The current status of EHDI programs in the United States

The importance of identifying congenital hearing loss during the first few months of life has been recognized for almost 60 years. Unfortunately, until more effective newborn hearing screening equipment and procedures were developed in the late 1980s, it was not practical to implement programs for identifying hearing loss during the first few months of life. This paper reviews the activities implemented by the federal government in the last 15 years to promote more effective Early Hearing Detection and Intervention (EHDI) programs, and summarizes legislation passed by states related to universal newborn hearing screening. In surveys conducted in 1998 and 2001, State EHDI Coordinators were asked to rate the degree to which various issues were obstacles to implementing effective EHDI programs. The most serious obstacles are the shortage of qualified pediatric audiologists, inadequate reimbursement for screening and diagnosis, and lack of knowledge among primary health care providers about EHDI issues. Opposition to EHDI programs by hospital administrators was rated substantially lower in 2001 than in 1998. State EHDI Coordinators were also surveyed about how well their EHDI program is addressing issues related to screening, diagnosis, early intervention, linkages to medical home providers, tracking and data management, and family support programs. Although substantial progress has been made, many gaps remain with current EHDI programs.     

National evaluation of US newborn screening system components

Newborn screening has existed as a state-based public health service since the early 1960s. Every state and most territorial jurisdictions have comprehensive newborn screening programs in place, but in the United States a national newborn screening policy does not exist. This results in different administrative infrastructures, screening requirements, laboratory and follow-up services, medical management approaches, and related activities across the country. Federal initiatives and support have contributed to limited evaluations of various aspects of individual newborn screening programs at the national level, but funding is an issue. The national evaluation strategies have taken various forms, all with the intent of improving the screening system through review of actions taken and suggestions for future improvements. While participation in the national evaluation effort for newborn screening laboratory practices includes all US programs, and this has aided in improving quality and harmonizing protocols, other national evaluation activities have been only moderately successful. National data reporting of quality indicators for various program elements must be comprehensive and timely, and the elements must be universally accepted in order to meet the evaluation and improvement needs of the national newborn screening system. A comprehensive real time national evaluation activity will likely require additional resources and enforcement incentives. Limited federal actions through grant incentives and selected reporting requirements provide a possible means of stimulating programs to participate in national harmonization efforts.     

Screening as an approach for adolescent suicide prevention

Among the provisions of the recently signed Garrett Lee Smith Memorial Act, Congress called for the use of screening to detect adolescents who are at risk for suicide. After a review of the literature, 17 studies involving screening instruments and programs were identified. We addressed the question: What do we know about the demonstrated effectiveness and safety of screening as a tool or program to prevent suicide among adolescents? While youth suicide screening programs offer the promise of improving identification for those who need treatment the most, further research is essential to understand how, when, where, and for whom screening programs can be used effectively and efficiently.     

Predicting preschool screening referral rates from district demographic data

The ability of social, economic, and educational variables to predict screening referral rates among 398 school districts in a statewide preschool screening program was examined. First, salient demographic and educational variables were identified and reduced to five global factors by principal (common) factor analysis. Then, five factor scores and one additional variable (percentage of handicapped students) for each school district were evaluated as predictors of two screening outcomes. In Study 1 the screening outcome was membership in groups of screening programs with the lowest versus highest referral rates. In Study 2 the screening outcome was referral rates among the screening programs. The results from both studies indicated that screening referral rates were not related to broad social, economic, and educational factors in any simple way. Alternative explanations are discussed, as well as implications for research on factors that may influence the screening of preschoolers.     

Review of Interventions Designed to Address Drinking Among Soldiers

Heavy and abusive alcohol use is a major health problem facing military service members. We reviewed literature on alcohol intervention programs targeting military personnel to assess the methodological quality and effectiveness of the programs. Although the search yielded more than 42,000 citations, only 150 met initial screening criteria. Eighteen studies had sufficient evidence to meet secondary screening and of these only 10 studies were included in the review. These studies employed several types of interventions, but only 1 used a randomized controlled trial. Our findings indicate that there is greater need to assess intervention strategies, and there is a particular need for high-quality studies using randomized controlled trials with standardized assessment tools to improve the generalizability of the findings. We discuss the implications of our findings for future research in this area.     

