Issues in Psychology:

•   Psychology in the Schools
•   Psychological Testing
•   Coping with Financial Despair
•   Psychologicalally Health Workplaces

Coping with Financial Despair

Debra and Bob have been married for 29 years. After years of careful investments, they were looking forward to a comfortable retirement. Bob, a teacher, could count on a regular pension. Debra ran a quilting business from home. Their daughters Laurie and JoAnn were still at university, while their oldest son Dean was working out west.

Then came the crash. Bob and Debra watched in horror as each day their stocks and investments dramatically decreased in worth.

“We should sell!” cried Debra. “No, the market will recover”, said Bob. As their savings dwindled, their despair increased, as did their fighting.

Bob took to spending long hours alone researching the market. Debra became increasingly anxious, and began to awake at night in a panic. Dinnertime became a routine of gloom, with each spouse speculating on what they must give up to get by in the future. They were in financial despair.

Many people are experiencing Debra and Bob's struggle. Although individuals vary in how invested they are in the market, all of us are affected by its recent setbacks. Psychologists have expertise in helping people cope with life's challenges: using a combination of strategies learned by psychologists, we can learn to weather this market storm.

Psychologists make the distinction between two types of coping. Instrumental coping refers to strategies for actively finding and implementing solutions to a stressful problem. Emotion-focused coping refers to strategies to manage the feelings that accompany a stressful problem. Most stressors in our lives require a combination of instrumental and emotion-focused coping. Moreover, these forms of coping tend to influence each other.

A good first instrumental coping strategy is talking about our financial situation. Couples facing reduced circumstances must negotiate their future options. Will we work longer or more? Will we decrease what we offer our children? Will we move? Active communication about our financial goals can help couples formulate the best actions to take.

For many of us, money has a deeper meaning. Our ideas about money are often rooted in the way we grew up. We witnessed our parents manage money, and were influenced by the cultural and community values that surrounded us. Sometimes, couples disagreements about money are linked to these differences. For example, Bob grew up with frugal farmers: his feelings of safety and approval are related to the amount of his savings. Debra's father was an unstable entrepreneur who alternately accumulated and squandered the family wealth. Debra views money as something fleeting which must be seized quickly to avoid deprivation. Bob's brooding and Debra's anxiety stem from their upbringings. Most couples can identify and resolve these differences on their own. If they cannot, a skilled psychologist can assist using couple's therapy.

Another sensible instrumental coping strategy is a consultation with a financial advisor. If a couple can agree on financial goals and values, working out options with a knowledgeable professional can help them make wise choices about their money.

Emotion-focused coping strategies include such methods as relaxation, exercise, and enjoyable pastimes. These methods are soothing, and increase overall quality of life. The old adage “count your blessings” is helpful to couples facing financial challenges. Seen in the context of one's health and relationships, financial problems can seem smaller. If despair over finances descends into a clinical depression (see the companion article on this topic), treatment by a psychologist may be required.
Debra and Bob went for couples counselling. Once they understood each other's unique perspectives on money, they settled on a new financial plan after they had gathered new facts from their financial advisor. For exercise and companionship, they took up walking together in the evenings. Although Debra and Bob did not solve the global financial crisis, they learned to get through it together.

Depression

• In North America, depression is the leading cause of disease burden, and the World Health Organization predicts that in the year 2030 it will be the second leading cause of disease burden worldwide after HIV.

• Approximately 5% of Canadian men and 10% of Canadian women experience symptoms of depression at some point in their life.

• While depression can be effectively treated in the community, many people delay seeking assistance due to stigma, lack of knowledge, or resources.

• Research from the American Journal of Cardiology indicates that individuals with depression and anxiety have a 50% increased risk for cardiovascular illness and death.

• Research from the University of Florida found that a perfectionistic personality characteristic with self-criticism is strongly associated with depression.

• Having one episode of major depression increases your risk of having another, but working with a psychologist can reduce the risk of future episodes or the intensity.

• The risk of major depression is increased with conditions such as Parkinson's disease, stroke, multiple sclerosis, and during the first year after childbirth. High levels of depression are also common enough those with economic difficulties.

It is common and even healthy to feel sad or blue at times, these feelings can be informative. Feeling down can tell us that we are bothered by something, stressed and need to slow down. Feeling depleted can indicate that particular issues burden us. These feelings can be a guide, telling us to take time and tend to our needs.

