Papers by Joseph A . Bianco
Health Communication
The integration of art therapy in medicine is expanding as are calls to strengthen its evidence b... more The integration of art therapy in medicine is expanding as are calls to strengthen its evidence base of clinical outcomes. In this essay, we elevate the voices of non-clinically based artists who work in community and home settings. Although we do not discount the value of art therapy, we add nuance and complexity to clinical and society narratives about art and health by bringing into focus experiential intent and outcome as well as context to explore the meaning-making capacity of the arts. We argue: (1) aesthetic experiences can foster self-expression, relational development, and employment beyond medically identified goals and treatment plans; and, (2) Equating community-based art programming with art therapy oversimplifies our understanding of art and health and does a disservice to both.
Health Communication, 2018
This essay offers a layered account of the origins and enactment of a narrative medicine program ... more This essay offers a layered account of the origins and enactment of a narrative medicine program at the Ohio University Heritage College of Osteopathic Medicine titled the Open Book Project (OBP). Narrative medicine positions clinical judgment as involving both scientific and narrative reasoning, a set of practices particularly well-suited to fostering inclusive health care and social justice. The OBP involved first-year medical students who met bimonthly to witness, reflect on, and write about literary passages, visual images, music and lyrics, and other works of art. Sessions also provided opportunities for participants to attentively listen and respond to others, opening themselves to diverse ways of knowing and being. The authors move between academic literature, participants' compositions developed during the project, and students' testimonies to illustrate the dividends and difficulties of narrative medicine.
Handbook of Borderline Personality Disorder in Children and Adolescents, 2014
Rural and remote health, Oct 16, 2009
In rural regions of the United States of America, estimates of pediatric obesity often exceed nat... more In rural regions of the United States of America, estimates of pediatric obesity often exceed national averages. This problem may be particularly pronounced in Appalachian regions, where significant health and economic disparities abound. This study presents the findings of a body mass index (BMI) screening program for 6-11 year old children living in a rural Appalachian community. County-wide estimates of high BMI (>or=85th percentile) were obtained to understand the health status and needs of our pediatric community and to compare obesity prevalence rates with national averages. An additional aim was to identify subpopulations of children who may warrant clinical intervention due to demographic and behavioral risks factors of high BMI. A school-based BMI screening was conducted of 6-11 year old children in southeastern Ohio. Investigators collected 3 sets of height and weight measurements from approximately 2000 elementary school students between 2006 and 2007. Caregivers for a...
Rural and Remote Health
In rural regions of the United States of America, estimates of pediatric obesity often exceed nat... more In rural regions of the United States of America, estimates of pediatric obesity often exceed national averages. This problem may be particularly pronounced in Appalachian regions, where significant health and economic disparities abound. This study presents the findings of a body mass index (BMI) screening program for 6-11 year old children living in a rural Appalachian community. County-wide estimates of high BMI (≥85 th percentile) were obtained to understand the health status and needs of our pediatric community and to compare obesity prevalence rates with national averages. An additional aim was to identify subpopulations of children who may warrant clinical intervention due to demographic and behavioral risks factors of high BMI. Methods: A school-based BMI screening was conducted of 6-11 year old children in southeastern Ohio. Investigators collected 3 sets of height and weight measurements from approximately 2000 elementary school students between 2006 and 2007. Caregivers for a subset of this population also completed a health behaviors questionnaire. Results: Thirty-eight percent of children had high BMI, with 17% at risk for overweight and 20.9% overweight. Boys were 23% more likely than girls to be overweight (χ 2 (1) = 95% CI = 1.08, 1.40) and 11% more likely to become overweight with each year of age (OR = 1.11, 95% CI = 1.07, 1.15). Overweight children were more likely to view television, eat meals at school, and live with a caregiver who smokes. Conclusions: Consistent with expectations, prevalence of high BMI in this sample of rural Appalachian children exceeds national averages. Prevalence of overweight varied by age and sex; boys are particularly vulnerable to developing obesity, especially as © K Montgomery-Reagan, JA Bianco, V Heh, J Rettos, RS Huston, 2009. A licence to publish this material has been given to ARHEN http://www.rrh.org.au 2 they age. Preliminary survey data suggest that eating breakfast at home and at school and increased hours of television viewing may be associated with higher BMI, especially in younger boys.
