File review consultation in the adjudication of mental health and chronic pain disability claims.

The role of the psychological file review consultant in assisting disability insurance carriers to adjudicate chronic pain and mental health claims is discussed. The authors advocate an empirical basis for the practice and outline the relevant professional issues and procedural steps to be taken in this consulting role. They examine the role of the consultant in evaluating the quality of assessment, whether empirically evaluated treatments have been applied, and what factors can be used in estimating return to work dates. Specific problems that a file review consultant might encounter and suggested solutions are described as are potential biases and ethical dilemmas that may occur when psychologists take on this emerging consulting role. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using registry nurses: coping with cost and quality issues

If a nursing service uses agency nurses to help cope with staff shortages, the nursing administrator must manage the cost and quality of care delivered by these nurses. The authors describe their hospital's system for using agency nurses. The components of their system--an orientation program, contracts with the agencies, and systematic performance evaluation--can be used or adapted in other institutions.     

Meeting mental health needs following a natural disaster: Lessons from Hurricane Katrina.

Hurricane Katrina had a devastating impact on hundreds of thousands of Louisiana and Mississippi families. Housing was destroyed, jobs were lost, and family members were separated, sometimes in different states and without communication. Postdisaster stress reactions were common, with vulnerable individuals most affected. Mental health services were not adequate to meet immediate needs, and postdisaster mental health issues often emerge over time. This article describes the mental health needs of dislocated and evacuee children and families and the steps that were taken to develop mental health programs that would be sustainable over time to meet this new level of need. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The performance of the Aedes aegypti eradication program in 2 towns of Ciudad de La Habana province, 1990-1992

BACKGROUND AND METHODS: The present study examined the ways in which demographic, psychosocial, and objective risk factors were related to perceived risk of skin cancer among 384 hospital employees who participated in a screening program. It was hypothesized that pyschosocial risk factors would account for a significant portion of the variance in risk perception beyond that accounted for by the other risk factors. RESULTS: The risk factors accounted for approximately 44% of the variance in risk perception. Psychosocial risk factors accounted for a statistically significant portion of the variance in risk perception beyond that accounted for by other risk factors. Worry, family history of skin cancer, and race/ethnicity were most strongly related to perceived risk. CONCLUSIONS: Results are discussed in terms of the need for educational programs that emphasize the relationship between level of risk and skin cancer and provide specific information regarding steps that can be taken to prevent skin cancer.     

The New Hampshire study of supported employment for people with severe mental illness.

This study compared supported employment services in 2 contrasting programs: (a) Group Skills Training, a professional rehabilitation agency outside of the mental health center that provided preemployment skills training and support in obtaining and maintaining jobs, or (b) the Individual Placement and Support (IPS) model, which integrated clinical and vocational services within the mental health center. People with severe mental disorders who expressed interest in competitive employment (N?=? 143) were randomly assigned to 1 of these 2 programs. Results showed that clients in the IPS program were more likely to be competitively employed throughout most of the 18-month follow-up. Among those who obtained jobs, there were few group differences, although workers in the IPS program did work more total hours and earn more total wages during the 18-month followup. There were no group differences on nonvocational outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparing master's clinical training with professional responsibilities in community mental health centers.

100 directors from randomly selected, federally funded community mental health centers and 70 coordinators from university-based, master's-level clinical training programs were surveyed by mail. A 5-part questionnaire sought information regarding (a) relative amount of time spent by master's-level clinicians performing 10 specified professional responsibilities, including psychodiagnostics, psychotherapy and counseling, research, administration, and consultation, or relative time spent at them in training; (b) the same estimates projected 10 yrs into the future; (c) differences in the groups' ratings of master's-level clinician's competency for the same 10 responsibilities; (d) perceived relative importance of each responsibility for the clinicians; and (e) estimates of importance 10 yrs hence. Results are based on return rates of 33% for center directors and 60% for program coordinators and are presented in both between- and within-groups comparisons. Master's-level clinicians were seen as competent professionals having a continuing role in mental health service delivery. Implications for training, provision of service, and degree recognition are considered. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responding to an identified need: A joint department of defense/department of veterans affairs training program in eye movement desensitization and reprocessing (EMDR) for clinicians providing trauma services.

An earlier study of federal Department of Defense mental health professionals found relatively few trained in the psychotherapies for posttraumatic stress disorder previously identified as effective by both this department and the federal Department of Veterans Affairs. In response to that need, a training program for one of the psychotherapies, eye movement desensitization and reprocessing (EMDR), was implemented utilizing personnel from these federal departments with assistance from a nonprofit agency. This article presents an evaluation of that program with rating data gathered from participants as well as treatment outcome data from the application of the training to patients. The program was highly rated by the participants and the impact of EMDR treatment was significant. Suggestions for similar programs and for further research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health consultation in the pediatric intensive care unit.

