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)     

Nursing and Psychological Treatments.

Presents a comment on "Psychological Treatments" (see record 2004-21168-001) by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Divided No More: Psychology's Role in Integrated Health Care.

Health-care providers increasingly recognize the need to address behavioural and emotional influences on physical health in order to provide quality and cost-effective services. As behaviour change experts, psychologists can be critically important in new models of integrated care that focus on both physical and psychological health. However, to be effective, psychologists must be prepared to address the major issues facing health-care systems today and be willing to re-examine and modify current modes of education and practice. This article describes important trends affecting health care and the ways in which psychologists could contribute. Lastly, two psychologists involved in new models of integrated care describe their training and the challenges and rewards of their current activities. (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)     

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)     

Health Care, National Health Insurance, and Psychology.

The role of psychologists as health care providers and the parameters of reimbursement for health care services are timely and controversial issues. A landmark decision was reached in this controversy in the 1980 appeal of a Virginia suit by clinical psychologists in which the court ruled that Blue Shield's refusal to directly reimburse psychologists was a violation of antitrust law. Thus, the requirement that psychologists bill through physicians was not upheld. In recent years a specific aspect of this controversy involved psychologists' roles in potential national health insurance programs. A limited study (appearing in the "National Register of Health Services Providers in Psychology" 1976-1978) of clinical psychologists' attitudes toward national health insurance suggests that Congress and psychologists may have disparate views. In addition to favoring national health insurance, over 85% of psychologists surveyed responded that consumers would benefit from such a program with mental health coverage. Only 16% agreed that such a program would constitute a subsidy of the rich by the poor (Albee, 1977). Several areas of conflicting or confusing responses in this study may reflect legitimate reasons for concern by Congress regarding institution of national health insurance. Belief that providers would benefit from mental health coverage in a national health insurance program was shared by 80% of respondents. Ninety-five percent of respondents identified the inclusion or exclusion of clinical psychologists in such a national health insurance as affecting the future of the profession. Curiously, over 50% of respondents agreed that primary care physicians should be reimbursed for mental health services, although such physicians have received no formal training in psychological services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of psychology in health care delivery.

There is a wealth of professional opportunities for practicing psychologists, particularly given the recent recognition of psychology as a health care profession. A number of dimensions are discussed that can be used as a heuristic to outline the participation of psychologists in the general health care arena. Dimensions include the breadth of disease categories in which psychology has been involved, the involvement of psychologists at different stages of the progression of illnesses, and the diverse roles that psychologists may play in health care. Examples are provided to exemplify the contributions psychologists have made to health care. Recommendations are made to strengthen psychology's role in the health care system. Recent challenges are also reviewed regarding the association of health care and the delivery of services that demand the participation of psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A primer for advancing psychology in the public sector.

Psychologists working in the public sector should, in addition to providing direct services, advocate for systems change. Although many consumers treated in the public sector face a constellation of severe life problems, working to improve the system of care is more difficult than providing treatment. Improving the quality of life of consumers of publicly funded mental health services requires that psychologists become advocates. Four prerequisites to systems change, plus coalition building, legislative advocacy, the work of state psychological associations, and forming alliances between psychologists and nonpsychological community organizations such as Rotary International, are described. In conclusion, 12 orienting ideas are listed for psychologists who want to advocate for social, institutional, and political change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarification on Psychological Treatments and Psychotherapy.

In this article, the author responds to a set of comments (see record 2005-11834-009; 2005-11834-010; 2005-11834-011) on his original article, "Psychological Treatments" (see record 2004-21168-001). The author responds to each comment. Hal Arkowitz (2005) misread the proposed distinction between "psychological treatments" and "psychotherapy" by presuming that the author was implying that the former is evidence based and the latter is not. Kwekkeboom et al. (2005), representing the nursing profession, noted quite correctly that nurses often deliver psychological treatments on the frontlines of primary care and are independently licensed to provide nursing services, including many approaches that could be categorized as "psychological." Ahmed and Boisvert (2005) agreed that psychological treatments are a core strength of psychology and also go on to provide additional interesting examples and to identify other areas of practice in which psychologists may be uniquely qualified. Overall, the author notes that only certain well-defined pathologies will be included in any health care system, and treatment for these conditions will increasingly need to be based on evidence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using community outreach to promote integrated health care: A pilot project.

Although research has demonstrated the efficacy of psychological services for ameliorating physical conditions, consumers are often uninformed of the advantages of integrated health care. To begin to address this knowledge gap, the authors developed, offered, and assessed a 2-hr community outreach program, which included lectures highlighting the benefits of providing psychological services within general health care, a demonstration of stress-reduction techniques, and first-person accounts of the benefits of psychological health care. The preliminary results of the evaluation were positive. It is recommended that similar programs be disseminated in diverse communities. Suggestions for planning and conducting these types of programs are offered. Furthermore, strategies for improving the goals and content of workshops are offered, with a focus on the distinction between promotion of attitudinal change versus practical activism. Finally, implications for community outreach that is intended to inform the public of the value of psychological health care services are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology, the stalwart profession, faces new challenges and opportunities.

Psychology emerged as a profession following World War II, seemingly out of nowhere and against all odds, through the sheer grit and determination of its early clinical psychology doctoral pioneers, who recognized the economic importance of licensure and third-party reimbursement. After 2 or 3 decades of prosperity in which psychology became the nation's preeminent psychotherapy profession, professional psychologists ignored warnings of impending managed care and the biomedical revolution and have suffered an unfortunate decline in income. Once again healthcare is confronted with double-digit inflation, and draconian reimbursement measures are being put into place that will impact psychological practice. Practicing psychologists need to heed these harbingers and deflect their negative effects while taking advantage of their potential opportunities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Leading Psychology Forward: Staying the Course in Uncertain Times.

