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Browsing by Author "Fullen, Matthew C."

Now showing 1 - 8 of 8
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    Access to Health Care at the Margins: Implications for Older Sexual Minority Women with Disabilities
    Westcott, Jordan Bailor (Virginia Tech, 2023-05-05)
    Counselors are called to address barriers to human growth and development through advocacy (ACA, 2014), such as those posed by inequitable health care access for socially disadvantaged groups (CDC, 2013; IOM, 2011). Health care contributes to positive health outcomes (Healthy People 2020) and is therefore an important component of advancing health equity among marginalized populations, such as older sexual minority women (SMW) with disabilities. Despite evidence of disparate health care access and health outcomes, no research to date has explored the health needs or health care experiences of disabled older SMW. This study therefore sought to address this gap in the literature by: identifying current levels of health care access and barriers among older SMW with disabilities; exploring predictors of health care access among older SMW with disabilities; and identifying protective factors, such as social support and resilience, that moderate the relationship between health care access barriers and health outcomes. Results obtained from a sample of 208 respondents provided baseline data about health care access and barriers among older SMW with disabilities. Generally, respondents had a place to receive health care, but few had access LGBTQIA+-specific health services despite indicating that this type of health care was important to them. Only about half had accessed mental health services in the last six months, and people who had accessed mental health care perceived it to be easier to access than people who had not. Respondents most highly endorsed external barriers related to cost of health care, and they reported higher health care stereotype threat related to age and disability compared to gender and sexuality. External barriers to health care were predictive of most health care access indicators (e.g., utilization of general and specific health services, as well as health outcomes). Among internal barriers, sexuality- and disability-related health care stereotype threat emerged as predictors of health care access and health outcomes respectively. Similarly, acceptability of health services, accessibility of health services, and affordability of health services were specific external barrier categories that appeared to influence health care access and outcomes among older SMW with disabilities. Neither resilience nor social support moderated the relationship of external access barriers to physical or mental health outcomes. However, resilience had a significant independent relationship with physical health outcomes, and both resilience and social support had significant independent relationships with mental health outcomes. These findings illustrate the structural factors related to health care access and outcomes for older SMW with disabilities, as posited by health equity frameworks (Braveman, 2014). The most influential internal barriers related to health care stereotype threat, which may develop in response to minority stressors specific to health care settings. The findings of this study support lifespan perspectives on LGBTQIA+ health (Fredriksen-Goldsen, Simoni et al., 2014), as well as minority stress processes (Meyer, 2003), as frameworks for understanding LGBTQIA+ health in later life. Implications for counselors, counselor educators, community organizations, and policies are discussed.
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    Ageism and the counseling profession: Causes, consequences, and methods for counteraction
    Fullen, Matthew C. (2018)
    As the number of older adults increases, it is important to understand how attitudes toward aging influence society, the aging process, and the counseling profession. Ageism—defined as social stigma associated with old age or older people—has deleterious effects on older adults’ physical health, psychological wellbeing, and self-perception. In spite of research indicating that the pervasiveness of ageism is growing, there are few studies, whether conceptual or empirical, related to the impact of ageism within the practice of counseling. This article includes an overview of existing literature on the prevalence and impact of ageism, systemic and practitioner-level consequences of ageism, and specific implications for the counseling profession. Discussion of how members of the counseling profession can resist ageism within the contexts of counselor education, gerontological counseling, advocacy, and future research will be addressed.
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    Bearing the Burden: Rural implications of licensed professionals' exclusion from Medicare
    Fullen, Matthew C.; Wiley, Jonathan D.; Morgan, Amy A. (2019)
    Medicare beneficiaries are unable to access mental health services provided by some licensed master’s-level clinicians, including licensed professional counselors (LPCs). Provider shortages in rural localities, combined with Medicare policy exclusion of these licensed mental health professionals, exacerbates rural mental health care access disparities. Very little is known about the impact of LPC exclusion from Medicare on rural beneficiaries. This study explored the lived experiences of mental health professionals who have turned away clients because of their Medicare-ineligible provider status. Interpretative phenomenological analysis was employed as a qualitative form of inquiry to guide the research design, participant recruitment, data collection, and analysis. Semistructured interviews were conducted with 9 Medicare-ineligible mental health professionals from a single, Mid-Atlantic state in the United States who have turned away clients because of their Medicare-ineligible provider status. Evidence from rural and nonrural practitioners highlighted the contextual implications of Medicare provider exclusion on rural beneficiaries. One superordinate theme, undue burden, is described through three emergent themes from the interview data: geographical disparities, intersectional hardships, and practice constraints. The results suggest that current Medicare provider regulations may create disparities of mental health care availability and accessibility for Medicare beneficiaries from rural communities. The qualitative evidence of this study describes systemic and proximal factors that result in unexpected termination, deterred help-seeking behavior, and untimely treatment for older adults and disabled clients within rural mental health care settings.
