The Future of Psychology in Medicaid's Health Delivery System for People with Disabilities

State Medicaid programs are rapidly converting fee-for-service health delivery systems to managed care for people with disabilities. In theory, managed care models of health delivery will substantially improve the quality of care for people with disabilities, but in reality, few successful models exist. This period of transition holds both opportunities and challenges for psychologists in medical settings. Because Medicaid reforms for people with disabilities may herald similar reforms for both the public and the private sectors, psychology's response will determine its role in the future of health care delivery for this population. Changes in training and increased attention to outcomes research, innovations in practice, and advocacy will be the keys to success.     

The Future of Psychology in Departments of Psychiatry

Health care reform has put increasing pressure on faculty of medical schools to become self-supporting. Opportunities for clinical revenue will decrease, but psychologists who are able to generate research funding will become increasingly competitive, albeit as mercenaries, i.e., capable of paying their own way plus generating a profit to support departmental operations and educational programs. Changes in the health care system signal an end to psychiatry's paternalistic relationship to psychology and present opportunities for psychology proactively to influence its future role in health care. Research, political action, and revised scientific mission, models, and roles represent important strategies in the redefining of psychology as a basic science and major profession in health care.     

2-Deoxy-d-Galactose Effects on Passive Avoidance Memorization in the Rat

2-Deoxy-d-galactose (do-gal) hinders glycoprotein fucosylation. This compound was intracerebroventricularly administered to male adult Wistar rats in order to assess whether it could exert amnesic effects on a passive avoidance response (PAR) to be learned in the light–dark box apparatus. Three experiments were performed. In the first, do-gal was administered immediately after the acquisition trials at three dosages (2, 4, and 8 μmol). It was found that only the 4-μmol dosage was followed by PAR disruption. In the second, do-gal was administered at the adequate dosage (4 μmol) either 30 min before the acquisition trial or 30 min before retrieval testing. It was found that only the preretrieval administration was followed by PAR impairment. In the third, do-gal (4 μmol) was administered in postacquisition, at increasing postacquisition delays (0.25, 1.5, 4, and 6 h). It was found that there was PAR disruption only after do-gal administration at the shortest (0.25 h) delay. The results confirm that in the rat, glycoprotein fucosylation is involved in some of the phases of memory trace processing, and they are discussed in relation to other findings in the rat and the chick.     

What is the pronunciation for -ough and the spelling for /u/? A database for computing feedforward and feedback consistency in English

Recent studies suggest that performance attendant on visual word perception is affected not only by feedforward inconsistency (i.e., multiple ways to pronounce a spelling) but also by feedback inconsistency (i.e., multiple ways to spell a pronunciation). In the present study, we provide a statistical analysis of these types of inconsistency for all monosyllabic English words. This database can be used as a tool for controlling, selecting, and constructing stimulus materials for psycholinguistic and neuropsychological research. Such large-scale statistical analyses are necessary devices for developing metrics of inconsistency, for generating hypotheses for psycholinguistic experiments, and for building models of word perception, speech perception, and spelling.     

Do substance abuse and mental health clients prefer automated assessments?

In both psychiatric and substance-abuse services, clinicians have been concerned with the introduction of automated assessments and with their clients’ reactions toward those assessments. The positive reactions of psychiatric clients have been well documented, but little has been known about substance-abusing clients’ impressions of automated assessments. The impact of automated assessment on clients seeking substance-abuse services was evaluated and compared with a previously analyzed sample of clients seeking mental health services. On the whole, both groups responded similarly and positively to automated assessments. Factor analyses revealed three underlying dimensions in client attitudes toward automated assessment,Completeness and satisfaction,Ease of use and enjoyment, andNegative attitudes. In addition, statistically, though not clinically, significant differences in attitudes were found between various demographic groups. Overall, the results support the use of automated assessments with individuals seeking either substance-abuse or mental-health services.     

Spline smoothing with model-based penalties

Nonparametric regression techniques, which estimate functions directly from noisy data rather than relying on specific parametric models, now play a central role in statistical analysis. We can improve the efficiency and other aspects of a nonparametric curve estimate by using prior knowledge about general features of the curve in the smoothing process. Spline smoothing is extended in this paper to express this prior knowledge in the form of a linear differential operator that annihilates a specified parametric model for the data. Roughness in the fitted function is defined in terms of the integrated square of this operator applied to the fitted function. A fastO(n) algorithm is outlined for this smart smoothing process. Illustrations are provided of where this technique proves useful.     

Internalizing and externalizing characteristics of sexually and/or physically abused children

This study evaluates the behavioral consequences of childhood abuse (sexual, physical, or both), with particular focus on prevalence of posttraumatic stress disorder (PTSD). Three abuse type groups and nonabused controls were contrasted on behavioral rating scales and on structured psychiatric interview data. The participants (109 abused children and 16 normal control children) were recruited from Arkansas Children’s Hospital and local agencies for abused children. As expected, proportionately more females than males were sexually abused. Overall, males were rated as more disturbed than females. Type of abuse did not consistently influence behavioral ratings. Externalizing scores were significantly higher than internalizing scores in all abused groups. PTSD was diagnosed in 50% of the abused children, with a higher rate for boys who had been sexually abused as opposed to physically abused only (58% versus 13%). The most frequent comorbid condition with PTSD was Separation Anxiety. Sexually abused boys were hospitalized for psychiatric treatment at a higher rate than were other abused children.     

The organization of multidimensional selection on the basis of color and shape: An event-related brain potential study

In this paper, we examine whether color and shape, tied to a single object in space, (1) are identified and selected in series or in parallel, (2) are identified and selected in a dependent, self-terminating manner or in an independent and exhaustive manner, and (3) are conjoined by a feature integration process before or only after an initial stage of separate attribute analyses has finished. We measured response time and the selection negativity (SN) derived from event-related brain potentials when participants responded to a unique conjunction of color and shape in a go/no-go target detection task. The discriminability of the color and the shape of the conjunction was manipulated in three conditions. When color and shape were easy to discriminate, the SNs to color and shape started at the same time. When one attribute was less discriminable, the SN to that attribute started later, but not the SN to the complementary attribute. This suggests that color and shape are identified and selected in parallel. In all three discriminability conditions, the SNs to color and shape were initially independent but later interacted. This suggests that color and shape are initially selected independently and exhaustively, after which their conjunction is analyzed. The SN to local shape features started later than that to the conjunction of color and global shape features, which suggests that feature integration can start before the analyses of the separate attributes have finished.