The Unmet Educational Agenda in Integrated Care

One of the reasons integrated care has not become a dominant service delivery model is the unmet training agenda. This article argues that the typical mental health professional is not trained to adequately address the challenges of integrated care. To insure competency both a macro and clinical training agenda are needed. At the macro-level, mental health professionals need to understand healthcare economics and basic business principles as any integrated care service delivery system is embedded and driven by economic forces. Integrated care practitioners also need some basic business skills to understand these forces and to create and manage a financially viable system, given the future flux of the system. Traditional mental health professionals also do not have the clinical skills to implement integrated care. Integrated care is not simply placing a traditionally trained mental health professional and letting them practice specialty mental health in a medical setting. Thus, the special skills needed in integrated care are enumerated and discussed. Finally, a new degree program is described as it is time given the huge need and advantages of integrated care to develop specialty training in integrated care.     

Evaluation of a Train-The-Trainers Model for Family Peer Advocates in Children’s Mental Health

Standardized training and credentialing is increasingly important to states and healthcare systems. Workforce shortages in children's mental health can be addressed through training and credentialing of professional peer parents (called family peer advocates or FPAs), who deliver a range of services to caregivers. A theory-based training program for FPAs targeting skills and knowledge about childhood mental health services (Parent Empowerment Program, or PEP) was developed through a partnership among a statewide family-run organization, state policy leaders, and academic researchers. Prior studies by this team using highly-experienced family peer advocates (who were also co-developers of the training program) as trainers found improvements in knowledge about mental health services and self-efficacy. In 2010, to meet demands and scale the model, a training of trainers (TOT) model was developed to build a cohort of locally-trained FPAs to deliver PEP training. A pre/post design was used to evaluate the impact of TOT model on knowledge and self-efficacy among 318 FPAs across the state. Participants showed significant pre-post (6 month) changes in knowledge about mental health services and self-efficacy. There were no significant associations between any FPA demographic characteristics and their knowledge or self-efficacy scores. A theory-based training model for professional peer parents working in the children's mental health system can be taught to local FPAs, and it improves knowledge about the mental health system and self-efficacy. Studies that evaluate the effectiveness of different training modalities are critical to ensure that high-quality trainings are maintained.     

Implementing a Primary Mental Health Service for Children: Administrator and Provider Perspectives

The Child Mental Health Service (CMHS) is an Australian primary care program introduced in July 2010 to provide mental healthcare to children who have, or are at risk of, developing psychological disorders. The Australian Government provided supports (e.g., training for mental health professionals), resources (e.g., funding for positions devoted to fostering inter-agency linkages or partnerships) and various flexibilities in service delivery. This study aimed to explore the processes used in the implementation of the CMHS in order to achieve its objectives of delivering a high quality standard of service, and forging linkages and support networks with other relevant health and non-health agencies. Structured interviews were conducted with 20 program administrators, six referring professionals and eight mental health professionals. Interviews were recorded, transcribed and analysed for themes using NVivo. The CMHS appears to have made good progress towards achieving its objectives by implementing processes that facilitated the delivery of a high quality service (e.g., engaging appropriately qualified, and encouraging additional training and clinical support for, mental health professionals; employing quality assurance mechanisms and clinical governance arrangements) and establishment of inter-agency linkages (e.g., devoting a professional role—Coordination and Liaison—to this purpose). Provider perspectives suggest that the CMHS has had a positive impact on children and their families. Comparable countries implementing primary mental health programs for children may benefit from considering similar additional supports (e.g., training for mental health professionals), resources (e.g., funding positions devoted to fostering service inter-agency linkages) and service delivery flexibilities as those available in the CMHS.     

