Resolution on Psychologists in Integrated Primary Care and Specialty Health Settings

Adopted by Council of Representatives in August 2016.

Introduction

Children, adolescents and adults across the life span frequently face serious threats to their health and well-being. Psychologists have spent over five decades in integrated primary care and specialty health settings conducting research with and providing evidence-based professional services to a diverse array of patients, families, and hospitals. With ongoing health care reform in the United States, our public and private health systems are focused on improving population health through interprofessional teams to increase access to comprehensive physical and behavioral health care and prevention interventions; assessment of patient, provider and health system outcomes; as well as new service delivery, business and financing models to reduce costs. These changes are associated with both opportunities and challenges for psychologists across the career trajectory in and outside health settings.

As part of the American Psychological Association's strategic goal to "expand psychology's role in advancing health" (American Psychological Association [APA], 2009) and the APA Presidential Task Force on the Future of Psychology Practice Final Report (APA, 2009), this Resolution on Psychologists in Integrated Primary Care and Specialty Health Care Settings aims to encourage and support American Psychological Association policies and initiatives that advance evidence-based, interprofessional approaches to patient and family health.

WHEREAS children, adolescents, and adults of all ages frequently receive their physical and mental health care in primary care settings includingpediatrics, family medicine, general internal medicine, geriatric medicine, and obstetrics and gynecology (Coons, Morgenstern, Hoffman, Streipe, & Buch, 2004; Poleshuck & Woods, 2014; Roberts & Steele, 2009; Stancin & Perrin, 2014), and deal with complex psychosocial and behavioral health challenges when coping with serious illness treated in specialty medical departments such as cardiology, pulmonology; surgical, medical and radiation oncology; reproductive endocrinology; maternal fetal medicine; urology, and urogynecology; neurology and physical medicine and rehabilitation care; general and transplant surgery; endocrinology; orthopedics and sports medicine; gastroenterology; infectious disease; psychiatry; emergency medicine; palliative care, long-term care, as well as school, military, and correctional health care.

WHEREAS primary care is considered the "de facto" mental health system (Regier, Narrow, Rae, Manderschied, Locke, & Goodwin, 1993) where at least 60% of medical visits have psychosocial components; approximately 20% of primary care patients meet criteria for a diagnosis of depression, and roughly 15% have generalized anxiety (Robinson & Reiter, 2007); depression, anxiety, obesity and smoking are frequently initially treated in primary care settings in adult patients; and attention deficit disorder is typically treated in pediatric primary care.

WHEREAS depression causes more disability than heart disease or diabetes and is projected to become the single greatest cause of disability worldwide by 2030 (WHO, 2016); frequently co-occurs with and complicates chronic conditions such as cardiovascular disease, diabetes, obesity, asthma, chronic pain, epilepsy, HIV, and cancer (APA, 2014; Jensen & Turk, 2014; Sherr, 2011); and is associated with increased utilization of medical care (Simon, 2001), poor adherence to treatments for diabetes (McKellar, 2004), HIV (Gonzalez, J. S., Batchelder, A. W., Psaros, C., Safren, 2011), heart disease (Gehi, Haas, Pipkin, & Whooley, 2005; McGrady, McGinnis, Badenhop, Bentle, & Rajput, 2009), increased adverse events during drug treatment (Mitsikostas, Mantonakis, & Chalarakis, 2014), and increased risk of prescription opioid misuse (Grattan, Sullivan, Saunders, Campbell, & Von Korff, 2012).

WHEREAS the annual costs of treating health conditions such as hypertension, heart disease, diabetes, and asthma are significantly higher when patients have co-occurring mental health conditions such as depression and anxiety (Petterson, Phillips, Bazemore, Dodoo, Zhang, & Green, 2008).

WHEREAS anti-depressant (Mojtabai & Olfson, 2015), anxiolytic, stimulant, and sleep hypnotic medications are most frequently prescribed in primary and specialty care settings by professionals who are not mental health specialists.

WHEREAS behavioral factors such as tobacco and substance abuse, limited exercise or physical activity, poor nutrition, and risky sexual behaviors are associated with chronic physical conditions, such as heart and pulmonary disease, cancer, HIV and other infectious conditions; and these collectively account for 41% of mortality from leading causes of death in the United States (Mokdad, Marks, Stroup, Gerberding, 2004; Murray, 2013).

