This systematic review explored ways in which doctoral-level clinical and counseling psychology graduate students are trained to build competency in self-care. The study aimed to examine which research methodologies have been utilized to examine self-care training, techniques and content of self-care training, and outcomes and effectiveness of self-care training methods. Twenty-one self-care competency training articles were identified. Results from the systematic review revealed most studies to date are quantitative (47.62%), followed by nonempirical (23.81%), mixed methods (14.29%), and qualitative (14.29%). Among quantitative studies, cross-sectional designs were most common (50%). Five themes of self-care training content were identified: culture of self-care, personal therapy, intervention, workbook/training tool, and mentorship/supervision. Five true outcome studies were identified and included outcomes such as frequency of use of self-care behaviors, self-care competency, wellness, stress, and mindfulness. Preliminary foundational evidence for effectiveness of self-care training methods is discussed. Recommendations are made for future research as well as suggestions at the policy level that incorporate several methods to train the self-care competency across training programs. Trainees and clinicians who practice self-care may then be able to avoid common pitfalls such as burnout, stress, and distress, and thereby function better in their roles as psychologists. Public Significance StatementThis study suggests that there are five types of self-care training that have been studied and implemented within the doctoral-level clinical and counseling psychology student population: creating a culture of self-care, personal therapy, intervention, workbook/training tool, and mentorship/supervision. Though the research on training effectiveness is in its early stages, results of the current systematic review describe preliminary evidence for training type effectiveness, with interventions and creating a self-care culture demonstrating the most promise. This study provides an overview of the state of research examining how to train the self-care competency. Considering self-care is an American Psychological Association mandated ethical standard, it is important to establish empirical evidence for how to and what to train regarding self-care with the dual goals of preventing burnout and protecting patient welfare.
Introduction In-laboratory polysomnography (PSG) is recommended for obstructive sleep apnea (OSA) diagnosis in children. However, cost, insufficient facilities, and disruption to families challenge PSG completion, particularly for youth with disabilities such as Down syndrome (DS) in whom OSA is common. By providing sleep architecture and arousal-associated hypopnea data, level II home sleep apnea testing (HSAT) with EEG has the potential to be accessible and accurate. We hypothesized that compared to PSG, HSAT would be accurate in detecting moderate-severe OSA in youth with DS and preferred by families. Methods Prospective comparative effectiveness study. Youth <18 years old with DS underwent in-laboratory PSG and level II HSAT at home. Parents completed questionnaires assessing feasibility, acceptability, and test preference. HSAT, scored using AASM criteria blinded to PSG result, were compared to reference PSG. OSA was defined as obstructive apnea hypopnea index (OAHI) greater than 5 events per hour on either test. Results Thirty-five (17 female) youth aged [median (IQR)] 10.0 (6.1, 16.9) years completed testing. Total sleep time for HSAT was 7.9 (6.9, 8.9) hours versus 6.8 (5.9, 7.0) hours for PSG (p=0.002). PSG OAHI was 12.7/hr (5.3, 21.5). Twenty-six (74.3%) participants had OSA by PSG, 20 of whom were correctly identified by HSAT; one participant with OSA diagnosed by HSAT (OAHI=6.2/hr) was not identified by PSG (OAHI=3.9/hr). Accuracy of HSAT for identifying OSA was 80.0%, sensitivity 76.9%, and specificity 88.9% compared to PSG. Signal quality was good except for pulse oximetry, with median (IQR) adequate signal for 79.5% (57.5%, 86.3%) of the study. Compared to PSG, 83.3% of parents reported that youth had a more normal night’s sleep with HSAT, 70.0% of parents found HSAT easier, and 90.0% of youth preferred HSAT. Conclusion In youth with DS, HSAT has good accuracy for detecting moderate-severe OSA. Limitations may include night-to-night variability, differences in environment, or loss of oximetry signal. Youth slept more during HSAT than in-lab PSG and the majority of families preferred level II HSAT. Level II HSAT could provide a means for expanding the evaluation of OSA in youth with DS. Support (If Any) NIH R21HD101003 (Tapia/Kelly)
Introduction Because of the high risk for obstructive sleep apnea syndrome (OSAS) in youth with Down syndrome (DS), in-lab polysomnogram (PSG) is recommended by age 4-years and if symptom screening warrants. Unfortunately, screening for “traditional” OSAS symptoms has been considered unreliable DS. Further, while in-lab polysomnography (PSG) is the gold standard in assessment of OSAS, undergoing in-lab PSG is time and cost intensive and often stressful for youth with DS and their families. This study examined the relationship of sleep disturbance questionnaires with in-lab PSG and home sleep apnea testing (HSAT) in youth with DS. Methods As part of a larger study comparing PSG to HSAT in individuals with DS aged 6-25y, caregivers completed the parent-proxy Pediatric Promis Sleep Disturbance Measure (PPSDM) and Modified Epworth Sleepiness Scale (ESS). The relationships of the PPSDM and ESS and sleep study variables (total sleep time, oxygen desaturation nadir (SpO2 nadir), wake after sleep onset (WASO), sleep efficiency, obstructive hypopnea index (OAHI), and arousal index) were examined using Spearman correlation. Results Caregiver-completed questionnaires were available for 38 individuals with DS (18 males; mean age of 15.0±4.7, 84% White; 95% Non-Hispanic). PSG OAHI median [IQR] was 12.9[5.5-22.8] events per hour, SpO2 nadir 86.5[81-89] %, PPSDM 25[20-33], ESS 2.5[1-8]. The PPSDM was negatively correlated with PSG SpO2 nadir (r=-0.437; p=0.006) but with no additional HSAT or PSG variables. ESS was positively correlated with the obstructive apnea hypopnea index (OAHI) on both PSG (r=0.340, p=0.03) and HSAT (r=0.372; p=0.02) and negatively correlated with HSAT WASO (r=-0.369; p=0.02). Conclusion Given the limited availability of sleep specialists and labs equipped to complete PSG in individuals who may require increased attention, overnight pulse oximetry overnight coupled with ESS and caregiver completed sleep disturbance questionnaires may provide an initial, noninvasive, cost-effective method to screen for OSAS in individuals with DS. Considering that ESS correlated with OAHI, this questionnaire could be used to decide repeat PSG in youth with DS. Support (if any) This study was support by NICHHD grant R21HD101003 (PIs: Kelly and Tapia).
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