Integrating mind and body: Graduate psychology education in primary behavioral health care

Extensive research supports the biopsychosocial model, but the current health care system generally operates according to a model of mind-body dualism. Integrated primary behavioral health care offers an alternative to this dualism. This paper describes the University of Louisville Graduate Psychology Education (GPE) program, a pre-doctoral integrated primary behavioral health care training program. This program emphasizes four shared psychosocial determinants that have been associated with physical health status: Victimization and potentially traumatic stress exposure, emotional functioning, social relationship functioning, and illness representations. It does so within the broader context of providing care for individuals who are underserved and economically disadvantaged. The initial phase of the program is evaluated and implications for graduate psychology education and patient care are discussed.     

Are All Types of Cooperation Equal? Impact of Academic Controversy Versus Concurrence-Seeking on Health Education

Cooperative learning is commonly used to promote prosocial outcomes. It is often assumed that all types of cooperative learning are equal. One way in which cooperative learning procedures differ is in the role of conflict. This study compares the relative impact of two types of cooperative learning (concurrence-seeking which emphasizes harmony among students and academic controversy which emphasizes intellectual conflict among students) on outcomes of a health education program focusing on tobacco use, alcohol use, and AIDS. Participants were 37 students from grades 9–12 in a career-education track in a suburban mid-western high school. The students were classified as being low performing academically and at risk for destructive health habits. Students in the controversy condition, compared with those in the concurrence-seeking condition, significantly improved in knowledge about AIDS, developed healthier attitudes related towards safe sex and cigarettes, developed higher academic self-esteem, generated greater social influence, and improved in constructive conflict skills.     

Parent education in the public school: The parent and preschooler's program

The public school is discussed as a milieu in which to provide parent education for parents of preschool children. Primary prevention within the public school setting is designated as a means by which many children and families can be reached while the mental health of infants and young children is addressed as an integral concern of the community. The Parent and Preschooler's Program is described as an example of the implementation of a preschool parent education program in a public school which was initiated by community members and is eagerly supported by the school system.     

A Qualitative Assessment of the Sex Education Needs of Married Iranian Women

Despite a comprehensive reproductive health program there is little sex education available in Iran. In this article we present results of a study conducted to identify content area for a proposed sex education program for married Iranian women. Twenty-one married female clients (23–45 years) and 18 reproductive health providers, recruited from urban health clinics in Tehran using non-probability sampling, participated in four focus group discussions. Sexual health information needs related to reproductive tract and sexually transmitted infections, “acceptability” of certain sexual practices such as oral and anal intercourse, and the sexual response cycles and physiology of men and women. Women’s sexual concerns related to communication, incompatibility of sexual interests and desire, and their ability to maintain a strong marriage. Two themes cut across women’s responses to all questions: modesty and maintaining a strong marriage. Results contributed to the design of a sex education program that addressed the specific information needs and concerns of Iranian women.     

Toward an expanded vision of clinical ethics education: from the individual to the institution

This paper advances a new paradigm in clinical ethics education that not only emphasizes development of individual clinicians' skills, but also focuses on the institutional context within which health care professionals work. This approach has been applied to the goal of improving the care provided to critically and terminally ill adults. The model has been adopted by about thirty hospitals and nursing homes; additional institutions will soon join the program, entitled Decisions Near the End of Life. Here, we describe the history and rationale for this approach, its goals, pedagogical assumptions, and design.     

A comprehensive and systematic approach to parent education

Abstract

This paper emphasizes the importance of parent education, particularly in our current rapidly changing society. The history of parent education is briefly reviewed and a new program called STEP, Systematic Training for Effective Parenting is discussed in detail.     

In-depth continuing education for clergy in mental health: Ten years of a large scale program

This paper describes an interdenominational continuing education program for parish clergy in the mental health dimension of pastoral work. The program is in its eleventh year and has reached a significant proportion of the clergy, representing a wide range of religious, ethnic, and socio-economic groups, within a large urban community. The format utilizes case-oriented, small group discussion focused on the clergy's own pastoral work. It emphasizes preventive educational activities along with the development of basic counseling and mental health skills. Ongoing evaluation indicates that the program constitutes an effective, economical, and flexible tool for continuing education with clergy.Dr. Wasman is Assistant Professor of Psychology, Dr. Corradi is Assistant Professor of Psychiatry, and Dr. Clemens is Assistant Clinical Professor of Psychiatry in the Department of Psychiatry, School of Medicine, Case Western Reserve University, Cleveland, Ohio, 44106. This work has been supported in part by the National Institute of Mental Health Grant MH11929 and by grants from the Cleveland Foundation, The Grant Foundation, Inc., and The Cuyahoga County Board of Mental Health and Retardation. The authors wish to thank Dr. Milton Matz, the current Director of the Pastoral Psychology Service-Institute, Case Western Reserve University, for his advice and cooperation in preparing this article.     

