State psychology licensure questions about mental illness and compliance with the Americans with Disabilities Act.

State licensing boards have obligations to protect the public from impaired professionals and to protect the rights of professionals applying for licensure. Competently functioning professionals who have or have had a mental health diagnosis or are being treated for a mental health condition should not be screened out, according to the Americans with Disabilities Act (ADA). A review of case law shows applicable precedents from discrimination among physicians and lawyers but not, to date, among psychologists. An examination of psychology licensure application materials from all 50 states and the District of Columbia revealed that some states, particularly Alaska, Arkansas, Colorado, Florida, Georgia, Kentucky, Missouri, Montana, and New Hampshire, include language that might screen out professionals with lived experience who are currently functioning competently. For comparison, we review a sample of licensure applications for physicians and lawyers and find a similar pattern. Five of the present authors offer ourselves and other published authors as examples of competent licensed psychologists who have lived with mental illnesses. We conclude with recommendations for more inclusive language and protection of confidentiality. (PsycINFO Database Record

Psychometric properties of seven self-report measures of posttraumatic stress disorder in college students with mixed civilian trauma exposure.

In this study psychometric properties of seven self-report measures of posttraumatic stress disorder (PTSD) were compared. The seven scales evaluated were the Davidson Trauma Scale (DTS), the PTSD Checklist (PCL), the Posttraumatic Stress Diagnostic Scale (PDS), the Civilian Mississippi Scale (CMS), the Impact of Event Scale-Revised (IES-R), the Penn Inventory for Posttraumatic Stress Disorder (Penn), and the PK scale of the MMPI-2 (PK). Participants were 239 (79 male and 160 female) trauma-exposed undergraduates. All seven measures exhibited good test-retest reliability and internal consistency. The PDS, PCL and DTS demonstrated the best convergent validity; the IES-R, PDS, and PCL demonstrated the best discriminant validity; and the PDS, PCL, and IES-R demonstrated the best diagnostic utility. Overall, results most strongly support the use of the PDS and the PCL for the assessment of PTSD in this population.

Sequential cognitive-behavioral therapy for children with obsessive-compulsive disorder with an inadequate medication response: a case series of five patients.

Few data have been reported on the efficacy of cognitive-behavioral therapy (CBT) for youth with obsessive-compulsive disorder (OCD) who have not responded to prior treatment with medication. Given this, we report an open trial of CBT for children who have remained symptomatic following medication trials. Five children with OCD who had an inadequate response to psychotropic medications (e.g., limited response and/or unable to be titrated to a complete dose due to side effects) received treatment in a 3-week intensive CBT program. Assessments were conducted at baseline and after treatment. All participants were classified as treatment responders (much improved or very much improved) and the severity of clinician-rated OCD symptoms and impairment significantly decreased after the intervention. Although a number of limitations of this preliminary report exist, this study provides preliminary support for the utility of an intensive intervention for youth with OCD who have had an inadequate response and/or adverse side effects.

Home-based behavioral health intervention: Use of a telehealth model to address poor adherence to type-1 diabetes medical regimens.

Youth with insulin-dependent diabetes mellitus face complex treatment regimens and often have difficulty adhering to treatment requirements. Many behavioral-health intervention strategies, such as psychoeducational groups, diabetes summer camps, individual therapy, and residential treatment have been utilized to address this issue. While some have been effective, many barriers exist that limit the number of youth who are able to utilize these treatments. Additionally, the effectiveness of these treatments does not typically generalize to the home environment. Telephone-based, intensive, behavioral-health interventions may address barriers to treatment access by providing lower cost treatment that is easier to access for youth who do not live near a knowledgeable behavioral-health specialist. Additionally, delivery via telephone enables the interventions to take place in the home. This, in combination with parental involvement in the treatment, may increase generalization of the positive treatment outcomes to the home environment. The purpose of this paper is to describe a controlled trial of a telehealth intervention for youth whose diabetes is poorly managed. Preliminary outcome data for the trial are promising. Representative cases from the trial are presented in case-study format.

The children's Yale-Brown obsessive-compulsive scale: psychometric properties of child- and parent-report formats.

The children's Yale-Brown obsessive-compulsive scale (CY-BOCS) is a commonly used, psychometrically sound clinician-rated instrument of pediatric obsessive-compulsive disorder (OCD) severity. Given the relatively direct rating format and potential benefits of alternative versions that could be easily administered to patients and parents, we developed and examined the psychometric properties of child- and parent-report formats of the CY-BOCS severity items. A total of 53 children and adolescents (8-17 years old) with OCD and their parents was administered the CY-BOCS, children's Yale-Brown obsessive-compulsive scale-child report (CY-BOCS-CR), children's Yale-Brown obsessive-compulsive scale-parent report (CY-BOCS-PR), and other measures of obsessive-compulsive symptoms, internalizing, and externalizing symptoms. In general, reliability and convergent and divergent validity of the CY-BOCS-CR/PR were satisfactory. Psychometric properties for the CY-BOCS-CR in those children and adolescents with externalizing behavior problems were lower relative to those without externalizing problems. Exploratory factor analyses identified a two-factor structure in both measures comprised of disturbance and severity factors. This study provides preliminary support for the use of child- and parent-report versions of the CY-BOCS.

The use of the trauma symptom inventory in the assessment of PTSD symptoms.

This study examined the Trauma Symptom Inventory (TSI; Briere, 1995) in a sample of 62 trauma-exposed community residents (80% Caucasian, 89% women), including 16 who had posttraumatic stress disorder (PTSD). PTSD and non-PTSD groups differed on seven TSI clinical scales and one validity scale, with effect sizes (r) ranging from 0.26 to 0.53. The largest effect sizes and best diagnostic utility were found for the Defensive Avoidance and Anxious Arousal scales. Diagnostic utility analyses suggest that TSI subscales in isolation are not superior to existing measures of PTSD. A logistic regression using the five most discriminating TSI scales produced a correct classification rate of 85.5%. TSI scales also demonstrated good convergent validity with other measures of PTSD. Overall, the results provide preliminary support for the use of the TSI in the assessment of PTSD.

Peer victimization and the development of obsessive-compulsive disorder in adolescence.

We describe an adolescent boy's experience of peer victimization and its relation with his development of obsessive-compulsive disorder (OCD). Subsequent to being peer victimized, this boy was seen for 20 sessions of cognitive-behavioral therapy over the course of 4 weeks that followed the protocol outlined by March and Mulle in 1998. Standardized post-treatment assessment indicated significant reductions in OCD, depressive, and anxious symptomatology as compared to baseline. This case illustrates how negative peer experiences may be related to the development and maintenance of OCD.

Cognitive-behavioral therapy for obsessive-compulsive disorder: review of treatment techniques.

Obsessive-compulsive disorder (OCD) is a chronic, impairing condition with an estimated lifetime prevalence in adults of 2.5%. Controlled treatment trials have demonstrated that cognitive-behavioral therapy (CBT) is an effective intervention for OCD. However, many individuals diagnosed with OCD do not receive appropriate, empirically validated interventions, perhaps due to limited knowledge of CBT among mental health practitioners. This article provides a review of CBT for OCD. Issues related to treatment delivery and assessment are presented and highlighted by an individual example.