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)     

Community Health Centers: Exciting Opportunities for the 21st Century.

What are important and increasingly available settings for psychologists interested in practicing primary behavioral health care? Community health centers (CHCs) represent the medical "safety net" for millions of uninsured and medically underserved Americans. The recent push to expand mental health services at CHCs creates the need for psychologists and other mental health providers, particularly those familiar with primary behavioral health care approaches. Federal funding to recruit and retain psychologists at CHCs has increased along with opportunities for multidisciplinary service approaches and training. The potential ways in which psychologists can respond to demonstrated societal needs and develop new clinical skills and methods at CHCs are described. (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)     

Psychology and health.

This article traces the historical development of Canadian medicare and its significant influence on shaping not only the clinical services provided within Canada's public health care system but also its major impact on the nation's overall health research agenda. Particular emphasis is placed on how this has influenced the development and role of psychology in the public health care system. It is argued that all psychologists, whether their work is focused on the applied or experimental areas of the discipline, have much to offer Canadians across the entire health care spectrum. Nevertheless, psychological services in the public health care system, and particularly in hospitals, have mainly developed within and continue to be primarily focused around mental health. Services in nonmental health areas of health have been more limited, although their importance is well recognized. The current situation partly reflects the limited training in general health issues that clinical psychologists-in-training generally receive in many graduate school programs in Canada. However, it also reflects the overall influence of medicare on the development of Canada's health care system. Medicare has tended to focus the activities of Canada's health care system primarily on treating illness rather than on preventing it and/or maintaining health. Also, medicare has oriented Canada's health care system mainly toward delivering medical services rather than providing more comprehensive health services (e.g., the "medically necessary" criterion for funding). However, times are changing. The growing emphasis among health policymakers in Canada on illness prevention and health promotion (e.g., the creation of the federal government Public Health Agency of Canada in 2004) will significantly expand psychology's role across all areas of health. Psychology education and training programs are urged to seriously examine whether psychology practitioners and researchers are being adequately prepared at present for the much broader array of future interdisciplinary professional, research, and educational activities and responsibilities that will emerge. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

La psychologie et la santé.

This article traces the historical development of Canadian medicare and its significant influence on shaping not only the clinical services provided within Canada's public health care system but also its major impact on the nation's overall health research agenda. Particular emphasis is placed on how this has influenced the development and role of psychology in the public health care system. It is argued that all psychologists, whether their work is focused on the applied or experimental areas of the discipline, have much to offer Canadians across the entire health care spectrum. Nevertheless, psychological services in the public health care system, and particularly in hospitals, have mainly developed within and continue to be primarily focused around mental health. Services in nonmental health areas of health have been more limited, although their importance is well recognized. The current situation partly reflects the limited training in general health issues that clinical psychologists-in-training generally receive in many graduate school programs in Canada. However, it also reflects the overall influence of medicare on the development of Canada's health care system. Medicare has tended to focus the activities of Canada's health care system primarily on treating illness rather than on preventing it and/or maintaining health. Also, medicare has oriented Canada's health care system mainly toward delivering medical services rather than providing more comprehensive health services (e.g., the "medically necessary" criterion for funding). However, times are changing. The growing emphasis among health policymakers in Canada on illness prevention and health promotion (e.g., the creation of the federal government Public Health Agency of Canada in 2004) will significantly expand psychology's role across all areas of health. Psychology education and training programs are urged to seriously examine whether psychology practitioners and researchers are being adequately prepared at present for the much broader array of future interdisciplinary professional, research, and educational activities and responsibilities that will emerge. (PsycINFO Database Record (c) 2010 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)     

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)     

Psychological Treatments.

Psychology has recently identified itself as a health care profession and codified this change in the bylaws of the American Psychological Association. Although psychologists make a number of contributions to the nation's health-and mental health-the most identifiable activity focuses on treating physical or psychological pathology with psychological interventions. Recently, health care policymakers have established that evidence supporting the efficacy of these interventions is more than sufficient for their inclusion in health care systems around the world. To promote faster and more widespread dissemination of these interventions specifically targeting problems severe enough to be included in health care systems and to solidify the identification of psychology as a health care profession, perhaps it is time for a change in terminology. It is proposed that psychologists label these procedures psychological treatments so as to differentiate them from more generic psychotherapy, which is often used outside of the scope of health care systems. (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)     

Comparison of public/private health care insurance parameters for independent psychological practice.

