Seven key insights from critical realism and their implications for ecological thinking and action in community psychology.

This article explores some of the possible links between community psychology and critical realism, a relatively new approach to the philosophy of science that has received little attention from community psychologists. Critical realism is presented in relation to seven key insights that can be linked to fundamental tenets of the ecological approach in community psychology. These insights are: (1) A complex reality exists independently of our ideas about it, and this reality is knowable, although imperfectly. (2) Reality is composed of a complex and stratified hierarchy of open systems. (3) Causality is best understood in terms of causal processes that may or may not be directly observable or generalizable; these processes involve complex interactions among generative mechanisms and contextual conditions. (4) Theory and theorizing about causal processes are central to both scientific explanation and practical action. (5) Theory exists at multiple levels of abstraction, ranging from models to metatheory. (6) A diversity of methods can provide evidence in the search for causal processes operating in context. (7) As social scientists, we have an obligation to use social science knowledge to promote human flourishing. Although these insights may be familiar to many community psychologists who adopt an ecological approach to their work, we suggest that clearly articulating these principles can provide more solid foundations for inquiry in the field. We conclude the article by highlighting how critical realism may help to bridge the research-practice gap in community psychology and similar social sciences.

Introduction to the special issue on critical realism.

This special issue explores how philosophy of science matters for both research and social action in community psychology. It explores the complex issue of what might be appropriate philosophical bases for community psychology theory, research, and practice. In particular, it focuses on critical realism, a relatively new approach to the philosophy of science. In this introductory article, we start by discussing the importance of philosophy of science for community psychologists. We then situate our subject by exploring the history of paradigms in community psychology. We next offer a brief description of critical realism by describing its assumptions on ontology (nature of the world), epistemology (theory of knowledge), axiology (theory of values), and methodology (theory of action).

United States Medical Licensing Examination and American Board of Pediatrics Certification Examination Results: Does the Residency Program Contribute to Trainee Achievement.

OBJECTIVE: To determine whether training site or prior examinee performance on the US Medical Licensing Examination (USMLE) step 1 and step 2 might predict pass rates on the American Board of Pediatrics (ABP) certifying examination. STUDY DESIGN: Data from graduates of pediatric residency programs completing the ABP certifying examination between 2009 and 2013 were obtained. For each, results of the initial ABP certifying examination were obtained, as well as results on National Board of Medical Examiners (NBME) step 1 and step 2 examinations. Hierarchical linear modeling was used to nest first-time ABP results within training programs to isolate program contribution to ABP results while controlling for USMLE step 1 and step 2 scores. Stepwise linear regression was then used to determine which of these examinations was a better predictor of ABP results. RESULTS: A total of 1110 graduates of 15 programs had complete testing results and were subject to analysis. Mean ABP scores for these programs ranged from 186.13 to 214.32. The hierarchical linear model suggested that the interaction of step 1 and 2 scores predicted ABP performance (F[1,1007.70] = 6.44, P = .011). By conducting a multilevel model by training program, both USMLE step examinations predicted first-time ABP results (b = .002, t = 2.54, P = .011). Linear regression analyses indicated that step 2 results were a better predictor of ABP performance than step 1 or a combination of the two USMLE scores. CONCLUSIONS: Performance on the USMLE examinations, especially step 2, predicts performance on the ABP certifying examination. The contribution of training site to ABP performance was statistically significant, though contributed modestly to the effect compared with prior USMLE scores.

Rapid Weight Gain in Pediatric Refugees after US Immigration.

Prior studies of immigrants to the United States show significant weight gain after 10 years of US residence. Pediatric refugees are a vulnerable population whose post-immigration weight trajectory has not been studied. We examined the longitudinal weight trajectory of 1067 pediatric refugees seen in a single university based refugee health program between the dates of September 3, 2012 and September 3, 2014 to determine how quickly significant weight gain occurs post-arrival. The most recent BMI was abstracted from the electronic health record and charts reviewed to obtain serial BMI measurements in 3 year increments after the date of US arrival. The mean arrival BMI percentile for all refugees was 47th percentile. This increased significantly to the 63rd percentile within 3 years of US arrival (p < 0.01). This rapid increase was largely attributable to African and South and Southeast Asian refugees. The overall prevalence of age and sex adjusted obesity rose from 7.4 % at arrival to 18.3 % within 9 years of US immigration exceeding the pediatric US national obesity prevalence of 16.9 %. Pediatric refugees are at increased risk of rapid weight gain after US immigration. Targeted interventions focused on prevention of weight gain in specific populations are warranted.

Leadership Styles of Oxford House Officers.

Oxford House recovery homes are unusual compared to most recovery homes in that they function entirely without the use of staff; instead members are elected to officer positions. The aim of this study was to perform preliminary analysis of the types of leadership styles utilized by members of oxford house. Twentynine house residents of five Oxford Houses were asked to rate their own leadership styles using the leader behavior description questionnaire and the multifactor leader questionnaire. Results showed that participants were more likely to use person-oriented behaviors above task-oriented actions. Transformational leadership was associated with higher outcomes than Transactional leadership. Implications for future research are discussed.

Generativity, the big five, and psychosocial adaptation in midlife adults.

The study examines the extent to which 2 sets of personality variables-(1) dispositional traits (and their facets) within the Big Five taxonomy and (2) the adult developmental construct of generativity-are associated with psychosocial adaptation in midlife adults (N=128), conceived as the combination of individual well-being and positive societal involvements. Generativity is conceived as an adult's concern for and commitment to promoting the well-being of future generations. Multiple regression analyses showed that dispositional traits were more strongly associated with individual well-being than was generativity, but generativity was much more strongly associated with positive societal engagement than were the traits. Correlations between dispositional traits and generativity revealed that highly generative adults were elevated on most of the facets of Extraversion and Openness. For the other 3 traits, generativity was positively related to facets of competence, achievement striving, dutifulness, altruism, and trust and negatively related to vulnerability, anxiety, depressiveness, and modesty.

