Establishing psychological services in a community-based,health care setting: A 3-year case study

Health care practitioners are being challenged to reorganize service delivery and psychology providers are emerging as important participants in shaping the development of primary health care practices. The article outlines the 3-year process of a community/academic/health care center partnership to develop a new model for providing interdisciplinary health care services. The authors describe the process of integrating psychological services into an interdisciplinary, primary care community-based health care center, outline specific planning strategies, and identify the roadblocks and barriers encountered.     

Clinical psychology in medical settings: Psychology's role in health care

The number of clinical psychologists working in medical settings has grown along with the range of services provided by psychologists to patients with a multitude of medical problems across the lifespan. Medical care cost savings brought about by these psychological interventions is highlighted along with issues of public policy and specialization of training. The opportunity for ongoing development of clinical psychology in medical settings is described as unlimited and the mission of the newJournal of Clinical Psychology in Medical Settings is presented as supporting that growth.     

Behavioral case consultation with parents and teachers: An example using differential reinforcement to treat psychogenic cough

This study presents a demonstration of successful behavioral case consultation combined with case study methodology in the treatment of a 13-year-old female who presented with a brief history of psychogenic cough. Psychogenic cough is diagnosed when there is no organic or physiologic basis for the repeated, harsh coughing. We first present a brief review of treatments for psychogenic cough and then describe how we used differential reinforcement of low rate responding (DRL) and differential reinforcement of zero responding (DRO) within an A-B-C design. The DRL schedule produced significant decreases in coughing but plateaued at about one-third the baseline rate. Thereafter, a DRO schedule was employed which resulted in complete and lasting elimination of coughing. Discussion focuses on the limitations of case study methodology as well as its usefulness for conducting service related research in the schools, implications of some of the findings for practitioners, and other issues related to treatment.     

Intervention-based school psychology services: Training for child-level accountability; preparing for program-level accountability

This research evaluated the outcomes of a school psychology training practicum by replicating intervention-based service delivery procedures established in prior research. The key components include describing a service delivery model, teaching the model, deriving practice guidelines that fit the model, supporting trainees in carrying out the steps, and evaluating the outcomes. Procedures to determine outcomes were based on single-case design facets including accountability design (A-B), visual analysis of graphic data, and social validity ratings. Meta-analysis techniques included calculation of effect sizes and percent of nonoverlapping data (PND). Goal attainment scaling (GAS) also was used to summarize outcomes. The analyses indicated that the interventions led to positive changes for most children. For example, the median effect size was 1.42 across cases. Social validity evidence showed that consumers judged the outcomes positively. Achieving ideal baseline and technical adequacy checks (e.g., observer agreement, intervention adherence) represented challenges for many consultations. The contributions of the study include describing methods for child- and program-level accountability in training and areas for improvement including further supporting the completion of technical checks for intervention services.     

Methods for overcoming methodological problems in the measurement of client satisfaction in a clinical psychology practice

This study surveyed client satisfaction with an outpatient service in clinical psychology at a university-based clinic in New Zealand. In an effort to collect honest opinions rather than grateful testimonials from clients, special consideration was given to the methodology used. In the absence of guidelines on how to analyze client satisfaction data, a variety of techniques was developed. These methods and analyses are reviewed and recommendations made with regard to future use.     

Medical Crisis Counseling on a Pediatric Intensive Care Unit: Case Examples and Clinical Utility

The intensive care unit is one of the most stressful and demanding work sites of the pediatric psychologist. The rapid changes in health status that necessitate stays on the intensive care unit often constitute an emotional roller coaster ride for both family members and the staff caring for their child. The Medical Crisis Counseling (MCC) intervention model is a useful approach to providing psychological support in the pediatric intensive care setting. A representative year's worth of consultation requests from the multidisciplinary intensive care unit of a large urban pediatric hospital is described and discussed in the context of the MCC model.     

Cluster analysis in school psychology: An example

This investigation demonstrates the use of Ward's method of cluster analysis to uncover the underlying classification structure in a group of children (N = 200) referred for psychological evaluations by their public school teachers. Data were acquired on children's intellectual development, academic achievement, and social adjustment. The cluster solution identifies six groups of children which are statistically distinct. All three measurement areas are important in distinguishing among the different groups. The six-group solution accounted for appreciable amounts (95%) of the variability in the three measurement areas. Implications for psychologists working in the schools are discussed.     

