Can the different versions of the Shirom-Melamed Burnout Measure be used to measure burnout among healthcare professionals? A systematic review of psychometric properties.


Journal

Journal of patient-reported outcomes
ISSN: 2509-8020
Titre abrégé: J Patient Rep Outcomes
Pays: Germany
ID NLM: 101722688

Informations de publication

Date de publication:
26 Sep 2024
Historique:
received: 16 05 2024
accepted: 11 09 2024
medline: 26 9 2024
pubmed: 26 9 2024
entrez: 26 9 2024
Statut: epublish

Résumé

The prevalence of Occupational Burnout is high among healthcare professionals (HCP). Hence, it is crucial to have robust measures for ascertaining burnout in this population. The Shirom-Melamed Burnout Measure is a prevalent tool used in the diagnosis of burnout, and in the delivery planning of mental health services. The 14-item Shirom-Melamed Burnout Measure (SMBM) was developed after a methodological revision of the 22-item Shirom-Melamed Burnout Questionnaire (SMBQ). Studies on the psychometric properties of the SMBM and SMBQ exist, but there remains a need for thorough evaluation to assess the methodological quality of individual studies. To address this gap, this systematic review aimed to critically appraise the measurement properties of the different versions of the Shirom-Melamed Burnout Measure/Questionnaire (SMBM/Q) used among healthcare professionals. Four databases (PubMed, CINAHL, PsychINFO, and Scopus) were searched for studies on the psychometric properties of all versions of the SMBM/Q among HCP. The methodological quality of the studies was evaluated using the COSMIN Risk of Bias checklist. Evidence supporting the measurement properties (EMP) of the SMBM was synthesized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Our final pool consisted of five research articles. One study on the 12-item SMBM was included to estimate content validity, two studies reported on the 14-item SMBM, while the other two employed the 22-item version. Interestingly, each study used the SMBM in a different language, namely English/Hebrew, Chinese, French, Serbian, and Swedish. Structural validity, internal consistency, and construct validity are the SMBM's most assessed measurement properties. The Hebrew and French versions demonstrated high levels of structural validity and internal consistency, and the remaining reports on validity demonstrated low levels due to methodological flaws. Per COSMIN guidelines, the SMBM should not be utilized for clinical purposes due to insufficient content validity, but has promising potential with ongoing research. Engaging critical stakeholders for concept elicitation will ensure the relevance, comprehensiveness, and comprehensibility of the PRO items. Likewise, establishing an MIC will allow capturing change over time, which will benefit longitudinal experimental studies. Occupational burnout is a significant problem among healthcare professionals, and it is crucial to have a reliable tool to measure it. The Shirom-Melamed Burnout Measure (SMBM) is commonly used to diagnose burnout and plan mental health services. Studies on the psychometric properties of the SMBM exist, but there remains a need for thorough evaluation to assess the methodological quality of individual studies. To address this gap, this systematic review critically appraised the measurement properties of the different versions of the Shirom-Melamed Burnout Measure (SMBM) used among healthcare professionals. Our findings indicate that only a few studies have examined the SMBM, and they have used the tool in different languages. Structural validity, internal consistency, and construct validity are the SMBM's most assessed measurement properties. We recommend that more research is needed to assess the content validity of the SMBM. We also suggest that critical stakeholders should be involved in the development of the SMBM to ensure that it is relevant, comprehensive, and understandable.

