PsyResearch
ψ   Psychology Research on the Web   



Couples needed for online psychology research


Help us grow:




Psychological Services - Vol 14, Iss 3

Random Abstract
Quick Journal Finder:
Psychological Services Psychological Services is an American Psychological Association Division publication. The official publication of the Division of Psychologists in Public Service (Division 18), Psychological Services publishes high-quality data-based articles on the broad range of psychological services. While the Division’s focus is on psychologists in "public service," usually defined as being employed by a governmental agency, Psychological Services covers the full range of psychological services provided in any service delivery setting.
Copyright 2017 American Psychological Association
  • American Akicita: Indigenous American warriors and military service.
    Indigenous Americans (i.e., Native/American Indians, AK natives, Pacific Islanders) have consistently volunteered for military service at greater rates than any other ethnic group, including the majority culture, since the early days of the country. This article is an introduction to the special section which includes a number of outstanding papers that provide an innovative and compelling effort to overcome the challenges of casualties from war and render effective and culturally informed care. These manuscripts describe culturally appropriate considerations of suicide (O’Keefe), family involvement and access to care (Whealin), and telehealth for treatment of rural Native veterans (Goss). Challenging and complex treatment needs call for equally mindful and competent approaches. These authors and providers present compelling examples of addressing these needs in working with our Wounded Warriors. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Rural American Indian and Alaska Native veterans’ telemental health: A model of culturally centered care.
    American Indian and Alaska Native (AI/AN) veterans living in rural areas have unique health care needs and face numerous barriers to accessing health care services. Among these needs is a disproportionate prevalence of posttraumatic stress disorder and other mental illnesses. Since 2001, 14 rural communities have partnered with the U.S. Department of Veterans Affairs and the Centers for American Indian and Alaska Native Health at the University of Colorado Anschutz Medical Campus to extend telemental health clinics to American Indian veterans. Administrative and, to some extent, clinical considerations of these clinics have been reviewed previously. This paper describes a model of care, evolved over a 14-year period, that weaves together evidence-based Western treatment, traditional Native healing, and rural Native communities into 4 main components: mental health care, technology, care coordination, and cultural facilitation. We delineate improvements to care made by addressing barriers such as system transference, provider-patient trust, and videoconferencing. Similarly, the discussion notes ways that the care model leverages strengths within Native communities, such as social cohesion and spirituality. Future steps include selection of appropriate performance indicators for systematic evaluation. The identification of key constructs of this care model will facilitate comparisons with other models of care in underserved populations with chronic and complex health conditions, and eventually advance the state of care for our warriors. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Factors impacting rural Pacific Island veterans’ access to care: A qualitative examination.
    Pacific Island veterans suffer from greater severity of posttraumatic stress disorder (PTSD) compared with Caucasian veterans but face substantial barriers to mental health care. However, the factors that may dissuade or facilitate veterans in the Pacific Islands from seeking mental health care are not known. The main aim of this study was to identify how internal and external factors interact to impact wounded warriors’ access to and use of mental health services. Veterans residing in 5 rural Pacific Island locations were mailed recruitment materials. Other veterans were made aware of the project by key stakeholders in their communities. Thirty-seven male veterans (across 5 focus groups) and 1 female veteran (via individual interview) participated. The study utilized an analytic design in which taped focus group discussions were transcribed verbatim and coded for major themes. Results indicated that most veterans identified Veterans Affairs (VA) as a positive source for health care. However, common concerns acknowledged were as follows: (a) difficulty navigating the VA system, (b) time associated with receiving care, (c) family stigma, (d) community stigma, (e) cultural differences, and (f) a lack of knowledge about VA services and benefits. Facilitators of care included the following: (a) individual knowledge and self-efficacy, (b) networking with other veterans, (c) family support, and (d) rural community support. All factor levels interacted in subtle ways to ultimately impact access to care. Next steps are described, including projects designed to better meet the needs of rural Pacific Island veterans. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Suicide among American Indian/Alaska Native military service members and veterans.
    Many American Indian/Alaska Native (AI/AN) communities experience high suicide rates. However, there is little discussion in epidemiological and empirical literature about suicide-related outcomes among AI/AN military service members or veterans. This article briefly reviews the literature on AI/AN suicide and discusses what is known about Native military service member and veteran suicide mortality and self-directed violence. Recent studies suggest high suicide death rates among AI/AN military service members and veterans. Discussion includes the potential for unique cultural protective and risk factors that could inform prevention efforts and some of the novel existing efforts to support AI/AN veterans are reviewed. Given concerning suicide rates among military service members and veterans, it is important for future research to clarify the risk to AI/AN military service members and veterans and how to best develop and implement effective suicide prevention/interventions. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • A culturally adapted family intervention for rural Pacific Island veterans with PTSD.
