Attitudes of Oregon psychologists toward physician-assisted suicide and the Oregon Death With Dignity Act

Since the passage of the Oregon Death With Dignity Act (ODDA), psychologists have been grappling with how to fulfill their legally specified role in the process of physician-assisted suicide. We surveyed Oregon psychologists to elicit their views on assisted suicide and the process of assessing patients who request such assistance. There was a high degree of support for assisted suicide and the ODDA, but also a minority who were highly opposed. Most survey respondents raised ethical or practical concerns with their role as assessors. Many important questions about how evaluations in the complex area should be conducted remain unanswered.     

The role of proxies in treatment decisions: evaluating functional capacity to consent to end-of-life treatments within a family context

Psychology as a profession has entered the arena of palliative and hospice care later in the process than other health care professions. Through the use of Familial Advance Planning Evaluations (FAPEs), however, psychologists can assist individuals and families in facing end-of-life transitions in important ways. Hospice and palliative care philosophy treats the patient and family as the unit of care. End-of-life decision-making is therefore a family matter as well as a normative developmental transition. Yet, little is known about the decision-making process. This paper reviews the literature regarding informed consent, advance care planning, and proxy decision-making and outlines a theoretical model for familial decision-making. Previous models of end-of-life capacity evaluations and family assessments are presented and serve as the basis for a comprehensive assessment of familial decision-making at the end of life. Functional capacity evaluations of individuals at the end of life regarding decisions about life-sustaining medical treatments enable both the individual patient and one identified proxy from his or her family to discuss important issues families may face during medical crises at the end of life. The information gleaned from such evaluations has the potential to assist psychologists and other professionals in designing family-specific interventions to reduce caregiving distress, improve quality of life for dying patients, and ease the transition to bereavement for caregivers.     

Pediatric Psychologists’ Collaboration in a National Pediatric Obesity Initiative: A Case Study in Interprofessional Collaboration

Health Care reform calls for collaborative team-based care; psychologists must therefore strengthen their competencies for work in interprofessional clinical care settings. Toward that end, a group of psychologists participated with physicians, dieticians, physical activity specialists, nurses, and others in a national interprofessional workgroup focused on pediatric obesity. The interprofessional group was designed to identify areas in need of national advocacy, key assessment and treatment concerns, and gaps in internal policies and procedures in children’s hospitals. This article provides a case report of psychologists’ roles and experience in this workgroup, and focuses on factors that underlie successful collaboration among diverse health professionals, as well as potential barriers to success. The participating psychologists developed a working model for collaboration with other disciplines. Additionally, they formed a Psychology Subcommittee to identify and address discipline-specific issues regarding collaborative practice in pediatric psychology. Lessons learned in this interprofessional collaborative undertaking have relevance for future collaborative endeavors.     

Trauma‐Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma‐informed. While community mental health and other human services settings are moving toward trauma‐informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle‐driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second‐order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.     

Partnering with Children Diagnosed with Mental Health Issues: Contributions of a Sociology of Childhood Perspective to Participatory Action Research

This paper explores the use of participatory action research (PAR) with children diagnosed with mental health issues. We argue that critiques from the sociology of childhood are useful for guiding PAR with children. First, we describe and critique values and assumptions that underlie research and practice with children who experience mental health issues. Second, we outline key qualities of the sociology of childhood, discuss their implications for PAR with children diagnosed with mental health issues, and touch on ethical issues. Five themes are explored: (a) values, (b) ontology/epistemology, (c) views about children, (d) agency/power in children’s relationships with adults, and (e) intervention/change focus. We conclude by encouraging community psychologists to consider PAR with children diagnosed with mental health issues.     

Ethical Requirements and Responsibilities in Video Methodologies: Considering Confidentiality and Representation in Social Justice Research

In recent years, psychologists have begun to use video more frequently in qualitative research, in particular, within research on social justice. The non‐confidential nature inherent in video, however, raises new ethical challenges for the field of psychology to address. Building upon a growing literature on video‐based research, in this article, we use an illustrative case study to examine how researchers' sense of ethical responsibility can find guidance from, clash against, or fill gaps left by extant federal and disciplinary ethical requirements. We focus specifically on issues of confidentiality and representation, highlighting the challenges and possibilities that video creates in relation to participants' power, dignity, and participation and arguing that psychologists must systematically engage questions about ethical responsibilities throughout the design and implementation phases of a research project. In doing so, psychologists, their community partners, and students will be better able to articulate and problematize their assumptions and intentions regarding video work.     

Exploring unique roles for psychologists

Presents a comment on "Psychological Treatments" by D. H. Barlow. Barlow highlighted unique roles that psychologists can play in mental health service delivery by providing psychological treatments--treatments that psychologists would be uniquely qualified to design and deliver. In support of Barlow's position, the authors draw from their own clinical practice with special psychiatric populations, such as adults with severe and persistent mental illness and behaviorally disordered youths, to illustrate some potential unique roles for psychologists. The authors believe psychologists are uniquely trained to design such individualized functional behavioral analysis protocols because of their training in research design, behavior analysis, learning theory, and behavior change. Psychologists may also be uniquely qualified to design, implement, and evaluate many specialized therapy techniques, as Barlow has outlined and suggested.     

Ageism and psychological testing with elderly immigrant women

The focus on aging and ageism are fairly recent in psychology. Nevertheless, it is clear that these processes are of particular interest to many psychologists involved in psychological assessment, since both of these affect the content and the process of the assessment. In the present paper some key issues are raised regarding ageism and stereotypes of the aging held by mental health professionals and psychologists in particular. On the assumption that psychological testing with the aging is required to achieve accurate diagnoses and therapeutic interventions, some concerns about how psychological testing with the aging should proceed is presented.     

