Doctor of Social Work Capstone Reports

Permanent URI for this collection

https://ir.ua.edu/handle/123456789/8357

Browse

Now showing 1 - 20 of 58

Prevalance of Adverse Childhood Experiences in Veterans Seeking PTSD Treatment at a Veteran's Affairs Medical Center
(2025) Anderson, Matthew G.; Alameda-Lawson, Tania; Nosen, Elizabeth
Background: In the past thirty years, public health research has demonstrated a dose-response relationship between Adverse Childhood Experiences (ACEs) and poor health outcomes across the lifespan. In 2014, researchers observed U.S. men who had any history of military service had a higher-level frequency of all 11 adverse childhood experiences compared to U.S. men without a history of military service (Blosnich, et al., 2014). Objective: This study examines the prevalence of ACEs and its correlation with Post Traumatic Stress Disorder (PTSD) symptoms in a sample population of 92 Veterans referred to a PTSD clinical team between 2022-2024. Methods: This study used retrospective data from medical records of 92 Veterans referred to a PTSD clinical team from 2022-2024 at a Veteran’s Administration Medical Center (VAMC) in the state of Mississippi. Data were collected via the traditional 10-item ACE Questionnaire (Felliti et al., 1998), the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), and the PTSD Checklist for DSM-5 (PAC-5) (Weathers, et al., 2013). Data were analyzed using descriptive statistics and correlational approaches. Results: The study included a total of 92 veterans, 76 of whom self-identified as male and 16 as female. Of these 92 veterans, 52 self-identified as Black, 37 as Caucasian, and 3 had no race recorded in the medical record. Overall, Veterans reported an average of 3 adverse childhood experiences (ACEs), with 76.1% reporting one ACE, 57.6% reporting two ACEs. These trends are notably higher compared to the 50% and 25%, respectively, found in the original sample examined in the ACE study conducted by Felitti, et al. (1998). Conclusions: This study did fine higher frequency of ACE for Veterans included in this sample population, compared to the original ACE study by Felitti, et al. (1998), or among other samples of Veterans (Blosnich, et al., 2014). Unlike others in comparable studies, Woodridge, et al., 2020, this study did not find any significant correlation between the number of ACEs reported by this sample and the reported PTSD symptoms when examining measurements obtained during intake. This paper discusses the possible need to expand the consideration of childhood exposure to community-based adversity as having a similar influence on long-term health outcomes like those factors found in the original ACE study by Felittii, et al. (1998). In 2015, researchers found when studying population samples, in Philadelphia, Pennsylvania, suggest childhood environmental and community experiences beyond the original ACE questionnaires may need to be considered by as significant regarding their influence on healthcare outcomes across the lifespan (Cronholm, et al., 2015). This study was approved by the Institutional Review Board at the G.V. Sonny Montgomery Veteran’s Affairs Medical Center, in Jackson, Mississippi (1782395-1). This study was also approved by the University of Alabama’s Institutional Review Board (24-05-7632).
Supporting Clients Through Loss: Exploring Best Practices of Accredited Assistance Dog Organizations
(2025) DeSantis, Dena; Cheatham, Leah; Hoy-Gerlach, Janet
"Introduction/Background: This study describes the practices in place at United States- based assistance dog organizations accredited by Assistance Dogs International (ADI) (N=21) to assist and support clients who have experienced the loss of their assistance dog either through death or retirement. Methods: The target population was identified through the ADI Membership List. Each organization received an email inviting a representative to participate in a semi-structured interview. The interview protocol was developed based on existing literature examining the impact of a partner’s relationship ending with their assistance dog. In addition, input was solicited from professionals affiliated with the Association of Pet Loss and Bereavement, assistance dog advocacy and education, and individual assistance dog partners who had experienced such a loss. Using thematic analysis, researchers coded the interviews to identify recurrent themes and practices. Results: The findings highlight the importance of the partner’s relationship with the assistance dog organization as a primary protective factor in mitigating a loss that is frequently not well understood by others. This lack of understanding outside the assistance dog community contributes to the partners’ experience of disenfranchised grief about the end of their relationship with their assistance dog and underscores the need for assistance dog organizations to implement strategies to help clients through the grieving process. Discussion: The practices identified by the assistance dog organizations interviewed for this study indicate assisting clients to maintain a meaningful connection with the assistance dog after its passing or retirement can bring comfort, support emotional healing, and provide a sense of closure, as the dog played an important role in the client's life and daily functioning. By acknowledging and nurturing this ongoing bond, clients can process their grief in a healthier way and feel more supported in adjusting to the loss."
