The primary care prescribing psychologist model: medical provider ratings of the safety, impact and utility of prescribing psychology in a primary care setting.

Family medicine providers at a large family medicine clinic were surveyed regarding their impression of the impact, utility and safety of the Primary Care Prescribing Psychologist (PCPP) model in which a prescribing psychologist is embedded in a primary care clinic. This article describes the model and provides indications of its strengths and weaknesses as reported by medical providers who have utilized the model for the past 2 years. A brief history of prescribing psychology and the challenges surrounding granting psychologists the authority to prescribe psychotropic medication is summarized. Results indicate family medicine providers agree that having a prescribing psychologist embedded in the family medicine clinic is helpful to their practice, safe for patients, convenient for providers and for patients, and improves patient care. Potential benefits of integrating prescribing psychology into primary care are considered and directions for future research are discussed.

Acceptability and cost-effectiveness of military telehealth mental health screening.

Telehealth has been touted as one solution to the shortage of mental health providers within the military. Despite developing evidence for the equivalence of telehealth mental health care, there is no research that covers the use of telehealth for population mental health screening, a standard component of postdeployment medical screening. This paper summarizes soldier perceptions of three separate screening events in which telehealth was used and the cost-effectiveness of telehealth versus in-person implementations of the same screening. Soldiers who have not been through telehealth screening report a strong preference for in-person screening. Soldiers who have been through telehealth screening still report preference for in-person screening, but they express more ambivalence about the screening method. Using telehealth-only mental health screening for large numbers of soldiers within a compressed time frame is more expensive than in-person screening. Telehealth resulted in higher referral rates than in-person screening. Government and military leaders should use care when making decisions about telehealth implementation. Although telehealth for small numbers may be sufficiently equivalent and economical, there is no evidence of cost savings or improved acceptability for telehealth mental health post-deployment screening.

Postdeployment mental health screening: an application of the Soldier Adaptation Model.

The Global War on Terrorism and its corresponding frequent and long deployments have resulted in an increase in mental health concerns among active duty troops. To mitigate these impacts, the Department of Defense has implemented postdeployment screening initiatives designed to identify symptomatic soldiers and refer them for mental health care. Although the primary purpose of these screenings is to identify and provide assistance to individuals, macrolevel reporting of screening results for groups can assist Commanders, who are charged with ensuring the wellbeing of their soldiers, to make unit-level interventions. This study assesses the utility of a metatheory of occupational stress, the Soldier Adaptation Model, in organizing feedback information provided to Army Commanders on their units' postdeployment screening results. The results of a combat brigade of 2319 soldiers who completed post-deployment screening following return from Iraq were analyzed using Structural Equation Modeling to assess the Soldier Adaptation Model's use for macrolevel reporting. Results indicate the Soldier Adaptation Model did not strengthen the macrolevel reporting; however, alcohol use and reckless driving were found to mediate the relationship between combat exposure and numerous mental health symptoms and disorders (e.g., post-traumatic stress disorder, anger, depression, anxiety, etc.). Research and practice implications are discussed.

Improving psychotherapy outcome: the use of immediate electronic feedback and revised clinical support tools.

The benefits of psychotherapy have been well documented; however, 5-10% of clients worsen while in treatment and another minority shows no response. The effects of feedback timing (delayed or immediate) and type (progress feedback and Clinical Support Tool [CST] feedback), aimed at reducing deterioration and improving outcomes, were examined in a sample of 1101 clients whose outcome was contrasted across experimental groups and with two archival groups: a delayed progress feedback and CST feedback group (n = 1374) and a treatment-as-usual control group (n = 1445). Progress feedback to therapists improved outcomes, especially for cases at risk for a negative outcome, but direct progress feedback to clients did not. Effects were significantly enhanced by using the manual-based CST. There were no significant differences in outcome between the 1-week-delayed CST feedback and 2-week-delayed CST feedback groups; however, clients in the week-delayed CST feedback timing condition attended three less sessions, on average, than their 2-week-delayed CST feedback counterparts while maintaining similar treatment gains. Results were interpreted as supporting the value of monitoring client progress and feeding back this information to therapists as well as assisting therapists in problem solving with cases at risk for treatment failure.