Being at EASE: Student Perceptions of Interprofessional Practice Following an Experiential Interprofessional Application for Sensitive Patient Encounters.

ABSTRACT: Learning to interact and collaborate with other professions is key to optimal patient care and is best achieved when started during one's education. This study implemented an interprofessional education simulation with family nurse practitioner and social work students utilizing standardized patients who presented with sensitive issues. The Student Perceptions of Interprofessional Clinical Education-Revised and Readiness for Interprofessional Learning Scale questionnaires were given before and after the activity. Significant changes were noted in both student groups regarding attitudes and perceptions of interprofessional collaboration. Interprofessional collaboration is crucial. Introducing interprofessional education in the education curriculum of health professionals can help future providers achieve essential competencies.

The Surgeon General's Facing Addiction report: An historic document for health care.

The publication of Facing Addiction in America: The Surgeon General's Report on Alcohol, Drugs, and Health presents an historic moment not only for the field of addiction medicine, but also for the United States as a nation. The Board of Directors of the Association for Medical Education and Research in Substance Abuse (AMERSA), on behalf of our organization, would like to express our appreciation of the efforts of Dr. Vivek Murthy and the Surgeon General's Office to publish the first surgeon general's report covering substance misuse and substance use disorders.

Effect of electrical parameters on ECT convulsive threshold and duration.

BACKGROUND: Optimal stimulus parameters for electroconvulsive therapy (ECT) are unclear. Pulse duration and frequency related to convulsive threshold and seizure duration in the first ECT treatment in a series were evaluated. METHODS: Convulsive threshold was estimated for all patients (N = 550) receiving ECT over 27 months. Thresholds were estimated using different brief pulse stimulators, starting with a dose of approximately 25 mC per pulse train for right unilateral (RUL) stimulation (50 mC for bilateral [BL] stimulation). The charge was applied in 25-mC serial increments (approximately doubling for BL stimulation) up to approximately 100 mC (>200 mC for BL stimulation) to a generalized motor seizure endpoint. Patients lacking seizure response at 100 mC (200 mC for BL stimulation) received >500 mC. RESULTS: Convulsive threshold increased with age, African American identity, diagnosis other than depression, and female sex, and decreased with RUL electrode placement, low frequency (30 Hz), and brief pulse width (0.5 msec). RUL stimulation and lower anesthetic medication doses promoted longer seizures. Younger patients had longer seizures than older patients. Pulse width and frequency did not affect seizure duration. Lower charge yielded longer seizures. CONCLUSIONS: ECT efficiency appears to be achieved by lower frequency and briefer pulse duration stimulation. Randomized trials are needed for corroboration of these findings.

Utilizing screening, brief intervention, and referral to treatment: teaching assessment of substance abuse.

Although social workers regularly encounter clients with substance use problems, social work education rarely addresses addictions with any depth. This pilot study explored the use of screening, brief intervention, and referral to treatment (SBIRT) with 74 social work students. Students completed SBIRT training with pre- and post-questionnaires that assessed attitudes, knowledge, and skills concerning substance misuse. Statistically significant differences were demonstrated with students reporting more confidence in their ability to successfully assess for alcohol misuse and subsequently intervene.

Structure and collapse of a surface-grown strong polyelectrolyte brush on sapphire.

