Adapting clinical services to accommodate needs of refugee populations.

The diversity of the refugee population in the United States requires practicing psychologists to respond by adapting clinical services to meet their mental health needs. However, the available literature on culturally adapted treatments is only a first step in guiding the process for adapting clinical services. This paper describes our experiences with designing and adapting a variety of clinical services for youth and families with refugee status. Guided by Sue's (2006) tenets for culturally competent service delivery, we discuss a therapeutic model of tiered service delivery used to deliver preventative services and treatment to refugee youth and adults. We discuss how we adapted treatments to help overcome access barriers to mental health treatment, and we provide specific examples of how existing treatments were used with refugee populations. In addition, we discuss information and approaches for how practicing psychologists can develop additional skills for working with refugee populations. We conclude by focusing on the need for our field to work toward improving access to mental health treatment for refugee youth and families and developing evidence-based treatments for this population. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Cultural competence and evidence-based practice in mental health services: A complementary perspective.

The need for cultural competence and the need for evidence-based practice in mental health services are major issues in contemporary discourse, especially in the psychological treatment of people of color. Although these 2 paradigms are complementary in nature, there is little cross-fertilization in the psychological literature. The present article illustrates the complementary nature of these 2 paradigms. A main point of convergence is related to the development of culturally adapted interventions in the move from efficacy research to effectiveness studies. The implications of cultural adaptations of empirically supported treatments for mental health services in terms of research and practice with ethnic/racial minority populations are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DWI prevention: Profiles of drinkers who serve as designated drivers.

This study was designed to profile drinkers who serve as designated drivers (DDs) and to determine if drinkers who are at risk for driving while intoxicated (DWI) serve as DDs. Bivariate and logistic regression analyses on data from 1,393 computer-assisted telephone interviews (CATIs) and 913 barroom surveys showed that DDs, relative to non-DDs, tend to be at-risk, heavier drinkers. Logistic regression using CATI data showed that DDs were more often heavy drinkers and reported higher levels of driving after drinking and riding with intoxicated drivers (RID). Logistic regression using barroom data showed that DDs reported more driving after drinking, in spite of drinking less often outside the home. DDs were also much more likely to have used a DD. These findings are consistent with those from several related studies that showed that drinkers who used DDs or free safe (taxi) rides tended to be heavier drinkers who reported more DWI. Future research may benefit from examining why at-risk drinkers take steps to avoid DWI on some occasions but not others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care rationing: the public's debate

OBJECTIVE: To elicit the views of a large nationally representative sample of adults on priorities for health services. DESIGN: An interview survey based on a random sample of people aged 16 and over in Great Britain taken by the Office of Population Censuses and Surveys. SUBJECTS: The response rate to the survey was 75%, and the total number of adults interviewed was 2005. MAIN OUTCOME MEASURES: A priority ranking exercise of health services supplemented with attitude questions about priorities, who should set priorities, and budget allocation. RESULTS: The results of the main priority ranking exercise of 12 health services showed that the highest priority (rank 1) was accorded to "treatments for children with life threatening illness," the next highest priority (rank 2) was accorded to "special care and pain relief for people who are dying." The lowest priorities (11 and 12) were given to "treatment for infertility" and "treatment for people aged 75 and over with life threatening illness." Most respondents thought that surveys like this one should be used in the planning of health services. CONCLUSIONS: The public prioritise treatments specifically for younger rather than older people. There is some public support for people with self inflicted conditions (for example, through tobacco smoking) receiving lower priority for care, which raises ethical issues.     

Psychology and manpower policy.