The need for psychosocial intervention to be integrated with medical care on intensive care units is high, but too often mental health professionals are ill-equipped by traditional training programs for such work. Medical crisis counseling provides a conceptual framework useful in developing the skills needed to effectively intervene in such settings. The pediatric intensive care unit ( PICU ) is arguably one of the most emotionally demanding and high-stress areas where mental health clinicians may be asked to consult. This article describes medical crisis consultation in the PICU setting, suggests survival strategies for the mental health consultant to the PICU, and provides illustrative case examples. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Fourth revolution in the treatment of mental disorders: Rehabilitative entrepreneurship.

Argues that there is a growing recognition that deinstitutionalization has not been an adequate solution to the plight of the chronic mental patient. The flaw being perceived in the community mental health movement is that there has been no insistence through cost-reimbursement procedures for actual change in patient behavior. The present author suggests that psychiatric treatment, funded through state and federal health programs, will not be perceived as adequate until therapy is conceptualized within a rehabilitation model, and fees for service are established through performance contracts based on demonstrable behavior change. It is believed that, if the goal is financial gain, such a therapy system will induce the private practitioner to enter actively into the treatment process. Limitations on therapy progress will therefore be considered in terms of the structure imposed by financial systems. A solution will be offered that rewards the entrepreneurial motive of the private practitioner and diminishes the rewards to the practitioner employed by public institutions who engages in therapeutic activity without any financial incentive to produce behavioral change. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary prevention: Historical perspectives and a blueprint for action.

Provides a history of primary prevention program development at the National Institute of Mental Health, achievements to date, and the unmet needs and future directions that must be addressed to advance the field of prevention. Specific proposals for action are identified as a blueprint for further program development at the nation, state, and local levels. Specialized perspectives of public service within a federal agency, as well as the opportunities to participate in shaping public policy that such national programs provide, are discussed. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiple functions for psychologists in community consultation.

"Psychologists are assuming a wider range of responsibilities in community program administration and community consultation: in mental health, corrections, education, and anti-poverty." A program for training consultants was developed in New Mexico during a 4-yr demonstration project. Selection criteria include: (1) sound graduate training including the PhD for psychologists, (2) substantial clinical skills in diagnosis and therapy, (3) experience in consultation and administration, and (4) experience in community work. A 2-mo., full-time orientation program was conducted for the consultants hired. The project stimulated development of various new resources in local communities including, among others, a day school for retarded children, a family casework agency, a day center for emotionally disturbed children, a training and consultation service to an orphanage, and an alcoholism treatment and rehabilitation program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing a comprehensive program for the prevention of conduct problems in rural communities: the Fast Track experience. The Conduct Problems Prevention Research Group

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

Review of Helping the noncompliant child: Family-based treatment for oppositional behavior (2nd ed.).

Reviews the book, Helping the noncompliant child: Family-based treatment for oppositional behavior (2nd ed.) by R. J. McMahon and R. L. Forehand (see record 2004-00004-000). Positive outcomes of parent training programs have been well documented in the literature (Lonigan, Elbert, & Johnson, 1998). These programs are often recommended for young children exhibiting disruptive behaviors (Kazdin, 1997). The efficacy of parent training programs for families who are able to complete treatment is documented for both short-term and long-term goals (Brestan & Eyberg, 1998; Lonigan et al., 1998). Helping the Noncompliant Child: Family-Based Treatment for Oppositional Behavior is the second edition of a successful parent training program that promises to deliver results similar to those of the earlier program. In their book, McMahon and Forehand present an intervention treatment program designed for children ages 3 to 8 years who present as "excessively noncompliant." The treatment program is based on the premise that "the child's noncompliant, inappropriate behavior is shaped and maintained through maladaptive patterns of family interaction, which reinforce coercive behaviors" (p. 28). McMahon and Forehand's HNC program provides parents with a specific and practical way to get out of the coercive cycle of negative interactions by using attention and rewards, ignoring negative behaviors, and giving clear instructions. The program falls short when it uses essentially the same time-out procedure for noncompliance for children between the ages of 3 and 8 and regardless of the function or reason for the noncompliance. To intervene effectively with a child, all of the issues at hand must be taken into consideration. In severe cases, the time-out procedure recommended could actually increase conflict between the parent and the child should the child not comply, resulting in family drop out or the need to modify the adjunctive individual therapies. Preparing parents for these exceptions and possible need for modifying the program by clarifying the populations who have been successful and unsuccessful in parent training programs would be a good addition to the book. This book can only be recommended for use with families for whom a thorough evaluation has determined that the child's noncompliant behaviors are a function of coercive family interactions consisting of unclear parenting messages. The child must evidence the ability to participate effectively in the time-out procedure. The child and family must clearly fit into the population shown to benefit from parent training programs. For these families, the HNC program may decrease noncompliant behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Child abuse and psychotherapy research: Merging social concerns and empirical investigation.

