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)     

Psychology's Role in Health in Canada: Reaction to Romanow and Marchildon.

The article reacts to Romanow and Marchildon's article (see record 2003-09748-001). Notwithstanding its high cost, the current Canadian health-care system provides Canadians with minimal access to publicly funded psychological services in spite of their demonstrated efficacy, comparative cost advantages, minimal risk of adverse treatment effects, and the public's preference for these services. Psychological services are now available not only for mental health problems but also for a wide range of physical health problems. A great deal of illness is preventable; population health research has illuminated the links between illness and risky individual behaviours, which are amenable to psychological intervention. These approaches have been shown to be effective in promoting health-enhancing behaviours that reduce morbidity and mortality. Nevertheless, the primary focus of the present health-care system is on the increasingly expensive detection and treatment of disease, often with expensive equipment and pharmaceuticals, rather than on the prevention of illness and health promotion. We believe that the current Canadian health-care system is not sustainable in the long run in its present form. We urge governments to act to provide Canadians with greater access to psychological services and we urge psychology education and training programs to ensure that students are adequately prepared to assume a larger role in a reformed health-care system. (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)     

Foundations for Medical Care.

Notes that, in California, what began as the San Joaquin County Medical Society's answer to Kaiser-Permanente (i.e., the San Joaquin Foundation for Medical Care) has spread to a growing movement that is now nationally recognized as a viable, effective, competitive model of health care delivery. Each foundation is a federation of fee-service practitioners into an organizational entity that can contract to provide designated services on a prepaid basis within a geographical area. This gives the foundation for medical care (FMC) many of the attributes of the health maintenance organization, and indeed, they are recognized in the Health Maintenance Organization Act of 1973, PL 93-222, as individual practice associations (D?rken, 1974). Additional details about the foundations are provided, including the participation of practicing psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital Health Care Delivery.

This article provides an overview of the articles that compose the Public Forum section of the American Psychologist. These articles explore the roles of psychologists (past, present, and future) in hospitals and the range of services that are or might be provided by the profession. (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)     

Infant Mental Health: Making a Difference.

Practicing psychologists are increasingly identifying serious problems in behavior, emotional development, and regulation in infants and very young children that result in impaired family functioning and relationships. Often these child challenges are in combination with a range of parental concerns including addictions, homelessness, teen parenthood, and unresolved feelings from the past. Infant mental health (IMH) is a broad field encompassing theory, research, and interventions with very young children and their families. This article provides an overview of IMH concepts, with special focus on assessment and interventions that can be integrated into the psychologist's current practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychologists as Leaders of Multidisciplinary Chronic Pain Management Teams: A Model for Health Care Delivery.

Psychologists have the potential to improve the quality of life of chronic pain patients by intervening not only through direct services but also by using their training for promoting proactive leadership in multidisciplinary teams and in the larger health care environment. To significantly impact pain management, psychologists must not only deliver state-of-the-art care but also take an active role in directing the design, implementation, and evaluation of these programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rehabilitation Psychologist as Health Care Executive: A Platform for Professional Diversification.

These are the best and worst of times in health care. Technological advances are offset by critical staff and cash shortages. Strong leadership is needed to navigate these challenges, yet the industry faces a widening leadership void. The effective psychologist possesses 5 specific competencies ("planks") that are well matched for success as a health care executive: clinical, relational, analytical, methodological, and ethical. By applying these competencies, rehabilitation psychologists can enhance their organizations and open new pathways for personal and professional growth. A 6th competency, financial, represents a unique "give and take" position that is portrayed through a replication and extension of J. G. Wiggins's (1994) analysis of careers in psychology. It is concluded that advocacy for our clients, our field, and ourselves is served by rehabilitation psychologists' achieving health care executive positions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Building Systems of Care for Children With Chronic Health Conditions.

Objective: To describe the leadership role that rehabilitation psychologists can play in improving the health care delivery system for children with special health care needs (CSHCN). Setting: Midwest academic health center and surrounding communities. Participants: Children with chronic health conditions and disabilities and their families. Intervention: A model research demonstration project designed to promote family-centered, comprehensive, coordinated, and community-based care for CSHCN. The project aims to enhance environmental supports for CSHCN and their families in 2 ways: (a) by improving the ability of primary care providers to deliver effective chronic care management and (b) by integrating this improved clinical practice into an enhanced Medicaid managed care service delivery system for persons with chronic illness and disabilities. Conclusions: Psychologists have the potential to improve the quality of life of CSHCN and their families by intervening not only through direct services but also by promoting positive changes in the larger health care environment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Transforming Mental Health Care for Children and Their Families.

In April 2002, the President's New Freedom Commission on Mental Health was created by executive order to study the mental health care delivery system in our nation and to make recommendations for improvements so that individuals with serious mental disorders can live, work, learn, and fully participate in their homes and communities. In its report, "Achieving the Promise: Transforming Mental Health Care in America," the commission provided strategies to address critical infrastructure, practice, and research issues. This article focuses on the work of the commission's Subcommittee on Children and Families, describing its vision for mental health service delivery for children and providing suggestions for strengthening community-based care for youths with or at risk of behavioral health disorders. Training, research, practice, and policy implications for psychologists are discussed. (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)     

New directions in children's mental health policy: Psychology's role.

The policies that influence the practice of children's mental health affect psychologists across the nation. Major recent events have brought this topic to the attention of national policymakers at the highest level and have created opportunities for psychologists to present information regarding recent scientific advances in the treatment of childhood disorders and to be involved in the development of solutions to address the needs of our nation's children. This article reviews these recent events, summarizes current knowledge in the field, and addresses specific issues and critical gaps in current national policies on children's mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Psychologists: The Backbone of the VA Health Care System.

Veterans returning from Iraq and Afghanistan are presenting in large numbers with serious mental health needs. Chairman Akaka addresses this concern and the role of the Department of Veterans Affairs in caring for those in need of mental health services. (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)     

Review of Professional psychology in transition.

Reviews the book, Professional psychology in transition by Herbert D?rkin and Associates (see record 1986-97926-000). This edited volume is a must for at least two groups of psychologists in Canada: (1) those interested in expanding and strengthening their share of the psychological services market; and (2) those interested in the development of psychology as a profession. The book contains three sections. The first, entitled "Trends in the Profession," documents the nature, scope, and influence of psychology's 45,000 licensed psychologists in the US. Sections 2 and 3 move us closer to the Canadian experience. Section 2 focuses on training and practice issues, and should be read by all those who train professional psychologists. Section 3 deals with economics and competition and presents us with some intriguing glimpses of our future. The book is highly recommended. (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)