Readiness for school: A study of parent, teacher, and preschool provider perspectives

A possible gap exists between what parents and preschool providers know concerning children's readiness for school and what they should know when compared to teacher expectations. Students are experiencing difficulty in early schooling as a result of this gap in perspectives. This study's purpose was to describe, explain, and analyze the perspectives of parents, teachers, and preschool providers concerning school readiness. The qualitative strategy of interviewing was used with six parents, six teachers, and two preschool provider participants. Interview transcripts, field notes, member checking, and document analysis were used to interpret data and support findings. Categorization and coding organized data and aided in theory development. ^ Major findings of the study include: (a) All participant groups stress social skills, communication skills, and enthusiasm as most valuable for school readiness; (b) All participant groups agree parents have primary responsibility for readiness preparation; (c) Many participants suggest variables concerning family, economics, and home life contribute to a lack of readiness; (d) Parents place greater value on academic skills than teachers or preschool providers; (e) Preschool programs are identified as having the potential to significantly influence readiness; (f) Communicating, providing positive learning experiences, and providing preschool experience are valuable ways to prepare students for school, yet, differences were found in the types of experiences noted; (g) Participant perspectives indicate that informing parents of readiness expectations is of major importance, and they offer suggestions to accomplish this goal such as using public libraries and pediatrician offices as houses for written information and having kindergarten teachers make presentations at preschools. ^ This study concludes that parents and preschool providers do have knowledge concerning readiness for school. They may not, however, be in a position to carry out their responsibilities due to the intervening variables that inhibit the amount of time, interaction, and communication they have with the children in their care. This study discloses the beliefs of parents and preschool providers that children are ready for school, while teachers conclude that many children are not ready. Suggestions for readiness preparation and information dissemination are significant findings that offer implications for practice and future study. ^

Selected psychosocial and demographic factors affecting levels of pre-retirement planning

In September 2002, the State of Florida implemented a new retirement structure for those employed in the Florida Public School System. Teachers were given the option to maintain their existing defined benefit plan or choose the newly offered defined contribution plan. The variables that affect planning for retirement are innumerable. Identifying the most significant variables is essential to understanding how one plans for retirement. ^ This study examined the relationship between hypothesized psychosocial and demographic factors and an individual's level of pre-retirement planning. The criterion variable, the level of pre-retirement planning, comprised two concepts. First, the time spent thinking about retirement was determined by the score an individual received on a pre-retirement planning scale. This scale included the concepts of information gathering, goals, anticipated resources, and long-range planning. Second, implementation of retirement plan procedures was determined by the percentage an individual annually deferred to retirement. ^ The survey used for data collection contained 50 close-ended items. It was distributed to all full-time teachers in nine randomly selected elementary, middle, and senior high schools throughout Miami-Dade County Public Schools. Multiple regression and crosstabulation indicated that math anxiety, general risk, years of service, and total family income were significant predictors of the level of pre-retirement planning, as measured by the pre-retirement planning scale. In addition, the statistical analysis indicated that math anxiety, internal locus of control, years of service, and total family income were significant predictors of the level pre-retirement planning, as measured by the amount deferred to retirement. An individual's level of math anxiety and family income were the two factors that were the most significant predictors for both concepts on the level of pre-retirement planning. ^ Based on the findings of the study, recommendations focused on assessing an individual's level of math anxiety and educating teachers, particularly pre-service candidates, about the factors that affect pre-retirement planning. Further research should investigate the benefit of such educational programs. ^

Black middle school students' perceptions of success and their influence on academic performance

The purpose of the study was to investigate the perceptions of success held by Black middle school students in a Miami-Dade County (FL) public school and how these perceptions influence academic performance. The study sought to determine if differences exist among African-American, Haitian-American, and Haitian immigrant subgroups of the Black student population. ^ The study combined qualitative and quantitative methodology in data collection and analysis. The qualitative data consisted of three focus group interviews. Using a semi-structured protocol, questions focused on the student's perceptions of the characteristics of successful people, definitions of success, behaviors associated with achieving success, and peer, family and school support. The quantitative data comprised the responses of 352 Black middle school students to the Inventory of Student Motivation (ISM) developed to measure mastery, performance and social goal orientations. Response similarities and differences were examined using a series of two-way ANOVAs on the success scales by gender and culture. A three-way repeated measures ANOVA was conducted on mastery, performance and social general goal scales by culture and gender. ^ The results of the ISM revealed no statistically significant differences among African-American, Haitian-American, and Haitian students in their mastery, performance or social goal orientations. All three cultural groups scored significantly high on the mastery goal scale. There was a significant effect for gender on the mastery general scale with the females being more concerned with mastery than the males. Qualitative focus group interview results included varying definitions of success. African-American and Haitian-American students defined success in materialistic terms. Haitian students defined success in scholastic achievement terms. All students indicated hard work, persistence and goal setting through completion as important to achieving success. Negative influences included peer pressure, teacher and societal expectations, and classroom environment. Parental reaction to low academic performance varied by culture. ^

