Moving Forward with Systems of Care: Needs and New Directions

The articles in this Special Issue on system change within systems of care (SOCs) provide guidance regarding strategies for modifying SOCs to address the needs of different populations, and ways for changing systems to support more positive child and family outcomes. This paper frames central needs, unanswered questions, and issues that remain for those working to implement SOCs. Specific needs and new directions considered include: (1) rigorous implementation-focused research to identify the necessary and sufficient elements of SOCs and the primary practice approach currently used in SOCs, wraparound; (2) applied research to assess SOCs and document their effectiveness in non-standard or non-traditional settings (i.e., non-mental health settings, including child welfare, juvenile justice, local housing authorities); (3) controlled outcome studies for school-based wraparound initiatives; (4) research to document the effectiveness of the family support efforts that are part of most SOCs; and (5) attention to context, for families, service providers, and collaborative implementation efforts, by researchers and providers alike. Progress in these areas can inform well-targeted system change efforts in the context of SOCs, a critical need given changes in federal funding for these initiatives.     

Taking a Step Back,Moving Forward: Place and Space without Mental Representations

ABSTRACT

The publication of the revised edition of Place and Experience provides the occasion to discuss Malpas’ original account of place, and its role in a proper account of the central features of human minds. The first edition is a groundbreaking work on the embodiment and embeddedness of human minds, that prefigures more recent developments of a now established field of research on embodied minds: so-called E accounts. In this paper, I address three issues in Malpas’ book that I found problematic at times and unclear at others, and argue that E- accounts, or better, a particular rendering of them, can better dissolve. These interrelated issues are: 1. the use of the idea of mental representations to understand location and orientation; 2. the claim that non-human animals have ‘environments’ but lack ‘worlds’, 3. the use of two exclusive vocabularies, the physical and the mental, for describing cognition. I thus question such ideas, associated with traditional accounts of cognition, which not only are responsible for some of the gravest criticisms such accounts have received, but seem inadequate to Malpas’ characterization of minds as placed. My recommendation is to take a step back from the traditional framework, and allow ourselves to simply move forward.     

Depression Among Transgender Older Adults: General and Minority Stress

This study aims to (a) examine the direct and indirect effects internalized heterosexism, disclosure of gender identity, and perceived general stress in association with depression among transgender older adults; and (b) to assess the relative contribution of each relationship. Secondary analyses of data from a large community‐based study of older sexual and gender minorities were conducted utilizing structural equation modeling with a subsample (n = 174) of transgender adults aged 50 to 86‐years old. Disclosure of gender identity had no significant direct or indirect effects on either perceived general stress or depression. Internalized heterosexism did not have a direct effect on depression, but did have a significant indirect effect through perceived general stress. Finally, perceived general stress had an additional significant direct effect on depression, over and above internalized heterosexism. Total effect sizes appear to be considerable with standardized betas greater than 5.0. Perceived general stress and internalized heterosexism independently and cumulatively have significant direct and indirect effects on depression among transgender older adults. Implications for depression among transgender older adults and the role of community psychology are discussed.     

Object-based and egocentric mental rotation performance in older adults: The importance of gender differences and motor ability

In this study, mental rotation performance was assessed in both an object-based task, human figures and letters as stimuli, and in an egocentric-based task, a human figure as a stimulus, in 60 older persons between 60 and 71 years old (30 women, 30 men). Additionally all participants completed three motor tests measuring balance and mobility. The results show that the reaction time was slower for letters than for both human figure tasks and the mental rotation speed was faster over all for egocentric mental rotation tasks. Gender differences were found in the accuracy measurement, favoring males, and were independent of stimulus type, kind of transformation, and angular disparity. Furthermore, a regression analysis showed that the accuracy rate for object-based transformations with body stimuli could be predicted by gender and balance ability. This study showed that the mental rotation performance in older adults depends on stimulus type, kind of transformation, and gender and that performance partially relates to motor ability.     

Inward- and Outward-Directed Violence in the Lives of Urban Minority Adults Followed from Middle School into Their Thirties

This study explores connections between inward-directed violence and outward-directed violence using data from the Reach for Health sample, which was originally recruited in the 1990s from three middle schools in economically distressed, predominantly African American neighborhoods of New York City. Now in their thirties, participants (N = 595) completed surveys assessing current suicidal thoughts and behaviors as well as other violence involvements, including intimate partner violence victimization and perpetration. About 10% of males and females reported any suicidal ideation or attempt in the past 12 months. In logistic regression analyses adjusting for sociodemographics, prior reports of feeling blue in middle school (OR: 1.12, CI: 1.02–4.39) and young adult suicidality (OR: 2.54, CI: 1.30–4.95) are significantly related to later suicidality. So are concurrent aggressive behaviors, including reports of physical fighting outside the home (OR: 2.70, CI: 1.29–5.67) and IPV perpetration (OR: 2.09, CI: 1.11–3.94). Neither IPV victimization nor witnessing neighborhood violence is correlated. Findings shed light on the persistence of suicidality in the lives of those who come of age, and often remain, in communities with high levels of poverty, and confirm linkages of suicidality with externally directed aggression. Life-stage interventions are needed to counter the interwoven causes and consequences of multiple forms of violence.     