Future Directions for Advancing Issues in Children’s Mental Health: A Delphic Poll

The current study utilized a Delphic poll to identify significant problems regarding children and families in which psychologists can assist. The Delphic poll methodology combines both qualitative and quantitative methodologies to obtain information and predictions about the future from a panel of knowledgeable experts. Thirty-one professionals participated in the first round of the survey, and 26 participants (83.9 % of the round 1 participants) chose to complete the second-round survey. Several themes emerged consistently across questions as important issues to be addressed in the future of childhood mental health. For example, participants frequently identified access, advocacy, research and research dissemination, prevention/early intervention, and integration of services as important issues. Implications and recommendations are drawn for organizations and individual psychologists as advocates for improving children’s mental health in the United States.     

Ethical Considerations for Psychologists Providing Treatment to Arab Americans

Given the recent increase in hate crimes against Arab Americans, there are growing concerns over the mental health needs of Arab Americans and a pressing need for psychologists’ competence in treating this group. Although there are several clinical guidelines for other health care professions, there remains a paucity of information on the ethical issues that may arise for psychologists treating this Arab Americans. This article briefly provides background information on Arab Americans, highlights elements of Arab culture that might influence psychological treatment, discusses ethical issues that might arise when psychologists provide services to Arab Americans, and provides recommendations to address these issues.     

Primary care physician attitudes and values toward end-of-life care and physician-assisted death

This study explores how primary care physician attitudes toward physician-assisted death (PAD) are related to their personal values toward end-of-life care and PAD. A group of 810 Michigan family physicians, internists, and general practitioners, divided into 4 typology groups by their intention toward participating in PAD, rated their attitudes toward PAD, along with their values and preferences for their own end-of-life care. Respondents who most objected to PAD were less likely to have executed an advance directive and more likely to have values promoting continued life-sustaining treatment in their own terminal care. Furthermore, a significant number of physicians, who had strong values against their own withdrawal of treatment in terminal care, were opposed to the withdrawing or withholding of life-sustaining treatment in patient care. Considerations of personal physician values are relevant in the discussion of PAD and the withdrawal of treatment in terminal care.     

A consideration of challenges to psychological assessment instruments used in forensic settings: Rorschach as exemplar

In this brief primer, we provide an outline of key issues that will help psychologists organize and prepare their expert testimony. These issues include the need to obtain essential sources of research, a review of the actual legal standards regarding admissibility of test data in expert testimony, the nature of the expert relative to the assessment instrument in expert testimony, the nature of legal versus scientific debate, and the examination of appropriate qualifications of expertise when offering legal testimony. In addition, we use a summary of information contained in several recent articles to address challenges directed against forensic psychological testing. We use the empirical literature on the Rorschach as an exemplar in discussing these issues, as the admissibility of the Rorschach in particular has been challenged, and the issues frequently focused on with the Rorschach are equally applicable to other psychological measures. In this article, we provide essential sources of Rorschach research regarding several empirical studies that summarize important information and directly address previous criticisms of the measure.     

Public and private responsibility for mental health services

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health service give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public-private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems.     

Rehabilitation. Psychology's greatest opportunity?

Rehabilitation is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in rehabilitation. Although psychologists have benefited from legislated membership in rehabilitation, most individual psychologists and the psychological associations have failed to recognize the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy is necessary to secure the scope of professional practice most psychologists expect.     

Psychologists in Academic Health Centers and Medical Centers: Being Visible,Relevant and Integral

Psychologists play key roles in academic health centers. This article is an outgrowth of a presentation at the 2015 Conference of the Association of Psychologists in Academic Health Centers addressing various strategies by which psychologists can effectively adapt to and develop successful careers in medical schools, academic health centers, and teaching hospitals. The authors encourage early career and mid-career psychologists in academic health centers to be active, engaged members of their institutions and to participate in multiple aspects of the research, educational, and clinical missions.     

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.     

Administrator Perceptions of Actual and Desired Time Spent by School Psychologists in Different Roles and Satisfaction with School Psychologists

Abstract

A total of 512 elementary and secondary administrators in Ohio were surveyed regarding their perceptions of the time spent by school psychologists in 15 role functions, the percentage of time they desired school psychologists to spend in these 15 roles, and their satisfaction with their school psychologist. Results indicated that administrators desired school psychologists to spend less time in assessment and administrative activities than they were perceived to be spending in these areas, and desired school psychologists to spend more time than they were perceived to be spending in all other roles surveyed. Six variables were found to be significant predictors of administrator satisfaction: discrepancy between actual and desired time spent administering and interpreting psychoeducational tests (negatively related), discrepancy between actual and desired time spent providing services to prevent student problems (negatively related), percentage of time spent working with parents and families (positively related), discrepancy between actual and desired time spent performing administrative duties (negatively related), discrepancy between actual and desired time spent conducting inservice activities (positively related), and discrepancy between actual and desired time spent counseling for career/vocational issues (negatively related). Results are discussed in terms of their implication for role expansion in school psychology.     

Social Responsibility and the Mental Health Professions

Summary

While mental health professionals tend to primarily focus on their professional responsibilities toward the specific members of the public whom they serve, many are also concerned about positively impacting the broader society or culture in which they live and work. This notion of social responsibility is addressed in the ethics codes of both psychologists and social workers. This article reviews how this notion is addressed for these two mental health professions and also examines the changes that have occurred for psychologists between the 1992 and 2002 ethics codes. Finally, some general issues regarding the role of mental health professionals in changing society are considered.