Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system’s six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.     

Metacognitive illusions for auditory information: Effects on monitoring and control

Prior work has demonstrated that the perceptual features of visually presented stimuli can have a strong influence on predictions of memory performance, even when those features are unrelated to recall (Rhodes & Castel, 2008). The present study examined whether this finding would hold in an auditory domain and influence study-choice allocation. Participants listened to words that varied in volume, made judgments of learning (JOLs) for each item, and were then administered a test of free recall. In Experiment 1, we showed that JOLs were influenced by volume, with loud words given higher JOLs than quiet words, and that volume had no influence on recall, illustrating a metacognitive illusion based on auditory information. In Experiment 2, we extended these findings to control processes and showed that participants were more likely to choose to restudy quiet words than loud words. These findings indicate that highly accessible auditory information is integrated into JOLs and restudy choices, even when this information does not influence actual memory performance.     

Source credibility and syllogistic reasoning

Two experiments examined whether a source credibility effect would be observed for a syllogistic reasoning task. In the experiments, people were given two statements, presented as the results from a survey, followed by a conclusion that was supposedly made by one of two sources. In Experiment 1, one of the sources was described as honest and the other as dishonest, and in Experiment 2, one of the sources was described as an expert and the other as a non-expert. Because a pilot experiment showed that credibility can be overridden by people’s experience with a source, all conclusions in Experiments 1 and 2 were ones that were likely to be accepted (i.e., necessary and possible strong conclusions). Both experiments showed a clear source credibility effect, particularly for the invalid conclusions. These results, along with the belief bias effect and previous research with conditional reasoning, suggest that people can be influenced by extraneous context, such as the honesty or expertise of a source, in a syllogistic reasoning task.     

Changing exercise through targeting affective or cognitive attitudes

Two studies investigated the impact of affective and cognitive messages compared to a no-message control on self-reported exercise. Students (Study 1, N = 383 and Study 2, N = 197) were randomly allocated to one of the three conditions (control - no message, affective message or cognitive message). Participants completed questionnaire measures tapping components of the theory of planned behaviour in relation to exercise and reported their level of exercise (3 weeks later). In Study 2, measures of need for affect (NFA) and need for cognition (NFC) were also completed. Results showed that affective messages consistently produced greater increases in self-reported level of exercise than the other conditions. In both studies, this effect was partly mediated by affective attitude change. Study 2 indicated these effects to be significantly stronger among those high in NFA or low in NFC. These findings indicate the value of affective messages that target affective attitudes in changing exercise behaviour.     

Location and frequency cues in auditory selective attention

The roles of frequency and location cues in auditory selective attention were investigated in a series of experiments in which target tones were distinguished from distractors by frequency, location, or the conjunction of frequency and location features. When frequency separations in high-rate tone sequences were greater than 1 octave, participants were fastest at identifying targets defined by frequency and were sometimes faster at identifying conjunction than location targets. Frequency salience diminished as filtering demands were reduced: At long interstimulus intervals (> 2.0 s), performance was superior in location conditions. The results suggest that frequency may play a role in auditory selective attention tasks analogous to the role of spatial position in visual attention.     

Perceptual asymmetries in face recognition

Four experiments were carried out to investigate perceptual asymmetries in face recognition. Perceptual asymmetries favoring the half-face on the observer's left were found under free viewing conditions for both unfamiliar faces (Experiment 1) and famous faces (Experiment 3). For unfamiliar faces, this asymmetry was not obtained when fixation was controlled by presenting faces tachistoscopically (Experiment 2). For famous faces, the perceptual asymmetry favoring the half-face normally seen on the left did not appear to be retained in memory (Experiments 3 and 4). Asymmetries in face perception have been explained in terms of a direct access model of laterally effects. However, these results raise the possibility that asymmetric scanning or attentional factors may be important.     

A Confirmatory Factor Analysis of the Short Form Sex Role Behavior Scale

The Sex Role Behavior Scale (SRBS; Orlofsky & O'Heron, 1987; Orlofsky, Ramsden, & Cohen, 1982) is the only measure of the extent to which people engage in male- and female-valued behaviors, as well as sex-specific behaviors. Because of this, researchers must be assured of its reliability and validity. Although the SRBS has demonstrated good reliability, validity tests have been limited to examinations of scale intercorrelations, correlations with other gender role measures, and tests of gender differences. Tests of the SRBS's construct validity have not been performed. Thus, a scale-based confirmatory factor analysis of the short form SRBS was undertaken to determine the validity of its proposed 12-factor, lower-order and 3-factor, higher-order factor structures. In this sample of undergraduates, both lower-order and higher-order models failed to provide a good fit to the data, which suggests that a new version of the SRBS may be required. Discussion focussed on possible directions for a revision, potential limitations, as well as the need for more measures like the SRBS.     

An own-age bias in face recognition for children and older adults

In the present study, we examined whether children and older adults exhibit an own-age face recognition bias. Participants studied photographs of children, younger adults, middle-aged adults, and older adults and were administered a recognition test. Results showed that both children and older adults more accurately recognized own-age faces than other-age faces. These data suggest that individuals may acquire expertise for identifying faces from their own age group and are discussed in terms of Sporer’s (2001) in-group/out-group model of face recognition.