1956
Psychology as a science is dedicated to the discovery of truth. Psychology as a profession is dedicated to the application of that scientific knowledge in the interests of human welfare. The American Psychological Association will, therefore, take an active position on any public policy or issue which jeopardizes these fundamental scientific and professional goals.
In areas other than the above, it is not the function of the American Psychological Association to attempt to influence the formulation of public policy. However, it may be appropriate for the Association to take a position with respect to such policy when it is being formally determined or implemented, where the criterion for action is the special competence of psychology as a science and a profession.
1965
Council voted the following resolution:
The Council of Representatives of the American Psychological Association is gratified by the passage of Public Law No. 89-97 calling for one or more studies of the mental health of children. It believes that many grave national problems, such as crime and delinquency, mental disorders, and social incompetence among adults, may be most effectively dealt with by early identification and intervention in years of childhood and adolescence. It sees the problem as involving a wide range of social agencies--educational, medical, correctional, and welfare--as well as a number of lay groups concerned with human development. It applauds the initiative of the American Psychiatric Association in establishing the Joint Commission on Mental Health of Children. It approves the participation of the American Psychological Association on the Commission on the basis of equal representation on its governing body of the range of organizations that have been actively concerned with the mental health of children (Newman, 1965).
1969
Abortion
WHEREAS, in many state legislature, bills have recently been introduced for the purpose of repealing or drastically modifying the existing criminal codes with respect to the termination of unwanted pregnancies; and WHEREAS, termination of unwanted pregnancies is clearly a mental health and child welfare issue, and a legitimate concern of APA; be it resolved, that termination of pregnancy be considered a civil right of the pregnant woman, to be handled as other medical and surgical procedures in consultation with her physician, and to be considered legal if performed by a licensed physician in a licensed medical facility.
1972
Council voted the following resolution:
BE IT RESOLVED that the American Psychological Association call upon President Nixon to reaffirm the national commitment to early child development, as stated by him in April 1969, and to implement the resolution of the White House Conference on Children calling for the permanent establishment of the Office of Child Development; and, BE IT FURTHER RESOLVED that the American Psychological Association call upon the President and members of Congress to support programs of comprehensive child development.
1974
Recognizing that the psychological and moral burdens imposed on U.S. citizens by the war in Indochina -- confronting them with profound divisions within their society, with anguish about the morality of actions taken in their names, with distrust of their national leadership, and with doubts about the justification for the sacrifices imposed upon them - weighed most heavily on the young men who were called upon to participate personally in the fighting in Indochina;
That the usual difficulty experienced by the veteran in the process of transition from military to civilian life, due to psychological traumata and other reasons, "had been markedly greater for the Vietnam veteran because of the controversial nature of the Vietnamese conflict and the rapid social-economic changes that occurred during his absence";
That "studies conducted by the military and the Veterans Administration indicate that serious and prolonged readjustment problems exist in approximately one out of five new veterans, but to a lesser degree, were experienced by all";
That Vietnam veterans as a group and their families have been receiving insufficient moral, psychological, and emotional support to enable them to come to terms with their experiences, to find employment, and to prepare themselves for the future;
And that many thousands of men who, for reasons of conscience, resisted the draft, or disobeyed military orders, or deserted, are now facing psychological problems associated with separation from their families, exclusion from their societies, and stigmatization as lawbreakers,
1. Increased benefits for Vietnam veterans and improvements in the administration of such benefits, in order to assure that the educational, occupational, medical, and psychological needs of these men are adequately met, with real-dollar benefits at levels at least as high as those extended to World War II veterans;
2. A broadened definition of Service-related disabilities, which would give veterans the opportunity, on a wholly voluntary basis, to obtain treatment for psychological problems that do not require hospitalization or that manifest themselves only some time after their return home, and to obtain treatment for members of their families who play a significant role in their readjustment;
3. Freedom of choice for Vietnam veterans in contracting for psychological treatment, allowing them - whether they are still in service or out of service - the option of receiving payment for such treatment by civilian practitioners of their own choosing, if they feel that their needs cannot be adequately met by mental health personnel working within the military or the Veterans Administration; and
4. Active participation of Vietnam era veterans in developing and running the programs designed to serve their needs.
Council urges APA divisions and state and local psychological associations to establish registers of appropriately qualified psychologists whose skills in therapy, counseling, group leadership, or other psychological services might be useful in the rehabilitation of Vietnam veterans and war resisters, and who are prepared to devote some portion of their time to work with these men and their families, free of charge or at reduced rates. Such registers should be forwarded to Central Office so that they might be maintained centrally. Psychologists should be urged to participate in these programs, indicating both their skills and their time limitations, with the understanding that the existence of the resisters will be publicized among prospective clients and that inquiries by such clients would periodically be referred to them.
Council requests that the Board of Social and Ethical Responsibility for Psychology generate recommendations for just and humane policies designed to ease the psychological problems faced by war resisters and to help them reestablish themselves within the society.
Council urges relevant divisions, boards, and committees within APA to develop mechanisms and provide occasions for discussing and analyzing the psychological and moral implications of the Vietnam War and its effects on the American population and particularly on the generation most directly confronted with it.
Council requests that the APA Central Office and relevant boards and committees take active steps to promote and support legislative and executive actions, as well as activities within the profession, designed to implement the above proposals. (1974)
*Quotations taken from a memorandum from the Department of Medicine and Surgery of the Veterans Administration, reproduced in part in the Congressional Record of October 12, 1973.
1978
Council voted strongly to endorse the United Nations International Year of the Child and actively to encourage the establishment of a National Commission for the International Year of the Child; further, the Council instructs APA's Representatives to the International Union of Psychological Science (IUPS) to request that the 1978 Assembly of the IUPS to endorse and encourage its member societies to support to the fullest extent possible the objectives and activities with the International Year of the Child (Conger, 1978).
Nuclear arms
The American Psychological Association (1) calls upon the President of the United States to propose to the U.S.S.R. that together both countries negotiate an immediate halt to the nuclear arms race. Specifically, we call upon each country to adopt an immediate mutual freeze on all further testing, production, and deployment of all nuclear warheads, missiles, and delivery systems; and (2) calls upon the Administration and Congress to transfer the funds saved to civilian use. Concurrently, they should work jointly with labor, management, and local communities to develop plans to convert the nuclear arms industry to civilian production, thus protecting jobs and strengthening our national economy. We hereby call upon elected officials at local, state, and federal levels publicly to endorse this resolution.
1984
Council adopted the following resolution: The recent International Conference on Psychological Abuse of Children and Youth has presented information that the incidence and prevalence of such acts are so high that concerned individuals need to organize to coordinate necessary efforts in definition, prevention, treatment, and research. The American Psychological Association recognizes the importance of this issue, and to this end invites relevant boards, committees, and divisions/states to explore the major issues of definition, prevention, treatment, and research, and to prepare brief position papers with supporting data, to be forwarded to the Board of Social and Ethical Responsibility for Psychology for consolidation and submission to the Council's January 1985 session.
1985
Boxing
WHEREAS, recent studies show that existing medical controls and safety measures have not prevented chronic brain damage in boxers who have fought in recent years (after 1960), and
WHEREAS, neuropsychological testing is a highly sensitive and accurate means of detecting brain damage in fighters and others with head injuries, and
WHEREAS, many psychologists educate the public and especially young people through courses and textbooks, and
WHEREAS, resolutions calling for the elimination of both amateur and professional boxing have been passed recently by the American Medical Association and the British Medical Association,
BE IT RESOLVED that the American Psychological Association: Encourage the elimination of both amateur and professional boxing, a sport in which the objective is to inflict injury; communicate its opposition to boxing to appropriate regulating bodies; assist state psychological societies to work with their state legislatures to enact laws to eliminate laws to eliminate boxing in their jurisdictions; educate the American public, especially children and young adults, about the dangerous effects of boxing on the health of participants; specifically, psychologists who give courses and who write textbooks that take up relations between behavior and the nervous system are asked to consider including material on boxing an brain damage in their courses and textbooks; encourage neuropsychological evaluations of boxers be given on periodic (one or two year) basis; and encourage ring-side evaluations during bouts be done by individuals who are trained to perform neurocognitive investigations of acute mental status change.
WHEREAS, the great majority of research studies have found a relationship between televised violence and behaving aggressively, and
WHEREAS, the conclusion drawn on the basis of 25 years of research and a sizable number of experimental and field investigations (NIMH, 1972, 1982) is that viewing televised violence may lead to increases in aggressive attitudes, values, and behavior, particularly in children, and
WHEREAS, many children's programs contain some form of violence,
BE IT RESOLVED that the American Psychological Association (1) encourages parents to monitor and to control television viewing by children; (2) requests industry representatives to take a responsible attitude in reducing direct imitable violence on 'real life' fictional children's programming or violent incidents on cartoons, and in providing more programming for children designed to mitigate possible effects of television violence, consistent with the guarantees of the First Amendment; and (3) urges industry, government, and private foundations to support relevant research activities aimed at the amelioration of the effects of high levels of televised violence on children's attitudes and behaviors.
1986
AIDS
AIDS
1987
Use of diagnoses “homosexuality” and “ego-dystonic homosexuality”
Adopted by the APA Council of Representatives on August 27 & 30, 1987
Archived by APA Council of Representatives in February 2019. Rationale: This policy statement solely speaks to obsolete diagnostics categories which no longer exist in diagnostic and clarification systems. It references ICD-9 and DSM-III-R. Therefore, it seems important to retain in archive but no longer retain as an active policy.
Whereas the American Psychological Association has been on record since 1975 that “homosexuality per se implies no impairment in judgment, stability, reliability, or general social and vocational capabilities”; and
Whereas it appears that the ICD-9-CM is widely used either by mandate or choice by many psychologists nationwide in connection with third-party reimbursement, institutional-based service delivery, and research; and
Whereas the next revision of the ICD is not anticipated to be completed until 1992 and may, according to current proposals, then contain the “ego-dystonic homosexuality” diagnosis which APA also opposes; and
Whereas the Council of Representatives already has urged APA members not to use the proposed DSM-III-R diagnoses of Periluteal Phase Disorder, Self-Defeating Personality Disorder, and Sadistic Personality Disorder because they lack adequate scientific basis and are potentially dangerous to women;
Be it resolved that the American Psychological Association: Urge its members not to use the “302.0 Homosexuality” diagnosis in the current ICD-9-CM or the “302.00 Ego-dystonic Homosexuality” diagnosis in the current DSM-III or future editions of either document.
Please cite this policy statement as:
Fox, R.E. (1988). Proceedings of the American Psychological Association, Incorporated, for the year 1987: Minutes of the Annual meeting of the Council of Representatives. American Psychologist, 43, 508-531.
1989
Special education and related services for children with conduct disorders
WHEREAS Congress has mandated that public schools provide special education services to all handicapped children, including those who are seriously emotionally disturbed;
WHEREAS Congress has defined serious emotional disturbance to include unsatisfactory relationships and inappropriate behavior that Interfere with educational performance over a long period of time and to a marked degree;
WHEREAS such characteristics are commonly associated with conduct disorders;
WHEREAS children with diagnoses manifested primarily by troubling behavior, such as conduct disorders and attention deficit disorders, constitute a large proportion of seriously emotionally disturbed children;
WHEREAS special education and related services, Including psychological services, are often critical to seriously emotionally disturbed children's educational progress;
WHEREAS schools are Important components In the child mental health system; and
WHEREAS psychologists provide services to seriously emotionally disturbed children both within and outside school settings;
THEREFORE BE IT RESOLVED that the American Psychological Association opposes efforts by some states to exclude conduct disordered children from special education and related services;
BE IF FURTHER RESOLVED that the Association calls upon the Congress a the United States Department of Education to take action to ensure that states do not further deprive seriously emotionally disturbed children of special education and related services, including psychological services, that are Important to their educational achievement and psychological development."
1990
Providers of Psychological Services to Ethnic, Lunguistic and Culturally Diverse Populationsopens in new window (PDF, 131KB)
1991
U.S. Department of Defense Policy on Sexual Orientation and Advertising in APA Publications
WHEREAS the American Psychological Association (APA) deplores discrimination on the basis of sexual orientation; and
WHEREAS APA will not let Its publications, as advertising media, be used by others In support of discriminatory employment practices; and
WHEREAS the U.S. Department of Defense (DoD) maintains a policy that homosexual orientation Is "Incompatible with military service"; and
WHEREAS the DoD will not knowingly admit bisexual, lesbian or gay Individuals to military service, Including research and clinical internship programs In psychology; and
WHEREAS an average of 1,5W men and women are unfairly discharged from military service each year because their sexual orientation becomes; known;
THEREFORE be it resolved that the APA opposes the DoD policy which finds homosexual orientation "Incompatible with military service"; and
Be it further resolved that APA take a leadership role among national organizations in seeking to change this discriminatory DoD policy, and
Be it further resolved that APA will not permit Its publications, as advertising media, to be used by the DoD after December 31, 1992, unless the DoD policy that homosexual orientation "is incompatible with military service" has been rescinded by that date."
In addition, Council approved the Inclusion of the following statement with all advertisements from the U.S. Military Services:
"Policies of the Department of Defense prohibit military service for individuals of homosexual orientation. Applicants must meet age and physical requirements".
Advertisements include printed announcements In APA publications, mailings using APA mailing lists and literature distributed at APA meetings.
APA Resolution on Neuropsychological Assessment and HIV Infection
APA resolution on neuropsychological assessment and HIV infection
APA Resolution on Legal Liability Related to Confidentiality and the Prevention on HIV Transmission
APA resolution on legal liability related to confidentiality and the prevention on HIV transmission
1992
Resolution on Lesbian, Gay and Bisexual Youths in Schools
Whereas society's attitudes, behaviors, and tendency to render lesbian, gay and bisexual persons invisible permeate all societal institutions including the family and school system (Gonsiorek, 1988; Hetrick & Martin, 1988; Ponse, 1978; Uribe & Harbeck, 1992);
Whereas it is a presumption that all persons, including those who are lesbian, gay, or bisexual, have the right to equal opportunity within all public educational institutions;
Whereas current literature suggests that some youths are aware of their status as lesbian, gay, or bisexual persons by early adolescence (Remafedi, 1987; Savin-Williams, 1990; Slater, 1988; Troiden, 1988);
Whereas many lesbian, gay, and bisexual youths and youths perceived to belong to these groups face harassment and physical violence in school environments (Freiberg, 1987; Hetrick & Martin, 1988; Remafedi, 1987; Schaecher, 1988; Uribe & Harbeck, 1992; Whitlock, 1988);
Whereas many lesbian, gay, and bisexual youths are at risk for lowered self-esteem and for engaging in self-injurious behaviors, including suicide (Hetrick & Martin, 1988; Gonsiorek, 1988; Savin-Williams, 1990; Harry, 1989; Gibson, 1989);
Whereas gay male and bisexual youths are at an increased risk of HIV infection (Savin-Williams, 1992);
Whereas lesbian, gay and bisexual youths of color have additional challenges to their self-esteem as a result of the negative consequences of discrimination based on both sexual orientation and ethnic/racial minority status (Garnets & Kimmel, 1991);
Whereas lesbian, gay and bisexual youths with physical or mental disabilities are at increased risk due to the negative consequence of societal prejudice toward persons with mental or physical disabilities (Pendler & Hingsburger, 1991; Hingsburger & Griffiths, 1986);
Whereas lesbian, gay, and bisexual youths who are poor or working class may face additional risks (Gordon, Schroeder & Abramo, 1990);
Whereas psychologists affect policies and practices within educational environments;
Whereas psychology promotes the individual's development of personal identity including the sexual orientation of all individuals;
Therefore be it resolved that the American Psychological Association and the National Association of School Psychologists shall take a leadership role in promoting societal and familial attitudes and behaviors that affirm the dignity and rights, within educational environments, of all lesbian, gay, and bisexual youths, including those with physical or mental disabilities and from all ethnic/racial backgrounds and classes;
Therefore be it resolved that the American Psychological Association and the National Association of School Psychologists support providing a safe and secure educational atmosphere in which all youths, including lesbian, gay and bisexual youths, may obtain an education free from discrimination, harassment, violence, and abuse, and which promotes an understanding and acceptance of self;
Therefore be it resolved that American Psychological Association and the National Association of School Psychologists encourage psychologists to develop and evaluate interventions that foster nondiscriminatory environments, lower risk for HIV infection, and decrease self-injurious behaviors in lesbian, gay and bisexual youths;
Therefore be it resolved that the American Psychological Association and the National Association of School Psychologists shall advocate efforts to ensure the funding of basic and applied research on and scientific evaluations of interventions and programs designed to address the issues of lesbian, gay, and bisexual youths in the schools, and programs for HIV prevention targeted at gay and bisexual youths;
Therefore be it resolved that the American Psychological Association and the National Association of School Psychologists shall work with other organizations in efforts to accomplish these ends (DeLeon, 1993, p. 782).
References
Freiberg, P. (1987, September). Sex education and the gay issue: What are they teaching about us in the schools? The Advocate, 42-48.
Garnets, L., & Kimmel, D. (1991). Lesbian and gay male dimensions in the psychological study of human diversity. In J. Goodchilds (Ed.), Psychological Perspectives on Human Diversity in America (pp 143-192). Washington, DC, American Psychological Association.
Gonsiorek, J.C. (1988). Mental health issues of gay and lesbian adolescents. Journal of Adolescent Heath Care, 9, 114-122.
Gordon, B.N., Schroeder, C.S., & Abramo, J.M. (1990). Age and social class differences in children's knowledge of sexuality. Journal of Clinical Child Psychology, 19 (1), 33-43.
Gibson, P. (1989). Gay male and lesbian youth suicide. In M. Feinleib, (Ed.), Report of the Secretary's Task Force on Youth Suicide, Washington, DC, Department of Health and Human Services. (Vol. 3, pp 110-142).
Harry, J. (1989). Sexual identity issues. In M. Feinleib, (Ed.), Report of the Secretary's Task Force on Youth Suicide, Vol. 2, pp 131-142. Washington, DC: Department of Health and Human Services. .
Hetrick, E.S., & Martin, A.D. (1988). Developmental issues and their resolution for gay and lesbian adolescents. In E. Coleman (Ed.) Integrated identity for gay men and lesbians: Psychotherapeutic approaches for emotional well-being (pp 25-43). Binghamton, NY: Harrington Park Press.
Hingsburger, D., & Griffiths, D. (1986). Dealing with sexuality in a community residential service. Psychiatric Aspects of Mental Retardation Reviews, 5 (12), 63-67.
Pendler, B., & Hingsburger, D. (1991). Sexuality: Dealing with parents. Sexuality and Disability, 9, 123-130.
Ponse, B. (1978). Identities in the lesbian world: The social construction of the self. Westport, CT: Greenwood.
Remafedi, G. (1987). Adolescent homosexuality: Psychosocial and medical implications. Pediatrics. 79, 331-337.
Savin-Williams, R.C. (1990). Gay and lesbian youth: Expressions of identity. New York, NY: Hemisphere.
Schaecher, R. (1988, Winter). Stresses on lesbian and gay adolescents. Independent Schools, 29-35.
Slater, B.R. (1988). Essential issues in working with lesbian and gay male youths. Professional Psychology: Research and Practice, 19, 226-235.
Troiden, R.R. (1988). Gay and lesbian identity: A sociological study. Dix Hills, NY: General Hall.
Uribe, V., & Harbeck, K.M. (1992). Addressing the needs of lesbian, gay and bisexual youth: The origins of PROJECT 10 and school-based intervention. In K. Harbeck (Ed.). Coming out of the classroom closet: Gay and lesbian students, teachers and curriculum (pp. 9-28). Binghamton, NY: Harrington Park Press.
Whitlock, K. (Ed.). (1988). Bridges of Respect: Creating support for lesbian and gay youth. Philadelphia, PA: American Friends Service Committee.
Resolution on the use of psychology to market tobacco productsopens in new window (PDF, 20KB)
Legal access to sterile injection equipment by drug users
Legal Access to Sterile Injection Equipment by Drug Users
Rust v. Sullivan Supreme Court Decision
WHEREAS the American Psychological Association in 1983 determined that… "requiring clinics to provide the same blanket information to every pregnant woman, rather than to provide for each woman whatever information is individually appropriate to her particular needs, is inconsistent with basic principles of effective counseling and will hinder, rather than promote, informed consent."
(APA Amicus Curiae, Akron v. Akron Center for Reproductive Health )
WHEREAS the American Medical Association and other health care provider organizations have already officially decried the hazardous effects of the Rust v. Sullivan Supreme Court Decision upholding the Title X Family Planning Program Regulations, known as the "Gag Rule"; and
WHEREAS the American Psychological Association has already adopted previous policies regarding a woman's right to reproductive choice.
BE IT RESOLVED that the American Psychological Association deplores the effects of the Title X regulations which prohibit health providers, including psychologists , who receive federal Title X funds, from informing women patients/clients of the availability of the alternative of abortion to terminate an unwanted pregnancy.
Further, the APA urges the Congress to enact legislation and to override Presidential vetoes, as needed, to both remedy this health hazard and to serve as a precedent to buttress against further erosion of the rights associated with Roe v. Wade.
Further, APA will seek to inform Congress, the public and its own membership of its position and its recommendations through a public affairs and advocacy effort including but not limited to:
press conferences in several major cities
letter writing and mail campaigns
news releases
APA Monitor and other appropriate APA, Division, and State Association publications
Further, we direct the Chief Executive Officer of the American Psychological Association to activate the necessary mechanisms to ensure the accomplishments of the aims and goals of this resolution, including the capacity to respond to ongoing critical reproductive issues by participating in public information/media outreach efforts as necessary to help preserve a woman's right to choose.
1993
NIOSH
Council voted to adopt the NIOSH (National Institute for Occupational Safety and Health) strategies as policy. Council also voted to request that APA staff encourage NIOSH to give explicit attention to stresses caused by discrimination or exploitative treatment with regard to gender, race, ethnicity, culture, disability, sexual orientation, age, and religion across all four strategies. Moreover, Council calls attention to the home as a workplace and notes the need for research in this area.
1994
Violence in Mass Media
On the recommendation of the Board of Directors and the Board for the Advancement of Psychology in the Public Interest, Council voted to adopt the following resolution, as amended, as APA policy, replacing the 1985 resolution on television violence:
Whereas the consequences of aggressive and violent behavior have brought human suffering, lost lives, and economic hardship to our society as well as an atmosphere of anxiety, fear, and mistrust;
Whereas in recent years the level of violence in American society and the level of violence portrayed in television, film, and video have escalated markedly;
Whereas the great majority of research studies have found a relation between viewing mass media violence and behaving aggressively;
Whereas the conclusion drawn on the basis of over 30 years of research and a sizeable number of experimental and field investigations (Huston, et al., 1992; NIMH, 1982; Surgeon General, 1972) is that viewing mass media violence leads to increases in aggressive attitudes, values, and behavior, particularly in children, and has a long-lasting effect on behavior and personality, including criminal behavior;
Whereas viewing violence desensitizes the viewer to violence, resulting in calloused attitudes regarding violence toward others and a decreased likelihood to take action on behalf of a victim when violence occurs;
Whereas viewing violence increases viewers' tendencies for becoming involved with or exposing themselves to violence;
Whereas viewing violence increases fear of becoming a victim of violence, with a resultant increase in self-protective behaviors and mistrust of others;
Whereas many children's television programs and films contain some form of violence, and children's access to adult-oriented media violence is increasing as a result of new technological advances;
Therefore be it resolved that the American Psychological Association:
urges psychologists to inform the television and film industry personnel who are responsible for violent programming, their commercial advertisers, legislators, and the general public that viewing violence in the media produces aggressive and violent behavior in children who are susceptible to such effects;
encourages parents and other child care providers to monitor and supervise television, video, and film viewing by children;
supports the inclusion of clear and easy-to-use warning labels for violent material in television, video, and film programs to enable viewers to make informed choices;
supports the development of technologies that empower viewers to prevent the broadcast of violent material in their homes;
supports the development, implementation, and evaluation of school-based programs to educate children and youth regarding means for critically viewing, processing, and evaluating video and film portrayals of both aggressive and prosocial behaviors;
requests the television and film industry to reduce direct violence in "real life" fictional children's programming or violent incidents in cartoons and other television or film productions, and to provide more programming designed to mitigate possible effects of television and film violence, consistent with the guarantees of the First Amendment;
urges the television and film industry to foster programming that models prosocial behaviors and seeks to resolve the problem of violence in society;
offers to the television and film industry assistance in developing programs that illustrate psychological methods to control aggressive and violent behavior, and alternative strategies for dealing with conflict and anger;
supports revision of the Film Rating System to take into account violence content that is harmful to children and youth;
urges industry, government, and private foundations to develop and implement programs to enhance the critical viewing skills of teachers, parents, and children regarding media violence and how to prevent its negative effects;
recommends that the Federal Communications Commission (FCC) review, as a condition for license renewal, the programming and outreach efforts and accomplishments of television stations in helping to solve the problem of youth violence;
urges industry, government, and private foundations to support research activities aimed at the amelioration of the effects of high levels of mass media violence on children's attitudes and behavior (DeLeon, 1995).
WHEREAS the American Psychological Association recognizes that the family constitutes a basic unit of society; and
WHEREAS the United Nations General Assembly has proclaimed 1994 as the International Year of the Family (IYF) with its theme: "Family--Resources and Responsibilities in a Changing World"; and
WHEREAS the activities for the observation of IYF will be concentrated at the local, national, regional, and international levels with primary focus at the local and national levels; and
WHEREAS the IYF encompasses and addresses the needs of all families recognizing the diversity of families; and
WHEREAS activities for IYF seek to promote human rights and fundamental freedoms for all individuals as set forth by United Nations instruments, whatever the status of each individual and the conditions within a given family; and
WHEREAS IYF policies aim at promoting inherent strengths of families; and
WHEREAS IYF programs support families in the discharge of their functions;
NOW, THEREFORE the American Psychological Association does hereby resolve to join International Year of the Family and asks the Board of Convention Affairs and all directorates of the Association to consider appropriate program initiatives for the 1994 APA convention.
Firearm Safety and Youth
WHEREAS the American Psychological Association deplores the increase in violence and its negative effects on children and youth who are victims, perpetrators, bystanders, and witnesses of violent incidents;
WHEREAS the negative effects of violence extend to indirect victims whose lives are affected by losses, anxiety, and terror even if they do not have firsthand experience with violent incidents;
WHEREAS the psychological research on factors that contribute to human aggression indicates that exposure and access to guns can result in an increased likelihood of aggression;
WHEREAS access to firearms as well as their presence and use fosters anxieties, fears, distrust, and suspicion among people;
WHEREAS access to and use of firearms by young people is associated with increased rates of suicide, homicide, and injury among children and youth;
WHEREAS the presence of firearms markedly increases the probability of fatality and severe injury in interpersonal violence;
WHEREAS access to firearms by children and youth contributes to unintentional injury and death;
WHEREAS children's exposure to the consequences of firearm injury and death is associated with increased symptoms of fear, anxiety, depression, and stress;
RESOLVED, that the American Psychological Association:
1. Supports nationwide licensing of firearm ownership based on attainment of legal voting age; clearance following a criminal record background check; and demonstrated skill in firearm knowledge, use, and safety;
2. Encourages federal, state, and local governments to increase specific legal, regulatory, and enforcement efforts to reduce widespread, easy, and unsupervised access to firearms by children and youth;
3. Supports the development, implementation, and evaluation of school-based programs to educate children and youth regarding the prevention of firearm violence and the reduction of both unintentional and intentional death and injury caused by firearms.
1996
Resolution on Sexuality Education
Passed by APA Council of Representatives 1996
Whereas American youth are exhibiting behavior leading to increasing rates of life-threatening or health-compromising sexually transmitted diseases that in part reflect ignorance of sexual health promoting behaviors (National Guidelines Task Force, 1991);
Whereas youth infection with HIV/AIDS has reached an epidemic level, particularly among young gay men and ethnic minority youth (National Commission on AIDS, 1993), in part because of lack of knowledge and lack of training about protective behaviors;
Whereas children are becoming involved in sexual activities at younger ages (Ravoira & Cherry, 1992; Singh & Wulf, 1990);
Whereas over one million teenage women become pregnant annually (National Guidelines Task Force, 1991) and approximately 300,000 of these teenagers become homeless or runaways or both (Ravoira & Cherry, 1992);
Whereas the prevalence of sexual intercourse appears to be higher among youth who did not receive sexuality education (Furstenberg & Crawford, 1986);
Whereas youth whose sexual orientation or whose values, beliefs, and practices differ from those deemed acceptable by many in our society are subject to persistent, subtle, or overt harassment and violence which may lead to suicide (Schaecher, 1988);
Whereas youth with a physical or mental disability may be more vulnerable to sexual coercion;
Whereas stranger rape, date rape, sexual abuse, and other forms of sexual violence are traumatic events that have become increasingly prevalent (Koss et al., 1994);
Whereas sexual health, personal self-esteem, and the ability to participate in responsible, caring, and stable relationships, as well as to develop positive interpersonal social attitudes can be promoted through education (Gordon & Schroeder, 1995);
Whereas the American Psychological Association has a necessary and important role in influencing public policy to the benefit and protection of youth in particular and the society in general;
Resolution
Therefore be it resolved that the APA supports access to information on sexuality as critical to healthy development. Such information should be positive, age appropriate, and culturally suitable, and should respect the choice of abstinence; it should acknowledge women's rights, should foster shared responsibility among males and females for sexual behaviors, and should promote tolerance for sexual diversity; and
Therefore be it resolved that APA public policy support the development and adoption, including research and evaluation, of such comprehensive sexuality education curricula and programs for the promotion of healthy sexual attitudes and behaviors and the prevention and mitigation of endangering and destructive behaviors. It is to be noted that this resolution does not endorse any particular curriculum, procedure, or site for instruction[, but seeks to promote a choice of means for implementing this resolution]. (February 1996)
References
Furstenberg, F. & Crawford, A. (1986). Teenage sexuality, pregnancy, and child welfare. In J. Laird & A. Hartman (Eds.), Handbook of child welfare: Context, knowledge, and practice. New York: Free Press.
