Imagine working side by side with physicians to help a woman who comes to the emergency room thinking she is dying but is really having a panic attack. You slow her breathing and lower her heart rate by asking her to visualize herself in a green meadow, safe and calm. Later, you explain how her heart rate's natural fluctuations can trigger a cycle of fear and physiological responses that could lead anyone to the ER. Armed with this new knowledge, the woman calms herself when her next panic attack arises — avoiding further medical bills that she can't afford.
Two University of Arkansas psychology grad students treat such patients every day at Community Clinic, thanks to the federal Graduate Psychology Education (GPE) program. Created in 2002, GPE provides $3 million a year to 20 doctoral programs, hospitals and clinics that train psychology students to work with physicians, nurses, dieticians, audiologists and others to reach medically underserved populations. At the University of Arkansas, that funding also supports monthly discussions on the economic and social forces that affect the health of underserved populations and a course on integrated health care.
The Community Clinic, a nonprofit federally qualified health center, offers comprehensive health care to about 25,000 patients each year. Of these patients, the University of Arkansas' GPE trainees see about 600 for issues including depression and anxiety, help with managing diabetes, lowering blood pressure or even handling children with behavior problems, says University of Arkansas psychology professor Ana Julia Bridges, PhD.
"We are redefining clinical psychology as a health profession, and not just a mental health profession," she says.
A patient-centered curriculum
In one day, a trainee might see up to 15 patients for a variety of issues.
"You might be called to help a mom manage the behavior of her 22-month-old baby, a senior who recently lost her husband and is mourning and dealing with grief, and a 14-year-old who is depressed," says Debbie Gomez, a clinical psychology student who is completing her practicum in the clinic. "There's always more to be learned and more experience to gain."
To prepare for the clinic, the students take courses in integrated care, diversity and medical consultation.
"We're being immersed in different cultures and populations, which might affect how we treat all clients," says Freddie Anibal Pastrana, a clinical psychology student whose practicum was also funded by the GPE program. "Psychology is not about following one specific manual."
In addition, GPE trainees learn to conduct research in primary-care settings and to evaluate programs, Bridges says. For instance, Pastrana and fellow clinical psychology student Bianca Teresa Villalobos gathered and organized data on patients' primary complaints, satisfaction with care and how much their health improved. Next, the students will study how patients in their integrated care-clinic fare compared with patients treated in more traditional clinics.
Another student, Carlos A. Ojeda, is investigating whether patients benefit from seeing psychologists of the same ethnicity or who speak their language. So far, the group has found that more than 70 percent of patients who see a GPE trainee at least twice improve significantly.
The take-home message? GPE trains future psychologists while providing cost-effective behavioral care to people who would otherwise lack treatment, says Bridges. That's why Bridges and many of her students headed to Capitol Hill last year in August to explain the importance of the program to federal legislators.
"It's difficult in this climate when no one wants to spend a dime," says Bridges. "But we've showed that when you spend $1 with us, you save money in other places."
Because the program began three years ago, many of the University of Arkansas students who have benefited from GPE funding are just beginning to plot their careers. But all say integrated care will play a major role and they are grateful for the hands-on experience GPE helped to provide. Samantha Gregus, for instance, hopes to become a tenured professor at a research university, studying community clinics that treat underserved populations. Fellow student Arthur Andrews hopes to continue working in integrated care and someday train students of his own. Gomez sees herself overseeing a center similar to the Community Clinic while researching and improving on integrated care.
Regardless of their particular career paths, these students hope to be psychology's pioneers of integrated care.
"The integrated model sets the journey toward the future of psychology," says Ojeda. "We must collaborate with other health professionals to avoid being isolated."