The Teaching Alliance Inventory: Evaluating the student-instructor relationship in clinical and counselling psychology training

The Teaching Alliance Inventory (TAI) was developed to measure the quality of the student-instructor relationship in graduate clinical and counselling psychology classrooms. Based on Bordin's (1983) original concept of the alliance as fundamental to the change process in psychotherapy, we developed the TAI to measure aspects of the classroom relationship that may be fundamental to learning essential skills of counselling and clinical psychology. Factor analysis revealed six subscales, four representing interpersonal variables not evaluated in traditional teaching effectiveness measures. We demonstrated internal consistency and split-half reliability with a large sample of graduate students and described evidence for the scale's face validity and content validity. Construct validity was supported by significant correlations between the TAI and its subscales with an established measure of teaching effectives and its logically related subscales (SEEQ; Marsh, 1987 Marsh, HW. 1987. Students’ evaluations of university teaching: Research findings, methodological issues, and directions for future research. International Journal of Educational Research, 11(Whole Issue 3): 253–288.  [Google Scholar]). The TAI may supplement traditional assessments of instructor quality by providing feedback regarding interpersonal impact in the classroom.     

Pediatric Psychology: Child Psychological Health in the Next Century

The future of pediatric psychology is reviewed and placed in brief historical context in relation to children's psychological health care. Contemporary trends affecting the delivery of psychological services, research, and clinical training are highlighted, with suggestions for future development. Pediatric psychology is a child-based, developmentally-focused multidisciplinary practice directed toward psychosocial and neuropsychological issues of health and illness in children and youth. Pediatric psychologists need to develop strong professional identities as health care psychologists combined with a collegial and collaborative arrangement with physicians to ensure the future growth and development of pediatric psychology in the next century as a major vehicle to promote children's health care.     

Health and behavior: The coming together of science and practice in psychology and medicine after a century of benign neglect

For thousands of years, physicians had available only a few drugs with which to minister to patients and the practice of psychology was an integral and therapeutically powerful component in the practice of medicine. Thus, good bedside medicine consisting of empathy, compassion, and a nurturant attitude toward the ill individual was a major component of the physician's armamentarium until relatively recently. However, the explosion in scientific knowledge in biology, physiology, chemistry, and microbiology which began a century ago and has continued through the twentieth century helped produce several generations of physician specialists and subspecialists with little knowledge of the powerful role psychological factors play in health and illness. As a result, practitioners of medicine and practitioners of psychology have had little or no contact during most of this century. However, as advances in microbiology, public health, and nutrition have eradicated many of the infectious diseases, infirmities associated with one's lifestyle have replaced the latter as the major causes of death today. One offshoot of this shift is that after a century of benign neglect, physicians and psychologists have rediscovered a common ground in the arena labeled health and behavior. Some factors responsible for these recent developments are highlighted.This article was an invited address delivered to a group of Japanese health psychologists as part of a Health Sciences Seminar in Tokyo on July 24, 1993. Concurrent with its publication here in English, it is being published in the Japanese language in the March 1994 issue of the journal,Japanese Health Psychology.     

A rose by any other name: Maintaining the name and highlighting the uniqueness of psychology as a health care profession

In this article, we reply to the comments made by Holden and Levant (preceding articles). While we agree with their goals of expanding the scope of practice of psychology, standardizing training, and educating the public and other health care professionals about the field of clinical psychology, we do not agree that changing the discipline's name to psychological physician is a necessary or sufficient means to these ends. We outline the bases for our disagreement with the name change proposal and provide other proposals for reaching the goals set forth by Holden and Levant.     

Evaluating complex interventions: Perspectives and issues for health behaviour change interventions

Objective: Health behaviour change interventions (HBCIs), used in health education, health promotion, patient education and psychotherapy areas, are considered complex interventions. The objective of this article is to discuss the value and limitations of using randomised clinical trials (RCTs) to asses HBCIs.

Methods: A scoping review of the literature was conducted to identify the main challenges of using RCTs for evaluating HBCIs. The issues were illustrated by case studies selected from research conducted by our multidisciplinary team.

Results: In complex interventions, effects are produced not only by the intervention, but are strongly linked to context. Issues relating to transferability of results are therefore critical, and require adjustments to the RCT model. Sampling bias, biases related to the experimental conditions and biases due to the absence of double-blindness were examined and illustrated by case studies.

Conclusion: The results underline the importance of a multidisciplinary approach. They call for adapted or alternative evaluation models that overcome the limitations of RCTs.     

