MIRRORS program: Helping pregnant and postpartum women and families with substance use problems.

Background: Pregnant and postpartum women with substance use disorders are a highly vulnerable population, especially when this is compounded by homelessness or unstable housing, justice involvement, and/or co-occurring mental health challenges. The MIRRORS (Maternal Initiative for Reflective Recovery-Oriented Residential Services) program provided expanded and enhanced residential substance use disorder treatment, prevention and recovery support for women and children through integrated, trauma-informed care and services strengthened by a comprehensive and coordinated family systems approach. This paper describes the program and provides evaluation of the outcomes. Methods: Pregnant and postpartum women (n = 215) were assessed at 3 time points: intake, discharge and 6-months post-intake using standardized measures of family functioning, parenting, recovery capital, and other outcomes. Multilevel modeling was employed to examine individual differences in trends over time. Results: Over 80% of participants reported that the MIRRORS program enhanced their recovery treatment experience. Women reported significant improvements in general family functioning, problem solving, behavioral control, affective responsiveness, and communication. Participants also reported increased recovery capital and improved parental monitoring over time. Conclusions: Outcomes indicate that the MIRRORS program was effective in improving family functioning and reducing substance use, thus enhancing women's functioning and recovery.

Development and evaluation of two instruments for assessing screening, brief intervention, and referral to treatment (SBIRT) competency.

BACKGROUND: Screening, brief intervention, and referral to treatment (SBIRT) is shown to be effective in identifying, intervening with, and making appropriate referrals for patients with unhealthy alcohol use. SBIRT training consists of knowledge-based and skill-based components and has increased the use of screening and intervention skills in clinical settings. This article reports on the development and evaluation of 2 SBIRT proficiency checklists for use across institutions to assess SBIRT skills in both simulated and clinical encounters. METHODS: A national panel of 16 experts identified 137 discrete SBIRT skills items for the checklists. From this final list, 2 proficiency checklists were derived: the SBIRT Proficiency Checklist (SPC), composed of 22 questions for videotaped interviews, and the Clinical SBIRT Proficiency Checklist (CSPC), composed of 13 questions for direct clinical observation. An evaluation was conducted to test the reliability of the SPC and to assess the utility of the CSPC. RESULTS: Two checklists for assessing SBIRT proficiency were developed by a collaborative workgroup. Fleiss' kappa analyses indicated moderate agreement. In addition, faculty recorded satisfaction with the CSPC for assessing residents on their SBIRT performance during clinical encounters. CONCLUSIONS: The SPC and the CSPC are practical tools for assessing competence with SBIRT and are easily integrated as standard instruments in a wide range of training settings. Future advancements to the checklists and their evaluation include modification of the SPC rating scale to be consistent with the CSPC, developing a training program for using the checklists, and further testing to improve interrater reliability.

Baylor Pediatric SBIRT Medical Residency Training Program: model description and evaluation.

BACKGROUND: The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment methods for alcohol and substance use problems. METHODS: This paper describes the training program created for pediatric residents and provides an evaluation of the program. Ninety-five first-year pediatric residents participated in the training program. They were assessed on satisfaction with the program, self-rated skills, observed competency, and implementation into clinical practice. RESULTS: The program was successfully incorporated into the residency curricula in two pediatric residencies. Evaluations indicate a high degree of satisfaction with the program, self-reported improvement in SBIRT skills, observed proficiency in SBIRT skills, and utilization of SBIRT skills in clinical practice. CONCLUSIONS: SBIRT skills training can be incorporated into pediatric residency training, and residents are able to learn and implement the skills in clinical practice.

Statistical challenges in studying complex and changing families.

This paper describes challenges of studying complex and changing families and provides suggestions for methods of analyses to study these family systems. Five common problems that NIMH-funded investigators have encountered in analyzing family based studies are addressed and analytic solutions for addressing these problems are illustrated using data from Family HIV/AIDS projects. The problems discussed in the paper are (1) differences in subgroup responses to interventions; (2) longitudinal changes in family relationships and covariates that vary by group in nested designs; (3) dealing with missing data over time from attrition and planned missing data due to death; (4) dealing with multiple reports from different family members; and (5) developing concordance measures among family members. The use of multi-level and growth curve modeling techniques to address these problems is illustrated with some of the studies.

Baylor SBIRT Medical Residency Training Program: model description and initial evaluation.

The Baylor College of Medicine SBIRT Medical Residency Training Program is a multilevel project that trains residents and faculty in evidenced-based screening, brief intervention, and referral to treatment (SBIRT) methods for alcohol and substance use problems. This paper describes the training program and provides initial evaluation after the first year of the project. The program was successfully incorporated into the residency curricula in family medicine, internal medicine, and psychiatry. Initial evaluations indicate a high degree of satisfaction with the program and, despite a slight decrease in satisfaction scores, participants remained satisfied with the program after 30 days. Implementation barriers, solutions, and future directions of the program are discussed.

