Academic Writing
Academic Writing
Embedded Files
Book Chapters
Book Chapters
Zhang, A., & Zebrack, B. (2024). Psychosocial Interventions to Facilitate Disease Management in Adolescents and Young Adults. In N. Schneiderman (Ed.) (2024) APA Handbook of Health Psychology. American Psychological Association Press.
Zhang, A., & Franklin, C. (2022). Solution-focused Therapy. In K. Corcoran, & A. R. Roberts (Eds.) (2022) Social Workers’ Desk Reference, (4th Edition), New York: Oxford University Press.
Zhang, A., Franklin, C., & Hopson, L. (2020). Family systems. In C. Jordan, & C. Franklin (Eds.) (2019) Clinical Assessment for Social Workers, (5th Edition), New York: Oxford University Press.
Zhang, A., & Franklin, C. (2020). Quantitative assessment methods. In C. Jordan, & C. Franklin (Eds.) (2019) Clinical Assessment for Social Workers, (5th Edition), New York: Oxford University Press.
Franklin, C., Zhang, A., Bolton, K., & Yates, H. T. (2022). Solution-focused couple therapy. In J L Lebow & D K Snyder (Eds.) (2022) Clinical Handbook of Couple Therapy (6th Edition), New York: The Guilford Press
Franklin, C., & Zhang, A. (2016). Quantitative assessment methods. In C. Jordan, & C. Franklin (Eds.) (2016) Clinical Assessment for Social Workers, (4th Edition), New York: Oxford University Press.
Franklin, C., Hopson, L., Guo, Y., & Zhang, A. (2016). Family systems. In C. Jordan, & C. Franklin (Eds.) (2016) Clinical Assessment for Social Workers, (4th Edition), New York: Oxford University Press.
I also served as the editorial assistant coordinating for all chapter authors in supporting the book editors, i.e., Catheleen Jordan and Cynthia Franklin
[Note that a new edition of the book is available]
Selected Journal Articles
Selected Journal Articles
You can request an author copy of the full text via my ResearchGate.
A full list of publications is in my Curriculum Vitae
Zhang, X., Ling, H., Zhang, X, & Zhang, A. (2027). Predicting laboratory test ordering in emergency departments using integrated structured and unstructured electronic health records: Machine learning study. JMIR Medical Informatics. https://doi.org/10.2196/85255
Abstract
Background: Laboratory testing is a cornerstone of diagnostic decision-making in emergency departments (EDs), yet its overuse contributes substantially to unnecessary health care costs and inefficiencies. Predictive approaches that leverage electronic health record data may help optimize and guide more appropriate test use. Objective: This study aims to develop and evaluate machine learning models that predict laboratory test use during ED visits by integrating structured clinical data and unstructured text from electronic health records. Methods: We analyzed 13,115 adult ED visits from the 2021 National Hospital Ambulatory Medical Care Survey–Emergency Department dataset. Structured predictors included demographics, vital signs, insurance status, and medical history, while unstructured data from chief complaints and injury descriptions were encoded using Bidirectional Encoder Representations from Transformers–based embeddings. Four model configurations were developed: structured-only, unstructured-only, combined structured and unstructured data, and an ensemble (mean probability) approach. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC). Results: The combined model achieved the highest predictive performance (AUC=0.83), outperforming both the structured only model (AUC=0.78) and the unstructured-only model (AUC=0.74). The ensemble model also performed well but did not exceed the combined model. Key predictors of laboratory testing included older age, ambulance arrival, abnormal vital signs, and chronic comorbidities, whereas injury-related visits were associated with a lower likelihood of testing. Conclusions: Integrating structured and unstructured electronic health record data improves the prediction of laboratory test use in ED settings. These findings support the development of data-driven clinical decision support tools aimed at enhancing diagnostic efficiency and reducing unnecessary testing.
