Primary Care Prescribing Psychologists in the Indian Health Service

Some of the largest health care disparities are those related to services for American Indians and Alaska Natives (AI/ANs), who show significantly greater prevalence for diabetes, coronary heart disease, smoking, obesity, heavy alcohol use, depression, and PTSD than the general population. Given the recognition of the behavioral components of all of these conditions, the Indian Health Service, the federal agency responsible for providing comprehensive health care services to AI/ANs, has been focusing on increasing the integration of behavior health and primary care. One innovation has been to hire prescribing psychologists on primary care teams. This paper describes the role of a prescribing psychologist on three treatment teams at an IHS facility in Montana. Prescribing psychologists in the Indian Health Service can serve as valuable members of comprehensive care teams, providing exceptional wrap-around care for some of our most vulnerable and underserved citizens. This model could be an example of how a prescribing psychologist could contribute to primary care clinics in a variety of other settings.     

汉川市公共卫生服务人员工作现状及岗位荣誉感调查分析

采用整群抽样的方法,对汉川市公共卫生服务人员进行问卷调查与小组讨论,了解汉川市公共卫生服务人员的工作现状及岗位荣誉感,探究我国公共卫生服务人员面临的主要问题。研究结果表明,公共卫生服务人员工作中最大的困难是业务经费不足,最大干扰是缺乏业务与学术交流,对岗位荣誉感影响最大的因素是工作收入与付出不符,其他因素还有年龄、学历、职称、职务和收入水平等,通过文献研究,针对所述问题提出管理策略,以提高从业人员的岗位荣誉感。     

Obesity in America: Implications for Clinical and Health Psychologists

The number of individuals classified as overweight and obese is increasing at alarming rates and these conditions are associated with numerous psychological and physiological health problems. Within this epidemic, there is an increasing need and demand for psychologists and other mental health professionals to participate in the care of patients with obesity, both in assessment and treatment domains. The current paper provides a review of the status of the obesity epidemic, including psychological comorbidities and treatment approaches. Throughout this review, we highlight and discuss the important roles and impact psychologists can have. These roles include serving as members of multidisciplinary obesity treatment programs, conducting assessments for bariatric surgery, and treating related psychiatric disorders, such as depression and disordered eating. Other considerations, such as weight gain associated with psychiatric medications, and directions for future involvement of psychologists in addressing the obesity epidemic are also discussed.     

Working in Indigenous Contexts: Self‐Reported Experiences of Non‐Indigenous Australian Psychologists

Despite assertions in the literature that psychologists adopt culturally inappropriate strategies for working with Indigenous clients, there is little empirical evidence about this. The aim of this study was to document the self‐reported experiences of non‐Indigenous psychologists working with Indigenous clients, the factors that they felt constrain these interactions, and the clinical, assessment and communication strategies they perceived as effective in Indigenous contexts. Structured interviews were held with 23 psychologists, 18 females and five males, with age groups ranging from 20–30 to 50+. Thematic analysis of the data revealed that participants experienced contradictions between the typical Western white psychologists' ways of interacting with clients, which they had been taught and the typical ways in which relationships are structured in Indigenous communities. The results suggest that the Western model of psychological training does not work very well in Indigenous contexts, and that psychologists working in Indigenous contexts have to work out their own methods on a trial‐and‐error basis. This points to the need for more systematic cultural competence training. However, there is a lack of research into the effectiveness of psychological intervention from the viewpoints of Indigenous clients themselves.     

Learning Experiences Contributing to Service-Delivery Competence in Applied Psychologists: Lessons for Sport Psychologists

The purpose of the present study was to compare learning experiences perceived to contribute to service-delivery competence in sport, clinical, and counseling psychologists. Twenty psychologists (11 female, 9 male; 28–70 years of age) participated in semistructured interviews. All participants emphasized the role of client interactions in learning service-delivery processes. In addition, clinical and counseling participants reported personal therapy and supervision as influential experiences. Applied implications for training include (a) regional supervision networks comprising peers and elders, (b) university-based sport psychology clinics, and (c) personal and professional development groups.     

