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The Defense Health Board conducted a year-long examination of mental health accession screening and related issues. In its August 2020 report, Examination of Mental Health Accession Screening: Predictive Value of Current Measures and Processes, the Board recommends a paradigm shift in how mental health impacts on readiness are understood and addressed. This shift can only occur with the development and implementation of a research plan that follows cohorts of military personnel from recruitment through their military career. The following article describes this research plan as an excerpt of the larger report.

Concern about the potential of medical and surgical residents making errors when fatigued has led to a reduction in resident duty hours. However, this reduction in duty hours, coupled with a lack of, or inadequate training in dealing with fatigue, may result in decreased opportunities for residents to learn how to provide safe care when fatigued. We conducted structured interviews with 18 senior residents completing their residency programs to investigate existing fatigue training programs and their experiences in coping with fatigue as physicians. Most reported receiving some lectures on fatigue, and use of one or more strategies to cope with fatigue while providing patient care. Respondents reported moderate to high concern about their ability to provide safe patient care when fatigued once residency training was completed. Further research is needed related to fatigue awareness and training.

This study sought to identify gender differences among medical patients for their spiritual/religious beliefs/practices and their associations with health. Patients (N = 168) completed the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS), and SF-36 general health perception (GHP) and general mental health (GMH) scales. No gender differences were found in endorsement of spiritual experiences, religious practices, or congregational support. For men, religious/spiritual coping significantly correlated with GHP and GMH, and religious support significantly correlated with GMH. For women, measures of spiritual experiences, religious practices, and congregational support were significantly correlated with GMH, but no significant correlations with GHP were noted. Regression analyses revealed that the interaction between gender and BMMRS was a significant predictor for GMH and GHP. Follow-up analyses suggested that for women, GMH was associated with religious/spiritual coping, religious support...

Background: Effective non pharmacological interventions are needed to treat neuropsychiatric symptoms and to improve quality of life for the 5.3 million Americans affected by dementia. Objective: The purpose of this study was to test the effect of a storytelling program, TimeSlips, on communication, neuropsychiatric symptoms, and quality of life in long-term care residents with dementia. Methods: A quasi-experimental, two-group, repeated measures design was used to compare persons with dementia who were assigned to the twice-weekly, 6-week TimeSlips intervention group (n = 28) or usual care group (n = 28) at baseline and postintervention at Weeks 7 and 10. Outcome measures included the Cornell Scale for Depression in Dementia, the Neuropsychiatric Inventory—Nursing Home Version, the Functional Assessment of Communication Skills, the Quality of Life—Alzheimer's Disease, and the Observed Emotion Rating Scale (this last measure was collected also at Weeks 3 and 6 during TimeSlips for the treatment group and during mealtime for the control group). Results: Compared with the control group, the treatment group exhibited significantly higher pleasure at Week 3 (p < .001), Week 6 (p < .001), and Week 7 (p < .05). Small to moderate treatment effects were found for Week 7 social communication (d = .49) and basic needs communication (d = .43). A larger effect was found for pleasure at Week 7 (d = .58). Discussion: As expected, given the engaging nature of the TimeSlips creative storytelling intervention, analyses revealed increased positive affect during and at 1 week postintervention. In addition, perhaps associated with the intervention's reliance on positive social interactions and verbal communication, participants evidenced improved communication skills. However, more frequent dosing and booster sessions of TimeSlips may be needed to show significant differences between treatment and control groups on long-term effects and other outcomes.

As reviewed by Bettencourt and colleagues,1 a number of studies have considered psychosocial issues as they relate to the experiences of rural dwelling women who have been treated for breast cancer. While many concerns reported by rural women are commensurate with those identified by urban women (eg, body image, effects of cancer diagnosis and treatment on family members), some differences seem to be emerging. In general, women living in rural areas may be more likely to experience distress than women living in urban communities.2 In addition to a recognized shortage of mental health care in rural communities,3 issues of stigma related to mental health care and expectations of self-sufficiency may limit acceptance of mental health services in rural areas.4 Among rural women living with cancer, high levels of depression and hopelessness/helplessness have been noted.5 Rural women living with cancer report lower than average quality of life6 and may have particular concerns about being stigmatized within their communities as a result of their cancer diagnosis.7 One way in which rural and urban areas may differ is in the availability of community-based social support. The importance of social support as a buffer to emotional distress has been widely studied among a variety of medical populations8 including individuals living with cancer.9 Potential effects of rural versus urban residence have been noted, although findings are somewhat equivocal, as both benefits and hindrances to well-being have been identified. For example, given the shortage of mental health care providers in rural communities,3 geographic distance may limit availability of professional social support for rural women.10 On the other hand, several characteristics of rural communities may be of benefit to individuals coping with cancer. Rural communities often value close relationships with family, community members and religious institutions,4,11 all of which can be excellent sources of social support. In fact, studies have highlighted the perceived benefit of increased community support experienced by female cancer survivors living in rural compared to urban areas.12 Thus, while there may be limited cancer-specific support services in many rural communities, women living in rural areas may have community networks which make general social support readily available.13 Due to unanswered questions regarding whether rurality may affect quality of life among cancer survivors, and recognizing the importance of social support in quality of life outcomes regardless of residence, analyses presented herein were conducted to examine the extent to which rural residence and social support seeking affect quality of life among breast cancer survivors in the early post-treatment period.

