Application of the APA ethics code for psychologists working in integrated care settings: Potential conflicts and resolutions

ABSTRACT

Increasingly, there is evidence of the potential benefits of an integrated care model. In fact, the American Psychological Association (APA) supports the role of psychologists in integrated healthcare given the positive outcomes for patients in primary care settings such as increased access to mental health services, reduced mental illness stigma, and improved health associated with recognizing the impact of psychosocial factors on physical wellbeing. Less attention has been paid, however, to ethical dilemmas that may arise for psychologists working in integrated healthcare. This paper explores considerations for resolving potential ethical conflicts that may arise for psychologists working in integrated care settings.     

Singaporean graduate majors in education perceptions of workplaces and roles of psychologists

This paper examined perceptions of workplaces and roles of psychologists of 315 Singaporean undergraduate students in education. The participants rated the appropriateness of 21 workplaces and 32 roles of psychologists using a 7-point scale. The group showed restricted views of psychology and psychologists as they related psychologists' work mainly to social and organizational services and referred roles of psychologists to giving social services related to delinquency and disorders.     

Counselling the community: The contribution of counselling psychologists to the development of primary care

The primary care groups (PCGs) newly introduced to the National Health Service require general practitioners and primary care teams to improve the health of their communities by addressing the health needs of their population, promoting the health of that population and working with other organizations to deliver effective and appropriate care. Community-oriented primary care (COPC) is an internationally tested model for primary health care development which is now being employed within the UK. This paper outlines the COPC model, and demonstrates how the skills and knowledge base of counselling psychologists and primary care counselling can contribute to a community-oriented primary care approach.     

Physician-assisted dying: review of issues and roles for health psychologists.

The authors review the recent empirical and theoretical literature on physician-assisted dying (PAD) since implementation of the Oregon Death With Dignity Act (ODDA) in 1997. The authors provide a brief overview of end-of-life practices; consider ethical and practical issues regarding PAD; outline governments' acts and health care organizations' current codified principles regarding PAD, including the American Psychological Association's goal to increase the visibility of psychology in end-of-life issues; examine recent data pertinent to ODDA implementation and psychologists' attitudes regarding PAD; and outline potential roles for health psychologists responding to requests for PAD and implementing PAD (where it is legal). Health psychologists can assume at least 4 roles regarding PAD: (a) policy advocates, (b) educators, (c) practitioners, and (d) researchers.     

Academic and nonacademic community psychologists: An analysis of divergence in settings,roles, and values

Differences between academic and nonacademic psychologists may be viewed as immutable, worthy of encouragement, or as a situation which the latter group must remedy by becoming “more scientific.” We contend that for community psychology, which perceives theory, application, and action as valid aspects of its broad paradigm, it would be most adaptive toexplicitly address the challenge of managing a balance between diversity and cohesion. There are signs that the present leadership of Division 27 recognizes aspects of this problem and is reconsidering the role and purpose of the Division as an organizing framework for the discipline (Trickett, Note 3). It is our view that engendering a commitment from various subgroups within the membership to addressing the disparities revealed by our respondents is required for resolving what we see as major obstacles to future development of the discipline. The conceptual and empirical approach presented in this study can be an important tool in forging constructive solutions to the challenges we have presented.     

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.     

The professional identity of counselling psychologists in health care: a review and call for research

Despite (a) anecdotal evidence which suggests that it is possible to be a counselling psychologist in non-traditional settings, and (b) the potential integration of counselling psychology foci with the medical model, there has been some discussion about whether counselling psychologists who practice in health care settings might experience a change in their professional identity. Professional identity is defined here as a sense of connection to the values and emphases of counselling psychology. The retention of professional identity seems important for counselling psychologists in health care settings. This is considering that the application of counselling psychology principles has the potential to make their contributions unique among mental health professionals in the health care arena. Here, the authors describe the evolution of ‘counselling health psychology’ and address issues of professional identity. Limitations of existing literature are examined. Recommendations for future research are also made.     

The practitioner‐researcher divide revisited: Strategic‐level bridges and the roles of IWO psychologists

This paper responds to, and extends, the debate between Gelade, Wall, Symon and Hodgkinson in JOOP. In concluding that JOOP is fulfilling its remit for robust information exchange between research and practice, four lines of argument are proposed that (i) the Principle of Scientific Replication warrants full details of study methods being routinely published, (ii) any divide is reflective of a perfectly natural distance between the two wings of the discipline and is not necessarily harmful as long as sufficient bridging mechanisms exist, (iii) several strategic‐level bridging mechanisms do exist but need to be better utilized and (iv) as JOOP will be unable to be all things to all readers, its most suitable niche remains as a scientific outlet for pragmatic research in IWO psychology internationally.     

