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Objectives This study evaluated whether COVID-19-specific risk factors (e.g., feeling guilty for not being present with the deceased at the time of the loss and feeling emotionally distant from the deceased prior to the loss) were associated with prolonged grief disorder (PGD) symptomatology or diagnosis among young adults bereaved due to any cause (e.g., illness and violent loss). Methods We surveyed 196 young adults who had a family member/close friend die during the COVID-19 pandemic. Participants completed the PGD-12 Questionnaire and the 10-item Pandemic Grief Risk Factors (PGRF) Questionnaire. Results More time spent with the deceased before the loss and greater endorsement of pandemic grief risk factors were associated with increased PGD symptoms and a greater likelihood of meeting the diagnostic criteria for PGD. Significance of results The COVID-19 pandemic created unique risk factors that affected the grieving process for bereaved individuals, regardless of whether the death was related to COVID-19 infection. These findings add to a growing body of literature examining grief and loss within the unique context of the COVID-19 pandemic and suggest that there may be detrimental long-term psychological outcomes for these bereaved individuals, regardless of the cause of death. Routine screening for these unique risk factors in medical and psychological clinics is warranted to help identify those individuals who could benefit from early intervention. Also, it will be important to understand and possibly modify evidence-based interventions and prevention programs to directly address the identified unique PGRF.

UNSTRUCTURED Objective Diabetes distress among adolescents with type 1 diabetes has been associated with suboptimal diabetes outcomes. The present study examined the feasibility and acceptability of a scalable self-led mindfulness-based intervention to reduce diabetes distress in adolescents with type 1 diabetes. Methods Adolescents (N=25) aged 14 to 18 diagnosed with type 1 diabetes completed a baseline assessment. Participants were randomized to receive 10-week self-guided mindfulness-based stress reduction program immediately (n=10) or after a 10-week wait (n=15). During the intervention period participants completed weekly assignments and qualitative and quantitative feedback surveys. At 10-weeks and 20-weeks, follow-up assessments were completed. Results Findings indicated that participants did not find the intervention feasible or acceptable based on weekly feedback and survey completion. Results from weekly surveys provided the foundation for recommendations of future iterations of the mindfulness-based intervention for adolescents with type 1 diabetes. Conclusion Participant feedback informed recommendations for self-led mindfulness programs for youths with type 1 diabetes.

Recent calls have been made to evaluate the range, rather than the

The purpose of this mixed methods study was to discover if and how clinicians integrate cultural factors into treatment, what specific 'culturally sensitive' practices clinicians utilize, and who clinicians use these practices with. In Study 1(N = 9) qualitative interviews were conducted with psychologists who shared information about the culturally sensitive clinical practices that they utilize. Based on the results from Study 1, a survey was created for Study 2 and completed by 142 psychologists. There were three overriding conceptual themes that were generated from the analysis of the data regarding how clinicians provide culturally sensitive psychological services and what specific culturally sensitive clinical practices clinicians use when working with clients. It was evident from the data that the delivery of culturally sensitive services was best conceptualized as a process. The process began with being aware that cultural factors existed. This awareness led to the development of hypotheses, which guided the assessment process. Based on the results of the assessment process clinicians then tailored the services they provided to the unique characteristics of their clients. The quantitative results from Study 2 indicate that that the qualitative results from Study 1 are generalizable to a larger sample of psychologists. Results from Study 2 also indicated that the vast majority of participants indicated that they engaged in culturally sensitive clinical practices regardless of client minority-status. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Parental separation and parental death during childhood are common but understudied forms of adverse childhood events (ACEs), thus little is known about the impact on psychological functioning in adulthood. We examined whether parental death and parental separation during childhood was associated with risk of diagnostic criteria for depressive disorders, anxiety disorders, posttraumatic stress disorder (PTSD), or personality disorders during adulthood. Second, we compared parental separation and parental death and psychopathology across African Americans (The sample consists of 1,211 participants (White participants reporting parental separation during childhood were more likely to report depressive disorders (OR = 2.151,Parental separation was a significant risk factor for adult psychopathology, but only for White participants. Parental death was not a risk factor for adult psychopathology no matter the person's race. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

