A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics

Implementation experts suggest tailoring strategies to the intended context may enhance outcomes. However, it remains unclear which strategies are best suited to address specific barriers to implementation, in part because few measurement methods exist that adhere to recommendations for reporting. In the context of a dynamic cluster randomized trial comparing a standardized to tailored approach to implementing measurement-based care (MBC), this study aimed to (a) describe a method for tracking implementation strategies, (b) demonstrate the method by tracking strategies generated by teams tasked with implementing MBC at their clinics in the tailored condition, and (c) conduct preliminary examinations of the relation between strategy use and implementation outcomes (i.e., self-reported fidelity to MBC). The method consisted of a coding form based on Proctor, Powell, and McMillen (2013) implementation strategy reporting guidelines and Powell et al.’s (2012) taxonomy to facilitate specification of the strategies. A trained research specialist coded digitally recorded implementation team meetings. The method allowed for the following characterization of strategy use. Each site generated 39 unique strategies across an average of six meetings in five months. There was little variability in the use of types of implementation strategies across sites with the following order of prevalence: quality management (50.00%), restructuring (16.53%), communication (15.68%), education (8.90%), planning (7.20%), and financing (1.69%). We identified a new category of strategies not captured by the existing taxonomy, labeled “communication.” There was no evidence that number of implementation strategies enacted was statistically significantly associated with changes in self-reported fidelity to MBC—however, financing strategies were associated with increased fidelity. This method has the capacity to yield rich data that will inform investigations into tailored implementation approaches.     

Moral injury and the priesthood of all believers1

This article proceeds from the conviction that moral injury suffered by many combat veterans is a deeply spiritual matter requiring spiritual resources for healing. The tradition of the care of souls commends itself. It takes into account that the “soul” is an expression of the whole person in all its physical, spiritual, and social realities. Moral injury affects all those dimensions of personhood or soul. Since the Reformation the care of souls has been a vocation for the ministry of the whole people of God under the theology of the priesthood of all believers. A caring community is essential to healing for many dealing with moral injury. Indeed, the veterans themselves, in sharing their stories and their pain, become part of that ministry of the priesthood of all believers and may well find healing in the meaningfulness of their mutual ministry.     

Enabled or disabled? Working parents of disabled children and the provision of child‐care

This research explores the reported experiences of working parents of disabled children with respect to formal and informal sources of child‐care, the need for which extends beyond the childhood years. Forty families with at least one disabled child, representing a variety of family structures and work situations, participated in semi‐structured interviews. The resultant data revealed an analytical axis of disabling and enabling features of child‐care. These are illustrated here with reference to the parents' accounts. Disabling barriers were physical, attitudinal or material. However, some features of either formal or informal care served to dismantle these barriers. Where formal child‐care was available, appropriate, flexible and accommodating to the needs of both the parents and the disabled child, the parents reported being able to combine working and caring roles successfully. However, where formal supports were inadequate or non‐existent, parents who could rely on the support of family and friends to supply emotional and instrumental assistance reported balance between work and caring roles. Whilst all parents need satisfactory child‐care in the early years, these parents' needs extend beyond the childhood years: the parents' accounts highlighted their complex and long‐term child‐care needs. Options for further research were proposed which would emphasize negotiation within families over time, or would focus on intersections of other parts of the work‐family‐community system. Copyright © 1999 John Wiley & Sons, Ltd.     

Television,madness and community care

This paper describes the forms and contents of television representations of mental illness in the UK in 1992. The theoretical framework is provided by Moscovici's theory of social representations and some modifications are proposed for the case of madness. Quantitative and qualitative methods are used in the empirical analyses. It is shown that madness has multiple meanings on television, while at the same time violence is commonly included. It is also suggested that a partial reconfiguration of the representational field has taken place in recent years. Media stories about the responsibility of the policy of community care for scandals and tragedies are now commonplace. © 1998 John Wiley & Sons, Ltd.     

