Impact of Primary Care-Mental Health Care Integration on Mental Health Care Engagement Across Racial and Ethnic Groups.

OBJECTIVE: Receiving mental health services as part of primary care in the Veterans Health Administration (VHA) might increase engagement in specialty mental health care. The authors reexamined the association between primary care-mental health integration (PCMHI) and continued engagement in specialty mental health care for VHA patients and assessed differences by race and ethnicity. METHODS: The study included 437,051 primary care patients with a first in-person specialty mental health encounter in 2015-2016 (no specialty mental health encounters in prior 12 months), including 46,417 patients with new PCMHI encounters in the year before the first specialty mental health encounter. Multivariable logistic regression assessed odds of follow-up specialty mental health care within 3 months of the first specialty mental health encounter. The dependent variable was care engagement (attending a second specialty mental health appointment); independent variables were whether patients were seen by PCMHI on the same day as the primary care appointment ("same-day access"), the time between PCMHI and first specialty mental health appointments, and race and ethnicity. RESULTS: PCMHI was associated with increased engagement in specialty mental health care for all patients, with a greater likelihood of engagement among non-Hispanic White patients. Same-day access to PCMHI was positively associated with care engagement, with no significant differences by race or ethnicity. PCMHI care within 3 months before a first specialty mental health encounter was associated with greater care engagement. CONCLUSIONS: PCMHI, especially same-day access to PCMHI care, may boost engagement in mental health care, although the study design precluded conclusions regarding causal relationships.

Treatment of posttraumatic stress disorder with prolonged exposure for primary care (PE-PC): Effectiveness and patient and therapist factors related to symptom change and retention.

Prolonged exposure (PE) is a first-line treatment for posttraumatic stress disorder (PTSD) available in specialty mental health. PE for primary care (PE-PC) is a brief version of PE adapted for primary care mental health integration, composed of four-eight, 30-min sessions. Using retrospective data of PE-PC training cases from 155 Veterans Health Administration (VHA) providers in 99 VHA clinics who participated in a 4- to 6-month PE-PC training and consultation program, we examined patients' PTSD and depression severity across sessions via mixed effects multilevel linear modeling. Additionally, hierarchical logistic regression analysis was conducted to assess predictors of treatment dropout. Among 737 veterans, medium-to-large reductions in PTSD (intent-to-treat, Cohen's d = 0.63; completers, Cohen's d = 0.79) and small-to-medium reductions in depression (intent-to-treat, Cohen's d = 0.40; completers, Cohen's d = 0.51) were observed. The modal number of PE-PC sessions was five (SD = 1.98). Providers previously trained in both PE and cognitive processing therapy (CPT) were more likely than providers who were not trained in either PE or CPT to have veterans complete PE-PC (OR = 1.54). Veterans with military sexual trauma were less likely to complete PE-PC than veterans with combat trauma (OR = 0.42). Asian American and Pacific Islander veterans were more likely than White veterans to complete treatment (OR = 2.93). Older veterans were more likely than younger veterans to complete treatment (OR = 1.11). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The "me too" decision: An analog study of therapist self-disclosure of psychological problems.

OBJECTIVES: To test the exploratory hypothesis that client perceptions of therapists are most favorable when therapists self-disclose their own personal experience with the same psychological problem to a moderate (vs. none, mild, or extreme) extent. METHOD: Undergraduate participants (N = 104; 63.5% female) were randomly assigned to read one of the four vignettes, which differed only in the extent to which the therapist disclosed their own personal experience with the same presenting problem (none, mild, moderate, or extreme). Participants then responded to questions assessing their perceptions of the therapist. RESULTS: The data generally supported the hypothesis. The moderate disclosure condition yielded the most favorable client perceptions, which differed significantly from those yielded by the no disclosure condition. CONCLUSIONS: Despite limitations and need for replication, this study provides perhaps the first empirical data regarding the effect of the extent, rather than the mere presence or absence, of therapist self-disclosure regarding personal psychological experiences.

