Attachment security and somatization: The mediating role of emotion dysregulation in a sample of Latinx young adults.

BACKGROUND: Somatization has been linked to the underdiagnosis of mental health disorders among individuals from racial and ethnic minority groups, notably among Latinxs. While prior research has emphasized sociocultural factors, the exploration of potential inter- and intrapersonal mechanisms behind somatization remains limited. METHODS: The current study examined the relation between attachment insecurity, emotion dysregulation, and somatization among Latinx young adults. Data were collected across seven separate Texas universities (N = 822). Most identified as female (76 %), were born in the United States (50.9 %) and were in their first or second year of university (60.6 %). RESULTS: Hypothesis testing relied on two mediation models: maternal attachment security and paternal attachment security. The maternal attachment security model significantly predicted somatization, explaining 25 % of the variance. Notably, emotion dysregulation and maternal attachment security had main effects on somatization after accounting for country of origin, age, and gender. Results were similar for the paternal attachment security model. LIMITATIONS: Limitations include skewed gender distribution, a non-clinical college student sample, cross-sectional design preventing causal inferences, and potential bias in self-report measures. CONCLUSIONS: Attachment security and emotion dysregulation play an essential role in the experience of somatic symptoms among Latinx young adults. Our results suggest that health care providers take into account insecure attachment and emotion regulation history of Latinxs presenting with somatic symptoms.

Impact of COVID-19 on Unaccompanied Immigrant Minors and Families: Perspectives from Clinical Experts and Providers.

The number of unaccompanied immigrant minors (UIMs) and families from Central America seeking asylum in the U.S. continues to rise. This growth, combined with restrictive government policies, led to crowded and suboptimal conditions in Customs and Border Patrol and non-governmental organization facilities. COVID-19 further taxed facilities and exacerbated uncertainty surrounding length of detention, basic human rights, and family reunification. The current project features testimonies from the authors who work as clinical experts and providers in Texas - a top destination for Central American immigrants. In collaboration with a deputy director of a not-for-profit human rights organization, volunteer psychologists, and the director of a humanitarian respite center, we describe challenges faced by administrators and clinical staff in addressing the mental health needs of immigrant children and families during the COVID-19 pandemic. The primary themes identified were anti-immigrant policies that occurred concurrently with COVID-19; difficulty implementing COVID-19 protocols alongside scarcity of supplies and volunteers; increased mental health needs among UIMs and immigrant families; and challenges in UIM placement upon release from custody. Strategies for addressing clinical challenges in the near- and long-term and opportunities for improvement in care systems to immigrant youth, including correcting anti-immigrant policies, addressing ongoing COVID-19 protocols and challenges, meeting mental and physical health needs, facilitating release and reunification for unaccompanied immigrant minors, and maximizing youth resilience through trauma-informed interventions, are presented.

Family Separation at the US and Mexico Border Continues.

Record-breaking levels of asylum seeking by families with young children continue at the United States/Mexico border, particularly the Rio Grande Valley sector. In this Commentary, our aim is to increase awareness by providing child and adolescent mental health care providers with an update on current migrant conditions, bringing to light issues of family separation previously highlighted in the Journal.1 For context, our international group has collected data, via 3 large-scale studies funded by the National Institutes of Health, from more than 600 Latinx immigrants seeking asylum at the US/Mexico border in the last 4 years, during which levels of violence, climate disruption, and poverty in the Northern Triangle of Central America (ie, El Salvador, Guatemala, and Honduras) and Mexico have propelled high and sustained levels of asylum seeking in the United States. We contribute expertise in clinical psychology, Latinx psychology, attachment disruption, and public health, as well as this front-row perspective.

A decolonial and liberation lens to social justice research: Upholding promises for diverse, inclusive, and equitable psychological science.

