Self-confidence was conceptualized and a multidimensional measure, the Personal Evaluation Inventory, was developed which assesses college students' confidence in six areas most important to them. The measure's psychometric properties and relationships with other personality attributes were described. Three studies exploring behavioral correlates of confidence demonstrated the following: People's expressed self-confidence is consistent with others' appraisals of their confidence; when given a choice between two activities, people choose the one on which their confidence is higher; and less confident people perceive their futures, although not those of other people, less favorably than highly confident people. The importance of distinguishing and assessing both domain-specific and general confidence is discussed.

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Two studies were conducted to examine the practical implementation of an integrated health care model in five primary care clinics in the Upstate New York Veterans Affairs (VA) system. The aims of the studies were: (a) to describe the basic clinical elements of the integrated health care service offered by behavioral health providers (BHPs) in the primary care setting, and (b) to evaluate the perceptions of providers and patients regarding integrated health care practices in their primary care clinics. In Study 1, we reviewed 180 electronic medical records of patients who met with a BHP in primary care. In Study 2, we used semistructured interviews and self-report questionnaires to collect information from 46 primary care providers, 12 BHPs, and 140 patients regarding their perceptions of integrated health care in their primary care clinics. Both studies illustrate a useful method for evaluating the practical implementation of integrated health care models.

Posttraumatic stress disorder (PTSD) is common among Veterans Affairs (VA) primary care patients and may be managed via multiple treatment pathways. Using the Behavioral Model of Health Service Use (Anderson, 1995), this retrospective study based on medical chart review examined factors associated with three types of mental health treatment: intervention by a 1) primary care provider (PCP), 2) primary care-mental health integration (PC-MHI) provider, and 3) specialty mental health (SMH) provider. A second goal was to describe PTSD treatment services for patients not receiving SMH by detailing the content of mental health treatment provided by PCPs and PC-MHI providers. Electronic medical record data for a five year time period for 133 Veterans were randomly selected for review from a population 6,637 primary care patients with PTSD. Results indicated that the evaluated needs of participants (i.e., number of unique medical and psychiatric disorders) were associated with Veterans receiving more intensive services (i.e., SMH). PCPs commonly addressed patients' mental health concerns, but patients often declined referrals for mental health treatment. PC-MHI consultations most often focused on medication management and supportive psychotherapy.

This column describes lessons learned by U.S. Department of Veterans Affairs (VA) researchers and clinical operations managers while they were engaged in a unique partnership. In this partnership, researchers turned generalizable lessons from implementation research into actionable guidance for use by clinical managers in implementing health care system change. The lessons learned are reflections about the necessary foundations for partnering, the importance of relationships, the need for regular communication, and the need to recognize and adapt to partners' timelines and time constraints.