: 05/30/2023]
Abstract
Objective: To examine the prevalence and characteristics of precollege sexual victimization (SV) experiences and associations with revictimization and recent substance use behaviors among a sample of college students who reported precollege SV. Participants: A sub-sample of 931 college students who reported precollege SV at baseline data collection for an ongoing multi-site clinical trial. Methods: Data were collected via electronic surveys between September 2015 and March 2017. Measures included precollege and during college SV, recent substance use, and alcohol-related harm reduction behaviors. Results: Precollege SV characteristics associated with revictimization included: Nonpenile penetration (aOR: 1.51, 95%CI: 1.04-2.19); pressured sex (aOR: 1.46, 95%CI: 1.06-2.01); and stranger assault (aOR: 2.03, 95%CI: 1.22-3.40). Past 30-day binge drinking was also associated with revictimization (aOR: 1.86, 95%CI: 1.36-2.54). Conclusions: The relationship between precollege SV and alcohol, especially binge drinking, may require a more integrated approach to preventing subsequent revictimization.
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Affiliation(s)
- Jocelyn C. Anderson
- Pennsylvania State University, College of Nursing
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | - Carla D. Chugani
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | - Kelley A. Jones
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | | | - Tammy Chung
- University of Pittsburgh School of Medicine, Department of Psychiatry
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Department of Pediatrics
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Miller E, Jones KA, McCauley HL, Rofey DL, Clark DB, Talis JM, Anderson JC, Chugani CD, Coulter RWS, Abebe KZ. Cluster Randomized Trial of a College Health Center Sexual Violence Intervention. Am J Prev Med 2020; 59:98-108. [PMID: 32362510 PMCID: PMC7360347 DOI: 10.1016/j.amepre.2020.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 02/09/2020] [Accepted: 02/10/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Sexual violence, particularly in the context of drinking, is prevalent on college campuses. This study tested a brief intervention to prevent sexual violence among students receiving care from college health centers. STUDY DESIGN This study was a two-arm, unblinded cluster RCT. SETTING/PARTICIPANTS On 28 campuses with health/counseling centers (1:1 randomization allocation; 12 intervention and 16 control), from September 2015 to March 2018, a total of 2,291 students seeking care at college health centers completed surveys before the appointment, immediately after, 4 months later, and 12 months later. INTERVENTION Intervention college health center staff received training on delivering sexual violence education to all students seeking care. Control sites provided information about drinking responsibly. MAIN OUTCOME MEASURES The primary outcome was students' change in recognition of sexual violence. Additional outcomes included sexual violence disclosure and use of services among students with a history of sexual violence at baseline. Generalized linear mixed models accounting for campus-level clustering assessed intervention effects. Data were analyzed from September 2018 to June 2019. RESULTS Half (55%) of students seeking care at college health centers reported any history of sexual violence exposure. No between-group differences in primary (β=0.001, 95% CI= -0.04, 0.04) or secondary outcomes emerged between intervention and control students. Post-hoc analyses adjusting for the intensity of intervention delivery (intensity-adjusted) revealed an increase in self-efficacy to use harm reduction strategies (β=0.09, 95% CI=0.01, 0.18) among intervention participants. Among those who reported sexual violence at baseline, intervention students had increased odds of disclosing violence during the visit (AOR=4.47, 95% CI=2.25, 8.89) in intensity-adjusted analyses compared with control. No between-group differences emerged for remaining outcomes. CONCLUSIONS Sexual violence exposure is high among students seeking care in college health centers. A brief provider-delivered sexual violence intervention, when implemented with fidelity, was associated with improved self-efficacy to use harm reduction and increased disclosure of sexual violence during clinical encounters but no increased use of services. More interventions that are stronger in intensity are needed to connect students to sexual violence services. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT02355470.
