Dismantling institutional racism: theory and action

Despite a strong commitment to promoting social change and liberation, there are few community psychology models for creating systems change to address oppression. Given how embedded racism is in institutions such as healthcare, a significant shift in the system's policies, practices, and procedures is required to address institutional racism and create organizational and institutional change. This paper describes a systemic intervention to address racial inequities in healthcare quality called dismantling racism. The dismantling racism approach assumes healthcare disparities are the result of the intersection of a complex system (healthcare) and a complex problem (racism). Thus, dismantling racism is a systemic and systematic intervention designed to illuminate where and how to intervene in a given healthcare system to address proximal and distal factors associated with healthcare disparities. This paper describes the theory behind dismantling racism, the elements of the intervention strategy, and the strengths and limitations of this systems change approach.     

Spiritual Tools for Enhancing the Pastoral Visit to Hospitalized Patients

The tradition of visiting the sick is a practice that brings comfort to patients who are suffering, offers prayers for healing, and keeps the connection with family and community alive. It is a practice recognized from ancient times through today, one which underscores the mission of the field of Pastoral Care. This paper describes the creative use of multi-sensory spiritual tools, such as music, singing, personal prayer, psalms, and traditional texts, to enhance the sick visit to the hospitalized patient. This brief structured model is replicable and teachable to lay and professional caregivers. Both patient, family members, and caregivers can benefit from sharing in these moments of inner spiritual attunement and connection with others. Israela Meyerstein, LCSW-C, LMFT, is a social worker and family therapist in private practice in Baltimore, Maryland. An Approved Supervisor for the American Association for Marriage and Family Therapy, Ms. Meyerstein has trained therapists of all disciplines and has published over two dozen articles relating to Family therapy, medical issues, and spirituality. She is co-founder of the Baltimore Jewish Healing Network. Correspondence to Israela Meyerstein, Imeyerstein@hotmail.com. Gila Ruskin has served as a congregational rabbi, psychiatric hospital chaplain, adult and day school educator, and pastoral counselor. Rabbi Ruskin currently teaches Bible, Holocaust Studies, and Creative Writing at the St. Francis Academy in Baltimore, Maryland. She is co-founder of the Baltimore Jewish Healing Network.     

Social validity assessment of behavior data recording among human services care providers

Care providers within human services organizations have many job responsibilities and performance expectations. In the present study, we conducted social validity assessment with 78 care providers concerning their attitudes and opinions about behavior data recording with adults who had intellectual disability and lived in community group homes. Specifically, the care providers responded to a written questionnaire that inquired about the practicality, training/supervision, and value of behavior data recording in the context of service delivery. Results indicated generally high approval of behavior data recording practices, purposes, and approaches to training. We discuss implications of these findings for implementing data recording by care providers and the contribution of social validity assessment to training and performance management within human services organizations.     

Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

Abstract

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.     

The effects of the Newborn Behavioral Observations (NBO) system in early intervention: A multisite randomized controlled trial

The purpose of this pilot study was to evaluate the effect of an infant mental health intervention, the Newborn Behavioral Observations system (NBO), versus usual care (UC) on infant neurodevelopment and maternal depressive symptoms in early intervention (EI). This multisite randomized trial enrolled newborns into the NBO (n = 16) or UC group (n = 22) and followed them for 6 months. Outcome measures included the Battelle Developmental Inventory (BDI-2), Bayley Scales of Infants Development (BSID-III), and Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D and BSID-III were collected at 3- and 6-months post EI entry and the BDI-2 was collected at EI entry and 6-months post-EI entry. We estimated group differences [95% CI], adjusting for program characteristics. At 6 months, the NBO group had greater gains in Communication (b = 1.0 [0.2, 1.8]), Self-Care (b = 2.0 [0.1, 3.9]), Perception and Concepts (b = 2.0 [0.4, 3.6]), and Attention and Memory (b = 3.0 [0.4, 6.0]) than the UC group. The NBO group also had greater decline in maternal postnatal depressive symptoms (b = −2.0 [−3.7, −0.3]) than the UC group. Infants receiving the NBO infant mental health intervention had greater gains in cognitive and adaptive functions at 6 months than infants receiving UC. Caregivers receiving NBO care had greater improvements in maternal depressive symptoms than caregivers receiving UC.     

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.     

Adaptation and implementation of the German social–emotional learning programme Papilio in Finland: A pilot study

This study investigated the cross-national adaptation and implementation of Papilio, a German social–emotional learning programme, in Finnish early childhood education and care (ECEC) centres. Papilio is a developmentally focused, scientifically based intervention programme focused on preventing behavioural problems and fostering social–emotional competence in children aged 3–7. The aim of this study was to investigate and evaluate the cross-national adaptation and cross-cultural adaptation and implementation of Papilio in the Finnish ECEC context. Results from qualitative interviews with one Finnish Papilio trainer, 11 early childhood education (ECE) teachers, two ECE special education teachers and two nursery nurses are supplemented with teachers' and nursery nurses' (N = 75) questionnaire data. Qualitative thematic analysis revealed that cultural adaptations were necessary on four levels: accommodation of materials, adaptation of the contents of the materials, structure and delivery. The materials and training contents were culturally adapted, whereas the delivery of the intervention was adapted according to Finnish ECEC practices. The structural adaptation included discarding timeout, due to opposition by some educators. The educators were committed to implementing the programme as instructed and resolving the practical difficulties they encountered. Their motivation to implement Papilio increased as they observed improvements in the children's social–emotional competence during intervention.     

Generalized Anxiety Disorder in Older Medical Patients: Diagnostic Recognition, Mental Health Management and Service Utilization

Background Primary care physicians often treat older adults with Generalized Anxiety Disorder. Objective To estimate physician diagnosis and recognition of anxiety and compare health service use among older adults with GAD with two comparison samples with and without other DSM diagnoses. Methods Participants were 60+ patients of a multi-specialty medical organization. Administrative database and medical records were reviewed for a year. Differences in frequency of health service use were analyzed with logistic regression and between-subjects analysis of covariance. Results Physician diagnosis of GAD was 1.5% and any anxiety was 9%, and recognition of anxiety symptoms was 34% in older adults with GAD. After controlling for medical comorbidity, radiology appointments were increased in the GAD group relative to those with and without other psychiatric diagnoses, χ² (2, N = 225) = 4.75, p < .05. Conclusions Most patients with anxiety do not have anxiety or symptoms documented in their medical records.     

The Financial Dimension of Integrated Behavioral/Primary Care

There are two reasons why mental health, now more appropriately termed behavioral healthcare, is declining: (a) a lack of understanding among psychotherapists of healthcare economics, particularly the intricacies of medical cost offset, and (b) our failure as a profession to see the importance of behavioral interventions as an integral part of the healthcare system inasmuch as the nation pays for healthcare, not psychosocial care. This paper will briefly describe the rapid changes in the economics of healthcare during the past 75 years, including the post World War II enthusiastic espousal of psychotherapy by the American public which was followed by a precipitous decline as our outcomes research in behavioral care remained ignorant of financial outcomes, leaving it to the government and managed care to arbitrarily curtail escalating mental health costs. At the present time psychology is on the cusp of becoming part of the healthcare system through integrated behavioral/primary care, renewing the primacy of financial considerations such as return on investment (ROI) and medical cost offset, as well as an urgency that we avoid the mistakes that are emerging in some flawed implementations of integrated care.