Pilot Evaluation of a Tablet-Based Application to Improve Quality of Care in Child Mental Health Treatment

Mental health systems need scalable solutions that can reduce the efficacy–effectiveness gap and improve mental health outcomes in community mental health service settings. Two major challenges to delivery of high-quality care are providers’ fidelity to evidence-based treatment models and children’s and caregivers’ engagement in the treatment process. We developed a novel, tablet-based application designed to enhance via technology the quality of delivery of trauma-focused cognitive-behavioral therapy (TF-CBT). We piloted its use in four community mental health service organizations using a blocked randomized controlled trial to examine the feasibility of implementing tablet-facilitated TF-CBT versus standard TF-CBT with 13 providers and 27 families. Provider fidelity and child engagement in treatment were observationally measured via session audio recording. Parent and child perceptions of the tablet application were assessed using structured interviews and mixed-method analyses. Providers actively and appropriately used tablet TF-CBT to facilitate treatment activities. Providers and families expressed high satisfaction with its use, demonstrating acceptability of this approach. Youth and caregivers in both conditions reported high alliance with their providers. Overall, we found that tablet-facilitated treatment is accepted by providers and families and may be integrated into mental health treatment with minimal training. Further study is needed to examine the extent to which technology-based applications may enhance the reach, quality, and clinical outcomes of mental health treatment delivered to children and families.     

The role of animacy and thematic relationships in processing active English sentences: evidence from event-related potentials

Recent event-related potential studies report a P600 effect to incongruous verbs preceded by semantically associated inanimate noun-phrase (NP) arguments, e.g., "eat" in "At breakfast the eggs would eat...". This P600 effect may reflect the processing cost incurred when semantic-thematic relationships between critical verbs and their preceding NP argument(s) bias towards different interpretations to those dictated by their sentences' syntactic structures. We have termed such violations of alternative thematic roles, 'thematic role violations.' Semantic-thematic relationships are influenced both by semantic associations and by more basic semantic features, such as a noun's animacy. This study determined whether a P600 effect can be evoked by verbs whose thematic structures are violated by their preceding inanimate NP arguments, even in the absence of close semantic-associative relationships with these arguments or their preceding contexts. ERPs were measured to verbs under four conditions: (1) non-violated ("At breakfast the boys would eat..."); (2) preceded by introductory clauses and animate NPs that violated their pragmatic expectations but not their thematic structures ("At breakfast the boys would plant..."); (3) preceded by semantically related contexts but inanimate NPs that violated their thematic structures ("At breakfast the eggs would eat..."); (4) preceded by semantically unrelated contexts and inanimate NPs that also violated their thematic structures ("At breakfast the eggs would plant..."). Pragmatically non-thematic role violated verbs preceded by unrelated contexts and animate NPs evoked robust N400 effects and small P600 effects. Thematically violated verbs preceded by inanimate argument NPs evoked robust P600 effects but no N400 effects, regardless of whether these inanimate arguments or their preceding contexts were semantically related or unrelated to these verbs. These findings suggest that semantic-thematic relations, related to animacy constraints on verbs' arguments, are computed online and can immediately impact verb processing within active, English sentences.     

Different time course for the memory facilitating effect of bicuculline in hippocampus, entorhinal cortex, and posterior parietal cortex of rats

Several lines of evidence indicate that gamma-aminobutyric acid (GABA) type A (GABA(A)) receptors regulate memory consolidation. Here we studied the effect on consolidation of the selective antagonist of GABA(A) receptors, bicuculline, given into several regions of the cortex at different times after one-trial step-down inhibitory avoidance (0.5 mA, 2-s footshock). Rats were bilaterally implanted with cannulae aimed at the CA1 region of the dorsal hippocampus, entorhinal cortex or posterior parietal cortex, three areas known to be involved in the memory consolidation of this task. At different times after training, bicuculline (0.5 microg/side) was infused into the above mentioned structures. Bicuculline increased memory retention when administered either immediately or 1.5h after training into CA1, and both immediately and 3h after training in the entorhinal or parietal cortex. Thus, in agreement with previous findings using other drugs, the response was biphasic in these latter structures. This suggests that GABAergic mechanisms normally downregulate, memory processing by inhibiting on-going activities necessary for consolidation at the times in which bicuculline was effective in each structure. Based on previous findings, in the hippocampus, such activity involves a number of receptors and signaling pathways in the first 1.5h after training. In the entorhinal and parietal cortex memory-related activities include the participation of protein kinase A and extracellularly regulated kinase (ERK) twice, right after training and then again 3h later.     

