Report of the Working Group on Governance and Administration

Prepared by the Working Group on Governance and Administration from the November 1995 Georgetown conference sponsored by the Association of Medical School Psychologists, this paper delineates the various trends in health care that may impact upon organizational structures for psychologists within academic medical centers. Ten variables that describe various functional issues within academic medical centers or health science centers are defined. Finally, seven organizational guidelines and recommendations pertaining to governance of psychological services are detailed.     

Personal warmth and psychological health at midlife

Personal warmth, arguably a strong trait in the makeup of psychological health, seems to fade in conceptual importance at midlife. In contrast, ideas of interiority and androgyny appear to gain conceptual importance at midlife. The present study sought to rebalance these foci by determining the predictive power of personal warmth for psychological health of men and women at age 50: first, by developing separate California Psychological Inventory (CPI) scales to assess personal warmth; next, by joining these warmth scales with the 20 standard CPI scales to predict psychological health. Without the personal warmth scale, the standard CPI scales do not significantly predict psychological health for men; for women, the standard scales do. For both genders, the personal warmth scales add significantly to the predictability of psychological health. The results point to an amendment of current theoretical formulations of interiority and androgyny to better understand optimal psychological development in men and women at midlife.     

Training Psychologists for a Future in Evolving Health Care Delivery Systems: Building a Better Boulder Model

Recent and dramatic changes in the demand for and reimbursement of psychological services and expertise in health care delivery systems have radical implications for the preparation of psychologists at the predoctoral, internship, and postdoctoral levels. In order to respond to these changes effectively and advance the profession, training programs must realize the expanded and potential role of psychological expertise in evolving health care delivery systems. In this paper, we review several limitations and unfortunate consequences of traditional training programs that have confined the scope of research and practice to the realm of mental health. We propose that future psychologists be recognized and trained from a broader perspective as behavioral scientists, prepared to operate at the highest levels of health care delivery systems. Specific recommendations for training and education are discussed.     

EVALUATION OF TWO HEALTH EDUCATION STRATEGIES FOR TESTICULAR SELF-EXAMINATION

We evaluated the effects of two health education teaching methods, a pamphlet based on a task-analyzed checklist and two professionally developed films, on the completeness, accuracy, and maintenance of testicular self-examinations (TSE). Subjects (N = 48) were videotaped while performing a TSE after training and at a follow-up visit. Direct observation of the tapes showed that checklist-based training resulted in more complete and longer TSEs (p < .05). Social validation ratings, however, suggested that physicians were unable to discriminate reliably the performances of subjects taught using the two methods. Accuracy of detection of simulated lesions on plastic models was also similar for the two groups. Adherence to TSE recommendations was high during the study, but declined across the follow-up period. Further study is needed to promote adherence to TSE and to document the effects of early detection on morbidity and mortality of testicular cancer.     

Reported prevalence of attentional difficulties in a general sample of college students

The present study investigated the self-reported prevalence of attention-deficit hyperactivity disorder (ADHD)symptoms in 770 college students using the Adult Rating Scale and the Wender Utah Rating Scale. Psychometric properties of these scales were explored. The study also investigated the performance of students with ADHD symptoms, relative to students without ADHD symptoms, on a battery of neuropsychological tasks. Results revealed that 7 and 8% of the students reported significant symptoms (i.e., 1.5 SD above the mean) on the Adult Rating Scale and the Wender Utah Rating scale, respectively, and 2.5% reported significant symptoms on both the Adult Rating Scale and the Wender Utah Rating Scale. Using more stringent criteria (two standard deviations), fewer (i.e, 4, 3.8%, and 0.5%) subjects reported significant symptoms associated with ADHD. Between-group differences were found on one of the neuropsychological tasks. The construct validity of the rating scales was supported. Limitations and implications for future research are advanced.Presented at the International Neuropsychological Society's Sixteenth European Conference, Angers, France, June 1994, and the Annual Convention of the American Psychological Association, Los Angeles, CA, August 1994.     

The interface between physical and mental disorders: The need to dismantle the biopsychosocialneuroimmunological model of disease

This article argues for the necessity of cognitive-behavioral assessment for a thorough understanding of how psychological factors mediate disease process across a wide range of diseases including coronary artery disease, breast cancer, and human immunodeficiency disease. Based on empirical data presented as part of the APA Presidential miniconvention, “To Your Health: Psychology through the Life Span,” the conclusion is that psychological treatment can help extend life. Stress management programs can positively influence adherence to treatment regimens and positively influence the human immune system response during the course of treatment and recovery from illness. Even in the face of life-threatening circumstances such as liver transplantation, Stage II and III breast cancer, and after HIV infection has been diagnosed, the quality of life can be remarkably improved. Physicians and psychologists must work together to produce the beneficial effects of the synergy between mind-body processes.     

The readability of educational materials written for parents of children with attention-deficit hyperactivity disorder

Health-care providers are relying increasingly on printed materials to educate patients and their families about varous aspects of their health or mental health conditions. For the target audience to be able to read and understand health brochures, they should be written at or about the 8th-grade level and incorporate variables that facilitate comprehension. The purpose of this study was to analyze brochures related to Attention-Deficit Hyperactivity Disorder to determine (a) if they were written at a level appropriate for the target audience, and (b) the extent to which they incorporated variables identified in the research literature as facilitating comprehension. The results showed that the brochures were written at a reading level beyond that of the target audience. Further, although the brochures incorporated a large number of variables which facilitate comprehension, many were not used to the extent necessary to ensure that readers would be able to understand the brochures. These results clearly indicated the need for health care materials to be written in such a way that they can be read and understood by the target audience.     

Crisis for community mental health: The use of groups in the struggle for survival

The task of community mental health is to provide quality services to clients despite funding cutbacks. This paper describes the recent evolution in conceptualization and service delivery in one center. The outcomes are a philosophy that is customer oriented, and treatment that draws upon brief techniques, in group and long term contexts.     

The Experience of Caregiving Among Mothers of Adults Suffering from Psychotic Disorders: Factors Associated with Their Psychological Distress

To identify correlates of psychological distress among multiple indicators, 99 women with adult children suffering from a psychotic disorder were interviewed. The women, who were recruited through hospitals and self-help groups, represented different socioeconomic levels. A face-to-face standardized interview was conducted, mainly in the participants' homes. Multiple hierarchical regression analysis showed that dimensions of burden and social support were strongly associated with distress reported by the participants. The negative interactions that participants had with their main confidant or spouse constituted a more powerful correlate than their perception of the quality of this relationship. Furthermore, a perception of their own health as poorer is a strong correlate of their distress. Since no control group was studied simultaneously, these results suggest, but do not prove, the presence of differences between mothers of adults with psychotic disorders and other mothers.     

Psychological Distress and Help Seeking in Rural America

The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.