What makes vocational rehabilitation effective? Program characteristics versus employment outcomes nationally in VA.

With the focus on well-defined models for rehabilitation of people with mental illness, there is interest in program elements that predict successful outcomes. Data on programmatic elements from 92 Veterans Affairs Compensated Work Therapy (CWT) programs were merged with 6,891 individual records. General estimation equation analyses were used to identify correlates of 3 dependent variables representing successful outcomes. Community-based work at the individual level was positively associated with all 3 measures of success. Program emphasis on assertive outreach was positively associated with competitive employment and achievement of constructive activity. Greater amounts of assertive outreach and less integration of mental health and vocational staff were associated with a greater likelihood of constructive activity. These results suggest that the best outcomes are achieved by community-oriented programs incorporating assertive outreach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

WAIS-R intersubtest scatter in patients with dementia of Alzheimer's type

This study explored the relationship between three indices of intersubtest scatter and level of cognitive deterioration in a sample of 104 patients with dementia of Alzheimer's type, who ranged in age between 52 and 84 years. Scatter was highly related to education and premorbid level of functioning. Advancement of dementia was shown to be associated with decrease in scatter, which suggests caution in interpretation of high magnitude of inter-subtest scatter as an indication of brain dysfunction. Easy-to-calculate range of scatter proved to be adequate measure of scatter. Calculation of more complex indices, such as PVI, provides only minimal incremental gain.     

Processing and recognition of facial affect in schizophrenia

A deficit in the recognition of facial affect has been well documented in people with schizophrenia. Our 1995 research with normal subjects showed that hemispheric bias for processing facial affect is related to accuracy of recognition of facial affect. We tested whether this relationship holds in a sample of 25 people with schizophrenia who completed tasks of identification of facial affect and chimeric facial affect. Subjects with a left visual-field bias were significantly more accurate in identifying one facial emotion (sad) than were other subjects. Individual differences in hemispheric advantage for processing affect appears to be an important variable related to functional brain capacity within different populations.     

Integrating peer support initiatives in a large healthcare organization.

The Veterans Health Administration (VHA) adopted a strategic plan for mental health that emphasizes implementation of recovery-oriented services, including peer support. To provide a baseline for assessing change, a national survey was conducted of peer service delivery for veterans with mental illness, including those with comorbid substance abuse or homelessness. The number of participating programs was small. However, responses indicate that existing VHA peer services can be categorized as partnership services. Program and position structures, such as goals and training requirements are each described. Role and administrative or systems processes, such as acquiring staff buy-in and liability are also described. Future areas of consideration include dissemination of peer support in VHA and other healthcare systems, with specific efforts to increase training protocols, evaluation, and payment options for peers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development and evaluation of validity scales for the Neuropsychology Behavior and Affect Profile: A dissembling study.

The Neuropsychology Behavior and Affect Profile ( NBAP) is a peer-rated inventory of behavioral and affective changes in brain injured individuals and consists of five Clinical Scales that have demonstrated strong external validity. A potential confound is the NBAP's susceptibility to rater bias. In the present investigation, four validity scales were developed and external validity and psychometric properties were examined through a dissembling paradigm. Study1 describes item selection and construction of the validity scales. Study 2 demonstrates that various combinations of both the clinical and validity scales effectively differentiated dissemblers from informants of two groups of traumatic brain injury patients. Although results differed somewhat when dissemblers were grouped according to their level of neuropsychological training, highly trained dissemblers (licensed clinical neuropsychologists) could be detected. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Early detection of cognitive decline in higher cognitively functioning older adults: Sensitivity and specificity of a neuropsychological screening battery.

The sensitivity and specificity of a neuropsychological screening battery designed to determine early cognitive decline in the high functioning elderly are presented. The battery is composed of 4 standard neuropsychological tests assessing cognitive domains commonly effected in early stages of CNS disease. Initial validation data were gathered by applying cutoff scores derived from published or submitted normative data to test data on 2 groups of elderly, higher cognitively functioning individuals: a sample of 45 elderly individuals diagnosed with 1 of 5 target disorders, and a sample of 61 independent elderly. Cutoff scores were identified that produce high rates of correct classification and a range of sensitivity and specificity. The suggested neuropsychological test battery classifies Ss as having a high, moderate, or low probability of cognitive impairment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vocational rehabilitation from a behavioral economics perspective.

Behavioral economics represents a synthesis of basic principles of economics and behavioral psychology that has become a major perspective for understanding addictions and health service utilization. The present article discusses the basic assumptions and concepts of behavioral economics as they apply to vocational rehabilitation (VR) services. The concepts of value and unit price, demand, elasticity, substitutes and complements, and discounting are examined within the context of VR and common choices of VR participants. Common models of VR, such as supported employment and transitional employment, are discussed from a behavioral economics perspective. Implications for VR programs and staff are identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subtypes of HIV-related neuropsychological functioning: A cluster analysis approach.

Sought to examine whether empirically derived subtypes of neuropsychological performance could be identified in a broad sample of Ss infected with HIV-1. 298 Ss from 3 diverse sites were studied. Using total factor scores obtained from a factor analysis of a comprehensive neuropsychological battery, a K-means cluster analysis was performed. Three reproducible subtypes were identified: unimpaired, depressed with psychomotor slowing and lowered verbal memory performance, and normal mood with lowered overall neuropsychological performance. These clusters also corresponded to actual raw neuropsychological test scores for members of each cluster. Future research should focus on relating the performance of individuals in these clusters to clinical endpoints or diagnostic criteria to further validate these empirically derived subtypes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)