Sustaining and Expanding Systems of Care to Provide Mental Health Services for Children, Youth and Families Across America

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.     

Conflict Transformation, Stigma, and HIV-Preventive Structural Change

Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.     

Associative status of the training context determines the effectiveness of compound extinction

Studies of extinction of a target cue in compound with another excitor have produced evidence of both deepened and attenuated extinction relative to elemental extinction. The present experiments sought to resolve this discrepancy by assessing the effect of the extinction context-unconditioned stimulus (US) association on compound extinction. In an ABC renewal situation with rats, Experiment 1 replicated the observation that enhanced extinction (i.e., reduced conditioned suppression) occurs as a result of nonreinforcement in compound with a concurrent excitor. In Experiment 2, inflation of the extinction context-US association through unsignaled, intertrial US presentations reversed the effect of a concurrent excitor (i.e., extinction with a concurrent excitor was less effective than elemental extinction). Experiment 3 compared compound extinction and second-order conditioning with respect to the effect of context inflation, and produced results incompatible with the view that second-order conditioning contributed to the results of Experiment 2. In Experiment 4, a concurrent excitor enhanced extinction in ABC renewal and attenuated extinction in AAC renewal. The present results suggest that the effect of a concurrent excitor during extinction depends on the strength of the extinction context-US association, thereby confirming predictions of the sometimes -competing retrieval model of associative acquisition and extinction.     

Analysis of voice impairment in aphasia after stroke-underlying neuroanatomical substrates

Phonation is a fundamental feature of human communication. Control of phonation in the context of speech-language disturbances has traditionally been considered a characteristic of lesions to subcortical structures and pathways. Evidence suggests however, that cortical lesions may also implicate phonation. We carried out acoustic and perceptual analyses of the phonation of /a/ in 60 males with aphasia (20 Wernicke's, 20 Broca's, 20 subcortical aphasia) and 20 males matched in age with no neurological or speech-language disturbances. All groups with aphasia were significantly more impaired on the majority of acoustic and perceptual measures as compared with the control speakers. Within the subjects with aphasia, subjects with subcortical aphasia were more impaired on most measures compared to subjects with Broca's aphasia, and they, in turn, more impaired than those with Wernicke's aphasia. Lesions in regions involved in sound production-perception result in dysfunction of the entire neurocognitive system of articulation-phonological language processing.     

Validity for an Integrated Laboratory Analogue of Sexual Aggression and Bystander Intervention

This study sought to develop and validate an integrated laboratory paradigm of sexual aggression and bystander intervention. Participants were a diverse community sample (54% African American) of heterosexual males (N = 156) between 21 and 35 years of age who were recruited to complete the study with a male friend and an ostensibly single, heterosexual female who reported a strong dislike of sexual content in the media. Participants viewed a sexually explicit or nonsexually explicit film clip as part of contrived media rating task and made individual choices of which film clip to show the female confederate. Immediately thereafter, participants were required to reach consensus on a group decision of which film clip to show the female confederate. Subjecting a target to an unwanted experience with a sexual connotation was operationalized as selection of the sexually explicit video, whereas successful bystander intervention was operationalized as the event of one partner individually selecting the sexually explicit video but then selecting the nonsexually explicit video for the group choice. Results demonstrated that a 1‐year history of sexual aggression and endorsement of pertinent misogynistic attitudes significantly predicted selection of the sexually‐explicit video. In addition, bystander efficacy significantly predicted men's successful prevention of their male peer's intent to show the female confederate a sexually explicit video. Discussion focused on how these data inform future research and bystander intervention programming for sexual aggression. Aggr. Behav. 38:309–321, 2012. © 2012 Wiley Periodicals, Inc.     

Depicting the Missing: Prospective and Retrospective Person Memory for Age Progressed Images

One approach that has been used to help recover missing children is forensic age progression. In forensic age progression, outdated photographs of missing children are aged to provide an estimate of the current appearance of the child. We examined the effectiveness of age progressed images in the context of both prospective person memory and retrospective person memory. Memory for outdated and age progressed images did not significantly differ. Moreover, there was some indication that age progressed images were associated with a more conservative response bias. The results failed to demonstrate an advantage for age progressed pictures. Copyright © 2011 John Wiley & Sons, Ltd.     

Disengagement and Engagement Coping with HIV/AIDS Stigma and Psychological Well-Being of People with HIV/AIDS

The stigma associated with HIV/AIDS poses a psychological challenge to people living with HIV/AIDS. We hypothesized that that the consequences of stigma-related stressors on psychological well-being would depend on how people cope with the stress of HIV/AIDS stigma. Two hundred participants with HIV/AIDS completed a self-report measure of enacted stigma and felt stigma, a measure of how they coped with HIV/AIDS stigma, and measures of depression and anxiety, and self-esteem. In general, increases in felt stigma (concerns with public attitudes, negative self-image, and disclosure concerns) coupled with how participants reported coping with stigma (by disengaging from or engaging with the stigma stressor) predicted self-reported depression, anxiety, and self-esteem. Increases in felt stigma were associated with increases in anxiety and depression among participants who reported relatively high levels of disengagement coping compared to participants who reported relatively low levels of disengagement coping. Increases in felt stigma were associated with decreased self-esteem, but this association was attenuated among participants who reported relatively high levels of engagement control coping. The data also suggested a trend that increases in enacted stigma predicted increases in anxiety, but not depression, among participants who reported using more disengagement coping. Mental health professionals working with people who are HIV positive should consider how their clients cope with HIV/AIDS stigma and consider tailoring current therapies to address the relationship between stigma, coping, and psychological well-being.     

Psychopathic traits and externalizing behaviors: a comparison of self- and informant reports in the statistical prediction of externalizing behaviors

It has long been assumed that features associated with psychopathy, such as a lack of insight and deceitfulness, may compromise the utility of self-report measures, particularly for understanding the relations between these traits and important outcomes (e.g., offending). Unfortunately, little research has explicitly examined the relations between self- and informant reports of psychopathy and their relations to these outcomes. The current study examined the incremental validity of self- and informant reports of psychopathic traits, assessed with 3 validated psychopathy measures, in the statistical prediction of externalizing behaviors (EBs). To reduce shared method variance, self- and informant reports of EBs (i.e., substance use, antisocial behavior, gambling, and intimate partner violence) were examined separately. Results indicate that both self- and informant reports of psychopathy are related to EBs and provide some degree of incremental validity, although self-reported psychopathy scores proved slightly more useful than other-reported psychopathy scores. These findings suggest that, in nonforensic settings, psychopathy data derived from both self- and other-reported psychopathy measures have utility in understanding the relations between psychopathic traits and EBs.     

Barriers to and Motivations for Physician Referral of Patients to Cancer Genetics Clinics

Although it is well known that under-referral of colon cancer patients to cancer genetics clinics is a chronic problem, no study has yet examined why physicians may be ordering testing independently rather than referring patients to cancer genetics clinics. The current study explored variables which may impact a physician’s preference for ordering testing independently or referring patients to outside cancer genetics experts. An online questionnaire, distributed to the membership of the American College of Gastroenterology and the American Society of Colorectal Surgeons, yielded responses from 298 physicians. Motivations to refer to cancer genetics clinics rather than order testing independently included fear of genetic discrimination and a belief that patients benefit from genetic counseling about the risks, benefits and consequences of testing. These results suggest that in order to increase referrals, genetic counselors must educate physicians about the unique benefits patients receive from participating in genetic counseling.