Formalized psychological services in state education programs.

In recent years "state regulations have played a major part in determining the nature of local school requirements" for psychologists. States having formally legislated provisions for school psychologists, states formally recognizing qualifications of school psychologists, professional training requirements for different levels of persons rendering psychological service in schools, and required supervised practicum or internship experience are discussed. The certification of school psychologists as teachers, the renewal of certification of school psychologists, the kinds of psychological services provided or used, the apparent absence of a sensitivity to a need for school psychological services, and the various titles by which psychologists are designated in school law or official statements are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Benchmarking the US physician workforce. An alternative to needs-based or demand-based planning

OBJECTIVE: To propose population-based benchmarking as an alternative to needs- or demand-based planning for estimating a reasonably sized, clinically active physician workforce for the United States and its regional health care markets. DESIGN: Cross-sectional analysis of 1993 American Medical Association and American Osteopathic Association physician masterfiles. POPULATION: The resident population of the 306 hospital referral regions in the United States. MAIN OUTCOME MEASURES: Per capita number of clinically active physicians by specialty adjusted for age and sex population differences and out-of-region health care utilization. The measured physician workforce was compared with 4 benchmarks: the staffing within a large (2.4 million members) health maintenance organization (HMO), a hospital referral region dominated by managed care (Minneapolis, Minn), a hospital referral region dominated by fee-for-service (Wichita, Kan), and the proposed "balanced" physician supply (50% generalists). RESULTS: The proportion of the US population residing in hospital referral regions with a higher per capita generalist workforce than the benchmark was 96% for the HMO benchmark, 60% for Wichita, and 27% for Minneapolis. The specialist workforce exceeded all 3 benchmarks for 74% of the population. The per capita workforce of generalists was not related to the proportion of generalists among regions (Pearson correlation coefficient=0.06; P=.26). CONCLUSIONS: Population-based benchmarking offers practical advantages to needs- or demand-based planning for estimating a reasonably sized per capita workforce of clinically active physicians. The physician workforce within the benchmarks of an HMO and health care markets indicates the varying opportunities for regional physician employment and services. The ratio of generalists to specialists does not measure the adequacy of the supply of the generalist workforce either nationally or for specific regions. Research measuring the relationship between physician workforces of different sizes and population outcomes will guide the selection of future regional benchmarks.     

The changing workforce, job stress, and psychological distress.

The change in the United States from a manufacturing economy to a service economy has important implications for theoretical models of the relationships between job characteristics and workers' psychological distress. A sample of 600 men and women employed full-time were recruited to test 2 theoretical models. The job demand-control model posits that jobs that are both high in job demands and low in decision latitude are associated with greater psychological distress. The job demand-service model posits that jobs that are high in job demands and low in service to others are associated with greater psychological distress. Results show that the job demand-control model is a significant predictor of psychological distress among employees in the manufacturing industry, whereas the job demand-service model is a significant predictor of psychological distress among employees in the services industries. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Restructuring public mental health and substance abuse service systems

The authors originally circulated the concepts in this proposal during May 1995. The purpose was to support an open, public dialogue regarding the restructuring of the mental health and substance abuse services in Illinois in anticipation of Medicaid funding changes. Restructuring mental health and substance abuse service systems should follow certain key principles. These principles are applicable to other states, particularly those large in territory and population. The authors propose the temporary use of multiple managed care companies serving as administrative services only (ASO) organizations, each of whom would have responsibility for a given geographic portion of a state. The role of the ASOs would be to organize providers into networks on a regional basis and transfer managed care expertise in financing and clinical management to the relevant state departments and provider groups. Changes in the service delivery system would be phased in over time with reorganization of key components of the system during each phase. Where the provision of mental health, substance abuse, and social services is split among multiple state agencies, these agencies would be merged to achieve unified funding and administrative efficiency. Patients and advocacy organizations would play a key role in overseeing and shaping system restructuring at all levels, including a governmental board reporting to the governor, overseeing ASO organizations' operations and assuring quality and access at the provider level. The authors propose funding of public behavioral health services through use of a tiered, integrated funding model.     

