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)     

Telehealth Brain Injury Training for Rural Behavioral Health Generalists: Supporting and Enhancing Rural Service Delivery Networks.

Rural psychologists are frontline primary behavioral health care providers for nearly 60 million Americans, but they face limited access to peer consultation and continuing education. This article describes a program that matched 70 rehabilitation inpatients who had new brain injury with rural clinicians from patients' home communities. Neuropsychologists provided one-on-one training for clinicians through telehealth video teleconferencing. Clinicians showed gains in brain injury knowledge, and clients rated trained providers higher than untrained providers. Families seeking brain injury services can connect with these trained rural providers through a Web site, which receives more than 800 hits per month. Telehealth offers potential for rural clinicians to receive support, reduce professional isolation, gain working knowledge of specialty conditions, and deliver high-quality services for their rural clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The economics of behavioral health services in medical settings: A summary of the evidence.

The health care system in the United States, plagued by spiraling costs, unequal access, and uneven quality, can find its best chance of improving the health of the population through the improvement of behavioral health services. It is in this area that the largest potential payoff in reduction of morbidity and mortality and increased cost-effectiveness of care can be found. A review of the evidence shows that many forms of behavioral health services, particularly when delivered as part of primary medical care, can be central to such an improvement. The evidence supports many but not all behavioral health services when delivered in settings in which people will accept these services under particular administrative and fiscal structures. (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)     

Clinical Supervision in Rural Settings: A Telehealth Model.

The task of providing supervisory services to clinical interns, trainees, and new psychologists in rural settings is often complicated by a host of environmental and economic constraints. Given the reemergence of telecommunication applications as a means of transcending similar obstacles in service delivery, the authors discuss the use of telecommunication technology as a means of enabling the traditional supervisor-supervisee relationship in settings in which face-to-face contact is difficult if not impossible. The evolution of telesupervision is discussed, followed by an outline of an integrated model of telesupervision and the goals, benefits, and challenges associated with the use of telecommunications technology in clinical supervision. (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)     

Pay for performance in primary and specialty behavioral health care: Two "concept" proposals.

Incipient pay-for-performance (P4P) plans offer to improve the quality of general medical care, but they have not yet begun to influence clinical outcomes in the behavioral health care arena. Following a brief review of the quality chasm in behavioral health care and some initial applications of P4P programs, this article presents 2 bird's-eye view proposals with which the primary and behavioral specialty care sectors of the American health care system can begin to design and implement P4P incentives. Discussion of the value of behavioral health care, the Provider Quality Index, P4P implementation issues, implications for practicing psychologists, and some cautionary notes conclude the article. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of physical health functioning, mental health, and sociodemographic factors in determining the intensity of mental health care use among primary care medical patients.

The present study examined sociodemographic and attitudinal predisposing factors (gender, age, marital status, health insurance, household income, attitudes about mental health care), and need/illness variables (depression severity, physical and mental health functional status) as predictors of past-year mental health care use intensity (i.e., visit counts) and use/nonuse. The sample included 283 adult primary care patients from the Midwestern United States in a cross-sectional study. Nonlinear regression models demonstrated that past-year treatment use intensity was significantly associated with both married status and poorer physical health functioning, while the use (vs. nonuse) of treatment was associated with depression severity. A sociodemographic and attitudinal multivariate predictor model only explained 5% of the variance in treatment use intensity, but a need/illness model significantly contributed an additional 23% variance. Poorer physical health functioning was significant in predicting treatment use intensity, while depression severity was significant in predicting the use (vs. nonuse) of treatment. Results demonstrate the particular importance of physical health problems in determining the intensity of mental health care use, and depression severity in determining the use/nonuse of treatment, notwithstanding the restricted sociodemographic contour of the sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depression in ethnically diverse women: Implications for treatment in primary care settings.

