Factors affecting behavioral health provider turnover in US Air Force primary care behavioral health services

Turnover and retention of integrated behavioral health practitioners in primary care is a significant challenge with limited empirical evidence to inform risk factors. This study used retrospective archival data from the Air Force Medical Service’s Behavioral Health Optimization Program on all civilian contractors hired from September 2012 to November 2014 to examine the potential influence of training background (e.g., social work v. psychology), size of healthcare facility, or the presence of on-site mentors. Turnover was evaluated across a large managed healthcare organization of 121 civilian contractors (psychologists and social workers) in 72 specific clinic settings. These sites varied considerably in regards to geographic location, population diversity, size of patient empanelment, rural, suburban, and urban settings and all provided care to active duty military, their civilian dependents and civilian retirees. Results found that 54% of all psychologists and social workers hired for these positions quit or were fired within 8 months of employment. Smaller medical facilities were found to have a more significant attrition rate compared to medium- and large-sized facilities; no other differences were noted. Findings provide initial insight into a potential critical period in the first year of a behavioral health consultants on-boarding, as well as unique considerations for consultants placed in smaller facilities who may be at elevated risk for attrition. These preliminary findings suggest targeted interventions for new integrated care programs as well as important avenues for future research.     

Linking level of care to level of need. Assessing the need for mental health care for nursing home residents

What are the mental health status and active treatment needs of nursing home residents? A stratified random sample of 828 residents in 25 facilities serving Medicaid recipients was assessed for levels of physical and psychosocial functioning. Although 91.2% had sufficiently high levels of medical and physical care needs to justify nursing home placement, 79.6% also had moderate to intense needs for mental health care. Older residents, relative to their younger counterparts, had more intense medical and mental health care needs. It was also found that psychiatric diagnosis was a poor indicator of mental health service needs, particularly among elderly individuals.     

The implications of death for health: a terror management health model for behavioral health promotion

This article introduces a terror management health model (TMHM). The model integrates disparate health and social psychology literatures to elucidate how the conscious and nonconscious awareness of death can influence the motivational orientation that is most operative in the context of health decisions. Three formal propositions are presented. Proposition 1 suggests that conscious thoughts about death can instigate health-oriented responses aimed at removing death-related thoughts from current focal attention. Proposition 2 suggests that the unconscious resonance of death-related cognition promotes self-oriented defenses directed toward maintaining, not one's health, but a sense of meaning and self-esteem. The last proposition suggests that confrontations with the physical body may undermine symbolic defenses and thus present a previously unrecognized barrier to health promotion activities. In the context of each proposition, moderators are proposed, research is reviewed, and implications for health promotion are discussed.     

Pastoral care in a trauma center

The pastoral staff of the Mercy Hospital of Pittsburgh, Pennsylvania, is a vital participant in the advanced trauma-care team. The staff of professionally certified chaplains take an active role in ministering to the unique temporal, psychological, and spiritual needs of both patients and patients' families. These professionals serve as hosts, counselors, confidants, and friends to people who have been suddenly thrown into chaos. The pastoral staff at a trauma center also ministers to the emotional and spiritual needs of the various medical and nursing staffs.     

The implementation and adoptability of behavioral skills training in a university career center

We evaluated the extent to which staff at a university career center (a) already used, (b) could be taught to use, and (c) might continue to use behavioral skills training (BST) when teaching interview answers to college students. We used a nonconcurrent multiple baseline design across three staff‐student dyads to assess the extent to which staff implemented BST and students provided appropriate answers before and after training. Results showed that interview training at the career center typically consisted of few BST steps, but staff could be taught on how to implement BST. All staff rated BST as an acceptable and effective form of interview training, but only one indicated that he or she was likely to adopt BST at the career center.     

A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children

A system of care for abused and neglected infants and young children should adopt a comprehensive perspective, with mental health considerations systematically incorporated into policies and decisions affecting children and their families. Children age birth to 5 years have disproportionately high rates of maltreatment, with long-term consequences for their mental and physical health. Research on normal development and developmental psychopathology has shown that early development unfolds in an ecology of transactional influences among biological, interpersonal, and environmental domains. Psychologists should collaborate with other early intervention disciplines to create systems of care based on an ecological-transactional model of development that includes early mental health principles in order to serve the needs of these young children. Didactic courses, practicums, and internships in infant and early childhood mental health should become integral components of undergraduate and graduate curricula in psychology in order to build capacity to achieve this goal. Recommendations are offered for systemic change by integrating infant and early childhood mental health principles into existing systems of care for young children and their families.     