African Journal of AIDS Research
In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, sugg... more In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, suggesting that many other people remain undiagnosed. Stigma related to HIV/AIDS is prevalent and contributes to low testing rates and under-diagnosis of the virus. Identifying factors that contribute to stigma, such as insufficient or inaccurate knowledge of HIV/AIDS, may be critical in increasing early identification and treatment. This cross-sectional study used nationally representative data from the 2013 Botswana AIDS Impact Survey (BAIS) IV to examine the relationship between HIV/AIDS knowledge and stigmatising attitudes toward people living with HIV/AIDS (PLWHA). The mean (standard error) for stigma towards PLWHA score and HIV/AIDS knowledge score were 0.99 (0.02) and 5.90 (0.03) respectively. HIV/AIDS knowledge score and stigma towards PLWHA score were strongly positively correlated r (4,4045) = 0.415, p < 0.001). After adjusting for potential confounders, HIV/AIDS knowledge score significantly predicted stigma towards PLWHA score [coefficient β (95% CI)] [−0.25 (−0.29, −0.20), p < 0.001]. These findings imply that programmes and interventions that increase HIV/AIDS knowledge may reduce the pervasive apprehension, blame, and stigmatising attitude held towards PLWHA in Botswana.
School Mental Health, 2016
Poverty lack of resources and pervasive adversity threaten the healthy social and emotional devel... more Poverty lack of resources and pervasive adversity threaten the healthy social and emotional development of many children living in rural Appalachia. Despite these traumatic stressors, however, Appalachian residents have proven surprisingly resilient and responsive to intervention. This article describes the twin efforts of the Partnerships Program for Early Childhood Mental Health and Project LAUNCH, a community-university-state initiative, to transform school systems by establishing enduring partnerships within and across schools and agencies, pooling and disseminating critical resources, and strengthening the skills, confidence and capacity of the early childhood education workforce. This article describes the three-tiered framework of services implemented at the schools, with special emphasis on its trauma-informed training for educators combined with trauma-specific mental health interventions delivered on site. Despite a modest sample size, results indicate significant pre-improvement/post-improvement in teacher confidence and hopefulness in positively impacting challenging child behaviors; a decrease in the negative attributes of the preschool learning environment; and increased teacher ratings of child resilience as measured by the Devereux Early Child Assessment. Program limitations and future directions for creating trauma-informed Appalachian schools are discussed.
Annals of Global Health, 2015
The Journal of the American Osteopathic Association, 2015
Context: Current osteopathic medical students will play an important role in implementing, modify... more Context: Current osteopathic medical students will play an important role in implementing, modifying, and advocating for or against the Patient Protection and Affordable Care Act (ACA) of 2010. Accordingly, medical educators will need to address curricular gaps specific to the ACA and medical practice. Research that gauges osteopathic medical students' level of understanding of the ACA is needed to inform an evidence-based curriculum. Objective: To assess first-and second-year osteopathic medical students' beliefs about the ACA. Methods: In this descriptive cross-sectional survey-based study, first-and secondyear students were recruited because their responses would be indicative of what, if any, information about the ACA was being covered in the preclinical curriculum. A 30-item survey was distributed in November 2013, after the health insurance exchanges launched on October 1, 2013. Results: A total of 239 first-and second-year osteopathic medical students completed the survey. One hundred ten students (46%) disagreed and 103 (43.1%) agreed that the ACA would provide health insurance coverage for all US citizens. The ACA was predicted to lead to lower wages and fewer jobs (73 students [30.5%]), as well as small business bankruptcy because of employees' health insurance costs (96 [40.2%]). Regarding Medicare recipients, 113 students (47.3%) did not know whether these individuals would be required to buy insurance through the health insurance exchanges. The majority of students knew that the ACA would require US citizens to pay a penalty if they did not have health insurance (198 [82.8%]) and understood that not everyone would be required to purchase health insurance through health insurance exchanges (137 [57.3%]). Although students took note of certain clinical benefits for patients offered by the ACA, they remained concerned about the ACA's impact on their professional prospects, particularly in the area of primary care. Conclusion: These findings build on the existing literature that emphasize the need for incorporating into the osteopathic medical curriculum knowledge of the dynamics of health care policy and reform and for creating opportunities for students to follow health policy developments as they evolve in real time.