Gender, "At Risk" Populations, and Health Disparities in Primary Care and Specialty Health Settings

WHEREAS women across the life span have higher rates of routine clinical encounters in primary care settings (i.e., obstetrics and gynecology, family and internal medicine) and in specialty settings (Blackwell, Lucas, & Clarke, 2014), and report increased satisfaction with comprehensive, integrated health services in one location.

WHEREAS access to psychological services through the US Department of Veteran's Affairs (Kearney, Post, Pomerantz, & Zeiss, 2014) and US Department of Defense (Hunter, Goodie, & Dobmeyer, 2014) healthcare systems allows for primary care settings to provide behavioral healthcare to veterans, active duty, and retired service men and women and their families. Psychologists are routine members of the VA's Patient Aligned Care Teams dedicated to providing comprehensive, integrated health services.

WHEREAS underserved, uninsured, racially/ethnically diverse and immigrant children, adolescents, and adults receive primary and specialty care in Federally-Qualified Community Health Centers, through the Indian Health Service, school and prison-based health centers and other safety net health settings across the country where psychologists address mental health, health behavior, and substance abuse issues to reduce health disparities and improve population health; and provide linguistically and culturally appropriate assessment for diverse populations.

WHEREAS a higher percentage of individuals in rural America live below the poverty line, and they have less access to primary care, special medical services, mental health and substance abuse treatment. In addition, adults, adolescents, and children in rural areas receive less preventive care and have higher rates of all chronic diseases than individuals in urban environments (Agency for Healthcare Research and Quality [AHQR], 2004; Bailey, 2010).

WHEREAS adults with serious mental illness treated in the public health system on average have higher mortality rates than their age cohorts in the general population. This disproportionately higher mortality rate is related to a number of interacting factors such as suicide and injury, under-treatment of chronic physical conditions, and side effects of medications frequently used to treat psychotic conditions (Colton & Manderscheid, 2006; Parks, Svendsen, Singer, Foti, & Mauer, 2006; Eaton, Roth, Bruce, Cottler, Wu, Nestadt, Muñoz, 2013).

WHEREAS three quarters of a dults age 65+ have multiple chronic conditions (Anderson, 2010) and account for nearly 1/3 of physician visits (Cherry, Lucas, & Decker, 2010) and prefer psychology services integrated with primary care (Gum, Arean, Hunkeler, Tang, Katon, Hitchcock,…Unützer, 2006); and patient-centered, team-based, primary care is effective in the delivery of mental health and substance use services for many older adults (Institute of Medicine, 2012).

WHEREAS facilitating the involvement of same-sex partners in treatment, or intervening when medical staff mis-gender patients can be critical roles for psychologists in integrated primary care settings (Israel, Walther, Gortcheva, & Perry, 2001).

WHEREAS people with disabilities account for approximately 19% of the US population (Brault, 2012) and are prone to poorer health outcomes than individuals without disabilities (Horner-Johnson, Dobbertin, Lee, & Andresen, 2013); people with disabilities experience higher rates of obesity, cardiovascular disease, and diabetes than people without disabilities (Reichard, Stolzle, & Fox, 2011); and institutional and societal factors limit access to physical and behavioral health services (Johnson & Woll, 2003).

Patient and Health System Outcomes and Barriers to Care in Integrated Health Settings

WHEREAS research has demonstrated that the inclusion of psychological and behavioral health services in primary and specialty care settings is associated with a range of improved patient and health system outcomes. Primary care behavioral health interventions have been shown to: reduce symptoms, psychological distress and insomnia (Hunter et al., 2014); improve adherence to treatment recommendations (Katon, 2012); decrease emergency room visits and hospitalizations (Blount, Schoenbaum, Kathol, Rollman, Thomas, O’Donohue, et al., 2007); and result in a cost offset of 20-40% for primary care patients (Collins et al., 2010). In addition, psychological interventions are preferred to pharmacological interventions among older adults with depression, who have two times the number of primary care visits as middle-aged adults (Ashman, Talwalker, & Taylor, 2014; Gum et al., 2006). Furthermore, psychosocial and behavioral interventions in specialty health settings have been shown to improve patient outcomes in cardiology (Dunbar, Dougherty, Sears, Carroll, Goldstein, Mark,…Zeigler, 2012; Peterson & Kim, 2011), reproductive endocrinology (Frederiksen, Farver-Vestergaard, Skovgård, Ingerslev, & Zachariae, 2015), HIV, (Spies, Asmal, Seedat, 2013; Crepaz, 2008) and oncology (Andersen, Farrar, Golden-Kreutz, Glaser, Emery, Crespin, Carson, 2004; Jacobsen & Wagner, 2012).

