Principles of Occupational Therapy Group Outcome Assessment in Mental Health

In today's penurious health care climate, occupational therapists must scrutinize their practice and substantiate their interventions in order to remain viable service providers. This article proposes a method of occupational therapy outcomes assessment in mental health care that is rooted in client-centered functional outcomes. Since little consensus exists on which instruments are most effective, this article begins with an outline of broadly accepted principles for assessment of patient outcomes in mental health. Next, we describe a practical method for selecting outcomes measures in interdisciplinary settings. Finally, we offer pragmatic solutions to address barriers to outcome assessment.     

Discrepant Alcohol Use,Conflict, and Couples Satisfaction in a Community Sample

Abstract

Discrepant alcohol use between partners has been shown to impact couples’ relationship functioning, emphasizing couples therapists’ need for careful assessment and informed treatment. This study recruited 514 participants from online crowdsourcing platforms to participate in an online survey. Participants were predominantly male (62.4%), heterosexual (76.1%), and Caucasian (47.6%). Ages ranged from 18 to 65 years and mean age was 33. Results indicated a negative association between couple satisfaction and both alcohol-related conflict and discrepant alcohol consumption. Being female combined with higher levels of alcohol discrepancies and couple satisfaction predicted increased alcohol-related conflict.     

Data Collection in a Flat World: The Strengths and Weaknesses of Mechanical Turk Samples

Mechanical Turk (MTurk), an online labor system run by Amazon.com, provides quick, easy, and inexpensive access to online research participants. As use of MTurk has grown, so have questions from behavioral researchers about its participants, reliability, and low compensation. In this article, we review recent research about MTurk and compare MTurk participants with community and student samples on a set of personality dimensions and classic decision‐making biases. Across two studies, we find many similarities between MTurk participants and traditional samples, but we also find important differences. For instance, MTurk participants are less likely to pay attention to experimental materials, reducing statistical power. They are more likely to use the Internet to find answers, even with no incentive for correct responses. MTurk participants have attitudes about money that are different from a community sample's attitudes but similar to students' attitudes. Finally, MTurk participants are less extraverted and have lower self‐esteem than other participants, presenting challenges for some research domains. Despite these differences, MTurk participants produce reliable results consistent with standard decision‐making biases: they are present biased, risk‐averse for gains, risk‐seeking for losses, show delay/expedite asymmetries, and show the certainty effect—with almost no significant differences in effect sizes from other samples. We conclude that MTurk offers a highly valuable opportunity for data collection and recommend that researchers using MTurk (1) include screening questions that gauge attention and language comprehension; (2) avoid questions with factual answers; and (3) consider how individual differences in financial and social domains may influence results. Copyright © 2012 John Wiley & Sons, Ltd.     

Toward Training Transformation

This article briefly discusses common themes concerning training transformation shared by articles in this special issue. Themes include: the continuing combat training center revolution, the interplay between theory and practice in military training programs, training as an engineering discipline, the role of training as a contributor to human performance in military operations, the use of training simulations to assess human performance, and data standards. The article emphasizes the need for researchers to better explain and articulate the value and return on investment of training in general and training transformation in particular. Meeting this need will better inform decisions and decision makers in allocating resources to training across the full range of defense requirements.     

Revisiting ‘What works for whom?’: A qualitative framework for evaluating clinical effectiveness in child psychotherapy

This paper describes a framework for evaluating the effectiveness of child psychotherapy used by child psychotherapists in an inner city Child and Adolescent Mental Health Service (CAMHS). The Hopes and Expectations for Treatment Approach (HETA) involves using the assessment for psychotherapy that normally precedes treatment to derive a baseline from which to generate a set of hopes/expectations as regards the effects of the treatment on the part of parents and the psychotherapist, to be revisited one year after the start of the psychotherapy and/or at its completion. The Strength and Difficulties Questionnaire, for parents and schools, was also administered before and after the treatment. The characteristics of the first 30 children referred for psychotherapy over a particular time period are described. Of the first 15 children in this group to complete one year of individual psychotherapy, all showed change or significant change in the areas concerning parents' and therapists' hopes at the end-of-year review, as rated by parents and psychotherapists. A case of a child with conduct disorder is used to describe how the assessment generated a psychoanalytic formulation, how the therapist's understanding was fed back to the parents, and how the parents' and therapist's hopes and expectations were derived and recorded. This case illustrates powerfully the impact of trauma in the parents' backgrounds on the internal world of the child, and how the method provides a useful bridge between parent and child work. Feedback from the psychotherapists, the parents and the referrers using the framework is reviewed, and in conclusion the paper argues for the framework's value in promoting good practice in the treatment and management of complex cases and in enhancing awareness of the nature and scope of the psychotherapy process.     

