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)     

Moving toward a broader model of health care.

This article looks at how we can move toward a broader model of health care. It discusses advances in U.S. health care, the issue of health care coverage for all Americans, the need for a biopsychosocial model of health care, and the impact that psychologists can make in improving health. (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)     

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)     

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)     

The integration of psychology into primary care: Personal perspectives and lessons learned.

The purpose of this article is to discuss the integration of psychology into a Veterans Affairs Medical Center Primary Care clinic, as experienced by the authors. There has been an evolving need for psychology's presence in primary care, due in part to the increasing number of primary care patients who present with complex physical and psychological issues, as well as institutional procedures for first-line treatment of more common mental health concerns (e.g., depression). Concurrent with the expansion of Medical Center services and patient population, an increasing demand has been placed upon psychology in primary care. To better accommodate the workload, a consultation-oriented model of treatment has been implemented. Within this integrated model, primary care providers and psychologists collaborate to provide multidisciplinary care. (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)     

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)     

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)     

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)     

Training for the future of psychology practice.

This article responds to the Eby et al. (this issue, pp. 57–68) paper on issues and dilemmas for the future of training for psychology practice. The author addresses these issues and discusses them in regards to our identity as psychologists and changes in training needed in light of the recent passage of federal health care reform legislation. The changes in health care include the importance of training to work in integrated health care systems, primary care, using electronic health records, and dealing with health disparities. Training recommendations from the 2009 APA Presidential Task Force on the Future of Psychology Practice are presented. (PsycINFO Database Record (c) 2011 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)     

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)     

Public policy and the provision of psychological services to older adults.

Public policy shapes who delivers health care, how care is delivered, and how much providers are paid. The impact of public policy will become even more important to psychologists who serve older adults as 76 million members of the so called “baby boom” generation enter their later years. Armed with basic public policy facts, psychologists can better maneuver the systems created by public policy and even change policy. This article reviews how Medicare works since it is the primary payer of mental health services for older adults. The article then turns to the question of how many health care professionals (including psychologists) will be required to meet the needs of a rapidly growing older population and concurrent challenges of training and building that work force. Finally, different policy visions for a better mental health care system for older adults are summarized since they may be roadmaps to what the future of mental health care will look like. The article closes with practical recommendations on how psychologists can influence mental health and aging public policy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

American Indian mental health policy.

Examines the utilization and delivery of mental health services for Native Americans (NAs). Delivery systems discussed include the Indian Health Service, the Bureau of Indian Affairs, university- and urban-based care, and tribal mental health care. It is noted that many NAs view mental illness as a justifiable outcome of human weakness and as a result of excessively individualistic behavior. Treatment of disturbed individuals is considered a community matter. Psychologists often try to impose their values on NAs. It is suggested that psychologists need to become familiar with mental health prevention processes. Recommendations for improving service provision and policies toward NAs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation psychology in primary care: Preparing for a changing health care environment.

Restructuring of health care delivery systems has deemphasized tertiary and specialty services with a resultant increase in primary medical care. These reform efforts are anticipated to continue, highlighting the need for rehabilitation psychologists to expand beyond tertiary care settings to sustain the growth and prosperity of their profession. New models of service delivery and training are needed to help them transition into the new health care environment. A recently developed model for integrating behavioral medicine into primary care may serve as a guide. In this paper we discuss a model for integrating behavioral science into the medical management of primary care patients. The model is applicable to the functions and philosophy of rehabilitation psychologists. A discussion of the new model and its relation to rehabilitation psychology is provided along with implications for predoctoral training and strategies for overcoming barriers to primary care integration. (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)