Sections du résumé

BACKGROUND BACKGROUND
The prevalence of Occupational Burnout is high among healthcare professionals (HCP). Hence, it is crucial to have robust measures for ascertaining burnout in this population. The Shirom-Melamed Burnout Measure is a prevalent tool used in the diagnosis of burnout, and in the delivery planning of mental health services. The 14-item Shirom-Melamed Burnout Measure (SMBM) was developed after a methodological revision of the 22-item Shirom-Melamed Burnout Questionnaire (SMBQ). Studies on the psychometric properties of the SMBM and SMBQ exist, but there remains a need for thorough evaluation to assess the methodological quality of individual studies. To address this gap, this systematic review aimed to critically appraise the measurement properties of the different versions of the Shirom-Melamed Burnout Measure/Questionnaire (SMBM/Q) used among healthcare professionals.
METHODOLOGY METHODS
Four databases (PubMed, CINAHL, PsychINFO, and Scopus) were searched for studies on the psychometric properties of all versions of the SMBM/Q among HCP. The methodological quality of the studies was evaluated using the COSMIN Risk of Bias checklist. Evidence supporting the measurement properties (EMP) of the SMBM was synthesized using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
RESULTS RESULTS
Our final pool consisted of five research articles. One study on the 12-item SMBM was included to estimate content validity, two studies reported on the 14-item SMBM, while the other two employed the 22-item version. Interestingly, each study used the SMBM in a different language, namely English/Hebrew, Chinese, French, Serbian, and Swedish. Structural validity, internal consistency, and construct validity are the SMBM's most assessed measurement properties. The Hebrew and French versions demonstrated high levels of structural validity and internal consistency, and the remaining reports on validity demonstrated low levels due to methodological flaws.
CONCLUSIONS CONCLUSIONS
Per COSMIN guidelines, the SMBM should not be utilized for clinical purposes due to insufficient content validity, but has promising potential with ongoing research. Engaging critical stakeholders for concept elicitation will ensure the relevance, comprehensiveness, and comprehensibility of the PRO items. Likewise, establishing an MIC will allow capturing change over time, which will benefit longitudinal experimental studies. Occupational burnout is a significant problem among healthcare professionals, and it is crucial to have a reliable tool to measure it. The Shirom-Melamed Burnout Measure (SMBM) is commonly used to diagnose burnout and plan mental health services. Studies on the psychometric properties of the SMBM exist, but there remains a need for thorough evaluation to assess the methodological quality of individual studies. To address this gap, this systematic review critically appraised the measurement properties of the different versions of the Shirom-Melamed Burnout Measure (SMBM) used among healthcare professionals. Our findings indicate that only a few studies have examined the SMBM, and they have used the tool in different languages. Structural validity, internal consistency, and construct validity are the SMBM's most assessed measurement properties. We recommend that more research is needed to assess the content validity of the SMBM. We also suggest that critical stakeholders should be involved in the development of the SMBM to ensure that it is relevant, comprehensive, and understandable.

Identifiants

pubmed: 39325224
doi: 10.1186/s41687-024-00788-8
pii: 10.1186/s41687-024-00788-8
doi:

Types de publication

Journal Article Systematic Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

108

Informations de copyright

© 2024. The Author(s).