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Affiliation(s)
- Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Kelley A Jones
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Heather L McCauley
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Dana L Rofey
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Psychiatry, Western Psychiatric Hospital, Pittsburgh, Pennsylvania
| | - Duncan B Clark
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Janine M Talis
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Jocelyn C Anderson
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; College of Nursing, Pennsylvania State University, State College, Pennsylvania
| | - Carla D Chugani
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Robert W S Coulter
- Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kaleab Z Abebe
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Chugani CD, Fuhrman B, Abebe KZ, Talis J, Miller E, Coulter RWS. Wellness and resilience for college and beyond: protocol for a quasi-experimental pilot study investigating a dialectical behaviour therapy skill-infused college course. BMJ Open 2020; 10:e036833. [PMID: 32565475 PMCID: PMC7311003 DOI: 10.1136/bmjopen-2020-036833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION College students' mental health problems and suicidal behaviour are serious, persistent and prevalent public health issues. With the need for mental health support greatly exceeding the availability of on-campus treatment, a recent trend on college campuses is to offer courses designed to teach students strategies for developing mental health or resilience. While these courses are exceptionally popular among students, a paucity of research investigates the health outcomes associated with participation. The purpose of this study is to investigate the acceptability, appropriateness, feasibility and preliminary effectiveness of a college course grounded in skills from dialectical behaviour therapy (DBT) titled, 'Wellness and Resilience for College and Beyond'. METHODS AND ANALYSIS During the spring and fall 2020 semesters, the course will be offered on five campuses in Southwestern Pennsylvania and West Virginia. The course consists of 15 weekly 2.5-hour lessons, weekly homework assignments and a final examination with content drawn from DBT, acceptance and commitment therapy and positive psychology. Undergraduate students aged 18-24 will self-select into the course and control subjects receiving 'university as usual' will be recruited to serve as a comparison group. Students who receive the course will complete measures of course acceptability, appropriateness and feasibility. All study participants will complete measures of adaptive coping skills use, emotion dysregulation and suicidality. ETHICS AND DISSEMINATION All of the study procedures were approved as an exempt protocol for evaluation of educational curricula by the University of Pittsburgh Human Research Protections Office (HRPO); the study was approved as a research study by the institutional review board (IRB) of the fifth study site. The University of Pittsburgh HRPO served as the IRB of record for all except one study site, which required standard IRB review. Data from this study will be disseminated via conference presentations, peer-reviewed publications and via our online stakeholder learning collaborative. TRIAL REGISTRATION NUMBER NCT04338256.
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Affiliation(s)
- Carla D Chugani
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Barbara Fuhrman
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Kaleab Z Abebe
- School of Medicine, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Janine Talis
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Elizabeth Miller
- School of Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, United States
| | - Robert W S Coulter
- School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
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Chugani CD, Byrd AL, Pedersen SL, Chung T, Hipwell AE, Stepp SD. Affective and Sensation-Seeking Pathways Linking Borderline Personality Disorder Symptoms and Alcohol-Related Problems in Young Women. J Pers Disord 2020; 34:420-431. [PMID: 30179582 PMCID: PMC7075353 DOI: 10.1521/pedi_2018_32_389] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Borderline personality disorder (BPD) and alcohol use disorder often cooccur, yet we know little about risk processes underlying this association. We tested two mechanistic pathways linking BPD symptoms and alcohol-related problems. In the "affective pathway," we hypothesized that BPD symptoms would be associated with alcohol-related problems through affective instability and drinking to cope. In the "sensation-seeking pathway," we proposed that BPD symptoms would be related to alcohol-related problems through sensation seeking and drinking to enhance positive experiences. We tested a multiple mediation model using age-18 cross-sectional data from the Pittsburgh Girls Study. Results supported both pathways: BPD symptoms had an indirect effect on alcohol-related problems by (1) affective instability and coping motives (β = .03, p < .05), and (2) sensation-seeking and enhancement motives (β = .02, p < .05). These results highlight coping and enhancement drinking motives as possible mechanisms that explain co-occurrence of BPD symptoms and alcohol-related problems in young females.
