Reducing emergency medical service use in patients with chronic psychotic disorders: results from the FAST intervention study

Patients with schizophrenia have disproportionately high rates of emergency medical service use, likely contributing to the high cost this illness places on society. The aim of this study was to examine the impact of a theory-based, behavioral intervention on immediate and long-term use of emergency medical services. Older patients with schizophrenia (n=240) were randomized to receive either a behavioral, skills-building intervention known as Functional Adaptation and Skills Training (FAST) or a time-equivalent attention-control condition (AC). Logistic regression analyses indicated that AC participants were nearly twice as likely to use emergency medical services in general (OR=2.54; p=0.02) and emergency psychiatric services in particular (OR=3.69; p=0.05) during the active intervention phase of the study. However, there were no differences between the interventions in terms of emergency service use during the long-term follow-up phase of the study (i.e., 6-18 months post-baseline). The FAST intervention appears efficacious for reducing the short-term risk of using emergency medical services. However, the long-term efficacy of the FAST intervention appears less clear. Future studies may want to provide more powerful maintenance sessions to encourage continued use of skills in patients' real-world settings.     

Learning by looking: Infants' social looking behavior across the transition from crawling to walking

This study investigated how infants gather information about their environment through looking and how that changes with increases in motor skills. In Experiment 1, 9.5- and 14-month-olds participated in a 10-min free play session with both a stranger and ambiguous toys present. There was a significant developmental progression from passive to active social engagement, as evidenced by younger infants watching others communicate more and older infants making more bids for social interaction. Experiment 2 examined longitudinally the impact of age and walking onset on this progression. The transition to independent walking marked significant changes in how often infants watched others communicate and made active bids for social interaction. Results suggest that infants transition from passive observers as crawlers to active participants in their social environment with the onset of walking.     

Indispensability and group identification as sources of task motivation

Traditional Instrumentality × Value (I × V) models have attributed gains in performance groups to various conditions affecting the instrumentality of group members’ effort for a variety of valued outcomes. Social identity models have challenged this interpretation, suggesting that the instrumentality of effort may be irrelevant when group identification is high. A laboratory study is reported in which both indispensability and group identification are manipulated, and participants’ effort on a physical persistence task is assessed. Contrary to the social identity predictions but consistent with I × V predictions, the indispensability of effort had a positive effect on participants’ effort. Group identification had no direct or moderating effects on effort.     

Measurement by subjective estimation: Testing for separable representations

Studying how individuals compare two given quantitative stimuli, say d₁ and d₂, is a fundamental problem. One very common way to address it is through ratio estimation, that is to ask individuals not to give values to d₁ and d₂, but rather to give their estimates of the ratio p=d₁/d₂. Several psychophysical theories (the best known being Stevens’ power-law) claim that this ratio cannot be known directly and that there are cognitive distortions on the apprehension of the different quantities. These theories result in the so-called separable representations [Luce, R. D. (2002). A psychophysical theory of intensity proportions, joint presentations, and matches. Psychological Review, 109, 520–532; Narens, L. (1996). A theory of ratio magnitude estimation. Journal of Mathematical Psychology, 40, 109–788], which include Stevens’ model as a special case. In this paper we propose a general statistical framework that allows for testing in a rigorous way whether the separable representation theory is grounded or not. We conclude in favor of it, but reject Stevens’ model. As a byproduct, we provide estimates of the psychophysical functions of interest.     

Synthesis of studies of co-occurring disorder(s) in criminal justice and a research agenda

The studies reported in this special issue were designed to take advantage of the unique opportunity that the Criminal Justice Drug Abuse Treatment Studies (CJDATS) cooperative provides to the systematic study of several key issues in programming for co-occurring disorder(s) (COD) in the criminal justice system. These papers present findings from CJDATS studies pertaining to co-occurring disorder(s), identify clinical initiatives to strengthen efforts to treat the population with co-occurring disorder(s), and point to a direction for the elaboration of a future research agenda. Four key areas of investigation are presented: Screening and Diagnosis; the Relationship of Co-Occurring Disorder(s) to Violence; Gender Differences; and the Delivery of Services for Co-Occurring Disorder(s). The first section of this article summarizes the studies included in this special issue within the context of the research literature already available. The second section suggests a future research agenda for the study of offender populations with co-occurring disorder(s), and concludes with a broad statement of clinical advancements to date.     

