Professional quality of life in home visitors: Core components of the reflective supervisory relationship and IMH-E® Endorsement® engagement.

Infant and early childhood home visiting models are gaining prominence as effective programs for families. Most U.S. state infant mental health associations (IMHAs) recommend reflective supervision (RS) and Infant Mental Health (IMH-E® ) Endorsement® as components of home visitor professional development. These efforts may promote workforce professional quality of life. It is unknown whether a workplace policy to provide RS improves the likelihood that best practice guidelines, especially core components of a reflective supervisory relationship, are experienced by the workforce. We sought to investigate associations between home visitor well-being indicated by professional quality of life (i.e., burnout, secondary traumatic stress, compassion satisfaction) and a workplace policy providing RS, consistent experience of core components of a reflective supervisory relationship, and engagement in endorsement. We also examined differences in consistently experiencing core components of the reflective supervisory relationship in home visitors who reported having a workplace policy for providing RS and those who did not, and for home visitors engaged or not engaged in the endorsement process. A Workplace Supports Survey was designed to investigate these associations; we report findings from a sample of home visitor respondents (N = 139).  A policy to provide RS was not associated with professional quality of life. However, analyses suggest an association between a policy to provide RS and consistently experiencing core components of a reflective supervisory relationship. Unanticipated positive associations between engagement in endorsement and burnout and secondary traumatic stress were also found. Finally, engagement in endorsement was associated with less consistent experience of these core components. Implications for future inquiry about the purposes of RS and IECMH Endorsement® as strategies to promote workforce development and well-being are discussed.

Los modelos de visitas a casa en el campo de la infancia y la temprana niñez han adquirido importancia como programas eficaces para familias. La mayoría de las asociaciones estatales de salud mental infantil en Estados Unidos promueven la supervisión con reflexión (RS) y en Endoso® de Salud Mental Infantil (IMH-E®) como recursos de desarrollo profesional. RS y el Endoso® IMH-E® pudieran también promover la calidad de vida de la fuerza laboral profesional. Se desconoce si una política laboral de proveer RS se asocia con la experiencia de la fuerza laboral y las mejores directrices en la práctica, incluyendo los componentes centrales de una relación de supervisión con reflexión (CCRSR). Investigamos las asociaciones entre la calidad de vida profesional del visitante a casa (v.g. cansancio, estrés traumático secundario, satisfacción en la compasión) y una política laboral para RS, la experiencia consistente de CCRSR y la participación en el endoso. Una Encuesta sobre los Apoyos Laborales se diseñó para investigar estas asociaciones; nosotros reportamos los resultados de un grupo muestra de visitadores a casa (N = 139). Una política para ofrecer RS no se asoció con la calidad de vida profesional. Sin embargo, los análisis indican una asociación entre una política para ofrecer RS y experimentar consistentemente CCRSR. Se observaron asociaciones positivas no anticipadas entre la participación en el endoso y el cansancio y estrés traumático secundario. Finalmente, la participación en el endoso se asoció con una menos consistente experiencia de CCRSR. Se discuten las implicaciones para consulta futura acerca de los propósitos de RS y el Endoso® IECHM como estrategias para promover el desarrollo y bienestar de la fuerza laboral.

Les modèles de visite à domicile du nourrisson/de la petite enfance ont gagné en importance en tant que programmes efficaces pour les familles. La plupart des associations de santé mentale du nourrisson au niveau des états aux USA font la promotion de la supervision réflective (RS) et de l'adoption Infant Mental Health (IMH-Eâ) en tant que ressources de développement professionnel. La RS et l'adoption IMH-Eâ peuvent aussi promouvoir la qualité de vie professionnelle des effectifs. On ne sait pas si le fait d'offrir la RS au travail est lié à l'expérience des effectifs des lignes directrices des pratiques exemplaires y compris les composants essentiels d'une relation de supervision réflective (CCRSR). Nous avons étudié les liens entre la qualité de vie professionnelle d'un visiteur à domicile (i.e. burnout, stress traumatique secondaire, satisfaction de compassion) et le fait d'avoir la RS au travail, l'expérience constante de la CCRSR et l'engagement dans l'adoption. Un Questionnaire de Soutien du Lieu de Travail a été conçu pour étudier ces liens. Nous faisons état des résultats à partir d'un échantillon de visiteurs à domicile (N = 139). Le fait d'offrir la RS n'était pas lié à la qualité de vie professionnelle. Cependant les analyses suggèrent un lien entre le fait d'offrir la RS et le fait de faire l'expérience de la CCRSR avec constance. Des liens positifs inattendus entre l'engagement d'adoption et le burnout et le stress traumatique secondaires ont été observés. Enfin, l'engagement d'adoption était lié à une expérience moins constante de la CCRSR. Les implications pour des recherches futures sur les objectifs de la RS et de l'adoption IECMH en tant que stratégies de promotion du développement et du bien-être au travail sont discutées.

"I Struggle with Breast Cancer and I Struggle with God": Insights from African American Breast Cancer Survivors.

