Child and adolescent psychological assessment: Current clinical practices and the impact of managed care.

Which psychological testing measures are clinical child and adolescent psychologists most commonly using? How has managed care influenced the practice of assessment for these professionals? This study provides survey data from 162 child practitioners employed in independent practice and in hospital, outpatient, and school-based settings throughout the United States. The results demonstrate marked consistency with recent surveys of clinicians working with adults, and a list of the 30 most frequently utilized measures is provided. Over 40% of the sample reported significant limitations in psychological testing due to managed-care policies. Strategies for maintaining an assessment practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Amplifying issues related to psychological testing and assessment.

Responds to comments by D. A. Smith (see record 2002-10716-011), H. N. Garb et al (see record 2002-10716-012), R. Fernández-Ballesteros (see record 2002-10716-013), J. Hunsley (see record 2002-10716-014) regarding the G. J. Meyer et al (see record 2001-00159-003) summary of evidence and issues associated with psychological assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Youth psychotherapy change trajectories and outcomes in usual care: Community mental health versus managed care settings.

Objective: The authors compared symptom change trajectories and treatment outcome categories in children and adolescents receiving routine outpatient mental health services in a public community mental health system and a private managed care organization. Method: Archival longitudinal outcome data from parents completing the Youth Outcome Questionnaire (Y-OQ) were retrieved for children and adolescents (4–17 years old) served in a community mental health system (n = 936, mean age = 12 years, 40% girls or young women, 28% from families of color) and a managed care organization (n = 3,075, mean age = 13 years, 45% girls or young women, race and ethnicity not reported). The authors analyzed Y-OQ data using multilevel modeling and partial proportional odds modeling to test for differences in change trajectories and final outcomes across the 2 service settings. Results: Although initial symptom level was comparable across the 2 settings, the rate of change was significantly steeper for cases in the managed care setting. In addition, 24% of cases in the community mental health setting demonstrated a significant increase in symptoms over the course of treatment, compared with 14% of cases in the managed care setting. Conclusions: These results emphasize the need for increased attention to negative outcomes in routine mental health services and provide a stronger foundation for identifying youth cases at risk for treatment failure. In addition, given the overall differences observed across treatment settings for average rate of change and deterioration rates, results suggest that setting-specific model heuristics should be used for identifying cases at risk for negative outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Constructing managed care, constructing brief therapy.

Comments on the article by P. Cushman and P. Gilford (see record 2000-05933-002). The author appreciates the questioning of managed care's use of positivism and "objective scientism" as well as a recognition of its focus on "instrumentality, efficiency, and conformity", but argues that brief therapy and managed care are not synonymous. The author sees many problems with managed care, but also sees the need for fiscally viable and clinically sound ways to provide broad services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communication and records: Hippa issues when working in health care settings.

To refocus awareness on the original mandate of the Health Insurance Portability and Accountability Act (HIPPA) regulations, this article will review record keeping requirements and examine patient-doctor and interdisciplinary communication as a way to improve the health care consumer's trust in the privacy of their personal information while facilitating integrated and fluid health care delivery systems. The HIPPA rules especially important in medical settings are discussed with a special emphasis on issues confronting psychologists who practice outside of medical institutions and hospitals. The article also examines important implications for practice activities when psychologists attend patients who are hospitalized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Rural Hawai'i Behavioral Health Program: Increasing access to primary care behavioral health for native Hawaiians in rural settings.

Health care access issues present significant challenges for rural populations and health providers. Psychology can support improved access and quality of rural health services through the development of integrated behavior health programs within primary care settings. This article reviews a clinical training and service delivery program, the Rural Hawai'i Behavioral Health Program, which has evolved in response to the pressing health needs of Native Hawaiians in rural communities. Native Hawaiian cultural factors and components of the primary care model that have supported the development of this program will be reviewed. Program expansion, sustainability, and treatment efficacy research will be discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological testing and psychological assessment: A closer examination.

