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Demographic shifts in the United State population and emerging health-care and technology trends will make it ever more important for practitioners to be culturally sensitive and market-aware, said panelists at an APA 2003 Annual Convention symposium on practice in the year 2020.

"I think this is a momentous time for changes in the field," said the session's discussant--psychologist Sandra Shullman, PhD, of the Executive Development Group in Columbus, Ohio. "We're going to have to prepare our students for multicultural work; we're going to be using psychoinfomatics more and more; and we're going to need to be flexible and creative."

Also emphasizing the need for such flexibility was psychologist Vickie Mays, PhD, of the University of California, Los Angeles, who spoke about challenges and opportunities facing psychology in light of America's changing demographics. In illustrating the variety among ethnic-minority groups, Mays cited 2000 census figures showing that Asian Americans have surpassed Hispanics as the most diverse minority group in the country. She addressed the lack of mental health service delivery to such groups and related challenges for psychology, including the need to develop multiple language proficiencies and to take advantage of opportunities to work in nontraditional areas.

In another example, she noted that the number of Americans who have never married jumped from 24 percent in 1975 to approximately 29 percent in 2002. The trend is even more evident in African-American populations, where the percentage increased from 32 to 43 percent, Mays said.

Psychologists need to understand these trends to help people navigate relationships in unique demographic environments--a particular need in client populations like young African-American women, who in some urban areas face a ratio of 16 marriageable women for each man, Mays said.

"Abysmal statistics like that exert pressures in relationships," she explained, noting that, for instance, "We find that some of these pressures are connected to sexual risk-taking, substance abuse and depressive distress."

Psychologists have a responsibility to understand such changing demographics, as well as shifting market forces toward a biopsychosocial model, technology inclusion and consumer-driven services, she and other panelists noted. That responsibility, they said, extends to psychologists' work creating preventive services, informing public policy, developing new specializations and educating and training students.

Reinventing the health-care model

One way psychology can meet the needs of a changing society is to play a more prominent role in an increasingly biopsychosocial health-care system, said psychologist Suzanne Bennett Johnson, PhD, of Florida State University.

Historically, the predominant structure in U.S. health care has been a less comprehensive biomedical model that has favored allotting patient-care and research dollars to biologically based assessments and treatments, Bennett Johnson said. But a biopsychosocial model--which is gaining favor as insurers and health-care providers increasingly address the impact of behavior on health--would infuse traditional care and research with behavioral, social and environmental influences, she said.

Recognition of the role of behavior, lifestyle choices and compliance with medical regimens in health is pushing the paradigm shift, she said. Seven out of 10 deaths in the United States are caused by such chronic diseases as heart disease and diabetes. And common behaviors--overeating and failing to exercise, for example--make people particularly prone to such diseases, she said. Psychologists can provide clients the skills to correct their own behaviors and improve their health.

To effectively provide such treatment, psychologists will need to meet the challenges of interdisciplinary health-care roles, said Bennett Johnson. Training programs should prepare students for integrated roles in health research and health care; practicing psychologists need to view and present themselves as health providers, not just mental health providers; and the practice community needs to willingly adopt guidelines based on evidence-based treatment, she said.

Integrating technology and treatment

As health providers, psychologists must also develop ways to use technology and be ready to respond to the new stressors it creates, said psychologist Leigh Jerome, PhD, of Pacific Telehealth and Technology.

"Expanding the scope of psychology and incorporating technology is not only about remaining competitive, it is about expanding our understanding of what it is to be alive and healthy," she said.

She listed several innovations that could improve psychology practice:

  • Mobile and wireless technology could enable health-care professionals to obtain knowledge immediately, whenever and wherever they need it.

  • Digital images, which require no processing time and can be duplicated indefinitely and transmitted without lag time, could improve diagnostic evaluations and care in remote areas.

  • Electronic medical records will help integrate aspects of health care through seamless transfers of patient information.

  • Desktop teleconferencing could lead to online triage and treatment, debriefing in disaster situations and reduction of isolation and loneliness for the elderly or chronically ill.

  • Advanced virtual reality techniques could create treatments for anxiety, phobias, pain, claustrophobia, body-image and brain injuries.

Changing roles for consumers

Indeed, in line with the power technology places in consumers' hands, the future holds the likelihood of a more consumer-driven health-care marketplace. That's the view expressed by psychologist Russ Newman, PhD, JD, APA's executive director for practice.

"Consumerism is about to engage the health-care system in ways we've not seen before," Newman said. "The passive consumer in the health-care system will start to be the dissatisfied consumer in the health-care system."

In a consumer-driven marketplace, employees would decide individually, for themselves, how to spend an allotted sum of health-care dollars, rather than subscribing to one overall plan selected by their employers. Employers may pay outright for preventative services that they hope employees will choose as a way to stay healthy--therefore keeping overall costs down, Newman said.

"It's incumbent upon us to continue to make arguments to employers that psychologists do in fact provide prevention-oriented services and that psychological services should be included among the funded preventive services that employers make available to employees," Newman explained.

This consumer-driven approach is being facilitated by the Internet, Newman said. And employers are supporting Web sources to make sure employees have the information they need to make good decisions about care, he added. Psychologists need to be included in the health-care choices consumers consider, he said.