While many of these same feelings occur with clinical depression the difference is in the intensity and duration of these experiences. Sadness or a sense of loss tends to linger, isolation sets in and resilience seems to be lost. When clinically depressed individuals fall they tend to stay down. They are often critical and blame themselves for their feelings. They become easily overwhelmed, easily exhausted, experience hopelessness, and withdraw socially. Some may have thoughts of death or suicide.

The good news is that clinical depression is highly amenable to treatment when receiving competent care. When issues are not addressed and feeling s not expressed symptoms can worsen, creating an unnecessary burden on oneself, family, and friends. Left untreated , major depression can last six to 12 months with 40 percent of individuals still having symptoms sufficient to meet the diagnosis after one year.

There is no single cause of depression that has been identified . Most practicing clinicians understand the cause to be biopsychosocial in nature and approach treatment in this manner. Paying attention to your family history, body chemistry, personality characteristics, mental and emotional functioning, and social and environmental influences can help one discover the cause of their own personal struggle with depression. Any approach focusing only on one of these factors is likely too simplistic and therefore not beneficial as a treatment.

Many people who experience depression and seek help through their family physician will find that there are a variety of medications available. Medication for many is an appropriate route and helpful in many cases, and for others it's neither appropriate nor helpful.

Research indicates that a combination of psychological counselling and medication is typically the preferred choice for clinical depression. Counselling alone can be considered the second treatment of choice, especially in non-clinical cases, and medication alone the third choice. There is an abundance of studies indicating that psychological interventions are as, or more effective than medication for the treatment of depression. By conducting an assessment, a licensed psychologist can help to make recommendations for an effective treatment.

The psychological counselling process can help individuals improve overall mental and emotional well-being. Clients and therapists work together to locate personal issues and life stressors that contribute to depression, as well as identify thinking patterns, behaviours, and emotional awareness. Counselling helps one learn about his or her own personal experience with depression and the changes that can be made to help prevent future episodes.

If you are experiencing symptoms of depression or any psychological difficulties it is important to address your concerns and consult with a licensed psychologist.

PSYCHOLOGY in the SCHOOLS:

A Guide for Parents

Have you met with a psychologist in a school recently? If you are a school teacher, administrator or parent of a child receiving services you have probably attended an assessment feedback or program planning meeting with a psychologist during the school year.

While you may never meet the psychologist that serves your local school, for many children and families the school-based psychologist is the first and the only psychologist they will ever meet.

If you are the parent of a child waiting for an assessment, support, or intervention services, getting to meet the school's psychologist may be taking longer than you would like.

This article describes the role of psychologists in the schools and some of the opportunities for improving the access to psychological services in the Nova Scotia education system.


How Psychologists Fit in the School System

For the Nova Scotia Department of Education, psychologists in the schools are “professional support staff”. That means that psychologists employed by school boards generally serve multiple schools and travel circuits that may cover more than one county.

While travel may be reduced in urban areas, school populations tend to be larger and the psychologists may be assigned to seven or more schools.

There are approximately 82 psychologists employed across the regional school boards in Nova Scotia. That number is based in part on the Nova Scotia Department of Education's current “core professional service ratio” of 2,500 students to one psychologist.

The Minister's Review of Services for Students with Special Needs recommended a review of that ratio as recently as 2007. The Nova Scotia Department of Education is scheduled to release new guidelines for the delivery of psychological services in schools in the very near future.

A psychologists who works in the school system may have been employed in the educational system before they returned to university to become psychologists. Or she or he may have completed their graduate level training and gone directly to work in the schools.

Some may have been practicing psychologists who worked in health, mental health, or in private practice prior to being employed by the school system. Regardless of the route they followed, psychologists who work in schools have completed an accredited graduate program, applied for registration with the Nova Scotia Board of Examiners in Psychology, and completed or are completing the requirements to be registered with the Nova Scotia Board of Examiners in Psychology (NSBEP), as a Psychologist in Nova Scotia.

The way psychologists work can vary from school to school or board to board according to policies and practices adopted in each school and/or board.

The effect is that what psychologists do in a specific setting appears to be dependent upon what teachers, principals, and school board administrators think psychologists should do as well as how much independence the psychologist has over how she/he does her/his job.

In the public school system, psychologists and the services they deliver are more often managed and/or supervised by staff other than psychologists. (e.g., principals, resource teachers, guidance counselors, speech-language pathologists, etc.)

This can pose a number of problems for the practicing school psychologist, one of which is that there may be unnecessary limitations or a lack of knowledge about what they can or cannot do. Psychologists in the schools have a great deal to offer. According to the Canadian Psychological Association:

School psychologists provide a wide variety of both educational and mental health services to districts, school staff, students, and their families.

