A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics

Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.’s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled “communication.” There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC—however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.     

Gender and sexual orientation differences in sexual response to sexual activities versus gender of actors in sexual films

In this study, the authors investigated the hypothesis that women's sexual orientation and sexual responses in the laboratory correlate less highly than do men's because women respond primarily to the sexual activities performed by actors, whereas men respond primarily to the gender of the actors. The participants were 20 homosexual women, 27 heterosexual women, 17 homosexual men, and 27 heterosexual men. The videotaped stimuli included men and women engaging in same-sex intercourse, solitary masturbation, or nude exercise (no sexual activity); human male-female copulation; and animal (bonobo chimpanzee or Pan paniscus) copulation. Genital and subjective sexual arousal were continuously recorded. The genital responses of both sexes were weakest to nude exercise and strongest to intercourse. As predicted, however, actor gender was more important for men than for women, and the level of sexual activity was more important for women than for men. Consistent with this result, women responded genitally to bonobo copulation, whereas men did not. An unexpected result was that homosexual women responded more to nude female targets exercising and masturbating than to nude male targets, whereas heterosexual women responded about the same to both sexes at each activity level.     

Moving Beyond an Exclusive Focus on Harm Avoidance in Obsessive-Compulsive Disorder: Behavioral Validation for the Separability of Harm Avoidance and Incompleteness

There is increasing recognition that symptoms of obsessive-compulsive disorder (OCD) may be associated not only with harm avoidance, but also with sensations of things being incomplete or not “just right.” Although preliminary research supports the presence of both harm avoidance and incompleteness in OCD, their validity as separate constructs has not been tested beyond the use of self-report measures. Therefore, the aim of the current study was to behaviorally validate the separability of harm avoidance and incompleteness using an unselected student sample. Consistent with hypotheses, self-reported levels of incompleteness and harm avoidance uniquely predicted participants' ratings of their experiences while performing OCD-relevant behavioral tasks (e.g., washing dirty dishes, arranging books on a bookshelf). Results suggest that harm avoidance is associated with anxiety/nervousness and a desire to prevent harm, whereas incompleteness is linked to feelings of tension/discomfort and a desire to perform tasks perfectly or just right. Theoretical and clinical implications are discussed.     

The Meanings and Manifestations of Religion and Spirituality among Lesbian, Gay, Bisexual, and Transgender Adults

The present study employed a mixed method approach in the effort to explore religious and spiritual practices among lesbian, gay, bisexual, and transgender (LGBT) individuals, as well as the meanings ascribed to the terms religiosity and spirituality by LGBT adults. Data were collected via a cross-sectional survey consisting of open- and close-ended items among 498 LGBT (lesbian, gay, bisexual, transgender) identified individuals attending an annual Pride event in a large northeastern city. Both quantitative and qualitative findings suggested that consistent with other studies, spirituality was defined largely in relational terms (e.g., in terms of one’s relationship with God and with self). Religion, in contrast, was defined largely in terms of communal worship and in terms of its negative influences in the lives of individuals and communities. For this sample of LGBT persons, spiritual identities were more pronounced than religious ones, and this pattern may be explained by their understanding of the spiritual self in relation to prosocial engagement and interconnectedness with others, the world around them, and the universe. Further, religious affiliation and practices were explained, in part, by the religion in which the individual was raised, level of educational attainment, as well as the developmental stage in which the person is currently situated. The findings highlight the reality that a substantial number of LGBT individuals may remain committed to religious and spiritual life, which may be related to a motivation to make sense of one’s place in the world especially in light of societal misunderstandings and intolerance to LGBT individuals.     

High School Biology/Life Science Teachers’ Presentation of Genetic Counseling and Health Care Career Options in Their Classrooms

Studies show teachers play an influential role in the career decision-making process of students and early knowledge of genetic counseling (GC) increases the likelihood students will consider this career option. This quantitative study is the first to explore the presentation of GC and other health care career options by high school (HS) biology/life science (B/LS) teachers in their classrooms. Our findings indicate most B/LS teachers present GC as a career option to HS students, agree it complements classroom activities, and perceive students as interested in learning about the profession. However, teachers note many barriers to spending class time presenting GC careers. Consequently, a substantial number of teachers spent a minimal amount of time presenting health care careers in general. We discuss ways genetic counselors can enhance career resources, reduce barriers, and foster student interest in pursuing a career in GC by developing partnerships with HS B/LS teachers.     

Comparison of delay discounting of different outcomes in cigarette smokers,smokeless tobacco users,e-cigarette users,and non-tobacco users

Delay discounting is the process by which a commodity loses value as the delay to its receipt increases. Rapid discounting predicts various maladaptive behaviors including tobacco use. Typically, delay discounting of different outcomes has been compared between cigarette smokers and nonsmokers. To better understand the relationship of delay discounting to different modes of tobacco use, we examined the differences in delay discounting of different outcomes between cigarette smokers, smokeless tobacco users, e-cigarette users, and non-tobacco users. In the present study, all participants completed 8 titrating delay-discounting tasks: $100 gain, $500 gain, $500 loss, alcohol, entertainment, food, a temporary health gain, and a temporary cure from a disease. Non-tobacco users discounted most outcomes less than tobacco users overall; however, there were no differences in discounting among the different types of tobacco users. These results suggest that nicotine consumption of any kind is associated with a higher degree of impulsivity compared to non-tobacco users. Adoption of tobacco products that have been perceived as less harmful (e.g., e-cigarettes) is not associated with a baseline difference or decrease in delay discounting if adopted after a history of cigarette use.     

Sensitivity to differences between enjoyment and non‐enjoyment smiles in children with autism spectrum disorder

The sensitivity of male children (5–15 years) with and without autism spectrum disorder (ASD) to the affective state of others was tested using an emotion recognition task. Only children without ASD could reliably differentiate between enjoyment and non‐enjoyment smiles. Results are considered in terms of the social impairments of children with ASD.