Improving Medicare coverage of psychological services for older Americans

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology.     

Twenty Years of the Journal of Clinical Psychology in Medical Settings: We Hope You Will Enjoy the Show

The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal—to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings—is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.     

Public skepticism of psychology: why many people perceive the study of human behavior as unscientific

Data indicate that large percentages of the general public regard psychology's scientific status with considerable skepticism. I examine 6 criticisms commonly directed at the scientific basis of psychology (e.g., psychology is merely common sense, psychology does not use scientific methods, psychology is not useful to society) and offer 6 rebuttals. I then address 8 potential sources of public skepticism toward psychology and argue that although some of these sources reflect cognitive errors (e.g., hindsight bias) or misunderstandings of psychological science (e.g., failure to distinguish basic from applied research), others (e.g., psychology's failure to police itself, psychology's problematic public face) reflect the failure of professional psychology to get its own house in order. I offer several individual and institutional recommendations for enhancing psychology's image and contend that public skepticism toward psychology may, paradoxically, be one of our field's strongest allies.     

American psychology's struggles with its curriculum. Should a thousand flowers bloom?

Although discussions of a core curriculum in doctoral training in psychology can be heard in contemporary psychology, there is no such common core, nor has one ever existed in American psychology's history. Advocates of a core curriculum argue that it ensures breadth of training, an outcome made even more important by growing specialization in psychology, and that it provides psychologists with a needed common identity as members of a recognized professional discipline. Opponents argue that a core curriculum places unwanted constraints on a program of study, prohibiting the kind of diversity needed to keep abreast of changes in psychology and related fields of study. The author reviews the history of this struggle within American psychology and discusses its implications for the science and practice of psychology.     

Genetics Education for Health Professionals: Strategies and Outcomes from a National Initiative in the United Kingdom

The National Health Service (NHS) National Genetics Education and Development Centre was established by the Department of Health in 2004 to help drive and co-ordinate genetics education for health professionals working outside specialist genetic services. This paper reviews the experiences and lessons learned to date. At the outset, it was clear that understanding the learning ethos, preferred delivery methods and attitudes towards genetics of different NHS healthcare groups was vital. We collected evidence by undertaking needs assessments with educators, practitioners and patients. We have determined the genetics knowledge, skills and attitudes which they said were needed and translated these into learning outcomes and workforce competences in a continuum of education. Beginning with core concepts introduced (and examined) pre-registration, the continuum continues with development of concepts post-registration as appropriate for role, leading to practical application and assessment of competences in the workplace. These are supported by a portfolio of resources which draw heavily on patient based scenarios to demonstrate to staff that genetics is relevant to their work, and to convince educators and policy makers that genetic education is likely to result in real clinical benefit. A long term educational policy, inclusive of learners, educationalists and their institutions must be evidence based, flexible and responsive to changes in workforce structure, provision of clinical services and conceptual and financial commitments to education. The engagement of national policy, regulatory and professional bodies is vital ().     

Histoire et tendances de la psychologie critique en Amérique du Nord

Critical psychology in the United States and Canada identifies psychology as inherently a political enterprise. It has developed along three overlapping but distinct lines that diverge in history, focus, and purpose: (a) building on psychology's empirical research methods, employing them to help reduce injustice and advance progressive or radical social change; (b) rejecting mainstream psychology's positivist and individualistic theoretical and empirical underpinnings and developing emancipatory theory and practices in their place; and (c) challenging psychology's institutional power over individuals, especially mentally and emotionally troubled individuals whose behavior strikes others as problematic. This article first describes each approach's history, influences, and roles in academic scholarship and institutions and in professional and nonacademic organizations. It then details recent efforts to expand and institutionalize a critical psychology presence despite mainstream North American psychology's strong resistance, while noting the central intertwining of personal networks, political leanings, and psychological theory. Finally, it briefly considers the implications and consequences of the lack of consensus about what critical psychology is and should become.     

Psychology and health. Research, practice, and policy

Since World War II, American psychology's role in health care has significantly expanded. This was formally recognized in 2001 when the membership of the American Psychological Association (APA) approved a bylaw change in its mission statement to include the word health. An accumulating body of research demonstrates and recent reviews conclude that psychological factors are primary in health and in illnesses. This article proposes a vision of psychology that endorses a bio-psycho-socio-cultural model of health research and interventions. The author provides 4 definitions of health, reviews selected psychology health research and interventions, summarizes APA's recent health-related activities, and presents 5 policy recommendations for consideration and debate.     

