Increasing psychology's role in health is one of APA's strategic goals — a goal that is particularly important in light of the paradigm shift occurring within medicine from the biomedical to the biopsychosocial model (see my September Monitor column). U.S. health care is moving from provider-centered care focused on biologic aspects of disease to patient-centered care characterized by interdisciplinary teams addressing all of the patient's needs — both medical and psychological. The Patient Protection and Affordable Care Act seeks to stimulate and support this important change in health-care delivery.
Patients enter the health-care system through primary care. Primary-care physicians include family practitioners, internists, pediatricians and sometimes obstetrician/gynecologists, who address all of their patients' health-care concerns. They see their patients regularly, often for many years, and refer them to specialists as needed. 1 It is not surprising that most patients bring their mental health concerns to their primary-care providers, yet these doctors are often ill-equipped to address mental health concerns appropriately.2 For this reason, there is great interest in transitioning primary care to a patient-centered interdisciplinary team delivery model, with teams constituted to include mental and behavioral health expertise.
Medicine's paradigm shift to the biopsychosocial model and primary care's shift to patient-centered integrated care open many opportunities for psychologists, who could become important members of the interdisciplinary care teams of the future. However, to serve in such a role, psychologists must be trained to practice in integrated care. Unfortunately, most psychologists have not received such training.
For the past year, an interorganizational work group has been meeting to articulate the essential competencies needed for psychologists to practice in primary care. The nine organizations participating in this work group include three APA divisions with considerable expertise in integrated care: Div. 20 (Adult Development and Aging), Div. 38 (Health) and Div. 54 (Society of Pediatric Psychology) plus the Association of Psychologists in Academic Health Settings, the Council of Directors of Clinical Health Psychology Programs, the Veterans Administration Training Council, the Collaborative Family Healthcare Association, the Society of Behavioral Medicine and the Society of Teachers of Family Medicine (STFM).
Each organization selected up to two members to serve on the work group; APA member Susan McDaniel, PhD, representing STFM, ably chaired the group. I had the opportunity to join the group in September as it finalized its report; I was very impressed with the group's recommendations.
Interorganizational collaboration is important because it brings many voices together, avoiding multiple statements and recommendations from many different groups. APA is one voice for psychology. When APA partners with other groups, it avoids duplication of effort with the confusion and dissension that may bring. It also broadens impact by allowing multiple organizations to speak with one voice, disseminating the interorganizational work group's product beyond the reach of a single organization. It also sets the stage for additional collaboration as efforts are put in place to make the group's recommendations a reality.
The report of the Interorganizational Work Group on Competencies for Psychological Practice in Primary Care is expected to be available this winter. Once it's ready, we will announce where to access it. The report will serve as a foundational effort for psychologists to position themselves as players in patient-centered integrated primary care. It will guide professional psychology training programs by identifying the core competencies students must have to function effectively on interdisciplinary care teams. It will guide continuing education for practicing psychologists who want to acquire the necessary skills to move into this exciting area of patient care. It will guide other health professionals by articulating the special competencies psychologists bring to team-based integrated care. I am grateful to all the organizations and their representatives for producing this important report. Now, it is up to our graduate education and professional practice communities to put its recommendations into action.
2Psychosomatic Medicine, 2010, 72:511–518