Implications of Healthcare Payment Reform for Clinical Psychologists in Medical Settings

Health reform, post the passing of the Patient Protection and Affordable Care Act, has highlighted the need to better address critical issues such as primary care, behavioral health, and payment reform. Much of this need is subsequent to robust data showing the seemingly uncontrollable growth of healthcare costs, and the exacerbation of these costs for patients with comorbid behavioral health and medical conditions. There is increasing recognition that incorporating behavioral health in primary care leads to improved outcomes and better care. To address these problems, primary care will play critical roles across the healthcare system, especially in the delivery of behavioral health services. Psychologists are uniquely positioned to take advantage of this propitious moment and can help facilitate the integration of behavioral and primary care by developing competencies in integrated care, training a capable workforce, and advocating for integrated care as the status quo.     

Gender Differences in Employment and Salaries of Psychologists Within Medical School Settings

A survey of 3,894 psychologists employed within medical schools and academic health centers was conducted in 1997 by the Research Office of the American Psychological Association (APA) in collaboration with the Association of Medical School Psychologists (AMSP). This survey, published as the 1997 Employment Characteristics and Salaries of Medical School Psychologists, included inquiries about various aspects of employment (e.g., academic rank, tenure status, employment activities, appointment characteristics, department affiliations, demographic characteristics) and earnings. Employment characteristics and salary information were compared by gender. The findings indicated that men had more favorable employment circumstances and higher base salaries than their female counterparts. These differences existed across all academic ranks and were found at each level of experience. This article discusses these findings and their implications.     

Book Review: Allocating Scarce Medical Resources

Theoretical Medicine and Bioethics -     

Ethical and Professional Issues for Psychologists and Counselors Employing Biofeedback in Counseling Settings

Biofeedback training is a relatively new procedure that is being incorporated into the counseling services of psychologists and counselors. If the highest professional standards and the appropriate safeguards for clients' welfare are to be maintained, careful attention should be given to the ethical and professional issues involved. The American Psychological Association's (1977) ethical standards for psychologists are the basis of the discussion. It is hoped that the discussion will stimulate further consideration of ethical and professional issues of the clinical application of biofeedback among practitioners.     

Healthcare Policy in the United States: A Primer for Medical Family Therapists

As family therapists increasingly practice in healthcare settings, they need to be aware of forthcoming changes in healthcare policy and the impact of these changes on their clinical work and the lives of their clients. In this paper, we provide a primer on healthcare policy for family therapists, which describes current and proposed changes in healthcare that will potentially revolutionize healthcare delivery for families. We describe three key initiatives: (1) Triple Aim; (2) the Accountable Care Organization; and (3) the Patient Centered Medical Home. We conclude with a discussion about future directions and healthcare policies that include families.     

Clinical Geropsychology: Implications for Practice in Medical Settings

Older adults are a rapidly growing segment of the population, who have high rates of chronic illness and who utilize health care resources heavily. Psychologists must become better prepared to work with older patients in geriatric settings, including geriatric assessment units, memory disorders clinics, and nursing homes. In addition, all psychologists will increasingly encounter older patients in environments such as primary care clinics, rehabilitation settings, and disease management programs focusing on problems that are prevalent in older patients (e.g., cancer, diabetes). Suggestions are offered for adaptation of usual clinical practice to address the special needs of older patients and their families, and recommendations made for advancing and expanding the practice of clinical geropsychology.     

Self-Serving Attributions for Performance in Naturalistic Settings: A Meta-Analytic Review1

The study of self-serving attributions in sports settings is fertile ground for testing the validity of self-serving attributional phenomena. This paper reports the results of a meta-analytic review of research examining self-serving attributions in the context of sports events. A total of 91 distinct hypothesis tests were located, comprising five dimensions of attribution: ability (N= 21), effort (N= 21), task difficulty (N= 21), luck (N= 21), and a general internal-external dimension (N= 7). The meta-analytic combination of significance levels indicated that the combined results were unlikely to occur if the null hypothesis of no effect were true (for each of the five dimensions of attribution). The internal-external dimension and the ability dimension produced effects of moderate magnitude, whereas effort, difficulty and luck produced effects of small magnitude. Meta-anaiytic focused comparisons revealed that self-serving attributions (ended to be more extreme in the context of larger team sizes, and for attribution measures focused upon the team rather than the individual. Discussion considers the implications of these findings and develops and explanation for the finding that ability is the specific attribution dimension exhibiting the greatest self-serving attribution effects.     

