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)     

Rehabilitation staff perceptions of characteristics of geriatric rehabilitation patients

OBJECTIVE: To determine if professionals treating older rehabilitation patients regarded them as having different characteristics than younger rehabilitation patients, to derive factors from these perceptions, and to examine the impact of the discipline of the professional and other factors on these perceptions. DESIGN: Rehabilitation professionals at a random sample of facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were surveyed to determine their level of agreement with 60 items addressing characteristics of older rehabilitation patients. The items were derived from focus groups with rehabilitation staff members. PARTICIPANTS: One thousand sixty-three rehabilitation professionals from nine disciplines (nursing, occupational therapy, physiatry, physical therapy, psychology, social work, speech pathology, therapeutic recreation, and vocational counseling) responded to the questionnaire and were included in the study. RESULTS: There was a wide range of agreement levels across the 60 items (range of median agreement, 12.7% to 93.5%). Factor analysis resulted in six categories of perceptions regarding older rehabilitation patients: (1) physical limitations, (2) motivational deficits, (3) psychological distress/need for support, (4) maturity and positive coping skills, (5) need for privacy/decreased adaptability, and (6) discharge complications. Significant differences across disciplines were found for five of six factors. Nurses agreed more strongly with the negative psychological factors (2, 3, and 5) compared to physical therapists, psychologists, and social workers. Physicians scored significantly higher than two other disciplines on the physical limitations factor. These differences may be related to the distinct role each discipline plays in the rehabilitation process. Older professionals also scored higher on four factors, likely because of personal rather than professional experience with aging. CONCLUSIONS: Treating professionals recognize differences between younger and older rehabilitation patients. Many of these perceived differences can be viewed as variables that require more effort and skill on the part of the treating professional. The training of rehabilitation professionals needs to better prepare individuals from all disciplines to adapt to age-specific differences.     

Review of Vocational rehabilitation and supported employment.

Reviews the book, Vocational rehabilitation and supported employment edited by Paul Wehman and Sherril Moon (1988). As the preface to this sourcebook notes, this collection of 23 articles from 39 contributors "represents only a beginning" to the formulation and critical assessment of supported employment (SE). Rehabilitation professionals should become familiar with this monograph because of the pivotal role of the contributors in the SE movement. Organizationally, this text is well conceived, consisting of five wide-ranging sections. The topic selection demonstrates a sensitivity to the kinds of questions rehabilitation workers are asking about SE. The first section provides the philosophical underpinnings of SE, a recent history of vocational rehabilitation, and a cost-benefit analysis. The three middle sections address a range of implementation issues. Topics include community consensus building, curricula for training rehabilitation staff, job development, and performance indicators. The fifth section consists of applications to specific populations: mental retardation, autism, traumatic brain injury, chronic mental illness, and physical disabilities. This book is an intelligent, up-to-date introduction that will find a wide audience among state planners, program administrators, employment specialists, and researchers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual expression and dementia. Views of caregivers: A pilot study

OBJECTIVE: To measure the attitudes of health professionals in nursing homes towards sexuality and sexual expression in cognitively impaired and cognitively intact residents. DESIGN: Postal survey. PARTICIPANTS: The staff (administrators, clinicians, social workers and others) of 300 randomly selected nursing homes located in three states. Of these, 114 representatives responded. MAIN OUTCOME MEASURE: A measure of attitudes towards resident sexuality developed during a prior study. RESULTS: Results suggest that respondents held a generally positive orientation towards residents' sexual expression which was expressed with respect to cognitively impaired residents as well as to those who were cognitively intact. Possibly because of the small sample size and resulting low statistical power, statistical analyses failed to demonstrate any significant differences among the groups of residents: administrators, clinicians, social workers, and undifferentiated 'others'. However, while non-significant, there was a consistent tendency for administrators to be relatively more conservative than were the other groups. Almost all respondents agreed that additional staff training should focus specifically on dealing with resident sexual expression. CONCLUSIONS: Overall, the sample reported generally positive attitudes towards resident sexuality and sexual expression.     

The cost-effective delivery of rehabilitation psychology services: The responsible utilization of paraprofessionals.

