Collaborative Communication Between Psychologists and Primary Care Providers

Psychologists frequently collaborate in the care of patients managed in primary care. Communication with a patient’s primary care team is important to ensure coordination and continuity of care. The communication is far from seamless. Although The Health Information Privacy and Portability Act (HIPPA) is designed to promote sharing of clinical information while protecting patient confidentiality, unique problems arise when mental health records are included. Mental health records are subject to different regulations to protect the patient’s confidentiality. Thus, what is communicated and how it will be accomplished are challenges. Further, psychologists and primary care providers often view documentation differently, resulting in different styles of documenting that may also impede coordinated care. Increasingly, health care systems are moving toward electronic medical records, creating greater opportunities for an integrated record. Improved communication through the record can keep other providers abreast of the mental health care being provided as well as suggestions they can use to reinforce the mental health care treatment plan.     

Motivational Interviewing in Primary Care

Healthcare systems are in the process of reforming themselves to better meet the needs of people with, or at risk of developing, chronic diseases and long term conditions. One goal of these efforts is the coproduction of activated, informed, engaged and motivated patients and citizens. The clinical, public health and financial benefits of achieving such a goal may be dramatic. Motivational Interviewing (MI) is a proven and practical front-line approach which can help deliver this goal whilst also helping to deliver such policy objectives and intermediate outcomes as increased levels of patient centered care, participatory or shared decision making, evidence-based healthcare and improved clinician-patient relationships. Until now, MI has been passively diffusing through the system as a result of the innovation and early uptake by insightful individuals and organizations. If healthcare systems want to breakthrough to higher levels of performance, investment in the conscious and deliberate implementation of MI into front-line settings may prove helpful.     

The Challenge of Integrated Care for Mental Health: Leaving the 50 minute hour and Other Sacred Things

A growing body of research has demonstrated the effectiveness of integrating mental/behavioral healthcare with primary care in improving health outcomes. Despite this rich literature, such demonstration programs have proven difficult to maintain once research funding ends. Much of the discussion regarding maintenance of integrated care has been focused on lack of reimbursement. However, provider factors may be just as important, because integrated care systems require providers to adopt a very different role and operate very differently from traditional mental health practice. There is also great variability in definition and operationalization of integrated care. Provider concerns tend to focus on several factors, including a perceived loss of autonomy, discomfort with the hierarchical nature of medical care and primary care settings, and enduring beliefs about what constitutes “good” treatment. Providers may view integrated care models as delivering substandard care and passively or actively resist them. Dissemination of available data regarding effectiveness of these models is essential (e.g. timeliness of treatment, client satisfaction). Increasing exposure and training in these models, while maintaining the necessary training in traditional mental health care is a challenge for training at all levels, yet the challenge clearly opens new opportunities for psychology and psychiatry.     

The Unmet Educational Agenda in Integrated Care

One of the reasons integrated care has not become a dominant service delivery model is the unmet training agenda. This article argues that the typical mental health professional is not trained to adequately address the challenges of integrated care. To insure competency both a macro and clinical training agenda are needed. At the macro-level, mental health professionals need to understand healthcare economics and basic business principles as any integrated care service delivery system is embedded and driven by economic forces. Integrated care practitioners also need some basic business skills to understand these forces and to create and manage a financially viable system, given the future flux of the system. Traditional mental health professionals also do not have the clinical skills to implement integrated care. Integrated care is not simply placing a traditionally trained mental health professional and letting them practice specialty mental health in a medical setting. Thus, the special skills needed in integrated care are enumerated and discussed. Finally, a new degree program is described as it is time given the huge need and advantages of integrated care to develop specialty training in integrated care.     