The Journal of the American Osteopathic Association, 2013
Context: Many studies have reported a decline in empathy as allopathic medical students progress ... more Context: Many studies have reported a decline in empathy as allopathic medical students progress through medical school. Data are needed to compare the pattern of changes in empathy in osteopathic and allopathic medical students. Also, it is important to investigate the associations between measures of empathy and attitudes toward interprofessional collaboration, which are among major elements of professionalism in medicine. Objectives: (1) To investigate correlations between empathy and interprofessional collaboration in osteopathic medical students; (2) to examine differences in empathy and interprofessional collaboration scores by sex, class year, and specialty interest; and (3) to compare empathy scores by class year between osteopathic and allopathic medical students. Design: Correlational and comparative study. Setting: Ohio University Heritage College of Osteopathic Medicine. Participants: Osteopathic medical students enrolled in academic year 2011-2012. Main Outcome Measures...
Health Communication, 2011
... There was little doubt in my mind that I would major in English; born of literary-minded pare... more ... There was little doubt in my mind that I would major in English; born of literary-minded parents and encouraged to read at an early age, I was raised between the covers of books. When Atari hit the scene and Pacman consumed my friends, I, in turn, consumed stories. ...
AIDS and Behavior, 2013
This clinical trial tested whether telephoneadministered supportive-expressive group therapy or c... more This clinical trial tested whether telephoneadministered supportive-expressive group therapy or coping effectiveness training reduce depressive symptoms in HIV-infected older adults. Participants from 24 states (N = 361) completed the Geriatric Depression Scale at pre-intervention, post-intervention, and 4-and 8-month follow-up and were randomized to one of three study arms: (1) 12 weekly sessions of telephone-administered, supportive-expressive group therapy (tele-SEGT; n = 122); (2) 12 weekly sessions of telephone-administered, coping effectiveness training (tele-CET; n = 118); or (3) a standard of care (SOC) control group (n = 121). Tele-SEGT participants reported fewer depressive symptoms than SOC controls at post-intervention (M SEGT = 11.9, M SOC = 14.3) and 4-(M SEGT = 12.5, M SOC = 14.4) and 8-month follow-up (M SEGT = 12.7, M SOC = 14.5) and fewer depressive symptoms than tele-CET participants at post-intervention (M SEGT = 12.4, M CET = 13.6) and 8-month follow-up (M SEGT = 12.7, M CET = 14.1). Tele-CET participants reported no statistically significant differences from SOC controls in GDS values at any assessment period. Tele-SEGT constitutes an efficacious treatment to reduce depressive symptoms in HIV-infected older adults.
Encyclopedia of Health Communication, 2014
Therapy. A type of cognitive behavioral therapy mainly used to treat Borderline Personality Disor... more Therapy. A type of cognitive behavioral therapy mainly used to treat Borderline Personality Disorder (BPD). Four Skill Modules: Mindfulness Distress tolerance Interpersonal effectiveness Emotion regulation Mindfulness Module. Cultivating the wise mind, "what" skills and "how" skills, observing, non-judging, being fully present, staying focused on your goals.
Journal of psychosomatic research, 2018
The working alliance predicts improvement following general psychotherapy, but how it operates in... more The working alliance predicts improvement following general psychotherapy, but how it operates in brief interventions conducted with medically ill patients is unknown. Also, the role of the working alliance may differ in emotion-focused versus educational interventions. We report secondary analyses of a randomized clinical trial (Keefe et al.) [35], in which patients with rheumatoid arthritis (RA) received four nurse-provided sessions of either a) Clinician-assisted Emotional Disclosure (CAED), which emphasized the disclosure, expression, and processing of emotions related to stressful events; or b) Arthritis Education (AE), which provided basic education about RA. The Working Alliance Inventory was completed by both patient and nurse after each session. Patients were evaluated on multiple health measures at baseline and 1, 3, and 12months post-treatment. Analyses compared the alliance between interventions and related the alliance to outcomes within interventions. Patients in CAED ...
