Behavioral Health Consultation and Primary Care: Lessons Learned

This article provides an overview of 20 years of professional experiences with developing and implementing a model for integrating behavioral health services into primary care. The Primary Care Behavioral Health (PCBH) model is designed to provide immediate access to behavioral care for a large number of primary care patients by positioning a behavioral health consultant in the exam room area to function as a core member of the primary care team. In an initial era of discovery, the authors were directly involved in developing and testing a variety of new approaches to providing behavioral health services in general medicine. In a second era focused on feasibility, the authors worked with Kaiser Permanente, the United States Air Force and Navy, the Veteran’s Administration, and the Bureau of Primary Care to system test this innovative model of integrated care. Now in an era devoted to dissemination, the authors review the various roles formal research, system level quality improvement initiatives and stakeholder analysis play in promoting integrated care. The authors also describe current efforts to (1) create a tool that helps systems develop integration targets and (2) use the PCBH model as a platform for teaching medical residents and behavioral health providers to work together in a redesigned primary care team model.     

过度医疗、适度医疗与诊疗最优化

过度医疗与过度服务有所不同。适度医疗应当是为患有某种疾病的病人提供有效、安全、便捷、耗费少的医疗服务。最优化的医疗是一种包括以优质的医疗服务实现了最佳疗效、最安全、痛苦最少、最便捷和费用低的医疗。一般地说,最优化的医疗首先应当是适度的医疗。最优化的医疗比适度医疗有更高的要求。不宜用优质医疗取代适度医疗,也不宜将适度医疗改称为最优化医疗。我们可以将适度医疗作为保健服务的基本要求,而将最优化医疗作为努力目标,一种理想化的目标。在满足人民的基本医疗、实行基本医疗保险过程中,我们更应当提倡适度医疗。     

Medical Humanities and Cultural Studies: Lessons Learned from an NEH Institute

In this essay, the directors of an NEH Institute on Medicine, Literature, and Culture consider the lessons they learned by bringing humanities scholars to a teaching hospital for a month-long institute that mingled seminar discussions, outside speakers and clinical observations. In an exchange of letters, they discuss the productive tensions inherent in approaching medicine from multiple perspectives, and they argue the case for a broader conception of medical humanities that incorporates the methodologies of cultural studies.     

Fear and Shame in an Israeli Psychoanalyst and His Patient: Lessons Learned in Times of War

Living in the midst of a war presents unique challenges to ongoing psychotherapeutic treatment. This paper focuses on the ever-present threat of fracture to the analytic frame and the limited ability of the therapist to create a safe, insulated environment— a reliable container—in which to work, while coping with a violent external reality. Using an intrapsychic lens, as well as an interpersonal one, the dynamics of both the analyst's and the patient's fear and shame are brought into focus. This delicate balance is illustrated through two cases: one occurring during the First Gulf War (1991) and the second taking place during the Second Lebanon War (2006). In both cases, fear and shame cause a stalemate in the psychotherapeutic process. The analyst recalls his active duty as a soldier during the Yom Kippur War (1973). These memories and their attendant acknowledgement of fear and shame by the analyst, as well as his analysand's “supervisory” comments, gradually dissolve the knot and repair the rupture in the analytic process. The ability to fully experience fear, shame, and helplessness is at the core of psychic health, a health once destroyed by dissociation and denial of these feelings. This ability to experience fear and shame is the psyche's antidote to mental breakdown. Following discussion of the two case studies, this paper seeks to illustrate how the very structure of a society, in this case Israel, can codify societal defense mechanisms against emotions like fear and shame, exacerbating the very problems it seeks to assuage.     

Behavioral Health Integration in Health Care Settings: Lessons Learned from a Pediatric Hospital Primary Care System

Behavioral health integration within primary care has been evolving, but literature traditionally focuses on smaller scale efforts. We detail how behavioral health has been integrated across a large, urban pediatric hospital system’s six primary care clinics (serving over 35,000 children annually and insured predominately through Medicaid) and discuss strategies for success in sustaining and expanding efforts to achieve effective integration of behavioral health into primary care. In a time span of 3 years, the clinics have implemented routine, universal behavioral health screening at well child visits, participated in a 15-month behavioral health screening quality improvement learning collaborative, and integrated the work of psychologists and psychiatrists. Additional work remains to be done in improving family engagement, further expanding services, and ensuring sustainability.     

宁养医学课程与医学生人文关怀

介绍宁养医学的定义,在医学生中开设宁养医学课程的做法、体会和存在问题.在此基础上,提出了宁养医学课程有助于在医学生中普及照顾不可治愈病人的原则和知识,培养人文关怀的理念,因此建议将其列为必修课.     

