Family Therapy Course
Using the brief case description below, prepare a script you could use to call the mock client’s pediatrician for a 10-minute conversation. To prepare, consider the following: What facts do you need to communicate to the doctor? What will the doctor likely want to know from you? What will you want to be sure to tell the doctor about your diagnosis of him having ADHD and treatment plan for family? You diagnose that he should be placed on medication and pediatricians nurse prescribe the diagnosis level
Case description: Your client is an 8-year-old male whose parents are concerned might have ADHD. He is the middle child of three boys. You have met the parents and the child in your initial sessions. At this point, you have had only three sessions with the family. Your client says he has lots of friends, he hates school because it’s boring, and his parents yell at him too much!
Write a mock transcript of an imaginary phone call between you and the client’s physician. In your mock discussion, include information you would provide to the doctor about your assessment, treatment plan, and orientation to treating ADHD; include the doctor’s questions or responses to the information you provide. Also, include questions you would ask the doctor, and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it ...
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxransayo
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated that more than 60% of patient
visits to primary care physicians (PCPs) include mental health concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint (Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986; Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other researchers and practitioners have
written books that serve as a guide to other mental health practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn et al., 1996).
The specialty of family medicine, which arose in the 1960s, embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of caring for the whole person
within his or her family, social context, and life cycle stage (Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat their patients’ mental health
problems. By definition of their specialty, FPs are trained to integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et al., 1996) as well as to manage
Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle, Maine; Deanna Linville, PhD, Couples and
Family Therapy .
This document provides an overview of medical family therapy, which integrates mind, body, and family in treating illness. It discusses the biopsychosocial framework, collaborative treatment model, and scope of medical family therapy. The document also presents a case study example and discusses applications of medical family therapy, such as personal development and family interventions.
Barriers to Practice and Impact on CareAn Analysis of the P.docxrosemaryralphs52525
This document summarizes barriers to practice for psychiatric mental health nurse practitioners (PMHNPs) in New York State. It discusses how statutory collaborative agreements requiring oversight from psychiatrists disrupt continuity of care for patients and limit PMHNPs' autonomous practice. National statistics show a significant need for more mental healthcare providers. While PMHNPs are well-positioned to address this need, barriers like restrictive regulations prevent them from doing so. The document calls for reforms to expand PMHNPs' scope of practice and reduce barriers that impede access to mental healthcare.
The document discusses barriers to interpersonal communication, including language barriers, cultural medical mistrust, psychological barriers, and differing cultural beliefs that can affect communication. It also describes the procedures used in a physical exam, such as inspection, percussion, palpation, auscultation, and manipulation. Finally, it explains the SOAP method for documenting patient data, where subjective data comes from the patient, objective data from observations and exams, assessment is the provider's analysis, and planning is the treatment plan.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
This document summarizes a study that evaluated the effectiveness of an educational program in mindful communication for primary care physicians. The program included mindfulness meditation, narrative exercises, and appreciative inquiry techniques. It was associated with short-term and sustained improvements in physician well-being, burnout, empathy, mood, and personality factors related to patient-centered care. However, the before-and-after study design limits conclusions about the causal effects of the intervention. Randomized trials with larger and more diverse groups of physicians are needed to validate these preliminary findings.
MayJune 2021 Volume 39 Number 3 111Nursing Economic$AbramMartino96
May/June 2021 | Volume 39 Number 3 111
Nursing Economic$
Developing a well-prepared and geographically
distributed mental health
workforce is a crucial goal of
healthcare workforce planning
initiatives and contributes to
health systems’ ability to
improve population health
(Beck et al., 2020). Before the
SARS COV-2 global pandemic,
sharp increases in suicide,
substance abuse, opioid crises,
gun violence, and severe
depression among young
people were increasing
demands on mental and
behavioral health professionals,
including nurses (Substance
Abuse and Mental Health
Services Administration, 2020).
However, the growing demand
for behavioral health services,
let alone treating the 44 million
American adults who have a
diagnosable mental health
condition, is being met by a
potential shortage of
professionals, which the Health
Resources and Services
Administration (2016) projects
will worsen to as many as
250,000 workers by 2025.
Access to mental health care is
crucial given the societal
upheaval brought about by the
SARS COV-2 global pandemic.
To address the growing
demand for mental health
services, many communities and
healthcare systems are exploring
novel ways to integrate mental
health treatment into primary
care delivery, for example, using
the Collaborative Care Model
(Vanderlip et al., 2016). Nurses
often contact people living with
mental or behavioral health
conditions while being treated
for physical and medical
conditions in both community
and hospital settings. A recent
focus on mental health care,
particularly in outpatient
settings, has been an emphasis
in team-based models,
telehealth, and integration of
mental health and primary care
with contributions from
physicians, nurses, social
workers, peer support, and
community health workers – all
of which can be beneficial
relative to more traditional and
often siloed models of mental
health treatment (Reiss-Brennan
et al., 2016).
Characteristics of Registered Nurses
and Nurse Practitioners Providing
Outpatient Mental Health Care
David I. Auerbach
Max C. Yates
Douglas O. Staiger
Peter I. Buerhaus
The growing demand for mental
health services, together with
current and increasing shortages
of mental health professionals
and increasing adoption of
integrated models of care
delivery, suggest nurses will
become increasingly needed to
provide mental health services.
Analysis of a national survey
finds registered nurses and
nurse practitioners working in
outpatient mental health settings
are older than those in other
settings. Most would benefit
from additional training. Provision
of team-based care was
associated with higher job
satisfaction.
May/June 2021 | Volume 39 Number 3112
The growing demand for
mental health services, together
with current and increasing
shortages of mental health
professionals and increasing
adoption of integrated models
of care delivery, suggest nurses
will b ...
Borderline Personalities; The Impact Of Clinician Bias & Education Shortf...StefanieMarshall
The document summarizes a literature review on stigma and biases among clinicians toward patients with borderline personality disorder (BPD). It discusses two main themes: biases among clinicians prevent adequate treatment for BPD patients, and lack of education and training for clinicians perpetuates misunderstanding of the disorder. The review assessed papers documenting clinician stigma and lack of treatment and resources for BPD patients. It recommends developing comprehensive training programs for clinicians to alleviate fears and educate them on treatment options.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
A NATIONAL SURVEY OF FAMILY PHYSICIANSPERSPECTIVES ON COLLA.docxransayo
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and family therapy (MFT),
members of both fields have made significant advances in collaborative health research
and practice. To add to this work, we surveyed a nationwide random sample of 240 family
physicians (FPs) and asked about their perspectives and experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their patients to receive MFT-
related care, but their referral to and collaboration with MFTs were limited. Through
responses to an open-ended question, we gained valuable information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing integrative, collaborative
healthcare, we know little about how commonly family physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our knowledge, there have been
no studies published from the perspective of the FP that describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware of MFT as a field, their per-
ceived need for their patients to receive MFT, or their attitude toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated that more than 60% of patient
visits to primary care physicians (PCPs) include mental health concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint (Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986; Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other researchers and practitioners have
written books that serve as a guide to other mental health practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn et al., 1996).
The specialty of family medicine, which arose in the 1960s, embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of caring for the whole person
within his or her family, social context, and life cycle stage (Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat their patients’ mental health
problems. By definition of their specialty, FPs are trained to integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et al., 1996) as well as to manage
Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle, Maine; Deanna Linville, PhD, Couples and
Family Therapy .
This document provides an overview of medical family therapy, which integrates mind, body, and family in treating illness. It discusses the biopsychosocial framework, collaborative treatment model, and scope of medical family therapy. The document also presents a case study example and discusses applications of medical family therapy, such as personal development and family interventions.
Barriers to Practice and Impact on CareAn Analysis of the P.docxrosemaryralphs52525
This document summarizes barriers to practice for psychiatric mental health nurse practitioners (PMHNPs) in New York State. It discusses how statutory collaborative agreements requiring oversight from psychiatrists disrupt continuity of care for patients and limit PMHNPs' autonomous practice. National statistics show a significant need for more mental healthcare providers. While PMHNPs are well-positioned to address this need, barriers like restrictive regulations prevent them from doing so. The document calls for reforms to expand PMHNPs' scope of practice and reduce barriers that impede access to mental healthcare.
The document discusses barriers to interpersonal communication, including language barriers, cultural medical mistrust, psychological barriers, and differing cultural beliefs that can affect communication. It also describes the procedures used in a physical exam, such as inspection, percussion, palpation, auscultation, and manipulation. Finally, it explains the SOAP method for documenting patient data, where subjective data comes from the patient, objective data from observations and exams, assessment is the provider's analysis, and planning is the treatment plan.
Association of an Educational Program in Mindful Communication With Burnout, ...DAVID MALAM
This document summarizes a study that evaluated the effectiveness of an educational program in mindful communication for primary care physicians. The program included mindfulness meditation, narrative exercises, and appreciative inquiry techniques. It was associated with short-term and sustained improvements in physician well-being, burnout, empathy, mood, and personality factors related to patient-centered care. However, the before-and-after study design limits conclusions about the causal effects of the intervention. Randomized trials with larger and more diverse groups of physicians are needed to validate these preliminary findings.
MayJune 2021 Volume 39 Number 3 111Nursing Economic$AbramMartino96
May/June 2021 | Volume 39 Number 3 111
Nursing Economic$
Developing a well-prepared and geographically
distributed mental health
workforce is a crucial goal of
healthcare workforce planning
initiatives and contributes to
health systems’ ability to
improve population health
(Beck et al., 2020). Before the
SARS COV-2 global pandemic,
sharp increases in suicide,
substance abuse, opioid crises,
gun violence, and severe
depression among young
people were increasing
demands on mental and
behavioral health professionals,
including nurses (Substance
Abuse and Mental Health
Services Administration, 2020).
However, the growing demand
for behavioral health services,
let alone treating the 44 million
American adults who have a
diagnosable mental health
condition, is being met by a
potential shortage of
professionals, which the Health
Resources and Services
Administration (2016) projects
will worsen to as many as
250,000 workers by 2025.
Access to mental health care is
crucial given the societal
upheaval brought about by the
SARS COV-2 global pandemic.
To address the growing
demand for mental health
services, many communities and
healthcare systems are exploring
novel ways to integrate mental
health treatment into primary
care delivery, for example, using
the Collaborative Care Model
(Vanderlip et al., 2016). Nurses
often contact people living with
mental or behavioral health
conditions while being treated
for physical and medical
conditions in both community
and hospital settings. A recent
focus on mental health care,
particularly in outpatient
settings, has been an emphasis
in team-based models,
telehealth, and integration of
mental health and primary care
with contributions from
physicians, nurses, social
workers, peer support, and
community health workers – all
of which can be beneficial
relative to more traditional and
often siloed models of mental
health treatment (Reiss-Brennan
et al., 2016).
Characteristics of Registered Nurses
and Nurse Practitioners Providing
Outpatient Mental Health Care
David I. Auerbach
Max C. Yates
Douglas O. Staiger
Peter I. Buerhaus
The growing demand for mental
health services, together with
current and increasing shortages
of mental health professionals
and increasing adoption of
integrated models of care
delivery, suggest nurses will
become increasingly needed to
provide mental health services.
Analysis of a national survey
finds registered nurses and
nurse practitioners working in
outpatient mental health settings
are older than those in other
settings. Most would benefit
from additional training. Provision
of team-based care was
associated with higher job
satisfaction.
May/June 2021 | Volume 39 Number 3112
The growing demand for
mental health services, together
with current and increasing
shortages of mental health
professionals and increasing
adoption of integrated models
of care delivery, suggest nurses
will b ...
Borderline Personalities; The Impact Of Clinician Bias & Education Shortf...StefanieMarshall
The document summarizes a literature review on stigma and biases among clinicians toward patients with borderline personality disorder (BPD). It discusses two main themes: biases among clinicians prevent adequate treatment for BPD patients, and lack of education and training for clinicians perpetuates misunderstanding of the disorder. The review assessed papers documenting clinician stigma and lack of treatment and resources for BPD patients. It recommends developing comprehensive training programs for clinicians to alleviate fears and educate them on treatment options.
An Interprofessional Approach to Substance Abuse in Primary CareASAMPUBS
An integrated model of treatment improves care by recognizing that patients need clear and consistent care from their primary care provider “in a way that thoroughly considers biological, social, behavioral, and psychological components of their presenting complaint” by integrating psychological, addiction, and other treatments into a cohesive whole.
Week 8 Discussion Response to Classmates.docxwrite5
1. The document provides instructions for students to respond to three classmates' discussion posts about integrated treatment for individuals with co-occurring mental health and substance use disorders.
2. Students are asked to respond separately to each classmate, citing sources to support any claims. They are also provided with a list of required sources to use for their responses.
3. The responses should further the discussion by asking questions, sharing insights, offering opinions, validating ideas with experience, or expanding on the original posts.
1) The document discusses the use of psychosocial interventions (PSI) for patients with severe mental illness, including techniques from cognitive behavioral therapy.
2) It presents a case study of a patient named Andrea who was admitted to an acute psychiatric ward and describes how staff overcame obstacles to engage Andrea and her family using PSI approaches.
3) Key aspects of the PSI used included flexible time for the nurse to build rapport with Andrea, assessing her symptoms and medication side effects, involving her family by addressing needs and devising a crisis plan, and explaining the stress vulnerability model to provide support and communication.
Three key barriers to the diagnosis and treatment of depression in Jordan were identified from focus groups with primary health care providers:
1) Lack of education about depression among providers which hinders proper identification, diagnosis, and treatment.
2) Limited availability of appropriate therapies like counseling services and antidepressant medications at primary care clinics.
3) Social stigma surrounding mental illness that prevents patients from accepting depression diagnoses due to beliefs that it reflects poorly on themselves or their families.
Addressing these barriers through provider education, expanding mental health services, and destigmatizing depression could improve rates of recognizing and treating depression in Jordan's primary care system according to the researchers.
For each of the learning objectives, provide an analysis of how thShainaBoling829
For each of the learning objectives, provide an analysis of how the course supported each objective.
1. Discriminate among the mechanisms of action for the major classes of drugs/medications
2. Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
3. Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
4. Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making
Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.
Provide evidence (citations and references) to support your statements and opinions.
All references and citations should in APA format.
14
Mental Health and Social Work
Shanae Hampton
Cal Baptist University
Introduction
How well a person is able to live a full life, build and maintain relationships and pursue their education, profession or other pursuits requires them to maintain their well-being ranging from physical to mental health. When assisting others to achieve good and self-motivated changes, social workers draw on their relationship-based abilities and emphasize personalization and rehabilitation. A key issue is, "What components and obstacles of an assessment are there in order to reach these outcomes?" When it comes to health promotion and public involvement, social workers are well-suited for this role since primary care is all about these things. Social workers who deal with mental health have unique challenges in assessment, which necessitates them learning and using psychiatric principles. Identifying the need for mental health care requires an understanding of assessment principles.
For this research, the focus is on urban youth's increase in mental health cases which is more influenced by lack of access to mental health care as a result of poverty that affects many children and families in the US. Young people are the most impacted by poverty, accounting for 33% of the total number of individuals in poverty. Children who live in "high risk neighborhoods" are more likely to lack access to the mental health supports they need to manage their symptoms. Stabilization, individual treatment, and symptom management are all important aspects of aftercare for children who have been hospitalized for behavioral difficulties by the time they are six years old (Hodgkinson, 2017).
Literature Review
Inequality based on race and class has been shown to be associated with a variety of negative health outcomes, including poor mental health. Increased financial disparity is associated with an increase in the prevalence of mental illness along a social gradient in mental health. However, psychiatric and psychological approaches have dominated ment ...
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Identifying the support needs of fathers affected bypost-par.docxwilcockiris
Identifying the support needs of fathers affected by
post-partum depression: a pilot study
N . L E T O U R N E A U 1 , 2 , 3 p h d r n , L . D U F F E T T- L E G E R 4 , 5 p h d ( c ) r n ,
C . - L . D E N N I S 6 , 7 p h d , M . S T E WA R T 8 , 9 p h d f r s c f c a h s &
P. D . T RY P H O N O P O U L O S 1 0 b n r n p h d s t u d e n t
1Canada Research Chair in Healthy Child Development, 2Professor, 4CIHR Allied Health Professional Doctoral
Fellow, 5Research Associate, 10Project Director, Faculty of Nursing, and 3Research Fellow, Canadian Research
Institute for Social Policy, University of New Brunswick, Fredericton, NB, and 6Canada Research Chair in
Perinatal Community Health, 7Associate Professor in Nursing and Psychiatry, University of Toronto, Toronto,
ON, and 8Health Senior Scholar, Alberta Heritage Foundation for Medical Research, and 9Professor, Faculty of
Nursing and School of Public Health, University of Alberta, Edmonton, AB, Canada
Keywords: barriers to accessing
support, fathers, men’s mental health,
men’s support needs, pilot study, post-
partum depression
Correspondence:
N. Letourneau
University of New Brunswick
PO Box 4400
Fredericton
NB E3B 5A3
Canada
E-mail: [email protected]
Accepted for publication: 9 August
2010
doi: 10.1111/j.1365-2850.2010.01627.x
Accessible summary
• The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had experienced
post-partum depression (PPD).
• Telephone interviews were conducted with a total of 11 fathers. We interviewed
seven fathers from New Brunswick and four fathers from Alberta.
• The fathers we spoke with experienced a number of depressive symptoms including:
anxiety, lack of time and energy, irritability, feeling sad or down, changes in
appetite, and thoughts of harm to self or baby. The most common barriers to
accessing support included not knowing where to look for PPD resources and
difficulty reaching out to others.
• This study demonstrated the feasibility of a larger-scale exploration of fathers’
experiences in supporting their spouses affected by PPD.
Abstract
The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had post-partum depres-
sion (PPD) in preparation for a larger study. Qualitative methods and community-
based research approaches were used in this exploratory/descriptive multi-site study,
conducted in New Brunswick and Alberta. Telephone interviews were conducted with
a total of 11 fathers in New Brunswick (n = 7) and Alberta (n = 4). Fathers experienced
a number of depressive symptoms including: anxiety, lack of time and energy, irrita-
bility, feeling sad or down, changes in appetite, and thoughts of harm to self or baby.
The most common barriers for fathers were lack of information regarding PPD
resources and difficulty seeking support. This pilot study establishes the fea.
Key Stakeholders in Public Health Issue.docx4934bk
Key stakeholders in a public health issue include those affected by the issue as well as those who can influence or make decisions related to the issue. It is important to identify stakeholders to understand their interests and perspectives which informs policy analysis. Primary care physicians, specialists, and other healthcare providers have an interest in public health issues that impact patient care. Government agencies also have an interest as they are responsible for funding programs and creating regulations and policies. Identifying stakeholders is crucial for conducting a thorough policy analysis.
Running head: SCHIZOPHRENIA 1
Working with Families
1. Effects of a psych educational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia
The article highlights the importance of both family and relatives to support the victim who has schizophrenia. Moreover, the article goes further and highlights the purpose of the study. The article assesses the effectiveness of a family psych educational program in the different outlook and health insights of the relatives of the patient with suffering from schizophrenia. Various programs aid in supporting both the family and relatives to gain more information about the schizophrenia and how they can best offer support to them.