Hispanic adolescents with severe substance abuse problems: Parental involvement, acculturation-related factors, and attachment

The main objective of the study was to investigate the relationship between parent-related, acculturation-related, and substance use-related variables found within individual, familial/parental, peer and school adolescent ecological domains, in a clinical sample (i.e. adolescents who met criteria for a Diagnostic Statistical Manual-IV [DSMIV] clinical diagnosis of substance abuse/dependence) of Hispanic adolescents from Miami, Florida. ^ The sample for this study consisted of 94 adolescent-mother pairs. The adolescent sample was 65% male, and 35% female, with a mean age of 15 years. More than half of the adolescents were born in the United States (60%) and had resided in the U.S. for an average of 12 years; 80% of the caregivers (primarily mothers) were foreign-born and lived in the U.S. for an average of 21 years. ^ Correlation and hierarchical regression were used to answer the research questions. The findings indicate that the hypothesized model and corresponding anticipated effect of the relationship between parental school and peer involvement on adolescents’ frequency of alcohol, marijuana and cocaine use was not supported by the data. Parental “acculturation-related” variables did not explain any of the variance in adolescent substance use frequency in this sample. Mediation and moderation models were not supported either. However, some interesting relationships were found: ^ The larger the acculturation gap, the lower the parental involvement in school tended to be (r = -.21, p < .05). Adolescents who experienced a greater acculturation gap with their parents (-.81, p >.01) had an earlier onset of marijuana (-.33, p < .01) and cocaine use (r = -.24, p <.01). The less acculturated parents experienced more parenting stress (r = -.31, p = < .01). Attachment was positively associated with parental peer involvement (r = .24, p < .05) and inversely associated with parenting acculturative stress (r = -.24, p < .05). Attachment was also positively associated with marijuana (r = .39, p < .01) and cocaine use (r = .33, p < .01). Adolescent males reported being more attached to their mothers when compared to adolescent females (r = .22, p >.05), they also reported using marijuana more frequently than females (.21, p >.05). ^

Effects of adolescent depressive symptoms, pubertal development, and interpersonal relationship satisfaction on sexual risk behaviors in adolescent romantic couples

This study examined links between adolescent depressive symptoms, actual pubertal development, perceived pubertal timing relative to one’s peers, adolescent-maternal relationship satisfaction, and couple sexual behavior. Assessments of these variables were made on each couple member separately and then these variables were used to predict the sexual activity of the couple. Participants were drawn from the National Longitudinal Study of Adolescent Health (Add Health; Bearman et al., 1997; Udry, 1997) data set (N = 20,088; aged 12–18 years). Dimensions of adolescent romantic experiences using the total sample were described and then a subsample of romantically paired adolescents ( n = 1,252) were used to test a risk and protective model for predicting couple sexual behavior using the factors noted above. Relevant measures from the Wave 1 Add Health measures were used. Most of the items used in Add Health to assess romantic relationship experiences, adolescent depressive symptoms, pubertal development (actual and perceived), adolescent-maternal relationship satisfaction, and couple sexual behavior were drawn from other national surveys or from scales with well documented psychometric properties. Results demonstrated that romantic relationships are part of most adolescents’ lives and that adolescents’ experiences with these relationships differ markedly by age, sex, and race/ethnicity. Further, each respective couple member’s pubertal development, perceived pubertal timing, and maternal relationship satisfaction were useful in predicting sexual risk-promoting and risk-reducing behaviors in adolescent romantic couples. Findings in this dissertation represent an initial step toward evaluating explanatory models of adolescent couple sexual behavior.