Zhang, A., Chen, M., Weaver, A., Francis-Levin, N., Walters, C., Rappapport, A., & Himle, J. (2027). Qualitative insights into a digital CBT program for AYAs with cancer: Participant perceptions of factors impacting feasibility and engagement. Journal of Psychosocial Oncology. https://doi.org/10.1080/07347332.2026.2669385
Abstract
Background. Adolescents and young adults (AYAs) with cancer face high levels of depression and anxiety. Yet developmentally appropriate and cancer-informed mental health services remain limited. Digital cognitive behavioral therapy (CBT) programs may help address known access barriers, but many lack the tailoring and engagement needed for meaningful retention of AYAs with cancer. Mind Your Total Health (MYTH) was partially tailored to reflect AYA cancer experiences. This study explored how AYAs perceived their experiences with MYTH and offered recommendations for refinements related to feasibility and engagement. Methods. This article reports qualitative findings of a sequential exploratory mixed-method (quant → qual) study assessing MYTH’s feasibility and preliminary efficacy. Eight AYAs (ages 19–25) who completed the MYTH program participated in semi-structured individual interviews. Interviews explored experiences with the program, perceived benefits and challenges, and recommendations for improvement. Data were analyzed using reflexive thematic analysis. Results. Participants described MYTH as accessible and integrative to their daily lives. Participants highlighted MYTH’s animated storyline and use of cliffhangers as elements that strengthened the program’s sense of relatability and encouraged sustained engagement. A cancer-relevant storyline was identified as a crucial step for enhanced program feasibility and engagement. Brief weekly check-ins served as an important source of accountability and emotional grounding for engagement. Conclusions. AYAs’ perspectives highlight the need for digital mental health programs that balance flexible, engaging design with content that reflects the realities of cancer.
Zhang, A., Urban-Wojcik, E., Seewald, M., & Zebrack, B. (2025). Mental Health Trajectories Among US Survivors of Adolescent and Young Adult Cancer as They Age. JAMA Network Open, 8(5), e2511430-e2511430. doi:10.1001/jamanetworkopen.2025.11430
Abstract
Objective. To understand the prevalence and trajectories of mental health challenges among middle-aged or older survivors of AYA cancer compared with those who received a diagnosis as adults or individuals without cancer. Design, Setting, and Participants. This cohort study used cross-sectional data from the Health and Retirement Study (HRS) to characterize mental health outcomes for US adults older than 50 years and longitudinal data to examine trajectories of mental health outcomes. The study started on September 1, 2023. HRS is a longitudinal, population-based national sample that interviews approximately 20 000 participants every 2 years since 1992 on topics related to health, employment, income, and others. Results. Cross-sectional estimates revealed survivors of AYA cancer had the highest prevalence of lifetime psychiatric issues (16.36% [95% CI, 7.17%-25.55%] to 37.80% [95% CI, 26.55%-49.06%]), prescription anxiety and/or depression medication (25.10% [95% CI, 17.09%-33.10%] to 33.78% [95% CI, 23.93%-43.64%]), and meeting major depression criteria (13.13% [95% CI, 6.08%-20.18%] to 20.96% [12.91%-29.01%]) versus other cohorts. Compared with adult cancer survivors and even after adjusting for demographic covariates, AYA cancer survivors had higher odds of lifetime psychiatric issues (in 4 of 14 waves), similar odds of taking anxiety or depression medications, and higher odds of meeting major depression criteria (in 3 of 7 waves). Linear mixed-effects growth models revealed age-dependent U-shaped trajectories for depression and anxiety symptoms but significantly higher mean levels of symptoms among AYA cancer survivors. A flattening of anxiety symptoms later in life was only observed for AYA cancer survivors.
