Professional Boundaries in Nontraditional Settings.

Psychologists are increasingly delivering or supervising services in the homes or residences of their clients. However, the very process of delivering home-based services creates challenges to the psychologist-patient relationship and an opportunity for clients to challenge the boundaries in ways that would not ordinarily occur in office-based services. Supervisees or inexperienced psychologists may be unprepared for the boundary challenges that could occur. This article reviews those challenges to professional boundaries and makes recommendations to ensure the quality of psychological services delivered in those settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Role functions of pediatric and health psychologists in health care settings.

686 pediatric and health psychologists completed questionnaires requesting background information concerning years of experience, current work settings, graduate training, and professional identification. Ss were also asked to describe services and functions they performed, difficulties they encountered, and general consultation goals. Results suggest that both groups are involved in a wide range of diagnostic, treatment, and consultative activities in health care settings and that there are many similarities in the ways they conceptualize their roles and how they function. However, pediatric psychologists were especially involved in clinical assessment activities, whereas research was a high priority for health psychologists. Other aspects of the roles, functions, and activities of these 2 groups are described. (15 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender and social influence: A social psychological analysis.

Men and women are believed to differ in how influential and easily influenced they are: Men are thought to be more influential, and women more easily influenced. In natural settings, men and women tend to differ in these ways, but these differences stem largely from formal status inequalities by which men are more likely than women to have high-status roles. Status is important because of the legitimate authority vested in high-status roles. Within appropriate limits, people of higher status are believed to have the right to make demands of those of lower status, and people of lower status are expected to comply with these demands. Yet, small, stereotypic sex differences in leadership and social influence generally have been found in laboratory experiments and other small-group settings where men and women have equal formal status. These small sex differences may occur because experience with hierarchical social structures in which men have higher status creates expectancies about male and female behavior, and these expectancies affect social interaction in ways that foster behavior that confirms the expectancies. Sex differences that occur in the laboratory as well as natural settings may stem from social structural factors—namely, from the existing distributions of women and men into social roles. (77 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In vivo perfusion measurements in the human placenta using echo planar imaging at 0.5 T

This paper alerts practitioners and administrators in correctional healthcare settings to a variety of issues of concern when advising or negotiating with state or county governments on the provision of managed behavioral healthcare. The participation of the mental health practitioner or administrator involved in determining the quality and appropriateness of behavioral managed care contractual services is an essential component of an overall healthcare service in a correctional setting. Several crucial elements are outlined relative to correctional settings, including the interface between custody and treatment providers, crisis intervention for incoming detainees or inmates, and provision of services for longer term "no parole" inmates in correctional settings. A number of considerations are reviewed, including (1) staffing, (2) drug formularies, (3) levels of service, and (4) "hidden costs," that may influence contractual negotiations as well as service provision by managed behavioral healthcare companies in correctional settings.     

Challenge of human service programs for psychologists.

The rationale for, and the manner in which, mental health services are provided in 1971 differs significantly from the patterns of a decade ago. The perspective and activities have expanded from the isolated clinic to the more encompassing community mental health program. During the 1970's psychologists will be challenged to evolve the scope even further by designing far-flung human service systems which seek to provide comprehensive and coordinated assistance to clients. 4 prominent alternative program structures are arising at the community level: information and referral centers, diagnostic centers, multiservice centers, and human services networks. It is predicted that psychologists may well be required to redesign their (a) practice, by developing job roles in nonpsychiatric settings; (b) research, by increased use of the ecological model for the resolution of pressing social problems; and (c) training, by expanded use of multidisciplinary settings offering broadly defined rather than narrowly circumscribed work experiences. (22 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Decisions and justifications by community mental health providers about hypothetical ethical dilemmas

OBJECTIVE: Community-based treatment of persons with serious mental illness requires providers to become involved in clients' personal lives to a greater degree than does hospital-based treatment. The study examined attendant ethical dilemmas, especially for staff who lack professional training or work in rural communities. METHODS: A total of 95 staff members from five community mental health centers read 14 vignettes describing ambiguous ethical dilemmas involving professional role boundaries or client confidentiality. Twenty-seven staff members were from rural agencies, and 68 from urban-suburban agencies; 60 were direct care staff, and 35 were supervisory. Participants were asked to make and justify a more conservative or a less conservative decision in response to each dilemma. RESULTS: Years of experience as a mental health provider and previous ethics training correlated positively with staff having experienced more situations similar to those in the vignettes; however, these variables were not related to the decision made or the type of ethical justification for it. When the analysis controlled for experience and previous ethics training, staff made fewer conservative decisions in boundary dilemmas than in confidentiality dilemmas. Compared with nonrural providers, rural providers had experienced more boundary dilemmas and made fewer conservative decisions in response to them. CONCLUSIONS: Boundary problems occur frequently in community-based services, especially in rural settings, and may or may not be handled conservatively. With the expansion of case management and other in vivo services, better understanding of ethical risks and informal practices will help improve services and provide appropriate training and supervision of staff.     