In the face of harmful disparities and inequities, it is crucial for researchers to critically reflect on methodologies and research practices that can dismantle systems of oppression, accommodate pluralistic realities, and facilitate opportunities for all communities to thrive. Historically, knowledge production for the sciences has followed a colonial and colonizing approach that continues to silence and decontextualize the lived experiences of people of color. This article acknowledges the harm to people of color communities in the name of research and draws from decolonial and liberation frameworks to advance research practices and psychological science toward equity and social justice. In this article, we propose a lens rooted in decolonial and liberatory principles that researchers can use to rethink and guide their scientific endeavors and collaborations toward more ethical, equitable, inclusive, respectful, and pluralistic research practices. The proposed lens draws on literature from community psychology and our lessons learned from field studies with historically marginalized Latinx communities to highlight six interrelated tensions that are important to address in psychological research from a decolonizing and liberatory lens. These interrelated tensions involve conflicting issues of (a) power, (b) competence, (c) practices and theories, (d) rationale, (e) approach, and (f) trust. In addition, seven practical recommendations and examples for decolonial and liberatory research practices are outlined. The recommendations can assist researchers in identifying ways to ameliorate and address the interrelated tensions to give way to decolonial and liberatory research practices. Community and social justice scientists have the responsibility to decommission oppressive research practices and engage in decolonization and liberation toward a valid, ethical, equitable, and inclusive psychological science. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interpersonal Trust in Adolescents With Borderline Personality Disorder: Comparisons With Healthy and Psychiatric Controls.

The aim of the current study was to utilize a well-known trust versus lottery paradigm to evaluate interpersonal trust in adolescents with borderline personality disorder (BPD). The study included 126 healthy controls, 59 inpatient adolescents with a diagnosis of BPD, and 137 inpatient adolescents without BPD. Alongside diagnostic measures, a questionnaire-based measure for assessing trust beliefs was administered to probe group differences in trust beliefs and associations between game behavior and trust beliefs. No main effect for group or condition was found. A significant interaction of trial and group was noted, suggesting that across games, psychiatric controls demonstrated the steepest increase in trust over time, followed by the BPD and healthy control groups. Healthy controls evidenced significantly higher levels of trust beliefs compared to BPD and psychiatric controls. Reasons for nonreplication of previously demonstrated anomalous game behavior in adults in this adolescent sample are discussed.

Liderando juntos y revueltos: A collectivistic leadership approach to address Latinx immigrant health and psychological needs.

Psychologists are positioned to help address societal and public health crises in beneficial ways, including collectively working with public sectors to serve marginalized communities. This article highlights the relevance of helping to address societal and public health crises with collectivistic psychological leadership approaches and uses Latinx psychology leaders for addressing the current immigrant needs among Latinx communities. We draw attention to the domains needed for collectivistic psychological leadership that are culturally nuanced and equity, diversity, and inclusion-focused to advance the well-being of historically marginalized immigrant communities. Finally, the article highlights how our collectivistic approach operates in the public sector by describing the creation of the Latinx Immigrant Health Alliance (LIHA) and targeted outcomes. Briefly, the LIHA informally started in 2017 and was founded in 2020 to fill a gap in Latinx immigrant health at the heart of systemic inequalities during the global pandemic, explicit anti-immigrant rhetoric, and anti-Latinx policies. The LIHA aims to collectively work with community organizations to promote Latinx immigration health research, policy, education, training, and effective interventions. We include future directions and opportunities for collectivistic psychological leadership to address today's complex social issues. In particular, we call for the translation of psychological methods and other skills (e.g., research, clinical skills, policy, quantitative and qualitative methodology) into public action for better wellness of our communities, as well as the advancement of social justice, health equity, and inclusion for historically marginalized communities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Exploratory Study of Healing Circles as a Strategy to Facilitate Resilience in an Undocumented Community.

Within the United States (U.S.), the COVID-19 pandemic highlighted critical inequalities affecting undocumented communities and resulting in particularly heightened stress for members of these communities. In addition to the stress associated to COVID-19, immigrants in the U.S. were more than ever subjected to a hostile anti-immigrant climate under Trump's administration. Given this compounded stress, the impact of the pandemic on mental health is likely to be disproportionately experienced by undocumented immigrants. In response, a group of psychologists partnered with a leading immigrant rights advocacy organization and formed a reciprocal collaboration to support undocumented communities. A major focus of the collaboration is to foster learning, supporting members of the immigrant community to contribute to their own well-being and others in the community. Accordingly, the collaborative developed and delivered a web-based mental health education session to the immigrant community and to practitioners serving this population. The session presented the use of healing circles as a strength-based approach to building resilience and also sought feedback regarding specific features of healing circles that can enhance their effectiveness in managing distress. Survey data and qualitative findings from this study show that those who participated in the web-based program perceived the session as validating and informative. Findings also underscored the need for creating safe spaces for community members to be vulnerable about their lived experiences while promoting ownership of their narratives. We discuss practical implications pertaining to the development and facilitation of social support groups for immigrants led by non-specialist community members trained for this role.

