Teleconferencing model for forensic consultation, court testimony, and continuing education

A medical center-based forensic clinic that provides the necessary comprehensive consultation, continuing education, court testimony, and clinical services through an applied model of teleconferencing applications is addressed. Telemedicine technology and services have gained the attention of both legal and clinical practitioners, examining trends and models of health care for underserved populations, and identifying where consultation with a team of professionals may benefit service providers in rural communities. The contribution offered herein provides an understanding of the history of the development of the clinic, a theoretical model that has been applied to a clinical forensic program that employs telepsychiatry services, and the ethical and malpractice liability issues confronted in using teleconferencing services. This model is examined through a child and adolescent forensic evaluation clinic. The goals of this model are offered, as are a number of applications within the broad spectrum of services utilizing telemedicine. Finally, changing patterns are addressed in clinically based health-care delivery for criminal justice, social services, and forensic mental health.     

Malpractice Arising From Negligent Psychotherapy: Ethical,Legal, and Clinical Implications of Osheroff v. Chestnut Lodge

This article reviews key philosophical and legal underpinnings of mental health professionals' obligation to obtain informed consent from consumers of their services. The basic components of informed consent are described, and strategies for clinically and ethically appropriate methods of obtaining informed consent are discussed. Emerging issues in informed consent involving duty to assess and protect against client dangerousness, obligations to third parties, and issues of deception are considered as well. The article proposes that part of the process of obtaining informed consent is the cultivation of a treatment environment that emphasizes beneficence and client autonomy.     

Users of secondary school‐based counselling services and specialist CAMHS in Wales: A comparison study

Background: The increasing prevalence of mental health issues in young people has contributed to a rise in the provision of school‐based counselling services in the UK. Between 2008/09 and 2010/11, data were collected from users of secondary school‐based counselling services in Wales. Aims: To identify the characteristics of users of school‐based counselling services in Wales – including demographics, referral pathways, presenting issues, and predominant issues – and how they compare to users of specialist CAMHS in Wales and Welsh secondary school pupils in general. Method: Data were collected on 10,687 episodes of counselling. School counsellors completed a client record sheet after each counselling episode and submitted these to their Local Authority. Collated results were then compared to matched data from Welsh specialist CAMHS and Welsh secondary schools data. Results/findings: A typical user of a secondary school‐based counselling service in Wales was female, of white ethnicity, and from the ‘middle’ school years. There was a marked under‐representation of users from BME backgrounds. Users were most often referred by school staff, and the most common presenting issues were family‐related, anger, and behaviour‐related. Conclusions: There was a higher proportion of females accessing school‐based counselling services than males. This was in direct contrast to data from specialist CAMHS and possible explanations for this are discussed. The under‐representation of BME populations suggested that there were some equality issues associated with accessing these services. Implications for practice: Future research should explore equality issues associated with young people from BME backgrounds accessing intervention services.     

Father absence and adolescent "problem behaviors": alcohol consumption, drug use and sexual activity

Among the issues faced by adolescents are problems relating to alcohol consumption, drug use, and sexual behavior. A survey of 813 adolescents found that adolescents are most likely to discuss these problems with peers and least likely to discuss them with parents, especially fathers. However, father absence from the home resulted in greater use of and problems with alcohol, marijuana, and sexual activity. This was the case especially for boys. The results obtained underscore the significance of the father as a key figure in the transmission of values and as a deterrent to certain behaviors. The results point to adolescents from fatherless homes, especially boys, as being at risk for problems in the areas noted. This suggests that community agencies providing services to adolescents should make special efforts to incorporate into their programs specially designed services to meet the particular needs of this group. Aspects of such programs are discussed.     

A Preliminary Study of Activation,Stress, and Self-Management of Parents of Children with Autism Spectrum Disorder

Children with autism spectrum disorder (ASD) and developmental disabilities are high users of services, yet very little is known about how parents of these children interact with the health care system. Further, compared to parents of children with other developmental disabilities, parents of children with ASD experience more stress and dissatisfaction with services. Current efforts for improving services point to a need for understanding caregivers’ perceptions of their own health-care related beliefs and actions. Activation is a construct that measures the belief, knowledge, action, and persistence of managing one’s health care needs. The objective of this preliminary study was to evaluate the activation of parents of children with ASD using an adapted parent activation measure (PAM) for children with developmental disabilities called the PAM-DD. Data were collected from parents who received treatment as usual from a community-based outpatient treatment planning service for children with ASD. PAM-DD scores were compared with parent ratings of stress, self-management, and service satisfaction. Results indicated that increased activation correlated positively with parent report of satisfaction and ability to self-manage child issues such as eating, sleeping, and behavior and correlated negatively with parenting stress. The study of activation shows promise as a feature of quality of care for parents of children with developmental disabilities.     