Références

World Health Organization (2024) ICD-11 for mortality and morbidity statistics. World Health Organization, Geneva. Available from https://icd.who.int/browse/2024-01/mms/en#129180281 . Cited 22 Apr 2024
Guseva Canu I, Marca SC, Dell’Oro F, Balázs Á, Bergamaschi E, Besse C et al (2021) Harmonized definition of occupational burnout: a systematic review, semantic analysis, and Delphi consensus in 29 countries. Scand J Work Environ Health 47(2):95. Available from /pmc/articles/PMC8114565/. Cited 16 Apr 2024
pubmed: 33258478 doi: 10.5271/sjweh.3935
Rotenstein LS, Torre M, Ramos MA, Rosales RC, Guille C, Sen S et al (2018) Prevalence of burnout among physicians: a systematic review. JAMA 320(11):1131–1150. Available from https://pubmed.ncbi.nlm.nih.gov/30326495/ . Cited 14 Apr 2024
pubmed: 30326495 pmcid: 6233645 doi: 10.1001/jama.2018.12777
Shanafelt TD, Hasan O, Dyrbye LN, Sinsky C, Satele D, Sloan J et al (2015) Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc 90(12):1600–1613. Available from https://pubmed.ncbi.nlm.nih.gov/26653297/ . Cited 15 Apr 2024
pubmed: 26653297 doi: 10.1016/j.mayocp.2015.08.023
Bruyneel A, Smith P, Tack J, Pirson M (2021) Prevalence of burnout risk and factors associated with burnout risk among ICU nurses during the COVID-19 outbreak in French speaking Belgium. Intensive Crit Care Nurs 65:103059. Available from /pmc/articles/PMC9759739/. Cited 15 Apr 2024
pubmed: 33875341 pmcid: 9759739 doi: 10.1016/j.iccn.2021.103059
Matsuo T, Kobayashi D, Taki F, Sakamoto F, Uehara Y, Mori N et al (2020) Prevalence of health care worker burnout during the coronavirus disease 2019 (COVID-19) pandemic in Japan. JAMA Netw Open 3(8):E2017271. Available from: /pmc/articles/PMC7403916/. Cited 15 Apr 2024
pubmed: 32749466 pmcid: 7403916 doi: 10.1001/jamanetworkopen.2020.17271
Prasad K, McLoughlin C, Stillman M, Poplau S, Goelz E, Taylor S et al (2021) Prevalence and correlates of stress and burnout among U.S. healthcare workers during the COVID-19 pandemic: a national cross-sectional survey study. EClinicalMedicine 35:100879. Available from /pmc/articles/PMC8141518/. Cited 15 Apr 2024
pubmed: 34041456 pmcid: 8141518 doi: 10.1016/j.eclinm.2021.100879
Roslan NS, Yusoff MSB, Asrenee AR, Morgan K (2021) Burnout prevalence and its associated factors among Malaysian healthcare workers during COVID-19 pandemic: an embedded mixed-method study. Healthcare 9(1). Available from /pmc/articles/PMC7829836/. Cited 15 Apr 2024
Torrente M, Sousa PAC, Sánchez-Ramos A, Pimentao J, Royuela A, Franco F et al (2021) To burn-out or not to burn-out: a cross-sectional study in healthcare professionals in Spain during COVID-19 pandemic. BMJ Open 11(2):44945. Available from /pmc/articles/PMC7907836/. Cited 15 Apr 2024
doi: 10.1136/bmjopen-2020-044945
Maslach C, Jackson SE (1981) The measurement of experienced burnout. J Organ Behav 2(2):99–113. Available from https://onlinelibrary.wiley.com/doi/full/10.1002/job.4030020205 . Cited 16 Apr 2024
doi: 10.1002/job.4030020205
Edú-valsania S, Laguía A, Moriano JA (2022) Burnout: a review of theory and measurement. Int J Environ Res Public Health 19(3). Available from /pmc/articles/PMC8834764/. Cited 15 Apr 2024
Schaufeli WB (2003) Past performance and future perspectives of burnout research. SA J Ind Psychol 29(4). Available from https://sajip.co.za/index.php/sajip/article/view/127 . Cited 16 Apr 2024
Schaufeli WB, Desart S, De Witte H (2020) Burnout assessment tool (BAT)—development, validity, and reliability. Int J Environ Res Public Health 17(24):1–21. Available from /pmc/articles/PMC7766078/. Cited 15 Apr 2024
doi: 10.3390/ijerph17249495
