Journal of Clinical Psychology in Medical Settings最新文献

Psychologists in academic medicine face pressure to juggle multiple roles, and research is often limited by a lack of available resources and funding. In other academic settings, student-led psychology research teams that utilize a tiered mentorship approach are able to produce advances in meaningful research while supporting the development of future professionals in the field. This article identifies the barriers of implementing a tiered mentorship model into an academic medicine setting and reviews a case study of how the model can be effectively adapted and evaluated to promote a self-sustaining, student-led psychology research team.

To explore the experiences and preferences of patients and healthcare professionals regarding the development of an app to provide psychological intervention to improve emotion regulation in the context of bariatric surgery (BS). Sixteen people (6 patients who underwent BS and 10 professionals) participated in two separate focus group sessions. We performed a content analysis of transcribed focus group discussions to extract and organize categories, subcategories and areas. Both sets of stakeholders provided information about how to develop and implement an app. According to participants' comment, content should include information (i.e., nutrition, exercise) and emotional regulation skills. Patients and professionals mentioned that the app should include visual information, continuous emotional assessments and peer contact. It was also mentioned that the app should be used before and after BS and its contents should be developed by a multidisciplinary team (i.e., collaboration of endocrinologist, nutritionists and psychologists). Participants in both focus groups considered technology to be useful in the context of BS, especially as part of blended interventions (combining face-to-face and online sessions). Patients and professionals seem to be receptive towards the use of technology in a BS context. Specific recommendations are identified for designing and implementing app solutions for BS. More efforts should be made in the future to develop and implement evidence-based apps according to patients and professionals' needs.

Pediatric Inflammatory Bowel Disease (IBD) is a chronic illness where patients may undergo ostomy surgery. Medical decision-making (MDM) for ostomy surgery is complex for patients/families and multidisciplinary healthcare professionals (HCPs) alike, with current uncertainty about how multidisciplinary HCPs think about ostomy care to inform future interventions to facilitate equitable multidisciplinary care for patients. This study sought to understand pediatric IBD multidisciplinary HCPs' perceptions regarding ostomy-related MDM and education. Multidisciplinary HCPs (e.g., gastroenterology medical providers, social workers, surgeons, and ostomy nurses) participated in semi-structured focus groups. Focus group data underwent qualitative analysis to identify themes. Three multidisciplinary focus groups were conducted, with n = 12 participants across all groups. Qualitative analysis identified three main themes, including (1) HCP perceptions of ostomies, (2) Patient/family-related factors, and (3) Professional roles and collaboration challenges. Ostomy surgery in pediatric IBD requires complex multidisciplinary MDM and education. Perspectives of multidisciplinary HCPs identified patient, HCP, and systems factors that may impact MDM for ostomy surgery. This work highlights nuances in MDM and education in IBD, and the critical role of ongoing research and improved standardized processes to coordinate multidisciplinary ostomy-related MDM and education in this population.

Prevalence rates of perinatal mood disorders range from 5 to 25%. Furthermore, suicide is a leading cause of death in postpartum women. Various factors have been associated with an increased risk of suicide in postpartum women, including co-occurring mental health disorders, lack of mental health care, and substance use. It is important for mental health screening and psychological assessment used within OB-GYN clinics to be current with regard to postpartum mood dysfunction and suicide risk assessment. We collected data from a sample of 78 postpartum women (0-6-month post-delivery), focusing specifically on patterns of emotional/internalizing dysfunction, using three different screening measures as predictors. Contrary to hypotheses, our sample did not produce significant elevations on target criterion scales of the Minnesota multiphasic personality inventory-3 (MMPI-3). Although the multidimensional behavioral health screen (MBHS) was better at differentially capturing MMPI-3 elevations when compared to the Edinburgh postnatal depression scale (EDPS) and patient health questionnaire-9 (PHQ-9), two of the three comparisons were not statistically significant. Statistical analyses were challenged by our extremely low base rate for elevated suicide risk. Despite this, the MBHS performed better than the EPDS and PHQ-9 at accurately capturing elevated suicide risk.

Early diagnosis of autism spectrum disorder (ASD) in children facilitates the provision of services and enhances opportunities for improving functioning via intervention. To date, limited studies have examined whether age of ASD diagnosis is associated with components of care of the patient-centered medical home (PCMH), a model of health care that emphasizes centralized, accessible, and coordinated care. The objective of the current study was to evaluate the associations between components of the PCMH and age of ASD diagnosis while controlling for associated clinical and socio-demographic factors, in a national sample of children 17 years and younger with ASD. The present study was a cross-sectional, observational study. Participants were caregivers of 1,193 children ages with ASD from the 2020 National Survey of Children's Health (NSCH). Hierarchical multiple linear regression analysis was run with age of ASD diagnosis as the criterion variable in two regression models. The binary composite medical home proxy variable was investigated as well as the five individual medical home components (usual source of care, personal doctor or nurse, family-centered care, care coordination, able to obtain referrals when needed). In the first regression analysis, the overall PCMH proxy variable was significantly correlated with the age of ASD diagnosis (standardized beta coefficient = -.08; p < .01). Of the five components of the PCMH assessed in the second regression model, only usual source of sick care was significantly associated with the age of ASD diagnosis (standardized beta coefficient = -.11; p < .01). Having a usual source of sick care may be an important factor in receiving an earlier ASD diagnosis for children and adolescents.

