February 26, 2008

APA Task Force Urges Integrated Health Care Model as Population Ages

Interdisciplinary cooperation imperative for effective care

WASHINGTON—Developing a model of integrated health care is essential as the U.S. population ages, and mental health care providers can make unique and critical contributions to this paradigm, according to a task force report issued today by the American Psychological Association.
“Blueprint for Change: Achieving Integrated Health Care for an Aging Population” outlines the challenges and benefits of building interdisciplinary teams to address the specific health care needs of older people, particularly as the Baby Boom generation ages. The report is the product of a task force launched by Sharon Stephens Brehm, PhD, APA's 2007 president and a professor of psychology at Indiana University.

“The idea for this presidential task force developed from personal experiences, demographic forecasts and insights by both individuals and organizations that a piecemeal, uncoordinated approach to health care for older adults simply does not work,” Brehm says in the report.

APA's Presidential Task Force on Integrative Health Care for an Aging Population was co-chaired by Toni C. Antonucci, PhD, and Antonette M. Zeiss, PhD.

“Our health care system is predominantly individualistic and individual provider-patient based,” the task force wrote. “In a hierarchical resource-limited system, older people are disadvantaged by care [that] is not sensitive to multiple morbidities, life span experiences, fragmented care, marginalization, ageism and stigma, as well as unique characteristics such as age, gender, class, race, religion and ethnicity.”

The report proposes a basic model for interdisciplinary health care that includes many health care providers, with the specific professions represented on any team varying according to the needs of patients served. Common professions that may be part of interdisciplinary teams to serve older adults include physicians, psychologists, nurses, physical therapists, pharmacists, social workers, among many professions. In an interdisciplinary team, no one person is designated as “the leader,” although one person might function as an administrative “coordinator.” Such teams “are characterized by shared leadership and shared power in decision making across all the professions involved in the team,” the task force wrote, adding that such teams have long been used by the Department of Veterans Affairs, as well as in many long-term care settings and in many geriatric primary care sites.

The knowledge and skills that psychologists can contribute to integrated health care include an understanding of aging and adult development and the ability to clarify which clinical problems might be reversible, such as those caused by other treatments or medications. Psychologists can also assess mood or anxiety disorders, psychosis and suicidal symptoms, among other mental health issues. Psychologists also can address behavioral medicine issues, such as insomnia, pain or difficulties adhering to medical treatment. The report specifically notes that the contributions of geropsychologists, health psychologists, neuropsychologists and others trained in behavioral medicine “will be particularly welcomed among integrated health care teams.”

“As members of an integrated health care team, psychologists are encouraged to offer consultation to family members, significant other close relations and to other professionals,” the task force wrote. “And, finally, psychologists should be sensitive to individual and community characteristics, and whenever possible, apply up-to-date research findings and evaluation techniques to the problems at hand.”

The authors were careful to state that the report is not a “how-to manual” with step-by-step details, and that psychology cannot single-handedly create integrated care. The report targets psychologists as the key audience in order to heighten awareness among psychologists of the integrated care model and its importance for older adults. As psychologists embrace this perspective, they can work effectively with other professions to develop integrated care services. The report closes with numerous recommendations aimed at fostering psychology's support for the growth and expansion of integrated health care for older adults through curriculum development, training, research, public policy advocacy and public education and awareness.

In addition to the co-chairs, task force members were:

Gregory A. Hinrichsen, PhD
Deborah A. King, PhD
Peter Lichtenberg, PhD, ABPP
Martita A. Lopez, PhD
Jennifer Manly, PhD

A copy of the report is available at http://www.apa.org/pi/aging/blueprint.html

The American Psychological Association (APA), in Washington, DC, is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 148,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting health, education and human welfare.