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)     

Assessing mental retardation in death penalty cases: Critical issues for psychology and psychological practice.

In 2002, the United States Supreme Court decided the Atkins case, which held that mentally retarded defendants could not be executed. The opinion gave no guidance on the definition of mental retardation, preferring to leave to individual states the task of determining not only the definition of mental retardation but also the assessment procedures to be used in making the diagnosis. This lack of guidance has resulted in many issues, including varying definitions of what constitutes mental retardation across states, use of different assessment procedures to make the determination that a person has mental retardation, and numerous psychometric concerns regarding the provision of psychological assessment services to the courts in capital cases that involve a defendant who may have mental retardation. This article examines these latter issues in detail from both psychological and legal perspectives and makes recommendations for practicing psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Case management: an American's observations of community care in Britain

The United States faces a rapidly growing aging population, government reforms, and policy shifts to give primary responsibility to the states for programs of community-based care for the elderly. At the same time, increasing concern is being given to the more effective use of home and community-based services, and particularly what role case management might play. Given these changes, much may be learned from the 1993 reforms to the British system of community care, which made case management the cornerstone of the system and gave primary responsibility for community care programs to local social service departments. This examination of the programs in Britain, conducted largely through site visits and personal interviews with social service staff, describes the successes and shortcomings of the implementation of the community care reforms with recommendations for program development in the United States.     

Service.

Presents a comment upon Arthur H. Brayfield's statement at the Hearings on Counseling on the Public Employment Service before the House Select Subcommittee on Labor (see record 1965-08213-001). The author is in hearty agreement with some of Brayfield's points with respect especially to the need for training of counselors and for more and better support of research, however, there are many more factors than these involved if the public employment service is to render the quality of service to which the public is entitled. It is noted that although most state employment services do not recognize it, nevertheless through their counseling, testing, selective placement of the handicapped, test development, occupational research, and industry services activities, they are in fact rendering psychological services on an enormous scale to a public which consists not only of applicants for work but also of employers individually and in association, unions, schools, and other community agencies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A scientific problem-solving approach to developing accountability procedures for school psychologists.

Discusses the use of evaluations of school psychological services in improving service delivery and professional development. The steps of a scientific problem-solving approach to accountability are outlined in terms of problem definition, generation of alternatives, decision making, implementation and outcome evaluation, dissemination of results, and meta-evaluation. The use of this model is illustrated by its application to the assessment of the evaluation, consultation, and referral services provided by a school psychologist. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Who requests psychological services upon admission to prison?

Structuring a system of psychological services for offenders and releasees requires an understanding of the offenders who voluntarily seek psychological services upon admission. To begin to develop such an understanding, a sample set of responses to the Psychological Services Inmate Questionnaire (PSIQ) from 2,674 newly committed male and female federal offenders were examined. About one-tenth of the sample made a request for psychological services upon admission to prison without a mandate or referral, and confirm that a combination of prior mental health treatment and current symptoms are among the factors associated with making the request. Logistic regression analysis indicated male gender, receipt of mental health treatment prior to current incarceration, history of a head injury, current symptoms of depression, hopelessness, nervousness, sleeping problems, and racing thoughts, were independent and significant predictors of service request. Implications for future corrections research, clinical training and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The impact of a decade long opisthorchiasis control program in northeastern Thailand

