Development and validation of a measure of primary care behavioral health integration.

INTRODUCTION: We developed the Practice Integration Profile (PIP) to measure the degree of behavioral health integration in clinical practices with a focus on primary care (PC). Its 30 items, completed by providers, managers, and staff, provide an overall score and 6 domain scores derived from the Lexicon of Collaborative Care. We describe its history and psychometric properties. METHOD: The PIP was tested in a convenience sample of practices. Linear regression compared scores across integration exemplars, PC with behavioral services, PC without behavioral services, and community mental health centers without PC. An additional sample rated 4 scenarios describing practices with varying degrees of integration. RESULTS: One hundred sixty-nine surveys were returned. Mean domain scores ran from 49 to 65. The mean total score was 55 (median 58; range 0-100) with high internal consistency (Cronbach's alpha = .95). The lowest total scores were for PC without behavioral health (27), followed by community mental health centers (44), PC with behavioral health (60), and the exemplars (86; p < .001). Eleven respondents rerated their practices 37 to 194 days later. The mean change was + 1.5 (standard deviation = 11.1). Scenario scores were highly correlated with the degree of integration each scenario was designed to represent (Spearman's ρ = -0.71; P = 0.0005). DISCUSSION: These data suggest that the PIP is useful, has face, content, and internal validity, and distinguishes among types of practices with known variations in integration. We discuss how the PIP may support practices and policymakers in their integration efforts and researchers assessing the degree to which integration affects patient health outcomes. (PsycINFO Database Record

Current process in hearing-aid fitting appointments: An analysis of audiologists' use of behaviour change techniques using the behaviour change technique taxonomy (v1).

OBJECTIVES: To observe and analyse the range and nature of behaviour change techniques (BCTs) employed by audiologists during hearing-aid fitting consultations to encourage and enable hearing-aid use. DESIGN: Non-participant observation and qualitative thematic analysis using the behaviour change technique taxonomy (version 1) (BCTTv1). STUDY SAMPLE: Ten consultations across five English NHS audiology departments. RESULTS: Audiologists engage in behaviours to ensure the hearing-aid is fitted to prescription and is comfortable to wear. They provide information, equipment, and training in how to use a hearing-aid including changing batteries, cleaning, and maintenance. There is scope for audiologists to use additional BCTs: collaborating with patients to develop a behavioural plan for hearing-aid use that includes goal-setting, action-planning and problem-solving; involving significant others; providing information on the benefits of hearing-aid use or the consequences of non-use and giving advice about using prompts/cues for hearing-aid use. CONCLUSIONS: This observational study of audiologist behaviour in hearing-aid fitting consultations has identified opportunities to use additional behaviour change techniques that might encourage hearing-aid use. This information defines potential intervention targets for further research with the aim of improving hearing-aid use amongst adults with acquired hearing loss.

A systematic review of techniques and effects of self-help interventions for tinnitus: Application of taxonomies from health psychology.

OBJECTIVE: Self-help interventions are followed by people independently with minimal or no therapist contact. This review aims to assess the effectiveness of self-help interventions for adults with chronic tinnitus and systematically identify the self-help techniques used. DESIGN: Systematic review and application of health psychology taxonomies. Electronic database searches were conducted, supplemented by citation searching and hand-searching of key journals. Prospective controlled trials, which used measures of tinnitus distress, functional management, anxiety, depression, and quality of life, were included. Michie et al's behaviour change techniques (BCTs) taxonomy and Taylor et al's PRISMS taxonomy of self-management components were applied to describe interventions. STUDY SAMPLE: Five studies were included, providing low-to-moderate levels of evidence. RESULTS: Randomized controlled trial studies were too few and heterogeneous for meta-analysis to be performed. Studies comparing self-help interventions to therapist-guided interventions and assessing non tinnitus-specific psychosocial outcomes and functional management were lacking. Fifteen BCTs and eight self-management components were identified across interventions. CONCLUSIONS: A lack of high-quality and homogeneous studies meant that confident conclusions could not be drawn regarding the efficacy of self-help interventions for tinnitus. Better reporting and categorization of intervention techniques is needed for replication in research and practice and to facilitate understanding of intervention mechanisms.

