Psychological Services

Walking the leadership walk: Integrating inclusivity in a large-scale health care organization.
This article focuses on the roles, actions, and resources developed by a group of leaders from the Office of Mental Health and Suicide Prevention (OMHSP) within the Department of Veterans Affairs during the unprecedented times of spring of 2020, when society was shaken by the fears and challenges of COVID-19 as well as social unrest sparked by the murder of George Floyd. We share a summary of our efforts to move beyond platitudes and statements and bring meaningful and sustainable change in justice, equity, diversity, and inclusion within OMHSP and across mental health services in Department of Veterans Affairs. This article is written through the lens of the founding members of the OMHSP’s Diversity, Equity, and Inclusion Steering Committee. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Training, skills, and leadership experience: The need to expand clinical psychology training as illustrated by psychology leadership stories.
Training for clinical psychologists is grounded in training models emphasizing clinical work, scholarship, and research. Rigorous competencies, varying by clinical specialty area, guide the specifics of training within domains of knowledge, skills, and aptitudes—with the goal of ensuring well-trained clinical psychologists. Research further illuminates the skills, characteristics, and experiences needed to maximize the effectiveness of clinical care provided by trained clinical psychologists. In addition, data indicate that clinical psychologists spend an average of 20% of their work time in management and leadership activities beyond clinical duties of direct care, requiring expanded and additional skills beyond those formally conceptualized and broadly included in graduate training. We utilize descriptions of three clinical psychologists’ leadership journeys to illustrate the gap in training filled by these bootstrapping autodidacts when successes led to promotion to higher levels of responsibility and leadership. Our proposed solution is a call to action. We call for consideration of an expansion of clinical psychology training by (a) overtly translating currently taught clinical skills into needed leadership skills to consistently fill the gap rather than relying on individuals to acquire enough experience to adequately perform the translation themselves, and (b) adding both pragmatic and theoretical leadership skills into an expanded training curriculum. We strongly urge this rethinking and expansion of training to adequately support and foster future clinical psychologists in administrative and other leadership roles. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Starting early: Case study of mentoring for undergraduate training through the Veterans Health Administration and implications for promoting equity.
Undergraduate mentoring and research internships promote entry into graduate training, academic success, research productivity, and greater career satisfaction. Most pathway programs to enhance representation within academia and health care intervene at the graduate level, leaving a critical gap in undergraduate training. The Veterans Health Administration’s (VHA’s) national network of clinicians and researchers is uniquely suited to provide equitable access to quality mentorship and education for undergraduates interested in health care careers. We present a program evaluation case study of a VHA undergraduate training program incorporating empirically supported components that promote success and transition to graduate school, including tiered mentorship, a didactic-preceptor model, hands-on experience, and interdisciplinary work. We describe participant characteristics and consider the program elements that may contribute to trainees’ success, highlighting the importance of undergraduate training within a health care system like VHA. We found that all program completers attained their bachelor’s degree and nearly 70% advanced to graduate studies. Despite some differences based on participant characteristics, all program components were deemed useful preparation for professional success, with hands-on research experience and mentoring cited as the most helpful. The promising results of our case study demonstrate the feasibility of successfully implementing an undergraduate training program to provide a pathway to advanced careers in health care within the VHA. We posit that programs like ours can serve as a framework for creating pathway training programs that target undergraduates traditionally underrepresented, subsequently empowering them to pursue health care careers, and ultimately increasing diversity by training professionals who are better prepared to assist with diverse patient needs. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Selecting senior leaders in the public sector: Challenges and best practices.
Although the careful assessment and selection of leaders are important for an organization to succeed, selecting senior leaders can prove paramount given their potential to impact the entire organization. While private sector businesses expend substantial resources to recruit and retain senior leaders, the public sector struggles to do so, which in turn impacts the attitudes and retention of employees throughout the enterprise. For example, a recent survey of federal employees in the United States found that most respondents did not believe their senior leaders generated high levels of motivation and commitment in the workforce. Enhancing the senior leader selection process thus represents a prime opportunity to enhance organizational success in the public sector. The current discussion reviews four core topics for senior leader selection: (a) determine organizational needs, (b) agree upon competencies for a senior leader, (c) leverage employees from all organizational tiers via a selection committee, and (d) examine ethical issues in selecting senior leaders. Each topic contains an overview of the relative challenge while drawing a contrast between senior and junior leadership positions, as well as comparisons between the public and private sectors. These challenges are presented alongside best practices that should produce a more effective selection process. Taken together, this combined evidence should enable organizational success by ensuring that the highest quality candidates are selected into senior leadership positions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Psychologists aspiring to leadership positions in public sector health care.
