Training Psychologists for Service Delivery in Long-Term Care Settings

Population changes have resulted in a growing number of older individuals in long-term care settings, and an impetus for training professionals competent to meet their specialized needs. Working in the environment of long-term care requires the professional to be attuned to the unique needs of the patients and staff. Specific tasks, such as psychological assessment, competency determinations, work within the structure of an interdisciplinary team, and staff development, are reviewed here in relation to work in this setting. Guidelines for training at the various levels, along with resources are also discussed.     

Promoting Community Partnerships: Public Policy Initiatives Related to Prenatal Care

Providing community-based health programs that are responsive to the perceived health needs of the community is key to providing critically needed health services to those currently untreated or uninsured. An innovative and culturally sensitive community-partnership program of prenatal care developed for rural Hawaii (Malama) provides a model for effectively integrating the values and expertise of academia and those of the community, as well as of psychology and nursing. Such illustrations are vital for effective healthcare reform.     

Resolving Ethical Challenges for Psychological Practice in Long-Term Care

Psychological practice in geriatric long-term care settings, which range from community-based services to skilled nursing facilities, can present ethical dilemmas. The context for practice in long-term care consists of a complicated structure of clients, services, payers, and disciplines, and as a result is extremely complex. Ethical codes and principles are useful in resolving dilemmas. In addition, familiarity with recent legal reform such as the patient self-determination movement and the guardianship reform movement, and attention to issues of race and ethnicity are important in guiding practice.     

Depression in Long-Term Care: Contrasting a Disease Model with Attention to Environmental Impact

The preceding review of depression in long-term care (LTC settings recognizes the prevalence of depression in LTC, addresses problems in assessment of depression, and examines empirical literature on the effectiveness of psychotherapy for depression. This commentary expands on the preceding review by focusing on a theoretical understanding of depression and how that understanding can inform treatment recommendations. The basic argument presented is that psychologists could best serve older adults in LTC settings by extending beyond traditional approaches to treatment of individuals who are depressed; psychologists can become good observers of the relationship of environmental factors in LTC to the internal emotional experience of depression, and then help to serve as change agents by collaborating in designing and implementing change in LTC environments. Such a radical shift could improve the quality of life for LTC residents. It also offers the possibility of defining theoretical linkages among external environmental variables, cognitive understanding of them, and emotional experience that could inform depression theory generally.     

Clinical Geropsychology and Primary Care: Progress and Prospects

This paper comments on the review by Arean & Ayalon (this issue) and on implications for the further development of clinical geropsychology in primary care. The review provides an outstanding summary of the impressive scientific progress that has occurred in this field over the past decade. Comments focus on prospects for the future of geropsychologists in primary-care settings. Psychologists have been major contributors to research in this area but are not assured of major clinical roles in behavioral healthcare delivery. As a profession, clinical psychology must attend to developing reimbursable clinical roles for psychologists and to training psychologists who are prepared for the challenges of primary-care geropsychology.     

Ethical Challenges in Community-Based Research: Introduction to the Series

We describe the inspiration for this series of articles and articulate several themes that run throughout the four articles that follow. Particular ethical challenges in community-based mental health research are identified, as is the tension between existing ethical codes and policies and the requirements of more collaborative, community-based research. We edited this special series with an eye toward promoting greater discussion of ethical issues in this realm and the eventual development and promotion of guidelines for ethical decision-making in community-based research.     

Maintenance of Treatment Effects: Introduction to the Special Series

This article introduces the special series on maintenance of gains following psychosocial interventions. The special series covers specific, prevalent disorders— unipolar depression, substance abuse, obesity, and conduct disorders—and treatments that have shown positive outcomes for follow-up periods as long as 1 year. The focus is on longer term maintenance, where much less is known. Promising strategies proposed in this series to extend treatment effects are highlighted, as are research strategies that have broad application across disorders.     

Affective and Developmental Considerations in Couple Therapy: Introduction to the Special Series

This article introduces the special series on affective and developmental considerations in couple therapy. Although considerable evidence supports the efficacy of couple therapy, an equally sizable literature documents limits to current strategies for treating relationship distress. One factor limiting couple therapy involves the comorbidity of relationship distress with individual psychopathology, particularly affective disorders. Research also documents important developmental influences on couple functioning and therapy outcome. Articles comprising the special series address conceptual and strategic advances incorporating affective and developmental issues in treating relationship distress in general and specific couple problems in particular.     

Research in Training Clinics and Practice Research Networks: A Route to the Integration of Science and Practice

The present commentary encourages the development of research infrastructures within the training clinics of clinical psychology programs, the use of such infrastructures for creating a true integration of science and practice in the earliest days of graduate student education, and the formation of collaborative practice research networks among clinics and across other mental health agencies. Such developments may contribute to more rapid creation of ways of integrating science and practice and to methods for creating large-scale, scientifically rigorous, and clinically meaningful research to answer the most pressing questions that our profession faces.     

