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.     

Parenting stress in parents of children with attention-deficit hyperactivity disorder and parents of children with learning disabilities

Parenting a child with ADHD can challenge parenting resources and coping. Increasingly, researchers are examining the relationship between the behavior of the child with ADHD and family functioning. While studies have shown inceased parenting stress in parents of children with ADHD, these studies have compared children with ADHD to non-disabled children. This study compares reports of parenting stress among mothers of children with ADHD, mothers of children with learning disabilities and mothers of non-referred children. Results showed that parenting stress was highest for mothers of children with ADHD. Increased parenting stress was associated with child characteristics and, in particular, with externalizing behavior problems.     

Families and family therapy in Germany

The author describes some of the effects of decades of life under a dictatorship for East Germans and the effects on family life and family therapy of changes following the recent reunification of Germany. A case example illustrates some intergenerational family problems associated with the changes. Contrasts are drawn between East and West Germany and family therapy's present stage of development is depicted in both parts of the reunified country. Germany has approximately 10,000 trained family therapists, a minority of whom work in private practice. The largest amount of family and couples therapy is performed in agencies.Portions of this material were first presented in a poster session at the American Association for Marriage and Family Therapy annual conference in Miami Beach, 1992.     

Long term marriages in Sweden: And some comparisons with similar couples in the United States

This international, five-country long term marriages study of couples who have been married, or unmarried and cohabiting, for 20 years or longer is designed to study, among other things, marital satisfaction. This first report of the Swedish part of the study reports on a Swedish version of the self-rating Dyadic Adjustment Scale (DAS) used to investigate self-rated marital satisfaction. The couples describe high marital satisfaction and a high sense of coherence (SOC) compared to other groups. Contrary to other studies, no differences were found between men and women regarding SOC. The differences between them, that describe high relative to low marital satisfaction, pertain to matters of recreation, sex, life philosophy, time spent together, and frequency of quarrels. The men reported greater marital satisfaction than the women.     

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.