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.     

The psychiatric nurse as group psychotherapist

An overview of current dimensions of group psychotherapy practice by psychiatric-mental health nurses is presented. The relationship between graduate education and the characteristics of the nurses' current practice is demonstrated. The psychiatric-mental health nurse's involvement in the general health care arena with nonpsychiatric populations is highlighted. Future trends for the practice of group by nurses is explicated and projected. In addition, implications for the education and practice of other group practitioners is drawn.Marianne DiMinno, R.N., M.S.N., assisted in the development of the survey questionnaire.     

Critical reflection in midwifery practice: the protection motivation theory

Background: The aim of this paper is to shed light on the notion of fear and inter-personal working relationships, and to promote safe midwifery practice, by critically reflecting on our practice and being aware of fear appeals and the protection motivation theory (PMT).

Theory: PMT provides a general account of the impact of persuasive communication, emphasising the cognitive processes that mediate behaviour change and questions whether ‘fear appeals’ could influence behaviour. Discussion: It is possible that when a midwife decides on a particular care pathway, she determines the degree and perception of the four elements of the PMT; severity, vulnerability, response-efficacy and self-efficacy. If the midwife decides that both the degree of severity and her perception of vulnerability are high, whereas response and self-efficacy perceptions are low, she will probably decide against her original care pathway. For the PMT to be used safely, an appropriate judgement call is required and is based on full understanding of the situation, effective communication with the multidisciplinary team, full knowledge of the proposed care, and competence and confidence in the proposed care. Conclusion: By critically reflecting on their practice and using the PMT, the author believes that midwives will be able to work in partnership with obstetricians to provide safe and effective care within their sphere of practice and in the absence of fear.     

An Ecological Understanding of Kinship Foster Care in the United States

We review empirical studies on kinship foster care in the United States. We conceptualize kinship foster care within the context of Urie Bronfenbrenner’s (1994) most recent ecological systems theory. Because there are multiple levels of influences on the developmental outcomes of children placed in kinship foster home, understanding the interrelations between the individual (child) and his or her surrounding environments (e.g., biological families, social-support network) is important. We argue that Bronfenbrenner’s most recent ecological systems theory is an appropriate theoretical framework for policy and practice implications in addressing complex issues surrounding kinship foster care system in the United States. This review integrates the empirical findings collectively on the factors associated with kinship foster care within and between five systems levels of the ecological systems theory: micro- (caregiver-child relationship, attachment, and kinship family environment), meso- (biological families), exo- (social-support network outside the family), macro- (race/ethnicity and policies), and chrono- (welfare reform) systems levels. Theories that are relevant to the ecological factors (e.g., attachment theory) are also discussed. Finally, we draw policy and practice implications from the ecological systems analysis.     

Listening for Safe Places: Networks of Playing and Chalcedon in Disaster Pastoral Care

Disaster pastoral care operates in diverse contexts, which may challenge clergy responders in ecclesiological meaning‐making of their practices of care. This article argues that pastoral care may be imagined as part of a larger “network” of caring acts understood as a collective, multiple care practice. Such practice reflects deep‐rooted movements described in psychoanalytical theory as playing, and the christological idea of communication of properties. Therein, spiritual “safe places” can be seen to emerge, even in the midst of traumatic events.     

Ethics and Changing Mental Health Care: Concerns and Recommendations for Practice

Recent developments in health care delivery in the United States have left many professionals baffled by the continuing changes in practice sparked by the relatively new managed care environment. Psychologists who practice in medical settings are struggling to balance the seemingly competing needs to deliver quality care to clients and patients, while meeting the demands of third-party payers and trying to remain true to their ethical responsibilities. Critical elements of managed care, which many suggest compromise the ethical provision of quality care, include utilization review, financial incentives, and threats to confidentiality. Recommendations are proposed so that mental health professionals may be proactive in protecting their ethical responsibilities in this changing environment.     

TOWARDS THE POSSIBILITY OF IMPASSIBILIST PASTORAL CARE

Not a few scholars reject the notion of divine impassibility. Contemporary theodicists in particular often see impassibility as impotent in the face of evil and suffering. At best, it is assumed that impassibility has no contribution to make to pastoral practice. At worst, it is argued that impassibility has negative repercussions for sufferers and carers. The purpose of this article will be to argue that impassibility has the potential to positively impact pastoral practice. It will be proposed that a constructive ‘impassibilist pastoral care’ arises from a well defined understanding of impassibility and an awareness of the weaknesses of passibility. Consequently, five principles of pastoral care will be identified. Relationality engenders practice which is mutual. Particularity resists the tendency in much care towards ‘normalisation’. Equivalence challenges the passibilist by submitting that the incarnation provides an ontologically equivalent divine suffering which stands in contrast to the so‐called ‘suffering of God’ thesis. Arationality affirms that human reason is limited and therefore prevents the carer from over rationalising suffering. Otherness arises from the belief that God is ontologically distinct and therefore he alone is the source of salvation. In light of these principles, the proposed understanding of ‘impassibilist pastoral care’ is brought into dialogue with the questions sufferers ask and a positive and effective definition of impassibility is submitted. In sum, this article seeks to bring together philosophical and theological defences of impassibility in order to submit a fresh approach to the care of those who suffer.     