Establishing a Foundation of Holistic Wellness: A Feasibility of Self-Care Practices and Self-Compassion Among BSW Field Students
(2025) Bohner, Rebecca; Cheatham, Leah; Watson, Cayce
Field education serves as the place where social work (SW) students are socialized to practice through application of classroom knowledge to real-life practice and begin development of their professional SW self. Due to the holistic, empathic, relational care required of social workers for effective practice, there is a cost to caring that places them at risk for helper distress, and can lead to health challenges, negatively impact client service delivery, and decrease sustainability in the SW profession. Despite the CSWE mandate that SW programs prepare students for safe, competent, and ethical SW practice, research reflects noncompliance by SW programs due to their lack of adequate self-care (SC) training that assists with development of essential skills. With holistic SC identified as a protective factor that mitigates helper distress and enhances student wellness, this pre-experimental research study, using the Health Belief Model as its foundation, evaluated the feasibility of a prevention-based curriculum for BSW field students. Adapted from two prior research studies, this 8-week online SC training utilized the CPIES and iM-PAACT frameworks to craft assignments that build a foundational SC competency. Using a pre- and post-test survey design, an availability sample of 13 BSW field students was evaluated for changes in frequency of SC practices and levels of self-compassion. Statistical analysis of the data, using SPSS, found that BSW field students who engaged in the SC training exhibited a statistically significant increase in frequency of SC practices and levels of self-compassion. Despite limitations to generalizability, these findings affirm past research findings from similar studies, suggesting value of SC training for SW students. Implications for SW education include implementation of prevention-based curriculum, nurturing of a SC informed SW program, and use of a shared wellness approach with practicum agencies to support student well-being.
Cervical Cancer Elimination: Finding the Right Megaphone
(2025) Schad, Vivian; Cheatham, Leah; McKinney, Bob
"Introduction: Cervical cancer is preventable! The world can eliminate this devastating disease through increased vaccination and screening. Still, almost 14,000 people in the United States will receive a diagnosis of cervical cancer this year and over 4,000 will die from this preventable disease, disproportionately from underserved communities. Even with the need established and the elimination tools available, the healthcare community cannot find the right megaphone to effectively spread the word that we can abolish cervical cancer. Discovering the most successful approach to share this incredible message is the basis for the research question: How can healthcare educators most effectively communicate the message of cervical cancer elimination? The best way to share information with diverse populations is to have the culturally competent and relevant messages come from people who are most respected within their community. The unique voice of cervical cancer survivors can help healthcare educators build and deliver a trustworthy message. Methods: Designed through a Community Based Participatory Research lens, the researcher conducted one-on-one semi-structured interviews with ten cervical cancer survivors in north Alabama. The Institutional Review Board-approved interviews were consented, audio recorded, transcribed verbatim and thematically analyzed. The interview data will inform outreach education proposals. Results: The survivors shared their thoughts on screening, HPV and vaccination, gave outreach suggestions, and recounted their lived cancer journey. The findings led to three outreach strategies. First, ensure outreach is trauma-informed. Second, design sensitive, clear, detailed and congruent outreach. Lastly, use varied routes for education to include social media, influencers and survivors to reach all generations. Discussion: Communities can implement this study’s strategies for robust and effective outreach. Even with the small sample size, this new knowledge builds on previous survivor and outreach literature and puts the right megaphone within reach. We can end cervical cancer. Let’s do this!"
A Systematic Review of Clinical Case Formulation Methods and Pedagogies
(2024) Pearce, Jason; Cheatham, Leah; McKinney, Bob
This systematic review aimed to improve behavioral health clinician training by examining different case formulation methods and pedagogical approaches. The review included case formulation studies utilized by psychologists, psychiatrists, social workers, and trainees, looking at both the specific methods taught and the pedagogical approaches used. Fifty-one studies met the inclusion criteria, encompassing diverse methodologies and geographical locations. The review found no single “best” method for case conceptualization; however, the studies highlighted the experiential learning approaches in training. Significant gaps remain in understanding the direct link between the implementation of specific methods and improved clinical outcomes. Further research is needed to clarify optimal case formulation approaches, develop comprehensive training programs addressing various influencing factors (e.g., experience, theoretical orientation, and uncertainty tolerance), and create robust assessment tools. These findings have implications for improving clinical training, standardizing practice, and, ultimately, enhancing the quality of mental health care.
