Psychological Services最新文献

Peer specialists (PS) in the Veterans Health Administration are veteran employees with lived mental health experience supporting others in recovery. While PS worked in traditional mental health settings for many years and demonstrated benefits to veteran engagement and satisfaction with health care, little is known about the best strategies to support implementation in novel, complex settings like primary care (PC). Implementation facilitation, which combined external facilitation plus national resources, was chosen to promote uptake when the VA MISSION Act of 2018 required the Veterans Health Administration to implement PS into PC. Using a mixed-methods, formative program evaluation approach, we examined the effects of implementation facilitation across two cohorts of 15 sites. Due to startup timing, Cohort 1 received minimal implementation facilitation during preimplementation compared with Cohort 2. Outcome measures included qualitative evaluation of facilitator notes, time to attain implementation milestones, and PS productivity and program fidelity (percent of total PS encounters in PC). Results suggested that overall productivity was similar across cohorts, but Cohort 2 demonstrated high program fidelity in Month 1 of implementation, while Cohort 1 required 12 months to attain similar fidelity. Qualitative findings indicated implementation facilitation that fostered team cohesion, clarified roles, supported supervisor training, and encouraged sites to guard against competing demands smoothed transitions for PS into PC. During preimplementation, implementation facilitation that focused on these findings resulted in the rapid attainment of program fidelity. Policymakers should consider the value of investing in preimplementation support for speeding the attainment of high-fidelity implementation of novel and complex practices such as PS in PC. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cognitive remediation (CR) for schizophrenia has been extensively studied and has proven effective in improving both cognition and functioning. Yet, implementation into mental health services is poor, with implementation and engagement barriers and facilitators not understood. The present study aimed to assess expert opinions on CR barriers and facilitators that pertain to staff, mental health services, and consumers. Thirty-seven international CR experts (clinicians/researchers) responded to Likert-scale questions on implementation and engagement facilitators, essential CR components, barriers in mental health facilities, barriers for clinicians, and barriers for consumer access and engagement across three rounds of a Delphi survey. The main barriers to CR implementation were (a) lack of staff training, (b) lack of perceived relevance/lack of knowledge about cognitive deficits in schizophrenia and CR usefulness in both clinicians and consumers, as well as (c) lack of staff employed in cognitive rehabilitation roles. The presence of defeatist beliefs and difficulty in accessing the place of delivery were both barriers to consumer engagement and access. The most important facilitators for CR were a good therapeutic alliance, CR delivered as part of integrated rehabilitation services, psychoeducation provided to families and stakeholders, and CR focusing on generalization of learning to everyday life. This study highlights the barriers to CR implementation from experts. A multitude of factors were identified that need attention. It is also apparent that CR cost-effectiveness studies are needed to facilitate organizational change and national guideline recommendations for improving mental health services policy around serious mental illness/schizophrenia health care provisions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Veterans deployed in the post-9/11 wars in Iraq and Afghanistan (Operations Enduring Freedom, Iraqi Freedom, and New Dawn) face a multitude of challenges reintegrating into civilian life after military service. There is a need for evidence-based support programs to address the wide-reaching cognitive, psychological, and physical symptoms that can impede civilian reintegration. The present study incorporates quantitative and qualitative methods to assess veterans' experiences with two reintegration treatments (Short-Term Executive Plus-Home [SH] and Present Centered Group Therapy for Reintegration [PCGT-R]) within the context of a larger randomized clinical trial. A total of 131 veterans ages 24-65 years, drawn from the SH (n = 66) and PCGT-R (n = 65) treatment arms, completed quantitative feedback forms and qualitative interviews. Quantitative surveys indicated SH was more highly rated than PCGT-R in terms of program satisfaction (p < .01), helpfulness (p = .03), and connection to other Veterans Affairs (VA) services (ps < .05). Thematic qualitative analysis indicated that both interventions provided beneficial social support and that both groups appreciated online implementation. They also revealed that SH veterans acquired more emotion regulation and impulse control skills and reported greater willingness to engage in further VA treatments, than PCGT-R veterans. Dropout did not differ significantly between groups, and the most highly cited reasons for dropout among both groups were scheduling conflict and dislike of group formats. Findings emphasize the opportunity for group and skills-based interventions focused on reintegration to increase support and access to VA care among veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Veterans with a history of military sexual trauma (MST) often experience poorer social, psychological, and physical outcomes compared with civilians and veterans who have experienced sexual assault outside of the military. Studies