Mental Health Services in Kentucky Nursing Homes: A Survey of Administrators

National surveys have shown that mental health problems are prevalent in long-term care and suggest that these settings are largely underserved by mental health services. Nursing home administrators are gatekeepers for mental health services in nursing homes. Administrators of Kentucky nursing homes were surveyed regarding their perceptions of mental health problems, current and future services use, satisfaction with services, and need for consultation. The response rate was 24%. Administrators appeared to underestimate mental health problems among residents. Most facilities were using at least one type of mental health service, but fewer residents received services than would be expected given the problem prevalence. Psychological services were underused, in spite of the fact that behavior management stood out as a major need. Psychiatry was more frequently used, but with less satisfaction. Results indicate significant financial and logistical barriers to mental health services. Future work is needed on developing, assessing, and disseminating models of effective service provision to long-term care.     

Evolution of an Inpatient Pediatric Psychology Consultation Service: Issues Related to Reimbursement and the Use of Health and Behavior Codes

The purpose of this study was to evaluate an inpatient pediatric psychology consultation service, with particular focus on issues related to financial reimbursement for services. Information was gathered over a four year period (2001–2005) regarding number of consults, referral source and referral question, type of insurance, and reimbursement rates for health and behavior codes versus mental health codes. The financial impact of hiring an insurance verification specialist was also explored. Results indicated that reimbursement rates for health and behavior codes were higher than reimbursement rates for mental health codes. Health and behavior codes were rejected in 31% of cases that they were billed; the primary reason for rejection was that these codes were not a covered service by Medicaid. Hiring an insurance verification specialist was found to be a cost-effective method for improving the financial “bottom-line” for psychology services. Implications for practice are discussed.     

Service Delivery Issues and Program Evaluation in Pediatric Psychology

Presents a framework for categorizing pediatric psychology research into practice and service system outcomes and functioning. The questions of importance are (a) who is being served, (b) what services are provided, (c) how treatments are implemented, (d) how services are organized and staffed, (e) what are the outcomes of the services, (f) how do various consumers perceive services, (g) how services are reimbursed, and (h) what are alternatives and innovations? The framework of program evaluation is detailed for domains most germane to service delivery in pediatric/child health psychology. Such domains include diagnostic information on patients, types of intervention, behavioral/psychological outcome variables, costs of treatments, service system functioning, and perceptions of satisfaction from multiple sources. This framework may be useful in directing future research on the delivery of services in pediatric psychology settings, thereby adding to the value of the field.     

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.     

Evaluation of a statewide initiative to reduce expulsion of young children

This program evaluation study describes 3 years of implementation of Arkansas's BehaviorHelp (BH) system, a statewide expulsion prevention support system for early care and education (ECE). BH coordinates three tiers of supports to ECE professionals, including phone support, on‐site technical assistance (TA), and infant and early childhood mental health consultation (IECMHC). We examine differences in characteristics of those served across BH service tiers, describe short‐term case outcomes, and explore factors associated with expulsions. BH accepted referrals for 1,195 children in 488 ECE programs. The majority of referrals involved male children over the age of three, and most cases were assigned to the TA tier (68.5%). Cases assigned to receive IECMHC (28.4%) were more likely to involve children in foster care, receiving developmental therapies, and with higher rates of exposure to potentially traumatic events. The expulsion rate among referred children was 2.9%, and reported teacher engagement with the support process was high. Teachers receiving IECMHC services reported significant improvements in children's symptoms of emotional and behavioral problems. Exploratory analyses revealed that risk factors for expulsion included being a male, in foster care, in a lower quality ECE environment, and having a teacher with less training in social–emotional development.     

Cultural Mistrust of Mental Health Professionals Among Black Males Transitioning from Foster Care

We examined cultural mistrust of mental health professionals among Black males who are transitioning from the foster care system (N = 74) and its relationship to their level of satisfaction with child welfare services and the frequency of negative social contextual experiences. Results of hierarchical regression analysis showed that the level of satisfaction with child welfare services moderated the relationship between negative social contextual experiences and cultural mistrust of mental health professionals. Specifically, more frequent negative social contextual experiences were related to greater cultural mistrust of mental health professionals for Black males reporting low satisfaction with child welfare services, but not for those reporting high satisfaction with child welfare services. Implications for service delivery are discussed.     