Contends that distinctive aspects of rigorous psychotherapy research are related to current issues in the literature on child maltreatment. Studies assessing the effectiveness of interventions with the families of maltreated children are reviewed, and a relative lack of relevant evaluation research is noted. Methodological and practical issues inherent in the empirical study of child maltreatment are discussed, including design, replicability and generalizability need for long-term follow-up, the definition of maltreatment, multiple agency involvement, and potential conflicts between the researcher's legal and ethical responsibilities and the conduct of the research. Suggestions are made as to how psychotherapy researchers and clinical service providers would benefit from the scientific investigation of treatment programs for abused and neglected children. It is emphasized that a wealth of information can be gleaned from the history of outcome research in psychotherapy. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beyond the token economy: A comparison of two contingency programs.

To determine whether the addition of milieu principles to a contingency program increases its effectiveness, 2 treatment programs in a mental hospital were compared: (a) a social learning or token economy approach and (b) a combined social learning and milieu approach in which patients were given increased decision-making responsibilities, group pressures were used, and both were integrated with response-contingent management. 37 patients (mean age, 34.9 yrs) were on the token economy ward and 37 (mean age, 33.2 yrs) were on the combined treatment ward. Because the patients in the combined social-learning-milieu program spent significantly more days out of the hospital during the 1-yr experimental period, it is concluded that the program was more effective than the token economy in promoting the generalization of adaptive inhospital behavior to community settings. (18 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using concept mapping to develop a conceptual framework of staff's views of a supported employment program for individuals with severe mental illness.

Describes the use of concept mapping to develop a pictorial multivariate conceptual framework of staff views of a program of supported employment (SE) for individuals with severe mental illness. The SE program involves extended individualized supported employment for clients through a mobile job support worker who maintains contact with the client after job placement and supports the client in various ways. Participants were 14 staff members of a psychiatric rehabilitation agency with assignments associated with the SE program. They brainstormed a large number of specific program activity statements (N?=?96), sorted and rated the statements, and interpreted the map that was produced through multidimensional scaling and hierarchical cluster analysis. The resulting map enabled identification of 4 issues that should be included in any theory of SE programs: the specific activity sequences that characterize the program itself, the pattern of local program evolution, the definition of program staff roles, and the influence of key contextual factors such as the client's family or the program's administrative structure. The implications of concept mapping methodology for theory development and program evaluation are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with key players for psychological and mental health public services.

Key players must be located and identified in order to perform public service. For doing this, a model for organizing a societal mental health program, which includes the 3 agency categories of voluntary, official, and professional, is presented. It shows that psychologists can function in any community, from local to international, in each category. The author portrays some of the forces that turned him to public service. Then he cites his public service experience in various communities, such as the mental health association, the official mental health program, the psychological association, and the university. He identifies key players and explains methods of working with them. Finally, he summarizes some requisite skills for successful service activities. Primary among the skills are locating and relating to key community decision makers and understanding how the helping community functions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pilot study of a health-focused day program on improving health behaviors, clinical functioning, and perceived wellness in individuals with severe mental illness.

Persons with severe mental illness (SMI) have poor physical health and high rates of premature death. There is limited research on health interventions for this population. This pilot study compares the health behaviors and perceived improvement of 2 day programs and comments on conducting research in health intervention in community-based persons with SMI. Nineteen individuals with SMI from a health-focused day program (HFP) and treatment-as-usual day program (TAU) were assessed for clinical functioning, health behaviors, and perceived improvement by using a semistructured interview and the Brief Psychiatric Rating Scale. The special features of the HFP included special dietary planning, a well-equipped gym, staff instruction, supervision of exercise programs, and limited time for smoking. HFP participants reported higher fruit and vegetable intake and greater perceived improvement in confidence than those at the TAU. There were no differences in the amount of exercise and rates of smoking between the programs. Methodological implications for further research in this area are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)