School psychologists:

• understand educational policies and issues because they work within the educational system

• understand the viewpoints of the many stakeholders in the educational system because their work requires their regular and direct contact with students, teachers, parents, and the community

• respond over long periods of time to students and situations that are chronic in nature (e.g. disruptive behaviour disorders, learning disabilities) and understand how these problems and situations affect and are affected by the classroom

• bring a scientific, research-based and objective approach to the analysis and assessment of students' learning, behavioural and emotional problems

• have the tools to systematically measure change in behaviour over time

• have the training to carry out psychological assessment of students' cognitive and learning styles for the purpose of educational planning

• have the training to recognize, diagnose, and intervene with various child and adolescent behaviour and learning disorders

• collaborate with students, families, teachers and other health care professionals in formulating appropriate recommendations, plans, and achievable goals for students

• support parents and teachers in the implementation of recommendations and plans

• maintain liaisons with other agencies in the community when appropriate to ensure comprehensive service delivery to students, parents, and the teachers with whom they collaborate

• develop, consult, and participate in programs designed to respond to crises and emergency situations in schools

• stay current with research related to psychology and education, and therefore offer psychological resource and expertise to the educational system in the development of educational policy and procedure as well as program evaluation

(Professional Practice Guidelines for School Psychologists in Canada, CPA)


What Does the Future Hold?

Historically, psychological services in school have been closely linked to the delivery of educational services for children with special needs.

Typically, schools expect psychologists to provide psycho-educational assessment services, often to the exclusion of other services they are both competent and prepared to deliver.

Currently, provincial educators are recognizing the need to integrate education and health care services for children and adolescents. A growing body of research documents the links between good mental health and the ability to learn.

There is substantial evidence to support focusing the delivery of psychological services in schools to more comprehensively meet the needs of Nova Scotia's children, youth, and families.

Canadian epidemiology research over the past two decades has consistently shown that approximately 18% to 20% of children will qualify for one or more psychiatric diagnoses during their time in school.

These diagnoses range from learning disabilities and Attention-Deficit/Hyperactivity Disorder (AD/HD) to depression and conduct disorder. These are mental health issues with major impacts on a child's or adolescent's behaviour in school and serious impacts on learning.

At the same time, learning difficulties can affect a student's social, emotional, and behavioural adjustment, and impact negatively on the child's mental health.

Psychologists in schools are uniquely positioned to provide primary mental health care . Similar to a primary health care model, primary mental health care includes:

- prevention and treatment of common mental health issues
- basic emergency mental health services
- referrals to/coordination with other levels of care (such as hospital and community based mental health services)
- mental health promotion
- healthy child/adolescent development
- school based rehabilitation services

In a primary mental health care model, the school-based psychologist can provide direct provision of first-contact services and a coordination function to ensure continuity and ease of movement when longer term or specialized services are required.

“School psychologists are the most highly trained mental health experts in schools. In addition to knowledge about prevention, intervention, and evaluation for a number of childhood problems, school psychologists have unique expertise regarding issues of learning and schools. It is [school psychologists'] ethical responsibility to become involved in programs aimed at problems that are broader than assessing and diagnosing what is wrong with a child. As the most experienced school professionals in this area, school psychologists must become invested in addressing social and human ills … Although [school psychologists] will not ‘solve' these ills, [they] must have a role in ameliorating their impact on the lives of children.”

– Sheridan, S. and Gutkin, T. School Psychology Review, v29 n4 p485-502 (2000)

The school-based integrated service model is already exemplified in Nova Scotia by the growing number of Teen Health Centres housed in public schools.

Psychologists in the schools are well placed and well prepared to work collaboratively with health care professionals and a variety of community agencies in addition to the Teen Health Centres. Together, they can identify and support students with mental health needs, and develop prevention and early intervention programs.

However, a significant obstacle to developing and enhancing the collaborative integrated model is a matter of numbers. According to the Nova Scotia Department of Education, there are 138,661 students currently enrolled in Nova Scotia Schools. This means that the estimated 18% or about 24,959 students who will need psychological support and/or intervention will likely not be offered these services.

The lack of capacity to meet the psychological needs of children and adolescents in the schools is due in large part to the fact that the 82 psychologists employed by school boards across the province already have a wait list of students for psycho-educational assessment and there is rarely time available for other services.

The Association of Psychologists of Nova Scotia (APNS) encourages the Nova Scotia Department of Education to explore and develop innovative, integrated school based service delivery models to promote mental health in the school age population, including but not limited to psycho-educational assessment. As the professional organization representing psychologists in Nova Scotia, APNS wishes to extend an offer of support and collaboration to this end.

