Training for substance abuse treatment among psychologists in a rural state.

Is treating substance abuse generally a part of psychological practice? Do psychologists feel prepared to deliver substance abuse treatment? Licensed psychologists in Idaho were surveyed about their training and provision of substance abuse services. Of 144 respondents (66% return rate), nearly all (89%) had contact with substance abusers, yet most rated their graduate training as inadequate preparation for practice. Rural psychologists reported seeing the highest percentage of substance abusers. Many psychologists limited their treatment to self-help group referral. Continuing education offers the most immediate solution and might be related to certification efforts. Predoctoral training of generalist psychologists, especially in rural areas, is advocated with an emphasis on integrated behavioral health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health psychology specialty practice opportunities in a rural community hospital: Practicing local clinical science.

There is currently considerable interest in opportunities for collaboration between psychologists and primary care providers, particularly in rural settings. This article is an attempt to expand this discussion by focusing on opportunities for more specialized health psychology practices within tertiary care settings. Two examples are provided of collaborative projects recently implemented in a rural community hospital in southern New Hampshire—1 in the department of surgery, the other in the department of cardiac rehabilitation. The process of developing these practice opportunities is described within the context of the psychologist functioning as a local clinical scientist. The article concludes with a discussion of practical issues, including staffing and funding. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meeting U.S. Health Care Needs: A Challenge to Psychology.

Is there really a growing need for primary care psychologists? U.S. population health statistics reveal a great deal of variability in the care Americans receive and in their associated health outcomes. Members of minority groups, the inner-city poor, and rural Americans bear a disproportionate burden of ill health. The decreasing pool of primary care physicians is documented as well as is the growing pool of nonphysician primary care providers. The need to expand the nature of psychological interventions in primary care is examined, and change in the training of professional psychologists is recommended. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dual-relationship dilemmas of rural and small-community psychologists.

Sixteen licensed psychologists who lived and practiced in rural areas and small communities participated in interviews about ethical dilemmas they faced in daily practice. Dilemmas involving professional boundaries were identified as significant concerns for all of the psychologists. Major themes were the reality of overlapping business relationships, the effects of overlapping relationships on members of the psychologist's own family, and the dilemmas of working with more than 1 family member as clients or with others who have friendships with individual clients. The psychologists knew the content of ethical codes but often struggled in choosing how to apply those codes in the best interest of clients. Ongoing discussions regarding these choices can contribute to the evolution of practice codes applicable to rural areas and other small communities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological consultation with primary care physicians: Obstacles and opportunities in the medical setting.

This article discusses the relationship between psychologists and primary care physicians and describes the training and practice of physicians in the areas of mental and behavioral health care. Issues affecting the relationship between psychologists and primary care physicians are then reviewed. Different models of psychological consultation are discussed, and an integrated behavioral systems model of psychological consultation is presented as a potentially effective model for consultation with primary care physicians. This model provides a framework for psychologists to function as coproviders of primary health care services. Practical strategies to enhance collaboration between psychologists and primary care physicians in private practice are discussed. The need for more research on primary care and for the inclusion of psychologists in managed care and health care reform are also highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Linking psychologists and family physicians for collaborative practice.

This article describes a pilot, demonstration project that linked psychologists and family physicians to improve the care of patients with alcohol and other drug abuse problems. The project facilitated collaborative practice between family physicians and psychologists to enhance treatment of patients with alcohol and other drug abuse and other psychosocial problems in rural America. Ten pairs of psychologists and family physicians in rural Texas and Wyoming participated in the project. The training successfully established linkages between psychologists and family physicians for the care of a broad range of medical and psychological problems. This article discusses the linkage training, factors that facilitated and hindered collaboration, as well as implications for future training and collaborative health care practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

National survey of ethical practices across rural and urban communities.