Ethics in medicine: Are we blind? In support of teaching medical ethics at the bedside

The ability to recognize and respond to the ethical dimension of medicine is integral to providing health care that is comprehensive and humane. However, this aspect of medical practice is underemphasized in clinical and academic medicine, despite attempts to devise curricula in this field. This paper examines the origins and consequences of this deficiency through a case history of a Jehovah's Witness who reluctantly accepted a blood transfusion. It emphasizes the ubiquity of the ethical context in medicine and argues that blindness to this context stems from the prevailing scientific and technological paradigm in medicine. Innovations in medical education are called for to enhance health care providers' abilities to appreciate and cope with these complex situations.     

Smoking Prevention and the Concept of Risk1

Sixth-grade children in 22 schools received either a social-influences smoking-prevention program or routine health education. The social-influences program was designed to teach youth about peer, parent, and media influences affecting smoking onset and to provide them with skills in resisting these influences. Comparison schools were given no program, but were permitted to continue their usual provision of health education. Program impact was evaluated as a function of pretreatment risk of future smoking. Risk was defined with respect to both (a) the prevalence of social models who smoked and (b) previous smoking experience. Two-and-a-half-year results show program impact to vary with both kinds of risk. Smoking-experience risk interacted such that, at first, there was greater impact on children with experience, but on later follow-up the pattern reversed, with the greater treatment effects seen for those initially with limited experience. Social-models risk showed a direct relationship, with greater risk being associated with greater program impact. Implications both for evaluation research and prevention programs are discussed.     

The Michigan infant mental health home visiting model

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent–child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.     

Ethical and Legal Considerations in the Training of Mental Health Professionals

Summary

A discussion is provided regarding ethical and legal considerations that relate to the training of mental health professionals. A training program which emphasizes a proactive approach to identifying and resolving potential ethical and legal problems, and their close connection with clinical issues is described, as are the responsibilities of supervisors and supervisees in such a program. For illustrative purposes, a training vignette and a clinical vignette conclude the article.     

Consultation to the court in infant/toddler custody cases

This paper describes a special component of an infant mental health program wherein infants are referred by the Department of Social Services for assessment and treatment. The infants in these cases are frequently in foster care and under court supervision for abuse and neglect. This paper describes the special role of the infant mental health specialist in establishing a working alliance with the family and in providing consultation to the Department of Social Services and the court. Note is made of the role of the infant mental health specialist within the legal system.     

Home-based early intervention: Emerging purposes,intervention approaches,and evaluation strategies

Infant and toddler home visiting programs constitute an important subgroup within the rapidly growing field of early intervention. Scores of such programs have been implemented by health, educational, and mental health agencies during the past decade. Recent reviews have reported on home-based early intervention for specific populations, such as biologically impaired infants or infants from economically disadvantaged families. Other reviews have focused on the effects of home-based early intervention in particular outcome domains, such as I.Q., or infant health. In this review the author draws together the information emerging from partial reviews and specific program reports in order to describe the full range of purposes and strategies encompassed by home-based early intervention and to draw inferences about its potential to enhance infant health and development and broader family functioning.     

Challenges of home visitor interventions with adolescent mothers and their infants

Issues in designing a home visitor intervention and research program for 130 adolescent mothers, 17 and under, and their infants from birth to 30 months are discussed. The overall project is described, and various aspects of creating and maintaining a home visitor intervention program are discussed, including: (1) Issues and problems that arise with the integration of a home visitor intervention component into an ongoing health department program; (2) the recruitment and training of lay home visitors in the context of arduous, often disheartening work; (3) issues of supervision and quality control faced by the mental health consultants; (4) coping with potential stresses and dangers faced by the home visitors; (5) assisting and maintaining maximum communication for the research components of the study to be successful.     

Experiencing the mastership in transdisciplinary studies for sustainability

In this article, we describe the transdisciplinarity process in our education postgraduate program at the University of Veracruz. The program emphasizes the main processes of the eco-formation experience for sustainability through a transdisciplinarity methodology that is focused on three processes: (a) Re-Learning; (b) Eco-literacy; and (c) Dialogue of Knowledge. The experience of self-knowledge is described through our specific re-learning practices in the Mastership program, which represents a central tenet in the process for creating our Learning Community through holarchy practices, profound dialogues, and self-organization processes. Finally we discuss three central ideas: creativity, spirituality, and play, which express and nurture our Learning Community.     

