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.     

Healthcare's greatest challenge: providing services for people with severe mental illness in managed care

The delivery of services for people with severe mental illness (SMI) is described as healthcare's most difficult challenge because SMI patients suffer from the combined effects of conditions that have 1) a chronic course, 2) disabling consequences, and 3) a high risk of poverty. The fundamental advantages of managed care for persons with chronic, disabling conditions are discussed along with an examination of how well these assumptions hold in actual practice for persons with SMI. The legal risks assumed by clinicians in managed care are reviewed, including the inherent risk of discriminating against high cost enrollees, such as patients with SMI. Finally, recommendations are made regarding the measures that might be taken to increase the "match" between the principles of managed care and the specialized needs of people with severe mental illness.     

Dual diagnosis in an Australian forensic psychiatric hospital: prevalence and implications for services

Despite a growing awareness of the unique needs of psychiatric patients with co-occurring substance abuse and dependence disorders (i.e. dual diagnosis), there is a dearth of research investigating the prevalence of dual diagnosis in forensic psychiatric populations. Similarly, little work has been done to determine the implications of dual diagnosis for forensic psychiatric patients. Patients at the Thomas Embling Hospital in Victoria, Australia, were assessed to determine the prevalence of substance abuse disorders and mental illnesses within this population. Results reveal that the majority of patients (approximately 74%) have a lifetime substance abuse or dependence disorder. Information was collected concerning patients' criminal histories and the Level of Service Inventory, Revised, was completed for each patient who participated. Results suggest that patients with both major mental illnesses and substance abuse disorders have more extensive criminal histories and demonstrate a higher level of risks and needs when compared with patients with major mental illness alone. The implications for the development and delivery of effective forensic mental health services that address both co-occurring disorders are also discussed.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

Effectiveness and cost offset analysis of group CBT for hypochondriasis delivered in a psychiatric setting: an open trial

Hypochondriasis is highly prevalent in medical settings, has detrimental effects for affected individuals, and is associated with high societal costs. Although cognitive behavior therapy (CBT) has been shown to be effective in the treatment of hypochondriasis, it is not widely available because of a lack of properly trained therapists. Therefore, it is essential to evaluate therapy forms that require less therapist time. The authors investigated the effect and economic impact of group CBT delivered in a psychiatric setting among 24 people with hypochondriasis. A within-group design with prolonged baseline was used, and all participants received 10 weeks of group-based treatment. The primary outcome measures were the Health Anxiety Inventory and the Illness Attitude Scales. Results indicate significant improvement on both measures at posttreatment and 6-month follow-up (Cohen's d = 1.03-1.72). Medical and nonmedical costs were substantially lowered. The authors conclude that group-based CBT delivered in a psychiatric setting is an effective and potentially highly cost-effective treatment for hypochondriasis.     

E-Hitz: A word frequency list and a program for deriving psycholinguistic statistics in an agglutinative language (Basque)

We describe a Windows program that enables users to obtain a broad range of statistics concerning the properties of word and nonword stimuli in an agglutinative language (Basque), including measures of word frequency (at the whole-word and lemma levels), bigram and biphone frequency, orthographic similarity, orthographic and phonological structure, and syllable-based measures. It is designed for use by researchers in psycholinguistics, particularly those concerned with recognition of isolated words and morphology. In addition to providing standard orthographic and phonological neighborhood measures, the program can be used to obtain information about other forms of orthographic similarity, such as transposed-letter similarity and embedded-word similarity. It is available free of charge from www .uv.es/mperea/E-Hitz.zip.     

The treatment of depression in older adults in the primary care setting: an evidence-based review.

