Use of personality assessment instruments in empirically guided treatment planning.

Treatment planning and monitoring are essential components of mental health service delivery in the era of managed care. Personality assessment instruments have long been used by practitioners to assist in psychodiagnosis and the identification of treatment needs and goals. Nevertheless, managed-care companies and 3rd-party payers are reluctant to authorize psychological assessment service and, instead, prefer that clinicians base their plans on clinical interviews. Research is reviewed documenting the utility of personality assessment instruments in empirically guided treatment planning and the superiority of this method over clinical interviewing. A new psychological test designed specifically for use in treatment planning, the Butcher Treatment Planning Inventory (J. N. Butcher, in press), is introduced and described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Base rates, utilities, and DSM-III: Shortcomings of fixed-rule systems of psychodiagnosis.

Discusses procedures for choosing fixed rules and the pitfalls of the fixed-rule approach to psychodiagnosis. DSM systems such as the DSM-III fall short of optimal fixed-rule systems in that they fail to systematically follow procedures for choosing the best cutting scores. A separate issue concerns shortcomings inherent in the use of fixed diagnostic rules in mental health treatment settings. Fixed rules fail to consider shifts in base rates between clinical settings when setting efficient cutting scores for clinical groups. They also fail to take account of temporal, regional, and individual variations in treatment practices and of the differing utilities of decisions in research and clinical situations. Fixed rules must rely on group data for assessment of individual diagnostic utilities. In finding solutions to these problems, clinicians must evaluate more clearly the utility of diagnoses for making management decisions. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the treatment of dual diagnosis clients who have chronic mental illness.

Examines several issues relevant to treating dual diagnosis clients who have coexisting chronic mental illness and substance abuse diagnoses. The development of various theoretical viewpoints on the relationship between substance abuse and mental illness is described along with a critical review of current research efforts. Suggestions are made for professionals to devote more attention to coordinating services and resources within mental health systems, adjusting academic training and professional development, and developing research efforts that will provide practical guidelines for clinicians. Until more definitive research is available, administrators, clinicians, and professional training programs are advised to adopt a broad clinical perspective of work with dual diagnosis clients that incorporates both mental health and substance abuse treatment modalities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Current perspectives on using linguistic and cultural factors in counseling the Hispanic client.

This review of the literature examines the role of language and culture in the mental health treatment of Hispanic clients. Several innovative approaches including the use of dichos and cuento therapy are described that incorporate linguistic and cultural traits in treatment. The article proposes that the assessment of such factors as language proficiency, level of acculturation, and the degree to which cultural expressions represent symptomatology should be considered in the development of an effective treatment plan. The process of acculturation is presented as a critical dimension influencing language, cultural beliefs, and mental health. Recommendations are made for future research on issues relating to the use of language switching and language mixing in therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of a Clinical Guide to Enhance Care for Suicidal Patients.

Suicidal thoughts and behavior are common among mental health patients and are a source of stress for clinicians, who typically receive limited formal training on suicide. The U.S. Air Force initiated a project to enhance care and increase practitioner confidence when working with suicidal patients. A clinical guide was developed containing 18 recommendations for assessing and managing suicidality, strategies for meeting the recommendations, and clinical tools to facilitate quality care. Training opportunities and marketing efforts accompanied distribution of the guide. This initial article reviews the guide's development, content, and evaluation plan as a model that other health care systems, clinics, or training programs can follow to enhance care for suicidal patients. Outcome data will be presented in a follow-up article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Addiction Severity Index as a predictor of the use of mental health care.

The Addiction Severity Index (ASI) has been extensively used in the United States and Europe as an indicator of the problems of substance abuse patients. Several studies have shown the ASI to be a reliable and valid instrument, but lately doubt has arisen regarding its validity and reliability. The article focuses on a specific scale of the ASI-the Psychiatric Status scale-and its strength in predicting the use of mental health care. A group of 1,027 heroin patients in Rotterdam, the Netherlands, who participated in a methadone program were the subjects. Three indices have been used: the evaluation index, the clinical index, and the composite scores. It appears that no matter which indices are used, the Psychiatric scale does discriminate between those who will have contact with mental health care and those who will not. However, the percentage of false positives is high. None of the indices predicts the intensity and duration of the mental health care treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief psychotherapy and psychological assessments: Entering a relationship, establishing a focus, and providing feedback.

Brief psychotherapy is aimed at facilitating change within a circumscribed time frame. To do this, therapists in this specialty actively engage clients, establish a focus to the treatment, and provide ongoing feedback throughout treatment. The authors show how using these features of brief psychotherapy in the assessment process can enhance the clinical usefulness of an assessment. By also incorporating an emphasis on respect for the client, in line with existential/client-centered principles, psychological assessments can be made more personally relevant and meaningful for the client. The approach outlined has been useful within a hospital-based, adult inpatient and outpatient mental health service in which assessments are conducted before starting psychotherapy or as clinical activities in themselves (e.g., psychodiagnosis). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of experience and amount of information on identification of cerebral impairment.