The new and rapidly changing health care environment necessitates innovation on the part of rehabilitation psychology to achieve cost-effectiveness. This innovation could take the form of rehabilitation psychologists' responsibly using bachelor's-level technicians, or paraprofessionals, in the delivery of clinical services. This article proposes a pyramid model of rehabilitation psychology service delivery using paraprofessionals and psychology trainees. Specific clinical activities appropriate for paraprofessionals are outlined. Controversies regarding use of bachelor's-level paraprofessionals and the inflationary process of over-credentialing doctoral-level psychologists are discussed. It is proposed that psychology interns and residents be cross-trained in allied health skills so that psychology trainees can provide clinical support to other health care disciplines, thereby improving the cost-effectiveness of, and preserving, hospital-based psychology training programs. The article emphasizes the need for doctoral-level rehabilitation psychologists to adopt administrative roles in medical settings in order to implement innovative service models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Barriers to the provision of mental health services to individuals with severe physical disability.

Surveyed 86 consumer advocates (67 with physical disabilities), 157 rehabilitation counselors, 94 rehabilitation administrators, 323 mental health administrators and professionals, and 145 severely disabled Ss concerning Ss' perceptions of the nature and extent of mental health services, barriers to mental health service provision for individuals with severe physical disabilities, and personal data. Overall, there was a general consistency among the sample groups in their perceptions of the extent to which each of 10 variables is a barrier to service delivery. The lack of accessible public transportation, especially in nonmetropolitan areas, and the accompanying limitation on costly mental health outreach services were viewed as serious problems. The limited knowledge and skills of many mental health professional regarding severe physical disability was perceived to be a moderate to substantial barrier to service provision. Findings indicate that individuals with severe physical disability are an underserved group. Recommendations regarding policy and program development and training of professionals are offered. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Crisis intervention training program: Influence on staff attitudes in a postacute residential brain injury rehabilitation setting.

Purpose/Objective: Acquired brain injury produces a host of behavioral changes, and specialized training in proper management of these behaviors is essential to resolve crises and calm aggressive clients. This study was conducted to determine whether crisis intervention training was effective in increasing staff comfort with difficult client behaviors in a residential rehabilitation program for individuals with postacute acquired brain injury and whether changes would be maintained over time. Research Method/ Design: Twenty-five rehabilitation staff members participated in Nonviolent Crisis Intervention training and completed the Rehabilitation Situations Inventory before training, immediately following completion of the program, and 1 month later. Results: Immediately following completion of the program, participants reported increased comfort when faced with client behaviors related to motivation and adherence, sexuality, and aggression and when interacting with other staff and client families. Changes in comfort level with sexual situations, aggression, and staff/staff interactions were maintained 1 month post training. Conclusions/Implications: These results suggest that crisis intervention training is effective in increasing levels of staff comfort with difficult situations commonly experienced in the rehabilitation setting and the changes are maintained following training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A symposium on skill dissemination for paraprofessionals: Models of training, supervision, and utilization.

Proposes designing better programs for training mental health paraprofessionals and presents a comprehensive training package focusing on skills that facilitate client life development. A broad conception of the roles proper for paraprofessionals is needed, and potential new roles are suggested. (76 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structure of Job Diagnostic Survey for public sector occupations.

Investigated the factor structure of the Job Diagnostic Survey (JDS) for 1,632 public sector employees. The JDS measured skill variety, task identity, task significance, autonomy, and feedback for state and county government employees who were administrators, professionals, technicians, paraprofessionals, clericals, and service and technical workers. In general, matrices supported the dimensionality of the JDS. However, for technicians and service and maintenance workers, 2 items designed to tap autonomy had higher loadings on the feedback, task identity, task significance, and skill variety factors. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The indigenous paraprofessional and involuntary civil commitment: A return to community values.