When wildlife forage and/or live in urban habitats, they often experience a shift in resource availability and dietary quality. Some species even use human handouts, such as bread, as well as human refuse, as a large part of their new diets; yet the influences of this nutritional shift on health and survival remain unclear. American white ibises are increasingly being seen in urban areas in Florida; they collect handouts, such as bread and other food items, from humans in parks, and are also found foraging on anthropogenic sources in trash heaps. We hypothesized that the consumption of these new anthropogenic food sources may trigger increases in indicators of physiological challenge and dampen immune responses. We tested this experimentally by raising 20 white ibis nestlings in captivity, and exposing 10 to a simulated anthropogenic diet (including the addition of white bread and a reduction in seafood content) while maintaining 10 on a diet similar to what ibises consume in more natural environments. We then tested two indicators of physiological challenge (corticosterone and heat shock protein 70), assessed innate immunity in these birds via bactericidal assays and an in vitro carbon clearance assay, and adaptive immunity using a phytohemagglutinin skin test. The anthropogenic diet depressed the development of the ability to kill Salmonella paratyphi in culture. Our results suggest that consuming an anthropogenic diet may be detrimental in terms of the ability to battle a pathogenic bacterial species, but there was little effect on indicators of physiological challenge and other immunological measures., White ibises are increasingly found foraging in urban environments, and previous work has shown that ibises in urban environments have elevated bactericidal capacities and depressed stress responses. We tested whether intake of an anthropogenic diet may explain those differences. An anthropogenic diet inhibited the development of bactericidal capacity against a pathogenic strain of bacteria.

Language is an essential part of psychotherapy and experts in cultural competence encourage the consideration of language as an element in cultural adaptation to therapy. Providing clients with services in their native language is associated with lower dropout and better outcomes. Therapies such as prolonged exposure therapy (PET) for posttraumatic stress disorder (PTSD) require clients to recount trauma memories to activate and correct overreactive fear networks in the brain. Research shows that the most genuine and detailed recall of these autobiographical memories occurs when people recollect in the same language in which the memory was encoded. Clients are less likely to drop out, tend to see better outcomes, and most closely follow the treatment protocol for PET when speaking in their native language. In an increasingly bilingual world, therapists may share a common language with a client but may be unable to speak the client’s native language. A novel solution for PET involves starting therapy in the therapist/client dyad’s shared language and then eventually conducting imaginal exposures in the client’s native language. The following case provides a successful example for how and why such therapy can be conducted.

Research regarding daily acute pain and its correlates has primarily been conducted with adolescents who have had major surgery or musculoskeletal pain, restraining efforts towards adapting interventions for adolescents with other sources of acute pain. We explored the trajectories and correlates of pain intensity. Adolescents with an opioid prescription to treat acute pain (N = 157) completed demographic questions, and the PROMIS pediatric depression and anxiety subscales. A 10-day daily diary assessed pain intensity, pain interference, sleep quality, and opioid use. Three trajectories of pain intensity emerged: (1) slow decreases in pain, (2) rapid decreases in pain, and (3) stable or slight increases in pain. Teens with stable pain demonstrated the greatest anxiety levels. Higher sleep quality predicted lower next day pain intensity and pain interference, when controlling for opioid use. Future research should employ intensive longitudinal methodology to further guide intervention development and prevent the transition to chronic pain.

Objective The development of habit (i.e., behavioral automaticity, the extent to which a behavior is performed with decreased thresholds for time, attention [effort], conscious awareness, and goal dependence), for goal-directed health behaviors facilitates health behavior engagement in daily life. However, there is a paucity of research examining automaticity for Type 1 diabetes self-management in adolescence. This study examined if greater perceived automaticity for diabetes self-management was associated with increased daily self-management, decreased daily self-regulation failures in glucose checking, and more optimal daily glycemic levels in adolescents with Type 1 diabetes. Method Adolescents aged 13-17 and diagnosed with Type 1 diabetes (n = 79) completed the Self-Report Behavioral Automaticity Index, a measure of automaticity of diabetes self-management (i.e., automaticity of glucose checking, carbohydrate counting, and insulin dosing), and a measure of perceived self-management at baseline. One to 3 months later, a subsample of teens (n = 42) also completed a daily diary for a 7-day period including perceptions of daily self-management, daily self-regulation failures in glucose checking, and daily glucose levels. Results Greater overall automaticity of diabetes self-management was associated with greater baseline and daily self-management, fewer daily self-regulation failures in glucose checking, and lower average daily mean blood glucose levels but not more optimal daily variations in blood glucose levels. Conclusions Greater automaticity for diabetes self-management may support more optimal daily diabetes self-management in adolescence. Further research is needed to clarify the benefits and mechanisms of automaticity and explore possible interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