The Experiences of Indigenous Australian Psychologists at University

Disparities exist between Indigenous Australians and non‐Indigenous Australians on indicators of life expectancy, alcohol and drug use, adult and juvenile incarceration, and rates of hospitalisation for self‐harm, suicide, and mental and behavioural disorders due to psychoactive substance use. Psychology is a discipline that can assist in remedying these issues, yet disparities are evident in Indigenous participation in higher education generally, as well as within tertiary psychology education specifically. Ten Indigenous Australian psychologists were interviewed to investigate possible barriers and enablers for Indigenous students studying psychology at university. Hermeneutic phenomenology guided the research and its analysis, whereby the data went through a process known as the “hermeneutic circle”; data were analysed in itself, as well as part of the whole, leading to the world views of the participant and researcher converging into a “horizon of meaning.” Sources of support for Indigenous students included family support, financial assistance, and Indigenous student support centres. Potential barriers to university study of psychology were negative conceptions of higher education and psychology by the Indigenous community, “culture shock” upon relocating to the metropolitan area, a lack of Indigenous content and staff, and culturally insensitivity by staff members. Efforts should be made to address these barriers to participation, as well as to support those structures and services that were supportive for students.     

Working with Mental Health Service Users to Change Mental Health Services

During the last ten years in the UK, service user consultation and collaboration has gradually entered the vocabulary of people providing and purchasing mental health services. However, we are not convinced that much needed change in mental health services will be achieved as a function of increased commitment to market consumerism. We argue here that service user consultation and collaboration should take account of the effects of social inequalities on mental health and on mental health services. This perspective highlights the need for fundamental change in mental health services, and helps us to appreciate the strength of resistance to change, and to understand some of the dynamics involved. We describe here how this perspective has motivated and shaped our own efforts to collaborate responsibly with service users to change mental health services.     

英国医疗保障制度的改革经验及对中国的启示

英国是福利型社会保障制度的国家,它的医疗保障制度有力地保障了国民的生命健康,而且在医疗消费方面体现了相对公平的原则,同时存在一些不足的地方.英国医疗保障制度有很多值得中国借鉴的地方,对中国卫生体制改革具有重要的启示作用.     

英国医疗保障制度的改革经验及对中国的启示

英国是福利型社会保障制度的国家,它的医疗保障制度有力地保障了国民的生命健康,而且在医疗消费方面体现了相对公平的原则,同时存在一些不足的地方。英国医疗保障制度有很多值得中国借鉴的地方,对中国卫生体制改革具有重要的启示作用。     

突发公共事件的心理健康服务体系的建构

突发公共事件的心理应急救助是我国心理健康服务体系的一个重要组成部分.突发公共事件需要心理救助,心理救助也是突发公共事件危机管理的组成部分.严重突发事件的心理健康服务包含事前的准备、应急和善后的完整建构.突发公共事件的心理健康服务的应急预案应包含完善的应急组织管理指挥、系统完整的过程评估、分级分类的响应、强有力的应急救援保障、综合救援的应急队伍.在运作上应该遵循综合预防、协同应对和规范管理三个基本原则.     

Ethics and Confidentiality for Psychologists in Academic Health Centers

Psychologists in academic health centers (AHC) face important ethical issues including confidentiality when working with a multidisciplinary team, sharing of information through the electronic health record, obtaining informed consent in a fast-paced healthcare environment, cultural competency in the medical setting, and issues related to supervision and training. The goal of this paper is to describe ethical issues for psychologists in AHCs in the context of case examples, and to consider ethical decision-making tools to enhance clinical care. Considerations for best practices in integrated care settings will be discussed, and the APA Ethical Standards will be referenced throughout.     

Preparing Psychologists in Academic Health Centers for the Rapidly Changing Health Care Environment

The Association of Psychologists in Academic Health Centers (APAHC) convened its 5th National APAHC Conference in Boston March 3–5 2011. The conference and its theme, “Preparing Psychologists for a Rapidly Changing Health Care Environment,” brought psychologists from academic health centers together to examine how psychology can adapt to and help lead health care efforts in the face of health care reform. This paper reports on the conference and introduces the special issue of JCPMS that is dedicated to the conference. The conference theme is framed in the historical context of the four national conferences that preceded it. In examining the focus and topics of the preceding conferences, recurrent themes are identified and progress in certain areas is highlighted.     

Competencies for Psychologists in Academic Health Centers (AHCs)

This paper begins by providing the landscape that undergirds the competency-based movement within professional psychology education, training, credentialing, and performance appraisal. Attention is then paid to the relevance of this culture shift for psychologists working as practitioners, educators, researchers, and administrators in AHCs. In this regard, there is an articulation of the essential subcomponents of each of the core foundational and functional competency domains that are salient for AHC psychologists. Implications of the competency-based movement for professional psychologists in AHCs are offered. This paper is based in part on the first author’s plenary address at the Association of Psychologists in Academic Health Centers Midwinter Meeting in Minneapolis, Minnesota, May 2007.     

