Competencies of Process: Toward a Relational Framework for Integrated Care

As integrated care (IC) has gained more traction within both the psychosocial and medical fields, the need to train medical family therapy students and established professionals in this care typology has increased in tandem. To address this stated need, there is a large body of literature pertaining to models of care, typologies of intervention, clinical and financial effectiveness, and now a burgeoning discussion related to the academic and practice-based competencies necessary for IC practice. While the ability of the medical family therapist as behavioral health provider (MedFT/BHP) to practice in integrated settings may rely on an understanding of population-based medicine, disease etiology, medication and psychopharmacology, as well as augmentations to patient conceptualization and practice, all of the specifics related to that care are ultimately leveraged on the relationships formed by the MedFT/BHP with their healthcare colleagues. What this means is while we have attempted to distill the gestalt of integrated care into its major practice-based parts (e.g., model development and implementation, competencies, financial viability, efficacy/effectiveness, mechanisms of activation, and marketing), we have not adequately described the competencies necessary to set the stage for these types of close working relationships: relationships that make integration, of any kind, a possibility. The following paper was written to discuss three competencies related to the relational process of integration: (a) conceptual flexibility, (b) understanding and acceptance, and (c) acknowledgment and appreciation, as well as how these competencies provide the backdrop against which integrated care, as a practice, can emerge.     

Teens' concerns: a national evaluation

Previous research found that adolescents in Toledo, Ohio, utilized a peer listening phone service predominantly for four reasons: to discuss peer relationships, family problems, and sexuality issues, as well as to have someone "just to talk to." The present study investigated whether adolescents in other areas of the United States used such services for similar reasons. Data were collected at four sites-Toledo, Los Angeles (California), Martinsville (Virginia), and Syracuse (New York)-over the course of one year. The results indicated that the callers were predominantly female and of high school age. The most frequently discussed issue was peer relationships (46% to 60%), regardless of site. Another frequent topic at all sites was family problems (10% to 20%). Other concerns varied by site.     

Neuropsychological Functioning and Recall of Research Consent Information Among Drug Court Clients

Evidence suggests that research participants often fail to recall much of the information provided during the informed consent process. This study was conducted to determine the proportion of consent information recalled by drug court participants following a structured informed consent procedure and the neuropsychological factors that were related to recall. Eighty-five participants completed a standard informed consent procedure to participate in an ongoing research study, followed by a 17-item consent quiz and a brief neuropsychological battery 2 weeks later. Participants performed within the normal range on most of the neuropsychological measures, although roughly one third showed deficits on measures of executive functioning. Participants failed to recall over 65% of the consent information within 2 weeks of entering the study, and their recall was significantly correlated with verbal IQ, drug problem severity, reading ability, memory, and attention. These factors may be useful in determining whether research participants require enhanced consent procedures.     

Do Research Intermediaries Reduce Perceived Coercion to Enter Research Trials Among Criminally Involved Substance Abusers?

We examined the efficacy of including a research intermediary (RI) during the consent process in reducing participants' perceptions of coercion to enroll in a research study. Eighty-four drug court clients being recruited into an ongoing study were randomized to receive a standard informed consent process alone (standard condition) or with an RI (intermediary condition). Before obtaining consent, RIs met with clients individually to discuss remaining concerns. Findings provided preliminary evidence that RIs reduced client perceptions that their participation might influence how clinical and judicial staff view them. This suggests that using RIs may improve participant autonomy in clinical studies.     

Corrected Feedback: A Procedure to Enhance Recall of Informed Consent to Research Among Substance Abusing Offenders

This study examined the efficacy of corrected feedback for improving consent recall throughout the course of an ongoing longitudinal study. Participants (N = 135) were randomly assigned to either a corrected feedback or a no-feedback control condition. Participants completed a consent quiz 2 weeks after consenting to the host study and at months 1, 2, and 3. The corrected feedback group received corrections to erroneous responses and the no-feedback control group did not. The feedback group displayed significantly greater recall overall and in specific content areas (i.e., procedures, protections, risks/benefits). Results support the use of corrected feedback for improving consent recall.     

Phenomenology of Bibliotherapy in Modifying Teacher Punitiveness

The authors examined the phenomenology of bibliotherapy and its effects in changing preservice teachers' punitive attitudes toward children. Participants (N = 29) were enrolled in a university course (Introduction to Emotional Disturbance). Five books by Torey Hayden, autobiographical accounts of teaching and building relationships with students with emotional and behavioral disorders, were read and discussed within the framework of group bibliotherapy. Participants completed a self-report rating form measuring their tendency toward punitiveness during the first and last weeks of the 15-week semester. Participants also completed a questionnaire measuring the bibliotherapeutic impact of reading Hayden's texts, and they kept journals about the experience of reading Hayden. Comparison of the group's pre- and post-measures on punitiveness showed a small, albeit significant decrease in punitiveness; decreased punitiveness was associated with the therapeutic impact of reading Hayden. Phenomenological analysis of the participants'journal entries revealed that the structure of the experience of reading Hayden was one of identification with the protagonist, leading to emotional and cognitive learning.