Based on the figures obtained from a regional survey in 1981, the overall prevalence of opisthorchiasis in northeastern Thailand was as high as 34.6%. Traditional consumption of improperly cooked fish dishes and unhygienic defecating habits among rural inhabitants have been recognized as significant factors determining such high prevalence of this liver fluke in that area. Following experience of Mahidol University's Faculty of Tropical Medicine in Thailand of treating liver fluke infected individuals with praziquantel, the Ministry of Public Health started a liver fluke control program in the northeast as special service units in 1984 in 4 provinces. In 1988, the program was expanded to cover all 19 northeastern provinces, services being rendered at a community level covering stool examination and treatment of positive cases. Intensive health education was integrated as one element of liver fluke control program. During the early phase of operation (attack phase) a mobile stool examination team was the crucial strategy for active service. Following the attack phase, passive service was operated at each health service facility provided that results of population based program evaluation in each area showed a low prevalence according to the set target. Regionwide assessments in 1991 and 1992 indicated a declining trend of prevalence from 34.6% to 30.19% and 24.01%, respectively. In 1994, a population-based sampling survey was carried out to measure the effect of the liver fluke control program over 10 years operation (1984-1994) on both behavioral outcomes and prevalence impact. Sample for the assessment of behavior were 1,268 individuals, while another 1,912 samples were used for determining disease prevalence. Health related behaviors regarding frequent consumption of uncooked fish dishes decreased from 14% in 1990 to 7% in 1994 while occasional consumption remains as high as 42%. The prevalence of opisthorchiasis is 18.5% with a large variation in infection rate (5.20-56.25%).     

Factors predicting levels of female inmates’ use of psychological services.

The number of female inmates in state and federal correctional institutions has increased dramatically over the past several years. In addition to this overall increase in number, women have greater levels of mental health service use than men, both in the community and during incarceration. It is important to understand what factors are associated with varying amounts of mental health service use as this population continues to grow. This study explores the influence of female inmate characteristics, including demographic variables and mental health service use before incarceration, on a continuous dependent measure of overall psychological services use during incarceration. Results indicate that for a sample of female inmates within the federal prison system, U.S. citizenship, prior community-based receipt of mental health services, and history of substance abuse were the strongest predictors of increased service use while incarcerated. Findings concerning routine versus volitional services suggest that female inmates with less severe mental health problems are among those who volitionally seek mental health services during incarceration. Recommendations for correctional mental health services training, practice, and research are made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Service providers in psychology: Results of the 1982 APA Human Resources Survey.

Obtained information on psychological service provision from a 1982 survey with a stratified random sample of 6584 members of the American Psychological Association. 65.5% of the respondents indicated that they provided either health services of educational services; 57% of these providers were health service providers (HSPs). 89.2% of HSPs held doctoral degrees. About two–thirds of all psychological service providers were men. 1.3% of the HSPs were Black, 0.9% were Hispanic, 1% were Asian, and 0.2% were Native American. Organized care settings, independent practice, and academic settings were the most frequent primary employment settings. About half of the psychological service providers delivered services in secondary settings, usually in independent practice. Median number of weekly visits was 20; median number of clinical service hours was 30. Distribution of the ethnicity of clients was similar to the ethnicity of the general US population. Clients presented with a wide range of problems and from all age ranges (the most underserved population was the elderly). Referrals to psychologists were made by a variety of professionals. Patterns of reimbursement are described. The median hourly fee in 1982, for doctoral HSPs, was $54.74 per hour. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gwinnett County: Changing its service delivery in response to population growth.

Describes the development of a comprehensive management system in the Gwinnett County (Georgia) psychological services unit. The unit altered its service delivery model from one with a primary emphasis on psychoeducational assessment to one focusing on consultation and preventative services. Adherence to the American Psychological Association's specialty guidelines for provision of psychological services in schools is described. This management system enabled the unit to provide quality services to a maximal number of students, parents, and educators, despite the inevitable constraints placed on delivery of services by their growing population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

CARE: Bridging the gap between clinicians and computers.