Psychologists are well-positioned to take on leadership roles in health care systems as a result of the broad-based skills included in doctoral level, professional training programs. These include knowledge of evidence-based practice, extensive training in applied research and clinical practice, emphasis on critical thinking in scientific methods and hypothesis testing, teaching, supervision, team consultation, and continuous learning (APA Presidential Task Force on Evidence-Based Practice, 2006; Korman, 1974; McFall, 2007). Formal opportunities to learn how to apply these skills in leadership and organizational management roles are, however, limited during graduate training. There have been recent efforts within the American Psychological Association to foster interest and readiness for leadership roles among psychologists. These efforts have included a leadership development fellowship, on-demand webinars, and online learning for continuing education (American Psychological Association, 2023). The content of these training opportunities is typically general in nature so that it can be applied to all types of organizational settings. Psychologists interested in leadership positions within public sector health care organizations are likely to benefit from information that aligns more specifically with the mission and organizational structures of such systems. This article presents a conceptual framework to prepare psychologists aspiring to leadership positions in public sector health care. Leadership theories and models from organizational management science are outlined which capture the context and organizational goals of such programs. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
The positive impact of women leadership in public sector settings: A case example in Virginia’s state mental health system.
The role of psychology (and ergo, psychologists) within the public sector has shifted considerably over the preceding decades to include increasingly versatile and psychology-adjacent leadership positions. This publication focuses on brief leadership stories within a state mental health system, with an emphasis on the unique roles that women psychologists have advocated for over the years. The authors provide foundational knowledge of this state’s mental health system in order to spotlight the ongoing need for effective leadership within this organization, identifying common ethical and public administration challenges, and ultimately using a structured questionnaire with women psychologists within this system to highlight their leadership roles. These stories expand upon the education and training they felt foundational to their growth in these roles, how they advocated for change and navigated organizational challenges, and how they hope their role can inspire junior (women) psychologists to take increasingly active roles in public service leadership. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Liderando juntos y revueltos: A collectivistic leadership approach to address Latinx immigrant health and psychological needs.
Psychologists are positioned to help address societal and public health crises in beneficial ways, including collectively working with public sectors to serve marginalized communities. This article highlights the relevance of helping to address societal and public health crises with collectivistic psychological leadership approaches and uses Latinx psychology leaders for addressing the current immigrant needs among Latinx communities. We draw attention to the domains needed for collectivistic psychological leadership that are culturally nuanced and equity, diversity, and inclusion-focused to advance the well-being of historically marginalized immigrant communities. Finally, the article highlights how our collectivistic approach operates in the public sector by describing the creation of the Latinx Immigrant Health Alliance (LIHA) and targeted outcomes. Briefly, the LIHA informally started in 2017 and was founded in 2020 to fill a gap in Latinx immigrant health at the heart of systemic inequalities during the global pandemic, explicit anti-immigrant rhetoric, and anti-Latinx policies. The LIHA aims to collectively work with community organizations to promote Latinx immigration health research, policy, education, training, and effective interventions. We include future directions and opportunities for collectivistic psychological leadership to address today’s complex social issues. In particular, we call for the translation of psychological methods and other skills (e.g., research, clinical skills, policy, quantitative and qualitative methodology) into public action for better wellness of our communities, as well as the advancement of social justice, health equity, and inclusion for historically marginalized communities. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Intentional leveraging of psychologist competencies: A case for expanding administrative leadership training opportunities in the Veterans Health Administration.
This article seeks to broaden the discussion of instituting training in administrative leadership at the doctoral internship and postdoctoral levels and offer guidance for programs interested in developing their own rotations. Following a brief review of literature pertinent to psychologist leadership development, this article describes the development of key competencies of leadership rotations aligned with the psychology profession-wide competencies within the Veterans Health Administration. In addition, the article disseminates a “tool kit” developed specifically to help add structure and support for the development of administrative leadership rotations at Veterans Health Administration (e.g., developmental opportunities, literature review, resources, etc.). Implementation of administrative leadership training are described in two community service settings, one at a Veterans Integrated Service Network and one at a VA Medical Center. The benefits of administrative leadership rotations to trainees, the organization, and the field of psychology are described. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Understanding veterans’ experiences with lung cancer and psychological distress: A multimethod approach.
Psychological distress while coping with cancer is a highly prevalent and yet underrecognized and burdensome adverse effect of cancer diagnosis and treatment. Left unaddressed, psychological distress can further exacerbate poor mental health, negatively influence health management behaviors, and lead to a worsening quality of life. This multimethod study primarily focused on understanding veterans’ psychological distress and personal experiences living with lung cancer (an underrepresented patient population). In a sample of 60 veterans diagnosed with either nonsmall cell lung cancer (NSCLC) or small cell lung cancer (SCLC), we found that distress is common across clinical psychology measures of depression (37% [using the Patient Health Questionnaire, PHQ-9 measure]), anxiety (35% [using the Generalized Anxiety Disorder, GAD-7 measure]), and cancer-related posttraumatic stress (13% [using the Posttraumatic Stress Symptom Checklist measure]). A total of 23% of the sample endorsed distress scores on two or more mental health screeners. Using a broader cancer-specific distress measure (National Comprehensive Cancer Network), 67% of our sample scored above the clinical cutoff (i.e., ≥ 3), and in the follow-up symptom checklist of the National Comprehensive Cancer Network measure, a majority endorsed feeling sadness (75%), worry (73%), and depression (60%). Qualitative analysis with a subset of 25 veterans highlighted that psychological distress is common, variable in nature, and quite bothersome. Future research should (a) identify veterans at risk for distress while living with lung cancer and (b) test supportive mental health interventions to target psychological distress among this vulnerable veteran population. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Informing implementation and dissemination of a specialized primary care medical home for patients with serious mental illness: Clinician and administrator perspectives.