COVID-19 pandemic stresses and relationships in college students.

Objective: The goal of this study was to understand how intergenerational intimacy and individuation associate with COVID-19 pandemic-related stresses and changes to relationship qualities, and consequentially, with substance use indicators, happiness, and life satisfaction. Background: Intergenerational family systems theory suggests that dysfunctional relationship patterns in one's family of origin contribute to greater stress, and consequentially, to poorer health outcomes. We examined how these patterns emerge for young adults during a pandemic. Method: A sample (N = 501) of young adults at a large university in Texas completed an online questionnaire about health and happiness. Results: More intergenerational intimacy was associated with more positive COVID-19 pandemic-related changes in relationship quality with family and friends, and with more happiness and life satisfaction. More intergenerational individuation was associated with less COVID-19 pandemic-related stress, fewer coping motives for alcohol use, and with more happiness and life satisfaction. Less COVID-19 pandemic-related stress and more positive COVID-19 pandemic-related changes in relationship qualities with family and friends were associated with more positive outcomes. Conclusion: More positive intergenerational relationships are associated with more positive outcomes in regards to COVID-19 pandemic-related stress and relationship changes. Implications: Promoting positive intergenerational relational qualities between young adults and their parents can buffer against pandemic-related consequences in health and happiness. Family health practitioners should promote these intergenerational qualities in families, which in turn should increase positive psychosocial and health outcomes in the context of a pandemic.

Parental monitoring, family conflict, and adolescent alcohol use: A longitudinal latent class analysis.

This study examined relationships among parental monitoring, family conflict, and subgroups of adolescent alcohol use identified through longitudinal latent class analyses (LLCA). Differences in these subgroups across sex and race/ethnicity were also examined. The present study used data (N = 4,067; 51% male, 49% female) collected during a longitudinal study in which adolescents completed questionnaires each semester for seven semesters, beginning in spring of their freshman year of high school until spring of their senior year. LLCA demonstrated three classes of drinking over time (low, increasing, and moderate use). The majority of adolescents were increasing-use drinkers. Moderate drinkers were more likely to be male than female; nondrinkers were most likely to be African American; and increasing-use drinkers were more likely to be Mexican American. Adolescents who received less maternal monitoring and experienced more family conflict were more likely to be identified in the class of moderate alcohol use compared to nonuse. These results highlight the importance of encouraging parental monitoring and decreasing family conflict to reduce the likelihood of adolescent alcohol use throughout the high school years (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Toward a new predoctoral model: Education and training in clinical psychopharmacology.

A ubiquitous research finding in regional and national studies is that at least 40% of persons with mental disorders cannot access mental health services, and pharmacotherapy in particular. The American Psychological Association's (APA) designated programs for the provision of education and training in clinical psychopharmacology can be of great help in alleviating this national need. We address key developments relevant to the foundation of a predoctoral model of clinical psychopharmacology education and training. To this end, an overview of the Master of Science in Clinical Psychopharmacology (MSCP) program at The Chicago School of Professional Psychology (TCSPP) is presented. TCSPP is now enrolling its eleventh consecutive cohort of MSCP students, many of whom are doctoral students who are concurrently attending various APA accredited Health Service Psychology (HSP) programs. We provide two predoctoral routes for completing MSCP training: (a) a route allowing for the creation of concentrations in clinical psychopharmacology in Health Service Psychology (HSP) doctoral programs, providing up to half of MSCP coursework; and (b) a joint doctoral PsyD or PhD/MSCP program meeting APA accreditation and designation standards integrated into a 5-year curriculum to impart HSP graduates with the competencies to provide both psychotherapy and pharmacotherapy. We conclude with a discussion about the future direction of predoctoral clinical psychopharmacology education and training. Given its emphasis on neuroscience and interdisciplinary health care, such curricular models may help to address the nation's immediate mental health care needs, while serving to enhance the sustainability of HSP education and professional practice in the 21st Century. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Detachment, peer pressure, and age of first substance use as gateways to later substance use.