Un -equal opportunity: Sex and school among first and second generation Mexican immigrant adolescent girls

The purpose of this dissertation was to determine the interactions of sexuality and education among low socioeconomic status first and second generation Mexican immigrant adolescent girls. Much of the existing research differentiates between immigrant generations with little examination of the differences within a particular immigrant generation. This study utilized qualitative methods to examine how various social institutions intersected to influence the young women's decisions about education and sexuality. The methodology included more than three years of participant observation in a South Florida high school and surrounding community; structured and unstructured interviews with twenty young women, their family members, school personnel, and community activists; and surveys conducted with the young women and their parent or guardian. ^ Moving beyond the limits of essentialist immigration theories, this project revealed within group (i.e. immigrant generation) complexities as well as between group similarities. The data included in this dissertation delineate how relationships of power and control permeated the lives of first and second generation Mexican immigrant adolescent girls. The lens of this dissertation is focused on the salient issues of sexuality and education: two dominant forces in many adolescent lives. ^ I found the young women represented a variety of positions on the academic orientation and sexuality continuums and engaged in activities that both reinforced and countered their stated positions on each of these issues. Specifically, first and second generation immigrants are often viewed as maintaining opposing viewpoints about both education and female sexuality however, for these young women the within group variation was larger than the between group variation. While all the young women in this study expressed a belief in the value of education, they engaged in activities that both fortified and contradicted that expressed position. Additionally, although acculturation can lead to increased sexual activity and decreased engagement with education, the first generation immigrant young women in this study became pregnant and/or withdrew from school in equal proportions to their second generation counterparts. In summary, structural forces combined, often inadvertently, and contributed to these young women's spiraling negative academic orientation and/or rational choice of motherhood. Finally, the findings are linked to policy implications. ^

Time trends and predictors of initiation for cigarette and waterpipe smoking among Jordanian school children: Irbid, 2008-2011

Smoking prevalence among adolescents in the Middle East remains high while rates of smoking have been declining among adolescents elsewhere. The aims of this research were to (1) describe patterns of cigarette and waterpipe (WP) smoking, (2) identify determinants of WP smoking initiation, and (3) identify determinants of cigarette smoking initiation in a cohort of Jordanian school children. ^ Among this cohort of school children in Irbid, Jordan, (age ≈ 12.6 at baseline) the first aim (N=1,781) described time trends in smoking behavior, age at initiation, and changes in frequency of smoking from 2008–2011 (grades 7–10). The second aim (N=1,243) identified determinants of WP initiation among WP-naïve students; and the third aim (N=1,454) identified determinants of cigarette smoking initiation among cigarette naïve participants. Determinants of initiation were assessed with generalized mixed models. All analyses were stratified by gender. ^ Baseline prevalence of current smoking (cigarettes or WP) for boys and girls was 22.9% and 8.7% respectively. Prevalence of ever- and current- any smoking, cigarette smoking, WP smoking, and dual cigarette/WP smoking was higher in boys than girls each year (p<0.001). At all time points, prevalence of WP smoking was higher than that of cigarette smoking (p<0.001) for both boys and girls. WP initiation was documented in 39% of boys and 28% of girls. Cigarette initiation was documented in 37% of boys and 24% of girls. Determinants of WP initiation included ever-cigarette smoking, low WP refusal self-efficacy, intention to smoke, and having teachers and friends who smoke WP. Determinants of cigarette smoking initiation included ever-WP smoking, low cigarette refusal self-efficacy, intention to start smoking cigarettes, and having friends and family who smoke.^ These studies reveal intensive smoking patterns at early ages among Jordanian youth in Irbid, characterized by a predominance of WP smoking. WP may be a vehicle for tobacco dependence and subsequent cigarette uptake. The sizeable incidence of WP and cigarette initiation among students of both sexes points to a need for culturally relevant smoking prevention interventions. Gender-specific factors, refusal skills, and smoking cessation of both WP and cigarettes for youth and their parents/teachers would be important components of such initiatives. ^

The relationship between participation in unethical behaviors during the nursing student experience and participation in unethical behaviors as a registered nurse

