Sara Honn Qualls

Psychologists in Practice With Older Adults: Current Patterns, Sources of Training, and Need for Continuing Education

Rapid population growth among older adults means an increased need for psychologists prepared to provide mental health services to this population. A representative survey of 1,227 practitioner members of the American Psychological Association yielded information about current patterns of practice with older adults, sources of training in geropsychology, perceived need for continuing education (CE) in geropsychology, and preferred CE formats. Most respondents provided some services to older adults, but typically very little. The services provided are inadequate to meet projected demand. Most respondents lacked formal training in geropsychology and perceived themselves as needing additional training. CE workshops at the regional level and distance education were the most popular formats. These data serve as a call to the field to expand training opportunities at all levels of training, with an emphasis on the need for empirically based, broadly accessible CE offerings.

Psychology and the aging revolution : how we adapt to longer life

Focuses on how longer life expectancies will change the fabric of soci ety and individual lives. Examines the latest theories and research o n how aging affects a wide variety of aspects -- memory, social relati onships, emotion, and mental health.

Competencies for psychology practice in primary care.

This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

Pikes Peak Model for Training in Professional Geropsychology.

The aging of the population will increase demand for psychological services for older adults, which challenges the profession of psychology to provide those services. In response to that challenge, professional geropsychology has been developing over the past few decades to meet current and prepare for anticipated future demand. The development of a range of training opportunities is important to enable psychologists to work effectively with older adults. This article describes the Pikes Peak model for training in professional geropsychology. The model is an aspirational, competencies-based approach to training professional geropsychologists that allows for entry points at multiple levels of professional development.

Therapy with aging families: Rationale, opportunities and challenges

Gerontological research provides sufficient evidence of the central role of families in the lives of older adults to warrant serious concern about families as a locus of intervention. Whether independent or dependent, older adults experience families as integral to their daily life and wellbeing (Shanas, 1979). The application of family therapy techniques and theories to aging families has been slow to emerge, however. Family therapy models that address the structure or functioning of the family are only rarely discussed as relevant to older adults (Qualls, 1995; Shields et al., 1995), and research investigating the impact of family therapy is rare. The purposes of this paper are to document the solid rationale for family therapy in later life, using one common later life process, cognitive deterioration, to illustrate the conditions under which family therapy would be the treatment of choice, and to suggest future directions and serious challenges to research on family therapy outcomes.

Help-seeking behaviors of people with sexual problems

Help-seeking activities associated with the sexual problems of community respondents (N = 503) were studied. Major findings include (i) a majority of respondents reported some form of social help-seeking from predominantly informal rather than professional helpers; (ii) a significant increase over early adulthood in the likelihood of reporting a dyadic sexual problem was evidenced, however there was no parallel change in help-seeking behaviors with age; (iii) help-seeking from intimates was associated with obtaining help from other informal contacts; (iv) help-seeking from extrafamilial, but not familial, supports was found to covary with income, and (v) a “normative” sequence to help-seeking behaviors was identified. Also discussed is the present works relevance to research on human immunodeficency virus transmisssion.

Family processes and treatment

Families are the most highly salient social context for older adults and thus may be presumed to be relevant to the etiology, course, prognosis and treatment of mental disorders.Despite a well-documented relationship between perceived social support from families and mental wellbeing, surprisingly little research has examined the relationship between families and mental disorders in later life. Under what conditions do family members enhance dysfunction in older persons or moderate the negative effects of disorder? When and how do families contribute to the assessment or treatment of mental disorder?What types of intervention bene® t families? How do families organize themselves and draw upon community resources to meet the needs of their older members? The papers in this special section provide a sampling of answers to questions of this kind. Although addressing a small portion of the important issues the ® eld must address, these papers illustrate how examination of family structure and processes can contribute to a better understanding of the problems faced by older adults and can lead to increased opportunities for successful treatment. The paper by Qualls provides a rationale for family level intervention with older adults, using the specific instance of cognitive deterioration to illustrate the argument. The particular example of cognitive deterioration makes explicit the shifting balance of interdependence that exists within families from birth to death. As an older person deteriorates cognitively, family members alter their roles to support the safety and wellbeing of the older person in ways that are often more implicit than explicit. Thus, when clinicians see older adults whose wellbeing is not being fostered, the family offers a logical focus for assessment and intervention. Qualls extends Minuchin’s (1974) family systems model for therapy, outlining the opportunities for family-level intervention with adults in later life. She also challenges the ® eld to build a meaningful research base to evaluate the value, efficacy and appropriateness of family-level interventions. Mitrani and Czaja describe the ® rst steps toward an empirical test of family-level interventions for caregivers of people with dementia. Their protocol has been developed as part of the REACH (Resources for Enhancing Alzheimer’s Caregiver Health) caregiving study, which is currently in ® eld trials in the USA.Targeted to supporting the family caregiver who is often burdened, stressed and at risk for mental disorder himor herself, this intervention program applies Structural EcosystemsTherapy (SET) in order to enhance family support for both caregiver and care recipient. These authors detail the essence of their intervention program for white American and Cuban American caregiving families, offering rich clinical examples of family interactions that foster or impede caregiver support. They describe several strategies for intervention, as well as how an understanding of the culture of a particular population can be used to make adaptations of the treatment approach so that it addresses pertinent clinical problems in a way that makes sense within the cultural context. Sandberg and Harper investigate the etiological role of marital distress for depression in older adults. They test a theoretical model that predicts that daily hassles (stress), health problems and marital distress in one spouse have both direct and indirect associations with depression in the other spouse.Their results suggest that the partner of an ill, depressed or stressed spouse warrants the attention of health care providers because of an elevated risk of depression. Furthermore, their data suggest that marital quality is often the indirect pathway through which health problems and stress adversely affect a spouse. The need for a relational view of depression in young and midlife adults is widely accepted.This papers extends the argument to older adults, offering evidence for the central role of relationship quality to depression etiology in later life couples. Shields, Travis and Rousseau focus on one important relationship characteristic, attachment, as a predictor of mental wellbeing in later life couples coping with cancer. They provide evidence of an

