Erin E. Emery

Development of a tool to evaluate geropsychology knowledge and skill competencies

BACKGROUND Workforce shortages to meet the mental health needs of the worlds aging population are well documented. Within the field of professional geropsychology in the U.S.A., a national conference was convened in 2006 to delineate competencies for psychological practice with older adults and a training model for the field. The conference produced the Pikes Peak Model of Geropsychology Training. The Council of Professional Geropsychology Training Programs (CoPGTP) aimed to produce a competency evaluation tool to help individuals define training needs for and evaluate progress in development of the Pikes Peak professional geropsychology competencies. METHODS A CoPGTP task force worked for one year to adapt the Pikes Peak Model geropsychology attitude, knowledge, and skill competencies into an evaluation tool for use by supervisors, students and professional psychologists at all levels of geropsychology training. The task force developed a competency rating tool, which included delineation of behavioral anchors for each of the Pikes Peak geropsychology knowledge and skill competencies and use of a developmental rating scale. Pilot testing was conducted, with 13 individuals providing feedback on the clarity and feasibility of the tool for evaluation of oneself or students. RESULTS The Geropsychology Knowledge and Skills Assessment Tool, Version 1.1, is now posted on the CoPGTP website and is being used by geropsychology training programs in the U.S.A. CONCLUSIONS The evaluation tool has both strengths and limitations. We discuss future directions for its ongoing validation and professional use.

Geropsychology content in clinical training programs: a comparison of Australian, Canadian and U.S. data.

BACKGROUND There is a worldwide shortage of mental health professionals trained in the provision of mental health services to older adults. This shortage in many countries is most acutely felt in the discipline of psychology. Examining training programs in clinical psychology with respect to training content may shed light on ways to increase interest among students and improve practical experiences in working with older adults. METHODS A large multinational survey of geropsychology content in university-based clinical and counselling psychology training programs was conducted in 2007 in the U.S.A., Australia, and Canada. Both clinical/counseling programs and internship/practicum placements were surveyed as to staffing, didactic content and training opportunities with respect to geropsychology. RESULTS Survey response rates varied from 15% in the U.S.A. (n = 46), 70% in Australia (n = 25) to 91.5% in Canada (n = 22). The U.S.A. and Australia reported specialist concentrations in geropsychology within graduate clinical psychology training programs. More assessment and psychopathology courses in the three countries were cited as having ageing content than psychotherapy courses. Many non-specialist programs in all three countries offered course work in geropsychology, and many had staff who specialized in working clinically with an older population. Interest in expanding aging courses and placements was cited by several training sites. Recruiting staff and finding appropriate placement opportunities with older adult populations were cited as barriers to expanding geropsychology offerings. CONCLUSIONS In light of our results, we conclude with a discussion of innovative means of engaging students with ageing content/populations, and suggestions for overcoming staffing and placement shortcomings.

An exploratory study of inducing positive expectancies for psychotherapy.

Objectives: The goal of this study was to determine whether explicit presentation of outcome data about the effectiveness of psychotherapy among older adults increased positive expectancy for treatment. Method: The study included an ethically diverse sample of 50 adults over age 60 who screened positive for depression and agreed to participate in the BRIGHTEN Program, an interdisciplinary geriatric mental health program. Prior to treatment initiation, we presented participants with outcome data about psychotherapy, asked participants to rate and respond to the data, and asked participants about prior experience with mental health treatment. These data were collected via semi-structured interviews. Results: Higher importance ratings for the outcome data were significantly associated with starting psychotherapy (r = 0.30, p = 0.04). Depression severity predicted importance assigned to the outcome data (ß = 0.36, p = 0.03), more severely depressed participants rated the outcome data as more important. Qualitative analyses indicated that the presentation of outcome data increased hopefulness for successful treatment. In a hierarchical regression analysis, hopefulness in the data predicted data importance ratings, above and beyond the influence of depression severity (ß = 0.50, p < 0.01). Conclusion: Our results suggest that information about the effectiveness of psychotherapy was important to participants and was associated with starting psychotherapy. High importance ratings for the data were primarily driven by the data increasing hopefulness for successful treatment outcomes. Although this study was exploratory, it suggests that explicit presentation of the effectiveness of psychotherapy may create positive expectancies for treatment among older adults.

Community Long-Term Care Teams: Assessing Team Fitness

Although long-term care is often conceptualized as institutional living, the majority of long-term care is provided in the community through primary care. The BRIGHTEN program (Bridging Resources of an Interdisciplinary Geriatric Health Team via Electronic Networking) provides interdisciplinary care utilizing a “virtual” team model. Highly cohesive and collaborative interactions are required for the success of health care teams. Team functioning thereby was assessed using the Team Fitness Test and Team Development Measure, followed by extensive discussion about identified strengths and weaknesses. The team was found to be “firmly in place” within 6 months of formation. While there were minimal changes in objective measures over time, the process of evaluation was found to be very helpful for the team. Implications of team assessment and development for older adult long-term care are discussed.

Who am I with Parkinson's Disease? A Psychologist Response to Chaplain Intervention in the Context of Identity Theory

Parkinsons disease can rob an individual of their most prized roles, and symptoms of the disease itself can make finding new ways to enact existing roles or developing new roles very challenging. The chaplains case study is reviewed from the perspective of a clinical geropsychologist through the lens of identity theory. The line between chaplain intervention and psychotherapy is addressed. The patients significant improvement in depression symptoms over the course of his participation in the BRIGHTEN program and with the chaplain are presented to suggest that chaplain intervention can be a central and effective part of an interdisciplinary treatment approach. The need for utilization of existing measures and development of new measures of chaplain intervention are discussed.

Treatment Adherence in Late-Life

Publisher Summary Eighty percent of older adults have at least one chronic illness, and 50% have two or more. Adherence to treatment plans for these chronic illnesses is imperative for effective symptom and disease management, as well as for containing health care costs. Adherence behavior is highly variable, dependent on a multiplicity of individual, provider, and system-level factors. This chapter reviews adherence determinants in the context of theoretical models of illness beliefs and behavior change, along with methods and tools for assessing adherence behavior and associated constructs. With life expectancy and chronic illness prevalence increasing, understanding treatment adherence becomes paramount to improving health outcomes and quality of life for older adults, and health care costs for all. Treatment adherence is multi-faceted and not comprehensively conceptualized by any single model. Multiple individual, provider, and systems-level factors must be taken into account to fully understand why older adults may or may not adhere to a treatment plan. Many assessments are available to measure these factors, including those that measure attitudes, beliefs, performance, or behavior, using self-report, observational, electronic, or physiological methods. As with most treatment modalities, however, the relationship between patient and provider appears to be key in maximizing treatment adherence. Consistent with the Recovery model, identifying and working within the patients goals for treatment and for life, which may reflect their socioeconomic status, culture, education, health literacy, cognitive status, and personality, is most likely to lead to adherence to an agreed upon plan.