The effect of unethical behaviors in health care settings is an important issue in the safe care of clients and has been a concern of the nursing profession for some time. The purpose of this study was to examine the relationship between use of unethical behaviors in the nursing student experience and the use of unethical behaviors in the workplace as a registered nurse. In addition, the relationship between the severity of unethical behaviors utilized in the classroom, clinical setting and those in the workplace was examined. To insure greater honesty in self-report, only a limited umber of demographic variables were requested from participants. During the summer of 1997, a 56 item questionnaire was distributed to registered nurses enrolled in either undergraduate or graduate courses in a public or private institution. The participants were asked to self-report their own use of unethical behaviors as well as their peers use of unethical behaviors. In order to assign a severity score for each item, nursing school faculty were asked to rate severity of unethical behaviors which could be used during the nursing student experience and nursing administrators were asked to rate unethical behaviors which could be used in the workplace. A significant positive relationship was found between individuals' use of unethical behaviors during nursing school and those used in the workplace r = .630. A significant positive relationship was found between the severity of unethical behaviors used in the nursing student experience and the severity of unethical behaviors used in the workplace r = .637. No relationship was found between years of practice, type of initial nursing education and whether or not the participant was raised inside or outside the United States and the use of unethical behaviors.

The Effects of Age, Ethnicity, Sexual Dysfunction, Urinary Incontinence, Masculinity, and Relationship with the Partner on the Quality of Life of Men with Prostate Cancer

Prostate cancer, the leading cause of cancer in men, has positive survival rates and constitutes a challenge to men with its side effects. Studies have addressed the bivaritate relationships between prostate cancer treatment side effects masculinity, partner relationship, and quality of life (QOL). However, few studies have highlighted the relationships among prostate cancer treatment side effects (i.e., sexual dysfunction, urinary incontinence), masculinity, and relationship with the partner together on QOL in men. Most studies were conducted with predominately Caucasian sample of men. Miami is a unique multiethnic setting that hosts Cuban, Columbian, Venezuelan, Haitian, other Latin American and Caribbean communities that were not represented in previous literature. The purpose of this study was to examine relative contributions of age, ethnicity, sexual dysfunction, urinary incontinence, masculinity, and perception of the relationship with the partner on the quality of life in men diagnosed with prostate cancer. Data were collected using self administered questionnaires measuring demographic variables, sexual and urinary functioning (UCLA PCI), masculinity (CMNI), partner relationship (DAS), and QOL (SF-36). A total of 117 partnered heterosexual men diagnosed with prostate cancer were recruited from four urology clinics in Miami, Florida. Men were 67.47 (SD = 8.42) years old and identified themselves to be of Hispanic origin (54.3 %, n = 63). Findings demonstrated that there was a significant moderate negative relationship between urinary and sexual functioning of men. There was a significant strong negative association between men’s perceived relationship with partner and masculinity. There was a weak negative relationship between the partner relationship and QOL. Hierarchal multiple regression showed that the partner relationship (β = -.25, t (91) = -2.28, p = .03) significantly contributed overall to QOL. These findings highlight the importance of the relationship satisfaction in the QOL of men with prostate cancer. Nursing interventions to enhance QOL for these men should consider strengthening the relationship and involving the female partner as an active participant.

Variables motivating parents to choose a specific type of private school

The purpose of this study was to investigate the reasons associated with parents' choices of specific types of private schools. The researcher hoped to determine if there were any significant differences in the reasons parents reported for enrolling their child in a specific private school. Studies in the past have explored why parents choose private schools. This study focused on why parents chose a specific type of private school, what were the variables involved, and were there any significant differences in the motivation of parents with children enrolled in different types of private schools.^ The study gathered data using a survey instrument which centered on 14 variables generally associated with the choice of private schools. The survey asked parents to rate the variables using a Likert type scale. The Likert rating was used because it does not require respondents to choose between variables. The general areas of emphasis were (a) academics, (b) religion and values/morals, (c) nurturing educational environment, and (d) proximity and convenience of the school. The survey also gather qualitative data in the form of comments volunteered by over a third of the respondents.^ The survey was mailed to 560 randomly selected families from 30 private high schools in a 50 mile radius of Miami, Florida. The 10 high schools, represented five types of private schools, Roman Catholic, Episcopal, Independent, Jewish, and Fundamentalist Christian. After four mailings a total of 401 surveys were returned for a rate 72%.^ Significant differences appeared as the data was analyzed using ANOVA and Tukey's HSD pairwise analysis. The variables showing significant differences between types of schools were (a) quality of instruction, (b) commitment of teachers, (c) emphasis on religion, (d) small class size, (e) well-defined academic goals, (f) proximity of the school's location, (g) preparation for desired secondary schools/colleges, and (h) convenience of school's operating schedule.^ Parents appeared to have specific reasons for choosing a particular private school. They appeared to look for a school that would satisfy the special needs of their child and would be compatible with their own values, morals, and personal philosophy. ^