A meta-ethnography of parents’ experiences of their children’s life-limiting conditions

ABSTRACT

As many children’s life-limiting illnesses (LLCs) are now often viewed as curable, there is an inevitable tension between providing good treatment and addressing patients and their families’ needs. For health care providers to provide optimal care, they must understand parents’ experiences of illness. Therefore, this article provides a meta-ethnography of parents’ experiences of their children’s LLCs by examining the findings of existing interpretative phenomenological analysis studies. Seventeen studies were included, which allowed the development of a conceptual model. Two multifaceted concepts emerged from the data, namely living in a bounded and polarised space and living in a collapsed time, and these are discussed with reference to their subconcepts. Recommendations for future research and practice are provided.     

Report of the Working Group on Governance and Administration

Prepared by the Working Group on Governance and Administration from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper delineates the various trends in health care that may impact upon organizational structures for psychologists within academic medical centers. Ten variables that describe various functional issues within academic medical centers or health science centers are defined. Finally, seven organizational guidelines and recommendations pertaining to governance of psychological services are detailed.     

The Changing Environment of Selling and Sales Management

New developments and trends in selling and sales management are creating demands and opportunities that require adaptation and new approaches on the part of both sales organizations and academic researchers. This paper summarizes critical dimensions of change in the environment that affect the practice of selling and sales management and introduces the papers that follow in this Anniversary Special Issue of JPSSM.     

Being, Doing, and Knowing: Developing Ethical Competence in Health Care

There is a growing interest in ethical competence-building within nursing and health care practising. This tendency is accompanied by a remarkable growth of ethical guidelines. Ethical demands have also been laid down in laws. Present-day practitioners and researchers in health care are thereby left in a virtual cross-fire of various legislations, codes, and recommendations, all intended to guide behaviour. The aim of this paper was to investigate the role of ethical guidelines in the process of ethical competence-building within health care practice and medical research. A conceptual and critical philosophical analysis of some paragraphs of the Helsinki Declaration and of relevant literature was performed. Three major problems related to ethical guidelines were identified, namely, the interpretation problem (there is always a gap between the rule and the practice, which implies that ethical competence is needed for those who are to implement the guidelines); the multiplicity problem (the great number of codes, declarations, and laws might pull in different directions, which may confuse the health care providers who are to follow them); and the legalisation problem (ethics concerns may take on a legal form, where ethical reflection is replaced by a procedure of legal interpretations). Virtue ethics might be an alternative to a rule based approach. This position, however, can turn ethics into a tacit knowledge, leading to poorly reflected and inconsistent ethical decisions. Ethical competence must consist of both being (virtues) and doing (rules and principles), but also of knowing (critical reflection), and therefore a communicative based model is suggested.     

Trends and developments in community and applied social psychology: JCASP 1991–2010

This paper looks back on the trends and developments in and of the Journal of Community and Applied Social Psychology since its inception twenty years ago. We review to what extent the aims that were originally set for JCASP have been fulfilled. The trends in nationality of authors, themes of publications and their methodology are discussed. Possible implications of these trends and developments for JCASP and its future are pointed at. Copyright © 2010 John Wiley & Sons, Ltd.     

Family Empowerment as a Mediator between Family-Centered Systems of Care and Changes in Child Functioning: Identifying an Important Mechanism of Change

We investigated the associations among perceived fidelity to family-centered systems of care, family empowerment, and improvements in children's problem behaviors. Participants included 79 families, interviewed at two time points across a one-year period. Paired samples t-tests indicated that problem behaviors decreased significantly across a one-year period. Hierarchical multiple regressions indicated that both fidelity to family-centered systems of care and family empowerment independently predicted positive change in children's problem behavior over a one-year period. However, when family empowerment is entered first in the regression, the relationship between fidelity to family-centered systems of care and change in children's problem behavior drops out, indicating that family empowerment mediates the relationship between family-centered care and positive changes in problem behaviors. Consistent with other literature on help-giving practices, family empowerment appears to be an important mechanism of change within the system of care philosophy of service delivery. Implications for practice and staff training are discussed.     

Clinical Geropsychology: Implications for Practice in Medical Settings

Older adults are a rapidly growing segment of the population, who have high rates of chronic illness and who utilize health care resources heavily. Psychologists must become better prepared to work with older patients in geriatric settings, including geriatric assessment units, memory disorders clinics, and nursing homes. In addition, all psychologists will increasingly encounter older patients in environments such as primary care clinics, rehabilitation settings, and disease management programs focusing on problems that are prevalent in older patients (e.g., cancer, diabetes). Suggestions are offered for adaptation of usual clinical practice to address the special needs of older patients and their families, and recommendations made for advancing and expanding the practice of clinical geropsychology.     

