REACHING PEOPLE IN NEED OF MENTAL HEALTH SERVICES THROUGH NOVEL MODELS OF INTERVENTION DELIVERY

The treatment gap refers to the difference in the proportion of people who have disorders and the proportion of those individuals who receive treatment. In developing and developed countries, the gap is enormous, i.e., most individuals in need of mental health services receive no treatment. Among the many barriers is the dominant model of delivering psychosocial interventions. That model includes one-to-one, in-person treatment, with a trained mental health professional, provided in clinical setting (e.g., clinic, private practice office, health-care facility). That model greatly limits the scale and reach of psychosocial interventions. The article discusses many novel models of delivering interventions that permit scaling treatment to reach people who are not likely to receiveservices. Four models (task shifting, best-buy, disruptive interventions, and Entertainment Education) are illustrated. These and other models are readily available, most have evidence in their behalf, but are still not sufficiently exploited to close the treatment gap. The article argues for the need for multiple models to optimize reaching the many diverse groups in need of care

Differential negative reinforcement of other behavior to increase compliance with wearing an anti-strip suit

Using a changing-criterion design, we replicated and extended a study (Cook, Rapp, & Schulze, 2015) on differential negative reinforcement of other behavior (DNRO). More specifically, educational assistants implemented DNRO to teach a 12-year-old boy with autism spectrum disorder to comply with wearing an anti-strip suit to prevent inappropriate fecal behavior in a school setting. The duration for which the participant wore the suit systematically increased from 2 s at the start of treatment to the entire duration of the school day at the termination of the study. Moreover, these effects were generalized to a new school with novel staff and persisted for more than a year. These findings replicate prior research on DNRO and further support the use of the intervention to increase compliance with wearing protective items, or medical devices, in practical settings

LLEGANDO A LAS PERSONAS QUE NECESITAN SERVICIOS DE SALUD MENTAL A TRAVÉS DE NOVEDOSOS MODELOS DE PRESTACIÓN DE INTERVENCIONES

La brecha de tratamiento se refiere a la diferencia en la proporción de personas que tienen trastornos y la proporción de personas que reciben tratamiento. En los países desarrollados y en desarrollo, la brecha es enorme; es decir, la mayoría de las personas que necesitan servicios de salud mental no recibe tratamiento. Entre las muchas barreras, se encuentra el modelo dominante de realizar intervenciones psicosociales. Ese modelo incluye tratamiento individualizado en persona, con un profesional de salud mental capacitado, proporcionado en un entorno clínico (por ejemplo, clínica, consultorio privado, centro de atención médica). Ese modelo limita en gran medida la escala y el alcance de las intervenciones psicosociales. El artículo analiza muchos modelos novedosos de prestación de intervenciones que permiten ampliar el tratamiento para llegar a las personas que probablemente no recibirán servicios. Se ilustran cuatro modelos (cambio de tareas, mejor compra, intervenciones disruptivas y educación en entretenimiento). Estos y otros modelos están fácilmente disponibles, la mayoría tiene evidencia a su favor, pero aún no se explotan lo suficiente como para cerrar la brecha de tratamiento. El artículo sostiene la necesidad de múltiples modelos para optimizar llegar a los diversos grupos que necesitan atención

Identifying evidence-based interventions for children and adolescents using the range of possible changes model: A meta-analytic illustration

We are very grateful to Kelly D. Brownell, Julia Kim-Cohen, Susan Nolen-Hoeksema, and Peter Salovey for extremely insightful discussions and commentaries on previous versions of this manuscript. We also thank Jennifer Thomas, Jessica Cronce, and Amelia Aldao for their careful and diligent participation as coders for this study. Please address correspondence to Andres De Los Reyes, Department of Psychology, University of Maryland at College Park, Biology/Psychology Building, Room 3123H, College Park, MD 20742; office: 301-405-7049; e-mail: [email protected] article discusses a study involving a framework (range of possible changes [RPC] Model) developed and applied to identify patterns in consistent and inconsistent intervention outcomes effects by informant, measurement method, and method of statistical analysis to the meta-analytic study of trials testing two evidence-based interventions for children and adolescents (youth-focused cognitive-behavioral treatment for child anxiety problems; parent-focused behavioral parent training for childhood conduct problems). This article illustrates how findings gleaned from applying the RPC Model allow for unique opportunities for hypothesis generation based on the patterns of consistent outcomes effects. Based on the RPC Model, studies can be closely examined to identify the specific instances in which interventions yield robust effects, and the authors illustrate how examining effects in this way can lead to new understandings of interventions and the outcomes they produce. Findings suggest that researchers can employ previously underutilized patterns of consistencies and inconsistencies in outcomes effects as new resources for identifying evidence-based interventions.This work was supported, in part, by National Institute of Mental Health Grant MH67540 (Andres De Los Reyes). This work was also supported by National Institute of Mental Health Grant MH59029 (Alan E. Kazdin)

Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication

Background Prior research indicates that conduct disorder (CD) is associated with a range of comorbid mental disorders. However, the actual prevalence, subtypes, and patterns of comorbidity of DSM-IV defined CD in the general U.S. population remains unknown. Method Retrospective assessment of CD and other DSM-IV disorders was conducted using fully structured diagnostic interviews among a nationally representative sample of respondents (n = 3,199) in the National Comorbidity Survey Replication. Results The estimated lifetime prevalence of CD in the U.S. is 9.5% (males = 12.0%, females = 7.1%), with a median age-of-onset of 11.6 (0.2) years. Latent class analysis identified five CD subtypes characterized by rule violations, deceit/theft, aggression, severe covert behaviors, and pervasive CD symptoms. A dose-response relationship was revealed between CD subtype severity and risk of subsequent disorders. Results also indicated that CD typically precedes mood and substance use disorders, but most often occurs after impulse control and anxiety disorders. Although both active and remitted CD is associated with increased risk of the subsequent first onset of other mental disorders, remitted CD is associated with significantly lower risk of subsequent disorders. Conclusions CD is prevalent and heterogeneous in the U.S. population, and more severe subtypes and the presence of active CD are associated with higher risk of comorbid disorders. Future prospective studies using general population samples will further inform the nature and course of this disorder.Psycholog

Early risk factors for adolescent antisocial behaviour: an Australian longitudinal study

Objective: This investigation utilizes data from an Australian longitudinal study to identify early risk factors for adolescent antisocial behaviour. Method: Analyses are based on data from the Mater University Study of Pregnancy, an on-going longitudinal investigation of women’s and children’s health and development involving over 8000 participants. Five types of risk factors (child characteristics, perinatal factors, maternal/familial characteristics, maternal pre- and post-natal substance use and parenting practices) were included in analyses and were based on maternal reports, child assessments and medical records. Adolescent antisocial behaviour was measured when children were 14 years old, using the delinquency subscale of the Child Behaviour Checklist. Results: Based on a series of logistic regression models, significant risk factors for adolescent antisocial behaviour included children’s prior problem behaviour (i.e. aggression and attention/restlessness problems at age 5 years) and marital instability, which doubled or tripled the odds of antisocial behaviour. Perinatal factors, maternal substance use, and parenting practices were relatively poor predictors of antisocial behaviour. Conclusions: Few studies have assessed early predictors of antisocial behaviour in Australia and the current results can be used to inform prevention programs that target risk factors likely to lead to problem outcomes for Australian youth

Don't Make Me Angry! A Psychophysiological Examination of the Anger–Performance Relationship in Intermediate and Elite Fencers

We aimed to identify the effect of state-anger on precision, speed, and power components of performance during fencing attacks. We conducted a laboratory-based, single-case research experiment to test the fine motor task performance of two experienced and two elite-level fencers under two emotional states: anger and emotion-neutral. We assessed anger via psychophysiological and self-report measures, and we induced anger via a brief imagery intervention. Through the use of an innovative design, which included multiple measures of change, we showed that anger had a consistent negative effect on precision but an inconsistent relationship with response time and muscle activity. The current research design and protocol offer a novel and in-depth method for examining the specific relationships between affective states, emotions, and the complexities that underpin performance. The specific effects of anger on performance were multifarious, complex, and inconsistent. Nonetheless, the results tend to indicate that anger facilitates reaction time and debilitates performance, and these effects were clearer for the most elite performers. The effects of anger on performance are clearly complex, so it would be rather premature to make any suggestions for future practice at this point. Nonetheless, the clearer findings with the elite fencers indicate that researchers will likely yield the most fruitful insights by examining the effects of emotion of performance in elite performers

The impact of behavioural skills training on the knowledge, skills and well-being of front line staff in the intellectual disability sector: a clustered randomised control trial

© 2019 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd Background: Staff with varying backgrounds and educational qualifications can be effectively trained to implement procedures in line with evidence-based practice. Behavioural skills training (BST) is a competency-based training model used to effectively educate a broad selection of professionals, including front line staff, in a range of work-related skills. However, BST has yet to be evaluated in a large group-based experiment. Methods: This study involved a parallel cluster randomised control trial. Six service sites, with a total of 54 participants, were randomised to the intervention condition using the ‘coin toss’ method. The intervention condition used BST to coach intellectual disability staff in reinforcement, systematic prompting, functional communication training and task analysis. Six service sites, with a total of 50 participants, were also randomised to a control condition in which generalised training in behavioural interventions was restricted. Recruited service sites were randomly assigned to the intervention condition (N = 6, n = 54) or the control condition (N = 6, n = 50) at one point in time, immediately after recruitment and before baseline testing took place. Allocations were stratified by service type (residential or day) and geographical region. One member of the research team allocated service sites using the ‘coin toss’ method, and another member, blind to the allocations, decided which experimental arm would receive the intervention and which would be designated as control. It was not possible to mask the intervention from participants, but they were recruited prior to randomisation. Results: Participants in the intervention condition demonstrated statistically significant improvements in their knowledge scores over the study period. Participants in the control condition showed no change or a statistically significant decrease in their knowledge scores. No statistically significant changes to well-being were observed for either group. There was clear evidence of knowledge maintenance, as well as skill acquisition and subsequent generalisation to the workplace environment, among participants in the intervention condition. Participants also evaluated the BST intervention positively. Conclusions: Results support BST as a method for disseminating evidence-based practice to front line staff working with adults with intellectual and developmental disabilities