Rehabilitation psychology practice, ethics, and a changing health care environment.

Rapid changes in the health care environment have brought about ethical and professional challenges for rehabilitation and rehabilitation psychology. The response of rehabilitation psychologists to the threats and opportunities of these challenges will have an impact on the welfare of persons with disabilities and the future of the profession. Managed care organizations have focused their efforts on the management of acute illness. Ethical concerns are being raised about patient access to care, self-determination, confidentiality, provider accountability, and marketing in managed care systems. Rehabilitation psychologists' skills in program development and outcome evaluation place them in a key position to influence the changes in the health care environment. To be effectual, however, fundamental changes must be made in research psychology practice, education and training, research focus, and professional activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preparing psychology and psychologists for new health care markets.

Because our training models in Clinical Psychology have not kept pace with the rapid changes in the health care marketplace, we may be in danger of preparing psychologists for markets that no longer exist. The next generations of psychologists will require the skills of the entrepreneur and the leader in addition to a range of core clinical skills. At the same time, our profession's historic commitment to science as the best epistemic game in town may founder if we fail to pay better attention to knowledge translation (i.e., how to move scientific findings expeditiously from the laboratory into practice). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical nutrition: opportunity in a changing health care environment

This article summarizes presentations from a satellite symposium, "Clinical Nutrition: Opportunity in a Changing Health Care Environment," held July 26, 1997, at the 37th annual meeting of the American Society for Clinical Nutrition in Montreal. The symposium was cosponsored by the American Society for Clinical Nutrition and the American Society for Parenteral and Enteral Nutrition. The diverse topics served as a practical forum for sharing information on innovative responses, concerns, and impediments in the rapidly evolving practice environment.     

Clinical health psychology: A health care specialty in professional psychology.

Clinical health psychology is a specialty recognized by both the American Board of Professional Psychology and the American Psychological Association. Clinical health psychology focuses on psychological and behavioral components of illness and health and promotes the understanding of psychology as a health profession. In this article the author reviews its definition, provides a brief overview of practice in the specialty, addresses its relevance for practitioners, and notes sample resources for further study. (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)     

Prescribing and primary care psychology: Complementary paths for professional psychology.

Two paths have been suggested for the future evolution of professional psychology. Prescribing psychology has already been legally authorized in two states, the military, and the Indian Health Service. Primary care psychology does not require legal recognition and has been slowly growing as a career option for psychologists across the nation. Both paths have their obstacles and limitations, but both are also associated with great potential. This article provides a brief summary of the strengths and weaknesses of each path and suggests an integrated perspective for planning the future of the profession. Each is seen as complementary to the other and providing a basis for pursuing the other. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The changing workforce: The role of health psychology.

Because the federal government is the largest payer of all health costs, unbridled increases in the health workforce have profound fiscal implications. Recent efforts to control health spending through modifications of health delivery systems are related to the consequences of the unlimited production of health professionals. However, the federal government has established processes to review physician workforce changes, and these mechanisms have become important in accessing federal training monies. Psychologists have no concerted workforce policy and receive little federal training money. Moreover, other health professionals have attained statutory authority to perform and provide the same services as psychologists. This diffusion of professional functions impedes the ability to assess the status of the workforce and the development of psychology as a health profession. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Promoting psychology in diabetes primary care.

Better diabetes management can be achieved by adding an explicit psychological component to diabetes treatment. Three cases are presented that illustrate how integrated assessment and psychotherapy can improve glucose control through three mechanisms: increasing patient acceptance of a disease state, enabling behavior change for self-care, and removing psychological barriers to disease control. Guidelines are suggested for standardized integration of psychology into diabetes care. The explicit treatment of psychological barriers to diabetes self-management would enhance standard medical practice, which normally relies on education to overcome treatment adherence problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Postdoctoral training in primary care health psychology: Duties, observations, and recommendations.

The need for postdoctoral training in health psychology has taken on added importance following transformations of the U.S. health care delivery system toward primary care models of delivery. This transformation provides psychologists with the opportunity to work as primary care practitioners, educators, and researchers, and it suggests the need for postdoctoral training that prepares students for those opportunities. The author addresses issues relevant to postdoctoral training from the perspective of a former participant in a postdoctoral fellowship training program in primary care health psychology. The duties and contributions of a primary care health psychologist are described. These include the provision of graduate medical education and clinical services tailored to primary care. The author also offers recommendations regarding postdoctoral health psychology training in order to enhance psychologists' ability to collaborate with medical professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality management for psychology services in health care facilities.

