Getting “SMART” about implementing multi-tiered systems of support to promote school mental health

With the growing adoption and implementation of multi-tiered systems of support (MTSS) in school settings, there is increasing need for rigorous evaluations of adaptive-sequential interventions. That is, MTSS specify universal, selected, and indicated interventions to be delivered at each tier of support, yet few investigations have empirically examined the continuum of supports that are provided to students both within and across tiers. This need is compounded by a variety of prevention approaches that have been developed with distinct theoretical foundations (e.g., Positive Behavioral Interventions and Supports, Social-Emotional Learning) that are available within and across tiers. As evidence-based interventions continue to flourish, school-based practitioners greatly need evaluations regarding optimal treatment sequencing. To this end, we describe adaptive treatment strategies as a natural fit within the MTSS framework. Specifically, sequential multiple assignment randomized trials (SMART) offer a promising empirical approach to rigorously develop and compare adaptive treatment regimens within this framework.     

The importance of prudent negative consequences for maintaining the appropriate behavior of hyperactive students

Teachers use both positive and negative consequences to influence classroom behaviors. Four experiments were conducted to examine the differential affects of these two types of consequences on the maintenance of appropriate behaviors of hyperactive children. Results of Experiment 1 showed that the use of both positive and negative consequences (combined) was associated with high levels of on-task behaviors. Withdrawal of negative consequences caused a significant and dramatic decrease in on-task performance. The withdrawal of positive consequences produced no change in the rate of on-task behaviors. In Experiments 2, 3, and 4, the on-task results of Experiment 1 were replicated using a different teacher, different children, a counterbalanced design, longer phases, and different types of negative consequences. The withdrawal of negative consequences led to decreases in productivity in Experiment 2. The results of Experiment 3 also suggested that a prudent (e.g., calm, concrete, and consistent) approach to discipline was more effective than an imprudent (e.g., loud, emotional, and inconsistent) approach. Some level of mild negative consequences for inappropriate behavior is an important ingredient in effective classroom management, and qualitatively different negative consequences may have drastically different effects on the behavior of hyperactive students.This research was supported in part by a grant from the Middle Country Central School District No. 11, Centereach, New York, to the second author. We are grateful for the district's continued support. In addition, the authors wish to thank K. Daniel O' Leary for his helpful editorial comments.     

Raising argument strength using negative evidence: a constraint on models of induction

Both intuitively, and according to similarity-based theories of induction, relevant evidence raises argument strength when it is positive and lowers it when it is negative. In three experiments, we tested the hypothesis that argument strength can actually increase when negative evidence is introduced. Two kinds of argument were compared through forced choice or sequential evaluation: single positive arguments (e.g., “Shostakovich’s music causes alpha waves in the brain; therefore, Bach’s music causes alpha waves in the brain”) and double mixed arguments (e.g., “Shostakovich’s music causes alpha waves in the brain, X’s music DOES NOT; therefore, Bach’s music causes alpha waves in the brain”). Negative evidence in the second premise lowered credence when it applied to an item X from the same subcategory (e.g., Haydn) and raised it when it applied to a different subcategory (e.g., AC/DC). The results constitute a new constraint on models of induction.     

The Role of Social Toxicity in Responses to a Slowly-Evolving Environmental Disaster: The Case of Amphibole Asbestos Exposure in Libby,Montana, USA

Experiencing a disaster has significant negative effects on psychological adjustment. Case study accounts point to two consistent trends in slowly-evolving environmental disasters: (a) patterns of negative social dynamics, and (b) relatively worse psychological outcomes than in natural disasters. Researchers have begun to explicitly postulate that the social consequences of slowly-evolving environmental disasters (e.g., community conflict) have their own effects on victims’ psychological outcomes. This study tested a model of the relationship between those social consequences and psychological adjustment of victims of a slowly-evolving environmental disaster, specifically those whose health has been compromised by the amphibole asbestos disaster in Libby, MT. Results indicate that experiencing greater community conflict about the disaster was associated with greater family conflict about the disaster which, in turn, was associated with greater social constraints on talking with others about their disease, both directly and indirectly through experiencing stigmatization. Experiencing greater social constraints was associated with worse psychological adjustment, both directly and indirectly through failed social support. Findings have implications for understanding pathways by which social responses create negative effects on mental health in slowly-evolving environmental disasters. These pathways suggest points for prevention and response (e.g., social support, stigmatization of victims) for communities experiencing slowly-evolving environmental disasters.     

