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1.
Wilfley DE Vannucci A White EK 《Journal of clinical psychology in medical settings》2010,17(4):285-300
Obesity and other eating-related problems are widespread and are associated with harmful physical, psychological, and social
problems. The dramatic increases in rates of pediatric obesity has created a mounting need for psychologists and other mental
health care providers to play a significant role in the assessment and treatment of youth with eating- and weight-related
problems. Therefore, it is imperative for providers to be aware of the causes and consequences of eating- and weight-related
problems and to be familiar with evidence-based assessment and intervention approaches. Currently, the most well-established
intervention approaches are family-based behavioral treatments, and weight loss maintenance treatments with a socio-ecological
focus are promising. This paper provides a comprehensive review of these topics and highlights the important roles that mental
health care providers can have. Medical settings are often the patient’s first point of contact within the healthcare system,
making mental health care providers in such settings uniquely suited to assess for a broad range of eating- and weight-related
problems and associated comorbidities, to deliver relevant evidence-based interventions, and to make appropriate referrals.
Moving forward, providers and researchers must work together to address key questions related to the nature of eating- and
weight-related problems in youth and to achieve breakthroughs in the prevention and treatment of such problems in this vulnerable
population. 相似文献
2.
Teresa L. Deshields Shannon K. Nanna 《Journal of clinical psychology in medical settings》2010,17(3):249-257
This paper describes a psycho-oncology consultation model of care (POCM) that provides a framework for psychosocial clinical
work with cancer patients. Goals for care are addressed that follow the recommendations of the Institute of Medicine report
advocating care for the “whole patient.” Specific goals include reducing distress and symptoms, building on the patient’s
existing strengths, enhancing self-efficacy, expanding the patient’s repertoire of healthy coping strategies, and addressing
informational needs. Specific interventions are described that clinicians can implement in order to address the above goals.
The paper also addresses the unique challenges encountered in working with cancer patients, as well as programmatic difficulties
that are inherent in providing mental health care in a medical setting. 相似文献
3.
Melissa Fuller Melanie Myers Thomas Webb Meredith Tabangin Cynthia Prows 《Journal of genetic counseling》2010,19(1):84-96
Family health history is one of the best predictors of an individual’s risk for common disease, yet it is underutilized in
routine care. Although the Surgeon General has recommended consumers record their family health history and share it with
their health care provider, providers’ perceptions of patient-generated family histories are unknown. To learn more about
providers’ experience with and perceptions about patient-generated family histories, we mailed surveys to 301 providers and
had a response rate of 24% (n = 68). Seventy-three percent felt a patient-generated computer pedigree would improve their ability to assess risk as compared
to their current methods. Seventy percent felt a patient-generated computer pedigree would either have no effect on or would
increase the number of patients that could be seen in a day. Results suggest that providers appreciate the potential benefits
of patient-generated family histories. Genetic counselors and nurses are in a prime position to promote and facilitate the
use of patient-generated family health histories in routine care. 相似文献
4.
Antonette M. Zeiss Bradley E. Karlin 《Journal of clinical psychology in medical settings》2008,15(1):73-78
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. 相似文献
5.
Trust in healthcare providers is associated with clinical outcomes among adult patients. Children with disabilities have complex health needs that place stress on caregivers. Consequently, they are increasingly likely to rely on their children's health care providers to ensure children's health care needs are met. However, no studies have explored factors affecting caregivers’ trust in their children's providers. We assessed caregivers’ trust in their children's providers and identified predictive factors of trust. The results indicate that children's disability condition, functional status, age, the providers’ specialty, and the type of health care plan are significant predicators of caregiver's trust. Specifically, caregivers of children with emotional/behavioral disabilities and children with poor physical or emotional/behavioral functioning reported less trust in their children's providers compared to caregivers of children without physical disabilities or no disability and those having higher levels of physical or emotional/behavioral functioning. In addition, caregivers of younger children had more trust compared to caregivers of older children. Caregivers of children enrolled in a managed care plan for physical health care reported less trust compared to caregivers of children in other organizational arrangements. Finally, caregivers reported more trust in physical health providers compared to mental health providers. 相似文献
6.
Cubic B Mance J Turgesen JN Lamanna JD 《Journal of clinical psychology in medical settings》2012,19(1):84-92
Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan
for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic
Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational
and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology
and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors,
most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between
primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental
perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described.
Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education
and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that
most patients seek their mental health treatment in primary care settings. 相似文献
7.
Reducing the Risk for Preschool Expulsion: Mental Health Consultation for Young Children with Challenging Behaviors 总被引:1,自引:0,他引:1
Deborah F. Perry M. Clare Dunne LaTanya McFadden Doreen Campbell 《Journal of child and family studies》2008,17(1):44-54
Increasing numbers of young children are being expelled from child care settings because of their problem behavior. Access
to mental health consultation is related to lower rates of expulsion, but additional data are needed to document the pathways
through which mental health consultation reduces the risk of expulsion. We report on outcomes from a 4-year project designed
to reduce the number of children expelled for problem behavior in a large suburban county in Maryland. Two master’s-level
professionals provided behavioral consultation to child care providers who identified nearly 200 children at imminent risk
for expulsion. Child care providers rated children’s social skills and problem behaviors at referral and discharge using the
Preschool Kindergarten Behavior Scales and the Brief Infant Toddler Social Emotional Assessment. Statistically significant
increases in social skills and reductions in problem behaviors were seen for children who received individualized consultation.
More than three-quarters of the children who were at risk for expulsion were able to be maintained in their current child
care placement; of those that changed placements, only half (n = 13) were removed involuntarily. These findings provide additional support for mental health consultation as a promising
strategy to reduce the risk for expulsion for young children with problem behaviors. 相似文献
8.
Peter Jenkins 《Counselling psychology quarterly》1999,12(2):169-181
Conflicts can arise within counseling in primary care settings over issues of client confidentiality as perceived from a therapeutic as opposed to medical perspective. ‘Ideal types’ of counseling confidentiality and medical confidentiality are compared, according to a proposed structural model of confidentiality. In contrast with a therapeutic concept of confidentiality as an interpersonal contract between client and counsellor, a structural model of confidentiality appropriate to medical and primary care settings would include reference to crucial aspects such as risk assessment, and the sharing of client information within a multi-disciplinary team. The client-centred counselling model of confidentiality is then explored with reference to the Derbyshire Inquiry Report on the mental health care provided for a client with psychiatric problems. The limitations of adopting an exclusive client-centred counselling approach towards confidentiality in primary care settings are noted, given the requirements of the Care Programme Approach for effective risk assessment and inter-professional liaison in the care of client and patients with psychiatric problems. The potential resultant issues of counsellor and general practitioner liability are identified in relation to complaints systems and the key legal concept of vicarious liability. 相似文献
9.
Wim Dekkers 《Theoretical medicine and bioethics》2009,30(5):335-349
The notion of home is well known from our everyday experience, and plays a crucial role in all kinds of narratives about human
life, but is hardly ever systematically dealt with in the philosophy of medicine and health care. This paper is based upon
the intuitively positive connotation of the term “home.” By metaphorically describing the goal of palliative care as “the
patient’s coming home,” it wants to contribute to a medical humanities approach of medicine. It is argued that this metaphor
can enrich our understanding of the goals of palliative care and its proper objectives. Four interpretations of “home” and
“coming home” are explored: (1) one’s own house or homelike environment, (2) one’s own body, (3) the psychosocial environment,
and (4) the spiritual dimension, in particular, the origin of human existence. Thinking in terms of coming home implies a
normative point of view. It represents central human values and refers not only to the medical-technical and care aspects
of health care, but also to the moral context. 相似文献
10.
《Journal of aggression, maltreatment & trauma》2013,22(1-2):541-552
Abstract Living through a terrorist event or under threat of attack affects both mental and physical health. A nation's primary care system plays a critical role under such circumstances. This article reviews the American experience after September 11, 2001 and advocates for integration of mental and physical health services in primary care settings as a key counter-terrorism strategy. Americans put their trust in primary care providers. The nation's healthcare system must develop and implement a strategy that informs and supports primary care providers in meeting the mental health needs of a nation confronted by terrorism. 相似文献
11.