What do health care practitioners need to know about providing adequate care for depressed minority women? This article examined the prevalence of depressive symptoms and clinical depression in ethnic minorities, the extent to which current health service utilization is congruent with needs, and the effectiveness of treatments provided to ethnic minorities in the primary care setting. The impact of ethnic minority women's sociocultural context on symptom expression and help-seeking behavior is also discussed. Finally, the clinical implications for accurate assessment and treatment of ethnic minority women by both medical and mental health practitioners working in the primary care sector are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The need for continuing education in ethics as reported by rural and urban mental health care providers.

Continuing professional education (CPE) sponsors planning events for mental health care licensees can assure better attendance if they can successfully address the needs of their target audience. Offering topics of interest is particularly crucial when CPE events need to draw large numbers of attendees to be financially viable. A survey of nearly 400 health licensees regarding CPE needs, especially as related to ethics, revealed that the greatest interest in such CPE was reported by master's-level mental health care providers. Topic areas with the greatest draw were the management of clients who present with special issues (e.g., substance abuse, medical illness, or cultural diversity) and competent management of colleague misconduct and impairment, rather than more traditional ethics issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting outcome in computerized cognitive behavioral therapy for depression in primary care: A randomized trial.

Objective: To explore pretreatment and short-term improvement variables as potential moderators and predictors of 12-month follow-up outcome of unsupported online computerized cognitive behavioral therapy (CCBT), usual care, and CCBT combined with usual care for depression. Method: Three hundred and three depressed patients were randomly allocated to (a) unsupported online CCBT, (b) treatment as usual (TAU), or (c) CCBT and TAU combined (CCBT&TAU). Potential predictors and moderators were demographic, clinical, cognitive, and short-term improvement variables. Outcomes were the Beck Depression Inventory–II score at 12 months of follow-up and reliable change. Results: Those with higher levels of extreme (positive) responding had a better outcome in CCBT compared with TAU, whereas those having a parental psychiatric history or a major depressive disorder diagnosis had a better outcome in CCBT&TAU compared with TAU. Predictors regardless of treatment type included current employment, low pretreatment illness severity, and short-term improvement on clinical variables. Conclusions: Optimistic patients, holding approach-oriented coping strategies, might benefit most from CCBT, whereas CCBT&TAU might be the most suitable option for those with more severe vulnerability characteristics. Those with the least impairment improve the most, regardless of treatment type. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral health in the pediatric primary care setting: Needs, barriers, and implications for psychologists.

Pediatric primary care providers (PPCPs) are increasingly being called on to assess children and adolescents for emotional and behavioral disorders, as well as to manage their care. The authors present the results of a survey of PPCPs regarding their comfort in assessing or diagnosing and treating or managing 19 emotional and behavioral problems, their expectations of how reasonable it is for PPCPs to assess and treat disorders, the actions they would take, barriers they face, and interest in developing formal relationships with mental health specialists. The authors discuss implications and opportunities for psychologists. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"The dismantling of our health system: Strategies for the survival of psychological practice": A reply to Cummings.

Comments on the original article, The dismantling of our health system: Strategies for the survival of psychological practice by Nicholas A. Cummings (see record 1986-22651-001). In response to this article, the current author says "no, no, no!" He believes that "survival with this degree of compromise amounts to doing anything for a buck." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An introduction to psychologists treating medically ill patients: Competent practice and seeking credentials in organized health care settings for routine or incidental practice.

Psychology has been recognized as a health care science and profession, and psychologists have been working clinically with medically ill patients and within organized health care settings and hospitals for decades. The potentially daunting environment of organized health care should be seen by psychology as an opportunity to further develop and expand its scope of practice. With knowledge of that environment's rules, regulations, ethics, bylaws, and traditions, the clinically competent psychologist who is first seeking to practice in hospitals should succeed alongside psychologists with busy practices who are already exclusively or occasionally within an organized health care setting or medical facility. This article reviews issues of competency, credentialing, privileges, bylaws, and practice expansion to guide psychologists toward a successful hospital practice with medically ill patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)