Mental health services in health maintenance organizations: Implications for psychology.

Contends that roles for psychologists in health maintenance organizations (HMOs) are affected by the nature of HMOs, economic considerations, standards set by federal legislation, claims for the cost-effectiveness of mental health services, and the federal administration's goal of removing mental health services from those required in law. Legislation is not precise concerning the nature or extent of mandated mental health services, and administrative interpretation of this legislation encourages considerable latitude in services provided. Studies do not support arguments for mental health services on the basis of their claimed cost-offset effects as strongly as one might wish. It is concluded that if psychologists are to establish areas of unique worth to HMOs, they may have to do so by adding contributions other than traditional clinical services to meet the need structure of HMOs. Possible ways of doing this are discussed, drawing on contributions that are developing in the field of behavioral health and relating these contributions to the prime purposes of HMOs. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists in secondary schools in the 1990s: Current functions, training, and job satisfaction.

Surveyed 173 school psychologists serving secondary schools concerning their current roles and functions, training needs, and general job satisfaction. Results revealed that many school psychologists in secondary schools are providing a wide variety of services, including direct (e.g., counseling) and indirect (e.g., consultation) services. Approximately three-quarters of the Ss reported being satisfied with their work in secondary schools. Job satisfaction was related to increased time spent in intervention-related activities and decreased time spent in psychological assessment activities. Data reflected encouraging findings regarding the scope of school psychological services in secondary settings but also underscored the need for diversified training of school psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary mental health care: A "find" for psychology?

Challenges within the emerging area of primary mental health care, in contrast with secondary or tertiary care, are discussed. A review including British and Canadian research in this area is provided. Some attention is given to employer-subsidized services that are available in the workplace. Special consideration is given to mental health services provided in pediatric and family medicine settings. Some suggestions are made in regard to organized psychology's response to these issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Survey of the degree to which ET nurses are performing current procedural terminology-coded services

ET nurses practice in many different settings including hospitals, home health, independent practice, and contract services. Reimbursement for their services is widely varied. To contribute meaningfully to health care reform, the services being provided by ET nurses must be identified. Familiarity with how these services overlap with those provided by other health care providers is essential. Current Procedural Terminology (CPT) codes, the language of payment within the health care system, are prepared and published annually by the American Medical Association for purposes of physician payment. Physicians are being paid for services that are also performed by ET nurses. This study identifies the CPT-coded services used in the practice of the ET nurse and also codes that overlap those for which physicians are paid. Identification of ET nurse-provided CPT-coded services delineates the ET nursing scope of practice and may serve as a foundation to address other practice issues, including reimbursement.     

Chiral separations by capillary electrophoresis in process chemistry

BACKGROUND: Conducting research in clinical settings can be problematic for many nurses in practice due to lack of experience and support. METHOD: Research collaboration between clinical nurse specialists and staff nurses in clinical settings can promote development of their research process skills. RESULTS: Strategies identified can be applied by clinical nurse specialists involved in continuing education and staff development in clinical practice through further research development. CONCLUSION: Collaboration among clinical nurse specialists and staff nurses provides a unique and strong link that transcends degrees and roles to make substantial contributions to professional nursing practice.     

Preparing psychologists for high-risk jobs: Key ethical considerations for military clinical supervisors.

Military psychologists must provide a full gamut of mental health evaluation, treatment, and consultative services in a variety of nontraditional settings. Internship training and postdoctoral supervision are key to producing competent military psychologists that can simultaneously serve effectively as commissioned officers. The context of supervision has evolved in recent years as the majority of military psychologists are deployed to the combat theater and many are tasked with nontraditional operational roles. This article explores the key ethical considerations faced by supervisors who prepare psychology interns, postdoctoral residents, or civilian psychologists for high-risk military roles in a time of war. Recommendations are provided for both clinical supervisors and military psychology leaders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The challenge to meet the mental health and biopsychosocial needs of the poor: expanded roles for hospital social workers in a changing healthcare environment

Despite the absence of coordinated federal health care reform, social workers in hospital settings have opportunities to identify, develop, advocate for, and facilitate access to innovative health care services, resulting in improved capacity to meet the mental health and biopsychosocial needs of the poor and, potentially, reduced hospital costs over time. There are opportunities for expanded roles for social workers in forging better linkages between hospital services and the community, developing an integrated biopsychosocial healthcare delivery system within hospitals and primary care settings, utilizing information systems as tools in an integrated system, and advocating for a client-centered approach to mental health services.     