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Affiliation(s)
| | - Amy L. Byrd
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Tammy Chung
- University of Pittsburgh, Pittsburgh, Pennsylvania
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Corcoran CT, Miller E, Sohn L, Chugani CD. The Development and Piloting of a Digital Checklist to Increase Access and Usage of Campus Online Sexual Violence Resources. Health Educ Behav 2020; 47:36S-43S. [PMID: 32452256 DOI: 10.1177/1090198120911879] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As colleges seek to respond to campus sexual assault, administrators are making policies, programs, and resources related to sexual violence available to students and members of the school community online. Keeping this content current and accessible can be challenging in the context of rapidly changing information and competing priorities across campuses. In response to this challenge, we developed a free, online protocol for campus leaders to quickly assess gaps in their online sexual violence resources. The "Digital Checklist" delineates action steps that campus administrators can take to determine whether information related to campus sexual assault is easily located, current, relevant, and accessible. We found that while schools made an effort to increase the availability of information online, the checklist helped identify gaps that, if remedied, would allow more students to access that information. The overall goal for the checklist is to provide schools with actionable, real-time, and trackable data regarding the utility and accessibility of online sexual violence information and resources and to complement other campus sexual assault prevention and intervention efforts.
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Affiliation(s)
| | - Elizabeth Miller
- UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa Sohn
- Futures Without Violence, San Francisco, CA, USA
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Affiliation(s)
- Robert W S Coulter
- Schools of the Health Sciences, University of Pittsburgh, Pittsburgh (Coulter, Egan, Chugani); RAND Corporation, Pittsburgh (Siconolfi)
| | - Daniel E Siconolfi
- Schools of the Health Sciences, University of Pittsburgh, Pittsburgh (Coulter, Egan, Chugani); RAND Corporation, Pittsburgh (Siconolfi)
| | - James E Egan
- Schools of the Health Sciences, University of Pittsburgh, Pittsburgh (Coulter, Egan, Chugani); RAND Corporation, Pittsburgh (Siconolfi)
| | - Carla D Chugani
- Schools of the Health Sciences, University of Pittsburgh, Pittsburgh (Coulter, Egan, Chugani); RAND Corporation, Pittsburgh (Siconolfi)
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Bonomi A, Nichols E, Kammes R, Chugani CD, De Genna NM, Jones K, Miller E. Alcohol Use, Mental Health Disability, and Violence Victimization in College Women: Exploring Connections. Violence Against Women 2018; 24:1314-1326. [PMID: 30078374 DOI: 10.1177/1077801218787924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study is an analysis of in-depth interviews with college women reporting a mental health disability and at least one experience of intimate partner violence (IPV) or sexual violence (SV) to elucidate how alcohol use is associated with both violence victimization and mental health symptoms. Our findings underscore salient alcohol-related themes in college women with histories of IPV/SV and mental health disability: alcohol use in their family of origin and/or with intimate partners, partying and heavy drinking as a normal college social context, abusive partners and SV perpetrators using alcohol as a mechanism for control and targeted rape, and worsening mental health symptoms after violence exposure, which prompted alcohol use to cope and was associated with vulnerability to more violence.
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Affiliation(s)
- Amy Bonomi
- 1 Michigan State University, East Lansing, MI, USA
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Uliaszek AA, Hamdullahpur K, Chugani CD. Mechanisms of change in group therapy for treatment-seeking university students. Behav Res Ther 2018; 109:10-17. [PMID: 30077803 DOI: 10.1016/j.brat.2018.07.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 07/10/2018] [Accepted: 07/23/2018] [Indexed: 11/17/2022]
Abstract
The present study examined mechanisms of change in dialectical behavior therapy (DBT) skills group and positive psychotherapy (PPT) group intervention, two treatments that have previously been shown to be effective at reducing symptoms of BPD and depression over a 12-week treatment protocol within the context of a college counseling center (Uliaszek et al., 2016). The present study is secondary data analysis of that trial. We hypothesized that change in dysfunctional coping skills use would be a specific mechanism for DBT, while change in functional coping skills use and therapeutic alliance would be mechanisms of change for both treatments. Fifty-four participants completed self-report and interview-based assessments at pretreatment, weeks 3, 6, 9, and posttreatment. Path models examined the predictive power of the mechanisms in predicting outcome; the moderating effect of group membership was also explored. Dysfunctional coping skills use across the course of treatment was a significant mechanism of change for BPD and depression for the DBT group, but not the PPT group. Conversely, therapeutic alliance was a significant mechanism of change for the PPT group, but not the DBT group. Findings highlight the importance of each mechanism during mid-to late-treatment specifically.
