The hospital practice of psychology.

Outlines California laws that enable clinical psycholgists to practice in hospitals and residential health care facilities. Survey data indicate that when projected nationally, the number of licensed psychologists who hold appointments to the organized medical staff of a hospital is approximately 6,800. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interdisciplinary collaboration in outpatient practice.

Psychology has had a long history of collaboration with the medical profession. This collaboration has been greatly enhanced over the past decade or more as an increasing number of psychologists have become successful in applying the science and practice of psychology to the problems of health and illness. This article reviews and summarizes salient aspects of professional issues in practice that contribute to successful collaboration with physicians in primary and tertiary ambulatory health care settings. Practical strategies to enhance collaboration in independent practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The APA and Deafness.

Until the 1960s, people who were Deaf and mentally ill lacked access to psychological treatment. Few mental hospitals and clinics had interpreters available, and few psychologists and mental health professionals had knowledge of sign language. Major court decisions and federal laws have effected change, culminating with the Americans With Disabilities Act of 1990. This legislation gave people who are Deaf the right to equal access to mental health care as well as a host of other opportunities they had been previously denied. New access laws allowed Deaf students to become educated as psychologists, and a number of hearing psychologists who knew sign language entered the field of deafness. These two groups assumed vital roles within the American Psychological Association in addressing the issue of mental health access for people who are Deaf. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital psychology in Canada.

Examined Canadian hospital psychology in terms of the existing organizational models, professional practices, academic activities, and professional orientations of hospital psychologists in a survey of 340 hospitals. Results reveal that psychologists were active clinically and academically in Canadian hospitals in a wide variety of health care areas in addition to traditional mental health areas. In the majority of hospitals, psychologists were organized in independent departments of psychology or behavioral science, although physician influence appeared to be a strong factor in practice. Medical staff membership and academic appointments for hospital psychologists were relatively low. Recommendations for the future development of hospital psychology in Canada are outlined. (French abstract) (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Preparation for the delivery of telehealth services: A self-study framework for expansion of practice.

Linked to increasing consumer demand for access to health care information and to the worldwide expansion of telecommunication services, telehealth has emerged as a new domain of practice within professional psychology. Psychologists who plan to incorporate telecommunication technologies (e.g., Internet and point-to-point videoconferencing) into their practices should first conduct a self-assessment and then enhance their knowledge and skills in using these alternative forms of service delivery. The current article provides a self-study framework, known as STEPS, for psychologists to use in planning for telehealth practice. STEPS focuses on 5 key domains of telehealth practice and organizes specific self-study questions around each of these domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A step in the right direction: A resource for collaboration on health-related issues.

Reviews the book, Health-related disorders in children and adolescents edited by L. Phelps (see record 1998-07780-000). This edited text provides an overview of 96 medical conditions that place children at risk of developing psychological or educational problems. The central feature of this book is that it is intended as a reference tool for professionals who collaborate with medical professionals. Increasingly, there have been many vehicles for school psychologists to collaborate with medical professionals, including comprehensive school health care programs and school-based health clinics, and community-based coordinated services that provide children and youth comprehensive care. In this regard, school psychologists are likely to encounter increasing numbers of children who experience health disorders, along with more traditional areas of practice including mental health and educational issues. Although not a purely medically oriented text, Phelps has taken a perspective that school psychologists work within the context of a multidisciplinary team of professionals who are likely to provide services for these children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communication and records: Hippa issues when working in health care settings.

To refocus awareness on the original mandate of the Health Insurance Portability and Accountability Act (HIPPA) regulations, this article will review record keeping requirements and examine patient-doctor and interdisciplinary communication as a way to improve the health care consumer's trust in the privacy of their personal information while facilitating integrated and fluid health care delivery systems. The HIPPA rules especially important in medical settings are discussed with a special emphasis on issues confronting psychologists who practice outside of medical institutions and hospitals. The article also examines important implications for practice activities when psychologists attend patients who are hospitalized. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Training psychologists for evidence-based practice.

Evidence-base practice (EBP) is now commonplace in many health care services and, in recent years, there has been a healthy debate about the role of EBP in psychology. In this article, I provide information on the nature of EBP and how it is consistent with professional training models and standards in psychology. In discussing some of the concerns that have been raised about the value of EBP in psychology, I present research findings on the relevance and potential impact of evidence-based assessment and treatment practices. Finally, after highlighting the promise of EBP, I offer some recommendations for how training efforts in professional psychology should be refocused in order to optimally prepare current and future psychologists to practice in an evidence-based manner. (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)     