Ernst R. Schwarz Kiran J. Philip Sinan A. Simsir Lawrence Czer Alfredo Trento Stuart G. Finder Laurent A. Cleenewerck 《Journal of religion and health》2011,50(4):872-879
Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological
and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal
issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such
as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on
clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes
represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular
assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates
for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to
critically reflect that in many cases, the patient’s best interest might not always mean pursuing maximal technological options
available. This article reflects on the multitude of critical issues that health care providers have to face while caring
for patients with end-stage heart failure. 相似文献
12.
Patokos T 《Theoretical medicine and bioethics》2011,32(4):245-258
In game theory, the word ‘game’ is used to describe any interdependence between interacting parties, and the Nash equilibrium
is a prominent tool for analysing such interactions. I argue that the concept of the Nash equilibrium may also be used in
non-gaming contexts. An individual is in a Nash equilibrium if his or her beliefs are consistent with his or her actions.
Given that discordance between beliefs and behaviour is a typical cause of psychiatric disorders, individuals who are not
in a Nash equilibrium are likely to be affected by such disorders. In this regard, the concept of the Nash equilibrium could
aptly be introduced into the medical practitioner’s vocabulary for describing a patient’s mental health status. 相似文献
13.
Teresa L. Kramer Ph.D. Aparna Vuppala M.D. Christopher Lamps M.D. Terri L. Miller Ph.D. Carol R. Thrush M.A. 《Journal of child and family studies》2006,15(4):377-392
Youth with emotional and behavioral disorders (EBD) are at an increased risk for school problems and negative consequences into adulthood, increasing the need for collaboration between families, school personnel and mental health providers. Current treatment guidelines emphasize the importance of information-sharing between providers and schools, yet few studies have addressed parents’ or students’ attitudes and preferences about this process or about the disclosure of mental health-related information to school professionals. Using a sample of 73 pairs of parents and their adolescents seeking outpatient treatment, this study assessed parental and adolescent attitudes about disclosure of mental health treatment information to school personnel. The majority of parents reported that the school should be informed that their adolescent was receiving counseling or medication for EBD, and that they should be the primary informant, rather than providers. By comparison, adolescents preferred more discretion about their involvement in treatment. Taken together, the study results highlight a number of implications relevant to the therapeutic relation and the process of obtaining and sharing mental health-related treatment information with various school personnel. Future research directions regarding the consultative and collaborative process with school personnel are also discussed. 相似文献
14.
15.
The Challenge of Integrated Care for Mental Health: Leaving the 50 minute hour and Other Sacred Things 总被引:1,自引:1,他引:0
Andrew S. Pomerantz John A. Corson Mark J. Detzer 《Journal of clinical psychology in medical settings》2009,16(1):40-46
A growing body of research has demonstrated the effectiveness of integrating mental/behavioral healthcare with primary care
in improving health outcomes. Despite this rich literature, such demonstration programs have proven difficult to maintain
once research funding ends. Much of the discussion regarding maintenance of integrated care has been focused on lack of reimbursement.
However, provider factors may be just as important, because integrated care systems require providers to adopt a very different
role and operate very differently from traditional mental health practice. There is also great variability in definition and
operationalization of integrated care. Provider concerns tend to focus on several factors, including a perceived loss of autonomy,
discomfort with the hierarchical nature of medical care and primary care settings, and enduring beliefs about what constitutes
“good” treatment. Providers may view integrated care models as delivering substandard care and passively or actively resist
them. Dissemination of available data regarding effectiveness of these models is essential (e.g. timeliness of treatment,
client satisfaction). Increasing exposure and training in these models, while maintaining the necessary training in traditional
mental health care is a challenge for training at all levels, yet the challenge clearly opens new opportunities for psychology
and psychiatry. 相似文献
16.
C. J. Peek 《Journal of clinical psychology in medical settings》2009,16(1):13-20
Integrated care is geared toward enhancing usual care and decision-making for common combinations of medical and mental health
conditions, including the behavioral health and behavioral change aspects. Yet even with comprehensive and well-integrated
care for health conditions and well-coordinated teamwork in place, some patients do not engage or respond to care in the way
clinicians would like or predict. This troubles patients and clinicians alike and may be chalked up informally to things like
medical complexity (multiple co-existing conditions), mental health conditions (that complicate care), or simply the case
being considered complex or difficult. It also raises the question of how to address person-specific factors that interfere
with care of whatever conditions the patient may have, and invites behavioral health clinicians in medical settings to look
beyond care of conditions to the care of persons, and to look beyond disease-specific care management protocols to master generic practices of care management across whatever conditions the person may have. This person-centered emphasis is intrinsic to
the concept of the “patient-centered medical home” which has burst into animated discussion and demonstration among providers,
health plans, government plans, employer purchasers, and professional associations across public and private entities. This
represents an opportunity for collaborative care clinicians to help shape the national state of the art in medical home and
includes a range of person-oriented (rather than disease-oriented) practices for care management, including working systematically
with complex patients and difficult patient–clinician relationships. 相似文献
17.
