In a longitudinal study of 253 bereaved adults, people with poorer social support, more concurrent stressors, and higher levels of postloss depression reported more rumination than people with better social support, fewer stressors, and lower initial depression levels. Women reported more rumination than men. People with a ruminative style at 1 month were more likely to have a pessimistic outlook at 1 month, which was associated with higher depression levels at 6 months. People with a more ruminative style were more depressed at 6 months, even after controlling for initial depression levels, social support, concurrent stressors, gender, and pessimism. Additional stressors and high depression scores at 1 month were also associated with higher levels of depression at 6 months.

Although there are effective treatments for Posttraumatic Stress Disorder (PTSD), many PTSD sufferers wait years to decades before seeking professional help, if they seek it at all. An understanding of factors affecting treatment initiation for PTSD can inform strategies to promote help-seeking. We conducted a qualitative study to identify determinants of PTSD treatment initiation among 44 U.S. military veterans from the Vietnam and Afghanistan/Iraq wars; half were and half were not receiving treatment. Participants described barriers to and facilitators of treatment initiation within themselves, the post-trauma socio-cultural environment, the health care and disability systems, and their social networks. Lack of knowledge about PTSD was a barrier that occurred at both the societal and individual levels. Another important barrier theme was the enduring effect of experiencing an invalidating socio-cultural environment following trauma exposure. In some cases, system and social network facilitation led to treatment initiation despite individual-level barriers, such as beliefs and values that conflicted with help-seeking. Our findings expand the dominant model of service utilization by explicit incorporation of factors outside the individual into a conceptual framework of PTSD treatment initiation. Finally, we offer suggestions regarding the direction of future research and the development of interventions to promote timely help-seeking for PTSD.

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Two studies examined the effects of embedding instructional materials in relevant fantasy contexts on children's motivation and learning. In Study 1, Ss showed marked preferences for computerbased educational programs that involved fantasy elements. In Study 2, Ss worked with these programs for 5 hr. One program presented purely abstract problems. Others presented identical problems within fantasy contexts. Some Ss chose among 3 fantasies; others were assigned identical fantasies. Tests on the material occurred before, immediately after, and 2 weeks after the experimental sessions. Ss showed significantly greater learning and transfer in the fantasy than in the no-fantasy conditions. Having a choice of fantasies made no difference. Motivational and individualization strategies for enhancing interest and promoting learning are discussed.Ask a group of college students to describe their most memorable and significant learning experiences in their elementaryschool years and one discovers some interesting recollections. One student may remember the third-grade classroom in which the teacher played the role of a "crooked" shopkeeper, cajoling delighted students to add, subtract, multiply, and divide accurately, lest they find themselves short-changed on their purchases. Another may recall the history teacher who had students prepare a Renaissance banquet, complete with appropriate food, music, costumes, and entertainment. Still another may speak of the social studies class in which the students held their own Constitutional Convention.For many years, master teachers have sought to create curriculum units to interest and to involve their students by embedding instructional materials and educational activities into appealing fantasy contexts (Lepper, Aspinwall, Mumme, & Chabay, 1990). Underlying the use of such strategies is the common

BackgroundWe evaluated a facilitation strategy to help clinical sites likely to experience challenges implement evidence-based Primary Care-Mental Health Integration (PC-MHI) care models within the context of a Department of Veterans Affairs (VA) initiative. This article describes our assessment of whether implementation facilitation (IF) can foster development of high quality PC-MHI programs that adhere to evidence, are sustainable and likely to improve clinical practices and outcomes.MethodsUtilizing a matched pair design, we conducted a qualitative descriptive evaluation of the IF strategy in sixteen VA primary care clinics. To assess program quality and adherence to evidence, we conducted one-hour structured telephone interviews, at two time points, with clinicians and leaders who knew the most about the clinics’ programs. We then created structured summaries of the interviews that VA national PC-MHI experts utilized to rate the programs on four dimensions (overall quality, adherence to evidence, sustainability and level of improvement).ResultsAt first assessment, seven of eight IF sites and four of eight comparison sites had implemented a PC-MHI program. Our qualitative assessment suggested that experts rated IF sites’ programs higher than comparison sites’ programs with one exception. At final assessment, all eight IF but only five comparison sites had implemented a PC-MHI program. Again, experts rated IF sites’ programs higher than their matched comparison sites with one exception. Over time, all ratings improved in five of seven IF sites and two of three comparison sites.ConclusionsImplementing complex evidence-based programs, particularly in settings that lack infrastructure, resources and support for such efforts, is challenging. Findings suggest that a blend of external expert and internal regional facilitation strategies that implementation scientists have developed and tested can improve PC-MHI program uptake, quality and adherence to evidence in primary care clinics with these challenges. However, not all sites showed these improvements. To be successful, facilitators likely need at least a moderate level of leaders’ support, including provision of basic resources. Additionally, we found that IF and strength of leadership structure may have a synergistic effect on ability to implement higher quality and evidence-based programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2217-0) contains supplementary material, which is available to authorized users.