Teacher key opinion leaders and mental health consultation in low-income urban schools.

Diffusion theory posits that information is disseminated throughout a social network by the persuasion of key opinion leaders (KOLs). This study examined the relative and combined influence of peer-identified KOL teachers (n = 12) and mental health providers (n = 21) on classroom teachers' (n = 61) self-reported use of commonly recommended classroom practices for children with attention-deficit/hyperactivity disorder in 6 low-income urban African American communities, relative to teachers (n = 54) at 4 matched schools who received mental health provider consultation only. Mixed-effects regression models showed that KOLs in collaboration with mental health providers promoted higher rates of teachers' self-reported use of recommended strategies than mental health providers alone, and that these effects were mediated by KOL support but not by mental health provider support. The results suggest an expanded role for KOL teachers as indigenous and natural supports for the dissemination and implementation of school-based mental health programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Enhancing breast cancer screening in the university setting

Mammography, physical examination by a health care professional, and breast self-examination (BSE) may increase the probability of detection of breast cancer at an early stage and thus increase long-term survivor rates. The purpose of this study was to investigate the effectiveness of supportive coaching as an intervention to enhance compliance with these breast cancer screening guidelines. The following research questions were identified: (a) what are the attitudes of women toward breast cancer screening? (b) what are the barriers to compliance identified by women in breast cancer screening? and (c) what are the effects of supportive interventions by a professional nurse and of compliance with breast cancer screening in women? A quasi-experimental design was used to study the research questions. The population chosen for the study included female employees in a state university setting. Participants were randomly assigned to one of two groups. All participants were asked to complete a prestudy questionnaire measuring attitudes and beliefs, gathering demographic and health information, and surveying breast cancer screening practices. The experimental group then received coaching and supportive interventions over the course of the academic year. The remainder of the sample served as a control group. A poststudy questionnaire was then sent to the entire sample to identify behaviors related to breast cancer screening. A variety of beliefs and attitudes were observed in the groups. No significant difference was found between the experimental and control groups on compliance with mammography and the clinical breast examination. A difference was noted on compliance with BSE by the experimental group evidencing more compliance.     

Effects of interviewer questions and response type on compliance: An analogue study.

67 clients were interviewed by 4 counselors to examine the relative effects of the type of questions asked, either positive or negative, and of interviewer feedback, positive or neutral, on behavioral compliance by means of a 2?×?2 analog design. The effects of the treatment procedures on participant compliance were assessed through a variety of behavioral measures including actual weight loss. Contrary to expectations, only an effect for the type of interviewer feedback was observed with little impact noted for type of questions. Clients who received positive feedback from the interviewers consistently complied more with interviewer requests and recommendations, including losing more weight and returning more frequently, than did those who received neutral feedback. Interpretations of these findings and implications for initial interviewing strategies are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telephone counseling via cassette tapes.

Describes a telephone tape program designed to provide basic mental and physical health information to callers. Each tape, lasting approximately 8–20 min, deals with the causes of a specific concern, suggestions whereby the listeners may help themselves, and referral sources for the problem. Preliminary information suggests that telephone tapes offer a relatively inexpensive, effective mental health communication system, offering anonymity to the listener with suggestions for the utilization of more traditional mental health resources. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-disclosure in a simulated psychiatric interview.

Describes 2 experiments in which a total of 192 undergraduates received 49 items of personal information previously scaled in terms of their intimacy and presented according to the method of constant stimuli. For each item, Ss indicated whether they believed they would have withheld or revealed that information under actual psychiatric interview conditions. Exp. I manipulated the professional role of the interviewer, confidentiality of obtained information, and sex of the interviewee in a 4 * 3 * 2 design. Results indicate that (a) Ss avowedly revealed more personal information to mental health professionals than they would in a control employment interview situation, with no differences between the mental health professionals; (b) informing Ss that the interview was not confidential produced significant information loss from female but not male Ss; and (c) Ss who received no information regarding confidentiality behaved like Ss who were told the information was confidential. In Exp. II, Ss were asked to assume the motivational-attitudinal state of persons either coerced or voluntarily seeking a psychiatric interview because they had violated interpersonal norms. Significant information loss occurred in coerced Ss while confidentiality had no effect on self-disclosure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of mental health consumers' and family members' involvement in advocacy