suggest some differences in endorsement of MST and its symptoms based on ethnoracial, age, sexuality, and gender-related factors. However, investigations into potential diversity-related patterns of functioning are sparse. This study examined the associations between identity factors and psychosocial functioning among veterans seeking mental health treatment following MST. During intake assessments, veterans (n = 144) completed semistructured clinical interviews and the World Health Organization Disability Assessment Schedule 2.0 as part of routine clinical care at a Midwestern Veterans Healthcare Administration hospital. Psychosocial functioning domains (cognition, mobility, self-care, getting along, life activities, and participation in society) were analyzed across veterans' race, age, sex, and sexual identity. Results revealed differences in participation in society based on sex and race and in mobility based on race and age. No significant differences were observed in functional domains for sexual identity. These findings highlight the importance of assessing salient identity factors and delivering culturally sensitive trauma-focused care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Research on the implementation of community gatekeeper training interventions for suicide prevention in Spanish-speaking countries is limited. Gatekeepers identify warning signs of suicidal behavior in at-risk population and refer them to specialized mental health care. To identify factors that influence the implementation of evidence-based practices, standardized measures are needed in Spanish. We culturally adapted and evaluated the factor structure and reliability of two measures for use in the Mexican population: the final version of Acceptability, Appropriateness, and Feasibility of the Intervention (Weiner et al., 2017), and the Organizational Readiness for Implementing Change (ORIC; Shea et al., 2014). Our study consisted of two consecutive phases. The first addressed the cross-cultural adaptation. In the second phase, we administered an online survey to a nonrandom sample of 453 middle school personnel and performed a confirmatory factor analysis (CFA). Participants were 73.95% female, 25.17% male, and 0.88% nonbinary/other and came from the 32 Mexican states. CFA indices for the Mexican Spanish version of the acceptability, appropriateness, and feasibility measure yielded values of comparative fit index (CFI) = 0.96, Tucker-Lewis fit index (TLI) = 0.94, root-mean-square error of approximation (RMSEA) = 0.05, and standardized root-mean-square residual (SRMR) = 0.03. Internal consistency was Ω = 0.95. CFA indices of the Mexican Spanish version of the ORIC were CFI = 0.95, TLI = 0.93, RMSEA = 0.08, and SRMR = 0.03, and internal consistency was Ω = 0.94. We conclude that both instruments show preliminary psychometric properties that support their validity and reliability in the Mexican Spanish-speaking context. These findings promise to drive research on the implementation of gatekeeper interventions and other evidence-based practices in Spanish-speaking school settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Two thirds of military personnel diagnosed with posttraumatic stress disorder (PTSD) do not engage in treatment. We examined the degree that prejudicial beliefs about people with PTSD negatively affected psychiatric medication acceptance. Public stigma is best defined as negative stereotypes regarding individuals being judged as inferior or weak for having PTSD. In comparison, self-stigma includes internalized negative prejudices about illness control and stability. An important preliminary stage in developing self-stigma is first developing prejudicial beliefs about those with an illness. Active duty soldiers on a U.S. Army post completed surveys of prejudicial beliefs, public stigma, negative beliefs about psychiatric medications, and PTSD symptoms. Soldiers' Post Deployment Health Reassessment and medical records were accessed to determine the relation between their survey answers and responses to a later offer of psychiatric medication. Importantly, increased prejudicial beliefs (but not public stigma) that oneself is to blame for having PTSD were associated with a reduced likelihood of accepting psychiatric medication. Increased age was also associated with increased likelihood of accepting medication. Antistigma efforts to date may have limited effectiveness by targeting public-stigma rather than self-stigma prejudicial beliefs about personal responsibility in the development of PTSD. The relevance of this finding is vital to developing public health campaigns that maximize treatment acceptance. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Although the careful assessment and selection of leaders are important for an organization to succeed, selecting senior leaders can prove paramount given their potential to impact the entire organization. While private sector businesses expend substantial resources to recruit and retain senior leaders, the public sector struggles to do so, which in turn impacts the attitudes and retention of employees throughout the enterprise. For example, a recent survey of federal employees in the United States found that most respondents did not believe their senior leaders generated high levels of motivation and commitment in the workforce. Enhancing the senior leader selection process thus represents a prime opportunity to enhance organizational success in the public sector. The current discussion reviews four core topics for senior leader selection: (a) determine organizational needs, (b) agree upon competencies for a senior leader, (c) leverage employees from all organizational tiers via a selection committee, and (d) examine ethical issues in