Evaluating the “possums” health professional training in parent–infant sleep

Infant sleep problems are among the most common issues reported by parents in the postnatal period. Yet, infant sleep and infant sleep interventions remain controversial. This study evaluated health professional training in a novel approach to parent–infant sleep: the Possums Sleep Intervention. Health professionals (n = 144) completed a short survey before and after the training, which focused on the sleep component. The Possums Sleep Intervention training included the following topics: sleep science, cued care, sleep hygiene, relaxation for parents and babies, problem solving, and acceptance and commitment therapy (ACT). Health professionals reported: improvements in knowledge on infant sleep regulation, the mother–infant relationship and ACT; improvements in health professionals’ own sleep quality; improvements in psychological flexibility; and a reduction in professional burnout and secondary traumatic stress. Moreover, the health professional training was received positively. Overall, this study is supportive of the Possums Sleep Intervention health professional training.     

Training program in psychosocial intervention for high-risk infants and their families

A multidisciplinary training program for psychosocial intervention in the Neonatal Intensive Care Unit (NICU) was developed. The purpose of the program was to train mental health and health care professionals in a psychosocial preventive intervention model for high-risk infants and their families throughout the infants' hospital course in the NICU. The program was divided into modules that include assessment and intervention with the infant, parents, family, and larger caregiving environment. Over a 3-year period 40 trainees from 9 disciplines were trained. A randomized clinical trial was conducted which showed the positive effects of the intervention. A clinical service including inpatient and outpatient follow-up has been established in the NICU based on the psychosocial model developed from the training program.     

Graduate trends for one marriage and family therapy program in an interdisciplinary setting

This research compared trends from 1981 to 1993 in several mental health professional training programs at the University of Houston Clear Lake, surveying graduates from three professional mental health master's programs—clinical psychology, school psychology, and family therapy—with the goal of identifying trends in the status of their professional credentialing and current employment. Four mental health groups have attained licensure since a 1981 survey, resulting in graduates now seeking professional licenses and perform psychotherapy more exclusively than other mental health activities. Interdisciplinary training has become increasingly important due to the introduction of managed care and other insurance regulating entities.     

Reports from the Front: The Effects of Hurricane Katrina on Mental Health Professionals in New Orleans

Hurricane Katrina created an unprecedented mental health crisis in New Orleans. Once they could return to work, local mental health professionals attempted to treat survivors of the storm while dealing with the storm's impact on themselves. Those working in public settings were offered in-service training and supervision. But clinicians in private practice often found themselves bearing the brunt of posttraumatic uncertainty alone. The current paper includes four experiential reports from area clinicians describing their early struggles to maintain a sense of continuity in their ongoing clinical work, only to realize how much of the personal is also professional in the aftermath of a disaster of this magnitude, and how personal and professional inevitably inform one another when clinicians and patients survived similar dangers and losses. The introduction locates these four papers in the larger context of post-Katrina New Orleans and a program that was specifically tailored to meet the needs of local clinicians. This program demonstrated the ways in which psychoanalytic ideas can be used to give meaning to a traumatized mental health community's profound disorientation.     

The Practice of Integrity for Mental Health Professionals

Summary

The focus of this article revolves around accuracy and honesty in the mental health field. Integrity, both professional and personal, is the foundation of all mental health professionals' functioning. Honesty, fairness, and respect for others are necessary ingredients to professional behavior. Mental health professionals avoid misleading other individuals with regard to professional training and other areas of expertise. In professional roles, they clarify as early as feasible the nature of the expectations and activities in which they are engaged.     

When is a mental health professional competent to assess a person's decision to hasten death?

As the country continues to debate the legality of aid-in-dying, it appears inevitable that at some point there will be a need for mental health professionals to be involved in assessments of individuals asking for a hastened death. I designed this article to provide a set of guidelines that will allow both mental health professionals and potential consultees to determine if a professional has the training and expertise necessary to be a competent consultant.     