Comprehensive Soldier Fitness and the future of psychology

Psychology responded to the national needs in World War I and World War II and was itself transformed. National need calls a third time: unprecedented levels of posttraumatic stress disorder, depression, suicide, and anxiety along with a need for a resilient Army capable of meeting the persistent warfare of the foreseeable future. As a large part of the Comprehensive Soldier Fitness program, positive psychology is meeting this need with new tests, with new fitness courses, and with resilience training. These developments may transform the practice of psychology and psychology's relation to medicine and education.     

Implementing a Virtual Health Telemedicine Program in a Community Setting

Aurora Health Care in eastern Wisconsin has a clinical genetics program driven by genetic counselors in the cancer/adult and prenatal genetics settings. In 2015, the workforce shortage of genetic counselors left us with 4 open positions for genetic counselors that we were unable to fill. We explored many models of alternative service delivery, and determined virtual health (VH) via telemedicine to be the best option for our system. Historically, telemedicine technologies have been used to provide access to healthcare services to patients in remote areas. We, however, were struggling to find genetics counselors to staff both our remote clinics and urban clinics. To solve this problem, we recruited genetic counselors from across the country to work remotely from their current home or home office utilizing VH to staff our clinics. We then created clinical workflows and an implementation process of virtual health for 9 prenatal and cancer clinics across the eastern Wisconsin footprint of our healthcare system over the course of 12 months. Here we provide our experience and process in establishing a VH program in order to help other institutions that have been affected by the workforce shortage of clinical genetics professionals.     

Sponsored research in the counseling psychology literature

Elliott and Shewchuk (1996) assert that counseling psychology should have considerable potential to influence national healthcare and public policy. A mechanism for realizing this potential entails being responsive to national, state and private funding initiatives for reaearch and other programmatic activities. To examine the extent to which counseling psychology resarch reflects an involvement in these initiatives, we studied the rate of sponsored research in three journals traditionally associated with mainstream counseling psychology research. We compared this rate with that observed in oher applied and theoretically oriented psychological journals. In comparison with the research published in the other outlets, results indicated that the mainstream counseling psychology literature has a disproportionately low level of sponsorship from national and federal sources. The scant representation of federally-funded research in the counseling psychology literature may effectively preclude full participation in addressing and setting national funding priorities and other health care and public policies germane to the field. Several issues are raised and discussed in light of these findings.     

Professional beliefs related to the practice of pediatric medicine and school psychology

This article proposes that pediatric medicine and school psychology are complementary fields. Five professional beliefs are reviewed: (a) the importance of classification, (b) a preference for evidence-based interventions, (c) an endorsement of advocacy in public policy, (d) the importance of working with the whole child including his/her parents, and (e) an assertion of team leadership. Each belief is discussed as a core value of pediatric medicine and considered for points of connection with school psychology. Some of these beliefs are widely shared by school psychologists, others are rejected because of historical and situational factors, and all warrant consideration in light of school psychology's continuing evolution.     

Postdoctoral Internships: Potential Adverse Impacts on Internships, Dissertations, and Trainees

Increased consideration of transforming the predoctoral psychology internship into a postdoctoral training experience has resulted from changes in the training and reimbursement for psychology trainees, concerns about employment of recent graduates, and the perceived limited status of psychology interns within health care settings. Whether this fundamental shift in psychology's training paradigm could resolve any of the problems that have led to its deliberation is not known. The authors identify problems with a postdoctoral internship which may be as thorny as the problems it is intended to ameliorate. It may have unintended adverse effects (e.g., risk of reduced quality in training and dissertations, new pressures on internship programs and trainees, increased licensure quandaries). Until a highly detailed proposal is developed and its full range of potential consequences are analyzed and debated, it is premature for professional organizations to conclude whether such fundamental change should be pursued.     

Forming State Collaborations to Diversify the Nation’s Health Workforce: The Experience of the Sullivan Alliance to Transform the Health Professions

Diversifying the nation’s health professions is essential in order to maintain a vigorous health workforce, able to respond to the needs of all Americans. The inability of the health workforce to keep pace with the changing demographics of the nation is a major cause of the persistent inequities in access to quality health care for ethnic and racial minorities in the U.S. Ethnic and racial minorities have been underrepresented in the genetic counseling profession since its inception, despite vigorous professional initiatives to remedy this situation. Mittman and Downs published a critical review of these initiatives detailing recommendations for change in this journal in 2008. One of their major recommendations was the need to learn from, and join, efforts with other health professions in seeking to increase professional diversity in genetic counseling. This paper reviews new findings on issues impacting health workforce diversity in the nation, presents a case study of a national best practice to diversify the health workforce and illuminates actions that can be taken by the genetic counseling profession. The Sullivan Alliance to Diversify the Health Professions is a culmination of two historic initiatives for addressing the dearth of minority health professionals and is a national catalyst for increasing diversity within the health professions by forging state collaborations among institutions of higher education, health professions schools and other key stakeholders.     