Kristensen TS, Borritz M, Villadsen E, Christensen KB (2005) The Copenhagen burnout inventory: a new tool for the assessment of burnout. Work Stress 19(3):192–207. Available from https://www.tandfonline.com/doi/abs/10.1080/02678370500297720 . Cited 15 Apr 2024
doi: 10.1080/02678370500297720
Demerouti E, Nachreiner F, Bakker AB, Schaufeli WB (2001) The job demands-resources model of burnout. J Appl Psychol 86(3):499–512
pubmed: 11419809 doi: 10.1037/0021-9010.86.3.499
Pines A, Aronson E (1988) Career burnout: causes and cures. Available from https://psycnet.apa.org/record/1988-98289-000 . Cited 16 Apr 2024
Ackerley GD, Burnell J, Holder DC, Kurdek LA (1988) Burnout among licensed psychologists. Prof Psychol Res Pr 19(6):624–631
doi: 10.1037/0735-7028.19.6.624
Glisson C, Hemmelgarn A (1998) The effects of organizational climate and interorganizational coordination on the quality and outcomes of children’s service systems. Child Abuse Negl 22(5):401–421. Available from https://pubmed.ncbi.nlm.nih.gov/9631252/ . Cited 15 Apr 2024
pubmed: 9631252 doi: 10.1016/S0145-2134(98)00005-2
Glisson C, Landsverk J, Schoenwald S, Kelleher K, Hoagwood KE, Mayberg S et al (2008) Assessing the organizational social context (OSC) of mental health services: implications for research and practice. Administration Policy Mental Health Mental Health Serv Res 35(1–2):98–113. Available from https://link.springer.com/article/10.1007/s10488-007-0148-5 . Cited 15 Apr 2024
doi: 10.1007/s10488-007-0148-5
Stamm BH (2010) The concise ProQOL manual, 2nd ed. ProQOL.org. Available from https://img1.wsimg.com/blobby/go/dfc1e1a0-a1db-4456-9391-18746725179b/downloads/ProQOL%20Manual.pdf?ver=16228393537252010 . Cited 24 Apr 2024
Shirom A, Melamed S (2006) A comparison of the construct validity of two burnout measures in two groups of professionals. Int J Stress Manag 13(2):176–200.
doi: 10.1037/1072-5245.13.2.176
Almen N, Jansson B (2021) The reliability and factorial validity of different versions of the Shirom-Melamed Burnout Measure/Questionnaire and normative data for a general Swedish sample. Int J Stress Manag 28(4):314–325.
doi: 10.1037/str0000235
Hobfoll SE, Shirom A (1993) Stress and burnout in work organizations. In: Golembiewski RT (ed) Handbook of organization behavior. Dekker, New York, pp 41–61
Hobfoll SE, Shirom A (2000) Conservation of resources theory: applications to stress and management in the workplace. In: Handbook of organization behavior, 2nd ed. Dekker, New York, pp 57–81
Shirom A (1989) Burnout in work organizations. In: Cooper CL, Robertson I (eds) International review of industrial and organizational psychology. Wiley, New York, pp 25–48
Shirom A (2003) The effects of work stress on health. In: Schabrag MJ, Winnbust JAM, Cooper LL (eds) Handbook of work and health psychology, 2nd ed. Wiley, New York, pp 63–83
Shirom A, Melamed S (2005) Does burnout affect physical health? A review of the evidence. Res Companion Organ Health Psychol 599–622
Toker S, Melamed S, Berliner S, Zeltser D, Shapira I (2012) Burnout and risk of coronary heart disease: a prospective study of 8838 employees. Psychosom Med 74(8):840–847. Available from https://pubmed.ncbi.nlm.nih.gov/23006431/ . Cited 15 Apr 2024
pubmed: 23006431 doi: 10.1097/PSY.0b013e31826c3174
Sassi N, Neveu JP (2010) Translation and validation of a new measurement of professional exhaustion: the Shirom-Melamed Burnout Measure. Can J Behav Sci 42(3):177–184.
doi: 10.1037/a0017700
Qiao H, Schaufeli WB (2011) The convergent validity of four burnout measures in a Chinese sample: a confirmatory factor-analytic approach. Appl Psychol 60(1):87–111. Available from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1464-0597.2010.00428.x . Cited 15 Apr 2024
doi: 10.1111/j.1464-0597.2010.00428.x