PURPOSE Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.

Breast cancer survivors experience cognitive difficulties following chemotherapy, yet the effects of these deficits on functional outcomes have not been systematically evaluated. This study assessed the relationships between post-chemotherapy cognitive difficulties and functional outcomes. Forty-six women with breast cancer were seen at 1-month post-chemotherapy; data were collected on cognitive functioning, psychological variables, and physical symptoms. Wilcoxon Signed Rank analyses revealed cognitive deficits in executive functioning and verbal fluency. Subsequent regression analyses demonstrated that poorer executive functioning was associated with decreased productivity, community involvement, and social role functioning. Poorer quality of life was predicted by depression and reluctance to seek social support, but not cognitive functioning. These findings indicate that executive functioning deficits are associated with important functional outcomes among breast cancer survivors 1-month post-chemotherapy. Thus, treatment efforts should focus on addressing cognitive, as well as psychological and physical, issues among cancer survivors.

This study examined the relationships between the Frontal Systems Behaviour Scale (FrSBe), neuropsychological tests and community integration outcomes among individuals with a history of TBI.Seventy-six individuals with a history of TBI were consecutively recruited from patients seen in a Neuropsychology clinic in an academic healthcare setting. Participants completed neuropsychological tests, the FrSBe and the Community Integration Questionnaire (CIQ) as part of a standard clinical neuropsychological evaluation.The FrSBe was a significant predictor of community integration (CIQ) outcomes. Specifically, poorer executive functioning (FrSBe Executive Functioning) predicted lower CIQ Total Scores, while increased apathy (FrSBe Apathy) was associated with reduced CIQ Productivity. Regarding neuropsychological tests, only Delayed Memory remained as a predictor: higher scores were associated with enhanced CIQ Total Scores and CIQ Social Integration. Finally, female gender was associated with superior CIQ Total Scores, CIQ Home Integration and CIQ Productivity.While neuropsychological tests of executive functioning failed to add predictive power to models of community integration following TBI with this sample, the FrSBe, a measure of behavioural manifestations of frontal lobe dysfunction, did predict these important functional outcomes. This suggests that use of the FrSBe may enhance the ecological validity of information gathered during a clinical neuropsychological assessment.

Missouri's traumatic brain injury (TBI) early referral programme connects individuals with TBI to state services in the acute stages of recovery. This study evaluated the impact of this programme on service utilization and functional outcomes.Sixty-seven individuals in the Early Referral (ER) programme were compared with 31 individuals who received services later in their recovery (controls) in terms of their functioning upon programme enrollment and programme services received. Telephone surveys were then completed with 29 ER and 22 later-referred controls assessing social/emotional and vocational functioning, as well as satisfaction with programme services.The ER group had greater functional limitations than controls upon enrollment. Despite this, at follow-up the ER group evidenced significantly better social integration, emotional well-being and vocational functioning than the control group. Individuals in the ER group did not require/receive more programme resources to achieve these better outcomes. Across both groups, 91% reported feeling the programme is valuable for individuals with TBI.Missouri's TBI early referral programme provides efficacious and cost-effective targeted support for individuals with TBI. Contact with clients and their families during or shortly after acute rehabilitation appears to be associated with better functional outcomes without an increase in the level of services rendered.

Cancer survivorship research has yielded important insights into the impact of breast cancer and associated treatments on such issues as vocational functioning, social role and community functioning, and quality of life. Efforts to understand factors that may impact these functional outcomes have specifically focused on medical, individual, and environmental variables. A relatively recent line of study suggests that neuropsychological functioning is an important individual variable to consider when assessing outcomes among breast cancer survivors, as there is evidence that at least a portion of women undergoing chemotherapy treatment for breast cancer will evidence an apparent decline in neuropsychological functioning. Two critically important issues are less well understood at this time, however. First, what is the underlying etiology of observed changes in cognitive functioning? Second, what is the functional significance of changes in neuropsychological functioning on work, social role and quality of life outcomes? To highlight potential directions for future research, this paper provides a review of existing literature documenting theories and research addressing these issues, and it discusses the potential impacts that changes in neuropsychological abilities may have on vocational, social role, and quality of life outcomes among breast cancer survivors.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program thatmatched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients.