Trait anxiety and trait anger measured by ecological momentary assessment and their correspondence with traditional trait questionnaires

Ecological momentary assessments (EMA) of anxiety and anger/hostility were obtained every 25–30 min over two 24-h periods, separated by a median of 6 months, from 165 employees at a university in the Northeast. We used a multilevel trait-state-error structural equation model to estimate: (1) the proportion of variance in EMA anxiety and anger/hostility attributable to stable trait-like individual differences; (2) the correspondence between these trait-like components of EMA anxiety and anger/hostility and traditional questionnaire measures of each construct; and (3) the test–retest correlation between two 24-h averages obtained several months apart. After adjustment for measurement error, more than half the total variance in EMA reports of anxiety and anger/hostility is attributable to stable trait-like individual differences; however, the trait-like component of each construct is only modestly correlated with questionnaire measures of that construct. The 6-month “test–retest” correlations of latent variables representing the true 24-h EMA average anxiety and average anger are quite high (r ? 0.83). This study represents the longest follow-up period over which EMA-based estimates of traits have been examined. The results suggest that although the trait component (individual differences) of EMA momentary ratings of anxiety and anger is larger than the state component, traditional self-report questionnaires of trait anxiety and anger correspond only weakly with EMA-defined traits.     

The Broaching Attitudes and Behavior Survey (BABS): An Exploratory Assessment of Its Dimensionality

The continuum of broaching behavior is a conceptual framework explicating how counselors broach or have explicit discussions about racial, ethnic, and cultural factors with their clients during treatment ( Day‐Vines et al., 2007 ). Counselors can assume 5 particular broaching orientations: avoidant, isolating, continuing/incongruent, integrated/congruent, and infusing. The authors operationalized the continuum of broaching behavior using the Broaching Attitudes and Behavior Scale and found support for a 4‐factor model of broaching behavior. El espectro de comportamiento de abordamiento es un marco conceptual que explica cómo los consejeros abordan o tienen discusiones específicas sobre factores raciales, étnicos y culturales con sus clientes durante el tratamiento ( Day‐Vines et al., 2007 ). Los consejeros pueden asumir 5 orientaciones de abordamiento particulares: evasiva, aislante, continua/incongruente, integrada/congruente e infundida. Los autores operativizaron el espectro de comportamiento de abordamiento usando la Escala de Actitudes de Abordamiento y Comportamiento y hallaron respaldo para un modelo del comportamiento de abordamiento de 4 factores.     

Issues in training clinical health psychologists

The author describes general issues in the training of clinical health psychologists and provides an overview of specific content needed in core health psychology and clinical health psychology assessment and intervention. Special attention is given to training in professional, personal, ethical and legal issues of practice.     

Examining the effects of perceived social support on momentary mood and symptom reports in asthma and arthritis patients

Objective: Social support has been linked to beneficial effects on health directly (main effect) and as a buffer to stress. Most research, however, has examined these relationships using global and retrospective assessments of health and stress, which may be subject to recall biases. This study used ambulatory ecological momentary assessment (EMA) methods to test the main and stress-buffering effects of social support on the daily health and well-being of asthma and rheumatoid arthritis (RA) patients.

Design: Community volunteers with asthma (n?=?97) or RA (n?=?31) responded to EMA prompts five times daily for one week.

Main outcomes: Baseline perceived social support was obtained, and then, participants reported mood, stress and symptoms using EMA. Multilevel mixed-modelling examined whether social support predicted mood and symptoms directly or via stress-reducing effects.

Results: Supporting a main effect, more perceived social support predicted decreased negative mood and stress severity. Supporting a stress-buffering effect, more perceived social support resulted in fewer reported symptoms when stress was present.

Conclusion: Results suggest perceived social support directly relates to better ambulatory status and dynamically buffers individuals against the negative effects of stressors, and highlight the importance of studying social support across different temporal and contextual levels.