Developing coherence in community and clinical psychology: the integration of idealism and pragmatism

Illustrations of how ideas from community psychology may be integrated with clinical psychological thinking and practice are described from the perspective of a clinical psychologist working in the NHS. The intentions are to consider socially relevant conceptualizations of the causes of people's well-being and distress, and to develop ways of helping individuals and communities to clarify and address these causes. Incorporating an analysis of social power also necessitates a critical awareness of the limited potency of psychological interventions. © 1998 John Wiley & Sons, Ltd.     

The efficacy of conjoint behavioral consultation on parents and children in the home setting: Results of a randomized controlled trial

The present study is a large-scale randomized trial testing the effects of a family–school partnership model (i.e., Conjoint Behavioral Consultation, CBC) for promoting behavioral competence and decreasing problem behaviors of children identified by their teachers as disruptive. CBC is a structured approach to problem-solving that involves consultants, parents, and teachers. The effects of CBC on family variables that are commonly associated with important outcomes among school-aged children (i.e., family involvement and parent competence in problem solving), as well as child outcomes at home, were evaluated. Participants were 207 children with disruptive behaviors from 91 classrooms in 21 schools in kindergarten through grade 3 and their parents and teachers. Results indicated that there were significantly different increases in home–school communication and parent competence in problem solving for participants in the CBC relative to control group. Likewise, compared to children in the control group, children in the CBC group showed significantly greater decreases in arguing, defiance, noncompliance, and tantrums. The degree of family risk moderated parents' competence in problem solving and children's total problem behaviors, teasing, and tantrums.     

The interpretation of change in verbal reports: Implications for health psychology

Abstract

This paper raises a number of issues for health psychology in relation to the interpretation of change in verbal reports. Drawing on a typology of change developed to evaluate organisational interventions, it is suggested that change may occur at an alpha level (e.g. changed health status), beta level (e.g. a recalibration of the respondent's scale for assessing health status) or gamma level (e.g. a reconceptualisation of the meaning attached to health). Given the likely presence of beta and/or gamma change in intervention data in health psychology, researchers may be analysing their change data at an inappropriate level. A number of existing methodologies which attempt to detect beta and gamma change are presented and discussed. The need to develop further methodologies which focus more explicitly on the nature of change is highlighted. Finally, the proposed typology has a number of practical implications for the design of health promotion interventions.     

Mental health treatment and medical utilization: First pilot study in the military

Savings in medical utilization, as a function of psychotherapeutic intervention, which has been widely demonstrated elsewhere, can be replicated in military medical settings. Results point not only to decreased medical utilization following mental health intervention, but also to more appropriate treatment.The material herein should in no way be construed as reflecting the views or opinions of the Department of Defense or the United States Air Force.     

Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients

The effectiveness of virtual reality (VR) as a behavioral intervention designed to decrease distress during port access procedure was examined in 20 7- to 14-year-old pediatric oncology patients. Children were randomized to either engage in an immersive VR environment during the procedure or to a no VR control condition. Children's distress was assessed through subjective self-ratings and objective physiological and behavioral ratings. Narrative accounts of the experience were used as a measure of how well the child coped with the procedure. VR was effective in reducing children's distress on all measures. Implications of these findings for intervention are discussed.     

An Investigation of Psychology Staffing in Australian Metropolitan Acute Public Hospitals

Psychology is one component of the multidisciplinary services provided to patients in acute public hospitals, with research demonstrating that psychological intervention significantly enhances clinical outcomes for patients across a range of health issues. Despite the increasingly important role that psychologists play in Australian hospitals, there remains a lack of information available about staff levels, discipline structures, and clinical activity for psychological services within acute hospital settings. The most recent Australian data about hospital‐based psychology services was collected 20 years ago. The current study provides updated information from a survey of 15 Australian metropolitan, acute public hospitals: presenting and critically reviewing staffing configurations and models of service delivery. Results suggest that: (a) hospitals employ a highly skilled workforce at a rate of 0.16 full‐time equivalent psychology staff for every 10 hospital beds; (b) psychologists have a viable career pathway within the hospital‐based health sector; (c) role diversity is common, with the primary focus varying as a function of position level; (d) neuropsychology staffing requires urgent attention to address significant delays in access to services; and (e) public hospitals actively contribute to current and future workforce development through supervision, research, and training. The implications of these results for the future of psychological services in Australian healthcare are discussed.     

Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.