WHEREAS research has demonstrated the utility and value of psychological and neuropsychological assessment for a broad range of health conditions. Evidence-based assessment plays a central role in the ongoing evaluation of affective, behavioral, cognitive, personality, and functional status; improvement or decline in relation to medical and behavioral health diagnoses and interventions; predicting surgical outcomes; and providing treatment recommendations to improve the quality of care and quality of life for patients (Celestin, Edwards, & Jamison, 2009; Carragee, Alamin, Miller, & Carragee, 2005; den Boer, Oostendorp, Beems, Munneke, Oerlemans, & Evers, 2006; Meyer, Finn, Eyde, Kay, Moreland, Dies, & Reed, 2001).

WHEREAS integrated services, such as pre-surgical psychological evaluations, pre-opioid therapy psychological evaluations, psychological evaluations for chronic pain, and psychological treatments for managing medical conditions, reduce health care costs and disability (Bruns, Mueller, & Warren, 2012).

WHEREAS some federal and state reimbursement regulations may compromise interprofessional approaches to mental health and substance abuse in primary care and specialty health settings and thus contribute to fragmented care, disparities in care, and reduced access to care.

Psychology Workforce in Integrated Care Settings

WHEREAS psychologists have routinely provided clinical services in pediatric, adult, and geriatric primary care; specialty medical practices; and other health settings for more than five decades with varied professional responsibilities including: consultation, screening, psychological and neuropsychological assessment; collaborative treatment with other health care professionals; quality improvement, program development and evaluation; interprofessional health provider and community education; health provider communications training and coaching; grant writing and research; patient and health system outcomes evaluation; as well as administrative and leadership roles.

WHEREAS psychologists working in pediatric, adult, and geriatric primary and specialty health settings have documented competencies necessary to provide evidence-based clinical and professional services, interprofessional education and research, and leadership (APA, 2008; APA, 2014; See APA Recognized Specialties and Proficiencies in Professional Psychology).

WHEREAS the American Board of Professional Psychology (ABPP) oversees 15 psychology specialties with four board certifications specifically related to the care of patients in health settings including: clinical health psychology, rehabilitation psychology, clinical neuropsychology, and geropsychology. Furthermore, a significant number of colleagues who are board certified in child and adolescent psychology and couple and family psychology work in integrated health care settings.

WHEREAS psychologists across the United States increasingly serve in leadership roles in academic health centers, community hospitals, and health systems in public and private sectors. Examples of administrative roles include: Deans of Medical Schools or Allied Health Schools, Vice or Associate Chairs of Family Medicine, Section Chiefs in Pediatrics, Directors of Integrated Behavioral Health, Chief Psychologists or Chiefs of Psychology Services, Directors of Behavioral Medicine, and Directors of Research Centers. In these leadership positions, psychologists advocate for the value of psychological research and services, a larger psychology workforce, increased access to psychological services, and appropriate clinical privileges at departmental and organizational levels. Nonetheless, psychologists working in academic health centers, hospitals, and health systems continue to face barriers to hospital staff appointments and clinical privileges and workforce development.

WHEREAS federal legislation (e.g., Patient Protection and Affordable Care Act; the Public Health Service Act for the National Health Service Corps Loan Repayment Program; Geriatric Workforce Enhancement Programs) includes psychologists in primary care practice; and loan re-payment is available for psychologists working in or with Medically Underserved Areas/Populations (MUA/P) or in outcome research in on Patient Centered Medical Homes (PCMH) to provide comprehensive, interprofessional and coordinated physical and behavioral health care to improve patient outcomes at lower costs. Nonetheless, systemic and local barriers often prevent psychologists from participating in Patient Centered Medical Homes, Accountable Care Organizations or other practice organizations to provide integrated care.

Workforce Development in Integrated Health Settings

WHEREAS there are an increasing number of positions for psychologists in pediatric, adult, and geriatric integrated primary care in public and private health systems, clinical, counseling and school psychology doctoral training programs and the current psychology workforce would consequently benefit from an expansion of training in service provision, interprofessional care, business operations, and/or research methods in primary care or specialty health settings.