The impact of stigma on behavioral health care utilization among active duty service members

This study assessed the relationship between the stigma of seeking psychological help and use of outpatient behavioral health services over a 2-year period among active duty military service members initially referred for neuropsychological evaluation secondary to their histories of mild traumatic brain injury. Although research has examined how stigma predicts proxies for help-seeking (i.e., attitudes towards/intentions to use services), very little research has looked at actual behavior, and studies that do have largely focused on previous use. In this study, we examined the relationship between participants’ stigma and subsequent behavioral health use. Our results indicated that whereas greater self-stigma (i.e., negative self-judgments for seeking psychological help) was associated with attending fewer behavioral health care sessions, public stigma (i.e., perceptions of public attitudes towards people who seek psychological help) was not associated with service use. These findings support the need for addressing the self-stigma associated with seeking behavioral health care.     

The modern mystic: a spirituality for health care workers

In this essay the author suggests that a deepening of one's spirituality may be the nurture that is required to remain fulfilled when working in the health care professions; and she illustrates this thesis by tracing a young chaplain's deepening spiritual journey in a Clinical Pastoral Education program. As the young aspiring chaplain attempts to minister to Joe, a dying farmer, he embarks on a path that leads to a religious experience. The essay concludes by listing eight criteria or guidelines that may help pastoral caregivers realize that they themselves may be nurtured by meeting the Holy in their caregiving acts.     

Individual differences in nostalgia proneness: The integrating role of the need to belong

Who is the nostalgia-prone person? The ‘sociality view’ sees an individual who frequently recalls meaningful memories rich in social content. The ‘maladaptation view’ sees an emotionally unstable, neurotic individual. In four studies, we integrated these contrasting views. We hypothesized that the link between neuroticism and nostalgia proneness arises because (a) neuroticism is associated with the need to belong and (b) the need to belong triggers nostalgia, with its abundant social content. Consistent with this hypothesis, Studies 1–2 found that the correlation between neuroticism and nostalgia proneness was eliminated when controlling for the need to belong. The need to belong predicted increased nostalgia proneness, above and beyond neuroticism. Specifically, Study 2 revealed that a deficit-reduction (rather than growth) belongingness orientation predicted increased nostalgia proneness. When the role of this deficit-reduction belongingness orientation was controlled, the positive correlation between neuroticism and nostalgia disappeared. Studies 3–4 showed that experimental inductions of a belongingness deficit augmented nostalgia, providing support for its compensatory role.     

Integrating mind and body: Graduate psychology education in primary behavioral health care

Extensive research supports the biopsychosocial model, but the current health care system generally operates according to a model of mind-body dualism. Integrated primary behavioral health care offers an alternative to this dualism. This paper describes the University of Louisville Graduate Psychology Education (GPE) program, a pre-doctoral integrated primary behavioral health care training program. This program emphasizes four shared psychosocial determinants that have been associated with physical health status: Victimization and potentially traumatic stress exposure, emotional functioning, social relationship functioning, and illness representations. It does so within the broader context of providing care for individuals who are underserved and economically disadvantaged. The initial phase of the program is evaluated and implications for graduate psychology education and patient care are discussed.     

Sex-typed play of toddlers in a day care center

By the age of 3, boys prefer gross motor and vehicle play and girls prefer doll and housekeeping play. The present study was an attempt to define the age at which these sex differences first appear by observing the play behavior of one- and two-year-olds in a day care center. We observed use of stereotyped toys in children 15 to 35 months old during free play. Boys played more with the masculine toys than with either of the other types, whereas girls showed almost equal use of all three types. Choice of sex-typed toys was more prevalent among older boys, while older girls showed less play with feminine toys than younger girls.     

Adolescent health. Challenges for behavioral scientists

Clearly, the role of behavioral scientists in adolescent health is not limited to service delivery. They also have a role to play via their contributions to basic knowledge of adolescent health and development, their involvement with the design and evaluation of health systems, their efforts to design and evaluate interventions to reduce adolescent morbidity and mortality, and their contributions to adolescent health policy. The once popular view of adolescence as a period of inevitable storm and stress has been replaced by one that emphasizes the potential of this developmental stage for constructive adaptation and maturation. Behavioral scientists have an important role to play in assuring that the potential of this life stage is reached for future generations of youth.