As demographics shift to include more elderly populations and those living with chronic medical conditions, costs for health care services continue to escalate. As a result, health care systems around the world increasingly struggle to provide cost-effective, coordinated, and quality health care to those they serve. Significant policy, procedural, and practice changes are essential in solving these growing problems. With experience in interdisciplinary teams, rehabilitation psychologists and other psychological providers have a clear vantage point from which to help guide movement toward an integrated health care model that values health promotion, prevention, and collaborative care. Psychologists can be an integral part of this new “interdisciplinary team,” but, as a profession, we must advocate for this inclusion and position ourselves to take on this new role through education and training.

This study examined how breast cancer diagnosis influences underlying cognitions and explicit worries about death, and their roles in health-related quality of life (QOL). Forty-two women who underwent surgery for the removal of either a cancerous or benign breast mass indicated their worries about dying, and completed measures of death-thought accessibility and QOL. Women with cancer reported lowered physical, emotional, and functional well-being. Further, although they did not differ in explicit worry about death, women with cancer (compared to those with a benign mass) evidenced greater death thought accessibility, which in turn mediated the effect of cancer diagnosis on well-being.

Research on neuropsychological difficulties among cancer patients has focused on chemotherapy as a primary cause, yet several studies have now shown that some patients evidence cognitive weaknesses prior to chemotherapy. As an alternative to the 'chemo-brain' theory, this study examined the hypothesis that stress and coping style may be associated with observed neuropsychological difficulties among female cancer patients. Thirty-six women completed neuropsychological testing and psychological questionnaires following surgery for breast cancer and prior to any subsequent treatments. Twenty-seven percent of participants evidenced deficits on at least one measure of verbal fluency, and 14% of participants were impaired on at least one memory measure. Self-reported stress was correlated with deficits in memory, verbal fluency, and attention. Subsequent mediational analyses indicated that use of passive coping styles may underlie this relationship between stress and neuropsychological deficits. These findings highlight the potential relevance of psychological mechanisms, such as coping style, in cancer patients' experience of neuropsychological deficits.

Objective: To examine the effects of a 10-week Tai Chi (TC) program on neuropsychological, psychological, and physical health of female cancer survivors. Design: Twenty-three women with a history of cancer participated in 60-min TC classes two times/week for 10-weeks. Main Outcome Measures: Before and after the intervention, participants completed neuropsychological tests (memory, executive functioning, language, and attention); 5 tests of balance; and self-report questionnaires of neuropsychological complaints, stress and mood, and fatigue. Results: After the 10-week session, participants evidenced fewer neuropsychological complaints and enhanced neuropsychological functioning. They also demonstrated improved balance and reported better psychological functioning. Conclusions: Results suggest that TC may promote gains in neuropsychological functioning, in addition to previouslydemonstratedimprovementsinphysicalandpsychologicalhealth.These findingssupporttheneed for controlled trials examining the potential benefits of TC on neuropsychological functioning after cancer.

In an effort to identify four-subtest Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) short forms valid for estimating Full-Scale IQ (FSIQ) among individuals with traumatic brain injury (TBI), seven tetrad versions of the WAIS-III were evaluated in a convenience sample of patients referred for neuropsychological assessment (n = 176). Estimated FSIQ scores were compared to actual FSIQ scores via correlation analyses, repeated-measures analyses of variance (ANOVAs), and frequency analyses. All short form-estimated FSIQ scores correlated highly with actual scores (all rs .91, ps .001). Repeated-measures ANOVAs identified no significant differences between actual and short form-estimated FSIQ scores for two of the seven short forms. These same two short forms had the highest percentage of scores within ±5 points of actual FSIQ scores (75.6% and 71.6%). Thus, two tetrad versions were consistently superior to others in accuracy of estimating FSIQ; these may be helpful when time constraints or other issues necessitate use of an abbreviated battery for estimating FSIQ among individuals with TBI.

