Michelle R. Byrd

A Preliminary trial of twelve-step facilitation and acceptance and commitment therapy with polysubstance-abusing methadone-maintained opiate addicts

The present study compared methadone maintenance alone to methadone maintenance in combination with 16 weeks of either Intensive Twelve-Step Facilitation (ITSF) or Acceptance and Commitment Therapy (ACT) in a preliminary efficacy trial with polysubstance-abusing opiate addicts who were continuing to use drugs while on methadone maintenance. Results showed that the addition of ACT was associated with lower objectively assessed opiate and total drug use during follow-up than methadone maintenance alone, and lower subjective measures of total drug use at follow-up. An intent-to-treat analysis which assumed that missing drug data indicated drug use also provided support for the reliability of objectively assessed total drug use decreases in the ACT condition. ITSF reduced objective measures of total drug use during follow-up but not in the intent-to-treat analyses. Most measures of adjustment and psychological distress improved in all conditions, but there was no evidence of differential improvement across conditions in these areas. Both ACT and ITSF merit further exploration as a means of reducing severe drug abuse.

Measuring resilience in women experiencing infertility using the CD-RISC: Examining infertility-related stress, general distress, and coping styles

Psychological morbidity concurrent with fertility problems has been the focus of substantial scientific inquiry. However, researchers have largely overlooked psychological resilience within this population. This study explored the associations between resilience, infertility-related and general distress, and coping behaviors in forty women from nine fertility clinics throughout the United States. Participants completed the Connor-Davidson Resilience Scale (CD-RISC), Symptom Checklist-90 (SCL-90), Beck-Depression Inventory-II (BDI-II), Fertility Problem Inventory (FPI), and Ways of Coping Questionnaire (WCQ). Women with fertility problems evidenced significantly lower resilience scores than published norms. This study established evidence for the reliability and convergent validity of the CD-RISC with infertile populations. However, similar to other studies using this instrument, the factor structure reported by Connor and Davidson [Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety 2003;18:76-82] was not well supported. Resilience was negatively associated with infertility-specific and general distress. Engagement in action-focused coping skills was positively correlated with resilience. Implications for enhancing resilience with this population as are discussed.

Web-based treatment for infertility-related psychological distress.

Infertility has been associated with stigma and negative psychosocial functioning. However, only a small proportion of this population actually receives care. Fertility patients predominantly use the Internet for information gathering, social support, and assistance with decision-making; yet, available web resources are unreliable sources of mental health care. Web-based alternatives also have the potential to assist with intervention access difficulties and may be of significant lower cost. This study evaluated the efficacy of a web-based approach to providing a cognitive behavioral intervention with 31 infertile women seeking medical reproductive technologies. Following randomized assignment, participants using the web-based intervention were compared with those in a wait-list control condition on general and infertility-related psychological stress measures. Results were mixed regarding intervention efficacy. Significant declines in general stress were evidenced in the experimental group compared with a wait-list control group. However, website access did not result in statistically significant improvements on a measure of infertility-specific stress. These findings add to the literature on psychological interventions for women experiencing fertility problems. Moreover, despite the widespread use of the Internet by this population, the present study is one of the first to investigate the usefulness of the Internet to attenuate stress in this population. Preliminary results suggest general stress may be significantly reduced in infertile women using an online cognitive behavioral approach.

Rapid Assessment for Psychopathology in a College Health Clinic: Utility of College Student Specific Questions

Abstract Objective: The purpose of this study was to determine the utility and unique benefits of employing the College Health Questionnaire (CHQ) in a college health care setting. The CHQ is a newly designed measure to assess psychosocial issues commonly problematic among college students. Participants: One hundred nine patients participated in the study during their medical appointments. Methods: Participants completed the study questionnaires (CHQ and Patient Health Questionnaire) in the waiting room. Their provider had the opportunity to use the responses in treatment decision making. Results: A majority (66.1%) endorsed at least one CHQ item. Patients who indicated traditional mental health problems were more likely to be prescribed psychotropic medications, whereas patients who endorsed psychosocial issues commonly problematic among college students were more likely to be referred for behavioral treatment. Conclusions: Screening for behavioral problems in college primary care settings without the use of college-related questions would result in missing numerous important psychosocial problems.

Screening for Behavioral Health Problems in Adult Primary Care

While clinical systems are adopting models of integrated primary care (IPC) at high rates, the scientific foundation for common IPC practices remains underdeveloped. In order for IPC to be successful both clinically and financially, multidisciplinary teams must be able to efficiently and effectively identify patients who would benefit from behavioral healthcare within the primary care service. To do so requires tactical broad and specific screening at both the population level and for those patients who are already known to be at risk for psychological and/or other behavioral health concerns. This chapter provides suggestions for screening practices to be utilized in adult IPC to assess for general behavioral health concerns as well as high prevalence specific clinical presentations.