    The Veterans Affairs mission to provide equitable, accessible, and patient-centered care necessitates that culturally appropriate interventions are available when cultural differences may jeopardize engagement in care. However, within the VA, wounded warriors residing in rural areas in the Pacific Islands have been offered interventions that were developed and tested using largely urban mainland populations. The objectives of this article were to (a) document the cultural adaptation of a cognitive-behavioral clinical intervention for use by rural Pacific Island veterans, and (b) report feasibility data for the intervention. The 5-stage Map of the Adaptation Process (assessment, selection, preparation, piloting, and refinement) was used to structure the work. The resultant intervention, called “Koa,” is a multisession family psychoeducational program that integrates selected Pacific Islander values, beliefs, and healing traditions with an empirically based mainstream U.S. intervention. To pilot Koa, rural Pacific Island dyads (28 veterans and 28 family members) participated via video teleconference and completed pre- and post- intervention measures. Outcome data indicated that participants perceived the intervention to be highly acceptable, useful, and relevant. Relationship quality scores substantially improved postintervention as measured by the Dyadic Relationship Scale (95% CI [−10.97, −1.84], t(22) = −2.9, p = .008, d = −0.53 for veterans; 95% CI [−11.06, −2.47], t(21) = −3.28, p = .004, d = −0.68 for family members). Family caregiving burden also improved significantly. The positive results of this investigation support the development of culturally adapted mental health interventions for culturally distinct subgroups of veterans and their families. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Actualizing culture change: The Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK 2.0) program.
    Nursing homes have been challenged in their attempts to achieve deep, organizational change (i.e., culture change) aimed at providing quality of care and quality of life for nursing home residents through person-centered care. To attain deep change, 2 well-defined components must be in place: a shared understanding of (a) the what, or content goals, and (b) the how, or process of change. However, there are few examples of this at a macro or micro level in long-term care. In an effort to enact true culture change in nursing homes statewide, the Kansas Department for Aging and Disability Services implemented the Promoting Excellent Alternatives in Kansas Nursing Homes program. This program is a Medicaid, pay-for-performance program that formalizes the content and process of achieving culture change through person-centered care principles. This article aims to detail the content (what) and process (how) of a model macro-level program of culture change throughout the State of Kansas. Applications to the micro level (individual homes) are presented, and implications for psychologists’ roles in facilitating culture change are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Identifying barriers to culture change: A qualitative analysis of the obstacles to delivering resident-centered care.
    A growing number of healthcare organizations have moved from traditional, institutional nursing home models to ones that emphasize culture change, or resident-centered care (RCC). In 2006, the Department of Veterans Affairs (VA) began implementing a number of changes to VA nursing homes, now called Community Living Centers (CLCs), to provide veterans with a more resident-centered and homelike environment. This study aimed to understand the barriers CLC staff face when delivering RCC. Ten CLCs were included on the basis of their performance levels on RCC and quality of care. Semistructured interviews that focused on facility efforts in RCC and quality were conducted with all levels of staff. Interviews were systematically content coded. We found similarities and differences in barriers reported at high- and low-performing sites. Staff across all performance levels cited 5 main categories of barriers to delivering RCC: staffing, resources, acuity of residents, RCC and quality of care conflicts, and regulations. Staff in high-performing sites reported fewer barriers to RCC, although 1 barrier cited was difficulty coordinating RCC across departments. Staff in low-performing sites reported additional categories of barriers related to administrator turnover/lack of guidance, CLC culture/staff morale, and difficulty working with residents and families. As RCC continues to spread, it is important to anticipate the barriers to implementing these practices. Particular focus on regulatory, leadership, organizational, workforce, and process factors may help organizations avoid or reduce barriers to RCC. Given their training and skill set, mental health providers may be uniquely situated to assist staff in overcoming these barriers. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Implementing a cornerstone of culture change: Consistent staff assignment in VHA community living centers.
    In 2011, the Veterans Health Administration (VHA) began implementing consistent staff assignment in its nursing homes (called Community Living Centers or CLCs). Consistent assignment, a cornerstone of culture change, minimizes the number of staff who provide a resident’s care. The present research assessed the level and stability of consistent assignment in units within VHA CLCs and identified unit characteristics related to implementation of this staff assignment model. Schedulers in 185 of 335 organizational units that make up VHA CLCs completed a Staffing Practices Survey. For the month prior to the survey, 53% of CLC units had full implementation of consistent assignment. Tracked back over time, 37% of CLC units had stable high consistent assignment, 29% had stable low consistent assignment, and 34% were variable. Units with stable high consistent assignment were most likely to use care teams with stable membership and to obtain staff input for care assignments. Schedulers in these units reported more positive experiences with consistent staff assignment and better unit functioning in terms of staff absences, complaints about workload fairness, and resolution of scheduling problems. Units with stable low and variable consistent assignment were similar in most of these respects; however, units with variable consistent assignment made greater use of stable care teams and were less likely to change assignments at a staff member’s request. Overall, consistent assignment implementation was not related to unit size, nursing hours per resident day, or specialty focus. Findings can help guide consistent staff assignment implementation in VHA and community nursing homes. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Adaptation of a nursing home culture change research instrument for frontline staff quality improvement use.