The psych educational program was efficient in adjusting to the caregivers’ outlooks. Nonetheless, the program did not influence the perceptions of healthcare. Moreover, the family and relative psych educational management program transforms the deleterious approaches of both family and relatives to schizophrenia. On the other hand, not all the agenda of this type may advance health difficulties; otherwise, their consequences might only appear in a long-term condition or situation.
The psycho-educational plan gave an enhancement in the outlooks of families to schizophrenia. Besides, this signifies that they have known how to think, feel, and act, in a positive method in regards to the disorder.
Seeing the unfortunate result of the majority of people who have schizophrenia, the process has made it possible for individuals to discover the influence of psych educational programs, which may aid indirectly or directly to advancing the quality and the course of life of these people and their families. Besides, it is vital to evaluate the efficiency of the agendas in diverse cultures and nations.
2. The Mediating Effect of Family Cohesion in Reducing Patient Symptoms and Family Distress in a Culturally Informed Family Therapy for Schizophrenia: A Parallel-Process Latent-Growth Model
The paper examines whether a CIT-S (Culturally Informed Family Therapy for Schizophrenia outdid the usual family psych education (PSY-ED) by not only in reducing patient schizophrenia signs but also in diminishing a person’s DASS. Since CIT-S nurtured family consistency in therapy; moreover, it is anticipated that an increase in family solidity would facilitate the cure effects.
The procedure permitted individual’s to be fixed in latent-change or latent-growth models to check the treatment impacts and guarantee the model fit was sufficient prior to joining them to parallel-procedure models and investigating the secondary outcomes. The latent-change model is assessing the medication influence on family solidity from standard to average, as shown in a Time Treatment Interaction (TTI). The CIT-S team displayed a natural growth of approximately on.
This document discusses holistic treatment for substance abuse. It provides an overview of the history and models of addiction treatment, including the moral, disease, and multi-causal models. Holistic treatment aims to address addiction in all aspects of a person's life through counseling, education, medical care, and lifestyle changes. The Veterans Administration uses holistic treatment including tai chi, yoga, and art/music therapy. Research on holistic treatment models like those used by the VA could help expand treatment options for co-occurring disorders.
This document describes a study that evaluated the effectiveness of a culturally adapted cognitive behavioral therapy (CBT) treatment protocol for Māori clients in New Zealand diagnosed with major depression. The treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. It was administered to 16 Māori clients and resulted in large, significant reductions in depressive symptomatology and negative cognition based on standardized assessments. This was the first study to examine individual psychotherapy outcomes for an indigenous population using an effectiveness design. The findings provide support for culturally adapting psychological treatments for ethnic minority groups.
This document provides a framework for improving collaboration between primary care and mental health services globally. It takes a three-step approach:
1. Identifying mental health services that can be delivered in primary care settings by primary care providers, with or without support from mental health professionals.
2. Outlining ways that effective collaboration can enhance primary mental health care, such as integrating mental health services within primary care settings or coordinating care when services are separate.
3. Examining system changes needed to support new roles and activities, and how collaboration can help address challenges facing all mental health systems.
Reply to the following two posts. In your replies, discuss what su.docxaudeleypearl
Reply to the following two posts. In your replies, discuss what surprised you about the theory your peers wrote about, and how it’s integrated into the study? What other type of research might this theory be useful in?
There is not an amount of words required. Just reply to post 1, and post 2.
FREE OF PLAGIARISM.
Post # 1: Michelle
The article I chose to analyze was “Making a connection: Family experiences with bedside rounds in the intensive care unit. The article examined the experience of families with a loved one in the intensive care unit and whether or not the families' participation in daily rounds decreased their anxiety and increased their overall positive perspective. The theoretical framework utilized by the authors Cody, Sullivan-Bolyai, and Reid-Ponte was the Family Management Style Framework.
The Family Management Style Framework was developed by Knafl and Deatrick in 1990 in order to better understand the coping style of families with children who had chronic health conditions (Knafl & Deatrick, 2003). The FMSF looked at the management behaviors and patterns of response to childhood chronic illness (Knafl & Deatrick, 2003). There are three major components in the FMSF, Definition of the situation, Management behaviors, and Sociocultural context (Knafl & Deatrick, 2003). The framework also describes five family management styles, thriving, accommodating, enduring, struggling and floundering (Knafl & Deatrick, 2003). The relationship between the family members, healthcare professionals, and their coping strategies is the basis for the framework.
The research study used the FMSF to look at which families participated in bedside rounds and which opted not to and the overall result. The framework looks specifically at the intersection of the management of chronic illness and the impact on family life (Knafl, et al., 2012). The finding was that the inclusion and willingness of families to participate in bedside rounds ultimately reduced their fear of the unknown and distrust in the healthcare providers. In the end, the families that attended the bedside rounds were better prepared for their loved one's discharge. The concept of the FMSF was woven throughout the study. The targeted areas of familial response to chronic illness were based on the three identified components of the definition of the situation or illness, management and coping behaviors of the individuals, and the perceived outcomes. The overarching finding of the study was that clear, consistent communication by the healthcare team to the families significantly decreased anxiety, and fear and increased trust in the healthcare professionals. The end result was an improved experience for the family.
King’s theory of Goal Attainment cis another framework that would be effective in this study. King’s theory examines individuals as they relate to personal, interpersonal and social systems (Petiprin, 2016). King noted that human beings function as dy ...
A University-Based Predoctoral Practicum In Pediatric PsychologyYolanda Ivey
The document describes the development of a university-based pediatric psychology practicum program at Purdue University, which provides clinical training experience for graduate students in pediatric settings. The program involves students providing psychological assessments and interventions for patients referred by pediatricians, under supervision of clinical psychologists and a pediatrician instructor. Evaluation found the practicum provides valuable training in pediatric psychology and increases collaboration between psychology and medical professionals.
National Consensus Project Clinical Practice Guidelines Disseminationlsmit132
The document summarizes the 3rd edition of the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines. It was created by a consortium of six palliative care organizations to improve palliative care quality in the US. The guidelines provide recommendations for interdisciplinary palliative care delivery across various clinical domains and settings. The 3rd edition features expanded recommendations regarding palliative care delivery requirements and quality standards based on recent healthcare reforms and evidence.
The document describes a study that analyzed video recordings of standard hospice interdisciplinary team meetings and meetings that included family caregiver participation via videoconferencing (ACTIVE meetings). Standard meetings were shorter and more task-focused, while ACTIVE meetings emphasized biomedical education, relationship-building, and increased socioemotional talk from social workers and chaplains. The inclusion of family caregivers in team meetings via videoconferencing led to longer, more collaborative meetings that addressed psychosocial needs in addition to medical issues.
The document discusses person-centered care in nursing, noting that it focuses on the patient's own experience of their health condition rather than just a medical diagnosis. Person-centeredness has become recognized as important in healthcare, especially nursing, and is embedded in several UK health policy initiatives. Effective communication between nurses and patients, both verbal and non-verbal, can help develop relationships and implement person-centered care, while poor communication can create barriers.
This document provides an overview of the Med-Peds specialty, which involves training and practice in both internal medicine and pediatrics. It discusses the history and development of Med-Peds programs, the residency and training process, practice options, growth potential, and salaries for Med-Peds physicians. The document also examines reasons for choosing Med-Peds and provides results from an O-Net profiler assessment of the author's investigative and social skills that relate to this specialty.
Running Head MUNCHAUSEN SYNDROMEMunchausen SyndromeKr.docxglendar3
This document summarizes a research article about the role of relationships and families in healing from trauma. The article discusses how most trauma treatment focuses on the individual, but trauma is also a relational event that affects close relationships. It argues that systemic protocols addressing interpersonal difficulties in addition to intrapersonal issues are critical for healing. To illustrate, a graphic case study is presented of a family experiencing trauma due to a kidnapping, and how individual versus systemic treatment approaches would differ in addressing their needs.
Running Head MUNCHAUSEN SYNDROMEMunchausen SyndromeKr.docxtodd581
Running Head: MUNCHAUSEN SYNDROME
Munchausen Syndrome
Krystina Joseph
Columbia College
Munchausen Syndrome Article Review
Introduction
The Munchausen Syndrome Article explains about the Munchausen Syndrome, which is a rare fictitious disorder which involves the frequent hospitalization together with an intentional display of signs of sickness and pathological lying. In this regards, the management needs the security history taking with collaboration with the sound clinical processes which entails organicity exclusion in addressing the psychological problems. It is worth noting that a case which is presented having unusual symptoms of same dimensions are as well discussed. The case in this regards brings the finer nuances in the assessment of the entity (Prakash., et al 2014).
Research Question
Based on the abstract of the article, it can be denoted that the research question of the article is the need to understand more on the Munchausen Syndrome as well as the symptoms and therefore the need to ensure that such issues are solved by having a sound clinical process to handle the problem. The problem for the case as well was to find out what caused the 19-year-old housewife to vomit pink substance.
Findings
The findings depict that the 19-year-old housewife was suffering from a factitious disorder, also termed as the Munchausen syndrome. The psychometry performed also showed that there is an elevation of scales of anxiety together with hysteria. Consequently, being managed in an empathetic as well as non-confrontational manner, the psychotherapy was intended to improve the positive coping abilities while at the same time improving the interpersonal relationships which had been imparted (Prakash., et al 2014).
Research Methods Used
The methods used involved observations and clinical assessments. Observations were done by checking regularly the presence of the bloodstained vomits as well as the asthenia and any forms of skin allergy. This was carried out to ensure that the patient had no issues. The observations, as well as little conversation, showed that there were no cases of psychiatric illnesses for the patient in the past. Further, the assessment entails involves the systematic examinations which were performed within the normal limit. The psychiatric evaluation was performed together with ward observations which were intended at revealing the comfortability of the patient while in the hospital (Prakash., et al 2014).
The credibility of the Source of Information
To know the credibility of sources, the authors are scrutinized where their qualifications and their areas of experience assessed to understand whether the information provided is related to the topic at hand. For this article, it can be denoted that all the information provided is credible. This is because all the four authors who contributed to the article have sufficient skills and knowledge pertaining to health-related disorders, and thus, their pieces of information.
The following pairs of co-morbid disorders and a write 700 words .docxssuser454af01
The following pairs of co-morbid disorders and a write 700 words
based on your research:
Depression and substance abuse
Address
the following:
Discuss the general concept of co-morbidity.
Format
your paper consistent with APA guidelines.
.
The following is an access verification technique, listing several f.docxssuser454af01
The following is an access verification technique, listing several files and the access allowed for a single use.
Identify the control technique used here and for each,
explain the type of access allowed
.
a. File_1 R-E-
b. File_12 RWE
c. File_13 RW--
d. File_14 --E-
2.
. The following is an access verification technique, listing several users and the access allowed for File_13.
Identify the control technique used here and for each and
explain the type of access allowed.
Finally, describe who is included in the WORLD category.
a. User_10 --E-
b. User_14 RWED
c. User_17 RWE-
d. WORLD R---
.
More Related Content
Similar to Family Therapy CourseUsing the brief case description below, pre.docx
Week 8 Discussion Response to Classmates.docxwrite5
1. The document provides instructions for students to respond to three classmates' discussion posts about integrated treatment for individuals with co-occurring mental health and substance use disorders.
2. Students are asked to respond separately to each classmate, citing sources to support any claims. They are also provided with a list of required sources to use for their responses.
3. The responses should further the discussion by asking questions, sharing insights, offering opinions, validating ideas with experience, or expanding on the original posts.
1) The document discusses the use of psychosocial interventions (PSI) for patients with severe mental illness, including techniques from cognitive behavioral therapy.
2) It presents a case study of a patient named Andrea who was admitted to an acute psychiatric ward and describes how staff overcame obstacles to engage Andrea and her family using PSI approaches.
3) Key aspects of the PSI used included flexible time for the nurse to build rapport with Andrea, assessing her symptoms and medication side effects, involving her family by addressing needs and devising a crisis plan, and explaining the stress vulnerability model to provide support and communication.
Three key barriers to the diagnosis and treatment of depression in Jordan were identified from focus groups with primary health care providers:
1) Lack of education about depression among providers which hinders proper identification, diagnosis, and treatment.
2) Limited availability of appropriate therapies like counseling services and antidepressant medications at primary care clinics.
3) Social stigma surrounding mental illness that prevents patients from accepting depression diagnoses due to beliefs that it reflects poorly on themselves or their families.
Addressing these barriers through provider education, expanding mental health services, and destigmatizing depression could improve rates of recognizing and treating depression in Jordan's primary care system according to the researchers.
For each of the learning objectives, provide an analysis of how thShainaBoling829
For each of the learning objectives, provide an analysis of how the course supported each objective.
1. Discriminate among the mechanisms of action for the major classes of drugs/medications
2. Critique evidence that supports proposed pharmacotherapeutic protocols for appropriateness of application across the lifespan
3. Integrate the teaching-learning needs of clients across the lifespan when proposing pharmacotherapies
4. Propose prescriptive therapies for selected clients evaluating safety factors while utilizing knowledge of how current health status, age, gender, culture, genetic factors, ethical concerns and prescriptive authority impact decision making
Explain how the material learned in this course, based upon the objectives, will be applicable to professional application.
Provide evidence (citations and references) to support your statements and opinions.
All references and citations should in APA format.
14
Mental Health and Social Work
Shanae Hampton
Cal Baptist University
Introduction
How well a person is able to live a full life, build and maintain relationships and pursue their education, profession or other pursuits requires them to maintain their well-being ranging from physical to mental health. When assisting others to achieve good and self-motivated changes, social workers draw on their relationship-based abilities and emphasize personalization and rehabilitation. A key issue is, "What components and obstacles of an assessment are there in order to reach these outcomes?" When it comes to health promotion and public involvement, social workers are well-suited for this role since primary care is all about these things. Social workers who deal with mental health have unique challenges in assessment, which necessitates them learning and using psychiatric principles. Identifying the need for mental health care requires an understanding of assessment principles.
For this research, the focus is on urban youth's increase in mental health cases which is more influenced by lack of access to mental health care as a result of poverty that affects many children and families in the US. Young people are the most impacted by poverty, accounting for 33% of the total number of individuals in poverty. Children who live in "high risk neighborhoods" are more likely to lack access to the mental health supports they need to manage their symptoms. Stabilization, individual treatment, and symptom management are all important aspects of aftercare for children who have been hospitalized for behavioral difficulties by the time they are six years old (Hodgkinson, 2017).
Literature Review
Inequality based on race and class has been shown to be associated with a variety of negative health outcomes, including poor mental health. Increased financial disparity is associated with an increase in the prevalence of mental illness along a social gradient in mental health. However, psychiatric and psychological approaches have dominated ment ...
Coping Strategies Among Caregivers Of Patients With Schizophrenia: A Descript...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Identifying the support needs of fathers affected bypost-par.docxwilcockiris
Identifying the support needs of fathers affected by
post-partum depression: a pilot study
N . L E T O U R N E A U 1 , 2 , 3 p h d r n , L . D U F F E T T- L E G E R 4 , 5 p h d ( c ) r n ,
C . - L . D E N N I S 6 , 7 p h d , M . S T E WA R T 8 , 9 p h d f r s c f c a h s &
P. D . T RY P H O N O P O U L O S 1 0 b n r n p h d s t u d e n t
1Canada Research Chair in Healthy Child Development, 2Professor, 4CIHR Allied Health Professional Doctoral
Fellow, 5Research Associate, 10Project Director, Faculty of Nursing, and 3Research Fellow, Canadian Research
Institute for Social Policy, University of New Brunswick, Fredericton, NB, and 6Canada Research Chair in
Perinatal Community Health, 7Associate Professor in Nursing and Psychiatry, University of Toronto, Toronto,
ON, and 8Health Senior Scholar, Alberta Heritage Foundation for Medical Research, and 9Professor, Faculty of
Nursing and School of Public Health, University of Alberta, Edmonton, AB, Canada
Keywords: barriers to accessing
support, fathers, men’s mental health,
men’s support needs, pilot study, post-
partum depression
Correspondence:
N. Letourneau
University of New Brunswick
PO Box 4400
Fredericton
NB E3B 5A3
Canada
E-mail: [email protected]
Accepted for publication: 9 August
2010
doi: 10.1111/j.1365-2850.2010.01627.x
Accessible summary
• The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had experienced
post-partum depression (PPD).
• Telephone interviews were conducted with a total of 11 fathers. We interviewed
seven fathers from New Brunswick and four fathers from Alberta.
• The fathers we spoke with experienced a number of depressive symptoms including:
anxiety, lack of time and energy, irritability, feeling sad or down, changes in
appetite, and thoughts of harm to self or baby. The most common barriers to
accessing support included not knowing where to look for PPD resources and
difficulty reaching out to others.
• This study demonstrated the feasibility of a larger-scale exploration of fathers’
experiences in supporting their spouses affected by PPD.
Abstract
The purpose of this pilot study was to describe the experiences, support needs,
resources, and barriers to support for fathers whose partners had post-partum depres-
sion (PPD) in preparation for a larger study. Qualitative methods and community-
based research approaches were used in this exploratory/descriptive multi-site study,
conducted in New Brunswick and Alberta. Telephone interviews were conducted with
a total of 11 fathers in New Brunswick (n = 7) and Alberta (n = 4). Fathers experienced
a number of depressive symptoms including: anxiety, lack of time and energy, irrita-
bility, feeling sad or down, changes in appetite, and thoughts of harm to self or baby.
The most common barriers for fathers were lack of information regarding PPD
resources and difficulty seeking support. This pilot study establishes the fea.
Key Stakeholders in Public Health Issue.docx4934bk
Key stakeholders in a public health issue include those affected by the issue as well as those who can influence or make decisions related to the issue. It is important to identify stakeholders to understand their interests and perspectives which informs policy analysis. Primary care physicians, specialists, and other healthcare providers have an interest in public health issues that impact patient care. Government agencies also have an interest as they are responsible for funding programs and creating regulations and policies. Identifying stakeholders is crucial for conducting a thorough policy analysis.
Running head: SCHIZOPHRENIA 1
Working with Families
1. Effects of a psych educational intervention program on the attitudes and health perceptions of relatives of patients with schizophrenia
The article highlights the importance of both family and relatives to support the victim who has schizophrenia. Moreover, the article goes further and highlights the purpose of the study. The article assesses the effectiveness of a family psych educational program in the different outlook and health insights of the relatives of the patient with suffering from schizophrenia. Various programs aid in supporting both the family and relatives to gain more information about the schizophrenia and how they can best offer support to them.
The psych educational program was efficient in adjusting to the caregivers’ outlooks. Nonetheless, the program did not influence the perceptions of healthcare. Moreover, the family and relative psych educational management program transforms the deleterious approaches of both family and relatives to schizophrenia. On the other hand, not all the agenda of this type may advance health difficulties; otherwise, their consequences might only appear in a long-term condition or situation.
The psycho-educational plan gave an enhancement in the outlooks of families to schizophrenia. Besides, this signifies that they have known how to think, feel, and act, in a positive method in regards to the disorder.
Seeing the unfortunate result of the majority of people who have schizophrenia, the process has made it possible for individuals to discover the influence of psych educational programs, which may aid indirectly or directly to advancing the quality and the course of life of these people and their families. Besides, it is vital to evaluate the efficiency of the agendas in diverse cultures and nations.
