Sustaining and Expanding Systems of Care to Provide Mental Health Services for Children, Youth and Families Across America

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.     

Conflict Transformation, Stigma, and HIV-Preventive Structural Change

Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.     

Five-Factor Model facets differentially predict in-the-moment affect and cognitions

The facets of the Five-Factor Model (FFM) of personality are presumed to represent distinct, biologically-based tendencies to act, think, and behave; yet they have received little behaviorally-based empirical validation. In this study, FFM facets were used to examine individual differences in affective and cognitive responses to stressors as they are experienced in daily life. Participants (N = 79) completed the NEO-PI-R followed by a week-long experience sampling procedure. As expected, hierarchical linear modeling showed that FFM facets captured affective and cognitive tendencies that were missed at the domain level. They additionally demonstrated convergent and divergent validity in predicting momentary affect. These results provide evidence that facets are distinct, non-interchangeable predictors of daily thoughts and emotions.     

Associative status of the training context determines the effectiveness of compound extinction

Studies of extinction of a target cue in compound with another excitor have produced evidence of both deepened and attenuated extinction relative to elemental extinction. The present experiments sought to resolve this discrepancy by assessing the effect of the extinction context-unconditioned stimulus (US) association on compound extinction. In an ABC renewal situation with rats, Experiment 1 replicated the observation that enhanced extinction (i.e., reduced conditioned suppression) occurs as a result of nonreinforcement in compound with a concurrent excitor. In Experiment 2, inflation of the extinction context-US association through unsignaled, intertrial US presentations reversed the effect of a concurrent excitor (i.e., extinction with a concurrent excitor was less effective than elemental extinction). Experiment 3 compared compound extinction and second-order conditioning with respect to the effect of context inflation, and produced results incompatible with the view that second-order conditioning contributed to the results of Experiment 2. In Experiment 4, a concurrent excitor enhanced extinction in ABC renewal and attenuated extinction in AAC renewal. The present results suggest that the effect of a concurrent excitor during extinction depends on the strength of the extinction context-US association, thereby confirming predictions of the sometimes -competing retrieval model of associative acquisition and extinction.     

Analysis of voice impairment in aphasia after stroke-underlying neuroanatomical substrates

Phonation is a fundamental feature of human communication. Control of phonation in the context of speech-language disturbances has traditionally been considered a characteristic of lesions to subcortical structures and pathways. Evidence suggests however, that cortical lesions may also implicate phonation. We carried out acoustic and perceptual analyses of the phonation of /a/ in 60 males with aphasia (20 Wernicke's, 20 Broca's, 20 subcortical aphasia) and 20 males matched in age with no neurological or speech-language disturbances. All groups with aphasia were significantly more impaired on the majority of acoustic and perceptual measures as compared with the control speakers. Within the subjects with aphasia, subjects with subcortical aphasia were more impaired on most measures compared to subjects with Broca's aphasia, and they, in turn, more impaired than those with Wernicke's aphasia. Lesions in regions involved in sound production-perception result in dysfunction of the entire neurocognitive system of articulation-phonological language processing.     

Validity for an Integrated Laboratory Analogue of Sexual Aggression and Bystander Intervention

This study sought to develop and validate an integrated laboratory paradigm of sexual aggression and bystander intervention. Participants were a diverse community sample (54% African American) of heterosexual males (N = 156) between 21 and 35 years of age who were recruited to complete the study with a male friend and an ostensibly single, heterosexual female who reported a strong dislike of sexual content in the media. Participants viewed a sexually explicit or nonsexually explicit film clip as part of contrived media rating task and made individual choices of which film clip to show the female confederate. Immediately thereafter, participants were required to reach consensus on a group decision of which film clip to show the female confederate. Subjecting a target to an unwanted experience with a sexual connotation was operationalized as selection of the sexually explicit video, whereas successful bystander intervention was operationalized as the event of one partner individually selecting the sexually explicit video but then selecting the nonsexually explicit video for the group choice. Results demonstrated that a 1‐year history of sexual aggression and endorsement of pertinent misogynistic attitudes significantly predicted selection of the sexually‐explicit video. In addition, bystander efficacy significantly predicted men's successful prevention of their male peer's intent to show the female confederate a sexually explicit video. Discussion focused on how these data inform future research and bystander intervention programming for sexual aggression. Aggr. Behav. 38:309–321, 2012. © 2012 Wiley Periodicals, Inc.     

Executive functions and the down-regulation and up-regulation of emotion

This study examined the relationship between individual differences in executive functions (EF; assessed by measures of working memory, Stroop, trail making, and verbal fluency) and ability to down-regulate and up-regulate responses to emotionally evocative film clips. To ensure a wide range of EF, 48 participants with diverse neurodegenerative disorders and 21 older neurologically normal ageing participants were included. Participants were exposed to three different movie clips that were designed to elicit a mix of disgust and amusement. While watching the films they were either instructed to watch, down-regulate, and up-regulate their visible emotional responses. Heart rate and facial behaviours were monitored throughout. Emotion regulatory ability was operationalised as changes in heart rate and facial behaviour in the down- and up-regulation conditions, controlling for responses in the watch condition. Results indicated that higher verbal fluency scores were related to greater ability to regulate emotion in both the down-regulation and up-regulation conditions. This finding remained significant even after controlling for age and general cognitive functioning. No relationships were found between emotion regulation and the other EF measures. We believe these results derive from differences among EF measures, with verbal-fluency performance best capturing the complex sequence of controlled planning, activation, and monitoring required for successful emotion regulation. These findings contribute to our understanding of emotion-cognition interaction, suggesting a link between emotion-regulatory abilities and individual differences in complex executive functions.     

Policy bundling to overcome loss aversion: A method for improving legislative outcomes

Policies that would create net benefits for society that contain salient costs frequently lack enough support for enactment because losses loom larger than gains. To address this consequence of loss aversion, we propose a policy-bundling technique in which related bills involving both losses and gains are combined to offset separate bills’ costs while preserving their net benefits. We argue this method can transform unpopular individual pieces of legislation, which would lack the support for implementation, into more popular policies. Study 1 confirms that bundling increases support for bills with costs and benefits and that bundled legislation is valued more than the sum of its parts. Study 2 shows this finding stems from a diminished focus on losses and heightened focus on gains. Study 3 extends our findings to policies involving costs and benefits of the same type (e.g., lives) generated by different sources (e.g., food vs. fire safety).