Outlines 5 contributions made by psychology to manpower policy: (1) the public has been encouraged to adopt a more humane attitude toward people who are ineffective; (2) the public has acquired a positive stance toward the amelioration of social and human ills, particularly through reliance on education, but also through other approaches including supportive services; (3) psychology's study of the distribution of human attributes has contributed substantially to the decline in discrimination toward women, Negroes, and others who were formerly beyond the pale; (4) psychology has led to more constructive views and behavior with regard to the rearing of children and development of young people; and (5) psychology has thrown a searchlight on the critical importance of work for individual and social integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of health services by children and young people according to ethnicity and social class: secondary analysis of a national survey

OBJECTIVE: To assess whether equity is achieved in use of general practitioner, outpatient, and inpatient services by children and young people according to their ethnic group and socioeconomic background. DESIGN: Secondary analysis of the British general household survey, 1991-94. SUBJECTS: 20 473 children and young people aged between 0 and 19 years. MAIN OUTCOME MEASURES: Consultations with a general practitioner within a two week period, outpatient attendances within a three month period, and inpatient stays during the past year. RESULTS: There were no significant class differences in the use of health services by children and young people, and there was little evidence of variation in use of health services according to housing tenure and parental work status. South Asian children and young people used general practitioner services more than any other ethnic group after controlling for socioeconomic background and perceived health status, but the use of hospital outpatient and inpatient services was significantly lower for children and young people from all minority ethnic groups compared with the white population. CONCLUSIONS: Our results differ from previous studies, which have reported significant class differences in use of health services for other age groups. We found no evidence that children and young people's use of health services varied according to their socioeconomic status, suggesting that equity has been achieved. A child or young person's ethnic origin, however, was clearly associated with use of general practitioner and hospital services, which could imply that children and young people from minority ethnic groups receive a poorer quality of health care than other children and young people.     

Strengthening mental health services in Head Start: A challenge for the 1990s.

Steps must be taken to strengthen mental health services by building on Head Start's philosophy and by translating innovations in mental health services for older children and adolescents into improved services for young children and their families. Recommendations for strengthening Head Start's mental health program include creating a unified vision that reaffirms a holistic, family-focused, and comprehensive services approach; ensuring that mental health services are responsive to the diversity in families served; increasing coordination of mental health services and linkages with new initiatives; increasing resources and providing assistance in gaining access to new sources of funding; supporting innovation; and integrating the new paradigm for children's mental health services into more traditional approaches to intervention within Head Start. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Characterization of acellular dermal matrices (ADMs) prepared by two different methods

This paper describes a program in Hamilton-Wentworth, Ontario, Canada, that brings mental health counselors and psychiatrists into the offices of 87 local family physicians, working in 35 practices serving 170,000 people. It outlines the organization of the mental health teams in the family physician's office and the way in which these teams are coordinated and discusses how this "shared care" approach can overcome many of the problems that traditionally bedevil the relationship between psychiatric services and family practices. It summarizes the benefits of this approach for patients providers and the health care system and looks at its implications for learners and for new approaches to continuing education. This model can be adapted to most communities.     

The effects of an adapted interactive writing intervention on kindergarten children's phonological awareness, spelling, and early reading development: A contextualized approach to instruction.

Using a pretest-posttest comparison-group design, this 16-week study investigated the effects of 2 instructional approaches on the phonological awareness, alphabetic knowledge, and early reading of kindergarten children. The primary goal was to compare a form of contextualized instruction based on an adapted interactive writing program with a field-tested program of metalinguistic games. For instructional purposes, the children in each treatment group were divided into small intervention classes, with groupings based on children's common strengths and needs. Each week, these classes met with trained literacy tutors for 4 20-min lessons. Pretest and posttest measures provided data on children's phonological awareness, spelling, and reading development. Statistical analyses of the data indicated no between-groups differences with regard to phonological awareness and spelling achievement. In contrast, results revealed statistically significant differences between the 2 groups on word identification, passage comprehension, and word reading development measures, with the adapted interactive writing group demonstrating greater achievement. These findings verify that the children participating in a contextualized program matched or exceeded the achievement of the children participating in a structured program of metalinguistic games. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Date rape and sexual aggression in dating situations: Incidence and risk factors.