Zhang, A., Chen, M., Brandon, R., Currin‐McCulloch, J., Liu, X., Cheladyn, B., ... & DuVall, A. S. (2025). The Current State of Palliative Care Research for Adolescents and Young Adults With Cancer: A Systematic Review and Meta‐Thematic Analysis of Empirical Literature. Psycho‐Oncology, 34(7), e70228. https://doi.org/10.1002/pon.70228
Abstract
Background. Palliative care is critical to the wellness of cancer patients and survivors, but adolescents and young adults (AYAs) with cancer are confronted with the divide between pediatric and adult palliative care as well as pediatric and adult/medical oncology. Consequently, attention to palliative care for AYAs with cancer has just started, and our understanding of palliative care for AYA oncology remains limited. Aim. This study aims to update our understanding of this salient topic through rigorous research synthesis. Design. A systematic review of empirical literature was adopted, and data was innovatively analyzed using meta-thematic analysis. The review was pre-registered on OSF (https://osf.io/zy9cs). Studies were searched across ten electronic databases from inception to August 1, 2024 (i.e., the search date). Eligibility criteria include: (1) study the topic of palliative care; (2) focus on AYA cancer; and (3) report empirical data. Meta-thematic analysis and reflexive thematic analysis informed data analysis methods. Results. Fifty-six primary studies from 2004 to 2024, inclusive of 478 data points, were included in the meta-thematic analysis. Five broad themes were identified: (1) the overall state of AYA palliative care; (2) key characteristics of palliative care for AYAs with cancer; (3) AYA palliative care communication, decision-making, and AYA involvement; (4) prevalent symptoms, care preferences, and priorities in palliative care among AYAs with cancer; and (5) effective interventions. Conclusions. Key insights regarding AYA cancer palliative care have been revealed. Notable areas of improvement regarding the delivery of palliative care to AYAs and future research directions have been identified.
Zhang, A., DuVall, A. S., Franklin, C., & Kim, J. S. (2024). Tailoring solution-focused brief therapy for adolescents and young adults with cancer: A qualitative investigation. Clinical Social Work Journal, 51, 354–364, https://doi.org/10.1007/s10615-023-00883-1
Abstract
Solution-focused brief therapy (SFBT) is an empirically-supported psychotherapeutic intervention in treating mental health issues in the general population. When being delivered to adolescents and young adults (AYAs) diagnosed with cancer, specific techniques and skills of SFBT need to be tailored to meet the unique bio-psycho-social challenges of the AYA cancer population. Using a patient-centered approach, our team interviewed 14 AYAs with cancer who received SFBT for cancer (SFBT-C) to inform the tailoring and refinement of the existing SFBT intervention specifically for the AYA cancer population. Themes emerged within three broad categories that informed the tailoring and refinement of SFBT for AYAs with cancer, i.e., general experiences, strengths, and weaknesses of SFBT-C. AYAs with cancer found SFBT-C overall positively different from other approaches. Strengths include SFBT-C’s collaborative nature, using positive emotion as an important change mechanism, and a good balance between being relevant to cancer and not focusing too much on their cancer. Areas of improvement include assignment flexibility and different strategies to address resistance. The findings of this paper significantly inform the delivery of SFBT-C to AYAs with cancer using patient-centered feedback and input.
Zhang. A., Weaver, A., Walling, E., Zebrack, B., *Levin, N. J., Stuchell, B., & Himle, J. (2022). Evaluating an engaging and coach-assisted online cognitive behavioral therapy for depression among adolescent and young adult cancer survivors: A pilot feasibility trial. Journal of Psychosocial Oncology. https://doi.org/10.1080/07347332.2021.2011530
Abstract
Objectives: Technology-assisted Cognitive Behavioral Therapy (tCBT) has significant potentials to provide engaging and accessible depression treatment for adolescents and young adults (AYAs) coping with cancer. This study evaluated the feasibility and preliminary efficacy of an engaging and tailorable tCBT – Mind Your Total Health (MYTH) – for AYA cancer survivors’ depression. Methods: Seventeen AYAs diagnosed with cancer were randomly assigned to either the intervention (MYTH) or control group. The intervention group (n = 10) received eight weekly 30–35 minutes coach-assisted tCBT (MYTH), while the control group (n = 7) received active control, BeatingtheBlues (BtB). Results: Eight out of ten participants in the MYTH group completed at least six out of eight sessions, suggesting strong feasibility (80% completion rate) among AYAs with cancer. Efficacy outcomes indicated that participants in the MYTH group reported significant pre- and post-treatment reduction in depression, t(9) = 5.25, p < 0.001, and anxiety, t(9)=5.07, p < 0.001. Notably, participants in the MYTH group reported significantly lower post-treatment depression than participants in the BtB group, t(15) = 2.40, p < 0.05. The between-group difference reflected a significant between-group treatment effect size, d = 1.12, p < 0.05. Discussion: This engaging, tailorable, and coach-assisted tCBT intervention is promising in alleviating depression and anxiety among AYA cancer survivors. Future research needs to include larger sample size and a more diverse patient population.
