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OBJECTIVES:. To determine the prevalence and extent of impairments impacting health-related quality of life among survivors of COVID-19 who required mechanical ventilation, 6 months after hospital discharge. DESIGN:. Multicenter, prospective cohort study, enrolling adults 18 years old or older with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received mechanical ventilation for 48 hours or more and survived to hospital discharge. Eligible patients were contacted 6 months after discharge for telephone-based interviews from March 2020 to December 2020. Assessments included: Montreal Cognitive Assessment-Blind, Hospital Anxiety and Depression Scale, Impact of Event Scale-6, EuroQOL 5 domain quality-of-life questionnaire, and components of the Multidimensional Dyspnea Profile. SETTING:. Two tertiary academic health systems. PATIENTS:. Of 173 eligible survivors, a random sample of 63 were contacted and 60 consented and completed interviews. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Mean age was 57 + 13 years and mean duration of invasive mechanical ventilation was 14 + 8.2 days. Six months post-discharge, 48 patients (80%; 95% CI, 68–88%) met criteria for post-intensive care syndrome (PICS), with one or more domains impaired. Among patients with PICS, 28 (47%; 95% CI, 35–59%) were impaired in at least 2 domains, and 12 (20%; 95% CI, 12–32%) impaired in all three domains. Significant symptoms of post-traumatic stress were present in 20 patients (33%; 95% CI, 23–46%), anxiety in 23 (38%; 95% CI, 27–51%), and depression in 25 (42%; 95% CI, 30–54%). Thirty-three patients (55%; 95% CI, 42–67%) had impairments in physical activity; 25 patients (42%; 95% CI, 30–54%) demonstrated cognitive impairment. CONCLUSIONS:. Eighty percent of COVID-19 survivors who required mechanical ventilation demonstrated PICS 6 months after hospital discharge. Patients were commonly impaired in multiple PICS domains as well as coexisting mental health domains.

Single-case research design is a useful methodology to investigate counseling treatment effects through a time-series graph. A systematic review of 42 counseling journals was conducted, yielding 50 studies, including 272 graphs. Most graphs did not meet recommended guidelines. How graphs impact visual analysis and suggestions to enhance interpretability are discussed.

School counselors are encouraged to employ evidence-based practices to meet students' mental health needs, yet a scarcity of outcome research limits their access to adequately supported prevention and intervention resources (Griffith et al., 2019). To maximize their impact and time, school counselors should consider conducting group counseling with students. Specifically, school counselors should consider implementing Adventure Therapy (AT), a kinesthetically engaging form of group counseling that uses adventure activities to promote participation through collaborative problem solving, encourage responsible decision-making, and foster accountability among students (Christian et al., 2019). While literature supports the use of AT in schools, there is a dearth of outcome studies examining its efficacy with students. This study explored the impact of AT on 7th graders' self-efficacy (n = 19). The researchers measured Total, Academic, Social, and Emotional self-efficacy using the Self-Efficacy Questionnaire for Children at pre, mid, post, and follow-up. Results suggested AT groups were effective for increasing all types of self-efficacy for participants with males showing a greater increase. Implications for school counselors and future research are described.

We examined the publication trends of faculty in 396 CACREP-accredited counselor education and supervision (CES) programs based on Carnegie classification by exploring 5,250 publications over the last decade in 21 American Counseling Association and American Counseling Association division journals. Using Bayesian statistics, this study expounded upon existing literature and differences that exist between institution classifications and total publications. The results of this study can be used to inform the training and preparation of doctoral students in CES programs through a Happenstance Learning Theory framework, specifically regarding their role as scholars and researchers. We present implications and argue for the importance of programs and faculty providing research experience for doctoral students in order to promote career success and satisfaction.

A mountain bike program was designed and adapted for the school setting with middle school-aged students during 2020, amid the COVID-19 pandemic. Two mountain bike groups were offered to facilitate training and development of mountain bike knowledge and skills: one group with integrated Adventure Therapy components to facilitate a therapeutic process and the other group without a therapeutic debriefing process. Forty-one students participated in the program after being randomly assigned to one of two groups. An exploratory qualitative analysis revealed that the pandemic negatively impacted participants' wellbeing and academics, leading to increased isolation and decreased motivation, while the mountain bike program increased their focus, competency, physical and mental wellbeing, and connection to the environment. It appears the mountain bike program served as a protective factor for participants. Implications for professionals and researchers are discussed.

