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)     

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)     

Primary care health psychology training: A collaborative model with family practice.

Are you planning a new postdoctoral training program in health psychology? Are your students seeking postdoctoral training in health psychology? Are you looking for a good formal postdoctoral fellowship in health psychology to continue your training? This article describes in detail the philosophy, educational objectives, and learning activities that make up a 13-year-old fellowship approved by the American Psychological Association in clinical health psychology, a model for clinical training in this specialty. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acquiring CMS funding for an APA-accredited postdoctoral psychology fellowship program.

In 2001 Congress reinterpreted existing legislation allowing hospital based, postdoctoral psychology training programs that were accredited by the American Psychological Association (APA) to file for and receive allied health reimbursement through the Center for Medicare/Medicaid Services (CMS). This became effective on March 13, 2001 (Health Care Financing Administration, 2001). Historically physician and other allied health training programs have received government funding, while psychology training has been nonfunded. This new legislation symbolized a shift in federal health policy and recognized psychology as a valuable discipline within the health care system. This article discusses several postdoctoral programs' successful approach in obtaining CMS funding and encourages other eligible programs to pursue it as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cost-effective delivery of rehabilitation psychology services: The responsible utilization of paraprofessionals.

The new and rapidly changing health care environment necessitates innovation on the part of rehabilitation psychology to achieve cost-effectiveness. This innovation could take the form of rehabilitation psychologists' responsibly using bachelor's-level technicians, or paraprofessionals, in the delivery of clinical services. This article proposes a pyramid model of rehabilitation psychology service delivery using paraprofessionals and psychology trainees. Specific clinical activities appropriate for paraprofessionals are outlined. Controversies regarding use of bachelor's-level paraprofessionals and the inflationary process of over-credentialing doctoral-level psychologists are discussed. It is proposed that psychology interns and residents be cross-trained in allied health skills so that psychology trainees can provide clinical support to other health care disciplines, thereby improving the cost-effectiveness of, and preserving, hospital-based psychology training programs. The article emphasizes the need for doctoral-level rehabilitation psychologists to adopt administrative roles in medical settings in order to implement innovative service models. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training in professional psychology: Are we addressing the issues?

Discusses the fact that there have been few articles about training in professional psychology published in Professional Psychology: Research and Practice. The author highlights the need for professional psychology to address the issues of doctoral program curricula, postdoctoral training and continuing professional education, and internship training issues focusing on the application and selection process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology and health care.

Recent advances in health care psychology are noted, especially those involving the conceptualization and treatment of lifestyle and chronic health problems. The contributions to health care psychology of community psychology, brief psychological treatments, behavioral medicine, and health psychology are outlined. The central task of both organized psychology and individual psychologists is to create an underlying structure of clear boundaries and standards for clinical practice and training in health care psychology. Initially, this task should involve an inventory of Canadian psychologists currently providing health care services and the nature and amount of those services. Subsequently, a need exists for the profession to examine and create guidelines in psychological service delivery, professional role models, training, and scientific methods pertaining to general health care. (French abstract) (27 ref) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Training Psychology Interns in Primary Behavioral Health Care.

This article describes a training program for primary behavioral health care (PBHC) for clinical psychology interns. The authors discuss the rationale for integrating mental health into primary care and the need for additional training programs at the predoctoral internship level. A review of relevant literature suggests that effective functioning in primary care requires competence in (a) generalist psychology, (b) health psychology, (c) interdisciplinary team functioning, and (d) skills specific to primary care. The authors advocate for a relatively intensive training program to address these areas. Common intern training difficulties observed during 3 years of program implementation are discussed. Practical, lessons-learned recommendations that address these problem areas provide guidance for others seeking to develop a PBHC training program. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists, Resist Managed Care! Comment.

Comments on the article by Sanchez and Turner (see record 2003-03405-005) examining the implications for practice and training in psychology in the era of managed care. The current author, having had direct experience with the model of primary medical care and behavioral care interface that Sanchez and Turner seem so enthusiastic about, warns of several shortcomings. The author likens the psychologists role in managed care to a form of assembly-line practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary care in psychiatry residency training

The author summarizes patient perspectives and government initiatives that have fostered closer medicine-psychiatry cooperation and more comprehensive treatment of patients. Despite the growing numbers of people requiring more formal mental health care, most patients are being treated by primary health care providers. This trend will continue as long as there is a decline in the number of medical students entering psychiatry. The author summarizes several general principles that psychiatry residency program directors should consider in designing primary care experiences for their residents and for medical students rotating on their services: longitudinal primary care experiences in organized medical care settings, training in basic medical principles and techniques, and instruction in the biopsychosocial model of disease. The author also recommends there specific training experiences for psychiatry residents that would enhance their ability to provide more effective mental health services to primary care physicians and their patients: consultation psychiatry, primary mental health care, and general psychiatry. The author concludes that medical students, through their contact with primary care-oriented psychiatry residency programs, would be more attracted to psychiatry as a specialty choice and that residents, upon completion of training, would be more inclined to practice in primary care settings.     