Http Dx Doi Org 10 1089 Chi 2010 0508, Nov 11, 2010
In addition, impoverished rural families lack education and resources to make healthy dietary cho... more In addition, impoverished rural families lack education and resources to make healthy dietary choices, and often spend less time in recreational exercise.79 These risk-factors and unique barriers challenge rural health profes-sionals to create comprehensive, affordable, and ...
UMI, ProQuest ® Dissertations &amp; Theses. The world&#x27;s most comprehensive collectio... more UMI, ProQuest ® Dissertations &amp; Theses. The world&#x27;s most comprehensive collection of dissertations and theses. Learn more... ProQuest, Therapists&#x27; willingness to self-disclose as a function of theoretical orientation and client diagnosis. ...
Clinical Psychology & Psychotherapy, 2015
Telepsychology research has focused primarily on treatment efficacy, with far less attention devo... more Telepsychology research has focused primarily on treatment efficacy, with far less attention devoted to how common factors relate to teletherapy outcomes. This research identified trajectories of depressive symptom relief in 105 older people living with HIV with elevated depressive symptoms enrolled in a randomized clinical trial testing two 12-session group teletherapies and compared common factors (e.g., therapeutic alliance and group cohesion) across depressive symptom trajectory groups. Growth mixture modelling of weekly depression scores identified three depressive symptom change groups: (1) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;early improvers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (31%) who reported reductions in depressive symptoms by Session 4; (2) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;delayed improvers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (16%) whose symptoms improved after Session 5 and (3) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;non-improvers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (53%). Therapeutic alliance was unrelated to treatment outcome group. Group cohesion was greater in early improvers than non-improvers. Group cohesion was unexpectedly lower, and group member similarity was greater in delayed improvers than non-improvers. Early improvers had been living with HIV/AIDS for fewer years than non-improvers. In group teletherapy, group cohesion and group member similarity are more important than client-therapist alliance. Copyright © 2015 John Wiley &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sons, Ltd. In group teletherapy with older people living with HIV (OPLWHIV), three latent outcome trajectory groups emerged over the 12-week treatment period: (1) non-improvers (53%); (2) early improvers (31%) and (3) delayed improvers (16%). In group teletherapy with OPLWHIV, group cohesion is a stronger predictor of depressive symptom relief than is client-therapist alliance. OPLWHIV in group teletherapy who do not respond to treatment until the latter therapy sessions can still experience depressive symptom relief comparable with early responders.
Behavioral Medicine, 2014
Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but a... more Older adults living with HIV/AIDS experience high rates of depression and suicidal ideation but are less likely than their younger counterparts to seek psychological services. HIV continues to disproportionately impact older men who have sex with men (MSM), many of whom were infected in their 20s and 30s. This study examined whether therapy attendance rates and the efficacies of two group-format teletherapies for the treatment of depression (coping effectiveness group training and supportive-expressive group therapy) were comparable for older MSM and older heterosexuals living with HIV. Intervention-outcome analyses found that older MSM and older heterosexuals living with HIV attended comparable numbers of teletherapy sessions. Older heterosexuals living with HIV who received telephone-administered supportive-expressive group therapy reported significantly greater reductions in depressive symptoms than SOC controls. A similar pattern was not found in older MSM. More research is needed to personalize and tailor group teletherapies for older MSM living with HIV.
AIDS and Behavior, 2011
This study characterized rates and correlates of ART adherence in 242 HIV-infected persons 50+ ye... more This study characterized rates and correlates of ART adherence in 242 HIV-infected persons 50+ years of age. Hierarchical regressions tested a model in which depression mediated the relationships between social support and avoidance coping with ART adherence. Results indicated low rates of consistent and timely adherence in both men (48%) and women (51%). For men and women alike, social support and avoidance coping predicted depression. Although rates of adherence and predictors of depression did not differ by gender, predictors of adherence did. Avoidance coping, social support and depression predicted ART adherence in older men, but not in older women. Contrary to expectations, depression did not mediate the relationships of coping and social support with ART adherence for either gender. These findings suggest that while HIV-infected older men and women share similar paths toward depression, they diverge in predictors of adherence. Adherence interventions may be more efficacious if they are sensitive to gender differences, although more research is first needed to identify factors related to adherence in HIV-infected older women.