Carbon Core Electron Spectra of Polycyclic Aromatic Hydrocarbons.

Aromaticity profoundly affects molecular orbitals in polycyclic aromatic hydrocarbons. X-ray core electron spectroscopy has observed that carbon 1s-π* transitions can be broadened or even split in some polycyclic systems, although the origin of the effect has remained obscure. The π electrons in polycyclic systems are typically classified in the Clar model as belonging to either true aromatic sextets (similar to benzene) or isolated double bonds (similar to olefins). Here, bulk-sensitive carbon core excitation spectra are presented for a series of polycyclic systems and show that the magnitude of the 1s-π* splitting is determined primarily by the ratio of true aromatic sextets to isolated double bonds. The observed splitting can be rationalized in terms of ground state energetics as described by Hückel, driven by the π electron structure described by Clar. This simple model including only ground state energetics is shown to explain the basics physics behind the spectral evolution for a broad set of polycyclic aromatic hydrocarbons, although some residual deviations between this model and experiment can likely be improved by including a more detailed electronic structure and the core hole effect.

Achieving same-day access in integrated primary care.

Same-day access to behavioral health services is a critical feature of integrated primary care. Despite the benefits of same-day access, implementing and sustaining this key feature has been a challenge for multiple health care settings. Further, there is relatively little practical guidance on how to implement this practice management feature. Diverse program design solutions for same-day access are implemented in clinics across the Veterans Health Administration. The authors identified innovative approaches, developed in local facilities, with demonstrated success in same-day access that can be implemented in any setting. The purpose of this article is to describe five approaches for providing same-day access within integrated care. The authors discuss key considerations (staffing, space, program maturity), potential challenges and facilitators, and provide practical recommendations for implementation. (PsycINFO Database Record

Doctoral training in clinical psychology across 23 years: Continuity and change.

OBJECTIVE: Doctoral training in clinical psychology has undergone substantial changes in recent decades, especially with the increasing heterogeneity of training models and graduate students. To document these changes, we analyzed program, student, and faculty characteristics of American Psychological Association (APA)-accredited clinical psychology programs over a 23-year span. METHOD: We surveyed directors of clinical training about their doctoral programs every 2 years from 1991 to 2013, securing 90%-98% response rates. With minimal exceptions, the survey questions remained constant. RESULTS: Percentages of female and racial/ethnic minority students continued to grow, such that women now comprise about three quarters of trainees and ethnic minorities about one quarter. There has been a decisive shift in faculty theoretical orientation toward cognitive/cognitive-behavioral and away from psychodynamic/psychoanalytic. Internship match rates were relatively high and stable until the early 2010s but have recently rebounded. CONCLUSION: We discuss the limitations of these survey results and their implications for the future of doctoral training in clinical psychology.

Nanoscale geochemical and geomechanical characterization of organic matter in shale.

Solid organic matter (OM) plays an essential role in the generation, migration, storage, and production of hydrocarbons from economically important shale rock formations. Electron microscopy images have documented spatial heterogeneity in the porosity of OM at nanoscale, and bulk spectroscopy measurements have documented large variation in the chemical composition of OM during petroleum generation. However, information regarding the heterogeneity of OM chemical composition at the nanoscale has been lacking. Here we demonstrate the first application of atomic force microscopy-based infrared spectroscopy (AFM-IR) to measure the chemical and mechanical heterogeneity of OM in shale at the nanoscale, orders of magnitude finer than achievable by traditional chemical imaging tools such as infrared microscopy. We present a combination of optical microscopy and AFM-IR imaging to characterize OM heterogeneity in an artificially matured series of New Albany Shales. The results document the evolution of individual organic macerals with maturation, providing a microscopic picture of the heterogeneous process of petroleum generation.

Treating PTSD in primary care: One small step is one giant leap.