School Counselors and Consultants: Legal Duties and Liabilities

This article provides an overview of legal issues and problems salient to school counselors who provide direct services to students or indirect services through consultation. Among legal issues addressed are privacy, confidentiality, and privilege—conceptually distinct topics that in practice often overlap. Also covered are legal duties pertaining to handling student records, conducting research projects, reporting child abuse, and testing and placing students. Among the legal liabilities discussed are those arising from contract, tort, and criminal law and from violations of federal constitutional and statutory rights.     

Ethical Issues and Potential Solutions Surrounding the Use of Spoken Language Interpreters in Psychology

The need for psychological services to limited English proficient clients is increasing. Psychologists who provide clinical services to limited English proficient clients are frequently required to use the services of spoken language interpreters. Research has shown that the quality and consistency of interpretation services are often in question. Interpreters are generally not required to hold any certifications or to meet training requirements prior to providing interpretation services. This lack of oversight leaves the psychologist responsible for the quality of the interpretation when adhering to the American Psychological Association’s (APA) 2010 Ethical Principles of Psychologists and Code of Conduct. This article includes a discussion of the ethical and clinical issues inherent in providing psychological services through an interpreter, how those issues affect a psychologist’s adherence to the APA Ethics Code, and recommendations for meeting the ethical standards while providing sound clinical services through the use of spoken language interpreters.     

The Role for Public Funding of Faith-Based Organizations Delivering Behavioral Health Services: Guideposts for Monitoring and Evaluation

The paper reviews policies promoting faith-based organizations' (FBO) participation in publicly-funded programs since the Charitable Choice statute was enacted during the Clinton administration and then additional faith-based initiatives were implemented by the Bush administration. The paper focuses on research findings on FBO participation in publicly-funded human service programs under these policies. It then proposes a framework for evaluation to assess the appropriateness of public funding for behavioral health services delivered by FBOs, in order to address: (1) the programmatic and systemic effects resulting from the infusion of new players from the faith community, and the consequences to the profile of services and who gets served; and (2) the content and effectiveness of faith-infused services as a basis for identifying interventions appropriate for public funding. The analysis considers classification issues, theoretical bases of measured effects of faith-infused services, and the transferability of faith-based interventions across religious and secular applications in order to satisfy constitutional issues and client choice.     

African American Pastors on Mental Health,Coping, and Help Seeking

Within the Black Church, there remains much that is unknown about pastoral motivations, beliefs, and attitudes about mental health. The purpose of this study was to investigate pastors' responses to parishioners dealing with mental health issues, including perspectives on counseling services and coping strategies. According to this study's findings, African American pastors often are the first line of support for parishioners' mental health and recognizing adaptive and maladaptive forms of coping.     

Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice.     

Religious involvement,God images,and life satisfaction

This study addresses two issues. The first is to identify the aspects of religious life that are associated with benevolent images of God including denominational affiliation (Conservative Christians versus others), church attendance, and church-based social support (i.e., spiritual support). Data from a nationwide survey suggests that church-based support appears to be the most consequential. The second issue involves embedding these constructs in a conceptual model that traces effects of benevolent God images on life satisfaction. The following hypotheses form the core of this model: (1) Conservative Christians will attend worship services more often, (2) individuals who go to church more often tend to receive more support, (3) people who receive more support are more likely to have benevolent images of God, (4) benevolent images of God are associated with greater hope, and (5) greater hope is associated with greater life satisfaction. The findings provide support for each hypothesis.     

An overview of issues in research on consumer satisfaction with child and adolescent mental health services

Research that focusses on consumer satisfaction with child and adolescent mental health services is reviewed. Satisfaction is broadly conceived to include any study where the perspectives of children, adolescents or their parents about mental health services were gathered and presented. Important conceptual issues in research on consumer satisfaction with children's mental health services are discussed. Some of the general methodological issues that have faced satisfaction researchers are also considered. The wide range of methodological variations that have been used to investigate this topic area are outlined. The most significant findings of previous research are presented and critiqued. In conclusion, suggestions are made about the most fruitful directions for future research.     

The mental health system and older adults in the 1990s.

