An analysis of the nature and justification of treatment decisions in inpatient settings.

83 mental health professionals employed at 2 inpatient settings participated in a study on the nature and justification of assessment and treatment decision making. Clinical psychologists, psychiatrists, a psychiatric nursing service staff group, social workers, nonpsychiatric physicians, physician assistants, mental health workers/psychiatric technicians who had at least a high school diploma, rehabilitation specialists, and psychiatric administrators completed a treatment decision questionnaire. It addressed several specific content areas relating to the types of assessment procedures, treatment goals, and treatment methods mental health professionals usually use, as well as the usual reason(s) for such procedures. Results showed that inpatient mental health professionals mostly relied on past success as well as logistical-practical factors in the determination and justification of assessment and treatment methods. Analyses of differences among inpatient institutions and mental health professionals are also presented. The conclusion was that, regardless of the specific assessment and treatment methods relied on, mental health professionals did use systematic decision procedures in choosing such methods. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Compelled mental health examinations, liability decisions, and damage awards in sexual harrassment cases: Issues for jury research.

Controversy surrounds the role that expert psychological testimony may play in sexual harassment litigation. In some circumstances, the defense may compel sexual harassment plaintiffs to submit to a mental health examination by a defense expert. This examination may be used to discover whether the plaintiff has a previous history of sexual victimization, which the defense could use to weaken the plaintiff s claims that the sexual behavior was unwelcome and/or damaging. Some advocates have advised that plaintiffs not place their mental health into controversy, so that they can avoid these compelled examinations. In this article, the authors (a) review the legal basis for compelled mental health examinations, (b) review the relevant psychological literature on jury decision making in sexual harassment cases, and (c) examine the implications of compelled mental health examinations for jury decision making, suggesting avenues for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic counseling: A developing area of interest for psychologists.

This article presents genetic counseling as a challenging field for psychologists. Developments in the field affect individual and public conceptions of the basic issues of reproduction and pregnancy, health and illness, and normality and abnormality. Genetic counseling provides a uniquely structured setting in which to examine major psychological topics, such as coping with threatening events, family dynamics, reactions to uncertainty, risk perception, and decision making. Psychological aspects of genetic counseling are presented on several key issues, including meanings of genetic information, patients' and families' coping with a genetic condition, recall and comprehension of information conveyed in genetic counseling, and decision making. Four roles are delineated for psychologists in this new field: providing direct services to counselees, consulting with counseling teams, training genetic counselors, and researching the psychological aspects of genetic counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The "consumer" in psychotherapy.

Maintains that the consumer movement has grown to be a recognized force in the mental health field. One can find strong support in the literature for the principle of client input into treatment planning and delivery. Views, however, that advocate unconditional and total control by the consumer over clinical decision making go too far. Among other things, the fact that some clients are extremely fragile and dependent, coupled with the power position of the therapist, suggests that certain clients in certain therapist-treatment situations cannot be considered as legitimate consumers (i.e., wholly capable of self-direction in regard to the clinical process). Researchers are asked to accept the challenge of developing a consumership grid that would identify what types of clients confronted with what types of situational conditions should have given degrees of influence in clinical decision making. (French abstract) (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the clinical practice of violence risk assessment: Technology, guidelines, and training.

Despite a long history of interest in, and criticism of, the ability of mental health professionals to assess and predict violence, there have been few efforts to develop or evaluate interventions to improve decision making in this area. This article provides a brief overview of recent research developments on violence risk. Drawing on these advances, 3 recommendations are outlined for improving the clinical practice of risk assessment: (a) to improve assessment technology, (b) to develop clinical practice guidelines, and (c) to develop training programs and curricula. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward a cognitive process model of ethnic/racial biases in clinical judgment.

The purpose of the present article is to discuss approaches to the development of cognitive process models of misdiagnosis of African Americans, with particular emphasis on structured clinical interviews. Two basic approaches to cognitive process models are discussed. The first is cognitive bias based on prototype models of information processing. The second approach involves using the structured clinical interview to see how and when the decision-making process may be flawed, or where cognitive shifts are made in considering one diagnosis over another. Although routine training in structured clinical interviews may nullify cognitive biases associated with clinician judgment, it does not address cultural biases in the diagnostic system. It is concluded that a comprehensive approach to training in clinical decision making for mental health professionals is needed which include courses in the administration of the Structured Clinical Interview for DSM-IV, sociocultural case formulation, and cross-cultural sensitivity in making psychodiagnostic judgments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building Trust and Managing Risk: A Look At A Felony Mental Health Court.