Comments on an article by J. A. Cigrang et al. (see record 2017-56601-006). At first glance, the article by Cigrang et al. is another in a long line of randomized clinical trials of psychotherapy for a common condition. Under closer scrutiny, however, it is a groundbreaking study that challenges many commonly held beliefs about effective interventions for posttraumatic stress disorder (PTSD). Cigrang et al. have begun to change the status quo with this study within the DoD. The same protocol is now in the early stages of implementation as a pilot in the VA's Patient Aligned Care Team (VA equivalent of the Patient Centered Medical Home). In addition to treating PTSD, cognitive processing therapy (CPT) and prolonged exposure may provide relief for individuals suffering from symptoms significant enough to cause distress but not rising to the level of precision needed for a diagnosis of PTSD: the bread and butter of integrated primary care. Although a significant step forward, the study by Cigrant et al. is only a beginning. There is obviously a need for replication and possible enhancements of this exposure treatment. There are other condensed versions of CPT being developed and tested as well. Many questions remain. (PsycINFO Database Record

Realistic molecular model of kerogen's nanostructure.

Despite kerogen's importance as the organic backbone for hydrocarbon production from source rocks such as gas shale, the interplay between kerogen's chemistry, morphology and mechanics remains unexplored. As the environmental impact of shale gas rises, identifying functional relations between its geochemical, transport, elastic and fracture properties from realistic molecular models of kerogens becomes all the more important. Here, by using a hybrid experimental-simulation method, we propose a panel of realistic molecular models of mature and immature kerogens that provide a detailed picture of kerogen's nanostructure without considering the presence of clays and other minerals in shales. We probe the models' strengths and limitations, and show that they predict essential features amenable to experimental validation, including pore distribution, vibrational density of states and stiffness. We also show that kerogen's maturation, which manifests itself as an increase in the sp(2)/sp(3) hybridization ratio, entails a crossover from plastic-to-brittle rupture mechanisms.

Capturing Psychologists' Work in Integrated Care: Measuring and Documenting Administrative Outcomes.

With the expansion of integrated primary care and the increased focus on fiscal sustainability, it is critical for clinical managers of these innovative systems to have practical methods for measuring administrative outcomes. Administrative outcomes will assist leadership in the development of efficient, streamlined clinics to provide services to the primary care population. Additionally, administrative measures can be utilized to provide information to assist in guiding resource utilization and management decisions. Several administrative outcomes are suggested for integrated primary care managers to consider for application, including: clinic utilization measures, integrated care administrative measures, wait time and access metrics, and productivity monitors. Effective utilization of these measures can help office managers and clinic leadership not only to maximize patient care, but also to enhance essential business operations, which increase the long-term sustainability of integrated primary care programs.

Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans.

OBJECTIVES: We evaluated the association of mental illnesses with clinical outcomes among US veterans and evaluated the effects of Primary Care-Mental Health Integration (PCMHI). METHODS: A total of 4 461 208 veterans were seen in the Veterans Health Administration's patient-centered medical homes called Patient Aligned Care Teams (PACT) in 2010 and 2011, of whom 1 147 022 had at least 1 diagnosis of depression, posttraumatic stress disorder (PTSD), substance use disorder (SUD), anxiety disorder, or serious mental illness (SMI; i.e., schizophrenia or bipolar disorder). We estimated 1-year risk of emergency department (ED) visits, hospitalizations, and mortality by mental illness category and by PCMHI involvement. RESULTS: A quarter of all PACT patients reported 1 or more mental illnesses. Depression, SMI, and SUD were associated with increased risk of hospitalization or death. PTSD was associated with lower odds of ED visits and mortality. Having 1 or more contact with PCMHI was associated with better outcomes. CONCLUSIONS: Mental illnesses are associated with poor outcomes, but integrating mental health treatment in primary care may be associated with lower risk of those outcomes.

Listening to the voice of the patient.

Comments on the article by T. J. Waltz et al. (see record 2014-31795-001). The article used population based screening to identify patients with depressive illness. An important feature of this article is that it addresses the needs of the patient, not the organization of the care system. It points us to patient perspectives and choices more than practice or system level offerings. This article should remind us that patient satisfaction and patient preferences are every bit as important, if not more so, to achieving good clinical outcomes as selection of the proper treatment (Swift, Callahan, & Vollmer, 2011).