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Affiliation(s)
- Amanda A Uliaszek
- University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, Canada.
| | - Kevin Hamdullahpur
- University of Toronto Scarborough, 1265 Military Trail, Toronto, Ontario, Canada
| | - Carla D Chugani
- University of Pittsburgh, 3420 Fifth Ave., Pittsburgh, PA, USA
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Chugani CD, Seiler AR, Goldstein TR. Recovery from Borderline Personality Disorder through Dialectical Behavior Therapy. Qual Rep 2017; 22:3014-3024. [PMID: 34308446 PMCID: PMC8297586 DOI: 10.46743/2160-3715/2017.3008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This article presents a qualitative investigation of the perspectives and experiences of recovery from borderline personality disorder from six individuals who were treated with comprehensive dialectical behavior therapy. Data were collected via semi-structured interviews, transcribed, and coded using a six-step analysis process. Six primary themes emerged: (1) belief about recovery, (2) current experience of self, (3) facets of recovery, (4) motivating factors, (5) external supports to recovery, and (6) characteristics required for recovery. Overall, the findings took a dialectical form in which participants often described conflicting experiences (e.g., feeling recovered while also continuing to experience heightened emotional sensitivity). We conclude that the themes presented in this article represent broad domains related to the meaning of recovery from BPD, and recognize that the relative importance of each domain is best determined by the individual.
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Affiliation(s)
- Carla D. Chugani
- Counseling and Psychological Services; Florida Gulf Coast University
- Now at Department of Pediatrics; Children's Hospital of Pittsburgh of UPMC; Pittsburgh Pennsylvania
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Chugani CD, Mitchell ME, Botanov Y, Linehan MM. Development and Initial Evaluation of the Psychometric Properties of the Dialectical Behavior Therapy Barriers to Implementation Scale (BTI-S). J Clin Psychol 2017; 73:1704-1716. [PMID: 28380249 DOI: 10.1002/jclp.22478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 02/22/2017] [Accepted: 03/05/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We examined the psychometric properties of the Dialectical Behavior Therapy (DBT) Barriers to Implementation Scale (BTI-S). METHOD Participants were clinicians completing a bipartite training, separated by 6 months of self-study, to implement DBT. Exploratory factor analysis was conducted with data collected from the initial training period (N = 790), while confirmatory factor analysis was based on data from the final training period (N = 660). RESULTS The final model included 26 items and 4 factors with overall acceptable fit, χ2 (293, N = 660) = 460.989, p < .001, comparative fit index = .909, Tucker-Lewis index = .899, root mean square root mean square error of approximation (90% confidence interval) = .015. The internal reliability of the scores was low (range = .56 to .72). CONCLUSION The final model fits reasonably well and measures four domains considered important for implementation of DBT. However, the low reliability of the scores indicates that the BTI-S would be improved with further development.
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Muhomba M, Chugani CD, Uliaszek AA, Kannan D. Distress Tolerance Skills for College Students: A Pilot Investigation of a Brief DBT Group Skills Training Program. Journal of College Student Psychotherapy 2017. [DOI: 10.1080/87568225.2017.1294469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Monicah Muhomba
- Psychological and Counseling Center, Department of Psychiatry & Behavioral Sciences, Vanderbilt University, Nashville, Tennessee, USA
| | - Carla D. Chugani
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Amanda A. Uliaszek
- Departments of Psychology and Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Divya Kannan
- Psychological and Counseling Center, Department of Psychiatry & Behavioral Sciences, Vanderbilt University, Nashville, Tennessee, USA
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Chugani CD, Landes SJ. Dialectical Behavior Therapy in College Counseling Centers: Current Trends and Barriers to Implementation. Journal of College Student Psychotherapy 2016. [DOI: 10.1080/87568225.2016.1177429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chugani CD. Dialectical Behavior Therapy in College Counseling Centers: Current Literature and Implications for Practice. Journal of College Student Psychotherapy 2015. [DOI: 10.1080/87568225.2015.1008368] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chugani CD, Ghali MN, Brunner J. Effectiveness of Short Term Dialectical Behavior Therapy Skills Training in College Students with Cluster B Personality Disorders. Journal of College Student Psychotherapy 2013. [DOI: 10.1080/87568225.2013.824337] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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