Violence Exposure and PTSD: The Role of English Language Fluency in Latino Youth

Although Latinos have been a rapidly growing population in the US, little is known about how mental health symptoms may present in Latino children especially in the context of those living in poverty and exposed to violence. We explored the level of violence exposure and trauma symptoms in Latino youth and the relationship of these factors with English language fluency. During 2000–2002, 1,601, Latino students from seven middle schools participated in a school-based screening to identify students with exposure to community violence and symptoms of Posttraumatic Stress Disorder (PTSD). The students completed a self-report instrument, in either Spanish or English, that combined a modified version of the Life Events Scale and the Child PTSD Symptom Scale (CPSS). Bivariate analyses and multivariate regression models showed that youth with higher English language fluency reported greater violence exposure and PTSD symptoms than those with lower fluency. No difference was found in functioning by English language fluency. English language fluency appears to be related to violence exposure and PTSD symptoms in these Latino youth. We discuss the importance of school-based programs especially designed to serve Latino students of varying English language fluency.     

Examining Externalizing Behavior Trajectories of Youth in Group Homes: Is there Evidence for Peer Contagion?

Although concerns about peer contagion are often cited in critiques of group treatments for troubled youths, few studies have examined the effects of exposure to deviant peers in residential group care settings. This study used administrative data of youth served at Boys Town, a nationally-known group care provider. Using latent class growth analysis, this study identified the externalizing behavior trajectories of youth in group care as well as the behavior trajectory of the peers with whom they lived, assessed the relationship between youth trajectory classes and individual and peer group characteristics as well as the relationship between an individual youth’s behavior pattern and the behavior pattern of proximal peers. Several results suggested the presence of peer contagion in group care: a trajectory class of gradually increasing externalizing behavior problems, the strength of deviant peer density in predicting an individual youth’s externalizing behavior trajectories and significant associations between behavior patterns of youth and proximal peers. While there is some evidence that suggests an increase in problem behavior during care, results from this study indicated that over 90% of the youth did not have an increase in problem behaviors and that positive peer influences may also be protective and inhibit problem behaviors.     

Chaplain–Physician Consultancy: When Chaplains and Doctors Meet in the Clinical Context

This paper summarizes the perspectives of 327 Australian health care chaplains concerning their interaction with physicians within the clinical context. In general terms the findings indicated that nearly 90% of chaplains believed that it was part of their professional role to consult with physicians regarding patient/family issues. Differences of involvement between volunteer and staff chaplains, Catholic and Protestant, male and female chaplains and the type of chaplaincy training are noted, as are the perspectives of chaplaincy informants regarding their role in relation to physicians. Some implications of this study with respect to chaplaincy utility and training are noted.     

Participatory Research in Systems of Care for Children’s Mental Health

The children’s system of care initiative in the United States requires the participation of caregivers of children with emotional or behavioral problems in conducting research and evaluation. This entails a restructuring of traditional power dynamics among families served by the community mental health system and other system stakeholders, including researchers. However, evidence indicates that system of care research may not currently embrace the different types of knowledge possessed by caregivers and may be frustrated by traditional power hierarchies, resulting in research findings that are not useful for the community. In this paper I examine a framework for power and knowledge and examine how, when viewed through this framework, participatory research in the system of care initiative thus far may be less than authentic. I conclude with improvements suggested by the framework that are expected to shift power to caregivers and result in more useful, actionable research findings for the community.     

INTRODUCTION: RETHINKING PHILOSOPHICAL PRESUMPTIONS IN LIGHT OF COGNITIVE DISABILITY

Abstract: This Introduction to the collection of essays surveys the philosophical literature to date with respect to five central questions: justice, care, agency, metaphilosophical issues regarding the language and representation of cognitive disability, and personhood. These themes are discussed in relation to three specific conditions: intellectual and developmental disabilities, Alzheimer's disease, and autism, though the issues raised are relevant to a broad range of cognitive disabilities. The Introduction offers a brief historical overview of the treatment cognitive disability has received from philosophers, and explains the specific challenges that cognitive disability poses to philosophy. In briefly summarizing the essays in the collection, it highlights the distinctive contributions the collection makes to ethics, political philosophy, bioethics, and the philosophy of disability. We hope that the richness of the topics explored by these essays will be a spur to further investigation.