Effects of Performance-Based Pay Systems on Quantity and Quality in Computer Programming

This experiment was conducted to investigate the effects of quality-contingent pay systems on quantity and quality. Three computer science students were paid to create simple computer programs across 25 sessions. A multiple-baseline across subjects design was used to compare the effects of three kinds of pay systems; pay-for-hour, pay-for-quantity, and pay-for-quality systems. The quantity was higher when pay was based on the quantity of the programs produced, and the quality was highest when pay was based on the quality of the programs. The production cost including quality inspection costs was highest when pay was based on the time worked.     

Substance use treatment programs in the active duty US military: A narrative review

Substance use disorders (SUDs) are a growing problem for the U.S. military. Each branch of the military has its own dedicated substance abuse treatment program. However, there has been limited attention to the research conducted on these programs. The purpose of this narrative review is to describe SUD treatment programs in the U.S. military and to review the extant research published between 2001–2015. Fourteen peer-reviewed articles, 2 official reports, 1 book chapter, 1 thesis, and 1 dissertation were identified. Most SUD treatment programs are nonconfidential, although a confidential program is being piloted by the Army. Recently, the programs have increased their focus on assessment and treatment of comorbid psychological disorders. Further research is required to examine the efficacy, effectiveness, and cost-effectiveness of the treatment programs.     

Evaluation of an islandwide screening,assessment and treatment program

This article reports on the effectiveness of the Islandwide Screening, Assessment, and Treatment Program of the Child Development Project in Bermuda. From 1982 to 1984, approximately 1100 families with 2-year-old children were screened for children's cognitive and language delay, for behaviour management problems and for other home characteristics that put children at risk for later school failure. Children who failed the screening and subsequent assessment procedures (of whom random samples received treatment) and samples of others who passed screening and assessment were evaluated from 1984 to 1986 at 4 years of age. This article focuses on the results of the cognitive and language programs; the more problematic behaviour management analyses were reported elsewhere (Miller and Scarr, 1988). The screening procedures and assessment measures developed for this project were themselves evaluated and adjusted to maximize efficiency and costeffectiveness. The screening and assessment procedures proved effective in bringing to the attention of the Child Development Project those families and children who need developmental services, and in not overidentifying normal children as potentially delayed in development. Two kinds of treatment services were compared: The Mother-Child Home Program (MCHP), administered by paraprofessional toy demonstrators, and other interventions tailored by professionals to the language and cognitive problems of the child (called ‘tailored programs’). Children who were not extremely delayed or disturbed were randomly assigned either to the MCHP or to a tailored program. Neither intervention program was preferable to the other. Even though improved, the 4-year-olds identified as developmentally delayed at 24 months still lagged behind children who passed all parts of screening and those who failed screening but passed assessment 2 years earlier. The screening and assessment procedures were very effective in the early identification of children with developmental problems, but the treatment programs failed to bring most children to normal levels of cognitive and language functioning.     

Family-strengthening approaches for the prevention of youth problem behaviors

Effective parenting is the most powerful way to reduce adolescent problem behaviors. Dissemination of research-based family interventions has been slow, with most practitioners still implementing ineffective programs. This article reviews 2 federal studies that involved national searches for effective family interventions targeting pre-birth to adolescence: Preventing Substance Abuse Among Children and Adolescents: Family-Centered Approaches (Center for Substance Abuse Prevention, 1998) and Strengthening America's Families (R. Alvarado, K. L. Kumpfer, K. Kendall, S. Beesley, & C. Lee-Cavaness, 2000). Results identified 3 effective prevention approaches, 13 principles of effectiveness, and 35 programs. Recommendations include increased dissemination research on training and technical assistance systems, adoption with fidelity and quality, and gender-, age-, and culturally sensitive adaptations.     

