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RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
A Psychological Perspective on the Implications of Retirement
Abbey Simshauser
Wagner College
Psychology Department
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Table of Contents
page
ABSTRACT……………………………………………………..…………………………….3
CHAPTER
1
HISTORY OF RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE…………....4
Historical Context…………………………………………………………………......4
Psychological Research………………………………………………………………..6
Maslow’s hierarchy of needs……………………………...……………...……6
Erikson’s theory of later life…………………………………………..……….9
Levinson’s theory of late adulthood………………………………………….12
Transition to modern psychological research……………………………….………..13
Conclusion……………………………………………………………………………14
2
TRANSITION FROM THE WORKPLACE TO RETIREMENT…………………..16
Motivation and Purpose………………………………………...……………………16
Financial Preparedness…………………………………………………………….....17
Connection with Friends and Family…………………………………….…………..18
Lifestyle and Leisure…………………………………………………………………18
Meaning and Purpose………………………………………………………………...19
Conclusion……………………………………………………………………………20
3
THE DARK SIDE OF RETIREMENT……………………………………………...22
Problems faced by retired individuals………………………………………………..22
Loneliness in retirement communities……………………………………….23
Solutions for decreasing loneliness…………………………………………………..24
Conclusion……………………………………………………………………………26
4
Reflection…………………………………………………………………………….28
LIST OF REFERENCES…………………………………………………………………….31
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Abstract
A psychological perspective in relation to retirement is essential in examining increased
sense of purpose and fulfilment during this transition. Chapter 1 discusses the history of
retirement from a psychological perspective. Throughout the late 18th and into the 19th
centuries aging theories in psychology helped us understand the development of individuals
into their old age. There is a dramatic shift in research to modern times with a focus on the
whole process of the transition rather than just the event itself. Chapter 2 focuses on the
literature behind the transition from the workplace to retirement. Variables analyzed include
motivation, financial capacity, family and partners goals, lifestyle and leisure and finally
meaning and purpose. Chapter 3 examines the potential dark side of retirement. This results
from increased isolation and as a result loneliness experienced by retired individuals. The
potential solution examined is increased social activities that these individuals engage in.
Finally, chapter 4 examines how research found throughout chapter 1-3 can be applied in a
practical setting. This practical setting is in a non-for-profit organization called Conversations
to Remember which essentially aims at targeting improved purpose and fulfilment for aging
adults in senior communities.
Keywords: retirement, aging theories, transition, purpose, fulfilment, loneliness,
workplace
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Chapter 1
History of Retirement: A Psychological Perspective
Retirement as we know it in the 21st century has taken a dramatic shift from what
would have seen in the late 18th and early 19th century. Although retirement in psychological
research is often considered a ‘modern’ concept, aging theories from the 19th century can be
used to asses in fundamental terms; coping with everyday problems in old age. During this
stage sensory functions tend to become less sensitive, central information processing
becomes slow, and motor action becomes weaker (Welford, 1992). Aging theories are useful
in understanding the challenges retirees would experience at this old age, however they lack
focus towards ensuring continued development, satisfaction and ways in which mental health
can be increased. The cause of this is due to a lack of studies focusing on the whole process
of retirement rather than just the event itself.
Such psychological theories of aging include Maslow’s hierarchy of needs, Erikson’s
theory of later life and Levinson’s theory of late adulthood. All three theories have in
common a focus on the individual’s development to late adulthood. Maslow’s theory is based
on human motivation and human needs which he believes dictates individuals behavior.
Alternatively, Erikson’s theory is based on human development through series of
psychosocial conflicts which one undergoes throughout different stages of their life.
Levinson’s theory is very similar to Erikson’s as much of research was based upon the
lifespan development theory of Erikson. Levinson however is the most useful in analyzing
retirement out of these three theories as he specifically discusses the issue of retirement in
multiple literature he worked on.
Historical Context
In order to understand the transition to what would be considered ‘modern’
retirement, context must first be established in relation to the historical events which
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influenced this movement. Prior to 1880, ideas associated to retirement were radical and
people simply did not retiree. If one was alive, they were required to work and this was the
expectation provoked on individuals within society (Laskow, 2014). The United States and
Germany can both be considered early pioneers for the adoption of a retirement system and
private pensions. In the United States, the first employer-provided retirement plan was
implemented by the American Express Company in 1875. This plan was only eligible to
those however, who were disabled from work either due to a disability or old age. This
pension plan also was only given to those who had completed 20 years or service, had been
recommended by the company’s general manager, approval given by the board of directors
and were at least 60 years of age (Seburn, 1991). Even though American Express is
considered an early pioneer for private pensions, it is clear their program still had a lot of
requirements individuals had to go through as they did not want everyone receiving this
pension.
Following this Otto Von Bismarck who was a German chancellor helped unify and
create the German empire following decades of war. In 1889 he introduced a proposal for
universal retirement payments for those who were disabled from work either by age or
disability. The rules of this engagement meant that anyone over the age of 65 were forced to
retire and a pension was paid to them. This in turn makes Germany the first nation in the
world to adopt an old social insurance program (Laskow, 2014). This pension program
harshly contrasted what we had previously seen in society in relation to workforce
expectations, however it was implemented as a method to get younger people to enter the
workforce through opening up more job availabilities to them. An insightful point to note is
that the life expectancy during this time was quite low, this meant that even though people
were promised a pension after 65, they often did not reach this age or live many years into
their retirement.
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The Great Depression and World War II were significant events which contributed to
the modernization of retirement as it can described today. Prior to President Roosevelt’s
signing of the Social Security Act of 1935 and during the Great Depression, majority of the
nonworking elderly lived in some form of economic dependency, lacking sufficient income
to be self-supporting. The extreme economic climate of the 1930s led to a dramatic increase
in “pension movements”. The depression as a result is considered a significant ‘triggering’
event which finally persuaded America to adopt a social insurance system (DeWitt, 2010).
World War II was another key event which shaped the development of a modern retirement
system as it is seen today. The pressures of the war put constraints on companies being able
to offer employees high wages. As a result, companies as a way to entice new workers whilst
still avoiding raising wages, recruited with the promise of future retirement benefits (Seburn,
1991).
Psychological Research
Retirement as a government policy was not recognized until the late 19th and early
20th centuries in most countries (Weisman, 1999). This created a lack of research from
psychologists in this area until it was officially considered a government policy. However, it
is possible to analyze the life stages and transitions experienced by retirees through aging
developmental theories with specific focus from 1943-1980.
Maslow’ Hierarchy of Needs
Abraham Maslow was an American psychologist who was most known for his
hierarchy of needs in relation to human motivation. This is a five-step pyramid where one
must move through each stage before they are able to move onto the next. The hierarchy
consists of psychological needs, safety needs, love and belonging, esteem and finally selfactualization. Within this theory, even if one is satisfised with the first four components it is
often still not possible to achieve self-actualization. Maslow refers to this final stage as an
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individual being all they are capable of being and the best version of themselves (Maslow,
1943). According to Maslow, self-actualized people are characterized by being problemfocused, incorporating an ongoing freshness of appreciation of life, a concern about personal
growth and the ability to have peak experiences. His proposals on the hierarchy seem to
support the proposals of both William James in 1892 and Mathes in 1981, that there are three
levels of humans needs (Huitt, 2007).
This theory of self-actualization along with Maslow’s theory of peak-experiences can
be directly related to the retirement transition. The ultimate problem faced by retirees since
the late 1800s has been a lack of purpose and fulfilment. Psychological theories of
development such as this help explain the goal one can expect to have during retirement,
however they fail to focus on how individuals dealt with this change. The goal of Maslow in
relation to retirement would be for an individual to become self-actualized and be able to
experience what he calls ‘peak experiences’. Maslow describes the word ‘peak-experiences’
to be related to a generalization for the best moments of the human being, for the happiest
moments of life, for experiences of ecstasy, rapture, bliss, of the greatest joy. Maslow in
relation to this theory discusses ‘values’ and that these are perceived differently by each
person. He states that many people discover too late that the retirement which was made
possible by years of work, doesn’t taste as sweet as the years of work did (Maslow, 1963).
Maslow’s theory in relation to retirement points to an unrealistic goal which could inevitably
lead to poor mental health if one is not able to achieve these expectations.
Self-Actualization and peak-experiences can be used in order to facilitate a healthy
retirement; however, we see during this period a lack of research emphasizing the importance
of ensuring constant mental health check ins and often psychological aspects were
overshadowed by the focus on physical and financial issues during this time. In turn it
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significantly impacted how individuals viewed and treated the retirement phase (Schultz &
Wang, 2011).
In 1974, Keahey and Seaman conducted a study to examine self-actualization and
adjustment in retirement. They further analyzed their findings implications for program
development. This is interesting as it one of the only literature reviews of its time to examine
retirement directly from a psychological perspective. In the article they state issues with
adjustment to retirement are hindered by a series of factors including a negative attitude
toward older people by much of the general population, poor self-image by retirees, and the
fact that little attention has been placed on teaching individuals how to make successful use
of their leisure time. They conclude from their findings that adult education programs which
are directed toward assisting individuals in their adjustment to retirement must consider those
self-actualizing values which best predict one’s ability to change. The goal of this would be
to allow older individuals in their retirement to fulfill both felt and unfelt needs (Keahey &
Seaman, 1974). Studies such as this reflect that individual felt as though self-actualization
was important for a healthy retirement transition; however, there is lack of focus on
development throughout this transition and no focus on ensuring health mental health during
such a large change in one’s life. This further proves this theory to point towards an
unrealistic goal as not everyone reaches self-actualization. Thus, how would someone in
retirement who is not self-actualized be able to feel a sense of purpose and fulfilment in their
life. This is a concept which research during this time fails to analyze which has the potential
to lead these individuals towards unrealistic expectations of what their retirement would look
like.
In 2001, Michael K Stein conducted an analysis of retirees climbing Maslow’s
hierarchy of needs ladder. In this he states for most of the last century, the central issue
during retirement was survival. This corresponds with physiological needs which is the
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lowest level on Maslow’s hierarchy of needs. It has however been proven with developing
aging theories including Erikson and Levinson as well as psychological theories in the 21st
century that times are changing. He refers to the 1930s when retirees were climbing to the
safety level through the use of pension plans in both government and corporate businesses.
Most importantly he states the Social Security act providing a safety net for millions of
retirees. Retirees then moved into Maslow’s next level of belonging after the second World
War when they began to enter into distinct groups. During this time as Stein states was when
retirees became a distinct group of interest in society. As a result, retirees had begun to raise
their sights from simply survival and were attempting to achieve the goal of having a lifestyle
in retirement which was similar to the lifestyle they had achieved prior to retirement (Stein,
2001). This is evident that Maslow’s hierarchy of needs can be related to this evolution of
retirement and contributed to the changing meaning of what a successful retirement meant.
This article is also useful in examining in relation to Maslow’s hierarchy of needs as it
provides analysis towards how it can be applied practically to retirement.
Stein further examines that contemporary retirees have created a new trend which
could be coined meaningful retirement. It is clear that many retirees have risen to the top of
Maslow’s hierarchy of needs and as a result they are no longer content. This moves to the
achievement of self-actualization through continuing to contribute to society, move forward,
build a legacy and accomplish things which are worthy of their best version and highest skills
(Stein, 2001). Further exemplifying the changing nature of retirement goals and directly
corresponding to Maslow’s theory of the hierarchy of needs.
Erikson’s Theory of Later Life
Erik Erikson was a psychoanalyst and life cycle theorist; he created an extremely
influential theory relating to human development. This theory was first seen in his book
“Childhood and Society” in 1950, which he described as the eight stages of man. According
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to this theory, personality development goes through a series of eight ordered stages, with
each one being associated with a psychosocial crisis which the individual either successfully
resolves or may fail to do so. Specific focus in relation retirement is the final stage ‘Ego
Integrity vs. Despair’. Ego integrity as described by Erikson is the acceptance of one’s one
and only life cycle as something that had to be and that, by necessity, permitted of no
substitution. This makes the final purpose in one’s life which they experience during
retirement to hopefully be them looking back on their life and viewing it as positive and
successful. Contrastingly, the negative side to the Integrity vs. Despair psychosocial crisis, is
when one looks back on their live and views it as being negative. This may potentially be due
to feelings of living an unsuccessful or unproductive life. Erikson states that despair
expresses the feeling that the time is short, too short for the attempt to start another life and to
try out alternate roads to integrity (Erikson, 1950). Furthermore, Erikson in 1994 states the
‘integrity’ as he uses it, lacks a clear definition but all human integrity stands and falls with
the one style of integrity of which he partakes (Erikson, 1994).
In 1982, J. Eugene Wright further examines Erikson’s theory of development which
helps understand his theory in greater depth. He states that in the eighth and final stage;
integrity and wisdom round out the cycle in interesting ways. In vast contrast however; the
danger side is despair. Here despair is considered when ego integration has not achieved
acceptance of one’s life cycle, there will be fear of death, panic will give way to
hopelessness, and despair will be expressed often times in disgust. This idea of disgust is
expressed specifically as well in Erikson’s own analysis of this final stage and it is essentially
lack of acceptance of oneself, but it often expressed in chronic complaining and disgust with
everything (Wright, 1982). If one is to feel despair during their retirement this may lead to
immense feelings of lack of worth due to the possibility of helplessness for being able to
achieve a ‘successful’ life.
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“In the aging person who has taken care of things and people and has adapted himself
to the triumphs and disappointments of being, by necessity, the originator of others and the
generator of things and ideas – only in him the fruit of the seven stages gradually ripens”
(Erikson, 1994). This quote from Erikson as well as analyzing the goals aging theories
expectations in relation to old age are essential in understanding how retirement was viewed
during this time. Aging theories such as Erikson’s created an unrealistic expectation of life
during retirement without focus on how one can achieve purpose and fulfillment during this
specific stage. These theories don’t examine how one can cope with living an unsuccessful
life which often is a factor retirees experience. Thus, research should have focused more
attention relating to how one can achieve these successes in their retirement if they had not
previously achieved it. This in turn would have increase life satisfaction and purpose of those
in retirement.
In 2009, John Osborne, an American Historian applied Erikson’s theory directly to the
purposes of identity in retirement. He states retirees may be surprised that retirement adjustment
can evoke past issues, specifically in relation to identity. These were issues the individual would
have already gone through if following Erikson’s development theory. In terms of identity, for
some retirees their identity may have been almost exclusively defined by their job, therefore this
can lead to an identity crisis as they are no longer a part of their workplace community. For
women, they may experience this in a heightened manor as it may contribute to lack of purpose as
a result of their children also leaving the home. This would relate back to Erikson Identity versus
Role diffusion stage of personality development which an individual would have experienced
during their teenage years. This is one example Osborne targets to propose that the relevance of
crises expressed in stages of Erikson’s model continues beyond the lifespan period in which they
first occur (Osborne, 2009). This makes it clear that there was a lack of focus on the continued
development for older adults, especially those who were retired.
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Levinson’s theory of late adulthood
Daniel Levinson was a developmental psychologist who was a pioneer in research
and theory on developmental stages and crises of adulthood. Levinson’s research was also
heavily influenced by Erikson. This theory is relation to retirement is extremely significant as
it can help understand some problems faced during this transition. Levinson’s theory was
published in the late 1970’s. As a result of it being later than both Maslow and Erikson’s
research there is a larger focus on retirement; he directly discusses this transition in his
research. Levinson believes adult development is a significant problem for psychology as a
discipline and it is also an important link between other disciplines such as sociology, biology
and history (Levinson, 1986). This may offer a possible explanation to the lack of
psychologies focus on retirement. This topic may have been explored across multiple
disciplines, thus potentially a reason it was not specifically focused on throughout the 1900s.
Levinson’s research in comparison to Maslow and Erikson has a specific focus on
transitions. One example of a period of change and readjustment is during retirement. He
focuses on the notion that the process of change is often so strong that little attention is then
given to the states that precede and follow that actual event. He describes a transition to be a
shift from state A to B and it important to research this; however, it is just an important to
study the process of change as well. Levinson believes that the study of change contributes to
our knowledge of events and adaptation but it cannot alone generate a theory of adult
development (Levinson, 1986).
Daniel Levisnon was interviewed on a radio broadcast by Ivan Lansberg specifically
in regards to retirement (Lansberg/Levinson, 1991). Here Levinson describes a denial of the
need to retire to be called unretirement. He describes this to be due to a psychological and
social dynamic around the negation of the issue, often that individuals go to great lengths to
avoid confronting the terror of this major life transition. In relation to his theory of adult
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development he states there are various aspects that are helpful in understanding retirement.
One major issue for retirees to come to terms with is when they retire, they move from being
a member of the dominant generation and instead move towards old age. Levinson describes
that this makes individuals feel less central, less relevant. This coincides with themes
demonstrated throughout other aging/developmental theories in relation to lack of purpose
and fulfilment. Levinson further describes that retirement should be considered a process, not
necessarily an event. This process consists of three stages, the first being preretirement phase,
then the retirement phase itself and finally the postretirement phase.
Levinson in this interview further states that society does not do a very good job to
transition to this final stage in the life cycle. He believes as a culture we have not been able to
develop a process that can help seniors address the developmental challenges in which they
face. This interview helps put into context how aging theories can target issue around
retirement and further points to a lack of focus on research of the whole transition of
retirement both prior and preceding the event.
Transition to Modern Psychological Research
Psychological studies have evolved after these aging theories to focus on the both the
preretirement phase and post retirement phase rather than just the event of retirement itself.
Robert Atchley who was an American gerontologist and sociologist enabled us to advance
theories which focus on the different stages through creating a 6-stage model that retirees
experience. This model included pre-retirement, retirement event, honeymoon phase,
disenchantment, reorientation and retirement routine. One component he looks at which is
essential in today’s understanding of retirement satisfaction is the difference between those
who retiree voluntarily as a pose to those who are forced out by compulsory policies. He
states those who retire voluntary have little or no difficulty adjusting and those who are
forced out tend to be the most dissatisfied at first. Another focus of current research is on
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ensuring meaningful activities. Through this it can increase a retiree’s sense of purpose and
fulfilment during this phase (Atchley, 1982). This is an important aspect in today’s
psychological research on retirement due to the focus on multiple stages throughout the
period rather than specifically just the event of retirement itself.
As we enter the 21st century the psychological aspects of retirement have become
more important as a result of the increased length of time people spend in their retirement.
There has been a more specific focus on ensuring that individuals during retirement
experience high self-purpose and life satisfaction. There has also been a focus on research
relating on ways to improve mental health during this transition through increasing tasks such
as participating in more leisure activities and volunteering. Recent research reflects that
retirement contributes to the relationship between basic psychological needs and well-being.
This type of research thus reflects the retirement transition and its effects on well-being
(Henning et al.,2019). Recent research such as this highlights the change from aging theories
which focused specifically on the actual event of retirement and towards a more progressive
approach to focus on the whole period of retirement in relation to well-being, fulfilment and
sense of purpose.
Conclusion
Psychological theories of retirement have developed significantly from the 19th
century to what can now described as 21st century retirement. Historically, retirement is
considered to be a relatively new phenomenon and as a result many psychological theories
did not begin to analyze and research this issue directly until the late 19th century (Schultz &
Wang, 2011). Psychological theories of aging such as Maslow’s hierarchy of needs,
Erikson’s theory of later life and Levinsons theory of adulthood can be considered the first
theories which helped explore the transition to retirement. They help us analyze specific
aspects of development and the transition to retirement; however, they lack further research
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on ways to deal with the retirement transition as a whole. Both Maslow and Erikson’s
theories point to an unrealistic goal of what a successful retirement. This is due to the fact
that not every will very fully satisfied and content with their lives during retirement. Overall,
these theories lack insurance of continued development for aging adults. We have a shift in
research going into the 21st century with psychological research on retirement focusing more
on satisfaction, development and mental health of retirees. These types of theories focus on
the whole transition throughout retirement rather than just the specific event of retirement.
