Psychology Workforce Development for Primary Care

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Psychology Workforce Development for Primary Care
Session A4 October 29, 20111030 AM

• Cynthia D. Belar, PhD, ABPP
• Executive Director, APA Education Directorate
• Cbelar_at_apa.org

Collaborative Family Healthcare Association 13th
Annual Conference October 27-29, 2011
Philadelphia, Pennsylvania U.S.A.
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Objectives

• Identify workforce development needs for
  psychology as related to primary care and the
  changing health care system.
• Identify distinctive competencies that psychology
  as a discipline and a profession brings to
  health.
• Describe a promising training model in
  collaborative care.
• Identify challenges to workforce development in
  psychology.

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Faculty Disclosure

• I have not had any relevant financial
  relationships during the past 12 months.

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Workforce DevelopmentPsychology as a Health
Profession

• Specialty mental health psychology
• Specialty clinical health psychology
• Primary care psychology

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Current StatusAPPIC Directory

• APA accredited internships
• 101 (22) major rotation
• 195 (42) minor rotation
• 47 (37) postdoctoral residencies

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APA Board of Educational Affairs Primary Care
Training Task ForcePreliminary Survey Results

• 54 of doctoral programs

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Roles/Services in Primary Care

• Team building
• Research (incl. QI)
• Program development
• Administration
• Supervision
• Education and Training

• Consultation (case centered and systems centered)
• Assessment and triage
• Psychological interventions
• Health promotion and disease prevention

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Psychological Service Areas

1. Prevention of illness/injury
2. Coping with illness
3. Preparation for stressful medical procedures
4. Adherence to medical regimens
5. Management of physical symptoms
6. Treatment of psychophysiological disorders
7. Problems of health care providers and health care
   systems.
8. Mental health disorders

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Curricular Assumptions

• Primary care psychologists are generalists.
• ET must be biopsychosocial and systemic.
• A lifespan, developmental approach
• A focus on prevention and wellness
• Collaborative care by an interprofessional team
  in partnership with the patient and family

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Assumptions

• Attention to patient-family, doctor-patient, and
  healthcare team relationships
• Primary care psychologists are experts in
  behavioral health assessment and treatment,
  psychopathology, family and systems issues, and
  research skills.
• Primary care psychology is practiced in a variety
  of settings, including clinics, private
  practices, community hospitals, academic
  medical centers

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Core Knowledge and Skills for Primary Care
McDaniel, Belar, Schroeder, Hargrove, Freeman
(2002)

• Biological components of health and disease
• Cognitive components of health and disease
• Affective components of health and disease
• Behavioral and developmental aspects of health
  and disease
• Sociocultural components of health and disease

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Core Knowledge and Skills

• 6. Health policy and health care systems
• 7. Common primary care problems
• 8. Clinical assessment of common primary care
  conditions
• 9. Clinical interventions in primary care
• 10. Interprofessional collaboration

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Core Competencies for Interprofessional
Collaborative Practice (May 2011)
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Core Knowledge and Skills

• Ethical issues in primary care
• Legal issues in primary care
• Professional issues in primary care

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What are the distinctive competencies that
psychology as a discipline and profession bring
to an integrated primary care system?
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All health service providers in psychology should
have skills in conducting practice-based research.
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Implications for Research Training

• Large N research
• Outcomes research
• Program evaluation
• Health measurement
• Health policy analysis
• Needs assessment
• Cost benefit models
• Multidisciplinary teams

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Similarity to Training in General Professional
Psychology
Agreement
Radically different 23
Moderately different 60
More similar than different 15
Synonymous 2
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Training Models
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Eastern Virginia Medical SchoolClinical
Psychology Training Programs

• Barbara Cubic, PhD
• GPE training grants
• Internship APA accredited for 31 years
• 5 interns, 1 postdoc, 2-3 graduate students
• Ghent Family Medicine Residency (5)
• Portsmouth Family Medicine Residency (5)

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Sample Activities - EVMS

• Joint patient care delivery
• Didactics
• Interdisciplinary Case Conferences
• Primary Care Rounds
• Joint precepting/supervision
• Specialized training in cultural diversity and
  unique needs of PC patients
• Briefing papers for patients and providers

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Training Model

• Psychology trainees function as part of the
  medical team and are part of all provider
  activities
• Direct patient care (assessment, treatment and
  consultation)
• Program development/evaluation
• Quality improvement efforts
• Staff training
• Patient centered outcomes research
• Teaching (ACGME competencies)

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Working with psychology trainees improves my
communication with patients, families,
communities, and other health professionals.
(Cubic, 2011)
Percentage of Respondents
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The presence of psychology trainees at the family
residency sites has lead to an increased emphasis
on psychosocial issues overall. (Cubic, 2011)
Percentage of Respondents
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Barriers

• Financial support faculty and students
• Faculty expertise

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Competent Supervisors

• Competent to practice in the area themselves
• Provide immediate access
• Skilled in interprofessional conflicts
• Prepare students re physical illness
• Prepare students in self-assessment

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APA Initiatives

• Graduate Psychology Education Program (HRSA
  BHPr)
• APAPO Advocacy
• APA Online Academy - CE
• Patient Centered Primary Care Collaborative
  Executive Committee

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Teaching Health Centers
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Education Advocacy Trust(EdAT)
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Need increased attention to

• Faculty role models
• Interprofessionalism
• Financing
• Supervision
• Health Information Technology

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Major Pedagogical Issue

• When in the doctoral curriculum is it best to
  begin experiential training in primary care?