Clinical Psychology & Psychotherapy, 2015
Telepsychology research has focused primarily on treatment efficacy, with far less attention devo... more Telepsychology research has focused primarily on treatment efficacy, with far less attention devoted to how common factors relate to teletherapy outcomes. This research identified trajectories of depressive symptom relief in 105 older people living with HIV with elevated depressive symptoms enrolled in a randomized clinical trial testing two 12-session group teletherapies and compared common factors (e.g., therapeutic alliance and group cohesion) across depressive symptom trajectory groups. Growth mixture modelling of weekly depression scores identified three depressive symptom change groups: (1) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;early improvers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (31%) who reported reductions in depressive symptoms by Session 4; (2) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;delayed improvers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (16%) whose symptoms improved after Session 5 and (3) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;non-improvers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; (53%). Therapeutic alliance was unrelated to treatment outcome group. Group cohesion was greater in early improvers than non-improvers. Group cohesion was unexpectedly lower, and group member similarity was greater in delayed improvers than non-improvers. Early improvers had been living with HIV/AIDS for fewer years than non-improvers. In group teletherapy, group cohesion and group member similarity are more important than client-therapist alliance. Copyright © 2015 John Wiley &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Sons, Ltd. In group teletherapy with older people living with HIV (OPLWHIV), three latent outcome trajectory groups emerged over the 12-week treatment period: (1) non-improvers (53%); (2) early improvers (31%) and (3) delayed improvers (16%). In group teletherapy with OPLWHIV, group cohesion is a stronger predictor of depressive symptom relief than is client-therapist alliance. OPLWHIV in group teletherapy who do not respond to treatment until the latter therapy sessions can still experience depressive symptom relief comparable with early responders.
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Papers by Joseph A . Bianco
Presenter: Joe Bianco, Ph.D.
Learning Objectives:
1. Participants will learn how chronic exposure to toxic stress and complex trauma affect the neurobiological, social, and emotional development of children.
2. Participants will learn the diagnostic criteria and rationale for Developmental Trauma Disorder, a new diagnosis proposed for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders.
3. Participants will discuss the treatment implications and recommendations for working with children with Developmental Trauma Disorder.
Outline:
1. Introduction
• Manifestations of trauma and adverse events in childhood
• Prevalence and impact on child development
• Why PTSD is not a suitable diagnosis for children suffering from trauma
2. Developmental Trauma Disorder
• Background and rationale
• Proposed criteria
• Discussion: does this proposed disorder fit your clinical experiences?
3. Clinical Implications/Treatment Recommendations
• Establishing safety
• Helping children achieve mastery and pleasure
• Dealing with traumatic triggers and re-enactments
• Promoting bodily awareness and symptom control
• Perry’s “vaccine” against childhood trauma
Ohio University Inn and Conference Center
331 Richland Avenue, Athens, Ohio
Wednesday, June 23, 2010
8:30 a.m. to 12:00 noon
This conference will be of interest to teachers, health professionals and others who are positioned to identify and provide intervention to children and families impacted by traumatic stress.
Agenda
8:00 a.m. – 8:25 a.m. Registration and Continental Breakfast
8:25 a.m. – 8:30 a.m. Welcome and Introductions
8:30 a.m. – 9:00 a.m. The Many Faces of Trauma
Joseph Bianco, Ph.D.
9:00 a.m. – 9:30 a.m. Trauma, Toxic Stress, and Early Brain Development
Joseph Bianco, Ph.D.
9:30 a.m. – 10:00 a.m. Working with Families Experiencing Traumatic Stress
Joseph Bianco, Ph.D.
10:00 a.m. – 10:15 a.m. Break
10:15 a.m. – 11:00 a.m. The Impact of Traumatic Event Exposure on Children
Amanda Adams-Mock, Psy.D.