PSYCHOLOGICAL TESTING

Be Informed before Consenting!

Registered psychologists are delivering services in our schools, our courts, our communities and in organizations across Nova Scotia. The Association of Psychologists of Nova Scotia (APNS) and the Nova Scotia Board of Examiners in Psychology (NSBEP) have worked together over the years to ensure the public receives professional services from psychologists. The Nova Scotia Psychology Act provides guidelines for the ethical conduct of psychologists but does not regulate the delivery of psychological related services by non-psychologists.

An on-going area of concern by both APNS and NSBEP is the use of psychological tests by unregulated users. This may include assessments in school settings, assessments for custody access, and employment-related assessments. Individuals with various degrees and certificates -- not necessarily in psychology -- can be qualified by test manufacturers to purchase and use psychological tests. Individuals do not have to be registered psychologists to administer, score and interpret psychological tests and the Nova Scotia Psychology Act does not apply to these test users.

Registered psychologists who administer tests as part of their practice must follow very strict guidelines to protect the public from the misuse of psychological tests. This is especially
important when tests results are used to help make important decisions concerning educational requirements, custody access decisions, type of therapy, or if an individual will receive a job offer or promotion.

Psychologists are obligated to ensure you fully understand the reasons you have been asked to take a test, what the test is designed to measure, the nature of the feedback you will receive, and how the test results might be used. Psychologists fully explain these issues to their clients and in doing so seek to obtain informed consent prior to administering any tests.

We would encourage the public to ask informed questions prior to taking any type of psychological test regardless of who asks you to take the test. If you or someone you know has been requested to take a psychological test - please consider asking the following questions prior to consenting to take the test.

Be fully informed before agreeing to take a psychological test! 

Questions to ask when ... You are asked to take a test as part of a job application.

Organizations and recruitment companies use psychological tests to help them find the right person for the right job. When well developed tests are used in a professional manner it can result in a more productive and satisfied work force. Prior to giving your consent to have a test administered, you should ask the following questions about the process:

What kind of test do I have to take?

Tests can be used to measure specific knowledge, skills, abilities and other attributes (KSAOs) that are related to the job. The test administrator should be able to tell you in general terms what type of test they want you to take.

How will the results be used?

Your test results should be combined with other information to make the final decision. The test results might carry a certain amount of weight in the selection process. Ask how the test information will be used to make a final decision.

Who gets to see my test results?

You have a right to privacy and the results should only be seen by those involved in the selection process. You should inquire as to who will see your results, whether or not they will become a part of your personnel file if hired, and what will happen to them if you are not hired.

Will I receive feedback on my test results?

You should be told in advance what type of feedback, if any you will be receiving about your performance on the test.

Who is responsible for the testing process?

Test publishers have guidelines in place concerning who can buy, administer and interpret tests. You should ask who this is in case you have concerns or other questions about the process.



Questions to ask when ... You are asked to go through a custody access assessment.

If divorcing parents can’t agree about their children’s living arrangements then a judge may order, or a lawyer suggest that the parents go through a custody access assessment. Custody access assessments are used to help the judge decide the best living arrangement (joint, shared, sole) and schedule for access (frequency, duration, etc.) for the child. If a judge orders the assessment then both parents must comply; so it is in the interests of both parents to come to agreement about custody and access issues before being court ordered to participate in a time-consuming, intrusive, and costly assessment. However, should parents find themselves involved in such an assessment; the following are important questions to ask:

What does informed consent mean?

The psychologist doing the assessment will tell you about, and provide in written form the limitations of confidentiality; in the case of a custody access assessment, the information gathered will be contained in the report generated from the assessment and become part of the court record.

What is the purpose of the custody and access assessment?

The purpose is to find what is in the interests for the child or children and how each parent can respond to those interests. In collecting information the psychologist will do an interview with each parent to gather a family history, etc, have each parent complete tests, and observe each parent, if possible, with the child or children. This information is then used by the psychologist to write a report that describes what the child or children need and how each parent’s abilities relate to those needs.

How will the Custody Access report be used?

The judge, lawyers, and parents will read the report which will then be used to resolve any disagreements between parents over the children’s living arrangements and access visits.

Who has access to the test data, file information, and report?

The test data and file information is kept by the assessing psychologist; the file and its contents are considered confidential but if ordered by the judge the psychologist must release the file and its contents. The report becomes part of the court record and anyone involved in the case then has access to the report.



Questions to ask when ... You are asked to give consent for your child to undergo a psychoeducational assessment.