Dentro de los Estados Unidos (EE. UU.), la pandemia de COVID-19 acentuó desigualdades críticas que afectan a las comunidades indocumentadas, provocando un nivel de estrés particularmente alto entre los miembros de estas comunidades. Además del estrés asociado con el COVID-19, los inmigrantes en los EE. UU. estuvieron más que nunca sujetos a un clima antiinmigrante y hostil bajo la administración de Trump. Dado este estrés agravado, es probable que los inmigrantes indocumentados experimenten el impacto de la pandemia en su salud mental de manera desproporcionada. En respuesta, un grupo de psicólogos se unió a una organización líder en defensa de los derechos de los inmigrantes y formó una colaboración recíproca para apoyar a las comunidades indocumentadas. Un enfoque central de esta colaboración ha sido fomentar el aprendizaje, apoyando así a los miembros de la comunidad inmigrante para que contribuyan a su propio bienestar y al de los demás en la comunidad. Por consiguiente y a través de esta colaboración, se desarrolló y presentó una sesión de educación en línea sobre salud mental a la comunidad de inmigrantes, así como a los profesionales que sirven a esta comunidad. La sesión presentó el uso de círculos curativos como una estrategia basada en las capacidades para desarrollar la resiliencia y buscó también obtener retroalimentación sobre características específicas de estos círculos que puedan aumentar su efectividad en el manejo de la angustia. Los hallazgos de la encuesta y cualitativos de este estudio muestran que los participantes percibieron la sesión como validante e informativa. Los hallazgos también destacaron la necesidad de crear espacios seguros para que los miembros de la comunidad puedan ser vulnerables sobre sus experiencias vividas mientras se promueve la propiedad de sus narrativas. Discutimos las implicaciones prácticas relacionadas al desarrollo y la facilitación de grupos de apoyo social para inmigrantes dirigidos por miembros de la comunidad capacitados para asumir dicho rol.

Factor structure of the Impact of Events Scale-Revised in Latin American young adults.

OBJECTIVE: More than 550 million people speak Spanish and, yet, psychometric data on psychological instruments in Spanish lags. Given evidence of significant traumatic exposure and distress among Spanish speakers, the aim of the current study was to examine the factor structure of the Impact of Events Scale-Revised (IES-R), in a large sample of Spanish-speaking adults. METHOD: Participants (n = 725) were university students living in Latin America (M = 21.02; SD = 3.12). Most were born in Mexico (77.6%) and the next largest subgroup was from Ecuador (18.9%). Respondents completed the 22-item IES-R. RESULTS: The IES-R mean score was 20.08 (SD = 21.34) and 26.6% of the sample met the cutoff score for clinically significant symptoms. Regarding factor structure, eight different factor structures that have demonstrated a good fit in the extant literature were examined. The one-factor model demonstrated an acceptable fit, χ²(209) = 839.13, p < .0001; root-mean-square error (RMSEA) = 0.06, 95% confidence interval (CI) [0.06, 0.07]; comparative fit index (CFI) = 0.91, Tucker-Lewis index (TLI) = 0.90. The two-factor model demonstrated good fit, χ²(208) = 746.70, p < .0001; RMSEA = 0.06, 95% CI [0.05, 0.06]; CFI = 0.92, TLI = 0.91, and nested model comparisons of the two-factor and one-factor models using the chi-square difference test supported the two-factor model. CONCLUSIONS: The most parsimonious of the multifactor models, a two-factor model with Avoidance symptoms as one factor and Intrusions and Hyperarousal combined into a second may be of greatest use for this particular version of the IES-R. The current research demonstrates strong psychometric support for Intrusion/Hyperarousal and Avoidance subscales when measuring traumatic stress in Spanish speakers and underscores the need for culturally and contextually sensitive assessment in this population, in which posttraumatic stress is prevalent. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Buscando la Calma Dentro de la Tormenta: A Brief Review of the Recent Literature on the Impact of Anti-Immigrant Rhetoric and Policies on Stress Among Latinx Immigrants.