Trends in mental health services for older adults during the past decade were used to predict salient issues for the current decade. These include overreliance on inpatient treatment, increased use of general hospitals as treatment sites, inadequate integration with the nursing-home industry, and insufficient mental health referrals from general medical providers. In the decade ahead, the mental health needs of older adults are unlikely to be an identified focus; rather the issues will overlap with other priorities (e.g., biomedical research on brain functioning, alternative treatment programs for the chronically mentally ill, and containing health care costs). Advocates for the elderly will be successful to the extent that they cast aging services within the context of these other concerns.     

Cultural, Gender, and Socioeconomic Contexts in Therapeutic and Social Policy Work

The contention of this paper is that the context of social and therapeutic problems is critical to their resolution, and that many of them stem from historical and structural injustice. It focuses on the contextual issues of cultural, gender, and socioeconomic equity as providing important insights into authentic notions of social inclusion and well-being, and encourages therapists, service providers, researchers, and policy makers to take responsibility to ensure that these injustices are addressed, and become part of the public discourse about the sources and solutions of endemic social problems. Critique and deconstruction of institutional power in our public, private, and voluntary services is encouraged in a manner that honors diversity and enables sensitive therapy, other forms of service delivery and policy making that genuinely reflect the range of cultural, gender, and socioeconomic experiences of citizens.     

Client perspectives on counselling: Before,during and after

This four‐year study investigated the under‐researched area of first‐time users’ perceptions of counselling and how these evolved over time. Research participants were drawn from six settings within university counselling services, the voluntary sector and primary care. Using an interpretive hermeneutic framework based on thematic analysis, 30 interviews were carried out. Results revealed that before counselling, participants were uncertain about the nature of counselling and what to expect, described stigma associated with peer influence and varying levels of confusion about specialist language. During counselling, participants experienced some level of positive change. At the same time, divergences of counsellor and client perception highlighted theoretical issues concerning counsellor approach and the exploration of emotions. Post‐counselling interviews revealed further positive change, and practical issues with implications for counsellor training and practice in terms of client assessment, preparation for counselling and the influence of cultural assumptions on theory and practice.     

Mental health and North American Indian/Native communities: Cultural transactions,education, and regulation

Critical issues in the delivery of mental health services to North American Indians/Natives residing in rural areas are discussed by describing Indian populations/communities; briefly summarizing available literature concerning the nature of mental health problems within Indian communities; examining Indian belief systems relevant to participation in mental health service delivery processes; exploring community expectations for structuring participatory interactions which may inhibit utilization of mental health services; and describing transactions between Indian consumers and non-Indian professionals which have become typical over time. The rural context was examined as it interacts with individual and community characteristics to affect Indian mental health. Relations between geography and culture, important in understanding the mental health problems of Indian people, are discussed in regard to expanding community healing resources through empowerment, and viewing "education as transformation" as a key concept in enhancing community healing processes.     

Ethical and Legal Considerations for Internet-Based Psychotherapy

The provision of mental health services over the Internet is becoming increasingly commonplace as new technologies continue to develop. Evidence in support of the efficacy of many such interventions is accumulating. Given the potential global reach of Internet-based psychological services, the authors examine ethical issues relating to this growing area of practice through the lens of the Universal Declaration of Ethical Principles for Psychologists (International Union of Psychological Science, 2008). They also raise issues relating to potential liability risks and offer recommendations intended to guide mental health practitioners who are considering involvement in the provision of Internet-based services.     

The elderly and high technology medicine: A case for individualized,autonomous allocation

The issues involved in decision making about the aggressiveness of future medical care for older persons are explored. They are related to population trends, the heterogeneity of older persons and a variety of factors involved in individual preferences. Case studies are presented to illustrate these points, as well as a review of pertinent literature. The argument is offered that, considering these many factors, a system of flexible, individualized care by informed patient preference, is more rational than the rationing of technological services by age.     

Parricides: Characteristics of offenders and victims,legal factors,and treatment issues

Parricides account for about 2% of all homicides. Perpetrators are typically White middle-class males without a history of prior criminal convictions. Most parricides involve single-victim, single-offender situations, with firearms more likely to be used against fathers than mothers. The popular literature as well as much of the professional literature have presented youths who killed a parent as prosocial individuals who feared for their lives. Adults who killed a parent have typically been presented as suffering from a severe mental disorder. These two scenarios describe many parricides. However, major mental disorders among youthful parricidal offenders, conduct disorder and antisocial personality disorder as well as other psychiatric comorbidities also occur in a significant proportion of parricides. Youthful and adult offenders experience different legal outcomes and receive mental health services in differing contexts. We review offender and victim characteristics, as well as legal and treatment issues, and outline needs for future research.