Gordon, B.B. & Schroeder, C. (1995). Sexuality. New York: Plenum.
Koss, M.P., Goodman, L.A., Browne, A., Fitzgerald, L.F., Keita, G.P., & Russo, N.F. (1994). No safe haven: Male violence against women at home, at work, and in the community. Washington, DC: American Psychological Association.
National Commission on AIDS. (1993). Behavioral and social sciences and the HIV/AIDS epidemic. Washington, DC: Author.
National Guidelines Task Force. (1991). Guidelines for comprehensive sexuality education: Kindergarten-12th grade. New York: Sex Information and Education Council of the U.S.
Ravoira, LaW. & Cherry, A. (1992). Social bonds and teen pregnancy. Westport, CT: Praeger Publishing Co.
Schaecher, R. (1988). Stresses on lesbian and gay adolescents. Independent Schools, 29-35.
Singh, S. & Wulf, D. (1990). Today's adolescent, tomorrow's parent: A portrait of the Americas. N.Y.: Alan Guttmacher Institute.
1998
Proposed APA Policy Statement on Legal Benefits for Same-Sex Couples
WHEREAS there is evidence that homosexuality per se implies no impairment in judgment, stability, reliability, or general social and vocational capabilities (Conger, 1975) for individuals;
WHEREAS legislation, other public policy, and private policy on issues related to same-sex couples is currently under development in many places in North America (e.g., Canadian Psychological Association, 1996);
WHEREAS the scientific literature has found no significant difference between different-sex couples and same-sex couples that justify discrimination (Kurdek, 1994;1983; Peplau, 1991);
WHEREAS scientific research has not found significant psychological or emotional differences between the children raised in different-sex versus same-sex households (Patterson, 1994);
WHEREAS APA has, as a long established policy, deplored "all public and private discrimination against gay men and lesbians in such areas as employment, housing, administration, and licensing ..." and has consistently urged "the repeal of all discriminatory legislation against lesbians and gay men" (Conger, 1975);
WHEREAS denying the legal benefits that the license of marriage offers to same-sex households (including, but not limited to, property rights, health care decision-making, estate planning, tax consequences, spousal privileges in medical emergency situations and co-parental adoption of children) cannot be justified as fair and equal treatment;
WHEREAS the absence of access to these benefits constitutes a significant psychosocial stressor for lesbians, gay men, and their families.
WHEREAS APA provides benefits to its members' and employees' domestic partners equivalent to those provided to members' and employees' spouses;
WHEREAS psychological knowledge can be used to inform the current public and legal debate on "same-sex marriage" (e.g., Baehr v. Levin);
THEREFORE BE IT RESOLVED that APA supports the provision to same-sex couples of the legal benefits that typically accrue as a result of marriage to same-sex couples who desire and seek the legal benefits; and
THEREFORE BE IT FURTHER RESOLVED that APA shall provide relevant psychological knowledge to inform the public discussion in this area and assist state psychological associations and divisions in offering such information as needed.
References
Canadian Psychological Association. (1996). Policy statement on equality for lesbians, gay men, and their relationships and families. [Available from the Canadian Psychological Association.]
Conger, J.J. (1975). Proceedings of the American Psychological Association, Incorporated, for the year 1974: Minutes of the Annual Meeting of the Council of Representatives. American Psychologist, 30, 620-651.
Kurdek, L.A. (1993). The nature and correlates of relationship quality in gay, lesbian, and heterosexual cohabiting couples: A test of the individual difference, interdependence, and discrepancy models. In B. Greene & G.M. Herek (Eds.), Lesbian and gay psychology: Theory, research, and clinical issues (pp. 133-155). Thousand Oaks, CA: Sage Publications.
Patterson, C.J. (1993). Children of the lesbian baby boom: Behavioral adjustment, self-concepts, and sex role theory. In B. Greene & G.M. Herek (Eds.), Lesbian and gay psychology: Theory, research, and clinical issues (pp. 156-175). Thousand Oaks, CA: Sage Publications.
Peplau. A.L. (1991). Lesbian and gay relationships. In J.C. Gonsiorek and J.D. Weinrich (Eds.), Homosexuality: Research implications for public policy (pp. 177-196). Newbury Park, CA: Sage Publications.
1999
Whereas the United Nations has designated 1999 as the International Year of Older Persons;
Whereas this segment of the population is increasing more rapidly than any other worldwide;
Whereas the needs of this segment are often ignored or neglected;
Whereas the membership of this Association affirms the dignity of all persons through the Association statement of mission and its principles of ethical behavior;
Whereas the Association, through actions of its Council of Representatives, has consistently underscored the worth and dignity of all persons;
Whereas the Association members manifest this earnest commitment to promoting healthy aging in the worlds population;
Whereas the Association has established a Standing Committee on Aging to focus on and address these issues;
Therefore, be it Resolved, that the American Psychological Association commends the United Nations for directing world attention to this issue through designating 1999 as the International Year of Older Persons and affirms the United Nations Principles for Older Persons.
WHEREAS the United Nations has designated the year 2000 as The International Year for the Culture of Peace;
WHEREAS Culture of Peace refers to promoting human welfare within communities, and has been defined by the UN along the lines of the following eight (8) principles: respect for human rights, tolerance, democracy, free flow of information, non-violence, sustainable development, peace education, and equality of men and women;
WHEREAS the membership of this Association seeks to promote human welfare and mental health;
THEREFORE BE IT RESOLVED that the American Psychological Association endorses the declaration of the Year 2000 as The International Year for the Culture of Peace.
2000
Resolution on Poverty and Socioeconomic Status
Whereas the income gap between the poor and the rich has continued to increase, with the average income of the poorest fifth of the population down 6% and the average income of the top fifth up 30% over the past 20 years (Bernstein, McNichol, Mishel, & Zahradnik, 2000);
Whereas the poverty rate in the United States is higher now than in nearly all years of the 1970s, child poverty (at 18.9% in 1998, representing 13.5 million children) continues to be higher here than in most other industrialized nations, and the proportion of the population living below the poverty line in 1998 was 12.7% (representing 34.5 million people) (Center on Budget and Policy Priorities, 1999; U.S. Census Bureau, 1999);
Whereas although Whites represented the largest single group among the poor in 1998, ethnic groups were overrepresented, with 26.1% of African Americans, 25.6% of Hispanics, 12.5% of Asians and Pacific Islanders, and 31% of American Indians on reservations living in poverty (National Congress of American Indians, 2000; U.S. Census Bureau, 1999), compared with the 8.2% of Whites who were poor;
Whereas families* with a female head of household had a poverty rate of 29.9% in 1998 and comprised the majority of poor families (U.S. Census Bureau, 1999);
Whereas the Task Force on Women, Poverty, and Public Assistance of the APA Society of the Psychology of Women (Division 35) has documented from the social sciences research literature the root causes of poverty and its impact for poor women, children, and their families, and called for a more effective public policy founded on this research base (Division 35 Task Force on Women, Poverty, and Public Assistance, 1998);
Whereas poverty is detrimental to psychological well-being, with NIMH data indicating that low-income individuals are 2 to 5 times more likely to suffer from a diagnosable mental disorder than those of the highest SES group (Bourdon, Rae, Narrow, Manderschild, & Regier, 1994; Regier et al., 1993), and poverty poses a significant obstacle to getting help for these mental health problems (McGrath, Keita, Strickland, & Russo, 1990);
Whereas accumulating research evidence indicates that the greater the income gap between the poorest and the wealthiest in a society, the higher the death rates for infants and adults and the lower the life expectancy for all members of that society, regardless of SES (Kawachi & Kennedy, 1997);
Whereas the impact of poverty on young children is significant and long lasting, limiting chances of moving out of poverty (McLoyd, 1998), poverty is associated with substandard housing, homelessness, inadequate child care, unsafe neighborhoods, and underresourced schools (Fairchild, 1984; Lott & Bullock, in press), and poor children are at greater risk than higher income children for a range of problems, including detrimental affects on IQ, poor academic achievement, poor socioemotional functioning, developmental delays, behavioral problems, asthma, poor nutrition, low birth weight, and pneumonia (Geltman, Meyers, Greenberg, & Zuckerman, 1996; McLoyd, 1998; Parker, Greer, & Zuckerman, 1988);
Whereas environmental factors such as environmental contaminants (e.g., lead paint, etc.), crowding, substandard housing, lack of potable water, and so forth have detrimental effects on mental and physical development that perpetuate and contribute to poverty;
Whereas low socioeconomic status is associated in women with higher mortality rates and with osteoarthritis, hypertension, cervical cancer, coronary heart disease, AIDS/HIV infection, and other chronic health conditions (Adler & Coriell, 1997), and poor women are sicker and more likely to have disabilities than their nonpoor counterparts, limiting their employment options and straining their financial resources (Falik & Collins, 1996; Olson & Pavetti, 1997);
Whereas men living in poverty are at high risk of violence (Reiss & Roth, 1993) and women living in poverty are at high risk of all types of violence, including sexual abuse as children, with researchers documenting reports by two thirds of poor mothers of severe violence at the hands of a childhood caretaker and by 42% of child sexual molestation (Browne & Bassuk, 1997), as well as severe and life threatening assaults as adults (Bassuk, Browne, & Buckner, 1996; Brooks & Buckner, 1996; Colten & Allard, 1997; Roper & Weeks, 1993), which presents obstacles to work and self-sufficiency (NOW Legal Defense and Education Fund, 1997; Raphael, 1996);
Whereas lack of affordable health insurance, including mental health and substance abuse coverage, impedes health and well-being, and poor women are over 3 times as likely as higher income women to be uninsured: 36% versus 11%, respectively (National Center for Health Statistics, 1995);
Whereas children of teenage pregnancy and single motherhood are at high risk for a life of poverty, and birth control is not covered by health insurance plans for a significant number of women;
Whereas older adults often live on limited retirement incomes, have limited prospects for future earnings, and frequently face overwhelming health care costs; 13% of older women and 20% of older persons living alone or with nonrelatives in 1998 lived on incomes below the poverty level; and 49% of older African American women living alone lived in poverty in 1998 (U.S. Census Bureau, 1999, cited in U.S. Administration on Aging, 1999);
Whereas lower socioeconomic status among older adults is associated with higher rates of medical and psychological disorders, poor older adults have poorer access to medical care, prescription medications, long-term care, and community-based care (Estes, 1995), and Medicare funds mental health care at a lower rate than medical care, and this further limits the access for older adults in poverty to mental health and substance abuse services;
Whereas migrant families are by the nature of their work and life circumstances poorly served by health and mental health professionals (Portes & Rumbaut, 1996; Wilk, 1986);
Whereas undocumented immigrants are vulnerable to legal actions that inhibit their access to health and mental health services, compounding issues of poverty and limited English language proficiency (Olivera, Effland, & Hamm, 1993);
Whereas research focused on low-income groups including immigrants, ethnic minorities, minimum wage workers, families receiving public assistance, the homeless, migrant workers, and older women is limited;
Whereas low-income groups are the targets of discrimination based on their socioeconomic status as well as other social indicators such as race/ethnicity and gender (Lott, in press);
Whereas perceptions of the poor and of welfare – by those not in those circumstances -- tend to reflect attitudes and stereotypes that attribute poverty to personal failings rather than socioeconomic structures and systems and that ignore strengths and competencies in these groups (Ehrenreich, 1987; Katz, 1989; Quadagno, 1994), and public policy and anti-poverty programs continue to reflect these stereotypes (Bullock, 1995; Furnham, 1993; Furnham & Gunter, 1984; Rubin & Peplau, 1975);
Whereas programs that ensure that poor individuals and families have basic needs met are important in addressing the impact of poverty;
Whereas ethnic strife and war disrupt the economic, public health, and social systems comprising the safety net that helps ensure basic needs are met;
Whereas psychologists as researchers, service providers, educators, and policy advocates have a responsibility to better understand the causes of poverty and its impact on health and mental health, to help prevent and reduce the prevalence of poverty and to effectively treat and address the needs of low-income individuals and families by building on the strengths of communities;
Whereas psychologists are ethically guided to "respect the fundamental rights, dignity, and worth of all people" (American Psychological Association, Ethical Principles of Psychologists and Code of Conduct, 1992);
Whereas "psychologists are aware of their professional and scientific responsibilities to the community and the society in which they work and live" (American Psychological Association, Ethical Principles of Psychologists and Code of Conduct, 1992);
Therefore be it resolved that the American Psychological Association:
Will advocate for more research that examines the causes and impact of poverty, economic disparity, and related issues such as socioeconomic status, classism, ageism, unintended pregnancy, environmental factors, ethnic strife and war, stereotypes, the stigma and feelings of shame associated with poverty, and mental and physical health problems, including depression, substance abuse, intimate violence, child sexual abuse, and elder abuse, as well as advocate for the broader dissemination of these research findings.
Will advocate for more research on prejudicial and negative attitudes toward the poor by other persons who may individually or collectively perpetuate policies that tolerate poverty and social inequality.
Will advocate for more research on special populations who are poor (women and children, immigrants, undocumented immigrants, migrants, ethnic minorities, older people, people with disabilities and other chronic health conditions such as AIDS/HIV infection, and rural and urban populations).
Will advocate for research that identifies and learns from indigenous efforts by low-income people to work together to solve personal and shared problems or create organizations that advocate effectively for social justice.
Will recommend that where possible and appropriate socioeconomic status be identified for published reports of social sciences research.
Will advocate for incorporating evaluation and assessment tools and for encouraging integrative approaches such as the building of public and private community partnerships in programs addressing the issue of poverty and the poor, which psychological research has identified as effective strategies for addressing community level issues and problems.
Will encourage in psychological graduate and postgraduate education and training curricula more attention to the causes and impact of poverty, to the psychological needs of poor individuals and families, and to the importance of developing "cultural competence" and sensitivity to diversity around issues of poverty in order to be able to help prevent and reduce the prevalence of poverty and to treat and address the needs of low-income clients.
Will support public policy that encourages access for all children to high-quality early childhood education and a high-quality public school education, better equipping individuals for self-sufficiency.
Will support public policy that ensures access to postsecondary education and training that allows working families to earn a self-sufficient wage to meet their family’s needs.
Will support public policy and programs that ensure adequate income, access to sufficient food and nutrition, and affordable and safe housing for poor people and all working families.
Will support public policy that ensures access to family-friendly jobs offering good quality health insurance, including coverage for comprehensive family planning, mental health and substance abuse services, flexible work schedules, and sufficient family and medical leave.
Will support public policy that ensures access to comprehensive family planning in private and public health insurance coverage.
Will support public policy that ensures parity with medical coverage for mental health and substance abuse services under Medicare and Medicaid and ensures for all individuals, regardless of ability to pay, access to health care and mental health and substance abuse treatment that is comprehensive and culturally sensitive, that accommodates the needs of the children of parents seeking treatment, and that addresses the special needs of older adults in poverty, including prescriptions and long-term care.
Will support public policy that encourages access for all children to high-quality early health care.
Will support public policy that ensures for all working families access to affordable, high-quality child care, which is available year round, for the full day, and for all work shifts, as well as before- and after-school care.
Will support public policy that provides early intervention and prevention for vulnerable children and families that enhance parenting, education, and community life so that children can develop the necessary competencies to move out of poverty.
Will support public policy that provides early interventions and prevention for vulnerable children and families that are strengths-based, community-based, flexible, sensitive to culture and ethnic values of the family, and that have a long-lasting impact.
*The word family should be understood to incorporate the functions of family members rather than their biological sex or sexual orientation, for example, lesbian heads of household.
References
Adler, N.E., & Coriell, M. (1997). Socioeconomic status and women’s health. In S.J. Gallant, G.P. Keita, & R. Royak-Schaler (Eds.), Health care for women: Psychological, social, and behavioral influences. Washington, DC: American Psychological Association.
American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. (1992). American Psychologist, 47, 1597-1611.
Bassuk, E.L., Browne, A., & Buckner, J.C. (1996, August 28). The characteristics and needs of sheltered homeless and low-income housed mothers. Journal of the American Medical Association, 276, 640-646.
Bernstein, J., McNichol, E.C., Mishel, L., Zahradnik, R. (2000, January). Pulling apart: A state-by-state analysis of income trends. Washington, DC: Center on Budget and Policy Priorities/Economic Policy Institute.
Bourdon, K.H., Rae, D.S., Narrow, W.E., Manderschild, R. W., & Regier, D.A. (1994). National prevalence and treatment of mental and addictive disorders. In R. W. Mandershild & A. Sonnenschein (Eds.), Mental health: United States (pp. 22-51). Washington, D.C.: Center for Mental Health Services.
Brooks, M. G., & Buckner, J. C. (1996). Work and welfare: Job histories, barriers to employment, and predictors of work among low-income single mothers. American Journal of Orthopsychiatry, 66, 526-537.
Browne, A., & Bassuk, S.S. (1997). Intimate violence in the lives of homeless and poor house women: Prevalence and patterns in an ethnically diverse sample. American Journal of Orthopsychiatry, 67(2), 261-278.
Bullock, H. E. (1995). Class acts: Middle-class responses to the poor. In B. Lott & D. Maluso (Eds.), The social psychology of interpersonal discrimination (pp. 118-159). New York: Guilford.
Center on Budget and Policy Priorities. (1999). Low unemployment, rising wages fuel poverty decline. Washington, D.C.: Author.
Colten, M. E., & Allard, M. A. (1997). In harm’s way? Domestic violence, AFDC receipt and welfare reform in Massachusetts. Boston: University of Massachusetts Center for Social Policy Research.
Division 35 Task Force on Women, Poverty, and Public Assistance, APA Division of the Psychology of Women. (1998). Making welfare to work really work. Washington, D.C.: American Psychological Association. (Available from https://www.apa.org/pi/wpo/welftowork.html)
Ehrenreich, B. (1987). The new right attack on welfare. In F. Block, R. A. Cloward, B. Ehrenreich, & F. F. Piven, The mean season: The attack on the welfare state (pp. 161-195). New York: Pantheon Books.
Estes, C. (1995). Mental health issues for the elderly: Key policy elements. In M. Gatz (Ed.), Emerging issues in mental health and aging (pp. 303-327). Washington, D.C.: American Psychological Association.
Fairchild, H. (1984). School size, per-pupil expenditures, and academic achievement. Review of Public Data Use, 12, 221-229.
Falik, M. M., & Collins, K S. (1996). Women’s health: The Commonwealth Fund Survey. Baltimore, MD: Johns Hopkins University Press.
Furnham, A. (1993). Just world beliefs in twelve societies. Journal of Social Psychology, 133(3), 317-329.
Furnham, A., & Gunter, B. (1984). Just world beliefs and attitudes towards the poor. British Journal of Social Psychology, 23, 265-269.
Geltman, P.L., Meyers, A.F., Greenberg, J., & Zuckerman, B. (1996, Spring). Commentary: Welfare reform and children’s health. Washington, D.C.: Center for Health Policy Research.
Katz, M.B. (1989). The undeserving poor: From the war on poverty to the war on welfare. New York: Pantheon Books.
Kawachi, I., & Kennedy, B.P. (1997, April 5). Socioeconomic determinants of health: Health and social cohesion: Why care about income inequality? British Medical Journal, 314, 1037.
Lott, B. (in press). Low income parents and the public schools. Journal of Social Issues.
Lott, B., & Bullock, H. E. (in press). Who are the poor? Journal of Social Issues.
McGrath, E., Keita, G.P., Strickland, B.R., & Russo, N.F. (1990). Women and depression: Risk factors and treatment issues. Washington, D.C.: American Psychological Association.
McLoyd, V. C. (1998). Socioeconomic disadvantage and child development. American Psychologist, 53, 185-204.
National Center for Health Statistics. (1995). Health: United States. Hyattsville, MD: U.S. Public Health Service.
National Congress of American Indians. (2000). Economic development. Washington, D.C.: Author.
NOW Legal Defense and Education Fund (1997, March). Report from the front lines: The impact of violence on poor women. New York: Author.
Olivera, V., Effland, J.R., & Hamm, S. (1993). Hired farm labor use on fruit, vegetable, and horticultural specialty farms. Washington, D.C.: U.S. Department of Education.
Olson, K., & Pavetti, L. (1997). Personal and family challenges to the successful transition from welfare to work. Washington, DC: The Urban Institute.
Parker, S., Greer, S., & Zuckerman, B. (1988). Double jeopardy: The impact of poverty on early childhood development. Pediatric Clinician, North America, 35, 1227-1240.
Portes, A., & Rumbaut, R. G. (1996). Immigrant America: A portrait (2nd ed.). Berkeley, CA: University of California Press.
Quadagno, J. (1994). The color of welfare: How racism undermined the war on poverty. New York: Oxford University Press.
Raphael, J. (1996). Prisoners of abuse: Policy implications of the relationship between domestic violence and welfare receipt. Clearinghouse Review, 30, 186-194.
Regier, D. A., Farmer, M. E., Rae, D. S., Myers, J. K., Kramer, M., Robins, L. N., George, L. K., Karno, M., & Locke, B. Z. (1993). One-month prevalence of mental disorders in the United States and sociodemographic characteristics: The epidemiologic catchment area study. Acta Psychiatrica Scandinavica, 88, 35-47.
Reiss, A. J., Jr., & Roth, J. A. (Eds.). (1993). Understanding and preventing violence. Washington, D.C.: National Research Council.
Roper, P., & Weeks, G. (1993). Over half of the women on public assistance in Washington reported physical and sexual abuse as adults. Seattle: Washington State Institute for Public Policy.
Rubin, Z., & Peplau, L. (1975). Who believes in a just world? Journal of Social Issues, 31(3), 65-89.
U.S. Administration on Aging. (1999). Profile of older Americans: 1999. Washington, D.C.: Author.
U.S. Census Bureau, U.S. Department of Commerce. (1999, September). Poverty in the United States: Current population reports: Consumer income. Washington, D.C.: Author.
Wilk, V. A. (1986). The occupational health of migrant and seasonal farm workers in the United States (2nd ed.). Washington, D.C.: Farm Worker Justice Fund, Inc.
2001
APA Resolution on Assisted Suicide
Whereas the issue of assisted suicide is complex, involving areas of ethics, religion, medicine, psychology, sociology, economics, the law, public policy, and other fields; and
Whereas in the United States there is significant social stratification related to cultural, ethnic, economic, gender, and religious differences; and
Whereas these differences in our society are associated with an equally diverse range of views regarding assisted suicide; and
Whereas in the United States decisions about assisted suicide are made in the context of serious social inequities in access to resources such as basic medical care; and
Whereas autonomy is an important guiding principle in the law and in psychological and medical aspects of decision-making, but in and of itself is insufficient to capture the full range of complex medical, familial, social, financial, psychological, cultural, spiritual, and legal issues involved in the practice of assisted suicide; and
Whereas there is increasing public support for assisted suicide, but this support is weakest among groups who express concerns about being pressured to die (i.e., older adults, people with less education, women, and ethnic minorities) (Blendon, Szalay, & Knox, 1992); and
Whereas reasonable, well-informed people starting from different positions about costs and gains associated with assisted suicide disagree about the potential effects of legalizing the practice; and
Whereas people with different values and priorities can reach different conclusions about the advisability of assisted suicide; and
Whereas some evidence suggests that there are fluctuations in the will to live (Chochinov, Tataryn, Clinch, & Dudgeon, 1999) and in wishes regarding life-sustaining treatments (Weisman, Haas, & Fowler, 1999); and
Whereas pain and clinical depression are frequently under-treated, which can lead to suffering that may result in requests for assisted suicide (Foley, 1995); and
Whereas evidence suggests that some people rescind their requests for assisted suicide when they receive more aggressive and comprehensive care (Ganzini et al., 2000); and
Whereas psychological, familial, social, and financial factors seem to be more important than physical factors in requests for assisted suicide (Breitbart, Rosenfeld, & Passik, 1996; Emanuel, Fairclough, Slutsman, & Emanuel, 2000; Sullivan, Hedberg, & Fleming, 2000); and
Whereas little empirical data exist to determine the effects of assisted suicide on survivors and on society (Cooke et al., 1998); and
Whereas the empirical database, legal developments, and policy discourse related to assisted suicide are evolving rapidly;
Therefore, be it resolved that the American Psychological Association take a position that neither endorses nor opposes assisted suicide at this time.
However,
Given that psychologists have many areas of competence, including assessment, counseling, teaching, consultation, research, and advocacy skills that could potentially enlighten the discourse about assisted suicide, end-of-life treatment, and support for dying persons and their significant others; and
Given that psychologists could be instrumental in helping health care providers to understand and cope with the concerns and needs of dying individuals and their families; and
Given that practicing psychologists may receive requests to be involved in the education of various groups regarding assisted suicide; and
Given that there is one state in which assisted suicide is legal and psychological or psychiatric assessment and consultation is required under certain circumstances; and
Given that practicing psychologists may be part of multidisciplinary end-of-life care teams including ones exploring requests for assisted suicide;
Let it be further resolved that the American Psychological Association will assist in preparing the profession to address the issue of assisted suicide by taking the following actions:
Advocate for quality end-of-life care for all individuals; and
Encourage and promote the development of research on assisted suicide; and
Monitor legal, policy, and research developments that may require or encourage psychologists to involve themselves in assisted suicide cases; and
Promote policies that reduce suffering that could lead to requests for assisted suicide; and
Promote psychologists' involvement in research on ethical dilemmas faced by clinicians and researchers dealing with issues related to assisted suicide; and
Promote psychologists' participation in multidisciplinary teams and ethics committees involved with reviewing end-of-life requests; and
Encourage psychologists to obtain training in the area of ethics as it applies to end-of-life decisions and care; and
Encourage practicing psychologists to inform themselves about criminal and civil laws that have bearing on assisted suicide in the states in which they practice; and
Encourage practicing psychologists to recognize the powerful influence they may have with clients who are considering assisted suicide; and
Encourage psychologists to identify factors leading to assisted suicide requests (including clinical depression, levels of pain and suffering, adequacy of comfort care, and other internal and external variables) and to fully explore alternative interventions (including hospice/palliative care, and other end-of-life options such as voluntarily stopping eating and drinking) for clients considering assisted suicide; and
Encourage practicing psychologists to be aware of their own views about assisted suicide, including recognizing possible biases about entitlement to resources based on disability status, age, sex, sexual orientation, or ethnicity of the client requesting assisted suicide; and
Encourage psychologists to be especially sensitive to the social and cultural biases which may result in some groups and individuals being perceived by others, and/or being encouraged to perceive themselves, as more expendable and less deserving of continued life (e.g., people with disabilities, women, older adults, people of color, gay men, lesbians, bisexual people, transgendered individuals, and persons who are poor).
References
Blendon, R. J., Szalay, U. S., & Knox, R. A. (1992). Should physicians aid their patients in dying? The public perspective. Journal of the American Medical Association, 267, 2658-2662.
Breitbart, W., Rosenfeld, B. D., & Passik, S. D. (1996). Interest in physician-assisted suicide among ambulatory HIV infected patients. American Journal of Psychiatry, 153, 238-242.
Chochinov, H. M., Tataryn, D., Clinch, J. J., & Dudgeon, D. (1999). Will to live in the terminally ill. Lancet, 354, 816-819.
Cooke, M., Gourlay, L., Collette, L., Boccellari, A., Chesney, M. A., & Folkman, S. (1998). Informal care givers and the intention to hasten AIDS-related death. Archives of Internal Medicine, 158, 69-75.
Emanuel, E. J., Fairclough, D. L., Slutsman, J., & Emanuel, L. L. (2000). Understanding economic and other burdens of terminal illness: The experience of patients and their caregivers. Annals of Internal Medicine, 132, 451-459.
Foley, K. M. (1995). Pain, physician-assisted suicide, and euthanasia. Pain Forum, 4, 163-178.
Ganzini, L., Nelson, H. D., Schmidt, T. A., Kraemer, D. F., Delorit, M. A., & Lee, M. A. (2000). Physicians' experiences with the Oregon Death with Dignity Act. New England Journal of Medicine, 342, 557-563.
Sullivan, A. D., Hedberg, K., & Fleming, D. W. (2000). Legalized physician-assisted suicide in Oregon -- The second year. New England Journal of Medicine, 342, 598-604.
Weisman, J. S., Haas, J. S., & Fowler, F. J. (1999). The stability of preferences for life sustaining care among persons with AIDS in the Boston Health Study. Medical Decision Making, 19, 16-26.
