Literature Collection

In recent years, the subject of integrated healthcare, including the integration of behavioral health services into primary care, within the healthcare field has been increasingly of interest to researchers, providers, and policy makers. However, little is known about the experiences of providers within integrated care and the impact of these experiences on inter-professional relationships and collaboration. The researchers aimed to explore differences in providers' perspectives, including inter-professional collaboration and overall job satisfaction, by provider type and level of integration. The current study uses a mixed method exploratory approach, gathering both qualitative and quantitative data to investigate the perspectives of providers (both psychologists and physicians) on their work together. This study included 30 psychologists and 30 primary care physicians from three levels of healthcare integration (traditional/coordinated, co-located, and integrated). As hypothesized, results indicated that providers in integrated settings were the most satisfied with their collaboration with other providers. Furthermore, the providers' narratives revealed promising insights which contribute to a broader understanding of how to improve the relationships between psychologists and primary care physicians in integrated healthcare and other settings.

It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.

Recent literature, public policy, and funding opportunities call attention to the need for better increased integration of health and mental health care services in primary care settings so as to best meet the needs of children and families. There are many benefits to such integration, but pediatric primary care providers (PCPs) face multiple barriers to identifying and managing patients with mental health difficulties. One way to address this problem is through the integration of psychologists into primary care settings who can collaborate with PCPs to provide integrated behavioral health care to youth and families. However, there are challenges to collaboration, which include differences in training, professional cultures, and expectations held by professionals from various disciplines. Effective communication is a key component in supporting interprofessional collaboration between primary care providers and psychologists working in primary care settings. This paper reviews aspects of pediatric medicine culture, critical components of communication, and strategies to improve communication. Three case examples are presented in which some of these challenges have been successfully addressed. Implications and future directions are discussed.

INTRODUCTION: Primary care providers need to be able to effectively recognize and treat common mental health concerns. Foundational mental health training is typically embedded into physician assistant (PA) didactic training; while essential, students in didactic training may not yet recognize the relevance and clinical nuances of these presentations. To better prepare university-based PA students to address mental health in primary care, a 4-session interdisciplinary psychosocial skills enhancement group was developed for second-year students and conducted over 3 years. This weekly virtual group was facilitated by a doctoral-level student in clinical psychology and attended by PA students in their family medicine rotation (n = 204). Students presented patient cases, provided feedback to fellow students, developed case conceptualizations, and engaged in didactics. METHODS: After completing the group, participants received a survey assessing their satisfaction, perceived improvements in behavioral health knowledge and comfort, and suggestions for refining the group. Descriptive analyses and qualitative content analyses were conducted. RESULTS: Survey results were overall positive, indicating that students felt more prepared to treat behavioral health conditions and enjoyed having a group facilitator from outside their program with expertise in psychology. Qualitative results suggested the benefits of increased reflective practice, improved peer support, and appreciation for didactic psychosocial content. DISCUSSION: Given the prevalence of behavioral health concerns in primary care, incorporating an interdisciplinary training and supervision component may be an effective way of increasing clinical competencies, enhancing professional well-being, and better meeting future patient needs.