WHEREAS, guidelines for interprofessional health provider education have been disseminated for the past several years by both federal agencies and health professions groups. Examples of publications from intra-organizational and interorganizational collaborations or health educators include: Core Competencies for Interprofessional Practice (Interprofessional Education Collaborative Expert Panel, 2011), Values Based Interprofessional Collaborative Practice: Working Together in Health Care (Thistlethwaite, 2012), Interprofessional Education: Definitions, Student Competencies, and Guidelines for Implementation in Pharmacy Education (Buring, Bhushan, Broeseker, Conway, Duncan-Hewitt, Hansen, Westberg, 2009), and the Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree (2010), among others. It is unclear, however, how many psychology doctoral programs are using interprofessional models to train their graduate students for clinical services or team science.

WHEREAS psychologists across the career trajectory are requesting information and training on competencies, clinical models, and business operations for individual and group practice in and outside of primary care and specialty health care settings (Coons et al, 2004).

WHEREAS the American Psychological Association does not currently have comprehensive data on the number of members in primary care or specialty health settings or information on their professional roles and responsibilities. This information would be useful for the development of collaborative relationships with other health professional organizations; for advocacy related to the inclusion of psychologists in integrated care settings, and for service for underserved populations in rural settings and other communities.

THEREFORE, BE IT RESOLVED that the American Psychological Association will encourage continued development and use of targeted communications, including social media, evidence-based articles and position papers, to disseminate research on the value of psychosocial and health behavior interventions in integrated health care settings to improve patient, clinician, health system, and population health outcomes; such messages will be targeted to health care thought leaders and systems designers, federal and state policy makers, professional organizations, health systems and foundations, health and science writers, and relevant consumer groups.

BE IT FURTHER RESOLVED that the American Psychological Association will continue to promote the inclusion of psychology and psychological science in integrated primary and specialty health care to improve patient, family, and population health across the lifespan through collaborations with influential health organizations federal agencies, and consumer groups.

BE IT FURTHER RESOLVED that the American Psychological Association will continue to promote the recommendations and findings from the Presidential Taskforce on Patient Centered Medical Homes (APA, 2014) through evidence-based articles, social media, and briefing papers on the value of including psychologists in Patient Centered Medical Homes for children, adolescents, and adults across the life span.

BE IT FURTHER RESOLVED that the American Psychological Association will continue to track and evaluate State Corporate Doctrine of Medicine laws regarding barriers to psychological assessment and intervention services in integrated health care settings.

BE IT FURTHER RESOLVED that the American Psychological Association will encourage the development and adoption of competencies and associated training materials for psychologists in primary and specialty health settings, such as those developed by the Inter-organizational Work Group on Primary Care Psychology Competencies (APA, 2015), and assist in the acquisition of these competencies through accreditation standards for doctoral training programs, internships, and post-doctoral fellowships.

BE IT FURTHER RESOLVED that the American Psychological Association will continue to disseminate information on competencies, optimal practice, and business models for individual and group practices providing integrated or collaborative care.

American Psychological Association. (2016). Resolution on Psychologists in Integrated Primary Care and Specialty Health Settings. Retrieved from: https://www.apa.org/about/policy/integrated-primary-care

Agency for Healthcare Research and Quality (AHRQ). Health Care Disparities in Rural Areas: Selected Findings From the 2004 National Healthcare Disparities Report.

Altman, B., Bernstein, A. (2008 ). Disability and Health in the United States, 2001-2005. National Center for Health Statistics, Hyattsville, MD [Chartbook]. 

American Psychological Association (2014). Primary Care Briefing Series on the Role of Psychology in Health Care.

American Psychological Association (2009). Presidential Task Force on the Future of Psychology Practice Final Report.

American Psychological Association. (2016). Recognized Specialties and Proficiencies in Professional Psychology. Retrieved from https://www.apa.org/ed/graduate/specialize/recognized.