Educational development as school psychology.

Four elements of school psychology practice are identified: level of functioning, professional activity, developmental level of students served by the educational system, and the immediate client. A broader view of school psychology is presented, which has room for new professional roles and expansion of psychological services to a variety of educational settings, including the university. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Delivering at the right price--the costs of primary maternity care at the Diepkloof Community Health Centre, Soweto

This paper reports on a study of the costs of primary maternity care services at the Diepkloof Community Health Centre (DK) in Soweto. DK, the Soweto community health centre system as a whole and numerous other non-hospital settings provide a wide range of maternal health services to substantial numbers of women, and relieve hospitals of a major potential clinical burden. However, no research has been done in South Africa on the relative costs of the provision of these services in different settings and by different types of health worker. The cost structure of these services at DK is presented and the costs of antenatal care, deliveries in midwife-run labour wards, postnatal care (at the health centre and at home) and family planning services detailed. Some comparisons are made with existing data for another community health centre and with Baragwanath Hospital. These results are relevant to policy and planning of maternal health services. They are also shown to be of relevance to management and several areas of potential improvement of these services are noted.     

Teachers' perceptions of school psychology: A comparison of regular and special education teacher ratings.

A total of 1533 regular education and special education teachers from eight school districts in four states rated their knowledge of and satisfaction with school psychological services. Perceived helpfulness of psychological services to teachers and children was also assessed. Finally, both groups rated their perceptions of school psychologists' roles versus school counselor roles. Regular education teachers, compared to special education teachers, reported less knowledge of school psychology, perceived school psychologists as less helpful to teachers, and reported lower satisfaction with school psychology services. These reports may have been influenced by the amount of contact each teacher had with school psychologists. Both teacher groups had a limited understanding of the broad roles and functions of school psychologists, and both groups viewed school counselors as delivering more services than school psychologists. Implications of these findings with regard to school psychology reform efforts are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organizational structures and service delivery in Nova Scotia.

Surveyed 16 clinical settings in Nova Scotia to determine the nature of the psychological services offered and examined their organizational context. 13 surveys were returned. The majority of the settings provide traditional mental health services. The majority of clinical psychologists are found in general regional hospitals rather than in mental health settings. Psychologists offer a wide array of services, such as those to medical patients. Psychologists practice independently; they are able to assess and treat patients in the absence of either assessment or referral by other professionals. The interests of psychologists tend to be represented at the highest level of their institutions by professionals other than psychologists. There were no organized psychology departments in more than half the settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and society: The challenge of change.

Argues that, during the last 15 yrs, a culmination of trends dating from World War II has produced a new configuration of the American economy, occupational and educational structure, and scientific and technical knowledge base. These social and economic trends have provided psychology with 2 identifiable opportunities: (a) expansion of psychology's role in providing clinical services and (b) enlargement of the range of social concerns to which psychological knowledge is applied. Data about psychologists' training, employment, and activities during the last 15 yrs, however, indicate a divided response to the broader social trends. On the one hand, the traditional service provider specialties have enjoyed growth, especially in nonacademic settings. Research specialties, on the other hand, have shown only modest expansion into nonacademic settings despite the contracting market in academia. Graduate programs in the research specialties have only recently begun to devote significant attention to training students for applied research and nonacademic career roles. If that effort continues, the 1980's may witness a growth of the applied research specialties that may rival the growth of the service provider specialties during the 1970's. (85 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mental health care in a high school based health service

This paper describes the mental health services provided at a high school based health center that integrates mental health and medical services. Five years after the inception of the center in 1988, mental health visits had quadrupled. In 1992 alone, students made 1,002 mental health visits. Strikingly, one-third of these students reported problematic substance use among other family members. Other leading reasons for utilizing mental health services included pregnancy (19%), past or present suicidal ideation (14%), obesity (8.7%), ongoing depression (8%), and issues related to sexuality (7.5%).     

Bilingual professionals in community mental health services

OBJECTIVE: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles. METHOD: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity. RESULTS: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. CONCLUSIONS: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.