When patients hear a diagnosis from a physician-something like "you have diabetes"-it's often the last thing they really hear during that visit, says Christina Esposito, PsyD, an assistant professor with the Philadelphia College of Osteopathic Medicine (PCOM).

That's why psychology interns and PsyD students at four PCOM health-care clinics in Philadelphia make it a priority to help patients focus on what comes next, and learn how to control a disease and not let the disease control them.

Each year, three psychology interns and eight to 10 PsyD students work at the health-care centers under the supervision of eight licensed psychologists and faculty members.

Once they finish the program, graduates and interns work everywhere from community health centers to rehabilitation centers, says Stephanie Felgoise, PhD, an associate professor and director of the clinical PsyD program.

"A lot of our graduates are either in direct service, or supervisory and consultative roles that have some emphasis on a multidisciplinary approach to patient care," Felgoise says.

The PCOM centers that prepare them for such work are located in rough neighborhoods, with high rates of poverty, domestic violence, substance abuse and crime, physicians say.

In a typical year, the centers handle about 28,000 patient visits.

Of all the patients the centers see in a typical year, more than half have some type of mental health or behavioral health factor complicating their treatment. Aiming to better serve these patients, the center added psychology interns and supervisors to its staff in 2001. That year, psychologists saw about 400 patients. That figure has tripled to about 1,200 patients a year, says Barbara Golden, PsyD, associate professor and director of clinical services at PCOM.

Insulin inspiration

Esposito remembers one particular patient who came to one of the health centers last year, a 14-year-old girl diagnosed with Type II diabetes. A physician was trying to explain to her the long-term consequences of leaving diabetes untreated, such as organ failure.

Brought in as a consultant by the physician, Esposito watched the physician explain some of the medical details. Esposito didn't think the teen was absorbing any of the information, so she asked the girl what she was interested in.

When the girl said "basketball," Esposito had an idea.

"I told her, if you'd like to continue playing basketball, these are the things you need to do, and if you don't do it, you're not going to feel well enough to play," Esposito says.

Working with the physician, Esposito talked to the girl about the need to regularly check her blood sugar levels, change her diet and get regular exercise to stay healthy.

Esposito's approach is just one example of how psychologists, interns and students from PCOM's PsyD program are improving the health for patients of the college's network of four primary-care clinics.

Besides helping patients with ways they can diet, exercise and comply with a course of medication, interns and psychologists help screen people for anxiety and depression at the request of the physicians, says Kim Simmerman, a fifth-year PsyD psychology intern currently working in the health-care centers.

"They may ask us to come in and have a conversation with the patient about depression or anxiety, and we might offer our services, and short- or long-term therapy at the center," Simmerman says.

Overcoming stigma

An additional challenge for the center's staff is the stigma against mental health treatment in the neighborhoods served by the centers. People do not want friends and family to know that they are receiving counseling, says Izola David, DO, medical director of the Lancaster Avenue Healthcare Center.

Having psychologists work in the same space as the physicians helps ensure that patients receive mental health services they might otherwise never get, says David.

"I've called [psychology interns] in on a number of patients, and they've sat with me and helped me with a lot of tough cases," she says.

PCOM's psychology program, which was founded in 1995, brings in about two dozen students every year, split between programs in Harrisburg, Pa., and Philadelphia.

At the centers, psychology interns are available for consultations with patients, if the physician handling the visit requests them. The interns make themselves available for both counseling sessions and consultations, working in half-hour blocks of time meant to fit in with the fast pace of appointments at the health centers.

The psychology interns learn an approach informally called BLUF-"Bottom Line Up Front"-a quick assessment of the most pressing problem faced by the patient. They then offer some advice to the physician, centered on whether the patient needs to come back for therapy, or needs help making some lifestyle changes, such as changing their diet and getting more exercise.

If a patient requires follow-up therapy, counseling sessions with psychology interns are available in stretches lasting up to 12 weeks, Golden says.

Harry Morris, DO, one of the center's family-practice physicians and chair of family medicine, says he's witnessed the difference therapy can make in the lives of his patients. Last year, for example, he treated a single mother with high blood pressure who was stressed by the demands of keeping a household running without much money. After she entered therapy, Morris says her physical and mental health improved.

"I can see tremendous improvements in the sense of well-being," he says.