Systems change as an outcome and a process in the work of community collaboratives for health

The widespread development of comprehensive community initiatives that aim to improve community health is driven by the need to change the systems charged with delivering the services and creating the policies related to a variety of health outcomes. Georgia's Family Connection initiative is the nation's largest statewide network of community collaboratives for health, with collaboratives operating in 159 counties. Data on community context, collaborative processes, engagement in systems change, and changes in programs and activities implemented, gathered consistently at the collaborative level over 3 years, will be used to answer the following questions. How do community contexts and the structure and processes of collaboratives affect implementation of systems change? How do systems changes affect intermediate outcomes such as the type of programs offered in a community? Longitudinal change in systems change and program implementation is described and significant predictors of between‐collaborative variation in longitudinal change for each outcome are identified.     

Transportability of an empirically supported dissonance-based prevention program for eating disorders

This study sought to evaluate the degree to which positive effects remained when a well studied cognitive dissonance eating disorder prevention program was disseminated through a large national sorority under naturalistic conditions. All participants underwent a 2-session program run by peer facilitators. The sample included 182 undergraduate women from a local chapter of a national sorority at a large public university. Analyses revealed that the program significantly reduced body dissatisfaction, thin ideal internalization, dietary restraint, and the use of the media as a source of information about beauty, and restrained eating. Importantly, effect sizes were maintained at 5-months and 1-year follow-up. These findings demonstrate that empirically supported programs can remain effective when disseminated with careful training in large social systems.     

The Integration of a Family Systems Approach for Understanding Youth Obesity,Physical Activity,and Dietary Programs

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.     

Universal newborn screening and adverse medical outcomes: a historical note

Universal newborn screening programs for metabolic disorders are typically described as a triumph of medicine and public policy in the US over the last 50 years. Advances in science and technology, including the Human Genome Project, offer the opportunity to expand universal newborn screening programs to include many additional metabolic and genetic conditions. Although the benefits of such screening programs appear to outweigh their costs, some critics have claimed that historical examples of inadvertent harm ensuing from false-positive screening results and subsequent inappropriate medical treatment should make us wary of expanding universal newborn screening. In this essay, we report the results of a review of the published literature to assess whether the extension of screening from at risk populations to all newborns led to substantial morbidity and mortality from misguided medical treatment. We provide a historical overview of universal newborn screening programs in the United States, and then focus on six early NBS programs: congenital hypothyroidism, phenylketonuria, congenital adrenal hyperplasia, galactosemia, sickle cell disease, and maple syrup urine disease. Our comprehensive search of published sources did not reveal a widespread problem of harm ensuing from medical treatment of children with false positive screening test results.     

Enhancing Cognitive Functioning in Healthly Older Adults: a Systematic Review of the Clinical Significance of Commercially Available Computerized Cognitive Training in Preventing Cognitive Decline

Successfully assisting older adults to maintain or improve cognitive function, particularly when they are dealing with neurodegenerative disorders such as Alzheimer’s disease (AD), remains a major challenge. Cognitive training may stimulate neuroplasticity thereby increasing cognitive and brain reserve. Commercial brain training programs are computerized, readily-available, easy-to-administer and adaptive but often lack supportive data and their clinical validation literature has not been previously reviewed. Therefore, in this review, we report the characteristics of commercially available brain training programs, critically assess the number and quality of studies evaluating the empirical evidence of these programs for promoting brain health in healthy older adults, and discuss underlying causal mechanisms. We searched PubMed, Google Scholar and each program’s website for relevant studies reporting the effects of computerized cognitive training on cognitively healthy older adults. The evidence for each program was assessed via the number and quality (PEDro score) of studies, including Randomized Control Trials (RCTs). Programs with clinical studies were subsequently classified as possessing Level I, II or III evidence. Out of 18 identified programs, 7 programs were investigated in 26 studies including follow-ups. Two programs were identified as possessing Level I evidence, three programs demonstrated Level II evidence and an additional two programs demonstrated Level III evidence. Overall, studies showed generally high methodological quality (average PEDro score?=?7.05). Although caution must be taken regarding any potential bias due to selective reporting, current evidence supports that at least some commercially available computerized brain training products can assist in promoting healthy brain aging.     

