Juventino Hernandez Rodriguez

Diagnoses, intervention strategies, and rates of functional improvement in integrated behavioral health care patients.

OBJECTIVE Compared with more traditional mental health care, integrated behavioral health care (IBHC) offers greater access to services and earlier identification and intervention of behavioral and mental health difficulties. The current study examined demographic, diagnostic, and intervention factors that predict positive changes for IBHC patients. METHOD Participants were 1,150 consecutive patients (mean age = 30.10 years, 66.6% female, 60.1% Hispanic, 47.9% uninsured) seen for IBHC services at 2 primary care clinics over a 34-month period. Patients presented with depressive (23.2%), anxiety (18.6%), adjustment (11.3%), and childhood externalizing (7.6%) disorders, with 25.7% of patients receiving no diagnosis. RESULTS The most commonly delivered interventions included behavioral activation (26.1%), behavioral medicine-specific consultation (14.6%), relaxation training (10.3%), and parent-management training (8.5%). There was high concordance between diagnoses and evidence-based intervention selection. We used latent growth curve modeling to explore predictors of baseline global assessment of functioning (GAF) and improvements in GAF across sessions, utilizing data from a subset of 117 patients who attended at least 3 behavioral health visits. Hispanic ethnicity and being insured predicted higher baseline GAF, while patients with an anxiety disorder had lower baseline GAF than patients with other diagnoses. Controlling for primary diagnosis, patients receiving behavioral activation or exposure therapy improved at faster rates than patients receiving other interventions. Demographic variables did not relate to rates of improvement. CONCLUSION Results suggest even brief IBHC interventions can be focused, targeting specific patient concerns with evidence-based treatment components. (PsycINFO Database Record

An Open Trial of Cognitive-Behavioral Therapy for Anxiety Disorders in Adolescents With Autism Spectrum Disorders

The frequent co-occurrence of anxiety disorders and autism spectrum disorders (ASD) in youth has spurred study of intervention practices for this population. As anxiety disorders in the absence of ASD are effectively treated using cognitive-behavioral therapy (CBT) protocols, an initial step in evaluating treatments for comorbid youth has necessarily centered on adaptation of CBT. One primary limitation of this research, to date, is that interventions for adolescents with anxiety disorders and ASD have not been systematically tested. In this study, 20 adolescents (90% male) with ASD and a comorbid anxiety disorder, between ages 11 and 14 years (M = 12.2 years, SD = 1.11 years), participated in an open trial of modified CBT targeting anxiety with ASD. Findings demonstrated significant reductions in anxiety severity, as assessed by clinician and parent ratings, from baseline to post-treatment. In addition, reductions in parent-rated externalizing symptoms were observed. Gains were maintained at a 1-month follow-up.

Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients.

The discrepancy between the growing number of Spanish speakers in the U.S. and the availability of bilingual providers creates a barrier to accessing quality mental health care. Use of interpreters provides one strategy for overcoming this linguistic barrier; however, concerns about whether sessions with interpreters, versus bilingual providers, impede therapeutic alliance remain. The current study explored associations between the use of interpreters and therapeutic alliance in a sample of 458 Spanish-speaking patients seen for integrated behavioral health visits at primary care clinics. Patients completed a brief (4 item) therapeutic alliance scale at their behavioral health appointment. In addition, to supplement the quantitative study data, a pilot study of 30 qualitative interviews was conducted with a new sample of 10 Spanish-speaking patients, 10 behavioral health consultants (BHCs), and 10 trained interpreters. Quantitative results showed that interpreter use did not relate to therapeutic alliance, even when controlling for relevant demographic variables. However, qualitative interviews suggested major themes regarding the relative benefits and challenges of using interpreters for patients, interpreters, and BHCs. In interviews, patients expressed a strong preference for bilingual providers. Benefits included greater privacy, sense of trust, and accuracy of communication. However, in their absence, interpreters were seen as increasing access to services and facilitating communication with providers, thereby addressing the behavioral health needs of patients with limited English proficiency. BHCs and interpreters emphasized the importance of interpreter training and a good collaborative relationship with interpreters to minimize negative effects on the quality of care.

Lunch Buddy Mentoring for Children Victimized by Peers: Two Pilot Studies

The authors describe two pilot studies examining the potential benefits of Lunch Buddy (LB) mentoring, a manualized approach to school-based mentoring. LB mentoring takes place during the school lunch period and is designed to promote positive changes in childrens peer relationships. In both studies, changes in peer victimization were assessed after one and three semesters of LB mentoring. In the first study, LB mentors were paired with elementary school children (N = 24) identified by child and teacher reports as victimized by peers. Results revealed significant declines in self- and teacher-rated victimization after one and three semesters of mentoring. In the second study, LB mentors were paired with victimized children who also engaged in bullying behavior (N = 23). Results indicated significant declines in self- and teacher-ratings of peer victimization after three semesters of mentoring. In both studies, ratings of perceived harm were low and ratings of satisfaction were high. Discussed are the implications of these findings for future research and for efforts to develop a nonharmful way to help children who are repeatedly victimized.

Identifying children repeatedly victimized by peers: A preliminary study

ABSTRACT Repeated victims of school bullying are at risk for maladjustment and could potentially benefit from selective intervention. However, selective intervention requires a practical method for accurately identifying members of the targeted group. We examined the extent to which the global victimization item from the Olweus Bully/Victim Questionnaire accurately identified children repeatedly victimized by peers. From a sample of 654 fourth-graders, we categorized 63 (9.7%) as repeated victims based on elevated reports of victimization from the same informant (self, teacher, peer) across two time points within an academic year. Logistic regression and ROC curve analyses examined the predictive utility of the recommended global item cutoff and more stringent cutoffs. Results indicated that the global victimization item offered limited utility as a means of identifying children categorized as repeated victims. We discuss possible reasons for the findings and potential implications for future research and practice.

Changes in acceptance of dating violence and physical dating violence victimization in a longitudinal study with teens

Teen dating violence is a pervasive issue in adolescence and has been linked to maladjustment (Temple, Shorey, Fite et al., 2013). Physical dating violence is a particularly significant problem with one in five adolescents reporting experiencing physical teen dating violence (TDV; Wincentak et al., 2017). Acceptance of violence has been suggested to increase the risk of TDV; however, most studies to date have been cross-sectional. The purpose of the current study is to examine patterns of acceptance of dating violence and TDV victimization across time. Participants were ethnically diverse teenagers (N = 1042; ages 13-18) who were followed over a four-year period. Multivariate latent growth curve modeling techniques were used to determine trajectories of physical TDV victimization and attitudes accepting of dating violence. Results showed two trajectories for physical TDV victimization, linear and quadratic, and two trajectories for acceptance of dating violence, non-linear and quadratic. Parallel models investigating the interplay between TDV victimization and acceptance demonstrated two possible trends; however, we did not find any evidence for a longitudinal relationship between the two variables, suggesting that change in acceptance was not related to change in physical TDV victimization. Instead, our results suggest a significant amount of heterogeneity in these trajectories. These findings suggest studies are still needed to further explore longitudinal patterns of TDV to better understand how to reduce the risk of teen dating violence.