2. The Mediating Effect of Family Cohesion in Reducing Patient Symptoms and Family Distress in a Culturally Informed Family Therapy for Schizophrenia: A Parallel-Process Latent-Growth Model
The paper examines whether a CIT-S (Culturally Informed Family Therapy for Schizophrenia outdid the usual family psych education (PSY-ED) by not only in reducing patient schizophrenia signs but also in diminishing a person’s DASS. Since CIT-S nurtured family consistency in therapy; moreover, it is anticipated that an increase in family solidity would facilitate the cure effects.
The procedure permitted individual’s to be fixed in latent-change or latent-growth models to check the treatment impacts and guarantee the model fit was sufficient prior to joining them to parallel-procedure models and investigating the secondary outcomes. The latent-change model is assessing the medication influence on family solidity from standard to average, as shown in a Time Treatment Interaction (TTI). The CIT-S team displayed a natural growth of approximately on.
This document discusses holistic treatment for substance abuse. It provides an overview of the history and models of addiction treatment, including the moral, disease, and multi-causal models. Holistic treatment aims to address addiction in all aspects of a person's life through counseling, education, medical care, and lifestyle changes. The Veterans Administration uses holistic treatment including tai chi, yoga, and art/music therapy. Research on holistic treatment models like those used by the VA could help expand treatment options for co-occurring disorders.
This document describes a study that evaluated the effectiveness of a culturally adapted cognitive behavioral therapy (CBT) treatment protocol for Māori clients in New Zealand diagnosed with major depression. The treatment incorporated Māori processes for engagement, spirituality, family involvement and metaphor. It was administered to 16 Māori clients and resulted in large, significant reductions in depressive symptomatology and negative cognition based on standardized assessments. This was the first study to examine individual psychotherapy outcomes for an indigenous population using an effectiveness design. The findings provide support for culturally adapting psychological treatments for ethnic minority groups.
This document provides a framework for improving collaboration between primary care and mental health services globally. It takes a three-step approach:
1. Identifying mental health services that can be delivered in primary care settings by primary care providers, with or without support from mental health professionals.
2. Outlining ways that effective collaboration can enhance primary mental health care, such as integrating mental health services within primary care settings or coordinating care when services are separate.
3. Examining system changes needed to support new roles and activities, and how collaboration can help address challenges facing all mental health systems.
Reply to the following two posts. In your replies, discuss what su.docxaudeleypearl
Reply to the following two posts. In your replies, discuss what surprised you about the theory your peers wrote about, and how it’s integrated into the study? What other type of research might this theory be useful in?
There is not an amount of words required. Just reply to post 1, and post 2.
FREE OF PLAGIARISM.
Post # 1: Michelle
The article I chose to analyze was “Making a connection: Family experiences with bedside rounds in the intensive care unit. The article examined the experience of families with a loved one in the intensive care unit and whether or not the families' participation in daily rounds decreased their anxiety and increased their overall positive perspective. The theoretical framework utilized by the authors Cody, Sullivan-Bolyai, and Reid-Ponte was the Family Management Style Framework.
The Family Management Style Framework was developed by Knafl and Deatrick in 1990 in order to better understand the coping style of families with children who had chronic health conditions (Knafl & Deatrick, 2003). The FMSF looked at the management behaviors and patterns of response to childhood chronic illness (Knafl & Deatrick, 2003). There are three major components in the FMSF, Definition of the situation, Management behaviors, and Sociocultural context (Knafl & Deatrick, 2003). The framework also describes five family management styles, thriving, accommodating, enduring, struggling and floundering (Knafl & Deatrick, 2003). The relationship between the family members, healthcare professionals, and their coping strategies is the basis for the framework.
The research study used the FMSF to look at which families participated in bedside rounds and which opted not to and the overall result. The framework looks specifically at the intersection of the management of chronic illness and the impact on family life (Knafl, et al., 2012). The finding was that the inclusion and willingness of families to participate in bedside rounds ultimately reduced their fear of the unknown and distrust in the healthcare providers. In the end, the families that attended the bedside rounds were better prepared for their loved one's discharge. The concept of the FMSF was woven throughout the study. The targeted areas of familial response to chronic illness were based on the three identified components of the definition of the situation or illness, management and coping behaviors of the individuals, and the perceived outcomes. The overarching finding of the study was that clear, consistent communication by the healthcare team to the families significantly decreased anxiety, and fear and increased trust in the healthcare professionals. The end result was an improved experience for the family.
King’s theory of Goal Attainment cis another framework that would be effective in this study. King’s theory examines individuals as they relate to personal, interpersonal and social systems (Petiprin, 2016). King noted that human beings function as dy ...
A University-Based Predoctoral Practicum In Pediatric PsychologyYolanda Ivey
The document describes the development of a university-based pediatric psychology practicum program at Purdue University, which provides clinical training experience for graduate students in pediatric settings. The program involves students providing psychological assessments and interventions for patients referred by pediatricians, under supervision of clinical psychologists and a pediatrician instructor. Evaluation found the practicum provides valuable training in pediatric psychology and increases collaboration between psychology and medical professionals.
National Consensus Project Clinical Practice Guidelines Disseminationlsmit132
The document summarizes the 3rd edition of the National Consensus Project for Quality Palliative Care Clinical Practice Guidelines. It was created by a consortium of six palliative care organizations to improve palliative care quality in the US. The guidelines provide recommendations for interdisciplinary palliative care delivery across various clinical domains and settings. The 3rd edition features expanded recommendations regarding palliative care delivery requirements and quality standards based on recent healthcare reforms and evidence.
The document describes a study that analyzed video recordings of standard hospice interdisciplinary team meetings and meetings that included family caregiver participation via videoconferencing (ACTIVE meetings). Standard meetings were shorter and more task-focused, while ACTIVE meetings emphasized biomedical education, relationship-building, and increased socioemotional talk from social workers and chaplains. The inclusion of family caregivers in team meetings via videoconferencing led to longer, more collaborative meetings that addressed psychosocial needs in addition to medical issues.
The document discusses person-centered care in nursing, noting that it focuses on the patient's own experience of their health condition rather than just a medical diagnosis. Person-centeredness has become recognized as important in healthcare, especially nursing, and is embedded in several UK health policy initiatives. Effective communication between nurses and patients, both verbal and non-verbal, can help develop relationships and implement person-centered care, while poor communication can create barriers.
This document provides an overview of the Med-Peds specialty, which involves training and practice in both internal medicine and pediatrics. It discusses the history and development of Med-Peds programs, the residency and training process, practice options, growth potential, and salaries for Med-Peds physicians. The document also examines reasons for choosing Med-Peds and provides results from an O-Net profiler assessment of the author's investigative and social skills that relate to this specialty.
Running Head MUNCHAUSEN SYNDROMEMunchausen SyndromeKr.docxglendar3
This document summarizes a research article about the role of relationships and families in healing from trauma. The article discusses how most trauma treatment focuses on the individual, but trauma is also a relational event that affects close relationships. It argues that systemic protocols addressing interpersonal difficulties in addition to intrapersonal issues are critical for healing. To illustrate, a graphic case study is presented of a family experiencing trauma due to a kidnapping, and how individual versus systemic treatment approaches would differ in addressing their needs.
Running Head MUNCHAUSEN SYNDROMEMunchausen SyndromeKr.docxtodd581
Running Head: MUNCHAUSEN SYNDROME
Munchausen Syndrome
Krystina Joseph
Columbia College
Munchausen Syndrome Article Review
Introduction
The Munchausen Syndrome Article explains about the Munchausen Syndrome, which is a rare fictitious disorder which involves the frequent hospitalization together with an intentional display of signs of sickness and pathological lying. In this regards, the management needs the security history taking with collaboration with the sound clinical processes which entails organicity exclusion in addressing the psychological problems. It is worth noting that a case which is presented having unusual symptoms of same dimensions are as well discussed. The case in this regards brings the finer nuances in the assessment of the entity (Prakash., et al 2014).
Research Question
Based on the abstract of the article, it can be denoted that the research question of the article is the need to understand more on the Munchausen Syndrome as well as the symptoms and therefore the need to ensure that such issues are solved by having a sound clinical process to handle the problem. The problem for the case as well was to find out what caused the 19-year-old housewife to vomit pink substance.
Findings
The findings depict that the 19-year-old housewife was suffering from a factitious disorder, also termed as the Munchausen syndrome. The psychometry performed also showed that there is an elevation of scales of anxiety together with hysteria. Consequently, being managed in an empathetic as well as non-confrontational manner, the psychotherapy was intended to improve the positive coping abilities while at the same time improving the interpersonal relationships which had been imparted (Prakash., et al 2014).
Research Methods Used
The methods used involved observations and clinical assessments. Observations were done by checking regularly the presence of the bloodstained vomits as well as the asthenia and any forms of skin allergy. This was carried out to ensure that the patient had no issues. The observations, as well as little conversation, showed that there were no cases of psychiatric illnesses for the patient in the past. Further, the assessment entails involves the systematic examinations which were performed within the normal limit. The psychiatric evaluation was performed together with ward observations which were intended at revealing the comfortability of the patient while in the hospital (Prakash., et al 2014).
The credibility of the Source of Information
To know the credibility of sources, the authors are scrutinized where their qualifications and their areas of experience assessed to understand whether the information provided is related to the topic at hand. For this article, it can be denoted that all the information provided is credible. This is because all the four authors who contributed to the article have sufficient skills and knowledge pertaining to health-related disorders, and thus, their pieces of information.
Similar to Family Therapy CourseUsing the brief case description below, pre.docx (20)
The following pairs of co-morbid disorders and a write 700 words .docxssuser454af01
The following pairs of co-morbid disorders and a write 700 words
based on your research:
Depression and substance abuse
Address
the following:
Discuss the general concept of co-morbidity.
Format
your paper consistent with APA guidelines.
.
The following is an access verification technique, listing several f.docxssuser454af01
The following is an access verification technique, listing several files and the access allowed for a single use.
Identify the control technique used here and for each,
explain the type of access allowed
.
a. File_1 R-E-
b. File_12 RWE
c. File_13 RW--
d. File_14 --E-
2.
. The following is an access verification technique, listing several users and the access allowed for File_13.
Identify the control technique used here and for each and
explain the type of access allowed.
Finally, describe who is included in the WORLD category.
a. User_10 --E-
b. User_14 RWED
c. User_17 RWE-
d. WORLD R---
.
The following discussion board post has to have a response. Please r.docxssuser454af01
The following discussion board post has to have a response. Please read the post and respond back according to the instructions attached below. Make sure to respond as instructed. Check attachment for response instruction and respond accordingly.
The instructions for the response to post is attached and highlighted.
The due date is Tuesday 5/10/2021 by 11:59 a.m. NO LATE WORK WILL BE ACCEPTED!
.
The following information has been taken from the ledger accounts of.docxssuser454af01
The following information has been taken from the ledger accounts of Isaac Stern Corporation
Total Income since incorporation$317,000
Total Cash Dividends pai d60,000
Total value of stock dividends distributed30,000
Gains on treasury stock transactions18,000
Unamortized discount of bonds payable32,000
Directions: Determine the current balance of retained earnings
.
The following attach files are my History Homewrok and Lecture Power.docxssuser454af01
The following attach files are my History Homewrok and Lecture Power Point. Please answer those questions by your own words and read the instructions carefully beofer you start writing.
Course Information:
In this course we will survey the history of technological developments from the Renaissance to the current day. We will focus on a series of technological objects—machines, tools, and systems—considering them in their broader historical (social, cultural, and political) contexts. Organized chronologically we will trace this history beginning with Leonardo Da Vinci and ending with the International Space Station. This is not, however, a teleological assessment, which assumes a progressive improvement of technology—each age has merits in its own rights.
.
The following is adapted from the work of Paul Martin Lester.In .docxssuser454af01
The following is adapted from the work of Paul Martin Lester.
In order to find meaning from a visual message, you need to learn a systematic way for studying images.
1.
Make an inventory list of every element in the image,
2.
Note the lighting used in the image,
3.
Note any eye contact by subjects in the image,
4.
Note the visual cues of color, form, depth, and movement,
5.
Note how the gestalt laws apply toward the composition of picture,
6.
Note any semiotic signs that are a part of the image's content, and
When you've gone through the six steps noted above, it's time to apply the six perspectives for visual analysis to the piece. Each perspective is noted below.
Personal Perspective - Gut Reaction
Rick Williams' Omniphasism (all in balance) or Personal Impact Analysis
1.
What is the picture's story?
2.
List primary words.
3.
List associative words.
4.
Select most significant associative words.
5.
Pair up primary & most significant associative words.
6.
Relate word pairs with your own feelings.
7.
Relate any inner symbolism.
8.
Write a brief story concerning personal insights.
Historical Perspective - The image's place in history
When do you think the image was made?
Is there a specific style that the image imitates?
Technical Perspective - Consider the process decisions
How was the image produced?
What techniques were employed?
Is the image of good quality?
Ethical Perspective - Moral Responsibility
Was the image maker socially responsible?
Has any person's rights been violated?
Are the needs of viewers met?
Is the picture aesthetically appealing?
Do the picture choices reflect moderation?
Is the image maker empathetic with the subject?
Can all the image choices be justified?
Does the visual message cause unjustified harm?
Cultural Perspective - Societal Impact
What is the story and the symbolism involved with the elements in the visual message?
What do they say about current cultural values?
Critical Perspective - Reasoned Opinion
What do I think of this image now that I've spent so much time looking and studying it?
Project Overview:
This week, you were introduced to six analytical perspectives for analyzing media. These perspectives form the foundation for your Media Analysis Project (MAP). Over the next three weeks, you will analyze a visual work from any media (print, film, television, Internet), of your own choosing.
Due Date:
June 5
Time Line:
·
Topic Assignment (Listed under Paper Topic)
·
June 5 Thesis and Outline (Listed in appropriate headings below)
·
June 5 Final Paper
NOTE: Thesis and Outline, and Final Paper are two separate documents.
Requirements:
Your analysis must encompass all six perspectives. This will be a detailed analysis consisting of 6-8 written pages. You must also use four credible academic sources in addition to the media itself. All sources must be cited in-text as well as on a reference page using standard APA format. Information on using .
The following article is related to deterring employee fraud within .docxssuser454af01
The document summarizes key findings from a report on occupational fraud. It finds that while asset misappropriation is most common, fraudulent financial statements cause the highest losses. Small businesses are most vulnerable due to lack of audits and controls. Establishing anonymous hotlines is the most effective way to reduce fraud losses, more so than audits. Fraud by executives results in highest losses and is best detected through tips rather than controls.
The Five stages of ChangeBy Thursday, June 25, 2015, respond to .docxssuser454af01
The Five stages of Change
By Thursday, June 25, 2015, respond to the discussion.
Discussion Question
Anthony is a 27 year old heterosexual Caucasian male. He was arrested 2 weeks ago for his second DWI and is facing a license suspension. He works as a delivery driver for a local store and after disclosing the arrest to his employer, as well as the consequences including loss of his license, he was terminated.
Anthony lives with his girlfriend of 3 years and their 2 year old son. Anthony’s drinking behavior has increased to consumption of a case of beer on Saturday and Sunday evenings each week. He consumes several beers after work during the week “to maintain.” He has also been using methamphetamines, specifically “crystal meth” several times weekly. Anthony’s girlfriend ended their relationship as a result of his increasing substance use and ongoing difficulties. Anthony feels depressed and anxious about his current life situation, especially now that he realizes that he has no job and may be homeless because of his substance use. He is also feeling down about the loss of his relationship. He researched a few outpatient treatment programs to help him stop using both alcohol and methamphetamines, but is ambivalent about entering treatment. Anthony has considered the need to stop using substances to improve his life and relationships with significant others, though fears that he will lose his friends and miss partying with them if he stops. He also fears what life will be like without the comfort of getting high.
Consider and discuss the 5 stages of change. Based upon the information provided discuss what stage Anthony is in, and provide a rationale for your decision. Next, discuss the other stages of change and what indicators we might see as Anthony progresses on through these stages. Your posting must be a minimum of 500 words.
.
The first step in understanding the behaviors that are associated wi.docxssuser454af01
The first step in understanding the behaviors that are associated with mental disorders is to be able to differentiate the potential symptoms of a mental disorder from the everyday fluctuations or behaviors that we observe. Read the following brief case histories.
Case Study 1:
Bob is a very intelligent, 25-year-old member of a religious organization based on Buddhism. Bob’s working for this organization has caused considerable conflict between him and his parents, who are devout Baptists. Recently, Bob has experienced acute spells of nausea and fatigue that have prevented him from working and have forced him to return home to live with his parents. Various medical tests are being conducted, but as yet, no physical causes for his problems have been found.
Case Study 2:
Mary is a 30-year-old musician who is very dedicated and successful in her work as a teacher in a local high school and as a part-time member of local musical groups. Since her marriage five years ago, which ended in divorce after six months, she has dated very few men. She often worries about her time running out for establishing a good relationship with a man, getting married, and raising a family. Her friends tell her she gets way too anxious around men, and, in general, she needs to relax a little.
Case Study 3:
Jim was vice-president of the freshmen class at a local college and played on the school’s football team. Later that year, he dropped out of these activities and gradually became more and more withdrawn from friends and family. Neglecting to shave and shower, he began to look dirty and unhealthy. He spent most of his time alone in his room and sometimes complained to his parents that he heard voices in the curtains and in the closet. In his sophomore year, he dropped out of school entirely. With increasing anxiety and agitation, he began to worry that the Nazis were plotting to kill his family and kidnap him.
Case Study 4:
Larry, a 37-year-old gay man, has lived for three years with his partner, whom he met in graduate school. Larry works as a psychologist in a large hospital. Although competent in his work, he often feels strained by the pressures of his demanding position. An added source of tension on the job is his not being out with his co-workers, and, thus, he is not able to confide in anyone or talk about his private life. Most of his leisure activities are with good friends who are also part of the local gay community.
For each case, identify the individual's behaviors that seem to be problematic for the patient.
For each case study, explain from the biological, psychological, or socio-cultural perspective your decision-making process for identifying the behaviors that may or may not have been associated with the symptoms of a mental disorder.
Based on your course and text readings, provide an explanation why you would consider some of these cases to exhibit behaviors that may be associated with problems that occur in everyday life, while others could be as.
The first one is due Sep 24 at 1100AMthe French-born Mexican jo.docxssuser454af01
Elena Poniatowska, a French-born Mexican journalist and author, will give a public lecture called "We Can All Be Writers" at ASU on September 24th. Students can receive extra credit by attending the full event and submitting a 250-word rhetorical analysis that identifies one thing the speaker did well and one thing not done well in reaching her audience.
On September 25th, fiction writer and poet Matt Bell will read from and discuss his work at ASU. Extra credit can be received by attending the full event and submitting a 250-word report and 500-word personal reflection on what was learned, anything surprising, and how something related to the student's personal experiences or writing.
The first part is a direct quote, copied word for word. Includ.docxssuser454af01
The
first part
is a
direct quote, copied word for word. Include the author's last name and the page number of the quote in parantheses. MLA format.
The
second part
of the journal entry, is
one paragraph that explains why you found the passage to be important
.
