Mild Traumatic Brain Injury in Sports: Neuropsychology's Contribution to a Developing Field

Mild traumatic brain injuries are common at all levels of athletic competition. Although once considered a routine part of the game, a significant amount of attention has recently been placed on these injuries at the professional, college, and high school levels. This paper reviews the epidemiology of sports-related brain injuries, the pathophysiology of the injuries, and the role of neuropsychology in this newly emerging area. Issues related to the adequacy of neuropsychological test instruments and approaches are discussed in light of future directions for research.     

Separating From the Mothership: A Coordinated Individual and Parent-Based Approach to Severe Agoraphobia in a Young Adult

Families are invested in an older adolescent gradually separating from the family to live independently as an adult, but for many families, adolescent psychopathology makes this transition difficult. Addressing such psychopathology is critical in preventing “failure to launch,” a breakdown in gaining age-appropriate independence from parents. This case study illustrates a promising approach directed at helping an 18-year-old female with agoraphobia and panic disorder who, upon intake, was at risk for long-lasting, prohibitive dependence on her parents. The clinical approach entails the convergence of two psychological treatments conducted in the same treatment center. One provider, working directly with the patient, delivered traditional cognitive-behavioral therapy (CBT) for anxiety. A second provider, working with the parents, delivered Supportive Parenting for Anxious Childhood Emotions (SPACE) a parent-based treatment focused on reducing family accommodation of the patient’s anxiety. Behavioral indices and self-report scores indicated clinically significant improvement following the combined intervention. Attention is drawn to the convergence of those treatments and the utility and special considerations in taking this kind of approach. Overall, the combined treatment may have been more successful than the sum of its parts at preventing failure to launch. This case study, the first to describe the integration of CBT and SPACE, can provide useful guidance for clinicians helping families of adult children to transition to independence.     

Healthcare,Responsibility and Golden Opportunities

When it comes to determining how healthcare resources should be allocated, there are many factors that could—and perhaps should—be taken into account. One such factor is a patient’s responsibility for his or her illness, or for the behavior that caused it. Policies that take responsibility for the unhealthy lifestyle or its outcomes into account—responsibility-sensitive policies—have faced a series of criticisms. One holds that agents often fail to meet either the control or epistemic conditions on responsibility with regard to their unhealthy lifestyles or their outcomes. Another holds that even if patients sometimes are responsible for these items, we cannot know whether a particular patient is responsible for them. In this article, we propose a type of responsibility-sensitive policy that may be able to surmount these difficulties. Under this type of policy, patients are empowered to change to a healthier lifestyle by being given what we call a ‘Golden Opportunity’ to change. Such a policy would not only avoid concerns about patients’ fulfilment of conditions on responsibility for their lifestyles, it would also allow healthcare authorities to be justified in believing that a patient who does not change her lifestyle is responsible for the unhealthy lifestyle. We conclude with a discussion of avenues for further work, and place this policy in the broader context of the debate on responsibility for health.

     

Consistent Belief in a Good True Self in Misanthropes and Three Interdependent Cultures

People sometimes explain behavior by appealing to an essentialist concept of the self, often referred to as the true self. Existing studies suggest that people tend to believe that the true self is morally virtuous; that is deep inside, every person is motivated to behave in morally good ways. Is this belief particular to individuals with optimistic beliefs or people from Western cultures, or does it reflect a widely held cognitive bias in how people understand the self? To address this question, we tested the good true self theory against two potential boundary conditions that are known to elicit different beliefs about the self as a whole. Study 1 tested whether individual differences in misanthropy—the tendency to view humans negatively—predict beliefs about the good true self in an American sample. The results indicate a consistent belief in a good true self, even among individuals who have an explicitly pessimistic view of others. Study 2 compared true self‐attributions across cultural groups, by comparing samples from an independent country (USA) and a diverse set of interdependent countries (Russia, Singapore, and Colombia). Results indicated that the direction and magnitude of the effect are comparable across all groups we tested. The belief in a good true self appears robust across groups varying in cultural orientation or misanthropy, suggesting a consistent psychological tendency to view the true self as morally good.     