Combatting Ageism: Evaluating the Impact of an Age-Positive Training in Healthcare
(2025) Lester, Barbara; Ruggiano, Nicole; Andersen, Troy
Introduction/Background: Ageism, defined as stereotypes, prejudice, and discrimination based on age, is a pervasive issue with detrimental effects on the wellbeing of older adults. Ageist attitudes among healthcare workers can lead to both over- and under-treatment of older adults. This project assessed whether an evidence-informed training program about aging and ageism could improve attitudes towards older adults among healthcare employees. Methods: A quasi-experimental pretest-posttest design was utilized to evaluate the impact of a one-hour workshop adapted from the “Ending Ageism Together” training developed by Changing the Narrative. A total of 167 employees from a large healthcare system in the intermountain west participated in the training. Among them, 126 participants completing the pretest, 107 completing the first posttest, and 64 completing the second posttest 30 days later. The Expectations Regarding Aging (ERA-12) scale and two knowledge-based questions were used to assess changes in ageist beliefs and knowledge. Results: Significant improvements were found with the total score on the ERA-12 and on the three ERA-12 scales (physical health, mental health, and cognitive function), with sustained improvements 30 days after the training. Participants also reported improved knowledge about aging, with many identifying changes in their attitudes and behaviors regarding ageism. Qualitative feedback was overwhelmingly positive, with participants acknowledging increased awareness of their own biases and commitments to reducing ageist behaviors. Discussion: The findings suggest that targeted educational interventions can significantly reduce ageism among healthcare employees, contributing to better care for older adults. This training model provides a promising framework for addressing ageism in healthcare, although future research with more diverse samples and control groups is needed to strengthen the evidence. Policymakers and healthcare organizations should consider mandating similar ageism reduction training to foster an age-inclusive workplace and enhance patient outcomes. Limitations include the lack of a control group and the overrepresentation of older and female participants, which may limit generalizability.
Community-Based Approaches to Sleep Disturbances in Dementia: An Updated Review of Non-Pharmacological Interventions
(2025) Childers, Patton; Ruggiano, Nicole; Brown, Ellen Leslie
Introduction/Background: Sleep disturbances create adverse cognitive and health outcomes for People LivingPeople Living with Dementia (PLwD). Approximately 19% of PLwDs living in the community have sleep disturbances, but no systematic review focuses on community-developed interventions. This systematic review builds on current research by identifying and evaluating non-pharmacological interventions (NPI) to address sleep disturbance for PLwD in the community setting. Methods: We updated the current research by building on a Cochrane Systematic Review by Wilfling et al. (2022). This review followed the same search strategy as Wilfling et al. (2022) but focused on high-quality community-based NPIs for PLwD experiencing sleep disturbances. We searched PsychINFO, CINAHL, Medline, Embase (OVIDSP), Web of Science, Central (Cochrane Library), ClinicalTrials.gov, and ICTRP databases from September 2024 through October 2024 for Randomized Control Trial studies published after January 2022. Included studies were selected by the team after a review of titles, abstracts, and full article reviews. Results: Six studies met the inclusion criteria. Four studies were extracted from Wilfling et al. (2022), and two studies were identified in the search. Common interventions were Photo/Light-Based, Activity-Based, or Multi-component Based. Photo/Light-based and Activity-Based approaches had mixed outcomes, while multi-component approaches had positive outcomes. Discussion: This review found that multi-component interventions, particularly NITE-AD and DREAMS START, as promising interventions to help treat sleep disturbances among people living with dementia (PLwD) in the community, likely due to their dyadic approach.