Referrers' Perceived Utility and Outcomes of Clinical Neuropsychological Assessment in an Adolescent and Young Adult Public Mental Health Service

Despite frequent informal or anecdotal acknowledgement of the usefulness of neuropsychological services within various settings, including mental health settings, few studies have formally investigated the satisfaction, perceived utility, or outcomes associated with such a service. This survey‐based study evaluated referring clinicians’ (n = 35) perceptions of the usefulness and outcomes associated with the provision of clinical neuropsychological assessment and feedback within an adolescent and young adult public mental health service in Melbourne, Australia. The results suggest that referrers perceive the neuropsychological service, including formal neuropsychological assessment report and verbal and written feedbacks, as a highly useful adjunct to their clinical practice. In addition, referrers frequently reported clinically meaningful outcomes in association with the neuropsychological service, including diagnostic changes or additions (11% of clients referred), changes to approaches in treatment (52% of clients referred), and increased or appropriate access to services, education, or work (33% of clients referred). Referrers also reported that almost 60% of neuropsychological assessment reports were forwarded to other services or clinicians involved in the client's care. The findings suggest that mental health settings are likely to benefit from routine inclusion of specialist neuropsychology services. However, future research should also examine client and family perceptions regarding the satisfaction and usefulness of neuropsychological services.     

Systemic Reflecting Team Training: Perceptions and Experiences of South African Educational Psychologists

Abstract

There is limited research on the application of systemic family therapy in developing countries. This qualitative study explored the perceptions and experiences of 12 educational psychologists and a family therapy trainer, who have worked within a systemic reflecting team using Tom Andersen’s method of training and supervision. The semi-structured interview findings suggested positive perceptions of systemic intervention, despite various challenges experienced in its implementation within the South African context. The educational psychologists identified their reflecting team experiences as being beneficial for both their professional development and current practices. Future research which investigates the reflecting team process in action is recommended.     

Mental Health Services in Juvenile Correctional Facilities: A National Survey of Clinical Staff

This study determined the use of best practices in providing mental health services to youth within juvenile correctional facilities. A national sample of 94 (49.7 %) lead clinical staff from all available and qualifying facilities responded to a mail and on-line survey. There were no statistically significant differences across respondents versus nonrespondents for security level, gender served, or census region of facilities. Specifically, we examined the provision of facility-wide mental health programming, individual, group, and family counseling, and case management services. Examination of these services included the use of evidence-based interventions provided through an established curriculum and methods used to evaluate the effectiveness of the interventions. We also examined staff involvement, and the perceived quality of services and barriers to providing interventions. Participants reported using a variety of evidence-based interventions; however, participants also acknowledged using other approaches that may not have empirical support. Additionally, although at least half of the participants reported mandatory individual and group counseling, less than a third of the participants reported that their facilities required family counseling. Clinical staff also reported a variety of methods used for evaluating the effectiveness of mental health services. Additional findings, as well as implications for research and practice, are discussed.     

Untapped Potential: Psychologists Leading Research in Clinical Practice

Enhancing the capacity of allied health professionals to engage in research is central to improving healthcare delivery. Psychologists have research skills given their training focus that emphasises the scientist‐practitioner model. We aimed to investigate among psychologists the link between individual research capacity and their current level of research activity, how this compares with other allied health professions, and the role of team and organisation research capacity. Psychologists (n = 60) working in clinical roles in a large metropolitan public health setting completed an online survey consisting of the validated Research Capacity and Culture tool, and questions related to current research activities, barriers, and motivators. The results indicated that psychologists reported relatively high individual research capacity, higher than both team and organisation levels, and greater individual research capacity compared with studies of dietitians and a mixed group of allied health. Preliminary findings suggested that team research capacity mediated the link between individual research capacity and the level of current research activity. Finally, barriers and motivators to research activity were similar compared with studies of other allied health professions. Overall, a multi‐strategy approach that focuses on and facilitates practice‐based and interdisciplinary research, and enhances the leadership skills of psychologists in research, as well as broader efforts from an organisational perspective to build a strong and sustainable research culture, may contribute to the rapid use of research skills in clinical practice and improve health and healthcare delivery.