Is depression the past tense of anxiety? An empirical study of the temporal distinction.

It has long been recognised that depression and anxiety share a common core of negative affect, but research on similarities and differences between these two emotions is growing. The focus of the current study was on whether the timing of a triggering event can determine whether the dominant emotional reaction is depression or anxiety. It was hypothesised that aversive events in the past would elicit more depression than anxiety, whereas the same aversive events in the future would elicit more anxiety than depression. We created temporally varied versions of vignettes describing aversive events occurring at either time, and asked participants to rate the extent to which the events would elicit feelings of depression or anxiety. Results indicated that adverse past events elicited much higher ratings of anticipated depression and adverse future events elicited much higher ratings of anticipated anxiety. Implications for understanding these two emotions and depressive and anxiety disorders are discussed.

Current versus ideal skin tones and tanning behaviors in Caucasian college women.

OBJECTIVE: To explore tanning behaviors and whether a discrepancy between current and ideal skin tones exists. PARTICIPANTS: The sample included 78 Caucasian women from a mid-sized midwestern university. METHODS: Data were collected in spring 2012 via a paper questionnaire. RESULTS: Sixty-two percent of the sample regularly engaged in salon tanning at least once per week, with an average frequency of 2.5 visits per week. Thirteen percent endorsed regularly tanning 4 or more times per week, and 26% reported visiting a tanning bed more than once in a 24-hour period. Ninety-four percent wished their current skin tone was darker, and ideal tone was significantly darker than current tone. CONCLUSIONS: The data suggest that the young Caucasian women in this sample tend to be dissatisfied with their current skin tone to an extent that leads the majority of them to engage in risky, potentially cancer-causing behavior by either salon tanning or considering tanning in the future as time and finances become available.

Applying the interprofessional patient aligned care team in the Department of Veterans Affairs: Transforming primary care.

The Veterans Health Administration (VHA) is the largest integrated health care system in the United States, serving more than 8 million veterans. VHA is currently undergoing extensive changes to its health care delivery model, moving toward the full implementation of the patient-centered medical home. Mental health providers, including psychologists working in primary care, are playing key roles in this transformation to interprofessional teams and systems-as clinicians, researchers, program evaluators, and educators. Moreover, VHA mental health staff serves critical leadership functions supporting primary care in the broad transformation that is required to implement the medical home. In this article, we review the implementation of mental health integration into this new model of care.

Mental health services in the medical home in the Department of Veterans Affairs: factors for successful integration.

Since the early 1990s, primary care has been described as the de facto mental health care system in the United States. Most individuals with mental health concerns present in primary care, but the majority are either not identified or do not receive evidence-based services or guideline concordant care. Despite 20 years of research supporting the integration of mental health services into primary care, the translation of this evidence into real-world settings remains limited. The growing impetus to build comprehensive health care systems that provide care for a defined population has recently spurred interest in providing mental health care within primary care. The Department of Veterans Affairs (VA) began to systematically incorporate psychological and other mental health services into primary care in 2007. National evaluation and local program data reviewed here have demonstrated that the initiative has already improved the identification and treatment of mental health disorders in the primary care population, increased the likelihood of receiving guideline concordant care, and enhanced treatment engagement for patients referred into specialty mental health services. These results provide support for expectations that integrated care enhances access to high-quality mental health care. This article summarizes critical factors for success identified in the VA integrated care rollout. These factors are applicable for other health care organizations that seek to improve mental health services delivery.

Downhole fluid analysis and asphaltene science for petroleum reservoir evaluation.