A Conceptual Exploration: Preparing Social Work Students For Trauma Exposure
(2025) Vanessa L. Jones; Jackson, Sebrena; Brown, Leslie
Social workers engage with and provide services to a multitude of populations in various settings. Many of these systems and settings were created because of or in response to trauma, oppression, poverty, and/or violence resulting in these issues becoming imbedded or intertwined into the foundation or nature of the settings. This results in social workers being exposed to trauma via the people they work with and/or the environment. Master of Social Work (MSW) programs prepare social workers to provide trauma-informed care, but do not prepare them for the trauma that they will be exposed to or potentially experience directly. Over time this can result in the development of compassion fatigue, moral injury or burnout. This writer offers both a framework for examining and understanding the impact of this issue, as well as a proposed training approach for MSW students. The objective of the training approach is to better prepare MSW students for trauma exposure in the workplace with a goal of social workers having a better understanding of how they are likely to be impacted by their work and how to counter the negative impact.
Exploring the Impact of Telehealth on Black Women Controlling Hypertension
(2024) Reese, Patrice J.; Wilkes, Sherron; Curtis, Davis
Black women are struggling to properly control their hypertension. Black women continue to be disproportionately affected by hypertension due to historically systemic and structural barriers. The Social Determinants of Health related to race, gender, and access are major contributing factors. The Black woman’s plight is explained through the concepts of Intersectionality Theory and the Superwoman Schema. With interventions varying on controlling hypertension, research agrees that adherence to preventative and follow-up care is essential to improving blood pressure results. During COVID-19, there was a resurgence in the use of telehealth to improve health outcomes without the need of in-person visits. Through the evaluation of literature and content analysis, this author utilized this information to encourage the use of telehealth as a workable intervention to provide Black women with additional resources to improve efforts to properly control their hypertension.
My Brother's Keeper: A Scoping Review of Holistic Wellness for Black Male Social Work Faculty
(2024) McNeil, M. Josh; Davis, Curtis; Bradley, Samuel
When public health challenges with amongst Black men are considered, those challenges can be exacerbated. Black men have the shortest lifespans of all groups in the United States. Using a scoping review, this study answers the following questions: How is social work literature contributing to the support of Black male social work faculty members? To what extent is the health of Black male social work faculty considered in this knowledge base? An analysis of the literature revealed that Black male social work faculty deal a with lack of mentorship, a lack of faculty guidance, feel they can be perceived as threats, are tasked with extra labor disguised as service projects, are invalidated, and deal with other challenges that hinder their performance in the academy that impact when or if they get tenured. If Black male social work faculty are not getting supported, this presents itself as a grand challenge in social work. Implications for the study lent themselves to a push for better support of Black male social work faculty.
Preparing HBCU Social Work Students for Leadership Through the Use of Virtual Reality (VR) and Computer-Based Simulations
(2024) Fischle, Helen; Jackson, Sebrena; Davis, Curtis
Virtual Reality (VR) and computer-based simulations are increasingly used in higher education along with other Artificial Intelligence (AI) technologies to enhance teaching and learning in various disciplines as educators seek to create lifelike simulations replicating real-life situations. In social work education, the use of VR and computer-based learning is emerging, and multiple studies have shown that such technologies can effectively teach social work students micro-skills such as engagement, assessment, and interviewing, allowing them to practice these skills without harming clients. However, little is known about how VR and computer-based simulations can encourage insight and self-reflection, an essential part of leadership development as discussed in the Social Change Model of Leadership (SCM), with social work students who attend Historically Black Colleges and Universities (HBCUs). This article will examine how social work educators have used VR and computer-based simulations with their students, as well as discuss why further study is needed to investigate the use of VR and computer-based simulations as a leadership development tool with HBCU students in preparation to meet the Grand Challenges of Social Work through the use of technology.
Reversing Recidivism: Utilizing a Cognitive Behavioral Intervention in Clinical Social Work Carceral Practice
(2024) Davis-Taylor, Traci DeAnne; Davis, Curtis; Aponte, Carmen
This conceptual paper explores the correlation between incarceration, intervention, and recidivism. The purpose of this paper is to determine if combating recidivism utilizing a culturally specific evidence informed cognitive behavioral intervention with high risk African American incarcerated females who have history of violence and are within one year of release to the community, will produce positive shifts in behavioral patterns (a reduction in disciplinary sanctions associated with violence as a form to meet their needs thinking) that demonstrates changes in cognition and beliefs (violence is not the only choice for meeting needs), that influence criminal behavior, through facilitation of a corrections centered cognitive behavioral intervention. This paper outlines a purposed plan of action to pilot The University of Cincinnati Criminal Institute’s Cognitive Behavioral Intervention-Core Adult program prior to reintegration to the community.
