Chaplain–Physician Consultancy: When Chaplains and Doctors Meet in the Clinical Context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.     

Observations of Muslim Physicians Regarding the Influence of Religion on Health and Their Clinical Approach

Although most patients report wanting their physicians to address the religious aspects of their lives, most physicians do not initiate questions concerning religion with their patients. Although religion plays a major role in every aspect of the life of a Muslim, most of the data on the role of religion in health have been conducted in populations that are predominantly non-Muslim. The objectives of this study were to assess Muslim physicians' beliefs and behaviours regarding religious discussions in clinical practice and to understand the factors that facilitate or impede discussion of religion in clinical settings. The study is based on a cross-sectional survey. Muslim physicians working in a tertiary care hospital in Saudi Arabia were invited to complete a questionnaire that included demographic data; intrinsic level of religiosity; beliefs about the impact of religion on health; and observations, attitudes, behaviours, and barriers to attending to patients' religious needs. Out of 225 physicians, 91% agreed that religion had a positive influence on health, but 62.2% thought that religion could lead to the refusal of medically indicated therapy. Over half of the physicians queried never asked about religious issues. Family physicians were more likely to initiate religious discussions, and physicians with high intrinsic religiosity were more likely to share their own religious views. Residents and staff physicians tended to avoid such discussions. The study results highlight the fact that many physicians do not address patients' religious issues and that there is a need to clarify ethically sound means by which to address such needs in Islamic countries. Medical institutions should work to improve the capacity of medical personnel to appropriately address religious issues. The training of clinical religious advisors is a promising solution to this dilemma.     

Pediatrician Identification of Child Behavior Problems: The Roles of Parenting Factors and Cross-Practice Differences

While most primary care pediatricians acknowledge the importance of identifying child behavior problems, fewer than 2% of children with a diagnosable psychological disorder are referred for mental health care in any given year. The present study examined the potential role of parental characteristics (parental affect, parenting style, and parenting self-efficacy) in pediatrician identification of child behavior problems, and determined whether these relationships differed across practices. Parents of 831 children between 2 and 16 years completed questionnaires regarding demographic information, their child’s behavior, their affect, their parenting style, and their parenting self-efficacy. Pediatricians completed a brief questionnaire following visits in four community-based primary care practices in the Midwest. Logistic regressions controlling for child behavior and demographic predictors of pediatrician identification found that an authoritarian parenting style, in which parents yell or strongly negatively react to problem behavior, was negatively associated with likelihood of identification in the overall sample. However, the variables that were predictive of pediatrician identification differed depending on the specific practice. Parental characteristics can aid in understanding which children are likely to be identified by their pediatrician as having behavioral problems. The finding that practices differed on which variables were associated with pediatrician identification suggests the need to potentially individualize interventions to certain physicians and practices to improve identification of child behavior problems in primary care.     

Children and Adolescents with Medically Unexplained Symptoms: A Systematic Review of the Literature

Abstract

Medically unexplained symptoms (MUS) in children and adolescents are confounding and concerning for patients, parents, and health care practitioners. Our goal was to review and summarize the literature for family therapists working with a diverse, challenging patient population coping with MUS. A search of multiple databases from 1994 to 2018 was conducted using MUS and related terms. The literature was then organized into subcategories based on its relevance to family therapists, particularly medical family therapists collaborating with primary care physicians. We conclude with a discussion about gaps in the literature and suggestions for clinical management.     

The value history: A necessary family document

Patients' wishes regarding health care and dying must be taken into consideration by their physicians. Competent patients need to record directives about their care in advance of a crisis situation. The primary care physician, seeing the patient at the time of a routine office visit, is in a favorable position to explore and record attitudes. A patient's value system should be part of a medical history before hospital admission. Details in a Value History Questionnaire facilitate guiding an incompetent patient through a terminal illness in accordance with wishes previously expressed. An instrument in the form of a questionnaire was designed to record the attitudes of 200 patients regarding health care and dying. Respondents ranged in age from 17 to 84 years, and all were members of one family practice. They reacted positively to the opportunity to record their values, opinions, and wishes about their health care and process of dying. They clearly indicated that, in the absence of prior directives, they would want their families consulted about crucial decisions.     