BACKGROUND Prior studies suggest that mobile health physical activity programs that provide only weekly or daily text-based health coaching evidence limit the efficacy in improving physical activity in adolescents with overweight or obesity. It is possible that incentives, combined with health coaching and daily feedback on goal success, may increase program efficacy; however, such programs have not yet been tested with adolescents with overweight and obesity. OBJECTIVE This study aims to examine the feasibility and acceptability of a 12-week, incentive-based, mobile health physical activity program with text-based health coaching, goal setting, and self-monitoring for adolescents with overweight or obesity. Program adherence and changes in tracked physical activity (ie, steps and active minutes while wearing a Fitbit [Google LLC]), body mass, and body fat are assessed. METHODS A total of 28 adolescents aged 13 to 18 years with a BMI ≥90th percentile participated in the program. Of the 28 participants, 2 (7%) were lost to follow-up; thus, data from 26 (93%) participants were used in analyses. RESULTS Participant-reported acceptability was high, with all mean ratings of text-based coaching, Fitbit use, and the overall program being >5 on a 7-point scale. In addition, 85% (23/26) of participants reported that they would like to continue to wear the Fitbit. Program adherence was also high, as participants wore the Fitbit on 91.1% (SD 12.6%) of days on average and met their weekly goals for an average of 7 (SD 3.5) of 11 possible weeks. There were no demographic (ie, sex, age, and baseline body mass) differences in the percentage of days participants wore their Fitbit. Across the 12-week study, there were significant improvements in tracked daily active minutes (P=.006) and steps (PP=.04). CONCLUSIONS The pilot program improved adolescent physical activity and physical health. A larger factorial design trial with adaptive daily goals may clarify the role of each program component in driving physical activity. CLINICALTRIAL

Background Greater overall positive emotion has been linked with increased physical activity and overeating. High approach positive emotions (HAPEs), a subtype of positive emotion, are theorized to facilitate this goal-driven behavior. However, the day-to-day associations of HAPE and physical activity and overeating, including both at the individual level and within caregiver–adolescent dyads, remain unknown. Purpose We examined the independent and dyadic associations between HAPE (positive emotions that occur pregoal and motivate individuals toward approaching/acting upon that motive) and obesity-related behaviors, including physical activity and overeating, in adolescents and their primary caregivers. Methods Adolescents (N = 47) aged 11–17 and their caregivers completed demographic questions and a 7-day diary at the end of each day about daily emotion, and physical activity and overeating behaviors. Results For adolescents and their caregivers, increased day-to-day fluctuations in HAPE and greater average HAPE was associated with increases in their own daily physical activity levels. Greater average caregiver HAPE was also associated with increased overeating in caregivers. When examining interdependency within dyads, greater average caregiver HAPE was associated with greater adolescent overeating behavior. Conclusions There is evidence that HAPE is related to obesity-related health promoting behaviors and health risk behaviors in adolescence and adulthood. Future studies should further explore mechanisms underlying these associations, including within the family system.

Summary Social workers fulfill vital roles, servicing clients from vulnerable populations and maintaining their welfare. As a result of frequent interaction with clients who have often experienced trauma, these workers are susceptible to experiencing burnout, secondary traumatic stress, and vicarious trauma. This study aimed to identify if purpose in life is a protective factor for adult/elder protective services (AEPS) and child protective services (CPS) workers. A comprehensive search of AEPS and CPS agencies resulted in more than 500 agencies throughout the United States. Three multiple regressions were run, with purpose in life as the independent variable, controlling for social workers’ years of experience, ethnicity, average of number of hours worked per week. Findings A sample of 292 participants ranging in age from 18 to 58 years of age, with a mean age of 42.03(12.34), participated in this study. Of the 292 social workers, 126 reported being CPS workers and 166 reported being AEPS workers. In all three linear regressions, higher purpose in life resulted in lower rates of vicarious trauma ( F(3, 263)=10.364, pApplications This study provides evidence necessary to warrant an intervention for protective services workers, specifically targeted toward increasing purpose in life.

