The contribution of psychological assessment to community mental health services

Specialist psychological assessment plays a potentially important role in multidisciplinary community mental health settings. This portfolio describes and evaluates this psychological assessment and provides four case studies.

Assessment and case conceptualization in sex offender treatment

The assessment of sexual offenders consists of the systematic collection of clinically relevant information in order to detect clinical phenomena or problems and to provide clear treatment targets. The result of this process is a conceptual model, or case formulation, representing the client’s various problems, the hypothesized underlying mechanisms, and their interrelationships. The focus of this article is on the importance of psychological assessment and case formulation in the rehabilitation and management of individuals convicted of sexual offences. First, we make a number of general points about the importance of evidence based assessment and clinical reasoning in case formulation. Second, we review key elements of contemporary sexual offender theory that highlights the heterogeneity evident among sex offenders and the implications for case formulation and treatment planning. Third, we discuss the role of case formulation for risk assessment and management. Finally, we illustrate our major points with a brief case study and conclude with a brief consideration of the value of case formulations.

The diagnostic validity and reliability of an internet-based clinical assessment program for mental disorders

BACKGROUND: Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. OBJECTIVE: The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. METHODS: Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. RESULTS: With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS' sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87). CONCLUSIONS: The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG).

Self-concept and motivation as predictors of actual consumer behaviour

The need to predict consumer behaviour outcomes is considered to be a very important issue for marketers. Isolated individual psychological constructs such as attitudes, motives, personality traits and learning styles have been used to identify their predictive capacity for actual consumer behaviour with varying degrees of success. This paper attempts to test
empirically the predictive power of two constructs, motivation and self-concept, regarding business consumer’s actions in a service context, using an Australian representative sample.

Patients' experiences of cardiology procedures using minimal conscous sedation

Aim: The study's purpose was to describe patients' experiences of minimal conscious sedation during diagnostic and interventional cardiology procedures.

Methods: Over a 6-week period, 119 consecutive patients (10% of annual throughput) from a major metropolitan hospital in Melbourne, Australia, were interviewed using a modified version of the American Pain Society Patient Outcome Questionnaire. Patients identified pain severity using a 10-point visual analogue scale and rated their overall comfort on a 6-point Likert scale ranging from very comfortable to very uncomfortable.

Results: Patients were aged 67.6 years (standard deviation 11.1), 70.8% were male, and the mean body mass index was 27.7 (standard deviation 4.8). Patients underwent diagnostic coronary angiography (67.5%), percutaneous coronary interventions (13.3%), or combined procedures (19.2%). Most patients (65%) were comfortable in the context of low-dose conscious sedation. Slight discomfort was reported by 26% of patients; 9% reported feeling uncomfortable primarily as a result of a combination of musculoskeletal pain, angina, and vasovagal symptoms experienced during the procedure. There was significant correlation (rho = .25, P = .01) between procedure length and patients' report of overall comfort, suggesting longer procedures were less comfortable for patients.

Conclusions: The minimal sedation protocol was effective for the majority of patients; however, 9% of patients experienced significant discomfort related to preexisting conditions, highlighting the need for individual patient assessment before, during, and after the procedure.

How deinstitutionalisation and the current public mental health system affects individuals with schizophrenia : four case reports

The professional component of this thesis focuses on how deinstitutionalisation and the current public mental health system have affected individuals with schizophrenia. Chapter one discusses the process of deinstitutionalisation and the research that has examined the impact of this initiative. Chapter two concentrates on schizophrenia, specifically the symptoms, course, etiological theories and treatments of this illness. Four case studies are then provided in order to explore how deinstitutionalisation and the current mental health system have affected individuals with schizophrenia. The names and identifying characteristics of these clients and their families have been modified to ensure anonymity. Chapter three describes a 47 year old woman, AA, who was referred for a neuro-psychological assessment. Chapter four outlines the second case study, a 23 year old male, BB, who was referred for a psychological assessment regarding diagnosis and treatment recommendations. Chapter five describes the third case study, a 54 year old woman, CC, who was referred for therapy and consultation regarding future treatment recommendations. Chapter six discusses the fourth case study, a 21 year old male, DD, who was seen for crisis intervention and treated in the community. Each of these case studies outlines the background history, formulation and treatment approaches. These case reports are used to illustrate how deinstitutionalisation and the present public mental health system affect individuals with schizophrenia. Chapter seven provides an overall discussion and conclusion to these case studies.

