Evaluating pediatric psychology consultation services in a medical setting: An example

We examined the nature of referrals to a health center-based pediatric psychology service from 1990 to 1993 and assessed the satisfaction of health professionals with these services. Archival evaluation of 1467 records showed that over half of the consultation requests came from general pediatrics, pediatric neurology, and surgical services and that 70% of the psychological services were delivered on an outpatient basis. The most frequent referrals were for cognitive/neuropsychological evaluation and externalizing behavior problems. Pediatric psychology trainees were involved in 94% of the consultations. Survey of health professionals (n = 143) indicated very high overall satisfaction with the quality of services delivered. Presenting problems yielding the greatest likelihood for future consultation requests were behavior problems, child abuse, coping with illness, and depression/suicide. Results are discussed in the context of previous evaluations of pediatric psychology services and recommendations for future evaluation research.     

Analysis of long-term stress reactions in emergency room patients: An initial study

The psychological stress reactions of 44 family medicine patients who were treated in the emergency room were examined approximately a year after the event. Patients were assessed on several psychological measures, including one for posttraumatic stress disorder (PTSD), and on their perception of how stressful the event was initially and now. Results show continuing stress reactions related to the emergency room event. Three patients endorsed symptoms indicating full PTSD and 13 appeared to have at least partial PTSD. Age appeared to be a factor in the presence of stress symptoms and in degree of perceived communication with the physician.     

Mental health service utilization among Puerto Rican children ages 4 through 16

This paper examines those children receiving mental health services in Puerto Rico, their demographic and psychosocial characteristics, and describes service providers and nature of facilities. The survey was done on a probability sample of children ages 4 through 16 across the island of Puerto Rico (N=777). Need for services was clinically defined as presence of a DSM-III diagnosis and functional impairment. The overall rate of service utilization for Puerto Rican children was 6% (26.2% of definite cases and 5.1% of probable cases). In most cases services were provided by psychologists and/or social workers, and they were mainly provided in schools and general medical facilities. In over 60% of the children assessed as cases, who did not receive services, the reason, given by the parent was that they considered the problem not serious. Factors associated with service utilization were measures of psychopathology, teacher's perceived need, and parental rates of criticism and hostility. These findings suggest that there is a need for more research on the motivating factors for service use (impairment and parental criticism). Teachers could benefit from receiving special training to help them readily recognize behavioral problems in children, communicate them to parents and set up services alternatives.     

Teaching simple addition to children with mental retardation using a microcomputer

Computer assisted instruction (CAI) was used for improving the efficiency of simple addition (single-digit without carrying) computation in three children with mental retardation. The training program, conducted on a portable personal computer, consisted of demonstrations and repetitive practices on simple addition presented in a vertical format. A number of behavioral instruction techniques such as direct feedback, corrective demonstration, verbal association, and token reinforcement were also included. To evaluate the effects of the CAI package, a multiple-baseline across subjects design with followup was employed. Results showed that performances of children improved with training and were maintained at 1-week, 4-week, and 12-week followups. Generalization of the learned skills was evident when children were assessed on a paper-and-pencil addition test in a vertical format. The skills were also transferable, with initial prompting, to a computerized addition test in a horizontal format. These findings reaffirmed the applicability of CAI and behavioral techniques for teaching math skills to children with mental retardation.     

Health and behavior: The coming together of science and practice in psychology and medicine after a century of benign neglect

