Impact of managed care on independent practice and professional ethics: A survey of independent practitioners.

Managed care significantly affects the service delivery patterns, business structures, ethics, and professional concerns of independent practitioners. This survey assessed psychologists' perceptions of the effects of managed care on practice and ethics. Most respondents reported significant increases in dependence on managed care services for income. Negative effects included loss of control over ethical decisions and potential harm to patients from erosion of confidentiality. A majority of respondents reported encountering ethical concerns not addressed by the American Psychological Association ethics code. Findings suggest directions for practice development, for public policy addressing confidentiality, and for clarification of ethical responsibilities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The dissertation in professional psychology programs: I. A survey of clinical directors on requirements and practices.

Examined dissertation policies and practices in 40 Vail-model, clinical psychology programs. A survey of their training directors revealed that 90% of programs required a dissertation, but only 25% dictated that the dissertation be empirical. Traditional experimental and correlational designs accounted for 66% of completed dissertations, and 34% reflected less traditional methodologies. All but the dissertation (ABD) rates averaged 24% 2 yrs after students' expected graduation. Dissertation methodologies were unrelated to ABD rates. Results were discussed with regard to potential obstacles to dissertation research and the need for training programs to encourage appropriate and innovative methodologies to answer relevant questions in the field of clinical psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Contemporary psychotherapists: A national survey of characteristics, practices, orientations, and attitudes.

Surveyed a representative sample of American psychologists engaged in psychotherapy concerning their characteristics, activities, affiliations, theories, and selected attitudes. 410 members (aged 24–79 yrs) of Division 29 (Psychotherapy) of the American Psychological Association responded to an 82-item questionnaire. Survey results are described and compared to the findings of a similar survey by J. C. Norcross and J. O. Prochaska (e.g., see record 1982-21987-001) of American clinical psychologists (Division 12 members). Among the most salient findings were that (1) over 80% of Ss have had personal therapy and highly value these experiences as preparation for providing therapy; (2) individual therapy is the most popular therapeutic modality, but over one-half of the Ss engage in marital and family therapy; (3) while therapists spend relatively small percentages of their time doing research, they do as a group publish and present papers; (4) private practice is the modal affiliation of the Ss and may be the most equitable employment setting; and (5) psychodynamic orientations have experienced renewed preference with eclecticism declining, suggesting a need for more integrative models of therapy. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Juvenile competence to stand trial evaluations: A survey of current practices and test usage among psychologists.

What is the current standard of practice for evaluations of juvenile competence to stand trial (JCST)? The present study surveyed psychologists regarding the practices used when conducting JCST evaluations. Respondents rated the importance of 17 elements that might be included in a JCST evaluation report. Of these elements, 7 were considered essential by 70% or more of respondents, with 9 additional elements rated as either essential or recommended. A majority of respondents felt that the use of psychological and forensic instruments was important. A list of tests used is provided, and the implications for the development of standards and policy are discussed to provide practitioners with additional knowledge that will help to further the state of the discipline. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment of multiple personality disorder: a survey of current practices

OBJECTIVE: Reported cases of multiple personality disorder have increased dramatically in the last decade. Few data are available on the treatment of multiple personality disorder. Current recommendations are based on the experience of individual clinicians rather than on systematic research. METHOD: A questionnaire study of 305 clinicians representing a spectrum of mental health professionals was conducted to survey the types and relative efficacy of treatment modalities currently used with cases of multiple personality disorder. RESULTS: Individual psychotherapy facilitated by hypnosis was uniformly endorsed as the primary treatment by all practitioner groups. The average patient was in twice-weekly psychotherapy facilitated by hypnosis for 3.8 years. Antidepressant and anxiolytic medications were reported to be moderately useful adjunctive treatments. CONCLUSIONS: These findings support current impressionistic treatment recommendations for multiple personality disorder regarding the primacy of psychotherapy and the moderate benefits of psychopharmacology with antidepressant and antianxiety agents.     