.
The final research paper should be no less than 15 pages and in APA .docxssuser454af01
The final research paper must be at least 15 pages long, not including the references page, follow APA format, and include visual elements like charts or pictures to support the study. Students will submit their papers through the eCourse website where a link for submissions will be provided.
The first one Description Pick a physical activity. Somethi.docxssuser454af01
The first one
Description: Pick a
physical activity
. Something you do all the time, or something you’ve never done before: bike riding, running, swimming, hiking, golf, playing twister, roller skating, soccer, basketball, etc. Now go and spend at least twenty minutes participating in this activity. Really do it. Engage. Explore and experience it. Pay attention to every part of your body and mind as you play/do the activity. Even if you’ve done it all your life, engage with every nuance of the activity. What do your muscles do and feel like when doing the activity? What is challenging? What is smooth and easy? What sounds to you experience? smells? Tastes? Sights? Sensations? What about your mind? Where do your thoughts go as you perform the activity? Really pay attention and discover the experience of the activity. Perform it for at least twenty minutes, mindfully paying attention to every part of the experience. Experience and notice the details. Now go home. And write about what you experienced. Detail it. Tell me about what was hard, easy, unusual, fun, new? What did you feel, taste, smell, hear, see? Take me through it beat by beat, moment by moment, nuance by nuance.
The second one
Description: Go to a busy café or diner, or some other eatery, where you can sit near TWO other people, engaged in a conversation, a dynamic interesting conversation with tenstion… where something is happening between the two people… EAVES DROP on conversations – without being obvious. Find one that has something interesting going on. Anticipate spending at least 20-30 minutes listening in to this conversation.
From this conversation, listen carefully, pay attention to what is being said, what conflict is arising, what is expressed and revealed through the language. NOW, also pay attention to the people involved. What do they look like? What is their body language? Pay attention to all the details. Do not write anything at the busy café or diner. Just listen to what is said. Watch. Pay attention to all the details.
At a later time (when you get back home)
write a letter as if you are one of the people you observed in the café. Write the letter addressing the person that they were at the café with. This can be a love letter, a complaint, an email, an apology, an explanation, etc… For this exercise to work, you must have 1) chosen a conversation to listen to where something was HAPPENING and 2) you must really have spent the time, listening in on a conversation and paying attention to the dramatic tension… something between the two people must have been witnessed, heard, experienced, by YOU the writer. If not this letter will be flat, uninteresting, and lacking conflict. Write about something you heard or observed happening between the two people, but write about it as if you are one of the people in the conversation to the other. Write about some inherent need, conflict, obstacles. The letter can be a complaint, an apology, a .
The first column suggests traditional familyschool relationships an.docxssuser454af01
The first column suggests traditional family/school relationships and the second identifies a more collaborative approach. Provide an example of a situation (attendance, behavior problems, academic difficulties) that could arise at school and suggest how this issue may be resolved with a collaborative approach. Respond to at least two of your classmates’ postings.
.
The first president that I actually remembered was Jimmy Carter. .docxssuser454af01
The first president that I actually remembered was Jimmy Carter. I do remember as a child Ford being mentioned, but I was certainly not engaged in his presidency. However, I remember Reagan quite well. He came to office after a major financial down turn and his policies did seem to improve things immediately. Some have said that his actions of borrowing money were a hindrance to the future. Do you feel that Reganomics was beneficial to future generations or did he just borrow from the future in order to benefit his present circumstance? Did this set precedence for future presidents to take the nation into debt in order to help their political careers? I look forward to your thoughts?
.
The final project for this course is the creation of a conceptual mo.docxssuser454af01
The final project for this course is the creation of a conceptual model for an integrated afterschool childhood prevention, education, or intervention program (Boys and Girls Club, for example). The program serves a wide range of age groups (ages 4 through 17) and demographic backgrounds. Students should design a program that can appropriately address the needs of the various learners. This final project should include a program foundation, program description, research proposal, and self-reflection.
The final product represents an authentic demonstration of competency because it requires students to apply classic theory in order to compose an original program based on advanced developmental principles. The project is divided into
four milestones
, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in
Modules Three, Five, Seven, and Ten.
Main Elements
1.
Program Foundation:
a narrative/essay format that will describe the main concept of the program (prevention, education, intervention) and if the program will focus on a specific topic (math, English, drugs, bullying, coping skills for stress or anxiety, peer pressure, or your choice). This foundational narrative will provide citations that link the program concept to at least two of the classical theories presented in this course (Montessori, Piaget, Vygotsky, Bandura, Bronfenbrenner). (approximately 3–4 pages)
·
What type of program will be the focus of this project? Will it be a prevention program to stop kids from using alcohol and drugs? To try and prevent bullying? Will the program be an educational model, for example, a program focused on improving educational outcomes like math, critical thinking, problem solving, science, language skills, or other? Will the program be an intervention model or a program that targets kids for problematic behaviors like truancy, acting out in class, running away, vandalism, minor theft, or underage possession of alcohol or substances?
·
Consider the critical tasks of development as laid out by the chosen theory that may help organize the approaches utilized for each age group.
2.
Program Description
: This section will provide specific descriptions of the elements (tasks, materials, activities) for the each developmental level spanning the age ranges from 4 through 17. These levels should be consistent with at least one of the two classical theories proposed in your program foundation narrative. (approximately 3–4 pages)
·
In what setting will this program be offered, for example, school setting, community center, treatment center, or a faith-based organization?
·
How will your topic differ across each developmental level?
·
How will you describe the activities, materials, and tasks that will take place in the program for each age range?
·
Are the age ranges consistent with at least one of the classic theories employed to guide this.
The finance department of a large corporation has evaluated a possib.docxssuser454af01
The finance department of a large corporation has evaluated a possible capital project using the NPV method, the Payback Method, and the IRR method. The analysts are puzzled, since the NPV indicated rejection, but the IRR and Payback methods both indicated acceptance. Explain why this conflicting situation might occur and what conclusions the analyst should accept, indicating the shortcomings and the advantages of each method. Assuming the data is correct, which method will most likely provide the most accurate decisions and why?
.
The Final Paper must have depth of scholarship, originality, theoret.docxssuser454af01
The document provides guidelines for a final paper assignment. It states that the paper must be 10-15 pages long, follow APA style guidelines, use 8-10 scholarly sources, and address specific topics related to the future of managed health care delivery systems. These topics include managed health care quality, provider contracting, cost containment, effects on Medicare and Medicaid, the future role of government regulations, and three recommendations for quality changes to Medicare and Medicaid plans. The paper must also include an abstract, introduction, conclusion, and separate reference page.
The Final exam primarily covers the areas of the hydrosphere, the bi.docxssuser454af01
The Final exam primarily covers the areas of the hydrosphere, the biosphere and the lithosphere. As in the Midterm, special attention should be paid to the lecture notes and the PowerPoint files, as well as the Discussion Boards. These sections are dependent on the text and the laboratory exercises, but the discussions and the lecture notes are more conducive to explanation and understanding with a essay-driven format. Additionally, the animated PowerPoints are good at achieving an understanding of processes that are in motion, especially when looking at the lithosphere, giving them more of a 3-dimensional quality.
For this final essay exam you are required to answer all five (5) of the questions. Although there is no set word limit for these essay questions, you will be graded on your knowledge of the material and the detail with which you write your answers. You should take care to cite your sources in APA format and provide full references in a Works Cited list.
Describe the paths of water through the hydrologic cycle. Explain the processes and the energy gains and losses involved in the changes of water between its 3 states. Operationally, we often most concerned with water does when it reaches the solid earth, both on the surface and in the sub-surface. Explain the relationship between the saturated zone, the water table, a ground water well and the cone of depression, all within the sub-surface.
The food chain is a valuable concept in biogeography. Give an example of a specific food chain, labeling the various levels of the food chain. After looking at characteristics of food chains, explain how a geographer’s approach to the study of organisms might be different than biologist’s study of organisms; what would each try to emphasize more than the other? What exactly is a biome? Compare/contrast the concept of the biome with that of the zoogeographic region. Compare/contrast the floral characteristics of 2 of the following biomes: Desert, Tundra, Midlatitude Grassland and Boreal Forest.
Theorize the difference in soil development in adjoining soils developed on forested, sloped area versus a grassed flat area. What are the soil-forming factors? Explain the importance of the nature of the parent material to soil formation and type. Then, cite at least 2 examples in which the influence of parent materials might be outweighed by other soil-forming factors. Explain the “struggle” between the internal and external processes in shaping the Earth’s surface. What are the different ways that the surface of the Earth is changed over time?
Describe the general sequence of events in continental drift since the time of 5 separate continents 450 million years ago. What is the difference between the older continental drift theory by Wegener and the more recent plate tectonic theory? Plate tectonics theory explains many seemingly unrelated phenomena. Explain how the patterns of volcanoes and earthquakes related to plate tectonics..
The Final Paper must be 8 pages (not including title and reference p.docxssuser454af01
The Final Paper must be 8 pages (not including title and reference pages) and should demonstrate an understanding of the reading assignments, class discussions, your own research, and the application of new knowledge. It must include citations and references for six to eight sources; one may be the text.
Micozzi, M. S. (2010). Fundamentals of complementary and alternative medicine. (4th ed.). St. Louis, MO: Saunders Elsevier.
At least four must be from the ProQuest, EBSCOhost, or PubMed Central databases in the University Library, and the remaining sources must be from other scholarly or professional Internet resources.
For the Final Paper,
Complementary and alternative medicines >> (
Natural Products)
Provide a brief discussion of the protocols, and provide details of historical events that shaped the practice.
Chronic Pain
Describe the disease or condition from the CAM perspective
Include potential cultural challenges faced by the afflicted patient population as well as the practitioner.
Describe how the CAM (Natural Products) practitioner diagnoses and treats the condition.
Identify potential questions or skepticisms other health care providers and potential clientele may have regarding the CAM selected, and address the questions, supporting your responses with a minimum of two sources of research for the health condition and system chosen.
Identify and substantively describe a minimum of two other CAM practice interventions that could be suggested to assist in minimizing the impact of the illness/condition. Justify implementation of the two interventions you are recommending.
Must begin with an introductory paragraph that has a succinct thesis statement.
Must address the topic of the paper with critical thought.
Must end with a restatement of the thesis and a conclusion paragraph.
Must utilize six to eight sources; one may be the text, at least four must be from the ProQuest, EBSCOhost, or PubMed Central databases, and the remaining sources must be from other scholarly or professional Internet resources.
Must document all sources in APA style.
Must include a separate reference page that is formatted according to APA style.
.
This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
Walmart Business+ and Spark Good for Nonprofits.pdfTechSoup
"Learn about all the ways Walmart supports nonprofit organizations.
You will hear from Liz Willett, the Head of Nonprofits, and hear about what Walmart is doing to help nonprofits, including Walmart Business and Spark Good. Walmart Business+ is a new offer for nonprofits that offers discounts and also streamlines nonprofits order and expense tracking, saving time and money.
The webinar may also give some examples on how nonprofits can best leverage Walmart Business+.
The event will cover the following::
Walmart Business + (https://business.walmart.com/plus) is a new shopping experience for nonprofits, schools, and local business customers that connects an exclusive online shopping experience to stores. Benefits include free delivery and shipping, a 'Spend Analytics” feature, special discounts, deals and tax-exempt shopping.
Special TechSoup offer for a free 180 days membership, and up to $150 in discounts on eligible orders.
Spark Good (walmart.com/sparkgood) is a charitable platform that enables nonprofits to receive donations directly from customers and associates.
Answers about how you can do more with Walmart!"
Main Java[All of the Base Concepts}.docxadhitya5119
This is part 1 of my Java Learning Journey. This Contains Custom methods, classes, constructors, packages, multithreading , try- catch block, finally block and more.
How to Make a Field Mandatory in Odoo 17Celine George
In Odoo, making a field required can be done through both Python code and XML views. When you set the required attribute to True in Python code, it makes the field required across all views where it's used. Conversely, when you set the required attribute in XML views, it makes the field required only in the context of that particular view.
it describes the bony anatomy including the femoral head , acetabulum, labrum . also discusses the capsule , ligaments . muscle that act on the hip joint and the range of motion are outlined. factors affecting hip joint stability and weight transmission through the joint are summarized.
हिंदी वर्णमाला पीपीटी, hindi alphabet PPT presentation, hindi varnamala PPT, Hindi Varnamala pdf, हिंदी स्वर, हिंदी व्यंजन, sikhiye hindi varnmala, dr. mulla adam ali, hindi language and literature, hindi alphabet with drawing, hindi alphabet pdf, hindi varnamala for childrens, hindi language, hindi varnamala practice for kids, https://www.drmullaadamali.com
Gender and Mental Health - Counselling and Family Therapy Applications and In...PsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Gender and Mental Health - Counselling and Family Therapy Applications and In...
Family Therapy CourseUsing the brief case description below, pre.docx
1. Family Therapy Course
Using the brief case description below, prepare a script you
could use to call the mock client’s pediatrician for a 10-minute
conversation. To prepare, consider the following: What facts do
you need to communicate to the doctor? What will the doctor
likely want to know from you? What will you want to be sure to
tell the doctor about your diagnosis of him having ADHD and
treatment plan for family? You diagnose that he should be
placed on medication and pediatricians nurse prescribe the
diagnosis level ----
Case description: Your client is an 8-year-old male whose
parents are concerned might have ADHD. He is the middle child
of three boys. You have met the parents and the child in your
initial sessions. At this point, you have had only three sessions
with the family. Your client says he has lots of friends, he hates
school because it’s boring, and his parents yell at him too
much!
Write a mock transcript of an imaginary phone call between you
and the client’s physician. In your mock discussion, include
information you would provide to the doctor about your
assessment, treatment plan, and orientation to treating ADHD;
include the doctor’s questions or responses to the information
you provide. Also, include questions you would ask the doctor,
and the doctor’s responses.
Transcript Length: 5 pages
A NATIONAL SURVEY OF FAMILY PHYSICIANS:
PERSPECTIVES ON COLLABORATION WITH
MARRIAGE AND FAMILY THERAPISTS
2. Rebecca E. Clark
Lifespan Family Healthcare, Newcastle, Maine
Deanna Linville
University of Oregon
Karen H. Rosen
Virginia Polytechnic Institute and State University
Recognizing the fit between family medicine and marriage and
family therapy (MFT),
members of both fields have made significant advances in
collaborative health research
and practice. To add to this work, we surveyed a nationwide
random sample of 240 family
physicians (FPs) and asked about their perspectives and
experiences of collaboration with
MFTs. We found that FPs frequently perceive a need for their
patients to receive MFT-
related care, but their referral to and collaboration with MFTs
were limited. Through
responses to an open-ended question, we gained valuable
information as to how MFTs
could more effectively initiate collaboration with FPs.
Despite the success of medical family therapists in providing
integrative, collaborative
healthcare, we know little about how commonly family
physicians (FPs) and marriage and fam-
ily therapists (MFTs) collaborate in routine patient care. To our
knowledge, there have been
no studies published from the perspective of the FP that
describe the extent to which FPs seek
the collaboration of MFTs, the degree to which they are aware
of MFT as a field, their per-
3. ceived need for their patients to receive MFT, or their attitude
toward MFT as a potential
resource for patient treatment.
Leaders in family medicine and MFT recognize the common
occurrence of mental health
concerns arising in a medical visit. In fact, it has been estimated
that more than 60% of patient
visits to primary care physicians (PCPs) include mental health
concerns (Moon, 1997), and
many of these concerns may not be the presenting complaint
(Jackson & Tisher, 1996;
Schurman, Kramer, & Mitchell, 1985). Several MFT ⁄ FP teams
have developed models for col-
laboration (Doherty & Baird, 1983; Dym & Berman, 1986;
Hepworth & Jackson, 1985; Sea-
burn, Lorenz, Gunn, Gawinski, & Mauksch, 1996). Other
researchers and practitioners have
written books that serve as a guide to other mental health
practitioners for how to be effective
collaborators with other healthcare practitioners (e.g., Seaburn
et al., 1996).
The specialty of family medicine, which arose in the 1960s,
embraces a systemic, biopsy-
chosocial perspective to illness that stresses the importance of
caring for the whole person
within his or her family, social context, and life cycle stage
(Chung, 1996; Fischetti &
McCutchan, 2002). It is not surprising that FPs regularly treat
their patients’ mental health
problems. By definition of their specialty, FPs are trained to
integrate behavioral science con-
cepts with their biomedical training (AAFP, 2000; Seaburn et
al., 1996) as well as to manage
4. Rebecca E. Clark, MS, Lifespan Family Healthcare, Newcastle,
Maine; Deanna Linville, PhD, Couples and
Family Therapy Program, Department of Counseling Psychology
and Human Services, University of Oregon;
Karen H. Rosen, EdD, Marriage and Family Therapy Program,
Department of Human Development, Virginia
Polytechnic Institute and State University, Northern Virginia
Center.
Address correspondence to Rebecca Clark, Lifespan Family
Healthcare, 80 River Road, Newcastle, Maine
04553; E-mail: [email protected]
Journal of Marital and Family Therapy
April 2009, Vol. 35, No. 2, 220–230
220 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
psychotropic medication. The American Academy of Family
Physicians (AAFP, 2000) recom-
mended curriculum guidelines delineate how family medicine
residents must understand the
individual in the context of his or her family, as well as the
emotional impact of illness, and be
able to evaluate and diagnose mental health disorders from a
biopsychosocial perspective. For
decades, authors in family medicine and collaborative
healthcare journals have published
literature regarding the use of MFT techniques such as family
systems thinking, the use of gen-
5. ograms, meeting with the entire family, brief therapy
techniques, and when to refer patients for
family therapy (Bader, 1990; Bloom & Smith, 2001; Bullock &
Thompson, 1979; Christie-Seely,
1981; Davis, 1988; Frank, 1985; Lang et al., 2002; Mayer et al.,
1996; Tomson & Asen, 1987).
Additionally, organizations such as the Collaborative Family
Healthcare Association (CFHA;
see http://www.cfha.net) and the Society for Teachers of Family
Medicine (STFM; see http://
www.stfm.org) continue to promote research, education, and
practice in collaborative health-
care. Given family medicine’s emphasis on family systems, the
family as the unit of care, and
biopsychosocial perspective, it seems that MFTs would be a
logical, and even sought-after,
complement to FPs in providing comprehensive patient care.
As a specialty of MFT, medical family therapy (MedFT) has
already made significant
advances in this area. Particularly helpful for chronic illness,
MedFT has enabled MFTs to
skillfully integrate the biopsychosocial-spiritual perspective, a
systemic integration of physical
and emotional health, familial ⁄ social relationships, and
spiritual belief systems, with a family
systems framework (McDaniel, Hepworth, & Doherty, 1992a;
Rolland, 1994; Weihs, Fisher, &
Baird, 2002). Specifically trained medical MFTs have
effectively collaborated with medical prac-
titioners to provide care for families struggling with chronic
medical illnesses such as infertility
(Burns, 1999; McDaniel, Hepworth, & Doherty, 1992b), cancer
(Yeager et al., 1999), childhood
asthma and diabetes, cardiovascular and neurological disorders
(Campbell & Patterson, 1995),
6. obesity (Campbell & Patterson, 1995; Flodmark, Ohlsson,
Ryden, & Sveger, 1993), somatoform
disorder (McDaniel, Hepworth, & Doherty, 1995), dual
diagnosis (Harkness & Nofziger, 1998),
and anorexia nervosa (Dare & Eisier, 1995).