Bereavement care in general practice: a survey in South Thames Health Region

BACKGROUND: Studies have shown that bereaved individuals suffer increased rates of physical and mental ill health. Bereavement support has recently been advocated as an area of prevention in primary care, with suggestions that general practitioners (GPs) should adopt protocols for the active follow-up of their bereaved patients, which relies on the early notification of deaths by hospitals and hospices. Little is known about the routine care currently provided by GPs and primary health care teams (PHCTs) to support their bereaved patients. AIMS: To explore GPs' perceptions of patient death notifications by hospitals and hospices. To describe practice policies relating to patient deaths and the provision of bereavement support. METHOD: Postal questionnaires were sent to senior partners of a random sample of 500 general practices in South Thames Health Region. RESULTS: Three hundred and fifty-three practitioners responded (71%). Hospitals were perceived to be significantly slower than hospices in notifying deaths (P < 0.0001). One hundred and ninety-six practices (56%) kept death registers, 230 (65%) discussed deaths together, and 142 (40%) identified bereaved relatives. One hundred and thirty-seven practices (39%) routinely offered bereaved relatives contact with a PHCT member; while 133 (38%) supported only those who asked for help. Routine support was significantly more likely to be provided by practices that kept a death register, discussed deaths together, identified bereaved relatives, and had a special interest in palliative care. CONCLUSIONS: GPs perceive hospitals to be slower than hospices at notifying deaths, particularly in the first 24 hours. They are divided over whether bereavement support should be proactive or reactive. Keeping a practice death register, discussing deaths together, and identifying newly bereaved relatives are activities related to providing routine bereavement care.     

Mixed Professional Corporations.

In this article, the author argues that it is past time for psychology to regard itself simply as a mental health profession and to recognize itself as the health profession it is. It is as broad as the state acts that license, certify, or register its practice. It is as broad as direct recognition/freedom of choice state laws delineate. It is noted that many psychologists in practice have established cordial referral and other working relationships with family practitioners, pediatricians, internists, psychiatrists, and other medical specialists. Generally, these interdisciplinary relations are informal and based on mutual regard. Occasionally, the basis is joint membership in a business, as distinct from a professional corporation. Over 20 states have laws that proscribe organized group practice. However, if private sector health care delivery is to be comprehensive, effective, and viable, a medium must be found to enable health practitioners of different disciplines to engage in professional corporate practice as colleagues. A new California law helps set the stage and may prove to be a useful model. With this law, California becomes the third state in which psychologists can engage in multidisciplinary corporate practice with physicians. By enabling the formation of multidisciplinary professional corporations wherein psychologists and physicians may practice as colleagues, these laws open a new avenue for the delivery of this broadened range of professional services to the public and further establish, in statute, a collaborative basis for practice among psychologists and physicians. (PsycINFO Database Record (c) 2010 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)     

Crossing the Quality Chasm in Behavioral Health Care: The Role of Evidence-Based Practice.

The concept of evidence-based practice (EBP) is one receiving increasing attention from providers, managers, payers, and regulators of care, yet practical guidelines for professional psychologists who may be interested in incorporating EBPs into their own work settings are not available. The author explores the pragmatics of EBP adoption within the broad context of quality problems in American health care, particularly as described in a heralded 2001 publication by the Institute of Medicine. Concrete suggestions are offered to help practitioners locate EBP resources for specific clinical problems, use an evidence hierarchy to infer "best practices," address the science-to-service management challenge, and generate outcomes data and feedback loops to continuously improve clinical effectiveness. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Considerations for ethical practice in managed care.

How does one maintain an ethical practice while facing the requirements and limits of a health care system that is dominated by managed care? Psychologists are increasingly raising such questions about ethical issues when working in or contracting with managed care organizations. The authors review the process involved in ethical decision making and problem solving and focus on 4 areas in which ethical dilemmas most commonly arise in a managed care context: informed consent, confidentiality, abandonment, and utilization management-utilization review. The need for sustained and organized advocacy efforts to ensure patient access to quality health care is discussed, as is the impact of managed care's competitive marketplace on professional relationships. Hypothetical examples of typical dilemmas psychologists face in the current practice environment are provided to illustrate systematic ethical decision making. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health psychology practice with asthmatics.

Behavioral and psychological problems associated with physical diseases can be most effectively and efficiently cared for by health psychologists/clinical psychologists who specialize in the care of such problems and who practice as independent professionals sharing responsibility for patient care with physicians treating the disease itself. If the optimum care of independent health psychology practice is to be realized, however, there must exist well-defined spheres of responsibility for each profession. The present article suggests 9 area divisions of responsibility (e.g., medication overuse, malingering, and noncompliance) in caring for asthmatics. (29 ref) (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)     

Hospital practice: Psychology's call to action.

The general public has recently made demands for continuity of care in psychological services from outpatient settings to inpatient facilities and back. These demands plus 3 economic and structural modifications within the nation's health-care arena, including the incursion of for-profit health-care corporations into the health delivery industry, the 1985 Joint Commission of Accreditation of Hospitals decision to include nonphysician providers on hospital medical staffs, and the 1990 California Supreme Court Decision (CAPP v. Rank) ensuring full medical staff participation by California psychologists, have opened the doors to the independent practice of psychology in hospitals, rehabilitation centers, nursing homes, and day treatment facilities. This article presents current professional realities for psychologists in hospitals and health-care settings and reviews the work of the American Psychological Association in support of hospital independent practice. (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)