Professional Psychology: Research and Practice

Earthquakes and children: The role of psychologists with families and communities.
The 2008 Sichuan Province earthquake and 2005 Pakistan earthquake are examples of natural disasters that took an unimaginable toll on children. In such disaster management contexts, family members as well as health care and school personnel are the first-line responders and are natural sources of continued social support as children recover. Although psychologists have increasingly sophisticated understandings of post-disaster reactions and strategies for helping children and adolescents cope with trauma, models for responding to mass catastrophes are limited, particularly in geographically remote communities and in regions in which mental health services are stigmatizing. With children’s well-being subsequent to earthquakes inextricably linked to family and community, psychologists can make important contributions in 3 spheres: (a) coordinating and activating collaborations within children’s existing social contexts to develop post-earthquake interventions; (b) designing prevention and preparedness programs focused on the emotional needs of children in earthquake-prone communities; and (c) conducting research on interventions and recovery with particular attention to developmental stage, sociocultural-economic contexts, and the similarities versus differences across various types of disasters. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Mental health symptoms in youth affected by Hurricane Katrina.
Natural disasters, such as hurricanes, may cause severe psychological impairment in children and adolescents, which may persist in youth who have survived hurricanes, their effects, or both. To better understand the needs of youth in the community after Hurricane Katrina, officials in St. Bernard Parish, LA, commissioned a youth needs assessment survey. The survey assessed how youth were coping approximately 2 years after Hurricane Katrina. The goal was to explore the prevalence and severity of depressive, anxious, and posttraumatic symptoms reported by youth. Based on retrospective reports from 43 youth, the prevalence of children’s mental health symptoms was 44–104% higher in the 2 years after Hurricane Katrina compared to pre-Katrina. The majority of mental health symptoms reported by youth had an onset after the hurricane, for example, 79% reported new onset of mental heath symptoms in the year after Katrina. The vast majority of these children (56%) continued to experience mental health difficulties 2 years after the disaster. Implications regarding post-Katrina mental health needs, service delivery, public response, and collaboration efforts are summarized and directions for future research are proposed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Ongoing traumatic stress response (OTSR) in Sderot, Israel.
In Sderot, a small city in southern Israel, seven years of continuous missile attacks have led to dramatic increases in treatment seeking for anxiety symptoms. For some clients, the clinical picture is consistent with a diagnosis of post traumatic stress disorder (PTSD). For other clients, however, the onset and constellation of symptoms are less typical of PTSD. In these cases, anxiety symptoms seem to evolve gradually and be associated with ongoing, daily stress about imminent attacks, rather than with a discrete, past traumatic event. Much of their avoidance behavior is reality based. They report hyperarousal, severe distress, and loss of control during and immediately following actual missile attacks. However, they are less likely to exhibit reexperiencing symptoms. Furthermore, in contrast to the typical presentation of PTSD, their symptoms tend to diminish dramatically or completely resolve when they are no longer within harm’s way. We suggest that this clinical presentation may be best understood as an ongoing traumatic stress response (OTSR), rather than PTSD or PTSD symptoms. We consider diagnostic features which discriminate between these two phenomena as well as implications for treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Building national capacity for child and family disaster mental health research.
Disaster mental health is a burgeoning field with numerous opportunities for professional involvement in preparedness, response, and recovery efforts. Research is essential to advance professional understanding of risk and protective factors associated with disaster outcomes; to develop an evidence base for acute, intermediate, and long-term mental health approaches to address child, adult, family, and community disaster-related needs; and to inform policy and guide national and local disaster preparedness, response, and recovery programs. To address the continued need for research in this field, we created the Child and Family Disaster Research Training and Education (DRT) program, which is focused specifically on enhancing national capacity to conduct disaster mental health research related to children, a population particularly vulnerable to disaster trauma. This paper describes the structure and organization of the DRT program, reviews the training curriculum, discusses implementation and evaluation of the program, and reviews obstacles encountered in establishing the program. Finally, key lessons learned are reviewed for the purpose of guiding replication of the DRT model to address other areas of community mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility.
Clinical lore abounds when discussing the issue of treating trauma-related symptoms in substance-dependent clients. Historically, clinicians have wondered whether they should wait until the client has gained substantial abstinence from abused substances before initiating trauma treatment or if trauma treatment should be conducted during substance use treatment. Furthermore, questions arise with regard to exactly how trauma-related symptoms should be addressed and how trauma treatment should be incorporated into the recovery process. In this article, the growing literature suggesting that posttraumatic stress disorder (PTSD) can be treated concurrently with substance use disorders is reviewed. In addition, the unique challenges of implementing treatment for PTSD with substance-dependent clients seeking treatment in a residential treatment facility are discussed. Specifically, we provide concrete suggestions about how to utilize prolonged exposure, a very effective treatment for PTSD, with clients in a residential substance use treatment facility, including use of the internet to facilitate exposure therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Minimal therapist-assisted cognitive–behavioral therapy interventions in stepped care for childhood anxiety.