Parent satisfaction with neuropsychological consultation after pediatric mild traumatic brain injury

Few studies have focused on consumer satisfaction following neuropsychological evaluation. We sought to examine parent satisfaction with neuropsychological consultation following a mild traumatic brain injury (TBI) in school-age children. We surveyed 71 parents of 8- to 17-year-olds participating in a prospective longitudinal study examining neuropsychological consultation as an intervention for persistent postconcussive symptoms. Children had sustained injuries between 2 and 12 months prior to enrollment. Neuropsychological consultation occurred on average 5 months post-injury. Parent satisfaction data were collected via telephone approximately 4 months after the neuropsychological consultation. The vast majority of parents were quite satisfied with the service (e.g., 94% overall satisfaction rate; 96% rated the service as good or excellent). Satisfaction rates were associated positively with time since injury and negatively with parental education. No other child, parent, or provider variable correlated with satisfaction. The results add to the relatively sparse literature on parent satisfaction with neuropsychological evaluation. A pressing future need in pediatric neuropsychology is to examine the satisfaction of other consumers of the service, including healthcare personnel, educators, and the child patients themselves.     

Treatment Participation among Children with Conduct Problems and the Role of Telephone Reminders

Children with antisocial, aggressive and disruptive behaviour problems are among the most frequent referrals to mental health services. These young people and their families present with a range of adverse contextual factors and can prove challenging to engage. We examined the characteristics of children with conduct problems, treatment participation, and the impact of telephone reminder calls. Consecutive referrals (N=262) to two child and youth mental health services were randomly assigned to either a reminder call condition or service as usual. In comparison to referrals without conduct problems, conduct problem children presented with greater sources of psychosocial adversity, attended fewer initial appointments and were at greater risk of treatment refusal. Importantly, telephone reminder calls significantly increased treatment attendance, though only for participants with elevated conduct problems. Telephone reminder calls, however, had no impact on treatment refusal, regardless of conduct problem status. The findings highlight a straightforward approach for enhancing treatment participation among a group that has been challenging for mental health services.     

Evaluation of the psychometrics properties of the alarm distress baby scale among 122 Brazilian children

The Alarm Distress Baby Scale (ADBB) aims at assessing infant withdrawal behavior. A previous validation study revealed acceptable reliability and validity indices. The present study investigated the psychometric properties of the scale in a larger sample from a culturally different population. Pediatricians evaluated the behavior of 122 infants, 2 and 19 months old, using the ADBB during routine physical consultation. Four investigators (two pediatricians and two nurses not specialized in pediatric care) examined video recordings of the evaluations. Results showed good interrater reliability coefficients among pediatricians and poor correlation when all professionals were grouped together. Test–retest reliability revealed good intraexaminer agreement (r = 0.91). The pediatricians' evaluation using the ADBB was compared with a psychiatric examination to investigate the scale's criterion validity. The cutoff point of 5 provided the best clinical validity (sensitivity of 79%, specificity of 81%). Results from construct validity showed that the scale had three dimensions. Comparison of the factor solution with other construct validity studies of the same instrument revealed similarities and differences. Results suggest that the ADBB may be a useful screening instrument to detect signs of psychiatric alterations related to withdrawal behavior in primary care services, and it is likely to provide consistent information.     

A Survey of Behavior Analysis and Behavioral Consultation Courses in School Psychology: Implications for Training School Psychologists

All 216 doctoral and specialist level school psychology training programs were mailed a seven question survey to determine how much behavioral consultation and behavior analysis course work school psychology students are offered. One hundred and twenty-eight surveys were returned, yielding a return rate of 58.26%. The results indicated that almost all programs offer didactic courses in consultation (98.79%) and behavior analysis/behavior modification (91.52%). The percentage of practicum devoted to behavioral consultation and behavior analysis/modification was considerably less (about 25% for each) than other subject areas. The results are discussed within the context of training needed to meet the needs of practitioners in the areas of behavioral consultation and behavior analysis/behavior modification.     

A study of families' satisfaction with a family interventions in psychosis service in Somerset

Although research has shown the efficacy of family interventions in psychosis, there has been little research into families' own experience of services in routine clinical settings. Fifteen of the first twenty-two referrals to a Somerset Family Interventions Service agreed to take part in semi-structured interviews regarding family satisfaction and clinical outcome. High levels of engagement and satisfaction with the service were reported in spite of initial apprehension regarding family sessions. Family members thought that the sessions had helped them deal more effectively with problems and relatives' symptoms. They valued the opportunity for open discussion, developing new perspectives and problem-solving, as well as liaison/closer working with mental health services. Positive therapeutic qualities/skills (e.g. empathic, non-judgemental approach; mutually agreed goals) were highlighted. This study also indicated that successful engagement in family work requires referral at an early stage. The findings of this study, particularly those relating to the therapeutic relationship, are discussed, including their relevance for future research.     