We have used neutron reflectometry to investigate the behavior of a strong polyelectrolyte brush on a sapphire substrate, grown by atom-transfer radical polymerization (ATRP) from a silane-anchored initiator layer. The initiator layer was deposited from vapor, following treatment of the substrate with an Ar/H(2)O plasma to improve surface reactivity. The deposition process was characterized using X-ray reflectometry, indicating the formation of a complete, cross-linked layer. The brush was grown from the monomer [2-(methacryloyloxy)ethyl]trimethylammonium chloride (METAC), which carries a strong positive charge. The neutron reflectivity profile of the swollen brush in pure water (D(2)O) showed that it adopted a two-region structure, consisting of a dense surface region ∼100 Šthick, in combination with a diffuse brush region extending to around 1000 Šfrom the surface. The existence of the diffuse brush region may be attributed to electrostatic repulsion from the positively charged surface region, while the surface region itself most probably forms due to polyelectrolyte adsorption to the hydrophobic initiator layer. The importance of electrostatic interactions in maintaining the brush region is confirmed by measurements at high (1 M) added 1:1 electrolyte, which show a substantial transfer of polymer from the brush to the surface region, together with a strong reduction in brush height. On addition of 10(-4) M oppositely charged surfactant (sodium dodecyl sulfate), the brush undergoes a dramatic collapse, forming a single dense layer about 200 Šin thickness, which may be attributed to the neutralization of the monomers by adsorbed dodecyl sulfate ions in combination with hydrophobic interactions between these dodecyl chains. Subsequent increases in surfactant concentration result in slow increases in brush height, which may be caused by stiffening of the polyelectrolyte chains due to further dodecyl sulfate adsorption.

Subtypes of alcohol dependence and their effect on sexual behavior change.

This study utilized data from a National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism funded community-based HIV prevention program in the Midwest in 2000. We categorized women who met lifetime criteria for alcohol dependence (using the DIS) and who also had used cocaine (n = 324) into four alcohol typologies based on onset of regular drinking and the length of time to dependence. The Risk Behavior Assessment measured sex behaviors, combined into a risk index, before and after the program. Generalized linear modeling compared decreases over time. Women who began drinking regularly later and became dependent more slowly significantly decreased risky sex behaviors. Tailored prevention protocols may more effectively decrease HIV risk.

One dozen considerations when working with women in substance abuse groups.

Women and men have different histories, presentations, and behaviors in substance abuse groups. Twelve considerations are offered for the beginning group leader when encountering women with substance abuse issues. These include understanding sexism, what brings women to treatment, and how women behave in group treatment. Implications for clinical practice with women in single-gender and mixed-gender groups are included.

Revisiting practice-based research networks as a platform for mental health services research.

Practice-based research networks (PBRNs)-collaborations of practice settings that work together to generate research knowledge-are underused in mental health services research. This article proposes an agenda for mental health services research that uses a variety of PBRN structures and that focuses on what really happens in practice, the effectiveness of practice innovations in real world care, the challenges of implementing evidence supported interventions, modification of clinician behavior, and assessment of the effect of mental health policy changes on practice. The challenges of conducting research within PBRNs are substantial, including difficulties in maintaining positive member relations, securing ongoing funding, sustaining productivity, overcoming IRB entanglements and achieving both scientific excellence in recruitment and measurement validity and utility for practitioner members. However, the awareness of these challenges allows researchers and practitioners to build networks that creatively overcome them and that infuse mental health services research with heavy doses of the realities of everyday clinical practice.

A comparison study of psychiatric and behavior disorders and cognitive ability among homeless and housed children.

This study examined the association of homelessness and related factors with child psychiatric and behavior disorders (diagnosed with structured diagnostic interviews) and child cognitive ability (on the Kaufman Brief Intelligence Test) in a randomly selected sample of 157 homeless children and their mothers and a comparison of 61 housed children and their mothers. Homeless children had more disruptive behavior disorders and lower cognitive scores than housed children. In multivariate analyses, maternal verbal scores and child nonverbal scores were associated with child verbal ability; maternal education, homelessness, and child nonverbal scores were related to child behavior disorders.

From early to late adolescence: American Indian youths' behavioral trajectories and their major influences.