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Chapter 2
Transition from the Workplace to Retirement
The transition from the workplace to retirement is important research to examine,
especially in today’s society where we see a growing number of people transitioning into this
phase of their life. The improvements in quality of life and healthcare of the past decades
have significantly changed the retirement process that we had previously seen. It is now more
common to see people frequently retiring in good health, still with several years ahead of
them (Halama et al., 2021). This step in one’s life can lead to changes in well-being and life
satisfaction. Retirement means relinquishing the daily structure that work provides and the
career-dependent meaning that it offers in one’s life. Therefore, the retirement transition
often involves contemplating how to spend newly-freed daily time and the implications of
retirement for one’s own life (Steiner & Amabile, 2022). Thus, variables which will be
examined in this literature review include; motivational changes as a result of retirement,
financial capacity, importance of family and partner life goals, changes in lifestyle and leisure
and finally the changes in meaning and purpose retirees will experience.
Motivation and Purpose
Previous research relating to cognitive aging and the use it or lose it hypothesis has
implied that some individuals during the retirement phase struggle to replace mentally
stimulating work activities as they would have had in their workplace. Therefore, keeping
motivation high during this period of one’s life is extremely important in increasing lifesatisfaction and well-being (Hamm et al., 2020). During this transition is when purposeful
engagement of those who are retired comes into question. This is commonly due to a direct
conflict between one’s occupation and their life goals, resulting in minimal purposeful
pursuits during the retirement phase than they would have had in previous decades.
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Therefore, motivation and ensuring a purposeful retirement may potentially require more
planning and a forward-thinking mindset to combat issues the aging population experience.
Additionally, increased motivation during one’s retirement is seen from increased
financial resources, health management and time spent with family and friends (Hill & Pfund,
2021). Thus, illustrating the importance of creating a purposeful retirement plan that will
utilize many aspects of their life to make this transition smoother.
Financial Preparedness
Moreover, financial capacity is another significant variable to be analysed when
discussing one’s transition from the workplace to retirement. This specifically relates to one’s
preparedness for this stage of their life financially. Almost one-third of adults in the United
States over the age of 55 have neither retirement savings nor a defined benefit retirement plan
(Nam & Loibl, 2020). Financial stability is essential during the retirement phase in order to
increase the well-being and satisfaction during such a large transitional period. Previous
research has reflected that society cannot guarantee enough financial support for a
comfortable retirement. Therefore, it is evident that individuals on their own must save
enough to prepare for this transition. This is evident in the Financial Planning for Retirement
(FPR) theory which consists of a series of activities involved in the accumulation of wealth to
cover needs in the post-retirement stage of life. This theory was firstly established as most
people do not possess the necessary knowledge to make optimal savings and investment
decisions. Secondly, individual planning is subject to many factors including income,
professional career and wealth. Thirdly, people may experience anxiety and develop negative
attitudes toward contemplating the alter stages of life and planning. It has recently been
useful in psychological concepts to help understand economic behavior (Topa et al., 2018).
This is a useful tool for those looking to retire as it can provide a way to ensure financial
stability throughout retirement.
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Connection with Friends and Family
Following this, connection with family and friends is another critical variable when
looking at increased well-being and satisfaction for the post retirement phase. Individuals that
align their post-retirement goals with their partner’s, will experience reduced stress and
increase wellbeing during this period. The lives we live interconnect with those around us. As
a result, research suggests that the goals and behaviors of these people significantly affect us
as individuals. Successful retirement often is associated with individuals seeing partners as
more instrumental to one’s goals both pre and post retirement (Lamarche & Rolison, 2021).
In the context of social relationships in general, these may be particularly important because
work environments are essentially social environments. Therefore, retirees often lose these
relationships and interactions when they stop working. This in turn places significance on
many other social relationships in an individual’s life including marriages, children and other
family/friends. These individuals who have strong connections in social settings may not see
as significant effects from the transition to retirement compared to someone without solid
social connections outside the workplace. This would see individuals with strong connections
to have a greater sense of purpose through more engagement in the community (Kail & Carr,
2019).
Lifestyle and Leisure
Furthermore, lifestyle and leisure changes are significant variables that impact an
individual’s transition from the workplace to retirement. An active lifestyle is often seen as a
key factor for successful aging, in particular during older age this can be in the form of
activity engagement (Henning et al., 2020). Not only does increased leisure in previous
research suggest greater well-being and mental health, it also has benefits for individuals’
health both physically and cognitively. These positive effects of leisure activities seem to
increase with age, and is stronger for retirees than those in the workforce. Research has
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reflected that most people maintain a similar pattern of leisure activity engagement into later
life. However, changes may occur during this transitional period as individuals have
considerably more free time available then they may have had before (Henning et al., 2020).
Another component of this is in relation to volunteering which is considered in research a
way for those in retirement to fill their free time. It is also important to note that cognitive
decline has been correlated with lower engagement in leisure activities; this is due to a
reduction in the amount of mentally stimulating activities these individuals are engaging in.
Research additionally suggests these cognitive declines differ across genders which is an
interesting variable to study in further detail (Hamm et al., 2020).
This proves that individuals during their retirement should be focusing on increasing
their lifestyle and leisure activities. This is a time where these types of activities can be seen
to decrease which can lead individuals to potential mental and physical implications.
Meaning and Purpose
Finally, the last variable that will be considered is the change in meaning and purpose
individuals experience during the retirement phase. This interrelates with previous variables
discussed but is important to analyse on its own as it is extremely prevalent during this stage
of one’s life. Managing the retirement change as stated in previous research has two major
developmental challenges. These include both social and psychological detachment from
work and developing a satisfactory post-retirement lifestyle (Halama et al., 2021). This
highlights the importance of keeping meaning in one’s life after they have left the workforce.
Several models have previously demonstrated ways to adapt to retirement and what makes
this process successful. These models include Barnes-Farrells’s role theory which looks at the
importance of income and health, Atchley’s continuity theory with studies the concept of an
aging individual engaging in activities that represent their past and Wang and Schultz’s
theory of life course perspective which analyses the psychological perspective of aging and
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
20
retirement (Halama et al., 2021). Furthermore, there is significant importance on having a
sense of purpose in life. As humans we are always looking for ways to add purpose to our
lives to feel a sense of satisfaction. Older adults with increased purposefulness in their life
appear less susceptible to a range of health ailments, and even early mortality (Hill & Pfund,
2021). Previous theoretical frameworks in relation to purpose show benefits which yield
health aging. This research suggests that purposeful individuals could be thinking about the
best routes to achieve their long-term goals and aims and increased life engagement which
leads to a more active lifestyle. Finally, this research also suggests that building and
allocating resources can facilitate future goal pursuits (Hill & Pfund, 2021). It is evident
therefore that increased meaning and purpose in one’s life is a reliable predictor of both
physical and cognitive successful aging outcome. Moreover, it is essential to note that as
personalities differ how purposeful they expect their retirement to be may be at one extreme
or the other, therefore these could be essential considerations to note in terms of how to
promote retirement planning. They state this could be done through the big five personality
test which includes openness, consciousness, extraversion, agreeableness and neuroticism
(Hill & Pfund, 2021).
Conclusion
The five variables examined in this literature include motivational changes in
retirement, financial capability, importance of family and partner life goals, changes in
lifestyle and leisure and finally the changes in meaning and purpose during retirement. These
variables all interrelate to suggest a common idea that there are many predictors of a
successful transition from the workplace to retirement with the goal of increasing well-being
and satisfaction. Retirement is an opportunity for people to rethink their identity and find new
meaning in their lives. The ability to find meaning in old age robustly correlates with
psychological health and overall well-being (Halama et al., 2021). Planning ahead for one’s
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
21
retirement can provide a foundation for achieving goals in post-work life; however, many of
the articles discussed a striking factor to be regarding whether people do expect to be goaloriented and engaged with life during retirement (Hill & Pfund, 2021). This is significant to
note as researchers should be interested in if these are the goals of retirees or whether they are
just looking for a more laid back and relaxed time without purpose during the retirement
phase.
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
22
Chapter 3
The Dark Side of Retirement
The dark side of the transition from the workplace to retirement is an important
change in one’s life which research needs to further analyze. This is such a large step an
individual’s life which can often lead to heightened experiences of loneliness which is often
as a result of struggles in changes within social relationships. Retirement in today’s society is
viewed as a blessed and blissful state, with retirement homes being advertised and promoted
as the place one needs to go to enjoy and live the happy life that they have earned (Duska,
2018). This does not however highlight the alternate dark side as mentioned of extreme
loneliness that living in such homes can have. Unsuccessful retirement adjustment may put
older adults at higher risk of experiencing negative physical and mental outcomes in later life
(Zhan et al., 2022). The support of risk variables during retirement is evidently often
overlooked in research and can often lead retired individuals to experiences of decreased
mental health and experiences of self-isolation as they move away from the workplace.
Problems faced by retired individuals
The potential implications and problems retired individuals face, stems from
increased feelings of loneliness and isolation that these retirees may not have experienced
whilst in the workforce. Loneliness is defined as a subjective sense of distress and discomfort
with one’s social ties (Segel-Karpas et al., 2016). Loneliness within research conducted on
retirement has been identified as a predictor of a variety of negative outcomes. These
negative outcomes include; individuals becoming more likely to suffer from poor health
outcomes and they are also more likely to die at an earlier age compared with their nonlonely counterparts. Systematic reviews have also reflected that loneliness does only have
detrimental effects on health, but it is also an independent risk factor for depression.
Explanations within these finding were given and suggest that these needs of companionship
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
23
and closeness are basic human needs, which need to be fulfilled. With their absence,
loneliness is likely to dramatically increase (Segel-Karpas et al., 2016). This is the case we
see for retired individuals who experience a new lack of companionship and closeness after
they leave the workforce. Moreover, this problem of increased experiences of loneliness and
isolation is seen at a greater level for those who have undergone involuntary retirement.
Often forced retirement is seen in job termination among older individuals who may be
experiencing poor health or disability. As result in the lack of choice of their retirement it
often leads to an increase in these negative feelings (Shin et al., 2019).
As a result, there is a significant need for research to understand the connections
between retirement and loneliness symptoms. Specifically, as this is proven to be a period
where individuals are more susceptible to declining social relationships. This can also be
referred to as the dark side of retirement. During this time, individuals not only have a
heightened sense of loneliness, they also reported lower sense of purpose levels, and retired
adults are more likely to decline on sense of purpose over time relative to working adults
(Hill & Pfund, 2021).
Loneliness in Retirement Communities
Correspondingly, an area of particular interest where we see retired individuals
experiencing heightened feelings of loneliness are within retirement communities which can
also be known as senior living communities. A study conducted to examine loneliness and
depressive symptoms from older adults aged 60-98 in independent living facilities found
depression rates to be around 15%. In contrast to depression, there are very little studies that
write about loneliness, but it has been suggested that loneliness may lead to depression for
older adults, particularly when there are ‘age-related losses or challenges’. Loneliness in this
study was measured by the UCLA Loneliness Scale (Version 3), which consists of 20
questions designed to identify feelings of loneliness in broad groups including older adults.
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
24
The results of this study demonstrated that higher levels of loneliness were experienced by
those who had less participation in organized social activities and lower church attendance
(Adams et al., 2004).
Moreover, recently the covid-19 pandemic has shed further light and increased levels
of loneliness felt by retired individuals. In retirement homes, to prevent the spread of
infections they were forced to limit physical interaction between residents and the outside
world and to drastically reduce their residents’ activities. The covid-19 pandemic
dramatically increased the number of older retired adults who were socially isolated and had
infrequent social contact. Research from the covid-19 pandemic as a result of this has
provided evidence that social isolation has detrimental impact on individuals’ health and
well-being. One particular study conducted in researching this impact of social isolation since
the pandemic has shown this variable to be associated with an approximately 50% increased
risk of developing dementia, a 29% increased risk of incident coronary heart disease and a
32% increased risk of stroke (Wu, 2020). This reflects evidently that research needs to focus
on potential solutions for decreasing loneliness. In retired individuals needs to be addressed
urgently due to its high risk and recent increase in numbers of affected individuals.
Solutions for decreasing loneliness
As a result of increased feelings of loneliness during the retirement period, it is
important to assess variables which can support increased well-being and manage this dark
side of retirement. As mentioned above there are significant health risks associated with
loneliness, not only physically but mentally as well. This further expresses the importance of
researching variables which can deter and limit these kinds of behaviors.
Variables which can be used as potential solutions to help with a smoother transition
from the workplace to retirement include; availability of retirement preparation programs for
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
25
people thinking of retiring, ensuring partner involvement in retirement planning and specific
methods such as increased social activities to decrease feelings of loneliness.
Firstly, more resources available for those pre-retirement can significantly contribute
to greater feelings of preparedness and in turn highlight ways in which loneliness can be
deterred prior to ever experiencing these feelings. A resource-based retirement model reflects
that through greater resources being available it allows for this smoother transition (Zhan et
al., 2022). This model may allow older workers to better manage the challenges they
experience due to losing their work role, such as the shrinkage of social networks, change of
daily life structure, and loss of meaning stemming from work itself. It can also better develop
new nonwork roles which may associate with specific responsibilities and rewards e.g., in the
family or volunteering domains. It has been proven in previous research that increased social
interactions significantly decreases isolations and experiences of loneliness (Zhan et al.,
2022). This makes it clear that levels of resources available can significantly impact
retirement transition experiences. Furthermore, increased partner involvement during this
transition can be used as another tool to ensure an easier transition to retirement. Majority of
humans live interconnected lives; this means our goals often exist in close connection with
our romantic partners. Often people who can more successfully navigate interdependence
dilemmas such as financial or social issues and can coordinate their retirement with their
partners should be in a better position to plan more effectively for their retirement (Lamarche
& Rolison, 2021). During this retirement transition if individuals are more connected to loved
one’s then they are less likely to experience symptoms of loneliness. This in turn leads to less
risk factors associated to physical and mental well-being.
Finally, the last variable that will be discussed in contributing to a seamless transition
to retirement is to increase engagement in socially activating activities. In previous research
this has been considered a significant implication in lower levels of isolation and loneliness
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
26
experienced by retirees. This could be achieved through engagement in non-for-profit
organizations. An example is Conversations to Remember which is a non-for-profit
organization in which is based on college and high school students engaging in weekly video
calls with retired individuals. This gives these people a new social activity each week and
something to they can look forward to. As a result, it increases their social network, in turn
decreasing levels of isolation and loneliness. Participation in social activities such a
community engagement and non-profit organizations overall improves the health of older
individuals for older adults. It ultimately results in lower morality and higher survival rates.
Through loss of work, social groups such as colleagues and social support which they may
have prior are no longer available. This is the reason research reflects such a high level of
feelings of loneliness during this period. Research has further suggested that retired men are
at a higher risk of social isolation and loneliness than that of retired women. This may be due
to women having increased social activities that they more commonly engaged in prior to
their retirement. It is essential that these social activities are valuable in these individuals’
communities; as a result, it is necessary to explore and understand the values and meaning of
social activities for them.
Conclusion
It is clear that the retirement transition for many individuals is a time where
experiences of loneliness and isolation occur. It is extremely important that prior to
retirement people are aware of this as it will allow them to better prepare for this potential
‘dark side’ they may experience. Moreover, this highlights to importance of mental health
awareness during this phase as it can be a time where this can significantly decrease.
Variables discussed which studies should further focus on to combat these issues include
availability of retirement preparation programs, ensuring partner involvement and increased
engagement in social activities. Overall, major experiences of loneliness occur when
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
27
individuals are isolated therefore the method to this resolution lies in social connections and
increasing how prepared one is for this transition.
�Chapter 4 redacted to remove personal reflections and any identifying information.
�RETIREMENT: A PSYCHOLOGICAL PERSPECTIVE
31
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�
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Text
Implementing Yoga as an Intervention for Reducing Caretaker
Burnout in Caregivers of the Autism Spectrum Disorder
Community on the North Shore of Staten Island
Adedayo Adebo – WCSN, Megan Chiu – WCSN
Wagner College Evelyn L Spiro School of Nursing
Introduction
Problem: Caretaker Burnout
Proposed Solution: The SAM Project
References
Autism spectrum disorder (ASD) refers to a broad
range of developmental disabilities that affect social
skills, repetitive behaviors, speech and nonverbal
communication.
Caretaker burnout: A state of physical, mental,
and/or emotional exhaustion that may be
accompanied by a change of attitude
• Can lead to stress, fatigue, alterations of
sleeping patterns, lowered immunity
• Can also result in inadequate care and
unintentional mistreatment for people with
ASD
How Yoga can be used as a way of combatting
caretaker burnout:
(1) McIntosh E. As autism rate rises, funding to Staten Island
agencies gets slashed-Staten Island Advance. 2017; Available
from https://eden2.org/blog/as-autism-rate-rises-funding-tostaten-island-agencies-gets-slashed-staten-island-advance/
There is an increasing prevalence of autism, but a
decreased level of support, guidance, and education
being offered. NYS made recent budget cuts to
Medicaid and funding for essential organizations like
the Office of People with Developmental Disabilities
and Eden 2 School. (1)
Caregivers of people with ASD may experience high
levels of stress from providing care without additional
support that may have negative physiological and
psychological effects on caregivers such as fatigue,
lowered immunity, and depression (2). This is how
caretaker burnout develops.
Yoga can provide relief for caregivers so they do not
experience burnout or can alleviate symptoms of
caretaker burnout. Research on the benefits of yoga
have been shown to enhance bonding and renewal of
familial relationships and improve gross and fine
motor functioning skills. (3, 4)
Community Assessment & Analysis
North Shore of Staten Island (5,6):
Population:
~175,000 people; 51% female, 49% are male
Age:
23% = under the age of 18
13% = over the age of 65
31% = over the age of 25 that has a Bachelor’s
degree
Financial hardship and instability:
21% live under the poverty line
Over 35% experience rent burden (uses 35% or
more of their income on rent)
Ethnicity:
Over 60% = another ethnicity or race other than
White
25% = foreign-born
If 1 in every 54 children is diagnosed with autism
according to the CDC, then there are at least 1100
families with children with ASD on Staten Island.
A study of maternal caregiving burden in
Turkish children with ASD showed that higher
caregiver burden was associated with lower life
satisfaction (7). Lower life satisfaction à
depression, anxiety, decreased quality of care
for their children, and possibly negative
physiological effects.
Caregivers of children with ASD compared to
caregivers of children with other disabilities:
More psychological distress associated
• Depression
• Anxiety
• Decreased family cohesion
• Caregiver burnout (2)
“Parental stress is an important predictor for
intervention outcomes in children with ASD
like lower levels of developmental
improvement in behavioural interventions,
including decreased development of language,
communication and other adaptive
behaviours” (8)
Caretakers need to remember that in order to
take care of the child with ASD, they need to
make sure that they are healthy. “If you don’t
take care of yourself, you won’t be able to care
for anyone else” (9).