American Psychological Association, Presidential Task Force on Integrated Health Care for an Aging Population. (2008). Blueprint for change: Achieving integrated health care for an aging population. Retrieved from https://www.apa.org/pi/aging/programs/integrated/integrated-healthcare-report.pdfopens in new window

Anderson, G. (2010). Chronic Care: Making the Case for Ongoing Care. Princeton, NJ: Robert Woods Johnson Foundation. Retrieved from https://www.rwjf.org/content/dam/farm/reports/reports/2010/rwjf54583opens in new window

Andersen, B.L, Farrar, W.B., Golden-Kreutz, D.M., Glaser, R., Emery, C.F., Crespin, T. R., Carson, W.E., III (2004). Psychological, behavioral, and immune changes after a psychological intervention: A clinical trial. Journal of Clinical Oncology, 22, 3570-3580.

Ashman, J. J., Talwalkar, A., & Taylor, S. A. (2014). Age differences in visits to office-based physicians by patients with diabetes: United States, 2010 (161) [Data Brief]. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db161.pdfopens in new window

Bailey, J. M. (2010). Why Health Reform Can’t Wait: The Benefits of Health Reform for Rural America. (Report No. 9).

Blackwell, D. L., Lucas, J. W., Clarke, T. C. (2014). Vital and Health Statistics 10(260). Summary health statistics for U.S. adults: NationalHealth Interview Survey, 2012 [Data Series]. Hyattsville, MD: US Department of Health and Human Services.

Blount, A., Schoenbaum, M., Kathol, R., Rollman, B.R., Thomas, M., O’Donohue, W. et al (2007). The economics of behavioral health services in medical settings: A summary of the evidence. Professional Psychology: Research and Practice, 38(3), 290-297. doi:10.1-37/0735-7028.38.3.290

Brault, M.W. (2012). Americans with disabilities: 2010 (Current Population Reports, P70-131. Retrieved from US Census Bureau website: https://www.census.gov/prod/2012pubs/p70-131.pdf.

Bruns, D., Mueller, K., & Warren, P. A. (2012). Biopsychosocial law, health care reform, and the control of medical inflation in Colorado. Rehabilitation Psychology, 57(2), 81-97. doi: 10.1037/a0028623

Buring, S. M., Bhushan, A., Broeseker, A., Conway, S., Duncan-Hewitt, W., Hansen, L.,Westberg, S. (2009). Interprofessional Education: Definitions, Student Competencies, and Guidelines for Implementation. American Journal of Pharmaceutical Education, 73(4), 59. 

Carragee, E. J., Alamin, T. F., Miller, J. L., & Carragee, J. M. (2005). Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in ubjects with benign persistent back pain. Spine Journal, 5(1), 24-35.

Celestin, J., Edwards, R. R., & Jamison, R. N. (2009). Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Pain Medicine, 10(4), 639-653. doi: 10.1111/j.1526-4637.2009.00632.x

Centers for Disease Control and Prevention. (2010). Quick-Stats: Delayed or forgone medical care because of cost concerns among adults aged 18-64 years, by disability and health insurance coverage status – National Health Interview Survey, United States, 59(44) [Morbidity and Mortality Weekly Report]. Atlanta, GA: Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention (2006). Disability and health state chartbook, 2006: Profiles of health for adults with disabilities [Chartbook]. Atlanta, GA: Centers for Disease Control and Prevention. 

Cherry, D., Lucas, C., & Decker, S. L. (2010). Population aging and the use of office-based physician services (No. 41) [Data Brief]. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db41.htm

Collins, C., Hewson, D.L., Munger, R., & Wade, T. (2010). Evolving models of behavioral health integration in primary care. New York, NY: Milbank Memorial Fund.

Colton, C. W., & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3(2), A42.  

Coons, H.L., Morgenstern, D., Hoffman, E., Streipe, M., & Buch, C. (2004). Psychologists in women’s primary care and obstetrics-gynecology: Consultation and treatment issues. In R. Frank, S.H. McDaniel, J. Bray & M. Heldring (Eds.), Primary Care Psychology. (pp. 209-226). Washington, DC: APA Publications.

Crepaz, N., Passin, W. F., Herbst, J. H., Rama, S. M., Malow, R. M., Purcell, D. W., & Wolitski, R. J. (2008) Meta-analysis of cognitive-behavioral interventions on HIV-positive persons’ mental health and immune functioning. Health Psychology, 27(1), 4-14). doi: 10.1037/0278-6133.27.1.4

den Boer, J. J., Oostendorp, R. A., Beems, T., Munneke, M., Oerlemans, M., & Evers, A. W. (2006). A systematic review of bio-psychosocial risk factors for an unfavorable outcome after lumbar disc surgery. European Spine Journal, 15(5), 527-536.