Lundgren-Nilsson Å, Jonsdottir IH, Pallant J, Ahlborg G (2012) Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ). BMC Public Health 12(1):1–8. Available from https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-12-1 . Cited 15 Apr 2024
pubmed: 22214479 pmcid: 3307433 doi: 10.1186/1471-2458-12-1
Schilling R, Colledge F, Brand S, Ludyga S, Gerber M (2019) Psychometric properties and convergent validity of the Shirom-Melamed Burnout Measure in two German-speaking samples of adult workers and police officers. Front Psychiatry 10. Available from https://pubmed.ncbi.nlm.nih.gov/31427997/ . Cited 15 Apr 2024
Gerber M, Colledge F, Mücke M, Schilling R, Brand S, Ludyga S (2018) Psychometric properties of the Shirom-Melamed Burnout Measure (SMBM) among adolescents: results from three cross-sectional studies. BMC Psychiatry 18(1)
Sundström A, Söderholm A, Nordin M, Nordin S (2023) Construct validation and normative data for different versions of the Shirom-Melamed Burnout Questionnaire/Measure in a Swedish population sample. Stress Health 39(3):499–515. Available from https://pubmed.ncbi.nlm.nih.gov/36166816/ . Cited 15 Apr 2024
pubmed: 36166816 doi: 10.1002/smi.3200
Mokkink LB, Terwee CB, Knol DL, Stratford PW, Alonso J, Patrick DL et al (2010) The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: a clarification of its content. BMC Med Res Methodol 10. Available from https://pubmed.ncbi.nlm.nih.gov/20298572/ . Cited 15 Apr 2024
Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL et al (2010) The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res 19(4):539–549. Available from https://pubmed.ncbi.nlm.nih.gov/20169472/ . Cited 15 Apr 2024
pubmed: 20169472 pmcid: 2852520 doi: 10.1007/s11136-010-9606-8
Prinsen CAC, Mokkink LB, Bouter LM, Alonso J, Patrick DL, de Vet HCW et al (2018) COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual Life Res 27(5):1147–1157. Available from https://pubmed.ncbi.nlm.nih.gov/29435801/ . Cited 15 Apr 2024
pubmed: 29435801 pmcid: 5891568 doi: 10.1007/s11136-018-1798-3
Terwee CB, Jansma EP, Riphagen II, De Vet HCW (2009) Development of a methodological PubMed search filter for finding studies on measurement properties of measurement instruments. Qual Life Res 18(8):1115–1123. Available from https://pubmed.ncbi.nlm.nih.gov/19711195/ . Cited 15 Apr 2024
pubmed: 19711195 pmcid: 2744791 doi: 10.1007/s11136-009-9528-5
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P et al (2008) GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ 336(7650):924–926. Available from https://pubmed.ncbi.nlm.nih.gov/18436948/ . Cited 15 Apr 2024
pubmed: 18436948 pmcid: 2335261 doi: 10.1136/bmj.39489.470347.AD
Reeve BB, Wyrwich KW, Wu AW, Velikova G, Terwee CB, Snyder CF et al (2013) ISOQOL recommends minimum standards for patient-reported outcome measures used in patient-centered outcomes and comparative effectiveness research. Qual Life Res 22(8):1889–1905. Available from https://pubmed.ncbi.nlm.nih.gov/23288613/ . Cited 18 Apr 2024
pubmed: 23288613 doi: 10.1007/s11136-012-0344-y
Jocic D, Djonovic N, Krajnovic D, Stefanovic S, Stojkov S, Kocic S (2018) Cultural adaptation and examination of metric characteristics Shirom-Melamed Burnout Questionnaire (SMBQ) on a sample of pharmacists in Serbia. Ind J Pharm Educ Res 52(1):166–180.
doi: 10.5530/ijper.52.1.19
Toker S, Shirom A, Shapira I, Berliner S, Melamed S (2005) The association between burnout, depression, anxiety, and inflammation biomarkers: c-reactive protein and fibrinogen in men and women. J Occup Health Psychol 10(4):344–362. Available from: https://pubmed.ncbi.nlm.nih.gov/16248685/ . Cited 15 Apr 2024
pubmed: 16248685 doi: 10.1037/1076-8998.10.4.344
Toker S, Biron M (2012) Job burnout and depression: unraveling their temporal relationship and considering the role of physical activity. J Appl Psychol 97(3):699–710. Available from https://pubmed.ncbi.nlm.nih.gov/22229693/ . Cited 15 Apr 2024