Autism Speaks organization found that
mothers of children with autism benefit
significantly from weekly stress-reduction
classes led by other mothers. The classes:
• Reduced high levels of personal stress,
anxiety and depression
• Improved the mom’s interactions with their
children (10).
• Yoga targets unmanaged stress
• Reduces activity of the sympathetic nervous system
and decreases levels of cortisol (stress hormone)
• This increases resilience and improves mind-body
awareness (11).
• Yoga can help caregivers develop higher resilience
• In a study that analyzed the health of caregivers of
people with autism:
• High resilience à lower cortisol levels à better
perceived health
• With the right amount and type of support,
caregivers can develop higher resilience to combat
caregiver burnout and stress (12)
The purpose of the SAM Project is to help participants
(both caregiver and children with ASD) get in touch with
their inner calm and combat their anxiety.
The program aims to:
• Help both caregivers and children with ASD manage
stress
• Provide the option to caregivers of either participating
with their children, or simply leave their children with
instructors to allow for time to engage in self-care
behaviors
• Support caregivers to allow for development of
resilience
The class features:
• Calming music: centers the mind and body and slows
down the sensory system’s over-processing of
information
• Yoga poses: enhance flexibility, muscle tone and body
awareness
• Individual goal-setting: become more comfortable
stretching both their body and their mind
• Create an atmosphere where participants can make
social connections and share meaningful
communication
• Trust-building exercises
• Focus on strengthening the mind and body with
teamwork and self-reliance
Learning Objectives:
Caretakers of the ASD Population should be able to:
1) Seek social support groups and programs;
2) Participate in yoga to alleviate and prevent
caregiver stress and burnout;
3) Exhibit other self-care behaviors such as
exercising, socializing, engaging in hobbies.
(2) Nik Adib N, Ibrahim M, Ab Rahman A, Bakar R, Yahaya N,
Hussin S, Wan Mansor W. Perceived Stress among Caregivers of
Children with Autism Spectrum Disorder: A State-Wide Study.
2019; Available from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517964/
(3) Betts DE, Betts SW. Yoga for Children with Autism Spectrum
Disorders : A Step-by-Step Guide for Parents and Caregivers.
Jessica Kingsley Publishers; 2006.
(4) Garcia JM, Baker K, Diaz MR, Tucker JE, Kelchner VP, Rice
DJ. Implementation fidelity of a mindfulness-based yoga
program for children with autism spectrum disorder and their
families: A pilot study. Advances in Neurodevelopmental
Disorders. 2019;3(1): 54–62. Available from:
https://ezproxy.wagner.edu:2310/10.1007/s41252-018-0091-3
(5) Census A. Census profile: Staten Island borough, Richmond
County, NY. 2019; Available from
https://censusreporter.org/profiles/06000US3608570915staten-island-borough-richmond-county-ny/
(6) N & N. Staten Island Community Board #1. In Staten Island
Community Board 1. Staten Island, NY: Community District
Profiles. 2017; Available from:
https://communityprofiles.planning.nyc.gov/staten-island/1
(7) Cetinbakis G, Bastug G, Ozel-Kizil E.T. Factors contributing to
higher caregiving burden in Turkish mothers of children with
autism spectrum disorders. International Journal of
Developmental Disabilities. 2020;66(1): 46-53. Available from
https://www.tandfonline.com/doi/abs/10.1080/20473869.2018.14
78630
(8) Begum R, Mamin F. Impact of Autism Spectrum Disorder
on Family. 2019; Available from:
https://www.longdom.org/open-access/impact-of-autismspectrum-disorder-on-family-44919.Html
(9) Maur J. Same Great Leadership, Same Great Mission.
Bridgeway Academy. 2019; Available from:
bridgewayohio.org/uncategorized/caregiver-burnout/
(10) Caring for the Caregiver. Available from
https://www.autismspeaks.org/tool-kit-excerpt/caring-caregiver
(11) Novotney A. Yoga as a practice tool. Monitor on Psychology.
2009;40(10). Available from:
http://www.apa.org/monitor/2009/11/yoga
(12) Ruiz-Robledillo N, De Andrés-García S, Pérez-Blasco J,
González-Bono E, Moya-Albiol L. Highly resilient coping entails
better perceived health, high social support and low morning
cortisol levels in parents of children with autism spectrum
disorder. Research in Developmental Disabilities. 2014;35(3):
686-695.
�
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Senior Presentations Archive
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This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
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Adedayo Adebo
Megan Chiu
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Implementing Yoga as an Intervention for Reducing Caretaker Burnout in Caregivers of the Autism Spectrum Disorder Community on the North Shore of Staten Island
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Josephine Marcantonio/Lorrie DeSena
Evelyn L. Spiro School of Nursing
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Gun Violence and its Effects on School Aged Children in Newtown, Connecticut
Aleksandra Kubrak WCSN, Alexa Burgalassi WCSN, Serena Lawerence WCSN
Wagner College Evelyn L. Spiro School of Nursing
Introduction
Problem in the Community
• Gun violence is an urgent, complex, and multifaceted problem
that needs to be addressed and it has become an
overwhelming issue that seems to have no answer in sight.
• This problem has become an unfortunate reality not only in
the streets, but as well as in schools around the country
thus leaving a worry in the back of every school age child,
every teacher, and every parents mind. The impact of gun
violence goes beyond those who are shot and killed.
• An estimated three million American children witness gun
violence every year, which can lead to poor performance in
school and serious physical and behavioral health issues later
in life (1).
Community Assessment and Analysis
(2)
•
•
•
•
The specific population to be focused on
are the children and school aged students
of Newtown (Fairfield County), Connecticut.
It is important to focus on those who have
been exposed or are at higher risk of
being exposed to gun violence; this younger
generation falls to the very vulnerable end
of the spectrum of victims of gun violence.
The community is predominantly white, with
le ss than 10% acco unting for other
ethnicities; 256 residents are foreign.
The current unemployment rate is 3.5%
within Newtown and recent job growth has
been negative with the consistent impact of
COVID-19.
Due to children being the population of
focu s, any eco no mic effects o n the
environment would be familial (I).
• The major issue our group identified is the effects of gun
violence in school aged children in Newtown, Connecticut. On
December 14th, 2012 at the Sandy Hook Elementary School
twenty year old Adam Lanza, shot and killed twenty-six people
including twenty children between the ages of six and seven,
and six adult staff members (3).
• The tragic events that took place in Newtown, Connecticut
started a much needed national conversation about gun violence
in school aged children.
• Sandy Hook stands out because of the large number of deaths in
a single incident, the nature of the premeditated act and the
characteristics of the victims; young, innocent, and defenseless.
• The shooting has been labeled as a “fundamentally different"
episode of gun violence (4). This tragedy became the second
deadliest school based shooting massacre in US history. The
aftermath became a tipping point in a national discussion
regarding potential solutions to curbing gun violence.
• Gun violence goes beyond the physical aspect of it; the mental
health effects are just as devastating. In the event of the
Sandy Hook Elementary School shooting, almost all direct
witnesses reported psychological symptoms. The National Center
for PTSD estimates that 28% of people who have witnessed a
mass shooting develop post-traumatic stress disorder (PTSD) and
about a third develop acute stress disorder (5). Those who are
impacted by gun violence may experience stress, depression, and
anxiety along with PTSD.
• The psychiatric effects of gun violence in school aged children is
another national conversation that must be brought to light.
Although resources are already available in Newtown,
Connecticut for those who experienced the 2012 tragedy,
implementing a threat assessment program may be beneficial for
those in the community.
Proposed Solution
• A Threat Assessment Program would establish interventions
and activities to foster a safe environment for students to
receive their education.The development of this program
would keep students aware of potential threats and give them
resources to stay safe.
• The primary prevention for the program would be to develop
a campaign to help educate students and staff on how to
identify threats when near it. Those who have an increased
risk of hurting themselves or others often show signs before
an act of violence takes place.
• A secondary prevention would be a screening tool to identify
students who are at risk of committing violence. Professionals
would be trained in using a questionnaire to screen students
and identify which students are a potential threat to others.
• High risk students from the screening tool would be
recommended to join a group therapy for conflict
management. The group therapy is the tertiary prevention
component of our program.
• The key component of the threat assessment program would
be the collaborative approach. It would ensure that a
psychologist or a mental health nurse is available to students
on school premises. It serves as a critical resource for
students to have the opportunity to speak to a professional
one on one whenever needed. The school psychologist or
nurse will be among the first to know when students are
experiencing problems or when they are a potential threat to
others. They should guide students through the emotional and
behavioral problems that they may be facing (6).
References
1.
“CT Against Gun Violence.” n.d. CT Against Gun Violence. Accessed November 23, 2020. http://cagv.org/.
2.
“Census.Gov.” n.d. Accessed November 23, 2020. https://www.census.gov/.
3.
Levine, Phillip B., and Robin McKnight. 2017. “Firearms and Accidental Deaths: Evidence from the Aftermath of the Sandy Hook School Shooting.” Science 358 (6368): 1324–28. https://doi.org/10.1126/science.aan8179.
4.
nShultz, James M, Glenn W Muschert, Alison Dingwall, and Alyssa M Cohen. 2013. “The Sandy Hook Elementary School Shooting as Tipping Point.” Disaster Health 1 (2): 65–73. https://doi.org/10.4161/dish.27113.
5.
“What Happens to the Survivors?” n.d. Https://Www.Apa.Org. Accessed November 14, 2020. https://www.apa.org/monitor/2018/09/survivors.
6.
“Keeping Our Schools Safe: A Plan for Preventing Mass Shootings and Ending All Gun Violence in American Schools.” n.d. Everytown Research & Policy. Accessed September 22, 2020. https://everytownresearch.org/report/a-plan-for-preventing-mass-shootings-and-ending-all-gun-violence-in-american-schools/.
�
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Title
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Senior Presentations Archive
Description
An account of the resource
This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
Date
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2017 -
Rights Holder
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Wagner College, Staten Island, NY
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2021
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2021_Nursing_Burgalassi-Kubrak-Lawrence
Creator
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Alexa Burgalassi
Aleksandra Kubrak
Serena Lawrence
Date
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5/1/2021
Title
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Gun Violence and Its Effects on School Age Children in Newtown, Connecticut
Contributor
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Doris Korona /Josephine Marcantonio
Evelyn L. Spiro School of Nursing
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text
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eng
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Wagner College, Staten Island, NY
Nursing
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Text
Homelessness in San Francisco
Alexa Calamia WCSN, Anna Calamia WCSN, Alanna Ferrandino WCSN
Evelyn L. Spiro School of Nursing Wagner College
Introduction and Selection of a Community
in Need
• Homelessness is the state of being without a
home. An individual who is homeless is
someone who lacks a secure, structured, and
sufficient nighttime residence.
• The community of San Francisco is currently
the third-largest population experiencing
homelessness in the United States (2).
• There are numerous contributing factors as to
why the homeless population is growing in
San Francisco; one of the main reasons is due
to the unsafe and dangerous sheltered homes.
Community Assessment and Analysis
• San Francisco is a city located in northern California
and the San Francisco bay area. It is the fourth largest
county in California and is a tourist-attracted city (1).
• Since 2017, there has been a 17% increase in the
homelessness population which was recorded to be
9,784 in 2019 (2).
• San Francisco’s ethnic and cultural patterns consist of
46.7% white, 34.2% Asian, 15.2% Hispanic or Latino,
5.2% black or African American, 0.3% of both Native
American and American Indian, and 5.4% of two races
or more (2).
Problems in the Community
Proposed Solution
• Homelessness is a public health issue:
• Individuals without housing have higher rates of chronic physical and
mental health conditions, which are made worse by poor living conditions
(4).
• They lack access to proper health care and transportation (6).
• Homelessness presents an economic issue:
• Those who are homeless are high consumers of public resources(4).
• This population experience high rates of health disorders & are more
susceptible to injuries they often rely on Emergency Department visits for
medical care.
• These individuals face competing factors in their daily lives.:
• Factors such as finding food and shelter may take priority over their health
conditions
• The National Alliance to End Homelessness states, without stable housing,
they cycle in & out of emergency departments, inpatient hospital stays,
psychiatric centers, detoxification programs, and jails resulting in high
public costs- costing the taxpayer an average of $35,3578 per year per
homeless person (5).
• Causes of Homelessness:
• Mental illness, addiction, job loss, domestic violence, and disabilities are all
causes of homelessness.
Mind and Body
• We chose the name Mind and Body, because without adequate mental
and physical health, one is not able to get the best quality of life.
• Mental aspects are addressed/mentally prepared and in the right state of
mind to get back on their feet.
• Mind and body will provide:
• Easily accessible health clinics for all.
• Health teaching & health promotion.
• Teach and identify healthy coping strategies.
• Accessible mental health services.
• Identify the causes that are disabling them to function as independently
as possible.
• Modify modifiable risk factors that jeopardize one’s health, which will
gear client’s towards an optimal level of health.
• Objectives for the population include:
• Adhering to our program, Mind and Body.
• Learning skills to obtain and maintain employment.
• An overall decrease of homelessness in the San Francisco area.
• These factors are also a result of homelessness
• Paramount of this program is to turn around such poor quality of life
into the best of each person’s ability and help them become employed.
• Homelessness in the US:
• Return to a normal state of function.
• Homelessness is a continuous issue in the United States, every year the
number of individuals who are homeless increases.
• Thus, staying off the streets.
• 567,715 individuals were reported to be homeless in the U.S. (2).
• San Francisco alone accounted for 9,784 of those individuals (2).
References
1. San Francisco, California. (2015, May 09). Retrieved November 03, 2020, from https://communitywealth.org/content/san-francisco-california
2. U.S. Census Bureau QuickFacts: San Francisco city, California; United States. (2019). Retrieved September 21, 2020,
from https://www.census.gov/quickfacts/fact/table/sanfranciscocitycalifornia,US/PST045219
3. State of Homelessness: 2020 Edition. (2020, May 20). Retrieved November 14, 2020, from
https://endhomelessness.org/homelessness-in-america/homelessness-statistics/state-of-homelessness-2020/
4. Homelessness. (n.d.). Retrieved November 14, 2020, from https://www.homewardboundwnc.org/wpcontent/uploads/2013/02/Homelessness-Dec.-2012.pdf
5. Ending Chronic Homelessness Saves Taxpayers Money. (n.d.). Retrieved November 14, 2020, from
http://endhomelessness.org/wp-content/uploads/2017/06/Cost-Savings-from-PSH.pdf
6. Housing and Homelessness as a Public Health Issue. (2017, November 07). Retrieved November 14, 2020, from
https://apha.org/policies-and-advocacy/public-health-policy-statements/policy-database/2018/01/18/housing-andhomelessness-as-a-public-health-issue
�
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Senior Presentations Archive
Description
An account of the resource
This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
Date
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2017 -
Rights Holder
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Wagner College, Staten Island, NY
Document
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Poster
Date Digital
2021
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2021_Nursing_Calamia-Calamia-Ferrandino
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Alexa Calamia
Anna Calamia
Alanna Ferrandino
Date
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5/1/2021
Title
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Homelessness in San Francisco
Contributor
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Doris Korona/Tina Marie Petrizzo-Hughes
Evelyn L. Spiro School of Nursing
Type
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text
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1 page
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eng
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U.S. and international copyright laws may protect this work. It is provided by Wagner College for scholarly or research purposes only. Commercial use or distribution is not permitted without prior permission of the copyright holder.
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Wagner College, Staten Island, NY
Nursing
-
Dublin Core
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Title
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Senior Presentations Archive
Description
An account of the resource
This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
Date
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Wagner College, Staten Island, NY
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7:14 minutes
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Alexa Parrella
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5/1/2021
Title
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How age at the time of placement affects the time it takes to achieve permanency
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Chien Liu
Sociology
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7:14 min
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<a href="https://drive.google.com/file/d/1D9--yFBlcss0-bVkhxfAhSGRaxf-ChyX/view?usp=sharing">Link to full presentation</a>
Sociology
-
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634f8ef73d773a0009bff6bf216ee566
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Text
DEFICITS IN HEALTHCARE
1
Deficits in Healthcare: Shortcomings in Psychiatric Theory, Research, Treatment, and
Employment
Alicia Erlandson
Wagner College, Department of Psychology
�DEFICITS IN HEALTHCARE
2
Table of Contents
page
ABSTRACT……………………………………………………………………………………….4
CHAPTER
1
THE HISTORY AND EVOLUTION OF NEUROSURGICAL INTERVENTIONS FOR
PSYCHIATRIC DISORDERS.…………………………………………………………...5
Trepanation…………………………..……………………………………………………5
Localization of Function........………...…………………………………………………...6
Burckhardt and the First Psychosurgery……………....……………………………...…...8
Moniz and the Leucotomy……………....……………...…….…….…….…….…….…...9
Freeman and the Lobotomy……………....…………………...…….…….…….…….…11
Minimally Invasive Procedures……………....…………………...…….…….…….…...12
Ethical Objections to Psychosurgery……………....……...…….…….…….…….……..14
Conclusion……………………………...…….…….…….…….…….…….…….……...15
2
EFFECTIVELY TREATING MAJOR DEPRESSIVE DISORDER WITH
CONTEMPORARY INTERVENTIONS ……………………………………………….16
Neurofeedback…………………………..……………………………………………….17
Ketamine........…………………………...……………………………………………….18
Psilocybin……………....………………………………………………………………...19
Limitations and Conclusion……………………………………………………….……..20
3
THE NURSING SHORTAGE AND ITS POSSIBLE SOLUTIONS…………………...22
Causes of the Nursing Shortage……………………………………………………….…22
Clinical Relevance….……………………………………………………………………23
Potential Solutions.………………………………………………………………………24
Conclusion…...……….………………………………………………………………….26
4
APPLICATIONS OF PSYCHOSURGERY IN CONTEMPORARY MEDICINE..……28
Trepanation and Burr Holes…………………….………………………………………..28
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Table of Contents
Stereotactic Procedures versus Radiofrequency Ablation……………………………….29
Contemporary Psychosurgery: Deep Brain Stimulation………………………………....29
Conclusion…...……….………………………………………………………………….30
LIST OF REFERENCES………………………………………………………………………...31
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Abstract
Throughout the history of psychiatric interventions, there have been deficits in treatment, as well
as subsequent innovation in response to these deficits. It is important to examine the historical
aspects of psychiatric interventions, along with how they came to be today and the problems
within the healthcare system. Chapter one focuses on the evolution of psychosurgery and how
techniques evolved as the understanding of behavior changed. Understanding the former
psychosurgical interventions such as trepanation and phrenology allowed for the framework of
surgical techniques to be introduced. Chapter two focuses on contemporary treatments for major
depressive disorder (MDD). There are multiple contemporary treatments that can be used which
provides a starting approach to creating and applying effective treatments to help MDD. Chapter
three provides potential solutions to a major problem with the healthcare system, the nursing
shortage. It is important for solutions to this problem to be created to allow for better patient care
within the healthcare system. Within chapter four, there is evidence of real application of
psychosurgery with contemporary medicine such as within a neurosurgery office and a hospital.
It was helpful to be able to connect many different themes seen throughout history to
contemporary problems still existing today within the field. Overall, the purpose of this paper is
to examine the importance of more effective plans for psychosurgical interventions, plans of
treatment for disorders such as MDD and providing the healthcare system with solutions to
improve the effectiveness of patient care.