Dunbar, S. B., Dougherty, C. M., Sears, S. F., Carroll, D. L., Goldstein, N. E., Mark, D. B., …Zeigler, V.L. (2012). Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families: A scientific statement from the American heart association.Circulation, 126(17), 2146-2172. doi: 10.1161/cIR.0b013e31825d59fd

Eaton, W. W., Roth, K. B., Bruce, M., Cottler, L., Wu, L., Nestadt, G., Muñoz, A. (2013). The relationship of mental and behavioral disorders to all-cause mortality in a 27-year follow-up of 4 epidemiologic catchment area samples. American Journal of Epidemiology, 178(9), 1366-1377. doi: 10.1093/aje/kwt219

Frederiksen, Y., Farver-Vestergaard I., Skovgård, N. G., Ingerslev, H. J., & Zachariae, R. (2015). Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men: A systematic review and meta-analysis. BMJ Open, 5(1). doi:10.1136/bmjopen-2014-006592

Gehi, A., Haas, D., Pipkin, S., & Whooley, M. A. (2005). Depression and medication adherence in outpatients with coronary heart disease: Findings from the Heart and Soul Study. Arch Intern Med, 165(21), 2508-2513. 

Gonzalez, J. S., Batchelder, A. W., Psaros, C., Safren, S. A (2011). Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. Journal of Acquired Immune Deficiency Syndromes, 58(2). doi: 10.1097/QAI.0b013e31822d490a

Grattan, A., Sullivan, M. D., Saunders, K. W., Campbell, C. I., & Von Korff, M. R. (2012). Depression and prescription opioid misuse among chronic opioid therapy recipients with no history of substance abuse. Annals of Family Medicine, 10(4), 304-311. doi: 10.1370/afm.1371

Gum, A. M., Arean, P. A., Hunkeler, E., Tang, L., Katon, W., Hitchcock, P., …Unützer, J. (2006). Depression treatment preferences in older primary care patients. The Gerontologist, 46(1), 14-22.

Horner-Johnson, W., Dobbertin, K., Lee, J., & Andresen, E. (2013). Disparities in chronic conditions and health status by type of disability. Disability and Health Journal, 6(4), 280-286.

Hunter, C. L., Goodie, J. L., Dobmeyer A. C., & Dorrance, K. A. (2014). Tipping points in the Department of Defense’s experience with psychologists in primary care. American Psychologist, 69(4), 388-398.

Hunter, C. L., Reiter, J. J., Robinson, P. J., Serrano, N., Corso, K. A., & Rosenfeld, B. (2014). The primary care behavioral health model (PCBH) model of service delivery: Key strategies for operations, practice, program evaluation and payment. Collaborative Family Health Care Conference. Washington, DC.

Institute of Medicine. (2012). The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands? 

Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

Israel, T., Walther, W. A., Gortcheva, R., & Perry, J. S. (2011). Policies and practices for LGBT clients: Perspectives of mental health services administrators. Journal of Gay & Lesbian Mental Health, 15(2), 152-168.

Jacobsen, P.B. & Wagner, L.I. (2012). A new quality standard: The Integration of psychosocial care into routine cancer care. Journal of Clinical Oncology, 30(11), 1154-1159.

Jensen, M. P. & Turk, D. C. (2014). Contributions of psychology to the understanding and treatment of people with chronic pain: Why it matters to all psychologists. American Psychologist, 60(2), 105-118.

Johnson, J. L. & Woll, J. (2003). A national disgrace: Health disparities encountered by persons with disabilities. Disability Studies Quarterly, 23 (1), 61-74.

Katon, W. (2012). Collaborative depression care models: From development to dissemination. American Journal of Preventive Medicine, 42(5), 550-552.

Kearney, L. K., Post, E. P., Pomerantz, A. S., & Zeiss, A. (2014). Applying the interprofessional aligned care team in the Department of Veterans Affairs: Transforming primary care. American Psychologist, 69(4), 399-408.

McGrady, A., McGinnis, R., Badenhop, D., Bentle, M. S., & Rajput, M. (2009). Effects of depression and anxiety on adherence to cardiac rehabilitation. Journal of Cardiopulmonary Rehabilitation & Prevention, 29(6), 358-364.

