Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

The psychologist's role in assessing and facilitating patients' knowledge of advance directives in medical settings: A preliminary investigation

In a time of budgetary shortfalls in the medical industry, an aging population, and an increased emphasis on health care choices, psychologists are being called upon to administer advance medical directive programs to patients. This study reports preliminary findings from a program to assess and facilitate patients' knowledge of advance directives (ADs) by the Psychology Service at the Ann Arbor VA Medical Center. The participant pool included 243 male veteran patients admitted to medical and surgical wards at the hospital. The intervention included the use of a computer-generated prompt for consultation, which was sent to the psychology staff in response to a patient inquiry regarding ADs. It also involved an increased emphasis on the delivery of written material on ADs by the admissions clerks. The intervention appeared to result in a modest increase in patients' knowledge of advance directives. Suggestions are offered for areas that should be emphasized in future attempts to increase patients' knowledge and utilization of advance directives.     

Social desirability,perceived stress,and PACT ratings in lung transplant candidates: A preliminary investigation

Some aspect of psychosocial criteria is commonly utilized by most transplant programs in assessing candidates' acceptability for transplantation. However, regardless of the assessment methodology, information obtained in pretransplant assessments may be limited given the evaluative nature of the assessment as well as the sensitive nature of the contents. Indeed, transplant candidates may present themselves in a favorable fashion, minimizing any negative traits or psychological dysfunction which they perceive might prevent transplantation. Unfortunately, there are limited data addressing the extent to which transplant candidates may present themselves in an overly positive light. This investigation surveys the prevalence of social desirability in lung transplant candidates as well as its association with self-reports of perceived stress. Further, the relationship between social desirability and interviewer ratings of transplant candidacy is examined. Subjects included 24 patients in end-stage organ failure being evaluated for lung transplant candidacy. Subjects completed the Perceived Stress Scale and a brief version of the Marlowe-Crowne Social Desirability Scale. Additionally, subjects were interviewer-rated on the Psychosocial Assessment of Candidates for Transplantation. Results indicate social desirability is a prevalent phenomenon in lung transplant candidates, with more than half of the sample scoring at or above the 84th percentile on the social desirability measure. Further, self-reports of perceived stress are moderately and inversely associated with social desirability (r=–.55,p .01). Social desirability was unrelated to interviewer-ratings of transplant candidates acceptability (r=.13,p .56). Future research might include larger samples of subjects, other organ transplant candidates, and more detailed assessments of symptom distress.     

Psychology and mind-body segregation: Are we part of the problem?

Despite advances in behavioral medicine and health psychology, the health care system and medical education continue to show resistance to a truly biopsychosocial model of medical practice. Psychologists in medical settings have generally been identified as challenging the concept of mind-body duality and the segregation of biologic and psychosocial sciences in medicine. However, examples are presented of how psychologists contribute to and perpetuate mind-body segregation via exclusive theoretical conceptualizations, arbitrary definitions of professional behavior, and dogmatic constraints on the limits of psychology's field of knowledge.     

Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

Increasing senior citizen participation in a community-based nutritious meal program

Two experiments were conducted to compare the effects of several prompting and reinforcement procedures on the participation of elderly citizens in a nutritious meal program. Experiment I employed a variation of the multiple-baseline design across three groups of approximately 60 households each. Elderly persons not previously participating in the program were introduced to the following conditions: (1) public service radio announcements for four weeks to advertise the meal program and the availability of free transportation, (2) a home visit that served as a personal invitation and a second prompt for participation, (3) a followup telephone call, and (4) an incentive menu for participation, which was sent through the mail. Results indicated that the home visits and incentives were both effective as recruitment procedures and superior to other conditions; however, incentives proved to be the most cost-effective intervention. Experiment II used a variation of the multi-element design to compare the effects of scheduled activities and incentives in maintaining higher levels of participation by those persons who had attended the meal program at least once in the past, but whose current rate of participation was low. Results showed that activities improved attendance levels somewhat and that incentives substantially increased the number of meal program participants. Data from these experiments thus indicate that relatively inexpensive procedures may be used effectively to increase the extent to which elderly persons make use of potentially beneficial community-based services.     

Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.     

Social influence matters: We follow pandemic guidelines most when our close circle does

Why do we adopt new rules, such as social distancing? Although human sciences research stresses the key role of social influence in behaviour change, most COVID-19 campaigns emphasize the disease’s medical threat. In a global data set (n = 6,675), we investigated how social influences predict people’s adherence to distancing rules during the pandemic. Bayesian regression analyses controlling for stringency of local measures showed that people distanced most when they thought their close social circle did. Such social influence mattered more than people thinking distancing was the right thing to do. People’s adherence also aligned with their fellow citizens, but only if they felt deeply bonded with their country. Self-vulnerability to the disease predicted distancing more for people with larger social circles. Collective efficacy and collectivism also significantly predicted distancing. To achieve behavioural change during crises, policymakers must emphasize shared values and harness the social influence of close friends and family.     

Interactive effects of social network centrality and social identification on stress

The present study aimed to integrate the social identity approach to health and well-being with social network analysis. Previous research on the effects of social network centrality on stress has yielded mixed results. Building on the social identity approach, we argued that these mixed results can be explained, in part, by taking into account the degree to which individuals identify with the social network. We hence hypothesized that the effects of social network centrality on stress are moderated by social identification. Using a full roster method, we assessed the social network of first-year psychology students right after the start of their study programme and three months later. The effects of network centrality (betweenness, closeness, eigenvector centrality) and social identification on stress were examined using structural equation models. As predicted, our results revealed a significant interaction between network centrality and social identification on stress: For weakly or moderately identified students, network centrality was positively related to stress. By contrast, for strongly identified students, network centrality was unrelated to stress. In conclusion, our results point to the perils of being well-connected yet not feeling like one belongs to a group.     

General vs health‐specific consideration of immediate and future consequences to explain eating and exercise behavior in a Norwegian student population: A randomized survey experiment

Over several decades, the consideration of future consequences (CFC) construct has been used to explain and predict health behaviors. However, the reported associations between CFC and health behaviors are relatively weak, leading to the low explanatory power of the models. Recent research suggests that CFC can be a domain‐specific construct. In this study, we explored the psychometric properties of the Norwegian CFC‐general and CFC‐health questionnaires in terms of factor structure and discriminant and convergent validity and tested the association between the general and domain‐specific CFC and exercise and eating behaviors. In a randomized survey experiment, 1,001 university students were assigned to either a CFC‐general or a CFC‐health questionnaire. In the tested models, two dimensions of CFC, consideration of immediate consequences (CFC‐I) and consideration of future consequences (CFC‐F), were independent variables. The exercise and eating behaviors, measured both as self‐evaluated behaviors and self‐reported frequency measures, were dependent variables. The results showed that in both CFC‐general and CFC‐health, CFC‐I and CFC‐F are distinct dimensions that differentially explain variance in health behaviors. A domain‐specific CFC‐health explained a significantly higher amount of variance in self‐reported eating and exercising behaviors than a general CFC. Self‐evaluated health behaviors were better explained by CFC than self‐reported behavioral frequencies. Practical implications of the findings and avenues for future research are discussed.