Psychology Workforce Development for Primary Care Cynthia D. Belar, PhD, ABPP Executive Director, APA Education Directorate Collaborative Family Healthcare Association 13 th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A. Session #A4 October 29, :30 AM

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.

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

Workforce Development Psychology as a Health Profession Specialty mental health psychology Specialty clinical health psychology Primary care psychology

Current Status APPIC Directory APA accredited internships 101 (22%) major rotation 195 (42%) minor rotation 47 (37%) postdoctoral residencies

APA Board of Educational Affairs Primary Care Training Task Force Preliminary Survey Results 54% of doctoral programs

Roles/Services in Primary Care Consultation (case centered and systems centered) Assessment and triage Psychological interventions Health promotion and disease prevention Team building Research (incl. QI) Program development Administration Supervision Education and Training

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

Curricular Assumptions Primary care psychologists are generalists. E&T 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

AssumptionsAssumptions 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

Core Knowledge and Skills for Primary Care 1.Biological components of health and disease 2.Cognitive components of health and disease 3.Affective components of health and disease 4.Behavioral and developmental aspects of health and disease 5.Sociocultural components of health and disease McDaniel, Belar, Schroeder, Hargrove, Freeman (2002)

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

Core Competencies for Interprofessional Collaborative Practice (May 2011)

Core Knowledge and Skills 11. Ethical issues in primary care 12. Legal issues in primary care 13. Professional issues in primary care

What are the distinctive competencies that psychology as a discipline and profession bring to an integrated primary care system?

All health service providers in psychology should have skills in conducting practice- based research.

Implications for Research Training Large N research Outcomes research Program evaluation Health measurement Health policy analysis Needs assessment Cost benefit models Multidisciplinary teams

Similarity to Training in General Professional Psychology % Agreement Radically different23% Moderately different60% More similar than different 15% Synonymous2%

Training Models

Eastern Virginia Medical School Clinical 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)

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

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)

Working with psychology trainees improves my communication with patients, families, communities, and other health professionals. (Cubic, 2011) Percentage of Respondents

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

BarriersBarriers Financial support – faculty and students Faculty expertise

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

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

Teaching Health Centers

Education Advocacy Trust (EdAT)

Need increased attention to: Faculty role models Interprofessionalism Financing Supervision Health Information Technology

Major Pedagogical Issue When in the doctoral curriculum is it best to begin experiential training in primary care?