Psychologists and other mental health specialists have yet to capitalize on the enormous potential of computers as "clinical assistants." Many therapeutic uses of computers reflect overly ambitious if not naive uses of these machines, such as providing warmth and understanding to hurting persons. The present authors review previous applications of computers in health care, the nature and scope of computer resistance, the relative merits of people and machines in performing different kinds of tasks, and the ethical–legal issues involved when psychological services are provided by computers. Also presented is a relatively simple algorithm for an automated psychological service delivery system that provides, in response to specified complaint statements, low-level inference evaluations, concrete clinical advice, and modest referral information. The use of this computerized assistance, referral, and evaluation (CARE) system in a college community is described. (33 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Explanatory factors for the geographic distribution of U.S. civil aviation mortality

BACKGROUND: State-specific aviation-related mortality rates differ substantially between various geographical regions of the United States. PURPOSE: The purpose of this study was to ascertain important explanatory factors that account for the geographical distribution of mortality. METHODS: National Center for Health Statistics sources were used to calculate state-specific, age-adjusted mortality rates. Fatalities studied were those attributed to select civil aviation-related causes (ICD-9 E-codes 840.2-.6, 841.2-.6, 842.2-.6) that occurred from 1979-89. State-specific information on a variety of selected variables was obtained from census, commerce, and Federal Aviation Administration (FAA) sources. Multiple linear regression techniques were used to assess the relationship between selected variables and state-specific mortality rates. RESULTS: There were 13,048 deaths for a U.S. 11-year mean mortality rate of 4.9 deaths/1,000,000 general population. Mountainous states of the western U.S. had the highest 11-year mean mortality rates (range 8.6-79.6 deaths/1,000,000). Mid-Atlantic states had the lowest rates (range 1.6-2.9 deaths/1,000,000). Regression analysis identified pilot density (number of pilots per 1,000,000 general population), top elevation (highest point of land within state boundaries), and flight intensity (number of general aviation flight hours flown per pilot) as important factors in explaining 92% of state mortality differences. CONCLUSIONS: Highest aviation-related mortality rates are found in states with expanses of mountainous terrain, and relatively high pilot densities and flight activity levels.     

Psychological testing and the public service.

The author, Chairman of the Untied States Civil Service Commission, argues that the necessity to measure characteristics of people that are related to job performance is at the very root of the merit system, which is the basis for entry into the career services of the Federal Government. Thus, over the years, the public service has had a vital interest in the development and application of psychological testing methods. He has no doubt that the widespread public confidence in the objectivity of hiring procedures has in large part been nurtured by the public's perception of the fairness, the practicality, and the integrity of the appraisal methods they must submit to. Sound testing methods are absolutely essential if there is to be real meaning to the concept of equal opportunity. He is concerned, therefore, that the current outcry against the use of personality tests should not endanger this hard-won confidence, nor inhibit our use of tests in carrying out the vital personnel management programs of the President. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

State psychological association creates a postdoctoral residency and internship training program.

State psychological associations can respond to supply and demand problems for postdoctoral residencies and internships by creating statewide training programs. A state psychological association training model is presented. The Arizona Psychological Association (AzPA) created a nonprofit subsidiary corporation- the Arizona Psychology Training Consortium-to increase the number of high-quality training opportunities in Arizona. The structure and operation of the program are described. The training model emphasizes cultural diversity, psychotherapy, and independent practice. Members of the practice community in Arizona serve as supervisors, trainers, and mentors. From 2001 through 2006, 19 postdoctoral residents and 51 interns completed the program. AzPA has benefited from increased student involvement. Many residents and interns later became association members. Arizona can serve as a model for other states that wish to help their professionals in training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Factors associated with child mental health service use in the community

OBJECTIVE: To determine the association of parent, family, and child factors with mental health services need and utilization. METHOD: Possible determinants of services need and utilization were assessed in a general population sample of 2,227 children aged 4 to 18 years. RESULTS: 3.5% of the total sample had been referred for mental health services within the past year. The most potent factors associated with service need and utilization were the child's problem behaviors (both internalizing and externalizing) and academic problems and family stress. Socioeconomic factors and the child's sex were not in itself associated with help-seeking factors. Parental psychopathology, life events, and family psychopathology lowered the parents' threshold for evaluating the child's behavior as problematic but did not increase the likelihood of referral. CONCLUSION: Referred children are more likely to live in families under stress than are children with the same level of problems who live in well-functioning families. Clinicians and researchers who make inferences from findings in clinical samples should realize, therefore, that children from problem families are overrepresented in their samples.