Nurses' understanding of patient-centred care in Bhutan

Aim The purpose of the study was to explore nurses' perceptions and understanding of patient-centred care (PCC) in Bhutan. Background Nurses' perceptions and understanding of PCC in Bhutan are unknown. Methods A non-probability convenience sample was taken and a mixed method (quantitative and qualitative descriptive) used. Survey questionnaires were administered to 87 Bhutanese nurses in three types of hospitals -- the National Referral Hospital, the regional referral hospital and the district hospital. Descriptive statistics including frequency distribution, mean and standard deviation (SD) were used for analysis. Spearman's correlation coefficients were used to investigate relationships between demographic variables. Results The nursing labour force in Bhutan knows which behaviours are considered necessary for practising PCC. The mean (SD) rating of behaviours considered critical for practising PCC was 4.29 (0.22), five being the highest score. Bhutanese nurses described PCC, according to qualitative descriptive analysis, as being based on individual patient assessment (22/87 or 25% of respondents), using a holistic model of care (38/87 or 44%) that was based on evidence (38/87 or 44%). A higher level of education (79/87 or 91%) was found to be the main factor that would facilitate the development of PCC, while inadequate staffing, in terms of insufficient numbers of staff and lack of advanced practitioners (56/87 or 64%), was revealed as the main factor that hinders development of PCC. Conclusion Bhutanese nurses believed certain behaviours were critical to PCC. Reform of higher nursing education, putting an emphasis on PCC, would improve nursing practice and increase its scope.

The effect of the category of sport team on the role of nostalgia in an individual supporter’s psychological connection to that sport team

With the many benefits related to high levels of psychological connection with a sport team, marketers, management and communities desire supporters to be highly connected with sport teams. A major gap has been identified in relation to the effect of the category of sport team on the role of nostalgia in determining that connection. A conceptual model is presented together with a proposed methodology. This research will aid academics and administrators in their communications with and targeting of consumers and affords communities the opportunity to benefit from consumers’ higher levels of psychological connection with a sport team.

Sex offender risk assessment : consideration of human rights in community protection legislation

ObjectivesRisk assessments provided to judicial decision makers as a part of the current generation of legislation for protecting the public from sexual offenders can have a profound impact on the rights of individual offenders. This article will identify some of the human rights issues inherent in using the current assessment procedures to formulate and communicate risk as a forensic expert in cases involving civil commitment, preventive detention, extended supervision, or special conditions of parole. MethodBased on the current professional literature and applied experience in legal proceedings under community protection laws in the United States and New Zealand, potential threats to the rights of offenders are identified. Central to these considerations are issues of the accuracy of current risk assessment measures, communicating the findings of risk assessment appropriately to the court, and the availability of competent forensic mental health professionals in carrying out these functions. The role of the forensic expert is discussed in light of the competing demands of protecting individual human rights and community protection. ConclusionActuarial risk assessment represents the best practice for informing judicial decision makers in cases involving sex offenders, yet these measures currently demonstrate substantial limitations in predictive accuracy when applied to individual offenders. These limitations must be clearly articulated when reporting risk assessment findings. Sufficient risk assessment expertise should be available to provide a balanced application of community protection laws.

An interview schedule for use in the assessment of tertiary students' learning development needs

The initial interview is an important aspect of development of and intervention in tertiary student learning. Yet there are no published interview schedules available to psychologists working in the area of tertiary academic skills development. This paper presents an interview schedule for use with individual tertiary students seeking assistance with learning and academic skills development. Some preliminary comments about the application of the schedule are also offered.

The effectiveness of an internet-based psychological treatment program for female sexual dysfunction

Introduction.  There has been limited evaluation of the effectiveness of psychological interventions for female sexual dysfunction (FSD). Furthermore, none of these studies have evaluated the effectiveness of these programs delivered over the Internet.

Aim.  The current study evaluated an Internet-based psychological treatment program for FSD. Revive consisted of three well-established and validated treatment components: communication skills training, sensate focus exercises, and regular contact with a therapist.

Main Outcome Measures.  Outcome measures included: the Female Sexual Function Index; the Depression, Anxiety, Stress Scale; the Sexual Function Scale; and the Personal Assessment of Intimacy in Relationships.

Methods.  In total, 39 women (17 in treatment group and 22 in control group) completed the program. The mean age for the treatment group was 34.91 (standard deviation [SD] = 10.27) and 33.30 years (SD = 9.34) for the control group.

Results.  The results demonstrated that women who completed treatment reported improved sexual and relationship functioning in comparison with those who received no treatment.

Conclusions.  These findings highlight the suitability of the Internet for providing psychological treatment for FSD and for targeting the individual and relationship factors often associated with these disorders.

Measurement and characterisation of individual differences in need for cognition.

This thesis investigated the measurement of differences between people in tendency to engage in effortful thought. Findings from this research will improve measurement in future research, while also providing insights into the motivation behind this tendency, with implications for diverse applications such as education, career selection, and prejudice.

Teacher subject specialisms and their relationships to learning styles, psychological types and multiple intelligences: implications for course development

This study explores issues in teacher education that increase our understanding of, and response to, the individual differences displayed by learners. A large undergraduate teacher education cohort provided evidence of the range and distribution of preferences in learning styles, psychological types and multiple intelligences. This information revealed that distributions of scores on the Kolb Learning Style Inventory, the Myers-Briggs Type Indicator, and the Multiple Intelligences Checklist for Adults provide evidence about the scope and range of differences between four teacher subject specialisms. This rich information about those participating in teacher education courses provides some guidance for educating those with their own clear preferences to the range of different preferences expressed by many other learners and highlights the existence of four sets of major differences in approaches to teaching and learning in prospective teachers.