Although many mental health courts are restricted to misdemeanors, the Brooklyn Mental Health Court primarily handles felonies. This article describes a felony mental health court and explores the decision to focus on felonies, including the planning team's experiences with problem-solving courts and the effort to balance a fair court process with effective, but lengthy, treatment mandates. The author describes several ways by which the court and its partners manage potential public safety risks posed by felony offenders: thorough evaluations of offenders, individualized treatment plans, shared decision making, candid communications between the court and its partners, and close judicial monitoring. The author also describes the ongoing program evaluation of the court and suggests areas for future research for felony mental health courts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research ethics for mental health science involving ethnic minority children and youths.

In response to U.S. Public Health Service projects promoting attention to disparities in the outcomes of mental health treatments, in July 2001, the American Psychological Association, the National Institute of Mental Health, and the Fordham University Center for Ethics Education convened a group of national leaders in bioethics, multicultural research, and ethnic minority mental health to produce a living document to guide ethical decision making for mental health research involving ethnic minority children and youths. This report summarizes the key recommendations distilled from these discussions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The challenge of double jeopardy: Toward a mental health agenda for aging women.

The elderly may be considered a group at risk with regard to mental health and the mental health system. Aging women experience a double jeopardy arising from social, economic, and psychological conditions surrounding age and gender—in particular, poverty, widowhood, and the dynamics of family caregiving. This double jeopardy translates into a vulnerability within the mental health system that is seen in issues of service utilization, therapist–client interactions, and diagnosis, most notably in diagnoses of Alzheimer's disease, alcohol and drug misuse, and depression. The failure of the mental health system to consider elderly individuals as psychological survivors further suggests an implicit assumption that mental decline is a normative part of the aging process. Recommendations for change include addressing gender and age interactions in mental health policy and in psychological research, training, and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy—is it safe, effective, and appropriate? The beginning of an evolutionary dialogue.

Discusses efforts made by the US Congress in the late 1970's and early 1980's to explore the extent to which those seeking psychotherapeutic services could be assured that the care they would receive would be beneficial. It is contended that psychology, psychiatry, and the mental health field have presented few summary statements to guide the educated consumer or enlightened 3rd-party payers in decision making about mental health care. The mental health field is still young, and there has been insufficient time to evaluate the efficacy of all forms of therapy for all the problems for which patients/clients seek help. But the knowledge gained from clinical experience can be used in a tentative fashion to direct more rigorous empirical investigation. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology can be indispensable to health care reform and the patient-centered medical home.

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March 2010, making health care reform a reality. Perhaps the most well-developed model of primary care that aligns with the PPACA's agenda is the patient-centered medical home (PCMH). Integrated care, as defined by collaborative care between mental health and primary care providers and systems, will undoubtedly play a critical role in the success of the PCMH. The role of psychology and integrated care in the PCMH as well as training implications for psychologists are discussed. This article is intended to challenge our discipline to embrace psychology as a health care profession that must prepare for and solidify its added value in the health care delivery models of the future. Requisite skill sets for primary care psychologists and existing training opportunities are presented. Finally, possible mechanisms for training psychologists in integrated care and the professional roles primary care psychologists can expect to fill are proposed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychologists and rural services: Addressing a new agenda.

Rural people in the 1990s are struggling with serious individual and community problems that threaten their very survival. The growth of professional psychology into a viable health, mental health, and social service profession places it in a position to be of assistance to rural communities. To do this, however, adequate training models must be developed to equip psychologists to ply their trade in rural areas. A strategy and model for training practicing psychologists is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Resolving issues raised by the Fort Bragg evaluation: New directions for mental health services research.