APA Resolution on End-of-Life Issues and Care
Whereas the nature of dying and death has changed across the twentieth century, occurring primarily in an institutional setting rather than at home (Benoliel & Degner, 1995); and
Whereas death has become more frequently the result of chronic illness (Battin, 1996); and
Whereas medicine and technology have evolved to the point where the terminal period can be significantly prolonged (Field & Cassel, 1997); and
Whereas there are many more people living longer with terminal diagnoses and thus having more time to make end-of-life decisions; and
Whereas end-of-life decision-making is complex, involving areas of ethics, religion, medicine, psychology, sociology, economics, the law, public policy, and other fields; and
Whereas the population of the United States is aging, resulting in larger numbers of people who may request psychological support in making end-of-life decisions; and
Whereas in the United States there is significant social stratification related to cultural, ethnic, economic, gender, and religious differences; and
Whereas this diversity in our society leads to an equally diverse range of views regarding end-of-life care and decisions;
Whereas reasonable, well-informed people starting from different values and priorities concerning what is valuable at the end of life can and do hold different positions regarding end-of-life care and decisions; and
Whereas autonomy is an important guiding principle in the law and in medical, ethical, and psychological aspects of decision-making, but in and of itself is insufficient to capture the full range of complex medical, familial, social, financial, psychological, cultural, spiritual, and legal issues involved in end-of-life decision-making; and
Whereas there is increasing public support for control over end-of-life decisions but this support is weakest among groups who express concerns about being pressured to die (i.e., older adults, people with less education, women, and ethnic minorities) (Blendon, Szalay, & Knox, 1992); and
Whereas in the United States medical end-of-life decisions are made in a context of serious social inequities in access to resources such as basic medical care; and
Whereas some evidence suggests that there are fluctuations in the will to live (Chochinov, Tataryn, Clinch, & Dudgeon, 1999) and in wishes regarding life-sustaining treatments (Weisman, Haas, & Fowler, 1999); and
Whereas pain and clinical depression are frequently under-treated, which can lead to suffering that may result in requests for, or assent to, medical interventions that affect the timing of death (Foley, 1995); and
Whereas more people are aware of the possible benefits to be gained by using psychological services to help them make end-of-life decisions; and
Whereas psychology has been largely invisible in the end-of-life arena; and
Whereas psychologists have many areas of competence, including assessment, counseling, teaching, consultation, research, and advocacy skills that could potentially contribute to the science of end-of-life care and to the treatment and support of dying persons and their significant others; and
Whereas psychological research on end-of-life issues is limited in comparison with the magnitude of the issue; and
Whereas there have been no systematic efforts to educate psychologists about end-of-life issues; and
Whereas psychologists in clinical practice have not typically been involved in end-of-life decisions to the degree that they could be; and
Whereas psychologists could assume a significant role in helping health care providers to understand and cope with the concerns and needs of dying individuals and their families; and
Whereas psychologists could be instrumental in supporting public education efforts to raise awareness of issues related to dying, death, grief, mourning, and loss;
Therefore, be it resolved that the American Psychological Association, an organization committed to promoting the psychological well-being of individuals across the life span, should redress psychology's historical under-commitment to end-of-life care by actively promoting and supporting psychology's involvement in end-of-life care. In order to advance this involvement, be it further resolved that the American Psychological Association:
Promote and encourage research and training in the area of end-of-life issues within psychology programs at all levels; and
Encourage and promote the development of a research agenda on end-of-life issues; and
Support efforts to increase funding for research associated with end-of-life issues; and
Encourage psychologists to obtain training in the area of ethics as it applies to end-of-life decisions and care; and
Promote and facilitate psychologists' acquisition of competencies with respect to end-of-life issues, including mastery of the literature on dying and death and sensitivity to diversity dimensions that affect end-of-life experiences; and
Encourage practicing psychologists to be aware of their own views about the end of life, including recognizing possible biases about entitlement to resources based on disability status, age, sex, sexual orientation, or ethnicity of the client making end-of-life decisions; and
Encourage psychologists to be especially sensitive to the social and cultural biases which may result in some groups and individuals being perceived by others, and/or being encouraged to perceive themselves, as more expendable and less deserving of continued life (e.g., people with disabilities, women, older adults, people of color, gay men, lesbians, bisexual people, transgendered individuals, and persons who are poor); and
Support interdisciplinary efforts to increase the competency of psychologists and other health care professionals in end-of-life issues; and
Promote quality end-of-life care including palliative care, access to hospice services, support for terminally ill people and family members, accurate assessment of depression and cognitive capabilities of dying persons, and assistance with end-of-life decision-making; and
Advocate for access to, and reimbursement for, professional mental health services for seriously ill individuals and their families; and
Promote and support public policies that provide for the psychosocial services for dying individuals and their families; and
Support psychologists who wish to participate in ethics committees dealing with end-of-life issues; and
Support psychologists as they work cooperatively with caregivers, medical providers, and multidisciplinary teams to enhance understanding of the psychological aspects of dying and death and to improve quality of care for the dying; and
Endorse the following principles on end-of-life care as articulated in the Institute of Medicine Report entitled Approaching Death: Improving Care at the End of Life (Field & Cassel, 1997):
- Care for those approaching death is an integral and important part of health care;
- Care for those approaching death should involve and respect both patients and those close to them;
- Good care at the end of life depends on clinicians with strong interpersonal skills, clinical knowledge, technical proficiency, and respect for individuals, and it should be informed by scientific evidence, values, and personal and professional experience;
- The health community has a special responsibility for educating itself and others about the identification, management, and discussion of the last phase of fatal medical problems;
- More and better research [in the areas of biomedical, clinical, psychosocial, and health services] is needed to increase our understanding of clinical, cultural, organizational, and other practices or perspectives that can improve care for those approaching death;
- Changing individual behavior is difficult, but changing a culture or an organization is potentially a greater challenge -- and often is a precondition for individual change.
References
Battin, M. P. (1996). The death debate: Ethical issues in suicide (pp. 175-203). Upper Saddle River, NJ: Prentice-Hall.
Benoliel, J .Q. & Degner, L. F. (1995) Institutional dying: A convergence of cultural values, technology, and social organization. In H. Wass & R. A. Neimeyer (Eds.) Dying: Facing the facts (pp. 117-141). Washington, DC: Taylor and Francis.
Blendon, R. J., Szalay, U. S., & Knox, R. A. (1992). Should physicians aid their patients in dying? The public perspective. Journal of the American Medical Association, 267, 2658-2662.
Chochinov, H. M., Tataryn, D., Clinch, J. J., & Dudgeon, D. (1999). Will to live in the terminally ill. Lancet, 354, 816-819.
Field, M. J., & Cassel, C. K. (Eds.). (1997). Approaching death: Improving care at the end-of-life. Washington, DC: National Academy Press.
Foley, K. M. (1995). Pain, physician-assisted suicide, and euthanasia. Pain Forum, 4, 63-178.
Weisman, J. S., Haas, J. S., & Fowler, F. J. (1999). The stability of preferences for life sustaining care among persons with AIDS in the Boston Health Study. Medical Decision Making, 19, 16-26.
2002
APA Guidelines on Multicultural Education, Training, Research, Practice and Organizational Change for Psychologistsopens in new window (PDF, 319KB)
Resolution on Ageism
Adopted by the APA Council of Representatives, February 2002.
Whereas psychologists have documented the role of ageism in assessment and treatment of older adults, the degree to which aging does (or does not) affect human behavior and performance, the effects of age stereotypes, the extent to which ageism is a factor in workplace discrimination, among other concerns related to age and behavior; and
Whereas over the past several years APA has affirmed its opposition to discrimination and stereotyping based on gender, race, physical disability, sexual orientation, and ethnicity; and
Whereas most recently (February 1999) APA affirmed by Council resolution its support of Affirmative Action and equal opportunity for all persons regardless of race, gender, age, religion, disability, sexual orientation and national origin; and
Whereas APA embraces diversity in all efforts and programs and recognizes the dimension of age as an important element of diversity;
Therefore, be it Resolved , that the American Psychological Association rejects ageism in all its forms and is committed to support efforts to eliminate it from our society.
Note: Archived by APA Council of Representatives in August 2020. Rationale: Out of date and replaced by 2020 APA Resolution on Ageism (PDF, 128KB)opens in new window.
2003
Resolution on the Maltreatment of Children with Disabilitiesopens in new window (PDF, 99KB)
2004
APA Resolution on Children's Mental Health
Adopted by the APA Council of Representatives, October 2003
(For ease of presentation the term child is used to refer to infants, children and adolescents.)
Whereas psychology has been in the lead in demonstrating the importance of mental health in child development (Burns, Hoagwood, & Mrazek, 1999; Coie et al., 1993; Mrazek, & Haggerty, 1990; Marsh & Fristad, 2002; Wolchik & Sandler, 1997);
Whereas psychology is committed to providing the highest quality mental health care to children based on the best available evidence derived from ecologically valid research and evaluation of promotion, prevention, and treatment interventions (Biglan, A., Mrazek, P. J., Carnine, D., & Flay, B. R. 2003; Nation, M., Crusto, C., Wandersman, A., Kumpfer, K. L., Seybolt, D., Morrissey-Kane, E., & Davino, K. 2003; Weisz, J.R., Jensen, A.L., & McLeod, B.D. in press);
Whereas there are various types of useful evidence of the effectiveness of interventions, including clinical consensus, program evaluations, research using randomized experimental and quasi-experimental designs, single-subject designs, and successful replicated demonstrations of effectiveness in real world settings (Chamberlain, P., & Smith D.K. in press; Durlak, J. A. & Wells, A. M.1997; Durlak, J.A., Wells, A.M., Cotton, J.K., & Johnson, S. 1995). For the purposes of this document, "evidence-based practice" involves the integration of best research evidence with clinical expertise and patient values (Institute of Medicine, 2001);
Whereas psychology has taken a leadership role in developing mental health promotion, prevention, and treatment interventions that meet high standards of effectiveness (Christopherson, E. R. & Mortweet, S. L. 2001; A. E. Kazdin & J. R. Weisz, Eds., 2003);
Whereas there is inadequate access to appropriate evidence-based promotion, prevention, and treatment services for children with, or at risk for, mental disorders (Paavola, 1994; Weisz, Donenberg, Han, & Weiss, 1995);
Whereas stigma regarding mental health imposes risk for children, and impedes understanding of mental health issues and access to needed mental health services (Corrigan & Lundin, 2002);
Whereas there is a disparity of access to appropriate evidence based promotion, prevention, and treatment services based on poverty, ethnicity, race, and special needs of children (Leong, 2001; Rollock & Gordon, 2000; U.S. Department of Health and Human Services, 2001);
Whereas there is inadequate financing for culturally competent, appropriate, evidence-based promotion, prevention, and treatment services (Bazelon Center for Mental Health Law, 1999; Sturm et al., 2000);
Whereas there is a need for increased research on the translation of evidence-based practices into promotion, prevention, or treatment services that are appropriate for children, families, schools, and communities in real world settings (Burns, 1999; Burns & Friedman, 1990; Burns & Hoagwood, 2002; Clarke, 1995; Kazdin & Weisz, 1998; Schoenwald & Hoagwood, 2001);
Whereas there is a need for increased research on the effectiveness of promotion, prevention, and treatment services for children, families, schools, and communities that are developed by practitioners dealing with problems and varied contexts in the community (Weisz, Donenberg, Hans, & Weiss, 1995);
Whereas there is an increased need for research on assessment and diagnosis of children's mental health problems and strengths in the context of their culture, family, school and community (Wandersman, A., & Florin, P., 2003; Kumpfer, K. L. & Alvarado, R., 2003; Wilson, D. B., Gottfredson, D. C., & Najaka, S. S., 2001; Wolchik, S. A., Sandler, I. N., Millsap, R. E., Plummer, B. A., Greene, S. M., Anderson, E. R., Dawson-McClure, S. R., Hipke, K., & Haine, R. A., 2002);
Whereas there is a shortage of trained providers to deliver culturally competent evidence-based promotion, prevention, and treatment services for children (U.S. Department of Health and Human Services, 1999; U.S. Public Health Service, 2000);
Therefore, bit resolved , that:
The American Psychological Association (APA) take a significant leadership role to support and advocate that it is every child's right to have access to culturally competent, developmentally appropriate, family oriented, evidence-based, high-quality mental health services that are in accessible settings.
APA take a leadership role in ensuring that the utilization of promotion, prevention, and treatment interventions for child mental health meet the highest standards of available evidence.
APA collaborate with other organizations, consumers, and policy makers to develop and implement a primary mental health care system for children that integrates culturally competent, evidence-based, high quality, promotion, prevention, and treatment services for children, families, schools and communities.
APA provide leadership, support, and advocacy for basic and applied research to develop culturally appropriate knowledge on the promotion of mental health and the prevention and treatment of mental health problems, to translate findings from research into effective services and to evaluate services that are developed at the community level.
APA support and advocate for developing adequate funding sources that are coordinated and efficient for supporting a primary mental health care system.
APA support, advocate, and provide leadership for education and training that builds upon culturally competent, evidence-based promotion of mental health and prevention and treatment of mental health problems for all children, and reduces economic, racial, ethnic and gender disparities.
References
Bazelon Center for Mental Health Law. (1999). Making sense of Medicaid for children with serious emotional disturbance. Washington, D.C.: Author.
Biglan, A., Mrazek, P. J., Carnine, D., & Flay, B. R. (2003). The integration of research and practice in the prevention of youth problem behaviors. American Psychologist, 58, No. 6/7, 433-440.
Burns, B. J., Costello, E. J., Angold, A., Tweed, D., Stangl, D., Farmer, E. M., & Erkanli, A. (1995). Children's mental health service use across service sectors. Health Affairs, 14, 147-159.
Burns, B., & Friedman, R. (1990). Examining the research base for child mental health services and policy. Journal of Mental Health Administration, 17, 87-98.
Burns, B & Hoagwood, K. (Eds.). (2002). Community treatment for youth: Evidence-based interventions for severe emotional and behavioral disorders. New York: Oxford University Press.
Burns, B., Hoagwood, K., & Mrazek, P. (1999). Effective treatment for mental disorders in children and adolescents. Clinical Child and Family Psychology Review, 2(4), 199-254.
Chamberlain, P., & Smith D.K. (in press). Antisocial behavior in children and adolescents: The Oregon multidimensional treatment foster care model. In A. E. Kazdin & J. R. Weisz (Eds), Evidence-based psychotherapies for children and Adolescents. New York: Guilford Press.
Christopherson, E. R. & Mortweet, S. L. (2001). Childhood therapies that help: A much needed resource. Washington, D.C.: American Psychological Association.
Clarke, G. N. (1995). Improving the transition from basic efficacy research to effectiveness studies: Methodological issues and procedures. Journal of Consulting and Clinical Psychology, 63, 718-725.
Coie, J., Watt, N., West, S., Hawkins, J., Asarnow, J., Markman, J., Ramey, S., Shire, M., & Long, B. (1993). The science of prevention: A conceptual framework and some directions for a national research program. American Psychologist, 4(8), 1013-22.
Corrigan, P., & Lundin, R. (2002). Don't call me nuts: Coping with the stigma of mental illness. Chicago: University of Chicago Recovery Press.
Durlak, J. A. & Wells, A. M. (1997). Primary prevention mental health programs for children and adolescents: A meta-analytic review. American Journal of Community Psychology, 25, 115-152.
Durlak, J.A., Wells, A.M., Cotton, J.K., & Johnson, S. (1995). Analysis of selected methodological issues in child psychotherapy research. Journal of Clinical Child Psychology, 24, 141-148
Hoagwood, K. (2001). Evidence-based practice in children's mental health services: What do we know? Why aren't we putting it to use? Report on Emotional & Behavioral Disorders in Youth, 1(4), 84-88.
Institute of Medicine (U.S.) Committee on Quality of Health Care in America (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press.
Kazdin, A. E. & Weisz, J. R. (Eds), (2003). Evidence-based psychotherapies for children and adolescents. New York Guilford Press.
Kazdin, A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66, 19-36.
Kumpfer, K. L. & Alvarado, R. (2003). Family-strengthening approaches for the prevention of youth problem behaviors. American Psychologist, 58, No. 6/7, 457-465.
Leong, F. (Ed.). (2001). Barriers to providing effective mental health services to racial and ethnic minorities in the United States. Mental Health Services Research, 3(4). Marsh, D., & Fristad, M. (Eds.). (2002). Handbook of serious emotional disturbance in children and adolescents. New York: John Wiley and Sons.
Mrazek, P., & Haggerty, R. (Eds.). (1990). Handbook of early childhood intervention: Frontiers in preventive intervention research. Washington, D.C.: National Academy of Sciences.
Nation, M., Crusto, C., Wandersman, A., Kumpfer, K. L., Seybolt, D., Morrissey-Kane, E., & Davino, K. (2003). What works in prevention. American Psychologist, 58, No. 6/7, 449-456.
Paavola, J. et al. (1994). Comprehensive and coordinated psychological services for children: A call for service integration. Washington, D.C.: American Psychological Association Task Force on Comprehensive and Coordinated Psychological Services for Children: Ages 0-10.
Roberts, R., Attkisson, C., & Rosenblatt, A. (1998). Prevalence of psychopathology among children and adolescents. American Journal of Psychiatry, 155, 715-725.
Rollock, D., & Gordon, E. (2000). Racism and mental health into the 21st century: Perspectives and parameters. American Journal of Orthopsychiatry, 70(1), 5-14.
Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190-1197.
Shaffer, D., Fisher, D., Dulcan, M. K., Davies, M., Piacentini, J., Schwab Stone, M. E., Lahey, B. B., Blurdon, K., Jensen, P. S., Bird, H. R., Canino, G., & Regier, D., A. (1996). The National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children Version 2.3: Description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865-877.
Sturm, R., Ringel, J., Bao, C., Stein, B., Kapur, K., Zhang, W., & Zeng, F. (2000). National estimates of mental health utilization and expenditures for children in 1998 (working Paper 205). Los Angeles, CA: Research Center on Managed Care for Psychiatric Disorders.
United States Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Rockville, MD.
United States Department of Health and Human Services. (2001). Mental health: Culture, race and ethnicity. (A supplement to Mental Health: A report of the Surgeon General.) Rockville, MD.
United States Public Health Service. (2000). Report of the Surgeon General's conference on children's mental health: A national action agenda. Rockville, MD.
Weisz, J.R., Jensen, A.L., & McLeod, B.D. (in press). Milestones and methods in development and dissemination of child and adolescent psychotherapies: Review, commentary, and a new deployment-focused model. In E.D. Hibbs & P.S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice, 2nd edition. Washington, DC: American Psychological Association.
Weisz, J., Donenberg, G., Han, S., & Weiss, B. (1995). Bridging the gap between lab and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 688-701.
Wilson, D. B., Gottfredson, D. C., & Najaka, S. S. (2001). School-based prevention of problem behaviors: A meta-analysis. Journal of Quantitative Criminology, 17, 247-272.
Wolchik, S. A., Sandler, I. N., Millsap, R. E., Plummer, B. A., Greene, S. M., Anderson, E. R., Dawson-McClure, S. R., Hipke, K., & Haine, R. A. (2002). Six-year follow-up of preventive interventions for children of divorce: A randomized controlled trial. Journal of the American Medical Association, 288, 1874-1881.
Wolchik, S. A., & Sandler, I. N. (1997). Handbook of children's coping with common life stressors. New York: Plenum.
Sexual orientation and military service
Sexual Orientation and Military Service
Sexual orientation, parents and children
Adopted by the APA Council of Representatives July 28 & 30, 2004.
Research Summary
Lesbian and Gay Parents
Many lesbians and gay men are parents. In the 2000 U. S. Census, 33% of female same-sex couple households and 22% of male same-sex couple households reported at least one child under the age of 18 living in the home. Despite the significant presence of at least 163,879 households headed by lesbian or gay parents in U.S. society, three major concerns about lesbian and gay parents are commonly voiced (Falk, 1994; Patterson, Fulcher & Wainright, 2002). These include concerns that lesbians and gay men are mentally ill, that lesbians are less maternal than heterosexual women, and that lesbians' and gay men's relationships with their sexual partners leave little time for their relationships with their children. In general, research has failed to provide a basis for any of these concerns (Patterson, 2000, 2004a; Perrin, 2002; Tasker, 1999; Tasker & Golombok, 1997). First, homosexuality is not a psychological disorder (Conger, 1975). Although exposure to prejudice and discrimination based on sexual orientation may cause acute distress (Mays & Cochran, 2001; Meyer, 2003), there is no reliable evidence that homosexual orientation per se impairs psychological functioning. Second, beliefs that lesbian and gay adults are not fit parents have no empirical foundation (Patterson, 2000, 2004a; Perrin, 2002). Lesbian and heterosexual women have not been found to differ markedly in their approaches to child rearing (Patterson, 2000; Tasker, 1999). Members of gay and lesbian couples with children have been found to divide the work involved in childcare evenly, and to be satisfied with their relationships with their partners (Patterson, 2000, 2004a). The results of some studies suggest that lesbian mothers' and gay fathers' parenting skills may be superior to those of matched heterosexual parents. There is no scientific basis for concluding that lesbian mothers or gay fathers are unfit parents on the basis of their sexual orientation (Armesto, 2002; Patterson, 2000; Tasker & Golombok, 1997). On the contrary, results of research suggest that lesbian and gay parents are as likely as heterosexual parents to provide supportive and healthy environments for their children.
Children of Lesbian and Gay Parents
As the social visibility and legal status of lesbian and gay parents has increased, three major concerns about the influence of lesbian and gay parents on children have been often voiced (Falk, 1994; Patterson, Fulcher & Wainright, 2002). One is that the children of lesbian and gay parents will experience more difficulties in the area of sexual identity than children of heterosexual parents. For instance, one such concern is that children brought up by lesbian mothers or gay fathers will show disturbances in gender identity and/or in gender role behavior. A second category of concerns involves aspects of children's personal development other than sexual identity. For example, some observers have expressed fears that children in the custody of gay or lesbian parents would be more vulnerable to mental breakdown, would exhibit more adjustment difficulties and behavior problems, or would be less psychologically healthy than other children. A third category of concerns is that children of lesbian and gay parents will experience difficulty in social relationships. For example, some observers have expressed concern that children living with lesbian mothers or gay fathers will be stigmatized, teased, or otherwise victimized by peers. Another common fear is that children living with gay or lesbian parents will be more likely to be sexually abused by the parent or by the parent's friends or acquaintances.
Results of social science research have failed to confirm any of these concerns about children of lesbian and gay parents (Patterson, 2000, 2004a; Perrin, 2002; Tasker, 1999). Research suggests that sexual identities (including gender identity, gender-role behavior, and sexual orientation) develop in much the same ways among children of lesbian mothers as they do among children of heterosexual parents (Patterson, 2004a). Studies of other aspects of personal development (including personality, self-concept, and conduct) similarly reveal few differences between children of lesbian mothers and children of heterosexual parents (Perrin, 2002; Stacey & Biblarz, 2001; Tasker, 1999). However, few data regarding these concerns are available for children of gay fathers (Patterson, 2004b). Evidence also suggests that children of lesbian and gay parents have normal social relationships with peers and adults (Patterson, 2000, 2004a; Perrin, 2002; Stacey & Biblarz, 2001; Tasker, 1999; Tasker & Golombok, 1997). The picture that emerges from research is one of general engagement in social life with peers, parents, family members, and friends. Fears about children of lesbian or gay parents being sexually abused by adults, ostracized by peers, or isolated in single-sex lesbian or gay communities have received no scientific support. Overall, results of research suggest that the development, adjustment, and well-being of children with lesbian and gay parents do not differ markedly from that of children with heterosexual parents.
Resolution
Whereas APA supports policy and legislation that promote safe, secure, and nurturing environments for all children (DeLeon, 1993, 1995; Fox, 1991; Levant, 2000);
Whereas APA has a long-established policy to deplore "all public and private discrimination against gay men and lesbians" and urges "the repeal of all discriminatory legislation against lesbians and gay men" (Conger, 1975);
Whereas the APA adopted the Resolution on Child Custody and Placement in 1976 (Conger, 1977, p. 432)
Whereas discrimination against lesbian and gay parents deprives their children of benefits, rights, and privileges enjoyed by children of heterosexual married couples;
Whereas some jurisdictions prohibit gay and lesbian individuals and same-sex couples from adopting children, notwithstanding the great need for adoptive parents (Lofton v. Secretary, 2004);
Whereas there is no scientific evidence that parenting effectiveness is related to parental sexual orientation: lesbian and gay parents are as likely as heterosexual parents to provide supportive and healthy environments for their children (Patterson, 2000, 2004; Perrin, 2002; Tasker, 1999);
Whereas research has shown that the adjustment, development, and psychological well-being of children is unrelated to parental sexual orientation and that the children of lesbian and gay parents are as likely as those of heterosexual parents to flourish (Patterson, 2004; Perrin, 2002; Stacey & Biblarz, 2001);
Therefore be it resolved that the APA opposes any discrimination based on sexual orientation in matters of adoption, child custody and visitation, foster care, and reproductive health services;
Therefore be it further resolved that the APA believes that children reared by a same-sex couple benefit from legal ties to each parent;
Therefore be it further resolved that the APA supports the protection of parent-child relationships through the legalization of joint adoptions and second parent adoptions of children being reared by same-sex couples;
Therefore be it further resolved that APA shall take a leadership role in opposing all discrimination based on sexual orientation in matters of adoption, child custody and visitation, foster care, and reproductive health services;
Therefore be it further resolved that APA encourages psychologists to act to eliminate all discrimination based on sexual orientation in matters of adoption, child custody and visitation, foster care, and reproductive health services in their practice, research, education and training (American Psychological Association, 2002);
Therefore be it further resolved that the APA shall provide scientific and educational resources that inform public discussion and public policy development regarding discrimination based on sexual orientation in matters of adoption, child custody and visitation, foster care, and reproductive health services and that assist its members, divisions, and affiliated state, provincial, and territorial psychological associations.
References
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist , 57, 1060-1073.
Armesto, J. C. (2002). Developmental and contextual factors that influence gay fathers' parental competence: A review of the literature. Psychology of Men and Masculinity , 3, 67 - 78.
Conger, J.J. (1975). Proceedings of the American Psychological Association, Incorporated, for the year 1974: Minutes of the Annual meeting of the Council of Representatives. American Psychologist , 30, 620-651.
Conger, J. J. (1977). Proceedings of the American Psychological Association, Incorporated, for the legislative year 1976: Minutes of the Annual Meeting of the Council of Representatives. American Psychologist , 32, 408-438.
DeLeon, P.H. (1993). Proceedings of the American Psychological Association, Incorporated, for the year 1992: Minutes of the annual meeting of the Council of Representatives August 13 and 16, 1992, and February 26-28, 1993, Washington, DC. American Psychologist , 48, 782.
DeLeon, P.H. (1995). Proceedings of the American Psychological Association, Incorporated, for the year 1994: Minutes of the annual meeting of the Council of Representatives August 11 and 14, 1994, Los Angeles, CA, and February 17-19, 1995, Washington, DC. American Psychologist , 49, 627-628.
Falk, P.J. (1994). Lesbian mothers: Psychosocial assumptions in family law. American Psychologist , 44, 941-947.
Fox, R.E. (1991). Proceedings of the American Psychological Association, Incorporated, for the year 1990: Minutes of the annual meeting of the Council of Representatives August 9 and 12, 1990, Boston, MA, and February 8-9, 1991, Washington, DC. American Psychologist , 45, 845.
Levant, R.F. (2000). Proceedings of the American Psychological Association, Incorporated, for the legislative year 1999: Minutes of the Annual Meeting of the Council of Representatives February 19-21, 1999, Washington, DC, and August 19 and 22, 1999, Boston, MA, and Minutes of the February, June, August, and December 1999 Meetings of the Board of Directors. American Psychologist , 55, 832-890.
Lofton v. Secretary of Department of Children & Family Services, 358 F.3d 804 (11th Cir. 2004).
Mays, V. M., & Cochran, S. D. (2001). Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. American Journal of Public Health , 91, 1869-1876.
Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin , 129, 674-697.
Patterson, C.J. (2000). Family relationships of lesbians and gay men. Journal of Marriage and Family , 62, 1052- 1069.
Patterson, C.J. (2004a). Lesbian and gay parents and their children: Summary of research findings. In Lesbian and gay parenting: A resource for psychologists . Washington, DC: American Psychological Association.
Patterson, C. J. (2004b). Gay fathers. In M. E. Lamb (Ed.), The role of the father in child development (4th Ed.). New York: John Wiley.
Patterson, C. J., Fulcher, M., & Wainright, J. (2002). Children of lesbian and gay parents: Research, law, and policy. In B. L. Bottoms, M. B. Kovera, and B. D. McAuliff (Eds.), Children, Social Science and the Law (pp, 176 - 199). New York: Cambridge University Press.
Perrin, E. C., and the Committee on Psychosocial Aspects of Child and Family Health (2002). Technical Report: Coparent or second-parent adoption by same-sex parents. Pediatrics , 109, 341 - 344.
Stacey, J. & Biblarz, T.J. (2001). (How) Does sexual orientation of parents matter? American Sociological Review , 65, 159-183.
Tasker, F. (1999). Children in lesbian-led families - A review. Clinical Child Psychology and Psychiatry , 4, 153 - 166.
Tasker, F., & Golombok, S. (1997). Growing up in a lesbian family . New York: Guilford Press.
Please cite this policy statement as:
Paige, R. U. (2005). Proceedings of the American Psychological Association, Incorporated, for the legislative year 2004. Minutes of the meeting of the Council of Representatives July 28 & 30, 2004, Honolulu, HI. Retrieved November 18, 2004, from the World Wide Web https://www.apa.org/governance/. (To be published in Volume 60, Issue Number 5 of the American Psychologist.)