People with serious mental illness (SMI) have lower rates of use of preventative medical services and higher rates of mortality compared to the general population. Research shows that specialized primary care medical homes improve the health care of patients with SMI and are feasible to implement, safe, and more effective than usual care. However, specialized medical homes remain uncommon and model dissemination limited. As part of a controlled trial assessing an SMI-specialized medical home, we examined clinician and administrator perspectives regarding specialized versus mainstream primary care and identified ways to enhance the scale-up of a specialized primary care model for future dissemination. We conducted semistructured interviews with clinicians and administrators at three sites prior to the implementation of an SMI-specialized primary care medical home (n = 26) and at 1-year follow-up (n = 24); one site implemented the intervention, and two sites served as controls. Interviews captured service design features that affected the quality of care provided; contextual factors that supported or impeded medical home implementation; and knowledge, attitudes, and behaviors regarding the care of patients with SMI. Interviews were transcribed and coded. Clinicians and administrators described SMI-specialized primary care medical homes as advancing care coordination and outcomes for patients with SMI. Stakeholders identified elements of a specialized medical home that they viewed as superior to usual care, including having a holistic picture of patients’ needs and greater care coordination. However, to enable scale-up, efforts are needed to increase staffing on care teams, develop robust clinician onboarding or training, and ensure close coordination with mental health care providers. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Brief trauma-informed care training to enhance health care providers’ knowledge, comfort, and implementation of trauma-informed care in primary care clinics: A pilot effectiveness study.
Trauma-informed care (TIC) training may be valuable for patient-facing health care providers within primary care in urban health care settings serving patients with high levels of trauma exposure. This study tested the pilot effectiveness of a clinic-wide TIC initiative to enhance providers’ knowledge, comfort in caring for trauma-exposed patients, and implementation of TIC within a primary care clinic of an urban safety net hospital using a single-arm longitudinal within-subjects design. Measures were obtained at baseline (T1), posttraining (T2), 1-month (T3), and 6-months (T4). Twenty-nine providers who completed TIC training were included in study analyses. Twenty-one completed T2 and 14 completed T3 and T4. Knowledge was measured with the Providers’ Knowledge Regarding Injury-Related Posttraumatic Stress, comfort with a researcher-generated two-item measure, and TIC implementation with an eight-item binary scale from the Trauma Provider Survey. Repeated-measures general linear model examining within-subjects change over time in knowledge was significant (n = 8; F₃ = 4.74, p = .01, ηp² = .40); the model measuring change in comfort was not significant but trending (n = 9; F₃ = 4.56, p = .06). The model examining change in TIC implementation from T1 to T4 was not significant (n = 14; F3 = 4.32, p = .21). This pilot study demonstrated the preliminary effectiveness of a brief TIC training on improving health care provider knowledge and comfort working with trauma-exposed patients that sustained through 6-months posttraining. The findings indicate that additional support is needed to change behaviors in provider implementation of TIC in primary care clinic settings. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A qualitative study of special operations forces chaplaincy teams’ relationship building for suicide prevention, intervention, and postvention.
The U.S. special operations forces (SOF) contribute to a range of complex missions and experience high operational tempo, which may result in heightened professional and personal stressors. Those who are experiencing stressors may be reluctant to seek professional mental health services due to career concerns. The chaplaincy community is at the forefront of bearing and responding to the pain of others including those at risk for suicide. As a formative step to developing a tailored suicide prevention curriculum for the U.S. SOF religious support teams (RSTs), we sought to understand SOF RSTs’ common strategies for suicide prevention, intervention, and postvention. We conducted confidential interviews with SOF RSTs via telephone and in person. We used an inductive thematic analysis to code a total of 57 transcripts. SOF RSTs prominently expressed that building relationships with SOF community members was foundational to their suicide prevention, intervention, and postvention practices: (a) Suicide prevention involved being available and cultivating a community of insiders who can provide resources as needed prior to crisis escalation; (b) Suicide intervention involved listening and responding to suicide risk and building autonomy for a suicidal SOF member to seek outside help; (c) Suicide postvention involved reaching out to suicide-loss survivors and grieving together through memorial services. The salient theme of building relationships points to opportunities to capitalize on RSTs’ social connections and to enhance skills and resources for military suicide prevention, intervention, and postvention practices. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Implementing and evaluating a veterans crisis line quality improvement initiative: The safety planning pilot program.