Perfilación criminológica: una revisión de la literatura y su aplicación en la investigación criminal en Colombia / Forensic pro ling: a review of the relevant literature and its application in criminal investigation in Colombia / Avaliação criminológica pelo perfil: uma revisão da literatura e da sua aplicação na investigação criminal na Colômbia

El estudio tuvo como objetivo realizar una revisión teórica de los aspectos más importantes de la perfilación criminológica, así como las condiciones bajo las cuales se utiliza esta técnica en Colombia, los resultados que se han obtenido tras utilizarla y los desafíos que representa en este país. Tras realizar la revisión de la literatura sobre el tema, se encontró que pese al creciente desarrollo de la perfilación en países como Estados Unidos, el Reino Unido y España, en Colombia la perfilación criminológica es una técnica de investigación escasamente utilizada, y desconocida tanto por los profesionales de salud mental como por los operadores de justicia. Existen deficiencias en la recolección de información para el desarrollo del perfil, y grandes carencias de investigaciones empíricas que soporten la validez de la técnica. Sin embargo, deben reconocerse adelantos en cuanto al uso práctico que se da de esta técnica, tal como se presenta en un análisis de caso realizado por el Grupo de Ciencias del Comportamiento y Perfilación Criminal (CICOP) de la Policía Nacional. Al final se discuten los desafíos que representan los conocimientos generados respecto a la perfilación criminológica para la investigación criminal en Colombia.

O estudo teve como objetivo realizar uma revisão teórica dos aspectos mais importantes da avaliação criminológica pelo perfil, assim como as condições nas quais se utiliza esta técnica na Colômbia, os resultados obtidos após sua utilização e os desafios que representa nesse país. Após ter feito a revisão da literatura no assunto, achou-se que apesar do desenvolvimento crescente da avaliação pelo perfil nos países como os Estados Unidos, Reino Unido e Espanha, na Colômbia a avaliação criminológica pelo perfil é uma técnica da investigação escassamente utilizada, e desconhecida pelos profissionais da saúde mental e pelos operadores da justiça. Têm deficiências na coleta das informações para o desenvolvimento do perfil, e as grandes carências das investigações empíricas que suportam a validez da técnica. Não obstante, é fundamental reconhecer avanços sobre o uso prático desta técnica, como se apresenta em uma análise de caso feita pelo Grupo de Ciências do Comportamento e Avaliação do Perfil Criminoso (CICOP) da Polícia Nacional. No final os desafios que representam o conhecimento gerado a respeito da avaliação criminológico pelo perfil são discutidos para a investigação criminal na Colômbia.

The purpose of this study has been to carry out a theoretical review of the most important aspects envisaged in forensic profiling together with the conditions in which this technique is used in Colombia and the results having been obtained here from its use, as well as the challenges posed. After having completed the review of the related literature, it was found that despite the growing experience gained in the development of profiling in countries like the United States, the United Kingdom and Spain, a still poorly used investigation technique prevails in Colombia, almost unknown to both mental health professionals and justice operators. There are some deficiencies in the collection of information required for profiling, as well as a notorious lack of empirical researches and investigations serving to support the validity of this technique; nevertheless, some advances should be acknowledged with regard to its practical use as shown in a case study analysis carried out by the National Police “CICOP” (Behavior Sciences and Criminal Profiling Group). To conclude, the challenges posed by knowledge obtained with regard to forensic profiling for criminal investigation in Colombia are discussed.

Development of a framework and coding system for modifications and adaptations of evidence-based interventions.

BACKGROUND: Evidence-based interventions are frequently modified or adapted during the implementation process. Changes may be made to protocols to meet the needs of the target population or address differences between the context in which the intervention was originally designed and the one into which it is implemented [Addict Behav 2011, 36(6):630-635]. However, whether modification compromises or enhances the desired benefits of the intervention is not well understood. A challenge to understanding the impact of specific types of modifications is a lack of attention to characterizing the different types of changes that may occur. A system for classifying the types of modifications that are made when interventions and programs are implemented can facilitate efforts to understand the nature of modifications that are made in particular contexts as well as the impact of these modifications on outcomes of interest. METHODS: We developed a system for classifying modifications made to interventions and programs across a variety of fields and settings. We then coded 258 modifications identified in 32 published articles that described interventions implemented in routine care or community settings. RESULTS: We identified modifications made to the content of interventions, as well as to the context in which interventions are delivered. We identified 12 different types of content modifications, and our coding scheme also included ratings for the level at which these modifications were made (ranging from the individual patient level up to a hospital network or community). We identified five types of contextual modifications (changes to the format, setting, or patient population that do not in and of themselves alter the actual content of the intervention). We also developed codes to indicate who made the modifications and identified a smaller subset of modifications made to the ways that training or evaluations occur when evidence-based interventions are implemented. Rater agreement analyses indicated that the coding scheme can be used to reliably classify modifications described in research articles without overly burdensome training. CONCLUSIONS: This coding system can complement research on fidelity and may advance research with the goal of understanding the impact of modifications made when evidence-based interventions are implemented. Such findings can further inform efforts to implement such interventions while preserving desired levels of program or intervention effectiveness.

