Implementation of Primary Care-Mental Health Integration Services in the Veterans Health Administration: Program Activity and Associations with Engagement in Specialty Mental Health Services

This paper describes the status of the Veterans Health Administration (VHA) Primary Care-Mental Health Integration (PC-MHI) services implementation and presents an assessment of associations between receipt of PC-MHI services and likelihood of receiving a second specialty mental health (SMH) appointment following an initial SMH encounter. The total PC-MHI service recipients and encounters/month rose substantially between October 2007 and April 2011. Adjusting for important covariates, the likelihood of receiving a second SMH encounter within 3 months of an index SMH appointment was 1.37 times greater among individuals who had received a PC-MHI encounter within 3 months of the initial SMH appointment. Implementation of VHA PC-MHI services has substantially increased VHA capacity to deliver mental health services in primary care and findings indicate that PC-MHI services are associated with greater engagement in SMH treatment. Implementation of VHA PC-MHI services is progressing with new technical assistance strategies being deployed.     

Confirmatory Factor Analysis of the School Refusal Assessment Scale-Revised: Child and Parent Versions

The School Refusal Assessment Scale-Revised (SRAS-R) is an instrument designed to evaluate the relative strength of four functional conditions of school refusal behavior in youth. Although previous work has shown the scale's child and parent versions to show good reliability, verification of the SRAS-R factor structure remains necessary. The present study investigated administrations of the child and parent versions of the SRAS-R (SRAS-R-C and SRAS-R-P) using confirmatory factor analysis. For both measures, four-factor models were supported following the removal of two SRAS-R-C and three SRAS-R-P items. Three-factor and two-factor models for each SRAS-R version were not supported. Ramifications of these results for use of the SRAS-R are discussed.     

VALUE SYSTEMS OF STUDENTS IN PAPUA NEW GUINEA AND AUSTRALIA

The Rokeach Value Survey was administered to 12 groups of indigenous respondents fluent in the English language and enrolled in tertiary institutions and training programmes in Papua New Guinea (over 1,100 subjects). Average value systems of these respondents were compared with those of three Australian student groups (secondary and tertiary). Marked differences were found in the relative importance assigned to particular values. Values assigned relatively high importance by the Papua New Guinea groups were discussed in relation to lower-order safety and security needs that may become salient in a developing country, and in terms of the traditional culture and the history of Papua New Guinea, especially the missionary influence, the extended family and wantok (”one-talk”) systems, possible expatriate influence on occupational roles, and present concern with emerging nationhood. Values assigned relatively high importance by the Australian groups were discussed in relation to higher-order needs that might become prepotent in a more affluent society. Factor analyses indicated that all 12 groups in Papua New Guinea were fairly similar in their average value systems.     

Effects of variable fatigue levels on reaction-time components

The effects of varying fatigue levels on reaction-time components were determined for 20 young, adult males. Each subject squeezed a hand-gripping device until strength decrements of 20, 40, or 60% were recorded; then the subject released his tension and then reacted to an auditory stimulus by gripping as quickly and forcefully as possible. Testing was also conducted under a nonfatigued state, and every subject was tested under all conditions. Total reaction time was divided into (a) a promoter component, the time from the stimulus to an alteration in the EMG of the finger flexors, and (b) a motor component, the time from the change in the EMG to the first sign of tension uptake. Analyses of variance failed to reveal any alterations in either reaction time or promoter time; however, there was a significant (p < .05) elongation of motor time when the muscle was fatigued, with motor time tending to increase linearly as fatigue increased. The results suggest that localized fatigue of this nature is primarily of peripheral (muscular) origin.     

Identifying the Function of School Refusal Behavior: A Revision of the School Refusal Assessment Scale

A revision of the School Refusal Assessment Scale (SRAS-R), a measure designed to help clinicians identify the primary function of a child's school refusal behavior, was examined. Changes in the original version of the scale were made to improve psychometric quality and align the measure in accordance with evolutions in the functional model. Two samples of youth with school refusal behavior, in addition to parents and teachers, were evaluated to determine the test-retest and interrater reliability and construct and concurrent validity of the SRAS-R. The scale was found to have good psychometric strength. Implications of these findings for clinicians who address this population are discussed.     

Treating Youths With Selective Mutism With an Alternating Design of Exposure-Based Practice and Contingency Management

Selective mutism is a severe childhood disorder involving failure to speak in public situations in which speaking is expected. The present study examined 9 youths with selective mutism treated with child-focused, exposure-based practices and parent-focused contingency management via an alternating treatments design. Broadband measures of functioning were employed, but particular focus was made on behavioral assessment of words spoken audibly and daily in public situations. Treatment ranged from 8 to 32 sessions and resulted in positive end-state functioning for 8 of 9 participants. Broader analyses indicated greater effectiveness for exposure-based practice than contingency management. The results support recent case reports of behavioral treatment for this population but in more rigorous fashion. Clinical and research challenges are discussed, including caveats about length and intensity of treatment for this population and need to develop standardized daily measures.     

Body elimination attitude family resemblance in Kuwait

The purpose of the present study was to determine the family resemblance of attitude toward body elimination in Kuwaiti participants. This study was conceptualized in the context of the theories of moral development, importance of cleanliness in the Muslim religion, cross-cultural differences in personal hygiene practices, previous research reporting an association between family attitudes and body elimination attitude, and health implications. The 24-item Likert-type format Body Elimination Attitude Scale-Revised was administered to 277 Kuwaiti high school students and 437 of their parents. Females scored higher, indicating greater disgust, than the males. Moreover, sons' body elimination attitude correlated more strongly with fathers' attitude (r = .85) than with that of the mothers (r = .64). Daughters' attitude was similarly associated with the fathers' (r = .89) and the mothers' attitude (r = .86). The high correlations were discussed within the context of Kuwait having a collectivistic culture with authoritarian parenting style. The higher adolescent correlations, and in particular the boys' correlation with fathers than with mothers, was explained in terms of the more dominant role of the Muslim father in the family. Public health and future research implications were suggested. A theoretical formulation was advanced in which "ideal" body elimination attitude is relative rather than absolute, and is a function of one's life circumstances, one's occupation, one's culture and subculture, and the society that one lives in.     

Short-term memory and working memory as indices of children's cognitive skills

In the current literature, empirical and conceptual distinctions have been drawn between a more or less passive short-term memory (STM) system and a more dynamic working memory (WM) system. Distinct tasks have been developed to measure their capacity and research has generally shown that, for adults, WM, and not STM, is a reliable predictor of general cognitive ability. However, the locus of the differences between the tasks has received little attention. We present data from children concerning measures of matrices reasoning ability, reading, and numerical skill along with forward and backward order serial recall of WM, STM, and STM with articulatory suppression tasks. As indices of children's cognitive skills, STM and WM are shown to be rather similar in terms of memory per se. Neither the opportunity for rehearsal nor task complexity provides satisfactory explanations for differences between memory tests.