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)     

Rehabilitation: Psychology's greatest opportunity?

Rehabilitation (RHB) is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in RHB. Although psychologists have benefited from legislated membership in RHB, most individual psychologists and the psychological associations have not recognized the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy are necessary to secure the scope of professional practice most psychologists expect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Investing in our future: Unrealized opportunities for funding graduate psychology training.

Purpose: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. Conclusion: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists and Governmental Affairs.

Discusses the problem of why economists and political scientists are frequently called to high-level administrative posts in government while psychologists are not. Several suggestions are made, including the following: (1) An APA Central Office sponsored research program consisting of personal interviews with major and key personnel in various federal departments, beginning with the President, with the goal of preparing a program for the federal government on the employment of psychologists as consultants and advisers or as full-time employees. (2) A communication from the APA Central Office to all members of the APA or to a selected group of prominent psychologists indicating to them the desirability of establishing and maintaining liaison with local and state political party organizations for promoting psychology and psychologists. (3) The inclusion of federal nonpsychologist major party officials in convention programs as invited speakers on appropriate topics that link psychology with national affairs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association for the Advancement of Psychology: 1980.

Founded in 1974 under the auspices of the Council of Representatives of the American Psychological Association, the Association for the Advancement of Psychology (AAP) is a nonprofit corporation that interacts with all branches of the federal government in the interest of psychology and the public. AAP's public policy activities in Congress and the federal agencies in 1980 continued to focus on the elimination of discrimination with regard to the treatment of mental illness and to mental health professionals; opportunities for funding in research and training; the protection of constitutional rights without exception; and fairness in government regulations. The cumulative effect of the advocacy effort, the constant monitoring of annual congressional appropriations and authorization processes, and the greater sophistication of AAP's interaction with the American Psychological Association resulted in significant gains for mental health in federal health programs. The AAP convention program featured a panel of psychologists who entered into a lively debate on the role of AAP and its interaction with state psychological associations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Association for the Advancement of Psychology: 1983.

This article describes the public policy activities in Congress of the Association for the Advancement of Psychology (AAP), which is the recognized independent national advocacy arm of American psychology, representing the interests of psychology in the public policy arena. AAP's public policy activities in Congress continued to focus on the elimination of discrimination with regard to the treatment of mental illness and mental health professionals, increased federal funding of behavioral and social science research and research training, and the protection of constitutional rights without exception. AAP activities included working with other mental health advocacy groups to urge Congress to enact fiscal 1984 appropriations measures favorable to psychology, lobbying for various child-related federal programs in 1983, and legislation drafted by the AAP to eliminate current discrimination between physical and mental health benefits for the 10 million federal employees, annuitants, and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Public policy and public service: Our professional duty.

Psychology is a steadily maturing profession, and we psychologists are finally beginning to accept our societal responsibility to be involved in the public policy and political process. Although psychologists have shown increased involvement in the recent past, there are still many areas in which psychologists could become markedly more involved—especially in the area of programs that affect the quality of life of our nation's elderly, disabled, and poor citizens. As our profession seeks to become more active in the overall health care arena, we will, of necessity, begin to define the parameters of "quality of care" for other professions. In doing so, we must closely explore the "outer limits" of our own practice. We must ensure that all state and federal legislative (and administrative) policies do not impose arbitrary limitations on the scope of practice. To accomplish this objective, we must seek to influence our subset of our nation's health policy priorities and policies that we have traditionally shunned—the subset that affects "the public good." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of health care reform: Implications of 1994 elections.

The Republicans took control of both houses of Congress in November of 1994 for the 1st time in 42 yrs. Although the magnitude of the Clinton Administration's proposed Health Security Act may well have triggered fears of overcontrol, it is clear that the delivery of psychological care will be changed dramatically by the combined forces of federal and state health reform. R. J. Resnick, President of the American Psychological Association, has appointed the Task Force on Education and Training for Work in Organized Delivery Systems to look at how psychological health care is provided in the new and evolving systems, and to examine how current training programs prepare new psychologists to practice in and around organized health care systems. Dr. Resnick is similarly concerned about standardization of training, training in nontraditional areas of competence, and increased federal recognition and funding of training in psychology. (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)     

Improving Medicare coverage of psychological services for older Americans.

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A paradigm shift in the scope of practice for health psychologists: Training health psychologists to be primary care case managers.

Innovative programs in the Department of Defense have challenged health psychologists to broaden their scope of practice. To this end, health psychologists at Tripler Army Medical Center independently admit and discharge patients and serve as primary care managers during hospitalization and follow-up aftercare. A conceptual overview of the Tripler health psychology training philosophy and how the training model has guided Army health psychology in managing, rather than simply consulting, on the care of patients will be offered. Practical considerations and a training curriculum are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physician domination in the health care industry: The pursuit of antitrust redress.

