Influences on Call Outcomes among Veteran Callers to the National Veterans Crisis Line

The association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls were examined. From October 1–7, 2010, 665 veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line; 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome (a resolution or a referral) when compared to an unfavorable outcome (no resolution or referral). A multivariable logistic regression was used to identify correlates of responder‐rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution, and 59% with a referral to a local health care provider. Calls from high‐risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high‐risk veteran callers. Responders appeared to use known risk and protective factors to determine caller risk.     

In-Home Family Services: Providing Lasting Results to Crisis Helpline Callers

Families oftentimes struggle with issues that seem too burdensome to bear alone. In an effort to alleviate this burden, Boys Town partnered with the Nebraska Region VI Office of Mental Health to provide in-home services to families calling the Nebraska Family Helpline. Results indicate that families experienced a significant reduction in stress and were able to remain intact. Follow-up data indicate that outcomes were maintained up to twelve months after case closure. This preliminary evidence suggests that this type of early intervention can have an impact on families not involved in public systems, but who are voluntarily asking for help.     

Practical Memory Concerns of Older Adults

We examine practical memory concerns in a sample of community-dwelling older adults. Participants responded to open-ended questions that were designed to solicit information regarding memory self-efficacy, memory management, memory remediation, and fears about memory aging in adulthood. Results indicated that (a) important dates, such as birthdays and anniversaries, were easily remembered, but names were not; (b) external memory aids were used most frequently; (c) a desire to improve memory for names and certain types of verbal information was expressed; and (d) loss of independence emerged as a fear associated with memory aging. Implications of these findings for the design of strategies to improve everyday memory performance and clinical memory management in older adults are discussed.     

Characteristics of Telephone Crisis Hotline Callers with Suicidal Ideation in Japan

Hotline callers do not always have suicidal ideation and previous studies have noted that the rate of such callers is limited. Crisis hotline counselors must be able to identify high‐risk callers in order to provide appropriate support. This study investigated the characteristics of Japanese crisis hotline callers in 2012 (N = 541,694) and is the first to analyze crisis hotline data for all parts of Japan over 1 year. About 14% of the callers had suicidal ideation and 6% had a history of attempted suicide. The odds ratio for suicidal ideation among those with a history of attempted suicide was 15.5. The suicidal ideation rate was much smaller compared to previous studies in other countries. There is a psychological barrier that must be broken for high‐risk people to use support hotlines. In addition, attempted suicide is a strong exclusive predisposing factor for death due to suicide; therefore, counselors should pay careful attention to callers with a history of attempted suicide. The characteristics of Japanese crisis hotline callers and the features of suicidal ideation revealed in the present study are expected to be useful in developing telephone crisis hotline strategies.     

Delivered as Described: A Successful Case of Cognitive Processing Therapy With an Older Woman Veteran With PTSD

Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran’s response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.     

Developing and Testing Crisis Line Facilitation to Encourage Help Seeking in Adults Receiving Inpatient Treatment for a Suicidal Crisis

Military veterans are at overall greater risk of suicide than nonveterans and have experienced increases in rates of suicide that are on par with or exceed those of the general population. The Department of Veterans Affairs has undertaken several initiatives to reduce suicide among veterans, including the development and expansion of the Veterans Crisis Line (VCL). The VCL has the potential to reduce suicidal behaviors, but it is likely underutilized by high-risk veterans. This paper describes the development of Crisis Line Facilitation (CLF) a brief intervention, designed to increase use of the VCL in this high-risk population. In a single session, CLF presents psychoeducational information about the VCL, discusses the participant’s perceived barriers and facilitators to future use of the VCL, and culminates in the veteran calling the VCL with the therapist to provide firsthand experiences that may counter negative impressions of the line. The intervention development process, intervention and control condition, and self-reported change indices are presented. Preliminary results (N = 301) suggest that veterans receiving CLF may experience a significant increase in comfort with, and confidence in, using the VCL during future crises compared to those in the control condition.     

Measuring Associations of the Department of Veterans Affairs' Suicide Prevention Campaign on the Use of Crisis Support Services

Campaigns have become popular in public health approaches to suicide prevention; however, limited empirical investigation of their impact on behavior has been conducted. To address this gap, utilization patterns of crisis support services associated with the Department of Veterans Affairs' Veterans Crisis Line (VCL) suicide prevention campaign were examined. Daily call data for the National Suicide Prevention Lifeline, VCL, and 1‐800‐SUICIDE were modeled using a novel semi‐varying coefficient method. Analyses reveal significant increases in call volume to both targeted and broad resources during the campaign. Findings underscore the need for further research to refine measurement of the effects of these suicide prevention efforts.     