Sensitivity to the Sampling Process Emerges From the Principle of Efficiency

Humans can seamlessly infer other people's preferences, based on what they do. Broadly, two types of accounts have been proposed to explain different aspects of this ability. The first account focuses on spatial information: Agents' efficient navigation in space reveals what they like. The second account focuses on statistical information: Uncommon choices reveal stronger preferences. Together, these two lines of research suggest that we have two distinct capacities for inferring preferences. Here we propose that this is not the case, and that spatial‐based and statistical‐based preference inferences can be explained by the assumption that agents are efficient alone. We show that people's sensitivity to spatial and statistical information when they infer preferences is best predicted by a computational model of the principle of efficiency, and that this model outperforms dual‐system models, even when the latter are fit to participant judgments. Our results suggest that, as adults, a unified understanding of agency under the principle of efficiency underlies our ability to infer preferences.     

Understanding Systems Change in Early Implementation of Housing First in Canadian Communities: An Examination of Facilitators/Barriers,Training/Technical Assistance,and Points of Leverage

We present interim findings of a cross‐site case study of an initiative to expand Housing First (HF) in Canada through training and technical assistance (TTA). HF is an evidence‐based practice designed to end chronic homelessness for consumers of mental health services. We draw upon concepts from implementation science and systems change theory to examine how early implementation occurs within a system. Case studies examining HF early implementation were conducted in six Canadian communities receiving HF TTA. The primary data are field notes gathered over 1.5 years and evaluations from site‐specific training events (k = 5, n = 302) and regional network training events (k = 4, n = 276). We report findings related to: (a) the facilitators of and barriers to early implementation, (b) the influence of TTA on early implementation, and (c) the “levers” used to facilitate broader systems change. Systems change theory enabled us to understand how various “levers” created opportunities for change within the communities, including establishing system boundaries, understanding how systems components can function as causes of or solutions to a problem, and assessing and changing systems interactions. We conclude by arguing that systems theory adds value to existing implementation science frameworks and can be helpful in future research on the implementation of evidence‐based practices such as HF which is a complex community intervention. Implications for community psychology are discussed.     

Navigating Complex Implementation Contexts: Overcoming Barriers and Achieving Outcomes in a National Initiative to Scale Out Housing First in Canada

The scaling out of Housing First (HF) programs was examined in six Canadian communities, in which a multi‐component HF training and technical assistance (TTA) was provided. Three research questions were addressed: (a) What were the outcomes of the TTA in terms of the development of new, sustained, or enhanced programs, and fidelity to the HF model? (b) How did the TTA contribute to implementation and fidelity? and (c) What contextual factors facilitated or challenged implementation and fidelity? A total of 14 new HF programs were created, and nine HF programs were sustained or enhanced. Fidelity assessments for 10 HF programs revealed an average score of 3.3/4, which compares favorably with other HF programs during early implementation. The TTA influenced fidelity by addressing misconceptions about the model, encouraging team‐based practice, and facilitating case‐based dialogue on site specific implementation challenges. The findings were discussed in terms of the importance of TTA for enhancing the capacities of the HF service delivery system—practitioners, teams, and communities—while respecting complex community contexts, including differences in policy climate across sites. Policy climate surrounding accessibility of housing subsidies, and use of Assertive Community Treatment teams (vs. Intensive Case Management) were two key implementation issues.     

When Height Carries Weight: Communicating Hidden Object Properties for Joint Action

In the absence of pre‐established communicative conventions, people create novel communication systems to successfully coordinate their actions toward a joint goal. In this study, we address two types of such novel communication systems: sensorimotor communication, where the kinematics of instrumental actions are systematically modulated, versus symbolic communication. We ask which of the two systems co‐actors preferentially create when aiming to communicate about hidden object properties such as weight. The results of three experiments consistently show that actors who knew the weight of an object transmitted this weight information to their uninformed co‐actors by systematically modulating their instrumental actions, grasping objects of particular weights at particular heights. This preference for sensorimotor communication was reduced in a fourth experiment where co‐actors could communicate with weight‐related symbols. Our findings demonstrate that the use of sensorimotor communication extends beyond the communication of spatial locations to non‐spatial, hidden object properties.