11:00 a.m. – 11:45 a.m. How to Respond to Children Who Have Experienced Trauma
Amanda Adams-Mock, Psy.D.
11:45 a.m. – 12:00 p.m. Questions/Answers/Evaluation
12:00 p.m. Adjournment & Awarding of Certificates of Attendance
You must attend the whole program and turn in an evaluation form in order to receive CE credit.
This program is funded by the Ohio Children’s Trust Fund, awarded by the Athens County Family and Children’s First Council.
Presenters:
Joseph Bianco, Ph.D.: Dr. Bianco obtained his Ph.D. in Clinical Psychology from Columbia University and completed an internship at Beth Israel Medical Center, NYC, where he trained in individual, couples, group and family therapy. His clinical work has focused on adult survivors of childhood trauma and abuse. More recently, he completed a post doctoral fellowship in clinical health psychology at Ohio University. Related clinical and research interests include the long-term effects of early childhood trauma on health and social development, and the use of storytelling and narrative interventions in trauma therapy. Dr. Bianco currently works at Ohio University’s College of Osteopathic Medicine.
Amanda Adams-Mock, Psy.D. Dr. Adams-Mock obtained her degree from Marshall University. She has trained with experts in the field of traumatic stress. Her research experience includes domestic violence, traumatic stress, and anxiety disorders. She also served as a research associate in a federal grant program investigating the social and emotional development of Appalachian children. Currently she is the manager of a child abuse prevention program, Project CRAFT, which she developed and obtained grant funding for this program which targets families at-risk.
Continuing education credit has been submitted for nurses, psychologists, counselors and social workers.
Joseph A. Bianco, PhD; Andy Wapner, DO; Molly Malone-Prioleau, MS, OMS-II; Gabriel Angel Martos, MD, PhD; Karen Montgomery-Reagan, DO; Michael Kushnik, PhD, & Jay Shubrook, DO.
Presenters:
In the past four decades, pediatric obesity rates have tripled, placing children at risk for adverse medical and psychosocial conditions later in life. Unfortunately, our awareness of the obesity crisis far exceeds our ability to effectively treat it. Concomitant psychological conditions, like depression and body image dissatisfaction, pose formidable barriers to treatment. Given obesity’s wide reach, it is important to expand treatment interventions beyond the pediatrician’s office. Indications exist that the most promising treatments are cross-disciplinary, target parents and children, and occur in familiar settings. In addition, because weight management requires ongoing lifestyle changes, behavior modification skills may enhance treatment outcome.
This presentation describes Take Action 2 (TA2), a multidisciplinary community-based program designed to enhance metabolic health, increase exercise capacity and improve self-image of overweight children, adolescents and their parents. In addition to TA2’s nutrition and exercise interventions, a psychosocial program was designed to assess and monitor participants’ depressive symptoms and body image perceptions through the course of the intervention. The program also aimed to teach participants ways to implement health behavior changes relevant to weight management. Toward that end, a skills-based didactic curriculum was created and delivered to two cohorts of children (ages 6-11 and 12-17) and their parents. The curriculum was specifically adapted to accommodate the unique cultural needs of its rural Appalachian participants. This presentation describes both the content of the program and the process of teaching a health and wellness curriculum to a rural population. It concludes with recommendations for rural communities seeking to implement similar programs.
Proposal Information
Category: Lecture/Discussion (60 minutes)
1. Description of the session
We propose a 60-minute didactic session consisting of approximately 40 minutes of lecture and 20 minutes of questions/answers. The presentation will begin with an overview of the childhood obesity epidemic. Next, presenters will describe obesity issues that are unique to rural Appalachian regions. Using local surveillance data, the prevalence and state of childhood obesity in southeastern Ohio (the setting for the Take Action 2) will be discussed. After briefly reviewing current research on multidisciplinary, community-based obesity treatment programs, presenters will discuss salient behavioral and psychosocial interventions shown to be effective in weight management. The bulk of the session will describe the development of the psychosocial curriculum and the ways in which it was integrated into the nutritional and exercise components of TA2. The content and implementation of the didactic lectures will be discussed. Particular attention will be paid to how specific behavioral interventions were adapted to meet the needs of the program’s rural Appalachian participants.
