Telehealth Brain Injury Training for Rural Behavioral Health Generalists: Supporting and Enhancing Rural Service Delivery Networks.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program that matched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth issues in consulting psychology practice.

Consulting psychologists have recognized the importance of providing comprehensive consultation and clinical services for consumers with special needs. Often because of distance and access to consultation services, remote and underserved populations may not have the necessary access to consultant specialists in psychology and other disciplines. Such services are now available through an innovative model of telehealth. Telehealth technology and services have gained the attention of scientists, clinicians, consultants, and health educators in a variety of settings. Examined are consultation case scenarios using telehealth qualitative observations of consultants who have used telehealth and liability issues consultants may face using this technology. A model release of liability is provided for consulting psychologists who may consider its use in their consultation practice. Case examples using telehealth applications are discussed, as are special applications for health care delivery to undeserved rural populations using telehealth technology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cross-cultural consultation in a South African cancer setting.

Describes a project involving an international cross-cultural health psychology consultation with American consultants assisting highly educated, urban Afrikaner medical and health care professionals in enhancing the cancer treatment provided primarily to rural, low-income Zulu, Tswana, and Pedi patients in South Africa. Today, South Africa struggles with the meaning of equality, not only in a political sense but also in terms of health care, education, and employment. Building a bridge of conversation and cultural understanding between the health care profession and traditional patients is a crucial 1st step to delivery of improved medical services in South Africa. This article is divided into 4 sections. The 1st describes the very rapidly changing context of medical care provision in South Africa. The 2nd presents 2 important. cross-cultural perspectives: the 5-dimensional research model of G. Hofstede (1991) and key consultee dimensions as informed by multicultural psychology. In addition, the program and process models of consultation are outlined. In the 3rd section, details of the project are conveyed, and in the 4th section a summary of implications and recommendations for other consultants interested in similar types of consultation is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emergency department-based home care

STUDY OBJECTIVE: To assess the feasibility of coordinating home care services from an inner-city emergency department. INTERVENTION: In a preintervention survey, the home care needs of 650 consecutive patients being discharged from the ED were evaluated. A nurse-coordinator who arranged and managed rapidly deployed home care services then was assigned to the ED for eight months. Patients were referred, and home care services were provided regardless of insurance status. SETTING: Teaching hospital serving a large indigent population. PARTICIPANTS: Adult patients about to be discharged home from the ED. MAIN RESULTS: Forty-five of 650 (7%) surveyed patients were not receiving home care services for which they were eligible. In the subsequent eight-month period, 670 patients were referred for home care on discharge from the ED (2% of all discharges). Seventy-six percent of these patients were women, and the average age was 73.5 years. Four hundred fifty patients (67%) received visits from home care providers managed by the ED coordinator. For 99 of these patients (22%), the availability of rapidly deployed home care services obviated the need for emergency admission to the hospital. Net billings to third-party payers exceeded the costs of the program. CONCLUSION: A significant proportion of elderly patients being discharged from the ED need home health services. Access to rapidly deployed home care services can obviate the need for hospital admission for a select group of debilitated patients. The provision of home care services from the ED is economically feasible.     

Rural hospital health promotion: programs, methods, resource limitations

Most hospitals provide health promotion programs for community residents. There is little information concerning the specific types of services offered by rural hospitals. A questionnaire was sent to every acute care hospital in Iowa (N = 124), including 99 rural hospitals and 25 urban hospitals. Surveys were returned from 95 rural hospitals (96%) and 20 urban hospitals (80%). Results indicated that 98.9% of rural hospitals offered health promotion services to community residents. These services provided on average 7.5 programs on a regular basis, while using only 1.2 full-time equivalent (FTE) employees. Urban hospitals provided 9.5 regular programs with 2.4 FTE. The most common types of rural promotion programs were blood pressure screening, cholesterol screening, safety and protection programs, diet/nutrition programs, prenatal/maternal health, and breast cancer screening. Over 40% of rural respondents stated that other less common programs, including substance abuse prevention and mental health promotion, were needed but could not be offered because of resource limitations; these types of services were offered more commonly in urban hospitals. Rural hospital health promotion programs are attempting to meet a wide variety of programming needs with limited resources, and attention may be well directed towards finding how best to provide various programs with limited resources to maximize their impact on community health.     