The current study examines the role of pediatric PCPs in bridging treatment for youth who have experienced mental health crises and the characteristics of these patients for whom PCPs sought psychiatric consultation and referral support from a child psychiatry access program, Maryland Behavioral Health Integration in Pediatric Primary Care. Psychiatric consultation and referral calls between 2012 and 2021 were included if a) the patient was recently seen in a higher level of care and b) the PCP was bridging treatment following the patient’s discharge; 208 calls met criteria. The most common mental health concerns included depressed mood, suicidal thoughts/gestures, and anxiety. Acute concerns of aggression, suicide attempts, and hallucinations were also reported. Over half of the patients had two or more mental health diagnoses. At the time of the call, only one quarter of these patients had outpatient therapy services while about half were receiving medication treatment. Most of these patients were discharged from the higher level of care without a care plan. Pediatric PCPs are managing their patients’ complex mental health concerns following receipt of higher levels of care. Improvements in collaboration and care coordination between pediatric PCPs and emergency department providers are needed.

Doctoral psychology internships play a key role in the development of the competencies of the clinical child and adolescent psychologist workforce needed to serve the increasing behavioral and mental health needs of children. This study surveyed 50 internship training directors regarding workforce needs, the structure of experiential internship components, and the organizational infrastructure and funding of internship programs that provide focused care to children and adolescents within medical settings. Findings suggest that internships most commonly occur within academic medical settings and include clinical child psychology, integrated care, pediatric psychology, neuropsychology, and developmental disabilities tracks. On average, sites had 6 interns, 3 tracks, and 4 major rotations per track. Training directors identified program funding to be the greatest barrier to sustaining internship programs. Currently, internships are funded through clinical revenue, grants, and organizational funds covering an average intern salary of $31,020 plus benefits as well as 0.3 FTE of a training director's time to administrate the program. The number of internship tracks within a single program was associated with greater administrative time for the training director. Implications for advocacy at the federal, state, profession, and institutional level to increase funding and decrease barriers to training are discussed.

Recent findings in health sciences and medical education highlight the importance of training healthcare professionals to interact with their patients in a culturally humble manner (Nadal et al., in Journal of Counseling and Development 92: 57-66, 2014; Pascoe & Smart Richman, in Psychological Bulletin 135: 531, 2009; Sirois & Burg, in Behavior Modification 27: 83-102, 2003; Williams & Mohammed, in Journal of Behavioral Medicine 32: 20-47, 2009). An important piece in the progression of our ability to address training challenges is the assessment of cultural humility. As an extension of previous research (Lombardero et al., in Journal of Clinical Psychology in Medical Settings, 30: 261-273, 2023), this study implemented an evidence-based cultural humility intervention (based on Acceptance and Commitment Training) to improve medical students' interactions with standardized patients (SPs) which was assessed via direct behavioral observation. Specifically, the observational measurement system was focused on culturally humble responses to patients reporting microaggressions to the medical professional. A pre-post comparison of the results demonstrated statistically significant improvements pertaining to participants' culturally humble responses to SPs' reports of microaggressions for one of the measurement scales used (i.e., ARISE), but not the other (i.e., Responsiveness to Racial Challenges Scale). Further analyses, on the bottom quartile of performers, were conducted to assess a possible ceiling effect of the scale that did not demonstrate significant change. These results and implications for future research will be discussed.

Cystic Fibrosis (CF) is a progressive condition resulting in reduced lung function and strongly associated with elevated anxiety and depression symptoms. Self-concept refers to an individual's overarching sense of identity, a positive level of which is widely associated with reduced anxiety and depression. There is a significant lack of self-concept research within CF. This study explores the association between self-concept and anxiety and depression in adults with CF. 64 adults living with CF in Western Australia completed validated online questionnaires (Generalised Anxiety Disorder-7, Patient Health Questionnaire-9, Tennessee Self-Concept Questionnaire 2: Short-Form) and consented to the collection of medical data. Descriptive, t-test, correlation and multiple regression analysis were undertaken. Higher levels of self-concept were associated with lower levels of anxiety and depression symptoms. Lower self-concept levels were a significant predictor of increased anxiety and depression symptoms after accounting for physical health status. Mean self-concept scores for those who required mental health intervention were significantly lower compared to those that did not. This study identifies a significant relationship between self-concept and anxiety and depression in adults with CF. Further research is required to establish causation and test the feasibility of self-concept interventions in reducing anxiety and depression symptoms.

Sickle cell disease (SCD) is a genetic blood condition that places youth at increased risk for deficits in complex attention suggestive of increased risk for Attention-Deficit/Hyperactivity Disorder (ADHD). We used systematic screening to assess the prevalence of ADHD in a clinic-based sample of youth with SCD and explored factors related to ADHD. Caregivers of 107 children with SCD (ages 7-11 years) completed routine psychosocial screening which included inattentive symptoms of ADHD. Follow-up diagnostic procedures were completed for patients with elevated inattentive symptoms to assess for ADHD diagnoses. Biomedical and social-environmental variables were examined from the screening and medical records. Twenty-six percent of patients showed elevated inattentive symptoms with 13% meeting diagnostic criteria for ADHD diagnoses. Most children (75%) who met criteria for ADHD had not been previously diagnosed. Disease severity did not predict inattentive symptoms or ADHD diagnoses, though a measure of chronic inflammation was associated with ADHD. Family functioning was related to elevated inattentive symptoms but not ADHD diagnoses. Children with SCD show relatively high rates of ADHD with many cases not detected through routine care. Screening for ADHD as part of hematology care may be a feasible strategy to improve identification and access to intervention.