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    Come as You Are: The Acceptability of Harm Reduction Approaches for Opioid Use Disorder among Professional Counselors
    Jordan, Justin Richard (Virginia Tech, 2021-04-07)
    Over the last two decades, the Opioid Epidemic has caused immense harm to communities nationwide. Over 400,000 fatal opioid overdoses occurred in the United States between 1999 and 2017 (CDC, 2019). Professional counselors are among the front-line treatment providers addressing substance use, including Opioid Use Disorders. Professional counselors have a unique professional identity that is built upon humanistic values, a commitment to social justice, and client empowerment. These values align closely with contemporary approaches to substance use treatment, including harm reduction strategies. Harm reduction is an approach to substance use treatment that involves mitigating risks and improving the quality of life of individuals, regardless of their willingness or ability to stop using substances. There are several harm reduction strategies that reduce the risk of fatal opioid overdose or secondary harms of opioid use specifically, including medication-assisted treatment and the distribution of naloxone for overdose reversal. This study examined the acceptability of harm reduction strategies for Opioid Use Disorder among addiction treatment professionals, with a focus on professional counselors. In addition to measuring the level of acceptance of harm reduction for Opioid Use Disorder among professional counselors, counselors were also compared to other professionals who treat substance use. Predictors of acceptability of harm reduction for Opioid Use Disorder were examined based on overlapping components of professional counseling identity and harm reduction philosophy among professional counselors as well. The results of this study provided a baseline for the level of harm reduction acceptance among counselors who treat substance use. Counselors did not have higher levels of harm reduction acceptance for OUD compared to social workers with advanced degrees or bachelor's level substance use treatment providers. Social justice attitudes and empathy were statistically significant predictors of acceptance among counselors. This research indicates that these two factors are key components of counselor identity that explain harm reduction acceptance. The findings of this study highlight a need for more research about harm reduction acceptance for OUD among counselors, including further examination of provider factors that influence acceptance and examination of a broader array of professionals. This research contributed to the understanding of how professional counselors perceive novel approaches for addressing Opioid Epidemic.
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    Comparing successful aging, resilience, and holistic wellness as predictors of the good life
    Fullen, Matthew C.; Richardson, Virginia E.; Granello, Darcy Haag (Taylor & Francis, 2018-01-01)
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    Counselor Views of the Role of Trauma in Borderline Personality Disorder
    Roosma, Shannon Kinzie (Virginia Tech, 2022-06-06)
    Borderline personality disorder (BPD) is a highly stigmatized disorder, including among clinicians. Though research indicates a connection between childhood trauma and BPD, there remains considerable debate about the role trauma plays in the diagnosis and whether the diagnosis is properly categorized as a personality disorder. Additionally, studies about counselor perspectives of the Diagnostic and Statistical Manual of Mental Disorders (DSM) indicate conflicted feelings combined with dependency on its use. Research examining clinician views of the diagnosis of BPD, including the role that trauma plays in the diagnosis and categorization as a personality disorder, have largely neglected to explore the views of counselors, indicating a significant gap in the research. This study took a qualitative approach to increasing understanding of the views and experiences of licensed counselors as they work with clients and encounter trauma and the diagnosis of BPD. A total of 17 themes emerged during data analysis. Each theme is examined and conclusions are discussed.
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    An Interpretative Phenomenological Analysis of Counselor Education Doctoral Students' Teaching Preparation Experiences
    Wiley, Jonathan D. (Virginia Tech, 2020-04-24)
    Teaching is a foundational professional role addressed within the curriculum of counselor education doctoral programs, yet little is known about the teaching preparation experiences of counselor education doctoral students. This interpretative phenomenological analysis explored the teaching preparation experiences of a purposeful sample of eight current or recently graduated counselor education doctoral students enrolled in Doctor of Philosophy (Ph.D.) programs accredited by the Council for Accreditation of Counseling and Related Educational Programs (CACREP) through semi-structured interviews. Four superordinate themes, Experiential Integration, Contextual Development, Interactive Reflection, and Emergent Teaching Values, were identified to illustrate how counselor education doctoral students make sense of their teaching preparation experiences. These themes provide in-depth, nuanced, and narrative accounts of the multifaceted, experiential, relational, and contextual developmental teaching preparation experiences of counselor education doctoral students. The findings of this study revealed several important implications for counselor education doctoral students, counselor educations, counselor education doctoral programs, and CACREP to enhance the teaching preparation experiences of counselor education doctoral students. This study overall extends our knowledge of counselor education doctoral students' teaching preparation experiences, adding to a growing body of literature on doctoral teaching preparation in counselor education.
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    The Medicare mental health coverage gap: How licensed professional counselors navigate Medicare-ineligible provider status
    Fullen, Matthew C.; Wiley, Jonathan D.; Morgan, Amy A. (2019)
    This interpretative phenomenological analysis explored licensed professional counselors’ experiences of turning away Medicare beneficiaries because of the current Medicare mental health policy. Researchers used semi-structured interviews to explore the client-level barriers created by federal legislation that determines professional counselors as Medicare-ineligible providers. An in-depth presentation of one superordinate theme, ineffectual policy, along with the emergent themes confounding regulations, programmatic inconsistencies, and impediment to care, illustrates the proximal barriers Medicare beneficiaries experience when actively seeking out licensed professional counselors for mental health care. Licensed professional counselors’ experiences indicate that current Medicare provider regulations interfere with mental health care accessibility and availability for Medicare-insured populations. Implications for advocacy are discussed.