In this study we assessed the incidence of and the risk factors for date rape and other forms of male-against-female sexual aggression (SA) in dating situations. Over the course of two semesters, 341 women and 294 men anonymously completed questionnaires. They were asked to describe their most recent date (to provide normative data on dating) and their worst experience with SA during a date, if applicable. We assessed possible risk factors in three ways: (a) For people who had been involved in SA, we compared the characteristics of their SA dates and their recent dates; anything occurring more often on SA dates than on recent dates might be a risk factor. (b) We compared the most recent dates of people who had versus had not experienced SA to identify differences in their date habits. (c) We compared attitudes of people who had versus had not been involved in SA. Results showed that 77.6% of the women and 57.3% of the men had been involved in some form of SA; 14.7% of the women and 7.1% of the men had been involved in unwanted sexual intercourse. Variables that appear to be risk factors are the man's initiating the date, paying all the expenses, and driving; miscommunication about sex; heavy alcohol or drug use; "parking"; and men's acceptance of traditional sex roles, interpersonal violence, adversarial attitudes about relationships, and rape myths. The length of time that dating partners have known each other seems unrelated to the risk of SA. Implications for rape-prevention programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epidemiology of traumatic brain injury in South Australia

Reviews of statewide hospital separations' summaries and medical record data from a major teaching hospital, were conducted to describe the epidemiology of traumatic brain injury (TBI) in South Australia (SA), and to document the demographics of the population affected and the nature of their injuries. The groups most at risk were defined for targeting preventive programmes, and predictions were made regarding their ongoing service needs, for more appropriate provision of care. The results indicate that SA experiences a high incidence of TBI. At 322 per 100,000 head of population annually, it exceeds studies (with comparable methodologies) in communities in the United States and Europe. The causes; nature and severity of the injuries were similar to those found in the international literature, as were the profiles of the population most at risk. Specifically, young males living in the country and working in manual trades showed the highest incidence, and were most likely to have sustained their TBI whilst driving a motor vehicle. When a formula to predict service needs was adapted using the SA data, it was apparent that hospitals in this state care for more than 4000 new cases of TBI each year and that, on discharge, over 1000 of these will have some degree of residual impairment and will therefore require some form of post-injury services.     

Psychotherapy in the real world.

Community or school-based services may be the answer to meeting the needs of disadvantaged or poor children and youth and their families. This article focuses on lessons learned in treating a special population of children and families and discusses how therapists in the real world often modify treatment protocols to address the specific needs of their patients. Office-based settings and traditional psychotherapy approaches may not be salient to meeting the mental health needs of a vast group of children, youth, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The vegetal determinants required for the Spemann organizer move equatorially during the first cell cycle

Embryos with no dorsal axis were obtained when more than 15% of the egg surface was deleted from the vegetal pole of the early 1-cell embryo of Xenopus laevis. The timing of the deletion in the first cell cycle was critical: dorsal-deficient embryos were obtained when the deletion began before time 0.5 (50% of the first cell cycle) whereas normal dorsal axis usually formed when the deletion was done later than time 0.8. The axis deficiency could be restored by lithium treatment and the injection of vegetal but not animal cytoplasm. Bisection of the embryo at the 2-cell stage, which is known to restore the dorsal structures in the UV-ventralized embryos, had no effect on the vegetal-deleted embryos. These results show clearly that, in Xenopus, (1) the dorsal determinants (DDs) localized in the vegetal pole region at the onset of development are necessary for dorsal axis development and (2) the DDs move from the vegetal pole to a subequatorial region where they are incorporated into gastrulating cells to form the future organizing center. A model for the early axis formation process in Xenopus is proposed.     

Dental care for children with mental retardation: thoughts about the Americans with Disabilities Act

The Americans with Disabilities Act bars discrimination in public accommodations, housing, employment and health care for people with disabilities. Efforts to "mainstream" (in housing and education) many of the individuals with mental retardation have altered the setting for dental services and place demands for services by dental practitioners in the community. These developments should be considered within the jurisdiction of this new legislation. Demographic characteristics and dental needs of children with mental retardation are reviewed to provide a background for this discussion.     

Major mental illness, housing, and supports: The promise of community integration.

