Feature

Imagine an Internet-based system that surveys psychologists on an ongoing basis, giving the profession instantaneous and continuously updated pictures of what is happening in practice: For instance, what are the emerging issues under managed care this month? What kinds of clinical problems are psychologists seeing more often or less often? What services are they providing? Have publicized events over the last month (a school shooting or a natural disaster) affected psychology practices?

That's the type of system APA's Practice Directorate is working to build over the next two years. APA's Outcomes Work Group of the Board of Professional Affairs and the Committee for the Advancement of Professional Practice have overseen the development of the system. A model of the system, called PracticeNet: The Real Time Psychology Information Network, which uses population-based "Real Time Behavioral Sampling" (RTBS), is now taking shape. APA will conduct the first two surveys this fall.

Practice Directorate leaders see this effort as enhancing the directorate's ongoing mission of better understanding and serving practitioners' needs. "We view PracticeNet as a systematic way of tapping into technology's potential to help inform our knowledge of psychology practice and our activities on behalf of the profession," said Russ Newman, PhD, JD, the Practice Directorate's executive director.

PracticeNet initially will provide a valuable series of cross-sectional snapshots of psychology practice. Even more substantial images are expected to take form as the system grows and information is collected more frequently.

"Eventually, we anticipate that the snapshots will evolve into a kind of moving picture that provides us with an ongoing reflection of psychology practice over time," Newman said.

The network's initial development is underwritten by the federal Center for Substance Abuse Treatment (CSAT) as part of that agency's effort to learn more about mental health providers' treatment of patients with substance abuse problems. And, in accordance with that agreement, the first two surveys will focus on substance abuse. In addition, future surveys may ask substance-abuse questions.

Gathering key data

For each of the snapshot surveys, APA will send an e-mail to several hundred practicing psychologists who have agreed to participate in the system. Instructions will ask the practitioners to pull up the Web page set up for receiving responses and enter information about a single, recent episode of care they have given a client. (The survey will never ask for any identifying information with regard to clients.)

For example, in an upcoming survey, respondents will click on multiple-choice answers to questions, including:

  • Whether the clinical service or visit was for a new or existing client.

  • What type of service it was and what type of setting.

  • If the client had a substance-abuse problem or was affected adversely by someone who does.

  • Whether the patient had used a substance in the last 30 days.

  • Which clinical interventions the psychologist provided for substance abuse.

The system will also collect information about the participating psychologists, such as demographic or practice characteristics, allowing analysis on whether particular factors are associated with certain types of practitioners.

And it will capture information about how psychologists are actually using their time, whether it be providing clinical services, teaching, supervising, or arguing with a managed care company about reimbursement issues.

According to the Practice Directorate, the system is unique in collecting practice information via the Internet and in using the methodology of focusing on one care episode for each practitioner surveyed.

With each survey, the more easily tallied results will be immediately available on the survey Web site. But each survey will also include questions that require analysis, and the results of those will be reported later on the Web site.

The directorate also expects to eventually disseminate results through news publications, special reports and possibly journal articles.

The power of information

Practice Directorate staff is encouraged by the system's methodological strengths. By asking questions on a single, recent episode of care and permitting practitioners to refer to notes, the system will allow highly accurate data collection, according to the directorate. The participants won't have to make mental estimates or go over several records.

And to avoid selection bias, the system will ask participants to report on the care episode they were engaged in at a specific time, such as 2 p.m. on Tuesday, July 26. If they were not giving care at that time, they will answer the questions for the last encounter prior to that time.

The e-mail alert will go out soon after the time designated for the care episode, but providers may have a week or more to fill out the survey. The whole process is designed to be simple for the practitioner, taking only about 10 minutes. But with at least 500 individual practitioners contacted with each survey, the data will provide significant analysis opportunity.

"With an Internet-based methodology, 8,000 episodes can be collected as easily as 200," said Geoffrey Reed, PhD, the Practice Directorate's assistant executive director for professional development. "The Real Time Behavioral Sampling Methodology has the potential to change the way we think about practice data."

To get the model under way, the directorate is recruiting psychologists to participate. Eventually it plans to have several thousand on the roster so the system can survey frequently without requiring any one provider to participate more than a few times a year.

Licensed psychologists who are interested in participating in the Practice Information Network should contact the Professional Development Department of the Practice Directorate at (202) 336-5911, e-mail: PracticeNet.

In addition to the start-up of the electronic system, under another part of the CSAT contract, APA will do a paper survey this fall of a random sample of its members as a part of the first national study on the prevalence of substance-abuse problems in the private practices of several types of professionals. Several other organizations, including the American Psychiatric Association and the National Association of Social Workers, will be doing parallel surveys.