Susceptibility to retroactive interference: The effect of context as a function of age and cognition

Previous studies have shown that contextual cues improve memory performance and reduce interference in younger adults. However, it is not clear whether middle-aged and older adults can also benefit from contextual cues, or if this ability diminishes with ageing and cognitive decline. In order to test this question, we tested 69 middle-aged adults (aged 30–50 years) and 65 older adults (aged 65–85). Participants completed a retroactive interference paradigm with or without contextual cues. Cognitive functioning of older adults was assessed using the Montreal Cognitive Assessment, which is a sensitive and highly validated tool to detect cognitive decline in older age. The results showed that while middle-aged adults were able to benefit from context to improve recognition and reduce interference, older adults were not able to benefit from it. However, when we compared older adults with lower (<26) and higher (≥26) scores on the Montreal Cognitive Assessment, we found that older adults with high cognitive functioning could benefit from context advantage at retrieval to improve recognition compared to those with lower cognitive functioning. Yet, similar to older adults with lower cognitive functioning, they could not benefit from context advantage at encoding and hence were still susceptible to interference.     

Factors associated with perceived helpfulness and use of mental health websites by Australian young adults with a family history of mental illness

Young adults with a family history of mental illness may be vulnerable to develop mental health conditions based on genetic and environmental features. This study aimed to explore factors associated with the use of mental health websites for young adults aged 18–30 years who reported a family history of mental illness. Young adults (n = 469) who reported a family history of mental illness completed an online survey regarding their use of mental health websites, demographic questionnaires and the Depression, Anxiety and Stress Scales. In total, 194 (41%) participants reported using mental health websites, with the majority using these for their own mental well-being (n = 156; 33%). Having a previous history of a mental health condition was associated with mental health website use, along with having a prior history of drug use and having more than one family member diagnosed with a mental illness.     

Social anxiety in older adults: phenomenology, prevalence, and measurement

Although phobias represent the most common anxiety disorders among the elderly, little is known about their social nature. The present study provides information about the prevalence, measurement, and phenomenology of social anxiety in older adults (n = 283) and compares results to those of younger adults (n = 318). Analyses revealed that social anxiety is less prevalent in old age than it is within younger cohorts and is associated with different symptomatology. The psychopathological profile of those who reach clinical levels of social anxiety is however similar, irrespective of age. Results regarding the psychometric properties of the SPAI when used for the elderly were promising, but the questionnaire appears to be difficult for some older adults to complete. Results are discussed in terms of explanations for age differences in social anxiety, initial psychometrics of the SPAI in an older adult sample, and suggestions for future research.     

Experiences of older adults interacting with a shared autonomous vehicle and recommendations for future implementation

IntroductionA recognised potential benefit of autonomous vehicles is increased mobility for older adults. However, this group is more apprehensive about adoption, which may hinder uptake. Shared autonomous vehicles (SAVs) represent a use case that may be especially relevant for older people due to emerging applications in retirement villages and similar precincts. However, little research has examined the SAV-related concerns of older adults and strategies to address them. This study used an exploratory approach involving SAV exposure to identify strategies that may increase older people’s receptiveness to SAVs.MethodOlder adults living in retirement villages (n = 63) were interviewed while interacting with an SAV to examine their needs, expectations, and concerns regarding SAVs. The interview data were coded and thematically analysed.ResultsParticipants recommended the following approaches to ensuring SAVs are useful and acceptable to older adults: providing physical accessibility for those with mobility impairments, comfortable and practical internal layouts, and operating SAVs on convenient routes at useful speeds. Strategies such as exposing older adults to SAVs in operation to encourage uptake and initially ensuring a human assistant is present were suggested methods of increasing receptivity.DiscussionThe findings suggest older passengers are likely to share many of the same reactions to SAVs as the broader population, but with a stronger focus on issues relating to accessibility and the physical layout of the vehicles. The solutions to these issues suggested by the study participants may be useful for those designing SAVs for use in older people’s settings and beyond.     