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Una revisión de los modelos explicativos de la relación entre el constructo hostilidad-ira-agresión y la enfermedad coronaria / A review of the explicative models which relate the construct hostility/anger/aggression to the coronary heart disease

El constructo hostilidad/ira/agresión (HIA) ha sido uno de los factores psicológicos que más se han estudiado en relación con la enfermedad coronaria (EC). A lo largo de las últimas décadas, la evidencia acumulada ha puesto de manifiesto la importancia de la hiperreactividad psicofisiológica como el mecanismo mediador entre el constructo HIA y la EC. Sin embargo, también se ha resaltado la importancia de factores socioambientales, constitucionales y comportamentales si se quiere comprender mejor cómo el constructo HIA puede llegar a provocar y/o agravar los procesos patofisiológicos de la EC. En este sentido, el objetivo del presente trabajo es hacer una breve exposición de los principales modelos que han servido de base para explicar el papel desempeñado por el constructo HIA en la EC: modelo de vulnerabilidad psicosocial, modelos de vulnerabilidad constitucional, modelo de salud conductual, modelo de reactividad psicofisiológica y modelo transaccional. Para concluir, finalizamos el trabajo presentando un modelo de síntesis que, además de resumir las principales aportaciones de los anteriores modelos, puede servir como punto de partida para el estudio de algunos aspectos que no han sido tratados anteriormente con la suficiente profundidad, como las características de especificidad o estereotipia individual. (AU)

Un ensayo de integración en psiquiatría: la conceptualización conductual; parte 2 / An essay of integration in Psychiatry: Behavioral conceptualization; part 2

El autor revisa los diferentes factores que subyacen la crisis conceptual que se evidencia en Psiquiatría y plantea la necesidad de una reformulación a través de un paradigma integrador organizado en torno al eje de la conceptualización conductual. Formula el concepto de Circuito Sintomatológico cuyo diagnóstico y ruptura constituirían las tareas principales de la intervención terapéutica. Entre los beneficios ofrecidos por el modelo propuesto destacan la posibilidad de un lenguaje común entre las diversas escuelas psiquiátricas, la integración coherente de técnicas diagnósticas y terapéuticas de diverso origen y la continua retroalimentación entre teoría y práctica.

Un ensayo de integración en psiquiatría: la conceptualización conductual; parte 1 / An essay of integration in Psychiatry: Behavioral conceptualization; part 1

El autor revisa los diferentes factores que subyacen la crisis conceptual que se evidencia en Psiquiatría y plantea la necesidad de una reformulación a través de un paradigma integrador organizado en torno al eje de la conceptualización conductual. Formula el concepto de Circuito Sintomatológico cuyo diagnóstico y ruptura constituirían las tareas principales de la intervención terapéutica. Entre los beneficios ofrecidos por el modelo propuesto destacan la posibilidad de un lenguaje común entre las diversas escuelas psiquiátricas, la integración coherente de técnicas diagnósticas y terapéuticas de diverso origen y la continua retroalimentación entre teoría y práctica.

lA PSICOLOGIA EN ODONTOLOGIA Y SU APLICACION CON UN METODO DE INYECCIONES PARA LA ANESTESIA LOCAL

He constatado que todo paciente tiene miedo a la extracción deltal en siversos grados. en consecuencia, la psicología aplicada a la odontología es importante y de realizaciones prácticas factibles en la influencia mental de los pacientes - El dominio del método inductivo no se improvisa; seobtiene por la experimentación de una serie de estudios de los distintos tipos biológicos - La indagación psicológica de las fisonomías, suministra los indicios que ande orientar la palabra y la actitud, cuando se trata de obtener un estado de sugestión útil - Aunque en general el metódo está endicado para todos, debe darse mayor enfasis en los niños, mujeres y adultos pusilámines