BACKGROUND: Prior research using psychosocial developmental models have identified emotional detachment from family and susceptibility to peer pressure as predictors of adolescent substance use. Despite mixed support for the gateway hypothesis, less is known about how these psychosocial developmental factors facilitate adolescent substance use. The purpose of this study was to examine how age of first substance use, emotional detachment from parents, and susceptibility to peer pressure influence the progression from alcohol, marijuana, and tobacco use to other illicit substance use (e.g., cocaine, hallucinogens). METHOD: Data (N = 5792) were collected from high school students across seven semesters. Latent growth curve modeling was used to examine how age of first use of alcohol, marijuana, and tobacco predicted initial levels and changes in emotional detachment, peer pressure, and other illicit substance use. RESULTS: Earlier age of first use of alcohol, marijuana, and tobacco predicted detachment, peer pressure, and a greater likelihood of initial use of other illicit substances. More initial emotional detachment was associated with increases in other illicit substance use. Earlier ages of first use of alcohol, marijuana, and tobacco had indirect effects on initial use of other illicit substances through initial emotional detachment. CONCLUSION: Emotional detachment from parents and peer pressure impact the likelihood of other illicit substance use across the high school years. Prevention programs may benefit by focusing on delaying the onset of first use of substance use and by preventing emotional detachment from parents and peer pressure.

A quarter century of psychological practice in mental health and health care: 1990-2016.

Powerful forces have shaped professional psychology over the past 25 years, including significant changes in health policy and health care delivery systems. Examples include managed care cost containment, rapid growth of nondoctoral mental health providers, federal mental health parity legislation, and passage of the Affordable Care Act of 2010, with its emphasis on primary care-behavioral health integration and alternatives to fee-for-service reimbursement. This article considers these factors for psychology as a mental health profession and as a health profession more broadly defined, and describes the American Psychological Association's advocacy about the value of psychology in each domain. While challenging to psychology's traditional models of care, these changes offer significant promise for the future of psychology in health care. (PsycINFO Database Record

Predicting heavy alcohol use among adolescents.

A prospective, school-based study of alcohol use in a multiethnic sample of 3,675 adolescents found that family factors, other drug use, psychosocial-behavioral factors, and ethnic status are important discriminators of adolescents who are heavy alcohol users when compared with those who are experimental or moderate users. Implications for prevention and intervention are discussed.

Individuation, peers, and adolescent alcohol use: a latent growth analysis.

The study used latent growth modeling to investigate longitudinal relationships between individuation, peer alcohol use, and adolescent alcohol use among African American, Mexican American, and non-Hispanic White adolescents (N = 6,048) from 7th, 8th, and 9th grades over a 3-year period. Initial levels of peer alcohol use were significantly related to changes in adolescents' alcohol use, whereas initial adolescent alcohol use also significantly related to changes in peers' alcohol use, suggesting a bidirectional relationship. Higher levels of intergenerational individuation were related to smaller increases in adolescent alcohol use and higher levels of separation were related to larger increases in youth drinking. The findings were similar across ethnic groups. Implications for development of prevention and intervention programs are discussed.

Behavior problems of clinic children: relation to parental marital status, age and sex of child.

Behavior problems of 703 children seen in a clinical setting were examined for interactions between and effects of family type (i.e., parental marital status) and age and sex of child. Significant differences were found based on family type, with children of separated, divorced, and remarried parents having more problems. Expected interactions between marital status and age and sex of child were not obtained, although results support prior research with regard to the effects of age and sex.

Innovative ways to address the mental health and medical needs of marginalized patients: collaborations between family physicians, family therapists, and family psychologists.

This article describes an innovative program to meet the needs of homeless women, children, and families residing at a transitional living center in an urban setting. The program involves collaboration between medical and mental health professionals to address the multiple problems and unmet needs of this population. Recommendations for future work in expanding collaborative practice are discussed. ((c) 2004 APA, all rights reserved)

Gender, perceived parental monitoring, and behavioral adjustment: influences on adolescent alcohol use.

This study examined relationships among gender, perceived parental monitoring, externalizing behaviors, and adolescent alcohol use in a 2-wave longitudinal study. Females reported more perceived parental monitoring and less alcohol use than males. Perceived maternal and paternal monitoring were related to less alcohol use over time. Increases in alcohol use were associated with increases in externalizing behaviors over time. Perceived maternal monitoring mediated the relationship between gender and youth drinking and was also a significant predictor of changes in adolescent drinking over time. Perceived paternal monitoring was not a predictor of adolescent drinking in the context of perceived maternal monitoring and externalizing behaviors. The importance of gender in implementation of prevention programs is discussed.

The future of psychology practice and science.

This article reviews the 2009 APA President's initiatives and recommendations for the future of psychology practice and science. The future of psychology practice requires that we expand the focus of traditional practice; become health care providers, not just mental health providers; use evidence-based practice, assessment, and outcome measures; incorporate technology into our practices, including electronic health records; and change training and focus to meet the needs of our diverse society. The future of psychological science requires that we train and work in multidisciplinary teams, employ different methods and approaches, and shift our focus to translational science. The future of our profession requires substantial changes in graduate education to prepare our students for science and practice in the 21st century. In light of advances in science and practice that reveal the critical importance of psychosocial and behavioral factors in health and disease, I call for the creation of a department of behavioral health within the federal government.