Preoperative pregnancy testing: a survey of current practice

STUDY OBJECTIVE: To examine contemporary practices and opinions regarding preoperative testing requirements, with special emphasis on perioperative pregnancy recognition and consequences thereof. DESIGN AND SETTING: Anonymous questionnaire survey distributed to 300 (almost exclusively American) physicians attending the 1996 Society of Obstetric Anesthesia and Perinatology meeting. MEASUREMENTS AND MAIN RESULTS: Responses from 169 anesthesiologists indicated that approximately one-third mandated pregnancy testing via departmental policy. More anesthesiologists (p = 0.02) mandated routine pregnancy testing of all elective (30%) versus all emergency (17%) surgical patients. Sixty-six percent versus 20% percent, respectively, would require rather than simply offer pregnancy testing when history indicated possible pregnancy; 20% and 15%, respectively, of those surveyed indicated elective surgery would be canceled by the anesthesiologist if the patient were pregnant or refused testing (p = NS). Although 98% of respondents recognized a legal requirement to report child abuse, and 82% believed pregnancy in a juvenile (i.e., the child's age is under local legal defined age for consent to sex) by definition constituted child abuse, fewer than 4% would report this information to the police, even if the impregnating male were known to be an adult. CONCLUSIONS: The desire to identify pregnancy using patient history was most prevalent among anesthesiologists, with less than one third using mandatory, departmentally imposed screening programs. Positive test results in minors are shared primarily with surgeons and patients, occasionally with parents and social services, but rarely with police, although a positive test almost universally signified child abuse, and mandatory reporting laws were acknowledged by anesthesiologists surveyed.     

Psychotherapy supervision: A survey of internship training practices.

A survey of 151 American Psychological Association-approved predoctoral internship programs showed a ratio of 3 hrs of psychotherapy provided by interns to 1 hr supervision received by the intern. Interns received an average of 4.25 hrs/wk of supervision, and the supervisory staff provided an average of 3.76 hrs/wk of supervision. One-to-one supervision was the predominant supervisory modality. Supervision was considered part of the job, not something to be specifically rewarded. No specific and direct evaluation procedures to assess supervision quality were available. One-third of the facilities reported that they provided training in supervision for interns. Programs could be characterized as "open" (accepting other than graduate psychology interns) or "closed" and more or less intensive in providing supervision. The dimensions of openness and intensity were related to the types and amounts of supervision provided. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Obstetric practice amongst Queensland general practitioners: a survey of needs and attitudes

A survey of Queensland general practitioners was carried out to assess their needs and attitudes regarding obstetric practice. Less than half of the respondents now practise obstetrics, and many general practitioners felt a lack of support from specialist obstetricians, paediatricians, and anaesthetists. Many of the respondents expressed needs for further obstetric training, especially in labour ward management and neonatal care; however, few were able to attend extended courses.     

Professional training and professional competence: A critique of current thinking.

Contends that professional schools and doctor of psychology programs may well represent the wave of the future in clinical psychology training. Yet advocates of the professional training model are premature in asserting that the model, as it has thus far been defined and evaluated, assures higher standards of professional competence than do traditional programs and should therefore become the official model for training all practitioners. The present study examines these claims from both empirical and pedagogical perspectives. Empirically, there is as yet no support for the superiority of explicit professional programs. Indeed, the lack of valid methods for assessing professional competence precludes meaningful evaluation of any training model. In the absence of empirical support, the new training model is examined in the light of 20th-century philosophy of professional education. From this perspective, the professional model rests on false assumptions concerning both the nature of professional competence and the optimal curriculum for developing competence. (40 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdisciplinary training and interdisciplinary functioning: a survey of attitudes and practices in community mental health

A survey of staff members and training-program directors suggests that inter-disciplinary functioning is the rule rather than the exception in community mental health centers, although there are significant differences by profession in time spent in interdisciplinary work and in attitudes toward it. Striking parallels are seen within each profession between attitudes of staff and of directors of training programs. Barriers to interdisciplinary functioning and training are identified and discussed.     

The risk intraocular juvenile xanthogranuloma: survey of current practices and assessment of risk

BACKGROUND: Juvenile xanthogranuloma (JXG) is an uncommon, usually uncomplicated disease of childhood. Ocular involvement, however, can result in glaucoma and blindness if left untreated. The incidence of ocular complications and how best to screen for their occurrence is unknown. OBJECTIVE: We attempted to ascertain management and referral practices among ophthalmologists and dermatologists and to characterize the risk for ocular complications in children with JXG. METHODS: A total of 431 dermatologists and 438 ophthalmologists were surveyed. In addition, the literature was reviewed. RESULTS: The response rate were 28% (dermatologists) and 44% (ophthalmologists). Most believed screening was important, but referral and surveillance practices varied widely. The survey incidence of ocular complications in patients with cutaneous JXG was approximately 0.3% (7 of 2371). The literature incidence was 0.4% (1 of 260). Children at maximum risk were 2 years of age or younger, had multiple skin lesions, and had newly diagnosed JXG. CONCLUSION: Ophthalmologic screening of patients with JXG should be particularly targeted to patients with risk factors of multiple skin lesions, new diagnosis, and age of 2 years or younger.     

Impact of law and regulation on professional practice and use of mental health services: An empirical analysis.

