A Business Model for Managing System Change Through Strategic Financing and Performance Indicators: A Case Study

This article describes how a system of care operated by a county government agency used a fiscal crisis as the opportunity to reform its children's system. A cross-system response to the crisis is outlined that includes a system of care framework coupled with a business model, inter-departmental collaboration and leadership, the use of strategic reinvestment strategies, and a quality improvement system that focuses on key indicators. Implementation of the system change is described with a specific focus on cross-system entry points, financing strategies that re-allocate funds from deep-end programs to community-based services, and management oversight through the use of performance indicators to monitor and support effectiveness. This article examines the results of the system change, including the diversion of youth from system penetration, the reduction in residential treatment bed days, the re-allocation of these savings to community-based services, and the outcomes of children who were diverted from residential care and served in the community. The article offers a number of recommendations for other communities contemplating system change.     

National suicide prevention lifeline: enhancing mental health care for suicidal individuals and other people in crisis

Linking at-risk callers to ongoing mental health care is a key goal of crisis hotline interventions that has not often been addressed in evaluations of hotlines' effectiveness. We conducted telephone interviews with 376 suicidal and 278 nonsuicidal crisis callers to the National Suicide Prevention Lifeline (Lifeline) to assess rates of mental health care utilization following Lifeline calls and to assess attitudinal and structural barriers to service utilization. Postcall utilization rates were approximately 50% for suicidal and crisis callers who received mental health care referrals. Lack of health insurance and callers' perceptions about mental health problems emerged as significant barriers to accessing continued help.     

Exploring an integrative model of infant behavior: what is the relationship among temperament, sensory processing, and neurobehavioral measures?

Traditionally, developmental psychology, occupational/physical therapy, and behavioral pediatrics view similar infant behaviors from temperament, sensory processing, or neurobehavioral theoretical perspectives. This study examined the relations between similar and unique summary scores of three infant assessments (Early Infancy Temperament Questionnaire - EITQ, the Infant Sensory Profile - ISP, and the NICU Network Neurobehavioral Scale - NNNS) in a healthy sample of 100, one-month-old infants. A Principal Components Analysis of selected subscale scores derived from the three assessments suggested a three-factor model. Temperament and sensory summary scores had the strongest relations on two factors: Sensory-Affective Reactivity and Engagement. A third factor had strong relations between state regulation and motor competence. This new integrative model also validates an existing model and expands explanation of infant behavior across disciplines and methods which have significant implications for assessment, intervention, and management practices.     

Mothers’ and Adolescents’ Perceptions of Family Environment and Adolescent Social-Emotional Functioning

Research has emphasized the importance of the relationship between family functioning and adolescent behavioral development. The present study examines family environment and social-emotional functioning of primarily minority adolescents, viewed from both adolescents’ and mothers’ perspectives. Participants were a school-based sample of adolescents with and without risk for emotional and behavioral disabilities and their mothers (N = 86 dyads). Results suggested an association between the mothers’ views of their adolescent children’s problem behaviors and the adolescents’ self-ratings of risk-taking behaviors across 5 years. Overall, mothers of the at risk youth receiving special education services reported higher ratings of youth problem behaviors, but results also indicated that mothers of the at risk adolescent boys not receiving special education services perceived greater depressive symptoms in their children and more family conflict in their homes. Mothers of youth at risk but not receiving special education services experienced higher levels of stress associated with being a parent than mothers of the not-at-risk adolescents. The parent measures of adolescent behavior and depressive symptoms, family conflict, and parental stress were not predictive of the social-emotional functioning of these adolescents in the multilevel models. Implications of these findings for early identification and family focused intervention programs are discussed.     

Evaluations Versus Expectations: Children's Divergent Beliefs About Resource Distribution

Past research reveals a tension between children's preferences for egalitarianism and ingroup favoritism when distributing resources to others. Here we investigate how children's evaluations and expectations of others' behaviors compare. Four‐ to 10‐year‐old children viewed events where individuals from two different groups distributed resources to their own group, to the other group, or equally across groups. Groups were described within a context of intergroup competition over scarce resources. In the Evaluation condition, children were asked to evaluate which resource distribution actions were nicer. In the Expectation condition, children were asked to predict which events were more likely to occur. With age, children's evaluations and expectations of others' actions diverged: Children evaluated egalitarian actions as nicer yet expected others to behave in ways that benefit their own group. Thus, children's evaluations about the way human social actors should behave do not mirror their expectations concerning those individuals' actions.     

Training the next generation of counseling psychologists in the practice of telepsychology

Training programs that integrate the use of technology are needed to prepare students for the future of service delivery in psychology. Training opportunities in telepsychology can equip students to develop, implement, and evaluate innovative modalities for mental health care. However, few options are available for trainees seeking to acquire these experiences, and while guidelines for service provision using technology are emerging, guidelines for and documented examples of training programs in telepsychology are virtually non-existent. The Telehealth Counseling Clinic, located at the Texas A&M Health Science Center, has developed a training model to prepare the next generation of psychologists to work with new technology to provide counseling services to low-income and uninsured individuals living in designated Mental Health Professional Shortage Areas in rural Texas. Training competencies necessary to serve this population through telepsychology are discussed and preliminary evaluation data of the training program are presented.