Counselling in Medical Settings

The slow development of counselling as an alternative to traditional treatment within the medical model is described. Counselling in medical settings has its roots in the work of the Marriage Guidance Council and the influence of Balint towards psychotherapy. 10-30% of all consultations in general practitioners' surgeries are related to emotional distress, yet the adoption and rise of counselling is more patchy than widespread. The factors which have hindered its expansion in the past are discussed, and it is concluded that its development in the future will depend largely upon pronounced changes in public health policy.     

A History of the Association of Medical School Psychologists

While psychologists have been active faculty members in medical schools for over 85 years, they lacked organization on the national level until 1981. This history traces the background of psychology's involvement in medical schools, landmark events that affected the discipline, and progress since formal organization has occurred. Office of the Senior Vice President and Provost     

JobShift: A Book Review

Book reviewed in this article: JobShtft: How to Prosper in a Workplace Without Jobs by William Bridges     

A Review of Family Therapy in Residential Settings

This article provides an overview of the history of family involvement in residential treatment as well as a synthesis of the research showing family-centered interventions and outcomes for youth in residential settings. There are many methods for engaging families in residential treatment that are discussed in the literature; however, there is a significant gap as the field has not yet identified specific family therapy approaches that demonstrate efficacy in working with youth and their families in this particular setting. A review of the literature over the past 10 years will highlight the emerging family therapy models being utilized in this setting, which include multiple-family group intervention, family-directed structural therapy, and narrative family therapy. The article will also include a discussion of three major, well-established theoretical approaches that have been found to be effective in working with youth with conduct issues and show promise in treating youth and families in the complex setting of residential treatment: brief strategic family therapy, multi systemic therapy, and functional family therapy.     

A Book Review

The Psychological Record -     

Psychology in Medical Settings in Thailand

This article explores the development of psychology as a profession in Thailand, its challenges, and future trends. There are currently very few Thai psychologists who are active in the medical fields in comparison to other health care professions. Being held back by limited education and training, many psychologists see their future career as less than promising. The lack of professional licensing standards and dominance of psychiatry further limit their career advancement. However, tremendous opportunities await those who persevere to expand their roles beyond the traditional assessment, treatment, and research models. A small number of them have ventured out into unexplored territories such as behavioral medicine, AIDS counseling, health promotion, and prevention of mental health problems. There is a strong potential for Thai psychologists to make significant contributions in these areas. It is clear that higher standards of education and more rigorous training are needed if this goal is to be realized in the near future.     

Depression Screening,Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists

Depression prevalence is between 15% and 20% in coronary heart disease patients, such as those with angina, or after a myocardial infarction or coronary artery bypass graft surgery. The presence of depression places a coronary heart disease patient at twofold higher risk for further major cardiac events and death, as well as poor quality of life and early exit from the labour force. As a consequence, several learned societies, including the National Heart Foundation of Australia, have published guidelines that recommend questionnaire screening to improve identification and management strategies for depression in coronary heart disease patients. Psychologists in hospitals, community settings, and private practice can have a key role in the realisation of the National Heart Foundation of Australia's aims. We review the recent guidelines and outline implications for psychologists to identify and manage depression in coronary heart disease patients. The evidence reviewed suggests that cognitive‐behavioural therapy and problem‐solving therapy are frontline non‐pharmacological interventions for depression in CHD patients.     

A Decade of Clinical Psychology in Medical Settings: The Short Longer View

The progress and accomplishments of psychology in medical settings over the past decade since the publication of the Handbook of Clinical Psychology in Medical Settings (J. J. Sweet, R. H. Rozensky, & S. M. Tovian, 1991) and the subsequent founding of the Journal of Clinical Psychology in Medical Settings (JCPMS) in 1994 are highlighted. Areas of progress and accomplishments reviewed include professional developments with our field, roles and services provided by psychologists, education, training and research issues, and program administration in medical settings. The current status of, and possible changes in, medical settings is identified. Future challenges and opportunities for the profession are discussed.     

Mindfulness-Based Stress Reduction in Medical Settings

Meditation, as a psychological intervention, has become of increasing interest to psychologists who conduct clinical research with or provide clinical services to medical populations. Mindfulness-based stress reduction (MBSR) is a manualized program which teaches a variety of meditation techniques and has frequently been used in medical settings with mixed medical populations. The following is a review of the literature, which provides preliminary support for the effectiveness of MBSR in specific medical populations, including persons with chronic pain, cancer and heart disease. Despite these encouraging findings, experts agree that continued research is needed, especially controlled studies with more rigorous methodology.