Overcoming Obstacles: Examining Challenges Confronting Underserved High-Achieving Students of Color in Educational Settings
(2024) De Simone, Kirsy; Davis, Curtis; Howard-Banks, Tyra
This scoping review delves into the multifaceted challenges experienced by underserved highachieving students of color within educational settings, incorporating the framework of oppression theory. Drawing upon this framework, the study explores the intricate interplay between systemic barriers, individual coping mechanisms and promising approaches to the problem. By synthesizing existing literature, this review aims to identify key stressors and impediments encountered by high achievers of color, shedding light on their unique experiences within educational contexts. The review examines various scholarly perspectives to elucidate pathways to help the students and their families overcome these obstacles while providing guidance to the institutions serving this demographic, and our government to do better. The findings contribute to a deeper understanding of the complex dynamics shaping the educational trajectories of underserved high achievers of color, with implications for policy, practice, and future research initiatives. Ultimately, this review underscores the imperative of addressing systemic inequities and promoting inclusive environments that nurture the academic and socioemotional well-being of underserved students of color and their families.
Connecting Workplace Bullying to Domestic and Sexual Victim Advocate Burnout
(2024) Fleming-Trice, Trace; Davis, Curtis; Scott, Hannah
This study sought to identify the prevalence of workplace bullying within domestic and sexual violence organizations and how this work hazard impacts anti-violence advocates. Three questions were investigated: (1) Do domestic and sexual violence victim advocates experience workplace bullying within domestic and sexual violence organizations? (2) Does workplace bullying contribute to domestic and sexual violence victim advocate burnout? (3) If advocates do experience workplace bullying, in what ways do advocates experience the phenomena in their organizations? Data was collected from 55 advocates throughout the United States and Canada. 55.6% of the respondents reported workplace bullying experiences occurring within the last 10 years of their careers. Most often, supervisors were found to be bullies. Instances of racism and homophobia contributed to advocate bullying experiences as did a lack of support from Boards of Directors. Advocates also indicated instances of bullying occurring from organizational community partners. The study found that over 70% of respondents indicated that exposure to bullying did contribute to their career burnout. Several advocates shared that they had left the field of domestic and sexual violence victim advocacy altogether due to their bullying experiences. Various forms of workplace bullying tactics found on the modified Duluth Power and Control Wheel for workplace bullying were identified by the respondents. This research suggests the urgent need for increased awareness of workplace bullying within the domestic and sexual violence victim service industry, leadership training, and organizational policy change to address protecting advocates.
Helping the Helper: A Systematic Review Regarding Clinical Supervision Techniques and the Impact on Supervisee Competencies
(2023) Wilderman, Summer; Davis, Curtis; Dickerson, Jay
Supervision is key to a new social worker’s continuing development. Research supports the importance of supervision, but the literature is lacking regarding what is and is not taught in curriculum, what best practices are in training someone to become an effective supervisor, and what the impact of supervision can be on supervisee competence. The following systematic review asks the question, will providing quality supervision increase a supervisee’s competence, with specific focus on curriculum, best practices, and the impact of supervision. The dearth of research in this area implies a call for changes to curriculum, application of established supervision best practices, and that there is a positive effect on supervisors’ knowledge and confidence, supervisees’ competence, and client outcomes when a supervisee receives effective supervision.
Supporting a Successful Transition to Independence for Youth in Residential Care Programs
(2023) Parker, Chad A.; Ruggiano, Nicole; Cheatham, Leah
The outcomes for transitional-aged youth in care continue to be a concern, regardless of their setting (i.e., foster homes, residential treatment centers, residential group homes). Successful transitional programming must consider the complex needs of these youth. This review synthesizes approaches to transition planning for youth in residential care programs. Five themes emerged from the literature: extending care, independent living, mentoring, self-determination, and policy interventions. Implications for research, policy, and practice are discussed.
