Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment

Mental health systems need scalable solutions that can reduce the efficacy–effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers’ fidelity to evidence-based treatment models and children’s and caregivers’ engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.     

A comparison of blocked and mixed‐trial methods for teaching auditory–visual discriminations

Behavior analysts typically teach conditional discriminations in a mixed‐trial format but may switch to a blocked‐trial format for learners displaying limited acquisition. No known research has shown that mixed‐trial methods are more effective or efficient than blocked‐trial methods for teaching discriminations, so it is not clear why this format has been adopted as the “first‐line” intervention. We compared blocked and mixed‐trial formats for teaching novel auditory–visual discriminations to three adults with intellectual and developmental disabilities (IDD). Results show blocked‐trial methods resulted in faster skill acquisition in all cases, suggesting this format may be a preferable starting point for instruction.     

Gender differences in adolescent coping behaviors and suicidal ideation: findings from a sample of 73,238 adolescents

Suicide among adolescents is an emerging global public health problem as well as a socioeconomic problem. Stress-coping strategies have been shown to be associated with suicidal ideation. We examined coping behaviors related to suicidal ideation and gender differences in adolescents using the data from the 2010 Korea Youth Risk Behavior Survey (ages 12–19 years; N = 73,238). Logistic regression analysis was used to evaluate associations between suicidal ideation and specific coping behaviors while controlling for potentially confounding variables. In both male and female groups, the coping behavior “drinking alcoholic beverages” and “smoking cigarettes” were positively associated with suicidal ideation. “Watching TV,” “playing online/mobile games,” and “sleeping” were negatively associated with suicidal ideation in both groups. In males, “engaging in sports” was negatively related to suicidal ideation. In females, “venting by talking to others” and “eating” were negatively related to suicidal ideation. The results indicate that there are gender differences in the effects of coping behaviors on adolescent suicidal ideation, and that developing adaptive coping strategies may function to reduce suicidality. Future studies are needed to examine whether improving coping skills can reduce suicidal ideation in a gender-specific manner.     

Cross-category revenue spillover in brand extensions: The role of within-category experience

Building on signaling theory, the current research proposes an empirical framework to help firms understand the degree to which cross-category purchases affect the revenue generated for each category and how within-category purchases influence the cross-category spillover effects. The framework is applied to novel individual-level, cross-sectional, and time-series transaction details from a leading lifestyle conglomerate in the Middle East. The empirical results provide strong support for the presence of revenue spillover across multiple categories of brand extensions, with the spillover being more pronounced in categories in which customers have infrequently purchased and thus had less within-category experience. These results add to the ongoing stream of research on brand extensions by offering evidence that both within- and cross-category learning play a significant role in revenue generation from brand extensions for multi-product or service firms.     

Gender differences in susceptibility to posttraumatic stress disorder

We examined data from a community survey of trauma exposure and DSM-IV PTSD in Winnipeg, Canada to explore factors associated with the higher rate of PTSD in women than men. Women were found to be at significantly increased risk for PTSD following exposure to serious trauma (odds ratio approximately 5), even when sexual trauma--which predominates in women--was excluded (odds ratio approximately 3). Adjusting for gender differences in the number of lifetime traumata, or in the likelihood of the trauma being associated with particular reactions to or consequences of the event (i.e. thinking that one would be killed or seriously injured; sustaining a serious physical injury; seeing someone else seriously injured or killed) did not result in a lessening of the PTSD risk in women. Women were found to be at increased risk for PTSD following nonsexual assaultive violence (e.g. mugging or other physical attack) but not following non-assaultive trauma (e.g. fire, witnessing injury to others). Understanding the basis of (and parameters for) this increased susceptibility to PTSD in women compared to men following trauma exposure should be a priority for future traumatic stress research.     

The utilitarian core hypothesis: cases for testing the stability of languages in the wake of conquest

Based on the "utilitarian core hypothesis" that the most common words of a language develop early and resist change, the current exploratory study examined three test cases to suggest what happens to the common core of a language when its speakers are conquered. Whissell (1998) raised this issue by implication through demonstrating that the common core of English is largely Anglo-Saxon and thus survived the Norman Conquest. The notion that unique merits of English accounted for its success has a long history dating at least to Verstegan (1605/1976). We suggested that there are also instances of conquest in history illustrating the persistence of other languages despite the political subjugation of their speakers. Test cases included, in addition to the Norman Conquest of England, the Arab-Berber Conquest of most of the Iberian Peninsula, and Russian domination of modern Uzbekistan. The combined results suggest that persistence of a utilitarian core despite conquest is not an isolated instance. As a phenomenon it offers a more parsimonious account than do appeals to the special merits of English, Spanish, or Modern Uzbek. We have integrated these findings within a psychological framework pertaining to language use and change.     

Neural control of behavior: countermanding eye movements

Understanding the self-control of action entails knowledge about how actions are initiated, how planned actions are canceled and how the consequences of actions are registered. We have investigated neural correlates of these processes using the countermanding paradigm – a task that required subjects to occasionally cancel a planned speeded response, and an analysis that provides an estimate of the time needed to cancel a planned movement. By monitoring the activity of single neurons in the frontal cortex of macaque monkeys performing this task we have distinguished signals responding to the visual stimuli, other signals that control the production of movements, and still other signals that seem to monitor behavior. Received: 31 March 1999 / Accepted: 23 July 1999     

Reliability and Validity Analyses of the Self-Management Questionnaire

The authors developed a parent-report measure to enhance findings for diagnoses and evaluations, and therefore, improve on the assessments currently being widely used for this purpose. Data were gathered on 322 clients (4–18 years old) seeking treatment at a private practice setting. Factor analysis revealed 18 subscales. Scores were internally consistent and distinct from other subscales. In addition, the questionnaire showed good diagnostic utility for depression, Oppositional Defiant Disorder (ODD), and Pervasive Developmental Disorder (PDD). This study provides sufficient evidence of the reliability and validity of the Self-Management Questionnaire (SMQ) to recommend its use for skills and needs assessment with children and adolescents.     

The influence of social and symbolic cues on observers' gaze behaviour

Research has shown that social and symbolic cues presented in isolation and at fixation have strong effects on observers, but it is unclear how cues compare when they are presented away from fixation and embedded in natural scenes. We here compare the effects of two types of social cue (gaze and pointing gestures) and one type of symbolic cue (arrow signs) on eye movements of observers under two viewing conditions (free viewing vs. a memory task). The results suggest that social cues are looked at more quickly, for longer and more frequently than the symbolic arrow cues. An analysis of saccades initiated from the cue suggests that the pointing cue leads to stronger cueing than the gaze and the arrow cue. While the task had only a weak influence on gaze orienting to the cues, stronger cue following was found for free viewing compared to the memory task.