As the service delivery system is redesigned, the involvement of consumers and family members in mental health policy-making is essential. Advocacy is a way for them to have an impact on policy or decision-making. To determine the extent of their participation in advocacy efforts, consumers and family members were surveyed by other consumers and family members about their involvement in advocacy and mental healthcare reform. Although more family than consumers reported receiving mental healthcare reform information, both groups had difficulty understanding this information. Consumers were more likely to have received information from a mental health professional while family were more likely to have received information from an advocacy group. Lack of economic resources and communication problems were the most often cited barriers to advocacy for consumers. Strategies are suggested for how to increase involvement of consumers and family in advocacy efforts. The limitations of conducting a state-wide study with consumers and family as data collectors is discussed.     

Does the use of telemental health alter the treatment experience? Inmates' perceptions of telemental health versus face-to-face treatment modalities.

In corrections, where staffing limitations tax an overburdened mental health system, telemental health is an increasingly common mode of mental health service delivery. Although telemental health presents an efficient treatment modality for a spectrum of mental health services, it is imperative to study how this modality influences key elements of the treatment experience. In this study, the authors compared inmates' perceptions of the working alliance, postsession mood, and satisfaction with psychiatric and psychological mental health services delivered through 2 different modalities: telemental health and face-to-face. Participants consisted of 186 inmates who received mental health services (36 via telepsychology, 50 via face-to-face psychology, 50 via telepsychiatry, and 50 via face-to-face psychiatry). Results indicate no significant differences in inmates' perceptions of the work alliance with the mental health professional, postsession mood, or overall satisfaction with services when telemental health and face-to-face modalities were compared within each type of mental health service. Implications of these findings are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of interventions to improve patient compliance: a meta-analysis

OBJECTIVES: This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical regimens. METHODS: The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), and (5) utilization (appointment making and keeping and use of preventive services). An effect size (ES) r, defined as Fisher's Z transformation of the Pearson correlation coefficient, representing the association between each intervention (intervention versus control) and compliance measure was calculated. Both an unweighted and weighted r were calculated because of large sample size variation, and a combined probability across studies was calculated. RESULTS: The interventions produced significant effects for all the compliance indicators (combined Z values more than 5 and less than 32), with the magnitude of effects ranging from small to large. The largest effects (unweighted) were evident for refill records and pill counts and in blood/urine and weight change studies. Although smaller in magnitude, compliance effects were evident for improved health outcomes and utilization. Chronic disease patients, including those with diabetes and hypertension, as well as cancer patients and those with mental health problems especially benefited from interventions. CONCLUSIONS: No single strategy or programmatic focus showed any clear advantage compared with another. Comprehensive interventions combining cognitive, behavioral, and affective components were more effective than single-focus interventions.     

Providing feedback in research with human subjects.

Feedback provided to Ss and 3rd parties from intra- and extramural investigators following the completion of research involving an agency's clients or staff is described. Ss were from the division of a public health department that provides mental health and substance abuse services in a city with 740,000 people. The division's research requirements include submission of annual progress reports and final reports. Of 135 studies conducted over 12 yrs, annual reports were received from 37% of investigators, and final reports from 30%. There were no significant differences based on investigator discipline or affiliation. Professional and ethical implications are discussed, including adequacy of professional training, the need for mechanisms to ensure compliance with ethical standards, the obligations of clinic directors, and the impact on public academic liaison programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Service use and mental impairment among the elderly: Arguments for consultation and education.

