Cost Analysis of Integrated Behavioral Health in a Large Primary Care Practice

A residency-based Family Medicine outpatient clinic chose to implement an integrated behavioral health care program in a large primary care clinic in the Southeast to improve patient access to behavioral health care. We hypothesized that embedding a BHP in a primary care setting would be a cost neutral intervention. We implemented a prospective cohort design and included expenses from both inpatient and outpatient visits. We implemented a mixed effects linear regression model to evaluate pre- and post-BHP exposure costs. A total of 1256 patients were identified in the post-BHP exposure period that had more than one-year post-exposure. After applying exclusion criteria, there were 926 patients included in analysis. These patient had an average total cost during the one-year pre-BHP exposure period of $5113 (SD = 7712) and one-year post-BHP exposure period of $5462 (SD = 7813). Our analysis shows a relatively cost neutral impact following the introduction of BHPs in a primary care setting. The results of this study provide a gauge for future planning of services.

     

Pregnancy, thirdness, and the aesthetics of catastrophe in Heinrich von Kleist

In documenting his own personal crisis of faith in Enlightenment rationalism through letters and essays, Kleist exposes the epistemological fissures in its edifice. This paper explores in psychoanalytic terms the dilemmas associated with knowing and not knowing, and the relationship between self and other, revealed by these texts. Kleist's literary work goes beyond expressing this crisis of knowledge to enact a kind of solution to it, not resolving the contradictions that are central in his world but presenting them aesthetically, intact and precariously balanced. More specifically, a pregnancy conceived without the knowledge of the mother-to-be--in his novella "The Marquise of O" (1807a)--suggests a modification of the psychoanalytic third to include within it the catastrophe that it also mitigates.     

Use of a driving simulator to assess performance under adverse weather conditions in adults with albinism

Participants with albinism have reduced vision and nystagmus with reduced foveation times. This prospective study evaluated driving in 12 participants with albinism and 12 matched controls. Participants drove a vehicle simulator through a virtual rural course in sunny and foggy conditions. Under sunny conditions, participants with albinism showed a narrower preferred minimum safety boundary during car-following tasks than did controls, but there was no difference under foggy conditions. Their driving did not differ significantly from that of controls when approaching a stop sign or when choosing gap size between oncoming vehicles when crossing an intersection. However, when compared to control drivers, participants with albinism had a decreased minimum safety boundary for car-following that should be included in counseling regarding driving safety.     

Influence of Genetic Risk Information on Parental Role Identity in Adolescent Girls and Young Women from Families with Fragile X Syndrome

Using a multi-group cross-sectional design, we explored self-concept related to parental role salience and enactment in 53 young women (14 to 24 years) with knowledge they were either carriers, non-carriers, or could be a carrier of fragile X syndrome (FXS). Parental role salience included the participants’ desire “to be a mother” and the importance they placed on this role. Enactment focused on the participants’ views regarding ways to become a mother (reproductive options), parenting a child affected by FXS, and the development of partner relationships (marriage). Participants completed the FXS Adolescent Interview and the FX-Visual Analog Scale. Participants’ knowledge of their genetic risk status appears to have influenced both salience and enactment of the parental role, and the effect varied based on carrier status. For many, knowledge of genetic risk appears to have led to reappraisal, redefinition, and re-engagement with the goal of becoming a parent. This process was prominent in those who were carriers and less so in those who were at-risk, and it did not typically occur in those who were non-carriers. Findings offer valuable insight into the impact of genetic risk information on developing perceptions of the parental role and offer new directions for genetic counseling with adolescents and young women with a family history of FXS.     