Describes a model of quality management, designed by a task force of the Canadian Psychological Association, to meet revised standards of the Canadian Council on Health Facilities Accreditation for psychology services. The incorporation of aspects of Continuous Quality Improvement, Total Quality Management, Indicators, and Benchmarking are discussed in relation to their application to psychology services in health care facilities. The Quality Management Model is based on the assumptions that everyone wants to do their job well and improve in their job performance; that the improvement in the quality of services is everyone's responsibility; and that psychological service provision in a health care facility involves complex linkages between providers, suppliers, and customers. The model also assumes that the major problems affecting quality of service are usually those same linkages, or the customers themselves; and that identifying and monitoring these linkages is crucial to understanding how to improve quality. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health care megatrends and health psychology.

Reviews the literature for historical, educational, and health care delivery system contributors to the field of health psychology, which is a major new area of professional practice that has emerged during a period of rapid changes in the health care industry. Four megatrends in medicine and health care are discussed that impinge upon health psychology: the "demythologization" of medicine, changing patterns of medical practice, "remedicalization" of psychiatrists, and alterations in financing health care. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology: Exploring issues.

Rehabilitation Psychology has several goals. One of its primary functions is to disseminate information that promotes the effective use of knowledge. While really new and current developments in rehabilitation interventions having psychological components may be known to the reader long before discussion of them appears in Rehabilitation Psychology, few "new findings" are dealt with to everyone's complete satisfaction. Many opinions exist about the efficacy of most innovative strategies; these conflicting views often are diverse, if not controversial. Therefore, it is helpful to provide professionals a forum in which they can discuss a problem and offer different viewpoints and perspectives that promote its resolution. I hope to make the journal such a forum within which these varying viewpoints can be heard. As Editor, I view Rehabilitation Psychology as being the single most significant organ through which the field can acquire additional clarity and identity. I view the role of Editor as being similar to that of a gatekeeper. The role entails major responsibility for ensuring that clinicians and academicians have an opportunity to present their findings and their opinions about critical issues facing the field. It is a role I hope to fulfill with competence and sensitivity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The health care revolution: Implications for psychology and hospital practice.

Suggests that the rapid escalation in health care costs and numbers of providers as well as the sharp increase in malpractice awards, increasing control through 3rd-party payers, and tighter regulation from professional monitoring organizations over the past decade have created a revolution in the health care sector of the economy. Psychologists and other health care professionals are experiencing drastic changes in their methods of practice, reimbursement, and referral sources that threaten their professional values, autonomy, and economic security. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managing risk in a changing health care system

This article examines the information requirements and other strategies needed to manage business and financial risk in health care organizations. The business and financial risk of providers in the changing health care market is defined. The major factors that are increasing risk are outlined, and strategies for measuring and managing risk are discussed. The interaction of business and financial risk is described, and strategic goals that will minimize the effect of this interaction are presented.     

Learning in a changing environment.

Multiple cue probability learning studies have typically focused on stationary environments. We present 3 experiments investigating learning in changing environments. A fine-grained analysis of the learning dynamics shows that participants were responsive to both abrupt and gradual changes in cue–outcome relations. We found no evidence that participants adapted to these types of change in qualitatively different ways. Also, in contrast to earlier claims that these tasks are learned implicitly, participants showed good insight into what they learned. By fitting formal learning models, we investigated whether participants learned global functional relationships or made localized predictions from similar experienced exemplars. Both a local (the associative learning model) and a global learning model (the Bayesian linear filter) fitted the data of the first 2 experiments. However, the results of Experiment 3, which was specifically designed to discriminate between local and global learning models, provided more support for global learning models. Finally, we present a novel model to account for the cue competition effects found in previous research and displayed by some of our participants. (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)     

Rehabilitation psychology and public health: Commonalities, barriers, and bridges.

Purpose: Those in rehabilitation and those in public health have worked to find a place in their respective disciplines. In this article, the author attempts to outline some of the commonalities inherent in the two areas, the barriers to joint work, and the bridges that may be able to allow a more comfortable interaction between the two. Conclusion: Practical realities in modern society have created the need for a closer bond among rehabilitation psychology, disability, and public health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Epilogue: Psychological interventions in the changing health care systems.

Psychotherapy has utility for a wide variety of circumstances that have significant economic, personal, and social consequences. This special issue is a small attempt to address some of these problems. There are important omissions, such as the frequent use of psychotropic medications in psychotherapy, psychological rehabilitation of patients and families with chronic health problems, and hospice care. The need for establishment of a national policy on how psychotherapy can be used to create more effective and humane solutions to societal problems has been identified. The challenge is how to fund the study of health and other social problems responsive to psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)