Appropriate Spiritual Care by Physicians: A Theological Perspective

It is argued that when spiritual care by physicians is linked to the empirical research indicating the salutary effect on health of religious beliefs and practices an unintended degradation of religion is involved. It is contended that it is much more desirable to see support for the patient’s spirituality as part of holistic care. A proposal for appropriate spiritual care by physicians is offered.

Military Influence Tactics: Lessons Learned in Iraq and Afghanistan

When deployed U.S. soldiers attempt to influence the attitudes, beliefs, or behaviors of civilians, success can save lives and failure can be deadly. Survey data from 228 military personnel with deployment experience to Iraq and Afghanistan revealed that in a challenging wartime environment, empathy, respect, prior relationships, and familiarity with influence targets predicted success in cross-cultural influence attempts. Influence techniques involving resources and positive feelings were used more commonly in relatively successful influence attempts; negative tactics were used more commonly in unsuccessful attempts.     

Training and Supervising Counselors: Lessons Learned From Deliberate Psychological Education

A psychological education curriculum package designed to stimulate growth in three target areas (psychologival development, mastery of skills, and understanding concepts) was piloted with 18 in-service counselors and teachers. Although significant gains were achieved in counseling skills and moral reasoning, shifts in ego and conceptual level failed to reach statistical significance. Bernier considers these results in light of developmental and cognitive theory and discusses implications for training and supervision. He presents a case for viewing counselor education within a developmental perspective.     

美国围产期姑息照护探析——从一则医疗叙事谈起

以美国本土发生的一则围产期姑息照护案例的叙事为引线,展开对美国围产期姑息照护的介绍,并重点分析家庭一体化意识对围产期姑息照护的重要性和围产期姑息照护共情的内涵。认为围产期姑息照护要求医护人员具有共情能力和家庭一体化意识,从而为处于围产期胎儿具有致命或限制生命的畸形情形下的家庭提供超越生理层面的有益的生理和心理-社会-精神的支持。另外,叙事培育共情,因此通过叙事(将患者的想法纳入医疗照护),医务人员可以学习如何和患者产生共情以及培育家庭一体化意识。     

社会主义和民族性问题:英国新左派的经验教训

20世纪60年代佩里.安德森与他的亲密合作者汤姆.奈恩与爱德华.汤普森围绕社会主义与民族性等问题展开了一场影响深远的论战。在这场论战中,佩里.安德森等人在具体历史认知和理论逻辑上的缺陷得到充分的暴露,而爱德华.汤普森则在反驳佩里.安德森等人的过程中留下一笔丰富的理论遗产。     

What a Difference Family-Driven Makes: Stories of Success and Lessons Learned

Community Psychology’s emphasis on citizen participation aligns with the nationwide children’s mental health family movement and is clearly evident in communities that have made sustainable system changes. The national family movement has long advocated for the meaningful engagement of families and youth who are the focus population of the federal Children’s Mental Health Initiative. Little rigorous research about the experience of families in leadership positions or of their impact on systems of care has been done. In the absence of scientifically acquired evidence, this article offers the reader a glimpse into the authority, influence and credibility earned by four family leaders as well as their impact on local system of care communities. Their stories occur in four distinct macro level arenas: governance, evaluation, legislative advocacy, and workforce development. In the end, common attributes emerge from their stories, providing anecdotal information useful to identifying the qualities of successful family leadership and their impact on sustainable macro level changes.     

Building Resiliency in Dyads of Patients Admitted to the Neuroscience Intensive Care Unit and Their Family Caregivers: Lessons Learned From William and Laura

Sustaining a stroke, regardless of its severity, is a life-changing and often traumatizing event that can lead to chronic depression, anxiety, and posttraumatic stress in both survivors and their family caregivers. Psychosocial interventions for emotional distress after stroke are limited, have emphasized psychoeducation rather than skills, treatment of chronic emotional distress rather than prevention, and have targeted either the patient or their caregiver without accounting for the context of their interpersonal relationship. Here we discuss “Recovering Together,” a novel program for dyads of patients with stroke and their family caregivers aimed at preventing chronic emotional distress by using cognitive behavioral principles to teach resiliency and interpersonal communication skills beginning during hospitalization in a neuroscience intensive care unit and continuing after discharge via telehealth. We illustrate the case of a pilot dyad enrolled in the Recovering Together program, to showcase how patients and caregivers can engage with and benefit from it. This dyad’s experience suggests that Recovering Together is credible, feasible, and useful. The potential dyadic benefit of this intervention lies not only in providing the opportunity to optimize recovery and prevent long-term emotional distress, but also in creating the space to come together as a pair and make meaning from critical illness.     