Telehealth: A clinical application model for rural consultation.

This article describes how a child psychologist in a rural community provides the necessary comprehensive consultation and clinical services using a video telephone and the services of Kentucky Telecare. The authors present a clinical consultation model of health care for underserved populations where professional consultation with a team of professionals may benefit service providers in rural communities. The article examines an innovative model of telehealth care delivery through a university-based telehealth system to an underserved regional school system. A number of applications within a broad spectrum of services using telehealth technology are offered. Finally, shifts in administrative paradigms, clinical models, and information technology prevention services through telehealth are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychiatric consultation to a general hospital medical evaluation service

Psychiatric consultation to a general hospital medical evaluation service was reviewed and compared with consultation patterns for general hospital inpatients and psychiatric emergency service patients. Results of a questionnaire survey indicated nearly 1 in 5 patients admitted to this acute medical service (24-hour maximum stay) required psychiatric consultation. A study of those patients seen by psychiatric consultants is reported. The prevalence of depressive illness as well as the psychiatric hospitalization referral rate was substantially greater than in general hospital inpatient or psychiatric emergency service evaluations. The implications of this relatively new area of consultation-liaison for hospital staffing and medical education are discussed.     

Training school psychologists: Some perspectives on a competency-based behavioral consultation model.

A behavioral consultation training model is presented that articulates training competency and service goals in school psychology. The model promotes evaluation of the competencies of school psychologists and their impact on the settings in which consultation services are provided. It also focuses on learning and adjustment problems in the socialization process and works on specific target behaviors. Problem-solving strategies are developed in 4 stages: (a) problem identification, (b) problem analysis, (c) intervention, and (d) evaluation. Difficulties encountered in implementing the model are discussed. (60 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Louisiana Spirit Specialized Crisis Counseling: Counselor perceptions of training and services.

This study examined perceptions of training, supervision, consultation, services provided, and role satisfaction among program personnel (N = 93) providing assistance to children, adults, and families affected by Hurricanes Katrina and Rita through the Louisiana Spirit Specialized Crisis Counseling Services (SCCS) Program. Findings indicated that there was uniform high satisfaction with the training, supervision, and consultation, which included the skills-based intervention, Skills for Psychological Recovery, provided by the SCCS Practice Directorate that included staff from Louisiana State University Health Sciences Center, the National Child Traumatic Stress Network, and the National Center for PTSD. Counselors also made high ratings of their perceptions of the helpfulness of services to survivors and overall satisfaction with their work. The vast majority of counselors, who had themselves been seriously affected by the hurricanes, indicated that their own hurricane-related experiences and losses were extremely helpful to them in relating to survivors and providing services. Fully 90% indicated that they had significantly benefited professionally from their work and would be interested in providing SCCS services in the event of another disaster. Provider perceptions of personal strengths derived from the hurricanes were associated with high levels of SCCS program satisfaction and conversely, difficulties providing SCCS services were associated with lower levels of program satisfaction. Multiple regression analyses indicated that provider's perceived negative impact of the hurricane on survivors predicted increased perceived helpfulness of SCCS provider trainings and services to survivors. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The provision of general surgical services in rural South Australia: a new model for rural surgery

BACKGROUND: Rural South Australia (SA), like other rural areas in Australia, faces a crisis in the medical workforce. It is also generally assumed that the same applies to rural surgical services but finding evidence to support this is scarce. METHODS: All hospitals situated outside the outer metropolitan area of SA were surveyed about surgical services (n = 57). Questions were asked about the frequency of emergency and elective theatre usage and which surgeons provided surgical services. RESULTS: Operating theatre facilities were in active use in 39 of the 57 hospitals studied. At the time of the study there were seven specialist general surgeons resident in rural SA. General practitioners continued to have a major input in the provision of surgical services, either by providing the general anaesthetic (34/39) or by performing the surgical procedures (26/39). CONCLUSIONS: The Department of Surgery at the University of Adelaide is instituting various measures to counter the rural surgical workforce problem and is developing a model that serves either the individual or the two-person surgical practice. Metropolitan teaching hospitals can play an important role in supporting current rural surgeons and can foster an increased commitment to the future of rural general surgery.     