Postdoctoral education and training for clinical service providers in health psychology.

Reviews issues behind the 1983 National Working Conference on Education and Training in Health Psychology recommendation that 2 yrs of postdoctoral education and training be mandated for future licensed health psychologists. Existing pre- and postdoctoral programs are discussed in terms of academic emphasis, and a model for education, including desired competencies, residency setting and faculty, and funding issues, is presented. Implications of the growth of health psychology and the need to expand the period of clinical training to meet advances in the field are examined. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Education and training in health psychology: Boulder or Bolder.

Reviews previous conferences on graduate education and training in health psychology (HP) as background for a 1983 conference on career and training issues in the field. Criteria characterizing professions are presented. Expected topics at the conference include societal need for orderly development of HP, work functions and roles of health psychologists, predoctoral specialty training, appropriateness of specializing in HP, official sanctioning, education and training settings, model doctoral programs emphasizing HP within a clinical psychology track, apprenticeship, and pre- vs postdoctoral training in HP. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Predoctoral Field Placement in Primary Care: Keeping It Simple.

The supply of psychologists with clinical experience in primary care settings has not kept pace with the growing demand. Pre- and postdoctoral training opportunities in primary care are rare, in part, because of the administrative, cultural, and educational complexities associated with interdisciplinary training endeavors. The authors describe the development of a modest, half-day primary care placement that is offered as part of a predoctoral internship in child clinical psychology. They provide a model and recommendations for exposing trainees and other interested practitioners to the themes, culture, and clinical opportunities of primary care, while avoiding many of the logistical problems that can encumber such efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of managed care on employment and training: A primer for survival.

Managed care has become the dominant economic force in health care delivery and has challenged many of professional psychology's training concepts and cherished attitudes. Organized psychology has not kept pace with the rapid industrialization of health care during the past decade and has been overlooked as a participant in health economic decisions. A number of changes need to be made in professional education and training if psychology is to be a major player in the new health systems. Additionally, professional psychologists must reexamine some of their most generally accepted attitudes and beliefs if they are to survive. These are described with a number of recommendations for the survival of an embattled profession. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology in health care: Future directions.

The nature of health care delivery in the U.S. will change radically in the next 5 years, and the nature of psychological services provided will also change. Psychology is evolving into a primary health care profession, at least in terms of "health psychology" broadly defined. Modern clinical health psychology includes, at the minimum, rehabilitation psychology, neuropsychology, and traditional health psychology. The present article represents the views of 20 experts from this evolving area of practice and research on matters of public policy, training, and the future of psychology in health care settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health Services and Health Care Economics: The Health Psychology Marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accountability, public policy, and psychiatry

The author identifies the direction of changes in health policy in the United States that need to be taken into account by the health professions in their dealings with government. She discusses three areas in which these changes will call for adjustment on the part of the medical profession and major health care institutions and defines the special challenge to psychiatry implicit in the changes. She concludes that the public's need for attention to the psychosocial aspects of health and the renewed interest in prevention present psychiatry with an opportunity to provide leadership in health care delivery.     

A training curriculum for professional psychologists in primary care.

Primary care psychology is a growing field that requires specific training opportunities for successful practice. The knowledge and skills that practitioners need for work in this setting are outlined here in detail. This curriculum integrates literature and experience in family psychology, health psychology, and pediatric psychology; considers multiple levels of education and training; and provides illustrative examples. It is a first attempt in an evolving process of integrating historical and cutting edge literature from many areas of psychology and other disciplines to contribute to comprehensive primary care psychology training. It can be used by programs and individual practitioners alike in designing education and training experiences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdoctoral education-training for specialty practice: Long anticipated, finally realized.

Recommendations for broad and generic predoctoral education and training and postdoctoral specialization for practice have been made by psychology education and training conference groups since 1949. The number of postdoctoral education and training offerings has grown steadily over the succeeding decades. Selected data on postdoctoral education and training are presented in this article for a sample of 388 current postdoctoral education and training sites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdoctoral training in severe mental illness: A model for trainee development.

The development of postdoctoral training in professional psychology has been gaining increased attention. This article presents a model of trainee development based on the processes of change that are deemed essential for the transition from an intern to a fully functioning professional psychologist. The model focuses on work with the severely mentally disordered, an area that currently lacks strong leadership within the mental health community. The program, which is highly integrated within the existing service-delivery system and teaching/research community of a medical center, emphasizes continuity with the internship experience, the integration of multiple treatment approaches, training in the provision of supervision, and scholarly contributions. The development of required, 1-yr, American Psychological Association-accredited postdoctoral training programs that provide the opportunity for specialization is recommended as the final stage in the professional initiation process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)