Roadblocks to Identifying and Managing Patient Psychosocial
Concerns
There is a range of limitations to the quantity and quality of
psychosocial care FPs can
deliver to their patients. Researchers have identified lack of
training (Christie-Seely, 1981;
Fosson, Elam, & Broaddus, 1982), time (Glied, 1998; Rost,
Humphrey, & Kelleher, 1994;
Tomson & Asen, 1987), patient reluctance (Kainz, 2002;
Williams et al., 1999), managed care
(DeGruy, 1997; Fisher & Ransom, 1997), and lack of
confidence (Gerdes, Yuen, & Frey, 2001;
Williams et al., 1999) as roadblocks to FPs and other PCPs
identifying and treating patient
mental health needs.
Roadblocks to referral. Regardless of to whom they refer,
physicians identify several road-
blocks when referring patients to mental health professionals.
These have included patient
reluctance, the unavailability of appropriate mental health
professionals in rural communities,
lack of affordability of mental health, significant lag time
between referral and appointment
availability, lack of adequate feedback from mental health
professionals, the stigma patients
attach to mental healthcare, and poor communication from the
mental health professional
(Kainz, 2002; Kushner et al., 2001; McCulloch et al., 1998;
7. Reust, Thomlinson, & Lattie, 1999;
Rost et al., 1994; Williams et al., 1999).
The purpose of this exploratory study was to discover FPs’
views of MFTs as potential
collaborators on the healthcare team. Specifically, this study
seeks to answer three research
questions:
(1) Do FPs view MFTs as a resource for patients with
psychosocial needs?
(2) Are FPs interested in collaborating with MFTs?
(3) What would make MFTs more helpful collaborators?
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
221
METHODS
This study was a national survey of 240 FPs. A questionnaire
was mailed to 240 board cer-
tified FPs who were randomly selected from the AAFP
directory. The inclusion criteria were
engagement in the practice of family medicine, graduation from
a U.S. medical school, comple-
tion of residency after 1969, and residence within a U.S. zip
code.
Participants and Procedures
After obtaining IRB approval, a randomly selected mailing list
was obtained from the
AAFP. Questionnaires were mailed along with an introductory
letter describing the study,
8. a brightly colored sticky note with a brief hand-written note,
and a self-addressed stamped
envelope. Each questionnaire was numbered to enable a follow-
up mailing to nonrespondents.
During the first wave, 104 questionnaires were returned. After 4
weeks the same material
was re-mailed to nonrespondents. After two mailings we
received 153 responses, representing
a 64% response rate. Of those responses, 16 questionnaires were
excluded from analyses
because respondents were no longer practicing family medicine
full time. Consequently, there
were a total of 137 usable questionnaires (57%). We received
responses from FPs in 37 out of
42 states as well as an FP in Puerto Rico and a deployed
military FP. Respondents had been
in practice for an average of 12 years and were an average age
of 46. Table 1 depicts demo-
graphic data such as gender and geographical distribution of
respondents. The four major
census regions of the United States as well as U.S. territories
and military were represented in
the sample. Based on the AAFP 2002 census of their members
(AAFP, 2003), the sample
appears representative of both the gender and regional
distribution of FPs throughout the
United States.
Table 1
Demographics
Variable
Percentage
of respondents
9. Percentage
of random
sample
Percentage
of 2002
National
AAFP
Censusa
Region
Northeast 15 13 15
South 35 33 33
Midwest 27 33 28
West 21 20 21
U.S. territory ⁄ Army Post Office 2 2 3
Gender
Male 66 71b
Female 34 29b
Note. n = 137. aMembership (U.S., U.S. Territories, and
Military; AAFP, 2003). bActive
AAFP members (this percentage includes 138 Canadian
members and 350 foreign members
that were not part of the sampled population). AAFP =
American Academy of Family
Physicians.
222 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
The questionnaire, which contained both closed and open-ended
10. questions, was based on a
review of literature and in consultation with MFTs and FPs. In
the development phase, the
questionnaire was administered to five FPs and revised based on
their feedback.
Analysis
Quantitative data analyses were completed using SPSS for
Windows, v10.0 (Norusis, 2000).
Qualitative data were analyzed using a modified version of the
constant comparative method
described by Strauss and Corbin (1990). Each segment of the
written responses to the open-
ended questions was coded independently by both authors to
identify and name major themes.
Once a list of major themes was developed, content analysis
(Patton, 2002) was used to deter-
mine how frequently each theme was mentioned by respondents.
RESULTS
In this section, each research question is addressed in turn.
When qualitative data gene-
rated noteworthy themes, the themes are identified and quotes
provided for illustration.
Do FPs View MFTs as a Resource for Patients With
Psychosocial Needs?
This research question was addressed by five questions on our
questionnaire. Respondents
were asked to estimate the percentage of their patients with
identified psychosocial concerns
who they believed could benefit from marital and ⁄ or family
therapy. Respondents were also
11. asked to estimate their referral practices. On average,
respondents estimated that 48% of their
patients could benefit from marital and ⁄ or family therapy and
that they referred 12% of their
patients for mental health services. However, respondents
estimated that they referred 5% of
their patients specifically for marital and ⁄ or family therapy–
related care. We specified marital
and ⁄ or family therapy–related care rather than MFT because at
that time several states did not
license MFTs (three of the states represented in this survey did
not).
Additionally, respondents were asked to check all that applied
from a list of potential
roadblocks encountered when referring patients for MFT-related
care. As can be seen in
Figure 1, ‘‘Patient reluctance’’ was checked by 85% of the
respondents, ‘‘HMO ⁄ Insurance’’ by
65%, ‘‘unavailability of appropriate therapists’’ by 40%,
‘‘time’’ by 34%, ‘‘lack of awareness of
appropriate therapists’’ by 33%, and ‘‘don’t feel this type of
therapy is helpful’’ by 4%.
Although 24 respondents provided written answers in response
to ‘‘other please specify,’’ no
new categories of roadblocks to referral emerged.
Figure 1. Roadblocks encountered by FPs when referring
patients for marriage and family
therapy–related care (n = 136).
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
223
12. Finally, respondents were asked if they were aware that MFTs
are licensed mental health
professionals ‘‘trained in psychotherapy and family systems and
licensed to diagnose and treat
mental and emotional disorders within the context of marriage,
couples, and family systems.’’
While 83% of respondents checked ‘‘yes’’ to this question, 64%
reported that prior to receiving
our survey they did not recognize the initials ‘‘LMFT’’ as
credentials for a Licensed Marriage
and Family Therapist.
Are FPs Interested in Collaborating With MFTs?
This research question was addressed by five questions on our
questionnaire. Respondents
were asked, ‘‘Have you ever consulted with a mental health
professional regarding a patient
case?’’ All of the respondents checked ‘‘yes’’ to this question.
When respondents were asked
whether or not they had ever consulted with an LMFT regarding
a patient or family, 47% of
the respondents checked ‘‘yes,’’ while 53% of the respondents
indicated they either had not or
were not sure if they had consulted with an LMFT.
Additionally, respondents were given a list of collaborative
modes and asked to check all
that applied to their experience of collaborating with MFTs or
comparable mental health pro-
fessionals in their community. ‘‘Infrequently receive reports’’
was checked by 49% of the FPs,
‘‘phone call ⁄ email with a MFT’’ by 43%, ‘‘informal
consultation with a MFT’’ by 40%, ‘‘no
patient-care contact with MFTs’’ by 20%, ‘‘regularly receive
reports’’ by 19%, and ‘‘regular
13. meetings with MFTs’’ by 3%.
Respondents were asked to describe how helpful they found
patient-care consults with
MFTs. The collaborative interactions with MFTs were indicated
by 82% of the respondents to
be either ‘‘very helpful’’ or ‘‘somewhat helpful.’’ Five percent
checked either ‘‘somewhat
unhelpful’’ or ‘‘very unhelpful,’’ while 12% checked ‘‘not
applicable.’’
Finally, respondents were asked to describe their interests in
collaborating with LMFTs or
comparable mental health professionals when identifying
patients’ psychosocial needs by check-
ing all that applied from a list of collaborative approaches. The
mode of collaboration pre-
ferred by most of the respondents was ‘‘referral out with
continuing collaborative
communication’’ (84%). Some respondents also indicated that
they would be interested in
‘‘inviting a family therapy provider to a patient’s appointment’’
(15%) or ‘‘meeting regularly
with a MFT regarding complex patients’’ (11%). Only 7% of the
respondents indicated they
were ‘‘not interested’’ in collaborating with MFTs.
What Would Make MFTs More Helpful Collaborators?
This research question was addressed by an open-ended
question. Respondents were asked
to ‘‘briefly describe what would make MFT providers a more
helpful resource when treating
patients with psychosocial issues, OR if you don’t consult with
an MFT, why not?’’ Eighty-nine
respondents (65% of sample) answered this question, offering a
14. total of 141 coded responses. A
content analysis produced six primary themes: (a) ideal
collaborative practices, (b) barriers to
referral, (c) MFT specialty awareness, (d) let us know who you
are, (e) barriers to collaboration,
and (f) attitudes toward MFTs. Quotes are included to better
illustrate the themes and
subthemes.
Ideal collaborative practices. Fifty-four responses were coded
as relating to collaborative
practices that would make MFTs more helpful resources. These
included proximity (‘‘I wish I
had a family therapist in my office’’), ease of referral (‘‘Be
available to my patients within
2 weeks of the request’’), collaborative communication (‘‘More
communication after [patient]
evaluation,’’ ‘‘Regular feedback’’), topical ⁄ specialty
information (‘‘Suggestions on what I can do
to help further the therapeutic goals,’’ ‘‘A specialist who could
incorporate issues related
to aging’’), and religious ⁄ faith-based (‘‘Faith-based, a plus!’’
‘‘I would like to work with a
Christian marriage and family therapist’’).
224 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
Barriers to referral. We coded 33 comments as barriers
respondents face when making
referrals to MFTs, including patient reluctance (‘‘Difficulty
convincing patients that therapy can
help them and sometimes even that there is a problem’’),
managed care (‘‘Many patients don’t
15. have mental health coverage,’’ ‘‘I do use other therapists when
driven by insurance’’), do not
know the therapist (‘‘hard to refer when don’t know
therapist’’), and lack of availability (‘‘Ther-
apists not available in my rural area,’’ ‘‘If one were more
readily available, this would be an
excellent resource’’). Only one of the responses indicated that
the respondent encountered no
barriers to referral.
MFT specialty awareness. We coded 15 responses as relating to
respondents’ awareness of
MFT as a specialty. Many of these respondents indicated they
were either completely unaware
of MFT as a distinct field or were unclear about the professional
role of an MFT (‘‘I didn’t
know there was a family ⁄ marriage therapy specialist’’). Other
respondents asked for more infor-
mation about MFTs and the types of services they provide.
Some indicated that they had not
differentiated between the various mental health professionals
with whom they worked (whether
they be MFTs, social workers, or psychologists).
Let us know who you are. We coded 14 responses as indicating
respondents wanted to be
able to identify the MFTs in their communities. Responses
placed in this category suggested
that respondents were either unaware of MFTs, had no
professional contact with MFTs in
their communities, or were less likely to work with therapists
they had not met (‘‘Probably
meeting face to face [would be helpful]’’).
Barriers to collaboration. We coded 13 responses as describing
barriers to collaboration.
16. Subcategories of this theme are the following: time
(‘‘Unfortunately we seem to have less time
to [collaborate]’’), managed care (‘‘HMO . . . typically listed an
800# to call . . . made commu-
nication very difficult between the anonymous therapist and
I’’), lack of therapist feedback
(‘‘Helpful to get reports back from therapists, but it often
doesn’t happen’’), and interest (‘‘I
like to refer but don’t necessarily feel I need to receive
reports’’).
Attitudes toward MFTs. We coded 12 responses as relating to
FPs’ attitudes regarding
MFTs. Seven responses had positive overtones (‘‘They are
already a helpful resource for me—I
can’t think of any way to improve this presently’’). Two
responses suggested an uncertain or
even negative mind-set toward MFTs (‘‘most of the MFT people
only have a Master’s . . . for
more complex cases, I might choose psychiatry or doctoral
psychology background’’). Three
responses made reference to the importance of a philosophical
fit.
DISCUSSION
The primary theme emerging from this study is that FPs are
interested in referral and col-
laboration, in some form, but face barriers. This theme is
illustrated by the quantitative and
qualitative data. The data suggest that there is a considerable
gap between the percent of
patients FPs identified as potentially needing MFT (48%) and
the percent of patients actually
referred for MFT (5%). This may, in part, be understood by the
roadblocks to referral (e.g.,
17. patient reluctance, HMO restrictions, unavailability of
appropriate therapist, and time) faced
by FPs in this study as well as in previous research studies
(Kainz, 2002; Orleans, George,
Houpt, & Brodie, 1985; Rosenthal, Shiffner, & Panebianco,
1990; Rost et al., 1994; Williams
et al., 1999).
Secondly, FP respondents in this study reported that they are
often unaware of MFTs in
their community or unfamiliar with the discipline of MFT.
Likewise, Kainz (2002) found that
physicians would be more likely to refer to the mental health
providers with whom they had
met and developed a good relationship or of whom they had
heard a good report from either
colleagues or patients. It may be that FPs are also uncertain of
the scope of MFTs’ training
and practice.
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
225
Thirdly, the FPs in this study appeared receptive to referring to
and collaborating with
MFTs, but collaboration is limited in its occurrence. In this
study, HMOs, time limitations,
and lack of therapist-initiated communication have been
identified as significant barriers to col-
laboration. These barriers that were identified by FPs are
similar to the collaboration barriers
identified by MFTs. Research articles and books written on
collaboration give considerable
attention to the issues around HMO-related barriers (e.g.,
18. DeGruy, 1997; McCulloch et al.,
1998; Seaburn et al., 1996). Other potential barriers to
collaboration may be attributed to
patient reluctance to accepting a mental health referral. Reust et
al. (1999) found that patient-
identified barriers to following through with a physician-
initiated mental health referral are
comparable to the barriers identified by FPs in this study.
Finally, FP respondents reported that they want feedback from
MFTs to whom they refer
a patient. This finding is consistent with the findings of other
studies on collaboration (Kainz,
2002; Rosenthal et al., 1990; Rosenthal, Shiffner, Lucas, &
DeMaggio, 1991) which have identi-
fied regular feedback to be essential, with the majority
describing this feedback ideally to be a
brief intake report or progress note. With these themes in mind,
we make suggestions for
enhancing collaboration between FPs and MFTs.
Suggestions for MFTs
Specific training in MedFT will facilitate MFTs’ ability to
collaborate and provide compre-
hensive, biopsychosocial care in conjunction with a client’s FP
or other medical practitioner
(McDaniel et al., 1992a). As with any relationship, it is
important to take a learning stance in
order to begin forging collaborative relationships with FPs.
Researchers and practitioners in
healthcare collaboration underscore the importance of
understanding how the cultural and
structural differences between the two professions present
unique challenges for collaboration
(McDaniel et al., 1992a; Patterson, Peek, Heinrich, Bischoff, &
19. Scherger, 2002). Knowledge of
the culture of family medicine or other medical specialties will
add to MFTs’ abilities to
approach collaboration with sensitivity and confidence. To
build mutual respect, MFTs should
communicate a desire to understand the needs of FPs and their
patients. Overall, constant
investments of time, communication, respect, and goal
clarification are important for develop-
ing successful collaborative relationships (McDaniel et al.,
1992a; Seaburn et al., 1996).
We found that some FPs are either unaware of MFT as a unique
discipline within the
mental health field or unaware of MFTs’ availability in their
community. In response to this
finding, MFTs might introduce themselves to local FPs,
especially those whose patients they
are already counseling. Recognizing that it may be intimidating
to make the initial contacts,
McDaniel et al. (1992a) suggested finding venues for
introduction such as through another
medical colleague or inviting the medical practitioner to lunch.
At this time it may be helpful
to offer a business card, rolodex insert, and brochure describing
areas of specialty in order to
facilitate future contact or referral from the FP.
As MFTs learn about the types of patient psychosocial concerns
that FPs commonly
encounter, it may be helpful to create fact sheets addressing
these concerns, offer brief work-
shops, or even participate on grand rounds in local hospitals.
FPs in this study suggested that
information on specific psychosocial issues would be helpful.
They most commonly requested
20. suggestions for reducing patient reluctance to MFT care. MFTs
might consider American Asso-
ciation for Marriage and Family Therapy (AAMFT) brochures
addressing specific mental
health issues as a resource to offer FPs or referred patients.
These brochures have a space for
professional contact information and are available for purchase
from AAMFT (see http://
www.aamft.org/store/shop/category.asp?catid=9). Also, MFTs
can regularly participate on
healthcare teams by obtaining releases from clients to exchange
information with the referring
physician. If a client declines to release his or her information,
the MFT may want to send a
brief note acknowledging and thanking the FP for the referral
and discuss with the client the
goals and potential benefits of a team approach.
226 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
Beyond the routine collaborative communication, MFTs can
look for ways to maintain con-
tact and develop the relationship. For instance, MFTs might
locate current journal articles or
other brief materials for FPs that may pertain to collaboration,
mental health issues, or behavioral
health techniques. Due to the demands of patient care, FPs have
limited time for researching
issues in mental health and may appreciate this collaborative
gesture (E. Ng, MD, personal
communication, December 3, 2003). Experienced collaborators
underscore the importance of the
long-term efforts necessary to maintain collaborative
21. relationships. MFTs may also be interested
in joining a collaborative healthcare organization such as the
CFHA (which includes a subscrip-
tion to the journal Families, Systems, and Health) or
participating in other like-minded events such
as the Conference on Families and Health sponsored by the
STFM and CFHA.
Implications for Clinical Training and the MFT Field
Professionals in the field of MFT must continue to look for
ways to bridge the gap
between these two compatible fields. Based on our findings, it
seems that MedFT and collabo-
rative training programs offer skills necessary to collaborate
with FPs in comprehensive,
systemic care. These trainings are offered in academic settings,
in fellowship training programs,
professional associations, professional journals, and community
interactions (for information
on training programs, see www.cfhcc.org/pages/education-and-
training/; see also a list of pro-
grams in Seaburn et al., 1996, pp. 270–272). It may be
necessary for MFT training programs to
add collaboration training or MedFT to their curriculum.
William Doherty (personal communi-
cation, March 22, 2003) stated that professionals most often
collaborate with whom they train
or know personally. Since most MFTs do not have the
opportunity to know FPs personally, a
collaborative component early in MFT training would offer an
opportunity for students to
interact with health professionals from other disciplines and for
medical health professionals in
the community to learn about MFT and meet future MFTs.
Students could be encouraged to
22. seek internships in medical settings or to conduct research
relevant to both fields and to publish
in family medicine journals.