So You Want to Do an Online Study: Ethics Considerations and Lessons Learned

The use of the Internet in conducting psychological research has become increasingly common over the past few decades, as Internet access has become more widespread. Although web-based work has a number of benefits, including lower cost, easy access to large samples, and strict standardization of administration, the limitations must also be considered. Among these limitations are the ethics concerns related to conducting psychological research online. These concerns include limitations in maintaining confidentiality, conducting thorough informed consent, and conducting valid assessment. Particular focus is given to the limitations inherent in conducting a fully automated online study. All of these limitations are discussed in detail through both a review of existing literature and the brief review of a recent study. The recent study identified areas in which participants struggled with completing a fully automated online task. This article discusses the ethics implications of Internet research as well as offering suggestions for researchers who intend to conduct web-based research, and thoughts on future directions as psychology moves forward in web-based research and assessment.     

Teaching Bioethics to a Large Number of Biology and Pharma Students: Lessons Learned

To be made aware of bioethical issues related to their disciplines, undergraduate students in biology and pharmaceutical sciences at the University of Basel are required to enroll in the bioethics course called “Introduction to Bioethics”. This article describes the chances and challenges faced when teaching a large number of undergraduate biology and pharmaceutical sciences students. Attention is drawn to the relevance and specific ethical issues that biology and pharmaceutical sciences students may be confronted with and to how these could be integrated into ethics curricula. Results from a survey addressing the knowledge and opinion of students taking the course in spring semester 2012, 2013, and 2014 are presented and discussed. Finally, we describe the lessons learned and how we have improved the course based on students’ feedback throughout the following years.     

The Quest for Multicultural Competence: Challenges and Lessons Learned from Clinical and Organizational Research

Multicultural competence refers to the ability to appreciate diversity and to work effectively in multicultural settings. In this increasingly diverse and globalized world, being culturally competent has become more important than ever. Integrating research in counseling and organizational studies, the authors examine the conceptualization of cultural competence across disciplinary boundaries. The authors review pertinent research to dissect the major challenges posted to the quest for cultural competence and conclude that training programs that overemphasize knowing the different ‘Others’ may promote a false sense of competence, and even fuel intergroup hostility and reactance. To enhance cultural competence, we recommend shifting the emphasis in competence trainings from knowing the different ‘Others’ to enhancing critical self‐awareness.     

A Model Psychosocial Support Training and Workshop during a Medical Mission for Syrian Refugee Children in Jordan: Techniques,Lessons Learned and Recommendations

ABSTRACT

This article describes a model training and workshop for volunteers that was implemented with child refugees in Jordan, to build empowerment, resilience, and connection with others. The importance of such services for this population is emphasized. The present model, with elements of arts activities and play similar to those used in the Child Friendly Spaces, is based on my extensive experience working with diverse populations under various conditions of crisis, natural disaster, and infectious diseases, mainly in low resource settings. I review activities from my toolbox, their purpose, methods, and processing. The clinical value of such psychosocial support is presented, as has been shown by pilot research in several settings, despite limitations of conducting empirical assessments, which are discussed. Lessons learned and recommended are given. The intervention for refugee children is presented in the context of international policy agreements that provide an important foundation for such projects that clinicians and researchers can use to support their work for this population and others, in efforts to heal children from the traumas of refugeeism and other similar extreme stresses.     

医学人文与医疗实践结合:人性化的医疗

医学人文与医学科学的结合是当代科学与人文关系的特点和本性,也是医学现实的迫切需求,其目标是实现人性化的医疗;医学人文存在不同水平的三个层次;医疗人性化是一个广阔的领域;营造平台是促进两者结合的重要条件.医学人文具有理论和实践两个向度,医学人文的实践向度是整个医学人文或人文医学的基础,没有实践向度,理论向度就失去了基础,整个医学人文就会成为不着边际的空话.医学人文的理论向度和实践向度,其基础都在临床实践.     

Immigrant Youth and Employment: Lessons Learned from the Analysis of LSIC and 82 Lived Stories

Finding a job has become a critical challenge to many youth. Immigrant youth, who have been a key part of the global migrants, are particularly vulnerable when entering the job market of the host country due to various structural barriers. However, in both public policy discourse and research, their labour market experience tends to be overlooked. In this paper, we report the employment experience of recently arrived immigrant youth based on an analysis of the LSIC and findings of in-depth interviews of 82 immigrant youth in four cities in Canada. Our results reveal that recently arrived immigrant youth tend to work in lower-skilled employment, experience significant delays in finding employment, have difficulties with foreign credential recognition, and have fewer means to access to job markets.