Keywords: psychosurgery, major depressive disorder (MDD), nursing shortage
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Chapter 1: The History and Evolution of Neurosurgical Interventions for Psychiatric
Disorders
Neurosurgery for psychiatric disorders, also called psychosurgery, is a term used to
describe attempts to physically alter behavior and consciousness in an effort to treat behavioral
pathologies and mental illness using surgical techniques (Bauerle et al., 2023). While
psychosurgical interventions are thought to have origins before the Common Era, psychosurgery
has changed greatly since its inception, especially in the mid-twentieth century, as a culmination
of the burden of psychiatric illness and novel understandings of how the brain may function and
its relationship to behavior (Robinson et al., 2012). The aim of this paper is to examine how the
modification of psychosurgical techniques occurred throughout history, starting from the
inception of psychosurgery and ending in the late twentieth century. Upon analysis, it is evident
that the evolution of psychosurgical techniques can primarily be attributed to outside forces,
specifically to what is now recognized as incomplete understandings of neuroanatomy and
neurophysiology, as well as experimental trial and error, which may provide an explanation for
modern ethical objections.
Trepanation
The first recorded human psychosurgery, with origins dating back to as early as the
Neolithic period of the Stone Age, is trepanation, known today as burr holing (Robinson et al.,
2012). The trepanning procedure begins with lacerating the scalp to reveal the skull, and is then
followed by drilling or cutting into the skull to form a hole. While trepanation is believed to have
been used traditionally as a method to alleviate symptoms of head trauma following injury, it is
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also hypothesized to have been used to excise evil spirits and demons, thought to be the cause of
mental and/or behavioral disorders, in the prehistoric era, although this likely was not the
purpose for performing the procedure most of the time (Bauerle et al., 2023). The practice of
trepanning continued well into the establishment of Greek and Roman civilizations, evidence of
which can be found in classical writings of Hippocrates, Galen, and Celsus (Bauerle et al., 2023;
Robinson et al., 2012). Trepanation as a psychosurgical intervention gained prevalence during
the Renaissance, as highlighted by Hieronymus Bosch’s painting The Extraction of the Stone of
Madness, likely painted around 1501. In this image, Bosch depicts a man undergoing a procedure
on his skull with the inscription describing the patient’s desire to remove “stones of folly” from
his head (Gross, 1999). Per Robinson et al. (2012), the idea of “brain stones” were a commonly
held superstition throughout this period, with the popular belief being these stones were
responsible for madness or epilepsy.
The prevalence of trepanation began to decrease as understandings of behavior changed.
René Descartes first proposed a formal link between the brain and behavior through his theory of
dualism (Descartes, 1641/1931). In his Meditations (1641/1931), Descartes describes the idea of
dualism, in which the mind and body are separate entities, yet the mind seems to control the
body, in a manner such as a ghost in a machine. According to Lokhorst and Kaitaro (2001),
Descartes believed the pineal gland in the brain served as a relay between mind and body,
indicating one of the first links between the brain and behavior, which would be expanded upon
in future research.
Localization of Function
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Into the eighteenth and nineteenth centuries, trepanation became less prevalent as focus
shifted towards identifying connections between brain and behavior, specifically as it pertained
to localization of function. Localization of function, as described by Bauerle et al. (2023), is the
idea that specific areas of the brain serve distinct functions. Research in this time period
originated with Franz Gall, a German physiologist, and his theory of phrenology. According to
Gall, functions of the brain were localized to individual organs within the brain, which worked in
tandem to create an individual’s personality. Gall thought ridges and grooves on the skull
reflected larger or smaller organs, respectively, and believed that larger organs indicated greater
ability. From these theories, Gall developed phrenology, which was described as the analysis of
the shape and size of the skull to predict personality (Jones et al., 2018).
Although Gall’s work was influential in changing the scope of neurological research, it
was proven to be pseudoscientific, though it did contribute to other localization of function
discoveries. In 1824, Pierre Flourens developed a method to test Gall’s assertions through
selectively ablating different regions of the brain. Flourens’ work disproved Gall’s theory of
phrenology in favor of what he called cerebral equipotentiality, which suggested the brain
functioned as a whole, though he did note that the cerebrum, cerebellum, and brainstem had
distinct differences in their individual functions and how they contributed to cerebral
equipotentiality (Bauerle et al., 2023; Pearce, 2009).
Further research in the nineteenth century supported localization of function to the
limited extent proposed by Flourens. In 1861, Pierre Broca discovered a localized area for speech
production. According to Bauerle et al. (2023), Broca’s discovery came following the
observation of a patient with widespread cerebral damage experiencing aphasia as an inability to
express speech. Through his observations, Broca attributed the motor component of speech to a
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single area on the frontal lobe, giving it the name Broca’s area. In a similar manner, Carl
Wernicke discovered a region separate from Broca’s area on the lateral sulcus on the temporal
lobe. From his studies, Wernicke found individuals with lesions to this area exhibited aphasia as
an inability to understand language, thus he deemed this region, named Wernicke’s area,
responsible for written and spoken language comprehension (Wernicke, 1970). The studies of
Gustav Frisch and Eduard Hitzig further emphasized some localization of function as it pertains
to motor function. In their research from 1870, Fritsch and Hitzig stimulated the cerebral cortex
of dogs in an effort to elicit a motor response, resulting in the identification of the motor cortex
(Fritsch & Hitzig, 2009).
Perhaps the most significant of localization of function findings for applications in
psychosurgical advancement was the case of Phineas Gage in 1868. Gage, a railway foreman,
experienced profound damage to his frontal lobe after an accident in which a tamping iron
penetrated his skull following an explosion (Bauerle et al., 2023). According to Gage’s
physician, John Harlow (1888), Gage experienced significant changes in his personality, with
Harlow noting he became impatient and easily irritated, with other accounts noting he became
belligerent and disinhibited (Bauerle et al., 2023). Gage’s accident, combined with
aforementioned localization of function research, provided foundations for modern
psychosurgical intervention by locating areas specific to personality and confirming the
possibility of the existence of these regions.
Burckhardt and the First Psychosurgery
Influenced by localization of function discoveries, Gottleib Burckhardt, a Swiss
psychiatrist, performed the first modern psychosurgery in 1888. Burckhardt operated under
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several assumptions based upon prior research. Firstly, he subscribed to the idea of biological
psychiatry, meaning he believed mental illness was a projection of a disordered brain and thus,
mental illness could be cured through fixing the brain (Kotowicz, 2005). Secondly, he believed
that the nervous system operated in a three-step system with an afferent sensory system, an
efferent motor system, and a connecting system to bridge the two (Stone, 2001). Lastly, believed
in a modular brain, consistent with localization of function, meaning symptoms could be traced
to a specific location of the brain. Therefore, Burckhardt hypothesized that the excision of a
specific cortical area could eliminate symptoms of mental illness (Kotowicz, 2005). In 1888,
Burckhardt performed a “topectomy” in the frontal, parietal, and temporal lobes, where pieces of
the cerebral cortex were surgically removed (Mashour et al., 2005). Burckhardt performed this
surgery on six patients, aiming to make the patients less violent and more easily managed. Of the
six patients he operated on, Burckhardt reported improvement in four patients, a death during the
procedure in one patient, and one death due to a postoperative complication (Kotowicz, 2005).
Although Burckhardt may have mostly met his described purpose of improving patients’
disposition, he was met with heavy criticism by the psychiatric community. Burckhardt’s work
was seen as immoral, reckless, and reprehensible, effectively prohibiting further psychosurgical
intervention at the time (Kotowicz, 2005; Stone, 2001).
Moniz and the Leucotomy
Psychosurgical research remained suspended until the months following the 1935 Second
International Neurologic Congress in London. At the conference, physiologist John Fulton
presented his research about the effects of frontal lobe dissection in primates. Fulton’s results
showed that, following partial frontal lobotomy, the primates exhibited more blunted affect while
still retaining cognitive abilities (Bauerle et al., 2023). These results inspired Egas Moniz to
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adapt the procedure for use in humans. Moniz hypothesized that mental illness was caused by
excessive synaptic connections, based on the neuron theory of Ramón y Cajal, which states that
neurons are discrete cells responsible for communication within the nervous system (Kotowicz,
2005). Therefore, Moniz believed that, by eliminating some synaptic connections within the
brain in subcortical white matter, the brain would begin to function normally, as mental illness
was merely a symptom of neuronal disarray (Moniz, 1937).
Moniz and his collaborator, Almeida Lima, began the process of destructing subcortical
white matter, known as a leucotomy, upon Moniz’s return to Portugal following the Neurologic
Congress. Together, the pair performed procedures on twenty patients (Kotowicz, 2005). The
first ten procedures utilized absolute alcohol ablation, in which a high concentration of alcohol
was injected directly into the white matter structures, however, due to the unpredictability of the
dispersion of alcohol, the procedure was modified for the second half of patients (Bauerle et al.,
2023). For the second set of patients, a tool now known as a leucotome was developed to
surgically sever subcortical white matter tracts (Mashour et al., 2005). According to Bauerle et
al. (2023), burr holes were drilled into the skull and the leucotome, a long device with a wire
loop on the end, was inserted into the brain and rotated to lesion the white matter in affected
patients.
Of his twenty patient trials, Moniz reported zero fatalities, and his reported side effects
were less severe than those reported by Burckhardt (Kotowicz, 2005). At the end of his study,
Moniz and Lima reported that seven patients were cured of mental illness, seven patients’
symptoms were improved, and six patients did not improve, though their symptoms also did not
worsen (Bauerle et al., 2023). Compared to Burckhardt, Moniz was met with welcoming
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reactions to his research, with the leucotomy gaining international favor due to promising results
of safety and efficacy (Moniz, 1937).
Freeman and the Lobotomy
Following the success of the leucotomy in Europe, Walter Freeman, an American
neurologist, introduced the procedure to the United States in 1936. Following his first leucotomy
with collaborator James Watts, Freeman observed a flaw in the original technique published by
Moniz, that is, the leucotomy intervention does not provide permanent relief of symptoms in all
patients, thus leaving patients susceptible to the return of their symptoms (Robinson et al., 2012).
According to Robinson (2012), Freeman performed post-mortem examinations of the brains of
individuals with mental illness in order to locate an area implicated in the production of
symptoms. Through these examinations, he observed degeneration of tissue in the thalamus,
which he believed was implicated in symptom production (Freeman, 1942). Therefore, using a
modified version of Moniz’s leucotome, Freeman and Watts lesioned the white matter tracts
between the prefrontal cortex and the thalamus in a procedure now known as the frontal
lobotomy (Bauerle et al., 2023).
Freeman and Watts performed over two hundred frontal lobotomies before 1942, of
which the majority were considered successful. According to Robinson et al. (2012), only 14%
of the outcomes of the surgery were negative, including both fatalities and negative postoperative
effects, while 63% of surgeries yielded improvement and 23% yielded no change. Encouraged by
this success, Freeman again modified the lobotomy procedure to eliminate the necessity of a
neurosurgeon. In this novel procedure, called the transorbital lobotomy, the patient was
anesthetized and a pick-like instrument was inserted through the orbital roof into the prefrontal
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cortex. Once in the brain, the instrument was swept across the prefrontal cortex in order to sever
white matter tracts in the frontal lobe (Mashour et al., 2005). This procedure was quickly
popularized in the United States due to its accessibility, as, unlike the leucotomy and frontal
lobotomy, the transorbital lobotomy did not require surgical training and it could be completed as
an outpatient visit (Bauerle et al., 2023).
The transorbital lobotomy procedure was performed in over 60,000 American patients
between 1936 and 1956, though its prevalence may not be due to its efficacy. According to
Mashour et al. (2005), psychiatric illness was extremely costly to the United States, with over
400,000 individuals being patients in psychiatric institutions costing over 1.5 billion dollars by
the 1940s. The accessibility of the transorbital lobotomy provided a method to quickly alleviate
some of the burden of mental illness, hence its rapid dissemination (Wang et al., 2022). While
transorbital lobotomies may have satiated an economic need, they were not without consequence.
By 1949, there was heavy skepticism pertaining to the safety and efficacy of the transorbital
lobotomy. While the procedure was criticized for “frontal lobe syndrome,” which encompasses
impulsivity and lack of emotionality, it was also criticized for its side effects, such as seizure
disorder, excessive cerebral bleeding, and death (Bauerle et al., 2023). Therefore, in combination
with the advent of antipsychotic drugs, skepticism pertaining to transorbital lobotomies
ultimately led to a sharp decline in the prevalence of the procedure.
Minimally Invasive Procedures
Although the transorbital lobotomy was the predominant psychosurgery in the United
States until the 1950s, less invasive procedures were beginning to emerge. William Scoville, an
American physician, is credited with the advent of a more precise version of the prefrontal
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lobotomy, known as selective orbital undercutting (Wang et al., 2022). Scoville claimed this
procedure was much more precise than the lobotomy, as only two specific areas of the prefrontal
cortex, the orbital, and the cingulate gyrus were targeted instead of the entirety of the frontal lobe
(Wang, 2022). Scoville is mostly known for his role in the case of H.M., where he performed a
bilateral medial temporal lobectomy in an effort to eliminate seizure activity (Squire, 2009).
Through this procedure, Scoville discovered implications of memory storage, such as the role of
the hippocampus in memory, and contributed to novel understandings of memory through the
Atkinson and Shiffrin model of memory (Wang et al., 2022)
Stereotactic procedures were also invented for use in psychosurgery following the
introduction and dissemination of the lobotomy in the United States. While stereotaxic
procedures were similar to other psychosurgical interventions in the sense that they lesioned the
brain, these procedures were different from others as they used alternative methods to create the
lesions. E. Spiegel was an influential proponent of these procedures, credited with the
development of the stereoenphalotome, which is the apparatus used in stereotaxic
psychosurgeries (Spiegel et al.1948). According to Spiegel (1947), the procedure starts with
securing the head in the stereotaxic apparatus, then performing an x-ray with the fixated
apparatus to determine a location to drill a burr hole. After finding a location and completing the
trepanation process, a wire or cannula is threaded into subcortical areas of the brain. From here,
Spiegel (1947) lesions the targeted area through radiation, thermocoagulation, fluid injection,
and/or fluid aspiration. While Spiegel focused primarily on lesioning the medial nucleus of the
thalamus, other procedures were focused on the subcaudate nucleus, the hippocampal
commissure, and other thalamic nuclei (Spiegel, 1948; Knight, 1973).
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Scoville also experimented with electronarcosis, also known as electrical anesthesia.
Electronarcosis, as described by Alan van Poznak (1963), is the process of delivering electricity
to the brain in order to induce sleep, reduce pain, and produce stupor. In his research, Scoville
observed minimal improvement in patients that received electrical anesthesia treatment, though
he was inspired to expand upon this research, which led to the aforementioned case of H.M.
Other electronarcosis research yielded similar results. In a study of individuals with
schizophrenia, electronarcosis was not found to make a profound difference upon patients
outside of their normal treatment (Garmany & Early, 1948). For this reason, in combination with
rising skepticism of psychosurgery, electronarcosis research was largely abandoned.
Ethical Opposition to Psychosurgery
Ethical objections to psychosurgery began to arise in the late 1940s with the popularity of
the transorbital lobotomy, however it was not until the late 1970s when controversy pertaining to
psychosurgery came to a head. (Casey, 2015). Many objections to psychosurgery pertained to
safety, efficacy, and questions of reliable testing. As previously discussed, the transorbital
lobotomy became a large source of controversy as efficacy and safety of the procedure was
called into question (Bauerle et al., 2023). Although Freeman and Watts may have data to
reinforce their claims of safety and efficacy, Mashour et al. (2005) highlighted several factors
that may have contributed to unreliable data. Firstly, due to the invasive nature of the procedures,
there were no controlled placebo interventions used to compare improvement of symptoms to,
thus leaving patient improvement and positive outcomes up to the physicians. Secondly, the
physicians who were evaluating their patients’ improvements were likely inherently biased in
their assessment, which would artificially inflate statistics for positive outcomes. Lastly, in a
similar manner, physicians may have under-reported poor outcomes in order to avoid speculation
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of safety and efficacy. Ultimately, ethical concern led to the The National Commission for the
Protection of Human Subjects of Biomedical and Behavioral Research limiting the continuation
of psychosurgical intervention in 1977, which has been primarily maintained into the
contemporary era (Casey, 2015).
Conclusion
Psychosurgery has a rich history dating back centuries, with techniques evolving as
understandings of behavior changed. Trepanation is evidence of the earliest psychosurgical
interventions, though its use quickly declined as phrenology and cerebral localization of function
became popular theories. Although phrenology was discredited, physiological research lended to
the development of new psychosurgical techniques. Although psychosurgical interventions were
initially unaccepted, as evidenced by Burckhardt, further research and theoretical development
allowed for the development of interventions like the leucotomy. By pioneering the leucotomy,
Moniz began a new era for psychiatric interventions, with the leucotomy becoming a
globally-instituted psychosurgery. The leucotomy was further developed in the United States by
Freeman into the lobotomy, and was soon adapted to increase its accessibility. At the same time,
new, more precise, and less invasive psychosurgical interventions, such as selective orbital
undercutting, stereotactic procedures, and electrical anesthesia were being developed and tested,
however they were largely overshadowed by the controversy and skepticism surrounding the
transorbital lobotomy. In the present era, psychosurgery is practiced within a limited scope due
contemporary limitations and ethical concerns, which are resultant from residual skepticism
pertaining to twentieth century interventions.
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Chapter 2: Effectively Treating Major Depressive Disorder with Contemporary
Interventions
Major depressive disorder (MDD), commonly known as depression, is a mental health
disorder primarily characterized by low mood, decreased energy, and anhedonia (Penn & Tracy,
2012). While these are the primary symptoms experienced by individuals with depression, other
common symptoms include, but are not limited to, decreased concentration abilities, decreased
self-esteem, appetite changes, sleep disruption, and onset of self-harm tendencies and/or suicidal
thoughts, persistent for at least two weeks (Bains & Abdijadid, 2023). Per Bains and Abdijadid
(2023), an individual must experience at least five of the aforementioned symptoms to be
diagnosed with MDD, to be in accordance with the Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition.
The exact etiology, or cause, of depression is unknown, but it is believed to have origins
in a variety of genetic, biological, environmental, and psychosocial factors (Bains & Abdijadid,
2023). Early theories describing the origin of MDD focused on a potential link between lowered
serotonin and depression, dating back to the 1960s. The validity of this hypothesis was
seemingly explained by the ability of Selective Serotonin Reuptake Inhibitor (SSRI)
antidepressants and other serotonin agonists to treat depression (Moncrieff et al., 2022).
Furthermore, additional research found that individuals with suicidal ideation have been
experimentally found to have “ low levels of serotonin metabolites,” which indicates low levels
of serotonin (Bains & Abdijadid, 2023). While the serotonin theory of depression was initially
widely accepted, more recent research shows no concrete evidence that lower serotonin
concentrations cause, or are associated with, depression. Therefore, alternative treatments for
depression may be more effective than traditional, serotonin-targeting pharmacological
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interventions in the treatment of major depressive disorders. This paper will seek to review
current literature pertaining to contemporary treatments for MDD.
Neurofeedback
Contemporary interventions for depression have begun to move beyond pharmacological
approaches. Neurofeedback training, for example, is a nonpharmacological intervention that may
be utilized in the treatment of depression. Neurofeedback training is described as a non-invasive
technique that teaches patients to control their brain functions by recording brain waves through
electroencephalogram (EEG) and providing some sort of signal in response (Marzbani et al.,
2015). Per Patil et al. (2023), neurofeedback has been adapted to work in the
psycho-physiological realm by training the brain waves specifically associated with depression.
