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What Do We (White Counsellors) Do About Whiteness?
No full textWhile there is considerable encouragement for counsellors to uphold social justice values in the course of therapy, there is little in the way of guidance when it comes to how white counsellors might address racial bias, thoughts, and behaviours with their white clients. This project reviews the state of research on whiteness from a psychological perspective, including in relation to counselling and counsellor education. There continues to be limited and reticent uptake on these issues both in the classroom and in the therapy room, despite plentiful evidence that prejudice not only hurts those being oppressed but also harms those active or implicit in oppression. There have been significant offerings from Black, Indigenous, and Person of Colour (BIPOC) scholars that provide grounding in how this work can go forward in order to address ongoing racial violence and injustice. The potential for making inroads in the therapeutic relationship to support white people to come to terms with their racial identity is compelling and illuminating models from several BIPOC experts are shared and co-mingled as a potential path for white counsellors to follow forward
Reframing the Self: Exploring How Late-Diagnosed ADHD Adults Make Meaning from Psychedelic Experiences
No full textAdults diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) later in life often undergo significant identity shifts as they reinterpret their life histories through a new diagnostic perspective. Emerging evidence suggests that psychedelic experiences may provide unique opportunities for meaning-making, emotional regulation, and self-compassion, yet little is known about how these experiences connect with a late ADHD diagnosis. This research will employ a qualitative narrative inquiry methodology to explore how adults diagnosed late with ADHD make meaning from psychedelic experiences. Semi-structured interviews will invite participants to share life stories that incorporate their ADHD diagnosis, psychedelic experiences, and the narratives they have built about themselves. Analysis will follow a restorying process to identify personal and shared themes, such as identity reconstruction, stigma reduction, and increased agency. The findings are expected to contribute to the interdisciplinary literature, linking neurodiversity studies, psychedelic science, and narrative theory, with potential implications for clinical practice, particularly in supporting integration work with neurodivergent clients. By focusing on lived experience, the goal of this project is to expand understanding of ADHD beyond deficit-based frameworks and highlight the therapeutic potential of narrative as both a research method and a process for integrating transformative experiences
Balanced Scorecard Awareness and the Factors of Adoption for Strategic Performance Reporting Systems in a Non-Profit Healthcare Organization: A Qualitative Study
No full textThis qualitative interpretative descriptive study addressed the deficient adoption and integration of standardized performance reporting frameworks and systems, such as the Balanced Scorecard (BSC), within non-profit healthcare organizations. The purpose was to describe the levels of BSC awareness and comprehension, alongside the adoption criteria for such systems, among leadership and management at a multistate non-profit U.S. healthcare system. The research was guided by an integrated conceptual framework combining diffusion of innovations theory, institutional theory, and resource-based view theory. A qualitative interpretative descriptive methodology was employed, using a multiple data sources design to collect data from 36 healthcare leaders and managers via semi-structured interviews and open-ended questionnaires. Thematic analysis of the data revealed a significant gap in strategic management knowledge, with 58% of participants reporting unfamiliarity with the BSC framework. This lack of awareness was contrasted by the finding that 86% of participants had extensive experience with various alternative, often fragmented, strategic tools. BSC comprehension was highly stratified by organizational role; 75% of upper management demonstrated understanding, compared to only 7% of frontline managers, indicating a severe disconnect in knowledge transfer. Key adoption criteria identified by participants included user-friendliness, demonstrated value, alignment with organizational goals, and comprehensive training. The most significant barriers to implementation were resistance to change, insufficient time and resources, and the prevalence of hierarchical, top-down decision-making processes that exclude implementers. The study concludes that the underutilization of comprehensive strategic systems in the non-profit healthcare sector stems not from resistance to measurement itself, but from critical challenges in organizational knowledge dissemination, a lack of inclusive engagement in decision-making, and inadequate implementation support. This research offers actionable recommendations for practice focused on education, leveraging existing tool usage, and fostering inclusive governance to improve the adoption and effective use of strategic performance reporting systems in healthcare