The Veterans Crisis Line (VCL) is part of the U.S. Department of Veterans Affairs’ suicide prevention mission. In 2021, VCL assessed the impact of a pilot implementation project of conducting six-part safety plans (SPs) instead of VCL’s usual risk mitigation plan. VCL responders offered to complete six-part SPs with eligible callers. Parametric and nonparametric methods compared call characteristics and Veteran Health Administration (VHA) utilization of eligible callers, by SP completion. We forecasted the operational impact of VCL-wide implementation. 27.37% (N = 448/1,637) of calls to designated responders were eligible for SPs. Of those, 27.23% (N = 122/448) completed SPs. Common barriers were call interruptions and the veteran declining. Among veteran callers who use VHA, SP completers were more likely to accept clinical referrals and had more outpatient mental health appointments before and after their VCL call. Calls involving SPs had a call plus documentation time 175% longer than eligible calls without SPs (87.78 vs. 49.66 min). If SPs were implemented VCL-wide, this would require 3–5(4.12%) more responders per hour to maintain current VCL call answer speed. SPs are adaptable to VCL; however, implementation presents logistical barriers. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Perceived social support moderates the relations between mental health symptoms and current suicidal ideation.
Despite efforts to identify risk factors associated with suicidal ideation (SI), less work has been conducted to highlight protective factors to promote prevention. Perceived social support has been shown to positively impact a wide range of psychological outcomes; however, prior efforts exploring whether perceived social support moderates the relationship between mental health (MH) symptoms and current SI among men and women have been hampered by limitations. To address knowledge gaps, data from the Comparative Health Assessment Interview Research Study was used to evaluate whether (a) perceived social support moderates the relationship between mental health symptoms (posttraumatic stress, anxiety, alcohol use, depressive) and current SI among veterans and nonveterans; (b) the strength of this moderating effect varies by gender and veteran status; and (c) the strength of this moderating effect varies by social support source (significant other, friend, family). Results suggest that perceived social support is more protective against SI for those with lower levels of mental health symptoms (≤ 25th percentile) than for those with higher symptom levels (≥ 75th percentile). Findings were largely consistent across study groups, support sources, and mental health symptoms examined; however, a significant moderating effect on the alcohol use–SI relationship was only observed for veteran men. Those with a lower mental health symptom severity may receive more benefit from strategies aimed at increasing perceived social support compared to those with higher symptom severity. Research is needed to match protective factors to individual phenotypes, with the goal of engaging those living with SI in more effective interventions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Inactivation of high-risk flags for suicide in the Veterans Health Administration: Association of documentation variation with suicide attempts.
Medical record high-risk flags for suicide indicate patients are receiving enhanced care and alert treating providers to patients’ high-risk status. Risk of suicide mortality remains high after flag inactivation, suggesting a need to improve inactivation determinations. This study describes variation in flag inactivation documentation, examines whether documentation varies by patient or facility characteristics, and explores the association between inactivation documentation type and subsequent suicide attempts. In a national sample of veterans with a documented suicide attempt who received a high-risk flag for suicide (n = 224), medical record review was used to categorize provider documentation of the rationale and procedures for high-risk flag inactivation. Mixed-effects logistic regression models were used to examine patient and facility characteristics associated with flag inactivation documentation type and to examine the association between documentation type and subsequent suicide attempts. Flag inactivation documentation fell into one of two categories: documentation stating the patient no longer met criteria for the high-risk flag (minimal documentation; n = 98, 43.8%); and documentation that included a review of one or more criteria for high-risk flag inactivation (more than minimal documentation; n = 126, 56.3%). Flag inactivation documentation was not associated with patient or facility characteristics. Veterans with minimal documentation (vs. more than minimal) were more likely to have a suicide attempt after flag inactivation (adjusted odds ratio, AOR = 2.20; 95% CI [1.01, 4.78]; p = .046). Findings suggest a need to better understand flag inactivation procedures in place and to develop a set of standardized procedures to reduce risk of premature high-risk flag inactivation. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Posttraumatic cognitions about the self are associated with depression symptoms in veterans endorsing a history of assaultive military sexual trauma.
