Patient autonomy is a primary value in US health care. It is assumed that patients want to be fully and directly informed about serious health conditions and want to engage in advance planning about medical care at the end-of-life. Written advance directives and proxy decision-makers are vehicles to promote autonomy when patients are no longer able to represent their wishes. Cross-cultural studies have raised questions about the universal acceptance of these health care values among all ethnicities. In the current investigation, Bosnian immigrants were interviewed about their views of physician-patient communication, advance directives, and locus of decision-making in serious illness. Many of the respondents indicated that they did not want to be directly informed of a serious illness. There was an expressed preference for physician- or family-based health care decisions. Advance directives and formally appointed proxies were typically seen as unnecessary and inconsistent with many respondents' personal values. The findings suggest that the value of individual autonomy and control over the health care decisions may not be applicable to cultures with a collectivist orientation.
The role of religion/spirituality (R/S) in the lives of incarcerated individuals is complex. Inmates may draw on R/S as a coping strategy, as a way to place responsibility, or as an approach to creating meaning. The importance of using R/S as a coping strategy can be amplified in the context of a correctional setting. While some attention has focused on the effectiveness of faith-based services in jails and prisons, very little emphasis has been placed on using those constructs in psychotherapy within the correctional context. Accordingly, this article explores the application of the multicultural orientation framework—including the important tenets of therapists’ cultural humility, cultural comfort, and cultural opportunities—into psychotherapy practices with incarcerated individuals. In doing so, we will focus on how cultural humility can assist in addressing intersecting identities, including spirituality, race/ethnicity, socioeconomic status (SES), and gender identity to enhance the process and outcome of therapy. We will discuss how cultural humility can be effectively used to address common challenges for therapists when working with R/S issues in corrections and conclude with two case studies to illustrate the application.
The present study investigated gender differences in the prevalence and incidence of violence-related traumatic brain injury (TBI) among justice-involved individuals, as well as potential associations between violence-related TBI and select biopsychosocial variables among women in the sample. Data from 409 justice-involved individuals were analyzed, and men and women were compared for rate of violence-related TBI. Women were grouped by violence-related TBI history and compared on eight biopsychosocial variables. Gender was significantly associated with multiple TBIs and multiple violence-related TBIs. History of violence-related TBI in women was associated with physical health problems and incarceration history. This research revealed a high rate of violence-related multiple TBIs among justice-involved women. Violence-related TBIs were associated with more prevalent physical illness and increased incarceration times. Identification of justice-involved women with these injuries may help clinicians better tailor services to improve inmate outcomes and reduce cost burdens to justice systems.
Offenders in justice system settings have high rates of traumatic brain injury (TBI) in comparison with the general population. Consequently, justice systems are using screening tools to identify and manage these individuals. Currently, that includes screening for TBI history and gross cognitive impairment. The present study attempted to determine whether the modified Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) was predictive of ongoing cognitive impairment as measured by the Automated Neuropsychological Assessment Metrics (ANAM) Core Battery. If so, the OSU TBI-ID could be used as a stand-alone measure of TBI history and impairment. This study had 223 participants (male = 160, female = 62). Sensitivity and specificity results revealed poor (.65) to very poor (.36) estimates for all OSU TBI-ID indices across all ANAM subtests. This study suggests that screening for lifetime history of TBI does not identify cognitive impairment. Implications for screening policy and future research are discussed.
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