School counselors (SCs) are tasked with addressing the academic, career, and personal/social development of all students. As mental health issues experienced by school-aged children have increased, SCs have been unable to provide adequate mental health services. Because of barriers to receiving community-based mental health services, school-based services are becoming increasingly necessary. In this article we propose that School-Based Mental Health Counselors (SBMHCs), specifically trained to work with school-aged children and placed within a school setting, are appropriate for meeting students' mental health needs. Although SBMHCs are not new to counseling, we make specific recommendations and suggestions for the training and practice of SBMHCs so that they can collaborate with SCs to meet the mental health needs of all students.

The authors implemented an A–B–A with follow‐up quasi‐experimental single‐case research design to assess the effectiveness of a consumer‐grade neurofeedback (NFB)‐assisted mindfulness‐based intervention (MBI) for reducing anxiety in high‐achieving high school students (N = 5). Three of the participants from racial/ethnic minority and lower socioeconomic status (SES) backgrounds reported reduced anxiety as measured by the State‐Trait Anxiety Inventory for Youth (STAI‐Y) during the intervention. In contrast, the two participants who identified as White, higher SES did not report decreased anxiety during the intervention. Results provide initial support for the use of the NFB‐assisted MBI used in this study as a brief, targeted intervention for highly anxious, high‐achieving high school students—specifically those from racial/ethnic minority and lower SES backgrounds. Implications for practice and research are discussed. [ABSTRACT FROM AUTHOR]

This study explored the group developmental process of Adventure Therapy (AT) conducted with 9th grade students (n = 20). Researchers measured avoidance, conflict, and cohesion and compared results from this study to the development of traditional counseling groups. Results suggested that AT groups follow a similar developmental process as traditional group counseling as evidenced by a statistically significant increase in cohesion, an increase then decrease in conflict, and a decrease in avoidance. This study is a response to a previous call for research related to AT group development. Implications for counselors, AT training programs, and future research are discussed.

Single-case research design is a useful methodology to investigate counseling treatment effects through a time-series graph. A systematic review of 42 counseling journals was conducted, yielding 50 studies, including 272 graphs. Most graphs did not meet recommended guidelines. How graphs impact visual analysis and suggestions to enhance interpretability are discussed. [ABSTRACT FROM AUTHOR]

While the role of the natural environment is considered integral to the therapeutic process in Adventure therapy (AT), facilitators often only passively view it as a backdrop rather than intentionally using it as a co-facilitator of change. In this article, we propose a framework – AT-EcoWellness Framework – integrating EcoWellness with AT concepts that facilitators employ to intentionally use nature in the process of planning and facilitating AT groups. We illustrate the AT-EcoWellness Framework through a planning guide and case example of a recent program. [ABSTRACT FROM AUTHOR]

In this article, we outline standards and recommendations for single-case research design (SCRD) graph construction to improve readability, transparency, and interpretation. Prior research indicates large variability among graph representation resulting in misinterpretation and lack of clarity of reported findings. Prominent graph features are discussed including esthetic and analysis altering characteristics. We provide a conceptual checklist along with visual and narrative descriptions to support the construction of SCRD graphs and help guide practitioners and researchers with reporting and displaying SCRD data. [ABSTRACT FROM AUTHOR]

Clinical supervision is an essential aspect of counselor training. Apart from traditional models of supervision, many new and creative ways of conducting supervision have emerged. The integration of the Kawa Model that employs a metaphorical river, with Bernard's Discrimination Model offers a culturally responsive and creative approach to clinical supervision. An overview of the Kawa Model, detailed description of the integration process, and case study are provided. [ABSTRACT FROM AUTHOR]

This study explored whether adolescents' introspection increased while engaged in a mindfulness-based intervention (MBI). Using a quasi-experimental design, the researchers identified high school students (n = 13) with elevated levels of anxiety to participate in an 11-week, multiphase MBI. Participants' introspection ability was assessed by comparing self-reported levels and observed percentage of time calm as recorded by a neurofeedback (NFB) device three times a week during the program. Using general linear modeling, results indicated a significant interaction effect with moderate effect sizes between self-reported scores by phase on NFB scores, F(2, 407)=4.12, p = 0.017 and a significant interaction between sex and self-reported scores on NFB scores overall, F(1, 407)=5.05, p = 0.025. Female participants appeared to have increased introspection compared to males. Results support the use of MBIs to foster introspection in adolescents. The MBI with an NFB device appeared to improve introspection, a key factor in accurate self-report. [ABSTRACT FROM AUTHOR]

