Psychology Workforce Development for Primary Care

1. Session #A4 October 29, 201110:30 AM Psychology Workforce Development for Primary Care Cynthia D. Belar, PhD, ABPP Executive Director, APA Education Directorate Cbelar@apa.org Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Objectives • Identify workforce development needs for psychology as related to primary care and the changing health care system. • Identify distinctive competenciesthat 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.

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

4. Workforce DevelopmentPsychology as a Health Profession • Specialty mental health psychology • Specialty clinical health psychology • Primary care psychology

5. Current StatusAPPIC Directory • APA accredited internships • 101 (22%) major rotation • 195 (42%) minor rotation • 47 (37%) postdoctoral residencies

6. APA Board of Educational Affairs Primary Care Training Task ForcePreliminary Survey Results 54% of doctoral programs

7. 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

8. Prevention of illness/injury Coping with illness Preparation for stressful medical procedures Adherence to medical regimens Management of physical symptoms Treatment of psychophysiological disorders Problems of health care providers and health care systems. Mental health disorders Psychological Service Areas

9. 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

10. 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

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

12. 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

13. Core Competencies for Interprofessional Collaborative Practice (May 2011)

14. Core Knowledge and Skills • Ethical issues in primary care • Legal issues in primary care • Professional issues in primary care

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

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

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

18. Similarity to Training in General Professional Psychology

19. Training Models

20. 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)

21. 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

22. 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)

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

24. 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

25. Barriers • Financial support – faculty and students • Faculty expertise

26. 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

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

28. Teaching Health Centers

29. Education Advocacy Trust(EdAT)

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

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