McKellar, J. D., Humphreys, K., & Piette, J. D. (2004). Depression increases diabetes symptoms by complicating patients' self-care adherence. Diabetes Education, 30(3), 485-492. 

Meyer, G. J., Finn, S. E., Eyde, L. D., Kay, G. G., Moreland, K. L., Dies, R. R., & Reed, G. M. (2001). Psychological testing and psychological assessment. A review of evidence and issues. American Psychologist, 56(2), 128-165.

Mitsikostas, D. D., Mantonakis, L., & Chalarakis, N. (2014). Psychiatry Research, 215(1), 82-86.

Mojtabai, R. & Olfson, M. (2015). Portion of antidepressant prescriptions without psychiatric diagnosis is growing. Health Affairs, 34(2), 1434-1442.

Mokdad, A. H, Marks, J. S., Stroup, D. F., Gerberding, J. L. (2004). Actual causes of death in the United States, 2000. JAMA, 291(10), 1238-1245.

Murray, J.L. (2013). The State of US health, 1990-2010: Burden of diseases, injuries, and risk factors. JAMA, 310(6), 591-608. doi:10.1001/jama.2013.13805

National Center for Health Statistics. (2011). Health, United States, 2010: With special feature on death and dying. Table 39—death rates for suicide, by sex, race, Hispanic origin, and age: United States, selected years 1950-2007 [Data Report]. Hyattsville, MD: US Department of Health and Human Services.

Parks, J., Svendsen, D., Singer, P., Foti, M. E., & Mauer, B. (2006). Morbidity and mortality in people with serious mental illness. Alexandria, VA: National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, 25.

Partnership for Health and Aging (2010). Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree. 

Petterson, S., Phillips, B., Bazemore, A., Dodoo, M., Zhang, X., & Green, L. A. (2008). Why there must be room for mental health in the medical home. American Family Physician,77(6), 757.

Poleshuck, E.L. & Woods, J. (2014). Psychologists partnering with obstetricians and gynecologists: Meeting the need for patient-centered models of women’s health care delivery. American Psychologist, 69(4), 344-354. doi: 10.1037/a0036044

Regier, D. A., Narrow, W. E., Rae, D. S., Manderschied, R. W., Locke, B. Z., & Goodwin, F. K. (1993). The de facto US mental and addictive disorders service system. Archives of General Psychiatry, 50, 85-94.

Reichard, A., Stolzle, H., & Fox, M. H. (2011). Health disparities among adults with physical disabilities or cognitive limitations compared to individuals with no disabilities in the United States. Disability Health Journal, 4(2), 59-67.

Roberts, M. C., Aylward , B. S., & Wu, Y. P. (2014). Clinical practice of pediatric psychology. New York, NY: Guilford.

Roberts, M. C. & Steele, R. G. (2009). Handbook of Pediatric Psychology, (4th ed.). New York, NY: Guildford.

Robinson, P. J. & Reiter, J. T. (2007). Behavioral Consultation and Primary Care: A guide to Integrating Services. Springer Science+ Business Media, LLC.

Sherr, L., Clucas, C., Harding, R., Sibley, E., & Catalan, J. (2011). HIV and depression: A systematic review of interventions. Psychology Health & Medicine, 16, 493–527. doi: 10.1080/13548506.2011.579990

Simon, G. E., Manning, W. G., Katzelnick, D. J., Pearson, S. D., Henk, H. J., & Helstad, C. P. (2001). Cost-effectiveness of systematic depression treatment for high utilizers of general medical care. Archive General Psychiatry,58(2), 181-187. doi:10.1001/archpsyc.58.2.181

Spies, G., Asmal, L., Seedat, S. (2013). Cognitive-behavioural interventions for mood and anxiety disorders in HIV: A systematic review. Journal of Affective Disorders, 150(2), 171-180. doi: 10.1016/j.jad.2013.04.018

Stancin, T. & Perrin, E. C. (2014). Psychologists and pediatricians: Opportunities for collaboration in primary care. American Psychologist, 69(4), 332-343.

Thistlethwaite, J.E. (2012). Values based interprofessional collaborative practice: working together in health care. New York, NY: Cambridge University Press.

World Health Organization (2016). Depression Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/depressionopens in new window.