selecting senior leaders. Each topic contains an overview of the relative challenge while drawing a contrast between senior and junior leadership positions, as well as comparisons between the public and private sectors. These challenges are presented alongside best practices that should produce a more effective selection process. Taken together, this combined evidence should enable organizational success by ensuring that the highest quality candidates are selected into senior leadership positions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Trauma-informed care (TIC) training may be valuable for patient-facing health care providers within primary care in urban health care settings serving patients with high levels of trauma exposure. This study tested the pilot effectiveness of a clinic-wide TIC initiative to enhance providers' knowledge, comfort in caring for trauma-exposed patients, and implementation of TIC within a primary care clinic of an urban safety net hospital using a single-arm longitudinal within-subjects design. Measures were obtained at baseline (T1), posttraining (T2), 1-month (T3), and 6-months (T4). Twenty-nine providers who completed TIC training were included in study analyses. Twenty-one completed T2 and 14 completed T3 and T4. Knowledge was measured with the Providers' Knowledge Regarding Injury-Related Posttraumatic Stress, comfort with a researcher-generated two-item measure, and TIC implementation with an eight-item binary scale from the Trauma Provider Survey. Repeated-measures general linear model examining within-subjects change over time in knowledge was significant (n = 8; F₃ = 4.74, p = .01, η_p² = .40); the model measuring change in comfort was not significant but trending (n = 9; F₃ = 4.56, p = .06). The model examining change in TIC implementation from T1 to T4 was not significant (n = 14; F3 = 4.32, p = .21). This pilot study demonstrated the preliminary effectiveness of a brief TIC training on improving health care provider knowledge and comfort working with trauma-exposed patients that sustained through 6-months posttraining. The findings indicate that additional support is needed to change behaviors in provider implementation of TIC in primary care clinic settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychological distress while coping with cancer is a highly prevalent and yet underrecognized and burdensome adverse effect of cancer diagnosis and treatment. Left unaddressed, psychological distress can further exacerbate poor mental health, negatively influence health management behaviors, and lead to a worsening quality of life. This multimethod study primarily focused on understanding veterans' psychological distress and personal experiences living with lung cancer (an underrepresented patient population). In a sample of 60 veterans diagnosed with either nonsmall cell lung cancer (NSCLC) or small cell lung cancer (SCLC), we found that distress is common across clinical psychology measures of depression (37% [using the Patient Health Questionnaire, PHQ-9 measure]), anxiety (35% [using the Generalized Anxiety Disorder, GAD-7 measure]), and cancer-related posttraumatic stress (13% [using the Posttraumatic Stress Symptom Checklist measure]). A total of 23% of the sample endorsed distress scores on two or more mental health screeners. Using a broader cancer-specific distress measure (National Comprehensive Cancer Network), 67% of our sample scored above the clinical cutoff (i.e., ≥ 3), and in the follow-up symptom checklist of the National Comprehensive Cancer Network measure, a majority endorsed feeling sadness (75%), worry (73%), and depression (60%). Qualitative analysis with a subset of 25 veterans highlighted that psychological distress is common, variable in nature, and quite bothersome. Future research should (a) identify veterans at risk for distress while living with lung cancer and (b) test supportive mental health interventions to target psychological distress among this vulnerable veteran population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Psychologists are well-positioned to take on leadership roles in health care systems as a result of the broad-based skills included in doctoral level, professional training programs. These include knowledge of evidence-based practice, extensive training in applied research and clinical practice, emphasis on critical thinking in scientific methods and hypothesis testing, teaching, supervision, team consultation, and continuous learning (APA Presidential Task Force on Evidence-Based Practice, 2006; Korman, 1974; McFall, 2007). Formal opportunities to learn how to apply these skills in leadership and organizational management roles are, however, limited during graduate training. There have been recent efforts within the American Psychological Association to foster interest and readiness for leadership roles among psychologists. These efforts have included a leadership development fellowship, on-demand webinars, and online learning for continuing education (American Psychological Association, 2023). The content of these training opportunities is typically general in nature so that it can be applied to all types of organizational settings. Psychologists interested in leadership positions within public sector health care organizations are likely to benefit from information that aligns more specifically with the mission and organizational structures of such systems. This article presents a conceptual framework to prepare psychologists aspiring to leadership positions in public sector health care. Leadership theories and models from organizational management science are outlined which capture the context and organizational goals of such programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved).