Ultrasound as visual feedback in speech habilitation: Exploring consultative use in rural British Columbia,Canada

Ultrasound has shown promise as a visual feedback tool in speech therapy. Rural clients, however, often have minimal access to new technologies. The purpose of the current study was to evaluate consultative treatment using ultrasound in rural communities. Two speech‐language pathologists (SLPs) trained in ultrasound use provided consultation with ultrasound in rural British Columbia to 13 school‐aged children with residual speech impairments. Local SLPs provided treatment without ultrasound before and after the consultation. Speech samples were transcribed phonetically by independent trained listeners. Eleven children showed greater gains in production of the principal target // after the ultrasound consultation. Four of the seven participants who received more consultation time with ultrasound showed greatest improvement. Individual client factors also affected outcomes. The current study was a quasi‐experimental clinic‐based study. Larger, controlled experimental studies are needed to provide ultimate evaluation of the consultative use of ultrasound in speech therapy.     

Ultrasound as visual feedback in speech habilitation: exploring consultative use in rural British Columbia, Canada

Ultrasound has shown promise as a visual feedback tool in speech therapy. Rural clients, however, often have minimal access to new technologies. The purpose of the current study was to evaluate consultative treatment using ultrasound in rural communities. Two speech-language pathologists (SLPs) trained in ultrasound use provided consultation with ultrasound in rural British Columbia to 13 school-aged children with residual speech impairments. Local SLPs provided treatment without ultrasound before and after the consultation. Speech samples were transcribed phonetically by independent trained listeners. Eleven children showed greater gains in production of the principal target /[image omitted]/ after the ultrasound consultation. Four of the seven participants who received more consultation time with ultrasound showed greatest improvement. Individual client factors also affected outcomes. The current study was a quasi-experimental clinic-based study. Larger, controlled experimental studies are needed to provide ultimate evaluation of the consultative use of ultrasound in speech therapy.     

An Examination of Behavioral Rehearsal During Consultation as a Predictor of Training Outcomes

The training literature suggests that ongoing support following initial therapist training enhances training outcomes, yet little is known about what occurs during ongoing support and what accounts for its effectiveness. The present study examined consultation sessions provided to 99 clinicians following training in cognitive-behavioral therapy for youth anxiety. Recorded consultation sessions (N = 104) were coded for content and consultative methods. It was hypothesized that behavioral rehearsal (an active learning technique) would predict therapist adherence, skill, self-efficacy, and satisfaction at post-consultation. Regression analyses found no significant relation, however, clinician involvement during consultation sessions positively moderated the relationship between behavioral rehearsals and skill. Implications, limitations, and future directions are discussed.     

Consultation-Liaison outcome evaluation system. I. Consultant-consultee interaction

The Consultation-Liaison Outcome Evaluation System characterizes the effectiveness of consultative activities. The initial phase of the system identifies consultees' responses to psychiatric consultants' recommendations and diagnoses and the variables critical to concordance with the use of quantitative measures. The observed incidence and concordance rates of the consultant-consultee interaction were integrated (1) to establish a concordance hierarchy clarifying consultees' priorities in seeking psychiatric consultation, (2) to provide reference points to guide psychiatric consultants' clinical actions, (3) to establish tentative standards with which to evaluate the effectiveness of psychiatric consultation, and (4) to signal the need for further outcome studies and the development of data-based consultation practices.     

Group process during a consultation an institution copes with perceived homosexual onslaught

Summary The authors illustrate how the consultative process may use group interventions to lead to an institutional solution of a longstanding problem via the mobilization of the consultees themselves in a concerted effort. The concerted effort in this example related to the loss of autonomy and territory by a school of education to homosexuals who pursued a particular lifestyle within that school of education and in which previously used security measures were all of no avail. The consultative group process itself paralleled the successful institutional coping device of shared assertiveness.From the Department of Psychiatry of the University of Cincinnati College of Medicine     

The emergence of work-centred issues in consultative work: an observation

During two separate series of consultative meetings for professionals engaged in direct work with adolescents, the authors noticed that the issues brought to consultation showed a definite and sustained shift away from matters to do with the workers' clientele, and towards matters concerning their working relationships and work settings. The possible causes and effects of this shift in the focus of work is discussed.     

Opportunities within a large metropolitan school district

As a school district employee, the child psychiatrist can offer valuable school consultations at multiple levels as an "insider." The access to teamwork within the district system is particularly empowering and advantageous. This article outlines the richness and variety of school consultative opportunities within the school district.     

Caregivers' expectations of services at Baragwanath Hospital, Soweto and their understanding of the child's disability

Sixty-one caregivers were interviewed before and after their first visit with the child in their care to specialist neurodevelopmental outpatient clinics at Baragwanath Hospital, Soweto. The interview focused on their understanding of the child's disability and their expectations of the service offered at the clinics. Before consultation the majority of caregivers had a fair understanding of the child's functional problems and the short-term complications, but after the consultation levels of understanding decreased significantly. Caregivers left the consultation with a significantly improved understanding of the aetiology of the problem. Understanding of long-term complications did not differ significantly before and after the consultation. These findings may reflect the consultative process, as professionals may be more comfortable discussing aetiology than long-term complications. Caregivers in a state of shock may be unable to absorb all the information given, and translation during consultation may also be a confounding factor. Even though more than half the caregivers had no idea what services the clinics offered prior to the consultation, the majority (81%) indicated they were satisfied with the service after the consultation.     

A retrospective view of school mental health consultation

General principles of mental health consultation as written about by Coleman and Maddux are enumerated. Historically, the refinement of these principles for school consultation was described in detail in the literature by Gerald Caplan and Irving Berlin. Common methods define the consultees' problems as work problems; the consultant views the consultees' difficulties as due to intrapsychic conflicts. Resolution of the consultees' difficulties requires the consultant to use methods that enhance the consultee's self-esteem and indirectly provide the consultee insight into the genesis of his or her problems. Thus, consultees are gradually better able to help the client with his or her difficulties. Training of child psychiatry residents in school consultation historically occurred in three divisions of child psychiatry. Training methods were quite similar. The history of consultation to school administrators at various levels, the issues that emerged, and methods of helping administrators to deal with these problems are elucidated. Special problems in dealing with school consultation on two American Indian reservations, especially that of gaining entrance into the school, are discussed.     

Using Multi-component Consultation to Increase the Integrity with Which Teachers Implement Behavioral Classroom Interventions: A Pilot Study

The goal of this pilot study was to evaluate the effectiveness of a multi-component consultation package in improving teachers’ classroom management skills, particularly among teachers with lower baseline levels of knowledge, skills, and intervention-supportive beliefs. Participants were 58 elementary school teachers (93% female; 50% non-Hispanic White) who received up to eight biweekly consultation sessions focused on general classroom management strategies and implementation of a daily report card intervention with one target student with or at risk of ADHD. Teachers were randomly assigned to either a comparison consultation condition designed to mirror current best practices (Frank & Kratochwill, in: Erchul, Sheridan (eds) Handbook of research in school consultation, Routledge, New York, 2014; Noell & Gansle, in: Erchul, Sheridan (eds) Handbook of research in school consultation, Routledge, New York, 2014) or a multi-component condition designed to simultaneously address teacher knowledge, skills, and beliefs as possible barriers to implementation of classroom interventions. Teachers in both conditions showed significant improvements in labeled praise, appropriate response to student rule violations, and general competence in classroom management. In support of the hypotheses, teachers with lower baseline levels of knowledge, skills, and intervention-supportive beliefs demonstrated more improvement in key outcomes in response to multi-component consultation, as compared to the comparison consultation (Cohen’s d ranged from 0.33 to 1.12). Implications for research and practice in school consultation are discussed.     

Is the Friday afternoon consult frequent? Timing of consultation requests on a psychiatric consultation service

Two hundred psychiatric consultations were reviewed to determine if there was a pattern regarding the time of day and day of the week that consultations were requested. Consultations were found to be requested on a random basis although a survey of consultation psychiatrists perceived that consultations were more often requested late in the day. The implications of such misperceptions are discussed as they relate to negative attitudes towards consultative psychiatry by psychiatric physicians.     

Création d’une consultation psychiatrique ouverte aux préparationnaires du 5e et du 6e arrondissement de Paris : retour d’activité sur l’année 2017–2018

Part of the French post-secondary education system is the Classes Préparatoires aux Grandes Écoles (High School Preparatory Classes) which consists of two intensive years (or three years sometimes) to pass the entrance examination of the Grandes Écoles. Grandes Écoles are highly selective, elite, and prestigious institutions [10]. The difficulties for these students are a higher stress (succeed the entrance examination), lack of time (all their time is dedicated to studies). The access to public psychiatric health system depends on where you live. Due to their schedule, they spend most of their time in the high school and they can’t consult in the psychological centre whom they depend [9]. In these conditions, in December 2017, public psychiatric care of the 5th and 6th districts of Paris created a psychiatric consultation in one high school opened to the students in Classes Preparatoires which signed a convention with the psychiatric ward.ObjectivesThis study aims to debrief the activity and the student profiles in the first year of this consultation.Patients and methodsThe patients are composed of students registered in Classes Préparatoires from the 5th and 6th district of Paris and who came to the psychiatric consultation, aged from 16 to 19 years old and referred by school nurses, school doctors, psychiatric ward or student himself. Retrospective study based on the activity of the consultation and medical files of psychiatrics consultations between December 2017 and July 2018.ResultsFifteen students consulted with a mean of 5.2 ± 2.9 consultations per students, eleven of them were oriented by school nurses. Eleven students benefited from a regular follow-up or an “in case of need” consultation. Five students had already received a psychotropic drug before the consultation; at the end of the year, ten of them received medication. The most prescribed category of medication are antidepressants and anxiolytics with seven patients apiece. The most represented disorders are a major depressive disorder (41%), adaptative disorder (29%), anxiety disorder (12%). Four students stopped their studies in the high school during the academic year. Two students needed to be hospitalized in the psychiatric ward of the district, they continued their education in their high school after hospitalization.ConclusionThe consultation for the Classes Préparatoires aux Grandes Écoles allowed an access to a psychiatric offer next to the place those students spend most of their time, without going to an emergency structure and with a shorter waiting time compared to the psychological centre in public health system. This consultation enables the evaluation, the follow-up and the orientation of the students, including the hospitalization when it is needed but also to sustain some students in their studies. In views of requesting a psychotherapy and the usual waiting time in the psychotherapeutic centre for students which already exist, there is important need to provide increased resources for these students.     

Psychiatric consultation and teaching in a home for the aged.

An outpatient psychiatric department of a medical center was organized as a community psychiatry team to provide direct services, consultation and education, and preventive programs for high-risk groups. By successfully handling requests for service from a home for the aged, the team established a consultative relationship and then a six-month teaching program centered on problems presented by the home's staff in group sessions. Results included a drop in requests for direct service, the establishment of group programs for residents, and an increase in the home's willingness to accept and deal with disturbed behavior without resort to hospitalization.     

Screening and Identifying Children with Autism Spectrum Disorders in the Public School System: The Development of a Model Process

Heightened public awareness of autism and increased prevalence estimates of autism spectrum disorders (ASDs) has generated a sense of urgency within the public school system to identify children with these disorders for targeted intervention. Two multidisciplinary groups of professionals, one each from two separate school districts, were identified and trained to provide diagnostic and consultative services. This paper outlines a model process for school personnel to develop a basic level of training and competence in recognizing and serving students who have an ASD by (1) providing an overview of the legal and clinical issues involved in screening for children with ASD within the school system, (2) defining a school-based professional training process and (3) outlining a school-based ASD screening process.     

Training programs in school consultation

The need to train psychiatrists in school consultation is important to approach mental health and psychosocial concerns from the broad perspective of addressing barriers to learning and promoting healthy development. There is a major national impetus to improve academic achievement and literacy, which can be amplified by addressing the social, emotional, and mental health needs of children and youth. Training in school consultation allows the psychiatrist to better understand a critical institution in each child's life and also provides technical assistance and training to school personnel, which facilitates networking between programs and individuals involved in or interested in school mental health. Each of the described programs approaches consultation from a specific focus that varies in time commitment, placement options, and frequency and order of didactic presentations. There is no conclusive available evidence as to which program is most effective, since such evaluation depends on the overall goals of the consultation program itself.     

School phobia: A babel of tongues

A review of the literature is presented with a focus on the historical trend from a broad conception of school avoidance toward a narrow conception of school phobia and back toward a systems analysis. The following parameters of clinical investigation are recommended for consultative definition of the syndrome: (1) Chronological age in relation to developmental factors; (2) transactional involvements with mother, family, and community; (3) intrapsychic dynamics; and (4) the personal view of the child toward his symptom as ego-alien or ego-syntonic. It is suggested that careful consideration of these four areas should permit diagnosis and tailored therapeutic intervention rather than a uniform approach to a complex symptom.This work was supported by Public Health Service Grant MH-07331 from the National Institute of Mental Health.     

The Development,Evaluation and Dissemination of a Training Programme for General Practitioners in Evidence-Based Parent Consultation Skills

General practitioners (GPs) and family doctors are usually the first point of professional contact for parents concerned about their children's behaviour and they are often asked for advice on the management of behavioural and emotional problems. The training of GPs to provide effective early intervention is an important issue in the prevention of child and adolescent mental health problems. This paper describes the development, evaluation and subsequent wide-scale implementation of a tailored training programme to prepare GPs to provide consultative advice and support to parents of children from birth to mid-adolescence. Primary care training in the Triple P-Positive Parenting Program was provided to 331 GPs in Queensland, Australia. Participation in a brief focused training course was associated with significant improvement in practitioners' consultation skills, greater satisfaction with their consultations and high levels of participant satisfaction with the training provided. The implications of this experience for population - level approaches to prevention of child and adolescent behaviour problems are discussed.     

Mental health consultation for school social workers: A conceptual model

There are some very seriously disturbed children, families, and teachers who require individual casework or other individual therapeutic help. However, in the face of the mental health job to be done in the schools, mental health consultation is one very important way of utilizing the scarce talents of social workers in a more effective way for more children. A conceptual model of mental health consultation is presented and a special adaptation to mental health consultation in the school setting is illustrated.He was for many years psychiatric consultant to the San Francisco Unified School District.