Psychological Services

Psychologists as change agents in chronic pain management practice: Cultural competence in the health care system.
Psychologists bring great value to health care systems, but our ethnocentrism regarding the medical community often limits our effectiveness as agents of change. Based on experience in developing pain management services within the Department of Veterans Affairs health care system, we discuss cultural issues as central to effective systems change and provide specific recommendations for psychologists aspiring to change organized health care systems, such as the Department of Veterans Affairs. Consideration is given to the misfit of the biomedical model to chronic pain, “physics envy” affecting the authority accorded psychology, and societal stigmatization of psychopathology. A process-based definition of cultural competence is recommended as improving on psychology's intrinsic group-based notion of culture in engaging the medical community. The systems thinking literature is sampled in summarizing practical recommendations that include identifying features of local medical culture and power dynamics between psychology and medicine that can be modified by engaging stakeholders in an interpersonally effective manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Correction to Erbes, Curry, and Leskela (2009).
Reports an error in Treatment presentation and adherence of Iraq/Afghanistan era veterans in outpatient care for posttraumatic stress disorder by Christopher R. Erbes, Kyle T. Curry and Jennie Leskela (Psychological Services, 2009[Aug], Vol 6[3], 175-183). The copyright for the article was listed incorrectly. This article is in the Public Domain. The online version has been corrected. (The following abstract of the original article appeared in record 2009-12007-001.) The ongoing wars in Afghanistan (Operation Enduring Freedom or OEF) and Iraq (Operation Iraqi Freedom or OIF) make the development and application of effective postdeployment mental health treatment programs a high priority. There has been some concern that existing treatment programs for combat-related posttraumatic stress disorder (PTSD) may not fit well with OEF/OIF veterans confronted with acute mental health difficulties while reestablishing community, familial, and occupational connections after their deployment. This study utilized data gathered from a large outpatient Veterans Affairs Medical Center PTSD treatment clinic to examine differences in initial treatment presentation and treatment adherence (attendance and dropout) between a group of Vietnam era veterans (n = 54) and a group of OEF/OIF veterans (n = 106). OEF/OIF veterans reported lower levels of symptom distress on questionnaires assessing posttraumatic reexperiencing, avoidance, dissociation, and arousal symptoms but similar levels of anger and acting out behaviors and higher levels of alcohol problems. OEF/OIF veterans had significantly lower rates of session attendance and higher rates of treatment dropout than Vietnam veterans, and this difference was not accounted for by differences in treatment presentation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
An examination of the co-morbidity between chronic pain and posttraumatic stress disorder on U.S. Veterans.
The purpose of this study was to assess the comorbidity between chronic pain and posttraumatic stress disorder (PTSD) and examine the extent to which PTSD is associated with changes in the multidimensional experience of pain in a sample of Veterans with chronic pain. It was hypothesized that Veterans with comorbid chronic pain and PTSD would report significantly higher scores on measures of pain intensity, pain behaviors, pain-related disability, and affective distress than Veterans with pain alone. Data were obtained from 149 Veterans who completed self-report questionnaires as part of their participation in a Psychology Pain Management program at a northeastern Department of Veterans Affairs health care facility. Analyses indicated that 49% of the sample met criteria for PTSD. A multivariate analysis of covariance was conducted with age, sex, pain duration, and depressive symptom severity as covariates. In partial support of our hypothesis, the presence of PTSD was found to contribute significantly to measures of affective distress, even after controlling for the effects of depressive symptom severity. The implications of these data are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Correction to Batten et al (2009).
Reports an error in Veteran interest in family involvement in PTSD treatment by Sonja V. Batten, Amy L. Drapalski, Melissa L. Decker, Jason C. DeViva, Lorie J. Morris, Mark A. Mann and Lisa B. Dixon (Psychological Services, 2009[Aug], Vol 6[3], 184-189). The copyright for the article was listed incorrectly. This article is in the Public Domain. The online version has been corrected. (The following abstract of the original article appeared in record 2009-12007-002.) The present study examined interest in family involvement in treatment and preferences concerning the focus of family oriented treatment for veterans (N = 114) participating in an outpatient Veterans Affairs outpatient posttraumatic stress disorder (PTSD) program. Most veterans viewed PTSD as a source of family stress (86%) and expressed interest in greater family involvement in their treatment (79%). These results suggest the need to consider increasing family participation in the clinical care of individuals with PTSD and to develop specialized family educational and support services for this population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
The “Postdeployment multi-symptom disorder”: An emerging syndrome in need of a new treatment paradigm.
Many veterans of Operation Enduring Freedom and Operation Iraqi Freedom have incurred blast related injuries during deployment. One of the most common blast related injuries is mild traumatic brain injury, with the long-term consequences known as postconcussive Syndrome (PCS). Because of frequent combat related injuries and lengthy deployments, many OEF/OIF returnees also report ongoing pain problems and symptoms of posttraumatic stress disorder (PTSD). A substantial percentage of these returning service members present to Department of Veterans Affairs facilities with multiple comorbid symptoms of PCS, pain, and PTSD, which we have termed “Postdeployment Multi-Symptom Disorder.” Despite the recent clinical literature suggesting that this clinical triad of symptoms appears to be a common phenomenon that may be resistant to current treatments, there has been no guidance toward how to best manage these problems. This article introduces the conceptualization of this new “disorder” comprised of the clinical triad of PCS, pain, and PTSD symptoms, and proposes an integrated treatment model based on the current empirically supported treatments for each of these conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Incorporating complementary and alternative medicine (CAM) therapies to expand psychological services to veterans suffering from chronic pain.