New effective, efficient, and accessible service delivery methods for cognitive–behavioral therapies for pediatric anxiety disorders are needed. Many anxious children do not receive needed treatment because of barriers such as limited availability of trained practitioners, costs of treatment, and time. A cognitive–behavioral therapy (CBT) stepped care approach that “steps up” care as needed from less intensive therapies with minimal therapist assistance to therapist-directed treatment may address barriers and provide more accessibility to treatment. A stepped care approach does not necessarily mean that traditional weekly face-to-face therapy sessions will not be needed. However, different service delivery methods that begin with CBT minimal therapist-assisted interventions may be a first line of treatment because not all children may need the full treatment package. This article provides an overview of the current research on CBT minimal therapist-assisted interventions (i.e., modified CBT protocols, computer-based therapy, bibliotherapy, telephone-based therapy, group treatment, and pharmacology) and information on how these first-line treatments may be incorporated into a stepped care model. Minimal therapist-assisted interventions within a stepped care model are in the early stages of development, although there is evidence that these types of treatment may be a viable first step to treating pediatric anxiety disorders. More research on minimal therapist-assisted interventions within stepped care models is needed, and challenges associated with disseminating and implementing stepped care need to be addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Training and consultation in evidence-based psychosocial treatments in public mental health settings: The access model.
We present a model of training in evidence-based psychosocial treatments (EBTs). The ACCESS (assess and adapt, convey basics, consult, evaluate, study outcomes, sustain) model integrates principles and findings from adult education and training literatures, research, and practical suggestions based on a community-based clinician training program. Descriptions of the steps are provided as a means of guiding implementation efforts and facilitating training partnerships between public mental health agencies and practitioners of EBTs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Practicing clinical psychologists’ provision of sexual health care services.
Practicing clinical psychologists are likely to work with sexual health concerns as part of their clinical practice because of high prevalence rates and sexual problems as symptoms of mental or physical health problems and their pharmacological treatment. However, the majority of clinicians do not receive didactic or supervised clinical training. This survey of 188 practicing clinical psychologists in one Canadian city confirmed that, despite lack of training, many clinicians discussed sexual health concerns with their clients and used a variety of sex therapy techniques. This survey also revealed, however, that 60% of clinicians did not ask, or very infrequently asked, clients about sexual health. In general, lack of training affected level of comfort, and both may result in inadequate application of sex therapy techniques and treatment. The results of this survey indicate an ethical imperative to included sexuality training in current graduate curricula to adequately prepare psychologists to assess, refer, and treat sexual health concerns. The inclusion of sexuality-related topics in existing clinical graduate courses, an increase in sexuality-specific courses focused on assessment and intervention in graduate curricula, and broader options for continuing education for practicing clinical psychologists are recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Ethical considerations in treatment of personality dysfunction: Using evidence, principles, and clinical judgment.
Clinical work with clients suffering from personality disorders can be among the most challenging for psychologists. These clients may have a wide range of clinical presentations, and many practitioners may lack the specialized training needed to provide successful treatment to these clients. Clinicians are faced with several challenges in making treatment decisions that are ethically informed and based on available research findings. Because of the relative dearth of evidence-based treatments for these clients, clinicians are encouraged to use a cost–benefit analysis approach when weighing the benefits versus disadvantages of specific interventions and treatment approaches. Recommendations for effective and ethical treatment of clients with personality dysfunction are provided that are based on an empirically grounded framework. Three expert commentators provide insights into the state-of-the-art of clinical work with these clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Clinical child psychology: A practice specialty serving children, adolescents, and their families.
Clinical child psychology is a growing and vibrant field of practice and research within professional psychology. The purpose of this article is to contribute to the recent series of articles on specialties in Professional Psychology Research and Practice and delineate the development, design, and purpose of clinical child psychology. The article describes the current trends in the specialty and the challenges clinical child psychologists face in tending to the mental health needs of youth and their families. The need for the specialty and the definition of the scope of the work of clinical child psychologists is described. The parameters of training are also discussed, with a focus on the distinctiveness of the role of the clinical child psychologist. Outlined are applications of the work with children, adolescents, and their families including types of professional practice and collaborations with other professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Specialty practice in rehabilitation psychology.
Rehabilitation psychology is a growing specialty that consistently involves interdisciplinary teamwork as a condition of practice and considers the relevant biological, psychological, social, environmental, and political factors to achieve optimal rehabilitation goals. Rehabilitation psychologists partner with individuals experiencing disabling conditions to assist them in meeting challenges and promoting quality of life across the life span. Services provided by rehabilitation psychologists include psychological assessments, interventions, consultations, research, consumer protection, and advocacy. This article presents a brief history of the specialty, overview of the practice of rehabilitation psychology, and description of the educational and training requirements involved in becoming a specialist in rehabilitation psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
The specialty practice of cognitive and behavioral psychology.
What makes cognitive and behavioral psychology a specialty practice when many psychologists of differing orientations may inquire about a client’s cognitions and behaviors? Distinctive and unifying aspects of the specialty practice of cognitive and behavioral psychology are discussed as they relate to psychotherapeutic practice. A brief history of the field is given, and procedures in assessment, case conceptualization, and treatment planning are reviewed. Information regarding education and training is provided. Resources are suggested for individuals who wish to develop competency in cognitive and behavioral psychology. Psychologists who use cognitive and behavioral principles in assessments, treatment planning, case conceptualizations, interventions, or all of these are encouraged to pursue specialty certification in cognitive and behavioral psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Professional Psychology: Research and Practice - Vol 41, Iss 1