Pay for performance in primary and specialty behavioral health care: Two "concept" proposals.

Incipient pay-for-performance (P4P) plans offer to improve the quality of general medical care, but they have not yet begun to influence clinical outcomes in the behavioral health care arena. Following a brief review of the quality chasm in behavioral health care and some initial applications of P4P programs, this article presents 2 bird's-eye view proposals with which the primary and behavioral specialty care sectors of the American health care system can begin to design and implement P4P incentives. Discussion of the value of behavioral health care, the Provider Quality Index, P4P implementation issues, implications for practicing psychologists, and some cautionary notes conclude the article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing, priming, and acting on values: Effects via motivational relations in a circular model.

Circular models of values and goals suggest that some motivational aims are consistent with each other, some oppose each other, and others are orthogonal to each other. The present experiments tested this idea explicitly by examining how value confrontation and priming methods influence values and value-consistent behaviors throughout the entire value system. Experiment 1 revealed that change in 1 set of social values causes motivationally compatible values to increase in importance, whereas motivationally incompatible values decrease in importance and orthogonal values remain the same. Experiment 2 found that priming security values reduced the better-than-average effect, but priming stimulation values increased it. Similarly, Experiments 3 and 4 found that priming security values increased cleanliness and decreased curiosity behaviors, whereas priming self-direction values decreased cleanliness and increased curiosity behaviors. Experiment 5 found that priming achievement values increased success at puzzle completion and decreased helpfulness to an experimenter, whereas priming with benevolence values decreased success and increased helpfulness. These results highlight the importance of circular models describing motivational interconnections between values and personal goals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resisting tempting foods and smoking behavior: Implications from a self-control theory perspective.

Objective: Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking. Design: Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess. Main Outcome Measures: Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable. Results: As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), χ2(1, N = 101) = 3.65 p     

Validity of a stage algorithm for physical activity in participants recruited from orthopedic and cardiac rehabilitation clinics.

Objective: For stage-matched interventions, individuals must be classified with respect to their previous behaviors and in conjunction with their future intentions. A novel procedure for the assessment of stages in physical activity was developed. For this, individuals' activity and their regarding intentions were compared with recommended levels of activity. The aim was to examine the psychometric properties. Design: In a cross-sectional study, stages were assessed in 366 study participants (84 in cardiac and 282 in orthopedic rehabilitation) in terms of their previous physical activity and their intention to perform recommended activity levels in the future. Main Outcome Measures: Stages of change were compared to self-reported behavior, intention, planning, self-efficacy, risk perception, pros, cons, and social support. Misclassification, sensitivity, specificity, receiver operating characteristic (ROC) curves, non-linear trends, and planned contrasts were computed. Results: In comparison to previous studies, sensitivity (44%–99%) was high and specificity was similar or low (3%–88%), depending on the type of validation outcome selected. When using less demanding criteria (i.e., less intensive activity), measurement quality decreased, although not always significantly. Applying contrast analyses, more than half of the predicted stage differences were confirmed. No main differences between orthopedic and cardiac, ambulant and stationary rehabilitation appeared and no interactions were found. Conclusion: The stage algorithm proved to have acceptable measurement qualities in study participants recruited in both cardiac and orthopedic rehabilitation. Especially in detecting Intenders and Actors the stage algorithm performed well. Mechanisms of adopting and maintaining recommended activity levels seem to operate equally in both groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Why seeking help from teammates is a blessing and a curse: A theory of help seeking and individual creativity in team contexts.

Research has not explored the extent to which seeking help from teammates positively relates to a person's own creativity. This question is important to explore as help seeking is commonly enacted in organizations and may come with reciprocation costs that may also diminish creativity. Results based on 291 employees in a single division of a large multinational organization revealed that seeking help predicted creativity and mediated the relationship between intrinsic motivation and creativity. However, help seekers also incurred reciprocation costs in that they tended to give more help to teammates, and giving help to teammates was negatively related to creativity. In general, giving higher levels of help attenuated the positive relationship between help seeking and creativity. We also tested an integrated model to show that help giving moderated the mediated relationship between intrinsic motivation and creativity via help seeking, such that higher levels of help giving attenuated this mediated effect. We discuss theoretical and practical implications recommending additional research regarding the interpersonal creative process in team contexts. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Service delivery in a "don't ask, don't tell" world: Ethical care of gay, lesbian, and bisexual military personnel.

Because current federal law prohibits gay, lesbian, and bisexual (GLB) persons from serving openly in the military, the 65,000 GLB men and women estimated to currently serve in the armed forces face unique occupational stressors and a heightened need for supportive services. Psychologists in military settings face numerous obstacles in efforts to provide ethical and efficacious clinical services to GLB service members. The authors highlight common clinical problems and referral issues for GLB persons in military settings, as well as primary ethical and administrative problems for the psychologists who treat them. The authors conclude with several recommendations for enhancing appropriate treatment while minimizing harm to GLB clients in the military. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Searching for and finding meaning in collective trauma: Results from a national longitudinal study of the 9/11 terrorist attacks.

The ability to make sense of events in one's life has held a central role in theories of adaptation to adversity. However, there are few rigorous studies on the role of meaning in adjustment, and those that have been conducted have focused predominantly on direct personal trauma. The authors examined the predictors and long-term consequences of Americans' searching for and finding meaning in a widespread cultural upheaval-the terrorist attacks of September 11, 2001-among a national probability sample of U.S. adults (N = 931). Searching for meaning at 2 months post-9/11 was predicted by demographics and high acute stress response. In contrast, finding meaning was predicted primarily by demographics and specific early coping strategies. Whereas searching for meaning predicted greater posttraumatic stress (PTS) symptoms across the following 2 years, finding meaning predicted lower PTS symptoms, even after controlling for pre-9/11 mental health, exposure to 9/11, and acute stress response. Mediation analyses suggest that finding meaning supported adjustment by reducing fears of future terrorism. Results highlight the role of meaning in adjustment following collective traumas that shatter people's fundamental assumptions about security and invulnerability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)