This is a case study under natural conditions of the effects that laws and regulations have had on professional practice and mental health service use in Hawaii from 1981 to 1989. Three major plans (Civilian Health and Medical Program of the Uniformed Services [CHAMPUS], Hawaii Medical Services Association [HMSA], and Medicaid) had the same fiscal intermediary and were served by the same pool of providers. Under conditions of direct access, psychologists provided more outpatient services than did psychiatrists. Under physician referral, the opposite was true. Trends over time are noted. To overturn certain restrictive Medicaid regulations, corrective legislation was introduced and enacted. Follow-up demonstrated that, when both psychologists and psychiatrists could certify mental impairment but the certifier could no longer be the therapist, service volume dropped—and so did public expenditure by $4.8 million (on removal of this conflict of interest, despite more than doubling the number of practitioners who could certify). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy supervision practices of academic faculty: A national survey.

A national sample of 300 American Psychological Association (APA) Division 12 members who hold academic appointments was surveyed about psychotherapy supervision practices. Of the 50.7% who returned questionnaires, results are reported for the 38.3% who described themselves as full-time faculty who regularly provide psychotherapy supervision. While there were substantial individual differences, the average academic supervisor devoted nearly seven hours per week to providing individual and group supervision and was responsible for an average of four graduate trainees, each of whom carried four cases. Despite the professional time commitment and attendant responsibilities and liabilities, 50% of faculty supervisors reported no additional compensation beyond their regular salaries. Also discussed are proportion of time allocated to various supervision modalities (e.g., live supervision) and gender differences in supervision. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Vocational-educational counseling practices: A survey of university counseling centers.

Assessed vocational-educational counseling at 52 university counseling centers. Surveyed were staff resources (level of staff) directed to vocational counseling, the use of innovative procedures in vocational counseling, and the degree to which career counseling services were evaluated. Results show that master's level staff and practicum students did most of the vocational counseling, innovative practices were few, and research and evaluation were limited. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A survey of UK manual therapists' practice of and attitudes towards manipulation and its complications

BACKGROUND AND PURPOSE: Little is known about the practice of manipulation by UK physiotherapists. This study was conducted to discover current practice of, and attitudes towards, manipulation among UK manipulative therapists. METHODS: A postal questionnaire was sent to 300 UK manipulative therapists who were members of two professional associations representing differing approaches to manual therapy: the Society of Orthopaedic Medicine (SOM) and the Manipulation Association of Chartered Physiotherapists (MACP). RESULTS: A 50% response rate was achieved and 129 respondents identified themselves as 'users' of manipulation. Anxiety about possible complications was a prominent reason adduced by 'non-users' and 'partial users' for their avoidance of manipulative procedures. The thoracic spine was the region most often manipulated, followed by the lumbar spine. Nineteen per cent of users had encountered complications from manipulation, which were most common in the cervical region and were predominantly non-serious. The majority of SOM members and a minority of MACP members used generalized cervical rotary manipulations--thought by some to be potentially dangerous. Attitudes to manipulation were generally positive, although overall respondents were uncertain as to whether its benefits outweighed its risks. Members of the SOM emerged as more frequent users of manipulation and as less conservative in their attitudes to certain aspects of manipulation. CONCLUSIONS: Allowing for possible under-reporting or other response biases, spinal manipulation emerged as a relatively safe and widely practised technique among this sample.     

Child custody evaluation practices: A survey of experienced professionals.

Investigated the activities, beliefs, and experiences of mental health professionals in 3 primary child custody areas: custody evaluation procedures, custodial decision making in joint and single-parent custody, and custodial recommendations. An extensive questionnaire was developed and mailed to 190 professionals (mean age 47.7 yrs) experienced in child custody evaluations. Results indicate that although Ss expressed a preference for impartiality, many continued to be retained by 1 parent only. This raises important ethical issues concerning the efficacy of certain evaluative roles in the pursuit of an optimal custodial recommendation. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Play therapists on play therapy I.: A report of methods, demographics and professional practices.

Conducted a survey of 1,166 professionals to determine practices, issues, and perceptions of play therapy for children. Data were collected from 4 different sources with representation from a range of professionals practicing play therapy. Survey items dealt with demographic, professional/practice, and clinical issues. Results show that there were more than 3 times as many females as males in the sample. Of all the between-Ss factors, job most often demarcated significant within-sex group differences among play therapists. Most of the Ss checked several specific theories as relevant to their play therapy work. Essentially there was considerable agreement in this sample regarding the everyday conduct of play therapy. Findings also indicate the need for additional graduate-level training in play therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Record-keeping practices of clinical and counseling psychologists: A survey of practitioners.

Record keeping by psychologists was examined with survey data. Results indicate substantial variability in policies and practices. Implications of the results are discussed, and it is recommended that more specific guidelines for practitioners be developed in order to reduce the variability in record keeping. (PsycINFO Database Record (c) 2010 APA, all rights reserved)