The purpose of this qualitative study was to explore the experiences of eleven doctoral students at three CACREP accredited programs to address issues in counselor education and supervision programs and faculty face regarding gatekeeping. The information was used to develop and provide recommendations for gatekeeping procedures that can be implemented at the departmental and classroom levels. Ways programs can improve the training of doctoral students for gatekeeping roles and responsibilities, steps faculty can take to create an environment which supports gatekeeping at their institution, as well as support doctoral students as they grow into future gatekeepers of the profession are discussed. [ABSTRACT FROM AUTHOR]

Counselor Education programs are required to prepare doctoral students to become supervisors, however there is both no single agreed upon pedagogy or method, as well as a seeming lack of culturally responsive pedagogy or teaching methods for instructing students in learning and developing supervision knowledge and skills in counseling supervision courses (Korcuska, 2016). The authors propose the integration of established pedagogical approaches to address students' implicit and explicit bias in order to develop cultural competence and humility in becoming culturally responsive supervisors. The authors provide an overview of Critical Race, Feminist, and Experiential Learning theories and how these theories can be infused to enable Counselor Educators to teach future supervisors with a diverse blend of methods. A sample case study is provided. [ABSTRACT FROM AUTHOR]

Objectives To examine randomised controlled trial (RCT) progression criteria including emergency department (ED) attendance and non-fatal overdose, from a holistic, integrated health and social care outreach intervention (PHOENIx), for people experiencing homelessness with recent non-fatal street drug overdose.Design Pilot RCT. 1:1 randomisation to PHOENIx plus usual care (UC) or UC.Setting Glasgow, Scotland.Participants 128 adults experiencing homelessness with at least one non-fatal street drug overdose in the preceding 6 months.Interventions Pharmacists from the National Health Service and third sector homelessness workers offered weekly outreach. PHOENIx teams develop therapeutic relationships to address health (physical health, mental health and problem drug use) and social care (housing, welfare benefits and social prescribing) in addition to UC. UC comprised building-based primary and secondary health, social and third sector services.Outcomes Primary: progression criteria: recruitment (≥100 participants in 4 months); ≥80% of participants with data collected at baseline, 6 and 9 months; ≥60% of participants retained in the trial at each follow-up period (6 and 9 months); ≥60% of participants receiving the intervention weekly; any reduction in the rate of presentation to ED and overdoses, at 6- or 9-month follow-up. Secondary: participants with, and time to: hospitalisations; health-related quality of life (QoL); treatment uptake for physical and mental health conditions, and problematic drug use.Results Progression criteria were exceeded. In PHOENIx compared with UC, there appeared to be a delay in the median time to ED visit, overdose and hospitalisation but no improvement in number of participants with ED visits, overdoses or hospitalisations. QoL and treatment uptake appeared to be higher in PHOENIx versus UC at 6 and 9 months.Conclusions A definitive RCT is merited, to assess the impact of PHOENIx on people with multiple, severe disadvantages.Trial registration number ISRCTN10585019.

School counselors are encouraged to employ evidence-based practices to meet students' mental health needs, yet a scarcity of outcome research limits their access to adequately supported prevention and intervention resources (Griffith et al., 2019). To maximize their impact and time, school counselors should consider conducting group counseling with students. Specifically, school counselors should consider implementing Adventure Therapy (AT), a kinesthetically engaging form of group counseling that uses adventure activities to promote participation through collaborative problem solving, encourage responsible decision-making, and foster accountability among students (Christian et al., 2019). While literature supports the use of AT in schools, there is a dearth of outcome studies examining its efficacy with students. This study explored the impact of AT on 7th graders' self-efficacy (n = 19). The researchers measured Total, Academic, Social, and Emotional self-efficacy using the Self-Efficacy Questionnaire for Children at pre, mid, post, and follow-up. Results suggested AT groups were effective for increasing all types of self-efficacy for participants with males showing a greater increase. Implications for school counselors and future research are described. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic made a resounding impact worldwide, forcing brick-and-mortar higher education institutions to move online. During this transition, students had to adjust while attempting to construct meaning amidst myriad of pandemic related challenges. At the same time, educators had to transition from in-person to online course delivery, while navigating their own uncertain circumstances. All the while, learning continued. This article describes experiential education and outlines how educators can use a model that integrates the adventure wave and experiential learning cycle to guide online instruction. The proposed model is useful for enhancing the learning process and promoting wellbeing by providing students the needed time to construct new knowledge about course content within the context of the pandemic. Case examples demonstrating the application of experiential education using the proposed model in a counseling theories course and basic skills course are included. Emphasis is placed on ensuring student welfare so that learning can continue during the disruption of COVID-19. [ABSTRACT FROM AUTHOR]

