Barbara A. Cubic

Competencies for psychology practice in primary care.

This article reports on the outcome of a presidential initiative of 2012 American Psychological Association President Suzanne Bennett Johnson to delineate competencies for primary care (PC) psychology in six broad domains: science, systems, professionalism, relationships, application, and education. Essential knowledge, skills, and attitudes are described for each PC psychology competency. Two behavioral examples are provided to illustrate each competency. Clinical vignettes demonstrate the competencies in action. Delineation of these competencies is intended to inform education, practice, and research in PC psychology and efforts to further develop team-based competencies in PC.

Psychologists and Primary Care Physicians: A Training Model for Creating Collaborative Relationships

For over a decade insurance reform, changes in health care delivery, reimbursement policies, and managed care have increased pressure on psychologists to diversify beyond traditional practices. Despite the negative impact of failing to make a transformation, most psychologists have not modified their practice and most training programs do not prepare psychologists to provide integrated care. The current paper describes the importance of primary care and psychology partnering to create integrated care models and makes the case that such partnerships are not only beneficial to patients but to both professions. The paper concludes with a description of a training model that has been implemented at the institution of the authors that provides opportunities for psychologists to learn how to practice in primary care settings.

Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.

ACGME Core Competencies: Helpful Information for Psychologists

The mission of the Accreditation Council for Graduate Medical Education (ACGME) is to improve graduate medical education in order to ultimately improve the quality of healthcare. To meet this mission the ACGME has firmly established a competency based focus for resident education. The current manuscript describes the six general ACGME competencies of Patient Care, Medical Knowledge, Practice-based Learning and Improvement, Interpersonal and Communication Skills, Professionalism and Systems-based Practice. Then, a brief description of efforts by the institution of the authors to create best practice models for competency based curriculums and outcomes is provided. Specific focus is on strategies used within the psychiatry residency and ways a Graduate Psychology Education grant fostered interdisciplinary training between psychology and family medicine that enhanced the development of competencies for both disciplines. The paper also comments on the training experiences and attitudes that can prepare psychologists to assist physician colleagues in meeting competencies.

Women Psychologists within Academic Health Systems: Mentorship and Career Advancement

Women are underrepresented on the faculties and within the senior leadership ranks of academic health systems. Nevertheless, despite the continuing existence of career development challenges related to gender, it is possible for women to thrive professionally in these settings. Mentorship is extremely important, and it is argued that effective mentorship is facilitated by an understanding of both gender differences in social behaviors and the culture of academic health systems. Furthermore, a systems’ level emphasis on faculty diversity and the career development of women faculty is recommended.

Pathways to success for psychologists in academic health centers: from early career to emeritus.

Careers in academic health centers (AHCs) come with a unique set of challenges and rewards. Building a stable and rewarding career as a psychologist in an AHC requires the efforts of a whole team of players and coaches. This paper outlines the characteristics of AHCs and the general skills psychologists need to thrive in this type of setting. Advice specific to each stage of career development (early, mid, and late) is offered, highlighting the themes of coaching and teamwork that are critical to success in an AHC.

Federal Funds to Train Clinical Psychologists for Work with Underserved Populations: The Bureau of Health Professions Graduate Psychology Education Grants Program

This paper describes the Bureau of Health Professions (BHPr) Graduate Psychology Education program (GPE), which supports projects that train health service psychologists for work with underserved populations. BHPr history and funding criteria are discussed, as are those of BHPrs parent organization, the Health Resources Service Administration. BHPr objectives and methods for support of clinical psychology training parallel those that BHPr has used to support training in other heath professions. The paper also describes three psychology internship training programs in academic medical settings that competed successfully for BHPr GPE funding in 2002. The three training projects differ significantly in training rotation sites, target populations with which trainees work, and the other health care professions that partner with psychology in interdisciplinary training—but they are similar in that each project provides an example of a program that effectively satisfied BHPr criteria for expanding psychologys scope of practice with underserved populations.

The train is leaving the station: is psychology aboard?