Comments on the G. J. Meyer et al (see record 2001-00159-003) summary of evidence and issues associated with psychological assessment. J. Hunsley states that Meyer et al failed to address two major issues at the very heart of psychological assessment practices in a consistent and sufficient manner: the crucial distinction between testing and assessment and the critical importance of incremental validity in both testing and assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologist supply, managed care, and the effects of income: Fault lines beneath California psychologists.

Data from the 2000 Calffornia Survey of Psychological Practice (D. Pingitore, R. Scheffler, M. Haley, T. Sentell, & D. Schwalm, 2001) were used to measure psychologists' income variation associated with demographic characteristics, managed care participation rate, and mental health workforce supply concentrations. A 10% increase in the supply of psychologists in a psychologists' market of practice resulted in a $1,749 reduction in income compared with a $1,330 income reduction due to a 10% increase in managed care participation. The authors discuss how psychologists' income and other aspects of practice are shaped by market dynamics, trends in the psychologist workforce, and public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practicing psychology in the era of managed care: Implications for practice and training.

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological assessment and care of organ transplant patients.

Organ transplant has been developed in animal models over the past 100 years. The major limiting factor in transplant medicine is the shortage of donor organs. This shortage creates pressure for fair and efficient allocation of organs, with expectations that those involved in transplantation will strive to achieve optimal outcomes and ensure just access. This article reviews the major types of transplants and the illnesses and behavioral comorbidities that lead to these procedures, the psychological assessment of transplant candidates, the adaptive tasks required of the transplant recipient at various stages of the transplant process, and relevant psychological interventions. Liaison with others on the transplant team and ethical issues of concern to psychologists who work with transplant patients, including living organ donors, are also discussed. Finally, new developments in transplant and suggestions for future psychological research in organ transplant are presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality measurement and the ethics of assessment.

Major criticisms of personality tests are that they are not adequate, that they are often misused (employed for inappropriate purposes or in misleading or ineffective ways), and that they invade privacy. If the "pressures of reality lead us to establish policy-based self-regulation in psychological assessment, it would seem imperative to include at the same time formal provisions for its continuing reappraisal." Major sections are: Self-regulation or public relations. The dilemma of regulation. Uses of assessment. Conflicts of commitment and the regulative process. The impact of policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Graduate training for managed care: A national survey of psychology and social work programs.

Although there is much discussion within the professional literature about the training needs of graduate students in response to managed care, little empirical research exists that assesses the extent to which graduate programs provide training opportunities in this field. The present study surveyed graduate program training directors in clinical psychology, counseling psychology, and social work about the training opportunities available for their graduate students. Almost 60% of the respondents indicated that they provide some type of training related to managed care. Implications and applications of these results are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to the special issue on methodological issues in psychological assessment research.

Our primary goal in this special issue on research methodology is to explore methodological issues across a broad range of psychological assessment research and to highlight pitfalls and problems that often plague researchers engaged in this pursuit. We believe that the methodological articles in this special issue will serve as an important resource for future research in the field of personality assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intelligence: Foundations and issues in assessment.

There is no more central topic in psychology than intelligence and intelligence testing. With a history as long as psychology itself, intelligence is the most studied and likely the best understood construct in psychology, albeit still with many “unknowns.” The psychometric sophistication employed in creating intelligence tests is at the highest level. The authors provide an overview of the history, theory, and assessment of intelligence. Five questions are proposed and discussed that focus on key areas of confusion or misunderstanding associated with the measurement and assessment of intelligence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Moral and ethical issues in human systems.

Human systems are primarily social and moral entities by their very nature. Although many in business organizations have argued that business and ethics cannot be integrated, the fundamental lack of attention to basic requirements for the moral development of human systems has contributed to intolerable levels and forms of systemic mismanagement. It is argued that consultation, too, inevitably has powerful moral influences, whether or not they are intended. This article addresses three approaches to optimizing moral influences on organizational clients. First, moral issues can be fully integrated into the usual organizational structure models that are employed. Second, conditions helpful in understanding and facilitating meaningful moral discourse as a routine process can be delineated. Third, important functions of the organization's leadership structure are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The need for continuing education in ethics as reported by rural and urban mental health care providers.