Preferences of Individuals in Committed Relationships About Premarital Counseling

Premarital educational and counseling programs provide one way of addressing many of the risk factors associated with couple distress and divorce. Unfortunately, few couples who are offered premarital programming engage in the programs offered. This study examined preferences for premarital programming in a sample of individuals in committed relationships who intended to marry the current partner. Results suggested that premarital counseling conducted by a therapist and of short duration, following engagement, was most preferred. The most preferred topics/contents were related to communication and conflict resolution.     

Working memory and planning during sentence production

Speakers retrieve conceptual, syntactic and lexical information in advance of articulation during sentence production. What type of working memory (WM) store is used to hold the planned information before speaking? To address this question, we measured onset latencies when subjects produced sentences that began with either a complex or a simple initial noun phrase, while holding semantic, phonological or spatial information in WM. Although we found that subjects had longer onset latencies for sentences beginning with a complex noun phrase, showing a phrasal scope of planning, the magnitude of this complexity effect was not affected by any type of WM load. However, subjects made more syntactic errors (but not lexical errors) for sentences beginning with a complex noun phrase, suggesting that advance planning for these phrases occurs at a syntactic rather than lexical–semantic level, which may account for the lack of effect with various types of WM load in the current study.     

The Before Baby Relationship Checkup: A Couples-Based Intervention to Reduce Relationship Risk Factors for Perinatal Mood and Anxiety Disorders

Relationship conflict and lack of partner support are risk factors for perinatal mood and anxiety disorders. An intervention to strengthen couples’ relationships before birth may reduce relationship risk factors for perinatal mood and anxiety disorders, though no research has explored this to date. The aims of this Stage 1 open-series non-experimental proof of concept study were to adapt the ‘Marriage Checkup’, an evidence-based intervention for relationship distress, as a preventative intervention for perinatal mood and anxiety disorders and to assess its feasibility and acceptability. Pregnant women receiving care at a university-based obstetric practice, and their partners, were recruited. Ten couples participated in the Before Baby Relationship Checkup, a personalized relationship health service offered in the obstetric clinic. Quantitative and qualitative data gathered suggests the intervention is feasible to implement in an obstetric setting, and acceptable to perinatal couples. Specific adaptations to the Marriage Checkup for perinatal couples are warranted and further testing is needed to evaluate efficacy.

     

Flexible attention deployment in threatening contexts: An instructed fear conditioning study

Factors leading humans to shift attention away from danger cues remain poorly understood. Two laboratory experiments reported here show that context interacts with learning experiences to shape attention avoidance of mild danger cues. The first experiment exposed 18 participants to contextual threat of electric shock. Attention allocation to mild danger cues was then assessed with the dot-probe task. Results showed that contextual threat caused subjects to avert attention from danger cues. In the second experiment, 36 participants were conditioned to the same contextual threat used in Experiment 1. These subjects then were randomly assigned to either an experimental group, trained to shift attention toward danger cues, or a placebo group exposed to the same stimuli without the training component. As in Experiment 1, contextual threat again caused attention allocation away from danger in the control group. However, this did not occur in the experimental group. These experiments show that acute contextual threat and learning experiences interact to shape the deployment of attention away from danger cues. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Vision-fair neuropsychological assessment in normal aging, Parkinson's disease and Alzheimer's disease

We examined performance of healthy older and younger adults and individuals with Alzheimer's disease (AD) and Parkinson's disease (PD) on digit cancellation, a task putatively sensitive to cognitive impairment, but possibly affected by visual impairment, particularly in contrast sensitivity. Critical contrast thresholds were established to create custom stimulus arrays that were proximally matched across individuals. Age- and PD-related differences in search were fully accounted for by the sensory deficit. Increased contrast benefited AD patients, but could not override cognitive impairment. We conclude that visually fair neuropsychological testing can effectively compensate for normal age- and PD-related visual changes that affect cognitive performance. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Bingo! Externally supported performance intervention for deficient visual search in normal aging, Parkinson's disease, and Alzheimer's disease

External support may improve task performance regardless of an individual's ability to compensate for cognitive deficits through internally generated mechanisms. We investigated if performance of a complex, familiar visual search task (the game of bingo) could be enhanced in groups with suboptimal vision by providing external support through manipulation of task stimuli. Participants were 19 younger adults, 14 individuals with probable Alzheimer's disease (AD), 13 AD-matched healthy adults, 17 non-demented individuals with Parkinson's disease (PD), and 20 PD-matched healthy adults. We varied stimulus contrast, size, and visual complexity during game play. The externally supported performance interventions of increased stimulus size and decreased complexity resulted in improvements in performance by all groups. AD also obtained benefit from increasing contrast, presumably by compensating for their contrast sensitivity deficit. The general finding of improved performance across healthy and afflicted groups suggests the value of visual support as an easy-to-apply intervention to enhance cognitive performance.