Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building Systems of Care for Children With Chronic Health Conditions.

Objective: To describe the leadership role that rehabilitation psychologists can play in improving the health care delivery system for children with special health care needs (CSHCN). Setting: Midwest academic health center and surrounding communities. Participants: Children with chronic health conditions and disabilities and their families. Intervention: A model research demonstration project designed to promote family-centered, comprehensive, coordinated, and community-based care for CSHCN. The project aims to enhance environmental supports for CSHCN and their families in 2 ways: (a) by improving the ability of primary care providers to deliver effective chronic care management and (b) by integrating this improved clinical practice into an enhanced Medicaid managed care service delivery system for persons with chronic illness and disabilities. Conclusions: Psychologists have the potential to improve the quality of life of CSHCN and their families by intervening not only through direct services but also by promoting positive changes in the larger health care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Performance Measurement, Health Care Policy, and Implications for Rehabilitation Services.

Provision of reliable, valid, and informative data to the public for evaluating the performance of health care services has been inconsistent at best and erroneous at worst. This article examines how private and governmental agencies are addressing this issue by concentrating on a well-defined set of performance indicators for several key diseases. In order to fully consider the implications of these developments for rehabilitation, the author discusses 4 topics: (a) how quality and safety concerns influence health care policy, (b) watershed events over the past half century that have contributed to a quality and safety dilemma in health care, (c) the difference between process and outcome indicators and implications for robust performance measurement, and (d) emerging coordination efforts by accreditation and regulatory agencies that will shape clinical service delivery in rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The quest for executive effectiveness: Consultants bridge the gap between psychological research and organizational application.

However we picture success for ourselves as consulting psychologists or for the executives and clients with whom we work, the role as pathfinder and mapmaker identifies those who "make a diference." Effectiveness for both consultant and executive calls for competencies in dealing with individual, group, and organizational-level issues. Critical competencies are discussed under the headings vision, motivation, and action. The ability to conceptualize, or to envision, relies on updated mental processes and stagnates without motivational astuteness. Key to motivation is emotional wisdom, the management of vital sign emotions: curiosity, anxiety, and anger. Finally, the invitational leadership approach (ILA) is presented as a synthesis of leadership research to assist a consultant or an executive in execution of the action competencies that get an organization moving in a coordinated, constructive direction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Establishing an integrated care practice in a community health center.

In a progressively complex and fragmented health care system and in response to the need to provide whole-person, quality care to greater numbers of patients than ever before, primary care practices throughout the United States have turned their attention and efforts to integrating behavioral health into their standard service-delivery models. With few resources and little guidance, systems struggle to gather the support required to establish effective integrated programs. Based on first-hand experience, we describe a working integrated primary care model, currently utilized in a large community health center system in Colorado, that encompasses universal screening, consultation, psychotherapy, and psychological testing. With appreciation for the way an organization's unique circumstances inform the best approach for that particular organization, we highlight the clinical-level and system-level variables that we consider necessary for successful practice development and address how our behavioral health program operates despite funding limitations. We conclude that organizations that aim for integrated primary care must mobilize leadership to implement systemic changes while making difficult decisions about program development, financing, staffing, and interagency relationships. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Graduate nursing education: developmental disabilities and special health care needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.     

Foreword to the special issue on long-term care.

This special issue on long-term care, guest edited by Carl and Susan Eisdorfer, addresses an issue that is rapidly becoming the most important health policy issue of the 1980s. The dilemma that we face as citizens and as rehabilitation professionals alike centers on our rapidly growing population of elderly citizens. While we have made unprecedented medical advances that have allowed for greater longevity, our health and social policies have not kept pace with these advances. We are therefore ill-equipped to deal with the myriad of economic, social, and health issues that confront our nation's elderly citizens. This issue of Rehabilitation Psychology is an attempt to address these questions by individuals who are leaders in the field of aging and long-term care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transformational leadership and psychological well-being: The mediating role of meaningful work.

Two studies investigated the relationship between transformational leadership, the meaning that individuals ascribe to their work, and their psychological well-being. In Study 1, the perceptions of meaningful work partially mediated the relationship between transformational leadership and positive affective well-being in a sample of Canadian health care workers (N=319). In Study 2, the meaning that a separate sample of service workers (N=146) ascribed to their work fully mediated the relationship between transformational leadership and psychological well-being, after controlling for humanistic work beliefs. Overall, these results support and add to the range of positive mental health effects associated with transformational leadership and are suggestive of interventions that organizations can make to improve well-being of workers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost offset: Past, present, and future.

The health of the U.S. health care system is precarious. Calls for reform in areas such as cost, quality, and equal access to health care are widespread and growing louder each day. Action is required on each of these issues, yet the lack of progress is cause for serious concern. A central problem is the reluctance to acknowledge the roles that the mind and behavior play in health and illness. One solution is the integration of psychological health care into the general health care system. A major vehicle for advancing the integration of health care is the "cost-offset" effect, a concept that involves paying systematic attention to psychological factors in order to reduce overuse of medical services and thereby decrease costs. Despite data demonstrating that the cost-offset hypothesis is quite robust, little has been done to implement integrated health care. This article reviews the literature on cost offset, discusses the policy implications, and considers its application to the public sector. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The health planning predicament.

