Doctor of Ministry , Ashland University, 2024, Doctor of Ministry Program

The purpose of this project was to discover the extent to which students in U.S.-based Association for Clinical Pastoral Education (ACPE)-accredited programs had received training in trauma-informed care (TIC) pastoral practices for adolescents. Fifty-two surveys were completed by chaplains within various healthcare settings who had received ACPE training within the previous ten years. The results showed overall disappointment with the amount of TIC training received and a perceived lack of preparedness for providing pastoral care to traumatized adolescents. The results indicate a critical need for more research and training in TIC for this commonly overlooked population.

Committee: Michael Elmore (Advisor) Subjects: Clergy; Pastoral Counseling; Religious Education

Doctor of Psychology (Psy.D.), Xavier University, 2025, Psychology

The present study sought to experimentally investigated the role of emotional numbing as a mediator in the relationship between posttraumatic stress symptoms and callous-unemotional traits in an adolescent sample seeking mental health or substance use treatment. Additionally, the relation of trauma exposure on treatment outcome and level of care referral was examined. Adolescents ages 11-19 (N = 119) who completed an intake for potential IOP treatment were enrolled in the study. Those who reported trauma were administered measures of posttraumatic stress, callous-unemotional traits, and emotional numbing during routine intake procedures. Referral decision, IOP substance abuse treatment outcome and duration were collected and their relation to trauma tested. Intended mediation analyses could not be conducted due to insufficient power. Trauma exposure was predictive of requiring intensive outpatient level of care or greater but was not associated with substance use disorder treatment outcome or days of treatment. More research is needed to better understand the role of trauma on treatment need and emotional numbing on developmental trajectories for youth with trauma history who develop callous-unemotional traits.

Committee: Susan Kenford (Advisor); Hannah Lubman (Committee Member); Stacey Raj (Committee Member) Subjects: Psychology

Master of Arts (M.A.), University of Dayton, 2023, Psychology, Clinical

Previous research has suggested that exposure to adverse childhood experiences (ACEs) and impulsivity are risk factors for adolescent substance use and delinquency. Additionally, previous research has indicated that ACE exposure is associated with increased levels of impulsivity, suggesting that impulsivity may mediate associations between ACEs exposure and adolescent substance use and delinquency. However, very little research has tested this possible mediation pathway, especially longitudinally. The present study addressed these gaps in the literature. Using longitudinal data from the Project on Human Development in Chicago Neighborhoods (PHDCN), the present study used path analyses to examine if: (1) exposure to ACEs is associated with increased levels of impulsivity, (2) if impulsivity is associated with increased levels of adolescent substance use and delinquency, and (3) if impulsivity mediates associations between ACEs and adolescent substance use and delinquency. Additionally, supplemental analyses examined the effects of specific clusters of ACEs and impulsivity subscales. Path analyses indicated that increased exposure to ACEs was associated with higher levels of impulsivity. Additionally, increased levels of impulsivity were associated with increased levels of marijuana use, and impulsivity acted as a mediator between ACEs and marijuana use. Finally, supplemental analyses revealed that the impulsivity subscale of decision time mediated associations between ACEs and marijuana use. Analyses did not reveal significant results for binge drinking, cigarette use, or delinquency. The present findings suggest that ACEs exposure is associated with increased risk for marijuana use through its associations with increased levels of impulsivity, specifically decision time.

Committee: Jackson Goodnight (Advisor); Catherine Zois (Committee Member); Lucy Allbaugh (Committee Member) Subjects: Clinical Psychology

Doctor of Healthcare Administration (D.H.A.), Franklin University, 2020, Health Programs