Restoring Equity for Black Youth in Urban Schools: A Scoping Review
(2023) Manigault, Douglas F., III; Davis, Curtis; Bradley, Samuel
Zero tolerance policies in urban schools increased the disparities in urban school discipline for Black youth in comparison to white youth. Restorative interventions continue to be a popular response to deviant student behaviors; however, exploring the impact of restorative interventions in reducing harsh discipline on Black youth should be a continued focal point for scholars. This study used a scoping review to explore knowledge available regarding using restorative interventions in urban schools and how they impact Black youth. Five databases were used to identify relevant literature. Eight pieces of literature met the criteria for inclusion in this review. Findings revealed that restorative interventions do not have substantially positive impact on Black youth’s suspension rates; yet racial inequities in school and perceived negative thoughts about Black youth are among chief reasons Black youth are more likely suspended. Implications for future research and interventions are discussed.
Addressing the "Digital Divide" and Impact to Educational Equity and Access: A Qualitative Inquiry of Students in Higher Education
(2023) Thorn, Lauren; Jackson, Sebrena; Tuchmayer, Jeremy
In March 2020, much of higher education transitioned to emergency online education as a response to the COVID-19 pandemic and the subsequent shutdown of colleges and universities, with many students being sent home to communities that were not able to support reliable broadband internet service or to environments that lacked the necessary devices and software for their educational studies (Ibacache et al., 2021). Universities were provided with funding to address student emergency needs, including providing additional devices to students and families, utilizing technology to make courses mobile-friendly and to connect students to the internet through hot spots or supplementing the costs of increased internet usage in their homes (Ratledge et al., 2020). This study explores the research question, “As online education and digital access remain an integral part of the higher education experience, what programs can colleges and universities implement to ensure equitable student access to technology and highspeed internet needed for academic success?” Through a review of current literature, relevant questions were identified, and a qualitative research study protocol was established to host focus groups with students who were impacted by the COVID-19 pandemic to assess their experiences and identify potential services and resources for additional support. Following review and coding of the focus group transcripts, key themes emerged around access to digital course codes and texts, technological efficacy and skills needed to engage in online classes, addressing financial barriers associated with external software and platforms, and integrating training and educationinto existing programs for faculty, students, and staff. The project explores systemic practice implications, legislative and policy impacts, and related theoretical framework that will guide future research in this area.
The VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (Mission) Act and Community Care: Progress, Opportunities, and the Path Forward
(2023) Ferrigno, Frank F.; Ruggiano, Nicole; Sloan, Douglas
Introduction/Background: The VA Health Care System was established in 1930 and Community Care (CC) for veterans has been available since 1924. Prior to 2014 CC was only utilized for veterans’ Care in exceptional cases. The passage of the VA Choice Act in 2014 and the VA Mission Act of 2018 rapidly increased the availability of CC to veterans. This study is the first that utilizes a macro historical perspective combined with an empirical examination of the impact of the increased use of CC under the VA Mission Act post-program implementation and offers recommendations for a path forward. Methods: An analysis examining the use of community care in the VA with a focus on the VA Mission Act that encompasses both the macro level of policy development and the micro level of program implementation. Results: The initial results following the implementation of the VA Mission Act were mixed. Greater options for care in the community and increased opportunities to obtain care via telehealth were enhancements to the care system. Disparate impact, challenges with care coordination, the need for increased support services and the lack of a readily accessible common set of performance metrics offer opportunities for improvement. Discussion: Proposals to effectively improve the VA Mission Act must be empirically driven, encompass both the macro and micro levels, and keep patient care as the centerpiece. Integral to achieving this goal will be a deliberate long-range plan that involves all internal and external stakeholders and facets of care delivery that considers all the potential indirect and direct impacts on the care being provided to veterans.
“Failure Is Not An Option”: A Scoping Review to Identify Contributing Factors of Nonprofit Organizational Failure
(2023) Thomas, Courtney Chapman; Davis, Curtis; Gold, Shaunna Payne
Failure in the context of nonprofit organizations is a concept that has intrigued many scholars. Unfortunately, the research of the root cause and indicators of failure is still fragmented. A great deal of the current research focuses on the success of nonprofits. This study is founded in systems theory and seeks to derive a list of common indicators of factors that attribute to failure among nonprofit organizations. It also seeks to determine if leadership is an overarching correlating factor among all failures. Through the evaluation of literature and a content analysis, this paper produces a list of indicators of failure within nonprofit organizations. The author utilizes this information to propose intervention and prevention models that could correct or deter failure with intentional focus on the role of Social Work Education.

Browse

Recent Submissions