Numerous associations (such as the AAFP, AAMFT, Health
Psychology Division of the
American Psychology Association, CFHA, and STFM) offering
workshops and conferences
provide additional opportunities for MFTs and FPs to interact
and increase their collaboration
skills. As MFTs learn to connect with FPs, it is possible that
MFTs and FPs will find ways to
work together to promote marketing and to advocate for
managed care policy change. Man-
aged care corporations may respond to pressure placed on them
by organized, collaborating
FPs and MFTs to ensure reimbursement for mental healthcare.
Limitations
When interpreting the results of the study, it is important to be
mindful of the following
limitations. First, the questionnaire has not been tested for
reliability or validity. While the sur-
vey method is an efficient mode for data collection,
questionnaires are self-administered tools
in uncontrolled settings. Thus, it is possible for the participants
to misinterpret questions. To
address these limitations, this survey was scrutinized by several
FPs, and qualitative questions
were included to add depth and clarity to the findings.
Secondly, although the size of our sample is sufficient to
produce a confidence interval of
about ±6% (Rea & Parker, 1997), it is still a relatively small
sample compared to a population of
23. over 53,000 FPs. Readers are encouraged to consider the margin
of error when interpreting results.
However, this study’s response rate (64%) is remarkable when
compared with physician response
rates to other surveys with and without incentives (VanGeest,
Wynia, Cummins, & Wilson, 2001).
Suggestions for Future Research
More research is needed to enhance our understanding of what
increases the likelihood of
successful collaboration between FPs and MFTs. One approach
to this may be for researchers
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
227
to examine collaborative relationships that are working. What
types of training in an MFT
program or FP residency are linked to increased collaboration?
What current practices of col-
laboration are most effective and why? Additionally, another
member of the collaborative triad,
the patient, could be a valuable source of information about the
helpfulness of FP ⁄ MFT col-
laboration. The patient’s perspective of the risks ⁄ benefits of
his or her FP and MFT working
together may be useful in establishing a link between
psychosocial care and cost-effective
healthcare that would interest managed care companies.
Despite the barriers and limitations to FP ⁄ MFT collaboration
identified in this study, our
findings suggest that FPs think many of their patients could
24. benefit from MFT and are inter-
ested in collaborating with MFTs. It is our hope that this study
will encourage interdisciplinary
discussion that continues to bridge the gap between FPs and
MFTs and ultimately promote
more effective care for the patient ⁄ client.
REFERENCES
American Academy of Family Physicians (2000). Skills. Human
behavior and mental health. Retrieved February 3,
2004, from http://www.aafp.org/x16550.xml. Updated February
7, 2009, from http://www.aafp.org/online/
etc/medialib/aafp_org/documents/about/rap/curriculum/mentalh
ealth.Par.0001.File.tmp/Reprint270.pdf
American Academy of Family Physicians (2003). Membership
in the American Academy of Family Physicians,
January 1, 2002 (Tables 134, 135). Retrieved March 23, 2003,
from http://www.aafp.org/x950.xml and
http://www.aafp.org/x949.xml. Current census data available at
http://www.aafp.org/online/en/home/
aboutus/specialty/facts.html
Bader, E. (1990). Working with families. Australian Family
Physician, 19, 525–527.
Bloom, M., & Smith, D. (2001). Brief mental health
interventions for the family physician (1st ed.). New York:
Springer-Verlag.
25. Bullock, D., & Thompson, B. (1979). Guidelines for family
interviewing and brief therapy by the family physi-
cian. Journal of Family Practice, 9, 837–841.
Burns, L. H. (1999). Genetics and infertility: Psychosocial
issues in reproductive counseling. Families, Systems &
Health, 17, 87–110.
Campbell, T. L., & Patterson, J. M. (1995). The effectiveness of
family interventions in the treatment of physical
illness. Journal of Marital & Family Therapy, 21, 545–583.
Christie-Seely, J. (1981). Teaching the family system concept in
family medicine. Journal of Family Practice, 13,
391–401.
Chung, M. K. (1996). Editorials: Why alternative medicine?
American Family Physician, 54, 773–779.
Dare, C., & Eisier, I. (1995) Family therapy. In G. Szmuller &
C. Dare (Eds.), Eating disorders (pp. 333–349).
Chichester, England: Wiley.
Davis, C. (1988). Family therapy. The Practitioner, 232, 1377–
1378.
DeGruy, F. (1997). Mental health care in the primary care
setting: A paradigm problem. Family Systems and
Health, 15, 3–26.
26. Doherty, W. J., & Baird, M. (1983). Family therapy and family
medicine: Towards the primary care of families.
New York: Guilford.
Dym, B., & Berman, S. (1986). The primary health care team:
Family physician and family therapist in joint
practice. Family Systems Medicine, 4, 9–21.
Fischetti, F., & McCutchan, F. (2002). A contextual history of
the behavioral sciences in family medicine revis-
ited. Families, Systems & Health, 20, 113–129.
Fisher, L., & Ransom, D. C. (1997). Developing a strategy for
managing behavioral health care within the
context of primary care. Archives of Family Medicine, 6, 324–
333.
Flodmark, C. E., Ohlsson, T., Ryden, O., & Sveger, T. (1993).
Prevention of progression to severe obesity in a
group of obese schoolchildren treated with family therapy.
Pediatrics, 5, 880–884.
Fosson, A. R., Elam, C. L., & Broaddus, D. A. (1982). Family
therapy in family practice: A solution to psycho-
social problems? Journal of Family Practice, 15, 461–465.
Frank, S. H. (1985). The unit of care revisited. Journal of
Family Practice, 21, 145–148.
27. Gerdes, J. L., Yuen, E. J., & Frey, C. M. (2001). Assessing
collaborative patterns and strength between primary
care and mental health providers. Families, Systems & Health,
19, 429–444.
228 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
Glied, S. (1998). Too little time? The recognition and treatment
of mental health problems in primary care.
Health Services Research, 33(4 Pt. 1), 891–910. Retrieved
February 7, 2009, from http://www.pubmedcentral.
nih.gov/pagerender.fcgi?artid=1070292&pageindex=1#page
Harkness, J. L., & Nofziger, A. (1998). Medical family therapy
casebook. Training in a collaborative context:
What we did not know then . . . we know now. Families,
Systems & Health, 16, 443–450.
Hepworth, J., & Jackson, M. (1985). Health care for families:
Models of collaboration between family therapists
and family physicians. Family Relations, 34, 123–127.
Jackson, L., & Tisher, M. (1996). Family therapy for general
practitioners. Australian Family Physician, 8, 1269–
1271.
Kainz, K. (2002). Barriers and enhancements to physician-
28. psychologist collaboration. Professional Psychology:
Research and Practice, 33, 169–175.
Kushner, K., Diamond, R., Beasley, J. W., Mundt, M., Plane, M.
B., & Robbins, K. (2001). Primary care physi-
cians’ experience with mental health consultation. Psychiatric
Services, 52, 838–840.
Lang, F., Marvel, K., Sanders, D., Waxman, D., Beine, K. L.,
Pfaffly, C., et al. (2002). Interviewing when family
members are present. American Family Physician, 65, 1351–
1354.
Mayer, R., Graham, H., Schuberth, C., Launer, J., Tomson, D.,
& Czauderna, J. (1996). Family systems ideas in
the 10-minute consultation: Using a reflecting partner or
observing team in a surgery. British Journal of
General Practice, 46(405), 229–230.
McCulloch, J., Ramesar, S. & Peterson, H. (1998).
Psychotherapy in primary care: The BATHE technique. Amer-
ican Family Physician, 57, 2131–2134. Available at
http://www.aafp.org/afp/980501ap/mcculloch.html
McDaniel, S., Hepworth, J., & Doherty, W. J. (1992a). Medical
family therapy: A biopsychosocial approach to
families with health problems. New York: Basic Books.
McDaniel, S., Hepworth, J., & Doherty, W. J. (1992b). Medical
29. family therapy with couples facing infertility.
American Journal of Family Therapy, 20, 101–122.
McDaniel, S. H., Hepworth, J., & Doherty, W. J. (1995).
Commentary. Medical family therapy with somaticizing
patients: The co-creation of therapeutic stories. Family Process,
34, 349–361.
Moon, J. R. (1997). Partnerships with primary care physicians:
Reinventing gatekeeper relationships. In N. A.
Cummings, J. L. Cummings, & J. N. Johnson (Eds.), Behavioral
health in primary care: A guide for clinical
integration (pp. 305–323). Madison, CT: Psychosocial.
Norusis, M. J. (2000). SPSS 10.0 guide to data analysis.
Englewood Cliffs, NJ: Prentice Hall.
Orleans, C. T., George, L. K., Houpt, J. L., & Brodie, H. K.
(1985). How primary care physicians treat psychiat-
ric disorders: A national survey of family practitioners.
American Journal of Psychiatry, 142, 52–57.
Patterson, J., Peek, C. J., Heinrich, R. L., Bischoff, R. J., &
Scherger, J. (2002). Mental health professionals in
medical settings: A primer. New York: W.W. Norton.
Patton, M. Q. (2002). Qualitative research and evaluation
methods. Thousand Oaks, CA: Sage.
Rea, L. M., & Parker, R. A. (1997). Conducting survey
30. research: A comprehensive guide. San Francisco: Jossey-
Bass.
Reust, C. E., Thomlinson, R. P., & Lattie, D. (1999). Keeping
or missing the initial behavioral health appoint-
ment: A qualitative study of referrals in a primary care setting
[Electronic version]. Families, Systems &
Health, 17, 399–411.
Rolland, J. S. (1994). Families, illness, and disability: An
integrative treatment model (pp. 127–164). New York:
Basic Books.
Rosenthal, T. C., Shiffner, J. M., Lucas, C., & DeMaggio, M.
(1991). Factors involved in successful psychother-
apy referral in rural primary care. Family Medicine, 23, 527–
530.
Rosenthal, T. C., Shiffner, J., & Panebianco, S. (1990).
Physician and psychologist beliefs influencing referral of
patients for psychotherapy. Family Medicine, 22, 38–41.
Rost, K., Humphrey, J., & Kelleher, K. (1994). Physician
management preferences and barriers to care for rural
patients with depression. Archives of Family Medicine, 3, 409–
414.
Schurman, R., Kramer, P., & Mitchell, J. B. (1985). The hidden
mental health network: Treatment of mental
31. illness by nonpsychiatrist physicians. Archives of General
Psychiatry, 42, 89–94.
Seaburn, D. B., Lorenz, A. D., Gunn, W. B., Jr., Gawinski, B.
A., & Mauksch, L. B. (1996). Models of collabo-
ration: A guide for mental health professionals working with
health care practitioners (1st ed.). New York:
Basic Books.
Strauss, A. L., & Corbin, J. M. (1990). Basics of qualitative
research. Grounded theory: Procedures and techniques.
Newbury, CA: Sage.
April 2009 JOURNAL OF MARITAL AND FAMILY THERAPY
229
Tomson, P. R. V., & Asen, E. (1987). Can general practitioners
be taught family therapy methods? Family
Systems Medicine, 5, 97–104.
VanGeest, J. B., Wynia, M. K., Cummins, D. S., & Wilson, I. B.
(2001). Effects of different monetary incentives
on the return rate of a national mail survey of physicians.
Medical Care, 39(2), 197–201. Available MFTP:
Hostname: vt.edu Directory: Ovid Citations.
Weihs, K., Fisher, L., & Baird, M. (2002). Families, health and
32. behavior—a section of the commissioned report
by the committee on health and behavior. Families, Systems and
Health, 20, 7–57.
Williams, J. W., Rost, K., Dietrich, A. J., Ciotti, M. C.,
Zyzanski, S. J., & Cornell, J. (1999). Primary care physi-
cians’ approach to depressive disorders: Effects of physician
specialty and practice structure. Archives of
Family Medicine, 8, 58–67.
Yeager, B., Auyand, M., Brown, D. L., Dickinson, P.,
Goldstein, J. A., Jaffe, N., et al. (1999). MFT student
training in medical family therapy: A collaborative hospital
project with radiation oncology. Families,
Systems & Health, 17, 427–436.
230 JOURNAL OF MARITAL AND FAMILY THERAPY April
2009
TRAINING FOR COLLABORATION: COLLABORATIVE
PRACTICE SKILLS FOR MENTAL HEALTH
PROFESSIONALS
Richard J. Bischoff, Paul R. Springer, Allison M. J. Reisbig
University of Nebraska-Lincoln
33. Sheena Lyons
Devereux
Adriatik Likcani
Kansas State University
The purpose of the study was to identify skills that mental
health practitioners need for
successful collaborative practice in medical settings. Known
experts in the field of collabo-
rative health care completed a survey designed to elicit their
suggestions about what is
needed for successful collaborative care practice. Through
qualitative analysis, a set of 56
skills was developed. These skills are organized into three
general categories of compe-
tency: (a) skills for working in a medical setting; (b) skills for
working with patients;
and (c) skills for collaborating with healthcare providers.
In their landmark text, Medical Family Therapy, McDaniel,
Hepworth, and Doherty (1992)
introduced an approach to health care delivery based on the
Engel’s (1977) biopsychosocial
(BPS) model. The foundation of medical family therapy
(MedFT) is an acknowledgment that
‘‘all human problems are BPS systems problems: there are no
psychosocial problems without
biological features and no biomedical problems without
psychosocial features’’ (McDaniel
et al., 1992, p. 26). The authors reasoned that treatments will be
more effective and outcomes
more positive when biological and psychosocial dimensions of
functioning are considered and
addressed simultaneously. This is facilitated by maximizing the
34. collaboration between physi-
cians and mental health therapists.
While the scholarship of the practice of collaborative health
care predates the publication
of this text, it has increased dramatically since 1992. Other
texts promoting the practice of
MedFT have been written (e.g., Blount, 1998; Patterson, Peek,
Heinrich, Bischoff, & Scherger,
2002; Prouty-Lyness, 2003; Seaburn, Lorenz, Gunn, Gawinski,
& Mauksch, 1996), giving stu-
dents of the approach a library of literature on the practice.
While started in 1983, the journal
Families, Systems, and Health has since become a premiere
journal in this specialty area of
mental health care. Research has established the link between
biological, social, and psychologi-
cal systems (see Campbell & Patterson, 1995) and the positive
impact of psychotherapy, espe-
cially relational approaches to treatment, on health outcomes
(Cambell, 1996; Crane &
Christenson, 2008; Law, Crane, & Berge, 2003). The
Collaborative Family Healthcare Associa-
tion, an association devoted to collaborative care practices that
are characteristic of MedFT,
has matured into a multidisciplinary association giving those
interested in collaborative care
practices a place to come together to share ideas and advance
the practice, research, and theory
of medical family therapy (Bloch & Doherty, 2001). It would be
difficult to imagine that one
could graduate from a clinical training program in marriage and
family therapy, psychology, or
Richard J. Bischoff, PhD, is a Professor and Director in the
Marriage and Family Therapy Program at
35. University of Nebraska-Lincoln; Paul R. Springer, PhD and
Allison M. J. Reisbig, PhD, are Assistant Professors in
the Marriage and Family Therapy Program at University of
Nebraska-Lincoln; Sheena Lyons, MS, Devereux,
Arizona; Adriatik Likcani, MS, is a Doctoral candidate in the
Marriage and Family Therapy Program at Kansas
State University.
Address correspondence to Richard J. Bischoff, Marriage and
Family Therapy Program, University of
Nebraska-Lincoln, PO Box 830800, Lincoln, Nebraska 68583-
0800; E-mail: [email protected]
Journal of Marital and Family Therapy
doi: 10.1111/j.1752-0606.2012.00299.x
June 2012, Vol. 38, No. s1, 199–210
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
199
social work without an understanding of the BPS model,
collaborative care practice, and Med-
FT. However, even with the existence of several degree granting
and postdegree training pro-
grams in MedFT and many more programs that have emphases
in medical family therapy and
collaborative health care, little is known about the competencies
needed to practice MedFT.
It is clear from reading any of the several texts on the subject
36. that MedFT is different from
the traditional mental health care practice. Those practicing
MedFT need to have the same
skills that are needed for traditional practice environments as
well as many other skills unique
to the collaborative health care environment. However, as yet,
these skills have not been orga-
nized nor explicitly identified. The development of a succinct
set of skills, similar to that of the
American Association for Marriage and Family Therapy
(AAMFT) core competencies (Nelson
et al., 2007), would be a step in the direction of developing
training and practice guidelines for
this rapidly developing approach to health care. This is
particularly important in this age of
outcomes-based educational standards (Maki, 2004; Miller,
Todahl, & Platt, 2010; Nelson
et al., 2007).
The purpose of this study was to develop a set of skills that
would aid educators and train-
ers interested in preparing mental health therapists for practice
in collaborative health care set-
tings. This was achieved through a qualitative design that began
with inductive qualitative
inquiry with leaders of collaborative care practice in an effort to
understand the competencies
that mental health therapists need to work effectively in
collaborative health care settings.
METHODOLOGY
Participants
After receiving Institutional Review Board approval, a
purposive sampling strategy was
37. used to invite experts in MedFT to participate in this study. To
be identified as an expert, indi-
viduals had to meet one of the following criteria: (a) the person
was an author on a minimum
of two peer-refereed journal articles directly related to
collaborative care practice or training or
(b) the person was identified as an expert by someone meeting
the two publication criterion.
The first criterion allowed for the inclusion of those identified
as experts because they were
advancing the field through publication. The second criterion
allowed for the inclusion of prac-
titioners who have influence on the development of the practice
of MedFT through clinical
practice. Thirty-three experts were invited to participate, and 25
contributed data for the study
(a response rate of 76%). Sixty percent of the participants were
men and 80% were over
35 years old. Sixty-eight percent reported that they had more
than 5 years of experience work-
ing collaboratively in a medical setting practicing the principles
identified in the research, and
24% reported more than 15 years of experience. Sixty percent
reported their primary place of
employment as a medical setting (11 respondents worked in a
medical residency program, three
in a medical school, and one in a primary care medical setting).
The remainder reported that
their primary employment setting was a university-based mental
health training program. Fif-
teen respondents identified their primary professional affiliation
as MFT. Other respondents
were primary care physicians (5), psychiatrists (2),
psychologists (2), and one nurse.
Survey
38. A survey consisting of 13 questions was developed for the
purposes of this study. Six open-
ended questions were designed to elicit skills needed for
successful collaborative practice. These
questions elicited data about knowledge (biomedical and mental
health) and clinical skills
needed for successful practice in medical settings. Participants
were also asked to relate an inci-
dent that exemplifies successful medical, mental health
collaboration. Six closed-ended questions
elicited demographic information. The final question requested
that the respondent identify oth-
ers who they would consider to be experts on collaborative care
practice and who might be able
to provide useful information. In an effort to facilitate
participation, participants either could
choose to complete the survey on-line through a secure,
password-protected website or through
a paper version that was mailed to them. Potential respondents
were contacted both by email
(if an email address was available) and by a letter sent via US
mail requesting participation in
the survey.
