Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.     

IMPACT OF JOINT ATTENTION ON SOCIAL‐COMMUNICATION SKILLS IN INTERNATIONALLY ADOPTED CHILDREN

Internationally adopted (IA) children have often experienced early adversity and are at risk for long‐term deficiencies in multiple developmental domains. This study examined the association between IA children's joint attention (JA) soon after arrival and later cognitive, communicative, and socioemotional competency 6 months’ postadoption. We expected a child's initial JA would positively predict later cognitive, communication, and social ability. IA children (n = 63) adopted from Eastern Europe were seen soon after their arrival into the United States to assess their JA. Their socioemotional competency, social communication, and cognitive abilities were measured at a follow‐up session 6 months’ postadoption. We found that higher order JA was positively associated with measures of social relatedness. Furthermore, individual hierarchical regressions of each measure of JA (higher order JA, initiating JA, responding to JA, and initiating behavior requests [BR]) considered with age‐at‐adoption showed that each measure was an independent and positive predictor of Mullen outcomes in the receptive and expressive language domains. These results suggest that JA may be a sensitive predictor of subsequent functioning in the social, communicative, and cognitive domains. Thus, assessing JA soon after arrival has the potential to identify at‐risk IA children, and interventions targeting JA may support those children in overcoming the negative impacts of early adversity.     

MOTHER–CHILD AND FATHER–CHILD PLAY INTERACTION: THE IMPORTANCE OF PARENTAL PLAYFULNESS AS A MODERATOR OF THE LINKS BETWEEN PARENTAL BEHAVIOR AND CHILD NEGATIVITY

Based on the premise that father–child play is an important context for children's development and that fathers “specialize” in play, similarities and differences in the role of playfulness in the father–child and mother–child relationship were examined. Participants in this study included 111 families (children's age: 1–3 years). Father–child and mother–child play interactions were videotaped and coded for parental playfulness, sensitivity, structuring, and nonintrusiveness as well as child negativity. Results indicated that mothers and fathers did not differ in playfulness and that mothers and fathers who were higher in playfulness had children with lower levels of negativity. However, playfulness differently moderated the links between parents’ and children's behaviors for mothers and fathers. A double‐risk pattern was found for mothers, such that the links between child negativity and maternal sensitivity, structuring, and nonintrusiveness were significant only for the subgroup of mothers with low levels of playfulness. When mothers had high levels of playfulness, these effects were negligible. For fathers, a double‐buffer pattern was revealed, indicating that the links between child negativity and paternal sensitivity and structuring were significant only for fathers with high levels of playfulness. When fathers had low levels of playfulness, these effects were negligible. These findings demonstrate the important role that parental playfulness has on parent–child interaction as well as the need to examine moderation patterns separately for fathers and mothers.     

Operant theory and methodology in infant vocal conditioning

The numerous mechanisms of behavior change in infant development are sometimes difficult to distinguish. Although it is agreed that elicitation and reinforcement both influence infant learning, the distinction between these two learning mechanisms was clarified in response to K. Bloom's (1984, Journal of Experimental Child Psychology, 38, 93-102) commentary. The theoretical and methodological assumptions of an functional analysis of infant behavior were made explicit in the context of the C. L. Poulson study (1983, Journal of Experimental Child Psychology, 36, 471-489). The rationale for the use of DRO schedules to control for elicitation effects of continuous reinforcement and the inadequacy of noncontingent schedules for this purpose were also discussed.     

Resistance to yielding and the expectation of cooperative future interaction in negotiation

The expectation of cooperative future interaction (ECFI) encouraged especially high joint benefit (the total of the two bargainers' individual outcomes) when resistance to yielding was high, but especially low joint benefit when resistance to yielding was low. Process data suggest that this finding can be explained as follows: When resistance to yielding is high, ECFI encourages problem solving and reduced contentious behavior; when resistance to yielding is low, ECFI encourages a collapse of aspirations. The results support Filley's (1975) dualconcern model and cast doubt on Deutsch's (1973) blanket assertion that a cooperative process leads to constructive conflict resolution.     

The use of categorial organization: Not an all-or-none situation

Second and fifth graders memorized each of two lists of words that differed in category representativeness. In addition, they received one of three memory instructions: standard free recall, repetition, or categorial processing. Recall performance was about equal for standard vs repetition, and both were lower than category processing, especially with the highly representative items. Age did not enter this interaction, so it is concluded that at both age levels, the accessibility of categorial information influences children's use of it. This suggests multiple types of possible production deficiencies.     

Rate changes in the speech of stutterers after therapy

The fluent speaking rate of nine adult male stutterers was compared before and after stuttering intervention. The subjects, ranging in age from 18 to 37 yr (mean, 25 yr, 3 mo), exhibited mild to severe stuttering prior to treatment. The only rate reduction strategy taught to subjects during intervention was to slow the first phoneme or syllable of sentences spoken. In addition, however, subjects significantly reduced their overall rate as determined by measurements made of their fluent speech at the middle of sentences, as well as overall sentence durations (excepting the first word of utterances). The data from this investigation are interpreted relative to the facilitation/simplification hypothesis.     

A feature analysis of stuttered phonemes

Stuttered and nonstuttered phonemes of 20 adult males were analyzed for distinctive feature patterns using the Chomsky-Halle system. The features (+ consonantal), (- voice), (+ continuant), and (- strident) occured significantly more often in stuttering than in nonstuttering instances. Results suggest that adult stuttering is most likely to occur when the primary sites of tension and discoordination are lingual and laryngeal and when the speaker must shift from (- voice) to (+ voice).     

Proofreading errors in good and poor readers

Seven-year-old children classified as good and poor readers carried out a proofreading task on two passages varying in level of difficulty. Misspellings were introduced by transposing two adjacent letters in the work "the," other three-letter words, and longer words. While both groups of readers were able to identify the correct spelling of the misspelled words on a spelling test, poor readers made significantly more proofreading errors. Word length had a significant effect on performance, indicating that sensitivity to word configuration is important for successful proofreading. The pattern of proofreading errors did not reflect underlying differences which might relate to strategies used by the two groups in normal reading. The results are compared with those from other proofreading and letter detection experiments in order to highlight methodological implications when such tasks are used to verify hypotheses concerned with normal reading strategies.