Depressive symptoms are a commonly observed yet understudied mental health sequalae of military sexual trauma (MST). Prior research supports the relationship between negative posttraumatic cognitions (NPCs) and the onset and course of trauma symptoms more broadly. We hypothesized that NPCs would be associated with depression symptoms in veterans endorsing a history of MST, specifically assaultive type MST. Our clinical sample included veterans presenting for treatment related to assaultive MST (N = 158; 70.9% female, 65.2% White, 27.8% Black). Participants completed self-report measures of posttraumatic stress disorder (PTSD), depression, and NPCs during intake at a Veteran’s Affairs specialty trauma clinic. Linear regressions were used to analyze the association between NPCs and depression symptoms controlling for PTSD symptom severity. PTSD severity and NPCs about the self were significantly associated with depression symptoms, explaining 46% of the variance severity, F(4, 153) = 33.16, R² = .46, p <.001. These findings newly demonstrate a relationship between NPCs about the self and depression in veterans with a history of MST. Clinicians may benefit from incorporating cognitive interventions into preexisting depression treatments to directly address NPCs in this population. Future study is needed to determine how these results may extend to other forms of MST or trauma types. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Worry differentially mediates posttraumatic cognition and posttraumatic stress symptom relationships among veterans seeking treatment associated with military sexual trauma.
Research has established negative posttraumatic cognitions (NPC) affect the development and course of posttraumatic stress symptoms (PTSS) following trauma exposure (L. A. Brown et al., 2019). Previous studies in civilian and combat veteran populations also suggest positive associations among worry, NPC (Beck et al., 2004; Bennett et al., 2009), and PTSS (Fergus & Bardeen, 2017). However, little research has investigated the prevalence of worry in veterans who have experienced military sexual trauma (MST), and no research has examined the role of worry in the relation between NPC and PTSS among veterans seeking treatment associated with MST. This project examined the prevalence of worry in a MST sample and whether worry mediated NPC-PTSS associations. Veterans (N = 91) seeking MST-related treatment presented to a Veterans Affairs Posttraumatic Stress Disorder specialty clinic for assessment and treatment recommendations. Veterans completed questionnaires assessing NPC, worry, and PTSS. Bootstrapped mediation analyses examined NPC-PTSS associations. Veterans reported similar levels of worry as nonveterans seeking treatment associated with generalized anxiety disorder. Mediation analyses showed worry significantly mediated NPC-PTSS relationships for beliefs about the world, self-blame, and coping competence but not for beliefs about the self or global NPC severity. Further, the degree of mediation differed by NPC type. Though a limitation of this study is the use of cross-sectional data, these results inform the use of clinical intervention strategies targeting worry in trauma-focused interventions and necessitate further research on whether trauma-focused interventions ameliorate co-occurring worry among veterans exposed to MST. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
A prognostic index to predict symptom and functional outcomes of a coached, web-based intervention for trauma-exposed veterans.
Researchers at the Department of Veterans Affairs (VA) have studied interventions for posttraumatic stress disorder and co-occurring conditions in both traditional and digital formats. One such empirically supported intervention is web skills training in affective and interpersonal regulation (webSTAIR), a coached, 10-module web program based on STAIR. To understand which patient characteristics were predictive of webSTAIR outcomes in a sample of trauma-exposed veterans (N = 189), we used machine learning (ML) to develop a prognostic index from among 18 baseline characteristics (i.e., demographic, military, trauma history, and clinical) to predict posttreatment posttraumatic stress disorder severity, depression severity, and psychosocial functioning impairment. We compared the ML models to a benchmark of linear regression models in which the only predictor was the baseline severity score of the outcome measure. The ML and “severity-only” models performed similarly, explaining 39%–45% of the variance in outcomes. This suggests that baseline symptom severity and functioning are strong indicators for webSTAIR outcomes in veterans, with higher severity indicating worse prognosis, and that the other variables examined did not contribute significant added predictive signal. Findings also highlight the importance of comparing ML models to an appropriate benchmark. Future research with larger samples could potentially detect smaller patient-level effects as well as effects driven by other types of variables (e.g., therapeutic process variables). As a transdiagnostic, digital intervention, webSTAIR can potentially serve a diverse veteran population with varying trauma histories and may be best conceptualized as a beneficial first step of a stepped care model for those with heightened symptoms or impairment. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Treatment-related beliefs and reactions among trauma-focused therapy completers and discontinuers: A qualitative examination.
Prolonged exposure (PE) and cognitive processing therapy (CPT) for posttraumatic stress disorder (PTSD) are effective, but some patients do not respond adequately, and dropout rates are high. Patients’ beliefs about treatment and perceptions of treatment components influence treatment outcomes and may be amenable to change through intervention. The present study sought to identify beliefs and reactions to PE and CPT that differentiated completers who screened negative for a PTSD diagnosis after treatment (PTSD−), completers who screened positive for a PTSD diagnosis after treatment (PTSD+), and discontinuers who attended six or fewer sessions. Thematic analysis was used to identify themes in qualitative data collected via retrospective semistructured interviews with 51 completers (19 PTSD− after treatment, 32 PTSD+ after treatment) and 66 discontinuers of PE/CPT. Participants were demographically diverse veterans across service eras. Treatment-related beliefs and reactions differentiating these groups included perceived helpfulness of treatment, self-efficacy in engaging in treatment, anticipatory anxiety and concerns, interpretations of ongoing symptoms, and perceived consequences of treatment on functioning. Further, some patterns seemed to differ in early treatment sessions compared to during the active components of treatment. Findings point to potentially malleable targets that could be intervened upon to improve trauma-focused treatment outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Perceptions of organizational culture among mental health providers at a Veterans Affairs hospital.