Notes that many community mental health centers in North America have on their staff paraprofessionals (PPs) who are indigenous to the community. Sharing the same cultural background as the community, they can often bridge the wide cultural barriers between the professional and the population served. Despite this, PPs have traditionally held a relatively subservient role in relation to their professional colleagues, with the more crucial decisions left to the professionals—specifically, the involuntary commitment of the potentially dangerous person. Because of their understanding of the community culture, PPs' involvement in civil commitment procedures would seem critical. Although medical-psychological training is adequate for assessing dispositional traits, the very nature of such training prohibits an emphasis on cultural–contextual variables. The use of indigenous PPs in the commitment process would reduce this methodological dilemma and would also attenuate the potential misuse of mental health facilities as agents of social control. (French abstract) (2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paraprofessionals, partners, peers, paraphernalia, and print: Expanding mental health service delivery.

Presents a model that defines 5 types of nonprofessional therapeutic agents–paraprofessionals, partners, peers, paraphernalia, and print—and proposes their use at 3 levels of intervention—prevention, treatment, and maintenance. Selected research using these nonprofessional agents is described, and additional therapeutic applications are suggested. Implications of the model for treatment effectiveness, the role of mental health professionals, and cost-effective service delivery are also explored. (5? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitudinal changes associated with two approaches to training mental health technicians in milieu and social-learning programs.

Gave 2 groups of nonprofessional trainees (n = 21) from a high-unemployment area specific job-related training in behavioral principles and procedures of both milieu and social-learning treatment programs for chronic mental patients. Group 1 received sequential training with professional staff 1st conducting classroom instruction, followed by on-the-job training. Group 2 received abbreviated classroom instruction by professional staff, integrated with clinical observation with experienced technicians. Demographic and personality assessment occurred before training, attitudinal assessment on modified versions of the Opinions about Mental Illness Scale and Paul's Therapist Orientation Sheet was obtained before and after the academic portion of training, and an academic test was obtained after academic training. The sequential-professional mode of training resulted in better academic performance. Attitudinal changes were associated with behavior-specific training, and differential patterns of change were found for the 2 approaches. Trainee attitudes tended toward those of instructors, and attitudinal similarity was related to academic performance. Comparisons with attitudes of other occupational groups indicated that the present nonprofessional trainees after training were unique but more similar to professionals than to nonprofessionals studied elsewhere. (22 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treatment outcome and maintenance in systematic desensitization: Professional versus paraprofessional effectiveness.

Determined the relative effectiveness of paraprofessionals and well-trained professionals in conducting systematic desensitization. 45 anxious college students were tested with the Test Anxiety Behavior Scale and the Symptom Check List and randomly assigned to a wait-list control group, 3 groups facilitated by experienced behavior therapists, and 3 groups led by paraprofessionals. Results of pretreatment, posttreatment, and 5-mo follow-up measures show that paraprofessionals can achieve outcome and maintenance effects equivalent to those of the more rigorously trained professionals. It is suggested that paraprofessionals can conduct desensitization in a high quality, cost-effective manner, thus reducing the professional case load and adding greatly to the scope of programs offered to the consumer. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating comparative studies of paraprofessional and professional helpers: A reply to Nietzel and Fisher.

Discusses the major disagreements between M. T. Nietzel and S. G. Fisher (see record 1981-22035-001) and the present author (see record 1979-31736-001) regarding the methodology to apply in evaluating comparative studies of paraprofessional and professional helpers' effectiveness. There is substantial agreement in both reviews on the conclusions that current data support. Research has failed to demonstrate significant differences in the outcomes obtained by paraprofessionals and professionals. Professional training, education, and experience do not appear to explain much of the variance in clinical outcome. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of paraprofessional and professional helpers.

The outcome and adequacy of design in 42 studies comparing the effectiveness of professional and paraprofessional helpers are reviewed. Although studies have been limited to examining helpers functioning in narrowly defined clinical roles with specific client populations, it is argued that the findings are consistent and provocative. Paraprofessionals achieve clinical outcomes equal to or significantly better than those obtained by professionals. In terms of measureable outcome, professionals may not possess demonstrably superior clinical skills when compared with paraprofessionals. Moreover, professional mental health education, training, and experience do not appear to be necessary prerequisites for an effective helping person. The strongest support for paraprofessionals has come from programs directed at the modification of college students' and adults' specific target problems and, to a lesser extent, from group and individual therapy programs for non-middle-class adults. Future studies need to define, isolate, and evaluate the primary treatment ingredients of paraprofessional helping programs to determine the nature of the paraprofessional's therapeutic influence. (62 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multidisciplinary approach to the treatment of child abuse

A multidisciplinary team of professionals and paraprofessionals provides an innovative therapeutic approach for the treatment of child abuse and neglect among a deprived and disadvantaged population of abusing mothers. The therapeutic approach stresses residential care for mother and child, behavior modification through corrective child care experiences, personality modifications through individual and group therapy, and environmental and social changes through staff assistance and education.     