    Enhanced interpersonal relationships and meaningful resident engagement in daily life are central to nursing home cultural transformation, yet these critical components of person-centered care may be difficult for frontline staff to measure using traditional research instruments. To address the need for easy-to-use instruments to help nursing home staff members evaluate and improve person-centered care, the psychometric method of cognitive-based interviewing was used to adapt a structured observation instrument originally developed for researchers and nursing home surveyors. Twenty-eight staff members from 2 Veterans Health Administration (VHA) nursing homes participated in 1 of 3 rounds of cognitive-based interviews, using the instrument in real-life situations. Modifications to the original instrument were guided by a cognitive processing model of instrument refinement. Following 2 rounds of cognitive interviews, pretesting of the revised instrument, and another round of cognitive interviews, the resulting set of 3 short instruments mirrored the concepts of the original longer instrument but were significantly easier for frontline staff to understand and use. Final results indicated frontline staff found the revised instruments feasible to use and clinically relevant in measuring and improving the lived experience of a changing culture. This article provides a framework for developing or adapting other measurement tools for frontline culture change efforts in nursing homes, in addition to reporting on a practical set of instruments to measure aspects of person-centered care. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Creating space for relationships.
    Sexuality is a key component of personality and behavior, encompassing basic human needs for touch, intimacy, love, affection, and sexual behavior. The design of long-term care facilities makes it almost impossible for a resident to be sexually intimate, to share romantic moments, or to have a meal in a private setting. This case study describes the rationale and process used to establish a private guestroom called the Family Room at Patriots Place, the specialized dementia unit in the Veterans Affairs (VA) Maine Healthcare System Community Living Center (CLC). As part of an overall commitment to culture change at VA Maine, the Family Room addresses needs for privacy and sexual intimacy as expressed by residents and their partners. Supporting the dignity and independence of individuals with dementia provided the basis for the policies established to support this project. Despite potential challenges, (e.g., staff acceptance, nursing coverage, facility space needs) residents, partners, and health care staff at VA Maine have expressed positive support for the Family Room. This resource is a way to accommodate the ongoing needs for privacy, intimacy, relational continuity, and sexual expression of long-term care residents with dementia and to support their autonomy and dignity. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Expanding our reach: Increasing the role of psychologists in public and community mental health.
    Psychologists are currently underrepresented in community and public mental health settings, despite the advanced training and competencies that are salient for service in various unique and important functions in the public sector. This article will explore those functions including: transformation to recovery-oriented care, delivery of positive behavioral support, implementation and evaluation of evidence-based interventions, application of scholarly guided practice, emphasis on context, therapeutic relationship, and history in therapeutic interventions, provision of training, education, program development and evaluation, and development of leadership and leadership training in systems of care. To illustrate these, the authors share specific clinical applications that provide a picture of psychologists serving in these roles, with the aim of providing examples for other organizations to increase the representation of psychologists in the public sector. Finally, the potential opportunities through initiatives such as loan forgiveness and other economic incentives are briefly explored as possible mechanisms to achieve this aim. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Collaborating with community-based services to promote evidence-based practice: Process description of a national initiative to improve services for youth with mental health and substance use problems.
    Many youth with significant mental health (MH) and/or substance use (SU) difficulties do not receive specialized services. Collaboration between service providers, researchers, and other stakeholders is essential to improve youth service system capacity to provide evidence-based services to meet the complex array of needs of youth. Facilitators and barriers of implementing evidence-based practice have been identified, but few studies provide examples of the processes of collaboration and implementation for youth MH services. This study explicates the design features and implementation processes of a project to improve screening activities in youth services. These processes supported the building of 16 collaborative networks of service providers from diverse youth-serving sectors (e.g., MH, youth justice, child welfare) in urban, rural, suburban, and remote Canadian communities. These cross-sectoral networks implemented an evidence-based practice (screening youth aged 12–24 years for MH and SU problems using the Global Assessment of Individual Needs—Short Screener [GAIN-SS]) across their services. Materials and resources were provided by a centralized research team. Core project components were standardized and adherence to these components was monitored. Over 800 service providers participated in cross-sectoral networks, capacity-building events, joint data analysis, or interpretation and recommendation sessions. Across the 89 participating agencies, service providers for 84% of participating youth implemented the evidence-based practice accurately in accordance with project protocols, with 98% of positive screens reviewed and addressed according to organizational protocols. Service provider feedback is reported. Facilitators, barriers, and implications of promoting implementation of evidence-based practices across sites and sectors are discussed. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Stakeholder perspectives on a toolkit to enhance caregiver participation in community-based child mental health services.