Responsibility to the population in general practice. Three years experiences with a patient-list systems in Norway

A list patient system has been tried out among general practitioners in four Norwegian municipalities for a period of three years. For some of the doctors involved the introduction of such a system led to increased work load due to mismatch between the doctor's work capacity and the number of patients on his/her list. However, the experience from the process of establishing the list provided useful knowledge and showed ways of avoiding similar problems if the system is introduced on a national basis. Waiting time for consultation has been reduced, and access to the doctor by telephone has improved. The demand for emergency on call services has been reduced because the doctors are easier to reach during the day. Patients are satisfied with the system and would like to see it become permanent. Two thirds of the GPs involved in the experiment share this standpoint.     

Personal computer teleradiology interhospital image transmission to facilitate tertiary pediatric telephone consultation and patient transfer: soft-tissue lateral neck and elbow radiographs

Although teleradiology systems are available commercially, they are expensive ($30,000), and different makes are incompatible with each other, making them unusable for interhospital image transfers. Standard components were added to a personal computer (PC) to build a functional teleradiology unit capable of interhospital image transmission at a low cost ($600 upgrade). This PC teleradiology system was studied to assess its accuracy in the interpretation of soft-tissue lateral neck x-rays with epiglottitis or retropharyngeal abscesses and elbow x-rays with joint effusions, fractures, or both. A radiologist and a pediatric emergency physician were asked to read the PC teleradiology images. Both physicians read 13 of 13 soft-tissue lateral neck x-rays and 15 of 15 elbow x-rays correctly. This study supports the premise that PC teleradiology can be used to facilitate telephone consultation and patient transfers between tertiary pediatric emergency centers by transmitting pertinent radiographic information over a phone line. Although verbal communication can often suffice in a telephone consultation or transfer, there are many instances when visualizing a radiographic image such as an x-ray or computed tomography scan can provide important information that cannot be optimally described verbally. Rural hospitals can form interhospital image transmission links with tertiary center resources. Tertiary centers may elect to organize interhospital image transmission and referral networks with their rural hospital sources.     

Referral, admission, and discharge patterns in a pediatric emergency department in Israel

The pediatric emergency department (PED) is an important component of the medical services provided by a hospital. The purpose of the study was to describe the patterns of referrals, admissions, and discharges in a PED to determine to what extent the PED is used solely as an emergency unit, as opposed to being used as a part of a set of primary care facilities. Data were recorded from 1200 patient charts, out of 19,000 visits to a PED in Israel in 1988. Variables such as age, sex, ethnicity, and distance between residence and hospital were checked. About half of the patients arrived during the morning shift. There was an inverse relationship between the distance from the patient's home to the hospital and the rate of visits to the PED. Fifty-eight percent of the total were self-referred; this rate increased to 84% during the night shift. Only one quarter of all children had additional laboratory or x-ray tests. Most of the diagnoses did not require emergency services. Eighty-one percent of the patients were discharged from the PED to their community physician. The rate of admissions was low (11%). This study shows that a large part of the PED work is actually primary care. Some of the demographic, cultural, and ethnic reasons for these patterns are reviewed.     

Exploratory eye movement dysfunctions in patients with schizophrenia: possibility as a discriminator for schizophrenia

Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents reported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively.     

Consultant and client outcomes of competency-based behavioral consultation training.