Mental illness is a growing concern among families in the United States, as one in five children between the ages of 13 and 18 suffer from a severe mental illness (National Alliance on Mental Illness, 2013). That means that 20% of children in the country are suffering from an illness whose treatment is difficult to access. Unfortunately, one-fourth of families report problems finding and initiating services for their children, with wait lists that typically start at three months (American Academy of Child and Adolescent Psychiatry, 2013). Even more troubling is the fact that 80% of children with mental illness do not receive any treatment at all (American Academy of Child and Adolescent Psychiatry, 2013). However, to improve access to treatment, organizations need to feel confident that they can open safe, financially sustainable mental health units. The Children's Hospital of Orange County (CHOC) in California recently opened an 18-bed inpatient psychiatric unit that services children ages 3-17 (Perkes, 2016). Many months of thoughtful consideration occurred to develop this elite and cutting-edge model of care. This researcher developed a specific model to approach pediatric mental healthcare through a different lens, called The Core Value Driven Care Model. The model of care is centered around three pillars of focus firmly built on the groundwork of core values. The pillars are representative of People, Place, and Practice, and are anchored in a foundation of empathy, compassion, trust, integrity, dignity, respect, sincerity, unity, honesty, and open-mindedness, as well as trauma-informed thinking. Implementing the Core Value Driven Care Model in a pediatric mental health unit directly impacts the perception of safety and quality of care being provided. The purpose of this study will be to assess the impact the 11 foundational core values have on employee perception of employee safety, patient safety, and quality of care.

Committee: David Meckstroth (Committee Chair); Alyncia Bowen (Committee Member); Jesse Florang (Committee Member) Subjects: Health Care; Health Care Management; Management; Mental Health; Occupational Health; Occupational Safety; Psychology; Systems Design

Psy. D., Antioch University, 2019, Antioch New England: Clinical Psychology

This qualitative study explores therapist views of the therapeutic relationship in adolescent residential treatment from an attachment perspective. The therapeutic relationship is a strong predictor of outcomes in adult psychotherapy and a significant body of research has relied on the attachment literature to understand its importance. Research yields comparable results when examining the significance of the therapeutic relationship with children and adolescents; however, there is virtually no literature exploring it from the attachment lens. This is particularly notable for children and adolescents in residential treatment. As treatment intensity increases from outpatient to inpatient to residential, challenges and opportunities within the therapeutic relationship increase, too: therapists form uniquely intense and intimate connections with children and adolescents they may see every day. This study employed constructivist grounded theory data analysis of semi-structured interviews with residential therapists exploring their views of the role of attachment in the therapeutic relationship with their adolescent clients. Key findings include role differences in therapists in adolescent residential treatment; the importance of affect management, attunement, and self-awareness within the therapeutic relationship in adolescent residential treatment; the healing nature of relationship, connection, and feelings of safety with adolescents in residential treatment; and the concept of attachment as fundamental in adolescent residential treatment. Implications for practice and training, limitations, and suggestions for future inquiry are also discussed.

Committee: Martha Straus PhD (Committee Chair); Gina Pasquale PsyD (Committee Member); Cara Bonuso PsyD (Committee Member) Subjects: Clinical Psychology

Master of Arts, Ursuline College, 2008, Art Therapy and Counseling

The trauma endured by children entering foster care can be horrific. The child often works diligently to recover from the abuse and neglect that he or she has endured. The pain that the child experiences through the healing process may hamper the recovery. The child may resolve or identify issues by using art to lessen the burden and pain he may hold within himself. Art therapy as part of a treatment team approach with a child who has many needs, such as a foster child, is usually welcomed by the child, and can be very effective as part of an overall treatment plan.

Committee: Cecile Brennan (Advisor); Gail Rule-Hoffman (Advisor); Diane Merros (Advisor); Valerie Treisch-Chirdon (Other) Subjects: Art Education; Behaviorial Sciences; Mental Health; Physiological Psychology; Psychology; Social Psychology; Therapy

Psy. D., Antioch University, 2011, Antioch New England: Clinical Psychology

This dissertation introduces and discusses Winnicott's (1958/1974) capacity to be alone construct and how it is engendered in a child by an attuned environmental framework. Literature from the psychoanalytical, developmental, attachment, and trauma fields are utilized to operationalize the capacity to be alone in terms of attachment status, emotional regulation, executive functioning, and impulse control. The goal was to generate an object relational-developmental framework that will be used as a non-pathologizing lens by which to view the internalizing and externalizing behaviors of adolescents in foster care as well as of youth who have not been placed in substitute care. Clinical implications that result from this model are examined, as well as recommendations for future research.

Committee: Martha Straus PhD (Committee Chair); Theodore Ellenhorn PhD (Committee Member); Len Fleischer EdD (Committee Member) Subjects: Clinical Psychology; Developmental Psychology; Mental Health; Psychotherapy