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.     

Body Esteem: An Exception to Self‐Enhancing Illusions?1

Participants were 192 university students (96 males, 96 females) who completed the Body Esteem scale (Franzoi & Shields, 1984) under instructions to rate their feelings about their own bodies, rate their feelings about a specific or “average” student's body, and rate the importance they and others attached to these feelings. One of the findings is that when individuals perceived themselves as less positive on a particular desirable physical trait, they also rated the trait as less important to possess in the first place. The only exception to this was women's weight concern. It was also found that men generally rated themselves higher on body‐esteem subscales than they rated other men, while women did not exhibit such self‐serving evaluations of their bodies. One implication from these results is that the same self‐enhancement strategies successfully employed by individuals in other areas of self‐evaluations were not successful in enhancing one's body esteem, especially women's weight concern.     

Who Is Referred to Mental Health Services in the Juvenile Justice System?

We describe the mental health referral rate among youth in a correction facility, examine how sociodemographic and criminal history characteristics relate to referral, and explore how these variables and diagnostic class differ by referral source. Data were abstracted from case records. The referral rate was low (6%). Non-Latino youth, repeat offenders, and violent offenders were more likely to be referred compared to all detained youth. Referral source also varied by violent offense history and diagnosis type. Future studies examining access to mental health services should take into account a detained youth's sociodemographic, criminal history, and clinical characteristics.     

Pavlovian heart rate and jaw movement conditioning in the rabbit: effects of medial prefrontal lesions

An experiment was conducted in which jaw movements (JM) and heart rate (HR) were concomitantly assessed in rabbits during simple Pavlovian conditioning. A 2-s 1200-Hz tone was the conditioned stimulus (CS) and an intraoral 1-cc pulse of 0.5 M sucrose-water solution was the unconditioned stimulus (US). Sham and medial prefrontal (mPFC)-lesioned animals received paired CS/US training with a 70- to 75-dB CS and were compared with sham- and mPFC-lesioned animals that received explicitly unpaired CS/US presentations. The percentages of JM CRs were significantly greater in the paired than the unpaired groups, but mPFC lesions had no effect on this measure. Conditioned HR decelerations occurred only in the paired groups and then only during the first session of training. Moreover, these CS-evoked cardiac decelerations were somewhat attenuated by the mPFC lesion. CS-evoked HR accelerations, which were significantly greater in unpaired than in paired animals, occurred during the four subsequent sessions. These results suggest that a CS-evoked cardioinhibitory process, mediated by the mPFC, is engendered by Pavlovian appetitive conditioning, as has been previously demonstrated for aversive conditioning. However, during JM conditioning these inhibitory changes are quickly replaced by tachycardia, possibly related to increased nonspecific somatomotor activity, since the tachycardia was somewhat greater in the unpaired animals.     

The impact of experienced versus non‐experienced suggestions on children's recall of repeated events

Three experiments were conducted to test the proposition that children's suggestibility about an occurrence of a repeated event is heightened when an interviewer suggests false details that were experienced in non‐target occurrences of the event as opposed to new details that never occurred. In each experiment, children participated in a repeated event during which specific items varied each time (e.g. the children always got a sticker but the theme of the sticker was different in each occurrence). Separate biasing and memory interviews were then conducted. In Experiment 1, the interviewer merely suggested that the false details might have occurred in the event. In the remaining experiments, the suggested details were clearly linked to the target occurrence with either a contextual or temporal cue. The potential moderating effect of the child's age (Experiment 1) and the retention interval (Experiments 1 and 2) were also examined. Consistent with the initial hypothesis, suggestions about experienced (non‐target) details were more likely to be repeated by the children compared to suggestions about non‐experienced details. In Experiments 2 and 3, experienced suggestions were also more likely to inhibit children's recall of the target occurrence. The relevance and generalizability of these findings to the legal setting are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Effective obesity treatments

To curb the epidemic of obesity in the United States, revised Medicare policy allows support for efficacious obesity treatments. This review summarizes the evidence from rigorous randomized trials (9 lifestyle trials, 5 drug trials, and 2 surgical trials) on the efficacy and risk- benefit profile of lifestyle, drug, and surgical interventions aimed at promoting sustained (= 2 years) reductions in weight. Both lifestyle and drug interventions consistently produced an approximate 7-lb (3.2-kg) weight loss that was sustained for 2 years and was associated with improvements in diabetes, blood pressure, and/or cardiovascular risk factors. Surgical interventions have a less solid empirical base but offer promise for the promotion of significant and sustained weight reduction posttreatment in the morbidly obese but with possible significant short-term side effects. In summary, there is strong and consistent support from rigorous randomized trials that lifestyle or drug interventions result in modest weight loss with minimal risks but disproportionate clinical benefit. Combinations of lifestyle, drug, and, where appropriate, surgical interventions may be the most efficacious approach to achieving sustained weight loss for the widest diversity of patients.     

Effectiveness of a responsible conduct of research course: a preliminary study

Training in the responsible conduct of research (RCR) is required for many research trainees nationwide, but little is known about its effectiveness. For a preliminary assessment of the effectiveness of a short-term course in RCR, medical students participating in an NIH-funded summer research program at the University of California, San Diego (UCSD) were surveyed using an instrument developed through focus group discussions. In the summer of 2003, surveys were administered before and after a short-term RCR course, as well as to alumni of the courses given in the summers of 2002 and 2001. Survey responses were analyzed in the areas of knowledge, ethical decision-making skills, attitudes about responsible conduct of research, and frequency of discussions about RCR outside of class. The only statistically significant improvement associated with the course was an increase in knowledge, while there was a non-significant tendency toward improvements in ethical decision-making skills and attitudes about the importance of RCR training. The nominal impact of a short-term training course should not be surprising, but it does raise the possibility that other options for delivering information only, such as an Internet-based tutorial, might be considered as comparable alternatives when longer courses are not possible.     

Adolescent suicide, gender, and culture: A rate and risk factor analysis

The current paper provides a comprehensive research review of gender differences in rates of and risk factors for adolescent suicidal behavior in four main U.S cultural subgroups: African Americans, Native Americans, Asian Americans, and Latino Americans. The paper highlights substantial findings from the most recent literature and provides direction for future research and clinical work. The data presented suggest that clinicians and interventionists relying on nonfatal expressions of suicide will continue to fail to identify adolescent males at risk for suicide, as females are more likely to report suicide ideation and attempts across all cultural groups reviewed. We conclude that researchers and clinicians should utilize indirect, broad measures of suicide proneness, as opposed to the traditional direct self-report tools. Although past research has examined cultural and gender differences in risk factors for suicidal behavior, these investigations have been primarily isolated from each other. Therefore, we sought to examine adolescent suicidal behavior and how it operates as a function of both gender and culture.     

Assessment of Spirituality in Counseling

A growing body of evidence points to the important role of spirituality in treating medical and psychological conditions. The authors suggest that spirituality is a 5th force in counseling and psychology. Consequently, the assessment of spirituality is a new and growing area of interest for counselors. Assessment can assist both the counselor and client in obtaining a better understanding of the role of spirituality in the issues that bring the client to counseling and in designing treatment interventions appropriate for resolution of those issues. Selected instruments currently in use are described and their psychometric properties and potential uses are examined.