Federal Funds to Train Clinical Psychologists for Work with Underserved Populations: The Bureau of Health Professions Graduate Psychology Education Grants Program

This paper describes the Bureau of Health Professions (BHPr) Graduate Psychology Education program (GPE), which supports projects that train health service psychologists for work with underserved populations. BHPr history and funding criteria are discussed, as are those of BHPr's parent organization, the Health Resources Service Administration. BHPr objectives and methods for support of clinical psychology training parallel those that BHPr has used to support training in other heath professions. The paper also describes three psychology internship training programs in academic medical settings that competed successfully for BHPr GPE funding in 2002. The three training projects differ significantly in training rotation sites, target populations with which trainees work, and the other health care professions that partner with psychology in interdisciplinary training—but they are similar in that each project provides an example of a program that effectively satisfied BHPr criteria for expanding psychology's scope of practice with underserved populations.     

Presidential reflections. Past and future

Key federal health initiatives and psychology's participation in public policy are briefly reviewed. There has long been agreement that psychologists have a responsibility to affirmatively address society's pressing needs, not only in health care but in other areas that affect the well being of society. The behavioral sciences are key to the United States' science and health policy in the 21st century. The unanswered question is, Has the field matured sufficiently to establish its own programmatic agenda via the public policy process? Community health, lifestyle choices, psychologically managed pharmacological treatment, and the use of telecommunications technology in education and treatment are areas in which psychology can contribute a great deal to the development of a healthier society.     

Rehabilitation. Psychology's greatest opportunity?

Rehabilitation is one of the fastest growing areas in the health industry. Supported by several key pieces of legislation, psychologists have established themselves as integral health care providers in rehabilitation. Although psychologists have benefited from legislated membership in rehabilitation, most individual psychologists and the psychological associations have failed to recognize the importance of public policy for the practice of psychology. Escalating health care costs have resulted in major revisions in the manner in which health insurers reimburse treatment. Medicare, the major federal health insurance provider, increasingly has been viewed as a model for the provision of all health care. The historic exclusion of psychologists from Medicare has limited the scope of psychologists' practice and the growth of professional psychology. The recent inclusion of psychologists in Medicare improves but does not solve practice and policy issues confronting psychology. Knowledge of national health policy formulation and greater participation by psychologists in health policy is necessary to secure the scope of professional practice most psychologists expect.     

The state of the psychology health service provider workforce

Numerous efforts to describe the health service provider or clinical workforce in psychology have been conducted during the past 30 years. The American Psychological Association (APA) has studied trends in the doctoral education pathway and the resultant effects on the broader psychology workforce. During this period, the creation and growth of the PsyD degree and the formalization of the predoctoral internship placement system (the APPIC Match) have been well noted, but efforts to gain a complete understanding of professional practice are lacking. Specifically, piecemeal research on the provider workforce has led to the study of specific subpopulations using varying approaches and definitions of those providing direct clinical service. Consequently, estimates of the supply and need for health service providers are distinctly divergent and generate protracted debate in organized psychology. The APA membership directory and the APA Doctorate Employment Surveys have traditionally been relied on for workforce analyses. Yet, these data have become characterized by limited generalizability in recent years because of declining survey response rates and the fact that APA member data may not be as representative of the entire psychology health service provider population as they were previously. The 2008 APA Survey of Psychology Health Service Providers targeted these limitations by including nonmember psychologists in the sampling frame. Results revealed emerging themes in the demographics, work settings, and delivery of health services of the psychology health service provider workforce. Future areas of research for APA and organized psychology to undertake in addressing need and demand are suggested.     

Addressing the Supply of Psychologists in the Workforce: Is Focusing Principally on Demand Sound Economics?

The growth of the psychologist workforce offers greater human capital for delivering psychological services. Workforce expansion also may contribute to excessive services or psychologists' employment concerns. Our survey revealed that interns and Internship Directors perceive the supply and demand workforce imbalance as one of the most important problems, and possibly the most challenging problem, facing professional psychology in the next decade. Organized psychology has predominantly focused on options for approaching workforce imbalances by exploring avenues for increasing the demand for psychologists' services and broadening the scope of their professional activities. Additional attention to moderating the supply of psychologists and current training levels is perceived as an important and potentially more successful means of addressing imbalances between the workforce supply and the demand for psychologists' services. Internship directors were pessimistic about the impact of most of the resolutions of the 1997 Supply and Demand Conference in addressing workforce imbalances.