Pediatric Sleep Resistance

The developmental importance of sleep cannot be overstated from both physical and psychological perspectives. Not only can insufficient quantity or quality of sleep result in growth deficits and other negative physical health outcomes but can also mimic or exacerbate several behavioral concerns such as anxiety, learning disabilities, and/or attentional difficulties and has been shown to increase the incidence of accidents and injuries (Paruthi et al., 2016). Sleeplessness in teenagers has been associated with serious mood disorders and even higher rates of suicidal and parasuicidal behavior (Paruthi et al., 2016). Moreover, sleep problems create a behavioral ripple effect within the family system, often adversely affecting not only the identified child but also their parents and siblings. Surveys of both pediatric medical providers and parents suggest that upwards of 20% of young children experience clinically noteworthy difficulties falling or staying asleep on at least an intermittent basis (Davis et al., 2012; Owens, 2008). Despite the high prevalence of concern, however, sleep problems are often not adequately addressed in the primary care setting. Given that children are seen within primary care on a regular and frequent basis compared to adults both for well-child and sick visits, this is the ideal setting in which to assess for and intervene on sleep problems.

Novel Health Information Technology Tool Use by Adult Patients Undergoing Allogeneic Hematopoietic Cell Transplantation: Longitudinal Quantitative and Qualitative Patient-Reported Outcomes

Purpose Health information technology (IT) is an ideal medium to improve the delivery of patient-centered care and increase patient engagement. Health IT interventions should be designed with the end user in mind and be specific to the needs of a given population. Hematopoietic cell transplantation (HCT), commonly referred to as blood and marrow transplantation (BMT), is a prime example of a complex medical procedure where patient-caregiver-provider engagement is central to a safe and successful outcome. We have previously reported on the design and development of an HCT-specific health IT tool, BMT Roadmap. Methods This study highlights longitudinal quantitative and qualitative patient-reported outcomes (PROs) in 20 adult patients undergoing allogeneic HCT. Patients completed PROs at three time points (baseline, day 30 post-HTC, and day 100 post-HCT) and provided weekly qualitative data through semistructured interviews while using BMT Roadmap. Results The mean hospital stay was 23.3 days (range, 17 to 37 days), and patients had access to BMT Roadmap for a mean of 21.3 days (range, 15 to 37 days). The total time spent on BMT Roadmap ranged from 0 to 139 minutes per patient, with a mean of 55 minutes (standard deviation, 47.6 minutes). We found that patients readily engaged with the tool and completed qualitative interviews and quantitative PROs. The Patient Activation Measure, a validated measure of patient engagement, increased for patients from baseline to discharge and day 100. Activation was significantly and negatively correlated with depression and anxiety PROs at discharge, suggesting that this may be an important time point for intervention. Conclusion Given the feasibility and promising results reported in this study, next steps include expanding our current health IT platform and implementing a randomized trial to assess the impact of BMT Roadmap on critical PROs.

Promoting Active Treatment Engagement in Child and Family Therapy

Children have considerable behavioral health need and families either do not engage in appropriate treatment or drop out early. Treatment engagement applied to families is arguably more complex than applying these strategies to adults, as there may be a number of consumers involved in the treatment of one child. Techniques for meeting this challenge are discussed from the perspective of the Stages of Change perspective and relayed in a stepped care framework. The empirical evidence base for these recommendations is reviewed.

Deconstructing the Time-Out: What Do Mothers Understand About a Common Disciplinary Procedure?

ABSTRACT Time-out (TO) is one of the most common and effective disciplinary tactics used to address problem behavior; however, parents rate TO as one of the least useful behavior modification techniques. This may be due to a discrepancy between empirically supported TO procedures and how mothers are actually conducting TO. Fifty-five mothers were asked to define TO, provide information on how they conduct TO, and identify errors in TO procedures. Results indicate that maternal knowledge and implementation of TO differs considerably from the empirical ideal, potentially impacting the utility and frequency of TO usage in the home to address child problem behaviors.

Pilot Testing of the Pediatric Screening Inventory in the Primary Care Setting

Objective: The present study was a preliminary evaluation of a parental self-report questionnaire appropriate for the pediatric primary care setting (The Pediatric Screening Inventory; PSI). The PSI assesses three domains: parenting skills, child behavior problems, and behaviors related to medical compliance. Methods: Piloting of the PSI involved a randomized block design that assigned pediatric primary care providers (n=214 visits) to either utilize the PSI (experimental condition) or conduct assessment as usual (control condition). Three hypotheses comparing the control and experimental conditions were tested. Results: The PSI was found to statistically significantly improve rates of detection and intervention of targeted problem domains in the pediatric primary care setting, while not having any observed adverse effects on either parent or provider satisfaction. Conclusions: These findings are consistent with the hypothesis that screening and providing effective and efficient behavioral interventions in the pediatric primary care setting can lead to positive outcomes.