So many options,so little control: Abstract representations can reduce selection demands to increase children’s self-directed flexibility

Children often struggle to behave flexibly when they must use self-directed goals (e.g., doing homework without prompting) rather than externally driven goals (e.g., cleaning up when told). Such struggles may reflect the demands of selecting among many potential options, as required for self-directed control. The current study tested whether (a) 6-year-old children show difficulty in selecting among competing semantic representations, (b) providing category labels designed to reduce selection demands improves performance, and (c) such benefits transfer to self-directed flexibility. Selection was measured using the blocked cyclic naming task for the first time with children. Pictures were named repeatedly in either homogeneous blocks from the same category (e.g., all animals), which create high selection demands due to spreading semantic activation and engage effortful cognitive control, or mixed blocks with each picture from a different category. Children showed robust difficulty in selecting among options, as indexed by response time (RT) differences between homogeneous and mixed blocks. Providing subcategory labels designed to reduce selection demands by distinguishing among same-category items (e.g., “A cow is a farm animal. A cat is a pet.”) improved selection. Providing superordinate categories (e.g., “A cow is an animal. A cat is an animal.”) also improved selection, but these benefits were less robust, and subcategory labels led to greater benefits than superordinate category labels on a subsequent verbal fluency task. These results support a role for subcategory representations in reducing selection demands to aid self-directed flexibility while suggesting that some children may use superordinate category labels to activate subcategory representations on their own.     

The Effects of Electronic Word of Mouth on Product Judgment and Choice: The Moderating Role of the Sense of Virtual Community1

Electronic word‐of‐mouth (WOM) communication influences potential consumer attitudes and behavioral intentions toward a product. Since consumers frequently assess online information based on their relationships with communities, rather than with individuals, online communities themselves function as referents for assessing information quality. This study examines whether consumer perceptions toward virtual communities (i.e., sense of virtual community or SOVC) moderate the perceived influence of product comments on attitude and purchase intention. This study manipulated 2 scenarios involving positive comments and negative comments regarding a newly issued game product. Analytical results indicated that SOVC reinforced the influences of online comments on attitude and purchase intention. Thus, marketers should consider the role of virtual communities when implementing WOM strategy online.     

Implementation Matters: A Review of Research on the Influence of Implementation on Program Outcomes and the Factors Affecting Implementation

The first purpose of this review was to assess the impact of implementation on program outcomes, and the second purpose was to identify factors affecting the implementation process. Results from over quantitative 500 studies offered strong empirical support to the conclusion that the level of implementation affects the outcomes obtained in promotion and prevention programs. Findings from 81 additional reports indicate there are at least 23 contextual factors that influence implementation. The implementation process is affected by variables related to communities, providers and innovations, and aspects of the prevention delivery system (i.e., organizational functioning) and the prevention support system (i.e., training and technical assistance). The collection of implementation data is an essential feature of program evaluations, and more information is needed on which and how various factors influence implementation in different community settings.     

Pragmatic Screening of Anxiety,Depression, Suicidal Ideation,and Substance Misuse in Older Adults

Older adults’ mental health needs are often unmet across care settings (e.g., primary or residential care) for a variety of reasons, such as mental health stigma and mental health care professionals’ lack of awareness of age-related changes in mental disorders. Screening, when coupled with access to evidence-based interventions, is effective at identifying and reducing anxiety, depression, suicidal ideation, and substance misuse in older adults across care settings. Unfortunately, due to lack of training many mental health care professionals may be unsure about what or how to screen, as well as which screening measures are available for use with older adults. Following professional guidelines recommended for older adults, we provide an overview of screening measures for anxiety, depression, suicidal ideation, and substance misuse that are evidence-based and meet pragmatic criteria identified by stakeholder research. Specific pragmatic criteria include screening measures developed with older adults (unless unavailable) as well as brief in length (items ≤30), time for administration (≤15 minutes), scoring (<5 minutes), and interpretation (<5 minutes). Other pragmatic criteria include screening measures readily available on the internet at no cost and usable across diverse settings (e.g., community, primary care, and/or residential care). For each measure, we also review relevant psychometric properties (e.g., reliability, cut-scores, sensitivity, specificity, and construct validity). Lastly, we discuss strategies to facilitate screening with older adults and direct mental health care providers to internet resources that can be used to learn more about assessment with older adults.     

