A network approach to public goods

Abstract We study settings where each agent can exert costly effort that creates nonrival, heterogeneous benefits for some of the others. For example, municipalities can forgo consumption to reduce pollution. How do the prospects for efficient cooperation depend on asymmetries in the effects of players' actions? We approach this question by analyzing a network that describes the marginal benefits agents can confer on one another. The first set of results explains how the largest eigenvalue of this network measures the marginal gains available from cooperating; as an application, we describe the players whose participation is essential to achieving any Pareto improvement on an inefficient status quo. Next, we examine mechanisms all of whose equilibria are Pareto efficient and individually rational; an outcome is called robust if it is an equilibrium outcome in every such mechanism. Robust outcomes exist and correspond to the Lindahl public goods solutions. The main result is a characterization of effort levels at these outcomes in terms of players' centralities in the benefits network. It entails that an outcome is robust if and only if agents contribute in proportion to how much they value the efforts of those who help them

Proceedings of the 3rd Biennial Conference of the Society for Implementation Research Collaboration (SIRC) 2015: advancing efficient methodologies through community partnerships and team science

It is well documented that the majority of adults, children and families in need of evidence-based behavioral health interventionsi do not receive them [1, 2] and that few robust empirically supported methods for implementing evidence-based practices (EBPs) exist. The Society for Implementation Research Collaboration (SIRC) represents a burgeoning effort to advance the innovation and rigor of implementation research and is uniquely focused on bringing together researchers and stakeholders committed to evaluating the implementation of complex evidence-based behavioral health interventions. Through its diverse activities and membership, SIRC aims to foster the promise of implementation research to better serve the behavioral health needs of the population by identifying rigorous, relevant, and efficient strategies that successfully transfer scientific evidence to clinical knowledge for use in real world settings [3]. SIRC began as a National Institute of Mental Health (NIMH)-funded conference series in 2010 (previously titled the “Seattle Implementation Research Conference”; $150,000 USD for 3 conferences in 2011, 2013, and 2015) with the recognition that there were multiple researchers and stakeholdersi working in parallel on innovative implementation science projects in behavioral health, but that formal channels for communicating and collaborating with one another were relatively unavailable. There was a significant need for a forum within which implementation researchers and stakeholders could learn from one another, refine approaches to science and practice, and develop an implementation research agenda using common measures, methods, and research principles to improve both the frequency and quality with which behavioral health treatment implementation is evaluated. SIRC’s membership growth is a testament to this identified need with more than 1000 members from 2011 to the present.ii SIRC’s primary objectives are to: (1) foster communication and collaboration across diverse groups, including implementation researchers, intermediariesi, as well as community stakeholders (SIRC uses the term “EBP champions” for these groups) – and to do so across multiple career levels (e.g., students, early career faculty, established investigators); and (2) enhance and disseminate rigorous measures and methodologies for implementing EBPs and evaluating EBP implementation efforts. These objectives are well aligned with Glasgow and colleagues’ [4] five core tenets deemed critical for advancing implementation science: collaboration, efficiency and speed, rigor and relevance, improved capacity, and cumulative knowledge. SIRC advances these objectives and tenets through in-person conferences, which bring together multidisciplinary implementation researchers and those implementing evidence-based behavioral health interventions in the community to share their work and create professional connections and collaborations

El conocimiento y la autoridad del analista: Una crítica a la ¿nueva perspectiva¿ en psicoanálisis

Se presenta una evaluación crítica de las posiciones adoptadas recientemente por Mitchell y Renik, a quienes se ha tomado como representativos de la ¿nueva perspectiva¿ en psicoanálisis. Se examinan un artículo de Mitchell y dos de Renik como paradigmáticos de ciertos modos de construir la naturaleza de la mente, el conocimiento y autoridad del analista, y el proceso analítico indebidamente influenciado por el giro postmoderno en psicoanálisis. Aunque los teóricos de la ¿nueva perspectiva¿ han aportado críticas válidas a la teoría y práctica psicoanalíticas tradicionales, terminan por adoptar posiciones insostenibles. Se cuestionan específicamente sus opiniones sobre la relación entre el lenguaje y la interpretación, por una parte, y los contenidos mentales del paciente por la otra. Se apunta una disyuntiva entre su discusión de material clínico y su posición conceptual, y se critican sus redefiniciones idiosincráticas de verdad y objetividad. Finalmente, se sugiere un ¿modesto realismo¿ como la posición filosófica más apropiada a adoptar por los psicoanalistas

Factors Influencing the Use of Cognitive-Behavioral Therapy with Autistic Adults: A Survey of Community Mental Health Clinicians