The challenges and opportunities inherent in teaching lifestyle modification skills to this population will be highlighted. Although the predominant focus of the session will involve the process of teaching the curriculum, outcome data for two psychosocial correlates of obesity--body image perceptions and self-reported depressive symptoms--will also be presented. The session will conclude with a discussion of “lessons learned” and recommendations for other rural communities seeking to create community-based psychosocial programs for weight management.
in Athens County
Karen Montgomery Reagan, D.O.; Joseph A. Bianco, Ph.D.; Victor Heh, Ph.D.; Jean Rettos, D.O.; Rebecca S. Huston, D.O.
Abstract
Introduction: In rural regions of the United States, estimates of pediatric obesity often exceed national averages. This problem may be particularly pronounced in Appalachian areas, where significant health and economic disparities abound. This study presents the findings of a school-based body mass index (BMI) screening program for 6-11 year old children living in Athens County.
Objectives: Using the nutritional status classification system established by the Center for Disease Control and Prevention, we sought to obtain county-wide estimates of children with high BMI (> 85th percentile) in order to (1) understand the health status and needs of our pediatric community; (2) identify subpopulations of children who are particularly vulnerable to developing obesity; and (3) locate the state of pediatric obesity in Appalachia within the national obesity crisis.
Methods: We conducted a school-based BMI screening of 6-11 year old children in Southeastern Ohio. Investigators collected a total of 5,306 height and weight measurements across three screening sessions between 2006 and 2007. Caregivers for a subset of this population also completed the Health Information Survey, a 17-item inventory of nutritional, recreational, and health-related activities shown in previous research to correlate with pediatric obesity.
Results: Prevalence of high BMI among children in Athens County (38%) significantly exceeded national averages (31.9%). Approximately 20.9% of children in the study were classified as overweight (BMI > 95th percentile). Boys were 23% more likely than girls to be overweight and 11% more likely to become overweight with each year of age. Relative to their non-overweight counterparts, children with high BMIs were more likely to come from poorer families, view television regularly, eat meals at school, and have at least one smoking caregiver in their household. Factors inversely related to high BMI include higher socioeconomic status, having more than one caregiver in the home, and participation in gymnastics.
Conclusions: Consistent with expectations, prevalence of high BMI in this sample of rural Appalachian children significantly exceeds national averages. Healthcare providers, educators, and parents of children in Athens County should pay particular attention to the nutritional and recreational habits of elementary-school boys, whose risk of developing obesity increases with each year of age. Preventing the duplication of home and school breakfasts and decreasing hours of television viewing may help to stabilize or reduce the prevalence of high BMI in our county.
Objective: To assess first- and second-year osteopathic medical students' beliefs about the ACA.
Methods: In this descriptive cross-sectional survey-based study, first- and second-year students were recruited because their responses would be indicative of what, if any, information about the ACA was being covered in the preclinical curriculum. A 30-item survey was distributed in November 2013, after the health insurance exchanges launched on October 1, 2013.
Results: A total of 239 first- and second-year osteopathic medical students completed the survey. One hundred ten students (46%) disagreed and 103 (43.1%) agreed that the ACA would provide health insurance coverage for all US citizens. The ACA was predicted to lead to lower wages and fewer jobs (73 students [30.5%]), as well as small business bankruptcy because of employees' health insurance costs (96 [40.2%]). Regarding Medicare recipients, 113 students (47.3%) did not know whether these individuals would be required to buy insurance through the health insurance exchanges. The majority of students knew that the ACA would require US citizens to pay a penalty if they did not have health insurance (198 [82.8%]) and understood that not everyone would be required to purchase health insurance through health insurance exchanges (137 [57.3%]). Although students took note of certain clinical benefits for patients offered by the ACA, they remained concerned about the ACA's impact on their professional prospects, particularly in the area of primary care.
Conclusion: These findings build on the existing literature that emphasize the need for incorporating into the osteopathic medical curriculum knowledge of the dynamics of health care policy and reform and for creating opportunities for students to follow health policy developments as they evolve in real time.