2005
2005 White House Conference on Agingopens in new window (PDF, 67KB)
Resolution on violence in video games and interactive mediaopens in new window (PDF, 89KB)
2006
Report of the Working Group on Psychotropic Medications for Children and Adolescentsopens in new window (PDF, 863KB)
APA Resolution on Drug Abuse Treatment to Prevent HIV Among Injecting Drug Users
APA resolution on drug abuse treatment to prevent HIV among injecting drug users
2007
Resolution on Anti-Semitic and Anti-Jewish Prejudice (PDF, 135KB)opens in new window
Policy archived by the APA Council of Representatives in February 2026.
2009
Resolution on The Psychological Needs of Children Exposed to Disasters
2011
Resolution on Family Caregivers
Resolution on Family Caregivers (PDF, 50KB)opens in new window
Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change
Introduction
Dementia in its many forms is a leading cause of functional limitation among older adults worldwide and will continue to ascend in global health importance as populations continue to age and effective cures remain elusive (Mathers & Loncar, 2006). Plassman et al. (2007) estimated that over 2.5 million Americans suffered from Alzheimer’s disease (AD), and nearly 4 million had that and other forms of dementia in 2002. Given expected increases in the size of the older adult population those numbers are expected to increase strikingly by 2050 (Alzheimer's Association, 2009).
The following guidelines were developed for psychologists who perform evaluations of dementia and age-related cognitive change. These guidelines conform to the American Psychological Association's Ethical Principles of Psychologists and Code of Conduct (APA, 2002). The term guidelines refers to statements that suggest or recommend specific professional behavior, endeavors, or conduct for psychologists. Guidelines differ from standards in that standards are mandatory and may be accomplished by an enforcement mechanism. Guidelines are aspirational in intent. They are intended to facilitate the continued systematic development of the profession and to help facilitate a high level of practice by psychologists. Guidelines are not intended to be mandatory or exhaustive and may not be applicable to every professional situation. They are not definitive and they are not intended to take precedence over the judgment of psychologists.
Guidelines on this topic were originally developed by an APA Presidential Task Force, approved as policy of APA by the APA Council of Representatives and published in 1998. Consistent with APA standards, these guidelines were subject to sunset or review in 2008. The Board of Professional Affairs (BPA) and the Committee on Professional Practice and Standards (COPPS) conducted an initial review and determined that they should not be sunset and revision was appropriate. The APA Committee on Aging empanelled a group of experts who reviewed and deemed appropriate the maintenance of these guidelines with appropriate revision and updating. The introduction to the original guidelines remains pertinent today:
“Psychologists can play a leading role in the evaluation of the memory complaints and changes in cognitive functioning that frequently occur in the later decades of life. Although some healthy aging persons maintain very high cognitive performance levels throughout life, most older people will experience a decline in certain cognitive abilities. This decline is usually not pathological, but rather parallels a number of common decreases in physiological function that occur in conjunction with normal developmental processes.
For some older persons, however, declines go beyond what may be considered "normal" and are relentlessly progressive, robbing them of their memories, intellect, and eventually their abilities to recognize spouses or children, maintain basic personal hygiene, or even utter comprehensible speech. These more malignant forms of cognitive deterioration are caused by a variety of neuropathological conditions and dementing diseases.
Psychologists are uniquely equipped by training, expertise, and the use of specialized neuropsychological tests to assess changes in memory and cognitive functioning and to distinguish normal changes from early signs of pathology. …. Neuropsychological evaluation and cognitive testing remain among the most effective differential diagnostic methods in discriminating pathophysiological dementia from age-related cognitive decline, cognitive difficulties that are depression-related, and other related disorders. Even after reliable biological markers have been discovered, neuropsychological evaluation and cognitive testing will still be necessary to determine the onset of dementia, the functional expression of the disease process, the rate of decline, the functional capacities of the individual, and hopefully, response to therapies.
... These guidelines, however, are intended to specify appropriate cautions and concerns for all clinicians which are specific to the assessment of dementia and agerelated cognitive decline. These guidelines are aspirational in intent and are neither mandatory nor exhaustive. The goal of the guidelines is to promote proficiency and expertise in assessing dementia and age-related cognitive decline in clinical practice. These guidelines may not be applicable in certain circumstances, such as some experimental or clinical research projects and/or some forensic evaluations.” (p.1298, APA 1998).
I. General Guidelines: Competence
1. Psychologists performing evaluations of dementia and age-related cognitive change are familiar with the prevailing diagnostic nomenclature and specific diagnostic criteria.
Rationale . A clear understanding of how cognitive disorders are defined and diagnosed is important for developing assessment plans, providing feedback to individuals and their family members, and communicating effectively with other professionals involved in an individual’s care. Differential diagnosis requires knowledge of a broad range of psychological and medical conditions that can affect an individual’s cognitive state and an appreciation of both the general trends and individual differences that characterize normal cognitive aging. Because diagnostic nomenclature and criteria evolve in response to clinical and scientific advances, updating of knowledge is recommended to sustain a high level of competence in assessing cognitive disorders.
The Diagnostic and Statistical Manual of Mental Disorders: 4 th Edition (DSM-IV) (American Psychiatric Association, 2000) outlines diagnostic criteria for the clinical syndrome of dementia and additional criteria for diagnosing dementia of the Alzheimer type and vascular dementia, as well as briefer guidelines for diagnosing 3 less common causes of dementia such as head trauma, Parkinson’s disease, and general medical disorders. Diagnostic guidelines for AD have also been provided by the National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) and by the Alzheimer’s Disease and Related Disorders Association (ADRDA) (McKhann et al., 1984). The NINCDS-ADRDA guidelines provide criteria for identifying probable and possible AD and are widely used in research. Neuropsychological testing to confirm the presence and nature of cognitive deficits is required in the NINCDS-ADRDA criteria for AD and figures prominently in the consensus panel guidelines for assessing other forms of dementia.
Consensus groups have offered detailed and clinically useful diagnostic criteria for several other major causes of late-life dementia, including vascular dementia (Roman et al., 1993), frontotemporal dementia (Neary et al., 1998), and dementia with Lewy bodies (McKeith et al., 2005). All diagnostic criteria require confirmation of dementia by clinical examination and the exclusion of other explanations for the cognitive deficits by history, clinical examination, or specialized tests.
If memory is the chief presenting complaint, but significant decline in everyday function is absent and observed performance is within expected ranges on relevant neuropsychological tests, the DSM-IV category of Age-Related Cognitive Decline may apply.
Some older adults have memory and cognitive difficulties that are greater than those typical of normal aging, but not so severe as to warrant a diagnosis of dementia. Many terms have been used to refer to these syndromes of borderline impairment. In recent years, the term Mild Cognitive Impairment (MCI) has come to the forefront in usage within the United States. Recent definitions of MCI include several subtypes (amnestic vs. nonamnestic, sole deficit vs. multifocal) (Winblad et al., 2004). The debate continues regarding the necessity and utility of MCI as a diagnostic entity but there is a substantial probability that some form of diagnosis for mild cognitive disorders (e.g. Minor Neurocognitive Disorder) will be present in DSM-V.
Cognitive impairment symptoms may also accompany common mental health conditions such as depression and anxiety disorders. Diminished ability to think or concentrate, or indecisiveness, is included in the DSM-IV diagnostic criteria for Major Depressive Episode and Generalized Anxiety Disorder. Familiarity with the cognitive sequelae of common psychiatric disorders is essential for differentiating between psychiatrically related cognitive impairments and mood changes that sometimes signal the onset of dementia (Devanand, 1996).
Application . Psychologists are encouraged to obtain training and continuing education to enhance and maintain their expertise of and utilize current diagnostic concepts, criteria and nomenclature in their evaluations of older adults.
2. Psychologists gain specialized competence in assessment and intervention with older adults.
Rationale . A central ethical tenet for psychologists is that they practice only within their area of competence (American Psychological Association, 2002). Psychologists who conduct evaluations of dementia and age-related cognitive changes are aware that special competencies are required for this activity. Competence in gathering clinical history; conducting clinical interviews; and administering, scoring, and interpreting psychological and neuropsychological tests is necessary but may not be sufficient.
Application . Psychologists engaged in evaluation of dementia and age-related cognitive change have a solid foundation in clinical psychology. In addition, they are encouraged to obtain fundamental education, training, and supervised experience in geropsychology, neuropsychology, rehabilitation psychology, pharmacology, neuropathology and psychopathology.
II. General Guidelines: Ethical Considerations
1. Psychologists are aware of the special issues surrounding informed consent in cognitively compromised populations.
Rationale . Psychologists recognize the special challenge of informed consent in dementia evaluations. Informed consent requires that one’s consent to treatment be competent, voluntary, and informed (American Bar Association & American Psychological Association, 2008). Informed consent implies the person has capacity to understand the significant benefits, risks, and alternatives of the proposed assessment and to make and communicate a health-care decision (Uniform Health- Care Decisions Act of 1993, 1994). Yet compromised cognitive ability to make health care decisions is one of the key capacities that may be affected by dementia and age-related cognitive changes. This creates the appearance of a double-bind regarding obtaining informed consent for dementia evaluations. The American Bar Association & American Psychological Association (ABA & APA) Assessment of older adults with diminished capacity: A handbook for psychologists (2008) provides guidance to help the clinician when accessing persons who may have diminished capacity. The Handbook notes: “The person may have capacity to consent to the evaluation, and either agrees or refuses. In this case, the person has provided a valid agreement or refusal, and this can be documented. Alternatively the person may not have the capacity to consent to the evaluation, and either agrees or refuses. If the person agrees, he or she is generally said to have “assented” and the assessment process goes forward. If the person disagrees, and refuses to comply with an interview, then the psychologist must document why the person is believed to lack the capacity to refuse the evaluation. In some situations, the capacity evaluation stops there. In other situations, where a capacity evaluation is court ordered, the psychologist may be asked to provide an opinion based on his or her observations of the person” (p.35, ABA & APA, 2008).
Application . Psychologists review the purpose, nature and procedures of the evaluation with the older adult in a manner and with terms most likely to foster understanding. Psychologists inform individuals and their legal proxies of limitations to confidentiality, constraints on release of raw test data, and mandatory reporting requirements. Psychologists define the benefits and risks for the person being assessed. These may include gathering of helpful clinical information that can be used in diagnosis and treatment planning but also the loss of decision-making rights, potential lack of confidentiality, and the possible need for a guardian or conservator. In certain situations psychologists may need to offer an expert opinion regarding capacity regardless of whether or not the person consents to a full evaluation. In these situations, psychologists are encouraged to inform the individual that the evaluation must be conducted whether or not they are willing participants and a refusal to participate will result in the evaluation being compiled from other sources.
If the individual is legally incapable of providing consent, the psychologist must obtain consent from a legally authorized person (See Section 3.10 of the APA Ethical Principles of Psychologists and Code Of Conduct, 2002) to carry out the evaluation and to gather information from other health professionals and family members (see Guideline III.1). Psychologists document the consent, assent, or refusal of the individual as appropriate. Psychologists also document evidence regarding the person’s capacity or lack thereof to consent to the assessment.
2. Psychologists seek and provide appropriate consultation in the course of performing dementia and age-related cognitive change evaluations.
Rationale . Complex issues arise during the evaluation of suspected cognitive decline or dementia. These issues may include multiple medical co-morbidities or medication side effects, genetic and heritability issues, abuse or neglect, issues regarding legal competence or guardianship, conflicting or unclear assessment results, and families overwhelmed or divided by the potential diagnosis. Psychologists providing services to this population strive to be particularly sensitive to the multiple health conditions that impact cognitive function. In all of these areas the clinician, individual, and/or family may benefit from the expertise or services of other professionals such as physicians, genetic counselors, adult protective and social service workers, attorneys, and other psychologists (ABA & APA, 2008).
Application . When the psychologist is the first professional the individual contacts, the psychologist seeks to gather existing medical records to complement the assessment. If appropriate, the individual may be referred for a thorough medical evaluation to discover any underlying medical disorder or any potentially reversible medical conditions associated with dementia or cognitive decline.
If issues of abuse or neglect arise, psychologists notify appropriate authorities and make referral for appropriate services. In addition, psychologists are encouraged to inform the individual of the reporting requirement prior to services being rendered. In matters of legal capacity and guardianship, the psychologist seeks additional legal consultation, supervision, and/or specialized knowledge, training, or experience as appropriate to address these issues. Psychologists communicate their findings to other health care professionals with sensitivity to issues of informed written consent that is compliant with HIPAA [Health Insurance Portability and Accountability Act of 1996] guidelines.
Psychologists are encouraged to help educate other health care professionals who administer mental status examinations or other brief psychological tools regarding the benefits and limitations of these instruments and their clinical utility for particular applications. Education can also be provided about the utility and limitations of more comprehensive psychological or neuropsychological assessment in dementia evaluations.
In all cases psychologists strive to consult widely with appropriate professionals or seek information to clarify relevant issues. Psychologists are encouraged to seek out the most current information and are mindful of instances where professional consensus has yet to be reached.
3. Psychologists are aware of cultural perspectives and of personal and societal biases and engage in nondiscriminatory practice.
Rationale . Biases may affect the evaluation of dementia and age-related cognitive function. Biases that could have untoward effects on assessment and guidelines are provided in APA’s Ethical Principles of Psychologists and Code of Conduct (2002). In particular, tests may have been constructed in accordance with the Principles’ goals to reduce or eliminate bias; however, the psychologist is advised to carefully evaluate the test quality and appropriateness for individual circumstances, especially when the test is being administered to individuals with different cultural and linguistic backgrounds (American Educational Research Association [AERA], American Psychological Association [APA], and National Council on Measurement in Education [NCME], 1999). Often only highly educated, majority normative samples were used for many neuropsychological tests. The psychologist is advised to ensure the tests used are appropriate for the individual being served. Certain populations, such as immigrants (with or without documentation), trauma victims and non-English speaking clients may be especially vulnerable. Secondly, individuals’ reactions and performances on testing may be influenced by their own expectations. For example, anxiety and/or stereotype threat (a confirmatory bias leading to performance that conforms with societal stereotypes) can reduce performance on cognitive testing (Scholl & Sabat, 2008). The psychologist is advised to be vigilant for such anxieties and work with the individual so they might better understand the evaluation procedures and purposes to ensure accurate and optimal performance.
Application . To varying degrees, biases are pervasive. The psychologist’s and individual’s biases (e.g., stereotype threat) may negatively influence an evaluation. The psychologist is alert and sensitive to differing roles, expectations, and normative standards within a sociocultural context. In practice and when appropriate, the psychologist discusses potential biases to ensure optimal performance is achieved for the assessment. The psychologist strives to control biases through reviewing relevant research and relying on evidence-based practice guidelines, and by seeking additional consultation or, in some cases, withdrawing from the evaluation. If the psychologist is unable to conduct the evaluation fairly, the ethical psychologist seeks to refer the individual to other psychologists capable of providing services.
III. Procedural Guidelines: Conducting Evaluations of Dementia and Age-Related Cognitive Change
1. Psychologists strive to obtain all appropriate information for conducting an evaluation of dementia and age-related cognitive change including pertinent medical history and communicating with relevant health care providers.
Rationale . Cognitive function and change are associated with several medical and psychosocial conditions that must be considered in any evaluation of current cognitive performance. However, individuals and even knowledgeable informants may be poor historians or lack information regarding the individual’s past and current medical status, medication use and daily function. Medical, occupational, and educational records and family history documents can provide important contextual and functional information pertinent to the evaluation (ABA & APA, 2008). In practice the amount of reliable information available to the psychologist for the evaluation may be highly variable, depending in part on the availability of relevant records as well as knowledgeable family, friends and other professionals. Conclusions and recommendations flowing from the evaluation may be constrained by the need for further information or follow-up evaluation.
Application . Psychologists strive to understand fully all facets of the referred individual’s context. Psychologists are encouraged to consult with health care providers and seek relevant records, particularly concerning the individual’s health status, medical history, and current medications. As the individual may be able to give only limited self-report and may be an unreliable historian, psychologists seek consent or assent from the individual to gather corroborative information from other informants. Psychologists inform these sources of the potential uses of the information and limits to confidentiality. In obtaining collateral information the psychologist considers the potential biases and motives of informants.
2. Psychologists conduct a clinical interview as part of the evaluation.
Rationale . Although objective neuropsychological testing provides valuable data for diagnostic purposes, the clinical interview remains an essential element of an in-depth assessment for dementia (ABA & APA, 2008; Mackinnon & Mulligan, 1998; National Center for Cost Containment, 1997). Obtaining contextual and historical information from interviewing knowledgeable informants improves diagnostic accuracy and may be less likely to be biased by sex and gender, education, or ethnicity in comparison to performance-based measures (Galvin et al, 2005; Monnot, Brosey, and Ross, 2005). Interview data from a corroborative source such as a caregiver or knowledgeable family member can provide information on everyday cognitive functioning (Waite et al, 1998). An advantage of informant history is the ability to assess change in performance from earlier in life which also potentially reduces test bias (Jorm, 1996). Finally, obtaining data from informant interviews can add greater precision in the design of appropriate behavioral, environmental and pharmacological treatments of dementia (Waite et al, 1998; Hartman-Stein, Reuter, and Schuster, 2002).
Directly interviewing the individual whenever possible allows the clinician to evaluate firsthand the level of cognitive function and the individual’s awareness of any cognitive and behavioral changes and to discern psychosocial stressors or other mental health problems that may be contributing to the cognitive change. Such data obtained from direct interviews are invaluable for both diagnostic and treatment planning purposes.
Application . In order to accurately to diagnose conditions that are associated with cognitive decline and functional disability, psychologists conduct a clinical interview with the individual and obtain corroboration from knowledgeable informants whenever possible. Key information obtained during the interview includes:
- the onset and course of changes in cognitive functioning
- pre-existing disabilities
- educational and cultural background that could affect testing variability
- general medical and psychiatric history
- past neurologic history including prior head injuries or other central nervous system insults (strokes, tumors, infections, etc.)
- current psychiatric symptoms and significant life stressors
- current prescription and over-the-counter medication use
- current and past use and abuse of alcohol and drugs
- family history of dementia
Psychologists may choose to incorporate structured, evidence-based clinical dementia rating tools, brief mental status examinations, and formal measures of functional status in their clinical interviews.
In order to design practical recommendations for treatment planning purposes, during the clinical interview the psychologist obtains, whenever possible, functional information from the individual and collateral sources regarding the individual’s ability to manage the important aspects of self care (ABA & APA, 2008). In evaluating suspected dementia, Psychologists are sensitive to families' and individuals’ understanding of the potential diagnosis of dementia and its ramifications. They are also aware of the individual’s past and current coping skills as well as resources from which the individual can receive support, including cultural, ethnic and religious communities.
3. Psychologists are aware that standardized psychological and neuropsychological tests are important tools in the assessment of dementia and age-related cognitive change.
Rationale . The use of psychometric instruments may represent the most important and unique contribution of psychologists to the assessment of dementia and cognitive change. (American Educational Research Association [AERA], American Psychological Association [APA], and National Council on Measurement in Education [NCME],1999). Psychometric assessment provides objective information on cognitive strengths and impairments necessary for diagnosis. Testing provides reliable information for tracking cognitive change over time or in response to interventions.
Brief mental status examinations contribute to the evaluation for possible dementia and other cognitive impairments and track cognitive change in individuals with more severe levels of impairment. Brief cognitive assessment tools should be standardized and have good positive predictive values for identifying possible cognitive impairment. Psychologists strive to be familiar with the positive and negative predictive values of these tools for identifying cognitive impairment in populations with similar age, educational, and ethnic and racial characteristics as the persons to be assessed. Common cut scores for brief mental status examinations generate adequate sensitivity to dementia, but may not have reasonable specificity (USPSTF, 2003). Moreover, brief mental status tests have poor sensitivity for pre-clinical detection of dementia. For these reasons there may be poor concordance between a brief mental status score and functional status or clinical concern. Thus, both positive and negative results on brief mental status testing may require follow-up with more in-depth neuropsychological testing.
Comprehensive neuropsychological evaluations for dementia and cognitive change include tests of multiple cognitive domains, typically including memory, attention, perceptual and motor skills, language, visuospatial abilities, reasoning, and executive functions. Measures of mood and personality may be relevant in many cases. Psychologists are encouraged to refer to current compendia resources and the clinical research literature in selecting assessment instruments.
There are many tests and approaches that are useful for assessments, and the number of tests with normative data for older age ranges has increased. Supplementing standard age norms with normative data obtained from samples where the absence of dementia has been established longitudinally may help to increase reliability in identifying mild levels of cognitive impairment.
Research to establish norms on commonly used clinical tests for specific ethnic and racial populations is growing, but representative norms are still lacking in some cases. Psychologists assessing older adults from racial and ethnic minorities strive to seek and use the best available tests for each individual’s background and consult with expert colleagues as needed regarding interpretation.
Technology assisted assessments (e.g., computer administered cognitive batteries, tele-health visits) are rapidly advancing but appropriate psychometric properties and normative data are nascent. These technologies may have significant advantages for older persons with limited mobility or health-care access, but may also disadvantage older persons with limited experience and expertise interacting with technology.
Application . Psychologists are encouraged to use standardized, reliable, and valid tests. Whether traditional or technology-assisted, appropriate tests have normative data for the age range of the person being assessed and are suitable for the individual’s ethnicity, race, and educational background. In particular, the positive and negative predictive values of the instruments are considered when selecting tests for dementia, cognitive impairment, and age-related cognitive change. Furthermore, testing instruments should be sensitive to subtle changes in cognitive function over time.
Regarding age norms, psychologists are aware of the relative stringency with which persons with mild cognitive impairment or beginning dementia were excluded from the standardization samples for a given test. They appropriately adjust their clinical decision making for these tests. Psychologists assessing cognitive function and change among older adults of ethnic and racial minorities are familiar with the adequacy of the normative data for ethnic and racial minorities for the various measures they employ.
4. When evaluating for cognitive and behavioral changes in individuals, psychologists attempt to estimate premorbid abilities.
Rationale . The diagnosis of dementia requires evidence of decline from a previously higher level of cognitive function. Ideally, psychologists assessing for cognitive declines in older persons would have baseline test data from earlier years against which current performance could be compared. Unfortunately, this information rarely exists, so psychologists must try to estimate premorbid abilities. Factors commonly considered include socioeconomic status, educational level, occupational history, and individual and family reports. This type of demographic and historical information can be supplemented by contemporaneous tests such as word recognition reading. Word recognition reading tests are highly correlated with global cognitive function but insensitive to early changes in most dementias (McGurn, et al., 2004). However, this method might be sensitive to dementia type and severity (Cockburn, Keene, Hope & Smith, 2000). Traditional methods of estimating premorbid cognitive functioning may be especially biased for ethnic and racial minorities. A particular difficulty may be posed by individuals with intellectual disabilities who present for dementia evaluation (for review see Margallo-Lana, 2009; Styron, Livingston, King & Hassiotis, 2007).
Application . Psychologists strive to use premorbid functioning estimating methods that are appropriate to individual needs. Psychologists are encouraged to be aware of the limits of various approaches to premorbid ability estimation and appropriately qualify their clinical judgments about premorbid function.
5. Psychologists are sensitive to the limitations and sources of variability and error in psychometric performance, and to the sources of error in diagnostic decision making.
Rationale . Psychometric instruments and clinical interpretations of these instruments are subject to error. Instruments have known or knowable limits to their reliability and validity (American Educational Research Association [AERA], American Psychological Association [APA], and National Council on Measurement in Education [NCME], 1999). Clinical decision making must contend with limits on positive or negative predictive values (Fletcher, Fletcher, & Wagner, 1996). These psychometric and clinical properties are impacted by varying factors (Smith, Ivnik, & Lucas, 2008) including demography (e.g., age, education, ethnicity, etc.) and context (e.g., clinical setting).
Application . Psychologists strive to understand sources of variability and error in their instruments and judgments about cognitive change. They strive to maximize the reliability and validity of the assessment process via appropriate collection of history and selection of instruments, norms, and procedures. Psychologists are encouraged to recognize limitations in the evaluation process by appropriately qualifying their judgments and conclusions.
6. Psychologists make appropriate use of longitudinal data.
Rationale . Existing cognitive data can serve as a baseline against which to measure future changes in cognitive functions. Magnitudes and rates of cognitive change, as well as response to treatment, can also be determined by follow-up testing. However, many cognitive instruments are insensitive to changes over shorter periods. In most cases, a one-year follow-up interval is adequate for monitoring changes in cognitive performance, unless the individual, family, or other health care professionals report a more rapid decline or improvement, emergence of new symptoms, or changes in life circumstances (APA, 1998).
Because test means may decline with age, it is important that tests selected for use in the evaluation of dementia and age-related cognitive change have adequately accounted for uncomplicated age-related changes in cognitive function. The lack of adequate longitudinal norms for older adults can pose a problem for longitudinal evaluation, even as better and larger standardization samples of older adults are now available for many commonly used clinical tests.
Application . Psychologists are encouraged to utilize prior cognitive data when available. Psychologists strive to be knowledgeable of the stability parameters of the instruments they use over specific inter-test intervals. Psychologists strive to become familiar with patterns of practice or learning effects and accommodate these effects in their test selection and application. Psychologists are thus aware of clinically meaningful magnitudes of test changes (e.g. Reliable Change Indices; Jacobson & Truax, 1991; Temkin, Heaton, Grant, & Dikmen, 1999) so that patterns and the extent of change can be interpreted appropriately. Psychologists recommend follow-up testing only as appropriate and recognize that interim follow-up not involving formal testing may also be useful in many cases.
7. Psychologists recognize that providing constructive feedback, support, and education as well as maintaining a therapeutic alliance, can be important parts of the evaluation process.
Rationale . Individuals concerned about cognitive and behavioral changes associated with aging, generally come to the evaluation process seeking information as well as emotional support. This often is a severely distressing situation for the individual, who may or may not have been the key individual in making the decision to have an assessment conducted (ABA & APA, 2008; APA, 1998). Provision of both information and support, while maintaining a sense of respect and dignity for the individual, regardless of level of cognitive impairment, reflect both professional ethics and sound clinical practice (APA, 2002). Establishing a therapeutic alliance is critical for accurate assessment, development of efficacious intervention, and increased likelihood that interventions will be effectively implemented with good adherence.
Application . In many instances, individuals may benefit from feedback regarding the evaluation in language that they can understand. Psychologists are encouraged to exercise clinical judgment and take into consideration the needs and capabilities of the particular individual when feedback is provided. The presence of a significant support person during feedback allows the clinician to assist with differences of opinion, respond to individual questions, and facilitate the interactions between the individual and persons in their support network (Green, 2006).
Providing feedback, education, and support to persons significant to the individual, with the individual’s informed consent, are also important aspects of evaluations and enhance their value and applicability. Knowledge regarding levels of impairment, the expected course, and expected outcomes can help these significant others to make adequate preparations. Working with the individual’s support network in this way can provide them with effective means of responding to the challenges posed by behavior changes stemming from a diagnosis of dementia. Healthy older adults who have had concerns about their cognitive functions can benefit from reassurance based on results of testing and from suggestions as to how they may enhance their everyday cognitive function.
With regard to feedback, education and support, psychologists are encouraged to be sensitive to issues of marriage, partnerships, family relationships and friendships of each unique individual. Psychologists strive to acknowledge and accord full respect to these relationships, including those of lesbian, gay, bisexual and transgender people even if these relationships are not recognized by law or acknowledged by individual institutions.
8. As part of the evaluation process, psychologists appropriately recommend interventions available to persons with cognitive impairment and their caregivers.
Rationale . Persons with cognitive impairment often also display mood disturbance and challenging behaviors and generally have compromised daily function. Functional, emotional, and behavior challenges can be addressed with a variety of cognitive, behavioral and psychosocial interventions. These interventions rely on retained abilities, such as preserved procedural/ nondeclarative memory and preserved reading abilities, social history, and environmental cues. It is therefore critical not only to be fully aware of the deficits associated with a diagnosis of dementia, but also to be knowledgeable of those abilities that are relatively spared in dementia, as well as the individual’s personal history, background, and current levels of functional capacity.
Functional deficit associated with cognitive decline can be partially mitigated through the use of cognitive training paradigms (e.g. spaced retrieval), or external aids (e.g. planners or medication dispensers). However, both approaches require intensive training. Moreover, caregivers and other environmental support are crucial in maintaining positive effects of these interventions.
Challenging behaviors (especially those falling within “the four A’s of dementia” i.e., agitation, aggression, anxiety, and apathy) are considered by some an attempt to communicate unmet human needs in persons with dementia and related disorders (Cohen-Mansfield, Libin, & Marx, 2007). Causes of challenging behavior can include physical issues (e.g., infections, undiagnosed pain), non-optimal levels of stimulation, undiagnosed depression, environmental triggers, and conditioning. As a result, psychologists are encouraged to consider and assess these potential causes to determine an appropriate treatment protocol. This requires considering interventions that might involve the individual, family or professional caregivers, institutions or policy makers (Camp & Nasser, 2003).
Cognitive impairment alone does not preclude the ability to benefit from various forms of psychotherapy. It is important to note that cognitive/behavioral interventions are effective in addressing dysphoria, agitation, anxiety, and apathy in persons with dementia (Teri et al., 2005). At more advanced stages of dementia, use of sensory stimulation often assists in addressing issues related to agitation or anxiety (Lin et al., 2009).
