System of Care Development in Children’s Mental Health: Lessons Learned from a Process Evaluation

Despite ongoing public calls for reform, the mental health needs of many children with psychological, emotional and behavioral disorders remain unmet. In response, providers continue to seek effective alternatives to institutional treatment by implementing comprehensive systems of care. The Children’s Enhancement Project (CEP) is a collaborative effort to provide holistic, community-based mental health services for children with an individualized, flexible, family-driven approach. We conducted a process evaluation of CEP’s early stage development and implementation utilizing both qualitative stakeholder interviews and quantitative survey components. The current article describes that evaluation and highlights the challenges and potential solutions encountered in developing a system of care. The lessons learned regarding system of care development, including the importance of a shared vision, establishing programmatic guidelines, achieving collaboration, and addressing sustainability concerns, are discussed.     

The Contributions of Child Behavioral Functioning and Parent Distress to Family Functioning in Pediatric Inflammatory Bowel Disease

The objective of this study was to examine the relative contributions of both parental and adolescent functioning to family functioning in adolescent patients with inflammatory bowel disease (IBD) and their families. Participants were 45 adolescents (27 male, 18 female) 13-17?years old (M?=?15.41?years, SD?=?1.32) with IBD and their parents. Families completed measures of patient behavioral functioning and depression, parent distress and family functioning. Disease severity assessments were completed via data provided by patients' gastroenterologists. Results indicated that parent-reported patient behavioral problems accounted for a significant 26% of variance in family functioning. Post-hoc analysis revealed that externalizing behavior problems accounted for the majority of this variance compared to internalizing behavior problems. These results suggest that externalizing problems may have a more significant impact on these families than previous research indicates. Moreover, externalizing behaviors may significantly impact family adaptation and should be taken into consideration during routine clinical care. Further research is needed to replicate and expand upon these findings.     

Body dysmorphic symptoms: phenomenology and ethnicity

Differences in the presentation of clinical features of body dysmorphic disorder (BDD) across ethnic groups have received little investigation. The current study assessed BDD symptoms in an ethnically diverse sample of adults (n=401) using an online survey. Participants completed self-report measures assessing BDD symptoms, body parts of concern and BDD behaviors. Compared to Caucasian participants, no significant differences were found in body parts or behaviors reported by Latino or African American participants. Significant group differences did emerge between Asian and Caucasian participants. Specifically, Asians reported more concern with straight hair and dark skin and fewer body shape concerns than Caucasians. Asians also endorsed lower rates of grooming, touching body parts, and camouflaging and higher rates of exercise compared to Caucasians. Although most clinical features of BDD appear similar across ethnic groups, results showed some differences in body parts and behaviors between Caucasians and Asian Americans with BDD symptoms.     

High-fat diets impair spatial learning in the radial-arm maze in mice

It has been suggested that hyperglycemia and insulin resistance triggered by energy-dense diets can account for hippocampal damage and deficits of cognitive behaviour. We wonder if the impairment of learning and memory processes detected in diet-induced obese (DIO) mice is linked to diet composition itself. With this purpose we have evaluated learning performance in mice undergoing a short-term high-fat (HF) treatment, which leads to a pre-obese state characterized by increased adiposity without significant changes of glucose and insulin plasma levels. C57BL/6J mice were fed either a HF (45 kcal% from fat) or control diet (10 kcal% from fat) during 8 weeks. Learning performance was evaluated by using the four-arm baited version of the eight-arm radial maze test (RAM). Mice were trained to learn the RAM protocol and then memory was tested at different time-points. Time spent to consume food placed in baited arms and errors committed to find them were measured in all sessions. DIO mice significantly spent more time in learning the task and made a greater number of errors than controls. Moreover, retention tests revealed that both working and total memory errors were also more numerous in DIO mice. The current results show that short-term DIO impairs spatial learning and suggest that impairment of hippocampal learning elicited by HF diets might be perceptible before metabolic alterations linked to obesity develop.     