This article describes how psychological services for Veterans being seen in an interdisciplinary pain management program were expanded to include Complementary and Alternative Medicine (CAM) approaches. The benefits observed following the introduction of CAM therapies included: improved attendance and Veterans' involvement in group-based therapies, reductions in self-reported pain and anxiety, improved sleep, and an increased sense of emotional well being in the participants. The data also show that CAM therapies, when offered as a treatment option in the format of a drop-in group clinic, were associated with a modest but significant average pain reduction of 1.02 units on a 0–10 Numerical Rating scale. The CAM therapies described in this program are relatively inexpensive and portable, and can appear to the patient as conventional Western or “real” medical treatment (and perhaps, therefore, have less stigma than psychotherapy) for pain and associated distress. They also require minimal training to use and, therefore, can be used as a self-treatment at home. If proven to be effective in future controlled trials, their use could improve access to effective pain care, particularly for Veterans residing in the rural settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Frequent use of psychiatric hospitalization for low-income, inner-city ethnic minority youth.
The clinical and demographic data of 664 youth (M age = 13.92, SD = 2.58) were used to identify factors associated with frequent use of psychiatric hospitalization. Clinical data included scores on the Self-Report of Personality (SRP) and Parent Rating Scales (PRS) of the Behavior Assessment System for Children, Second Edition (BASC-2). Demographic data included age, race/ethnicity, gender, and the presence or absence of surrogate care. Results indicated that those youth with frequent admissions to the hospital were generally between 13 and 18 years old (p = .01), African American (p = .03), and in surrogate care (p = .04). Relative to the other youth in our sample they were more aggressive (p p p p = .003). The implications of these findings and the recommended interventions for youth with disruptive behaviors are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Direct observational coding of staff who are the victims of assault.
Staff members in psychiatric hospitals are frequently assaulted by patients. When asked what events triggered specific assaults on staff, staff and patients disagree. Staff members usually say that symptoms of psychosis led to the assault, whereas patients usually say aversive interactions with staff triggered the incident. For years, experts have called for direct observational research to address this issue and possibly resolve the discrepancy found in the verbal-report data. Over 26,000 hr of direct observational coding of staff activities, including staff–patient interactions, was collected across 10 years by independent, noninteractive raters on Social Learning Program units. Eight of nine kinds of aversive staff–patient interactions occurred more frequently among staff members who had been assaulted. One possible interpretation of these data is that aversive interactions lead to assaults on staff, but other possibilities must be considered. Practical recommendations for reducing likelihood of assault are detailed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Correctional psychologist burnout, job satisfaction, and life satisfaction.
Corrections is a stressful environment, but do correctional psychologists experience greater levels of occupational burnout and life stress than other public sector and nonpublic sector psychologists? Data collected from 203 doctoral level psychologists including correctional (CR; n = 44), Veteran's Affairs (VA; n = 56), public psychiatric hospital (PPH; n = 54), and university counseling centers (CC; n = 49) indicated that CR psychologists do experience significantly more occupational burnout relative to VA and CC psychologists. Furthermore, CR and PPH psychologists reported significantly less job satisfaction than CC psychologists. Although psychologists working in PPH settings reported significantly lower levels of life satisfaction than VA and CC psychologists this was not the case for CR psychologists. Professional identity related to occupational setting emerged as a significant predictor of occupational burnout. Implications of these findings are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
Funding of applied behavior analysis services: Current status and growing opportunities.
Across the United States, unprecedented numbers of individuals with disabilities are transitioning from mental institutions and developmental centers to community-based settings. As the growing tide of individuals needing community-based services advances, the daunting task of procuring the resources necessary to support them is at hand. Practitioners of applied behavior analysis (ABA), in conjunction with professionals from disciplines such as psychiatry, psychology, medicine, and other specialized ancillary services including occupational therapy, physical therapy and speech and language pathology, have been able to forge beneficial partnerships to maintain the movement to community-based life for individuals with long-term support needs. In this article, we provide an overview of funding options for ABA services at the federal, state, and local levels and for various disability types. We also discuss current and future initiatives to increase funding for ABA services for specific populations who are currently underserved. (PsycINFO Database Record (c) 2010 APA, all rights reserved)
The tragedy of Native American youth suicide.
High rates of suicide among American Indian and Alaska Native populations call for significant efforts by lawmakers and public sector psychologists to develop, implement, and evaluate policy and programs that increase our understanding of factors that contribute to these high rates, and lead to effective resources that reduce the suicide crisis among these groups. The author describes how the federal government has responded to this crisis, what the barriers have been, and what is needed in the future from multiple sectors to ensure our nation's health care system is responsive to the tremendous health care needs that have long been evident in American Indian and Alaska Native communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Psychological Services - Vol 7, Iss 3