President's Column

Expanding psychology’s role in advancing health is one of three components of APA’s strategic plan. To reach this goal, psychology must become a bigger player in integrated care. Our current fee-for-service health-care system is not working; U.S. health-care costs continue to rise and far exceed the expenditures of other developed countries with poorer health outcomes.1 The passage of the Patient Protection and Affordable Care Act has stimulated new approaches to health care that are patient-centered, rather than provider-centered. Such approaches attempt to address all of a patient’s needs — both medical and psychological — through the efforts of an interdisciplinary health-care team committed to an integrated care model.

Integrated care is not entirely new. As a licensed practitioner who specialized in childhood diabetes, I saw my patients in a pediatric diabetes clinic. Childhood diabetes is a lifelong illness that cannot be cured. Not only is the diagnosis of the disease a shock to the child and family, but the daily demands of managing the disease are sobering (e.g., giving insulin injections, pricking the child’s finger to test blood glucose). On top of this, families have to live with the normal developmental challenges associated with nurturing a child into adulthood, all of which may negatively impact the child’s diabetes management. The psychological demands of the disease are as great as the medical demands. Having a psychologist on the health-care team eases the burden on the child, family and the medical provider. Further, having a psychologist on the team eliminates the stigma of seeing a psychologist for the patient and family and provides immediate access to someone with specialty training in diabetes.

However, the need for integrated care — one that marries both psychological and medical treatment in a patient-centered approach — is not limited to specialty clinics for children with life-threatening diseases. Most patients with mental health conditions are seen in primary care and most receive no mental health treatment.2 Primary-care providers do their best to address patients’ complaints; however, this often involves many diagnostic tests and referrals to specialists, at considerable expense, before the underlying psychological issue is discerned — if it is identified at all. Integrated care teams can better address patients’ needs by providing the full range of expertise in a collaborative team-based approach.

While there is no question that appropriately trained psychologists have much to offer integrated care teams, many health providers are unfamiliar with the particular skills psychologists offer and may turn to other professionals — such as social workers and nurses — for these services. Adding to the problem is that most psychologists are not trained to practice in integrated care settings. As the health-care system moves toward integrated care, it is essential we prepare psychologists to effectively practice in team-based, primarycare settings.

I am pleased to report that APA has initiated an interorganizational effort to specify the competencies needed for psychologists to practice in primary care. Several APA divisions that have a long history of integrated care training and practice (Div. 20, Adult Development and Aging; Div. 38, Health; Div. 54, Pediatric) have joined with the Association of Psychologists in Academic Health Centers, the Collaborative Family Healthcare Association, the Council of Directors of Clinical Health Psychology Training Programs, the Society of Behavioral Medicine, the Society of Teachers of Family Medicine and the Veterans Administration Training Council to form this inter-organizational work group. It is chaired by Dr. Susan McDaniel, a pioneer in the delivery of psychological services as part of primary care. Their work will inform 1. training programs preparing the next generation of psychologists to practice in this new health-care environment, 2. practicing psychologists who want to expand their skills to practice in primary-care settings; and 3. other healthcare providers about the many important contributions psychologists can make to integrated care teams.

1 Ann Intern Med. 2008;148:55-75.
2 Psychosomatic Medicine 2010;72:511-518