For thousands of years, physicians had available only a few drugs with which to minister to patients and the practice of psychology was an integral and therapeutically powerful component in the practice of medicine. Thus, good bedside medicine consisting of empathy, compassion, and a nurturant attitude toward the ill individual was a major component of the physician's armamentarium until relatively recently. However, the explosion in scientific knowledge in biology, physiology, chemistry, and microbiology which began a century ago and has continued through the twentieth century helped produce several generations of physician specialists and subspecialists with little knowledge of the powerful role psychological factors play in health and illness. As a result, practitioners of medicine and practitioners of psychology have had little or no contact during most of this century. However, as advances in microbiology, public health, and nutrition have eradicated many of the infectious diseases, infirmities associated with one's lifestyle have replaced the latter as the major causes of death today. One offshoot of this shift is that after a century of benign neglect, physicians and psychologists have rediscovered a common ground in the arena labeled health and behavior. Some factors responsible for these recent developments are highlighted.This article was an invited address delivered to a group of Japanese health psychologists as part of a Health Sciences Seminar in Tokyo on July 24, 1993. Concurrent with its publication here in English, it is being published in the Japanese language in the March 1994 issue of the journal,Japanese Health Psychology.     

Influences of character-based coping style on psychological health

This study explores the moderating effects of early adult character style on correlations between social relationships in adolescence and midlife psychological health. Participants were drawn from the ongoing longitudinal studies at the Institute of Human Development. Individuals who beat the odds of an adverse environment and those who failed to capitalize on beneficial environments were identified and compared at age 30 on the California Psychological Inventory, the Meredith-Millsap Component Scores, and the Thematic Apperception Test. Social relatedness and personal independence were characteristics at age 30 of all subjects who went on to develop good psychological health by age 50. Social relatedness was more associated with overcoming a difficult environment, while self-assurance was more associated with capitalizing on a good one.     

Evaluating children's mental health service systems: An analysis of critical behaviors and events

A lack of studies which evaluate system change by tracking client outcomes is noted in the children's mental health area. This deficit may be a result of the inability of researchers to define outcomes and to draw conclusions about which measures reflect the efficacy of services and service delivery systems. This paper reviews five social validation surveys which examined children's mental health outcome measures. Based on the results of the five surveys, a model of critical behaviors and events is presented. This model will assist evaluators and researchers in understanding which critical events and behaviors should be measured to assess the impact of community-based mental health services for children.     

Facilitator influence in facilitated communication

The use of facilitated communication with individuals with autism has generated considerable controversy over the past several years. Only recently has research begun appearing which examines the procedure using reasonable scientific controls to establish the validity of this form of communication. The present study assessed the validity of facilitated communication and evaluated the effects of facilitator influence with seven individuals with autism and mental retardation. Three individuals showed clear evidence of facilitator influence, another three showed no such influence, and one subject performed at chance levels. A follow-up session with the three subjects who showed no facilitator influence demonstrated that they also showed no unexpected language competence compared to their measured IQ and to assessment under standard conditions. Results are discussed in terms of significance for facilitated communication in general and in terms of the utility of the methodology as a means of demonstrating language competence or facilitator influence.     

Teamwork makes the dream work: Testing for shared perceptions on psycho-behavioural skills between athletes,coaches and parents

Psycho-behavioural skills play a key role in optimising progression through talent development, and this study investigated to what extent athlete’s self-perceptions align with those of their coaches and parents. Firstly, we examined if levels of alignment between these three raters differ across age of the athlete. To this end, 122 athletes between 9 and 18 years old (12.17 ± 2.41 years old; 47 gymnasts, 13 cyclists and 62 badminton players) completed a psycho-behavioural questionnaire. The ANOVA’s indicated low levels of correspondence between the ratings of the athlete, the coach and the parents during childhood, while better levels of shared perceptions were found in adolescence. Secondly, we investigated to what extent coaches and parents believed their own perception of the athlete’s and the perception of the athlete’s psycho-behavioural skills were accurate. Parents appeared to be more confident in accurately perceiving the psycho-behavioural skills of the athlete than coaches. Parents and coaches also believed that older athletes would be more honest on their psycho-behavioural shortcomings than younger athletes. Altogether, these findings highlight that athletes and other stakeholders in the talent development environment should strive for better alignment in perceptions on psycho-behavioural skills during the talent development pathway. With better integrated perceptions, a more functional and efficient talent development system for the athlete targeting the psycho-behavioural skills can be created.