The effects of syntactic structure on letter detection in adjacent function words

In the present study, we examined letter detection in very frequent function-word sequences. It has been claimed that such sequences are processed in a unitized manner, thus preempting access to their constituent letters. In contrast, we showed that letter detection in the words for and the (1) was no more difficult when the words appeared in adjacent locations in a sentence (familiar) than when they appeared apart (less familiar sequence) and (2) was contingent upon the words' syntactic roles within the phrase. Thus, letter detection in for was easier when the sequence was separated by a clause boundary than when the words were part of the same clause. The advantage derived from clause separation was strongest when a comma divided clauses. These results challenge the unitization account of the "missing-letter" effect in common phrases and support a position where this phenomenon is seen to reflect the extraction of phrase structure during reading.     

Mood effects on attitude judgments: independent effects of mood before and after message elaboration.

This study investigated the independent effects of induced mood on the encoding of persuasive messages and on the assessment of attitude judgments. In Experiment 1, positive or negative mood was induced either before the encoding of a counterattitudinal message or before the assessment of attitude judgments. When mood was induced before message presentation, Ss in a bad mood were more persuaded by strong than by weak arguments, whereas Ss in a good mood were equally persuaded by strong and by weak arguments. When Ss encoded the message in a neutral mood, however, the advantage of strong over weak arguments was more pronounced when Ss were in a good rather than in a bad mood at the time of attitude assessment. In Experiment 2, Ss exposed to a counterattitudinal message composed of either strong or weak arguments formed either a global evaluation or a detailed representation of the message. Positive, negative, or neutral mood was then induced. Ss in a good mood were most likely and Ss in a negative mood least likely to base their reported attitudes on global evaluations.     

Social sensitivity in adolescents and adults with learning disabilities.

This study investigated social sensitivity and self-concept in students with learning disabilities (LD) and their non-learning-disabled (non-LD) peers. Thirty students each from public junior and senior high schools and a community college participated in the study; at each grade level, half were identified as learning disabled and half experienced no learning problem. Students were individually assessed in 30-minute interviews for their accuracy in interpreting the thoughts and feelings of actors in tape-recorded stories depicting two adults in happy angry, anxious, and sad interactions. A questionnaire assessing four dimensions of self-concept in learning situations (motivation, task orientation, problem-solving ability, and class membership) was also administered. LD students at all grade levels were significantly less accurate at interpreting social situations than were their non-LD peers, and had significantly lower self-concepts. These results support the need for remediation efforts specifically aimed at social skills for overcoming social deficits in adulthood.     

Motion over the retina and the motion aftereffect.

The motion aftereffect (MAE) was measured with retinally moving vertical gratings positioned above and below (flanking) a retinally stationary central grating (experiments 1 and 2). Motion over the retina was produced by leftward motion of the flanking gratings relative to the stationary eyes, and by rightward eye or head movements tracking the moving (but retinally stationary) central grating relative to the stationary (but retinally moving) surround gratings. In experiment 1 the motion occurred within a fixed boundary on the screen, and oppositely directed MAEs were produced in the central and flanking gratings with static fixation; but with eye or head tracking MAEs were reported only in the central grating. In experiment 2 motion over the retina was equated for the static and tracking conditions by moving blocks of grating without any dynamic occlusion and disclosure at the boundaries. Both conditions yielded equivalent leftward MAEs of the central grating in the same direction as the prior flanking motion, ie an MAE was consistently produced in the region that had remained retinally stationary. No MAE was recorded in the flanking gratings, even though they moved over the retina during adaptation. When just two gratings were presented, MAEs were produced in both, but in opposite directions (experiments 3 and 4). It is concluded that the MAE is a consequence of adapting signals for the relative motion between elements of a display.     

Effects of reinforcement schedules on rats' choice behavior in extinction.

The effects of reinforcement schedules on rats' choice behavior in extinction were studied. In a free-operant chamber equipped with two retractable bars, the experimental animals were trained to press the bars separately for a food reward. One bar delivered the reward on a continuous reinforcement (CRF) schedule, and the other delivered the reward on a partial reinforcement (PRF) schedule. Control animals earned the reward from both bars with the same reinforcement schedule, either a CRF or a PRF. When both bars were simultaneously available during extinction, the experimental animals responded more frequently to the CRF than to the PRF alternative, demonstrating a reversed within-subjects partial reinforcement extinction effect (PREE). A conventional between-subjects PREE was replicated in the control subjects. The results of this study were inconsistent with both Amsel's (1962, 1967) frustration hypothesis and Capaldi's (1966, 1967) sequential hypotheses.