    Client engagement in services is a critical element of effective community-based child and family mental health service delivery. Caregiver engagement is particularly important, as caregivers often serve as gatekeepers to child mental health care and typically must consent for services, facilitate service attendance, and are often the target of intervention themselves. Unfortunately, caregiver engagement has been identified as a significant challenge in community-based child mental health services. To address this gap, the Parent And Caregiver Active Participation Toolkit (PACT), which includes therapist training and participation tools for caregivers and therapists, was developed. Stakeholders’ perspectives regarding the delivery of interventions designed to improve the quality and effectiveness of community-based care are essential to understanding the implementation of such interventions in routine service settings. As such, this mixed methods study examined the perspectives of 12 therapists, 8 caregivers, and 6 program managers who participated in a community-based randomized pilot study of PACT. Therapists, caregivers, and program managers agreed that PACT was acceptable, appropriate, and feasible to use in community settings and that both changes in therapist practices and caregiver participation resulted from implementing PACT. Some variable perceptions in the utility of the therapist training components were identified, as well as barriers and facilitators of PACT implementation. Results expand the parent pilot study’s findings as well as complement and expand the literature on training community providers in evidence-based practices. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Patterns of psychiatric emergency department utilization among community-dwelling Medicare beneficiaries under 65.
    This study estimated patterns and trends in all-cause (any reason, including psychiatry related) and psychiatric emergency department (ED) utilization among Medicare beneficiaries under 65 who were residing in community settings (i.e., noninstitutionalized or in their own homes). Medicare beneficiaries under the age of 65 enrolled in Medicare for Social Security Disability Insurance (SSDI) due to permanent physical or mental disabilities are a population with poor health conditions and high utilization of health services; however, this vulnerable population has received limited attention from researchers and policymakers compared to the Medicare beneficiaries 65 years and older. Data from the 2002–2009 Medicare Current Beneficiary Survey (MCBS) with linked Medicare administrative claims data were used to select a total of 4,864 Medicare beneficiaries under the age of 65 with a total of 10,384 person-years (weighted n = 30,086,846 person-years). We found that trends in all-cause and psychiatric ED utilization among the young and disabled Medicare beneficiaries remained stable, but trends in the proportion of all-cause ED visits that were psychiatric related increased, and trends in the proportion of psychiatric ED visits resulting in a psychiatric inpatient stay decreased over time. Factors associated with a higher likelihood of psychiatric ED utilization included younger age, residence in the Northeast region, lower education level, Medicare–Medicaid dual eligibility, use of psychotropic medication, and greater number of chronic and psychiatric conditions. These findings highlight the need for policies, programs, and system interventions designed to reduce future psychiatric ED events and improve the access and quality of community mental health services for the community-dwelling, young, and disabled Medicare population. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source

  • Are expectations for community mental health increasing among older adults in China?
    In recent years, the Chinese government began expanding access to social services to older adults. This study examined whether older adults have increasing expectations that psychological consulting services will be provided by their communities. We analyzed the responses of participants in a prospective cohort study at 2 time points: 2005 and 2008. We utilized logistic regression with survey weights to determine whether there were any changes in attitudes toward community mental health services during the study period, and to determine the correlates of this change. The study participants had a higher expectation that their government would provide psychological consulting services in 2008 than 2005. The multiple logistic regressions conducted indicated that there was a statistically significant relationship between expectations for community-provided psychological consulting services and being a rural resident (odds ratio [OR] = 0.553, 95% confidence interval [CI] [0.353, 0.865]), change in gross regional product per capita (OR = 0.967, 95% CI [0.937, 0.997]), the interaction of those 2 variables (OR = 1.07, 95% CI [1.03, 1.11]), and increase in psychological well-being (OR = 0.971, 95% CI [0.954, 0.988]). Our study highlights the role that economic development can play in changing attitudes toward community-provided psychological consulting services. It suggests that as economic development occurs, expectations for local communities to provide mental health services will increase. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
    Citation link to source



Back to top


Back to top