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.

     

The BlackBerry project: capturing the content of adolescents' text messaging

This article presents an innovative method for capturing the content of adolescents' electronic communication on handheld devices: text messaging, e-mail, and instant messaging. In an ongoing longitudinal study, adolescents were provided with BlackBerry devices with service plans paid for by the investigators, and use of text messaging was examined when participants were 15 years old and in the 10th grade (N = 175; 81 girls). BlackBerries were configured so that the content of all text messages, e-mail messages, and instant messages was saved to a secure server and organized in a highly secure, searchable, online archive. This article describes the technology used to devise this method and ethical considerations. Evidence for validity is presented, including both information on use of text messaging to show that participants used these devices heavily and frequencies of profane and sexual language in a 2-day sample of text messaging to demonstrate that they were communicating openly.     

Condition-dependent adaptive phenotypic plasticity and interspecific gene-culture coevolution

Evolutionary socioecological theory and research proposing linking parasites with human social organization is uncommon and therefore welcome. However, more generally, condition-dependent adaptive phenotypic plasticity requires environmental uncertainty on a small scale, accompanied by reliable cues. In addition, genes in parasites may select among biologically adaptive cultural alternatives directly without necessarily going through human genetic predispositions, resulting in inter-specific gene-culture coevolution.     

Can We Be Self‐Deceived about What We Believe? Self‐Knowledge,Self‐Deception,and Rational Agency

Abstract: This paper considers the question of whether it is possible to be mistaken about the content of our first‐order intentional states. For proponents of the rational agency model of self‐knowledge, such failures might seem very difficult to explain. On this model, the authority of self‐knowledge is not based on inference from evidence, but rather originates in our capacity, as rational agents, to shape our beliefs and other intentional states. To believe that one believes that p, on this view, constitutes one's belief that p and so self‐knowledge involves a constitutive relation between first‐ and second‐order beliefs. If this is true, it is hard to see how those second‐order beliefs could ever be false. I develop two counter‐examples which show that despite the constitutive relation between first‐ and second‐order beliefs in standard cases of self‐knowledge, it is possible to be mistaken, and even self‐deceived, about the content of one's own beliefs. These counter‐examples do not show that the rational agency model is mistaken—rather, they show that the possibility of estrangement from one's own mental life means that, even within the rational agency model, it is possible to have false second‐order beliefs about the content of one's first‐order beliefs. The authority of self‐knowledge does not entail that to believe that one believes that p suffices to make it the case that one believes that p.     

‘The third person in the room’: Recording the counselling interview for the purpose of counsellor training – barrier to relationship building or effective tool for professional development?

Objective: Audio and videotape interview recording for training and supervision in counsellor education is commonplace within New Zealand, yet researchers have paid little attention to its value perceived by students. This study explores counselling students’ perceptions of the effects of recording counselling interviews on themselves, their clients and on the counselling process. Design: Counselling students from five tertiary educational settings in New Zealand participated in individual or focus group interviews to discuss their experiences of recording counselling interviews. Findings: All interviewees indicated that recording initially curtailed their ability to be completely present in the counselling interview. Some thought this may have negatively influenced their clients’ ability to use the counselling session effectively. Most noted their own increased confidence over time. Almost all considered recording to be extremely beneficial to the development of effective counselling skills. Conclusion: Most students considered the benefits of recording to outweigh the drawbacks. Implications for continuing the practice of recording and playing back interviews in counsellor‐education programmes are considered.     

Links between Family Social Status and Preschoolers' Persistence: The Role of Maternal Values and Quality of Parenting

Children who develop persistence in the preschool years are likely to function more effectively during the transition into school. In this study of 231 3‐year‐old children and their mothers, we examined the relations among family social status, maternal values of self‐direction, quality of parenting, and children's persistence in challenging tasks. Results of structural equation modelling path analysis indicated that family social status was related to maternal values of self‐direction, which in turn were associated with the quality of maternal cognitive stimulation and emotional support and child persistence at preschool age. Family social status and maternal values were indirectly related to child persistence through emotional support. Focusing on parental values of self‐direction and provision of support during challenging tasks may help to reduce the gap in school success between children from lower and higher social status families. Copyright © 2012 John Wiley & Sons, Ltd.     

Subcultural Research on Organizational Commitment With the 15 OCQ Invariant Instrument

The 15 item organizational commitment scale (15 OCQ) has been developed, tested, and validated in the USA (Mowday et al. 1979). Its adaptability to other countries and other languages is necessary for subcultural and cross-cultural research in industrial settings. A French version of the OCQ instrument was developed and assessed. Exploratory and multi-group invariance testings were used to assess the instrument invariance with French and English Canadian salespeople. The comparable English and French versions should facilitate future research.     

Motivational interviewing as a way to promote physical activity in obese adolescents: A randomised-controlled trial using self-determination theory as an explanatory framework

Using self-determination theory (SDT) as an explanatory framework, this randomised-controlled study evaluates the effect of a motivational interviewing (MI)-based intervention as an addition to a standard weight loss programme (SWLP) on physical activity (PA) practice in obese adolescents over a six-month period. Fifty-four obese adolescents (mean age?=?13?years, mean BMI?=?29.57?kg/m²) were randomly assigned to an SWLP group (n?=?28) or SWLP?+?MI group (n?=?26). Both groups received two SWLP sessions, supplemented for the SWLP?+?MI group, by six MI sessions. Perceived autonomy support, perceived competence, motivational regulations, PA and BMI were assessed at baseline, three and six months (i.e. the end of the programme). MLM analyses revealed that compared to SWLP, the SWLP?+?MI group had a greater BMI decrease and a greater PA practice increase over time. Moreover, the SWLP?+?MI group reported greater autonomy support from medical staff at the end of the programme, greater increase in integrated and identified regulations and a stronger decrease in amotivation. MI appears as an efficient counselling method as an addition to an SWLP to promote PA in the context of pediatric obesity.     

A Multilevel Investigation of the Influences of Employees' Resistance to Empowerment

We employed a multilevel research design to examine the effects of employees' resistance to empowerment. Survey responses were obtained from 637 customer service engineers who worked in 121 empowered teams. At the team level of analysis, resistance to empowerment climate related negatively to customer satisfaction as mediated by transition processes. In addition, resistance to empowerment climate evidenced an indirect relation with team performance via team action processes. At the individual level of analysis, employees' resistance to empowerment related negatively to their job satisfaction. Moreover, a cross-level relation was evidenced whereby team-level resistance to empowerment climate related negatively to job satisfaction, beyond that accounted for by the individual-level effects, as partially mediated by team interpersonal processes. Results are discussed in terms of the multilevel manner in which employees' resistance to empowerment can undermine organizational design changes.