Investigated the issue of diagnosing cerebral impairment as it applies to clinical human neuropsychology. The Halstead-Reitan battery of neuropsychological tests was administered to 10 patients with demonstrable and 10 patients with suspected brain function impairment. This test battery, as interpreted by inexperienced clinicians, yielded the best hit rate when compared to actuarial approaches or experienced clinicians using more traditional clinical batteries. Findings suggest that any prediction scheme, clinical or actuarial, based on instruments that have no claim to validity for the particular task at hand will always do poorly. It is concluded that schemes based on a combined clinical actuarial approach, using valid instruments, will have a generally good hit rate. (34 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological care for persons of diverse religions: A collaborative continuum.

The purpose of this paper is to describe to psychologists and other clinicians a continuum of mental health care for persons of diverse religions. The continuum delineates boundaries between clinical care provided by mental health professionals and religious care provided by clergy, as well as describes pathways of collaboration across these boundaries. A prevention science based model of Clergy Outreach and Professional Engagement (COPE) is offered to guide this collaboration. The model describes a continuum that moves from the care already present in religious communities, through professional clinical care provided in response to dysfunction and returns persons to their own spiritual communities. One challenge for clinicians is that in addition to a wide diversity of beliefs and practices across religions, there is great ethnic diversity within religions. These diversities are reflected in varied correlations with mental health outcomes. Therefore, we recommend that clinicians assess religious beliefs and their cultural variations when designing religious inclusive psychotherapy specific to the client. There are ethical concerns as to the place of religion in clinical care. The “Resolution on Religious, Religion-Based and/or Religion-Derived Prejudice” adopted by the American Psychological Association has stated that it is not the role of professional psychologists to be spiritual guides. Through spiritual assessment of clients and strategic collaboration with religious leaders via COPE, mental health professionals can focus their efforts on clinical care that respects and incorporates the religious views of clients and does not attempt to recreate the lived religions of the clients' communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The research readership and information source reliance of clinical psychologists.

Conducted a mail survey of 95 clinical psychologists employed in VA hospitals, medical schools, state mental hospitals, and federally funded community mental health centers to determine the extent to which clinicians read research articles and/or rely on other sources of information for their professional work activities. Results indicate that academic clinicians and medical school psychologists read slightly more than 4 research articles each month, while the other psychologists read slightly more than 2 articles each month. Furthermore, the groups of psychologists differentially relied on such information sources as nonresearch articles and workshops. Findings are discussed in the context of mental health research utilization and mental health innovation diffusion. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Risk management with the suicidal patient: Lessons from case law.

Suicide continues to account for a comparatively large proportion of all lawsuits filed against mental health professionals. However, despite the prominence of suicide in mental health malpractice litigation, clinicians must resist resorting to defensive clinical practices in an attempt to shield themselves from potential lawsuits. By using accepted tenets of suicide management as a starting point, the author aims in this article to inform and educate practitioners about clinical malpractice from a legal, as well as a clinical, point of view. Hence, this article aims to demystify relevant case law for practitioners by offering informative, real life examples of how therapeutic practice is interpreted in the courtroom, as well as examples of how juries and judges typically view the treatment decisions clinicians routinely make regarding their suicidal patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical Decision Making About Psychopathy and Violence Risk Assessment in Public Sector Mental Health Settings.

Although there has been extensive research on psychopathy, it is unknown how, or whether, clinicians in public sector mental health settings consider the Psychopathy Checklist (PCL) for assessing violence risk. Mental health clinicians (N = 135) from 4 facilities were interviewed by using multiple methods for collecting data on decision making. Participants considered clinical information most often when assessing violence risk, indicating that these data were most readily available. Clinicians perceived formal testing results (e.g., PCL) to be least available and considered testing least often, especially if clinicians had less clinical experience. Participants did not explicitly report using the PCL but did implicitly rely on psychopathy factors when assessing violence risk. Clinicians in crisis settings reported less availability of historical data typically needed for the PCL. The data point to specific ways to improve the clinical practice of violence risk assessment in public mental health settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

To use or not to use: Clinicians' perceptions of telemental health.