Pastoral Counseling of Older Adults: Toward a Short-term Integrative Approach

A rapidly aging population with its mental health care needs presents an enormous challenge in the current mental health field. In light of this, pastoral counselors will have an increasingly important role to play in the care of older adults because of their strategic position in the community and their competence in dealing with religious/spiritual issues particularly salient in old age. This article proposes a short-term integrative approach to enable pastoral counselors to effectively and efficiently meet the mental health care needs of the elderly.

Military Enlistment Selection and Classification: Moving Forward

This article places the articles included in this special issue within the larger context of the objectives of a selection and classification system. It examines the full range of individual differences and how, until relatively recently, a focus on training success has led to an emphasis on the cognitive subset of these differences within the military. It describes how, consistent with a greater recognition of the importance of job performance, the research described in this issue has opened the door to expanded coverage of both cognitive and noncognitive attributes. It summarizes the methodological advances that have contributed to the efficacy of new noncognitive measures. It explores how popular approaches to the measurement of classification efficiency have led to unwarranted pessimism regarding the classification potential of multiattribute measures and discusses research indicating how much greater classification efficiency is possible with existing measures. Finally, it examines potentially fruitful areas of future research to better meet military objectives. These include development of an approach to performance measurement and validity transportation that makes future military classification research feasible; exploration of currently untapped individual-difference domains, particularly those that might differentially predict across job groupings; exploration of the interaction between cognitive and noncognitive attributes; and exploration of alternative measurement techniques.     

Competitive Memory Training for treating depression and rumination in depressed older adults: a randomized controlled trial

Although rumination is an important mediator of depressive symptoms, there is insufficient proof that an intervention that specifically targets rumination ameliorates the clinical condition of, depressed patients. This study investigates whether a time-limited cognitive behavioral intervention (Competitive Memory Training, or COMET for depressive rumination) is an effective treatment for depression and rumination. This intervention was tested in older adult depressed outpatients. A total of 93 patients (aged ≥65 years with major depression and suffering from rumination) were treated in small groups according to the COMET protocol in addition to their regular treatment. Patients were randomized to two treatment conditions: 7 weeks of COMET + treatment-as-usual (TAU) versus TAU only. COMET + TAU showed a significant improvement in depression and rumination compared with TAU alone. This study shows that the transdiagnostic COMET protocol for depressive rumination might also be successful in treating depression and rumination in older adults.     

The role of executive functioning in CBT: a pilot study with anxious older adults

Cognitive behavior therapy (CBT) is an effective treatment for late life anxiety and depression. The successful use of CBT is assumed to rely on cognitive skills known as executive functions (EF; e.g., hypothesis generation, allocation of attention, self-monitoring) governed by the prefrontal cortex. Because older adults sometimes have executive deficits as a consequence of normal aging, EF may be a mediator of CBT outcome in older samples. The current pilot study tested the hypothesis that older adults with executive deficits (as measured by neuropsychological tests) would show decreased therapeutic benefit from CBT for generalized anxiety disorder, as compared to a group with intact EF. Results indicated differential response to CBT within the dysfunction group depending on the stability (and possibly, the etiology) of executive deficits from pre- to posttreatment. Those whose EF scores remained low from pre- to posttreatment did not respond to CBT, while those whose scores improved responded quite well, similar to an Intact EF group. Results indicate that some, but not all, older adults with executive dysfunction show decreased benefit from CBT, and are consistent with the assumption that executive skills are important for the successful use of CBT. However, some participants may show improvement on both mood and cognitive skills during treatment, which is discussed further.     

Individually tailored internet-based cognitive behaviour therapy for older adults with anxiety and depression: a randomised controlled trial

Mixed anxiety and depression is common among older adults. The aim of the study was to compare the effects of an eight-week-long tailored internet-supported cognitive behaviour therapy (ICBT) programme and to compare against the provision of weekly general support. A second aim was to investigate if pre-treatment cognitive flexibility and self-reported cognitive problems would predict outcome. We included 66 older adults (aged over 60 years) with mixed anxiety/depression following media recruitment and randomised them into treatment and control groups. We also included a one-year follow-up. As a measure of executive function, we used the Wisconsin Card Sorting Test (perseverative errors) and the Cognitive Failures Questionnaire during the pre-treatment phase. Results showed a moderate between-group effect on the main outcome measure, the Beck Anxiety Inventory (BAI) (d= .50), favouring the treatment group. Nearly half (45.5%) of that group were classified as responders. One person (3%) in the treatment group deteriorated. There were significant correlations between perseverative errors and outcome (on the BAI r = ?.45), but not among self-reported cognitive function. We conclude that guided, tailored ICBT may be effective for some older adults and that the role of cognitive function needs to be investigated further.     