Trambiolli et al. (2021) describe four primary steps of neurofeedback interventions. First,
a primary neural target must be identified. As previously mentioned, certain brain waves can be
isolated to train in order to alleviate depressive symptoms (Patil et al., 2023). According to
Marzbani et al. (2015), alpha, beta, and theta brain waves can be targeted in neurofeedback for
depression treatment. Alpha and theta brain waves are generally associated with relaxation and
peacefulness while beta brain waves are associated with sustained attention and alertness.
Individuals with depression appear to have underactivation of the right parietal region, which is
indicative of decreased alpha wave activity. Therefore, using neurofeedback techniques to
increase alpha and theta frequencies while simultaneously inhibiting beta frequencies have been
shown to experimentally improve depression symptoms (Marzbani et al., 2015).
The next steps of neurofeedback training include recording and processing the neural
activity of the neural target while controlling for artifacts, or features produced by the imaging
modality that are not present in the brain, and then providing feedback to the user in real-time.
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This feedback is provided through either visual or auditory modalities, vibrations, electrical
impulses, or through proprioceptive modalities, which test the body’s ability to perceive its own
orientation and movement (Trambiolli et al., 2021). The ultimate purpose of the feedback is to
provide constant updates to the trainee about their present neural state, enabling them to alter and
improve strategies for controlling mind and behavior and providing the patient with improved
self-regulation abilities, or the capacity to adjust and respond to outside stimulus, for neural
activity (Birbaumer et al., 2013). Throughout various studies, results of neurofeedback training
have shown to be promising as the vast majority of results have produced statistically significant
clinical improvements (Patil et al., 2023). With this being said, limitations still exist within
published literature. Specifically, many studies did not subscribe to best research practices,
which may infringe upon the validity of the published results. Neurofeedback studies
consistently lacked robust samples and struggled to differentiate between specific and
non-specific effects, so future research in the field should focus on refining methodology to yield
more reliable results (Patil et al., 2023; Trambiolli et al., 2021). Therefore, while neurofeedback
studies have provided favorable results, further scientific research must be performed to confirm
the effectiveness of neurofeedback training before it is widely adopted for treatment of MDD.
Ketamine
In addition to neurofeedback training, nontraditional pharmacological methods are being
adopted for the treatment of major depressive disorder. Ketamine, for example, is a dissociative
anesthetic used traditionally in the maintenance of surgical anesthesia, however it appears to
have applications in the treatment of depression. Ketamine is an N-methyl-D-aspartate (NMDA)
receptor antagonist, meaning it inhibits the action of the NMDA receptor (Iglewicz et al., 2015).
Per Ates-Alagoz and Adejare (2013), the NMDA receptor subtype for the neurotransmitter
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glutamate has been implicated in several neurodegenerative and neuropsychiatric disorders,
including depression. Ketamine serves as an uncompetitive antagonist, meaning it prevents
NMDA receptor subtype agonists from binding to the receptor allosterically. Therefore, ketamine
does not bind to the active site of the receptor, where the neurotransmitter would typically bind,
but instead binds to a different area of the receptor to inhibit glutamate.
Multiple research studies show ketamine is an effective antidepressant, with emphasis on
the minimal latency between administration and effect. Unlike SSRIs or other traditional
antidepressant drugs, ketamine treatments provided therapeutic effects for individuals with
depression almost immediately, compared to the typical six to eight week window of onset for
SSRIs (Iglewicz et al., 2015). Due to this quick onset, ketamine may be of interest in emergency
depression treatments, especially due to its ability to decrease suicidal ideation (Peters et al.,
2022). Additionally, decreased latency of onset may be of interest to hospice populations. While
questions of safety may exist for the use of ketamine in treating depression in hospice
populations, Iglewicz et al. (2015) showed 93% of hospice patients who had a dose of ketamine
experienced relief of depressive symptoms on days 0-3, while 80% continued to experience
therapeutic effects through days 4-7 in a randomized control trial of 31 patients. Similarly, in a
population of individuals with a form of treatment-resistant depression, Peters et al. (2022) found
statistically significant results supporting the effectiveness of racemic ketamine for the treatment
of depression with minimal adverse effects through the analysis of a randomized control trial of
108 participants. Therefore, preliminary research shows promise for safe and effective treatment
of MDD using ketamine.
Psilocybin
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Psilocybin is another drug that appears to have antidepressive characteristics. As a
hallucinogen, or psychedelic drug, psilocybin typically produces hallucinations when used
recreationally, however novel research shows it may be used to treat MDD (Pearson et al., 2022).
Like ketamine, psilocybin works more rapidly than traditional pharmacological measures,
however, unlike ketamine, psilocybin is a serotonin agonist (Griffiths et al., 2016). While the
exact mechanism for depression is unknown, psilocybin is hypothesized to work in various ways
(Pearson et al., 2022). The first proposed mechanism is termed the ‘Ebenezer Scrooge’ model,
where a sudden transformation in mood is brought upon by the drug experience. The second
model is the adjunct to psychotherapy model, where it is hypothesized that the psilocybin leaves
an individual in a state more susceptible to suggestion, enabling psychotherapy to be more
impactful. The third and final model is the traditional pharmacological model, which proposes
that psilocybin works as a serotonin agonist to produce antidepressive neurobiological effects
(Pearson et al., 2022).
Regardless of the mechanism, research shows abundant evidence of rapid and successful
treatment of MDD using psilocybin. Per Griffiths et al. (2016), a single dose of psilocybin had
antidepressant effects in 73% of patients with life-threatening cancer for at least six months.
Pearson et al. (2022) performed a review of several studies using psilocybin to treat depression,
which all yielded similar positive results. These findings provide an evidentiary basis for the
future use of psilocybin as an antidepressant intervention.
Limitations and Conclusion
While novel pharmacological interventions appear promising, a major limitation to their
usage is accessibility. Intravenous ketamine is highly costly, making it inaccessible to off-label
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use for depression (Peters et al., 2022). While ketamine is used medically, psilocybin is not as it
is currently considered a Schedule I drug, meaning it has been deemed illegal by the federal
government of the United States. Other nations have also begun research on the use of psilocybin
for the treatment of depression, and have yielded similar results. Per Rucker et al. (2022),
research in London has shown psilocybin was effective in reducing symptoms associated with
MDD in 67% of patients, although it is considered illegal in much of Europe. Therefore, in order
to make psilocybin treatments accessible, a reclassification of psilocybin would have to occur
internationally (Pearson et al., 2022; Rucker et al., 2022).
While contemporary treatments for major depressive disorder show promise, especially
due to their latency of effect, it is evident that further research needs to be done before
widespread adaptation of these measures can occur. Therefore, it is difficult to conclude with
certainty that alternative treatments for depression are more effective than traditional,
serotonin-targeting pharmacological interventions in the treatment of major depressive disorders,
however it is valid to say these contemporary interventions are promising. Future research should
focus predominantly on optimizing trials pertaining to the interventions mentioned above, as
well as the exploration of potential future interventions to effectively treat major depressive
disorder.
�DEFICITS IN HEALTHCARE
22
Chapter 3: The Nursing Shortage and its Possible Solutions
Around the globe, there exists a drastic international shortage of nurses working on
nursing units, with pre-COVID estimates of deficits ranging from 300,000 to over a million in
the United States alone by 2025 (Aiken et al., 2009). This shortage has increased following the
onset of the coronavirus pandemic, with an estimated deficit of over six million nurses
worldwide in 2021 (Catton & Iro, 2021). This deficit comes in addition to the necessary
replacement of almost five million nurses set to retire over the next decade, meaning the nursing
profession will need over ten million nurses worldwide within the next decade to effectively
meet the needs of both the community and the United States as a whole (Catton & Iro, 2021).
Therefore, it is pertinent to discuss both the causes of the nursing shortage, as well as potential
resolutions.
Causes of the Nursing Shortage
The problem of the nursing shortage is multifaceted, with several factors contributing to
global nursing deficits. Shortages of nursing faculty prevent a greater number of students from
training as nurses, due to limited resources. With one-third of the nursing workforce set to retire
in the next decade, including nurse faculty members, nurse educator roles will need to be filled
as well. If these roles are unable to be filled, the number of seats in nursing programs will have
to be reduced, leading to decreased nurse output from various nursing programs (Haddad et al.,
2023; Siela et al., 2008). Additionally, nursing programs as a whole are trending towards the
elimination of certificate programs. This means higher level academic degrees, specifically
Associate degrees and Baccalaureate degrees, are becoming required in nursing, which therefore
means nurses need increasingly higher certifications to serve as nurse educators, serving as a
barrier for more nurses becoming nurse educators (Aiken et al., 2009).
�DEFICITS IN HEALTHCARE
23
Nursing migration also leads to regional inequities of workforce dispersion as nurses are
unevenly distributed across the country. In the United States, there are regional differences in
growth, with the Western and Mountain regions having the greatest growth potential while also
maintaining the lowest population density (Haddad et al., 2023).
Burnout in healthcare, specifically in nursing, is another major contributor to the nursing
shortage, likely due to its poor work-life balance, specifically as it pertains to parenthood, as well
as the somewhat violent nature of the profession (Haddad et al., 2023). According to Reith
(2018), burnout, which is especially prevalent in individuals employed in healthcare, such as
physicians, nurses, and other staff, can be defined as “a combination of exhaustion, cynicism,
and perceived inefficacy resulting from long-term job stress” (p. 1). Per Buchanan and Aiken
(2008), a majority of nurses are women, which may encroach upon an individual’s work-life
balance, especially once they and thus make those nurses more prone to burnout. Burnout is
significant in the nursing shortage as it leads to early retirement or premature departure from the
profession (Haddad et al., 2023). Per Reith et al. (2018), 43% of nurses experienced symptoms of
emotional exhaustion, which leaves these individuals more susceptible to burnout and early
departure from nursing, further contributing to the nursing shortage.
Clinical Relevance
The nursing shortage is of clinical concern as it leads to decreased nurse-to-patient ratios,
which in turn may produce poor patient outcomes (Haddad et al., 2023). According to Reith et al.
(2018), burnout in healthcare professionals leads to an increase in prevalence of major medical
errors, patient mortality, and spread of hospital-transmitted infections. According to Haddad et
al. (2023), high patient loads increase propensity for burnout, meaning that the nursing shortage
contributes to the aforementioned negative patient outcomes. Additionally, high staffing ratios
�DEFICITS IN HEALTHCARE
24
contribute to unsafe discharges as units cannot accommodate all patients in need, so patients who
still require care are transferred out of the unit or discharged to locations with inadequate
intensities of care available. These inappropriate discharges may contribute to negative outcomes
and increased mortality outside of the hospital.
Potential Solutions
While there are several theoretical solutions for resolving the nursing shortage, none have
actively been implemented, nor is there one single solution to eliminate the nursing shortage, due
to the complexity of the problem (Buchanan & Aiken, 2008). Involving nurses in dual-role
positions would increase the number of nurse educators in the classroom, which would in turn
increase the number of students able to participate in nursing programs. Therefore, the number of
nurses graduating from these programs annually would increase, contributing to the
diminishment of the nursing shortage (Siela et al., 2008). A drawback, however, is that moving
nurses who actively serve in the clinical setting into the classroom, even for one shift a week,
may leave clinical units immediately understaffed, which is counterproductive to diminishing the
negative effects of high nurse to patient ratios. This also may leave nurses more susceptible to
burnout as they are spending more time at work or preparing for work, which may encroach
upon work-life balance (Reith et al., 2018; Siela et al., 2008). Another limitation of this
intervention is that it requires active nurses to receive higher education to become a faculty
member. As previously mentioned, while most active nurses have Associate degrees and
Baccalaureate degrees, Master’s level degrees or higher are typically required to teach nursing
education, which would be a deterrent in becoming an educator (Aiken et al., 2009).
Another potential to combat the nursing faculty shortage, suggested by Aiken et al.
(2009), is to shift public policy towards funding more Bachelor’s of Science in Nursing (BSN)
�DEFICITS IN HEALTHCARE
25
programs. The promotion of BSN degrees would more easily lend to the advancements of BSN
nurses into an advanced Master’s of Science in Nursing (MSN) degree, which would further
increase the number of nurses eligible to be nursing instructors. Therefore, Aiken et al. (2009)
proposes that, if public policy changes to support BSN programs, it would incentivize nurses to
continue with their education in the future. One immediate limitation would be the desire for
quicker gratification in the workforce. Part of the appeal of an ASN degree is that it lasts only
two years, compared to four years for a BSN. Even with the provision of public subsidies for
BSN degrees, it is difficult to anticipate if these subsidies will be greater than the amount of
compensation ASN nurses would receive from an extra two years in the workforce and the lack
of debt ASN nurses may have from two fewer years of school.
A potential solution to both increasing the number of nurse educators and increasing the
number of nurses with baccalaureate degrees may be to provide incentives that would outweigh
the drawbacks of extra education and increased hours through teaching hospital partnerships. For
example, if institutions of higher learning were to partner with hospitals, a mutually beneficial
relationship could be established to both increase the number of BSN nurses and enable current
BSN nurses to pursue their MSN. If hospitals alter nurses’ shifts to work with MSN courses
offered by their partner institution and the partner institution provides some form of scholarship
to these nurses, it would address concerns of both price of higher education and encroachment of
work-life balance by providing support from both establishments and enabling them to continue
to work. By supporting a partnership between university and hospital, MSN students would have
a chance to practice as a nurse educator, while BSN students would have the ability to learn from
experienced nurses, regardless of the degree the nurses currently hold. Additionally, enabling
MSN students to serve as nursing instructors, like teaching assistants do in doctorate programs,
�DEFICITS IN HEALTHCARE
26
would increase the number of students able to enroll in BSN programs and would, in turn,
increase the number of nurses entering the workforce each year.
Another approach to combating the nursing shortage is to focus on increasing retention
by working to decrease burnout within the existing nurse population. One potential method of
reducing burnout is the provision of mental health resources by hospitals in order to increase
nurses’ feelings (Catton & Iro, 2021; Reith et al., 2018). One limitation, however, to the
provision of mental health interventions is the stigma surrounding mental health in healthcare
professionals. Even if hospitals provided these resources, there is not a guarantee they would be
utilized due to nurses’ potential fear of stigmatization (Reith et al., 2018). One possible solution
would be to preemptively combat stigma in the workplace in order to enable individuals to feel
comfortable seeking help. This could be done through encouraging self-disclosure in the
workplace or encouraging group discussion, perhaps to the extent of making it mandatory, about
mental illness to allow individuals to be comfortable with seeking help without fear of retaliation
and stigmatization.
Conclusion
The nursing shortage has been a long-term problem in the United States, however it is on
the brink of becoming critical due to the effects of the COVID-19 pandemic. Although the exact
cause of the nursing shortage is multifactorial, it is evident that, in general, the number of nurses
entering the workforce needs to increase, as does the number of nurses who choose to become
nurse educators, in order to resolve this crisis. Without resolution, the nursing shortage will
continue to have negative implications on patient outcomes and patient care. Therefore it is
pertinent to incentivize nursing students to enter the nursing workforce and incentivize presently
�DEFICITS IN HEALTHCARE
employed nurses to pursue higher education, while supporting current nurses’ mental health to
ensure they remain in the profession for longer.
27
�Chapter 4 redacted to remove personal reflections and any identifying information.
�DEFICITS IN HEALTHCARE
31
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37
�
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Senior Presentations Archive
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This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
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Deficits in Healthcare: Shortcomings in Psychiatric Theory, Research, Treatment, and Employment
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Psychology
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•
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C- Call
O- Observe
P- Protect
S- Safety
�
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The Epidemic of Depression and Suicide Among the NYPD
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22a15851876bf69ac5409eda75196207
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The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
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Senior Presentations Archive
Description
An account of the resource
This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
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Wagner College, Staten Island, NY
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2021_Nursing_Gonzalez-Santorelli
Creator
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Angelina Gonzalez
Sam Santorelli
Date
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5/1/2021
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Increased Sexually Transmitted Infections in the Bronx
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Doris Korona/Tina Marie Petrizzo-Hughes
Evelyn L. Spiro School of Nursing
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eng
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Wagner College, Staten Island, NY
Nursing
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89900423067679f7e86e6562885a5e60
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Implementing Trauma-Focused Cognitive Behavior Therapy in COVID-19 Related Orphanhood in the
District of Columbia
Anida Bolevic WCSN, Finesa Morina WCSN, & Alexis Scott WCSN
Department of Nursing, Wagner College 2023
Abstract
● The COVID-19 pandemic has severely impacted the
health and well-being of children and families worldwide.
● The pandemic's effects have not been felt equally in all
communities.
● Families in the District of Columbia have experienced
disproportionate rates of COVID-19 infections and deaths
and continue to face extreme challenges in their everyday
lives.
● Children and adolescents have been affected by grief,
isolation, and loss due to COVID-19 related deaths in
their immediate families.
● The pandemic has compromised the emotional well-being
and mental health of many children in the District, leading
to orphanhood.
● The proposed solution is to implement trauma-focused
cognitive behavioral therapy for orphaned patients under
the age of 18 who lost their caregiver due to COVID-19.
● The implementation of cognitive behavioral therapy can
reduce the risk of trauma-related distress and emotional
and behavioral difficulties in these children.
● Coping strategies created through therapy can potentially
follow these children into adulthood.
Community Assessment
Community Assessment of Washington D.C.
● Population: 670,050, majority African American adults
(246,000) and White adults (234,000), with 57,622 Hispanic
adults. 1
● Economic environment: The COVID-19 pandemic has
worsened existing social issues, and the economic fallout
negatively affects Black, Hispanic/Latino, and Asian residents,
along with young people and women, leading to an inequitable
economic recovery..Income and poverty vary across wards, with
poverty rate over 40% in Wards 7 and 8. 1
● Health: Prior to the pandemic, 11.4% of adult residents in the
District reported having poor mental health for more than 14
consecutive days, and 14.3% of the District’s population had
been diagnosed with a depressive disorder.
● Behavioral health disparities: Since the pandemic, 27% of all
adults in the District with children reported feeling down,
depressed, or hopeless for more than half of the days in the past
week, and 35% felt nervous, anxious, or on edge for more than
half of the days or nearly every day in the past week.Access to
care is also an issue in the District, with 48.7% of District youth
with a major depressive episode not receiving mental health
services in 2020. 2
● District's response: Strengthening behavioral health system of
care for children and families by integrating community-based
organizations and school-based behavioral health supports into
public schools across the city.
Problem in the Community
Community Health Problem: Orphanhood-related issues caused
by the spread of COVID-19 in the District of Columbia and globally
● Impact in the District of Columbia: Disproportionate caregiver
loss imbalance, with Black and Hispanic children being more
affected than White children, resulting in traumatic or prolonged
grief, depression, anxiety, low self-esteem, post-traumatic stress
disorder, low academic attainment, high dropout rates, high rates
of substance and drug abuse, increased risk of suicide, and
unemployment.
● Global Impact: Approximately 5.2 million children and
adolescents affected by COVID-19-associated orphanhood and
caregiver death in the first 14 months starting from March 1st,
2020, to April 30th, 2021. 3
● Nurse's role in addressing the problem: Performing Cognitive
Behavioral Therapy (CBT) on children with traumatic,
complicated, or prolonged grief, which is an evidence-based
intervention that has shown improvements in coping with grief,
anxiety, and depression. Screening for children at risk of
developing disaster reactions such as generalized anxiety
disorder (GAD-7), PTSD (DSM-5), and depression (PHQ-9) to
provide appropriate interventions.
