Government Relations Update

When patients visit any one of northwest Arkansas’s three Community Clinic locations, they get more than standard medical care. Thanks to three years of federal funding, a psychology doctoral student is now on board to check for behavior or mental health problems that may be contributing to a patient’s physical symptoms. As a result, patients in for routine check-ups at this community health center leave with a better understanding of how to stick to their diet and medication regimens and new mothers get brief counseling on stress and depression at their postpartum appointments.

The U.S. Health Resources and Services Administration awarded a Graduate Psychology Education grant to the University of Arkansas’s clinical psychology training program. It has allowed the university to support four psychology doctoral students in the integrated behavioral health portion of the program, bringing the total number to eight.

The students work with physicians, nurses, dieticians and medical personnel to provide behavioral health services to Community Clinic patients who might not otherwise seek care. GPE trainees also provide workshops on behavioral health topics for the community and write newspaper articles about mental health concerns.

A preliminary evaluation of the program by training director Ana Bridges, PhD, shows that behavioral health interventions offered by psychology graduate students are helping bring patients’ distress down to subclinical levels — even though students typically only spend between 10 and 30 minutes with patients. The GPE program is also improving awareness of mental health issues among other health-care professionals, says Kathy Grisham, executive director of Community Clinic.

“Our providers are to the point where they don’t really want to practice unless they know there’s a behavioral health specialist that can help them that day with services,” Grisham says. “That is quite a remarkable shift in the way we practice medicine.”

The Arkansas training program is one of 20 GPE grants awarded in 2010 to institutions working to improve care for the nation’s underserved and low-income populations, including economically disadvantaged older adults, children, chronically ill people and victims of abuse, trauma and disasters, says Nina G. Levitt, EdD, associate executive director for APA’s Education Government Relations Office.

“These grants represent the range and depth of psychology training to address the mental and behavioral health needs of our nation’s underserved communities,” Levitt says. “The interdisciplinary approach to training ensures a competent workforce for integrated health care, which is especially effective among these populations.”

Meeting families where they are

Psychology interns and postdoctoral fellows at Children’s Hospital of Los Angeles are also learning to provide culturally competent mental health services to an underserved population through a $190,000 GPE grant. Nearly 30 interns and fellows in the University of Southern California’s Child and Pediatric Psychology program are trained and provide evidence-based mental health care within the hospital’s behavioral health clinics.

Because nearly 75 percent of the families served by the program are Latino, students receive a grounding in cultural competency and learn to speak Spanish fluently through individualized language training and individual and group supervision conducted in Spanish, says Sara Sherer, PhD, the program’s training director. Participants also learn evidencebased practices in psychology that best address the mental health needs of the children served by the hospital. They receive certification in programs such as Incredible Years (a series of interventions that promote social and emotional competence and prevent conduct problems in high risk populations) and Child-Parent Psychotherapy (a trauma-focused intervention for children from birth to age 5.)

The program has also directed funds from its GPE grant to faculty development by supporting consultation and training in these evidence-based practices with the intent of gaining certification and authorization to train future intern and fellow classes. “Our bigger goal is to make sure we have a faculty of certified trainers who can train students within an internship or fellowship to ensure our program is as sustainable as possible,” Sherer says.

Serving older adults in need

GPE grants are also boosting psychologists’ training in older adult care. Research continues to show that older adults are much less likely to seek mental health care, even though they are among the populations that need it most. Barriers to such care include transportation-related issues, insurance and payment concerns, and stigma and fear over seeing a psychologist.

Doctoral students at the University of Colorado at Colorado Springs are learning to address older adult needs by integrating behavioral health services into primary care. With the help of a $139,000 GPE grant, the program has added three more trainees for three years, bringing the program’s current total number to six and enhancing the depth of that training, says Daniel L. Segal, PhD, the program’s training director.

Trainees work with physicians, nurses, social workers, occupational and physical therapists and other professionals across a variety of settings. Segal says that older patients are more open to psychological interventions when they are offered in conjunction with their physician’s services.

“When a primary-care doctor or other medical professional recognizes that a client might not be managing their medications very well or seems anxious or lonely, they can hand the client off right then and there to a clinician who’s either in the room or just down the hall,” Segal says. “We’ve found that when services are integrated like this, older adults have a much higher acceptance of them.”

In addition to serving older adults, Segal says, the program is building a pipeline of workers trained in integrated care. “It’s the vision of the future to have graduates who hopefully become leaders and champions of pushing this integrated care model forward, wherever they land professionally,” he says.

Amy Novotney is a writer in Chicago.