A mixed method approach was utilized to assess the organizational culture of the mental health service line at a large Veterans Affairs (VA) hospital. The goals of the study were to assess the organizational culture, identify how employees differ in perceptions of organizational culture, and identify areas of strength and challenges. Two hundred thirteen participants returned a questionnaire assessing perceptions of organizational culture using the Organizational Culture Assessment Questionnaire (Sashkin & Rosenbach, 2013). Additionally, 22 employees and seven service line leaders participated in five focus groups that assessed for perceptions of culture. Quantitative results suggest that employees had a generally average to high average opinion of the organizational culture of the mental health service line within their VA hospital. Subscale scores suggested that customer orientation was a particular strength of the organization. Relative areas of weakness were that staff felt many decisions were imposed from outside the service line and that hard-working clinical staff were not always sufficiently recognized or rewarded for their actions. In general, demographic variables were not significantly related toward respondent opinion of the organizational culture. Substantial overlap existed between the qualitative and quantitative results. This study suggests that, at this VA’s mental health service line, customer service was a strength. However, increased recognition of employees and externally imposed decision-making needed improvement. Although interventions have been implemented in these areas, it would be useful to repeat aspects of this study over time and across different institutions. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Culturally adapted cognitive behavioral therapy for psychosis (CaCBTp): A review of key features of cultural adaptation and considerations for psychologists.
Cognitive behavioral therapy for psychosis is an effective treatment for psychosis. However, psychosis presents differentially according to an individual’s cultural context, and it is currently unclear which methods have been used to formulate culturally adapted cognitive behavioral therapy for psychosis (CaCBTp). The current systematic review examines the approaches to CaCBTp that have been evaluated to date and comments on preliminary evidence for the efficacy of CaCBTp. Key features of CaCBTp interventions are discussed in reference to broader cultural adaptations of psychosocial interventions for psychosis and culturally adapted cognitive behavioral therapy for other disorders. Overall, our results identified 12 studies and highlighted five overarching themes of cultural adaptation that clinicians should integrate into the design of future CaCBTp interventions, including family members in treatment, targeting stigma, relying on spiritual leaders, using multifaceted models of mental health, and ensuring adequate language match. The results of this review also highlight the paucity of literature in global CaCBTp interventions, as only 10 studies examining CaCBTp interventions were found. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
From plan to practice: A qualitative study of public mental health therapists’ session-planning practices.
Therapists must dedicate considerable time to session plan to implement evidence-based practices (EBPs) flexibly and with fidelity. It is unclear whether public mental health settings offer the structural and organizational support for therapists to engage in session planning and, therefore, whether they provide the necessary infrastructure for EBP implementation. In Fall 2022, 18 therapists working in public mental health settings in New York City were recruited through snowball sampling to participate in 90-min semistructured qualitative interviews. Therapists were prompted to review their session-planning practices using a chart-stimulated recall strategy; to describe structural, organizational, and individual barriers and facilitators to session planning; and to generate recommendations to support their session planning. Qualitative data were analyzed using thematic analysis. A diverse group of therapists participated in the study—22% identified as Black; 22% as Asian; and 11% as Hispanic/Latinx. Seventy-eight percent of therapists were social workers; and they had on average 6.18 (SD = 5.70) years of clinical experience. The research team identified four multilevel session-planning barriers and three multilevel session-planning facilitators. Therapists proposed seven multilevel recommendations to support their session planning. Overall, therapists indicated that managing high productivity standards, severe clinical presentations, and clients’ social needs often prevent them from having time to plan for sessions. Efforts to implement EBPs in public mental health settings cannot neglect the structural realities faced by agencies, therapists, and clients. Multilevel resources and reforms to support therapists’ session planning are necessary. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Recruitment tools for transgender and gender diverse veterans in health care research.
Transgender and gender diverse (TGD) veterans in the Veterans Health Administration experience health and health care disparities, and research with this population is needed to improve gender-affirming care in Veterans Health Administration. However, TGD veterans may experience hesitancy to participate in research. We must address barriers to participation through feasible and acceptable methods. Opt-out letters are an effective tool used to recruit veterans in mental health research. The present study examined the feasibility and acceptability of opt-out letters modified for TGD veterans. Opt-out letters were sent to 54 potential TGD participants at three sites. The letters stated the research team would begin contacting veterans by phone in 2 weeks if they did not opt out of being contacted. Feasibility was measured through response rate. Acceptability was assessed through qualitative template analysis of interview data. Of the 54 potential participants, two opted out, three letters were undeliverable, and eight veterans called to opt in. Veterans reported that they found the letters to be clear and useful. The responses to the opt-out letters resulted in completing recruitment for two of the three sites. The research team then called the veterans who received the letter at the third site (three veterans) and recruited one additional veteran, for a total of nine TGD veterans. Opt-out letters may be a helpful tool to recruit TGD veterans to participate in research. Although these letters were designed to opt out, 89% of participants called the research team to opt in. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Supporting psychosis research, implementation, and training through an academic intermediary–purveyor organization.