At all stages of dementia, apathy is the most common behavioral challenge facing caregivers. Therefore, provision of optimal stimulation and ensuring positive engagement are critical features of interventions to improve the quality of life of both persons with dementia and their caregivers.
Enabling family members to accept, support, and engage the person with dementia as he or she is now is an important challenge to address. It is also critically important that therapeutic goals be discussed directly with the individual who has dementia. This not only provides the respect and dignity that should be given any individual, but also provides highly relevant information regarding the individual’s understanding and attitude about the goal, his or her motivation in achieving the goal, and his or her willingness to expend time and energy working toward the goal.
Application . Psychologists strive to educate themselves regarding currently approved medical and behavioral treatments of dementia and age-related cognitive decline. This is a rapidly evolving area and both families and healthcare professionals can benefit from learning about best practices based on sound empirical evidence. Psychologists strive to recommend appropriate interventions to maximize individual function and minimize challenging behavior and emotional distress associated with dementia or age-related cognitive change. Psychologists seek to determine underlying environment, social, historical, psychological, functional and medical causes of emotional and behavioral disturbance associated with dementia. Individuals and families can be educated about these treatments, which can be offered to individuals as appropriate. Psychologists directly provide or assist other health care providers and lay caregivers, as well as organizations, to provide appropriate treatment and support to individuals with dementia and their caregivers.
9. Psychologists are aware that full evaluation of possible dementia is an interdisciplinary, holistic process involving other health care providers. Psychologists respect other professional perspectives and approaches. Psychologists communicate fully and refer appropriately to support integration of the full range of information for informing decisions about diagnosis, level of severity, and elements of the treatment plan.
Rationale . Traditional healthcare continues to be more reactive rather than focused on prevention and promotion of wellbeing (Epstein & Sherwood, 1996). Traditional healthcare may be provided in isolated settings with outdated systems of manual record-keeping. This exacerbates older persons vulnerability to fragmented care. Receiving conflicting diagnoses and care advice from different providers can demoralize individuals and their caregivers. The increasing burden of chronic and acute medical conditions in old age further combine to disempower individuals and providers alike (McWilliam, Brown, Carmichael, & Lehman, 1994). No single provider is ever likely to have all the essential information that can contribute to making an accurate diagnosis. An interdisciplinary team is most likely to provide all the essential information necessary to make an accurate diagnosis and develop a comprehensive treatment plan. Interdisciplinary teams adopt “an approach to care characterized by a high degree of collaboration across the various health professionals serving patients in assessment, treatment planning, treatment implementation, and outcome evaluation.” (APA, 2008). An integrated approach to health care benefits older adults. These concerns apply to diagnoses of dementia and to intervention decisions regarding individuals with dementia and their caregivers.
Application . Psychologists strive to ensure that every effort is made to involve all relevant providers in the diagnostic process. Psychologists are encouraged to take proactive steps to develop collegial, interdisciplinary relationships with other health care providers serving the population for whom they routinely receive referrals for dementia assessment. With appropriate informed and written consent, information is shared across providers as needed to reach an accurate diagnosis and coordinate appropriate interventions. Psychologists are encouraged to make appropriate referrals to other members of an integrated health care team.
Conclusion
In 2010 approximately 40 million people in the U.S. are age 65 or older. This number is expected to double by 2050. As this cohort grows in number it also grows in diversity (AOA, 2008). Psychologists must be prepared to serve the needs of this population. Psychologists adhering to the guidelines enumerated herein can make significant contributions to the care and well-being of the rapidly expanding number of older persons confronted by age-related cognitive change or dementia.
Author notes : This revision of the 1998 “Guidelines for the Evaluation of Dementia and Age-Related Cognitive Decline” was completed by the APA Task Force to Update the Guidelines for the Evaluation of Dementia and Age-Related Cognitive Decline and approved as APA policy by the APA Council of Representatives in February 2011. Members of the APA Task Force to Update the Guidelines for the Evaluation of Dementia and Age-Related Cognitive Decline were Glenn Smith, PhD (Chair), Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Past President, APA Division 40; Cameron Camp, PhD, Linda-&-Camp, Inc., Solon, Ohio; Susan Cooley, PhD, Chief, Geriatric Research and Development and Chief, Dementia Initiatives, Office of Geriatrics & Extended Care, U.S. Department of Veterans Affairs; Hector M. González, PhD, Institute of Gerontology and Family Medicine, Wayne State University; Paula Hartman-Stein, PhD, Independent Practitioner, Center for Healthy Aging, Kent, Ohio and Adjunct faculty, Lifespan Development and Educational Sciences, Kent State University; Asenath LaRue, PhD, Senior Scientist, Wisconsin Alzheimer’s Institute, University of Wisconsin, Member of the original Guideline Presidential Task Force; Nancy A. Pachana, PhD, School of Psychology and Co-Director, Ageing Mind Initiative, The University of Queensland, Australia; and, Antonette Zeiss, PhD, Acting Deputy Chief Patient Care Services Officer for Mental Health, U.S. Department of Veterans Affairs. The Task Force is thankful to the APA Committee on Aging for convening the Task Force and to the U.S. Department of Veterans Affairs for hosting conference calls to permit this work to advance. APA Office on Aging Director, Deborah DiGilio and assistant Susie Hwang provided outstanding administrative support.
The literature cited herein does not reflect a systematic meta-analysis or review of the literature but rather was selected by the panel to emphasize clinical best practices. Care was taken to avoid endorsing specific products, tools, or proprietary approaches. No direct financial support was provided for the development of these guidelines.
References
Administration on Aging (2008). Older Americans 2008: Key Indicators of Well-Being, Appendix A: Detailed Tables. Retrieved February 9, 2010, from https://www.agingstats.gov/agingstatsdotnet/Main_Site/Data/Data_2008.aspx Alzheimer’s Association. (2009).
Alzheimer’s disease facts and figures. Alzheimer’s & Dementia, 5(3).
American Bar Association & American Psychological Association. (2008). Assessment of older adults with diminished capacity: A handbook for psychologists. Retrieved January 19, 2010, from https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf
American Educational Research Association, American Psychological Association, & National Council of Measurement in Education (1999). Standards for educational and psychological testing. Washington, DC: AERA.
American Psychiatric Association. (2000). The Diagnostic and Statistical Manual of Mental Disorders: 4th Edition. American Psychiatric Publishing, Inc: Washington, DC.
American Psychological Association, Presidential Task Force on Integrated Health Care for an Aging Population. (2008). Blueprint for change: Achieving integrated health care for an aging population. Retrieved January 19, 2010, from https://www.apa.org/pi/aging/programs/integrated/integrated-healthcare-report.pdf
American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. In Bersoff, Donald N. (Ed), Ethical conflicts in psychology (4th ed.). (pp. 14-30). Washington, DC, US: American Psychological Association.
American Psychological Association, Presidential Task Force on the Assessment of Age- Consistent Memory Decline & Dementia (1998). Guidelines for the evaluation of dementia and age-related cognitive decline. American Psychologist, 53, 1298- 1303.
Camp, C. J., & Nasser, E . H. (2003). Nonpharmacological aspects of agitation and behavioral disorders in dementia: Assessment, intervention, and challenges to providing care. In P. A. Lichtenberg, D. L. Murman, & A. M. Mellow (Eds.), Handbook of dementia: Psychological, neurological, and psychiatric perspectives (pp. 359-401). New York: John Wiley & Sons.
Cockburn, J., Keene, J., Hope, T., & Smith, P. (2000). Progressive decline in NART score with increasing dementia severity. Journal of Clinical and Experimental Neuropsychology, 22, 508-517.
Cohen-Mansfield, J., Libin, A., & Marx, M.S. (2007). Nonpharmacological Treatment of Agitation: A Controlled Trial of Systematic Individualized Intervention. The 16 Journals of Gerontology Series A: Biological sciences and medical sciences, 62, 908-916.
Devanand, D. P., Sano, M., Tang, M. X., Taylor, S., Gurland, B. J., Wilder, D., Stern, Y., & Mayeux, R. (1996). Depressed mood and the incidence of Alzheimer's disease in the elderly living in the community. Archives of General Psychiatry, 53, 175- 182.
Epstein, R., & Sherwood, L. (1996). From outcomes research to disease management: A guide for the perplexed. Annals of Internal Medicine, 124, 832-37.
Fletcher, R., Fletcher, S., & Wagner, E. (1996). Clinical epidemiology: The essentials. Baltimore, MD: Williams & Wilkins.
Galvin, J. E., Roe, C. M., Powlishta, K. K., Coats, M. A., Muich, S. J., Grant, E., Miller, J. P., Storandt, M., & Morris, J. C. (2005). The AD8: A brief informant interview to detect dementia. Neurology, 65, 559-564.
Green, J. (2006). Feedback. In D.K. Affix & K.A. Welch-Bohmer (Eds.), Geriatric neuropsychology: Assessment and intervention (pp. 223-236). New York: Guilford Press.
Hartman-Stein, P.E., Reuter, J., & Schuster, J. (2002, July). The behavioral competence inventory: A measure of functional ability in older adults at risk for dementia. Poster presented at the 8th International Conference on Alzheimer’s Disease and Related Disorders, Stockholm, Sweden.
Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936 (1996). Retrieved February 1, 2010, from U.S. Department of Health and Human Services, Office for Civil Rights Web site: https://www.hhs.gov/ocr/hipaa
Jacobson NS, Traux P. (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology,59, 12-19
Jorm, A. F. (1996). Assessment of cognitive impairment and dementia using informant reports. Clinical Psychology Review, 16, 51-73.
Lin, L., Wu, S., Kao, C., Tzeng, Y., Watson, R., & Tang, S. (2009). Single ability among activities of daily living as a predictor of agitation. Journal of Clinical Nursing, 18, 117-123.
Mackinnon, A., & Mulligan, R. (1998). Combining cognitive testing and informant report to increase accuracy in screening for dementia. American Journal of Psychiatry, 155, 1529-1535.
Margallo-Lana, M. L., Tyrer, S. P., & Moore, P. B. (2009). Overview of the neuropsychological assessment of dementia in intellectual disability. In V.P. Prasher (Ed.), Neuropsychological assessments of dementia in Down syndrome and intellectual disabilities (pp. 1-18). London: Springer.
Mathers, C. D., & Loncar, D. (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med, 3(11), e442.
McGurn, B., Starr, J. M., Topfer, J. A., Pattie, A., Whiteman, M. C., Lemmon, H. A., Whalley, L. J., & Deary, I. J. (2004). Pronunciation of irregular words is preserved in dementia, validating premorbid IQ estimation. Neurology, 62, 1184-1186.
McKeith, I. G., Dickson, D. W., Lowe, J., & et al. (2005). Diagnosis and management of dementia with Lewy bodies: Third report of the DLB consortium. Neurology, 65, 1863-1872.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease. Report of the NINCDS- ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurology, 34, 939-44.
McWilliam, C. L., Brown, J. B., Carmichael, J. L., & Lehman, J. M. (1994). A new perspective on threatened autonomy in elderly persons: the disempowering process. Social Science & Medicine, 38(2), 327-38.
Monnot, M., Brosey, M., & Ross, E. (2005). Screening for dementia: Family caregiver questionnaires reliably predict dementia. Journal of American Board of Family Medicine, 18(4), 240 – 256
National Center for Cost Containment. (1997). Assessment of competency and capacity of the older adult: A practice guideline for psychologists (National Technical Information Service publication no. pb-97-147904). Milwaukee, WI: Author.
Neary, D., Snowden, J. S., Gustafson, L., & et al. (1998). Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology, 51, 1546- 1554.
Plassman, B. L. et al. (2007). Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study. Neuroepidemiology, 29, 125-132.
Roman, G. C., Tatemichi, T. K., Erkinjuntti, T., & et al. (1993). Vascular dementia: diagnostic criteria for research studies: report of the NINDS-AIREN International Workshop. Neurology, 43, 250-260.
Scholl, J.M.,& Sabat, S.R. (2008). Stereotypes, stereotype threat and ageing: Implications for the understanding and treatment of people with Alzheimer's disease. Ageing & Society, 28, 103-130.
Smith, G.E., Ivnik, R.J., Lucas, J.A. (2008). Assessment Techniques: Tests, Test Batteries, Norms and Methodological Approaches in J. Morgan and J. Ricker, (Eds.). Textbook of clinical neuropsychology. New York; Taylor & Francis.
Strydom, A., Livingston G., King, M., & Hassiotis A. (2007). Prevalence of dementia in intellectual disability using different diagnostic criteria. British Journal of Psychiatry, 191, 150-157.
Temkin, N.R., Heaton, R.K., Grant, I., & Dikmen, S.S. (1999). Detecting significant change in neuropsychological test performance: a comparison of four models. Journal of the International Neuropsychological Society, 5, 357–369
Teri, L., Huda, P., Gibbons, L., Young, H., & van Leynseele, J. (2005). STAR: A Dementia-Specific Training Program for Staff in Assisted Living Residences. The Gerontologist, 45, 686-693.
Uniform Health Care Decisions Act National Conference of Commissioners on Uniform State Laws 9 U.L.A. (1994), p. 93 suppl.
U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality. (2003). Screening for Dementia. Rockville, MD. Retrieved January 19, 2010, from https://www.ahrq.gov/clinic/uspstf/uspsdeme.htm
Waite, L. M., Broe, G. A., Casey, B., Bennett, H. P., Jorm, A. F., Creasey, H., Cullen, J., & Grayson, D. A. (1998). Screening for dementia using an informant interview. Aging, Neuropsychology and Cognition, 5, 194-202.
Winblad, B., Palmer, K., Kivipelto, M., & et al. (2004). Mild cognitive impairment: beyond controversies, towards a consensus – report of the International Working Group on Mild Cognitive Impairment. Journal of Internal Medicine, 256, 240-246.
2012
APA Resolution on Combination Biomedical and Behavioral Approaches to Optimize HIV Prevention
APA resolution on combination biomedical and behavioral approaches to optimize HIV prevention
2014
Resolution on Interrogations of Criminal Suspects
WHEREAS law enforcement officers, upon gaining a confession from a criminal suspect, often close their investigation, deem the crime solved, and sometimes overlook exculpatory evidence or other possible leads–even in cases in which the confession is internally inconsistent, contradicted by external evidence, or the product of coercive interrogation (Leo & Ofshe, 1998; Drizin & Leo, 2004; Findley & Scott, 2006; Hirsch, 2007; Kassin & Gudjonsson, 2004);
WHEREAS prosecutors, upon learning of a suspect's confession, tend to charge suspects with the highest number and types of offenses, set bail higher, and are far less likely to initiate or accept a plea bargain to a reduced charge (Leo & Ofshe, 1998; Drizin & Leo, 2004; but see Redlich, 2010);
WHEREAS many adults with mental disabilities and younger adolescents are limited in their understanding of the Constitutional rights to silence and to counsel, lack the capacity to weigh the consequences of a rights waiver, and are more likely to waive their rights (Cooper & Zapf, 2008; Rogers et al., 2007a; Clare & Gudjonsson, 1991; Everington & Fulero, 1999; Fulero & Everington, 1995; O'Connell, Garmoe & Goldstein, 2005; Abramovitch, Higgins-Biss & Biss, 1993; Abramovitch, Peterson-Badali & Rohan, 1995: Colwell,Cruise, Guy et al., 2005; Goldstein, Condie, Kalbeitzer et al., 2003; Grisso, 1980, 1981; Redlich, Silverman & Steiner, 2003; Viljoen, Klaver & Roesch, 2005; Viljoen & Roesch, 2005; Wall & Furlong, 1985; Clare & Gudjonsson, 1995: Everington & Fulero, 1999; O'Connell, Garmoe & Goldstein, 2005; Goldstein, Condie, Kalbeitzer et al., 2005; Redlich, Silverman & Steiner, 2003; Singh & Gudjonsson, 1992); a pattern that also afflicts ordinary adults who are under stress (Rogers, Gillard, Wooley, & Fiduccia, 2011; Scherr & Madon, 2013);
WHEREAS interrogations that are excessive in length, include the presentation of false evidence, or include implicit or explicit promises of leniency increase anxiety, create an incentive to escape the situation, mislead the suspect into believing that a confession is in one's best interests, and thereby increase the risk of false confessions (Drizin & Leo, 2004; Horselenberg, Merkelbach, & Josephs, 2003; Kassin & Kiechel, 1996; Kassin & McNall, 1991; Klaver et al., 2008; Leo & Ofshe, 1998; Ofshe & Leo, 1997a, 1997b; Nash & Wade, 2009; Perillo & Kassin, 2011; Redlich & Goodman, 2003 ; Russano et al., 2005; Swanner, Beike, & Cole, 2010; White, 2001);
WHEREAS innocent persons have falsely confessed to committing offenses of which they have been accused only later to be exonerated (Drizin & Leo, 2004; Gudjonsson, 1992, 2003; Kassin, 1997; Kassin & Gudjonsson, 2004; Lassiter, 2004; Lassiter & Meissner, 2010; Leo & Ofshe, 1998; Garrett, 2008; Scheck, Neufeld, & Dwyer, 2000; https://www.innocenceproject.org/);
WHEREAS confessions are particularly potent forms of evidence that jurors and others do not fully discount — even when they are judged to be coerced (Kassin & Neumann, 1997; Kassin & Sukel, 1997; Lassiter & Geers, 2004; Leo & Ofshe, 1998; Drizin & Leo, 2004; Kassin & Wrightsman, 1980; Neuschatz et al., 2008; Redlich, Ghetti, & Quas, 2008; Redlich, Quas, & Ghetti, 2008); Wallace & Kassin, 2012);
WHEREAS jurors and other triers of fact have difficulty distinguishing true and false confessions (Kassin, Norwick, & Meissner, 2005; Honts, Kassin, & Craig, in press) and whereas false confessions are highly counterintuitive (Leo & Liu, 2009; Levine, Kim, & Blair, 2010) and in part because these statements, & Blair, 2010) and in part because these statements, as seen in the confessions of defendants who were ultimately exonerated, typically contain vivid and accurate details about the offense and victim, facts that were not in the public domain, as well as other indicia of credibility (e.g., statements of motivation, apologies and remorse, corrected errors), indicating that the innocent confessor obtained the information from leading questions or other secondary sources of information (Garrett, 2010; Appleby, Hasel, & Kassin, 2008; Kassin, 2006; Leo, 2008; Leo & Ofshe, 1998, Ofshe & Leo 1997a, 1997b);
WHEREAS videotaping of interrogations in their entirety provides an objective and accurate audio-visual record of the interrogation, provides a vehicle by which to resolve disputes about the source of non-public details in a suspect's confession, and has the potential to deter interrogators from using inappropriate tactics and deter defense attorneys from making frivolous claims of police coercion (American Bar Association, 2004; Boetig, Vinson, & Weidel, 2006; Cassell, 1996a, 1996b; Drizin & Colgan, 2004; Geller, 1994; Gudjonsson, 2003; Kassin et al., 2010; Leo, 1996c; Slobogin, 2003; Sullivan, 2004; The Justice Project, 2007);
WHEREAS interrogations video recorded from a "neutral" camera perspective — one focusing attention equally on suspects and interrogators — produce less prejudiced judgments or interpretations of suspects' statements and behaviors than the more typical "suspect-focus" camera perspective that directs greater attention onto suspects than interrogators (Landström, Roos af Hjelmsäter, Granhag, 2007; Lassiter, 2002, 2010; Lassiter, Diamond, Schmidt, & Elek, 2007; Lassiter, Geers, Handley, Weiland, & Munhall, 2002; Lassiter, Geers, Munhall, Handley, & Beers, 2001; Lassiter, Ware, Lindberg, & Ratcliff, 2010;
WHEREAS, the findings set forth in this resolution regarding the phenomenon of false confessions are the product of established research methods that are widely accepted in the field of psychology, as evidenced by the AP-LS scientific review paper (Kassin et al., 2010) peer reviewed journals, and books that are cited in the resolution and its supporting references; and
WHEREAS, as a scientific and educational organization, the American Psychological Association's mission is in part to promote the application of sound research findings to advance the public welfare;
THEREFORE, BE IT RESOLVED that the American Psychological Association recommends that all custodial interviews and interrogations of felony suspects be video recorded in their entirety and with a "neutral" camera angle that focuses equally on the suspect and interrogator;
BE IT FURTHER RESOLVED that APA recommends, recognizing that the risk of false confession is increased with extended interrogation times, that law enforcement agencies consider placing limits on the length of time that suspects are interrogated;
BE IT FURTHER RESOLVED that APA recommends that law enforcement agencies, prosecutors, and the courts recognize the risks of eliciting a false confession by interrogations that involve the presentation of false evidence;
BE IT FURTHER RESOLVED that APA recommends that police, prosecutors, and the courts recognize the risks of eliciting a false confession that involve minimization "themes" that communicate promises of leniency;
BE IT FURTHER RESOLVED that APA recommends that those who interrogate individuals who are young (with particular attention paid to developmental level and trauma history), cognitively impaired, those with impaired mental health functioning, or in other ways are vulnerable to manipulation receive special training regarding the risk of eliciting false confessions; and
BE IT FURTHER RESOLVED that APA recommends that particularly vulnerable suspect populations, including youth, persons with developmental disabilities, and persons with mental illness, be provided special and professional protection during interrogations such as being accompanied and advised by an attorney or professional advocate.
Suggested Citation
American Psychological Association. (2014). Resolution on interrogations of criminal suspects. Retrieved from https://www.apa.org/about/policy/interrogations
References
Abramovitch, R., Higgins-Biss, K., & Biss, S. (1993). Young persons' comprehension of waivers in criminal proceedings. Canadian Journal of Criminology, 35, 309-322.
Abramovitch, R., Peterson-Badali, M., & Rohan, M. (1995). Young people's understanding and assertion of their rights to silence and legal counsel. Canadian Journal of Criminology, 37, 1-18.
American Bar Association (2004). Resolution 8A – Videotaping custodial interrogations. Approved February 9, 2004.
Appleby, S.C., Hasel, L.E., & Kassin, S.M. (2011). Police-induced confessions: An empirical analysis of their content and impact. Psychology, Crime and Law.
Boetig, B. P., Vinson, D. M., & Weidel, B. R. (2006). Revealing incommunicado. FBI Law Enforcement Bulletin, 75 (12), 1-8.
Cassell, P. G. (1996a). Miranda's social costs: An empirical reassessment. Northwestern University Law Review, 90, 387-499.
Cassell, P. G. (1996b). All benefits, no costs: The grand illusion of Miranda's defenders. Northwestern University Law Review, 90, 1084-1124.
Clare, I., & Gudjonsson, G. H. (1991). Recall and understanding of the caution and rights in police detention among persons of average intellectual ability and persons with a mild mental handicap. Issues in Criminological and Legal Psychology, 1, 34-42.
Clare, I., & Gudjonsson, G. H. (1995). The vulnerability of suspects with intellectual disabilities during police interviews: A review and experimental study of decision-making. Mental Handicap Research, 8, 110-128.
Colwell, L., Cruise, K., Guy, L., McCoy, W., Fernandez, K., & Ross, H. (2005). The influence of psychosocial maturity on male juvenile offenders' comprehension and understanding of the Miranda warning. Journal of the American Academy of Psychiatry and Law, 33, 444-454.
Cooper, V. G., & Zapf, P. A. (2008). Psychiatric patients' comprehension of Miranda rights. Law and Human Behavior, 32, 390-405.
Drizin, S. A., & Colgan, B. (2004). Tales from the juvenile confession front: A guide to how standard police interrogation tactics can produce coerced and false confessions from juvenile suspects. In G.D. Lassiter (Ed.), Interrogations, confessions, and entrapment (pp. 127-162). New York: Kluwer Academic/Plenum.
Drizin, S. A., & Leo, R.A. (2004). The problem of false confessions in the post-DNA world. North Carolina Law Review, 82 , 891-1007.
Everington, C., & Fulero, S. (1999). Competence to confess: Measuring understanding and Suggestibility of defendants with mental retardation. Mental Retardation, 37, 212-220.
Findley, K. A., & Scott, M. S. (2006). The multiple dimensions of tunnel vision in criminal cases. Wisconsin Law Review, 2006, 291-397.
Fulero, S., & Everington, C. (1995). Assessing competency to waive Miranda rights indefendants with mental retardation. Law and Human Behavior, 19, 533-545.
Garrett, B. (2010). The substance of false confessions. Stanford Law Review 62, 1051-1119.
Garrett, B. (2008). Judging Innocence. Columbia Law Review, 108, 55-142.
Geller, W.A. (1994). Videotaping interrogations and confessions. FBI Law Enforcement Bulletin, January 1994.
Goldstein, N., Condie, L., Kalbeitzer, R., Osman, D., & Geier, J. (2005). Juvenile offenders' Miranda rights comprehension and self-reported likelihood of false confessions. Assessment, 10, 359-369.
Grisso, T. (1980). Juveniles' capacities to waive Miranda rights: An empirical analysis. California Law Review, 68 , 1134-1166.
Grisso, T. (1981). Juveniles' waiver of rights: Legal and psychological competence. New York: Plenum.
Gudjonsson, G. H. (1992). The psychology of interrogations, confessions, and testimony. London: Wiley.
Gudjonsson, G. H. (2003). The psychology of interrogations and confessions: A handbook. Chichester, England: John Wiley & Sons.
Horselenberg, R., Merckelbach, H., & Josephs, S. (2003). Individual differences and false confessions: A conceptual replication of Kassin and Kiechel (1996). Psychology, Crime and Law, 9, 1-1 8. https://www.innocenceproject.org/.
Kassin, S. M. (1997). The psychology of confession evidence. American Psychologist, 52, 221-233.
Kassin, S. M. (2008). False confessions: Causes, consequences, and implications for reform. Current Directions in Psychological Science, 17, 249-253.
Kassin, S. M. (2006). A critical appraisal of modern police interrogations. In T. Williamson (Ed.), Investigative interviewing: Rights, research, regulation (pp. 207-228). Devon, UK: Willan Publishing.
Kassin, S. M., Drizin, S. A., Grisso, T., Gudjonsson, G. H., Leo, R. A., & Redlich, A. D. (2010). Police-induced confessions: Risk factors and recommendations. Law and Human Behavior, 34, 3-38.
Kassin, S. M., & Gudjonsson, G. H. (2004). The psychology of confession evidence: A review of the literature and issues. Psychological Science in the Public Interest, 5, 35-69.
Kassin, S. M., & Kiechel, K. L. (1996). The social psychology of false confessions: Compliance, internalization, and confabulation. Psychological Science, 7, 125-128.
Kassin, S. M., & McNall, K. (1991). Police interrogations and confessions: Communicating promises and threats by pragmatic implication. Law and Human Behavior, 15, 233-251.
Kassin, S. M., Meissner, C. A., & Norwick, R. J. (2005). "I'd know a false confession if I saw one": A comparative study of college students and police investigators. Law and Human Behavior, 29, 211-227.
Kassin, S. M., & Neumann, K. (1997). On the power of confession evidence: An experimental test of the "fundamental difference" hypothesis. Law and Human Behavior, 21, 469-484.
Kassin, S.M., & Sukel, H. (1997). Coerced confessions and the jury: An experimental test of the "harmless error" rule. Law and Human Behavior, 21, 27-46.
Kassin, S.M., & Wrightsman, L. S. (1980). Prior confessions and mock juror verdicts. Journal of Applied Social Psychology, 10, 133-146.
Klaver, J., Lee, Z., & Rose, V. G. (2008). Effects of personality, interrogation techniques and plausibility in an experimental false confession paradigm. Legal and Criminological Psychology, 13, 71-88.
Landström, S., Roos af Hjelmsäter, E., & Granhag, P. A. (2007). The camera perspective bias: A case study. Journal of Investigative Psychology and Offender Profiling, I, 199-208
Lassiter, G. D. (2002). Illusory causation in the courtroom. Current Directions in Psychological Science , 11, 204-208.
Lassiter, G. D. (Ed.) (2004). Interrogations, confessions, and entrapment. New York: Kluwer Academic.
Lassiter, G. D. (2010). Psychological science and sound public policy: Video recording of custodial interrogations. American Psychologist, 65, 768-779.
Lassiter, G. D., Diamond, S. S., Schmidt, H. C., & Elek, J. K. (2007). Evaluating videotaped confessions: Expertise provides no defense against the camera-perspective effect. Psychological Science, 18, 224-226.
Lassiter, G. D., & Geers, A. L. (2004). Bias and accuracy in the evaluation of confession evidence. In G. D. Lassiter (Ed.), Interrogations, Confessions and Entrapment (pp.197- 214). New York: Kluwer/Plenum.
Lassiter, G. D., Geers, A. L., Handley, I. M., Weiland, P. E., & Munhall, P. J., (2002). Videotaped confessions and interrogations: A change in camera perspective alters verdicts in simulated trials. Journal of Applied Psychology, 87, 867-874.
Lassiter, G. D., Geers, A. L., Munhall, P. J., Handley, I. M., & Beers, M. J. (2001). Videotaped confessions: Is guilt in the eye of the camera? In M. P. Zanna (Ed.), Advances in experimental social psychology, (Vol. 33, pp. 189–254). New York: Academic Press.
Lassiter, G. D., & Meissner, C. A. (Eds.). (2010). Police interrogations and false confessions: Current research, practice, and policy recommendations . Washington, DC: American Psychological Association.
Leo, R. A. (1996c). The impact of Miranda revisited. The Journal of Criminal Law and Criminology, 86, 621-692.
Leo, R. A. (2008). Police Interrogation and American Justice. Cambridge, MA: Harvard University Press.