The mental health burden associated with anti-immigrant rhetoric and ever-changing immigration policies is undeniable, though the psychological and emotional sequalae may remain invisible for years to come. Exclusionary immigration policies, as a form of structural racism, have also led to an epidemic of stress-related health within the Latinx community, particularly the Latinx immigrant community, across the United States. Recent examples of anti-Latinx and anti-immigrant rhetoric and policies include the 45th President's implementation of the Zero Tolerance policy, Migrant Protection Protocols, and Title 42. The recognition of previous and existing anti-immigrant policies, and the impact on Latinx immigrants, is critical in understanding the manifestation of psychological stress to prevent it from becoming chronic. For mental health providers, attention to existing policies that can be detrimental to the Latinx immigrant community is essential to understanding their mental health trajectory and applying frameworks that honor an individual's psychological stress to prevent pathologizing the immigrant experience and negative health outcomes. The objective of the present brief review is to shed light on recent research and offer recommendations for practice (eg, educating the Latinx community about the link between the immigrant experience and psychological stress) and policy (eg, drafting of legislation aimed at rescinding harmful immigration policies) regarding the relation between aggressive anti-immigration rhetoric and psychological stress among Latinx immigrants in the United States.

First data and translation of the Child Attachment Interview en Español.

The Child Attachment Interview (CAI) was designed to assess attachment representation in middle childhood-filling a gap between behavioral paradigms and adult interviews-and has demonstrated adequate psychometric properties in middle childhood and adolescence. To date, the CAI has not been available in Spanish, given the absence of an accepted translation and psychometric data. Spanish is the second most spoken language in the world, and assessment of attachment in an individual's native language is critical given differences in emotional processing, memory, and disclosure in first versus second languages. We translated the CAI (with consultation from its creator) utilizing standardized translation and back-translation procedures and examined its psychometric properties in a sample of Spanish-speaking high school students. In this study, we report on that process and data gathered from N = 94 Spanish-speaking adolescents in grades 9-12; 20% were double-coded and interrater reliability was acceptable. Findings support the single factor "Security-Dismissal" model, and relations between classifications and subscales were consistent with previous findings. Support for convergent and discriminant validity was provided for both classifications and subscales; however, concurrent validity varied across classifications and subscales. In sum, our translation demonstrates psychometric promise for the assessment of internal working models of attachment in Spanish-speaking high school students. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Insecure Adult Attachment Style and PTSD Symptom Severity among Firefighters: The Role of Distress Tolerance.

Trauma exposure and posttraumatic stress disorder (PTSD) symptoms among firefighters are prevalent and well-documented. Insecure adult attachment style (AAS) and distress tolerance (DT) present two factors with demonstrated relevance to the etiology and maintenance of PTSD. Few studies have examined these constructs in relation to PTSD symptomatology among firefighter populations. The present investigation examined the indirect effect of insecure romantic AAS (i.e., anxious AAS, avoidant AAS) on PTSD symptom severity through DT among firefighters. Exploratory analyses examined this model with each of the PTSD symptom clusters as outcomes. The sample was comprised of 105 firefighters (Mage=40.43, SD=9.15, 95.2% male) recruited from various departments in the southern U.S. An indirect effect was calculated using 10,000 bootstrapped samples. Indirect effects models in the primary analyses were significant when both anxious AAS (ß=.20, SE=.10, CI=.06-.43) and avoidant AAS (ß=.28, SE=.12, CI=.08-.54) were evaluated as predictors. Effects were evident after accounting for gender, relationship status, years of fire service, and trauma load (i.e., number of potentially traumatic event types experienced). Exploratory analyses revealed that anxious and avoidant AAS are both indirectly related to the PTSD intrusion, negative alterations in cognitions and mood, and alterations in arousal and reactivity symptom clusters through DT. Anxious AAS also demonstrated an indirect association with PTSD avoidance symptoms through DT. Attachment styles may influence PTSD symptoms among firefighters through a firefighter's perceived ability to withstand emotional distress. This line of inquiry has potential to inform specialized intervention programs for firefighters. Clinical and empirical implications are discussed.

Applying an Antiracist Approach to Promoting Health Equity and Psychological Well-Being in Unaccompanied Immigrant Minors.