Replies to comments by J. R. Weisz et al, K. Hoagwood, P. H. DeLeon and J. G. Williams, L. Saxe and T. P. Cross, L. Behar, and S. Feldman (see records 84-32869, 32806, 32791, 32850, 32776, and 32800 respectively) regarding the author's (see record 83-31861; L. Bickman et al, 1995) Fort Bragg study. Six major concerns are addressed: timing, cost and decision making, service effectiveness, nature of mental health treatments, generalizability of results, and present and future directions as a result of the study. The author stresses the need for mental health professionals to face the issues raised by this study and to assume responsibility for improving the effectiveness of services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of training in rational decision making on the quality of simulated career decisions.

Investigated whether training in rational decision making improves the quality of simulated career decisions. 147 community college students aged 16–50 yrs were randomly assigned to either a 90-min training program in rational decision making or a placebo control. Assessment instruments were the College Board's Career Decision-Making Skills Assessment Exercise and the Career Decision Simulation. ANOVA results showed that training in rational decision making resulted in superior performance for females on one subscore of the knowledge measure (establishing an action plan). It also resulted in superior simulated career choices by females and younger males. The older males generally made poorer decisions after receiving training in rational decision making. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Supporting children's mental health in schools: Teacher perceptions of needs, roles, and barriers.

There is a significant research to practice gap in the area of mental health practices and interventions in schools. Understanding the teacher perspective can provide important information about contextual influences that can be used to bridge the research to practice gap in school-based mental health practices. The purpose of this study was to examine teachers' perceptions of current mental health needs in their schools; their knowledge, skills, training experiences and training needs; their roles for supporting children's mental health; and barriers to supporting mental health needs in their school settings. Participants included 292 teachers from 5 school districts. Teachers reported viewing school psychologists as having a primary role in most aspects of mental health service delivery in the school including conducting screening and behavioral assessments, monitoring student progress, and referring children to school-based or community services. Teachers perceived themselves as having primary responsibility for implementing classroom-based behavioral interventions but believed school psychologists had a greater role in teaching social emotional lessons. Teachers also reported a global lack of experience and training for supporting children's mental health needs. Implications of the findings are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

What is a good treatment decision? The client's perspective.

63 adult outpatient clients of a community mental health center evaluated 5 methods of clinical decision making: intuition, research, therapist's informal successful experience, professional recommendation therapist, and no rationale. Clients rated their therapists' informal successful experience and the use of research as favorable decision methods. Clients thought that their therapists would also rate these methods as favorable. We conclude that clients want their therapists to make clinical decisions on the basis of informal experience in which the efficacy of the recommendations is demonstrated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Integrating peer support initiatives in a large healthcare organization.

The Veterans Health Administration (VHA) adopted a strategic plan for mental health that emphasizes implementation of recovery-oriented services, including peer support. To provide a baseline for assessing change, a national survey was conducted of peer service delivery for veterans with mental illness, including those with comorbid substance abuse or homelessness. The number of participating programs was small. However, responses indicate that existing VHA peer services can be categorized as partnership services. Program and position structures, such as goals and training requirements are each described. Role and administrative or systems processes, such as acquiring staff buy-in and liability are also described. Future areas of consideration include dissemination of peer support in VHA and other healthcare systems, with specific efforts to increase training protocols, evaluation, and payment options for peers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research utilization in community mental health: Some comments on O'Donohue, Curtis, and Fisher (1985).

Criticizes the study by W. T. O'Donohue et al (see record 1986-04773-001) on the use of research in the practice of community mental health (CMH), questioning their operational definition of CMH research utilization. It is suggested that the data of O'Donohue et al bear more directly on the level of sophistication of CMH clinical decision making, to which research consumerism contributes. The evidence for unsophisticated clinical practice advanced by O'Donohue et al may reflect in part sloppy bookkeeping or paperwork burnout. General comments on mental health research utilization are offered. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Latency to categorize disoriented alphanumeric characters as letters or digits.

Previous research has shown that if Ss must decide quickly whether a disoriented alphanumeric character is normal or backward, they "mentally rotate" an internal representation of the character to its normal upright position before making the decision. The present study with 12 undergraduates showed that latency to decide whether a disoriented character was a letter or a digit was barely affected by angular orientation, implying that mental rotation is not necessary for this task. However, latency was significantly shorter for normal than for backward characters, regardless of angular orientation, suggesting that the difference between normal and backward characters does register prior to mental rotation. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)