Publications by Year: 2017

Results of an RCT examining the effects of a brief psychosocial intervention on inpatient satisfaction

Background and Objectives

Increasing attention is being paid to patients’ experience of hospitalization. The brief psychosocial intervention, BATHE, is an intervention found to improve patients’ outpatient experience but not yet studied in inpatient settings. This RCT examined whether daily administration of BATHE would improve patients’ satisfaction with their hospital experience.

Methods

BATHE is a brief psychosocial intervention designed to reduce distress and strengthen the physician-patient relationship. In February-March 2015 and February-March 2016, 25 patients admitted to the University of Virginia Family Medicine inpatient service were randomized to usual care or to the BATHE intervention. Participants completed a baseline measure of satisfaction at enrollment. Those in the intervention group received the BATHE intervention daily for five days or until discharge. At completion, participants completed a patient satisfaction measure.

Results

Daily administration of BATHE had strong effects on patients’ likelihood of endorsing their medical care as “excellent.” BATHE did not improve satisfaction by making patients feel more respected, informed or attended to. Rather, effects on satisfaction were mediated by patients’ perception that their physician showed “a genuine interest in me as a person.”

Conclusions

Our study suggests that patients are more satisfied with their hospitalization experience when physicians take a daily moment to check in with the patient “as a person” and not just as a medical patient. The brevity of the BATHE intervention indicates that this check-in need not be lengthy or overly burdensome for the already busy inpatient physician.

Keywords: hospitalization, patient satisfaction, physician patient relationship

Secondary school is a vulnerable time where stagnation or declines in classroom behavioral engagement occur for many students, and peer relationships take on a heightened significance. We examined the implications of adolescents’ perceptions of relatedness with classroom peers for their academic learning. Participants were 1084 adolescents (53% female) in 65 middle and high school classrooms. Multilevel cross-lagged path analyses found that adolescents’ perceived relatedness with classroom peers subsequently predicted their increased self-reported behavioral engagement in that classroom from fall to winter and again from winter to spring. Higher engagement in spring predicted higher end of year objective achievement test scores after statistical control of prior year test scores. Implications are discussed for increasing classroom peer relatedness to enhance adolescents’ achievement.

Adolescents face the developmental challenge to establish a sense of identity and autonomy while at the same time remaining connected to and engaged with their family—the original source of safety. Not only do teens strive to establish a healthy balance with their families, but they also are learning to navigate more autonomous relationships with peers, and later with romantic partners. Failure to form healthy close relationships in adolescence has been linked to poor psychological, social, and physical health into adulthood, highlighting the importance of these early relationships. We review the extensive research on adolescent autonomy from our longitudinal study of adolescent development. Overall, research on parental influence on adolescent development is largely informed by research on the mother–child relationship. Less research has considered the unique role that fathers may play in adolescent development. We will report on new research findings that father–child relationships with high levels of both autonomy and relatedness are linked to better quality of teen romantic relationships, both concurrently and longitudinally. This recent work is discussed and future directions proposed to consider the distinct role of fathers for the developmental task of establishing autonomy yet remaining connected to others in adolescence.

In the My Teaching Partner (MTP) program, coaches engage teachers in six to nine coaching cycles across a school year. Guided by the program’s theory, coaches help teachers reflect on the emotional, organizational, and instructional features of classrooms. MTP was originally developed for Pre-K and early elementary classrooms (MTP Pre-K), but the current paper focuses on the secondary school version of this program, MTP-Secondary (MTP-S), given the need for coaching models with middle and high school teachers. The paper presents the guiding theory of MTP-S and how it relates to key components of the coaching cycle. We then offer a brief synthesis of research demonstrating its effectiveness in raising achievement, promoting positive peer interactions, and reducing racial disparities in teachers’ discipline practices. We provide ideas for future research that would help advance theory on the essential components of effective coaching programs in secondary schools.

Objective—Social support is associated with better health. This association may be partly mediated through the social regulation of adrenomedullary activity related to poor cardiovascular health and glucocorticoid activity known to inhibit immune functioning. These physiological cascades originate in the hypothalamic areas that are involved in the neural response to threat. We investigated whether the down regulation, by social support, of hypothalamic responses to threat is associated with better subjective health.

Methods—A diverse community sample of seventy-five individuals, ages 23–26, were recruited from an ongoing longitudinal study. Participants completed the Short Form Health Survey (SF-36) a well-validated self report measure used to assess subjective general health. They were scanned, using fMRI, during a threat of shock paradigm involving various levels of social support, which was manipulated using hand-holding from a close relational partner, a stranger, and an alone condition. We focused on a hypothalamic region of interest (ROI) derived from an independent sample to examine the association between hypothalamic activity and subjective general health.

Results—Results revealed a significant interaction between handholding condition and selfreported general health, F(2, 72) = 3.53, p = .032, partial η 2 = .05. Down regulation of the hypothalamic ROI during partner handholding corresponded with higher self-ratings of general health, ß □= −.31, p =.007.

Conclusion—Higher self-ratings of general health correspond with decreased hypothalamic activity during a task that blends threat with supportive handholding. These results suggest that associations between social support and health are partly mediated through the social regulation of hypothalamic sensitivity to threat.

The potential importance of depending on others during adolescence in order to establish independence in young adulthood was examined across adolescence to emerging adulthood. Participants included 184 teens (46% male; 42% non-White), their mothers, best friends, and romantic partners, assessed at ages 13–14, 18, 21–22, and 25. Path analyses showed that associations were both partner and age specific: markers of independence were predicted by participants’ efforts to seek support from mothers at age 13, best friends at 18, and romantic partners at 21. Importantly, analyses controlled for support seeking from these partners at other ages, as well as for other potentially confounding variables including attachment security, scholastic/job competence, and physical attractiveness over time. Moreover, analyses suggested the transfer of support seeking behavior from mothers to best friends to romantic partners over time based on support given by the previous partner at an earlier age.

Negativity in parent–child relationships during adolescence has been viewed as a risk factor for teens’ future personal and interpersonal adjustment. This study examined support from romantic partners and close friends during late adolescence as protective against maternal negativity experienced during early adolescence. A combination of observational, self-report, and peer-report measures were obtained from a community sample of 97 youth (58 % female), their mothers, closest friends, and romantic partners assessed at ages 13, 18, and 20. Moderating effects suggested a protective effect of romantic support against maternal negativity across a variety of psychosocial outcomes, including depressive symptoms, self-worth, social withdrawal, and externalizing behavior. Protective effects were found even after controlling for initial levels of outcome behavior and observed support from close friends throughout adolescence. Receiving support from a romantic partner may provide teens with new, positive ways of coping with adversity and help them avoid more serious distress that may be predicted from maternal negativity when such support is not available.

Middle adolescents’ close friendship strength and the degree to which their broader peer group expressed a preference to affiliate with them were examined as predictors of relative change in depressive symptoms, self-worth, and social anxiety symptoms from ages 15 to 25 using multimethod, longitudinal data from 169 adolescents. Close friendship strength in midadolescence predicted relative increases in self-worth and decreases in anxiety and depressive symptoms by early adulthood. Affiliation preference by the broader peer group, in contrast, predicted higher social anxiety by early adulthood. Results are interpreted as suggesting that adolescents who prioritize forming close friendships are better situated to manage key social developmental tasks going forward than adolescents who prioritize attaining preference with many others in their peer milieu.