Intermediary–purveyor organizations (IPOs) are a type of dissemination support system that are intended to enhance the adoption and sustainment of empirically supported treatments (ESTs) by deploying empirically supported strategies to remediate implementation challenges. Despite the recent proliferation of government-funded IPOs for other psychiatric populations, IPOs that can redress the substantial science-to-practice gap among clients who experience psychotic disorders are not well documented. This article provides an overview of an IPO in an R1 academic medical center whose mission is to enhance access to evidence-based interventions for individuals who have or are at risk for a psychotic disorder. The article spotlights the functions of an IPO and illustrates these functions with a use case, cognitive behavioral therapy for psychosis. We highlight IPO-led activities related to cognitive behavioral therapy for psychosis purveyance, professional development, quality improvement, public awareness education and training, research and evaluation, as well as program and policy development. Finally, we address the advantages and disadvantages of establishing IPOs of this nature in academic medical centers, the importance of academic–community partnerships in advancing EST implementation, and present considerations for replication. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Psychotherapy to emphasize self-directed recovery for persons with serious mental illness: Contributions from metacognitive reflection and insight therapy (MERIT).
Recovery from serious mental illness (SMI) is a complex process that can be supported by different levels of mental health care, for example, individual psychotherapy. Current individual evidence-based psychotherapy for persons with SMI is often focused on specific objective recovery outcomes, including symptom reduction and functional improvement, and requires a minimum level of insight. Less common but also important are broader, more flexible approaches that allow clients to explore their needs and challenges, without predetermined goals or a certain level of insight. The current article aims to describe (1) the development of metacognitive reflection and insight therapy (MERIT), an evidence-based psychotherapy that is focused on self-determination, or self-directed recovery, and (2) how MERIT advances care for persons with SMI by addressing a significant gap in the field for the treatment of people with SMI with limited metacognitive capacity and insight, offering an adaptable approach emphasizing self-directed recovery. MERIT utilizes a metacognitive framework that is guided by flexible key elements and an interpersonal environment. Training MERIT therapists early in their careers may be helpful in providing a holistic view of SMI to promote self-directed recovery in ways that are personalized and meaningful for each person. MERIT training has been completed in multiple countries across different levels of training (e.g., internship and psychology practicum). Professionals such as psychologists and social workers have effectively played a role in MERIT development and dissemination, which ultimately strives to advance psychotherapy for a wide range of individuals with SMI. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Law enforcement mental health: A systematic review of qualitative research.
The aim of this review was to explore qualitative accounts of law enforcement (LE) officers’ personal experiences of mental health, in terms of linguistic descriptions, relationships between occupational experiences and mental health, and challenges to maintaining mental well-being. Using preferred reporting items for systematic reviews and meta-analyses guidelines, 1,876 articles were screened, and 31 studies were included in the current review. A risk of bias assessment was used to assess the study’s methodological rigor, and data were extracted to answer three exploratory research questions. Results revealed that LE officers frequently experience occupational stressors and identify different mental health difficulties as a result. Additionally, cultural norms and stigma prevalent in the LE profession were noted to contribute to experiences of mental health and impact LE officers’ ability to reach out for help and utilize professional resources. This review suggests that efforts to offer mental health services to LE officers need to prioritize cultural competence, confidentiality, and education to overcome stigma and increase mental health literacy and service use. Stakeholders addressing the LE mental health crisis may find this review useful due to several practical recommendations offered. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Readiness for treatment predicts depression outcomes in a partial hospital program.
Evidence-based interventions vary in effectiveness for individuals with depression, which has a large public health burden. Readiness for change or treatment can be an important individual difference predictor of depression outcomes. To inform public service initiatives targeting readiness for treatment, characterizing readiness across settings and levels of care is key. However, limited data exist on the role of readiness for treatment in acute psychiatric settings and in particular, partial hospital programs which are key points in the continuity of inpatient and outpatient care. The present study assessed readiness for treatment in terms of importance, confidence, and motivation to engage in a partial hospital program and tested whether higher levels of readiness were associated with better treatment outcomes among clients with depression. Participants (N = 192) with major depressive disorder rated their readiness for treatment (Readiness Rulers), depression (Patient Health Questionnaire–9), and global improvement (Clinical Global Impression Scale—Improvement Self-Report) while enrolled in a partial hospital program. Generalized linear regression models assessed the effect of baseline readiness on outcomes at discharge, adjusted for baseline level of the outcome, age, sex, race, and ethnicity. Greater baseline readiness predicted reduced depression and better global improvement at discharge. Higher confidence and motivation to engage in treatment, but not importance, were associated with better depression outcomes. Identifying and addressing readiness for treatment by leveraging public health systems and services (e.g., help lines, family interventions) prior to or upon starting a partial hospital program may be useful to maximize gains in treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
An exploratory study of service user and clinical outcomes in telehealth-delivered dialectical behavior therapy for adolescents skills groups.