Predicting Risk Adjustable Chronic Kidney Disease in Medicare Advantage Members
No full textChronic kidney disease (CKD) is a highly prevalent condition that contributes substantially to patient morbidity, healthcare utilization, and financial risk in value-based reimbursement models. In Medicare Advantage (MA), accurate documentation of CKD is essential both for guiding appropriate clinical management and for ensuring risk-adjusted payments that reflect population health needs. Yet CKD is often under-documented, leading to gaps in care and misaligned reimbursement. This study investigated whether predictive models trained on routinely collected administrative claims and laboratory data could identify likely cases of undocumented but risk-adjustable CKD. A quantitative, non-experimental design was employed using a dataset of MA beneficiaries from 2021 to 2023. Two modeling approaches were developed and compared: multivariate logistic regression and Extreme Gradient Boosting (XGBoost). Data preprocessing included feature selection through Lasso, Ridge, and Elastic Net regularization. Model performance was assessed on a temporally separated 2023 holdout sample to simulate real-world deployment. Evaluation metrics included accuracy, precision, recall, F1 score, and area under the receiver operating characteristic curve (ROC AUC). SHAP (SHapley Additive exPlanations) values were used to interpret model predictions. Both models achieved strong predictive validity. Logistic regression yielded an accuracy of 0.896, precision of 0.855, recall of 0.771, F1 score of 0.811, and ROC AUC of 0.952. XGBoost slightly outperformed it, with accuracy of 0.900, precision of 0.842, recall of 0.806, F1 score of 0.824, and ROC AUC of 0.955. SHAP analysis confirmed that clinically meaningful predictors—particularly estimated glomerular filtration rate (eGFR), creatinine, age, and diabetes—were the dominant drivers of prediction, consistent with established knowledge of CKD progression. The findings demonstrate that interpretable predictive models can effectively surface likely undocumented CKD in MA populations, offering a scalable pathway for improving documentation accuracy, enhancing reimbursement integrity, and supporting earlier clinical intervention. This work contributes to the literature by framing predictive modeling not only as a tool for disease prediction, but also as a mechanism for addressing documentation gaps—an often-overlooked dimension of healthcare quality and equity
Evaluating Machine Learning Predictions for Budget Overruns in U.S. Mass Transit Projects: A Correlational Study
Get PDFThis study examined supervised and unsupervised machine learning methods to determine if statistical correlations could be established to validate mass transit project budgets. Capital budget forecasts for new mass transit projects in the United States have consistently been underestimated. These budget overruns resulted in funding allocation challenges for the Federal Transit Administration and obligated local transit authorities to secure additional financing. Developing accurate budget estimates is a significant challenge for project managers, particularly given the influence of cognitive biases such as optimism bias. Data from 108 projects were collected from publicly available U.S. government documents to serve as input for the machine learning models. Using a neural network and k-means clustering in SPSS software, the study created models that explained 94.6% (R2 = 0.946) and 88.2% (R2 = 0.882) of the variance in project budget outcomes. The findings highlighted the importance for organizations to apply AI-based machine learning technology to validate budget forecasts. This research built on prior research by applying machine learning methods that had been explored in other project contexts and problem domains. By employing SPSS software with configurable settings, rather than relying on customized Python code, the study enhanced the transparency and accessibility of machine learning regression analysis. The results demonstrated that a budget validation process could be developed using reproducible, data-driven predictive models that incorporate both project-specific and environmental variables
Getting Out of the Office: Building Deeper Connections Through Alternative Counselling Approaches
No full textThis capstone explores how alternative counselling approaches, specifically those that move beyond the traditional office setting, can support more accessible and relational services for adolescents in schools. The starting point for this inquiry is the recognition that power dynamics, physical space, and stigma can influence whether or not students feel comfortable seeking support. In response, this paper looks at three areas of practice: movement-based counselling, nature-based therapy, and experiential approaches. This review highlights how each of these strategies can strengthen the therapeutic alliance by reducing formality, supporting emotional regulation, and building connection through experience. Attention is also given to the importance of accessibility, including considerations for disabled and neurodiverse students, as well as the longstanding connection between land and well-being in Indigenous communities. This paper invites school counsellors to think broadly about the possibilities of what counselling can look like and the impact of small shifts in space, movement, and approach might help students feel more supported. Recommendations include integrating flexible environments, adapting relational approaches drawn from experiential work, and advocating for school policies that allow for more creativity in practice