This special issue of the Journal of Clinical Psychology in Medical Settings (JCPMS) considers integrated care between psychology and primary care. This is not an altogether new subject, as individual journal papers and a range of books discussing aspects of the subject have been published for years. Strong advocates underscoring the importance of providing effective mental health services in primary care settings, such as Nicholas Cummings, William O’Donohue, Kirk Strosahl, Patricia Robinson, Andrew Pomerantz and Alexander Blount, have been trying to wake up the psychology community for years to the dilemmas created by two silos of health care. Despite previous writings on the subject we think this issue is unique for two reasons. The first is, the collection of papers represents a deconstruction of the construct of integrated care into its essential elements and then each paper addresses the key issues, such as clinical, operational, administrative, financial, training and research aspects to integrated care. The second, taken as a whole, the special issue explores whether psychology will play a meaningful role in the now rapid emergence of integrated care and we hope gives a call to action. The importance of integrated care has been increasingly embraced in the health care system. Whether a willingness to align psychology closer with medicine is growing within psychology is an open question, but psychology has made some contributions. Championing psychological treatments of medical patients, the American Psychological Association was instrumental in the American Medical Association’s adoption of the Health and Behavior codes and Medicare reimbursement of these codes nationally. However, despite Medicare adoption of these codes, acceptance of the codes by other financial pay sources has been unequal and providing a convincing argument to financial entities to do so has been left to individual practitioners efforts at the local coverage levels (Kessler, 2008). There are multiple systematic reviews each concluding, with limitations, that collaborative primary care is effective. Such initiatives have been undertaken by such organizations as the Cochrane Collaboration and most recently the Agency for Health Care Research and Quality (Gilbody, Whitty, Grimshaw, & Thomas, 2003; Butler et al., 2008). The Substance Abuse Mental Health Services Administration (SAMHSA) in partnership with the Health Resources and Services Administration (HRSA) recently authored a publication entitled Integration of Mental Health/Substance Abuse and Primary Care advocating the financing of behavioral health in primary care and outlining a set of recommendations for doing so (Butler et al., 2008). Even more recently the World Health Organization published its 2008 World Report (http://www.who.int/whr/ 2008/en/) entitled Primary Health Care––Now More Than Ever, a call for collaborative primary care across the world. Since 2003 SAMHSA has been funding a grant program entitled Screening, Brief Intervention, Referral and Treatment SBIRT (http://sbirt.samhsa.gov/) each grant being 10? million dollars over 5 years, to provide substance use and identification services within primary care and other settings. In an economic climate in which meeting attendance is in retreat, there is an annual meeting of the R. Kessler (&) Department of Family Medicine, and the Center for Translational Science, University of Vermont College of Medicine, 371 Pearl Street Burlington, Burlington, VT 05401, USA e-mail: Rodger.Kessler@UVM.edu

Establishing appropriate symptomatic control groups for the eating disorders

Two symptomatic control groups for the eating disorders were defined using high and low scores on the Dietary Restraint and Disinhibition scales of the Three Factor Eating Questionnaire. Clinical subjects diagnosed with anorexia and bulimia nervosa were compared with these symptomatic control groups using measures of body weight, bulimic symptoms, and anorexic symptoms. In comparison to the high-Restraint/low-Disinhibition group, anorexic subjects scored higher on measures of eating disorder symptoms but not on Restraint and Disinhibition. The high-Restraint/high-Disinhibition group differed from bulimia nervosa subjects on measures of eating disorder symptoms but did not differ on Restraint and Disinhibition. The results suggested that a control group defined by high Restraint and low Disinhibition formed an appropriate control group for anorexia nervosa. For bulimia nervosa, the most appropriate control group was defined by high Restraint and high Disinhibition.

Passing the Torch: The Future of Psychology in Academic Health Centers

From 1993–2006 the Journal of Clinical Psychology in Medical Settings (JCPMS) was under the helm of its founding editor, Ron Rozensky, Ph.D., and his editorial board. In 2007 a new editorial board will guide JCPMS. This manuscript outlines the anticipated driving forces for the future of JCPMS and highlights the challenges and opportunities the journal faces.