Like everyone in the country, those in organized psychology have functioned recently in a climate marked by threats of terrorism, uncertainty, and a declining economy. In such challenging times, it might seem logical for the profession to wonder how it needs to change to respond to current circumstances. Yet at such times, staying the course already charted is likely a far more effective strategy. For psychology, this means continuing to press for mental health parity, educating decision makers about the important role of psychological services in preventive care, helping to integrate psychological and physical health services, continuing to hold managed care companies accountable, and increasing the profession's political giving. Psychologists must also be prepared to ensure that psychological services are treated as an integral part of any health reform plan that emerges. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost effectiveness and medical cost-offset considerations in psychological service provision.

Suggests that empirical evidence has demonstrated that psychological interventions can effectively treat a wide range of child and adult health problems. The focus of this review is on costing issues associated with psychological interventions, including cost-effectiveness and cost offset (i.e., a reduction in health care costs attributable to effective intervention). Recent evidence has demonstrated that psychological interventions can be more cost-effective than optimal drug treatment. For example, although having comparable effectiveness, cognitive-behavioral treatments for panic disorder and for depression have been estimated to cost approximately one-third less than pharmacological treatment. Further, a recent meta-analysis of 91 research studies published between 1967 and 1997 found that average health care cost savings due to psychological intervention were in the range of 20-30% across studies, and 90% of the studies reported evidence of a medical cost offset. In conclusion, the evidence indicates that psychological treatments (1) can be cost-effective forms of treatment and (2) have the potential to reduce health care costs, as successfully treated patients typically reduce their utilization of other health care services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology as a Health-Care Profession: Implications for training.

This article places a magnifying glass on psychology's current training realities in the context of global health developments, particularly those of the Canadian health-care system. The authors argue that curriculum review and revision is needed to solidify psychology as a true health care profession; such a review should be proactive and must consider the likely changes in our overall health-care system. In preparing for anticipated changes in health care, it is proposed that curricula modifications be made to better reflect how psychology can contribute (in a broad fashion) to the health of Canadians. Two particular models for psychology's future role are offered for discussion: a) a modified, comprehensive parallel/vertical model that sees psychologists similar to other health-care providers; versus, b) a more innovative horizontal/cross-cutting model in which psychologists provide a unique blend of education, innovation, teaching, system consultation, prevention, as well as direct service provision, to patients with physical and mental health problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs about the helpfulness of interventions for mental disorders: a comparison of general practitioners, psychiatrists and clinical psychologists

OBJECTIVE: The aim of this study was to assess health professionals' beliefs about the helpfulness of a broad range of possible interventions for mental disorders. METHOD: The study involved a postal survey of 872 general practitioners (GPs), 1128 psychiatrists and 454 clinical psychologists. These health practitioners were presented with a vignette describing either a person with schizophrenia or one with depression. The vignettes were taken from an earlier survey of the general public. Respondents were asked to rate the likely helpfulness of various types of professional and non-professional help and of pharmacological and non-pharmacological interventions. RESULTS: Two-thirds or more of each profession agreed that the person with schizophrenia would be helped by GPs, psychiatrists, clinical psychologists, antipsychotic agents and admission to a psychiatric ward. Similarly, two-thirds agreed that the person with depression would be helped by GPs, psychiatrists, clinical psychologists, antidepressants, counselling and cognitive-behavioural therapy. However, there were also areas of disagreement. Psychiatrists were less likely than GPs and clinical psychologists to rate psychological and lifestyle interventions as helpful, while clinical psychologists were less likely to rate specifically medical interventions as helpful. Younger members of the professional groups and female members (who also tended to be younger) tended to rate a wider range of interventions for each disorder as likely to be helpful. CONCLUSIONS: Despite areas of broad agreement about treatment, health practitioners were more likely to endorse the interventions associated with their own profession. However, younger members of each profession tended take a broader view. If these age differences represent a cohort effect, health professionals may in the future show greater acceptance of the helpfulness of interventions offered outside their profession. These conclusions are limited by the methodology of the survey, which involved a questionnaire designed for the public rather than professionals.     

Introduction to the special section on assessment in psychological treatment: A necessary step for effective intervention.

Great changes are taking place in mental health treatment, because health care providers are placing constraints on therapists. Yet psychologists have been slow to react to these demands and have not incorporated personality measurement in treatment planning to address therapeutic effectiveness. Many therapists initiate therapy without obtaining a personality assessment in the early stages of therapy. Psychological assessment can, however, provide an effective means of detecting problems and motivation for therapy and can, if therapist test feedback is provided, serve to bring about desired behavior change more effectively than if assessment is not used. This Special Section is devoted to the potentially fruitful role psychological assessment can play in treatment planning. The contributors who were invited to write articles were chosen for their expertise in using psychological procedures in treatment planning. Their contributions provide important insights into methods for facilitating psychological therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Good psychologists must also be good citizens.

In the United States, the wealthiest nation in history, our nation, 43 million of our fellow citizens, including more than 6 million children, have no health insurance. Of those who do have insurance, the vast majority do not have mental health benefits. Among those who have insurance, increasing numbers are insured by for-profit HMO and managed care plans that limit provider selection, dictate patient care, and seem far more interested in the profits of shareholders and the compensation of CEOs than the well-being of patients. The average citizen, and, for that matter, the average professional acting individually, probably feels he or she has little direct ability to affect these and other issues facing our country. I want to dispel that notion and insist that individual psychologists, and psychology as a profession, are, in fact, influencing policy every day in Congress and in state legislatures. But there is much more to be done. The message of this article is that good psychologists, for their own benefit and for the benefit of their patients and their nation also must be good citizens. (PsycINFO Database Record (c) 2010 APA, all rights reserved)