Compared the service use patterns of older adults with varying levels of mental impairment, and assessed the effects of services received on their mental health status over a 1-yr period. Data were obtained from a US General Accounting Office (1977, 1979) study of 531 elderly persons (mean age 76.1 yrs), which included administration of a modified version of the Older Americans Resources and Services Multidimensional Functional Assessment Questionnaire. Ss were interviewed twice, 1 yr apart. 174 Ss were classified as having a mild psychiatric impairment, and 118 Ss had a severe psychiatric impairment. The existence of mental impairment was related to marital status, race, and level of education. Usage of mental health services was low, although mentally impaired Ss were more likely than unimpaired Ss to use social and medical services. Results also suggest that such services can have an important effect on the mental health of older persons. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing adolescents' acceptance of long-term personal health behavior.

Assessed the effects of contingency management procedures for increasing children's acceptance of fluoride mouthrinsing. 351 7th and 8th graders received specific action instructions or simple reminders, and all Ss received rewards contingent on compliance. Action instructions had the predicted beneficial impact on compliance among urban lower-income Ss; however, among suburban upper-middle-income Ss, they had a negative effect. The participation level was 66% for urban Ss. Postcard reminders had no effect on compliance in either population. At this time, the primary finding of the series of studies of which this is part is that only contingent rewards seem to have generally beneficial effects on adolescents' long-term personal health behavior; the addition of action instructions seems useful for some populations, but must be approached with caution until the factors affecting the response to such instruction are better understood. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clients' demographic characteristics and therapeutic treatment: Differences that make a difference.

Studied the relationship between clients' demographic characteristics (age, sex, education, income, marital status, and ethnicity) and services received (diagnosis, type of treatment, type of personnel rendering services, and type of therapy and number of sessions). Ss were 1,190 White and 1,294 minority-group community mental health center clients. Client attributes were related to services rendered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fear of psychological treatment and its relation to mental health service avoidance.

We evaluated whether a measure of mental health treatment fearfulness is associated with past mental health treatment history and/or current treatment status. Student Ss who either were or were not about to begin psychotherapy responded to the fear measure and a measure of psychological distress, and they also answered questions about their mental health treatment-seeking history. Analysis indicated that increased treatment fearfulness was associated retrospectively with a history of service underconsumption and cross-sectionally with a nonclinical treatment status. We conclude that treatment fears are associated with treatment-seeking decisions and suggest that future studies focus on delineating the causal relation of these variables and on the role that treatment fears may play in treatment compliance and behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role of gender, sex role identity, and Type A behavior in anger expression and mental health functioning.

This study, including 407 female and 222 male college students, investigated the relationship of gender, sex role identity, and Type A behavior to multiple dimensions of anger expression and mental health functioning. Significant multivariate effects were found for sex role and behavior pattern type for anger expression. Significant gender differences were not observed. Univariate analyses revealed consistent relationships between sex role identity and anger proneness, suppression, and control and the tendency to express anger outwardly. Consistent relationships were found between behavior pattern type and both anger proneness and suppression. Significant multivariate effects were found for gender, sex role, and behavior pattern type for mental health functioning. Gender differences were not observed in depression. Women obtained higher scores on indirect hostility, irritability, and dependency, and men obtained higher scores on assault and aggressiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health practitioners and HIPAA.

The privacy and security of patients' medical records continue to challenge mental health practitioners in an ever-increasing electronic environment. Although practitioners were to be in compliance of the 1996 Health Insurance Portability and Accountability Act (HIPAA) by April 20, 2006, many practitioners still struggle to understand the nuances of the regulations. This article will cover the areas of HIPAA that relate specifically to the mental health practitioner who treats both adults and children. The article begins with important definitions such as “covered entity,” “individually identified health information,” and “electronic transactions.” Establishing that many mental health practitioners likely meet the definition of covered entities, the article details The Privacy Rule and The Security Rule. Included are issues concerning consents, authorizations, and objections along with enforcement of HIPAA. Also changes in enforcement to HIPAA by the Health Information Technology for Economic and Clinical Health Act (HITECH), a part of the American Recovery and Reinvestment Act of 2009 are discussed. Examples of violations and resulting enforcement will help practitioners better understand the regulations and how best to comply with these regulations. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Internet-based diabetes self-management and support: Initial outcomes from the Diabetes Network project.