An organizational learning approach to expatriate cross-cultural adjustment, organizational commitment, and job satisfaction

The purpose of this study was to investigate the relationship between organizational learning and expatriation in overseas subsidiaries as well as in organizations as a whole. In doing so, two issues were addressed--(i) the use of expatriation as firms internationalize, and (ii) the significance of various factors to expatriate success as firms gain international experience. The sample of companies for this study was drawn from U.S. Fortune 500 multinational corporations (MNCs) in two sets of related industries--computers/electronics and petroleum/chemicals. Based on the learning that takes place within organizations as they increase their involvement overseas, a positive relationship was expected between international experience and expatriation when internationalization was low, and a negative relationship was expected when internationalization was high. Results indicate a significant positive relationship between country experience and the proportion of expatriates in that subsidiary when subsidiaries were relatively young, and a negative relationship, however not significant, for more mature subsidiaries. The relationship between overall firm degree of internationalization (DOI) and the proportion of expatriates in the firm as a whole was negative regardless of stage of internationalization, but this relationship was significant only for highly internationalized firms. It was further suspected that individual, environmental, and family-related characteristics would have a significant effect on the success of expatriates whose firms were low on internationalization, and that organizational characteristics would play a significant role in highly internationalized firms. Support for these hypotheses was received with respect to certain outcomes and some determinants of success. The preponderance of support was found for those addressing the effects of both environmental and family-related characteristics on the cross-cultural adjustment of expatriates in firms with little international experience. Considerable support was also found for those hypotheses addressing the impact of organizational characteristics on the job satisfaction levels of expatriates assigned to mature subsidiaries. The relevant literatures on organizational learning and expatriation are reviewed, and a model is developed underlying the logic of the hypotheses. Research methods are then described in full detail, results are reported, and implications for theory and for management are discussed. ^

Selecting a college or university: A study of students and their parents

This case study investigated the decision-making process of high-achieving high school students and their parents in selecting a college or university. The conceptual framework that guided this study included theoretical and empirical research framed around a three-phase model of college choice. Parental influence dominated the first phase of this model. The search phase, which was the second and the most crucial one, included financial considerations related to this decision, admissions considerations during the search phase, the psychology of decision making, and advertising strategies for teenagers. Once students completed the search phase they developed expectations of the institutions they considered prior to making the final decision. The study employed qualitative methods using individual interviews with students and their parents. ^ Six high-achieving high school seniors from a South Florida high school and their parents were selected to participate in this study. Of these students, four were female and two were male. Participants were individually interviewed on two separate occasions over a three-month period. Students and their parents were interviewed separately, with one exception, during the first set of interviews and together during the second. The data obtained from these interviews were transcribed and these transcripts were coded, categorized, analyzed, and sorted into major themes and submitted to interpretive analysis. ^ In-depth descriptions of participants' experiences during the decision-making process are described in the study. Financial factors—which included the cost of college, the socio-economic status of the family, and scholarship possibilities—drove the selection process for these students and their parents, most of whom reported their family incomes between the lower-middle to upper-middle class range. All of these students took advantage of the Bright Futures Scholarship Program, other scholarship opportunities, and the lower tuition costs of in-state public institutions. The effectiveness of recruitment techniques, such as brochures, campus visits, the development of college Web sites, and the overall impact of Internet resources, was assessed by the researcher. ^ As these students had progressed through the search phase, they developed perceptions of potential institutions as they were assisted by those around them. The value of familiarity with institutions and the use of heuristics were quite evident in the final analysis of this study, based on what the students communicated about how their knowledge of and comfort in these institutions affected their decisions. Parental influence played an important role in the selection process for the students in this study as the parents clearly directed the process, by the constant advice they gave their children and by the financial limitations they communicated to them. ^

Longitudinal effects of family factors on alcohol use and alcohol-related problems among males from pre-adolescence to adulthood