The Doctor-Patient Relationship in the Post-Managed Care Era

The growth of managed care was accompanied by concern about the impact that changes in health care organization would have on the doctor-patient relationship (DPR). We now are in a “post-managed care era,” where some of these changes in health care delivery have come to pass while others have not. A re-examination of the DPR in this setting suggests some surprising results. Rather than posing a new and unprecedented threat, managed care was simply the most recent of numerous strains on the DPR that have occurred throughout the century. These strains are a constant, inevitable consequence of the varying needs and concerns of patient and physicians as they seek to balance their desires for a certain type of DPR with their simultaneous desire for other aspects of care such as lower costs, greater technological sophistication, and improved outcomes.     

Selection of consultees in school mental health consultation

To further understanding regarding the selection of teacher consultees, 15 mental health consultants completed a questionnaire. Consultants ranked teachers in their school consultation placements on ability to meet academic and socioemotional needs of children, receptivity to change, and likability. Next, after indicating which teachers they would most and least like to work with, consultants rated the teachers on nine 5-point rating scales. In general, results indicate that most preferred consultees, in comparison to least preferred consultees, are perceived as less needy of assistance around issues concerning children and lessons, more responsive to consultation, and more likable. It appears that teachers most in need of assistance are not selected for consultation.     

Parents’ View of Child Care Quality: Values, Evaluations, and Satisfaction

Parents’ view of the quality of early childhood education and care services has mostly been addressed from the perspective of customer satisfaction. This study investigated parents’ view within a more comprehensive framework in which parents’ values of child care, their evaluations of their child’s experience at the service and overall satisfaction with the service were considered. In particular, the study explored how values and evaluations are related and how they affect overall satisfaction. A questionnaire including a total of 96 items was filled in by 2,936 parents of children attending infant-toddler day-care centres in Rome, Italy. Parents were asked to express their values regarding child care quality and evaluate specific aspects of their experience. Parents’ perspectives of both their child’s and their own experience of childcare services were addressed separately. Two principal component analyses were performed in order to identify latent dimensions underlying parents’ values about child care quality and their evaluations of the service attended by their child. The relationships between the different dimensions of value, evaluation, and overall satisfaction with their child’s and their own experience were explained through two path models, in which values predict evaluations and these, in turn, predict overall satisfaction. Results showed that parents have a multi-faceted view of child care quality and confirm the relevance of taking into account their point of view in an analysis of the quality of early childhood education services.     

Reducing the Risk for Preschool Expulsion: Mental Health Consultation for Young Children with Challenging Behaviors

Increasing numbers of young children are being expelled from child care settings because of their problem behavior. Access to mental health consultation is related to lower rates of expulsion, but additional data are needed to document the pathways through which mental health consultation reduces the risk of expulsion. We report on outcomes from a 4-year project designed to reduce the number of children expelled for problem behavior in a large suburban county in Maryland. Two master’s-level professionals provided behavioral consultation to child care providers who identified nearly 200 children at imminent risk for expulsion. Child care providers rated children’s social skills and problem behaviors at referral and discharge using the Preschool Kindergarten Behavior Scales and the Brief Infant Toddler Social Emotional Assessment. Statistically significant increases in social skills and reductions in problem behaviors were seen for children who received individualized consultation. More than three-quarters of the children who were at risk for expulsion were able to be maintained in their current child care placement; of those that changed placements, only half (n = 13) were removed involuntarily. These findings provide additional support for mental health consultation as a promising strategy to reduce the risk for expulsion for young children with problem behaviors.     