PURPOSE: Recognizing that spiritual and religious beliefs are personal and vary within communities, the purpose of this qualitative study was to explore the influence of these beliefs on experiences with breast cancer care and social support among African American Christian breast cancer survivors. METHODS: Forty-seven African American breast cancer survivors participated in focus groups (n = 7) in three northeastern urban cities. We used thematic analyses to identify major themes. RESULTS: Three themes emerged relating to how spirituality influenced participants' cancer journeys: (1) struggling with God, (2) reclaiming my power, and (3) needing religious social support. Participants described the rhythmic flow of their spiritual beliefs as they navigated their lived experiences during diagnosis, treatment, and post-treatment. Spirituality was intimately intertwined with their illness experience as they grappled with their health and well-being. CONCLUSIONS: Participants used spirituality as an avenue to cope and navigate through their diagnosis and treatment. These spiritual relationships created "church families" and provided the survivors' access to cancer support groups, financial support, and therapeutic support. Our findings support faith-based approaches to health promotion and call for more studies to understand the influence of religion on health.

You Aren't as Close to my Family as You Think: Discordant Perceptions about In-laws and Risk of Divorce.

In-law relationships can act as sources of both support and stress for couples. Independent of the nature of the actual relationships with in-laws, it may be that couple similarity in perceptions of these ties determines if they undermine or facilitate marital stability. The current study sought to examine how spousal connections to in-laws and concordance about these relationships early in marriage predicted marital stability in a sample of 355 Black and White married couples followed over 16 years. Husbands and wives reported on time spent with families, whose family they turn to for support, and closeness with families during their first year of marriage. Analyses revealed that discordance on these issues early in marriage was common. We found that even after controlling for husband and wife reports of connections with in-laws, discordance on closeness with the wife's family predicted divorce. Thus, when conceptualizing the costs and benefits of connections with in-laws, it is important to consider not only the nature of spouses' ties to each other's families, but the extent to which their views of these ties are concordant.

Racial Differences in Choice and Control Among Older Adults: Results From Connecticut's Money Follows the Person Rebalancing Demonstration.

We examined racial differences in determinants of choice and control in daily activities and service coordination for a sample of White and Black participants in the Connecticut Money Follows the Person (MFP) Rebalancing Demonstration. Within-group analyses were conducted to understand factors that contribute to choice and control among participants. While no disparities were found in the odds of reporting choice and control, our findings show that White participants with mental health challenges, who lived with family, and had more functional impairments and Black participants with engagement transition challenges were less likely to have choice and control over daily activities. Determinants varied by race for choice in service coordination. Findings indicate a need for initiatives to target different factors for White and Black MFP participants to optimize opportunities for choice and control after returning to community living.

IS REFLECTIVE SUPERVISION ENOUGH? AN EXPLORATION OF WORKFORCE PERSPECTIVES.

Infant mental health practice requires the performance of intense emotional labor. Professionals comprising the infant mental health (IMH) field are largely women at seminal points in adult life-span development. The purpose of this article is to explore the day-to-day challenges faced by clinical infant mental health professionals and their perspectives on the supports available for effective job performance. We review reflective supervision as a long-cherished professional support in the IMH field designed to hold the practitioner's fears, worries, and ambivalence, so that she may return to the work fortified to remain in therapeutic alliance with families despite unsolvable problems and an unknowable future (Weatherston, D., 2009). Yet, we propose that reflective supervision alone may not be an adequate protective measure for a workforce performing intensive emotional labor for extended periods and therefore at potentially increased risk for burnout and high turnover (Hochschild, A.R. ; C. Maslach, , C.M. Brotheridge & A.A. Grandey, 2009; A.S. Wharton, ). We suggest that structural factors concerning organizational culture, flexibility in scheduling, and professional growth and versatility bear deeper examination for their merits in supporting the IMH workforce. Finally, we contend that the overrepresentation of women in practitioner positions in IMH leaves an empirical gap where little is known about the experience of male IMH practitioners and the ramifications of their performance of emotional labor.

Perceived Admiration and Transition to Parenthood for Black and White Married Couples.

Perceived admiration was examined in this study as a mediator of marital quality and transition to parenthood among Black American and White American couples. Both positive and negative dimensions of marital quality were assessed for husbands (N = 148) and wives (N = 155) during their first and third years of marriage in a large-scale survey. Findings revealed that transitioning Black American husbands reported lower marital tension than transitioning White American husbands. Perceived admiration mediated the link between transition to parenthood and marital wellbeing for wives, and between transition to parenthood and marital tension for husbands. Results suggest that perceived admiration plays a critical role in understanding the transition to parenthood, regardless of race. Insights are offered for practitioners who provide relationship or parental counseling and education to couples during the transition to parenthood.

Social support sources, types, and generativity: a focus group study of cancer survivors and their caregivers.