Tailored Caregiver Therapy: Consumer Response to Intervention

Interventions must be tailored to meet the specific needs of a given individual, and caregivers represent a large population of individuals with diverse needs. A wide range of goal areas complicates assessment of multi-component interventions, and few tools are designed to capture the value of specific interventions to caregivers who are clients involved in these clinical interventions. Further, no studies have examined caregiver interventions from the consumer perspective. The current study includes an analysis of the goal areas identified by caregivers as relevant to their situations, including information about goals areas that are likely to co-occur and insight into the utility of specific interventions for particular goal areas.

Development and Preliminary Examination of the Psychometric Properties of the Behavior Problem Checklist

ABSTRACT Objective: Clinical settings require an efficient and informative approach to the assessment of caregiving situations to help providers decide how to focus interventions. Providers serving caregivers need to know about care recipients, who may not be available in the same clinical setting where the caregiver is being served, so checklists have been developed to elicit the caregivers’ perceptions of the problem (e.g., symptoms, functional challenges, and attributions for the problem). The purpose of this study was to conduct a preliminary test of reliability and validity of an assessment tool designed for use in clinical settings that serves caregivers of persons with physical illness as well as dementias.Methods: Informal family caregiver clients in a counseling program (N = 502) completed assessment questionnaires, including a new measure, the Behavior Problem Checklist, during intake, prior to intervention. The sample was divided into a development sample (N = 400) and a verification sample (N = 102) in order to examine the psychometric properties of the Behavior Problem Checklist.Results: The Behavior Problem Checklist exhibited item-total internal reliability, test-retest reliability, and convergent validity with another measure of behavior problems.Conclusions: The Behavior Problem Checklist appears to be a valid tool to assess problem behaviors. At its current level of development, it is deemed to be appropriate for use in research settings. With further study, the BPC may prove to be a useful clinical tool for use with caregivers to help identify care recipient problem areas that can assist providers with selection of interventions.

Motivational and Cognitive Pathways to Medical Help-Seeking for Alzheimer’s Disease: A Cognitive Impairment Response Model

OBJECTIVES Relationships among cognitive and motivational factors in predicting medical help-seeking for Alzheimers disease (AD) symptoms were tested. METHOD Community residents awaiting jury service (N = 280) completed questionnaires, including responses to a vignette depicting prototypical early symptoms of AD in a hypothetical mother. Cognitive responses to the vignette included AD symptom identification and AD attribution. Affective-motivational responses to vignettes were symptom impact and behavior appraisals. General knowledge of AD was assessed. Intention to seek medical help was the dependent variable. RESULTS The impact and identification of AD symptoms, appraisals of risk, and attribution of the scenario to AD were modest, yet all contributed to prediction of medical-help-seeking intentions. The best fitting model had distinct but interrelated cognitive and motivational paths explaining 49% of the variability in medical help-seeking. Motivational variables had particularly important direct and indirect effects on help-seeking. DISCUSSION Findings are interpreted as evidence of the importance of motivational as well as cognitive aspects of perceptions of illness behavior in another person. The substantial impact of the tested variables on the desired outcome of medical help-seeking may suggest options for public health efforts to enhance early medical help-seeking for AD that sets the stage for early intervention.