Patients' Motivations and the Analyst's Experience

Although the analyst's way of organizing what he or she hears is influenced by assumptions about human motivation, the analyst's experience in the room with a patient is quite removed from any theories about motivation he or she might hold. So compelling is the clinical interaction that it may only be retrospectively that it is possible to observe how one's theory of motivation influences one's work. Several years ago, on the day before I began working on this paper, I took verbatim notes on the last three sessions of a holiday shortened week to see whether I could discern what assumptions about motivation I was making. I would not describe my theory of motivation as it appears at the end of the essay the way I did at the time I wrote this essay. Today, I would try to integrate drive theory with object relations more explicitly.     

Neurological subtle signs and cognitive development: A study in late childhood and adolescence

Introduction and Aim: Neurological subtle signs (NSS) are often observed during the neurological examination of children and tend to disappear with age. Their persistence into late adolescence or young adulthood has been related to psychiatric and neurocognitive disorders. To provide a better understanding of their functional basis, a longitudinal correlational study with neurocognitive measurements was performed.

Method: We conducted multiple regression and correlation analyses of NSS with demographic and cognitive measures on a subset of 341 healthy children (56% males), taking part in a longitudinal dental study. Participants, whose ages ranged between 11–15 years, at first evaluation, undertook yearly, during 5 years, a 6-item NSS exam (producing a total score ranging between 0–18) and a comprehensive battery of neurocognitive tests. Effects of age, gender, IQ, and 7 neurocognitive factors on NSS were analyzed.

Results: Over the years, NSS scores correlated consistently with selective attention (Stroop test), motor speed (finger tapping), and visuomotor speed (pegboard speed).

Discussion: These results suggest that the disappearance of NSS in late childhood and adolescence occurs primarily in parallel with the development of motor and visuomotor functions and secondarily in relation to higher order functions such as selective attention (Stroop) and executive control (B-A Trails difference).     

A Practice-Based Approach to Group Identification in Nonverbal Learning Disorders

Evidence-based practice, the rigorous conduct of clinical analysis and intervention, includes practice-based evidence. Here, practice data were the source of three “clinical portraits” used for exploratory analysis of an array of cognitive and social problems in 30 children whose neurobehavioral profiles fulfilled psychometric criteria for a nonverbal learning disability (NLD). Qualitative analysis of the children's academic and adjustment difficulties revealed patterns of dissociable deficits. These findings argue for at least three groups within the NLD construct. Identifying such subgroups is of practical importance: More precise characterization of neuropsychological competencies leads to improved interventions and better outcomes.     

Instrumental lying by parents in the US and China

The practice of lying to one's children to encourage behavioral compliance was investigated among parents in the US (N = 114) and China (N = 85). The vast majority of parents (84% in the US and 98% in China) reported having lied to their children for this purpose. Within each country, the practice most frequently took the form of falsely threatening to leave a child alone in public if he or she refused to follow the parent. Crosscultural differences were seen: A larger proportion of the parents in China reported that they employed instrumental lie‐telling to promote behavioral compliance, and a larger proportion approved of this practice, as compared to the parents in the US. This difference was not seen on measures relating to the practice of lying to promote positive feelings, or on measures relating to statements about fantasy characters such as the tooth fairy. Findings are discussed with reference to sociocultural values and certain parenting‐related challenges that extend across cultures.     

General feelings of gratitude,gratitude to god,and hemoglobin A1c: Exploring variations by gender*

Research indicates that feeling grateful is associated with better physical health. However, most studies rely on self-reports of health. The purpose of this study is to see if feelings of gratitude in general as well as feeling grateful to God specifically are associated with a key biomarker of health – hemoglobin A1c (HbA1c). HbA1c is an indicator of blood sugar control. In the process of assessing the relationship between gratitude and HbA1c, an effort is made to see if the relationship between these measures and HbA1c vary by gender. Findings from a recent nationwide survey indicate that women are more likely than men to feel grateful in general and to feel grateful to God. The results further reveal stronger feelings of general gratitude are associated with lower levels of HbA1c. However, this relationship did not differ for men and women. In contrast, feeling grateful to God was associated with lower HbA1c, but this relationship emerged among women only.