The disclosure of sensitive information concerning mental health, drug and alcohol use, and communicable diseases requires express patient consent under federal and state laws. This paper presents the results of a retrospective medical record abstraction of hospital consent-to-treatment and release-of-information forms, examining whether the forms are present in the records, and, if so, whether they are signed by patients. The results suggest that patients who have sensitive information in their medical records or pay out of pocket for their care are less likely to consent to disclosure of their records. We discuss the implications of these results and recommend further research to understand patients' perceptions of medical confidentiality and the processes used for securing consent to hospital treatment. 相似文献
18.
The challenges of dealing with disclosure of HIV status cause frustration to health care providers and counselors. This frustration
follows from the already known high risk to the third party on one hand and our ethical obligation to “respect persons” in
terms of privacy and confidentiality on the other side. Given the stubbornly low rates of voluntary disclosure (partner notification)
among couples, however, it is quite tempting to suggest a paradigm of routine third party disclosure to identifiable sexual
partners by health care providers. This might be the lesser of the two evils and might give better public health outcomes
in the fight against HIV/AIDS in Sub-Saharan Africa. 相似文献
19.
Adeya Richmond Jessica Jackson 《Journal of clinical psychology in medical settings》2018,25(3):305-315
Many health concerns in the United States (e.g., diabetes) are routinely managed in primary care settings. Regardless of the medical condition, patients’ health is directly influenced by factors such as healthcare providers and cultural background. Training related to how behaviors influence health, coupled with training on how cultural diversity intersects with mental health, allows psychologists to have the relevant expertise to assist in the development of primary care behavioral health interventions. However, many psychologists in primary care struggle with how to integrate a culture-centered paradigm into their roles as behavioral health providers. This paper provides an introduction on how three culture-centered concepts (providers’ cultural sensitivity, patient–provider cultural congruency, and patients’ health literacy) can be applied in primary care using the Five A’s Organizational Construct and a model of cultural competence. In addition, the paper includes a section on integration of cultural considerations into consultation and training and concludes with a discussion of how the three culture-centered concepts have implications for health equity. 相似文献
20.
The Application of Behavior Change Theory to Family-Based Services: Improving Parent Empowerment in Children’s Mental Health 总被引:1,自引:0,他引:1
S. Serene Olin Kimberly E. Hoagwood James Rodriguez Belinda Ramos Geraldine Burton Marlene Penn Maura Crowe Marleen Radigan Peter S. Jensen 《Journal of child and family studies》2010,19(4):462-470
We describe the development of a parent empowerment program (PEP) using a community-based participatory research approach.
In collaboration with a group of dedicated family advocates working with the Mental Health Association of New York City and
state policy makers, academic researchers took an iterative approach to crafting and refining PEP to better prepare family
advocates to help bridge the gaps in service access among children with emotional and behavioral problems. Despite the growth
of family-led, family support programs nationally, research that demonstrates the positive benefits of such programs is scarce
in the children’s mental health literature. The PEP model is based on research data about barriers families face in mental
health service utilization (e.g., stigma, perceptions of providers, attitudes towards mental illness, service availability,
etc.). PEP is premised on (a) the concept of empowerment as a process, (b) the need to engage parents in becoming active agents
of change, and (c) the application of an integrated framework to empower parents, called the Parents as Agents of Change model.
Our paper focuses on describing the application of a Unified Theory of Behavior Change as a theoretical framework to help
activate parents as change agents in meeting their children’s mental health needs. Based on an integrated model of grassroots
driven Principles of Parent Support and research-based Unified Theory of Behavior Change, PEP’s Parents as Agents of Change
model provides a conceptual framework for testing the effectiveness of family support services in children’s mental health,
a much-needed area for future research. 相似文献