Various research studies have identified the sources and types of support that people with cancer receive; however, few have focused on identifying the specific characteristics of emotional, instrumental, and informational support. In this study, focus groups consisting of Gilda's Club members explored the types of support that people with cancer and their caregivers experienced and valued. Results showed that although men and women with cancer and caregivers identify similar sources of support, they experience different types of support. Results also indicated a desire among participants to help and support others, a concept referred to as generativity. Implications for social workers and health care providers are explored.

Early Family Ties and Marital Stability Over 16 Years: The Context of Race and Gender.

Spouses' emotional ties to family early in marriage are linked to marital outcomes, but little is known about how these ties affect marital stability and whether these effects vary by race and gender. The present study examines the links between emotional ties to family of origin and in-laws in the first year of marriage and marital stability over the first 16 years of marriage. Data were collected as part of a longitudinal study following Black American (n=199) and White American (n=174) married couples. Analyses revealed that perceptions of closeness to in-laws early in marriage were associated with odds of divorce over time, but the results varied by race and gender. Findings are discussed in terms of couples' ties to family early in marriage and the role that in-law bonds play for marital stability. We also offer insights for practitioners who provide premarital and marital education and counseling services to couples.

Personal mastery and psychological well-being among young grandmothers.

This study examined the association between relationship quality, personal mastery, and psychological well-being among 83 young Black and White American grandmothers in families with teenage mothers. Interviews were conducted during the early stages of adaptation to grandparenthood due to the birth of a baby to a teenage daughter. Findings indicated that the effects of the mother-daughter relationship are mediated through mastery. When grandmothers feel a sense of mastery, the conflict with the teenage mother is not as detrimental to their psychological health. Findings are discussed in the context of developing supportive services for grandmothers in families with teenage mothers.

DSM-IV 12-month and lifetime major depressive disorder and romantic relationships among African Americans.

BACKGROUND: This brief report examines the association between marital and relationship status and 12-month and lifetime prevalence of major depressive disorder (MDD) among African Americans. Previous work has found that adults with major depressive disorder are less likely to be married or in a cohabiting relationship. This report extends previous research by investigating whether unmarried, non-cohabiting African Americans with depression are also less likely to be involved in a romantic relationship. METHODS: Data are from the African American sub-sample (n=3570) of the National Survey of American Life (NSAL; 2001-2003). The DSM-IV World Mental Health Composite International Diagnostic Interview was used to assess 12-month and lifetime MDD. Weighted logistic regression was used. RESULTS: The findings indicate that for both 12-month and lifetime major depressive disorder, African Americans who are depressed are not only less likely to be married; they are also significantly less likely to be involved in a romantic relationship. This is particularly the case for 12-month depression. LIMITATIONS: Due to limitations in the number of cohabiting respondents, currently married and cohabiting respondents were combined into a single category. CONCLUSION: The findings of this brief report highlight the importance of changes in marital and relationship circumstances of the U.S. population for research and practice on depression and other psychiatric disorders. Our study provides evidence for a more nuanced approach in which examining marital and romantic relationship status together promotes a better understanding of the impact of major depression on romantic unions.

Exploring the dynamics of middle-aged and older adult residents' perceptions of neighborhood safety.

This study examined what variables best predict concerns about neighborhood safety among middle-aged and older adults. Eighty-five participants were selected from a Midwestern urban area. Participants completed a 22-item questionnaire that assessed their perceptions of neighborhood safety and vigilance. These items were clustered as: (a) community care and vigilance, (b) safety concerns, (c) physical incivilities, and (d) social incivilities. Police crime data were also used in the analyses. Our findings suggest that aspects of the broken window theory, collective efficacy, and place attachments play a role in affecting residents' perceptions of neighborhood safety.

Marital Conflict Behaviors and Implications for Divorce over 16 Years.

This study examined self-reported marital conflict behaviors and their implications for divorce. Husbands and wives (N = 373 couples; 47% White American, 53% Black American) reported conflict behaviors in years 1, 3, 7, and 16 of their marriages. Individual behaviors (e.g., destructive behaviors) and patterns of behaviors between partners (e.g., withdrawal-constructive) in Year 1 predicted higher divorce rates. Wives' destructive and withdrawal behaviors decreased over time, whereas husbands' conflict behaviors remained stable. Husbands reported more constructive and less destructive behaviors than wives and Black American couples reported more withdrawal than White American couples. Findings support behavioral theories of marriage demonstrating that conflict behaviors predict divorce and accommodation theories indicating that conflict behaviors become less negative over time.

Care recipients' psychological well-being: the role of sense of control and caregiver type.

The current study tested mediation and moderation hypotheses to examine the link between caregiver type, sense of control, and depressive symptoms in older adult care recipients. All recipients (127 older adults, aged 60-98) reported at least one instrumental activity of daily living impairment and 75% reported at least one activity of daily living limitation. Results indicated that care recipients' depressive symptoms varied by caregiver type and level of sense of control. Recipients with low sense of control and family caregivers reported higher depressive symptoms than those with a low sense of control and non-family caregivers. The findings suggest that although some care recipients have caregivers they may yet experience poor psychological well-being. Implications for practitioners are that in addition to their medical and physical health needs, the psychological well-being of care recipients is also important to consider.