Determinants of patient satisfaction with the medical consultation

Abstract

This study assessed patient satisfaction with the medical consultation in ambulatory settings. A multistage sampling method, stratified by geographical location in metropolitan Sydney and type of medical practice, was employed. Two hundred and seventy-two patients attending medical consultations completed a brief questionnaire and interview immediately following a medical consultation with either a general practitioner or a medical specialist. Factor analysis of the questionnaire indicated that 58% of the variance in patient satisfaction ratings was accounted for by the level of interpersonal warmth and respect and the amount of information communicated by the doctor. Other factors impacting on satisfaction included the number of patient requests perceived to be met by the doctor, and the characteristics of the medical encounter, such as the length of the consultation and whether the visit was a first or subsequent consultation. There was no association between level of satisfaction and gender of doctor or the type of medical practice attended.     

The role of attitudes and beliefs in differential health care utilisation among Chinese in Singapore

Abstract

One hundred and twenty-eight Chinese patients at two Western medical practices and two Chinese medical practices in Singapore completed a questionnaire regarding perceptions of illnesses. Health beliefs and attitudes towards different medical practitioners. Results indicate significant differences between those who consult only allopathic physicians (Western doctors) and those who consult both practitioners of traditional Chinese medicine (sinsehs) and Western doctors. Individuals consulting both Western doctors and sinsehs perceived a smaller proportion of “general” illness attributes (those found in both Western and Chinese medicine) to be relevant to specific diseases and showed greater endorsement of Chinese health beliefs than did individuals seeking help only from Western doctors. Also individuals consulting both types of practitioners expressed less satisfaction with the doctor's treatment than did those consulting only Western doctors and also rated sinsehs as more concerned with patient well-being and as listening more to their patients.     

Physician-assisted suicide: the role of mental health professionals

A review of the literature was conducted to better understand the (potential) role of mental health professionals in physician-assisted suicide. Numerous studies indicate that depression is one of the most commonly encountered psychiatric illnesses in primary care settings. Yet, depression consistently goes undetected and undiagnosed by nonpsychiatrically trained primary care physicians. Noting the well-studied link between depression and suicide, it is necessary to question giving sole responsibility of assisting patients in making end-of-life treatment decisions to these physicians. Unfortunately, the use of mental health consultation by these physicians is not a common occurrence. Greater involvement of mental health professionals in this emerging and debated area is advocated. Beyond describing mental health professionals' role in the assessment of patient competency or decision making capacity, other areas of potential involvement are described. A discussion of ethical principles relevant to this area follows, along with comments on the training necessary to adequately serve patient needs.     

The effect of relational continuity of care in maternity and child health clinics on parenting self‐efficacy of mothers and fathers with loneliness and depressive symptoms

This study explored the parenting self‐efficacy of the parents of 18‐month‐old children in the context of Finnish maternity and child health clinics. This parenting self‐efficacy was observed in relation with the relational continuity of care and parents' experienced loneliness and depressive symptoms. The relational continuity of care was provided by a public health nurse in maternity and child health clinics. The participating parents were drawn from the STEPS study that is being carried out by the Institute for Child and Youth Research at the University of Turku. The results showed that relational continuity of care provided by the same public health nurse in the maternity and child health clinics was associated with mothers' higher emotional loneliness and with lower scores on three dimensions of parents' parenting self‐efficacy. Loneliness and depressive symptoms negatively influenced parents' parenting self‐efficacy – however, in the case where the family had experienced relational continuity of care, the parents' higher levels of depressive symptoms had not weakened their parenting self‐efficacy beliefs. These results are discussed in terms of organizing maternity and child health clinic services.     