Leo, R. A., & Ofshe, R. J. (1998). The consequences of false confessions: Deprivations of Liberty and miscarriages of justice in the age of psychological interrogation. Journal of Criminal Law and Criminology, 88, 429-496.
Levine, T. R., Kim, R. K., & Blair, J. P. (2010). (In)accuracy at detecting true and false confessions and denials: An initial test of a projected motive model of veracity judgments. Human Communication Research, 36, 81-101.
Nash, R.A., & Wade, K.A. (2009). Innocent but proven guilty: Using false video evidence to elicit false confessions and create false beliefs. Applied Cognitive Psychology, 23, 624-637.
Neuschatz, J. S., Lawson, D. S., Swanner, J. K., Meissner, C. A., & Neuschatz, J. S. (2008). The effects of accomplice witnesses and jailhouse informants on jury decision making. Law and Human Behavior, 32, 137-149.
O'Connell, M. J., Garmoe, W., & Goldstein, N. E. S. (2005). Miranda comprehension in adults with mental retardation and the effects of feedback style on suggestibility. Law and Human Behavior, 29, 359-369.
Ofshe, R. J., & Leo, R.A. (1997a). The social psychology of police interrogation: The theory and classification of true and false confessions. Studies in Law, Politics, and Society, 16, 189-251.
Ofshe, R. J., & Leo, R. A. (1997b). The decision to confess falsely: Rational choice and irrational action. Denver University Law Review, 74, 979-1122.
Perillo, J. T., & Kassin, S. M. (2011). Inside interrogation: The lie, the bluff, and false confessions. Law and Human Behavior, 35, 327-337.
Ratcliff, J.J., Lassiter, G. D., Jager, V. M., Lindberg, M. J., Elek, J. K., & Hasinski, A. E. (2010). The hidden consequences of racial salience in videotaped interrogations and confessions. Psychology, Public Policy, and Law, 16, 200-218.
Redlich, A. D. (2010). False confessions and false guilty pleas. In G. D. Lassiter & C. A. Meissner (Eds.), Police Interrogations and confessions: Current research, practice and policy recommendations (pp. 49-66). Washington, DC: American Psychological Association.
Redlich, A. D., Ghetti, S., & Quas, J. A. (2008). Perceptions of children during a police interview: A comparison of suspects and alleged victims. Journal of Applied Social Psychology, 38, 705-735.
Redlich, A. D., & Goodman, G. S. (2003). Taking responsibility for an act not committed: Influence of age and suggestibility. Law and Human Behavior, 27, 141-156.
Redlich, A. D., Quas, J. A., & Ghetti, S. (2008). Perceptions of children during a police interview: Guilt, confessions, and interview fairness. Psychology, Crime, and Law.
Redlich, A. D., Silverman, M., & Steiner, H. (2003). Pre-adjudicative and adjudicative competence in juveniles and young adults. Behavioral Sciences and the Law, 21, 393-410.
Rogers, R., Harrison, K., Hazelwood, L, & Sewell, K., (2007a). Knowing and intelligent: A study of Miranda warnings in mentally disordered defendants. Law and Human Behavior, 31, 401-418.
Russano, M. B., Meissner, C. A., Narchet, F. M., & Kassin, S. M. (2005). Investigating true and false confessions within a novel experimental paradigm. Psychological Science, 16, 481-486.
Scheck, B., Neufeld, P., & Dwyer, J. (2000). Actual innocence. Garden City, NY: Doubleday.
Singh, K., & Gudjonsson, G. (1992). Interrogative suggestibility among adolescent boys and its relationship to intelligence, memory, and cognitive set. Journal of Adolescence, 15, 155-161.
Slobogin, C. (2003). Ohio State Journal of Criminal Law, 1, 309-322.
Sullivan, T. P. (2004). Police experiences with recording custodial interrogations. Chicago: Northwestern University Law School, Center on Wrongful Convictions.
Swanner, J. K., Beike, D. R., & Cole, A. T. (in press). Snitching, lies and computer crashes: An experimental investigation of secondary confessions. Law and Human Behavior.
The Justice Project (2007). Electronic recording of custodial interrogations: A policy review. Washington, DC: The Justice Project.
Viljoen, J., & Roesch, R. (2005). Competence to waive interrogation rights and adjudicative competence in adolescent defendants: Cognitive development, attorney contact, and psychological symptoms. Law and Human Behavior, 29, 723-742.
Viljoen, J., Klaver, J., & Roesch, R. (2005). Legal decisions of preadolescent and adolescent defendants: Predictors of confessions, pleas, communication with attorneys, and appeals. Law and Human Behavior, 29, 253-277.
Wall, S., & Furlong, J. (1985). Comprehension of Miranda rights by urban adolescents with law related education. Psychological Reports, 56, 359-372.
White, W. S. (2001). Miranda's waning protections: Police interrogation practices after Dickerson. Ann Arbor: University of Michigan Press.
2015
APA resolution on gender and sexual orientation diversity in children and adolescents in schools
APA resolution on gender and sexual orientation diversity in children and adolescents in schools
Resolution on Violent Video Games
Video game use has become pervasive in the American child's life: More than 90% of U.S. children play some kind of video games; when considering only adolescents ages 12 - 17, that figure rises to 97% (Lenhart et.al, 2008; NPD Group, 2011;). Although high levels of video game use are often popularly associated with adolescence, children younger than age 8 who play video games spend a daily average of 69 minutes on handheld console games, 57 minutes on computer games, and 45 minutes on mobile games, including tablets (Rideout, 2013). Considering the vast number of children and youth who use video games and that more than 85% of video games on the market contain some form of violence, the public has understandably been concerned about the effects that using violent video games may have on individuals, especially children and adolescents.
News commentators often turn to violent video game use as a potential causal contributor to acts of mass homicide. The media point to perpetrators' gaming habits as either a reason that they have chosen to commit their crimes, or as a method of training. This practice extends at least as far back as the Columbine massacre (1999) and has more recently figured prominently in the investigation into and reporting of the Aurora, CO theatre shootings (2012), Sandy Hook massacre (2012), and Washington Navy Yard massacre (2013). This coverage has contributed to significant public discussion of the impacts of violent video game use. As a consequence of this popular perception, several efforts have been made to limit children's consumption of violent video games, to better educate parents about the effects of the content to which their children are being exposed, or both. Several jurisdictions have attempted to enact laws limiting the sale of violent video games to minors, and in 2011 the US Supreme Court considered the issue in Brown v. Entertainment Merchants Association, concluding that the First Amendment fully protects violent speech, even for minors.
In keeping with the American Psychological Association's (APA) mission to advance the development, communication, and application of psychological knowledge to benefit society, the Task Force on Violent Media was formed to review the APA Resolution on Violence in Video Games and Interactive Media adopted in 2005 and the related literature in order to ensure that the APA's resolution on the topic continues to be informed by the best science currently available and that it accurately represents the research findings directly related to the topic. This Resolution is based on the Task Force's review and is an update of the 2005 Resolution.
Scientists have investigated the effects of violent video game use for more than two decades. Multiple meta-analyses of the research have been conducted. Quantitative reviews since APA's 2005 Resolution that have focused on the effects of violent video game use have found a direct association between violent video game use and aggressive outcomes (Anderson et al. 2010, Ferguson 2007a, Ferguson 2007b, Ferguson & Kilburn 2009). Although the effect sizes reported are all similar (0.19, 0.15, 0.08, and 0.16, respectively), the interpretations of these effects have varied dramatically, contributing to the public debate about the effects of violent video games.
The link between violent video game exposure and aggressive behavior is one of the most studied and best established. Since the earlier meta-analyses, this link continues to be a reliable finding and shows good multi-method consistency across various representations of both violent video game exposure and aggressive behavior (e.g., Moller & Krahe, 2009; Saleem, Anderson, & Gentile, 2012). Aggressive behavior examined in this research included experimental proxy paradigms, such as the administration of a noise blast to a confederate, and self-report questionnaires, peer nominations and teacher ratings of aggressiveness focused on behaviors including insults, threats, hitting, pushing, hair pulling, biting and other forms of verbal and physical aggression. The findings have also been seen over a range of samples, including those with older children, adolescent, and young adult participants. There is also consistency over time, in that the new findings are similar in effect size to those from past meta-analyses.
Similarly, the research conducted since the 2005 APA Resolution using aggressive cognitions and aggressive affect as outcomes also shows a direct effect of violent video game use (e. g., Hasan, Begue, Scharkow & Bushman, 2013; Shafer, 2012). Researchers have also continued to find that violent video game use is associated with decreases in socially desirable behavior such as prosocial behavior, empathy, and moral engagement (e.g., Arriaga, Monteiro & Esteves, 2011; Happ, Melzer & Steffgen, 2013).
The violent video game literature uses a variety of terms and definitions in considering aggression and aggressive outcomes, sometimes using "violence" and "aggression" interchangeably, or using "aggression" to represent the full range of aggressive outcomes studied, including multiple types and severity levels of associated behavior, cognitions, emotions, and neural processes. This breadth of coverage but lack of precision in terminology has contributed to some debate about the effects of violent video game use. In part, the numerous ways that violence and aggression have been considered stem from the multidisciplinary nature of the field. Epidemiologists, criminologists, physicians and others approach the phenomena of aggression and violence from different perspectives than do psychologists, and emphasize different definitions of the phenomena accordingly. Some disciplines are interested only in violence, and not other dimensions of aggression. In psychological research, aggression is usually conceptualized as behavior that is intended to harm another (see Baron & Richardson, 1994; Coie & Dodge, 1998; Huesmann & Taylor, 2006; VandenBos, 2007). Violence can be defined as an extreme form of aggression (see Encyclopedia of Psychology, 2000) or the intentional use of physical force or power, that either results in or has a high likelihood of resulting in harm (Krug, Dahlberg, Mercy, Zwi, & Lozano,2002 ).
Thus, all violence, including lethal violence, is aggression, but not all aggression is violence. This distinction is important for understanding this research literature, which has not focused on lethal violence as an outcome. Insufficient research has examined whether violent video game use causes lethal violence. The distinction is also important for considering the implications of the research and for interpreting popular press accounts of the research and its applicability to societal events.
Resolution
Consistent with the American Psychological Association's mission to advance the development, communication and application of psychological knowledge to benefit society and improve people's lives, this Resolution on Violent Video Games finds:
WHEREAS scientific research has demonstrated an association between violent video game use and both increases in aggressive behavior, aggressive affect, aggressive cognitions and decreases in prosocial behavior, empathy, and moral engagement;
WHEREAS there is convergence of research findings across multiple methods and multiple samples with multiple types of measurements demonstrating the association between violent video game use and both increases in aggressive behavior, aggressive affect, aggressive cognitions and decreases in prosocial behavior, empathy, and moral engagement;
WHEREAS all existing quantitative reviews of the violent video game literature have found a direct association between violent video game use and aggressive outcomes;
WHEREAS this body of research, including laboratory experiments that examine effects over short time spans following experimental manipulations and observational longitudinal studies lasting more than 2 years, has demonstrated that these effects persist over at least some time spans;
WHEREAS research suggests that the relation between violent video game use and increased aggressive outcomes remains after considering other known risk factors associated with aggressive outcomes;
WHEREAS although the number of studies directly examining the association between the amount of violent video game use and amount of change in adverse outcomes is still limited, existing research suggests that higher amounts of exposure are associated with higher levels of aggression and other adverse outcomes;
WHEREAS research demonstrates these effects for children older than 10 years, adolescents, and young adults, but very little research has included children younger than 10 years;
WHEREAS research has not adequately examined whether the association between violent video game use and aggressive outcomes differs for males and females;
WHEREAS research has not adequately included samples representative of the current population demographics;
WHEREAS research has not sufficiently examined the potential moderator effects of ethnicity, socioeconomic status, or culture;
WHEREAS many factors are known to be risk factors for increased aggressive behavior, aggressive cognition and aggressive affect, and reduced prosocial behavior, empathy and moral engagement, and violent video game use is one such risk factor;
Therefore,
BE IT RESOLVED that the American Psychological Association (APA) engage in public education and awareness activities disseminating these findings to children, parents, teachers, judges and other professionals working with children in schools and communities;
BE IT FURTHER RESOLVED that APA support funding of basic and intervention research by the federal government and philanthropic organizations to address the following gaps in knowledge about the effects of violent video game use:
The association between violent video game use and negative outcomes for understudied ethnic and sociocultural populations who may be at increased risk for negative outcomes because of increased violent video game exposure or the presence of other risk factors for aggressive outcomes;The nature of the association between violent video game use and negative outcomes for males and females separately;The association between violent video game use and negative outcomes for school age and preschool age children;The relation between degree of exposure to violent video games and negative outcomes;The persistence of negative outcomes over time;The relation between game ratings and types, amounts, and degrees of violence present in violent video games;The relation between negative outcomes and game characteristics such as properties of the game, including type and degree of violence, how the game is played, and how the game is perceived by the player;The intersection of variables related to negative outcomes of violent video game use and the broader context of violence within the games, including choices about targets of violence, game themes, and the development and marketing of games;The impact of rapidly changing game technology and formats on users' experience and outcomes;The role of competition and cooperation in the association between violent video game use and negative outcomes; andThe role of media literacy in mediating negative effects associated with violent video game use;
BE IT FURTHER RESOLVED that APA endorses the development and implementation of rigorously tested interventions that educate children, youth and families about the effects of violent video game use; and
BE IT FURTHER RESOLVED that APA strongly encourages the Entertainment Software Rating Board to refine the ESRB rating system specifically to reflect the levels and characteristics of violence in games in addition to the current global ratings.
Suggested Citation
American Psychological Association. (2015). Resolution on Violent Video Games.
References
American Psychological Association, Task Force on Violent Media. (2015). Technical report onthe review of the violent video game literature. Washington, DC: Author.
Anderson, C.A., Shibuya, A., Ihori, N., Swing, E.L., Bushman, B. J., Sakamoto, A., Rothstein, H.R., & Saleem, M. (2010). Violent video game effects on aggression, empathy, and prosocial behavior in eastern and western countries: A meta-analytic review. Psychological Bulletin, 136(2), 151-173.
Arriaga, P., Monteiro, M. B., & Esteves, F. (2011). Effects of playing violent computer games on emotional desensitization and aggressive behavior. Journal of Applied Social Psychology, 41(8), 1900-1925.
Baron, R. A., & Richardson, D. R. (Eds.) (1994). Human Aggression: Perspectives in SocialPsychology . New York, NY: Springer.
Coie, J. D., & Dodge, K.A. (1988). Multiple sources of data on social behavior and social status in the school: A cross-age comparison. Child Development, 59(3), 815-829
Ferguson, C. J., & Kilburn, J. (2009). The public health risks of media violence: A meta-analytic review. The Journal of Pediatrics, 1-5. 10.1016/j.jpeds.2008.11.033.
Ferguson, C. J. (2007a). Evidence for publication bias in video game violence effects literature: A meta analytic review. Aggression and Violent Behavior, 12, 470-482.
Ferguson, C. J. (2007b). The good, the bad and the ugly: A meta-analytic review of positive and negative effects of violent video games. Psychiatric Quarterly, 78, 309-316. DOI 10.1007/s11126-007-9056-9.
Happ, C., Melzer, A., & Steffgen, G. (2013). Superman v. BAD man? The effects of empathy and game character in violent video games. Cyberpsychology, behavior, and social networking. 1-7.
Hasan, Y., Begue, L., Scharkow, M., & Bushman, B. J. (2013). The more you play, the more aggressive you become: A long-term experimental study of cumulative violent video game effects on hostile expectations and aggressive behavior. Journal of Experimental Social Psychology, 49, 224-227.
Huesmann, R. L., & Taylor, L. D. (2006). The role of media violence in violent behavior. AnnualReview of Public Health, 27, 393-415. DOI:10.1146/annurev.publhealth.26.021304.144640.
Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R. (2002). World report on violence and health. Geneva: World Health Organization.
Lenhart, A., Kahne, J., Middaugh, E., MacGill, A., Evans, C., & Vitak, J. (2008). Teens, videogames and civics. Washington, DC: Pew Internet & American Life Project. https://www.pewresearch.org/internet/2008/09/16/teens-video-games-and-civics/.
Moller, I., & Krahe, B. (2009). Exposure to violent video games and aggression in German adolescents: A longitudinal analysis. Aggressive Behavior, 35, 75–89.
NPD Group (2011). Kids and gaming, 2011. Port Washington, NY: The NPD Group, Inc.
Rideout, V. (2013). Zero to eight: Children's media use in America 2013. San Francisco, CA: Common Sense Media.
Saleem, M., Anderson, C. A., & Gentile, D. A. (2012). Effects of prosocial, neutral, and violent video games on children's helpful and hurtful behaviors. Aggressive Behavior, 38(4), 281-287.
Shafer, D. (2012). Causes of State Hostility and Enjoyment in Player Versus Player and Player
Versus Environment Video Games. Journal of Communication, 62(4), 719-737.
VandenBos, G.R. (Ed.) (2007). APA Dictionary of Psychology. Washington, DC: American Psychological Association.
2017
Resolution on Palliative Care and End-of-life Issues and Justification
Resolution on Palliative Care and End-of-life Issues
Adopted by APA Council of Representatives in August 2017. (Suggested citation is included with references.)
Whereas the issues and terminology of end-of-life have evolved since the American Psychological Association (APA)'s 2001 Resolution on End-of-life Issues and Care; and
Whereas palliative care is a team-based approach to care focused on: improving the quality of life for individuals facing serious or life-limiting illness and their care partners (e.g., families of origin or families of choice); preventing and relieving suffering by means of early identification; thorough, culturallysensitive assessment and treatment of pain and physical, psychosocial, and spiritual problems; and by providing bereavement care (Kelley & Morrison, 2015; National Consensus Project for Quality Palliative Care, 2013); and
Whereas palliative care is appropriate at any age and at any stage of a serious illness, can be provided at the same time as disease-directed or curative treatment, and is not dependent on prognosis (World Health Organization [WHO], 2016); and
Whereas end-of-life or hospice care, which is often tied in the United States to the Hospice Medicare Benefit, focuses on palliative care for terminally ill individuals who may have only limited time to live and have elected no longer to pursue curative treatment for their underlying disease (Kelley & Morrison, 2015); and
Whereas most hospice programs are limited in their present structure and reimbursement mechanisms to meet the needs of children with serious and life-limiting illness and their families (National Hospice and Palliative Care Organization, 2001); and
Whereas many more individuals with terminal diagnoses across the lifespan are living longer than before and thus have more opportunity to make end-of-life decisions (Morrissey, Herr, & Levine, 2015; Murtagh et al., 2014); and
Whereas death has become more frequently the result of advanced serious illness that must be managed for weeks and often years, with multiple health, functional, and emotional changes occurring throughout the disease process (Institute of Medicine [IOM], 2014); and
Whereas individuals with advanced serious illness will grapple with multiple conditions that may interact in complex ways and will face a system of care that is often fragmented, uncoordinated and confusing (Byock, 2012; Coalition to Transform Advanced Care [C-TAC], 2015; IOM, 2014); and
Whereas the nature of death and dying has changed across the twentieth century, occurring primarily in an institutional setting rather than at home (Centers for Disease Control and Prevention [CDC], 2005); and
Whereas systemic barriers continue to exist to integrating evidence-based treatment programs and practices into standards of care system-wide (Allison & Sudore, 2013; Lynch, 2013; Weaver et al., 2015); and
Whereas medical technology has advanced to the point where patients in hospitals infrequently die without a decision to withhold or withdraw life-supporting therapy (Gedge, Giacomini, & Cook, 2007; Lantos, 2011) with those decisions being psychologically complex for all parties involved, especially in the absence of advance directives; and
Whereas end-of-life decision making is complex, involving areas of ethics, religion, medicine, psychology, sociology, economics, the law, public policy, and other fields (Baergen, 2001; National Consensus Project for Quality Palliative Care, 2013; Wells-DiGregorio, 2008); and
Whereas some evidence suggests that there are fluctuations in the will to live (Chochinov, Tataryn, Clinch, & Dudgeon, 1999) and in wishes regarding life-sustaining treatments (Fried et al., 2006); and
Whereas autonomy is an important principle in the law and in medical and ethical aspects of decision making, but in and of itself is insufficient to capture the full range of complex psychosocial, medical, familial, financial, cultural, spiritual, and legal issues involved in palliative care and end-of-life decision making (Byock, 2009; Winzelberg, Hanson, & Tulsky, 2005); and
Whereas in the United States, end-of-life decisions are made in the context of significant social stratification related, but not limited to, age, culture, disability status, ethnicity, gender identity, geographic location, health status, immigration status, marital status, race/ethnicity, religion, sex, sexual orientation, socioeconomic status, and veteran status, leading to inequalities in access to resources such as basic health care and resources for in-home supported living (Canetto, 2011; Payne, 2016; Lee et al., 2017; Robinson, et al., 2009; Sue, 2001); and
Whereas severe health disparities in timely and adequate access to care profoundly influence the nature and availability of end-of-life care for underserved individuals and communities and, consequently, affect the concerns of individuals and their care partners making end-of-life care decisions (Johnson, 2013; Koffman et al., 2007; Lynch, 2013; Robinson et al., 2009; Williams et al., 2012); and
Whereas the 20 percent of the U.S. population living long-term with disability or chronic illness (e.g., HIV/AIDS) (Shorthill & Demarco, 2017) commonly experiences social stigma that can be further compounded by the stigma of approaching death, and end-of-life care offered to individuals with disabilities (e.g., often involving nursing home placement) may inadvertently compound their vulnerability by disrupting their carefully cultivated self-management and support systems (Stienstra, D'Aubin, & Derksen, 2012, thereby increasing social disconnection, lack of agency, and risk of abuse and coercion by caregivers (who may also have decisional authority); and
Whereas 42 percent of people with disabilities experience sexual abuse and 87 percent experience verbal abuse and inhumane practices in caregiving situations (Baladerian, Coleman, & Stream, 2013); and
Whereas over the next two decades, the number of individuals age 65 and older (the age group that encompasses the majority of people with advanced illness) will nearly double to more than 72 million, with racial and ethnic minority older adult populations projected to increase to 21.1 million in 2030 (Administration on Aging [AOA], 2015), thus significantly increasing the need for culturally competent palliative and hospice care; and
Whereas vulnerable populations of adults with diminished capacity for autonomous decision making and living with advanced serious illness may lack the ability to communicate medical decisions and may experience daily fluctuations in awareness or lucidity (American Bar Association [ABA] & APA, 2008; Stormoen, Almkvist, Eriksdotter, Sundstrom, & Tallberg, 2014; Trachsel, Hermann, & Biller-Adorno, 2015); and
Whereas there are 400,000 children in the United States with life limiting illness, with cancer as the leading cause of disease-related death for adolescents and young adults (Friebert, 2009; State Initiatives in End-of-life Care, 2002); and
Whereas survival with these illnesses has improved far less for 15 to 24-year-olds than it has for older individuals (Bleyer, O'Leary, Barr, & Ries, 2006; Institute of Medicine [IOM], 2013; Robison, 2011), and about one fourth of children with cancer will die prematurely (Murphy, Xu, & Kochanek, 2013; Vinchon, Baroncini, Leblond, & Delestret, 2011); and
Whereas individuals with serious or life-limiting illness often rely on family members (of origin or of choice) for care, and this care can be rewarding and also challenging and result in significant psychological and physical morbidity and strain, including economic strain, to the care partner (Morgan, Williams, Trussardi, & Gott, 2016; Roth et al., 2013; Rumpold et al., 2016; Vanderwerker, Laff, KadanLottick, McColl, & Prigerson, 2005; Wadhwa et al., 2013); and
Whereas care partners of individuals with serious or life-limiting illness often are at risk for complications associated with anticipatory grief and bereavement and many risk factors for grief and bereavement can be addressed through quality palliative and end-of-life care (Garrido & Prigerson, 2014; Hudson et al., 2014); and
Whereas for immigrant and first generation U.S. families, caregiving and end-of-life decisions may cross borders due to transnational circles of care, and health providers should be mindful of the implications of U.S. policies on caregivers and family decision makers who are either abroad or who hold different cultural views on palliative care and end-of-life decisions (Baldassar, 2011; Baldassar, 2017; Baldassar & Merla, 2013; Kilkey & Merla, 2014); and
Whereas diversity in human values, status, power, and resources leads to an equally diverse range of views and needs and power regarding palliative care and end-of-life care and decisions (Boucher, 2016); and
Whereas reasonable, well-informed people start from different values and priorities concerning what is valuable at the end-of-life, and can and do hold different positions regarding end-of-life care and goals of care (Crawley, 2005); and
Whereas there is significant public support for individual control over end-of-life decisions but support for hastening death is weakest among groups who express concerns about being pressured to die (e.g., older adults, people with disabilities, people with less education, people with fewer financial resources, women, racial and ethnic minorities) (Crawley, Marshall, Lo, & Koenig, 2002; Krakauer, Crenner, & Fox, 2002; Lyon et al., 2008; Phillips et al., 2000); and
Whereas the absence or avoidance of advance care planning results in substituted decisions for or against aggressive care near death that may be incongruent with individual values, and associated with greater symptom and financial burdens, reduced quality of life, and greater risk of psychiatric complications for care partners (Alexi et al., 2008; Detering, Reade, & Silvester, 2010; Sucore & Fried, 2010; Temel, Greer, Muzikansky, Gallagher, & Admane, 2010); and
Whereas individuals living with advanced serious illness and nearing death experience a range of symptoms that often are unrecognized and/or undertreated, including but not limited to pain, depression, anxiety, worry, existential distress, dyspnea/breathlessness, fatigue, and anorexia (Azuero, Allen, Kvale, Azuero, & Parmelee, 2014; Fisher et al., 2002; Hughes et al., 2016; Kamal, Nipp, Bull, Stinson, & Abernethy, 2015; Kissane, 2012; Moens, Higginson, & Harding, 2014; Yennurajalingam et al., 2013); and
Whereas these symptoms can lead to suffering that may result in requests for, or assent to, medical interventions that affect the timing of death (Ruijs, Kerkhof, van der Wal, & Onwuteaka-Philipsen, 2013); and
Whereas psychologists have begun the important work of developing, evaluating, and disseminating evidence-based psychological interventions for people with advanced serious illness and their care partners, yet to date these interventions are limited in scope and underutilized (Allen et al., 2014; Hudson et al., 2012; Kasl-Godley, King, & Quill, 2014; Kuhne et al., 2012; Northhouse, Katapodi, Song, Zhang, & Mood, 2010; Wallio & Twillman, 2010); and
Whereas behavioral and psychological issues intersect and interact with the biological, social, and spiritual issues faced by people with serious illness, and psychologists' skills can enhance and optimize communication and interventions delivered by professionals from other disciplines (Feldman, Sorocco, & Bratkovich, 2014; Sullivan, Mongoue-Tchokote, Mori, Goy, & Ganzini, 2016); and
Whereas there is increasing consumer demand for psychological services (Bureau of Labor Statistics, 2016-17) and need for addressing end-of-life stressors and decision making with psychologists' support (Murtagh et al, 2014; Nydegger, 2008); and
Whereas psychologists have many areas of competence including, but not limited to, assessment, intervention, teaching, consultation, research, and advocacy skills that could contribute to the science of palliative care and end-of-life issues and to the treatment and support of people with advanced serious or life-limiting illness, their significant others, and other health care providers (Carpenter, 2015; Connor, Lycan, & Schumacher, 2006; Gamino & Ritter, 2012; Golijani-Moghaddam, 2014; Johnson, Cramer, Conroy, & Gardner, 2014); and
Whereas psychologists possess these intervention, research, and teaching competencies and yet are underutilized due to reasons including, but not limited to, formal or informal exclusion from care systems and programs, lack of opportunities for reimbursement, perceptions that psychological services are not warranted, and lack of understanding by other providers regarding the specific skillset and competencies that psychologists provide near the end-of-life (Azuero et al., 2014; Haley, Larson, KaslGodley, Neimeyer, & Kwilosz, 2003; Patterson, Croom, Teverovsky, & Arnold, 2014); and
Whereas psychology has been integrated into interdisciplinary, palliative care teams in the Veterans Health Administration (VHA, 2016), but psychologists in clinical practice outside of the VHA have not typically been involved in palliative care and end-of-life decisions to the degree that they could be (Garrido, Penrod, & Prigerson 2014; Haley et al., 2003); and
Whereas current Medicare policy authorizes reimbursement for advance care planning conversations only for physicians, nurse practitioners, or their supervisees (Jones, Acevedo, Bull, & Kamal, 2016), yet psychologists trained in palliative and end-of-life care possess knowledge and skills to help people obtain the health information they need, effectively communicate questions to their providers, weigh the risks and benefits of different choices, reflect on their preferences and values, and communicate their wishes when contemplating end-of-life situations; and
Whereas there have been few systematic efforts to educate psychologists about end-of-life issues in comparison with the magnitude of the issue and opportunity (APA, 2000; Kasl-Godley, King, & Quill, 2014); and
Whereas core competencies in palliative and end-of-life care are now widely articulated and psychological issues are a core practice domain, yet psychologists remain largely absent from professional work groups involved in developing these competencies (Ryan et al., 2014); and
Whereas psychological research on palliative care and end-of-life issues is expanding but remains limited in comparison with the magnitude of the issue (Keall, Clayton, & Burtow, 2015; Naik, Martin, Moye, & Karel, 2016; Singer et al., 2016; Xiao, Kwong, Pang, & Mok, 2012); and
Whereas The National Institute of Nursing Research (NINR, 2013), the Coalition to Transform Advanced Care (C-TAC, 2015), and the Institute of Medicine (IOM, 2014) have identified gaps in compassionate science, including: (a) integrating behavioral and psychosocial sciences into palliative care; (b) developing a scientific basis for clinical practice for people with advanced serious illness of all ages, that is person- and family-centered; (c) relieving symptoms and suffering; (d) enhancing communication among persons with advanced serious illness, their care partners and clinicians; and (e) understanding decision making about care among persons with advanced serious illness; and
Whereas psychologists could assume a significant role in helping other health care providers understand and cope with the concerns and needs of individuals with serious or life-limiting illness and their care partners (Allen, Haley, Roff, Schmid, & Bergman, 2006; Gustin, Way, Wells-Di Gregorio, & McCallister, 2016); and
Whereas psychologists could be instrumental in supporting interprofessional public education efforts to increase health literacy and raise awareness of issues related to palliative and end-of-life care including advance care planning, symptom management, dying, death, grief, mourning, and loss (Higginson et al., 2014; Long, 2011); and
Whereas psychologists could assume a significant role in the development and implementation of standardized tools for measuring outcomes of palliative and end-of-life care (Kearns, Cornally, & Molloy, 2017); and
Whereas the practice of palliative and end-of-life care is, at its best, interprofessional to address the complex care needs of individuals and their care partners, and that collaborative practice operates from a biopsychosocial perspective to provide more patient-centered, comprehensive, ongoing assessment, treatment planning, and interventions in the most efficient and effective manner (APA, 2008; Kelly & Morrison, 2015; National Consensus Project for Quality Palliative Care, 2013); and
Whereas team-based health care results in higher quality care and interprofessional practice competencies are recognized as integral to palliative and end-of-life care, yet few professions, including psychology, have opportunities across all levels of professional education and development to train together, leaving them unprepared for the practice environments in which they will work (Interprofessional Education Collaborative Expert Panel, 2011; Ryan et al., 2014); and
Whereas a number of national and international organizations have issued their own policy statements and documents and have collaborated on developing guidance documents regarding end-of-life issues, often without the involvement of APA representatives or other psychologists, including The Clinical Practice Guidelines for Quality Palliative Care (The National Consensus Project for Quality Palliative Care, 2013), Dying in America: Improving Quality and Honoring Individual Preferences Near the End-of-life (IOM, 2014), and the White Paper on Standards and Norms for Hospice and Palliative Care in Europe (European Association for Palliative Care, 2009).