● Alignment with WHO Sustainable Development Goals:The
healthcare problem faced by the District of Columbia is in line
with the WHO Sustainable Development Goals, particularly
Goal 3, which aims to ensure healthy lives and promote wellbeing for all ages.
Proposed Solution
Evidence-based Health Initiative: Implementing Trauma-Focused Cognitive
Behavioral Therapy for Orphaned Children and Adolescents Under 18 Who Lost
Their Caregiver Due to COVID-19
Community Health Goals:
● Reduce trauma-related distress, emotional and behavioral difficulties in
orphaned children and adolescents under 18 who lost their caregiver due to
COVID-19.
● Improve mental health outcomes, including reducing depression, anxiety, low
self-esteem, feelings of anger, and trauma symptoms in this vulnerable
population.
● Increase access to evidence-based trauma-focused cognitive behavioral therapy
in various settings, including schools, clients’ homes, and in individual and
group therapy settings.
● Raise awareness about the psychological impact of COVID-19-related caregiver
loss among children and adolescents.
Innovative Program Activities:
● Train lay counselors, social workers, and other healthcare professionals to
deliver trauma-focused cognitive behavioral therapy for orphaned children and
adolescents under 18 who lost their caregiver due to COVID-19.
● Provide evidence-based psychoeducation to caregivers, parents, and family
members of orphaned children and adolescents about the impact of caregiver
loss and the importance of seeking mental health services.
● Offer individual and group therapy sessions for orphaned children and
adolescents under 18 who lost their caregiver due to COVID-19, including
gradual exposure and skill-building components.
● Use teletherapy and other virtual technologies to increase access to traumafocused cognitive behavioral therapy for children and adolescents living in
remote or underserved areas.
How Solution Differs from What is Currently in Place or Available:
● Currently, there may be limited access to evidence-based mental health services
for orphaned children and adolescents who lost their caregiver due to COVID19.
● While traditional cognitive behavioral therapy may be available, traumafocused cognitive behavioral therapy is specifically designed to address traumarelated distress and emotional and behavioral difficulties in children and
adolescents who experienced caregiver loss.
● The proposed solution is tailored to the unique needs of this vulnerable
population and emphasizes the importance of using evidence-based
interventions to improve mental health outcomes.
Funding:
● The solution could be funded through grants from government agencies, private
foundations, and non-profit organizations.
● Private insurance companies and Medicaid/Medicare may also cover the cost of
trauma-focused cognitive behavioral therapy for eligible individuals.
● Community fundraising events and donations from individual donors could also
be used to support this initiative
Acknowledgements
1.COVID-19 and Children’s Behavioral Health in the District of Columbia. (2021,
June).Child Health Advocacy Institute, Children’s National Hospital. Retrieved from
https://childrensnational.org/-/media/cnhs-site/files/advocacy-and-outreach/child-health-ad
vocacy-institute/covid19-and-childrens-behavioral-health-in-dc.pdf?la=en
2. COVID-19 and Children’s Behavioral Health in the District of Columbia. (2021, June). Child Health Advocacy Institute, Children’s
National Hospital. . Retrieved from https://childrensnational.org/-/media/cnhs-site/files/advocacy-and-outreach/child-health-advocacyinstitute/covid19-and-childrens-behavioral-health-in-dc.pdf?la=en
3. Annor, F.B., Blenkinsop, A., Cluver, L., Demissie, Z., Donnelly, C.A., Flaxman, S., Hillis, S.D.,Leandris, L., Masseti, G.M., Mercy, J.A.,
Nelson III, C.A., Ratmann, O., Sherr, L., Unwin, J.T., Villaveces, A. (2021). COVID-19- Associated Orphanhood and Caregiver Death in the
United States. Pediatics, Volume 148 (Issue 6), https://doi.org/10.1542/peds.2021-053760
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Senior Presentations Archive
Description
An account of the resource
This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
Date
A point or period of time associated with an event in the lifecycle of the resource
2017 -
Rights Holder
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Wagner College, Staten Island, NY
Document
A resource containing textual data. Note that facsimiles or images of texts are still of the genre text.
Date Digital
2023
Text
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text
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If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data
Poster
Dublin Core
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Identifier
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2023_Nursing_Group3 Bolevic Morina Scott
Creator
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Anida Bolevic, Finesa Morina, Alexis Scott
Date
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5/1/2023
Title
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Implementing Trauma-Focused Cognitive Behavior Therapy in COVID-19 Related Orphanhood in the District of Columbia
Contributor
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Lorrie DeSena
Nursing
Format
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application/pdf
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1 page
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eng
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U.S. and international copyright laws may protect this work. It is provided by Wagner College for scholarly or research purposes only. Commercial use or distribution is not permitted without prior permission of the copyright holder.
Rights Holder
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Wagner College, Staten Island, NY
Nursing
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b196cd03ad51cb86fe4a9965477beec5
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Text
The Health Effects of Air Pollution on Children in
Mott Haven, Bronx
Anisa Kurtesi WCSN, Selena Maragh WCSN, Silvia Salerno WCSN
Wagner College Evelyn L. Spiro School of Nursing
●
Introduction
Research shows that young children in the Mott Haven
community have developed health issues due to the areas
poor air quality brought upon air pollution (1) . Our research
question is How air pollution affects young children's health
and how we can mitigate those harmful health effects. Our
proposed solution to mitigate these adverse effects on their
health is to create an educational program called “Get Some
Fresh Air.” This program will strive to raise awareness of air
pollution in the Mott Haven community and its effects on
children’s health, as well as provide the necessary tools they
can utilize to lessen the negative effects of air pollution.
●
●
●
●
●
●
●
●
●
●
●
●
●
Community Assessment
Mott Haven, South Bronx, NY
68.3% Hispanics and Latinos (2)
27.7% non-hispanic African American(2)
In 2019 poverty rate in Mott Haven was 39.6% (2)
Deemed the third poorest neighborhood in NYC(1)
1 in 6 adults are unemployed(1)
59% of residents spend 30% of their monthly gross
income on rent(1)
Top causes of death are heart disease and cancer (1)
2nd highest rate of alcohol related hospitalization
and 5th highest rate of drug related hospitalizations (1)
Highest rate of asthma hospitalization rate among
children ages 5-14 (1)
Obesity rate of 33% (1)
15% rate of diabetes (1)
Air pollution- Levels of PM25 (most harmful air
pollutants) are 10 micrograms per cubic meter in Mott
Haven compared to 9.1 (Bronx) and 8.6 (Citywide) (1)
●
●
●
●
●
●
●
●
●
Problem
Proposed Solution
Our problem is how air pollution affects young
children's health in Mott Haven, Bronx.
Air pollution is defined as the presence of toxic
chemicals in the air that affects an individual’s health.(1)
Mott Haven is a low income area located in the Bronx
and this area has a lot of factories and industrial buildings.
These factories play a major role in increasing the
pollution. (1)
The percentage of air pollution in Mott Haven is
severely higher than other parts in the Bronx.
Recent studies have shown that about 20% of school
aged children attend school near this area. (1)
Air pollution has caused young children to develop
asthma. There has been about 647 visits of young
children that have asthma in Mott Haven compared to
the entire Bronx.(1)
Inhaling the bad quality of air affects children’s lungs
and causes them to have other major health problems.
These problems affect children’s growth and may cause a
relapse in their health.
Children in Mott Haven are also having a rise in cases
of hypertension, obesity and diabetes. These issues have
been exacerbated from air pollution.(1)
The U.S. as a nation is being affected by air pollution
and according to the World Health Organization (WHO)
93% of young children are affected by air pollution.
Majority of these children live in urban areas and the
BREATHE project believes children gets exposed when
they commute to school. (1)
Children that have to commute by walking to school
and back home are getting exposed twice. This makes
their chances of getting sick really high.
●
.Our proposed solution is an innovative health program,
called “Get Some Fresh Air”, that educates parents of Mott
Haven on how to decrease environmental/household air
pollution.
The program will hold assembly meetings for parents
●
●
●●
●
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●
to attend to in schools. Parents will be given pamphlets so
that they can have the presented information with them
to bring home.
The specific community health goal is to increase
awareness of air pollution and ways to decrease exposure
to children.
Learning objectives:
Parents will learn that air pollution can lead to
several health effects in children including asthma
exacerbations, respiratory infections, cardiovascular
diseases, and cancer.
Parents will be able to list which air pollutants, like
lead and carbon monoxide, are harmful to children’s
health when exposed to them.
Parents will learn interventions that can decrease
air pollution levels and apply them to their everyday
lives to avoid exposure.
Interventions: Conserve energy and
electricity at home, recycle and reuse, carpool,
use public transportation, bike, or walk
whenever possible, choose a cleaner commute,
use environmentally safe cleaning products if
possible, stop smoking, etc. (3)
○
○
○
Program activities:
Smoking cessation
Air Now
Air Pollution Health Risk Assessment
1.
2.
3.
4.
References
What is Air Pollution: Environmental Pollution Centers [Internet]. What Is Air
Pollution | Environmental Pollution Centers. [cited 2022Mar29]. Available from:
https://www.environmentalpollutioncenters.org/air/
Mott Haven/melrose neighborhood profile [Internet]. NYU Furman Center.
[cited 2022Mar30]. Available from:
https://furmancenter.org/neighborhoods/view/mott-haven-melrose
Actions you can take to reduce air pollution | ground-level ozone | New
England | US EPA [Internet]. EPA. Environmental Protection Agency; [cited
2021Nov21]. Available from:
https://www3.epa.gov/region1/airquality/reducepollution.html
The New York City Community Air Survey [Internet]. [cited 2022Apr15].
Available from:
https://www1.nyc.gov/assets/doh/downloads/pdf/environmental/comm-air-survey08-15.pdf
(4)
�
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Senior Presentations Archive
Description
An account of the resource
This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
Date
A point or period of time associated with an event in the lifecycle of the resource
2017 -
Rights Holder
A person or organization owning or managing rights over the resource.
Wagner College, Staten Island, NY
Document
A resource containing textual data. Note that facsimiles or images of texts are still of the genre text.
Date Digital
2022
Original Format
If the image is of an object, state the type of object, such as painting, sculpture, paper, photo, and additional data
Poster
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Identifier
An unambiguous reference to the resource within a given context
2022_Nursing_Group15 Kurtesi Maragh Salerno
Creator
An entity primarily responsible for making the resource
Anisa Kurtesi
Selena Maragh
Silvia Salerno
Date
A point or period of time associated with an event in the lifecycle of the resource
5/1/2022
Title
A name given to the resource
The Health Effects of Air Pollution on Children in Mott Haven, Bronx
Contributor
An entity responsible for making contributions to the resource
Lorrie DeSena/Josephine Marcantonio
Nursing
Type
The nature or genre of the resource
text
Format
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application/pdf
Extent
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1 page
Language
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eng
Rights
Information about rights held in and over the resource
U.S. and international copyright laws may protect this work. It is provided by Wagner College for scholarly or research purposes only. Commercial use or distribution is not permitted without prior permission of the copyright holder.
Rights Holder
A person or organization owning or managing rights over the resource.
Wagner College, Staten Island, NY
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59d9231f414ef4775736a710af86d153
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E-cigarette Use Amongst Adolescents in Staten Island
Dina Arslani, Kristi Simonetti, Jessica Verga
Wagner College, Evelyn L. Spiro School of Nursing
• How is vaping affecting the health of the adolescent population
in the Staten Island community?
• “Staten Island has the highest rate of electronic cigarette
(e-cigarette) use among high school students in New York City,
according to recent data, and U.S. Sen. Charles Schumer is
urging the Food and Drug Administration (FDA) to regulate the
inhalable product” (2019).
• “The number of middle (ages 11-13) and high school students
(ages 14-18) using e-cigarettes rose from 2.1 million in 2017 to
3.6 million in 2018—a difference of about 1.5 million youth”
(12).
• The electronic cigarette (e- cigarettes/vaping products) has
gained widespread popularity nationwide and has an increasingly
negative effect on public health. These devices have acquired
recognition based on the belief that it is a safe and viable potential
smoking cessation aid (5).
• This growing epidemic has attributed to health issues including,
but not limited to, respiratory, cardiovascular, and immune system
diseases. Ongoing studies continue to gather data investigating
the effects of vaping on the vital organs.
• “People using vape products have reported a variety of
symptoms, developing over a period of days to weeks, including:
pulmonary symptoms (cough, shortness of breath, chest pain),
gastrointestinal symptoms (nausea, vomiting, diarrhea), fatigue,
fever, headache, and weight loss” (3).
• One of the substances reported to have the most harmful effect
on public health is vitamin E acetate. This substance is found in
almost all cannabis- containing vaping products, and “is now the
key focus of the Department of Health’s investigation of potential
causes of vaping associated pulmonary illnesses” (3).
• The use of e-cigarette is increasing not only in the U.S. but
worldwide. The European Region has the highest rated tobacco
use in the world, “with an estimated 209 million people smoking”
(90% of lung cancers can be avoided by eliminating tobacco use,
new WHO report reveals, 2019). The United Kingdom along with
France and Belgium have the highest levels of e-cigarette use (8).
• As of February 18, 2020, a total of 2,807 hospitalized EVALI
cases or deaths have been reported to CDC from all 50 states,
the District of Columbia, and two U.S. territories (Puerto Rico and
U.S. Virgin Islands). Sixty-eight deaths have been confirmed in
29 states and the District of Columbia. (7).
• In a 2017 survey of 15 to 17- year- old adolescents in New York
State currently using electronic vapor products, which 19% of the
adolescents said that flavors were the reason that they first tried
an e-cigarette and 27% said flavors were the reason for
maintaining use (6).
• The persuasive marketing tools these companies use in
promoting appealing flavors are directed towards the
adolescent and young adults contributing to the outbreak of
vaping in this age bracket.
• A proposed solution for the cessation of e-cigarettes is to educate
and change the false narratives that e-cigarettes are a safe and
healthier alternative to smoking.
• The use of e-cigarettes, specifically in youth, can lead to
nicotine dependence, which is a major concern in the
development of the adolescent brain.
• The goal is to spread awareness through television, radios,
posters, and social media. By increasing the awareness of the
harmful effects of e-cigarettes, we can challenge the
advertisements seen on social media.
• Using nicotine in adolescence can harm the parts of the brain
that control attention, learning, mood, and impulse control.
• Adolescents who use e-cigarette are more likely to engage in
risky behavior. The correlation between adolescent e-cigarette
use and other substances such as alcohol, marijuana,
amphetamines increase with the use of e-cigarettes (11).
• Of the 5 boroughs, Staten Island is known as vaping central.
Vaping has dominated the adolescent population island-wide
due to its convenience, accessibility, and its appealing nature.
Staten Island has the highest rate of electronic cigarette
(e-cigarette) use among high school students in New York
City, about 1 in 5 high school students are using e-cigarettes
(2).
• This proposed solution is based on the theorist, Everette Rogers,
and his work called, Diffusion of Innovations Theory. The
diffusions of theory will be used as a guide to help us promote,
spread and increase our social media page.
Learning objective goals are:
1. To decrease the use of e-cigarettes amongst the adolescent
population.
2. To recognize the adverse effects of e-cigarette use.
3. To use social media as an advantage to increase public health.
• This method can be effective by influencing adolescents and
young adults to steer away from using e-cigarettes which may
increase public health in the future.
• With the continuing rise of e-cigarettes, Staten Island faces an
increase in use among adolescents, especially while in
school.
• In September of 2019, Governor Andrew Cuomo has
implemented “emergency executive action to ban the sale of
flavored electronic cigarettes in New York State” (6). A
contributing factor for the easy access of e-cigarettes is the
fact store owners allow adolescents (under twenty-one years)
to purchase the e-cigarette. The governor has also stated any
retailer selling vaping products to minors will now face criminal
penalties along with civil penalties.
• The new course of e-cigarettes swept in and changed the
dynamic of what we thought would have been the end of an era
of tobacco smokers.
• Instead, we see a rise in nicotine addiction amongst the
adolescent population due to the increasing demand for
e-cigarettes.
• The Staten Island community is composed of predominantly
whites, being 75.2% of the total population (10).
• The top two demographics being of Italian and Irish descent (9).
• To reduce this up rise in popularity, a proposed solution is to
create a social media platform to provide evidence and risk
factors about e-cigarettes.
• Italian Americans represent one of the largest influxes in ethnicity
throughout history.
• This method can be effective by influencing adolescents and
young adults to steer away from using e-cigarettes which may
increase public health in the future.
• The rate of employment has risen by 13% since 2017 in Staten
Island in the following work areas: construction, social assistance,
leisure and hospitality, and health care (4).
• This solution will help the new generation of Americans who are
at risk of nicotine addiction.
• About 70% of the population living on the island are homeowners,
the highest rate in comparison to all five boroughs (4).
• The major health issues that are currently plaguing the Staten
Island community are obesity, poor air quality, smoking, unmet
mental health needs, and drug overdose deaths (1). Smoking
comes in third place.
1.
2.
3.
4.
5.
6.
• Deaths from heart disease and chronic lower respiratory disease
represent the highest in Staten Island when compared to the other
four boroughs (1).
7.
8.
9.
10.
11.
12.