Managed care cost-cutting strategies are more prevalent in the private (employer provided) than public (Medicare/Medicaid) health care sectors. The main organizational managed care strategy pertaining to the independent practice of psychology has been the separation of the administration of mental from medical health care though behavioral health carve-outs. These organizations typically offer lower reimbursement rates and have greater preauthorization requirements than non-managed care public plans for the same psychological service. Dispute resolution in the private sector involves lawsuits and state consumer protection programs while public plans utilize internal review and are subject to investigations of provider billing fraud and abuse. Behavioral health carve-outs have reduced mental health care utilization rates with unknown effects upon outcome. There is some evidence that psychologists have chosen to limit practice within the private sector, but national data on the overall effect is lacking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Evolution of Behavioral Primary Care.

The financing, organization, and delivery of behavioral health care services has undergone dramatic change in the past 25 to 30 years. The authors trace the evolution of behavioral health care delivery in the United States over the past several decades and find (a) that the value of mental health "carve-outs" has diminished greatly and that they are being replaced by "carve-ins," (b) that primary care physicians (PCPs) are becoming a primary source of mental health care secondary to the introduction of new medications, and (c) that PCP treatment of mental health disorders is suboptimal. The authors conclude that the behavioral health care system is entering an era of flux as it experiments with ways of integrating behavioral and primary care. Opportunities for psychologists are explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychology, spirituality, and end-of-life care: An ethical integration?

With an increased focus on multidisciplinary care, psychologists are being called to work within palliative care teams. Spirituality is often a salient issue for palliative individuals, and has significant implications with respect to psychological functioning. This paper discusses the incorporation of spirituality/religion into psychological end of life care, with a focus on the biopsychosocial-spiritual model of health, and the consideration of spirituality/religion as an aspect of cultural diversity. Discussion also surrounds the ethical integration of spirituality/religion into psychological assessment and treatment, as well as recommendations for clinical training. An overall theme of this article is that attending to the spiritual needs of palliative individuals is important to fulfill one's ethical responsibilities as a psychologist. Thus, seeking ways to ethically integrate these concepts into psychology training and practice remains an essential endeavour. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost offset: Past, present, and future.

The health of the U.S. health care system is precarious. Calls for reform in areas such as cost, quality, and equal access to health care are widespread and growing louder each day. Action is required on each of these issues, yet the lack of progress is cause for serious concern. A central problem is the reluctance to acknowledge the roles that the mind and behavior play in health and illness. One solution is the integration of psychological health care into the general health care system. A major vehicle for advancing the integration of health care is the "cost-offset" effect, a concept that involves paying systematic attention to psychological factors in order to reduce overuse of medical services and thereby decrease costs. Despite data demonstrating that the cost-offset hypothesis is quite robust, little has been done to implement integrated health care. This article reviews the literature on cost offset, discusses the policy implications, and considers its application to the public sector. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Primary Care Psychology Training on Campus: Collaboration Within a Student Health Center.

Applied psychological services are being implemented into the primary care treatment milieu to improve patient treatment and reduce health care costs. Unfortunately, few psychologists have training specifically oriented to working in this setting. A predoctoral training program wherein psychology graduate students may obtain practicum experience working in a student health center on a university campus is described. The theoretical underpinnings of this training are based on the integrated primary care models of K. Strosahl (1997) and K. Strosahl, N. Baker, M. Braddick, M. Stuart, and M. Handley (1997), which emphasize integration of psychological and medical treatment, brief intervention, consultation, and expedited referral for longer term cases. Though many issues remain, integrated primary care offers promise for improved health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Shaping the Future of Psychological Services in the Canadian Health-Care System: A Response to Romanow and Marchildon (2003).

Our response to Romanow and Marchildon's article (see record 2003-09748-001) on the role of psychology in the Canadian health-care system focuses on two challenges that emerge from the article, namely the continuing marginalization of mental health services and the dominance of political considerations over compelling scientific evidence for the impact of psychological services on health and recovery from illness. We conclude our comment with calls for (a) continuing efforts to educate policymakers, the media, and Canadians about the value of psychological services and (b) active involvement from psychologists in efforts to develop new models of primary health care in Canada. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing suicide risk in primary care: Practice recommendations for behavioral health consultants.

Psychologists working in primary care clinics can have a significant positive impact on preventing suicide. For psychologists working within the behavioral health consultant (BHC) model in primary care, however, the issue of how to appropriately manage suicide risk within this model has yet to be adequately addressed. Given the time-limited and focused nature of the BHC model, it is important to establish a framework for psychologists to provide adequate care that is practical within this model of health care. This article offers 26 empirically supported recommendations for suicide screening, accurate and time-efficient risk assessment, and effective risk management strategies, as well as suggestions for consultation with primary care physicians, all of which are consistent with the BHC model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)