Personality traits and subjective health in the later years: The association between NEO-PI-R and SF-36 in advanced age is influenced by health status

This study examined the association between personality traits (as measured by the NEO-PI-R) and subjective ratings of mental and physical health (as measured by the SF-36) in two samples of older adults differing in health status (Baltimore Longitudinal Study of Aging, BLSA, n = 393, vs. Medicare Primary and Consumer-Directed Care Demonstration, Medicare PCC, n = 648). The association between personality traits and subjective mental health did not differ significantly across samples. The association between personality and subjective physical health, however, was significantly stronger in the healthy BLSA sample than in the medically challenged Medicare PCC sample. Differences in health conditions and recent hospitalizations partially accounted for this effect. Lifespan developmental considerations and implications for the use of subjective health ratings as outcome measures in clinical studies are discussed.     

The influence of face age on identification from a video line-up: A comparison between older and younger adults

A group of young-adult (aged 18–35 years) and older-adult witnesses (aged 61–83 years) viewed films of two similar staged thefts, one that depicted a young culprit and the other an older culprit. After a short delay of 40–60 minutes participants were presented with two separate video line-ups, one for each target. In one line-up the target was present (TP) and the other the target was absent (TA). Older adults performed more poorly in target present and absent line-ups, and showed no own-age bias, however young adults showed an own age advantage for the TA line-ups.     

Autobiographical memory and well-being in aging: The central role of semantic self-images

Higher levels of well-being are associated with longer life expectancies and better physical health. Previous studies suggest that processes involving the self and autobiographical memory are related to well-being, yet these relationships are poorly understood. The present study tested 32 older and 32 younger adults using scales measuring well-being and the affective valence of two types of autobiographical memory: episodic autobiographical memories and semantic self-images. Results showed that valence of semantic self-images, but not episodic autobiographical memories, was highly correlated with well-being, particularly in older adults. In contrast, well-being in older adults was unrelated to performance across a range of standardised memory tasks. These results highlight the role of semantic self-images in well-being, and have implications for the development of therapeutic interventions for well-being in aging.     

Moving European research on work and ageing forward: Overview and agenda

This longitudinal retrospective study shows that when the results of an organizational development intervention are fed back properly and action plans are made, factors associated with leadership and commitments to organization are enhanced. The study compared the effects of survey feedback, including the making of action plans and survey feedback without action plans, to the effects of no feedback at all on several psychosocial factors and sick leave over a 3-year period. The data were derived from 1236 individuals for whom baseline data were available and who completed a 3-year follow-up. Applied statistics revealed that the feedback action plan group reported greater improvements regarding leadership factors and commitment to the organization. The results reveal no differences between the feedback groups in regard to sick leave. There is a need for further studies, preferably with a randomized control design, on how to enhance both the psychosocial work environment and employee health and also how to reduce sick leave in the workplace.     

Contextual Design for driving: Developing a trip-planning tool for older adults

Independent living depends on mobility, and mobility depends on driving, particularly for people 65 years and older. The longer older adults can safely drive, the longer they can independently run errands, shop, exercise, and maintain social networks. Age-related decline of perceptual, motor, and cognitive abilities can undermine the mobility and driving safety of older drivers. Data from driving simulators, on-road tests, surveys, and crash reports describe the driving safety and mobility challenges of older adults, but these methods offer a limited view of these challenges and fail to indicate design solutions. Contextual Design—a combination of Contextual Inquiry interviews, model building, and affinity diagrams—offers a complementary approach to uncover challenges that older adult drivers’ experience. For two weeks, 39 drivers age 65 and above, had their vehicles instrumented to collect driving and video data. Applying Contextual Design to these data showed that older drivers in urban and rural settings faced different mobility challenges and adopted various strategies to mitigate risk: older drivers often involved their spouse or passenger in the driving task, avoided certain driving maneuvers such as left turns, avoided unfamiliar or poorly lit roads at night, and planned trips to avoid risky driving situations. Ridesharing and trip planning emerged as important strategies to improve the safety and mobility of older drivers. Ridesharing could serve as a potential solution to prolong mobility; however, factors such as wait time, scheduling conflicts, costs, and trust were concerns for older drivers. A paper prototype was developed to validate the driving challenges faced by older drivers, and guide the development of a customized web-based trip-planning tool. The trip-planning tool could help older drivers make safer route choices by offering routes with fewer driving challenges, thereby enhancing their driving safety, mobility, and independence.