Economic Impact of the Statewide Implementation of an Evidence-Based Treatment: Multisystemic Therapy in New Mexico

Several states have made considerable investments into large-scale implementation of evidence-based treatments (EBTs), yet little is known about key success indicators for these implementation efforts such as cost and sustainability. To that end, the present study examined the economic impact of statewide implementation of multisystemic therapy (MST; Henggeler, Schoenwald, Borduin, Rowland, & Cuningham, 2009), a family- and community-based behavioral EBT for serious juvenile offenders in New Mexico. Participants were 1,869 youth who received MST across 23 teams during the study period. We conducted a cost-benefit analysis using metrics from state data sources that compared the cost of MST to its benefits (i.e., avoided expenses from pre- to posttreatment) in two domains: (a) behavioral health services (i.e., Medicaid claims) and (b) juvenile crime (i.e., taxpayer expenses, tangible and intangible expenses to crime victims). MST costs were based on Medicaid claims, which were reimbursed at an enhanced billing rate that was intended to cover expenses for both clinical and implementation (e.g., training, quality assurance) activities. Results suggest that implementation of MST in New Mexico over the 7-year study period may have produced net benefits, through 2 years posttreatment, of more than $4,643 per youth in avoided behavioral health claims and $15,019 per youth through reductions in juvenile crime. Stated differently, every dollar that New Mexico spent on MST appeared to have returned $3.34 for a total benefit of $64.2 million over the course of the study. We discuss implications of these findings for policymakers, administrators, and researchers who are interested in increasing the sustainability of complex EBTs in community settings.     

Subjective past, present, and future fit: effects on anxiety depression, and other indicators of well-being

Hypotheses were tested regarding the effects of subjective current, retrospected, and anticipated person-environment fit on affective and somatic strain and well-being. Two-hundred seven university students preparing for annual academic examinations at an Indian university completed self-administered questionnaires measuring parameters of the hypotheses. A distinction was made between cognitive (e.g., meeting demands for intelligence, good memory) and motivational (e.g., being able to muster the effort) fit. Cognitive poor fit had a greater effect on predicting high levels of strain across all time frames but did best in the past and current frames. Motivational poor fit had its greatest effect on strain when poor fit dealt with anticipated or current fit. These findings are discussed in terms of hypotheses, which suggest that the more subjectively uncontrollable a dimension of fit, the more salient it is in the past time frame, whereas the more subjectively controllable the dimension, the more salient it is in the future time frame.     

Argumentation Analytics for Treatment Deliberations in Multimorbidity Cases: An Introduction to Two Artificial Intelligence Approaches

Multimorbidity, the presence of multiple health conditions that must be addressed, is a particularly difficult situation in patient management raising issues such as the use of multiple drugs and drug-disease interactions. Clinical Guidelines are evidence-based statements which provide recommendations for specific health conditions but are unfit for the management of multiple co-occurring health situations. To leverage these evidence-based documents, it becomes necessary to combine them. In this paper, using a case example, we explore the use of argumentation schemes to reason and combine evidence-based recommendations from clinical guidelines, expected effects, conflicts stemming from said recommendations, and preferences regarding treatment goals. We compare the results of reasoning using the schemes for practical reasoning and argument from negative consequences in the Carneades Argumentation System with those of ASPIC-G, an extension of the artificial intelligence system ASPIC+.

     

Television Situation Comedies: Female Weight,Male Negative Comments,and Audience Reactions

A content analysis of 18 prime-time television situation comedies (two episodes each) examined the body weights of 37 central female characters (92% White, 8% Black), the negative comments they received from male characters about their weight or bodies, and the audience reactions (e.g., laughter) following the negative comments. It was found that (a) below-average weight females were overrepresented in the programs, (b) the heavier the female character, the significantly more negative comments were made about or to her, and (c) negative comments were significantly associated with audience reactions. These results indicate that situation comedies present males making derogatory remarks about heavier women's weights and bodies, with this behavior being reinforced by audience laughter. This combination of thinness modeling and vicarious reinforcement likely contributes to the internalization of gender and weight stereotypes which deleteriously affect the health of female adolescents.     

The Dynamic Relationships of Work Affect and Job Satisfaction with Perceptions of Fit

This study assessed the longitudinal relationship between perceived fit (i.e., person–organization fit, person–job fit) and affect‐based variables (i.e., job satisfaction, negative affect, positive affect) using momentary (i.e., within‐person level) and stable (i.e., between‐person level) assessments of both sets of variables. In doing so, we tested 3 theoretical models of the perceived fit and work affect relationship (i.e., fit preceding affect; affect preceding fit; reciprocal fit–affect relations) to determine (a) the antecedents and consequences of fit perceptions, (b) whether fit perceptions exhibit meaningful within‐person variability, and (c) if direct fit perceptions are simply the result of affect/job satisfaction at work or can influence such work experiences. In addition, we examined whether the relationships between affect/job satisfaction and fit perceptions were homologous (i.e., similar) across the 2 levels of analysis (i.e., within‐person and between‐person). Results indicated that fit primarily preceded affect and job satisfaction at both levels of analysis, though some specific relationships exhibited reciprocal causality and others supported affect as an antecedent of fit perceptions. Our findings paint a complex picture of the causal relationship between perceived fit and work affect.     