The Interface between Mental Health Providers, Families, and Schools: Parent and Child Attitudes about Information-Sharing

Youth with emotional and behavioral disorders (EBD) are at an increased risk for school problems and negative consequences into adulthood, increasing the need for collaboration between families, school personnel and mental health providers. Current treatment guidelines emphasize the importance of information-sharing between providers and schools, yet few studies have addressed parents’ or students’ attitudes and preferences about this process or about the disclosure of mental health-related information to school professionals. Using a sample of 73 pairs of parents and their adolescents seeking outpatient treatment, this study assessed parental and adolescent attitudes about disclosure of mental health treatment information to school personnel. The majority of parents reported that the school should be informed that their adolescent was receiving counseling or medication for EBD, and that they should be the primary informant, rather than providers. By comparison, adolescents preferred more discretion about their involvement in treatment. Taken together, the study results highlight a number of implications relevant to the therapeutic relation and the process of obtaining and sharing mental health-related treatment information with various school personnel. Future research directions regarding the consultative and collaborative process with school personnel are also discussed.     

Systemic training for healthcare professionals: the Chicago Center For Family Health approach

There has been increasing interest in family-centered, collaborative, biopsychosocial models of care by health and mental health professionals and consumers. This trend has led to growing demand and development of specialized training in family systems approaches to health care. This article describes the Families, Illness, and Collaborative Healthcare programs developed at the University of Chicago affiliate, the Chicago Center for Family Health. The program philosophy is guided by the following principles: a systems orientation focused on the family, a Family Systems Illness Model, a family resilience framework, a family-centered collaborative model of health care, and a social justice and advocacy orientation. Specific training components that implement these principles are described, including intensive certificate and fellowships; workshops, conferences, and institutes; and consultation and training services for community-based organizations. Discussion includes professional networking opportunities, funding challenges, and policy recommendations.     

Families in Crisis

Abstract

Families are in crisis. With an increasing array of problems affecting children in the home, from child abuse to familial alcoholism, schools are facing a vast array of behavioral and emotional concerns affecting childhood behavior. Unfortunately, many negative behaviors are learned at home. Violent and aggressive behaviors, for example, as well as drug and alcohol abuse, are often demonstrated by parents. From a community perspective, schools are in a pivotal position from which to intervene. Yet, many school-based mental health professionals, including school psychologists, school counselors, and school social workers, lack the knowledge to provide direct interventions. This article examines contemporary problems facing families, considers the home-school linkage, and explores interventions for schools and school-based mental health professionals.     

How parents view professional behaviors: A cross-professional analysis

This study examined the responses of more than 900 parents of children with serious emotional disorders to survey questions about the importance and frequency of professional behaviors and compared these responses across professions. The findings indicated that parents with lower income and less education tended to work more with social workers, counselors, and teachers, less with psychologists and psychiatrists. Professional behaviors concerned with the parent-professional relationship, honesty, non-blaming attitude, supportiveness, and inclusion in decision-making were considered important by most parents regardless of the professional with whom they worked. Parents rated professions differently on the importance of evaluation, home visits, and providing child-raising information, probably reflecting expectations that parents have about the roles and training of professionals. The behaviors that parents considered important also tended to occur frequently. Significant differences across professions were found with respect to the frequency of providing information on child rearing, advocacy, home visits, providing information on resources, and help with coping, although these behaviors were considered relatively less important by parents. An examination of discrepancies between what parents considered important and what they experienced suggested that parents' expectations were only partially met. Implications for practice, professional education, and research are discussed.Editor's Note: We acknowledge the sampling issue raised by the low survey return rate in this study and the resulting threat to generalizability of findings. Nevertheless, the study is judged to merit publication as one of the first efforts to examine empirically parents' views of their relationships with mental health professionals. Our hope is that this report will serve to stimulate further scientific investigation on the topic—Donald Oswald (AE).     

Attitudes toward suicide prevention in front-line health staff

A questionnaire assessing attitudes toward suicide prevention was constructed and shown to have satisfactory reliability and internal consistency. The determinants and distribution of these attitudes were investigated in four groups of health professionals who are in contact with suicidal patients: general practitioners, accident and emergency nurses, psychiatrists in training, and community psychiatric nurses. Attitudes toward suicide prevention were shown to differ significantly between professional groups. More positive attitudes were associated with mental health professionals, working in the community, and previous training in suicide risk assessment. Negative attitudes should be assessed and targeted in training designed to improve the management of suicide risk.     