Zhang, A., Ji, Q. Y., Currin-McCulloch, J., Franklin, C., Solomon, P., Li, Y., … Chen, Y. (2018). The effectiveness of solution-focused brief therapy for psychological distress among Chinese parents of children with a cancer diagnosis: A pilot randomized controlled trial. Supportive Care in Cancer, 26(8), 2901-2910. https://doi.org/10.1007/s00520-018-4141-1
Abstract
Purpose. Given the critical role of parental care for pediatric cancer patients, this pilot study evaluated the feasibility and effectiveness of a hospital-based solution-focused brief therapy (SFBT) intervention for reducing psychological distress among parents of pediatric cancer patients in China. Differences between treatment and active control (AC) groups were assessed on dimensions of psychological distress. Parents’ level of hope was also assessed. Methods. Participants (N = 44) were randomly assigned to SFBT or AC. Parents received four sessions of SFBT twice a week delivered by graduate-level hospital social workers. Pre- and post-intervention assessments measured change in distress (depression, anxiety, and somatization symptoms) of parents as well as their level of hope. Results. Analysis of covariance (ANCOVA) indicated the SFBT group had better outcomes than the AC group on overall distress of somatic, anxiety, depression symptoms and level of hope. Within- and between-group treatment effects reported significantly greater effect of the SFBT group than of the AC group. Conclusions. Considering the inherent limits of a pilot feasibility study, results suggest that SFBT is a feasible, culturally compatible, and promising intervention for alleviating distress among Chinese parents of children with cancer. Additional comprehensive trials are needed to draw more definitive conclusions.
Zhang, A., Wang, K., Zebrack, B., *Tan, C. Y., Walling, E., & Chugh, R. (2021). Psychosocial, behavioral, and supportive interventions for pediatric, adolescent, and young adult cancer survivors: A systematic review and meta-analysis. Critical Reviews in Oncology/Hematology, 160, 103291. https://doi.org/10.1016/j.critrevonc.2021.103291
Abstract
Background. Pediatric, adolescent, and young adult (PAYA) cancer survivors suffer from multiple domains of adverse psychosocial and behavioral outcomes during and after their cancer treatment. This study conducted a systematic review and metaanalysis of psychosocial, behavioral, and supportive interventions for PAYA cancer survivors. Methods. We searched 11 electronic databases, 4 professional websites, and manual search of reference lists in existing reviews. We selected randomized controlled trials and controlled trials without randomization focusing on PAYA cancer survivors across six outcome domains. Results. We included 61 studies (4,402 participants) published between 1987 and 2020. Overall risk of bias across studies was low. We identified an overall moderate and statistically significant treatment effect size for PAYA cancer survivors across six outcome domains. Conclusion. Psychosocial, behavioral, and supportive interventions were overall effective for PAYA cancer survivors. However, interventions were not effective for certain outcome domains, and less effective among AYA versus pediatric cancer survivors.
Franklin, C., Zhang, A., Froerer, A., & Shannon, J. (2016). Solution-focused brief therapy: A systematic review and meta-summary of process research. Journal of Marriage and Family Therapy, 43(1), 16-30. https://doi.org/10.1111/jmft.12193
Abstract
This article presents a systematic review of the process research on solution-focused brief therapy (SFBT). We searched published and unpublished studies in English across five databases, five major journals, two book chapters, and four websites to locate studies that investigate why and how SFBT works. Thirty-three studies that used various research methods were located and included for further analysis using a meta-summary approach. The findings supported the significance of the co-construction process within SFBT and the effects of specific types of SFBT techniques. The most empirical support was found for the strength-oriented techniques in comparison to the other techniques and for the co-construction of meaning. Current studies require replications with larger samples and experimental designs that study SFBT process in relationship to outcomes.
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