Equal access to mental health services is necessary for healthy individuals and communities. However, due to geographical distances and other barriers, some clients cannot easily access mental health professionals. Technologies such as videoconferencing for clinical purposes (i.e., telemental health) may help to bridge these gaps to connect clients and clinicians at geographically diverse locations. However, despite its potential utility, telemental health has not been widely adopted in Canada. This study is an exploratory investigation into mental health professionals' attitudes toward telemental health, factors that affect the frequency with which they use this technology, and their perceptions of individual characteristics that make clients more or less suitable candidates for telemental health. This study has a particular focus on remote and rural and Operational Stress Injury (OSI) contexts. One hundred sixty mental health workers across Canada participated in an online survey, and 25 mental health workers from Operational Stress Injury clinics across Canada participated in in-person interviews. The data were examined using qualitative and quantitative analysis methods. Findings suggest that mental health workers have overall positive attitudes toward the use of telemental health—particularly for clients in remote and rural locations. Additionally, receiving training in telemental health, being in the mental health field for longer, and perceiving the technology as easy to use are associated with more frequent use of telemental health. Finally, clinicians reported specific client characteristics that they perceive to make some clients unsuitable candidates for telemental health. Implications of these findings and directions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Spouses of workaholics: Clinical implications for psychotherapy.

This article examines the impact of work addiction on the family system, particularly spouses of workaholics—an area that has been neglected by social scientists and mental health clinicians. An argument is made for researchers and psychotherapists to pay more attention to this essential area of mental health. Recommendations for how to address this issue in clinical settings are presented along with research considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Working with foreign language interpreters: Recommendations for psychological practice.

Given the growing linguistic diversity in the United States, many practicing psychologists will work with foreign language interpreters. However, few clinicians receive formal training in providing interpreter-aided psychological services. By federal law (88th Congress, 1964; PL-88-352), psychologists or their agencies are responsible for providing interpreter services. To maintain a patient-centered, rather than interpreter-centered dialogue, psychologists should initiate pre- and postsessions to orient the interpreter to the pending encounter, clarify expectations, and discuss cultural issues. Psychological testing, diagnostic interviewing, crisis intervention, family, child, and individual adult therapy present distinct challenges when an interpreter is involved. Mental health is a specialized area requiring advanced interpreter knowledge and skills. According to the American Psychological Association’s (2002) “Ethical Principles,” psychologists are responsible for ensuring that interpreters demonstrate competence and professionalism. Because there are relatively few interpreters trained specifically for mental health practice, psychologists and health care institutions may need to assist in providing specialized interpreter education. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bilingual professionals in community mental health services

OBJECTIVE: This paper presents results from research that explored the roles of bilingual professionals in community mental health services in the Sydney metropolitan area of New South Wales. There were two main objectives to the research: (i) to identify and describe the roles of bilingual professionals that are important in improving the quality of community mental health services for clients from non-English-speaking backgrounds (NESB); and (ii) to identify and describe the factors that facilitate and inhibit the conduct of these roles. METHOD: Data collection involved indepth interviews with bilingual professionals and team leaders in community mental health services and various other community health services; and various staff responsible for policy and service development with regard to cultural diversity. RESULTS: Bilingual mental health workers were found to have at least four critical roles. These were (i) direct clinical service provision to NESB clients; (ii) mental health promotion and community development; (iii) cultural consultancy; and (iv) service development. Respondents reported that the latter three roles were seriously underdeveloped compared to the clinical service provision role. CONCLUSIONS: It is critical that service managers implement strategies to make better use of the linguistic and cultural skills of bilingual professionals. In addition to their role in clinical service provision ways must be found to facilitate the community-focused, cultural consultancy and service development roles of bilingual professionals employed in mental health services.     

A survey of master's-level staffing patterns and clinical roles.

1,157 mental health agencies were surveyed concerning the employment of master's-level clinical psychologists, and usable data were provided by 637. Numbers and proportions of staff positions, salaries, job functions performed, and training models preferred for master's-level clinicians are reported for 9 types of mental health agencies. Community mental health centers and state hospitals provided the best sources of employment. The optimal training program should prepare the student to perform group and individual therapy, psychological testing, and community mental health functions. Research skills were more important in state hospitals than in community mental health centers. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetic theories and the validation of psychiatric diagnoses: Implications for the study of children of schizophrenics.

Argues that the success of prospective methods for studying the development of schizophrenia in those few offspring of schizophrenics who also become schizophrenic (high-risk method) depends on using valid diagnostic criteria for selecting the parent probands. Data from a high-risk study in which the affected parents were diagnosed by 5 clinicians are used to illustrate how different diagnostic standards affect the comparison of high-risk samples and control samples of children of other psychiatric patients. Publicly reporting careful assessments of affected parents will also facilitate comparisons among different high-risk samples and will allow estimates of the risks for individuals within each high-risk sample. Genetic theory and empirical data suggest that children with severely affected parents and children with many affected relatives will have the highest risks, while samples of children with only 1 mildly affected parent may have risks that approach the population base rates. Genetic theory further suggests that some children of validly diagnosed schizophrenics will have no genetic risk for schizophrenia, and some of those who do have the genetic predisposition will enjoy a lifetime of adequate mental health even without intervention, thus confounding the effort of high-risk research to validate indicators of the high-risk genotype with follow-up status. High-risk researchers are cautioned against premature implementation of intervention strategies based on unvalidated indicators of the risks to individuals. (2? p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)