The Haven Mother's House Modified Therapeutic Community: Meeting the gap in infant mental health services for pregnant and parenting mothers with drug addiction

The specialized needs of pregnant and parenting women in the treatment of drug addiction must not be underestimated. The impact of substance abuse on developmental outcomes for young infants and children supports the notion that attention to the parent–child relationship is a critical aspect of addiction treatment for this population. As such, the standard of care appears to be shifting from separating mothers and young children while the mother completes addiction treatment to women residing with their children while in treatment and receiving concurrent addiction treatment and parenting education. While parenting education is important, it may not provide the needed relationship intervention to address the myriad of issues often present for female recovering addicts and their children. This article describes the evolution and workings of a program for integrating infant mental health practice into a long‐term residential treatment community for pregnant and parenting women with addiction. The principles and structure of the modified therapeutic community are described, as are the ways in which infant mental health practice have been effectively integrated and incorporated into the addiction treatment philosophy. A case example is provided, and clinical implications are discussed.     

The effects of violence on infants and young children: international perspectives on prevention

People become subject to political and social violence when governments fail to give priority to basic health care or education. Attempts to meet foreign obligations also produce severe economic recessions which further impede efforts to improve the general quality of life of disadvantaged populations. Since multiple factors contribute to violence, a multidisciplinary approach is best suited to address the problem. For example, poverty and its associated risks are linked to violence, but living in poverty does not necessarily engender violence. Living in poverty may, however, fuel high rates of child mortality, illiteracy, malnutrition, excessive population growth, street children, and familial disintegration. An integrated action program was developed in Brazil for at-risk individuals and their families based upon the idea of building and reinforcing family ties and intergenerational togetherness. Undernourished infants, street children, the handicapped, women subjected to violence, and neglected senior citizens received special interventions in the program described in the text.     

Treating infants and mothers in psychic distress: A mental health program for infancy

Our purpose is to outline a program of mental health for mothers and infants up to the age of 3. The theoretical background of the program refers to the psychoanalytical genetic point of view developed by French and American authors. The therapeutic objectives consist of promoting the infant's self-development and the mother's reflective self-capacity to improve the infant's resiliency. These objectives aim to have preventive purposes. The program has clinical, research and training activities and a multidisciplinary staff. The clinical population is referred by medical services, from families with a middle-low socioeconomic status. With the data collected during the assessment phase, we establish a diagnosis based on a psychodynamic analysis of the pathological process and the evaluation of the risk and protective factors. Our multidisciplinary approach combines individual therapeutic modalities focused on mothers, child or mother-child relationship, with family interventions in our Unit or in the community. An evaluation of our intervention based on Parent-Infant Relationship-Global Assessment Scale (PIR-GAS) is presented. © 1997 Michigan Association for Infant Mental Health     

A community mental health clinic's infant-toddler services

A community mental health clinic study of 20 infants for psychological risk status combined with a group of mother (200) and infant-toddler visits (450) over 1-year period is described as a program for providing services to the 0 to 3 age group. Recent studies in the development of human competence emphasize the importance of these years in obtaining various social and nonsocial abilities that are crucial to life and/or work satisfaction. The community mental health clinic has the knowledge, expertise, and mandate to provide services to this age group.     

Mental health among people with psoriasis undergoing patient education in climate therapy

This study investigated the mental health of people with psoriasis undergoing patient education in climate therapy. A prospective design included a baseline assessment and two follow‐ups after a 3‐week patient education program. Participants were 254 adults. Positive mental health was measured by the mental health continuum short form (0–70), and negative mental health by the emotional distress subscale (1–4) of the health education impact questionnaire. Paired‐samples t‐tests were used to evaluate changes in mental health from baseline to follow‐up. Multiple linear regression was used to analyse the ability of socio‐demographic and clinical variables and emotional distress to predict changes in positive mental health. To predict change in negative mental health we repeated the same analysis but with a change in negative mental health as a dependent variable and positive mental health as an independent variable. The results show that positive mental health and health‐related emotional distress improved significantly from before to after the intervention by 7.1 points, p < 0.001 and 0.21 points, p < 0.001) respectively. At the second follow‐up, health‐related emotional distress remained significantly improved compared with baseline levels by 0.11 points, p = 0.004. The longer participants had lived with psoriasis ( β = 146, p = 0.027), and the presence of co‐morbid health problems (β  =  111, p = 0.051) the greater the improvement in the positive mental health immediately after the intervention. No predictors were identified for negative mental health. This study indicates that the promotion of positive mental health needs to be integrated into the climate therapy program, and sustained in their home context.