pubmed: 22229693 doi: 10.1037/a0026914
Melamed S, Shirom A, Toker S, Shapira I (2006) Burnout and risk of type 2 diabetes: a prospective study of apparently healthy employed persons. Psychosom Med 68(6):863–869. Available from https://pubmed.ncbi.nlm.nih.gov/17132837/ . Cited 18 Apr 2024
pubmed: 17132837 doi: 10.1097/01.psy.0000242860.24009.f0
Armon G, Melamed S, Shirom A, Shapira I (2010) Elevated burnout predicts the onset of musculoskeletal pain among apparently healthy employees. J Occup Health Psychol 15(4):399–408. Available from https://pubmed.ncbi.nlm.nih.gov/21058854/ . Cited 15 Apr 2024
pubmed: 21058854 doi: 10.1037/a0020726
Armon G, Melamed S, Toker S, Berliner S, Shapira I (2014) Joint effect of chronic medical illness and burnout on depressive symptoms among employed adults. Health Psychol 33(3):264–272. Available from https://pubmed.ncbi.nlm.nih.gov/23895204/ . Cited 15 Apr 2024
pubmed: 23895204 doi: 10.1037/a0033712
Armon G, Shirom A, Melamed S (2012) The big five personality factors as predictors of changes across time in burnout and its facets. J Pers 80(2):403–427. Available from https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-6494.2011.00731.x . Cited 15 Apr 2024
pubmed: 21449937 doi: 10.1111/j.1467-6494.2011.00731.x
Shoman Y, Hostettler R, Canu IG (2023) Psychometric validity of the Shirom-Melamed Burnout Measure and the burnout assessment tool: a systematic review. Archiv Indus Hygien Toxicol 74(4):238. Available from /pmc/articles/PMC10750325/. Cited 15 Apr 2024
doi: 10.2478/aiht-2023-74-3769
Shoman Y, May EE, Marca SC, Wild P, Bianchi R, Bugge MD et al (2021) Predictors of occupational burnout: a systematic review. Int J Environ Res Public Health 18(17). Available from https://pubmed.ncbi.nlm.nih.gov/34501782/ . Cited 16 Apr 2024
Redelinghuys K, Morgan B (2023) Psychometric properties of the burnout assessment tool across four countries. BMC Public Health 23(1):1–14. Available https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15604-z . Cited 1 Apr 2024
doi: 10.1186/s12889-023-15604-z
Carrière ME, Mokkink LB, Tyack Z, Westerman MJ, Pijpe A, Pleat J et al (2023) Development of the patient scale of the patient and observer scar assessment scale (POSAS) 3.0: a qualitative study. Qual Life Res 32(2):583–592. Available from https://pubmed.ncbi.nlm.nih.gov/36355319/ . Cited 15 Apr 2024
pubmed: 36355319 doi: 10.1007/s11136-022-03244-6
Draaijers LJ, Tempelman FRH, Botman YAM, Tuinebreijer WE, Middelkoop E, Kreis RW et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113(7):1960–1965. Available from https://pubmed.ncbi.nlm.nih.gov/15253184/ . Cited 18 Apr 2024
pubmed: 15253184 doi: 10.1097/01.PRS.0000122207.28773.56

Auteurs

Sabrina Figueiredo (S)

Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, 2600 Virginia Ave NW, Suite 300, Office 350, Washington, DC, 20037, USA. sfigueiredo@gwu.edu.

Jacques Arrieux (J)

Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, 2600 Virginia Ave NW, Suite 300, Office 350, Washington, DC, 20037, USA.

Samia Abdallah (S)

Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, 2600 Virginia Ave NW, Suite 300, Office 350, Washington, DC, 20037, USA.

Timothy C McCall (TC)

Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, 2600 Virginia Ave NW, Suite 300, Office 350, Washington, DC, 20037, USA.
National Association of County and City Health Officials, Washington, DC, USA.

Ulrich Koch (U)

Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, 2600 Virginia Ave NW, Suite 300, Office 350, Washington, DC, 20037, USA.

Eliezer Oliveira (E)

Children's National Hospital, Family Services, Washington, DC, USA.

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