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.     

An examination of the Self-Administered Interview as a verbal veracity assessment tool

The self-administered interview (SAI) is a written eyewitness recall tool that elicits more information from cooperative witnesses than written free recall (WFR) formats. To date, SAI research has examined the accounts of cooperative people providing honest reports. In the current experiment, truthful and fabricating participants (N = 128) either completed a WFR or a SAI after witnessing a crime (initial account). After a 1-week delay, participants were interviewed verbally (subsequent interview). Truth tellers reported significantly more detail than liars in both the initial account and subsequent interview, and participants who completed the SAI reported more detail than those completing the WFR. Truth tellers repeated and omitted more information in the subsequent interview than liars; however, there was no significant difference in the number of reminiscent details reported. Although the SAI is effective in eliciting information as an initial eyewitness reporting tool, no benefits for the detection of deception were demonstrated.     

Cross-cultural differences in eyewitness memory reports

Increasingly, investigators conduct interviews with eyewitnesses from different cultures. The culture in which people have been socialised can impact the way they encode, remember, and report information about their experiences. We examined whether eyewitness memory reports of mock witnesses from collectivistic (sub-Saharan Africa) and individualistic (Northern Europe) cultures differed regarding quantity and quality of central and background details reported. Mock witnesses (total N = 200) from rural Ghana, urban Ghana, and the Netherlands were shown stimuli scenes of crimes in Dutch and Ghanaian settings and provided free and cued recalls. Individualistic culture mock witnesses reported the most details, irrespective of detail type. For each cultural group, mock witnesses reported more correct central details when crime was witnessed in their own native setting than a non-native setting, though for different recall domains. The findings provide insight for legal and investigative professionals as well as immigration officials eliciting memory reports in cross-cultural contexts.     

Attack-target attributes and pigeon aggression: Accessibility,vocalization, and body movements

Characteristics of the attack-target in laboratory tests appear to greatly influence the tendency for aggression to be initiated, maintained, and stopped. To address this question, accessibility, target movement, and vocalization among pigeon conspecifics were investigated in two different aggression tests: 1) paired aggression (PA); and 2) schedule-induced aggression (SI). In the PA test, dominant and subordinate roles formed quickly, and soon aggression episodes started to decline. In part, the subordinate's yielding behavior appeared to discourage attack. The significance of the target bird's behavior on attack frequency was borne out by the finding in the SI test that pigeons attacked a shielded, live, active target more often than a passive one. Furthermore, using a specially constructed stuffed pigeon in the SI test, results indicated that programmed, combined aggressive vocalization and body movement evoked most attacks with the VT schedule, vocalization alone evoked the next highest number of attacks, body movement alone the third most, and combined silence and immobility the least attacks. These findings provide a basis for explaining some past reported results associated with target features and a means for selecting other target features for future study.     

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).     

Hineni and Transference: The Remembering and Forgetting of the Other

Emmanuel Levinas proposed a philosophical critique that worked to unsettle and decenter generalizing, totalizing, and thematizing attempts to define the self. However, on the other hand, Levinas provides the space for the formation of a configuration of the self that has been conditioned by ethical relation and even points to some of the ingredients for (or shape of) such a self. Throughout Levinas’ work, the concept of hineni (“Here I am”) is used to illustrate the moral event that best characterizes the “psyche.” In the following paper, we consider how to apply the notion of hineni to modern psychological constructs of the human self. In the first section, we flesh out the characteristics of a self lived as hineni. We argue that such a self is “shaped” or oriented morally toward the outside and is radically exposed to the Other (not merely a bearer of moral consciousness or moral attributes). It is a remembering of the preoriginal and primordial ethical relation. In the second section, we use the psychoanalytic concept of transference to illustrate how the moral shape of the self can be forgotten, and how the self enters a state of “mineness” wherein the Other is reduced to one’s own history (Levinas 1990). In this state of forgetfulness, we argue that a “concreteness of egoism” (Levinas 1969) is maintained and a self lived toward the outside remains untenable. Transference, we argue, is an impoverished relation and a forgetting of and violence to the Other. Its proper use, however, in the therapeutic alliance allows for the possibility of a remembering of the Other and a calling beyond oneself.

Beyond unusual? Examining the role of attention in the weapon focus effect

The current study examined whether the weapon focus effect could be accounted for in terms of stimulus novelty. Participants viewed a slideshow of a simulated event while attending to a secondary task. In the critical slide, the target was shown holding a threatening object (weapon condition), a novel object (unusual condition) or a neutral object (control condition). Reaction times on the secondary task were impaired in the weapon and unusual conditions. Participants in the weapon condition had poorest recognition scores for the target's appearance when confidence was also taken into account. Results suggest that while both unusual and threatening objects command attention, the significance of a weapon can lead to impaired performance on less immediately informative aspects of a scene such as target appearance. Copyright © 2006 John Wiley & Sons, Ltd.