Mental health of the bisexual Veteran

Despite evidence showing that bisexual individuals may be at greater risk for mental health issues than lesbian and gay individuals, they are often combined into a single group, with lesbian and gay individuals the actual focus of the research. This study aims to address this gap in the literature among US Veterans. Using data collected from a multicity purposive sample (N = 4,493), logistic regression was used to analyze whether the following groups differ in current posttraumatic stress disorder (PTSD) and depression: (a) bisexual (n = 101) vs. heterosexual Veterans (n = 4,271); (b) bisexual vs. lesbian/gay Veterans (n = 121); (c) lesbian/gay vs. heterosexual Veterans; and (d) combined group of lesbian, gay, and bisexual (LGB; n = 222) vs. heterosexual Veterans. Controlling for significant covariates, bisexual Veterans had 2.5 times the risk of severe depression (95% confidence interval [CI] = 1.34–4.67; p = 0.004) and 2.3 times the odds of PTSD (95% CI = 1.40–3.77; p = 0.001) relative to heterosexual Veterans. Bisexual Veterans had 3 times the risk of severe depression (95% CI = 1.22–7.44; p = 0.017) and 1.9 times the risk of PTSD (95% CI = 1.02–3.70; p = 0.045) compared to lesbian/gay Veterans. Lesbian/gay Veterans had no significant difference in risk for depression compared to heterosexual Veterans. However, the combined group of LGB Veterans had 1.6 times the odds of PTSD (95% CI = 1.12–2.15; p = 0.008) compared to heterosexual Veterans. These findings suggest that past research showing mental health disparities between LGB and heterosexual individuals may be driven by the inclusion of bisexual individuals. Research should assess bisexual individuals as a distinct group, and future studies should explore factors leading to depression and PTSD among bisexual Veterans.     

Helping Callers to the National Suicide Prevention Lifeline Who Are at Imminent Risk of Suicide: The Importance of Active Engagement,Active Rescue,and Collaboration Between Crisis and Emergency Services

In 2012, the SAMHSA‐funded National Suicide Prevention Lifeline (Lifeline) completed implementation of the first national Policy for Helping Callers at Imminent Risk of Suicide across its network of crisis centers. The policy sought to: (1) provide a clear definition of imminent risk; (2) reflect the state of evidence, field experience, and promising practices related to reducing imminent risk through hotline interventions; and (3) provide a uniform policy and approach that could be applied across crisis center settings. The resulting policy established three essential principles: active engagement, active rescue, and collaboration between crisis and emergency services. A sample of the research and rationale that underpinned the development of this policy is provided here. In addition, policy implementation, challenges and successes, and implications for interventions to help Lifeline callers at imminent risk of suicide are detailed.     

Mental Health Concerns of Older Adults Living in Long-Term Care Facilities: An Area of Expansion for MFTs

As baby boomers reach retirement age, the number of older adults living in long-term care will inevitably increase. Living in long-term care often brings psychological, relational, and emotional challenges for older adults, their families, and professional care-providers. Despite these trends and associated challenges, there appears to be an underrepresentation of attention addressing the mental health care of older adults and their families in marriage and family therapy (MFT) literature. Emphasis needs to be turned to assessing the quality and effectiveness of mental health resources for older adults in residential facilities, and to filling the gap where needed services are unavailable. The current review summarizes research addressing residential care for older adults, detailing a) mental health challenges faced by residents, families, and professional care-providers, b) effective mental health treatment options, and c) how MFTs are uniquely suited to working in long-term care settings.     

Workplace Perceptions of Veterans and Nonveterans in the Department of Veterans Affairs

Much has been written about veterans and their reintegration into civilian society, but little or no information is available about veterans’ workplace perceptions and how these might differ from those of nonveterans. The authors compared veterans’ and nonveterans’ attitudes about work (including job satisfaction aspects, perceptions of coworker interactions, supervisory support, and others) in the U.S. Department of Veterans Affairs (VA) based on responses to the organizational census, VA All Employee Survey (AES; N = 179,271). Based on differences in crude (unadjusted, but controlling for location) item odds ratios (range 0.65–1.08), compared to nonveterans, veterans scored modestly lower on most AES items. The authors show how controlling for demographics changes the relative size and, in some cases, the direction of the differences. This current study is 1 of only 2, to our knowledge, large-scale assessments of veterans’ workplace perceptions and the only 1 which controlled the results for demographic characteristics.     