Cognitive–behavioral therapy (CBT) can improve anxiety and depression in autistic adults, but few autistic adults receive this treatment. We examined factors that may influence clinicians’ use of CBT with autistic adults. One hundred clinicians completed an online survey. Clinicians reported stronger intentions (p = .001), more favorable attitudes (p \u3c .001), greater normative pressure (p \u3c .001), and higher self-efficacy (p \u3c .001) to start CBT with non-autistic adults than with autistic adults. The only significant predictor of intentions to begin CBT with clients with anxiety or depression was clinicians’ attitudes (p \u3c .001), with more favorable attitudes predicting stronger intentions. These findings are valuable for designing effective, tailored implementation strategies to increase clinicians’ adoption of CBT for autistic adults. Autistic adults have high rates of anxiety and depression (Buck et al. 2014; Croen et al. 2015), and often do not receive quality mental healthcare for these or other co-occurring conditions (Maddox et al. 2019; Roux et al. 2015; Shattuck et al. 2011). Developing strategies to address co-occurring psychiatric conditions is a high research priority for stakeholders in the autistic community (Frazier et al. 2018; Pellicano et al. 2014). Recent research suggests that cognitive–behavioral therapy (CBT) is effective at treating anxiety and depression in autistic adults (Spain et al. 2015), but many autistic adults do not receive CBT (Roux et al. 2015). This study examined factors that may influence community mental health clinicians’ use of CBT with autistic adults with co-occurring anxiety or depression. Identifying factors that influence clinicians’ use of CBT is crucial for developing mental health services and clinician training programs for autistic adults. The current study focuses on CBT because (1) CBT is a well-established evidence-based treatment for anxiety and depression among adults in the general population, making it the “current gold standard of psychotherapy” (David et al. 2018, p. 1), and (2) CBT is the most studied and supported psychosocial treatment for anxiety and depression in autistic adults (Weiss and Lunsky 2010; White et al. 2018). Few studies have examined reasons why mental health clinicians who work with—or could work with—autistic adults may or may not use CBT with this population. Cooper et al. (2018) surveyed 50 therapists in the UK about their experiences adapting CBT for autistic clients (of any age) and their confidence working with this population. An important study limitation is that the survey respondents were recruited through a training workshop about adapting CBT for autistic people. In this self-selected sample, 64% of therapists had not received prior training on working with autistic clients. On average, they reported feeling moderately confident about using their core therapeutic skills with autistic people (i.e., being empathetic, developing a therapeutic relationship, and gathering information from an autistic client to understand his or her difficulties), and reported less confidence in using other key skills, such as identifying effective therapeutic approaches for autistic clients and using their knowledge of mental health treatments to help autistic clients. However, this study did not test which factors influence the therapists’ intention to use CBT or actual use of CBT with their autistic clients. How can we increase clinicians’ use of CBT with autistic adult clients who present with anxiety or depression? To explore this question, we applied the theory of planned behavior (TPB; Ajzen 1991), a leading causal model of behavior change. The TPB posits that an individual’s attitudes, perceived norms, and/or self-efficacy influence intentions to perform a behavior, and that intentions predict behavior, under circumstances that permit the individual to act (Fig. 1). While the TPB has been used to predict and understand many health-related behaviors (Armitage and Conner 2001), it has only recently been applied to the implementation of evidence-based practices for autistic children in community settings (Fishman et al. 2018, 2019; Ingersoll et al. 2018). For example, Fishman and colleagues (2018) found that autism support classroom teachers’ intentions to use visual schedules with their students strongly predicted their subsequent use of this evidence-based practice. These findings highlight the value of measuring intentions to use specific practices. Fig. 1 The proximal determinants of intention and behavior, as defined by the theory of planned behavior (Ajzen 1991) Full size image The present study is the first to assess TPB constructs in the context of community mental health clinicians providing CBT to autistic adults with co-occurring anxiety or depression. Specifically, we measured community mental health clinicians’ intention, or motivation, to start CBT with their autistic adult clients with co-occurring anxiety or depression, and four potential determinants of this intention (described below): attitudes, descriptive norms, injunctive norms, and self-efficacy towards starting CBT with autistic adults with co-occurring anxiety or depression. To determine whether these associations were specific to working with autistic adults, we also asked about clinicians’ intentions and potential determinants of intentions to start CBT with non-autistic adult clients with anxiety or depression. For the current study, intention to start CBT is a more appropriate outcome than the actual use of CBT with autistic adults because many community mental health clinicians have few to no autistic clients on their caseload and lack training in autism (Maddox et al. 2019). In the TPB, intentions are the most proximal determinant of behavior (Fishbein and Ajzen 2010). Thus, understanding clinicians’ intentions to use a specific evidence-based practice can directly inform future efforts to change clinician behavior and address barriers to treatment access (Fishman et al. 2018; Moullin et al. 2018). In this study, attitudes refer to the clinicians’ perceptions of the advantages and disadvantages of starting CBT with their adult clients with co-occurring anxiety or depression. Normative pressure refers to the clinicians’ perceptions of what others like them do (descriptive norms) and what others expect them to do (injunctive norms) when offering anxiety or depression treatment to an adult client. Self-efficacy (also called perceived behavioral control) refers to the clinicians’ sense of agency to start CBT with an adult client. One advantage of considering these factors is that they are malleable and could be targeted with tailored implementation strategies to improve implementation of evidence-based practice (Fishman et al. 2019). However, it is important to note that these factors are only a small subset of possible barriers to clinicians delivering CBT to autistic adults. For example, we do not examine financial or funding issues, agency leadership engagement, implementation climate, organizational policies, or characteristics of the clients (Damschroder et al. 2009). The current study represents a first step in better understanding the research-to-practice gap related to mental health services for autistic adults

Depression Stigma and Depression Stigma Among University Students: A Five Nation Survey

Depression disorders have increased markedly as a source of disability worldwide. These trends are broadly mirrored in the university setting. Moreover, most students do not seek treatment for depression in-part due to social stigma surrounding depression. However, how depression severity and social stigma vary between universities worldwide remains unknown. As a result, this cross-sectional study was performed to determine differences in depressive disorders and stigmatized beliefs between students from five countries. A survey containing Patient Health Questionnaire-9 (PHQ-9) and Depression Stigma Scale (DSS) was distributed to universities in the United States, Taiwan, United Arab Emirates, Egypt, and Czech Republic. Depression, stigmatized of personal views, and stigmatized perceptions about depression were compared between students in each nation using ANOVA and post-hoc Tukey tests. Responses were obtained from the United States (n=593), Taiwan (n=217), United Arab Emirates (n=134), Egypt (n=105), and Czech Republic (n=238). Of 1287 responses, 30.7% screened positive for a depressive disorder. Students from the United Arab Emirates exhibited more depression followed by students from the Czech Republic, Untied States, and Taiwan (