Military psychology in the age of managed care: The Wilford Hall model

Military medicine is currently being overhauled through Tricare, a comprehensive, managed care program designed to reduce costs and increase clients' access to health care. This article presents reforms initiated by the psychologists at Wilford Hall Medical Center, the largest military hospital in the world, in response to Tricare. These reforms have resulted in adult, outpatient services that are immediately accessible, effective, and cost efficient. The Wilford Hall approach to psychological services is offered as model that can be used in other outpatient settings. Additionally, potential limitations of this approach to psychological care are presented.     

An Examination of Happiness, Racism, and Demographics on Judgments of Guilt

A policy-capturing study was conducted to evaluate the roles of both plaintiff and defendant race and gender on judgments of criminal guilt in either an assault or a theti case. It was hypothesized that defendant gender and race would affect likelihood of guilt ratings. Moreover, mock jurors' dispositional happiness, scores of modern racism, and race and gender were explored as potential influences on their decision-making policies and judgments. As predicted, strong support was found for the role of defendant gender on judgments of guilt. However, defendant race did not significantly impact guilt ratings. Post hoc analses revealed the importance of race and gender of the victim to juror decisions. In addition, participants' own race and gender played signiticant roles in the decisionmaking policies that were produced. Limitations of the study are discussed. as are topics for future research.     

Positive Life Events as a Moderator of Stress‐Related Depressive Symptoms

This study examines the relationships among positive life events, negative life events, and depressive symptoms in a sample of college students. Consistent with predictions, the results of a hierarchical multiple regression indicated a significant main effect for negative life events in predicting depressive symptoms such that increases in negative life events were associated with increases in depressive symptoms. There was also significant interaction between positive and negative life events such that the depressive effects of higher levels of negative life events seem to be reduced for subjects who had also experienced higher levels of positive life events.     

Bayesian inference for finite mixtures of generalized linear models with random effects

We present an hierarchical Bayes approach to modeling parameter heterogeneity in generalized linear models. The model assumes that there are relevant subpopulations and that within each subpopulation the individual-level regression coefficients have a multivariate normal distribution. However, class membership is not known a priori, so the heterogeneity in the regression coefficients becomes a finite mixture of normal distributions. This approach combines the flexibility of semiparametric, latent class models that assume common parameters for each sub-population and the parsimony of random effects models that assume normal distributions for the regression parameters. The number of subpopulations is selected to maximize the posterior probability of the model being true. Simulations are presented which document the performance of the methodology for synthetic data with known heterogeneity and number of sub-populations. An application is presented concerning preferences for various aspects of personal computers.     

Efficiency in functional analysis of problem behavior: A quantitative and qualitative review

Originating in the mid-1960s, functional analysis (FA) has become the gold standard method for understanding the environmental variables that come to shape and maintain problematic behaviors such as aggression, self-injury, and property destruction. Over the decades, a number of studies have refined FA methods, attempting to improve the overall efficiency of the analysis through experimental design and procedural modifications. In the present review, we used ongoing visual-inspection criteria and basic probability theory to compare and analyze levels of efficiency across FA types. The multielement design and synthesized contingency analyses were about equally efficient with respect to the mean number of sessions conducted per function tested, and the trial-based and synthesized contingency analyses were the 2 most efficient with respect to the mean duration per function tested. We discuss the implications of these findings in the broader context of efficiency and provide recommendations for maximizing efficiency during an FA. We also discuss other qualitative procedural details that may influence the overall efficiency of an FA.     

A translational evaluation of potential iatrogenic effects of single and combined contingencies during functional analysis

Recent research suggests that combining putative reinforcers for problem behavior into a single, synthesized contingency may increase efficiency in identifying behavioral function relative to traditional functional analysis (FA). Other research suggests potential shortcomings of synthesized contingency analysis (SCA), such as the potential for false-positive outcomes. In prior comparisons of traditional FAs and SCAs, investigators could not ascertain with certainty the true function(s) of the participants' problem behavior for use as the criterion variable. We conducted a translational study to circumvent this limitation by training a specific function for a surrogate destructive behavior prior to conducting a traditional FA and SCA. The traditional FA correctly identified the previously established function of the target response in all six cases and produced no iatrogenic effects. The SCA produced differentiated results in all cases and iatrogenic effects (i.e., an additional function) in three of six cases. We discuss these findings in terms of the mechanisms that may promote iatrogenic effects.     

Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression

Do negative cognitive styles provide similar vulnerability to first onsets versus recurrences of depressive disorders, and are these associations specific to depression? The authors followed for 2.5 years prospectively college freshmen (N = 347) with no initial psychiatric disorders at high-risk (HR) versus low-risk (LR) for depression on the basis of their cognitive styles. HR participants had odds of major, minor, and hopelessness depression that were 3.5-6.8 times greater than the odds for LR individuals. Negative cognitive styles were similarly predictive of first onsets and recurrences of major depression and hopelessness depression but predicted first onsets of minor depression more strongly than recurrences. The risk groups did not differ in incidence of anxiety disorders not comorbid with depression or other disorders, but HR participants were more likely to have an onset of anxiety comorbid with depression.     

Stimulus fading and differential reinforcement for the treatment of needle phobia in a youth with autism

Stimulus fading in the form of gradually increased exposure to a fear-evoking stimulus, often combined with differential reinforcement, has been used to treat phobias in children who are otherwise normal and in children with autism. In this investigation, we applied stimulus fading plus differential reinforcement with an adolescent with autism and diabetes whose needle phobia had prevented medical monitoring of his blood glucose levels for over 2 years. Results showed that the treatment was successful in obtaining daily blood samples for measuring glucose levels.