Abstract Background Drug-related deaths in Scotland are the highest in Europe. Half of all deaths in people experiencing homelessness are drug related, yet we know little about the unmet health needs of people experiencing homelessness with recent non-fatal overdose, limiting a tailored practice and policy response to a public health crisis. Methods People experiencing homelessness with at least one non-fatal street drug overdose in the previous 6 months were recruited from 20 venues in Glasgow, Scotland, and randomised into PHOENIx plus usual care, or usual care. PHOENIx is a collaborative assertive outreach intervention by independent prescriber NHS Pharmacists and third sector homelessness workers, offering repeated integrated, holistic physical, mental and addictions health and social care support including prescribing. We describe comprehensive baseline characteristics of randomised participants. Results One hundred and twenty-eight participants had a mean age of 42 years (SD 8.4); 71% male, homelessness for a median of 24 years (IQR 12–30). One hundred and eighteen (92%) lived in large, congregate city centre temporary accommodation. A quarter (25%) were not registered with a General Practitioner. Participants had overdosed a mean of 3.2 (SD 3.2) times in the preceding 6 months, using a median of 3 (IQR 2–4) non-prescription drugs concurrently: 112 (87.5%) street valium (benzodiazepine-type new psychoactive substances); 77 (60%) heroin; and 76 (59%) cocaine. Half (50%) were injecting, 50% into their groins. 90% were receiving care from Alcohol and Drug Recovery Services (ADRS), and in addition to using street drugs, 90% received opioid substitution therapy (OST), 10% diazepam for street valium use and one participant received heroin-assisted treatment. Participants had a mean of 2.2 (SD 1.3) mental health problems and 5.4 (SD 2.5) physical health problems; 50% received treatment for physical or mental health problems. Ninety-one per cent had at least one mental health problem; 66% had no specialist mental health support. Participants were frail (70%) or pre-frail (28%), with maximal levels of psychological distress, 44% received one or no daily meal, and 58% had previously attempted suicide. Conclusions People at high risk of drug-related death continue to overdose repeatedly despite receiving OST. High levels of frailty, multimorbidity, unsuitable accommodation and unmet mental and physical health care needs require a reorientation of services informed by evidence of effectiveness and cost-effectiveness. Trial registration UK Clinical Trials Registry identifier: ISRCTN 10585019.

Abstract Background People experiencing homelessness (PEH) have complex health and social care needs and most die in their early 40 s. PEH frequently use community pharmacies; however, evaluation of the delivery of structured, integrated, holistic health and social care intervention has not been previously undertaken in community pharmacies for PEH. PHOENIx (Pharmacy Homeless Outreach Engagement Non-medical Independent prescribing Rx) has been delivered and tested in Glasgow, Scotland, by NHS pharmacist independent prescribers and third sector homelessness support workers offering health and social care intervention in low threshold homeless drop-in venues, emergency accommodation and emergency departments, to PEH. Building on this work, this study aims to test recruitment, retention, intervention adherence and fidelity of community pharmacy-based PHOENIx intervention. Methods Randomised, multi-centre, open, parallel-group external pilot trial. A total of 100 PEH aged 18 years and over will be recruited from community pharmacies in Glasgow and Birmingham. PHOENIx intervention includes structured assessment in the community pharmacy of health, housing, benefits and activities, in addition to usual care, through weekly visits lasting up to six months. A primary outcome is whether to proceed to a definitive trial based on pre-specified progression criteria. Secondary outcomes include drug/alcohol treatment uptake and treatment retention; overdose rates; mortality and time to death; prison/criminal justice encounters; healthcare utilisation; housing tenure; patient-reported measures and intervention acceptability. Analysis will include descriptive statistics of recruitment and retention rates. Process evaluation will be conducted using Normalisation Process Theory. Health, social care and personal resource use data will be identified, measured and valued. Discussion If the findings of this pilot study suggest progression to a definitive trial, and if the definitive trial offers positive outcomes, it is intended that PHOENIx will be a publicly funded free-to-access service in community pharmacy for PEH. The study results will be shared with wider stakeholders and patients in addition to dissemination through medical journals and scientific conferences. Trial registration International Clinical Trial Registration ISRCTN88146807. Approved protocol version 2.0 dated July 19, 2022.