The COVID-19 pandemic led many in-office therapeutic programs to pivot to virtual programming without empirical data supporting the acceptability and efficacy of the remote-delivered adaptations. These adaptations were essential for continuing care and addressing surging youth psychological problems at the time. To serve adolescents with comorbid psychiatric disorders and associated problems (e.g., emotion dysregulation), we adapted and implemented virtual and hybrid formats of a dialectical behavior therapy for adolescents (DBT-A; Rathus & Miller, 2015) program within a public university training clinic, such as separating the traditional multifamily group into adolescent-only and caregiver-only groups. Building on qualitative reports on virtual DBT-A, we explored preliminary service user and clinical outcomes of the virtual and hybrid DBT-A adolescent skills group component in a longitudinal retrospective cohort study for teenagers treated during the first 2 years of the pandemic (N = 21; 81% Hispanic/Latinx; 100% White). Aim 1 described service user outcomes (e.g., retention, group cohesion, client satisfaction) in the remote-delivered skills groups. Most youth completed treatment. Caregiver satisfaction was high, whereas adolescent satisfaction was mild. Aim 2 explored preliminary clinical outcomes of remote-delivered skills group adaptations. Overall anxiety, panic, and two emotion regulation facets (i.e., emotional awareness; goal pursuit when upset) significantly reduced across treatment. There were no significant reductions in depression. No suicide attempts or suicides occurred during the program. Further work is needed to clarify the efficacy of telehealth formats of DBT-A skills groups in larger, more racially diverse samples and to identify which adolescents are most appropriate for virtual and/or hybrid DBT-A. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Preventing job loss and functional decline: Description and demonstration of the Veterans Health Administration supported Employment: Engage and Keep (SEEK) program.
The high incidence of untreated mental health concerns among veterans can harm other areas of life, including employment. Loss of employment can lead to other adverse outcomes, such as financial instability, functional decline, and increased risk for suicide. Current Veterans Health Administration (VHA) vocational services are limited in that they primarily serve veterans who are unemployed and already enrolled in VHA. There is a need to prevent job loss among veterans who are struggling with mental health and vocational concerns and are not accessing VHA services, thus decreasing the risk of suicide and more costly interventions. Consistent with the existing national VHA initiatives on increasing access to health care and preventing suicide, a novel work-based intervention, Supported Employment: Engage and Keep (SEEK), was created. Building on the supported employment framework, SEEK assertively outreaches to already employed veterans by collaborating with workplaces that employ veterans. SEEK providers build rapport with employers and veterans and become a trusted VHA resource. SEEK engages veterans, facilitates enrollment in needed health care, and provides needed job maintenance support. This article outlines the SEEK model and provides a case demonstration and analysis of the course of SEEK care provided to a veteran at risk of losing their job. Clinical recommendations for implementing SEEK and future directions for evaluating this model are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved)
Prosumers’ experiences of witnessed discrimination and internalized stigma: A moderated mediation.
Discrimination toward individuals with lived experiences of mental illness is widespread within the field of clinical psychology. Further, there is some presence of clinical psychologists who are both consumers and providers of mental health services, termed prosumers. However, no research has evaluated how witnessing discrimination as part of professional activities may influence prosumers’ experiences with internalized stigma, anticipated stigma, and stigma resistance. This exploratory study aimed to establish associations and interactions between having witnessed discrimination toward others with lived experiences of mental illness and internalized stigma, anticipated stigma, and stigma resistance from the perspective of prosumers within the clinical psychology field. A cross-sectional quantitative approach was employed to understand these dynamics by utilizing descriptive, correlational, and multivariate regressions analysis. A total 175 prosumers (39 graduated doctoral-level clinical psychologists and 136 in training) completed survey measures pertaining to witnessed discrimination, internalized and anticipated stigma, and stigma resistance. Prosumers reported witnessing frequent subtle and overt discrimination by their colleagues, supervisors, and faculty members. Overt discrimination was reported as witnessed more frequently compared with subtle discrimination experiences or microaggressions. Our findings have implications for the prevalence of witnessed discrimination and how these may create cumulative experiences of stigma and stigma resistance among prosumers in clinical psychology. Further research should explore additional understanding of how clinical psychologists, including prosumers, may hold stigmatizing attitudes and perpetuate discrimination toward individuals with lived experiences of mental illness. (PsycInfo Database Record (c) 2024 APA, all rights reserved)

Psychological Services - Vol 21, Iss 4