Baker, T. (2016). Retrieved from https://rumcsi.org/Uploads/Public/Documents/FinalCSP.pdf Level V
Bascome, E. Staten Island high school students using e-cigs at high rate, data shows. 2017, November 22). Retrieved from
https://www.silive.com/news/2017/11/schumer_calls_on_fda_for_e-cig.html. Level V
Department of Health.New York State Department of Health Announces Update on Investigation into Vaping-Associated Pulmonary Illnesses Retrieved November 7, 2019, from
https://www.health.ny.gov/press/releases/2019/2019-09-05_vaping.htm. Level IV
DiNapoli, T.P., Bleiwas, K.B. An Economic Snapshot of Staten Island. (2018, September). Retrieved from Rpt7-2019.pdf Level IV
Eltorai, A. E. M., Choi, A. R., & Eltorai, A. S. Impact of Electronic Cigarettes on Various Organ Systems. Respiratory Care, 64(3), 328–336. (2019).
https://doi.org/10.4187/respcare.06300 Level II
Governor Cuomo Announces Emergency Executive Action to Ban the Sale of Flavored E-Cigarettes. (2019, September 18). Retrieved from
https://www.governor.ny.gov/news/governor-cuomo-announces-emergency-executive-action-ban-sale-flavored-e-cigarettes. Level IV
Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products. (2019, November 8). Retrieved from
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html. Level IV
Shapiro, H. No Fire, No Smoke: The Global State of Tobacco Harm Reduction 2018. 2018). Retrieved from https://gsthr.org/downloads/GSTHR Report/GSTHR.pdf Level IV
Staten Island Population 2019. (n.d.). Retrieved from http://worldpopulationreview.com/boroughs/staten-island-population/. Level V
U.S. Census Bureau QuickFacts: Richmond County (Staten Island Borough), New York. (n.d.). Retrieved from
https://www.census.gov/quickfacts/fact/table/richmondcountystatenislandboroughnewyork/PST045218
Walley, S. C., Wilson, K. M., Winickoff, J. P., & Groner, J. A Public Health Crisis: Electronic Cigarettes, Vape, and JUUL. Pediatrics, 143(6), 1–11. (2019).
https://doi.org/10.1542/peds.2018-2741 Level IV
Youth and Tobacco Use. (2019, February 28). Retrieved from https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm. Level IV
�
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Text
DISABILITY RESOURCE EXPANSION
1
The Development, Evolution and Application of Special Education Resources
Ava de Velasco
Department of Psychology, Wagner College
�DISABILITY RESOURCE EXPANSION
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Table of Contents
page
ABSTRACT……………………………………………………………………………………….4
CHAPTER
1
HISTORICAL ANALYSIS ON THE INITIAL ATTITUDES TOWARD AND
SUBSEQUENT ADVOCACY FOR SPECIAL EDUCATION GROUPS ……………....5
Historical Figures and their Attitudes……………………………………………………..5
Instances of Mistreatment........…………………………...……………………………...10
Advocacy Instances.……………………………………………………………………..13
Legal Efforts…………....………………………………………………………………..14
Continuous Flaws Despite Improvement……………....………………………………...15
Conclusion……………………………………………………………………………….16
2
THE IMPORTANCE OF SOCIALIZATION IN SCHOOL CHILDREN WITH
INDIVIDUALIZED EDUCATION PLANS…………………………………………….17
Role of Social Development Theory…………………………………………………….17
Social Participation…………….………………………………………………………...18
Inclusion & Benefits of IEP’s………..…………………………………………………..20
Impact of Social Exclusion……….……………………………………………………...21
Integrity and Attitudes……….…………………………………………………………..22
Conclusion...…….…………………………………………………………………….…23
3
CONSIDERATIONS FOR APPROACHING HESITANT FAMILIES TO UTILIZE
SPECIAL EDUCATION RESOURCES………………………………………………...24
Solution: Advocacy and Support Resources……….……………………………………26
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Solution: Increased Knowledge and Emphasis on Collaboration…..……………………...26
Solution: Official Mediated Processes………………………….…..……………………...27
Conclusion……………………………………………………...…..……………………...28
4
REFLECTING ON SCHOOL OBSERVANCE EXPERIENCE………………………...29
LIST OF REFERENCES………………………………………………………………………...32
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Abstract
Special education resources were not always a readily available accommodation, or considered
to be a universally accepted or necessary system. It is important to examine the historical
analysis of how special education attitudes initially developed and how this community was
treated, as it allows insight into how the movement has become what it is today. Chapter one
focuses on the initial attitudes and treatment toward those with disabilities, and how specific
psychological contributors, as well as community based movements have contributed to the
societal shift from isolation to integration. Research has recognized the benefits of socialization
amongst special education students. Chapter two discusses the importance of socialization for
students with disabilities, and how programs can be created or restructured in order to give those
students access to the least restrictive learning environment as outlined in the standards of the
Individualized Education Plan. While special education reform has come a long way, not all
families share an understanding of what these resources entail. Chapter three explores
considerations on how to approach families who are hesitant to utilize special education
resources. Chapter four gives insight into an actual educational setting, as well as first hand
exposure to various special education and disability reform efforts being implemented. Overall,
the purpose of this paper is to examine the historical and modern attributes which contributed to
special education programs used within schools today in order to ensure the success of the
disabled in their endeavors.
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Chapter 1: Historical Analysis of the Initial Attitudes Toward and Subsequent Advocacy
for Special Education Groups
Special education programs have not always been common. It was not until the 1970s
that legal reform to implement special education efforts within schools began. Prior to the
development of special education programs, it was common for individuals with disabilities to be
isolated from the general group in both an academic and social context. While reform efforts are
fairly recent, research on these groups has been present since the early 19th century. Through
analyzing historical and current literature, it is evident that the societal viewpoint on those with
special needs has vastly changed over time due to a shift in values, as well as a decline in various
stigmas. The stances on children with disabilities requiring special education needs and
accommodations have changed from an approach of neglect to one of support and acceptance.
This can be credited to the works of the various psychologists, researchers, academics and
advocacy groups who contributed to the disability rights movement.
Historical Figures and Their Attitudes
Various scholars and researchers have evaluated the disabled community. Thomas
Hopkins Gallaudet, the co-founder of the first school of the deaf, was said to take pity upon a
little girl and “her unfortunate class” (Barnard, 1854, p.375), which motivated him to dedicate
his life to pioneering education for the disabled. In this instance, the term “unfortunate class” is
used to describe an entire community of individuals with a negative connotation. It can be
inferred that the negative connotation taken to address the disabled community he was catering
to was aligned more with societal biases rather than Gallaudet’s himself, as he evidently had
good intentions within the disability movement. This was illustrated through direct testimony of
those impacted by him, saying “What meed of praise shall be awarded to him who not
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only-emancipated a whole class of men, in all states and for all time, from the thrall of ignorance
and moral degradation: who not only restored to them their rights, invaluable, inestimable, but
the humanity of which they were robbed” (Barnard, 1854, p. 376). This shows the impact which
Gallaudet had on the deaf community, not only playing a part in separating them from ignominy,
but also giving them the opportunity to pursue a fair education. This led to a university being
named after him in 1864, just 13 years after his death. Gallaudet University, located in
Washington D.C., is the only liberal arts college in the world which is exclusively tailored
toward deaf students. This shows the impact which Gallaudet had on the special education
movement, taking the disconnect between society and those with disabilities in the 1800s and
personally transforming the learning experience for those with this disability.
Authors contributing to the American Phrenological Journal (1857) also mentioned the
methods of Gallaudet, crediting him with successfully contributing to the education of these
children through various measures and introducing the methods to other countries. When these
authors visited a school which grouped those with disabilities together with those considered to
be psychotic, they were surprised to find the children, or “company of little urchins” (American
Phrenological Journal, 1857, p.14) getting along peacefully. The grouping of those with
disabilities along with criminal or violent children showed the evident disregard which society
still held for those with disabilities, despite conscious considerations and awareness of the
positive contributions of figures such as Gallaudet to the movement. The fact that the surveyors
expected to find the children engaging in reckless behavior showed the prejudice which was
bestowed upon them. They even insisted that those with disabilities “have no facts, no wants, no
aspirations” (American Phrenological Journal, 1857, p. 15). This illustrated the degradation and
discrediting of those with disabilities which was published during the 1800s.
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Around the same time, various debates regarding the origins, as well as the prevention, of
disabilities were circulating amongst researchers and psychologists. The nature versus nurture
debate, initiated by Charles Darwin’s The Origin of Species and further investigated by Francis
Galton, Darwin’s cousin, was a widespread controversy. Galton, who was one of the first
experimental psychologists, was an advocate for eugenics. Galton himself derived this term from
the Greek phrase “eugenes”, which means “good in stock” (Galton, 1883, p.18). He wanted to
coin a “brief word to express the science of improving stock” (Galton, 1883, p.18). Galton was
the chief defendant of the practice of eugenics, advocating for selective breeding measures in
order to attain a perfect society without the presence of any individuals who inhibited
undesirable traits, including those with disabilities (Stephens & Cryle, 2017). The practice of
eugenics involved assessing a person's genetically determined social worth and fitness (Antonak,
1993). During Galton’s time, those with disabilities ranked low in social desirability, as was
illustrated through their general treatment as well as the published literature circulating on the
topic. Galton essentially did not want anyone to be part of society that had a disability, and aimed
to control the evolution of society by containing the groups which he found to be problematic
and eliminating them (Galton, 1904).
English psychologist Cyril Burt spent time attempting to figure out if
“feeble-mindedness,”, a term used in reference to special education children, was a cause of
environmental or genetic influence (Burt, 1912). Burt and Galton had a personal connection,
with Burt’s father being a family doctor who treated the Galton family (Chitty, 2013). As a
result, Burt embraced Francis Galton’s findings, forming the opinion that intelligence was mostly
inherited, and subsequently proposed eugenics and other ideas to “cure” child delinquency. Burt
spent his life studying the inheritance of IQ and other intelligence measures, becoming the first
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British psychologist to be knighted and receiving attention for his twin studies. These studies,
however, would be the downfall of Burt’s reputability, as they led to the surfacing of the “Burt
Scandal” (Jensen, 1991). This alleged that Burt’s data had been faked, and that he was guilty of
deception later in his career (Clark, 1981). Although these claims have yet to be completely
resolved, Burt’s status as a once renowned psychologist studying both gifted and delinquent
children had been impaired nonetheless.
Physicians such as Samuel Gridley Howe proposed that children with disabilities were
born that way because of their parents' violation of natural laws, therefore producing an “unfit
instrument for the manifestation of the powers of the soul” (Howe, 1858, p.366). Howe was said
to have viewed disabilities as a “social disease”, deriving from immortality or sinning (Flynn,
2017). Similarly to the American Phrenological Journal, he implied an association between
criminals and violent individuals and those who have special education needs such as the blind
and the deaf (Howe, 1874). By doing this, he contributed to the stigma around those with
disabilities. Society further succumbed to this stigma by collectively assuming negative
connotations of those within the disabled community. However, Howe did strive to provide care
for the disabled, believing them to have the potential to be trained and redeemed from their
unaccepted habits (Howe, 1874).
Many groups which researchers and psychologists associated with further promoted
sterilization and additional efforts to prevent those with disabilities from spreading them to their
offspring and further perverting society. For example, the Eugenic Records Office at Cold
Springs Harbor wrote the ‘Model Eugenical Sterilization Law’ (Antonak et al, 1993). This
proposal was designed in order to provide a legal template that could be adapted and eventually
applied into lawful policy and programs. This showed the measures which communities were
�DISABILITY RESOURCE EXPANSION
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willing to take in order to eliminate the disabled population, going so far as to propose laws
which would allow drastic measures such as sterilization and other eugenical processes to be
carried out within the disabled community.
Henry H. Goddard was an American psychologist and eugenist. Goddard believed in
limiting the reproductive capacity of those who were “morons”, a term which he is credited with
inventing for clinical use when describing individuals with disabilities (Antonak et al, 1993).
Goddard also felt that segregating those with disabilities was an appropriate effort, and he
supported the idea of creating specialized colonies for these individuals to congregate within
(Goddard, 1920). He felt that those who had low IQs were to be identified as a “menace of
society and of civilization” (Goddard, 1915, p. 307) because their IQs were considered
insufficient to function within the various social structures that were becoming present in the
increasingly advancing free world. Goddard rationalized this thought through his adoption of the
Binet-Simon scale of intelligence, which he is credited with introducing to the United States after
discovering it in Belgium and presenting it to his colleagues. He became the principal advocate
of using this test in the diagnosis of mental deficiency in America, distributing thousands of
copies of the manual over the years (Antonak et al, 1993). Researchers such as himself would
attempt to identify those with disabilities, and then use this test as justification for eugenics. His
motives behind using the test were not aligned with those of the creator, Alfred Binet.
Alfred Binet was a French psychologist who sought to create a measure of general
intelligence. This was primarily because teachers and doctors during this time were often
accused of making unreliable diagnoses of intelligence (McCredie, 2017). Binet emphasized that
IQ scores were not meant to define permanent conditions, and they were to be used as a rough
guide to improve the learning experience of the disabled. However, researchers such as Goddard
�DISABILITY RESOURCE EXPANSION
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took the test and skewed it from its initial intentions. Binet himself believed in finding methods
to keep children in schools, directly contrasting the views of others who supported segregation
and eugenics such as Goddard and Galton (Nicolas et al, 2013).
Similarly, Lev Vygotsky was a Soviet psychologist who had a view relatable to the
perspective of Binet. He believed that dividing those who were disabled from the general
population would only enhance the separatism between the two. He said “instead of helping
children escape from their isolated worlds, our special school usually develops in them
tendencies which direct them toward greater and greater isolation and which enhance their
separatism” (Vygotsky, 1929/1993, p.65). Vygotsky was against the idea of creating segregated
disabled communities, believing it would eliminate any opportunity to integrate those with
disabilities into society.
In contrast, Désiré-Magloire Bourneville was a French neurologist who dedicated his life
to pediatric neurology. Bourneville supported isolation measures within special education. He
thought that disabled children would be better off if they were removed from the standard
curriculum and instead referred to an asylum-school. He felt that specialized institutions would
provide “medico-educational treatment that could be applied to idiot, epileptic, retarded
children” (Plantade, 2015, p.268). It can be inferred through Bourneville's dedication and
positive contributions that he likely had good intentions for the betterment of those with
disabilities through these propositions, but was also following the then-normalized social pattern
of isolation and institutionalization in his proposals.
Instances of Mistreatment
High profile attention on misjustices toward those with disabilities induced a societal
shift toward establishing different standards of assistance for those with disabilities. A significant
�DISABILITY RESOURCE EXPANSION
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event which gained national attention on this issue was the exposé on The Willowbrook School
by journalist Geraldo Rivera in 1972 after he was given a key by a recently fired Dr. Michael
Wilkins. Wilkins was dismissed from employment at the institution because of his efforts to
educate parents on reform needed within the school (Flynn, 2017).
The Willowbrook State School (1947-1987) was initially established as an institution for
children with intellectual disabilities, but it became the site of a major turning point in the history
of disability rights that revolutionized the way in which the care of people with disabilities was
to be addressed (Flynn, 2017). It became an overcrowded institution, housing over 2,000 more
adults and children than their maximum capacity allowed. Residents at the school were subjected
to physical, sexual and emotional abuse (Weiser, 2020). They were also unwilling participants in
Defense Department-funded medical research on hepatitis and other diseases. In these studies,
children were intentionally given the virus in order to gain understanding into its variations.
Vaccinologist Maurice Hilleman described the hepatitis studies performed at the institution as
“the most unethical medical experiments ever performed on children in the United States”
(Offitt, 2007, p.27).
Willowbrook residents were denied their basic rights while living at the school, receiving
even less benefits than those in prisons. It was emphasized that prisons alloted 80 square feet per
inmate, while Willowbrook provided only 35 square feet per resident as well as no space for
personal belongings (Dalton, 2020). Due to the social stigma surrounding those with disabilities
at the time, as well as the conditions of the school, employee interest was low, resulting in staff
members not having to submit a background check for employment. The staff to patient ratio
was estimated to be about 50:1 (Dalton, 2020). Willowbrook is often referred to as the symbol of
�DISABILITY RESOURCE EXPANSION
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deinstitutionalization in America because of the horrific conditions which its residents endured
(Flynn, 2017).
The closing of Willowbrook was not a seamless process. Parents of the children residing
there collaborated to produce the New York State Association for Retarded Children v. Carey
(1972), which claimed the conditions at Willowbrook violated the constitutional rights of the
residents. Various negotiations took place, with the Willowbrook Consent Decree (1975)
eventually being implemented with the intent to improve living conditions and placement options
for these children. The school closed in 1987 after years of public outcry.
Similarly, the Pennhurst State School and Hospital, or the Eastern Pennsylvania State
Institution for the Feeble-Minded and Epileptic (1908-1987), was an institution meant to provide
care for those with disabilities. Pennhurst was engulfed in controversy throughout its operation,
with its chief physician quoting Henry Goddard and his eugenic remarks when discussing
methods of isolation and contraceptive efforts implemented within the school (Schmidt, 1983).
The facility was regarded as “understaffed, dirty and violent” (“Law: Patients' Rights”, 1981,
para.1). Drugs were often used for staff to exert control over patients instead of for treatment
purposes, and patients often suffered from physical deterioration as well as overall regression
from their stays at the institution. Harsh methods of punishment were a commonality for
residents, such as electric shock therapy machines and teeth pullings of inobedient patients
(Beitiks, 2012).
The Pennhurst State School was subjected to a class action lawsuit, Halderman v.
Pennhurst State School & Hospital (1974) after a television exposé by Bill Baldini was aired in
1968 exposing the conditions within the hospital, which continued to deteriorate after the release
of the exposé despite promises of improvement. Pennhurst was found to be unable to provide the
�DISABILITY RESOURCE EXPANSION
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appropriate care which violates federal and state law ensured for its patients. Prominent civil
rights attorney David Ferleger, who represented the plaintiffs of the case, stated the court ruled
“retarded people placed in state facilities have a right to adequate care free from discriminatory
separation from nonretarded people, and that the institution was irredeemably incapable of
providing that care” (Ferleger & Boyd, 1979, p. 718). Despite various appeals, as well as
multiple arguments in the Supreme Court, this resulted in the closing of Pennhurst in 1987,
which was coincidentally the same year which Willowbrook closed its doors.
Advocacy Instances
In addition to the lawsuits which initiated the deinstitutionalization of disabled students,
various laws were drafted and proposed during the disability rights movement. Section 504 of
the Rehabilitation Act of 1973 was introduced as one of the first federal civil rights laws that
offered documented protection for people with disabilities, as well as prohibited discrimination.
It ensured the upholding of the dignity and respect of disabled individuals. However, there was
much delay and opposition to the ruling, resulting in stalling of the law being properly regulated.
As a result, the 504 Sit-Ins took place, which consisted of demonstrators marching across the
nation to advocate for the regulations and enforcement of Section 504. One demonstration, the
San Francisco federal building sit-in, lasted 26 days (Osorio, 2022). This was the longest sit-in at
a federal building (Lu, 2021). Regulations were finally signed four years after the law passed on
April 28, 1977 (Carmel, 2020).
The Americans with Disabilities Act of 1990, or the ADA, prohibited discrimination
against individuals with disabilities in all areas of public life which the general public had access
to, ensuring equal access to resources amongst all. The law was stalled for months by the House
Committee, which led to various protests being organized by concerned activists, including The
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Capitol Crawl. The Capitol Crawl, which took place on March 13, 1990, saw over 1,000
protestors march from the White House to the U.S. Capitol to demand that Congress pass the
ADA (Little, 2020). During the protest, several participants who were in wheelchairs abandoned
the devices and crawled up the stairs of the Capitol, which was symbolic of the right to
reasonable accommodations which the ADA contained (Carmel, 2020). The crawl directly
illustrated the barriers which were in place for people with disabilities, and therefore gave a
visual representation of the necessity for the law to be signed. As a result of this protest, the law
was signed months later on July 26, 1990 (Little, 2020).
Legal Efforts
In addition to the legal advocacy efforts pertaining to Section 504 of the Rehabilitation
Act of 1973 and The Americans with Disabilities Act of 1990, various other legal
implementations were made in order to further secure the rights of those with disabilities. The
Education for All Handicapped Children Act, as well as Individuals with Disabilities Education
Improvement Act, or the IDEIA, focused on special education reform in particular.
The Education for All Handicapped Children Act made it mandatory to make education
equally accessible to those with physical and mental disabilities. The act declared that those with
physical and mental disabilities must be given equal opportunity to education, as well as one free
meal a day. This also introduced the idea of the least restrictive environment, which paved the
way for admitting children with disabilities into the general student classrooms. This was
something that was not always practiced within schools, especially before the 1970s (Larson,
1985).
The Individuals with Disabilities Education Improvement Act of 2004, or IDEIA,
introduced various elements to law regarding special education procedure. The primary goal of
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IDEIA was to improve learning outcomes and accessibility for students with disabilities (Yell et
al, 2006). Standout pieces of the legislation included the expansions of the least restrictive
environment (LRE), the individualized education program (IEP), and the right to a free and
appropriate public education (FAPE) (Yell et al, 2006). This law made the appropriate resources
available for those with disabilities in order to gain a fair education which is specific to their
needs. The IDEIA is an expansion of the Individuals with Disabilities Education Act, or the
IDEA, which was passed in 1990. One of the reasons IDEA was amended was its language. The
writing influenced teachers to misidentify minority students as having learning disabilities. The
IDEIA also required states to establish goals for students with disabilities that aligned closer to
the goals of their general education peers, which the IDEA did not fully consider (Renner, 2023).