Therefore , be it resolved that the American Psychological Association, an organization committed to promoting the psychological well-being of individuals across the life span, actively
Promotes and supports psychology's involvement in palliative care and end-of-life issues in the United States of America and as invited on international platforms.
In order to advance this involvement, be it further resolved that the American Psychological Association:
Promotes and encourages research and education in the areas of palliative care and end-of-life issues within psychology training at all levels.
Encourages psychological research and the use of clinical skills to assess and address the psychological factors that have an impact on end-of-life decision making and will to live, including, but not limited to, untreated or undertreated distressing physical symptoms, depression, anxiety, loss of perceived dignity, existential distress, cognitive capacity, and increased social marginalization experienced by individuals already living with marginalized health conditions (including HIV/AIDS, substance abuse, mental health disorders) or disabilities.
Promotes psychologists' collaboration with other disciplines and organizations in the formulation and implementation of a behavioral and psychological research agenda on palliative care and end-of-life issues.
Advocates for funding for behavioral and psychological research on palliative care and end-of-life issues, collaborating when possible with other palliative and hospice-focused professional organizations.
Encourages psychology to bring its perspective in organizational systems to close research gaps and to implement best practices system-wide for persons across the lifespan with serious or life-limiting illness.
Promotes psychologists' acquisition of knowledge and skill competencies with respect to palliative care and end-of-life issues, including, but not limited to, developmentally-sensitive assessment and treatment of bio-psycho-social-spiritual aspects of advanced illness; dying, death, and bereavement care; communication and advance care planning; interprofessional practice; legal and ethical issues; and, sensitivity to all diversity and developmental dimensions that affect end-of-life experiences.
Promotes psychologists' acquisition of competence in interprofessional collaboration that is the foundation of palliative and end-of-life care.
Encourages psychologists working with minors living with advanced serious or life-limiting illness to obtain training at all levels in the area of ethics as applied to decision making by and care of minors who may have no legal rights, but are supported by public policy to be involved in decision making about their health care, consistent with the principles of justice and respect for peoples' rights and dignity.
Encourages psychologists working with vulnerable populations of adults with diminished capacity for autonomous decision making and living with advanced serious illness to obtain training at all levels in the area of ethics as applied to decision making by individuals with diminished capacity, consistent with the principles of justice and respect for peoples' rights and dignity.
Encourages all psychologists to obtain training at all levels in the area of ethics (including APA ethical standards), social justice, and legal issues as they apply to palliative care and end-of-life issues. In addition, psychologists working with vulnerable persons living with serious or life-limiting illness are encouraged to obtain training in ethics as they apply to their research and practice when working with individuals of all developmental stages and cultures with serious or life-limiting illness.
Encourages psychologists to be aware of their own attitudes about palliative care and end-of-life issues that may influence their clinical practice, research, education/training, and advocacy, and to recognize possible biases about quality of life or entitlement to resources based on group identities and their related social statuses, including, but not limited to, age, culture, criminal justice involvement, disability status, gender identity, geographic location, health status (including stigmatized conditions such as HIV, substance use, mental health disorders), immigration status, marital status, race/ethnicity, religion, sex, sexual orientation, socioeconomic status, and veteran status.
Encourages psychologists to obtain an understanding of how power, social status, and facets of identity, including, but not limited to, age, culture, criminal justice involvement, disability status, gender identity, geographic location, health status, immigration status, marital status, mental health status, race/ethnicity, religion, sex, sexual orientation, socioeconomic status, and veteran status contribute to disparities in palliative and end-of-life care. Specifically, psychologists are encouraged to apply this understanding to: (a) promote the elimination of inequities related to access to care, retention, and outcomes; (b) increase awareness of provider and patient biases; (c) improve communication about goals of care and related decisions; (d) expand recognition that social disenfranchisement of marginalized individuals may intensify at end-of-life in ways that influence decision making; and (e) understand the treatment preferences and values of individuals to assist with advance care planning and decision making.
Encourages psychologists to familiarize themselves with the roles and competencies of, and clinical care provided by, medical, social work, nursing, and chaplaincy and other professional colleagues related to end-of-life issues, decision making, and care.
Encourages psychologists' efforts to increase the understanding of other health care professionals with regard to behavioral, psychological, and diversity aspects of palliative care and end-of-life issues.
Promotes high-quality and effective palliative and end-of-life care that includes support for individuals across the lifespan with advanced serious illness and their care partners all along the illness trajectory; culturally sensitive assessment and treatment; thorough symptom management; promotion of mental health and psychological wellbeing; optimal expression of cognitive capabilities; facilitation of effective communication and assistance with advance care conversations and decision making that is shared and informed by individual/family needs, values, and preferences; bereavement care; and promotion of quality of life in all these activities.
Advocates for access to, and insurance coverage for, mental health services for seriously ill individuals and their care partners, across all settings of care and geographic locations, and for family members during bereavement.
Promotes and endorses public policies that provide for behavioral and psychosocial services for seriously ill individuals across the lifespan, and their care partners.
Advocates for expansion of Medicare coverage to include psychologists among those providers who may conduct advance care planning conversations and provide hospice consultations.
Advocates and endorses legislation to make public and private health, and mental health systems more flexible for meeting the health and mental health needs of children and adolescents with serious and life-limiting illness.
Advocates for public and private financial support of psychology and interprofessional training in palliative care and end-of-life issues at the pre-doctoral, internship, postdoctoral, and post-licensure level.
Advocates for psychologists' participation in national, state, and local interdisciplinary efforts to inform the development of policy and standards for palliative care and end-of-life issues including, but not limited to, involvement in research funding advisory groups, practice and treatment guideline and quality assurance outcomes development efforts, ethics committees, clinical care committees, and administrative work groups.
Supports interprofessional efforts to increase the competency of psychologists and other health care professionals in identifying and addressing the behavioral, psychological, and social aspects of serious or life-limiting illness.
Endorses the following principles on care for individuals with advanced serious illness as articulated in the Institute of Medicine Report entitled Dying in America: Improving Quality and Honoring Individual Preferences Near the End-of-life (IOM, 2014):
- Care for individuals with advanced serious illness should be comprehensive, of high quality, accessible, and available through governmental and private health insurers and care delivery programs. Comprehensive care is integrated, interdisciplinary, patient-centered and family oriented, coordinated across all providers and settings;
- Individuals should have the opportunity to engage in conversations about their health care, the results of which should be incorporated into ongoing care plans. Clinician-patient communication and advance care planning should be guided by quality standards that reflect evolving population and health system needs, are measurable, actionable and evidence-based, are adopted by both payer and health care delivery organizations, and linked to reimbursement. Professional societies should adopt policies that facilitate tying standards to reimbursement, licensing and credentialing;
- Educational institutions, credentialing bodies, accrediting boards, state regulatory agencies and health care delivery organizations should establish appropriate training, certification, and/or licensure requirements to strengthen basic palliative care knowledge and skills of all clinicians caring for individuals with advanced serious illness. This knowledge and these skills should include communication skills, interprofessional collaboration and symptom management;
- Federal, state, and private insurance and health care delivery programs should integrate and finance coordinated medical and social services necessary to support the provision of quality care consistent with the values and goals of individuals with advanced illness. Payment and health care delivery systems should collect and report quality measures, outcomes and costs regarding care for individuals with advanced illness and near the end-of-life;
- Public outreach, engagement, and education about care of individuals with advanced serious illness is needed to dispel myths and facilitate advance care planning and informed health care decision making. Renews its strong commitment and become a transformative force in the field of mental health and palliative care and end-of-life issues.
Suggested Citation
American Psychological Association. 2017. Resolution on Palliative Care and End-of-Life Issues. Retrieved from: https://www.apa.org/about/policy/palliative-care-eol.
References
Administration on Aging. (2015). Profile of older Americans: Minority aging. Retrieved from https://www.aoa.acl.gov/Aging_Statistics/minority_aging/index.aspx
Allen, R. S., Haley, W. E., Roff, L., Schmid, B., & Bergman, E. J. (2006). Responding to the needs of caregivers near the end of life: Enhancing benefits and minimizing burdens. In J. L. Werth, Jr., & D. Blevins (Eds.) Psychosocial Issues Near the End of Life: A Resource for Professional Care Providers (pp. 183-201). Washington, DC: American Psychological Association.
Allen, R. S., Harris, G. M., Burgio, L. D., Azuero, C. B., Miller, L. A., Shin, H., Eichorst, M. K., Csikai, E. L., DeCoster, J., Dunn, L. L., Kvale, E. A., & Parmelee, P. (2014). Can senior volunteers deliver reminiscence and creative activity interventions? Results of the legacy intervention family enactment randomized controlled trial. Journal of Pain and Symptom Management , 48(4), 590- 601. doi: 10.1016/j.jpainsymman.2013.11.012
Allison, T. A., & Sudore, R. L. (2013). Disregard of patients' preferences is a medical error: comment on “Failure to engage hospitalized elderly patients and their families in advance care planning.” JAMA Internal Medicine, 173(9), 787. doi: 10.1001/jamainternmed.2013.203
American Bar Association & American Psychological Association. (2008). Assessment of Older Adults with Diminished Capacity: A Handbook for Psychologists. Retrieved from https://www.apa.org/pi/aging/programs/assessment/capacity-psychologist-handbook.pdf
American Psychological Association. (2000). Report from the APA working group on assisted suicide and end-of-life decisions. Retrieved from https://www.apa.org/pi/aging/programs/eol/index
American Psychological Association, Presidential Task Force on Integrated Health Care for an Aging Population. (2008). Blueprint for change: Achieving integrated health care for an aging population. Retrieved from https://www.apa.org/pi/aging/programs/integrated/integratedhealthcare-report.pdf
Azuero, C., Allen, R. S., Kvale, E., Azuero, A., & Parmelee, P. (2014). Determinants of psychology service utilization in a palliative care outpatient population. Psychoncology, 23(6), 650-657. doi: 10.1002/pon.3454
Baergen, R. (2001). Ethics at the end of life. Belmont, CA: Wadsworth Publishing Co.
Baladerian, N. J., Coleman, T. F., & Stream, J. (2013). Abuse of people with disabilities: Victims and their families speak out. Los Angeles, CA: Spectrum Institute. Retrieved from https://disability-abuse.com/survey/survey-report.pdf
Baldassar, L. (2011) Italian Migrants to Australia and their relationship to Italy: Return visits, transnational caregiving and the Second Generation. Journal of Mediterranean Studies, 20(2), 255-282.
Baldassar, L. (2017). Who cares? The unintended consequences of policy for migrant families. In D. Tittensor & F. Mansouri (Eds.), The Politics of Women and Migration in the Global South (pp. 105-123). doi: 10.1057/978-1-137-58799-2_7
Baldassar, L. & Merla, L. (Eds.). (2013). Transnational families, migration and the circulation of care: understanding mobility and absence in family life (Vol. 29). New York, NY: Routledge.
Bleyer, A., O'Leary, M., Barr, R., & Ries, L. A. G. (Eds.). (2006). Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, including SEER incidence and survival: 1975-2000. Bethesda, MD.: National Cancer Institute.
Boucher, N. A. (2016). Direct engagement with communities and interprofessional learning to factor culture into end-of-life health care delivery. American Journal of Public Health, 106(6). 996- 1001. doi: 10.2105/AJPH.2016.303073
Bureau of Labor Statistics. (2016-2017). Occupational outlook handbook, 2016-17 edition, psychologists. Retrieved from https://www.bls.gov/ooh/life-physical-and-social-science/psychologists.htmopens in new window
Byock, I. (2009). Personal health and human development in life-threatening conditions. In: H. M. Chochinov & W. Breitbart (Eds.), Handbook of psychiatry in palliative medicine (2nd ed., pp. 281- 299). New York, NY: Oxford University Press.
Canetto, S. S. (2011). Legal physician-assisted suicide in the U.S.: Issues, roles and implications for clinicians. In S. H. Qualls & J. Kasl-Godley (Eds.), End of life care and bereavement (pp. 263-284). New York: Wiley.
Carpenter, B. D. (2015). Geropsychological practice with people near the end of life. In P. A. Lichtenberg & B. T. Mast (Eds.). APA handbook of clinical geropsychology. Volume 2: Assessment, treatment, and issues of later life (pp. 579-599). Washington, DC: American Psychological Association.
Centers for Disease Prevention and Control. (2005). National vital statistics system, mortality. Worktable 309. Deaths by place of death, age, race, and sex: United States. Retrieved from https://www.cdc.gov/nchs/nvss/mortality/gmwk309.htmopens in new window
Chochinov, H. M., Tataryn, D., Clinch, J. J., & Dudgeon, D. (1999). Will to live in the terminally ill. Lancet, 354(9181), 816-819. doi: 10.1016/S0140-6736(99)80011-7.
Coalition to Transform Advanced Care (C-TAC). (2015) Mission Statement. Retrieved from https://www.thectac.orgopens in new window/.
Connor, S. R., Lycan, J., & Schumacher, J. D. (2006). Involvement of psychologists in psychosocial aspects of hospice and end-of-life care. In J. L. Werth, Jr., & D. Blevins (Eds.). Psychosocial issues near the end of life: A resource for professional care providers. 203-217. Washington, DC: American Psychological Association.
Crawley, L. M. (2005). Racial, cultural and ethnic factors influencing end-of-life care. Journal of Palliative Medicine , 8 (suppl 1). doi: 10.1089/jpm.2005.8.s-58
Crawley, L. M., Marshall, P. A., Lo, B., & Koenig, B. A. (2002). Strategies for culturally effective end-of-life care. Annals of Internal Medicine, 136, 673-679. doi: 10.7326/0003-4819-136-9-200205070- 00010
Detering, K. M., Hancock, A. D., Read, M. C., & Silvester, W. (2010). The impact of advance care planning on end of life care in elderly patients: Randomised controlled trial. BMJ, 340:c1345. doi:10.1136/bmj.c1345.
European Association for Palliative Care. (2009). White Paper on standards and norms for hospice and palliative care in Europe: Recommendations from the European association for palliative care. European Journal of Palliative Care, 16(6), 278-301.
Feldman, D. B., Sorocco, K. H., & Bratkovich, K. L. (2014). Treatment of posttraumatic stress disorder at the end-of-life: Application of the stepwise psychosocial palliative care model. Palliative Support Care, 12(3):233-43. doi: 10.1017/S1478951513000370
Fisher, S. E., Burgio, L. D., Thorn, B. E., Allen-Burge, R., Gerstle, J., Roth, D. L., & Allen, S. J. (2002). Pain assessment and management in cognitively impaired nursing home residents: Association of certified nursing assistant pain report, minimum data set pain report, and analgesic medication use. Journal of the American Geriatrics Society, 50(1), 152-156. doi: 10.1046/j.1532- 5415.2002.50021.x
Friebert, S. (2009). National hospice and palliative care organization. Facts and figures: Pediatric palliative and hospice care in America. Retrieved from https://allianceforcareathome.org/opens in new window
Fried, T. R., Byers, A. L., Gallo, W. T., Van Ness, P. H., Towle, V. R., O'Leary, J. R., & Dubin, J. A. (2006). Prospective study of health status preferences and changes in preferences over time in older adults. Archives of Internal Medicine, 166(8), 890-895. doi: 10.1001/archinte.166.8.890
Gamino, L. A., & Ritter, R. H., Jr. (2012). Death competence: an ethical imperative. Death Studies, 36(1), 23-40. doi: 10.1080/07481187.2011.553503
Garrido, M. M., Penrod, J. D., & Prigerson, H. G. (2014). Unmet need for mental health care among veterans receiving palliative care: Assessment is not enough. American Journal of Geriatric Psychiatry, 22(6), 540-544. doi: 10.1016/j.jagp.2013.08.008.
Garrido, M. M., & Prigerson, H. G. (2014). The end-of-life experience: Modifiable predictors of caregivers' bereavement adjustment. Cancer, 120(6), 918-925. doi: 10.1002/cncr.28495
Gedge, E., Giacomini, M., & Cook, D. (2007). Withholding and withdrawing life support in critical care settings: Ethical issues concerning consent. Journal of Medical Ethics, 33(4), 215–218. doi.org/10.1136/jme.2006.017038
Golijani-Moghaddam, N. (2014). Practitioner psychologists in palliative care: Past, present, and future directions. Counselling Psychology Review, 29(1), 29-40.
Gustin, J. L., Way, D. P., Wells-Di Gregorio, S., & McCallister, J. W. (2016). Validation of the family meeting behavioral skills checklist. An instrument to assess fellows' communication skills. Annals of the. American Thoracic Society, 13(8), 1388-93. doi: 10.1513/AnnalsATS.201601-021OC
Haley, W. E., Larson, D. G., Kasl-Godley, J., Neimeyer, R. A., & Kwilosz, D. M. (2003). Roles for psychologists in end-of-life care: Emerging models of practice. Professional Psychology: Research and Practice, 34(6), 626-633. doi:10.1037/0735-7028.34.6.626
Higginson, I. J., Gomes, B., Calanzani, N., Gao, W., Bausewein, C., Daveson, B. A., … Harding, R. (2014). Priorities for treatment, care and information if faced with serious illness: A comparative population-based survey in seven European countries. Palliative Medicine , 28(2), 101-110. doi: 10.1177/0269216313488989
Hudson, P., Remedios, C., Zordan, K., Clifton, D., Crewdson, M., Hall, C., Trauer, T., Bolleter, A., Clarke, D., & Bauld, C. (2012). Guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients. Journal of Palliative Medicine , 15(6), 696-702. doi: 10.1089/jpm.2011.0466
Hudson, P., Trauer, T., Kelly, B., O'Conner, M., Thomas, K., Zordan, R., & Summers, M. (2014). Reducing the psychological distress of family caregivers of home based palliative care patients: longer term effects from a randomised controlled trial. Psychooncology , 24(1), 19-24. doi: 10.1002/pon.3610
Hughes, R. E., Holland, L. R., Zanino, D., Link, E., Michael, N., & Thompson, K. E. (2016). Prevalence and intensity of pain and other physical and psychological symptoms in adolescents and young adults diagnosed with cancer on referral to a palliative care service. Journal of Adolescent and Young Adult Oncology, 4(2), 70-75. doi:10.1089/jayao.2014.0015
Institute of Medicine. (2014). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
Institute of Medicine. (2013). Identifying and addressing the needs of adolescents and young adults with cancer: Workshop summary. Washington, DC: The National Academies Press.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D. C.: Interprofessional Education Collaborative.
Johnson, S. M., Cramer, R. J., Conroy, M. A., & Gardner, B. O. (2014). The role of and challenges for psychologists in physician assisted suicide. Death Studies, 38(9), 582-588. doi: 10.1080/07481187.2013.820228
Johnson, K. S. (2013). Racial and Ethnic Disparities in Palliative Care. Journal of Palliative Medicine , 16 (11), 1329–1334. doi: 10.1089/jpm.2013.9468
Jones, C. A., Acevedo, J., Bull, J., & Kamal, A.H. (2016). Top 10 Tips for Using Advance Care Planning Codes in Palliative Medicine and Beyond. Journal of Palliative Medicine , 19 (12), 1249-1253. doi: 10.1089/jpm.2016.0202
Jünger, S., Payne, S., Costantini, A., Kalus, C., & Werth, J. L. (2010). EAPC task force on education for psychologists in palliative care. European Journal of Palliative Care, 17(2), 84-87.
Kamal, A. H., Nipp, R. D., Bull, J., Stinson, C. S., & Abernethy, A. P. (2015). Symptom burden and performance status among community-dwelling patients with serious illness. Journal of Palliative Medicine , 18(6), 542-544. doi:10.1089/jpm.2014.0381
Kasl-Godley, J. E., King, D. A., & Quill, T. E. (2014). Opportunities for psychologists in palliative care: Working with patients and families across the disease continuum. American Psychologist , 69 (4), 364-376. doi: 10.1037/a0036735
Keall, R. M., Clayton, J. M., & Butow, P. N. (2015). Therapeutic life review in palliative care: A systematic review of quantitative evaluations. Journal of Pain and Symptom Management , 49(4), 747-761. doi: 10.1016/j.jpainsymman.2014.08.015
Kearns, T., Cornally, N., & Molloy, W. (2017). Patient reported outcome measures of quality of end-oflife care: A systematic review. Maturitas, 96, 16-25. doi: 10.1016/j.maturitas.2016.11.004
Kelley, A.S., & Morrison, R.S. (2015). Palliative care for the seriously ill. New England Journal of Medicine , 373, 747-55. doi: 10.1056/NEJMra1404684
Kilkey, M. & Merla, L. (2014). Situating transnational families' care-giving arrangements: The role of institutional contexts. Global Networks, 14, 210–229. doi:10.1111/glob.12034
Kissane, D. W. (2012). The relief of existential suffering. Archives of Internal Medicine, 172(19), 1501- 1505. doi: 10.1001/archinternmed.2012.3633
Krakauer, E. L., Crenner, C., & Fox, K. (2002). Barriers to optimum end-of-life care for minority patients. Journal of American Geriatric Society , 50(1), 182-190. doi: 10.1046/j.1532-5415.2002.50027.x
Koffman, J., Burke, G., Dias, A., Raval, B., Byrne, J., Gonzales, J., & Daniels, C. (2007). Demographic factors and awareness of palliative care and related services. Palliative Medicine , 21(2), 145-153.
Kuhne, F., Krattenmacher, T., Beierlein, V., Grimm, J. C., Bergelt, C., Romer, G., & Moller, B. (2012). Minor children of palliative patients: A systematic review of psychosocial family interventions. Journal of Palliative Medicine , 15(8), 931-945. doi: 10.1089/jpm.2011.0380
Lantos, J. D. (2011). The interface of ethics and palliative care. In J. Wolf, P. S. Hinds, & B. M. Sourkes (Eds.). Textbook of Interdisciplinary Pediatric Palliative Care . Philadelphia, PA: Saunders.
Lee, B. C., Houston, P. E., Rana, S. R., Kimmel, A. L., D'Angelo, L. J., & Lyon, M. E. (2017). Who will speak for me? Disparities in palliative care research with ‘‘unbefriended'' adolescents living with HIV/AIDS. Journal of Palliative Medicine . Advanced online publication. doi:10.1089/jpm.2017.0053
Long, C. O. (2011). Ten best practices to enhance culturally competent communication in palliative care. Journal of Pediatric Hematology and Oncology, 33(Suppl. 2), S136-S139. doi: 10.1097/MPH.0b013e318230dfb4
Lynch (2013). Hospice and Palliative Care Access Issues in Rural Areas. American Journal of Hospice & Palliative Medicine, 30(2) 172-177. doi: 10.1177/1049909112444592opens in new window
Lyon, M. E., Williams, P. L., Woods, E. R., Hutton, N., Butler, A. M., Sibinga, E., Brady, M. T., & Oleske, J. M. (2008). Do-not-resuscitate orders and/or hospice care, psychological health, and quality of life among children/adolescents with acquired immune deficiency syndrome. Journal of Palliative Medicine , 11(3), 459-469. doi: 10.1089/jpm.2007.0148
Moens, K., Higginson, I. J., & Harding, R. (2014). Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. Journal of Pain and Symptom Management , 48(4), 660-677. doi: 10.1016/j.jpainsymman.2013.11.009
Morgan, T., Williams, L. A., Trussardi, G., & Gott, M. (2016). Gender and family caregiving at the end-oflife in the context of old age: A systematic review. Palliative Medicine , 30(7), 616-624. doi:10.1177/0269216315625857.
Morrissey, M., Herr, K., & Levine, C. (2015) Special issue: 2015 WHCoA: Public health imperative of the 21st century: Innovations in palliative care systems, services, and supports to improve health and well-being of older Americans. The Gerontologist, 55(2), 245-251. doi:10.1093/geront/gnu176
Murphy, S. L., Xu, J., & Kochanek, K. D. (2013). Deaths: Final data for 2010. National Vital Statistics Reports, 61 (4). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_04.pdfopens in new window
Murtagh, F. E. M., Bausewein, C., Verne, J., Groeneveld, E. I., Kaloki, Y. E., & Higginson, I. J. (2014). How many people need palliative care? A study developing and comparing methods for populationbased estimates. Palliative Medicine , 28(1), 49-58. doi: 10.1177/0269216313489367
Naik, A. D., Martin, L. A., Moye, J., & Karel, M. J. (2016). Health values and treatment goals of older, multimorbid adults facing life-threatening illness. Journal of the American Geriatrics Society, 64(3), 625-631. doi: 10.1111/jgs.14027
National Consensus Project for Quality Palliative Care. (2013). The Clinical Practice Guidelines for Quality Palliative Care . Retrieved from https://www.nationalconsensusproject.org/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdf
National Hospice and Palliative Care Organization, Children's International Project on Palliative/Hospice Services Administrative/Policy Workgroup. (2001). A call for change: Recommendations to improve the care of children living with life-threatening conditions. Alexandria, Virginia: Author.
National Institute of Nursing Research. (2013). Building Momentum: The Science of End-Of-Life and Palliative Care. A Review of Research Trends and Funding, 1997-2010. Washington, DC: National Institutes of Health, National Institute of Nursing Research.
Northouse, L. L., Katapodi, M. C., Song, L., Zhang, L., & Mood, D. W. (2010). Interventions with family caregivers of cancer patients: Meta-analysis of randomized trials. CA: A Cancer Journal for Clinicians, 60(5), 317-339. doi: 10.3322/caac.20081
Nydegger, R. (2008). Psychologists and hospice: Where we are and where we can be. Professional Psychology: Research and Practice, 39(4), 459-463. doi: 10.1037/0735-7028.39.4.459
Patterson, K. R., Croom, A. R., Teverovsky, E. G., & Arnold, R. (2014). Current state of psychiatric involvement on palliative care consult services: Results of a national survey. Journal of Pain and Symptom Management , 47(6), 1019-1027. doi: 10.1016/j.jpainsymman.2013.06.015
Payne, R. (2016). Racially associated disparities in hospice and palliative care access: Acknowledging the facts while addressing the opportunities to improve. Journal of Palliative Medicine , 19(2). doi: 10.1089/jpm.2015.0475
Phillips, R. S., Hamel, M. B., Teno, J. M., Soukup, J., Lynn, J., Califf, R., Vidaillet, H., Davis, R. B., Bellamy, P., & Goldman, L. (2000). Patient race and decisions to withhold or withdraw life-sustaining treatments for seriously ill hospitalized adults. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. American Journal of Medicine , 108, 14-19. doi: 10.1016/S0002-9343(99)00312-5
Robinson, C.A., Pesut, B., Bottorff, J. L., Mowry, A., Broughton, S., & Fyles, G. (2009). Rural Palliative Care: A comprehensive review. Journal of Palliative Medicine , 12(3): 253-258. doi:10.1089/jpm.2008.0228.