Unaccompanied immigrant minors (UIMs) are a fast-growing demographic in the United States, doubling in population since 2014.1 According to the Office of Refugee Resettlement, a UIM is someone under the age of 18 years who enters the United States without lawful status and an accompanying guardian.2 Most UIMs in the United States originate from the Central American northern triangle (ie, El Salvador, Guatemala, Honduras), with violence, extreme poverty, and family re-unification as the top 3 reasons for migration.1,3 Repeated exposure to stressful and/or traumatic events at home, during migration, and upon arrival increases UIMs' risk for psychological distress and mental disorders.3 UIMs' repeated encounters with race-based trauma (eg, racism, discrimination) further heightens this risk.3 The repercussions of these events are compounded by the fact that UIMs lack the adversity buffering effect that is traditionally associated with the presence of a caregiver.3 Furthermore, UIMs' mental health risk is augmented by their interaction with US systems (eg, legal, immigration, child welfare, educational, healthcare) with policies and practices that are discriminatory, are exclusionary, propagate the view of UIMs as racialized threats to society, and fail to consider their developmental context.3,4 Considering these risks, it is imperative to the well-being and positive development of UIMs that they have access to quality mental health services (MHS).

Trust Beliefs in Significant Others, Interpersonal Stress, and Internalizing Psychopathology of Adolescents with Psychiatric Disorders.

This study examined relations between trust beliefs in significant others (TBSO), interpersonal stress, and internalizing psychopathology for adolescents with psychiatric disorders. Two hundred and thirty-four adolescents from an acute inpatient unit (154 females, Mage = 14.72 years, SD = 1.39 years) completed standardized scales/interviews that assessed TBSO (mother, father, teacher, peers and TBSO as a total score), interpersonal stress, and internalizing psychopathology. It was found that adolescents' TBSO and trust beliefs in each significant other were negatively associated with interpersonal stress and internalizing psychopathology. The findings confirmed that the relation between the adolescents' interpersonal stress and internalizing psychopathology was moderated by TBSO, trust beliefs in mother, and trust beliefs in peers. The findings supported the conclusion that holding elevated TBSO (particularly trust beliefs in mother and peers) by adolescents with psychiatric disorders promotes their psychosocial adjustment including their resilience to the effects of interpersonal stress on internalizing psychopathology.

Can Sleep Facilitate Adaptation for Immigrant High Schoolers? Longitudinal Relations Between Sleep Duration, Acculturative Stress, and Acculturation.

Rising rates of youth migration are occurring globally and, thus, the adaptation of immigrant youth to their host country's cultural norms is a pressing public health concern. Indeed, both acculturation and acculturative stress are associated with mental health for immigrant youth. The broad aim of this study was to examine how sleep duration would prospectively relate to acculturation (Short Acculturation Scale) and acculturative stress (Social, Attitudinal, Familial, and Environmental Acculturative Stress Scale) following migration for N = 110 immigrant high school students across 1 year. We hypothesized that acculturation would increase, and acculturative stress would decrease over the course of 1 year of data collection. We found evidence of both anticipated longitudinal changes, with significant slope parameters that were of opposite direction (i.e., acculturation positive, acculturative stress negative). Longer sleep duration at baseline was predictive of both greater increase in acculturation and greater decrease in acculturative stress over 1 year.

Trauma in the American asylum process: Experiences of immigrant families under the migrant protection protocols.

OBJECTIVE: Latinx asylum-seeking families report posttraumatic distress that is 161-204% higher than in nonimmigrants, with adverse consequences for health and well-being. Recent U.S. policies have further embedded trauma in the asylum-seeking process by forcing families to remain in Mexico, enduring dire living conditions in tent encampments near the border while awaiting processing. These families are now entering the United States in large numbers. This article sheds light on their recent experiences and mental health needs, using a mixed methods-grounded theory design, presenting quantitative and qualitative data to describe the experiences of six asylum-seeking families who waited for 1-2 years in the refugee camp in Mexico. METHOD: Quantitative data was obtained from the Brief Symptom Inventory-18 and the Harvard Trauma Questionnaire while qualitative interviews provided insight into reasons for migration and trauma at different stages of the migration process. RESULTS: All participants experienced multiple traumas and endorsed trauma related symptoms. Important themes of psychological distress and trauma emerged, including unending suffering, hunger, and worry for the safety of their children while living in the refugee camp. Asylum-seeking families experienced substantial distress and trauma secondary to their stay in Mexico and COVID-19. CONCLUSION: Families arriving to the United States have experienced significant trauma, separation, and loss before and during their journey. Interactions with an unprepared and overwhelmed immigration system further compromises their psychological well-being. It is imperative that first-person narratives inform policy that addresses their complex needs and protects their human rights. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A strong contender for mental health screening in Latinx immigrant youth: Psychometric properties of the Strengths and Difficulties Questionnaire.