200 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
Data Analysis
Data were initially analyzed using a process similar to the
constant comparison qualitative
data analysis method (Miles & Huberman, 1994) by the primary
researcher and a research
39. assistant. Using this method, content analyses were performed,
and a preliminary codebook of
themes or skills was inductively identified. Specifically, each
participant’s response was read in
its entirety to understand the skills being emphasized by each
respondent. Each reader kept a
list of skills that emerged from the data. They then met to
review and compare their separate
lists and come up with a consensus list. No skills identified by
readers were eliminated from the
list. Both the primary researcher and the research assistant then
separately returned to the data
to carefully examine the responses to each question. All
responses to question number one were
read, identifying support for the skills identified on the list and
adding new skills to the list by
comparing incidents in the data with all others. Question
number two was then analyzed simi-
larly, and so on. Subsequent responses were compared with
those preceding them in the analy-
sis, with the result being the addition of new skills or the
addition of evidence for skills already
noted, as appropriate.
The validity, or substantive significance, of the data was
established through analyst trian-
gulation (Patton, 2002). Using a deductive method, three
secondary coders reviewed and vali-
dated the presence and salience of each theme identified by the
primary coder and his research
assistant. Skills that lacked clear support in the data were
discussed and compared with all
other skills that had been identified. This process helped
establish the validity of the primary
researcher’s and the graduate assistant’s preliminary coding of
the data. The primary researcher
40. and secondary coders then collapsed and sorted each theme or
skill into categories and subcate-
gories. The result of this process ensured that all categories and
subcategories were examined
and agreed upon by all coders. In addition, this process ensured
that the interpretation of the
data was comprehensive and accurate.
RESULTS
Qualitative analysis of the survey responses resulted in a set of
56 skills that uniquely char-
acterize MedFT. It is evident from the data that while the
practice of MedFT includes compe-
tence in the practice of psychotherapy, it also includes skills
unique to working in medical
settings and to collaborating with medical providers and other
professionals. Consequently, the
identified skills have been clustered into three categories that
represent logical groupings of
these skills: (a) skills for working in a medical setting; (b)
unique skills for working with
patients in medical settings; and (c) skills for collaborating with
healthcare providers. Skills
within each category are further broken down into
subcategories. The skills are presented by
category in Tables 1–3. Each category is described below.
Skills for Working in a Medical Setting
Participants were careful to explain that working in medical
settings is different from work-
ing in traditional mental health practice settings. In describing
this difference, one respondent
explained that the medical setting is ‘‘a fast paced environment
that has an organizational
41. structure entrenched in traditional biomedical influence.’’
Others created lists such as: ‘‘differ-
ences in language, pace, communication styles, confidentiality
expectations, team roles, and
documentation.’’ Differences such as these require those
practicing MedFT to demonstrate
competence in working within this unique practice environment.
These skills can be organized
according to those relating to (a) the unique practice culture of
the medical setting, (b) medical
knowledge, (c) accommodating to the medical setting, and (d)
nurturing one’s professional
identity.
The unique practice culture of the medical setting. When
stepping into a medical setting,
one is stepping into a unique culture; one that is different from
traditional mental health care
practice. Those practicing MedFT recognize this work to
understand the culture, and to prac-
tice in culturally sensitive ways. One respondent counseled that
‘‘It is important for the mental
health professional to recognize that he or she is entering a
different culture.’’ Another respon-
dent explained that ‘‘a medical setting is part of the culture of
medicine. It has a language, a
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
201
history, a set of shared myths and archetypes like any culture.’’
The data suggest that it is par-
ticularly important for mental health therapists to attend to the
following characteristics of this
42. unique culture.
Language. Respondents explained that the language of medical
settings has been devel-
oped to facilitate the work of medicine and that this language is
unique and different from that
found in traditional mental health care settings. One respondent
explained,
Bridging the language barrier is [important]. Many MHPs
[Mental Health Providers]
enter into a medical setting speaking therapy and not
understanding medicalease.
[Developing a common language] means abandoning the terms
that we learned in
graduate school for more user friendly words that medical
professionals understand.
Another respondent explained that ‘‘The language is
instrumental and action oriented. [It]
mirrors the kind of expectations that the [medical provider] may
have of mental health provid-
ers (what can you do rather than what do you think).’’ Another
respondent succinctly wrote
that there is a ‘‘preference for concreteness over abstractions.’’
The importance of the language
used applies equally to verbal and written (e.g., charting)
communication. Several respondents
explained that mental health therapists ‘‘should understand the
abbreviations for medication
Table 1
Skills for Working in a Medical Setting
The unique practice culture of medical settings
Medical family therapists . . .
43. Recognize that medical settings have a unique practice culture
Recognize and respect the professional hierarchy in medical
settings
Respect the differences between medical and mental health
providers in scope of
practice, practice patterns and strategies, approach to patient
care, etc.
Know the difference between primary, secondary, and tertiary
care
Respect and value the contributions of the biomedical approach
to care
Are curious and willing to learn about unfamiliar, new, and
nontraditional approaches
to healing and promoting wellness
Know the services that are available and how to utilize them
Are visible within the medical environment as an active
participant of the care team
Medical knowledge
Medical family therapists . . .
Speak the language of the medical setting (e.g., medical terms,
abbreviations, jargon)
Access and use medical and pharmacological information from
reliable sources
Know the diagnostic tests and treatments that are commonly
used for patient medical
care
Accommodations to the medical setting
Medical family therapists . . .
Match the pace of the medical setting
44. Are comfortable with frequent interruptions by medical staff
during treatment sessions
Are flexible in working with patients and families in
examination rooms and
other nontraditional settings
Accommodate to how confidentiality is handled in medical
settings
Document patient progress consistent with medical setting
protocols
Have the ability to be an excellent short-term interventionist
Nurturing professional identity
Medical family therapists . . .
Are willing to be shaped in professional identity and role
Stay connected with mental health colleagues
202 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
(e.g., QID, QD, PO)’’ and should be able to document
psychotherapy consistent with medical
charting protocols and in a way that will make this information
useful to medical providers.
Time management. It is important to attend to the pacing of the
medical setting and in
how medical providers manage time with patients. One
respondent explained that ‘‘MDs
[Medical Doctors] carry a case load of several thousand and see
a minimum of [four] patients
per hour.’’ Another explained that ‘‘The medical clinician is
usually working with [two] patients
45. at one time.’’ This use of time can be disconcerting for the
naı̈ ve mental health therapist. But,
echoing the sentiment of others, one respondent wrote, ‘‘MDs
must be action oriented. This
time crunch should never be interpreted as evidence that the MD
does not care about his ⁄ her
patients.’’
The team approach to patient care. Contrary to the independence
and autonomy that are
hallmarks of traditional mental health practice, treatment in
medical settings is typically charac-
terized by a team approach where health care providers from
various specialties and disciplines
work together in caring for a patient. There are two noteworthy
consequences of this approach
for mental health therapists. First, the mental health care is
often not the primary focus of the
treatment. As one part of the overall care plan, the mental
health treatment must support and
complement the other parts of the care plan, some of which have
greater immediacy and
demand more attention than the mental health concerns. Second,
the therapist may not occupy
a primary role in direct patient care and may at times not even
see the patient. There is a
Table 2
Skills for Working with Patients
The practice lens
Medical family therapists . . .
Conceptualize pathology from the biopsychosocial perspective
Medical knowledge
46. Medical family therapists . . .
Have a basic understanding of biochemical processes and
pharmacology
Have a basic understanding of anatomy and physiology
Know about the biological processes of diseases
Know the medical conditions that commonly have psychosocial
comorbidity
Know mental health conditions that commonly manifest through
physical symptoms
Know common psychiatric medications, names and
abbreviations, doses, and side effects
Patient care
Medical family therapists . . .
Are skillful in working with a wide variety of treatment
modalities (e.g., couple, family,
individual, group)
Assess and diagnose mental disorders using the current DSM
and ICD
Provide patient psychoeducation in both individual and group
formats
Engage patients who do not see the connection between their
medical conditions and
other areas of functioning
Respond to a wide range of patient responses to illness and
medical treatment
Organize and conduct family meetings
Know when and how to effectively intervene in the physician-
patient relationship to
improve treatment outcomes
Facilitate patient groups including psychoeducational groups
Are able to manage chronic illness and stress
47. Effectively apply evidence-based brief psychotherapies
Effectively apply evidence-based psychotherapies to the
treatment of specific problems
Teach mind–body techniques
Understand that the medical provider may be more invested in
the patient’s mental
health treatment than the patient
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
203
hierarchy within the medical setting that must be respected to
honor the team approach to care.
One respondent simply stated: ‘‘You are part of a team, but
your work is not at the center [of
patient care].’’ Another provider pointed out: ‘‘You are likely
to feel one-down, and you should
not take this personally, but see it in part as part of the culture
of medicine.’’ Third, there is an
expectation that necessary information will be readily shared
among professionals. Each per-
son’s job in patient care is dependent on information obtained
by other members of the care
team. One respondent explained:
It is . . . normal for treatment in medical settings to be done in
teams . . . Information
flows freely on the team because life and death matters are
often involved. This may
pose a problem for mental health professionals who have a more
traditional view of
how confidentiality should be dealt with. The mental health
provider must think of
him ⁄ herself as part of a treatment team; that communication
48. within the team is as
important as anything else the mental health provider may do,
that his ⁄ her role may
be consultative as often as it will be treatment oriented, that he ⁄
she may need to be
flexible with regard to availability.
Table 3
Skills for Collaborating with Medical Providers
Relationship building
Medical family therapists . . .
Understand the importance of relationship building to effective
collaboration
Build relationships with medical providers and office staff
Are available, accessible, and visible to healthcare providers
and flexible in style
of working
Actively collaborate with health care providers as a member of
the care team
Place self in the traffic pattern without getting in the way
Collaborative communication skills
Medical family therapists . . .
Work within multidisciplinary teams, keeping lines of
communication open to
coordinate treatment
Communicate with medical providers in an efficient and clear
manner
Fluently use appropriate medical terminology
Talk about mental health problems in a way that is easily
understood by health care
49. providers and that is respectful of all perspectives
Keep medical providers informed of progress and changes in
care
As invited, feel comfortable to provide feedback on the work of
medical provider
colleagues in the treatment of their patients
Interpersonal expertise
Medical family therapists . . .
Understand that many medical providers become frustrated
when dealing with chronic
mental health problems
Perceive medical provider distress and respond appropriately to
alleviate the distress
Monitor and appropriately respond to emotional reactivity in
oneself and in medical
providers
Think relationally, not just in conceptualizing patients’
experiences, but also in
conceptualizing the relationships among providers
Assess one’s own participation in and contributions to the
relationship with medical
providers
Evaluate the effectiveness of the collaborative relationship
among care team members
and among treatment providers and patients
204 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
50. Many respondents explained that they use their skills as a
family therapist in their interac-
tions in the multidisciplinary team in culturally sensitive ways.
Similar to others, one
respondent wrote that to be successful in the practice of MedFT
‘‘we need to use our
therapeutic skills in order to join with this new system just like
we would with a new family in
therapy . . .’’ Another respondent emphasized: ‘‘MH providers
need to JOIN, JOIN, JOIN with
the culture and the providers.’’
Medical knowledge. Medical knowledge is the foundation of the
language of medical set-
tings. While mental health therapists do not need to be medical
experts, it was consistently
underscored that they need to have enough knowledge that they
can have sufficient conversa-
tional fluency to participate as team members in patient care.
This includes knowing basic
information about diseases, disease processes, course, and
treatments, including pharmacologi-
cal treatments. They should have a basic understanding of
pharmakinetics and psychopharma-
cology and know how and where to access medical and
pharmacological information on an
on-going basis. They should be able to discuss the impact of
commonly used medications on
patient functioning and should recognize that medical providers
may want to consult with
them about pharmacological treatments. A few respondents
indicated that it is important to
know the ‘‘difference between primary and tertiary care and
understand the domains of vari-
51. ous specialties (e.g., neurology, endocrinology, oncology,
obstetrics and gynecology, rheuma-
tology).’’ Familiarity with most commonly used medical terms,
abbreviations, and jargon in
medical settings was also cited as important. One provider
wrote:
I don’t think the person has to be an expert or even very
authoritative in all of these
areas, especially in the beginning of the collaborative
relationship. But an acknowledg-
ment of their importance and a willingness to continue learning
are crucial.
Accommodating to the medical setting. Mental health therapists
trained to work in tradi-
tional mental health care settings need to accommodate their
style of practice to fit the practice
environment of the medical setting. One respondent wrote:
‘‘The medical system is bigger than
us. MHP-s are the ones that need to do the cross-over learning
and bridge the two cultures.’’
Several respondents were careful to point out that not all
medical settings are alike, even
though the culture of medicine is common to each. Medical
settings differ according to spe-
cialty, treatment emphasis, population served, and other factors.
The therapist’s ability to adapt
their own way of working to match that of the setting is a key to
success. Most respondents
identified attributes that facilitate adaptability including
‘‘humility, patience, curiosity, non-
judgmental attitude toward physician behavior, empathy, and
willingness to take risks,’’ ‘‘lots
of flexibility,’’ ‘‘self-motivation, persistence,’’ ‘‘openness,’’
52. and ‘‘a sense of humor.’’ These attri-
butes allow therapists to adapt their approach and apply their
expertise to the unique medical
practice setting within which they are working.
Mental health therapists cannot succeed if they treat it as a
traditional mental health
care practice setting, nor can they succeed if they attempt to
practice traditional psychother-
apy. Two representative examples from the data describe the
types of accommodations that
need to be made. First, the fast-paced nature of the practice of
medicine places constraints
on traditional mental health treatments. Respondents
emphasized the importance of applying
brief focused therapies that match the problem-focused,
outcomes-oriented approach of med-
icine. Second, the respondents pointed out the need to adapt the
traditional role of the
therapist as a treatment provider. A respondent explained that in
these settings, therapists
need to
Be able to expand [their] sense of mental health treatment
beyond the 50-minute ses-
sion, for example, to see the opportunities such as being
available for informal consul-
tations, joining an MD in a medical visit with a challenging
patient, considering issues
related to the general mental health of the staff and work
relationships, attending to
the relationship between the health care providers and patients,
etc.
Nurturing one’s professional identity. Mental health therapists
working in medical settings
53. can expect to experience a challenge to their professional
identity, which could result in a redefini-
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
205
tion of how they see themselves as professionals and in how
they see themselves in relation to
their peers who are not working in medical settings. One of the
respondents related the following:
One should expect a redefinition of one’s professional identity.
When I started in this
setting . . . I thought of myself as a family therapist. But over
the years that has
proven to be an inadequate designation. I see individuals as
much as anything else.
Often the main focus of the treatment I provide is to help the
MD ⁄ patient relation-
ship. I consult and educate as much as provide therapy. My
most important interven-
tions often have little to do with what goes on in the therapy
hour (which is often not
an hour!). I think that mental health professionals who want to
work in collaborative
settings must realize that the setting will shape them, and this
can be very exciting and
enriching, but it can also be disorienting.
Respondents explained they found it important to stay
connected and involved with other
mental health colleagues and with their professional
organization. Another respondent cau-
tioned: ‘‘Establish a support network with other mental health
54. folks, either on site or in other
settings. Share experiences. Consult regarding systems issues,
and support each other. Take care
of yourself. Have fun.’’ Staying connected to and grounded in
the mental health discipline
helped these respondents stay oriented and helped them preserve
a coherent sense of professional
identity. It also allowed them to test out their evolving ideas, to
stay abreast of advances in men-
tal health treatments, and to ensure that they were engaging in
ethical mental health practice.
Skills for Working With Patients
All the competencies needed for traditional mental health care
practice are needed for work
in medical settings. Respondents explained that mental health
therapists practicing MedFT
need ‘‘sound therapy skills, including individual, couple, and
family’’ and ‘‘excellent interview-
ing skills.’’ But, working with patients in a medical setting also
requires the use of unique skills
in patient care.
Conceptualizing patient problems. Participants uniformly
identified the BPS model as the
most useful conceptual model when providing direct patient
care. They explained that those
practicing MedFT need to recognize that most patients get
mental health treatment only after
seeking help for medical conditions or relief from biological
symptoms. Often the mental health
problem is co-occurring with a biological health problem, and
both must be considered in order
for mental health treatment to be successful. The patient
perspective, like that of the medical
55. provider, is first biological and then (if at all) psychosocial.
Knowing about the patient’s medical condition. Respondents
acknowledged that patients
expect mental health therapists working in medical settings to
be part of the health care team.
Therapists demonstrate that they are part of the team through
their comfort with biomedical
language and knowledge and curiosity about biomedical
conditions. It is expected that they will
use language that, while it may not be the same as that used by
the medical provider, is at least
consistent with that used by the medical provider. The therapist
should be familiar with the
patient’s medical condition and the diagnostic tests and
treatments associated with that condi-
tion. While they do not need to know everything about it, they
should ‘‘know enough of the
medical condition and treatments in order to explain it to
patients.’’ What the therapist does
not know, they should be willing to learn. One respondent
wrote:
I think that there is a difference between what information a
mental health profes-
sional should know and what they should be willing and able to
learn. . . . So, in a
sense, I believe that would serve the mental health professionals
(and the PCP [Primary
Care Providers] and patient) the best to ‘‘know’’ how to access
this information.
Patient care. Respondents wrote that mental health therapists
working in medical settings
are expected to assess and diagnose patients using the approved
nosology found in the current
56. versions of the Diagnostic and Statistical Manual of Mental
Disorders (DSM) and Interna-
tional Statistical Classification of Diseases and Related Health
Problems (ICD). They are
expected to know the evidence-based protocols and have
competency in applying accepted
206 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
treatments to specific mental health diagnoses. One respondent
described this expectation in the
following way:
Medical providers are interested in problem-based knowledge.
They are not interested
in one’s conceptual framework, they are interested in what
problems you can address.
The biggest problem is depression. Other problems are anxiety,
substance abuse, pain
management, smoking cessation, weight loss, ADHD. I think
that these problems pre-
dominate because they are very challenging for MDs to treat.
All these problems
require an understanding of DSM IV categories. It is fine to
treat these problems in a
family systems modality, but it is vital that the mental health
professional feel comfort-
able with traditional diagnostic categories. MDs expect mental
health professionals to
be able to assess, diagnose, treat, and make recommendations to
the physician regard-
ing how to manage these patients in office visits. They expect
the kinds of things they
57. would expect from any specialist.
Mental health therapists can also expect that they will be asked
to work with the most
difficult patients. One respondent explained that therapists need
to be prepared to work with
‘‘somatically-oriented, drug-seeking, dependent, hopelessly
depressed, and chronically mentally
ill patients.’’ These are patients who are often unwilling to
accept that there are psychosocial
problems co-occurring with (or in some cases, superseding) the
biomedical ones. They should
be able to creatively work with these and other patients who
may not be interested in even
acknowledging a mental health problem, let alone willing to
accept a referral to a mental health
therapist.
It was common for respondents to explain that while this work
with difficult patients is
designed to improve patient functioning, that much of the
mental health therapist’s work with
these patients is to provide relief and support for the medical
provider. One respondent
explained: ‘‘You are a resource to clinicians for their own
development of comfort with
patients.’’
Skills for Collaborating With Medical Providers
It is clear from the data that multidisciplinary collaboration is a
hallmark and essential
characteristic of MedFT. Collaboration is facilitated as mental
health therapists (a) build rela-
tionships with medical providers, (b) ensure frequent and
accurate communication about
58. patients, and (c) objectively attend to relationship processes.