One barrier to the systematic provision of consultation services in the schools may be the lack of applied training provided to preservice individuals in graduate preparation programs. A model of behavioral consultation training which extends previous competency-based progams is presented. Five doctoral students in school psychology were trained in behavioral consultation procedures using written manuals, videotape models, behavioral rehearsal, performance feedback, self-monitoring, and generalization training. Following university-based practice with trained consultees and student teachers, consultants were assigned consultation cases with teachers who presented actual cases. Behavioral consultation services were effective at remediating behavioral and academic difficulties in 4 of 5 target clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

University counseling center consultation: Developing a faculty outreach program.

A faculty outreach program created by a university counseling center had the goals of strengthening the working relationship between staff of the center and academic faculty, informing faculty of the center's services and their relationship to the academic mission, providing coordination of academic departments' requests for outreach and consultation services, and increasing center staff involvement in outreach services to faculty. In its first year this program reached 53 departments and programs and 370 faculty and staff. The program design, results, and future directions are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative costs to the Medicare program of seven prepaid group practices and controls

This research was conducted in order to compare costs to the Medicare program for providing health care service to old people enrolled in two forms of health delivery organization: open market and prepaid group practice (pgp). Two data sources were employed: cost data provided by the Social Security Administration for seven prepaid group practices in five SMSAs and northern California and interviews conducted with administrators of the prepaid groups to determine: organizational sponsorship, incentive structure, pattern of selectivity of patients, and resource availability. Major findings are: (1) Enrollees in prepaid groups incur higher physician costs. This includes services provided by practitioners in and outside the plans. (2) Overall, prepaid groups demonstrate savings to the Medicare program in provider-initiated services- in hospital care and extended care facility services, but not in home health care. (3) Reduced spending in the hospital component does not imply reduction in the extended care facility or home service. (4) Outpatient costs in the hospital are generally higher in the open market modes, probably because this mode of care is viewed as an alternative to physician visits. (5) The greatest cost savings to the Medicare program are demonstrated by groups which are relatively small, yet hospital-based.     

La consultation: Un r?le professionnel à mieux définir.

There are currently increasing requests for psychologists to provide “consultation” services to their peers, other professionals (ex., physicians, social workers, school teachers) or community services (ex., school, community agencies, mental health services, mass-medias). However, so far, there are few empirical works systematically aiming at defining the character of that professional activity and consultation may still be confused with the competency of intervention in the field of clinical psychology. This article aims at defining “consultation” as a specific professional activity, presenting the models of consultation and exploring clinical examples of consultation. Then, practical, ethical and training considerations related to “consultation” activities are discussed and some recommendations are provided, based on available literature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teacher perceptions of consultation services provided by school psychologists.

Investigated the following questions: Do teachers prefer consultation or traditional testing services? Do teachers view the consultee role as one that is appropriate for their profession? Do consultation interactions result in increased professional skills for the consultee? 12 schools from a wide range of communities were provided with school psychology consultants for 14 wks. At the end of this time, teacher attitudes concerning the consultation process were assessed. Data analyses revealed that the 173 teachers reacted positively to the consultation services, placed a high priority on working along with school psychology consultants, and believed that their professional skills would improve as a function of consultation interactions. None of the results differed between schools as a function of gross demographic characteristics. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Multiple functions for psychologists in community consultation.

"Psychologists are assuming a wider range of responsibilities in community program administration and community consultation: in mental health, corrections, education, and anti-poverty." A program for training consultants was developed in New Mexico during a 4-yr demonstration project. Selection criteria include: (1) sound graduate training including the PhD for psychologists, (2) substantial clinical skills in diagnosis and therapy, (3) experience in consultation and administration, and (4) experience in community work. A 2-mo., full-time orientation program was conducted for the consultants hired. The project stimulated development of various new resources in local communities including, among others, a day school for retarded children, a family casework agency, a day center for emotionally disturbed children, a training and consultation service to an orphanage, and an alcoholism treatment and rehabilitation program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)