Making Positive Changes Counseling (MPCC) Program: A Creative Adaptation of Motivational Interviewing for Use with Children in School Settings

ABSTRACT

Motivational Interviewing (MI)-based counseling can be creatively adapted for working with elementary school students in disciplinary alternative education program (DAEP) settings. The purpose of this article is to describe the implementation of MI with elementary-aged students in the DAEP. The Making Positive Changes Counseling (MPCC) program is a six-session program, which addresses children’s readiness for change, exploration of values and goals and current behaviors, recognition of personal strengths, perspective taking, recognition for possible changes, and effective decision making. The program is an adaptation of the standardized MI approach utilizing visuals and age-appropriate materials that are easily adaptable to individualized (or even group) guidance format.     

Applying Motivational Interviewing in a Domestic Violence Shelter: A Pilot Study Evaluating the Training of Shelter Staff

ABSTRACT

This pilot study examined the use of motivational interviewing (MI) with 20 women receiving services at a domestic violence shelter. The experimental group (n = 10) received regular treatment services (RTS) from shelter counselors who were trained in MI; the control group (n = 10) received RTS only. Fisher's exact test showed that participants who received MI-enhanced RTS were significantly more motivated for change (p = .029), as measured through a dichotomous readiness for change motivational variable on the University of Rhode Island Change Assessment (URICA; Center on Alcoholism, Substance Abuse, &; Addiction Research Division, 1996 Center on Alcoholism, Substance Abuse, &; Addiction Research Division. 1996. University of Rhode Island Change Instrument (URICA) Scale, Albuquerque, NM: Author.  [Google Scholar]). Findings suggest that MI can be helpful in increasing the readiness for change in domestic violence survivors who contemplate leaving abusive relationships.     

Integrated Primary Care: An Inclusive Three-World View Through Process Metrics and Empirical Discrimination

Integrating behavioral health services within the primary care setting drives higher levels of collaborative care, and is proving to be an essential part of the solution for our struggling American healthcare system. However, justification for implementing and sustaining integrated and collaborative care has shown to be a formidable task. In an attempt to move beyond conflicting terminology found in the literature, we delineate terms and suggest a standardized nomenclature. Further, we maintain that addressing the three principal worlds of healthcare (clinical, operational, financial) is requisite in making sense of the spectrum of available implementations and ultimately transitioning collaborative care into the mainstream. Using a model that deconstructs process metrics into factors/barriers and generalizes behavioral health provider roles into major categories provides a framework to empirically discriminate between implementations across specific settings. This approach offers practical guidelines for care sites implementing integrated and collaborative care and defines a research framework to produce the evidence required for the aforementioned clinical, operational and financial worlds of this important movement.     

Integrating Mental Health and Primary Care Services in the Department of Veterans Affairs Health Care System

Integrating mental health care in the primary care setting has been identified in the literature as a model for increasing access to mental health services and has been associated with enhanced clinical and functional patient outcomes and higher patient satisfaction. The Department of Veterans Affairs (VA), which operates the nation’s largest integrated health care system, has taken a leadership role in creating a health care system in which mental health care is provided in the primary care setting. This article examines VA’s efforts and progress to date in implementing evidence-based models of integrated mental health services nationally in community based outpatient clinics, home based primary care, and outpatient primary clinics at medical facilities. Psychology plays an important role in this progress, as part of an overall interdisciplinary effort, in which all professions are crucially important and work together to promote the overall well-being of patients. This article is based in part on a presentation by the first author at the 3rd National Conference of the Association of Psychologists in Academic Health Centers (APAHC) in May of 2007 in Minneapolis, Minnesota.     

Implementing Trauma-Informed Care in Primary Medical Settings: Evidence-Based Rationale and Approaches

ABSTRACT

Chronic stress stemming from trauma exposure and posttraumatic stress disorder (PTSD) leads to many health problems that are typically seen by primary care providers. Unfortunately, providers rarely identify trauma as the root cause of patient difficulties. The present paper provides an evidence-based rationale for implementing trauma-informed care principles and processes into medical primary care systems. Beginning with a review of prevalence of trauma exposure and PTSD in primary care clinics, this article elucidates relationships between trauma exposure and behavioral and medical health problems, as well as clinical and physiological pathways that lead from trauma exposure to illness. The article concludes with exposition of trauma-informed interventions that can be implemented in primary care clinics, and discussion of future directions.     

医疗决策的程序公正

由于社会满足不了所有的医疗需求,医疗决策问题变成了确定医疗的限度问题。由于社会对于限度决定很难获得共识,医疗决策要通过公正的程序获得。医疗决策不能由某个人或某个团体或权力机构做出,而应该通过民主协商来做出,否则,人们会质疑医疗决策的合法性。     

Cultural Influences in the Aetiological Beliefs of Saudi Arabian Primary Care Patients About Their Symptoms: The Association of Religious and Psychological Beliefs

Objective To develop a self-report questionnaire to measure the beliefs of Arabic primary care patients about the causes of their physical symptoms; to use this to quantify the beliefs of patients consulting their general practitioners (GPs) in Saudi Arabia; and to test whether patients with psychological problems differ from others in their beliefs, particularly religious and supernatural beliefs. Methods Consecutive patients (N = 224) completed a specially developed aetiological beliefs’ questionnaire. Patients were divided into two groups (cases and non-cases of emotional disorder) according to the GHQ-12. Results Religious and supernatural aspects of culture colour patients’ symptom beliefs: that their symptoms were a test or punishment from Allah’ was the most common belief. Even in non-cases, around half the patients also endorsed nerves and stress as a cause of their physical symptoms. Cases were more likely than non-cases to endorse items related to both religious and psychological factors. Conclusion There is no support for the view that Saudi Arabian patients explain symptoms supernaturally as a way of denying psychological factors. GPs and health professionals in Saudi primary care need to understand what patients believe to be the cause of their problems and to appreciate that religious and psychological beliefs are both very common. GPs should address psychological beliefs and concerns even with those patients who present physical symptoms.     

Primary care decision making in response to psychological complaints: the influence of patient race

Eighteen general practitioners indicated diagnostic and treatment decisions in response to patient vignettes. Results indicated that White patients were more likely to be correctly diagnosed as having anxiety than any other complaint. Asians were just as likely to receive a physical diagnosis as they were to receive one of anxiety. Copyright © 2000 John Wiley & Sons, Ltd.