Petroleum reservoirs are enshrouded in mysteries associated with all manner of geologic and fluid complexities that Mother Nature can inspire. Efficient exploitation of petroleum reservoirs mandates elucidation of these complexities; downhole fluid analysis (DFA) has proven to be indispensable for understanding both fluids and reservoir architecture. Crude oil consists of dissolved gases, liquids, and dissolved solids, known as the asphaltenes. These different fluid components exhibit fluid gradients vertically and laterally, which are best revealed by DFA, with its excellent precision and accuracy. Compositional gradient analysis falls within the purview of thermodynamics. Gas-liquid equilibria can be treated with a cubic equation of state (EoS), such as the Peng-Robinson EoS, a modified van der Waals EoS. In contrast, the first EoS for asphaltene gradients, the Flory-Huggins-Zuo (FHZ) EoS, was developed only recently. The resolution of the asphaltene molecular and nanocolloidal species in crude oil, which is codified in the Yen-Mullins model of asphaltenes, enabled the development of this EoS. The combination of DFA characterization of gradients of reservoir crude oil with the cubic EoS and FHZ EoS analyses brings into view wide-ranging reservoir concerns, such as reservoir connectivity, fault-block migration, heavy oil gradients, tar mat formation, huge disequilibrium fluid gradients, and even stochastic variations of reservoir fluids. New petroleum science and DFA technology are helping to offset the increasing costs and technical difficulties of exploiting ever-more-remote petroleum reservoirs.

How big is the competent community? And who gets in?

Comments on the original article, "The competent community: Toward a vital reformulation of professional ethics," by W. B. Johnson et al. (see record 2012-04007-001). Johnson et al. offered a welcome and promising glimpse into the future of psychology ethics. The notion that the field of psychology should encourage its members to make a communitarian commitment toward caring for each other as well as those we serve seems indubitable and perhaps even overdue. Assuming that the merits of the "competent community" are recognized, a couple of subsequent questions regarding its implementation should be addressed. First, how big should the competent community be? The second question centers on who gets in to our professional community in the first place: Should admission to graduate programs in psychology depend on an applicant's commitment to communitarianism?

Use of discrete event simulation to improve a mental health clinic.

OBJECTIVE: To improve clinic design, trial-and-error is commonly used to discover strategies that lead to improvement. Our goal was to predict the effects of various changes before undertaking them. METHOD: Systems engineers collaborated with staff at an integrated primary care-mental health care clinic to create a computer simulation that mirrored how the clinic currently operates. We then simulated hypothetical changes to the staffing to understand their effects on percentage of patients seen outside scheduled clinic hours and service completion time. RESULTS: We found that, out of the change options being considered by the clinic, extending daily clinic hours by two and including an additional psychiatrist are likely to result in the greatest incremental decreases in patients seen outside clinic hours and in service time. CONCLUSION: Simulation in partnership with engineers can be an attractive tool for improving mental health clinics, particularly when changes are costly and thus trial-and-error is not desirable.

Minimization of fragmentation and aggregation by laser desorption laser ionization mass spectrometry.

Measuring average quantities in complex mixtures can be challenging for mass spectrometry, as it requires ionization and detection with nearly equivalent cross-section for all components, minimal matrix effect, and suppressed signal from fragments and aggregates. Fragments and aggregates are particularly troublesome for complex mixtures, where they can be incorrectly assigned as parent ions. Here we study fragmentation and aggregation in six aromatic model compounds as well as petroleum asphaltenes (a naturally occurring complex mixture) using two laser-based ionization techniques: surface assisted laser desorption ionization (SALDI), in which a single laser desorbs and ionizes solid analytes; and laser ionization laser desorption mass spectrometry (L(2)MS), in which desorption and ionization are separated spatially and temporally with independent lasers. Model compounds studied include molecules commonly used as matrices in single laser ionization techniques such as matrix assisted laser desorption ionization (MALDI). We find significant fragmentation and aggregation in SALDI, such that individual fragment and aggregate peaks are typically more intense than the parent peak. These fragment and aggregate peaks are expected in MALDI experiments employing these compounds as matrices. On the other hand, we observe no aggregation and only minimal fragmentation in L(2)MS. These results highlight some advantages of L(2)MS for analysis of complex mixtures such as asphaltenes.