Focusing on Patient Needs and Preferences May Improve Genetic Counseling for Colorectal Cancer

During cancer genetic counseling, different items which counselors consider important are discussed. However, relatively little empirical evidence exists regarding the needs and preferences of counselees. In this study needs and preferences were assessed from counselees with a personal and/or family history of colorectal cancer (CRC), who were referred for genetic counseling regarding CRC. They received a slightly modified version of the QUOTE-GENE^ca questionnaire prior to their first visit to the Hereditary Cancer Clinic. Response rate was 60 % (48/80 participants). Counselees rated the importance of 45 items assessing their needs and preferences regarding the content and process of genetic counseling. Participants rated the items regarding discussion of information about their familial CRC risk (100 %) and preventive options (98 %) as important or very important. Fewer participants rated items concerning general information on genetics as important. Sensitive communication during counseling was considered very important by a large percentage of counselees. Generally, no major differences were seen between participants in relation to individual characteristics. Our data suggest that focusing on familial CRC risk and surveillance options, in combination with sensitive communication may lead to better satisfaction with genetic counseling.     

Discussing the therapeutic setting in child and adolescent psychoanalytic psychotherapy

The aim of this paper is to contribute to a debate on the particular characteristics of the therapeutic setting in child and adolescent psychoanalytic psychotherapy and its differences from the setting in adult therapy. In our opinion, there is a fundamental difference between these two, as in child and adolescent psychotherapy two distinct aspects co-exist and in some areas, overlap. In this paper, we attempt to delineate these two aspects, following Green’s division of the analytical setting into the active matrix and the casing. We propose that in child and adolescent psychotherapy the therapeutic contract, the active matrix, concerning the necessary conditions for making a therapy psychoanalytic – namely, the therapist’s free-floating attention and the patient’s free associations – is agreed between the therapist and the child/adolescent. We argue that in contrast, the contract regarding the casing – the timings of sessions, the fees and so on – is agreed primarily with the parents or carers of the child/adolescent. Ruptures and possible modifications in both the matrix and the casing of the setting are discussed through the presentation of clinical material.     

French translation and validation of the Karitane Parenting Confidence Scale

IntroductionPerceived parental self-efficacy (PSE) is thought to play a crucial role in parental well-being, the parent-infant relationship, and other aspects of infant development, particularly in the early postnatal period. The Karitane Parenting Confidence Scale (KPCS) is a 15-item self-report questionnaire designed for parents with infants aged 0–12 months.ObjectiveTo explore the factor structure of a French translation of the KPCS and assess its psychometric qualities.MethodUsing a French-language translation of the KPCS (KPCS-F), 257 parents of children aged 0–12 months were recruited via childcare structures (e.g. nurseries, community centers, mother and child protection centers). Confirmatory factor analyses (CFA) were conducted to examine 2- and 3-factor solutions for the KPCS-F scale. Internal reliability and convergent validity were evaluated.ResultsThe best model was a two-factor solution (PSE “infant care” and PSE “parental role”) restricted to 12 items. Sound internal consistency was indicated, with a Cronbach's alpha coefficient of 0.80 and a McDonald's omega coefficient of 0.80. Test-retest reliability was good. KPCS-F score was correlated with social support and psychological well-being scores.ConclusionThe KPCS-F showed substantial validity and reliability for this sample. The translated scale should therefore improve assessment and intervention processes for professionals working with parents of young children.     

When Psychologists Work with Older Adults: A Survey of Ethical Beliefs and Practices

Despite the number of publications concerning legal and ethical issues faced by psychologists, and despite the increased interest in addressing specific concerns related to aging, little is known about the actual beliefs and practices of psychologists when they work with older adults. Given the changing demographics in the United States, many mental health professionals will have contact with older adult clients, and the focus of the present study was to examine the extent to which psychologists are prepared to work competently with older adult clients. Survey data were collected from 156 APA Division 12 (Clinical Psychology) and 17 (Counseling Psychology) members regarding the degree to which they engaged in each of 50 behaviors and the degree to which they considered each behavior ethical. Findings are presented in terms of percentages of responses to items on the questionnaire, and ANOVAs were performed on important demographic items to identify statistically significant differences among variables. Coursework in geropsychology or aging, specialization with older adults, and working with a high percentage of older adults were related to higher scores on the Overall Ethical Behavior scale. Females scored higher than males on the Overall Ethical Belief scale.