Expectations and prescriptions for responding to peer aggression: The adolescent offenders' perspective

The purpose of the current research was to investigate adolescent offenders' perspectives about responses to interpersonal aggressive encounters. Specifically, participants' perspectives were assessed regarding the role of a bystander when either a friend or an acquaintance of the bystander was the victim of an aggressive act. Two aggressive acts were presented. First, the bystander witnessed an acquaintance stealing from the victim. Second, the bystander witnessed an acquaintance hitting the victim. Participants were asked to indicate (a) if the bystander would do anything (bystander expected behavior), (b) what the bystander would do (expected behavioral action), (c) if the action would be the right thing to do (evaluation of bystander expected behavioral action), and (d) what the bystander should do in response to the violation (prescribed bystander behavioral action). Results indicate that the adolescent offenders' perspectives varied as a function of offender status, type of aggressive act, as well as relationship of the victim to the bystander. Aggr. Behav. 23:149–160, 1997. © 1997 Wiley-Liss, Inc.     

Wounds of Dislocation and the Yearning for Home: Re-Imagining Pastoral Theology

This article contributes to current conversations concerning the role pastoral care and theology can play in the renewal of public life.     

Investing in Children, Families, and Communities: Challenges foran Interdivisional Public Policy Collaboration

An interdivisional collaboration to foster the development of strengths-based policies for children, youth, families, and communities is described. The initiative includes (1) producing a book that integrates scholarly research and policy; (2) developing materials for policymakers to use, including a policy-oriented summary of the book; (3) enhancing the capacities of the divisions to communicate with and influence policymakers; and (4) taking action steps to influence policymakers. During the process of developing these products, a number of tensions emerged between the academically-based and policy-based authors of the book, many of which centered around how the information should be presented and, in particular, how to formulate and present policy recommendations. Tensions fell into four general categories: understanding the appropriate scope for recommendations, using the right language, understanding the kind of information that is needed, and understanding the bottom line. The author concludes by urging psychologists to become adept at understanding and participating in the public policymaking process.     

Outcome Trajectories for Adolescents in Residential Treatment: A Statewide Evaluation

Although residential treatment represents one of the largest and most expensive components of the mental health service system for children and adolescents, little is known about the anticipated outcomes of this service. Still less is known about the trajectory through which change occurs within these settings. We examined the clinical status of 285 adolescents over a 2-year period after placement in residential treatment by the Department of Mental Health in a western state. Using a growth modeling technique, the rate of change was determined over a set of symptoms measured by the Acuity of Psychiatric Illness—Child and Adolescent Version (CAPI). Results suggest that while adolescents tended to improve overall during the course of their stays, there was considerable variation in which symptoms improved and which did not. Two symptoms actually became reliably worse with treatment. In addition, significant variation in outcomes was demonstrated across sites, with adolescents in one site getting reliably worse during the course of residential treatment. Our findings demonstrate the utility of outcomes management and have significant implications for how residential services for children and adolescents should be managed.     

重症加强监护医学与临床思维

重症加强监护医学的发展史,也是其临床思维的发展史,一个由个体性呼吸衰竭救治观念转化为集群性救治启动了重症加强监护学的建立,它们的发展带动亦受益于其临床思维、动态思维的发展。重症加强监护的实施,引发了医学伦理学新的思考与选择,而新的生物技术革命,必将导致重症加强监护医学及其临床思维的巨大变革。     

Anxiety Disorders Among Older Primary Care Patients

Data from the 1997 National Ambulatory Medical Care Survey (NAMCS) were accessed to obtain information about naturalistic patterns of recognition, service utilization, and treatment for late-life anxiety in primary care. The NAMCS is a national probability sample survey of office visits to non-Federal, U.S. physicians engaged in patient care. The survey was conducted by the Division of Health Care Statistics, National Center for Health Statistics, and Centers for Disease Control and Prevention (CDC). Data are now in the public domain. For the current report, all cases indicating office visits for patients age 60 and older were selected (n = 7,687). Anxiety disorders were assigned for 1.3% (n = 99) of these visits, with anxiety disorder NOS the most frequent diagnosis. For 20.2% of these visits (n = 20), a coexistent depressive disorder also was diagnosed. Depression without coexistent anxiety was diagnosed for 2.3% of all visits (n = 176). These figures suggest that late-life anxiety may often go unrecognized and may be more difficult to detect than depression. Nevertheless, other data indicate that appropriate pharmacological treatment and mental health services or referrals are often provided when anxiety or depression is recognized. However, visits wherein these disorders are recognized require increased physician time, and significant proportions of patients in some groups may still not receive appropriate mental health care. Results are discussed in terms of the nature of usual care for late-life anxiety and the needs for future research.