The relationships among rehabilitation staff members' reports of cognitive dysfunction and neuropsychological assessment in an acute rehabilitation population.

Purpose/Objective: To examine the relationships among rehabilitation staff members' observations of the extent to which attention and memory functioning interfered with participants' rehabilitation progress and the relationship between these observations and neuropsychological testing. Research Method/Design: Participants were 39 adults admitted to a Commission on Accreditation of Rehabilitation Facilities-accredited, acute physical medicine rehabilitation unit who were referred for neuropsychological assessment. For study purposes, participants were administered the Mental Control subtest of the Wechsler Memory Scale-Third Edition (D. Wechsler, 1997) and the Neuropsychological Assessment Battery (R. A. Stern & T. White, 2003). Occupational therapists, physical therapists, and nurses were asked to rate the extent to which participants' attention/concentration and memory interfered with their progress in rehabilitation. Results: Staff ratings of participants' attention or memory functioning interfering with rehabilitation progress were strongly and most closely related to their own ratings of the other cognitive domain. Objective attention and memory test performance were weakly and nonsignificantly correlated with each other. Relationships between staff observations and test data were also weak. Conclusions/Implications: Rehabilitation staff members may be viewing cognition as a unitary construct rather than identifying the independent contributions of different cognitive domains as they apply to rehabilitation performance and progress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparative effectiveness of professional and paraprofessional helpers.

Used meta-analysis to resolve some of the contentious issues raised in the debate between J. A. Durlak (see PA, Vols 62:11736 and 66:2004) and N. T. Nietzel and S. G. Fisher (see record 1981-22035-001) about the relative effectiveness of professional and paraprofessional counselors. Effect sizes based on 154 comparisons from 39 studies show that clients who sought help from paraprofessionals were more likely to achieve resolution of their problem than those who consulted professionals; moderators of this conclusion were related to experience, duration of treatment, and the manner in which effectiveness was measured. It is concluded that there is substantial evidence that paraprofessionals should be considered as effective additions to the helping services, at least when compared to professionals. (26 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of assessment center ratings for the prediction of performance ratings and school climate of school administrators.

Describes the validation of an assessment center used to select school administrators on the basis of ratings of 153 school administrators who had participated in the center between 1976 and 1981. Behaviorally anchored rating scales were obtained from supervisors, teachers, and support staff; and measures of 7 school climate dimensions were provided by teachers, students, and support staff. Results show a significant relationship between an overall assessment center placement recommendation and supervisory, teacher, and support staff ratings on most performance dimensions. Climate measures were significantly related to few assessment-center ratings regardless of the source of the climate measure. It is suggested that the assessment center proved valid for a sample from widely distant geographic areas and school districts of differing sizes and levels. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in nonprofessional (novice) interviewers over a 3-year training period

This is a study of the changes that occur in undergraduate interviewers as traced in 3 interviews over a 3-yr training period and replicated over 2 classes. For each class, the 3 sets of novice interviews were compared with a single set of professional interviews. Interviewees were female freshmen students. A total of 46 interviewers, student and professional, participated. Student interviewees perceived student interviewers as more benign than professional interviewers over the series of interviews. They rated the professionals as more skilled but only on the 1st set of interviews. On warmth and genuineness, student interviewers either maintained or acquired advantages over the professional group over the duration of the study. Student interviewers were more verbally flustered than professionals in their first interviews but not later. The payoff variable of interviewee productivity did not distinguish between professionals and novices at any time. Implications for the concept of interviewer status and for the use of paraprofessionals in conducting mental health interviews are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)