Schizencephaly is a rare neuromigrational/organizational disorder characterized by the development of cerebral clefts, which are typically associated with neurological sequelae including seizures, motor disturbances, and cognitive dysfunction. Although there are multiple case reports of schizencephaly and associated neurological sequelae, primarily in children, the literature regarding neuropsychological manifestations of schizencephaly is limited. This article reviews the case of a woman diagnosed with bilateral schizencephaly at age 29. Neuropsychological testing revealed intact intelligence and memory functioning. However, impairments were noted in attention, executive functioning, expressive language skills, visual-spatial abilities, and bilateral manual motor skills, all of which were adversely impacting her functional abilities (e.g., ability to be gainfully employed). Given the potential variability in deficits associated with schizencephaly, this case demonstrates the utility of neuropsychological evaluation for understanding cognitive and functional consequences of bilateral schizencephaly.

Legislative advocacy is a prerequisite for the development of research and community services benefiting individuals with traumatic brain injury (TBI). Dr Mitchell Rosenthal and other leaders in rehabilitation began the process of advocating for TBI services more than 25 years ago, before many in the field fully appreciated the necessity of these efforts. Since that time, substantial gains have been made through advocacy efforts on behalf of individuals with TBI and their families. This article provides an overview of the TBI advocacy movement, highlighting federal legislation resulting in appropriations for TBI services and protecting the rights of individuals with TBI. Key government entities engaged in developing states' TBI infrastructure and providing services to individuals with TBI and their families are also discussed. In addition to celebrating some of the successes that were initiated by the efforts of Dr Rosenthal and other visionaries, select shortcoming of current legislation is noted to provide insights regarding future advocacy needs.

Objective: Research has documented modest cognitive difficulties among women treated for breast cancer. The present study was designed to evaluate the effects of these subtle cognitive changes on quality of life after treatment. Methods: Data are presented from women breast cancer patients who completed neuropsychological tests and questionnaires regarding quality of life 6 and 12 months post-chemotherapy (n's=39 and 33). Neuropsychological test scores were examined for evidence of cognitive difficulties at each time point; repeated measures ANOVAs were used to identify changes over time. Regression analyses assessed relationships of quality of life outcomes with cognitive functioning, social support seeking, and fatigue. Results: Small percentages of participants (

Up to one-third of women breast cancer survivors report difficulties with concentration, multi-tasking, and memory. Research in the University of Missouri, Department of Health Psychology, suggests that these cognitive difficulties are associated with poorer quality of life among breast cancer survivors after treatment. This article discusses this treatment side effect and its consequences for daily functioning, highlights ongoing research on the potential role of stress in the development of cognitive difficulties, and reviews treatment options.

To determine relationships among spiritual beliefs, religious practises, congregational support and health for individuals with traumatic brain injury (TBI).A cross-sectional analysis of 61 individuals with TBI evaluated in an outpatient clinic using the Brief Multidimensional Measure of Religiousness/Spirituality (BMMRS) and the Medical Outcomes Scale-Short Form 36 (SF-36).For persons with TBI the BMMRS Meaning and Values/Beliefs sub-scales were significantly correlated with the SF-36 General Health Perception sub-scale and the BMMRS Religious Support sub-scale was significantly correlated with the SF-36 General Mental Health sub-scale. Hierarchical regressions indicated that the BMMRS Values/Beliefs and Forgiveness sub-scales accounted for 16% additional variance in SF-36 General Health Perception scores beyond that accounted for by demographic variables (i.e. age, income); no BMMRS sub-scales accounted for additional variance in predicting the SF-36 General Mental Health sub-scale beyond that accounted for by demographic variables (i.e. age, income).The physical health of individuals with TBI is associated with spiritual beliefs but not religious practises or congregational support. Better mental health is associated with increasing congregationally based social support for persons with TBI. Religious practises (i.e. praying, etc.) are not related to either physical or mental health, as some persons with TBI may increase prayer with declining health status.

Although there is considerable research on the vocational outcomes of individuals with traumatic brain injuries (TBI), there has been minimal research on the characteristics of persons with TBI who seek services from state vocational rehabilitation services. Such research is deemed critical given the significant number of individuals who request such services, as well as the significant federal and state costs associated with these programs. The current article reviews a series of studies completed collaboratively between the University of Missouri-Columbia and Missouri Division of Vocational Rehabilitation (DVR). Information is reported regarding the typical demographic, injury severity, and neuropsychological characteristics of DVR clients with TBI, as well as the most common DVR services provided to them and their vocational outcomes (i.e., successful, unsuccessful). Studies are reviewed which indicate that the provision of specific DVR services predict successful vocational outcomes, although traditional medical and neuropsychological variables do not. Additional studies are reviewed which examine the impact of gender, race, age, geographic location (i.e., rural vs. urban), and concomitant disabilities on vocational outcomes. Results indicate the importance of considering environmental and social factors when providing vocational rehabilitation services to clients with TBI, and that specific DVR services can lead to successful vocational outcomes regardless of TBI severity. Implications for future clinical services and research are presented.