Practice Profile

She may be in independent practice, but clinical health psychologist Helen L. Coons, PhD, rarely treats a patient alone. As president and clinical director of the Philadelphia-based Women's Mental Health Associates, a private practice dedicated to improving the well-being of women coping with cancer and chronic medical conditions, Coons works side by side with primary-care physicians, obstetrician/gynecologists, physical therapists, oncologists, genetic counselors, nutritionists--even plastic surgeons--to enhance her patients' health.

Women's Mental Health Associates holds formal rental agreements at three private health-care offices--a multi-specialty women's practice, an obstetrician/gynecologist office and a reproductive endocrinology center--and sees more than 30 patients per week. By planting her practice in primary-care and specialty settings, Coons can work with clients in a place that's convenient and familiar for them. This leads to increased access to mental health and health psychology services when they're needed, she says.

"As others have noted, primary care is the de facto mental health system today," Coons says, "so why not be in that system?"

This collaborative setting also ensures that Coons is in sync with a patient's other health-care providers to better coordinate patient care. Patients appreciate receiving their care from an integrated team of providers, she says.

"We're all working together to support the patient in her journey to maximize her well-being," Coons says.

Teaming up

On a typical day, you'll find Coons and her colleague Trudy D. Helge, PsyD, working with women experiencing perinatal depression, infertility and pregnancy loss and chronic and life-threatening medical conditions such as cancer. They often see women with breast cancer who may be coping with the illness's effect on their sexual well-being or worried about a recurrence. At other times, Coons and Helge may be offering a "curbside consult"--where they are brought in on the spot to weigh in on a patient's health, mental health or psychosocial concerns.

Working closely with medical professionals across disciplines creates a level of trust among providers that leads to improved health and mental health outcomes, says Ann Honebrink, MD, medical director at Penn Health for Women at Radnor, in Radnor, Pa., who has collaborated with Coons for 13 years. Honebrink says that having psychologists available in her office improves her patients' access to mental health services and helps destigmatize treatment. Plus, ongoing and frequent discussion between the psychologist and medical practitioner often improves both parties' ability to render care.

"We just do a better job caring for patients when we're all in the same place," says Honebrink.

For example, last year, Coons and Honebrink, along with a gynecological oncologist worked together to provide treatment to a 40-year-old woman who came in to Honebrink's office with an abnormal pelvic ultrasound and MRI suggesting a possible gynecological cancer. The team helped the patient and her husband make tough decisions about treatment options and prepare for surgery and addressed post-surgery concerns, Coons says. They also recommended ways the couple could explain the situation to their children.

"We collaborated to help the patient and her family deal with the anxiety associated with this uncertain diagnosis," Coons recalls.

Getting in

Locating an independent practice in a health setting is an excellent way to diversify practice options, says Coons, who does her own scheduling and bills her patients or their insurance company directly for her services, just like in private practice.

Private practitioners interested in getting their foot into the door of a primary-care setting can start by offering to see a patient and their family in the provider's office and making sure they send brief written communications about their patients to all referring providers, to keep everyone abreast of a patient's progress, says Coons. Psychologists can also volunteer to provide a free talk on a psychosocial or behavioral health issue or develop patient education materials on health psychology topics for the provider's facility. They might also consider giving a lunchtime presentation to the provider's staff on managing stress in the workplace or co-presenting with a primary-care physician at a health-care conference. Psychologists should also send referrals to referring physicians, she adds.

The key is to be available, visible and flexible, says Coons. "Physicians' schedules can be so challenging," she says. "It's best to build a good, supportive relationship with everyone on the office staff. Many of our referrals actually come from the triage nurses and nurse practitioners in the physicians' offices."

When it comes down to it, however, your biggest source of referrals will come from the good work you do, Coons says.

"The best thing we can do is take good care of patients with them," she says. "That speaks volumes."