Continuing professional education (CPE) sponsors planning events for mental health care licensees can assure better attendance if they can successfully address the needs of their target audience. Offering topics of interest is particularly crucial when CPE events need to draw large numbers of attendees to be financially viable. A survey of nearly 400 health licensees regarding CPE needs, especially as related to ethics, revealed that the greatest interest in such CPE was reported by master's-level mental health care providers. Topic areas with the greatest draw were the management of clients who present with special issues (e.g., substance abuse, medical illness, or cultural diversity) and competent management of colleague misconduct and impairment, rather than more traditional ethics issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Psychologist supply, managed care, and the effects of income: Fault lines beneath California psychologists": Erratum.

Reports errors in the original article by D. Pingitore et al (Professional Psychology: Research and Practice, 2001, Vol 32[6], 597-606). In the first paragraph on page 601, lines 5-10 should read: "Net income for psychologists aged 40-54 years was significantly greater than for psychologists 39 years and younger (pt test for income differences by age group should be pp>.05). (The following abstract of this article originally appeared in record 2001-05464-006.) Data from the 2000 California Survey of Psychological Practice (D. Pingitore, R. Scheffler, M. Haley, T. Sentell, & D. Schwalm, 2001) were used to measure psychologists' income variation associated with demographic characteristics, managed care participation rate, and mental health workforce supply concentrations. A 10% increase in the supply of psychologists in a psychologists' market of practice resulted in a $1,749 reduction in income compared with a $1,330 income reduction due to a 10% increase in managed care participation... (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Practising Psychology in Rural Settings: Issues and Guidelines.

Rural practice presents important yet challenging issues for psychology, especially given the North American and international distribution of the population, levels of need for psychological services in rural settings, limited availability of rural services, and migration of rural residents to urban centers. Direct service issues include the need to accommodate a wide variety of mental health difficulties, issues related to client privacy and boundaries, and practical challenges. Indirect service issues include the greater need for diverse professional activities, including collaborative work with professionals having different orientations and beliefs, program development and evaluation, and conducting research with few mentors or peer collaborators. Professional training and development issues include lack of specialized relevant courses and placements, and such personal issues as limited opportunities for recreation and culture, and lack of privacy. Psychology will need to address more fully these complex issues if rural residents are to receive equitable treatment and services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estimating variability in outcomes attributable to therapists: A naturalistic study of outcomes in managed care.

To estimate the variability in outcomes attributable to therapists in clinical practice, the authors analyzed the outcomes of 6,146 patients seen by approximately 581 therapists in the context of managed care. For this analysis, the authors used multilevel statistical procedures, in which therapists were treated as a random factor. When the initial level of severity was taken into account, about 5% of the variation in outcomes was due to therapists. Patient age, gender, and diagnosis as well as therapist age, gender, experience, and professional degree accounted for little of the variability in outcomes among therapists. Whether or not patients were receiving psychotropic medication concurrently with psychotherapy did affect therapist variability. However, the patients of the more effective therapists received more benefit from medication than did the patients of less effective therapists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patients' perceptions of care and safety within psychiatric settings.

There is growing concern over institutional measures of control (e.g., seclusion, restraint) and other potentially harmful or traumatic experiences within psychiatric hospitals. The purpose of the present study was to examine the relationship between demographic variables, potentially harmful and/or traumatic psychiatric experiences, and patients' perceptions of care and safety in psychiatric settings among 142 public-sector psychiatric patients. Data revealed 45.1% of patients reported they had been to a psychiatric facility they would never want to return to, and the majority of patients did not communicate with staff after a distressing event occurred. There were no significant differences in perceptions of care and safety by race, gender, or age. However, patients who reported potentially harmful or traumatic psychiatric events were significantly more likely to report that they had been to a psychiatric facility they would not want to return to. Encouragingly, most patients (84.5%) reported that psychiatric facilities have become safer in recent years. These data suggest the need to better understand how adverse psychiatric events influence how patients view their care and their subsequent engagement in that care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)