Latinx youth seeking asylum in the U.S. experience mental health disparity due to exposure to trauma and adversity. Health systems and schools in the U.S. are unprepared to screen for psychopathology in this population, much of which is mono-lingual Spanish-speaking, due to the absence of psychometrically-vetted instruments. The Strengths and Difficulties Questionnaire (SDQ) has strong empirical support as a mental health screener in other demographics. However, there has been no psychometric research in Spanish-speaking immigrant youth and, therefore, the utility in this population remains unknown. The aims of the current study were to examine the SDQ's (a) internal structure, (b) factor structure, (c) test-retest reliability, and (d) concurrent validity. Results are based on N = 110 recently immigrated high school students (60% male, Mage = 19) who completed the SDQ in Spanish. Findings provided support for the Total Score, which displayed evidence of internal consistency, test-retest reliability, and concurrent validity with the Child Behavior Checklist. However, support for the use of the SDQ's subscale scores was limited. In sum, the SDQ Total Score holds promise as a screening instrument for recently immigrated Latinx youth in clinical, health, and educational settings, and use of the subscales requires future research and refinement.

Familismo neutralizes the effects of discrimination on suicide-related thoughts and behaviors in Latinx young adults.

In recent years, there has been a significant increase in rates of suicide-related thoughts and behaviors among Latinx young adults. Given Latinx young adults are one of the fastest growing subgroups in the United States, this raises significant public health concern. Perceived discrimination has consistently been identified as a risk factor and has been positively associated with depressive symptoms, further exacerbating risk for the development of suicide-related thoughts and behaviors. Critical to understanding Latinx mental health is familismo, a core cultural value that entails connectedness, dedication, commitment, and loyalty to family. Moreover, it involves seeking family for advice and support. The current study sought to examine depressive symptoms as mediator for the relation between perceived discrimination and suicide-related thoughts and behaviors while investigating familismo as a moderator in attenuating these relations within a college aged Latinx sample (N = 1037, 75.3% female, Mage = 21, SD = 4.49). Across models, depressive symptoms explained the relation between perceived discrimination and suicide-related thoughts and behaviors (p ≤0.001-0.024) with familismo significantly acting as moderator (p = .009). In exploring the protective effects of an important Latinx cultural value on a growing public health disparity, the current study provides novel insight that may be used to tailor and adapt current intervention and prevention efforts for Latinx young adults at risk for suicide-related thoughts and behaviors.

Attachment, loss, and related challenges in migration.

Attachment theory-built on the knowledge that infants have an innate need to form an attachment bond with a caregiver and that separation from or loss of that caregiver has a lasting impact on the child's development-is a useful lens through which to examine the consequences of family separation due to migration. The aim of this review was to highlight the impacts of separation due to migration on children's attachment security and psychosocial outcomes to illustrate that family separation-regardless of whether is it "chosen" by a family who sees no other path towards safety or prosperity or inflicted by legal policies associated with immigration, detention, and deportation-negatively affects children's attachment security with serious consequences for their well-being.

Does coding internal working models of attachment have to be so hard?

The Child Attachment Interview (CAI) has demonstrated promise in youth, yet widespread use is thwarted by the need for interview transcription, face-to-face training, and reliability certification. The present study sought to examine the empirical basis for these barriers. Thirty-five archival CAIs were re-coded by: (1) expert coders (i.e., trained and reliable) without access to transcripts, (2) trained coders who had not completed reliability training, and (3) novice coders who had no formal training. Agreement with consensus classifications was computed with the expectation of moderate agreement. Results supported coding by experts without transcription of the interview. Near-moderate agreement preliminarily supported the use of trained coders who have not attempted reliability certification with appropriate caveats. While moderate agreement was not achieved for novice raters, findings suggest that self-paced training options for the CAI may hold future promise. These contributions erode a number of significant barriers to the current use of the CAI.