The objective of this study was to conduct an evidence-based review of treatments for depression in older adults in the primary care setting. A literature search was conducted using PsycINFO and Medline to identify relevant, English language studies published from January 1994 to April 2004 with samples aged 55 and older. Studies were required to be randomized controlled trials that compared psychosocial interventions conducted within the primary care setting with "usual care" conditions. Eight studies with older adult samples met inclusion criteria and were included in the review. Two treatment models were evident: Geriatric Evaluation Management (GEM) clinics and an approach labeled integrated health care models. Support was found for each model, with improvement in depressive symptoms and better outcomes than usual care; however, findings varied by depression severity, and interventions were difficult to compare. Further efforts to improve research and clinical care of depression in the primary care setting for older adults are needed. The authors recommend the use of interdisciplinary teams and more implementation of psychosocial treatments shown to be effective for older adults.     

Multidimensional treatment foster care (MTFC): results from an independent replication

This study examines 24‐months post‐baseline outcomes for thirty‐five Swedish antisocial youths who received either treatment in multidimensional treatment foster care (MTFC) or treatment as usual (TAU). MTFC is a community‐based treatment programme that has been successful in treating chronic juvenile offenders in the USA. This study is the first randomized control study outside the USA. The youth treated in the MTFC programme consistently showed some statistically significant positive treatment effects compared to the youth exposed to TAU. The results suggest that MTFC might be an effective method in treating youth with severe behaviour problems in a Swedish context. The authors conclude that the programme ought to be of great interest for Swedish social services as an alternative to traditional care.     

A model of a psychological service for adults in a formal educational setting

This article describes the development and operation of a psychological service addressing the needs of adults in a formal educational setting. The structure and content of the service differs significantly from that historically available to children or adolescents in Irish schools. The major elements in the service - induction course, workshops, personal growth groups, and individual counselling - are detailed. The present research builds on an earlier investigation by the same authors into the needs of adults in full-time education at Pearse College, Dublin.     

A group-based treatment for clients with Obsessive Compulsive Disorder (OCD) in a secondary care mental health setting: Integrating new developments within cognitive behavioural interventions – An exploratory study

Aims: This paper presents a model of a group-based intervention for the treatment of clients with Obsessive Compulsive Disorder (OCD) referred to secondary mental health care services, which has been developed by the authors over the last five years. Method: Groups are not a common form of treatment design for this client group, however the available literature is briefly reviewed and the common issues that informed the design are identified. Following this additional technique of neuropsychological theories, Mindfulness, and socialisation are presented and a brief rationale for their inclusion provided. Quantitative and Qualitative outcome measures of the most recent group are discussed with respect to the utility and validity of the model. Conclusion and implications for practice: It is concluded that the group has good ecological as well as outcome validity and provided a method of linking together evidence-based practice (EBP) and practice-based evidence (PBE) movements.     

New directions for the education of clinical psychologists: The primary care setting,the VA's PRIME program,and the in-depth generalist model

As part of this special issue on psychology in primary care settings, we describe the Department of Veterans Affairs' (VA's) new approach to education for practice in the primary care setting and we concurrently address some general issues related to the education of clinical psychologists for practice in this setting. In this article we argue that the primary care psychologist, in parallel with the generalist in medicine, must have a strong generic background in clinical psychology in order to gain the broad range of clinical skills necessary to function effectively as an in-depth generalist (IDG) who is capable of addressing the variety of psychological issues that emerge in the primary care setting. The IDG model of professional practice, which we believe is best suited for primary care/managed care settings, requires extensive training in generic clinical skills and increased time devoted to its implementation at both the predoctoral and the postdoctoral levels.     

A Microcomputer Assessment System (MAS) for administering computer-based surveys: Preliminary results from administration to clients at an impaired-driver treatment program

The Microcomputer Assessment System (MAS), written in C language, allows a researcher to design and administer computer-based surveys by manipulating ASCII text files and requires no knowledge of a traditional programming language. The system was designed to provide maximum user flexibility: MAS allows both multiple-choice and open-ended (fill-in) questions and allows control over text color, allowable answers, and summary output. MAS also assesses response latency and includes support for random assignment of different instruments to respondents. MAS runs under MS-DOS 3.0 or higher, requires 640K of RAM, a color screen (EGA or better), and an extended keyboard. Preliminary results from an application of MAS to a sample of. 121 clients at an impaired-driver treatment program are summarized.