La autoridad personal en el sistema familiar: adaptación y validación a la población mexicana / Adaptation and validation of the Mexican Spanish version of Personal Authority in Family System Questionnaire

El propósito este estudio fue el obtener un instrumento estandarizado de autoridad personal para la población mexicana. Se utilizó el Cuestionario de Autoridad Personal en el Sistema Familiar y se examinó su estructura factorial. Los participantes fueron 600 personas voluntarias, mayores de edad, casadas o en unión libre residentes del Distrito Federal y área metropolitana con número de hijos y ocupaciones variables. Las dimensiones propuestas en el cuestionario original fueron distintas para la población mexicana. Los resultados sugieren una solución de 16 factores para explicar el fenómeno y uno adicional correspondiente a un estudio exploratorio preliminar. Entre las diferencias, se encontraron factores por separado para el padre y la madre relacionados con la intimidad e intimidación intergeneracional en lugar de dimensiones unificadas. También se observaron factores exclusivos para describir la importancia de las expectativas de la madre hacia los hijos resaltando el impacto de la estructura de la familia mexicana en la obtención de los resultados. El análisis factorial de segundo orden muestra la conformación de cinco dimensiones que subyacen a la autoridad personal.

The aim of this study was to propose a standardized measure that assessed personal authority in Mexican population. The Personal Authority in Family System Questionnaire (PAFS-Q) was used. The sample consisted of 600 adult volunteers who were married or who lived with a formal partner at the time of the research. They were Mexico City's or metropolitan area residents with different occupations and from different age groups. The PAFS-Q factor structure was examined. Findings suggest a sixteen-factor solution plus a one-factor preliminary exploratory study with important differences from those reported when the PAFS-Q was developed and standardized for Americans. The main differences were that this study found separate Father and Mother Intimacy and Intimidation factors instead of single Intergenerational Intimacy and Intergenerational Intimidation dimensions. By the way, there were also found two additional factors for describing Mother's expectations that should be fulfilled by her adult children. This might be explained by the impact of Mexican culture in traditional family structure. A second- order factor analysis provided a further explanation of Personal Authority dimensions.

Pathways to adolescent alcohol use: family environment, peer influence, and parental expectations.

PURPOSE: This study was conducted to examine the relationships among family environment, peer influence, stress, self-efficacy, and adolescent alcohol use and to test for the potential moderating effects of parental expectations regarding adolescent alcohol use. METHODS: Data were obtained from questionnaires completed by high school students (n = 2573) participating in a longitudinal study of substance use and other problem behaviors. Variables were lagged across three time points to reflect a causal sequence relating family environment to adolescent alcohol use through self-efficacy, peer influence, and stress. A latent measure of family environment included adolescents' perceptions of parental acceptance, parental monitoring, and communication with parents. The latent measure of peer influence included use of alcohol by same-age peers and friends and friends' approval of alcohol use. Observed scale scores were used for self-efficacy and stress measures, and the latent measure of alcohol behaviors included quantity, frequency, and associated problems. RESULTS: Structural equation modeling indicated good model fit, chi(2) (144) = 831.69, p < .001, comparative fit index (CFI) = .992, root mean square error of approximation (RMSEA) = .043 (.040, .046). Family environment exerted significant indirect effects on adolescent alcohol use through peer influence, self-efficacy, and stress, and parental expectations significantly moderated all structural paths. CONCLUSIONS: Parental expectations of adolescent alcohol use significantly moderated all structural relationships, and greater parental disapproval was associated with less involvement with friends and peers who use alcohol, less peer influence to use alcohol, greater self-efficacy for avoiding alcohol use, and lower subsequent alcohol use and related problems.

Acculturation, substance use, and deviant behavior: examining separation and family conflict as mediators.

This longitudinal study examined how separation and family conflict mediated the effects of two acculturation variables (English language use and generational status) on substance use (alcohol, tobacco, and marijuana use) and deviant behavior outcomes in a Mexican American high school age sample. Structural equation modeling indicated that separation was a significant mediator of the relationship between acculturation and alcohol use, tobacco use, and deviant behavior. Family conflict mediated the effects of acculturation on marijuana use and deviant behavior. Model comparisons across gender groups suggested that generational status was an influential acculturation measure for females but not males. Additionally, English language use maintained a direct effect on marijuana use among females, whereas this relationship was mediated by separation for males.