Robison, L. L. (2011). Late effects of acute lymphoblastic leukemia therapy in patients diagnosed at 0-20 years of age. Hematology. American Society Hematology Education Program , 238-242. doi:10.1182/asheducation-2011.1.238
Roth, D. L., Haley, W. E., Hovater, M., Perkins, M., Wadley, V. G., & Judd, S. (2013). Family caregiving and all-cause mortality: Findings from a population-based propensitymatched analysis. American Journal of Epidemiology, 178(10): 1571-1578. doi: 10.1093/aje/kwt225
Ruijs, C. D. M., Kerkhof, J. F. M., van der Wal, G., & Onwuteaka-Philipsen, D. (2013). Symptoms, unbearability and the nature of suffering in terminal cancer patients dying at home: A prospective primary care study. BMC Family Practice, 14 (201). doi: 10.1186/1471-2296-14-201
Rumpold, T., Schur, S., Amering, M., Kirchheiner, K., Masel, E. K., Watzke, H., & Schrank, B. (2016). Informal caregivers of advanced-stage cancer patients: Every second is at risk for psychiatric morbidity. Support Care Cancer , 24(5), 1975-1982. doi: 10.1007/s00520-015-2987-z
Ryan, K., Connolly, M., Charnley, K., Ainscough, A., Crinion, J., Hayden, C. … Wynne. M. (2014). Palliative care competence framework steering group. Palliative Care Competence Framework . Dublin: Health Service Executive.
Shorthill, J. & DeMarco, R. F. (2017). The Relevance of Palliative Care in HIV and Aging. Interdisciplinary Topics in Gerontology and Geriatrics, 42, 222-233. doi: 10.1159/000448566
Singer, A. E., Goebel, J. R., Kim, Y. S., Dy, S. M., Ahluwalia, S. C., Clifford, M., ... Goldberg, J. (2016). Populations and interventions for palliative and end-of-life care: A systematic review. Journal of Palliative Medicine , 19(9), 995-1008. doi:10.1089/jpm.2015.0367
State Initiatives in End-of-Life Care. (2002). Creating a new policy framework for pediatric palliative care, 16. Retrieved from https://www.rwjf.org/content/dam/files/legacy-files/articlefiles/2/State_Initiatives_EOL16.pdfopens in new window
Stienstra, D., D'Aubin, A., & Derksen, J. (2012). Heightened vulnerabilities and better care for all Disability and end-of-life care. Palliative and Supportive Care, 10(01), 17-26.
Stormoen, S., Almkvist, O., Eriksdotter, M., Sundstrom, E., & Tallberg, I. M. (2014). Cognitive predictors of medical decision-making capacity in mild cognitive impairment and Alzheimer's disease. International Journal of Geriatric Psychiatry, 29(12), 1304-1311.
Sudore, R. L., & Fried, T. R. (2010). Redefining the “planning” in advance care planning: preparing for end-of-life decision making. Annals of internal medicine, 153(4), 256-261.
Sue, D. W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist , 29(6), 790-821. doi: 10.1177/0011000001296002
Sullivan, D. R., Mongoue-Tchokote, S., Mori, M., Goy, E., & Ganzini, L. (2016). Randomized, double-blind, placebo-controlled study of methylphenidate for the treatment of depression in SSRI-treated cancer patients receiving palliative care. Psychooncology . doi: 10.1002/pon.4220
Temel, J. S., Greer J. A., Muzikansky, A., Gallagher, E. R, & Admane, S. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine , 363(8):733-742.
Trachsel, M., Hermann, H., & Biller-Adorno, N. (2015). Cognitive fluctuations as a challenge for the assessment of decision-making capacity in patients with dementia. American Journal of Alzheimer's Disease and Other Dementias, 30(4), 360-363.
Vanderwerker, L. C., Laff, R. E., Kadan-Lottick, N. S., McColl, S., & Prigerson, H. G. (2005). Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. Journal of Clinical Oncology , 23(28), 6899-6907. doi: 10.1200/JCO.2005.01.370
Veterans Health Administration. (2016). Directive 1140. 11, October 11, 2016, Washington, DC: Author.
Vinchon, M., Baroncini, M., Leblond, P., & Delestret, I. (2011). Morbidity and tumor-related mortality among adult survivors of pediatric brain tumors: A review. Child's Nervous System, 27(5), 697- 704. doi: 10.1007/s00381-010-1385-6
Wadhwa, D., Burman, D., Swami, N., Rodin, G., Lo, C., & Zimmermann, C. (2013). Quality of life and mental health in caregivers of outpatients with advanced cancer. Psychooncology , 22(2), 403- 410. doi: 10.1002/pon.2104
Wallio, S. C. & Twillmen, R. K. (2011). Nonpharamcological approaches to pain and symptom management. In S. Qualls & J. Kasl-Godley (Eds.), End-of-life issues, grief, and bereavement: What clinicians need to know (pp. 148-167). Hoboken, New Jersey: John Wiley & Sons, Inc.
Weaver, M. S., Heinze, K. E., Kelly, K. P., Wiener, L., Casey, R. L., Bell, C. J., Wolfe, J., Garee, A. M., Watson, A., & Hinds, P. S. (2015). Palliative care as standard of care in pediatric oncology. Pediatric Blood Cancer, 62, S829-S833. doi: 10.1002/pbc.25695
Wells-Di Gregorio, S. (2008). Family end-of-life decision making. In J.L. Werth & D. Blevins (Eds.). Decision making near the end of life: Issues, development, and future directions (pp. 247-280). New York, NY: Brunner-Routledge.
Williams, B. A., Goodwin, J. S., Baillargeon, J., Ahalt, C., & Walter, L. C. (2012). Addressing the aging crisis in U.S. criminal justice health care. Journal of the American Geriatrics Society, 60(6), 1150-1156. doi: 10.1111/j.1532-5415.2012.03962.x
Winzelberg, G. S., Hanson, L. C., & Tulsky, J. A. (2005). Beyond autonomy: Diversifying end-of-life decision-making approaches to serve patients and families. Journal of the American Geriatrics Society. 53(6), 1046-1050. doi: 10.1111/j.1532-5415.2005.53317.x
World Health Organization. (2016). WHO Definition of Palliative Care. Retrieved from https://www.who.int/cancer/palliative/definition/en/opens in new window
Wright, A. A., Zhang, B., Ray, A., Mack, J. W., Trice, E., Balboni, T.,… Prigerson, H. G. (2008). Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment. JAMA, 300(14), 1665-1673. doi:10.1001/jama.300.14.1665
Xiao, H., Kwong, E., Pang, S., & Mok, E. (2012). Perceptions of a life review programme among Chinese patients with advanced cancer. Journal of Clinical Nursing, 21(3-4), 564-572. doi: 10.1111/j.1365-2702.2011.03842.x
Yennurajalingam, S., Kwon, J. H., Urbauer, D. L., Hui, D., Reyes-Gibby, C. C. & Bruera, E. (2013). Consistency of symptom clusters among advanced cancer patients seen at an outpatient supportive care clinic in a tertiary cancer center. Palliative and Supportive Care, 11(6), 473-480. doi: 10.1017/S1478951512000879
Justification Resolution on Palliative Care and End-of-Life Issues
Purpose and Rationale for Resolution and Relevance to Psychology
In the United States, health science disciplines have extended the healthy lifespan, resulting for many in a period of living while dying that is marked by complex choices about end-of-life care, often in a state of advanced serious illness. The growing field of palliative and end-of-life care uses an interprofessional team-based approach to care, focused on improving the quality of life of individuals facing serious or life-limiting illness and their families, and preventing and relieving suffering by means of early identification and thorough assessment and treatment of pain and physical, psychosocial, and spiritual problems, and bereavement care. Excellent palliative care not only improves the quality of life, but can extend life when symptoms, including mental health, are appropriately treated. Inclusion of this element strengthens the argument for palliative care (Temel et al., 2010). Palliative care is appropriate at any age and at any stage of a serious illness. It can be provided at the same time as disease-directed or curative treatment and is not dependent on prognosis (WHO, 2016; CAPC, 2007). End-of-life care focuses on palliative care for those terminally ill patients and their family members who may have only months to live and have elected to no longer pursue curative treatment for their underlying disease. Recent concurrent care models, also referred to as open access or simultaneous care, allow patients to receive hospice, palliative care, and curative treatments concurrently (CMS, 2016).
Psychology has obvious relevance to palliative and end-of-life care, evident in the behavioral and psychosocial issues highlighted in the Institute of Medicine's 2014 Dying in America: Improving quality and honoring individual preferences near the end of life report. Yet psychology's attention to people with advanced illness, their caregivers, and the professionals who support them has not been commensurate with the need and opportunity. In 2001, APA issued two resolutions, the Resolution on End-of-life Care and the Resolution on Assisted Suicide, followed by the establishment of working groups charged with recommending and implementing strategies to increase psychology's visibility and role in end-of-life care, including the development of continuing education opportunities. However, since these efforts ended over ten years ago, there has been no critical examination of whether, and how, the roles of psychologists in the end of life arena have changed, nor guidance offered on how to increase the visibility of psychologists going forward in this area, despite the increasing number of psychologists working in palliative care settings and with individuals with serious and life-limiting illness.
The Resolution on Palliative Care and End of Life Issues incorporates recent empirical findings, in particular those regarding the influence of disability, race and ethnicity, age, socioeconomic status, sexual orientation and gender identity, and other aspects of diversity and health disparities on choices related to end of life and access to care. The resolution also clearly describes the contemporary roles psychologists play (and could play) in this arena, and provides recommendations for increasing psychology's visibility and contributions to palliative and end-of-life care, in the critical support of optimal quality of life during serious illness and at the end-of-life.
Importance to Psychology and Society as a Whole
Psychologists emerge from education and training programs with strengths including but not limited to: conducting and critically examining research; assessment of cognitive and overall psychological functioning; psychosocial and behavioral health interventions; and communication and supportive skills. These strengths are of critical importance in the palliative and end-of-life care arena to promote treatment team members' biopsychosocial appreciation of seriously ill or dying individuals and the delineation of values and goals of care. Psychology has unique and important roles to play in the following: 1) develop theory and conduct rigorous empirical research to expand and apply knowledge about needs, experiences, and effective psychosocial treatments of people who are seriously ill or dying; 2) train scholars, scientists, and practitioners in end-of-life issues; 3) apply psychology's expertise in assessment and treatment to improve the care of people with serious advanced illness; and 4) advocate for policies that ensure compassionate, comprehensive, and equitable care. Additionally, our nation is comprised of many diverse and intersecting cultures and values which interact with individual and family decision making during serious illness and end-of-life care (Baergen, 2001; National Consensus Project for Quality Palliative Care, 2013; Wells-DiGregorio, 2008). These decisions are made in the context of significant social stratification and unequal access to medical care (Canetto 2011; Lynch, 2013; Payne 2016). Psychologists are well-trained to promote awareness and redress of these inequities.
Excellent palliative and end-of-life care is optimally a product of the combined contributions of professionals in chaplaincy, medicine, nursing, psychiatry, psychology, social work, and rehabilitation, with a growing contingency of psychologists as members of or contributing to these interprofessional treatment teams. The resolution delineates the roles appropriate to psychologists in the continuum of palliative and end-of-life care, and strongly conveys APA's role in advocacy for the training and utilization of psychologists in this work through research, practice, and public policy.
Representative Scientific and Empirical Findings Related to the Resolution
The resolution includes citations to relevant scientific literature. Psychological research contributing to the field of palliative and end-of-life care is highlighted, as well as findings and recommendations from collaborating disciplines in medicine, social work, and spiritual care - since it is by definition a system of care that melds expertise across disciplines. The World Health Organization ([WHO] 2016), Center to Advance Palliative Care ([CAPC] 2016), and Institute of Medicine ([IOM] 2014) have been foundational in describing the nature of death and dying, and focusing international attention on gaps or inequities in care and implications for new directions, based on review of empirical evidence.
The literature documents that complexities of decision making during serious illness and end-of-life care involve nuanced blending of ethics with professional medical, legal, technological, and scholarly fields (Azuero, Allen, Kvale, Azuero, & Parmelee, 2014; Baergen 2001; Chochinov, Tataryn, Clinch, & Dudgeon, 1999; Fisher et al., 2002; Gedge, Giacomini & Cook 2007; Hughes et al., 2016; Kamal, Nipp, Bull, Stinson, & Abernethy, 2015; Kissane, 2012; Lantos 2011; Moens, Higginson, & Harding, 2014; Wells-DiGregorio, 2008; Yennurajalingam, et al., 2013). Although autonomy in the U.S. is a heavily weighted legal-ethical principle in decision making around goals of care during serious and life-limiting illness, it is of variable relevance and not sufficient to address the complexities across the diverse national weave of cultures, beliefs, and practices (Winzelberg, Hanson & Tulsky 2005). Public support for increased autonomy and control over the circumstances of death is increasing as reflected by legalization of physician assisted death in Oregon, Montana, Washington, Vermont, and California as of 2016, however this support is weakest among groups who express concerns about vulnerability to pressure to hasten death (Crawley, Marshall, Lo, & Koenig, 2002; Krakauer, Crenner, & Fox, 2002; Lyon et al., 2008; Phillips et al., 2000). In examining the experiences of diverse individuals during serious illness and end-of-life care, research has shown that age, setting, culture, race, ethnicity, sex, gender identity, income, education, marital status, geographic location, and religious differences are among the contributors to significant disparities in access to care (Byock, 2009; Canetto, 2011; Friebert, 2009; Johnson, 2013; Lynch, 2013; Payne, 2016; Sue, 2001; Robison 2011; Robinson et al., 2009; Winzelberg, Hanson, & Tulsky, 2005). For individuals who are seriously ill or dying, family members (of origin or of choice) play an important role in their care and advocacy for their treatment goals. Psychological research on these care partners' experiences describes the mixture of challenges and rewards that can contribute to psychological, physical, and financial strain for the care partner (Morgan, Williams, Trussardi & Gott 2016; Rumpold et al., 2016; Wadhwa et al., 2013; Vanderwerker, Laff, Kadan-Lottick, McColl, & Prigerson, 2005).
The current and potential roles of psychologists in the field of palliative and end-of-life care have also received growing attention in the literature, which describes the strengths of psychological training in knowledge, skills, and competencies required of psychologists in palliative and end-of-life care (Allen, Haley, Roff, Schmid, & Bergman, 2006; Azuero et al., 2014; Carpenter, 2015; Connor, Lycan, & Schumacher, 2006; Gamino & Ritter, 2012; Golijani-Moghaddam, 2014; Gustin, Way, Wells-Di Gregorio, & McCallister, 2016; Haley, Larson, Kasl-Godley, Neimeyer, & Kwilosz, 2003; Johnson, Cramer, Conroy, & Gardner, 2014; Patterson, Croom, Teverovsky, & Arnold, 2014). There is also recognition that psychologists are underutilized in palliative and end-of-life care outside of the Veterans Health Administration (Garrido, Penrod, & Prigerson 2014; Haley et al., 2003) with limited options for Medicare reimbursement (Jones, Acevedo, Bull & Kamal 2016). Gaps in education, training, consultation, research, and advocacy roles of psychologists in palliative and end-of-life care have been highlighted (Higginson et al., 2014; Interprofessional Education Collaborative Expert Panel, 2011; Kasl-Godley, King, & Quill, 2014; Ryan et al., 2014).
The Extent to which the Resolution is Consistent with APA's Core Values, and the Extent to which it Addresses Human Rights, Health and Welfare, and Ethics
The resolution calls for increased support for the acquisition and application of the unique strengths, skills, knowledge, and competencies of psychologists as members of interprofessional palliative and end-of-life care teams. The resolution calls for the application of psychological science to the practice of palliative and end-of-life care and for increased support of a psychological research agenda on palliative and end-of-life issues. Related to human rights, the resolution advocates for policies that address disparities in access to and appropriateness of care for diverse individuals, cultures, and values systems. The resolution is particularly attentive to ethical and psychosocial issues of delivering palliative care, extending through the developmental lifespan from minors to older adults who are seriously ill or facing a limited prognosis.
Likelihood of Constructive Impact on Public Opinion or Policy
Death and dying is without exception universal, touching on every individual. Attention to this issue has increased and the science and practice of palliative care has evolved since APA's 2001 Resolution on End-of-Life Issues and Care. We believe this updated resolution on Palliative Care and End of Life Issues will convey that the Association and its members continue to be engaged in this evolving and expanding area of concern. The resolution will increase understanding among other disciplines, policy makers, and the general public of the importance of addressing the mental/behavioral health needs of individuals with serious or life-limiting illness and their family members. In addition, it will highlight psychology's contribution to the science of palliative care and end-of-life issues and to the treatment and support of people with advanced serious or life-limiting illness, their caregivers, and other health care providers.
Implementation
The resolution will be broadly disseminated to APA constituencies, national health and professional organizations, and policy makers active in this area.
References
Allen, R. S., Haley, W. E., Roff, L., Schmid, B., & Bergman, E. J. (2006). Responding to the needs of caregivers near the end of life: Enhancing benefits and minimizing burdens. In J. L. Werth, Jr., & D. Blevins (Eds.) Psychosocial Issues Near the End of Life: A Resource for Professional Care Providers (pp. 183-201). Washington, DC: American Psychological Association.
Azuero, C., Allen, R. S., Kvale, E., Azuero, A., & Parmelee, P. (2014). Determinants of psychology service utilization in a palliative care outpatient population. Psychoncology, 23(6), 650-657. doi: 10.1002/pon.3454
Baergen, R. (2001). Ethics at the end of life. Belmont, CA: Wadsworth Publishing Co.
Byock, I. (2009). Personal health and human development in life-threatening conditions. In: H. M. Chochinov & W. Breitbart (Eds.), Handbook of psychiatry in palliative medicine (2nd ed., pp. 281- 299). New York, NY: Oxford University Press.
Canetto, S. S. (2011). Legal physician-assisted suicide in the U.S.: Issues, roles and implications for clinicians. In S. H. Qualls & J. Kasl-Godley (Eds.), End-of-life care and bereavement (pp. 263-284). New York: Wiley.
Carpenter, B. D. (2015). Geropsychological practice with people near the end of life. In P. A. Lichtenberg & B. T. Mast (Eds.). APA handbook of clinical geropsychology. Volume 2: Assessment, treatment, and issues of later life (pp. 579-599). Washington, DC: American Psychological Association.
Center for Medicare & Medicaid Services. (2016, July 28). Medicare care choices model. Retrieved from https://innovation.cms.gov/initiatives/Medicare-Care-Choices/opens in new window
Center to Advance Palliative Care. (2007). Crosswalk of joint commission standards and palliative care policies: Procedures and assessment tools. New York: Center to Advance Palliative Care. Retrieved from https://media.capc.org/filer_public/88/06/8806cedd-f78a-4d14-a90eaca688147a18/nqfcrosswalk.pdfopens in new window
Chochinov, H. M., Tataryn, D., Clinch, J. J., & Dudgeon, D. (1999). Will to live in the terminally ill. Lancet, 354(9181), 816-819. doi: 10.1016/S0140-6736(99)80011-7
Connor, S. R., Lycan, J., & Schumacher, J. D. (2006). Involvement of psychologists in psychosocial aspects of hospice and end-of-life care. In J. L. Werth, Jr., & D. Blevins (Eds.). Psychosocial issues near the end of life: A resource for professional care providers (pp. 203-217). Washington, DC: American Psychological Association.
Crawley, L. M., Marshall, P. A., Lo, B., & Koenig, B. A. (2002). Strategies for culturally effective end-of-life care. Annals of Internal Medicine, 136, 673-679. doi: 10.7326/0003-4819-136-9-200205070- 00010
Fisher, S. E., Burgio, L. D., Thorn, B. E., Allen-Burge, R., Gerstle, J., Roth, D. L., & Allen, S. J. (2002). Pain assessment and management in cognitively impaired nursing home residents: Association of certified nursing assistant pain report, minimum data set pain report, and analgesic medication use. Journal of the American Geriatrics Society, 50(1), 152-156. doi: 10.1046/j.1532- 5415.2002.50021.x
Friebert, S. (2009). National hospice and palliative care organization. Facts and figures: Pediatric palliative and hospice care in America. Retrieved from www.nhpco.orgopens in new window
Gamino, L. A., & Ritter, R. H., Jr. (2012). Death competence: An ethical imperative. Death Studies, 36(1), 23-40. doi: 10.1080/07481187.2011.553503
Garrido, M. M., Penrod, J. D., & Prigerson, H. G. (2014). Unmet need for mental health care among veterans receiving palliative care: Assessment is not enough. American Journal of Geriatric Psychiatry, 22(6), 540-544. doi: 10.1016/j.jagp.2013.08.008
Gedge, E., Giacomini, M., & Cook, D. (2007). Withholding and withdrawing life support in critical care settings: Ethical issues concerning consent. Journal of Medical Ethics, 33(4), 215–218. doi.org/10.1136/jme.2006.017038
Golijani-Moghaddam, N. (2014). Practitioner psychologists in palliative care: Past, present, and future directions. Counselling Psychology Review, 29(1), 29-40.
Gustin, J. L., Way, D. P., Wells-Di Gregorio, S., & McCallister, J. W. (2016). Validation of the family meeting behavioral skills checklist. An instrument to assess fellows' communication skills. Annals of the American Thoracic Society, 13(8), 1388-93. doi: 10.1513/AnnalsATS.201601-021OC
Haley, W. E., Larson, D. G., Kasl-Godley, J., Neimeyer, R. A., & Kwilosz, D. M. (2003). Roles for psychologists in end-of-life care: Emerging models of practice. Professional Psychology: Research and Practice, 34(6), 626-633. doi:10.1037/0735-7028.34.6.626
Higginson, I. J., Gomes, B., Calanzani, N., Gao, W., Bausewein, C., Daveson, B. A., … Harding, R. (2014). Priorities for treatment, care and information if faced with serious illness: A comparative population-based survey in seven European countries. Palliative Medicine , 28(2), 101-110. doi: 10.1177/0269216313488989
Hughes, R. E., Holland, L. R., Zanino, D., Link, E., Michael, N., & Thompson, K. E. (2016). Prevalence and intensity of pain and other physical and psychological symptoms in adolescents and young adults diagnosed with cancer on referral to a palliative care service. Journal of Adolescent and Young Adult Oncology, 4(2), 70-75. doi:10.1089/jayao.2014.0015
Institute of Medicine. (2014). Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D. C.: Interprofessional Education Collaborative.
Johnson, K. S. (2013). Racial and Ethnic Disparities in Palliative Care. Journal of Palliative Medicine , 16(11): 1329–1334. doi: 10.1089/jpm.2013.9468
Johnson, S. M., Cramer, R. J., Conroy, M. A., & Gardner, B. O. (2014). The role of and challenges for psychologists in physician assisted suicide. Death Studies, 38(9), 582-588. doi: 10.1080/07481187.2013.820228
Jones, C. A., Acevedo, J., Bull, J., & Kamal, A. H. (2016). Top 10 tips for using advance care planning codes in palliative medicine and beyond. Journal of Palliative Medicine , 19 (12), 1249-1253. doi: 10.1089/jpm.2016.0202
Kamal, A. H., Nipp, R. D., Bull, J., Stinson, C. S., & Abernethy, A. P. (2015). Symptom burden and performance status among community-dwelling patients with serious illness. Journal of Palliative Medicine , 18(6), 542-544. doi:10.1089/jpm.2014.0381
Kasl-Godley, J. E., King, D. A., & Quill, T. E. (2014). Opportunities for psychologists in palliative care: Working with patients and families across the disease continuum. American Psychologist, 69(4), 364-376. doi: 10.1037/a0036735
Kissane, D. W. (2012). The relief of existential suffering. Archives of Internal Medicine, 172(19), 1501- 1505. doi: 10.1001/archinternmed.2012.3633
Krakauer, E.L., Crenner, C., & Fox, K. (2002). Barriers to optimum end-of-life care for minority patients. Journal of American Geriatric Society, 50(1), 182-190. doi: 10.1046/j.1532-5415.2002.50027.x
Lantos, J. D. (2011). The interface of ethics and palliative care. In J. Wolf, P. S. Hinds, & B. M. Sourkes (Eds.). Textbook of Interdisciplinary Pediatric Palliative Care. Philadelphia, PA: Saunders.
Lynch (2013). Hospice and palliative care access issues in rural areas. American Journal of Hospice & Palliative Medicine, 30(2), 172-177. doi: 10.1177/1049909112444592
Lyon, M. E., Williams, P. L., Woods, E. R., Hutton, N., Butler, A. M., Sibinga, E., Brady, M. T., & Oleske, J. M. (2008). Do-not-resuscitate orders and/or hospice care, psychological health, and quality of life among children/adolescents with acquired immune deficiency syndrome. Journal of Palliative Medicine, 11(3), 459-469. doi: 10.1089/jpm.2007.0148
Moens, K., Higginson, I. J., & Harding, R. (2014). Are there differences in the prevalence of palliative care-related problems in people living with advanced cancer and eight non-cancer conditions? A systematic review. Journal of Pain and Symptom Management, 48(4), 660-677. doi: 10.1016/j.jpainsymman.2013.11.009
Morgan, T., Williams, L. A., Trussardi, G., & Gott, M. (2016). Gender and family caregiving at the end-oflife in the context of old age: A systematic review. Palliative Medicine, 30(7), 616-624. doi: 10.1177/0269216315625857
National Consensus Project for Quality Palliative Care. (2013). The Clinical Practice Guidelines for Quality Palliative Care. Retrieved from https://www.nationalconsensusproject.org/NCP_Clinical_Practice_Guidelines_3rd_Edition.pdfopens in new window
Patterson, K. R., Croom, A. R., Teverovsky, E. G., & Arnold, R. (2014). Current state of psychiatric involvement on palliative care consult services: Results of a national survey. Journal of Pain and Symptom Management, 47(6), 1019-1027. doi: 10.1016/j.jpainsymman.2013.06.015
Payne, R. (2016). Racially associated disparities in hospice and palliative care access: Acknowledging the facts while addressing the opportunities to improve. Journal of Palliative Medicine, 19(2). doi: 10.1089/jpm.2015.0475
Phillips, R. S., Hamel, M. B., Teno, J. M., Soukup, J., Lynn, J., Califf, R., Vidaillet, H., Davis, R. B., Bellamy, P., & Goldman, L. (2000). Patient race and decisions to withhold or withdraw life-sustaining treatments for seriously ill hospitalized adults. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatments. American Journal of Medicine, 108, 14-19. doi: 10.1016/S0002-9343(99)00312-5
Robinson, C.A., Pesut, B., Bottorff, J. L., Mowry, A., Broughton, S., & Fyles, G. (2009). Rural Palliative Care: A comprehensive review. Journal of Palliative Medicine, 12(3): 253-258. doi:10.1089/jpm.2008.0228.
Robison, L. L. (2011). Late effects of acute lymphoblastic leukemia therapy in patients diagnosed at 0-20 years of age. Hematology. American Society Hematology Education Program, 238-242. doi:10.1182/asheducation-2011.1.238
Rumpold, T., Schur, S., Amering, M., Kirchheiner, K., Masel, E. K., Watzke, H., & Schrank, B. (2016). Informal caregivers of advanced-stage cancer patients: Every second is at risk for psychiatric morbidity. Support Care Cancer, 24(5), 1975-1982. doi: 10.1007/s00520-015-2987-z
Ryan, K., Connolly, M., Charnley, K., Ainscough, A., Crinion, J., Hayden, C. … Wynne. M. (2014). Palliative care competence framework steering group. Palliative Care Competence Framework. Dublin: Health Service Executive.
Sue, D. W. (2001). Multidimensional facets of cultural competence. The Counseling Psychologist, 29(6), 790-821. doi: 10.1177/0011000001296002
Temel, J.S., Greer, J.A., Muzikansky, A., Gallagher, E.R., Admane, S., Jackson, V.A., … Lynch, T.J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. New England Journal of Medicine, 363, 733-42. doi: 10.1056/NEJMoa1000678
Vanderwerker, L. C., Laff, R. E., Kadan-Lottick, N. S., McColl, S., & Prigerson, H. G. (2005). Psychiatric disorders and mental health service use among caregivers of advanced cancer patients. Journal of Clinical Oncology, 23(28), 6899-6907. doi: 10.1200/JCO.2005.01.370
Wadhwa, D., Burman, D., Swami, N., Rodin, G., Lo, C., & Zimmermann, C. (2013). Quality of life and mental health in caregivers of outpatients with advanced cancer. Psychooncology, 22(2), 403- 410. doi: 10.1002/pon.2104
Wells-Di Gregorio, S. (2008). Family end-of-life decision making. In J.L. Werth & D. Blevins (Eds.). Decision making near the end of life: Issues, development, and future directions (pp. 247-280). New York, NY: Brunner-Routledge.
Winzelberg, G. S., Hanson, L. C., & Tulsky, J. A. (2005). Beyond autonomy: Diversifying end-of-life decision-making approaches to serve patients and families. Journal of the American Geriatrics Society. 53(6), 1046-1050. doi: 10.1111/j.1532-5415.2005.53317.x
World Health Organization. (2016). WHO Definition of Palliative Care. Retrieved from https://www.who.int/cancer/palliative/definition/en/opens in new window
Yennurajalingam, S., Kwon, J. H., Urbauer, D. L., Hui, D., Reyes-Gibby, C. C. & Bruera, E. (2013). Consistency of symptom clusters among advanced cancer patients seen at an outpatient supportive care clinic in a tertiary cancer center. Palliative and Supportive Care, 11(6), 473-480. doi: 10.1017/S1478951512000879
2020
Resolution on Ageism (PDF, 128KB)opens in new window