Objective: The Diabetes Network (D-Net), a randomized trial of an Internet-based, diabetes self-management and peer support intervention, was evaluated after 3 months. Design: The study assessed separate and combined effects of diabetes self-management and peer support. Outcomes included physiologic, behavioral, mental health, and website usage. Results are presented on the first 160 type 2 diabetes patients recruited from 16 primary care offices. Of those eligible, 61 % participated in the study. Results: There was significant overall improvement, especially on dietary behavior, but no significant between-condition differences. Conclusions: Providing basic diabetes information as well as a "personal coach," self-management intervention entirely over the Internet proved feasible. Even novice computers users will participate in an Internet-based program to assist themselves in managing their diabetes. Validated Internet interventions could prove to be valuable resources that overcome many costs and limitations of conventional diabetes management. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Four-year cross-lagged associations between physical and mental health in the medical outcomes study.

This article provides an application of structural equation modeling to the evaluation of cross-lagged panel models. Self-reports of physical and mental health at 3 different time points spanning a 4-yr interval were analyzed to illustrate the cross-lagged analysis methodology. Data were collected from a sample of 856 patients with hypertension, diabetes, heart disease, or depression (or any combination of these) participating in the Medical Outcomes Study. Cross-lagged analyses of physical and mental health constructs revealed substantial stability effects across time. A structural model with standard effects revealed positive effects of physical health on mental health but negative (suppression) effects of mental health on physical health. The effects of mental health on physical health became nonsignificant when the model was revised by adding nonstandard effects (direct effects of measured variable residuals on latent variables). Recommendations for structural equation modeling of cross-lagged panel data are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How numeracy influences risk comprehension and medical decision making.

We review the growing literature on health numeracy, the ability to understand and use numerical information, and its relation to cognition, health behaviors, and medical outcomes. Despite the surfeit of health information from commercial and noncommercial sources, national and international surveys show that many people lack basic numerical skills that are essential to maintain their health and make informed medical decisions. Low numeracy distorts perceptions of risks and benefits of screening, reduces medication compliance, impedes access to treatments, impairs risk communication (limiting prevention efforts among the most vulnerable), and, based on the scant research conducted on outcomes, appears to adversely affect medical outcomes. Low numeracy is also associated with greater susceptibility to extraneous factors (i.e., factors that do not change the objective numerical information). That is, low numeracy increases susceptibility to effects of mood or how information is presented (e.g., as frequencies vs. percentages) and to biases in judgment and decision making (e.g., framing and ratio bias effects). Much of this research is not grounded in empirically supported theories of numeracy or mathematical cognition, which are crucial for designing evidence-based policies and interventions that are effective in reducing risk and improving medical decision making. To address this gap, we outline four theoretical approaches (psychophysical, computational, standard dual-process, and fuzzy trace theory), review their implications for numeracy, and point to avenues for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Insight into reduced use of medical services after psychotherapy.

31 patients who had received a brief evaluation at the mental health department of a health maintenance organization either were placed on a 4-mo waiting list or received insight-oriented, time-limited psychotherapy. An 18-mo follow-up telephone interview was used to examine whether Ss showed insight into the link between their illness behavior and psychological factors. Examination of medical utilization before and after the mental health intervention showed that the acquisition of insight was unrelated to changes in utilization. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Basic behavioral science research for mental health: Sociocultural and environmental processes.

Provides a selective overview of sociocultural research investigating the role of culture in the course of mental illness and suggests promising directions for future research. Sociocultural variation in basic psychological processes and experiences including identity, self-esteem, attribution, and motivation are discussed. The role of race, ethnicity, SES, changing work roles, and communities in mental health across the life span are also explored. Possible directions for future research include cross-cultural research on universal vs culturally specific aspects of behavior, the expression and effects of ethnic discrimination, and factors mediating the effects of SES on the mental health of children and adults (0 ref). (PsycINFO Database Record (c) 2010 APA, all rights reserved)