Reviews the book, The health planning predicament by Victor G. Rodwin (1984). There are many different ways health care can be distributed and paid for. Medical care utilization is an important behavior widely studied by health services researchers and by economists. Planning in health care requires an understanding of the need for services and the mechanisms required to pay for them. In this book, Rodwin presents a thoughtful analysis of the new challenges for health planners in four Western countries. Most Western cultures are guided by the assumption that medical care is good. Thus, most developed countries have increased access to medical care by creating systems for third-party payment of expenses. As a result, the availability of services for underserved groups has greatly improved. In addition, health care costs have steadily increased in most Western countries. A growing number of critics now argue that developed countries spend too much on health care and that ease of access has created new problems, including increased iatrogenic illness and threats to economic solvency. Rodwin addresses these and other questions by comparing health services systems in the United States, France, Canada, and England. Although these four countries have similar cultural and economic characteristics, they differ in the way they distribute health care services. The differences among the systems considered by Rodwin provide for many interesting comparisons of physician behavior, and of patient service utilization. They also provide a new basis for the evaluation of different health care policies. In summary, Victor Rodwin has produced an interesting and readable comparison of health planning in different countries. Despite different approaches to the same problem, all four governments are faced with a health planning predicament. The book is full of interesting insights and may stimulate new thinking about some very serious policy questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A health care system of one.

Health care has been, and to large measure remains, an enormous collection of considerably independent professionals, freestanding institutions, highly individualized consumer demands, and laws that vary considerably state by state. To a great extent, health services in the US have been organized and offered as an exchange between individuals, and American practitioners and patients have valued this independence. Over the past decade and a half, however, we have begun to recognize that provision of health care on an individuated basis comes at an enormous cost. Beyond simply the economic cost, there is the growing realization that the "independent" nature of the actions taken by the individuated sectors of our health system can often be characterized as idiosyncratic, unmanaged, uncoordinated, and irrational. One small but critical step toward improving the fractious nature of our health system is to advance the cause of states recognizing the professional licensure of health professionals by other states. Such mutual recognition, long overdue, promises real benefits for patients and, in the long run, for professionals as well. Professional bodies both private and public should focus on patients and their needs when considering any regulatory changes to be made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stigma and barriers to care in soldiers postcombat.

The present study examined the effects of leadership and unit cohesion on mental health stigma and perceived barriers to care. A sample of 680 soldiers from combat support units were surveyed 3 months after their return from combat operations in Iraq. The survey included scales on psychological symptoms and perceptions of leader behaviors and unit cohesion, as well as items assessing stigma and barriers to care. The sample was used to test the independent and interactive effects of leadership and unit cohesion on soldiers’ perceptions of stigma and barriers to care. Analyses yielded significant interaction effects between leadership and cohesion in predicting stigma and barriers to care, while controlling for the effects of mental health symptoms. Soldiers who rated their leaders more highly and who reported higher unit cohesion also reported lower scores on both stigma and perceived barriers to care. Thus, positive leadership and unit cohesion can reduce perceptions of stigma and barriers to care, even after accounting for the relationship between mental health symptoms and these outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Executive Growth Along the Adult Development Curve.

This article describes how principles of adult psychological development can inform executive coaching. An adult developmental perspective is used to identify key transformational tasks of adulthood that help shape executive role functioning. The correlation of psychological competencies with leadership competencies is outlined in more detail for the roles of senior vice president and executive vice president. Coaching case material is used to further illustrate how consultants can use an adult developmental framework to better align organizational life with personal strivings for meaning and growth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing leadership: to thrive in a world of change

Change is becoming the norm in health care environments. Nurse executives in leadership positions are an essential part of an institution's ability to adapt successfully and flourish with change. It is important for the nurse executive to have a clear concept of leadership, the change process, and organizational cultures. This will allow the nurse executive to create an environment within the organization where change is seen in a positive manner and staff are empowered to meet the challenges of health care today.     

Putting Outcome Measurement in Context: A Rehabilitation Psychology Perspective.

This article provides an overview of topics related to health care measurement as applied to medical rehabilitation. Described are conceptual models of health outcome measurement in rehabilitation and their utility for researchers and clinicians, the application of contemporary measurement approaches to rehabilitation outcome measurement, and accrediting organizations' efforts to implement performance indicators for rehabilitation. The discussion situates participation as a key interest of rehabilitation psychologists and other stakeholders. Reviewed are examples of instruments designed to operationalize participation, advances in measurement theory, and methods that allow outcome indicators to be measured more accurately and easily, including item response theory. This introduction concludes by considering how public disclosure of outcomes can help consumers make more informed choices and help accrediting organizations' efforts to promote outcome disclosure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The tragedy of Native American youth suicide.

High rates of suicide among American Indian and Alaska Native populations call for significant efforts by lawmakers and public sector psychologists to develop, implement, and evaluate policy and programs that increase our understanding of factors that contribute to these high rates, and lead to effective resources that reduce the suicide crisis among these groups. The author describes how the federal government has responded to this crisis, what the barriers have been, and what is needed in the future from multiple sectors to ensure our nation's health care system is responsive to the tremendous health care needs that have long been evident in American Indian and Alaska Native communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology: Realizing the true potential.

As the Division of Rehabilitation Psychology (Division 22) celebrates its 50th anniversary this year, this article reflects on the current status and important trends in health care and technology that are likely to have the largest impact on the science and practice of rehabilitation psychologists in the next decade. These trends include the prevalence of chronic conditions, health disparities, Operation Iraqi Freedom and Operation Enduring Freedom injuries, and caregiver burden. The implications of these trends are also discussed in the context of rehabilitation psychologists' involvement in public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)