The Framingham Stroke Risk Profile (FSRP) is a validated model for predicting 10-year ischemic stroke risk in middle-aged adults, yet has not been demonstrated to consistently translate in older populations. This is a systematic review of independent risk factors measured among > 65 year olds, with subsequent first ischemic stroke, using PRISMA guidelines. We appraised peer-reviewed publications that included participants > 65 years old at risk assessment. Combined with other criteria, results were abstracted from 28 papers reporting six types of stroke risk factors: Serologic/Diagnostic, Conventional, Psychosocial, Genetic, Cognitive, and Antibiotic use. These studies demonstrated levels of serum androgens, C-reactive protein, and advanced glycation endproducts; thrombin generation; left ventricular mass; depressive symptoms; phosphodiesterase 4D single nucleotide polymorphisms; coagulation factor XII gene; peak thrombus generation; and lower cognitive functioning were independent risk factors for ischemic stroke in older adults. Plasma adipokines, free fatty acids and antibiotic use did not predict ischemic stroke. Purpose in life and APOEe2 allele were protective for ischemic stroke. This systematic review provides evidence of risk and protective factors for ischemic stroke in older cohorts that are not included in the FSRP. Further studies are needed to understand whether these factors are important enough to comprise a risk score.

Past research has investigated the rates of compassion satisfaction (CS), compassion fatigue (CF), and burnout within health-care providers. Findings indicate higher levels of CS and lower levels o...

Harmful algal bloom events are increasing in a number of water bodies around the world with significant economic impacts on the aquaculture, fishing and tourism industries. As well as their potential impacts on human health, toxin exposure from harmful algal blooms (HABs) has resulted in widespread morbidity and mortality in marine life, including top marine predators. There is therefore a need for an improved understanding of the trophic transfer, and persistence of toxins in marine food webs. For the first time, the concentrations of two toxin groups of commercial and environmental importance, domoic acid (DA) and saxitoxin (including Paralytic Shellfish Toxin (PST) analogues), were measured in the viscera of 40 different fish species caught in Scotland between February and November, 2012 to 2019. Overall, fish had higher concentrations of DA compared to PSTs, with a peak in the summer / autumn months. Whole fish concentrations were highest in pelagic species including Atlantic mackerel and herring, key forage fish for marine predators including seals, cetaceans and seabirds. The highest DA concentrations were measured along the east coast of Scotland and in Orkney. PSTs showed highest concentrations in early summer, consistent with phytoplankton bloom timings. The detection of multiple toxins in such a range of demersal, pelagic and benthic fish prey species suggests that both the fish, and by extension, piscivorous marine predators, experience multiple routes of toxin exposure. Risk assessment models to understand the impacts of exposure to HAB toxins on marine predators therefore need to consider how chronic, low-dose exposure to multiple toxins, as well as acute exposure during a bloom, could lead to potential long-term health effects ultimately contributing to mortalities. The potential synergistic, neurotoxic and physiological effects of long-term exposure to multiple toxins require investigation in order to appropriately assess the risks of HAB toxins to fish as well as their predators.

The rate of false allegations has been a topic of research spanning back to as early as the 1970s. Studies have often relied on data gathered by Child Protective Services workers and court administrators. Some researchers have also used hypothetical scenarios to estimate rates. However, given the plethora of sampling methods, there is a large variation in estimated rates of false allegations of sexual abuse depending on the data source and context of the allegation. Additionally, methodological problems such as unclear or invalid criteria used to judge truth or falsity of an allegation, unrepresentative samples, and ignoring important contextual variables such as the stage at which an allegation is made, currently all render the determination of actual rates of false child sexual abuse allegations to be unknown. This examination of literature is intended to gain a firmer understanding of the frequency at which allegations are false and during which stage of prosecution they occur, thus assisting with the legal practice of distinguishing between a false versus positive allegation. Research reviewed supports two general conclusions: (a) the vast majority of allegations are true but (b) false allegations do occur at some non-negligible rate. Suggestions for future research, as well as cautions about claims about specific rates of false allegations in the courtroom, are provided.

The Deferred Action for Childhood Arrivals (DACA) executive order intended to protect undocumented youth from deportation and mitigate the negative impact of their undocumented status. Using qualitative methods, eight DACA recipients were interviewed. Participants were primarily females, ranged in age from 19 and 27 years old, and had immigrated from Mexico. Our findings revealed that as participants grew up, they experienced a sense of liminality, or “non-belonging”; however, upon receiving DACA status, these feelings of liminality were temporarily abated. Problematically, as our participants encountered the limitations of DACA, their feelings of liminality returned. While DACA increases access to education, health care, and legal system participation, it only temporarily mitigates the impact of having an undocumented status. The ramifications of the sense of liminality that occur with being undocumented is discussed and policy reforms in areas of federal and state educational policy and immigration policy are suggested.