Building relationships with medical providers. Mental health
therapists working in medical
settings must recognize that the relationship among providers is
the foundation for collabora-
tive health care and that they must attend to these relationships
if they are to be successful.
One of the respondents wrote: ‘‘The most important key to
success is the relationship between
providers.’’ Another added that relationships among providers
‘‘are the basis for referral and
collaboration.’’
Respondents emphasized that medical providers are problem-
focused and action-oriented.
Mental health therapists build relationships by being available
to medical providers, by showing
a willingness to accommodate to the pace of the work
environment, and by actively participat-
ing with medical providers in their patient care activities, such
as rounds, care team meetings,
and patient interviews. They should be flexible in their style of
working (e.g., accepting inter-
ruptions during treatment sessions, curbside consultations), and
they should be able to place
themselves in the traffic pattern without getting in the way.
Collaborative communication. Frequency, length, and content of
communication character-
ize collaborative relationships in medical settings. Respondents
indicated that medical providers
expect regular communication about patients and treatment
progress and that this communica-
tion should be of sufficient frequency that medical providers
can feel they are included in the
59. treatment, that they have not lost their patient. ‘‘Once the
collaborative medical professional
refers a patient he or she will also want to be updated regularly
and be included as part of the
treatment process.’’ This level of communication respects the
hierarchy within the medical
setting and acknowledges that the medical provider is ‘‘in
charge’’ of patient care.
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
207
Because the use of language in medical settings is instrumental
and action-oriented, the
mental health therapist should match this communication style.
Messages should be efficient
and clear. One respondent explained that ‘‘most collaboration
occurs through interactions that
last <5 min. These are the bumps in the hall.’’ Because of this,
being ‘‘accessible’’ and ‘‘visible’’
were repeatedly mentioned as essential to effective
communication and collaboration.
Several respondents stressed that medical providers expect to
hear ‘‘what works and what
one can do rather than what one thinks.’’ The caution to
traditionally trained mental health
therapists is to limit theoretical explanations and to stick to
what is directly relevant to the care
plan. One respondent counseled: ‘‘Don’t bore people with
details that don’t impact patient
management.’’ Similar advice was given by another who wrote:
‘‘Be able to be concise and jar-
gon free about what you believe is going on in a case.’’ Another
60. wrote: ‘‘willingness to talk the
medical language as much as possible and minimize
psychobabble.’’ Another respondent even
went as far as to caution well-intentioned therapists to be
careful not to ‘‘proselytize’’ or
become too ‘‘psychosocially fixated.’’ Yet another wrote that a
successful mental health thera-
pist is ‘‘one who does not feel he ⁄ she needs to preach systems
to those who work in the setting;
very off- putting.’’
Communicating in this way requires mental health therapists to
be ‘‘comfort[able] with their
own skills [without a] continuous need to prove oneself [and an]
ability to function without a lot
of . . . validation.’’ As participants in the communication
dynamic within a medical setting, thera-
pists are confident, assertive, patient, flexible, and
accommodating. The respondents explained
that this stance leads medical providers to ‘‘confidently value
the role you play.’’
Be relationship experts. It is clear from the data that one of the
roles played by mental
health therapists, as relationship experts, is to attend to the
relationships among providers and
between providers and patients, and to intervene in a way that
improves collaboration and
health outcomes.
Respondents explained that medical providers expect the mental
health therapist to objec-
tively observe these relationships and to intervene
appropriately.
DISCUSSION
61. This study results in a greater understanding of the practice of
MedFT, and the unique
skills needed to engage in this practice. It is clear from the data
that the practice of MedFT is
different from traditional mental health care practice. There
appear to be two primary differ-
ences. First, in addition to requiring competency in the practice
of psychotherapy, MedFT
requires additional competencies unique to working within the
culture of medicine. Second,
some competencies, while perhaps not unique to MedFT, are
noteworthy because they are
uniquely prominent in the practice of MedFT. So, for example,
while all MFTs should have
competency in multidisciplinary collaboration, it is uniquely
prominent in the practice of Med-
FT where therapists must negotiate daily professional
relationships in a multidisciplinary envi-
ronment that is inherently hierarchical.
These two types of unique competencies are most likely an
outgrowth of the application of
the BPS model that requires therapists to consider multiple
systems of functioning simulta-
neously. In the practice of MedFT, the curative work of the
therapist includes both interactions
with the patient and family as well as interactions with medical
providers and others involved
in the patient’s care. A true acknowledgment of the biological
system begs multidisciplinary col-
laboration just as a true acknowledgment of the social system
begs family involvement in treat-
ment. Consequently, the application of the BPS model expands
the practice and the treatment
to include interactions with other systems and people. This
62. requires competencies in addition to
those expected of skilled marriage and family therapists.
Multidisciplinary collaboration appears to be a hallmark of
MedFT. The modern medical
system is inherently collaborative, while the modern mental
health care system is not. Medical
systems generally adopt a leadership model of collaboration that
has a clear hierarchy with
physicians, and in some cases, mid-level medical providers in
the leadership role. It is clear
from the data obtained from those experienced in the practice of
MedFT that if MFTs are to
succeed in a medical system, they must understand and respect
the leadership model of
208 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
collaboration. They may need to change their way of practicing
to accommodate to the system
rather than try to change the system to fit their way of doing
things. This may even include the
way that psychotherapy is practiced. Participants frequently
extolled the importance of flexibil-
ity in practice, curiosity about new ways of doing things, and
willingness to learn.
The results of this study are the next step in articulating the
competencies mental health
therapists need to have to practice what has come to be known
as MedFT. It would be a mis-
take to assume that the set of competencies generated through
this study is exhaustive. Perhaps
63. if we would have returned to the participants to request
additional competencies, others would
have emerged. We know through the literature that other skills
have been identified that were
not mentioned in the data that we obtained. For example, some
authors have expanded the
BPS model to include the spiritual dimensions of patient
functioning (e.g., Prest & Robinson,
2006), yet none of our participants acknowledged the spiritual
dimension nor skills specific to
working within this dimension. Also, while participants
indicated that it was important to be
curious about nontraditional approaches to care, only one
participant made even passing refer-
ence to mind–body techniques. Yet, the literature suggests that
these techniques are particularly
efficacious (Astin, Shapiro, Eisenberg, & Forys, 2003) and
within the scope of practice of mar-
riage and family therapists (McCollum & Gehart, 2010). We are
aware of some therapists
working in medical settings who regularly teach mind–body
techniques to their patients and to
medical students (Saunders et al., 2007). Other skills not
mentioned include the importance of
knowing how patients move through the medical system and
being able to intervene on the
patient’s behalf, skills specifically related to making referrals
so that the biological dimensions
of mental health problems are addressed, and understanding
how payment and billing occur
within the medical setting in which one is working (Patterson et
al., 2002).
Emphasized in our data was the importance of cultural
competence in relation to the culture
of the medical system. Given that this was such a prominent
64. theme, we found it curious that we
were not able to find references to the importance of
demonstrating competency with the culture
of the patient’s system. Similarly, while participants were
careful to identify the importance of
recognizing and negotiating power imbalances in the medical
setting, they did not identify the
importance of being sensitive to how these same power
dynamics impact patients and families
and the role of the therapist in helping them navigate these
power imbalances. That these two
seemingly important skills were not mentioned may be a
function of how the questions were
worded; we specifically asked for unique knowledge and skills
to the practice of MedFT. It may
be that participants see these competencies as important to the
practice of marriage and family
therapy and psychotherapy in general and not unique to the
practice of MedFT.
It is possible that had we asked specifically about these, and
other techniques gleaned from
the literature and experience, that we would have been able to
develop a more comprehensive
list. But, then we might have sacrificed coming to understand
those competencies that are spe-
cifically unique to the practice of MedFT. Additional research
is needed to further refine and
expand this list of skills. Specifically, it is possible that the
application of a Delphi methodology
(Stone Fish & Busby, 1996) could be helpful in clarifying those
skills that are particularly
important to the practice of MedFT. This method has been used
successfully by others to
develop lists of skills, most notably the list that has become the
AAMFT core competencies
65. (Nelson et al., 2007).
Implications for Training and Practice
Identifying competencies is a first step toward developing
learning and assessment activities
that will expedite student learning (Maki, 2004). A logical next
step is to develop learning and
assessment activities, similar to what has been carried out with
regard to the AAMFT core
competencies (Hodgson, Lamson, & Feldhousen, 2007; Miller,
Linville, Todahl, & Metcalfe,
2009; Openshaw et al., 2006; Perosa & Perosa, 2010). The
results of this research will facilitate
the development of these learning and assessment activities.
Developing these activities in light
of learning outcomes will lead to training that is more focused
and efficient and that will better
prepare students for the realities of collaborative care practice.
The results will also help experi-
enced therapists interested in expanding or changing their
practice to include work in medical
settings and medical, mental health collaborations. These
therapists can use this research to
June 2012 JOURNAL OF MARITAL AND FAMILY THERAPY
209
understand the skills unique to the practice of MedFT.
Attending to these unique skills will
help them appropriately incorporate these skills into their
practice, thereby increasing the likeli-
hood that the transition in their practice will be successful.
Those already working in medical
66. settings will find that these results provide them with literature
that will help to document and
articulate the competencies needed for MedFT. This may be
particularly important in attempt-
ing to described MedFT to those who may not be familiar with
it. It may also help by provid-
ing a useful organization of these skills and practices unique to
MedFT. These and other
implications are important to the advancement of the practice of
MedFT.
REFERENCES
Astin, J. A., Shapiro, S. L., Eisenberg, D. M., & Forys, K. L.
(2003). Mind-body medicine: State of the science,
implications for practice. The Journal of the American Board of
Family Practice, 16, 131–147.
Bloch, D. A., & Doherty, W. J. (2001). The continuing
evolution of the Collaborative Family Healthcare Associ-
ation. Families, Systems, and Health, 19, 1–3.
Blount, A. (Eds.) (1998). Integrated primary care: The future of
medical and mental health collaboration. New
York: Norton.
Cambell, T. L. (1996). Clinical trials of collaborative
healthcare. Families, Systems, and Health, 14, 137–144.
Campbell, T. L., & Patterson, J. M. (1995). The effectiveness of
family interventions in the treatment of physical
illness. Journal of Marital and Family Therapy, 21, 545–584.
67. Crane, D. R., & Christenson, J. D. (2008). The medical offset
effect: Patterns in outpatient services reduction for
high utilizers of health care. Contemporary Family Therapy, 30,
127–138.
Engel, G. L. (1977). The need for a new medical model: A
challenge for biomedicine. Science, 196, 129–136.
Hodgson, J. L., Lamson, A. L., & Feldhousen, E. B. (2007). Use
of simulated clients in marriage and family
therapy education. Journal of Marital and Family Therapy, 33,
35–50.
Law, D. D., Crane, D. R., & Berge, J. (2003). The influence of
marital and family therapy on high utilizers of
health care. Journal of Marital and Family Therapy, 29(3), 353–
363.
Maki, P. L. (2004). Assessing for learning: Building a
sustainable commitment across the institution. Sterling, VA:
Stylus.
McCollum, E. E., & Gehart, D. R. (2010). Using mindfulness
meditation to teach beginning therapists therapeu-
tic presence: A qualitative study. Journal of Marital and Family
Therapy, 36, 347–360.
McDaniel, S., Hepworth, J., & Doherty, W. (1992). Medical
family therapy: A biopsychosocial approach to fami-
68. lies with health problems. New York: Basic Books.
Miles, M. B., & Huberman, A. M. (1994). Qualitative data
analysis (2nd ed.). Thousand Oaks, CA: Sage.
Miller, J. K., Linville, D., Todahl, J., & Metcalfe, J. (2009).
Using mock trials to teach students forensic core
competencies in marriage and family therapy. Journal of Marital
and Family Therapy, 35, 456–465.
Miller, J. K., Todahl, J. L., & Platt, J. J. (2010). The core
competencies movement in marriage and family ther-
apy: Key considerations from other disciplines. Journal of
Marital and Family Therapy, 36, 59–70.
Nelson, T. S., Chenail, R. J., Alexander, J. F., Crane, D. R.,
Johnson, S. M., & Schwallie, L. (2007). The devel-
opment of core competencies for the practice of marriage and
family therapy. Journal of Marital and Family
Therapy, 33, 417–438.
Openshaw, D. K., Miller, J. K., Todahl, J. L., Linville, D., Platt,
J. J., & Coyle, S. (2006, October). The AAMFT
core competencies: Conceptualization and application. Paper
presented at the 2006 Annual Conference of
the American Association for Marriage and Family Therapy,
Austin, TX.
Patterson, J., Peek, C. J., Heinrich, R. L., Bischoff, R. J., &
Scherger, J. (2002). Mental health professionals in
69. medical settings: A primer. New York: Norton.
Patton, M. Q. (2002). Qualitative research and evaluation
methods (3rd ed.). Thousand Oaks, CA: Sage.
Perosa, L. M., & Perosa, S. L. (2010). Assessing competencies
in couples and family therapy ⁄ counseling: A call
to the profession. Journal of Marital and Family Therapy, 36,
126–143.
Prest, L. A., & Robinson, W. D. (2006). Systemic assessment
and treatment of depression and anxiety in families:
The BPSS model in practice. Journal of Systemic Therapies,
25(3), 4–23.
Prouty-Lyness, A. M. (2003). Feminist perspectives in medical
family therapy. New York: Haworth.
Saunders, P. A., Tractenberg, R. E., Chaterji, R., Amri, H.,
Harazduk, N., Gordon, J. S., et al. (2007). Promot-
ing self-awareness and reflection through an experiential mind-
body skills course for first year medical stu-
dents. Medical Teacher, 29, 778–784.
Seaburn, D. B., Lorenz, A. D., Gunn, W. B., Gawinski, B. A., &
Mauksch, L. B. (1996). Models of collaboration:
A guide for MHP-s working with health care practitioners. New
York: Basic Books.
Stone Fish, L., & Busby, D. M. (1996). The Delphi method. In
D. H. Sprenkle & S. M. Moon (Eds.), Research
70. methods in family therapy (pp. 469–484). New York: Guilford.
210 JOURNAL OF MARITAL AND FAMILY THERAPY June
2012
Copyright of Journal of Marital & Family Therapy is the
property of Wiley-Blackwell and its content may not
be copied or emailed to multiple sites or posted to a listserv
without the copyright holder's express written
permission. However, users may print, download, or email
articles for individual use.
O R I G I N A L P A P E R
‘‘Is Our Daughter Crazy or Bad?’’: A Case Study
of Therapeutic Assessment with Children
Francesca Fantini • Filippo Aschieri • Paolo Bertrando
Published online: 28 March 2013
� Springer Science+Business Media New York 2013
Abstract In this paper we present a new model of intervention
with documented efficacy
that combines psychological tests and assessment methods with
therapeutic techniques to
promote change in clients. We will discuss Therapeutic
71. Assessment of Children and their
families (TA-C) through the case of a 4-year-old girl, Clara, and
her family. Clara’s parents
were distressed by her uncontrollable rage outbursts and feared
she might be ‘‘crazy’’. The
treatment helped to shift the narrative the parents had about
Clara and give new meanings
to her behaviors. We describe in detail the steps of the
assessment and provide a theoretical
discussion of the therapeutic processes involved.
Keywords Assessment � Family � Children � Therapy
Within systemic therapy, skepticism about the tools and
methods typical of psychological
assessment has been fostered both by the social constructionist
stance that prevailed within
the field in recent year, and by prejudices about the very nature
of testing, i.e., the idea that
psychological tests pertain to the domain of naı̈ ve realism and
tend to give an account of
clients’ problems framed in a positivistic view. In such a
context, psychological assessment
is viewed as an effort to measure the ‘‘true reality’’ of clients’
problems, thereby mini-
72. mizing their own experiences, views, and hypotheses (Brown
1972). While this underlying
philosophy may characterize the traditional approach to
psychological assessment, in
recent years new ways have been developed of integrating the
tools and methods of the
assessment practice in a therapeutic and post-modern
framework. This is the case of
Therapeutic Assessment (TA), a semi-structured form of brief
integrative intervention
(Kaslow 2000) developed by Finn and his colleagues (Finn and
Tonsager 1992, 1997; Finn
2007) over the last 20 years. TA combines psychological
assessment with techniques and
F. Fantini � F. Aschieri (&)
European Center for Therapeutic Assessment, Università
Cattolica del Sacro Cuore, Via Nirone 15,
20123 Milan, Italy
e-mail: [email protected]
P. Bertrando
Private practice, Milan, Italy
123
Contemp Fam Ther (2013) 35:731–744
DOI 10.1007/s10591-013-9265-3
73. principles of interpersonal and systemic psychotherapy. TA has
proved to be effective with
different types of clients such as adult outpatients (Finn and
Tonsager 1992; Newman and
Greenway 1997), couples (Durham-Fowler 2010), families with
children (Tharinger et al.
2009; Smith et al. 2010), and adolescents (Ougrin et al. 2008).
Research has focused on the
effectiveness of TA with different types of problems, i.e., self-
harm (Ougrin et al. 2008);
internalizing symptoms, (Aschieri and Smith 2012);
externalizing symptoms (Smith et al.
2010); disorganized attachment (Smith and George 2012); and
developmental trauma
(Tarocchi et al. in press).
Therapeutic Assessment with Children and Their Families
TA with children and their families (TA-C) involves a
suggested series of steps described
in various publications (Aschieri et al. 2013; Smith et al. 2009;
Tharinger et al. 2008a; Finn
2007). In summary, after the initial phone contacts, the assessor
meets the parents to co-
construct assessment questions that capture their main puzzles
and worries about their
74. child or their relationship with their child (Step 1). By focusing
on the parents’ questions,
the assessor aims to involve parents as active participants from
the beginning of the
process. Assessment questions are used to build an alliance
around parents’ motivations
and goals, and to foster their curiosity about their child. Also,
the clear formulation of the
assessment goals as focused on their puzzles and worries has
the effect to lower the
parents’ anxiety about the assessment. The assessor also works
to gather background
information about the family and uses assessment questions as
guides to chose which
themes the parents are open to discuss and don’t find
threatening. In fact, besides the
explicit goal of collecting parents’ questions, the assessor also
works to build a secure
relationship with them, based on experiences of emotional
attunement, collaborative
communication and the repair of possible disruptions (Finn
2012). The creation of a such a
relationship is considered essential for a therapeutic change to
occur. The child being
75. assessed may have his/her own questions too, and these are
collected in the second session,
usually scheduled with the whole family. Afterwards, the
assessor begins the testing phase
with the child to collect useful information relevant to the
assessment questions. The
parents are usually asked to observe test administration or the
unstructured activities (i.e.
drawings) that are part of this phase from behind a one-way
mirror, over a video link, or
from the corner of the testing room (Step 2). Later, the assessor
and parents discuss their
observations and their relevance to the parents’ assessment
questions (Tharinger et al.
2008b). Different from other systemic collaborative
interventions (see, for example,
Teixeira et al. 2011), in TA-C the parents are involved directly
as co-assessors, observing
and interpreting their children’s behaviors during the testing.
Next the assessor schedules
one or more family sessions, the so called intervention sessions;
these represent occasions
to work even more on the systemic aspects of the child’s
problem and to work with the