Delivering Diagnoses: Parents as Translators and Withholders of Children’s Mental Health Diagnoses

There is a lack of research on how mental health diagnoses are delivered and explained to children and the effectiveness of these strategies. This qualitative study examines how emerging adults recall the delivery of mental health diagnoses in childhood and how they suggest these diagnoses should be delivered to children. Semi-structured interviews were conducted with 42 emerging adults (aged 18–22) who were diagnosed with attention deficit hyperactivity disorder (ADHD), depressive disorders, generalized anxiety disorder (GAD), and/or bipolar disorder in childhood. Findings reveal that parents, rather than mental health professionals, often inform children of their diagnoses. The data suggest that parents often act as translators of diagnostic information, acting as liaisons between mental health professionals and their children. The paper explores ways in which parents and mental health professionals withhold diagnoses from children, and how this affects children’s experiences. Drawing on their own experiences, participants offer suggestions regarding the best ways to deliver diagnoses to children. Findings suggest that adults should share mental health diagnoses openly with children. Implications for social workers and other allied health professionals who support families when children are diagnosed are discussed.     

Counseling in Thailand: Development From a Buddhist Perspective

The authors present historical and current accounts of the counseling profession in Thailand. In addition to the influences of Buddhism on counselor training and practices, professional issues such as licensure, professional organizations, and the relationship between counselors and other mental health professionals are summarized. The role of counselors in recent political and natural disasters is highlighted, along with the importance of adapting Western counselor training and service practices to better meet the needs of the Thai population.     

Developing coordination of services between a mental health center and a public school system

A child-and-family oriented community mental health center of necessity is concerned with the manner in which the school system in its community is providing for the psychological, social, and emotional development of children. Fortunately, over the last decade, the number of school systems that are aware of their responsibility in this regard has greatly increased, and many affluent and enlightened school systems have moved to develop extensive pupil personnel services, functioning in many ways as in-house mental health programs. Where there are mental health providers both within the community and within the school system, however, problems may develop such as professional competition, overlapping functions, and differences with regard to how mental health problems are best dealt with. This paper will examine the relationship of a town-supported mental health program and the town's public school system. Highlighted will be the variety of problems which develop, including those mentioned above, and strategies adopted to resolve the problems.     

Issues in Professional Training to Implement Evidence‐based Parenting Programs: The Preferences of Indigenous Practitioners

Indigenous children have elevated risk for poor health, behavioural, emotional, and social outcomes. Significant evidence exists that parenting programs can reduce family risk factors and improve outcomes for children and families; however, mainstream programs have had slower uptake in Indigenous communities than other communities. Culturally sensitive delivery of evidence‐based programs can enhance engagement of parents, yet the development of a workforce to deliver programs to Indigenous parents faces many obstacles. This project seeks to identify professional training processes that enhance Indigenous practitioners’ skills and confidence in delivering an evidence‐based parenting program. A survey of trained parenting practitioners via an online practitioner network assessed their views of the training and post‐training support processes they had experienced. Respondents were 57 Indigenous and 720 non‐Indigenous practitioners from 15 countries. Most training processes were rated equally helpful by Indigenous and non‐Indigenous practitioners. However, several training processes were identified as important for the delivery of culturally competent training, such as tailoring the pace of training and simplifying the language in teaching resources. Practitioners with higher ratings of the helpfulness of peer support following training reported higher program uptake and implementation. Qualitative themes also focused on the helpfulness of program resources, and having a peer support network and mentoring. Increasing access to appropriate, flexibly delivered training and post‐training support for Indigenous professionals will support the development of a skilled workforce with local knowledge and connections, and further increase the reach of evidence‐based services in Indigenous communities.