Automatic vigilance: the attention-grabbing power of approach- and avoidance-related social information

The automatic processing of information was investigated, varying valence (positive vs. negative) and relevance (other-relevant traits [ORT] vs. possessor-relevant traits [PRT]; G. Peeters, 1983) of stimuli. ORTs denote unconditionally positive or negative consequences for persons in the social environment of the holder of the trait (e.g., honest, brutal) whereas PRTs denote unconditionally positive or negative consequences for the trait holder (e.g., happy, depressive). In 2 experiments using the Stroop paradigm, larger interference effects were found for ORTs than PRTs. This is due to the behavior-relatedness of ORTs. In a go/no-go lexical decision task (Experiment 3), participants either had to withdraw their finger from a pressed key (i.e., "avoid") or had to press a key (i.e., "approach") if a word was presented. Responses to negative ORTs were relatively faster in the withdraw condition, whereas positive ORTs were relatively faster in the press condition.     

Using a Learning Collaborative Model to Disseminate Cognitive Processing Therapy to Community-Based Agencies

Although effective treatments for posttraumatic stress disorder exist, their use in community settings is disappointingly low. Training alone does not necessarily lead to adoption. To address this problem, we trained community clinicians in cognitive processing therapy, an evidence-based treatment for posttraumatic stress disorder, using a Learning Collaborative, an intensive training methodology focused on both clinical training and developing sustainability. Sixty clinicians within 18 agencies began the year-long, team-based Learning Collaborative. Clinicians attended three in-person Learning Sessions, received weekly consultation, and submitted audio-recorded sessions to be rated for fidelity. Clinicians were rostered as approved treatment providers if they completed all training requirements. Additionally, we engaged leadership from each agency to build a sustainable practice. Clinicians trained through the Learning Collaborative demonstrated a high degree of fidelity to the treatment (average competence ratings “satisfactory” to “good”), and most (68%) were rostered as approved treatment providers. Patients treated by clinician trainees exhibited significant symptom reductions (d = 1.68 and 1.28 for posttraumatic stress and depression symptoms, respectively, among treatment completers). At a 6-month follow-up, 95% of rostered clinicians and 100% of agencies with rostered clinicians were still providing the treatment. These results suggest that the Learning Collaborative model is a promising approach for the dissemination and implementation of evidence-based treatments for adult posttraumatic stress disorder.     

The Role of Professional Training Experiences and Manualized Programs in ABA Providers’ Use of Parent Training With Children With Autism

Parent training, in which providers teach parents intervention strategies to promote their children’s skill acquisition and/or behavior management, is considered a best practice in the treatment for children with autism spectrum disorder (ASD) and yet is underutilized in community settings. The present study examined the role of training experiences and manual use in promoting the use of parent training by community providers who serve children with ASD. Applied behavior analysis (ABA) providers (N = 1,089) from across the United States completed self-report questionnaires online. The total number of professional training experiences related to parent training significantly predicted the extensiveness of providers’ use of parent training. Receiving supervision in parent training, being trained in a specific parent training approach, taking a course related to parent training, and participating in self-guided learning (e.g., webinar) were unique predictors of parent training extensiveness. While only 15% of ABA providers used manualized parent training programs, using a manual was also a unique predictor of parent training extensiveness. Parallel multiple mediator analyses demonstrated that family-, provider-, and organization-level barriers all partially mediated the relationship between number of training experiences and parent training extensiveness; only provider- and organization-level barriers mediated the relationship between manual use and parent training extensiveness. Recommendations for training and supporting providers at the pre-service and in-service levels are discussed as a means of increasing access to parent training for children with ASD in community settings.     

Updating the Textbook: A Novel Approach to Training Graduate Students in Evidence-Based Youth Practices

Despite the ever-improving base of evidence-based practices (EBPs) for the treatment of childhood disorders, a gap between EBP research and their use in community settings continues to exist. An exciting opportunity to close this gap exists in the form of graduate student training; however, at present, several roadblocks exist. In this paper, we review the current state of graduate training in delivering EBPs and obstacles involved in training future community clinicians (i.e., graduate students) in EBPs. Next, we describe in detail our initiative to develop a curriculum that addresses these challenges. This innovative course empowered graduate students to receive training in the delivery of youth EBPs in community settings through reviews of the research literature, active learning techniques (e.g., discussions of case conceptualizations, role-playing case studies), and a written, publication-quality review of EBPs. Finally, we offer recommendations for other educators of mental health professionals (e.g., psychologists, social workers, counselors) to improve upon this curriculum in their training of graduate students in the theory and application of EBPs for treating childhood disorders.