Secondary traumatic stress (STS) is a pattern of psychological symptoms that approximates the symptoms of posttraumatic stress disorder (PTSD) and occurs in professionals who are exposed to individuals who have experienced trauma. While victim advocates are frontline health professionals who are trained to support victims of crime and interpersonal violence and are at risk for developing STS, they have been largely neglected in the extant literature on STS. The STS Scale (STSS) is a 17-item self-report questionnaire utilized to assess frequency of symptoms of intrusion, avoidance, and arousal, specifically related to providing services to victims of trauma. The purpose of this study was to investigate the psychometric properties of the STSS with a sample of victim advocates ( N = 135) using confirmatory factor analysis (CFA). Results indicated that both a single-factor model and three-factor model were equivalent. This study represents a first attempt to validate a measure of STS among victim advocates, a unique and understudied population who are at risk for developing STS given their work with individuals who have experienced interpersonal violence. Establishing effective, easy to administer, and efficient measures of STS is important given that this population encounters secondary trauma on a regular basis in the context of their job. While additional theoretical work regarding the construct of STS is needed, the STSS did demonstrate high reliability with this population and thus can be used as part of the assessment of STS among victim advocates.

Objective: To explore a 5-year comparison of disparities in intravenous t-PA (IV t-PA) use among acute ischemic stroke (AIS) patients based on race, gender, age, ethnic origin, hospital status, and geographic location. Methods: We extracted patients’ demographic information and hospital characteristics for 2010 and 2014 from the New York Statewide Planning and Research Cooperative System (SPARCS). We compared disparities in IV t-PA use among AIS patients in 2010 to that in 2014 to estimate temporal trends. Multiple logistic regression was performed to compare disparities based on demographic variables, hospital designation, and geographic location. Results: Overall, there was approximately a 2% increase in IV t-PA from 2010 to 2014. Blacks were 15% less likely to receive IV t-PA compared to Whites in 2014, but in 2010, there was no difference. Patients aged 62-73 had lower odds of receiving IV t-PA than age group ≤61 in both 2010 and 2014. Designated stroke centers in the Lower New York State region were associated with reduced odds of IV t-PA use in 2010 while those located in the Upper New York State region were associated with increased odds of IV t-PA use in both 2010 and 2014, compared to their respective nondesignated counterparts. Gender, ethnic origin, and insurance status were not associated with IV t-PA utilization in both 2010 and 2014. Conclusion: Overall IV t-PA utilization among AIS patients increased between 2010 and 2014. However, there are evident disparities in IV t-PA use based on patient's race, age, hospital geography, and stroke designation status.

Helping professionals play an essential role in the recovery of victims of trauma. However, research has demonstrated that, as a result of their work, helping professionals’ indirect exposure to clients’ trauma increases the likelihood of experiencing negative psychological responses, including vicarious trauma (VT), secondary traumatic stress (STS), and burnout. The present study examined the concurrent validity between the STS subscale on the Professional Quality of Life (ProQoL) scale and the Secondary Traumatic Stress Scale (STSS). Furthermore, the relationships between compassion satisfaction (CS) and burnout were investigated. Participants were recruited using a comprehensive web search of agencies across the United States that employed victim advocates, a subtype of helping professionals that are understudied. A list of possible agencies ( N = 75) was generated, and each agency was sent an email about the study. In total, 132 victim advocates provided data for these analyses. Findings revealed positive correlations between the STS subscale on the ProQoL and the STSS. In addition, a negative correlation was found between burnout and CS. Two-level hierarchical multiple regression analyses demonstrated that burnout accounted for 47.3% of the variance in STS, and CS contributed an additional 3.9%. Furthermore, burnout accounted 45.8% of the variance in VT, whereas CS contributed an additional 0.6%, indicating that burnout is a strong predictor of VT and STS, but CS may serve as a protective factor against experiencing both. Prevention and intervention efforts should target reducing burnout to combat these psychological sequelae and increasing CS.