Eosinophilia and the seroprevalence of schistosomiasis and strongyloidiasis in newly arrived pediatric refugees: an examination of Centers for Disease Control and Prevention screening guidelines.

The US Centers for Disease Control and Prevention has published refugee health guidelines that recommend examination of the absolute eosinophil count (AEC) to screen for asymptomatic schistosomiasis and strongyloidiasis. We examined the predictive validity of an AEC >400 cells/microL to identify refugees with serologic evidence for schistosomiasis or strongyloidiasis. Our study revealed that eosinophilia was not predictive of serologic evidence of either a Schistosoma species or Strongyloides stercoralis infection in the pediatric refugees examined in this study.

Increases in tolerance within naturalistic, intentional communities: a randomized, longitudinal examination.

The authors examine differential changes in values of tolerance among 150 participants discharged from inpatient treatment centers, and randomly assigned to either a self-help-based, communal living setting (i.e., Oxford House), or usual aftercare. Participants were interviewed every 6 months for a 24-month period. Hierarchical linear modeling (HLM) was used to examine the effect of condition (therapeutic communal living versus usual aftercare) on wave trajectories of tolerance (i.e., universality/diversity scores). Over time, residents of the communal living model demonstrated significantly greater values of tolerance than usual aftercare participants. Communal living participants who resided in the house for over 6 months showed the most substantial increases in tolerance. Results support the notion that communal living residents may develop more tolerant attitudes by striving toward superordinate community goals (objectives held by (a) the whole group and (b) which individual members could not achieve alone).

Family metaphors and moral intuitions: how conservatives and liberals narrate their lives.

This research examines life-narrative interviews obtained from 128 highly religious and politically active adults to test differences between political conservatives and liberals on (a) implicit family metaphors (G. Lakoff, 2002) and (b) moral intuitions (J. Haidt & C. Joseph, 2004). Content analysis of 12 key scenes in life stories showed that conservatives, as predicted, tended to depict authority figures as strict enforcers of moral rules and to identify lessons in self-discipline. By contrast, liberals were more likely to identify lessons learned regarding empathy and openness, even though (contrary to prediction) they were no more likely than conservatives to describe nurturant authority figures. Analysis of extended discourse on the development of religious faith and personal morality showed that conservatives emphasized moral intuitions regarding respect for social hierarchy, allegiance to in-groups, and the purity or sanctity of the self, whereas liberals invested more significance in moral intuitions regarding harm and fairness. The results are discussed in terms of the recent upsurge of interest among psychologists in political ideology and the value of using life-narrative methods and concepts to explore how politically active adults attempt to construct meaningful lives.

The ethics of interrogation and the American Psychological Association: a critique of policy and process.

The Psychological Ethics and National Security (PENS) task force was assembled by the American Psychological Association (APA) to guide policy on the role of psychologists in interrogations at foreign detention centers for the purpose of U.S. national security. The task force met briefly in 2005, and its report was quickly accepted by the APA Board of Directors and deemed consistent with the APA Ethics Code by the APA Ethics Committee. This rapid acceptance was unusual for a number of reasons but primarily because of the APA's long-standing tradition of taking great care in developing ethical policies that protected anyone who might be impacted by the work of psychologists. Many psychological and non-governmental organizations (NGOs), as well as reputable journalists, believed the risk of harm associated with psychologist participation in interrogations at these detention centers was not adequately addressed by the report. The present critique analyzes the assumptions of the PENS report and its interpretations of the APA Ethics Code. We demonstrate that it presents only one (and not particularly representative) side of a complex set of ethical issues. We conclude with a discussion of more appropriate psychological contributions to national security and world peace that better respect and preserve human rights.

Improving guideline adherence for the diagnosis of ADHD in an ambulatory pediatric setting.

BACKGROUND: The American Academy of Pediatrics (AAP) has published clinical practice guidelines for the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). However, implementation of guidelines has been notoriously difficult to achieve in the wider context of changing individual physicians' clinical practice. OBJECTIVE: Implement a formalized diagnostic protocol for ADHD and study whether this protocol improved adherence of pediatric residents and faculty to published guidelines for the diagnosis of ADHD. METHODS: Quasi-experimental retrospective record review of 63 pediatric patients evaluated for ADHD by pediatric residents and faculty in an outpatient pediatric clinic before (n = 25) and after (n = 38) implementation of a formal diagnostic process for ADHD. The key elements of the new diagnostic process include completion of a semistructured interview and mandatory rating scales for home and school. The published AAP guidelines include 1) documentation of Diagnostic and Statistical Manual for Mental Disorders (DSM) IV criteria; 2) evidence of core symptoms obtained directly from home and 3) from school; and 4) assessment for coexisting conditions. Adherence was assessed to each criterion individually (yes/no) and was summarized in a single score. RESULTS: Only 4% of clinicians and nurse practitioners diagnosing children in the before group adhered to all 4 AAP guidelines, compared to 82% in the after group (P < .001). Significant improvement was observed across each of the 4 criteria in the AAP guidelines. Moreover, the improvement in adherence to all 4 guidelines was noted for residents and faculty. CONCLUSION: A significant improvement in adherence to AAP guidelines was obtained for all providers through implementation of a structured diagnostic approach to ADHD.