This study examines ethical dilemmas and problems that are encountered by psychologists across rural and urban communities. A survey instrument was created on the basis of previous surveys of ethical practices. A national sample of 1,000 psychologists stratified into urban and nonurban practitioners was surveyed; 447 usable surveys were returned. Data analysis revealed significant differences between small town/rural and urban/suburban groups for several ethical categories. Notably, small town/rural psychologists are more likely to encounter several types of multiple relationships than their urban counterparts. Small town/rural practitioners are also more likely to be highly visible, or well-known, in their communities. Qualitatively, respondents described their struggles with dual relationships, and several offered suggestions to cope with boundary issues. These findings suggest the need to study the practice of psychology in rural communities in more depth, to study the impact of rural characteristics on clients and practitioners, and to create a conceptual model of best practices for rural practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists and rural services: Addressing a new agenda.

Rural people in the 1990s are struggling with serious individual and community problems that threaten their very survival. The growth of professional psychology into a viable health, mental health, and social service profession places it in a position to be of assistance to rural communities. To do this, however, adequate training models must be developed to equip psychologists to ply their trade in rural areas. A strategy and model for training practicing psychologists is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology can be indispensable to health care reform and the patient-centered medical home.

The Patient Protection and Affordable Care Act (PPACA) was passed into legislation in March 2010, making health care reform a reality. Perhaps the most well-developed model of primary care that aligns with the PPACA's agenda is the patient-centered medical home (PCMH). Integrated care, as defined by collaborative care between mental health and primary care providers and systems, will undoubtedly play a critical role in the success of the PCMH. The role of psychology and integrated care in the PCMH as well as training implications for psychologists are discussed. This article is intended to challenge our discipline to embrace psychology as a health care profession that must prepare for and solidify its added value in the health care delivery models of the future. Requisite skill sets for primary care psychologists and existing training opportunities are presented. Finally, possible mechanisms for training psychologists in integrated care and the professional roles primary care psychologists can expect to fill are proposed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Psychological needs and resources as perceived by rural and urban psychologists.

Practicing psychologists in rural and urban Oregon were surveyed about their perceptions of psychological needs and resources in their communities. Both groups indicated the most salient unmet community needs as adequate access to appropriately trained medication prescribers, comprehensive psychological assessment services, and psychological services for children. When compared with urban communities, those in rural communities have more difficulties with accessing all professional services, and rural psychologists have access to fewer professional resources. However, there appear to be few differences between perceived needs and resources in rural and urban communities. Psychologists who practice in these communities perceive a strong need for more access to psychological services in both settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telecommunications and rural health care

Telehealth has many applications, including the education and training of health professionals. This article describes the use of advanced telecommunications technology to educate family nurse practitioners in rural areas of Kansas. Four Kansas universities use compressed video technology (an interactive audio and video system) to offer five common core courses in primary care to students enrolled in FNP programs at the respective institutions. Using technology to educate FNPs in rural communities has resulted in a greater percentage of graduates (approximately 67% of 258 graduates) going to work in rural underserved communities. In addition to learning the course content, students learn to use technology as a tool to access telehealth information and services Knowing how to use these technologies provides greater opportunities to rural health care providers, as well as the recipients of health care.     

Acknowledging the inevitable: Understanding multiple relationships in rural practice.

There are many factors that contribute to increased rates of multiple relationships in rural practice. Although limited availability of mental health practitioners and access difficulties are the most commonly cited factors, characteristics of rural communities and characteristics of psychologists who practice there may also promote the likelihood of these relationships. These characteristics may consequently promote acceptance of multiple relationships. This article addresses some of the unique aspects of rural practice and provides strategies for evaluating, preventing, and managing multiple relationships in rural practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Rural Hawai'i Behavioral Health Program: Increasing access to primary care behavioral health for native Hawaiians in rural settings.

Health care access issues present significant challenges for rural populations and health providers. Psychology can support improved access and quality of rural health services through the development of integrated behavior health programs within primary care settings. This article reviews a clinical training and service delivery program, the Rural Hawai'i Behavioral Health Program, which has evolved in response to the pressing health needs of Native Hawaiians in rural communities. Native Hawaiian cultural factors and components of the primary care model that have supported the development of this program will be reviewed. Program expansion, sustainability, and treatment efficacy research will be discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

It is past time: Moving psychology into primary health care.