Non-binary youth: Access to gender-affirming primary health care

ABSTRACT

Background: Transgender (trans) youth who identify outside the gender binary are a growing subpopulation. In this article, we document differences in access to gender-affirming health care between binary and non-binary identified trans youth and explore ways of meeting the health needs of non-binary youth within primary care settings.

Methods: The Canadian Trans Youth Health Survey is a national online survey of trans youth, 14–25 years, conducted in 2013–2014. Among the 839 participants who responded to gender identity items in the survey, 41% identified as non-binary. We compared demographic, health outcome, and health care access responses between non-binary and binary (trans girls/women and trans boys/men) youth.

Results: Non-binary and binary youth were similar in most demographics, including age, geographic distribution, and ethnocultural backgrounds, however a larger proportion (82%) of non-binary youth were assigned female at birth. Older non-binary youth (aged 19–25) were significantly more likely to forego needed healthcare than older binary youth; no significant differences were found between younger (14–18) non-binary and binary youth in foregoing healthcare. Overall, non-binary youth (13%) were significantly less likely than binary youth (52%) to access hormone therapy, but they were more likely than binary youth to report experiencing barriers to accessing hormone therapy when needed.

Conclusions: Non-binary trans youth in Canada report challenges in accessing needed gender-affirming healthcare. Primary care providers are well-situated to integrate a broad range of gender-affirming care services into practice in order to address the unique needs of non-binary youth. Future research is warranted to explore experiences of non-binary youth related to barriers to care and to explore how services can be designed and delivered to better meet the needs of non-binary youth seeking gender-affirming primary care.     

Special Aspects of Countertransference in Analytic Group Psychotherapy

The structure of health care delivery is in a period of rapid change. An understanding of psychotherapy service use patterns indicates the importance of time categories as well as the relevance of group techniques. Traditional interpersonal and psychodynamic group techniques may be modified for time-limited use without sacrificing basic values and with demonstrated effectiveness. Adapting to a more fiscally stringent practice environment requires the clinician to undertake a difficult process of transition. As professionals our task is to prepare ourselves for this challenge and to let the health care system know that proper practice guidelines are necessary to achieve effective treatment for our patients.     

Considerations on medical training for gender-affirming care: Motivations and perspectives

Abstract

Background: Many transgender individuals lack access to needed medical care, partially due to a lack of providers with experience in gender-affirming healthcare.

Aims: The purpose of this study was to identify professional motivators for medical providers seeking out training in gender-affirming care and to define which training experiences were most beneficial to their career development. By identifying experienced providers’ recommendations on which training modalities are most relevant to their practice, we aim to suggest future directions for medical education initiatives to effectively expand the transgender care workforce.

Methods: A voluntary cross-sectional electronic survey was distributed through professional listservs and publicly-available referral lists to interdisciplinary providers who self-identified as having experience in providing care to transgender individuals.

Results: One hundred and fifty-three (n?=?153) physicians, physician assistants, or advance-practice nurses responded to the survey. The majority (96.7%) were located in the United States, representing 37 states. The two most common motivators for seeking out training in gender-affirming care were filling a need in the community (73.0%) and/or having met a transgender-identified person in a clinical setting who requested care (63.8%). While many providers gained skills independently (57.3%), the two most commonly-available training opportunities were professional conferences (57.3%) and mentorship (41.3%). Respondents were most likely to recommend that others in their field be trained via structured clinical experience (e.g., a rotation or longitudinal exposure during training), rather than additional didactic training.

Discussion: This study identifies key high-yield training methodologies which could improve access to quality gender-affirming healthcare. Through integration of structured clinical experiences during training, direct clinical mentorship, and professional development at conferences on gender-affirming care, the workforce of welcoming and prepared healthcare providers for transgender patients will increase. This will lead to a tremendous improvement on access to gender-affirming care in our communities.     

Building and Maintaining Clinical Programs

This paper describes the basic elements of practice development and management within the academic medical setting. These include assessment of the market environment, both in the community and within the medical setting, product development, marketing, budget basics, quality, managed care negotiations, and finding time to do research in a financially-driven health care system.     

The Future of Psychology in Medical Specialities: Introduction to the Special Issue

The continuing evolution of the health care delivery system in the United States presents threats and opportunities to psychologists in medical settings. This special issue explores the future of psychology in psychiatry, family medicine, rehabilitation, geriatric medicine, and pediatric medicine. The challenges facing neuropsychology and pain management are explored also. Finally, the professional issues of ethics in managed care, psychology in the public sector, and training future psychologists are addressed. Each paper summarizes concerns and provides recommendations for clinical practice, research, and training.