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.     

Perceptions of Responsibility and Mental Health Help-Seeking Among Psychologically Distressed Older Adults

This study explored the perceptions of responsibility for the cause and the solution of problems and the models of helping (or helping orientations) characterizing a sample of 319 community-dwelling, psychologically distressed older adults. All participants were referred for psychotherapy and had either accepted or rejected their referrals. We investigated whether the models distinguished acceptors and rejecters of psychotherapy referrals and whether they were differentially associated with help-seeking from nontherapist helpers. Results indicated that the preponderance of respondents subscribed to the moral and compensatory models. The compensatory model was associated with rejection of referrals, whereas the moral model was associated with increased help-seeking both from mental health professionals and from other formal and informal helpers. Implications of the findings for promoting older adults' utilization of mental health services are discussed.     

Mental health professionals' support of self‐help groups

Objective. Self‐help groups and other consumer‐led services are viewed as valuable additions to mental health services. This study describes professional support for self‐help groups and examines the hypothesis that professional support of self‐help is influenced by the degree to which professionally‐led groups are viewed as more helpful than self‐help groups. Method. Survey data were obtained from a representative sample of over 900 mental health professionals employed in mental health agencies in a large US State. The survey assessed beliefs, behaviours, attitudes, and intentions toward professional and self‐help groups. Results. Respondents who perceive professionally‐led groups to be significantly more helpful than self‐help groups were less inclined to support self‐help groups through referrals, help in organizing groups, or financially. Conclusion. To the extent that professional support of the self‐help movement is diminished, valuable allies in the struggle to expand the reach of mental health services are lost. It is proposed that mental health professionals should obtain additional information about the benefits of self‐help and the constructive role that self‐help groups can play in expanding the availability and continuum of beneficial mental health services. Copyright © 2001 John Wiley & Sons, Ltd.     

Evaluating programs in applied settings through behavioral consultation

A behavioral consultation school psychology service model is presented which provides a vehicle for services and communication of process and outcome measures in program evaluation research. Within the context of the problem-solving perspective of applied behavior analysis, the consultation model (a) promotes process and outcome evaluation across a wide variety of settings, situations, and time; (b) leads to use of an applied research technology with wide applicability in educational settings; and (c) provides a communication technology for the program evaluation process through a four-stage problem-solving strategy. It is argued that the professional behavioral school psychologist can provide technical expertise to function as a system change agent within this evaluation model.     

Implementing Skills for Psychological Recovery at a Psychology Training Clinic During COVID-19

The COVID-19 global pandemic has disrupted the routine provision of community mental health services, which is especially concerning given that emerging data suggest a rise in mental health concerns related to the COVID-19 crisis (Xiong et al., 2020). Thus, it seems imperative to provide trauma-informed services that are tailored to clients’ coping with the pandemic and can be effectively delivered via telehealth. The goals of these important services would be to mitigate current distress, help prevent the onset of long-term mental health problems, and facilitate client safety during a public health crisis. The present article provides an overview of adoption and telehealth implementation of the Skills for Psychological Recovery (SPR) secondary prevention program within a psychology training clinic. Initial clinical outcome data supported the program’s success in reducing mental health symptoms among individuals in psychological distress due to the COVID-19 crisis; however, the results were more striking for adults than for youths. The article concludes with recommendations for broader implementation and future directions for clinicians, supervisors, organizations, and researchers.     

Parents Plus Systemic,Solution‐Focused Parent Training Programs: Description,Review of the Evidence Base,and Meta‐Analysis

Parents Plus (PP) programs are systemic, solution‐focused, group‐based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child‐focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p < .001) from a meta‐analysis of 10 controlled studies for child behavior problems compares favorably with those of meta‐analyses of other well‐established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p < .001) effect sizes for goal attainment (d = 1.51), parental satisfaction (d = 0.78), and parental stress reduction (d = 0.54). PP programs may be facilitated by trained front‐line mental health and educational professionals.     

Exploring the Base for Family Therapy Edited by Nathan W. Ackerman,Frances L. Beatman,and Stanford N. Sherman

General systems theory and group psychoanalytic psychology are utilized to present a typology of consultation requests that face the liaison psychiatrist in a general medical ward. These theories are also used to suggest interventions that enable the liaison psychiatrist to accomplish the dual purpose of providing useful consultations to the medical staff and training them in the psychological care of their patients without becoming trapped in the contradictory demands of the pressured medical-ward setting. Examples of psychosocial-medical rounds are presented illustrating three different kinds of consultation requests and specific intervention strategies.