OBJECTIVE: This article identifies behavioral trajectories of American Indian adolescents and examines their predictors. METHOD: A total of 401 urban and reservation American Indian adolescents were interviewed yearly from 2001 to 2004 (with 341 youths, or 85%, retained to 2004, and 385 completing at least two interviews). The Youth Self-Report total problem score is used to model behavior change trajectories, with psychological (addictions and mental health) and environmental (family, peer, community, and services) variables as independent variables. Analyses were based on PROC TRAJ, an SAS macro. RESULTS: Five trajectory groups were found. Youths who started with a Youth Self-Report score less than the clinical cutoff were low stable (n = 142) or low improving (n = 175). Youths with initial scores over the cutoff were very high chronic (n = 5), high improving (n = 30), or high chronic (n = 33). High improvers scored close to the low improving group by 2004. At baseline, the high improving group was more likely than the high chronic group to be from the reservation (odds ratio 5.94), have greater family satisfaction (1.14), and have fewer school problems (0.84). Over time, the high improving group had substance use and depression drop, family satisfaction increase, fewer parents with mental health or addictions problems, fewer peers using substances, and a decrease in neighborhood problems and stressors. CONCLUSIONS: A significant majority (more than 82%) of the youths exhibited relatively low levels of problem behaviors over all 4 years, and 42% of those with clinically significant problems improved over time.

Interrater reliability and coding guide for nonpsychotic formal thought disorder.

Reliable and valid assessment of abnormal speech patterns may enable earlier recognition of nonpsychotic disorders through characteristic speech patterns. This study sought to establish interrater reliability using a standardized guide for scoring. A scoring guide defining 27 elements (e.g., inappropriate self-reference, simple loss of goal, circumstantiality) of disordered thought was developed. The seminal work of Andreasen's and Holzman's groups provided 12 elements, and 15 new elements were suggested by clinical literature. Audiotaped interviews with 12 psychiatric inpatients, adults of both sexes and various ages hospitalized for acute management of nonpsychotic psychiatric disorders, provided speech samples for observation of disordered thought by two independent raters. Using the guide's definitions and accompanying examples of elements of disordered thought, reliability in scoring was high (kappa of .85 for agreement on the presence of any abnormal speech element and kappa values from .66 to 1.00 for agreement on the presence of individual elements).

The role of providers in mental health services offered to American-Indian youths.

OBJECTIVE: American-Indian adolescents have high rates of addiction and mental health problems but low rates of service use. The gap between service need and use appears to be even larger than the known gap for the general population, and few of the services are provided by specialists. This study examined receipt of treatment by American-Indian youths for addictions or mental health problems, the service provider who first identified a problem and sent a youth to treatment, and the extent to which the provider's knowledge and assessment predicted variance in service actions. METHODS: A sample of 401 American-Indian youths (196 from an urban area and 205 from a reservation) aged 12 to 19 years was first interviewed in person in 2001. A total of 188 of the youths' treatment providers were then interviewed. RESULTS: Structural equation modeling showed that 30 percent of the variance in addictions or mental health services provided to youths was predicted by the provider's assessment of the youth's mental health, the provider's resource knowledge, and provider type. CONCLUSIONS: The results demonstrate that professional, informal, and traditional providers play a pivotal role in providing treatment services offered to American-Indian youths and that these providers were more likely to identify a youth's problems and to offer and refer services when the provider knew more about community resources for the youth and about the youth's personal and environmental problems.

Family-responsive psychoeducation groups for families with an adult member with mental illness: pilot results.

This paper documents recent pilot efforts of the Psychoeducation Responsive to Family (PERF) model, a yearlong group for families with an adult member coping with mental illness. PERF advances state-of-the-art in its: (a) application in community settings; (b) utility for families coping with all types of mental illness; (c) use of a standardized model, yet retaining a flexible curriculum responsive to family group membership concerns; and (d) recruitment from one-day family workshops of participants eager to further explore their issues. This report examines changes in these families' knowledge and mastery in a small random assignment study comparing the PERF model (n = 9) with a "usual services" (n = 10) condition. Study participants completed surveys measuring perceived mastery and knowledge at baseline and at 3, 6, and 12 months for both conditions. Families in the active PERF intervention demonstrated significant post-intervention improvements in four of five variables analyzed. For one of these items, PERF demonstrated significantly greater improvement than the usual care condition. Achievement of significant changes in these measures was examined in relation to timing of presentation of curriculum topics in the groups. Gains in perceived crisis effectiveness temporally correlated with coverage of that topic in the PERF groups, while gains in other items were instead steadily cumulative across the entire year. The encouraging results of this second pilot effort serve to substantiate the initial efforts in developing the PERF group model.