It is past time for psychologists to expand their services into primary health care. For too long, psychological work has been limited to mental health care. Psychology also has much to offer in primary health care. One of my major initiatives during my tenure as president of the American Psychological Association (APA) was to focus on psychologists' contributions to health care in general, particularly on what psychologists are doing to help cancer patients. A great need exists for professional psychologists to expand into these areas. To illustrate the value of psychological interventions in primary health care, I focus on two major health care problems: heart disease and cancer. Both are particularly important areas for health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Professional practice out of the urban context: Defining Canadian rural psychology.

There is an often unacknowledged difference between urban and rural practice in psychology which lacks clarity, in part, because of the lack of a common definition of rurality. Rural psychology in Canada presents complex and nuanced aspects of professional practice. The professional and social milieus of rural communities position the practising psychologist within a context that may differ vastly from urban settings. The rural context highlights the need to define this specific practice setting. This paper proposes a tentative definition of rural Canadian professional practice in psychology. This is meant to elucidate the distinct practice, training, and ethical considerations that may be the realities of the psychologists who are in professional practice in rural Canada. Rural professional practice is unique and Canadian training programs are urban-based. Training of future psychologists needs to acknowledge the unique features of rural practice to meet our obligations to students specifically and to rural Canadians generally. This is enhanced with a shared definition of rural professional practice in psychology. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A critical examination of gender differences in nutritional risk for rural adults with disability.

Objectives: To examine gender differences in nutritional risk for rural adults with disability. To identify specific perceived nutrition barriers that intervention programs might target among rural adults with disability. Study Design: Telephone interviews. Participants: One hundred twenty-four rural adults from Meals-on-Wheels and Center for Independent Living programs (46 men, 78 women; mean age = 57.7 years, 96% Caucasian). Outcome Measures: Nutrition Screening Initiative, Nutritional Risk Index, Perceived Nutrition Barriers Scale. Results: Women reported greater nutritional risk on all measures, but gender differences appeared mediated by age and disability. Top barriers were identical for men and women. Conclusions: Rehabilitation psychologists should consider age and disability first, rather than gender-related assumptions about nutritional risk. Nutrition intervention should encourage shared food cost, transportation, preparation, and new tastes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Telehealth Brain Injury Training for Rural Behavioral Health Generalists: Supporting and Enhancing Rural Service Delivery Networks.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program that matched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician management preferences and barriers to care for rural patients with depression

OBJECTIVE: To describe rural primary care physicians' current preferences in treating depression and the barriers they face in providing effective care for this condition. DESIGN: Cross-sectional survey of randomly selected practicing primary care physicians registered in Arkansas. SETTING: Primary care practices in nonmetropolitan counties. PARTICIPANTS: Forty of 50 eligible physicians completed a face-to-face interview; one physician, an interview by telephone; and two physicians, an interview in questionnaire form. Total response rate was 86%. MAIN OUTCOME MEASURES: Physician preferences for and barriers to the effective management of depression. RESULTS: An estimated 44% of rural physicians consider medication alone to be the best initial approach to treating depression; 30% prefer to prescribe medication and refer patients to mental health care professionals for counseling; and 26% prefer to prescribe medication and conduct counseling themselves. The greatest barriers to treatment were the physician's lack of time and the patient's failure to recognize depression. Most physicians had recently referred one or more depressed patients to specialty care and had encountered few referral sources, long waiting lists, and inadequate follow-up. CONCLUSIONS: The majority of rural primary care physicians prefer to treat depressed patients in their practices themselves. Except for the limited availability of specialty services, most of the barriers to the provision of effective care for depression perceived by rural physicians do not appear to be unique to rural practices.     

Rehabilitation psychology in primary care: Preparing for a changing health care environment.

Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)