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Journal of Mental Health Counseling
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Volume 36, Number 2, april 2014


1. Mental Health Services in Primary Care: Implications for Clinical Mental Health Counselors and Other Mental Health Providers (Pages 95-98)

Lisa M. Hooper, Guest Editor

I am pleased to introduce this special issue of the Journal of Mental Health Counseling dedicated to mental health in primary care. Though the idea of incorporating mental health services into primary care is not new, there is a clear need to promote the transportability of counseling theories and culturally sensitive counseling practices to primary care settings. Clinical mental health counselors who are not aware of the importance of fostering meaningful collaborations and consultation with primary care physicians can garner useful information from the articles that appear in this special issue of the Journal of Mental Health Counseling. Knowledge acquired from this special issue about the dearth of quality mental health care for some patients seen in primary care settings may engender innovative solutions, both put forward by clinical mental health counselors and co-created with primary care physicians. I also hope that the articles in this special issue may stimulate future research and produce implications for treatment and services that can be piloted and evaluated for their sustainability, patient-centeredness, and cultural responsiveness to the long-standing clinical issue of ensuring effective mental health services in primary care settings. Full Article


2. Integrated Health Care Best Practices and Culturally and Linguistically Competent Care: Practitioner Perspectives (Pages 99-114)

Kiara Alvarez, Yesenia A. Marroquin, Luis Sandoval and Cindy I. Carlson

Practitioners in two federally qualified health centers (FQHCs) were interviewed to explore how their organizations carried out best practices in cultural and linguistic competence (CLC) when integrating mental health services into primary care. Archival data and data from interviews with eight clinical service providers were analyzed using exploratory cross-case synthesis. To highlight best practices in integrated health care (IHC), clinical, systemic, and organizational themes were identified: patient-centered care for underserved populations, building and sustaining a successful multidisciplinary team, and increasing capacity and adapting to changing circumstances. CLC did not emerge as a distinct interview theme, though it was present in subthemes and was discussed by both mental health and medical practitioners as central to effective healthcare delivery. The results underscore the need for culturally-tailored research and training that examines how IHC can best serve diverse groups and communities. Full Article


3. Behavioral Health Training Is Good Medicine for Counseling Trainees: Two Curricular Experiences in Interprofessional Collaboration (Pages 115-129)

Jared Cox, Eve Adams and Mary Jo Loughran

Based on training efforts at two universities, this article explores considerations when mental
health professionals (MHPs) are trained to work effectively in primary care settings. It first
outlines the curriculum of an advanced doctoral level course in health psychology practice. To better refine the experiences of trainees, it then describes a qualitative pilot study of counseling psychology practicum students (N = 4) in a primary care setting. Six themes from the interviews and focus groups are identified: mental health culture, primary care context, challenging entry, adapting to the primary care context, managing complex cases, and results of the collaborative process. Finally, it provides recommendations for future training and research direction. Full Article


4. Integrated Primary Care: Why You Should Care and How to Get Started (Pages 130-144)

Mark E. Vogel, Sylvia A. Malcore, Rose Anne C. Illes and Heather A. Kirkpatrick

Many mental health practitioners who are interested in primary care may not know how to get involved. Integrated Primary Care (IPC) is a model that normalizes mental and behavioral health issues in primary care with the goal of improved health outcomes; it shows promise for addressing mental health care disparities. Recognizing that mental and physical health problems are interwoven, utilizing the primary care system of medical health delivery offers an opportunity for patients to have greater access to behavioral services. Recent movements have increased the demand for integration of physical and behavioral health. This article reviews research on access issues, adherence, and the effectiveness of IPC with particular attention to newer studies and those examining culturally diverse groups. Finally, it offers suggestions for counselors seeking to integrate their practice with the primary care setting in a culturally sensitive way. Full Article


5. Variables Associated with High Caregiver Stress in Patients with Mild Cognitive Impairment or Alzheimer's Disease: Implications for Providers in a Co-Located Memory Assessment Clinic (Pages 145-159)

Daniel Hall, Joseph Wilkerson, James Lovato, Kaycee Sink, Dana Chamberlain, Rabeena Alli, Philip Clarke, Samantha Rogers, Jose Villalba, Julie Williams, Edward G. Shaw

Caregiver burden—the stress associated with caring for a loved one with chronic illness—is rated as high or very high by about two-thirds of Alzheimer’s caregivers. At Wake Forest School of Medicine, both patients with memory loss or cognitive impairment and caregivers are evaluated at a geriatrician-led co-located Memory Assessment Clinic (MAC). In a sample of 100 MACevaluated patient-caregiver dyads this study assessed both patient severity of Alzheimer’s disease or other dementia, self-reported behavioral disturbances, degree of functional independence in general activities of daily living and instrumental activities of daily living (IADLs), and caregiver stress as measured by the Caregiver Burden Scale (CBS). Several patient factors were found to be related to high caregiver stress (CBS score > 25), in particular moderate-severe dementia; inability to perform most IADLs, especially managing medications; and most behavioral disturbances, especially agitation/aggression and appetite/eating problems. The article also suggests ways medical and mental health providers and researchers can help reduce caregiver stress. Full Article


6. Lessons Learned from Designing and Leading Multidisciplinary Diabetes Educational Groups (Pages 160-172)

Bethany P. Glueck and Brett H. Foreman

Diabetes is a serious health condition that significantly impacts physical and emotional well-being. Working with primary care providers, clinical mental health counselors have an opportunity to contribute to its efficacious treatments. Researchers and clinicians have suggested a multidisciplinary approach to diabetes care may be useful. To increase knowledge and awareness about the use of collaborative care models for diabetes care, the authors—a licensed professional counselor and a family physician—share lessons learned from their experiences designing and cofacilitating a series of multidisciplinary-led diabetes groups in 2007, 2008, and 2009. The series covered education, support, and self-management techniques related to diabetes care. All 57 participants were asked to complete a program evaluation survey. All 29 participants who did so (100%) reported having a better understanding of diabetes, and 21 (71%) reported applying what they had learned (e.g., increasing exercise and making better nutritional choices). Implications for counselors in practice and research are discussed.


7. Cultural Competency, Culturally Tailored Care, and the Primary Care Setting: Possible Solutions to Reduce Racial/Ethnic Disparities in Mental Health Care (Pages 173-188)

Laura P. Kohn-Wood and Lisa M. Hooper

Racial and ethnic minorities in the United States are less likely to receive treatment for psychiatric disorders than are White Americans. For two decades, clinicians and researchers have worked to reduce health and health care disparities, with at best minimal success. In 2001 the Surgeon General issued a seminal report that described the magnitude of the problem (U. S. Department of Health and Human Services, 2001). Nevertheless, the vexing problem of unequal treatment persists. This review provides preliminary evidence for reducing racial and ethnic disparities in mental health treatment in primary care settings by giving priority to culturally competent practices and cultural tailoring in assessment, diagnosis, and treatment. Full Article

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