The goal of this study was to examine the longitudinal effects of five family factors on alcohol use among adolescent males. The family factors included familism (family pride, loyalty, and cohesion), parent derogation (being put down by parents), parent/child communication, family alcohol problems and family drug problems. The study focused on the effects of the family factors reported by a sample of 451 White-non-Hispanic and African American males during early and mid-adolescence on (1) the intensity of alcohol use in mid-adolescence, and (2) the number of problems associated with alcohol use during the transition to young adulthood. The study also explored racial differences in the effects of the family factors. The data for this study were derived from a two-phase longitudinal epidemiologic cohort study of male and female adolescents enrolled in middle schools in Miami, FL. Data were collected at four points between 1990 and 2001. Linear and logistical regressions were used to analyze the effects of the family variables on the dependent variables. ^ The results of the analyses indicated that all of the family variables except family drug problems were statistically significant predictors of the level of alcohol use and alcohol-related problems. Familism had a moderate influence on both of the dependent variables at all data points, while parent derogation, parent/child communication and family alcohol problems were weak predictors. While the family factors varied by race, their impact on the dependent variables did not vary substantially. ^ This study had methodological shortcomings related to measurement and design that may have contributed to the weak influence of the variables. Future studies should explore possible mediating effects of these variables, and should employ more sensitive measures that are culturally appropriate. The results suggest that, since early family factors have long-term effects on children's substance-using behaviors, the family environment should be addressed in prevention and intervention efforts. ^

The development and testing of a multivariate model of differentiation of self among Hispanics

Individuals of Hispanic origin are the nation's largest minority (13.4%). Therefore, there is a need for models and methods that are culturally appropriate for mental health research with this burgeoning population. This is an especially salient issue when applying family systems theories to Hispanics, who are heavily influenced by family bonds in a way that appears to be different from the more individualistic non-Hispanic White culture. Bowen asserted that his family systems' concept of differentiation of self, which values both individuality and connectedness, could be universally applied. However, there is a paucity of research systematically assessing the applicability of the differentiation of self construct in ethnic minority populations. ^ This dissertation tested a multivariate model of differentiation of self with a Hispanic sample. The manner in which the construct of differentiation of self was being assessed and how accurately it represented this particular ethnic minority group's functioning was examined. Additionally, the proposed model included key contextual variables (e.g., anxiety, relationship satisfaction, attachment and acculturation related variables) which have been shown to be related to the differentiation process. ^ The results from structural equation modeling (SEM) analyses confirmed and extended previous research, and helped to illuminate the complex relationships between key factors that need to be considered in order to better understand individuals with this cultural background. Overall results indicated that the manner in which Hispanic individuals negotiate the boundaries of interconnectedness with a sense of individual expression appears to be different from their non-Hispanic White counterparts in some important ways. These findings illustrate the need for research on Hispanic individuals that provides a more culturally sensitive framework. ^

Family and group cognitive behavior therapy: Evaluation of treatment outcome and treatment specificity

This dissertation examined the efficacy of family cognitive behavior treatment (FCBT) and group cognitive behavior treatment (GBCT) for reducing anxiety disorders in children and adolescents using several approaches: clinical significant change, equivalence testing, and analyses of variance. It also examined treatment specificity in terms of targeting family/parents (in FCBT) and peers/group (in GCBT) contextual variables using two main approaches: analyses of variance and structural equation modeling (SEM). The sample consisted of 143 children and their parents who presented to the Child Anxiety and Phobia Program housed within the Child and Family Psychosocial Research Center at Florida International University. Diagnostic interviews and questionnaires were administered to assess youth anxiety. Questionnaires were administered to assess child and parent views of family/parents and peers/group contextual variables. In terms of clinical significant change, results indicated that 84.6% of youth in FCBT and 71.2% of youth in GBCT no longer met diagnostic criteria for their primary/targeted anxiety disorder. In addition, results from analyses of variance indicated that FCBT and GCBT were both efficacious in reducing anxiety disorders in youth across both child and parent ratings. Results using both analyses of variance and structural equation modeling also indicated that there was no meaningful treatment specificity between FCBT and GCBT in terms of either family/parents or peers/group contextual variables. That is, child social skills improved in GCBT in which these skills were targeted and in FCBT in which these skills were not targeted; parenting skills improved in FCBT in which these skills were targeted and in GCBT in which these skills were not targeted. Clinical implications and future research recommendations are discussed.