Follow‐up with Callers to the National Suicide Prevention Lifeline: Evaluation of Callers’ Perceptions of Care

Continuity of care for suicidal individuals engaged with a variety of health and mental health care systems has become a national priority, and crisis hotlines are increasingly playing a part in the risk management and continuum of care for these individuals. The current study evaluated a national initiative to have crisis centers in the National Suicide Prevention Lifeline network provide follow‐up care to suicidal callers. Data were obtained from 550 callers followed by 41 crisis counselors from 6 centers. Two main data sources provided the information for the current study: a self‐report counselor questionnaire on the follow‐up activities completed on each clinical follow‐up call and a telephone interview with follow‐up clients, providing data on their perceptions of the follow‐up intervention's effectiveness. The majority of interviewed follow‐up clients reported that the intervention stopped them from killing themselves (79.6%) and kept them safe (90.6%). Counselor activities, such as discussing distractors, social contacts to call for help, and reasons for dying, and individual factors, such as baseline suicide risk, were associated with callers’ perceptions of the impact of the intervention on their suicide risk. Our findings provide evidence that follow‐up calls to suicidal individuals can reduce the perceived risk of future suicidal behavior.     

Pragmatic Concerns and Images of the World

I defend a pragmatist reinterpretation of Sellars’s famous manifest-scientific distinction. I claim that in order to do justice to this important distinction we must first recognize, despite what philosophers—including, arguably, Sellars—often make of it, that the distinction does not draw an epistemological or metaphysical boundary between different kinds of objects and events, but a pragmatic boundary between different ways in which we interact with objects and events. Put differently, I argue that the manifest-scientific distinction, in my view, can be best understood, not as a metaphysical distinction between apparent and real objects and events, or an epistemological distinction between perceptible and imperceptible objects and events, but rather as a distinction, which is not necessarily rigid over time, between distinct ways in which we collectively deal, in practice, with objects and events.     

伦理的视阈:从金融危机看"经济人"的偏执及其危机

金融危机背后所隐藏的是"经济人"的偏执及其危机,它的突出表现是工具理性的无限扩张和对"自由"的扭曲与滥用、对信用的漠视和践踏.新自由主义的市场意识形态及其极端数理化的倾向,是金融危机的始作俑者.它极大地增强了这种危机的严重性,同时也启示人们:人的发展才是经济发展和经济学研究的最高价值,为此,必须建立和发展一种新的经济价值观,强化制度伦理的建设.     

An Investigation of Teachers' Concerns About Vocabulary and the Representation of These Concerns in Content Literacy Methodology Textbooks

The purpose of this study was twofold: to (a) find out what questions currently practicing middle grade teachers have about vocabulary instruction and (b) determine what current undergraduate content area textbooks include that provide answers to these vocabulary questions. As researchers and practitioners directly responsible for teaching preservice middle grades teachers, this was a beginning step in examining whether our own teacher preparation programs are meeting the needs of new teachers as they encounter the demands of teaching vocabulary in their content areas. Teacher concerns about vocabulary instruction were determined by a survey instrument administered to 390 middle school teachers to ascertain questions they have about teaching vocabulary. A content analysis of the three leading content area textbooks was then undertaken to determine to what degree the top five concerns of middle grades teachers were addressed in these texts. Though direct information on how to teach vocabulary was provided, the researchers found that twice as much information was presented indirectly, embedded under subheadings where it was mentioned. In other words, only half the time did the texts explain how to teach the principles advocated.     

Connecting Veterans at Risk for Suicide to Care Through the HOME Program

The Home‐Based Mental Health Evaluation (HOME) program, which engages veterans in care following psychiatric hospitalization, was evaluated. Thirty‐four veterans who participated in the HOME program were compared to 34 veterans from a matched archival control group on treatment engagement and implementation outcomes. Veterans who participated in the HOME program were significantly more likely to engage in care, engaged in care more quickly, and attended significantly more individual mental health appointments. Veterans reported high levels of satisfaction. Results suggest that the HOME program is effective at engaging veterans in care during the high‐risk period of time following psychiatric hospitalization.     

Addressing the Mental Health Concerns of International Students

International students on the American college campus are a diverse and increasing population whose unique concerns are traditionally overlooked. However, given the evidence that the demands for cultural adjustments frequently place international students at greater risk for various psychological problems than are students in general, it is important that sufficient and readily accessible mental health services be established for them. This article examines the sources of international students' psychological concerns, the reasons for their notable underutilization of existing counseling services, and the ways to provide more culturally sensitive services.