Training needs among nonmental health professionals working with service members: A qualitative investigation

Though many service members will not directly seek mental health care due to stigma and other factors, they may interact with the healthcare system in other ways including contact with first responders, nurses, and allied health care professionals. However, little attention has been spent in this regard on the educational needs of these professionals whose contact with service members and Veterans may provide the opportunity to assist Veterans in need with overcoming barriers to accessing mental health care. This qualitative study investigates the educational training needs of first responders and health care professionals in contact with military families and trauma survivors to determine whether, and what type, of additional training is needed. A sample of 42 first responders and health care professionals including emergency medical technicians, police officers, fire fighters, speech language pathologists, occupational therapists, physical therapists, and nurses were recruited to participate in 1 of 6 focus groups. Sessions were audiotaped and transcribed verbatim. Data analysis was guided by a thematic analysis approach. Thematic analyses suggest there is a significant knowledge gap with unmet educational needs of these professionals such as information on the invisible wounds of war, military culture, and screening and referring patients who present symptoms falling outside professionals’ scope of practice. Findings point to a need and desire for more robust education for first responders and health care providers around mental health concerns of military populations, including topics such as trauma, military culture, and screening tools. Efforts to develop curricula addressing these concerns are warranted.     

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.     

Are we certain about which measure of intolerance of uncertainty to use yet?

Intolerance of Uncertainty (IU) has been understood as a dispositional tendency to view the presence of negative events as unacceptable and threatening, regardless of the likelihood of those events occurring. The preference over the 12-item vs. 27-item of the IUS has been central to debate. The goals of the present study were to evaluate two competing models of measuring IU with model-fitting analyses and explore model invariance of gender (e.g. men vs. women). A sample of 980 individuals completed an online IUS survey. Results indicated that the two-factor short-form model provided better fit to the data compared to the full-length two-factor model proposed by. Results also indicated that the short-form IUS is gender invariant, suggesting acceptable use among men and women. These findings provide further support of a two-factor structure and suggest that the IUS is appropriate for men and women.     

Developing symbolic capacity one step at a time

The present research examines the ability of children as young as 4 years to use models in tasks that require scaling of distance along a single dimension. In Experiment 1, we found that tasks involving models are similar in difficulty to those involving maps that we studied earlier (Huttenlocher, J., Newcombe, N., & Vasilyeva, M. (1999). Spatial scaling in young children. Psychological Science, 10, 393-398). In Experiment 2, we found that retrieval tasks, where children indicate the location of a hidden object in an actual space are substantially more difficult than placement tasks, where children put a visible object in a particular location in an actual space. We discuss possible implications of the differential difficulty of retrieval and placement tasks for the understanding of symbolic development.     

Cortisol reactivity and regulation associated with shame responding in early childhood

The purpose of this study was to characterize cortisol response and regulation associated with shame responding in early childhood and to examine how general the relation between shame and cortisol is. It was predicted that children responding to task failure with shame would show a larger and more prolonged cortisol response than other children. Participants were 214 children (124 boys, 90 girls) ranging from 3.7 to 4.5 years of age (M = 4.14 years, SD = 0.24). Shame responding was assessed from children's emotion-expressive behavior in response to failing 6 performance tasks, 2 preceding (initial) and 4 following (subsequent) assessment of hypothalamic-pituitary-adrenal axis activation. Cortisol response and regulation associated with failure were assessed from saliva sampled before and 15, 20, 25, 30, and 40 min following the first of the 2 initial failures. For boys and for some girls, high initial shame was associated with greater cortisol reactivity and slower regulation of the cortisol response. For boys, high initial shame and relatively slow regulation of the associated cortisol response predicted subsequent shame responding occurring after recovery of the cortisol response. For girls, high initial shame, but not cortisol response, predicted subsequent shame responding. (PsycINFO Database Record (c) 2008 APA, all rights reserved).     

Preferences for emotional information in older and younger adults: a meta-analysis of memory and attention tasks

The authors conducted a meta-analysis to determine the magnitude of older and younger adults' preferences for emotional stimuli in studies of attention and memory. Analyses involved 1,085 older adults from 37 independent samples and 3,150 younger adults from 86 independent samples. Both age groups exhibited small to medium emotion salience effects (i.e., preference for emotionally valenced stimuli over neutral stimuli) as well as positivity preferences (i.e., preference for positively valenced stimuli over neutral stimuli) and negativity preferences (i.e., preference for negatively valenced stimuli to neutral stimuli). There were few age differences overall. Type of measurement appeared to influence the magnitude of effects; recognition studies indicated significant age effects, where older adults showed smaller effects for emotion salience and negativity preferences than younger adults.     

Competence to make treatment decisions in anorexia nervosa: thinking processes and values

This paper explores the ethical and conceptual implications of the findings from an empirical study of decision-making capacity in anorexia nervosa. In the study, ten female patients aged 13 to 21 years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semi-structured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient participants were also tested using the MacCAT-T test of competence. This is a formalised, structured interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief self-administered questionnaires to assess their levels of psychopathology.The issues identified from the interviews are described under two headings: difficulties with thought processing, and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches or current standardised tests of competence.     

Through neural stimulation to behavior manipulation: a novel method for analyzing dynamical cognitive models

The dynamical systems' approach to cognition (Dynamicism) promises computational models that effectively embed cognitive processing within its more natural behavioral context. Dynamical cognitive models also pose difficult, analytical challenges, which motivate the development of new analytical methodology. We start by illustrating the challenge by applying two conventional analytical methods to a well-known Dynamicist model of categorical perception. We then introduce our own analysis, which works by analogy with neural stimulation methods, and which yields some novel insights into the way the model works. We then extend and apply the method to a second Dynamicist model, which captures the key psychophysical trends that emerge when humans and animals compare two numbers. The results of the analysis-which reveals units with tuning functions that are monotonically related to the magnitudes of the numbers that the agents must compare-offer a clear contribution to the contentious debate concerning the way number information is encoded in the brain.     

Five reasons to doubt the existence of a geometric module

It is frequently claimed that the human mind is organized in a modular fashion, a hypothesis linked historically, though not inevitably, to the claim that many aspects of the human mind are innately specified. A specific instance of this line of thought is the proposal of an innately specified geometric module for human reorientation. From a massive modularity position, the reorientation module would be one of a large number that organized the mind. From the core knowledge position, the reorientation module is one of five innate and encapsulated modules that can later be supplemented by use of human language. In this paper, we marshall five lines of evidence that cast doubt on the geometric module hypothesis, unfolded in a series of reasons: (1) Language does not play a necessary role in the integration of feature and geometric cues, although it can be helpful. (2) A model of reorientation requires flexibility to explain variable phenomena. (3) Experience matters over short and long periods. (4) Features are used for true reorientation. (5) The nature of geometric information is not as yet clearly specified. In the final section, we review recent theoretical approaches to the known reorientation phenomena.