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Primary Care and Psychology – American Psychologist Special Issue May/June 2014

The current issue of American Psychologist is a special issue featuring Primary Care and Psychology.The scholarly lead article, “An Introduction to Primary Care and Psychology,” is written by Susan H. McDaniel and Frank V. deGruy, III. The abstract states that “This article introduces psychologists to the fundamental changes taking place in primary care and to the various roles that psychologists can play in the new health care system.” Following the introductions are groups of articles addressing Clinical Primary Care Across the Lifecycle; Special Populations;  and Education, Research and Evaluation, and Policy. Among the authors are deGruy and C.J. Peek, who serve on the National Integration Academy Council (NIAC), and Benjamin F. Miller and Deborah J. Cohen of the Academy Team.

These articles provide an excellent overview of the integration of behavioral health in primary care (BHPC) and discuss the possibilities of various types of collaboration. The application of this approach is discussed as it relates to children with special needs, persons with serious mental illness, refugees, and deaf people. The experience of the U.S. Departments of Defense and Veterans Affairs, with the BHPC model is also discussed. Workforce issues are addressed in terms of competencies for psychologists in primary care practices, and the colocation of providers. The importance of research and evaluation are discussed as they apply to the transformation of primary care. One of the resources for this lies in accessing the knowledge and skills of psychologists to understand what works best in practicing psychology in the primary care setting.

A feed with abstracts of the articles is available at: http://content.apa.org/journals/amp.rss

Links to the full documents are at: http://psycnet.apa.org/journals/amp/69/4/

 

Get Your Latest News Via the Academy

Stay current with the latest news! Access timely topical news that’s relevant to the integration of behavioral health and primary care. You can access the Latest News stories through the portal topical pages or under News Archives.

Click on the topical pages below where you can see recently posted Latest News items:

Policy & Financing

  • The Paradox of Parity

Clinical & Community

  • Commentaries on the "Joint Principles: Integrating Behavioral Health Care into the Patient-Centered Medical Home"

 

 

Integrated Care in Psychiatry

Paul Summergrad, M.D., President of the American Psychiatric Association, and NIAC member Roger Kathol, M.D., CPE, are the editors of a newly published book titled Integrated Care in Psychology: Redefining the Role of Mental Health Professionals in the Medical Setting. This publication serves as “a guide to implementing behavioral health in inpatient and outpatient medical setting, emphasizes the importance of understanding the dynamic interaction between physical and mental conditions,” and is useful to psychiatrists at all stage in their careers.

In the book, the authors call for coordination of care for patients with co-occurring physical and mental health conditions and argue that major improvements needs to happen quickly to change the delivery of  psychiatric care. Currently, the medical and psychological models of care are segregated and have competing “subcultures that have resulted in a lack of dialogue among health providers, administrators, and payers–and thus in less than optimal patient outcomes.” To solve this problem, Kathol and Summergrad offer a “road map” to “truly coordinated, patient-centered care where the care experience for the patient, the medical care itself, and the cost outcomes improve as the system changes from fee-for-service to population-based health.” This book is a major contribution to the literature and a wonderful resource for clinicians, policymakers, payers, administrators, and anyone interested in integrated care.

The book can be previewed and purchased online.

AHRQ Releases National Healthcare Quality and Disparities Reports 2013

In May 2014, the Agency for Healthcare Research and Quality (AHRQ) released the National Healthcare Quality Report (NHQR) and the National Healthcare Disparities Report (NHDR) for 2013. Since 2003, AHRQ has “reported [annually] on progress and opportunities for improving health care quality and reducing health care disparities.” The 2013 NHQR and NHDR monitored “more than 200 health care process, outcomes and access measures” prior to implementation of insurance expansions and protections under the Affordable Care Act. As they do each year, the reports emphasized a specific population: “people with disabilities, including children with special health care needs and adults with multiple chronic conditions.” Findings of the reports indicate that across all health quality measures tracked, 60% showed improvement. Improvements also occurred across all racial, ethnic, and income groups. And although one-third of access measures worsened for the overall U.S. population from 2000-2002 to 2010-2011, according to the new reports, a number of these access measures have improved for Hispanics and people who are poor. With regard to Integration, the reports discuss patient-centeredness and emphasize the need for better patient-provider communication, more family engagement, culturally and linguistically appropriate services, and shared decision-making. Finally, the NHQR and NHDR assert that health care in the U.S. is in dire need of coordinated care especially for people with “multiple chronic medical conditions.” In turn, coordinated care will improve patient outcomes and reduce costs.

Access the reports: http://www.ahrq.gov/research/findings/nhqrdr/index.html

Psychologists in Primary Care—Experiences at DoD

Date: 
Tue, 06/10/14

The U.S. Department of Defense (DoD) was a pioneer in the integration of behavioral health and primary care and is widely acknowledged as an exemplar. This article by Christopher Hunter, et al. reviews the development of integrated behavioral health care in the DoD primary care clinics. The authors explain the crucial role of psychologists in this process. In addition to successfully promoting integrated care as a core component of the DoD patient-center medical home (PCMH), psychologists played key roles in policy development, the development and implementation of training programs, clinical care, and program evaluation.

The article goes into detail, providing information on the different approaches taken across service branches, the structural and funding issues across the DoD, a description of the shifts made in a clinic implementing the behavioral health in primary care, and the primary care physician perspective. The authors end by saying that, while psychologists played a significant role in the development and implementation of integrated care programs in DoD clinics, there is still a lot to be done and psychologists will continue to have a significant role as the process moves forward in the DoD clinics.