运动区Beta节律的活动特点及功能意义

人类大脑运动皮质的Beta(15~30 Hz)和Mu节律(8~14 Hz)有共同的活动特征,研究指出二者可能是联合的脑电成分。然而越来越多研究表明运动区Beta节律可能独立于Mu节律,且具有特殊的功能意义。线索诱发的Beta节律降低、运动前Beta节律降低和运动后Beta节律回复增强都是Beta与Mu节律不同的活动形式,表明运动区Beta节律有其独特的心理意义。本文主要对运动区Beta节律不同于Mu节律的活动特征及已有的理论解释进行了梳理和分析,并结合儿童研究的数据,从发展的角度对运动后Beta节律的理论假说进行了评述,最后在此基础上为进一步探索运动区Beta节律的功能意义提出了研究的展望。     

Judgment of infant cry: The roles of acoustic characteristics and sociodemographic characteristics

Adult judgments of infant cry are determined by both acoustic properties of the cry and listener sociodemographic characteristics. The main purpose of this research was to investigate how these two sources shape adult judgments of infant cry. We systematically manipulated both the acoustic properties of infant cries and contrasted listener sociodemographic characteristics. Then, we asked participants to listen to several acoustic manipulations of infant cries and to judge the level of distress the infant was expressing and the level of distress participants felt when listening. Finally, as a contrasting condition, participants estimated the age of the crying infant. Using tree‐based models, we found that judgments of the level of distress the infant was expressing as well as the level of distress listeners felt are mainly accounted for by select acoustic properties of infant cry (proportion of sound/pause, fundamental frequency, and number of utterances), whereas age estimates of a crying infant are determined mainly by listener sociodemographic characteristics (gender and parental status). Implications for understanding infant cry and its effects as well as early caregiver‐infant interactions are discussed.     

The roles of the temporal lobe in creative insight: an integrated review

Recent studies have revealed that the temporal lobe, a cortical region thought to be in charge of episodic and semantic memory, is involved in creative insight. This work examines the contributions of discrete temporal regions to insight. Activity in the medial temporal regions is indicative of novelty recognition and detection, which is necessary for the formation of novel associations and the “Aha!” experience. The fusiform gyrus mainly affects the formation of gestalt-like representation and perspective taking. The anterior and posterior middle temporal gyri (MTG) are individually associated with extensive semantic processing and inhibiting salient or routine word associations, which are necessary to form non-salient, novel and remote associations. The anterior and posterior superior temporal gyri (STG) are individually responsible for integrating/binding and accessing various types of available conceptual representations. Based on the current knowledge, an integrated model of the temporal lobe's role in insight and some future directions are proposed.     

Religion and anxiety treatments in primary care patients

Earlier data suggested that religious physicians are less likely to refer to a psychiatrist or psychologist. This follow-up study measures how religious beliefs affect anxiety treatments in primary care. We surveyed US primary care physicians and psychiatrists using a vignette of a patient with anxiety symptoms. Physicians were asked how likely they were to recommend antianxiety medication, see the patient for counseling, refer to a psychiatrist, refer to a psychologist or licensed counselor, encourage meaningful relationships and activities, and encourage involvement in religious community. We experimentally varied symptom severity, whether the patient was Christian or Jewish, and whether she attended religious services. Physician attendance at religious services was assessed in the survey. The response rate was 896 out of 1427 primary care physicians and 312 out of 487 psychiatrists. Religious physicians were more likely to promote religious resources. There was no statistically significant difference between physicians' recommendations for religious and nonreligious patients. There was no statistically significant difference in religious and nonreligious physicians' referrals to a psychologist, licensed counselor, or psychiatrist. Ultimately, we did not find a difference in religious and nonreligious physicians' support for mental health referrals, however, religious physicians were more likely to encourage using religious resources.     

Depression secondary prevention in primary care

In order to analyse efficacy, effectiveness and efficiency of several depression secondary prevention programs, three group interventions were developed in Primary Care Centres: cognitive-behavioral therapy, promotion of one's coping resources therapy (just paying attention to abilities, without training) and social support. The sample was composed by 60 people with from-mild-to-moderate depressive symptoms, who were randomly assigned either to any of the treatments or to a control group (waiting list). Psychopathology, quality of life and attendance to mental health services variables were assessed at pretest, posttest and two follow-up evaluations, 6 and 12 months afterwards. Outcomes: both therapies had more efficacy, effectiveness and efficiency compared to the social support group, and this one was better than the waiting list.     

Counselling in primary care and the new NHS

A detailed overview of the changes in the structures of the new NHS in England, Scotland and Wales is presented, looking at the effect these changes will have on counsellors working in primary care. New structures for the provision of counselling in primary care and their implementation are explored. Supervision of counsellors in primary care is addressed and how supervision might fit into a managed counselling service. The requirements of clinical governance are discussed, as is the necessity of appropriate audit and evaluation data to inform service and individual development.