Providing housing and supports for people with psychiatric disabilities, particularly those who are homeless, is a major public policy challenge. This article summarizes the ways in which the concept of these needs is rapidly shifting in the mental health field. The article is based on research on the effectiveness of non-facility-based community support and rehabilitation approaches, the findings of other disability fields, and the emergence of mental health consumers' own preferences for expanded choices, normal housing, and more responsive services, including consumer-operated services. These new sources of knowledge are facilitating a paradigm shift in which people with psychiatric disabilities are no longer seen as hopeless, or merely as service recipients, but rather as citizens with a capacity for full community participation and integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Understanding the mental health needs of children and adolescents in residential treatment.

With the penetration of managed care approaches in child welfare, residential treatment services have come under increased scrutiny. In these circumstances it is critical to understand the clinically indicated use of these expensive interventions. As part of a community-reinvestment strategy of reform within a state child welfare agency, a needs-based assessment of children and adolescents was undertaken. A review of cases revealed that although the level of mental health need for many was significant, a substantial proportion of children in residential placement were not at high levels of risk. On the basis of these data, a process of placement review was designed and implemented for more effective use of residential treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Approaches to Serious Emotional Disturbance: Involving Multiple Systems.

Practice with children who have serious emotional disturbance (SED) increasingly requires multiple-systems intervention. Through a sample case, this article explores these interventions within the context of current national policy. Mental health collaboration with the systems of juvenile justice, education, child welfare, primary health care, and drug and alcohol services is summarized. The specific programs of multisystemic therapy, Pennsylvania's family-based mental health services, and Wraparound Milwaukee are presented as multiple-systems approaches that are successful with this population. The authors offer suggestions for emerging roles for psychologists within this context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using vicarious experience and verbal persuasion to enhance self-efficacy in pre-service teachers: "Priming the pump" for consultation.

This experimental study investigated whether self-efficacy perceptions pertaining to working with difficult-to-teach children could be increased for pre-service teachers using vicarious experience and verbal persuasion. 89 pre-service teachers were randomly assigned to groups. The experimental group was shown a 33-minute videotape describing and demonstrating effective behavior-management procedures, including supportive teacher testimonials and published research. A control group watched a placebo videotape of similar length detailing society's treatment of handicapped people. Data analyses indicated that the experimental group exceeded the control group on two of four self-efficacy measures. Results are discussed in terms of how enhancing teachers' self-efficacy perceptions might be used to "prime the pump" for consultation services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A model psychosocial screening program for children and youth with newly diagnosed Type 1 diabetes: Implications for psychologists across contexts of care.

Psychosocial factors are strongly associated with long-term medical and mental health outcomes for children with Type 1 diabetes. As a result, current national and international guidelines now call for psychosocial screening at or near the time of diabetes diagnosis. Despite this recommendation, there are no published protocols to provide guidance to psychologists attempting to screen and identify at-risk patients and their families and prevent the emergence of secondary psychological and medical complications. In this article, the authors describe a model psychosocial screening program that was designed to minimize barriers to implementation and that can potentially be adapted for use by psychologists in different settings. Preliminary findings from the pilot phase of program development suggest that the screening is effective at identifying patients at risk for subsequent problems with diabetes management. The screening was able to identify specific, modifiable risk factors that provide targets for efforts at preventive intervention using treatment approaches familiar to most psychologists. The authors conclude with a discussion of the importance of screening and knowledge of diabetes risk factors for psychologists working in different treatment settings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The Sexual Health Help Centre: a service for young people

BACKGROUND: The Sexual Health Help Centre (SHHC) was opened in 1995 to provide treatment, advice and information on family planning and sexual health issues for young people under the age of 20 years, in a way which is open and non-threatening. This paper describes an evaluation conducted during the first 9 months of service operation. METHODS: Young people's experience of the SHHC were elicited, and compared with their experiences of conventional family planning services in Glasgow. RESULTS: The SHHC has been successful in attracting young people for help with family planning problems and provides a more acceptable environment than conventional family planning services. However, a greater number of young men and young people under the age of 16 should be encouraged to attend the service. CONCLUSION: Young people are more likely to visit family planning services if they are offered a wide range of family planning and sexual health services in a non-judgmental, non-threatening environment.