Continuous Flaws Despite Improvement
Many efforts for special education advocacy led to an overabundance of students being
determined as special needs, which took away from the resources received by those who actually
needed it (Belluck, 1996). This can be illustrated from the fact that twelve years after the
Education for All Handicapped Children Act took effect, the number of handicapped students in
US public schools had increased to 11 percent of their total enrollment, showing a need for
specialized and appropriate learning (Daniels, 1988).
Diana v. State Board of Education (1970) exposed placement errors and biases within
testing systems despite heightened reform efforts. Schools were thereby forced to be more
diligent in their testing and assignment processes. This involved determining whether the
educational problems of children were actually the result of a learning disability or due to other
possible factors. Larry P. V Riles (1972) expanded on Diana, marking the beginning of the end to
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IQ testing in school settings. Financial cuts or other fiscal restraints have also had various
regressive effects on the efforts made to tailor special education (Weintraub & Ramirez, 1985).
Despite implemented changes, thousands of students are still deprived of the services of
which they have the right to access. Just as recently as 2016, the New York City Department of
Education found that nearly 9,000 students recommended for services were not receiving them at
all, and more than 60,000 students were receiving only some of the services they needed.
(Taylor, 2016). This illustrates that despite the reform efforts which have taken place throughout
history, there is still work to be done to ensure all students benefit from the sacrifices and
advocacy that so many people fought for.
Conclusion
While the initial evaluation and attitudes toward those with special needs involved
sometimes undesirable elements, as the field has matured through advocacy efforts,
psychologists and researchers have seen a considerable turnabout in the field in comparison to its
initial quality. Psychologists in particular have contributed to various advocacy efforts through
doing research and reporting their findings and stances to lawyers and representatives of parental
groups (Routh, 2005). Although contrasting views were evidently present, ranging from the
controversial ideas of Galton and Goddard to the progressive and embracing contributions of
Binet, Gallaudet and Vygotsky, all input provided helped shape the field to become the way it is
known today. Although some, such as Howe and Bourneville meant well by supporting special
schools, they were unsuccessful. It took a movement, as well as the presence of appalling
scandals such as Willowbrook and Pennhurst to get things to change. These changes have now
allowed those with disabilities of any kind which require special accommodations the
opportunity to gain an education that is valuable to their specific needs.
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Chapter 2: The Importance of Socialization in School Children with Individualized
Education Plans
The field of special education encompasses many different circumstances, including
specialized programs, tailored services, and specifically designed instruction. Each child who
qualifies as special needs shares a common denominator. That is the fact that each child is given
an IEP, also known as an Individualized Education Plan. The IEP is designed as a personalized
plan for students to achieve academic success in their general education curriculum in a way
which aligns with their specific needs (Kurth et al, 2021). A primary goal within the IEP is
access to the LRE, or the least restrictive environment, which encourages those with an IEP to
gain access to the general class environment (IDEA, 2004), allowing them to socialize amongst
their peers. This review will analyze how the socialization of, as well as the environment in
which children with IEPs interact, strengthens the academic, socioemotional, functional, and
overall wellness outcomes of these students.
Role of Social Development Theory
The ideas of Lev Vygotsky and his Social Development theory concluded that social
interactions and social relations are primary sources of development (Rubtsov, 2020). He argued
against the social prejudices that were being continuously enforced against handicapped
individuals (Vygotsky, 1929/1993), advocating for inclusion and collaboration between advanced
students and those who require assistance. Additionally, he emphasized the zone of proximal
development, which relies heavily on peer interaction to achieve success. The zone of proximal
development is the space between what someone can learn without assistance and what they are
capable of learning with assistance (Gindis, 1999). Through this particular theory and his general
works, Vygotsky emphasized the importance of social interaction between peers, as well as the
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role of a learning person's environment in their advancements, as it was his belief that learning is
influenced by the environment.
Social Participation
In the past, literature has often concluded that isolation of those with special needs was
the best course of action to ensure the success of both general education students and special
needs students. This concept of isolation has been heavily researched and debated, and it has
been concluded that exclusion can have negative effects on both learning and social skills
(Freeman & Alkin, 2000). This has resulted in current laws advocating for student inclusion.
The primary act which solidified this was the Individuals with Disabilities Education Act, Sec.
300.114. This section of the law requires that students with special needs are placed in the least
restrictive environment (LRE) in order to allow students to be integrated within a unified
learning environment. This states that, “To the maximum extent appropriate, children with
disabilities, including children in public or private institutions or other care facilities, are
educated with children who are nondisabled” (US Department of Education, 2017, p. 31).
The International Journal of Educational Methodology acknowledges the fact that
historically, children with disabilities in most parts of the world have not been given access to the
educational opportunities offered by traditional schooling (Somma & Bennett, 2020). This
journal accounts for how these changes should be implemented schoolwide through the
acknowledgement that the pedagogy itself may require reform, as teachers’ confidence, attitudes,
and willingness toward inclusion itself are factors in determining the success of inclusion for
students (Somma & Bennett, 2020). After investigating the literature of Schoger (2006), it is
clear that socialization contributes to the overall wellbeing and advancement of those with
special needs. Not only do those with disabilities benefit from interaction with others with
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disabilities, but those without disabilities do as well. It is paramount to consider the idea that
although a child may have a disability, they are still children in nature. Because of this, just as
other children do, children with disabilities will still learn from their environment, regardless of
what that environment’s circumstances may be (Schoger, 2006). This emphasizes the importance
of surroundings and a positive environment, as these children will pick up on the atmosphere
around them, as all children do, which in turn will influence their habits and practices in the
academic setting.
Youth experiences of social participation as a whole are related to the social interactions
of which they observe in their school environment (Vetoniemi and Kärnä, 2021). This
emphasizes the idea that necessary socialization skills are initially formed in school, and develop
as one grows older and further assimilates into society. This ties into the functional outcomes of
students with disabilities partaking in traditional classroom activities and settings, as it allows
them to observe and participate in the standard conditions of their peers and become
accommodated to the practical expectations of society. The idea of heterogeneous grouping,
where students are interacting with their age level peers who fall within all different levels of
ability, as well as a balanced educational experience were popular amongst educators in
particular, as it allowed students to experience diverse levels of knowledge and adjust
appropriately (Somma & Bennett, 2020). By exploring the literature of those who have
experienced the results of these types of environments and learning structures on children, we are
able to better understand how these changes positively impact the special education field as a
whole.
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Inclusion & Benefits of IEP’s
The support of IEPs and the benefits that they bring to children with disabilities is
evidently conveyed through the acknowledgement that the social, as well as academic benefits of
inclusion for students with disabilities have been well researched and well documented (Schoger,
2006). In the instance of the Reverse Inclusion Theory, those with disabilities “started to initiate
social interactions with not only their reverse inclusion friends, but other peers as well”
(Schoger, 2006, p. 7). This shows that through implementing inclusive measures, students took
initiative to become more sociable on their own. In addition to this, after just eighteen weeks of
increased socialization, the children improved on both their participation and communication
skills. This data showed that promoting an environment made up of inclusionary practices, as
well as placing an emphasis on social interactions, resulted in positive enhancements and
functioning in the behavior and demeanor of those students with disabilities.
Educators have recognized the benefits of switching to a fully inclusive pedagogy on the
basis of collaboration and observational learning (Somma & Bennett, 2020). This is due to
positive experiences and advancements such as the development of independence and
socialization skills. Many instances of children with disabilities paired with collaboration have
proven to be successful in relation to both social and academic success (Somma & Bennett
2020). The learning environment is also emphasized by acknowledging that inclusion extends
beyond their lessons. The concept also expands into the attitudes and beliefs of all students in the
class and school environments, therefore integrating standards of inclusion into everyday life.
One study found effective communication elevated the student’s abilities to adhere to
collaboration efforts, as well as take note of practical ways to work together within and outside
of classrooms. This resulted in a shared understanding of inclusionary measures across
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environments (Garcia et al, 2022). This illustrates that promoting a positive classroom culture
with reinforcement is essential to driving student interaction and inclusion. Additionally, Schoger
(2006) makes the point that social skills are developed from observational learning, which means
that these students require increased opportunities to observe the socially acceptable,
age-appropriate behaviors that their general education peers exhibit in order to create their own
understanding of social cues. By keeping this idea in mind, it is chiefly important to allow those
with disabilities to have hands-on experience with those who do not have disabilities, as it allows
them to gain an integrative perspective on various aspects of their peers' habits and sociability.
Impact of Social Exclusion
Various other literature takes into perspective the idea of social exclusion. Beld et al.
(2019) acknowledge that risk factors for social exclusion may be particularly disproportionate in
special education classes due to the accommodations which these students may need. The
importance of adequate social information processing, which is obtained mostly through social
scenarios, is emphasized. When a child lacks socialization, they may possess inadequate social
skills and have inappropriate reactions to social situations. This may cause these particular
students to isolate themselves and become incapable of building and maintaining rewarding
social relationships with their peers. This then ties into emotional isolation, which can result in a
lack of self regulation and tendency to have outbursts. Vetoniemi and Kärnä (2021) focus on the
experiences of students with special education needs in a mainstream school environment.
Similarly to Beld et al. (2019), these writers mention how an exclusionary environment can have
a negative impact on students with disabilities. This is because exclusion can cause these
students to feel isolated and lonely, therefore leading them to become discouraged to socialize
and interact with peers. This instance shows the socioemotional implications which exclusion
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can have on children with disabilities, and how this can affect the way in which they see and feel
about themselves and others. This can contribute to the formation of negative feelings, as well as
contribute to hesitancy and discouragement to get involved with peers. Sullivan and Castro
(2013) discuss responses to intervention, or RTI’s, which tie directly into these ideas regarding
socioemotional adaptation and implications. They make the point that RTIs may “contribute to
the positive socialization of students by reducing inappropriate and unnecessary placements in
special education, thereby minimizing stigmas and stereotypes associated with labeling”
(Sullivan & Castro, 2013, p. 185). This shows that the process of diagnostic decision-making is
important, as these interventions determine the environment in which students are placed to
learn. By minimizing the unnecessary placements in the classroom, staff may be more
encouraged to implement more constructive and practical interventions in the working
environment. This also allows schools to focus on all students and create socialization plans that
positively impact every student.
Integrity and Attitudes
Intervention integrity plays a part in the child's experience as a whole, as well as their
attitudes toward participation in a mainstream schooling environment (Sullivan & Castro, 2013).
If the intervention process is presented in a positive manner, this may further motivate the child
to willingly partake in activities that promote advancement. The initial presentation as well as
upholding of the classroom environment plays a part in the results seen from intervention. In
addition to this, changing the historical standard of children being pulled out for more
individualized instruction will contribute to students' motivation and incentive to socialize and
create meaningful connections in the classroom.
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The idea of isolation as a whole goes back to the primary idea of a positive, inclusionary
environment. It is inferred that a positive classroom climate affects students' social skills in a
positive way, as it allows them to develop a positive perception of social relationships by
participating in positive interactions (Beld et al., 2019). It has been discovered that efforts to
promote a positive classroom environment were associated with low levels of social exclusion,
showing that environment plays an important role in the experiences of these children as a whole
in regards to their social, functional, and emotional experiences. This shows that the environment
and overall classroom culture play an important role in the overall success and experiences of
students with special needs.
Conclusion
In conclusion, current literature shows that children with IEPs make advancements
through socialization with other school children. Children with IEPs who are placed in
integrative learning scenarios are likely to become more socially fluent and adaptable, setting
them on a path to succeed in their future endeavors. It has been illustrated that integrative
learning offers not only academic benefits, but also various other benefits such as the
strengthening of their social, functional and emotional skills, and therefore preparing them to
advance adequately both during and post engagement in an academic setting. Future research
should continue to investigate how to maximize the equity and accessibility of the educational
experiences of children with IEPs.
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Chapter 3: Considerations for Approaching Hesitant Families to Utilize Special Education
Resources
A potential problem which may occur within the school system is a parent or guardian
not being completely comfortable with allowing their child to access school resources such as an
Individualized Education Plan, or IEP. Within the goals outlined in an IEP, there are many
resources available to children who need a more individualized approach to learning. Various
outside factors, however, may stand in the way of their guardian giving the school permission to
implement these approaches. This can be an issue because parents need to provide consent for
their child to partake in any additional school resources. If a child is recommended resources that
a parent may not agree with, there are various processes in place to handle disagreements.
Throughout this chapter, solutions will be discussed in order to give a clear understanding into
the processes which help solve this problem in schools.
Hesitance can be derived from several factors, but one that seems to cause a large issue
within accepting school resources is cultural differences (Barrio, 2021). Cultural differences tend
to stand as a blockade for parents when presented with the opportunity to accept school
resources. A lack of communication, as well as lack of adequate informational resources, also
contributes to parental hesitancy (Lo, 2012). Some parents may perceive a cultural mismatch of
beliefs and values from their children's school, contributing to apprehension toward accepting
accommodations (Barrio, 2021). This can result in conflict between parent and teacher, which as
a result directly impacts the student’s academic experience (Lasater, 2016). Being sensitive and
respectful to cultural differences is important to ensure mutual understanding, and it is important
to reassure these families that their personal values will not be infringed upon or overlooked
within the academic environment.
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Regardless of the reason parents decline school resources, the relationship between
parents and teachers is what really drives the success of educational planning. Parents and
teachers must work together in order to find the most efficient educational plan for a student.
This relationship stands as the foundation for student success. This is an issue within the
educational environment because parental and teacher conflict can negatively influence the
child’s behavior, as one study found fluctuations in student–teacher closeness contributed to
increased aggression in children (Lee & Bierman, 2018). It can also affect their learning habits,
as it was revealed that student participants reported experiencing anxiety or self-doubt as a result
of disagreements between their parents and teachers (Lasater, 2016).
A three-year study indicated that special education teachers provided the most input in
IEP meetings about students’ strengths, needs, and interests (Mereoiu et al, 2016). While this is a
positive aspect and illustrates teacher involvement, it also shows a need for more parental
involvement and input. Since “the house is the first educational environment, and the first
community in which a child lives and grows” (Abed, 2014, p.1), a closely aligned relationship
between home and school is integral to the growth and development of a child. The legal system
supports this sentiment, as the laws surrounding special education “encourage a working
relationship between the home and school that fosters an educational team with the goal of
providing the child with appropriate services” (Mueller, 2009, p.60). Meaningful engagement is
an important aspect of collaboration which requires informed consent on the parental spectrum,
as well as total accessibility to information on specialized programs (Rossetti et al, 2018). The
support of families and school personnel is integral to the success of any educational planning on
behalf of the child. Hesitance to work collaboratively may affect the learning outcomes of the
child (Bryce et al, 2019).
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Solution: Advocacy and Support Resources
A potential solution to this problem is the implementation of resources such as advocacy
training or an Individualized Family Service Plan, which may make families feel more
comfortable in accepting accommodations. The use of advocacy training programs such as the
Special Education Advocacy Training and the Volunteer Advocacy Project (Burke, 2013) may
allow parents to feel more in control of their role in the planning process of the IEP, encouraging
them to feel secure in contributing to the conversation and accepting staff recommendations.
There are also resources available such as the Individualized Family Service Plan (IFSP), which
involves a “team-based approach with a focus on the child, family, and natural environments”
(DeSpain & Hedin, 2022, p.171). Adopting this type of advocacy may be useful as it allows
parents to formally consider and document environmental factors both at home and in school
when assessing the progress of a child. Holding Facilitated Individual Education Program
meetings, or FIEPs, allow mediation between parents and staff in order to come to the best
decision. The aim of FIEP meetings is to provide the team with the opportunity to work through
issues of disagreement throughout the IEP document collaboratively, with a facilitator or
advocate available to provide support as needed (Mueller & Vick, 2019).
Solution: Increased Knowledge and Emphasis on Collaboration
An additional solution to solve the problem of at home and in school balance and
consensus is increasing knowledge on the programs, as well as emphasizing the importance of
collaboration throughout the process. There is a particular importance of knowing and
understanding the family structure and culture, as well as defining partnership as giving a
balance of power between both parents and teachers according to the setting. A model of
partnership should be mutually selected, which is mostly dependent on the parents and their
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willingness, but should work best for all parties involved (Abed, 2014). Placing an emphasis on
the idea of partnership, opposed to giving one party dominance when determining the best course
of action makes both parties increasingly assured in their confidence toward potential successes
(deFur, 2012). Knowledge on both ends is an important aspect as well. Some teachers likely
don’t realize that the families of children might feel frustrated with what they perceive as
unsuccessful and culturally insensitive IEP meetings (Rossetti et al, 2016). Accomplishing
cultural sensitivity can be achieved by asking if families would like an interpreter at meetings, or
by making the effort to inquire about information on the families' culture, which may help
achieve a better understanding of the student (Edwards & Da Fonte, 2012). This also sets an
example for the child of how they can properly function in a team environment, serving as an
additional learning experience.
A key aspect of partnership is mutual knowledge and understanding. Many parents who
are from other countries may not know what exactly they are walking into when an IEP meeting
is set. Receiving background information on the topic, either through an interpreter, staff
member, or even through implementation of other resources such as an introductory video before
the meeting may make the process easier for both parties, as well as more comfortable for the
parent (Lo, 2012). When considering these types of situations, culturally responsive transitions
made toward an IEP involves acknowledging the cultural priorities which the family holds, as
well as giving the family a space to vocalize their personal needs and their envisioned long-term
goals in the decision-making process (Barrio, 2021).
Solution: Official Mediated Processes
If all efforts to amend the situation fail, parents do have the right to call for impartial
hearings under Section 504 of the Rehabilitation Act (Zirkel, 2012). Parents may opt for this if
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they feel their child is not being given access to a free appropriate public education, or FAPE.
The predominant avenue for resolving these disputes is an impartial hearing (Zirkel, 2012).
Impartial hearings are mediated by a hearing officer. This officer listens to both sides and decides
the best way to move forward. While this process may be useful to resolve a case, the
implications of a child witnessing parent-teacher conflict were found to consistently have a
negative effect on the child’s learning outcomes (Lasater, 2016).
Conclusion
In conclusion, various responsibilities fall both on the guardians as well as the school
staff when collaborating for a child’s advancement. Outside factors such as cultural competency,
barriers, and understanding contribute to parental hesitancy to enroll their children in school
facilitated programs or objectives. Proposing solutions such as promotion of cultural
understanding and sympathy on both ends, increase of resources to enhance parental knowledge,
advocacy resources and support for parents, or if all else fails, official processing, may be
beneficial. Through ensuring a mutually understanding relationship between parent and school,
as well as placing an emphasis on the wellbeing and growth of the child, planning and agreeing
on routes of success for the child are more probable.
�Chapter 4 redacted to remove personal reflections and any identifying information.
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�
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Senior Presentations Archive
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This archive contains materials from Wagner’s annual ‘Senior Presentations.’ This event honors outstanding students from each discipline who completed their Senior Learning Community project with excellence. The work is representative of Wagner’s highest standards, and is exemplary of the diversity of subject matter, public-facing scholarship, and civic-minded professionalism our students have attained through their four years here. These students were specially invited to present their work in a formal setting, traditionally the day of Baccalaureate. Students are encouraged to present their work in a format appropriate for their discipline, and so, the presentations vary in their format. Some might be in the form of a short video, or paper abstracts, while others might be posters or music clips. We expect this archive to serve as a resource for generations to come. Congratulations to our Seniors!
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The Development, Evolution and Application of Special Education Resources
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Psychology
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