Care plans and care planning in the management of long-term conditions in the UK: a controlled prospective cohort study

Background

In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits.

Aim

To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care.

Design and setting

A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning.

Method

Implementation of care plans and care planning in general practice was assessed using the 2009–2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling.

Results

The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time.

Conclusion

The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning.     

Enhancing Mental Health Service Delivery to Ethnically Diverse Populations: Introduction to the Special Series

The American Psychological Association's adoption of guidelines for providing psychological services to diverse populations and the enactment by the National Institutes of Health (NIH) of regulations that required the representation of women and ethnic minorities in NIH-funded research projects called attention to the need to improve mental health services for ethnically diverse populations. This special series illustrates the relevance of cultural and ethnic factors in addressing contemporary mental health needs and the role of these factors in the work of clinicians who serve ethnically diverse clinical populations. The articles comprising the series examine the mental health dimensions of five contemporary clinical practice issues: HIV/AIDS, eating disorders, hate crimes, folk healing, and youth at high risk for drug abuse.     

Behavioral Interventions to Reduce Infections in Pediatric Long-term Care Facilities: The Keep It Clean for Kids Trial

Children in pediatric long-term care facilities (pLTCF) represent a highly vulnerable population and infectious outbreaks occur frequently, resulting in significant morbidity, mortality, and resource use. The purpose of this quasi-experimental trial using time series analysis was to assess the impact of a 4-year theoretically based behavioral intervention on infection prevention practices and clinical outcomes in three pLTCF (288 beds) in New York metropolitan area including 720 residents, ages 1 day to 26 years with mean lengths of stay: 7.9–33.6 months. The 5-pronged behavioral intervention included explicit leadership commitment, active staff participation, work flow assessments, training staff in the World Health Organization “‘five moments of hand hygiene (HH),” and electronic monitoring and feedback of HH frequency. Major outcomes were HH frequency, rates of infections, number of hospitalizations associated with infections, and outbreaks. Mean infection rates/1000 patient days ranged from 4.1–10.4 pre-intervention and 2.9–10.0 post-intervention. Mean hospitalizations/1000 patient days ranged from 2.3–9.7 before and 6.4–9.8 after intervention. Number of outbreaks/1000 patient days per study site ranged from 9–24 pre- and 9–18 post-intervention (total = 95); number of cases/outbreak ranged from 97–324 (total cases pre-intervention = 591 and post-intervention = 401). Post-intervention, statistically significant increases in HH trends occurred in one of three sites, reductions in infections in two sites, fewer hospitalizations in all sites, and significant but varied changes in the numbers of outbreaks and cases/outbreak. Modest but inconsistent improvements occurred in clinically relevant outcomes. Sustainable improvements in infection prevention in pLTCF will require culture change; increased staff involvement; explicit administrative support; and meaningful, timely behavioral feedback.     

A Healthy New World: Emergent Opportunities for Clinical Psychologists in the Patient Protection and Affordable Care Act

The Patient Protection and Affordable Care Act (ACA) is radically transforming the health and mental healthcare landscape. Emergent opportunities exist for clinical psychologists to redefine their role in health care. We reflect on Chor, Olin, and Hoagwood ( 2014 ) and present additional recommendations for consideration. Specifically, we highlight three points: (a) moving beyond just training and hoping; (b) recovery, not just symptom reduction; and (c) it's a healthy new world. Under each of these points, we suggest tactics for how to achieve these goals.     

A Contextual Family/Systems Approach to Pediatric Psychology: Introduction to the Special Issue

Introduced the special issue on "Family System in PediatricPsychology" by organizing the papers around a series of themesrelevant to understanding families in pediatric psychology.Themes reflect the relationships between parent and child adjustment,family subsystems, legacies and traditions, social support systems,family interventions, the constancy of change in families, thechallenges of conducting longitudinal research, the inclusionof fathers, and the importance of a competency framework inpediatric family psychology. The paper concludes with recommendationsfor pediatric family psychology, including suggestions for increasingdiversity, expanding methodological approaches, and enhancingfamily competence.     

Stressing the (Other) Three Rs in the Search for Empirically Supported Treatments: Review Procedures, Research Quality, Relevance to Practice and the Public Interest

The Society of Clinical Psychology's task forces on psychological intervention developed criteria for evaluating clinical trials, applied those criteria, and generated lists of empirically supported treatments. Building on this strong base, the task force successor, the Committee on Science and Practice, now pursues a three-part agenda: (a) evolution of review and classification procedures with an emphasis on reliability across reviewers, (b) an active role as gadfly in promoting improved research, and (c) a dissemination program (with an evolving web site) to make our process, findings, and data base accessible to practitioners, researchers, policy makers, and the public. We seek to link practitioners and researchers in the shared goal of improving mental health care by encouraging evidence-based practice and training.