Psychology Workforce Psychology Workforce Development for Primary CareDevelopment for Primary Care

Psychology Workforce Psychology Workforce Development for Primary CareDevelopment for Primary Care

Cynthia D. Belar, PhD, ABPP

Executive Director, APA Education Directorate

Cbelar@apa.org

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

Session #A4Session #A4October 29, 2011October 29, 201110:30 AM10:30 AM

ObjectivesObjectives• 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 DisclosureFaculty DisclosureFaculty DisclosureFaculty Disclosure

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

Workforce DevelopmentWorkforce DevelopmentPsychology as a Health Profession Psychology as a Health Profession

Workforce DevelopmentWorkforce DevelopmentPsychology as a Health Profession Psychology as a Health Profession

• Specialty mental health psychology

• Specialty clinical health psychology

• Primary care psychology

Current StatusCurrent StatusAPPIC DirectoryAPPIC Directory

Current StatusCurrent StatusAPPIC DirectoryAPPIC Directory

• APA accredited internships

• 101 (22%) major rotation

• 195 (42%) minor rotation

• 47 (37%) postdoctoral residencies

APA Board of Educational Affairs APA Board of Educational Affairs Primary Care Training Task ForcePrimary Care Training Task Force

Preliminary Survey ResultsPreliminary Survey Results

APA Board of Educational Affairs APA Board of Educational Affairs Primary Care Training Task ForcePrimary Care Training Task Force

Preliminary Survey ResultsPreliminary Survey Results

54% of doctoral programs

Roles/ServicesRoles/Services in Primary Care in Primary CareRoles/ServicesRoles/Services in Primary Care 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 AreasPsychological Service AreasPsychological Service AreasPsychological Service Areas

1. Prevention of illness/injury2. Coping with illness3. Preparation for stressful medical procedures4. Adherence to medical regimens5. Management of physical symptoms 6. Treatment of psychophysiological disorders7. Problems of health care providers and health

care systems. 8. Mental health disorders

Curricular AssumptionsCurricular AssumptionsCurricular AssumptionsCurricular 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

AssumptionsAssumptionsAssumptionsAssumptions• 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 Core Knowledge and Skills for Primary CarePrimary Care

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

Core Knowledge and SkillsCore Knowledge and SkillsCore Knowledge and SkillsCore 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 Core Competencies for Interprofessional Collaborative Interprofessional Collaborative

Practice (May 2011)Practice (May 2011)

Core Competencies for Core Competencies for Interprofessional Collaborative Interprofessional Collaborative

Practice (May 2011)Practice (May 2011)

Core Knowledge and SkillsCore Knowledge and SkillsCore Knowledge and SkillsCore 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 What are the distinctive competencies that psychology competencies that psychology as a discipline and profession as a discipline and profession bring to an integrated primary bring to an integrated primary

care system?care system?

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

care system?care system?

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

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

Implications for Research Implications for Research TrainingTraining

Implications for Research Implications for Research TrainingTraining

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

Similarity to Training in General Similarity to Training in General Professional PsychologyProfessional Psychology

Similarity to Training in General Similarity to Training in General Professional PsychologyProfessional Psychology

%Agreement

Radically different 23%

Moderately different 60%

More similar than different

15%

Synonymous 2%

Training ModelsTraining ModelsTraining ModelsTraining Models

Eastern Virginia Medical SchoolEastern Virginia Medical SchoolClinical Psychology Training ProgramsClinical Psychology Training Programs

Eastern Virginia Medical SchoolEastern Virginia Medical SchoolClinical Psychology Training ProgramsClinical 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 - EVMSSample Activities - EVMSSample Activities - EVMSSample 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 ModelTraining ModelTraining ModelTraining 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 Working with psychology trainees improves my communication with patients, families, my communication with patients, families, communities, and other health communities, and other health professionals. (Cubic, 2011)professionals. (Cubic, 2011)

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

0 10 20 30 40 50 60 70

Strongly Disagree

Somewhat Disagree

Somewhat Agree

Strongly Agree

Percentage of Respondents

The presence of psychology trainees at The presence of psychology trainees at the family residency sites has lead to an the family residency sites has lead to an increased emphasis on psychosocial increased emphasis on psychosocial issues overall. (Cubic, 2011)issues overall. (Cubic, 2011)

The presence of psychology trainees at The presence of psychology trainees at the family residency sites has lead to an the family residency sites has lead to an increased emphasis on psychosocial increased emphasis on psychosocial issues overall. (Cubic, 2011)issues overall. (Cubic, 2011)

Percentage of Respondents

BarriersBarriersBarriersBarriers

• Financial support – faculty and students

• Faculty expertise

Competent Supervisors Competent Supervisors Competent Supervisors 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 InitiativesAPA InitiativesAPA InitiativesAPA Initiatives

• Graduate Psychology Education Program (HRSA BHPr)

• APAPO Advocacy

• APA Online Academy - CE

• Patient Centered Primary Care Collaborative Executive Committee

Teaching Health CentersTeaching Health CentersTeaching Health CentersTeaching Health Centers

Education Advocacy TrustEducation Advocacy Trust(EdAT)(EdAT)

Education Advocacy TrustEducation Advocacy Trust(EdAT)(EdAT)

Need increased attention to:Need increased attention to:Need increased attention to:Need increased attention to:

• Faculty role models

• Interprofessionalism

• Financing

• Supervision

• Health Information Technology

Major Pedagogical IssueMajor Pedagogical IssueMajor Pedagogical IssueMajor Pedagogical Issue

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