21st birthday celebratory drinking: evaluation of a personalized normative feedback card intervention.

This research was designed to evaluate a personalized normative feedback birthday card intervention aimed at reducing normative perceptions, alcohol consumption, and negative consequences associated with 21st birthday celebrations among college students (N=281; 59.15% women). Students were randomly assigned to receive or not receive a birthday card about 1 week prior to their 21st birthday. Approximately 1 week following their birthday, students were asked to complete a brief survey concerning their birthday celebration activities. Findings indicated that the birthday card intervention was not successful at reducing drinking or consequences; however, the card did reduce normative misperceptions. Additional findings indicated that many students experienced negative consequences, such as passing out or driving after consuming alcohol. Combined, these findings suggest that prevention is needed for drinking associated with turning 21. However, prevention efforts should consist of more than a birthday card.     

Inanspruchnahme, Verlauf und Ergebnis ambulanter Psychotherapie

This paper summarizes the major results of the study ?Optimizing psychotherapy service provision via transparency and outcome orientation: evaluating outpatient psychotherapy“ (TRANS-OP). Between September 1998 and February 2000, all insured persons of a major German health insurance company (?Deutsche Krankenversicherung“) who requested reimbursement of outpatient psychotherapy were asked to participate in the study. Comprehensive data concerning structural, process and outcome criteria of outpatient psychotherapy were collected from 714 participants and from the majority of their psychotherapists during a 2-year observation period. Participants applied for the following treatments eligible for reimbursement in the German health insurance system: psychodynamically oriented psychotherapy (52%), cognitive behavioral therapy (31%), and psychoanalytic psychotherapy (17%). The amounts of sessions claimed for reimbursement were approved almost without exception. Participants in the three treatment modalities did not differ in socio-demographic characteristics, or in initial symptom severity as assessed by standardized measures. Even though courses of improvement of the symptoms varied, therapy outcome after 2 years was similar in the three forms of treatment. In addition, a cost offset was found, i.e. medical costs, especially for hospital days, substantially decreased during the course of psychotherapy. These findings support the effectiveness as well as the economic significance of outpatient psychotherapy across different treatment modalities in routine care. However, allocation of psychotherapeutic resources should be more considerate of individual patient needs and treatment outcome.     

Clinical and Non-Clinical Characteristics Associated with Medication Use Among Children with Serious Emotional Disturbance

Our study explores the clinical and non-clinical characteristics associated with medication use among children with serious emotional disturbance who are referred into community-based family-driven system of care settings. Using data collected as part of the Comprehensive Community Mental Health Services for Children and Their Families Program initiative, our study provides results from analyses completed on 7,009 children and adolescents with serious emotional disturbance. Using both bivariate and multivariate statistical analyses, the researchers found that females entering systems of care were less likely to have received medication in the 6-months prior to entry, as were children of African-American and Native-American heritage compared to children from non-Hispanic White heritage. Children referred from mental health, child welfare or who were self-referred were more likely to use medications than those referred from juvenile justice. Children with histories of prior inpatient, outpatient, day treatment, or school-based services were between 2 and 4 times more likely to use medications than children without such histories. Children with family histories of mental illness and those who were Medicaid recipients were also more likely to use medications. Family income was also positively related to medication use and younger children were more likely to use medications than older children. Implications of the findings are discussed.     

Familialism, social support, and stress: positive implications for pregnant Latinas

This study examined the association of familialism, a cultural value that emphasizes close family relationships, with social support, stress, pregnancy anxiety, and infant birth weight. Foreign-born Latina (n = 31), U.S.-born Latina (n = 68), and European American (n = 166) women living in the United States participated in a prospective study of pregnancy in which they completed measures of familialism, social support, stress, and pregnancy anxiety during their second trimester. As expected, Latinas scored higher on familialism than European Americans. Familialism was positively correlated with social support and negatively correlated with stress and pregnancy anxiety in the overall sample. As predicted, however, the associations of familialism with social support and stress were significantly stronger among Latinas than European Americans. Moreover, higher social support was associated with higher infant birth weight among foreign-born Latinas only. Implications of cultural values for relationships and health are discussed.