Argues that the exclusion of qualified practitioners from the medical staffs of hospitals and the exclusion of psychological services from federal and commercial health care programs threaten the independent and autonomous practice of psychology in any national health insurance program. If psychological services are to be made available to consumers through such a program, psychologists must act now to preserve their status as independent professionals. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The critical importance of personal involvement.

Suggests that the deliberations surrounding Medicare may once again become the key to the enactment of national health care reform legislation and argues that if psychologists want to directly influence public policy, more of them must become personally involved in full-time advocacy and public policy work. Examples of federal policies that affect psychologists are discussed as well as the importance of joint psychology-law programs and the efforts of a psychologist and associate commissioner in Maine to shape a unified, outcome-driven mental health and mental retardation system. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pediatric consultation: New concepts in training.

Consultation-liaison has become increasingly important to the diversification of psychological practice. With the advent of national health proposals, the ability to service individuals (including the youth of this nation) in a variety of settings will be critical. This article describes a comprehensive training program in consultation-liaison child and adolescent psychology and encourages its adoption in other training programs. Psychology training programs will need to provide practice experiences in a variety of settings for psychologists to remain viable in an increasingly competitive mental health market place. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Difficulties in family practice residency training: Recommendations for training health psychologists in primary care settings.

We attempt to pursue a model for health psychologists by developing recommendations for behavioral science input into family practice residencies, gleaned from experiences of several health psychologists specifically trained to be directors of behavioral science programs of such medicine departments. This information is accumulated and based on a 7-year period at one university-based, inner-city program and two community-based hospitals. These recommendations are offered in the hope that health psychology training specialists will anticipate roadblocks associated with family practice residency training programs and will plan accordingly. Specifically, we make recommendations regarding program overview and training background, roadblocks (including medicine as the final authority), theoretical versus practical teaching orientation, resident time constraints, administrative support and priorities, and training effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing the societal contribution of organized psychology.

Encourages greater political involvement by psychologists and offers commentary on the experiences of 25 psychologists who have recently served on Capitol Hill. The current and potential contribution of psychology to a selected series of policy areas, including child health issues, care for the elderly, functional illiteracy, and criminal justice, is discussed. Also examined are the role and associated responsibilities of psychologists with regard to the health care field. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medicaid policy: Psychology's overlooked agenda.

Although psychologists are recognized as autonomous providers under almost every major federal health care initiative, they are not federally recognized as such under Medicaid because of Medicaid's unique federal–state partnership. State-by-state information on the access to psychologists under state Medicaid regulations are presented. As the move toward national health care reform becomes increasingly evident in the 1990s, psychologists have the responsibility and the opportunity to design innovative, behaviorally oriented health care delivery models in response to the national concerns of adequate coverage, access, and quality care. To do this, psychology as a profession must gain formal recognition under the various state Medicaid plans, either on a state-by-state basis or by way of federal mandates (as it was achieved by professional nursing). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health professions education: The shaping of a discipline through federal funding.

The federal government has been the single most dominant force shaping the development of health professions over the past 50 yrs. Described as both a patron and proprietor of health professions education, the federal government's role is a factor that health professionals cannot ignore. This article focuses on the 3 major federal initiatives (Veterans Administration training programs, Title VII of the Public Health Service Act, and Medicare's Graduate Medical Education) which have most significantly influenced the training in and development of the disciplines of psychology and medicine. The significance for psychology's involvement in national health policy, particularly during this era of reform, is highlighted. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How Changes in Population Demographics Will Impact Health Psychology: Incorporating a Broader Notion of Cultural Competence Into the Field.

U.S. population demographics are undergoing striking changes that will impact health care and the research and practice of health psychology. An increase in the number of people who are older; belong to an ethnic minority group; have disabilities; identify as lesbian, gay, bisexual, or transgendered; or live in poverty will influence definitions of aging, health, and illness, and will challenge current psychological and medical treatment models. The authors argue that health psychologists need to become context competent for the field to be relevant and viable over the course of this new century. Health psychologists need to become aware of the multiple, overlapping contexts in which people live and apply this knowledge on a regular basis to research, practice, education and training, and policy in health psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical and health psychology: Future directions.

Whether clinical psychology continues to comprehensively serve the public and to benefit from enhanced future professional opportunities depends significantly on its ability to extend the professional identity and mainstream activities of clinical psychologists beyond the current nearly exclusive focus on mental health. Clinical psychology needs to embrace all areas of health with the same vigor and skill that has been applied to mental health. This enhancement in professional role requires significant change in the educational approach of many Canadian clinical psychology doctoral training programs. Such suggested change will undoubtedly provoke much resistance. Considerable leadership will be required of our professional associations and accreditation bodies to encourage and guide the broadening of clinical psychology educational and training programs. Suggestions for educational reform are presented here to stimulate discussion rather than to provide a blueprint for the re-conceptualization of clinical training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)