Spiritual Need Four: Opportunities to Be Served and to Share with Others

SUMMARY

Older adults have unique opportunities to be served and to share with others through groups and individual relationships and programs in religious congregations. Where programs and senior centers with public funding can provide only for physical, emotional, and social needs, religious congregations can be more wholistic and provide for the spiritual needs as well. This chapter offers further discussion of planning that will facilitate program development for the whole person.     

Training school psychologists in neuropsychological assessment: Current practices and trends

Directors of school psychology programs at the Master's, sixth-year and doctoral levels were surveyed as to their program's degree of emphasis in neuropsychological screening and assessment. Despite variability according to program level, directors identified a need for training in these areas. This was particularly evident at the doctoral level, where greater flexibility exists in designing a student's program of studies. The results of this survey support the notion that training in neuropsychological screening and assessment techniques is appropriate in the preparation of specialists in the area of school psychology.     

Challenges to professional psychology education in the 21st century: response to Peterson

Professional psychology education faces many critical challenges brought about by the major changes occurring in the health care arena. This article shows that professional schools and programs have a good record of responding to these challenges and of taking proactive steps sponding to prepare their graduates for new health care roles and delivery systems. Data on admissions to psychology doctoral training programs demonstrate little support for the toral concerns raised by Donald R. Peterson (2003, this issue) about the preparation of students for graduate training in professional programs. Although quality concerns are important to investigate, such examination best resides with portant the American Psychological Association's Committee on Accreditation, which has the promotion of quality and excellence in professional psychology education and training as its major goal and responsibility.     

Experiences and Decisions that Motivate Women at Increased Risk of Breast Cancer to Participate in an Experimental Screening Program

Although the discovery of mutations on BRCA1 and BRCA2 genes associated with high breast cancer risk has given rise to screening and surveillance initiatives, there is little documentation on why high-risk women choose to enter screening programs. The objective of this qualitative study was to develop a detailed understanding of the experiences and decisions that motivate women with increased risk of hereditary breast cancer to participate in the multicentered Quebec experimental breast screening program. Our study involved 21 participants who were either BRCA carriers or at risk and untested. These women were interviewed while participating in the screening program. Our study demonstrates that intensive screening programs may provide valuable reassurance for women with increased familial risk of hereditary breast cancer, who count on early detection and rapid response from professionals if and when a problem arises. Health professionals must take these and others concerns into account to ensure their interventions are most consistent with women’s needs.     

How can We Reduce the Distress Associated with Health Screening? From Psychological Theory to Clinical Practice

Health screening involves the early identification of risk factors for disease or early‐stage disease. There is clear evidence of a health benefit following many screening programs. However, these programs may also contribute to significant psychological distress in a significant minority of vulnerable individuals. This paper considers the impact of screening in relation to breast cancer, focusing on assessment of genetic risk for breast cancer and mammography. It then reviews how these programs presently try to minimize any distress among participants before examining how health and clinical psychological theory can contribute to the development of new interventions, focusing on the use of cognitive challenge and teaching appropriate emotion‐focused coping strategies such as mindfulness and distraction. Future research developments are then addressed.     

A transactional systems model of autism services

There has been an escalation in the number of children identified with autism spectrum disorders in recent years. To increase the likelihood that treatments for these children are effective, interventions should be derived from sound theory and research evidence. Absent this supportive foundation, intervention programs could be inconsequential if not harmful. Although atypical, the development of children with autism should be considered initially from the perspective of the same variables that affect the development of typical children. In addition, the developmental deviations that characterize autism must be considered when developing intervention programs. Behavioral systems models describe both typical and atypical development and emphasize dynamic multidirectional person-environment transactions. The environment is viewed as having multiple levels, from the individuals with autism themselves, to larger societal and cultural levels. Behavioral systems models of human development can be generalized to a transactional systems model of services for children with autism. This model is the foundational theoretical position of the Southern Illinois University Center for Autism Spectrum Disorders. The center's programs are described to illustrate the application of the model to multiple levels of the social ecology.