Based on their experience, the authors provide 9 recommendations for psychologists to consider, depending upon the role they play in integrated care. They conclude by stating: 

“As the nation faces significant changes in its health care system, the diverse contributions of psychologists in the DoD, from direct clinical care to policy development, suggest that psychologists are critical for implementing integrated care in systems throughout the United States.”

 

Hunter CL, Goodie JL, Dobmeyer AC, et al. Tipping points in the Department of Defense’s experience with psychologists in primary care. American Psychologist 2014 May-Jun; 69(4): 388-398. doi: 10.1037/a0035806

 

NOTE: This article is one of 11 in American Psychologist - Journal of the American Psychological Association, Special Issue: Primary Care and Psychology

The article may be accessed at: http://psycnet.apa.org/journals/amp/69/4/388/

The abstract and related citations may be found at: http://www.ncbi.nlm.nih.gov/pubmed/?term=Tipping+points+in+the+Department+of+Defense%E2%80%99s+experience+with+psychologists+in+primary+care.

Get Your Latest News Via the Academy

Stay current with the latest news! Access timely topical news that’s relevant to the integration of behavioral health and primary care. You can access the Latest News stories through the portal topical pages or under News Archives.

Click on the topical pages below where you can see recently posted Latest News items:

Clinical & Community

  • An Introduction to Primary Care and Psychology
  • Psychologists in Primary Care - Experiences at DOD

An Introduction to Primary Care and Psychology

Date: 
Tue, 06/10/14

This article by Susan H. McDaniel, PhD, and Frank V. deGruy III, MD, MSFM, serves as the introduction to the recent special issue of American Psychologist , the journal of the American Psychological Association (APA).  The authors point out that

“The value of primary care turns on its comprehensiveness, which means that behavioral health care-health behavior change, mental health care, management of psychological symptoms and psychosocial distress, and attention to substance abuse-must be woven into the fabric of primary care practice. This integration is beginning to happen as psychologists and other behavioral health clinicians are incorporated as essential team members in the patient-centered medical home and other emerging models of primary care.”

The article introduces psychologists to the changes evolving in primary care and the variety of roles for psychologists as the new health care system emerges in the U.S. The authors go on to explain the many aspects of primary care transformation, such as policy, research and education, and the roles psychologist play in each facet. Each of these facets is further explicated in the subsequent articles in this special issue of the APA journal.

To view the abstract, go to:  http://www.ncbi.nlm.nih.gov/pubmed/24820682

The full article may be obtained at:  http://psycnet.apa.org/journals/amp/69/4/325/

American Psychologist – BH Integration Featured in Special Issue

American Psychologist Features Integration in Special Issue

The American Psychological Association (APA) featured behavioral health integration in a Special Issue: Primary Care and Psychology, published in May-June 2014.

The articles were developed through collaborations between psychologist and primary care physician authors. Susan H. McDaniel, PhD, and Frank V. deGruy, III, MD, MSFM, provided the lead article, An Introduction to Primary Care and Psychology.

Many of the 11 articles in this special issue will be featured on the Academy Portal in this and upcoming updates.

Public Knowledge about Mental Health Parity

A recent survey, commissioned by the American Psychological Association (APA) as part of their mental health parity awareness initiative, indicates that only 4% of Americans know that health insurance is mandated to cover mental health, behavioral health, and substance abuse disorders as it does physical health. Despite the increase of national discussions about mental health services, people are no more of aware of the Mental Health Parity and Addictions Equity Act (MHPAEA) than they were in 2010. Moreover, 90% of the American public has never heard of “parity” according to Katherine Nordal, executive director for professional practice at APA. In the six years since MHPAEA was passed, she would have thought that the average consumer knew more. Nordal calls for “public education to let [consumers] know how their insurance benefit is changing and allow them to seek treatment,” especially now when mental health and substance use treatment is an essential health benefit under the Affordable Care Act. Thirty million people are expected to receive health coverage through Medicaid and the insurances exchange, which includes mental health care. Under MHPAEA, insurance companies are required to provide behavioral health coverage benefits equal to or better than coverage for physical health benefits. There can be no annual limits, and copays and deductibles must be equal to or less than those for medical benefits.

Nevertheless, “cost and whether or not providers [will] accept insurance” is one of the major barriers for consumers with regards to accessing services. “Financial concerns outweigh stigma,” Nordal says. She adds that many people do not read over their health insurance policy unless they have to. According to the survey, 29% of Americans said that their insurance has different co-pays or limits on mental health care, 24% said they aren’t sure if their insurance provides the same coverage for mental and physical health, and just 56% of people said that their insurance covers seeing a psychologist or other mental health professionals. Furthermore, “when asked what information they would need before being treated by a psychologist or mental health professional,” 75% of consumers said they would have to know if they accepted insurance. These findings suggest that consumers ultimately need to know that their mental health co-pays will be low since they compare to co-pays for medical benefits. Still, psychologists are hopeful that with vanishing economic barriers, more patients will get the evidence-based psychological help they need.

Read the related press release: https://www.apa.org/news/press/releases/2014/05/mental-health-coverage.aspx

Access resources on the mental health parity law: http://www.apa.org/helpcenter/parity-law-resources.aspx

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