Coming to Terms: Clarifying Pedagogical Language for Teaching and Research
No full textThe relationship between language and learning has always been as complex as it is fascinating, a fluid interplay of words that convey and define the very essence of pedagogy. It is within this intricate landscape that my journey as a writer and an educator began, and it is this journey that has shaped the creation of Coming to Terms: Clarifying Pedagogical Language for Teaching and Research. In this book, I delve into the etymology, historical usage, and present-day application of selected pairs of specific words that are often mistakenly viewed as synonymous. My hope is that through careful examination, readers will develop a clearer understanding of how language evolves and impacts the educational discourse, leading to the correct usage of terms vital to both teaching and research
Losing Your Religion: An Exploration of the Psychosocial Supports Needed for Clients Leaving High-Control Religions
No full textHigh-control religions often operate within patriarchal and colonial structures, promote rigid gender roles, and involve emotional and spiritual manipulation. Their biblical literalism reinforces heteronormative ideals and traditional family models. Ex-members frequently experience grief, trauma, identity disruption, and social exclusion. This capstone examines clinical strategies to support individuals transitioning into secular communities. Chapter 1 outlines key definitions, the theoretical framework, and the issue’s relevance to counselling. Chapter 2 presents the research analysis across six areas: grief, belief deconstruction, personal development, religious trauma, marginalized group experiences, and reintegration. Notably, gaps remain in research on the diverse impacts for People of Colour, Women of Colour, and across cultural and societal contexts, especially between those born into versus those who converted to high-control religions. Limited sample sizes in some studies highlight the need for further research. Grounded in humanistic and existential frameworks, this work advocates for trauma-informed, client-centered care that fosters autonomy, identity reconstruction, and resilience. Chapter 3 offers clinical recommendations for supporting clients through the process of leaving authoritarian faith systems
Ambiguous Loss in Familial Caregivers: Exploring Meaning Making to Increase Resiliency
No full textIn Western society there has been a socially acceptable grief process that follows a death-related loss. This capstone reviewed non-death loss in relation to familial caregivers and looked at ways counsellors can support familial caregivers experiencing ambiguous loss. Ambiguous loss has been observed in response to a loved one with a diagnosis where they are still physically present but face psychological and mental complexities impacting the relationship dynamic for the caregiver and future the caregiver had imagined and expected. The grief appears as a result of emotionally losing parts of their loved one, which has not been commonly recognized or acknowledged as loss within our society. The research from these findings has pointed to the use of meaning-making to support family members experiencing a non-death loss. Findings have shown that meaning-making can be developed through support groups utilising interventions such as re-storying, creative writing, and a resilience-oriented approach to increase resiliency and support the grief process of an ambiguous loss. This capstone has studied the many ways in which counsellors can work with ambiguous loss to better recognize and acknowledge types of living loss and the grief that follows. This awareness can increase responses counsellors have and reduce the isolation and shame that those experiencing a living loss often face through both identifying and validating the loss and supporting the client to find meaning in their experience
Borderline Personality Disorder - What Have We Learned and What's Next?
No full textThe goal of this Capstone is to provide a brief history of borderline personality disorder beginning with its inclusion in the DSM-III in 1980. It is organized into decades exploring the research based on changes between 1990–1999, 2000-2009, 2010–2019, and finally 2020 to present. BPD will be explored through the themes of DSM criteria, treatment options, common comorbidly diagnosed disorders, and stigma. The data is interpreted through social learning and feminist theory to capture the impact of both socialization and gender dynamics that influence the conception and treatment of BPD. The themes will explore current and past research with a focus on the gaps in the research to direct future focus. The Capstone concludes with implications for future research and the need to further explore the impact and treatment of trauma along with behaviour in BPD clients