School psychologists use psychological tests to investigate children’s learning strengths and weaknesses and to gain understanding of social and emotional functioning that might interfere with a child’s school progress. The tests are chosen to be appropriate for the child’s age, language abilities and problems. The psychologist responsible for choosing and administering tests in psychoeducational assessments will want you to understand the purpose of the test, the results that may be obtained from them, and how the results will be reported and recorded.

What is this test supposed to measure?
Each test chosen should measure specific skills, abilities or other attributes pertinent to the reason for assessment. The psychologist will be able to tell you what each test measures and why that information is important. Some tests compare your child to large samples of other children who have been given the same test. This comparison is intended to help you understand the extent to which your child has acquired or developed abilities compared to other children the same age.

How will the results be used?
Results of individual tests are combined with other information before an assessment is complete. The test results will be viewed in relationship to one another and in context of your child’s development. No single test result can answer all important questions about your child’s abilities. The psychologist will be able to tell you what kind of a decision can be based on the information from the assessment        This is an important consideration in determining the appropriateness of the test results. Be sure you understand the information the psychologist gives you in respect to what each test measures, how well your child matches the group to which he/she will be compared and how the results will be in context to other important information.

Who sees the test results?
Test results are generally considered to be private information, only viewed by those involved with your child’s learning needs. The results of the test will be interpreted by the psychologist and explained to you. A written report of the results is generally provided for the school record with your written consent. The School Psychologist will be able to tell you who within the school board has access to the report and provide you with information about what steps are taken to obtain your consent when a request is made to release test information to others. Ask when you will be told of the results, who else will receive this information and how it will be kept confidential.

Who is responsible for the testing process?
Psychological tests should be selected and administered by psychologists. The use of these tests is regulated by Standards for Educational and Psychological Testing, a set of guidelines developed by the American Psychological Association and endorsed by psychologists licensed by the Nova Scotia Board of Examiners in Psychology. Interpretation of psychological tests requires specialised training. Psychologists will be pleased to tell you about their qualifications.

Questions to ask when ... You are considering psychotherapy.

Many people encounter circumstances in their lives that may be overwhelming. Taking the step of talking to someone who can help may be difficult. While friends and family can be willing to lend a hand, taking to someone who has the training and skills to help you solve the problem can be beneficial. Talking to a professional can also help to determine if there are any psychological problems, such as anxiety, that may also be adding to your distress.

Who should I see?
When you make the decision to talk to someone you should make sure that the person is a regulated professional. Many people are surprised to know that in Nova Scotia, as in other provinces, anyone can hold themselves out as a counsellor or psychotherapist. In Nova Scotia, the responsibility to regulate psychologists is given to the Nova Scotia Board of Examiners in Psychology (NSBEP) by the provincial Government.

Many Nova Scotians also do not realize that the terms “psychologist” and “psychological” are restricted titles and can only be used by professionals who have met rigorous standards of training and who are able to provide a high standard of care. If you choose to see a psychologist for therapy you are assured that they have met the standards required by the law. Seeing an unregulated person gives you no assurance that this person has met the level of training needed to help people with serious and important problems. If you receive bad advice by an unqualified person, you have no way to remedy the situation.

Why choose a regulated professional?
Before you see a therapist, you should ask the person if a regulatory body recognized by the Nova Scotia Government regulates his or her practice. For example, all psychologists practising in Nova Scotia must be registered and in good standing with the NSBEP. A list of all registered psychologists is available online at www.nsbep.org Any person who calls themselves a psychologist in Nova Scotia without being registered is guilty of an offence. You should also be aware that many therapists belong to professional associations, but membership in such associations is voluntary and not the same as being registered. Remember, anyone can call himself or herself a “therapist”, “psychotherapist”, “life coach” or “counsellor”.

How do I find a psychologist?
You may locate a psychologist by talking to a friend who may have seen one, asking your family doctor for a referral, speaking with your employee assistance program, or consulting the Yellow pages. Psychologists are employed in hospitals, clinics, schools and in private practices throughout Nova Scotia. APNS also provides an online directory of psychologists at www.apns.ca

Before choosing a psychologist be sure to ask questions about the type of problems they deal with, their experience, and fees. In most cases, fees for a private psychologist can be claimed through your private medical insurance. After you have determined the psychologist’s credentials and have started the therapy process, the best way to decide if the psychologist is right for you is based on your feelings. You should ask yourself is the psychologist kind, understanding and non-judgemental and do I feel my problem is being helped? If you don’t feel the “fit” is right, talk to the psychologist or consider referring yourself to another psychologist.