Vicarious trauma is referred to as the detrimental change in the manner that professionals understand and interpret material, as a result of exposure to second-hand traumatic material (McCann & Pearlman [1990] Journal of Traumatic Stress, 3:131). According to Aparicio et al. (Health & Social Work, 2013, 38:199), vicarious trauma comprises both affective and cognitive components and, while it is distinct from posttraumatic stress disorder (PTSD), it is associated with similar symptoms, including re-experiencing and avoiding traumatic material and experiencing depressed mood. The purpose of this study was to analyse the psychometric properties of the Victim Trauma Scale (VTS) and provide additional support, supplementing the findings of Aparicio et al. (2013), but instead using victim advocates as participants (n = 142). The survey was open between February 2016 and February 2017. More than 96% of participants were in paid employment positions, as more than 80% reporting working 40 or more hours a week. Aparicio et al. (2013) found that the VTS was two-dimensional (affective and cognitive); however, after examining the goodness of fit of the two-factor model using a confirmatory factor analysis (CFA) approach, this study concluded that the two-dimensional model was not a good fit. Due to the poor goodness of fit of the two-factor model and the post hoc EFA resulting in a one-factor model, our data do not support the findings of Aparicio et al. (2013). Further, the findings suggest the VTS is an acceptable measure of vicarious trauma, as demonstrated by the high internal consistency and the single-factor loading.

In the field of applied psychology, there have been a recent emphasis and even a requirement to employ what has become known as “culturally sensitive” or “culturally competent” practices in all professional services (e.g., Betancourt et al, Public Health Rep, 2016; Griner and Smith, Culturally adapted mental health intervention: a meta-analytic review. Psychother Theory Res Pract Train 43(4):531–548, 2006). A purported claim for the necessity of cultural sensitivity and cultural practice is that clients who experience culturally insensitive behavior report a variety of adverse psychological reactions (e.g., feelings of being insulted, disconnectedness, uncomfortableness, even trauma). This chapter will examine some of the assumptions and assertions of the cultural competence movement in relation to clients’ reported experience of negative psychological reactions and explain the problems with these. These problems include issues with reliability and validity of self-reports, lack of clarity of concepts related to key psychological reactions such as “uncomfortableness,” lack of discernment between levels of adverse experiences/impairment, whether the effects of the listener are always relevant, utilization of cultural competence to combat egregious behaviors/values, pseudo−/problematic attempts at relating to culturally diverse clients, whether cultural competence results in positive psychological reactions, and the lack of empirical support for the causal pathways that are assumed.

Historically, disadvantaged racial and ethnic groups (Institute of Medicine, Unequal treatment: confronting racial and ethnic disparities in health care. National Academy Press, Washington, DC, 2002) and sexual minorities (Avery et al, Am J Public Health 91(6):990, 2001) have been problematically served by mental health interventions. This problem is even more complex because an additional aspect is that there are often more barriers for members of minority groups for accessing behavioral health services (Benuto and O’Donohue, Enhancing behavioral health in Latino populations. Springer International Publishing, Cham, 2016). To adapt mental health services to better serve individuals from minority groups, there has been a movement to incorporate cultural considerations into professional guidelines and ethical standards in a variety of disciplines within the fields of behavioral health (e.g., Griner and Smith Psychother Theory Res Pract Train, 43(4):531–548, 2006; Betancourt et al, Public Health Rep, 2016). However, despite these efforts over a number of years, the wide variety of standards and guidelines developed related to these activities have both strengths and also limitations and flaws, including unclear function and scope, conflict with other important values, a lack of empirical evidence related to the extent to which these documents actually have any effect in producing desired competence outcomes, inconsistent restrictions on professionals to judge and thus target potentially maladaptive behaviors and values in minority cultures, a problematic assumption of homogeneity within each minority culture, and the assumption that an understanding of universal values will not suffice to improve these services. This chapter will examine each of these issues with respect to some of the major documents in the behavioral health field, provide specific examples of how these problems exist within current documents and standards, as well as provide suggestions for future development of more sound standards.

Child sexual abuse is a type of a traumatic event that may involve “unwanted and inappropriate sexual solicitation of, or exposure to, a child by an older person; genital touching or fondling; or penetration in terms of oral, anal or vaginal intercourse or attempted intercourse” (Andrews, Corry, Slade, Issakidis, & Swanston, 2004). A national survey comprised of 4,549 children in the United States found a 1-year sexual abuse prevalence rate of 6.1% (Finkelhor, Turner, Ormrod, Hamby, & Kracke, 2009). A portion of these victims of child sexual abuse may later develop psychiatric issues, including posttraumatic stress disorder (PTSD).