Health services and health care economics: the health psychology marketplace.

In an effort toward cost containment, the health care system in the United States has undergone radical changes in the last decade. These changes have influenced the delivery of clinical health psychology services. This article reviews several economic and marketing factors salient to the clinical health psychology marketplace. For example, these economic changes have placed greater emphasis on the need for cost-effectiveness and accountability in the health psychology field. Implications for education and training, collaboration with other health care specialties, new practice initiatives, and public relations are reviewed. Future challenges and opportunities for clinical health psychology are discussed.     

Service Delivery Issues and Program Evaluation in Pediatric Psychology

Presents a framework for categorizing pediatric psychology research into practice and service system outcomes and functioning. The questions of importance are (a) who is being served, (b) what services are provided, (c) how treatments are implemented, (d) how services are organized and staffed, (e) what are the outcomes of the services, (f) how do various consumers perceive services, (g) how services are reimbursed, and (h) what are alternatives and innovations? The framework of program evaluation is detailed for domains most germane to service delivery in pediatric/child health psychology. Such domains include diagnostic information on patients, types of intervention, behavioral/psychological outcome variables, costs of treatments, service system functioning, and perceptions of satisfaction from multiple sources. This framework may be useful in directing future research on the delivery of services in pediatric psychology settings, thereby adding to the value of the field.     

PDP and Gestalt: An integration?

Summary The possibility of a synthesis between parallel distributed processing approaches (PDP) and Gestalt psychology is discussed. The empiricist outlook of PDP is an obstacle to such a synthesis. Gestalt's belief in organization of the psychological field as the basic principle is not shared by the PDP approach. It is claimed that, nevertheless, Gestalt psychology can use PDP techniques for modeling organization processes, provided that some constraints are obeyed. From a PDP point of view, importing Gestalt constraints could be a useful strategy for obtaining testable predictions.     

Human science and counselling psychology: Closing the gap between research and practice

In this article, the case is made that human science-or ‘qualitative research’ as it is now popularly known–promises to be a better way of closing the gap between research and practice in counselling psychology than has been provided by the natural science approach to the discipline as instantiated in the Boulder model of the scientist-practitioner. Like the practice of counselling psychology, human science focuses on subjectivity and stresses the achievement of an understanding as opposed to the demonstration of truth; it stresses collaboration with participants rather than a subject-object dualism; and it emphasizes holism in contrast with fragmentation. Some practicalities entailed in the conduct of human science in counselling psychology are discussed.     

An Investigation of Psychology Staffing in Australian Metropolitan Acute Public Hospitals

Psychology is one component of the multidisciplinary services provided to patients in acute public hospitals, with research demonstrating that psychological intervention significantly enhances clinical outcomes for patients across a range of health issues. Despite the increasingly important role that psychologists play in Australian hospitals, there remains a lack of information available about staff levels, discipline structures, and clinical activity for psychological services within acute hospital settings. The most recent Australian data about hospital‐based psychology services was collected 20 years ago. The current study provides updated information from a survey of 15 Australian metropolitan, acute public hospitals: presenting and critically reviewing staffing configurations and models of service delivery. Results suggest that: (a) hospitals employ a highly skilled workforce at a rate of 0.16 full‐time equivalent psychology staff for every 10 hospital beds; (b) psychologists have a viable career pathway within the hospital‐based health sector; (c) role diversity is common, with the primary focus varying as a function of position level; (d) neuropsychology staffing requires urgent attention to address significant delays in access to services; and (e) public hospitals actively contribute to current and future workforce development through supervision, research, and training. The implications of these results for the future of psychological services in Australian healthcare are discussed.     

Cost Effective Assessment Models in Providing Patient-Matched Psychotherapy

Examined are various models of assessing cost-effectiveness in the use of psychological measures employed for screening patient pathology through psychological testing as a precursor to providing psychotherapy. Actual and simulated quality assurance studies are provided. The authors caution that cost-containment limited to financial incentives may have negative consequences for patient care. Systems analysis and program restructuring designed to better balance the service system through levels of care may be more clinically sound, and less costly. Clinical algorithms and critical pathways are discussed, as are recommendations that incorporate psychological testing services as an ingredient in providing contemporary psychotherapy.     

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.     

Exporting analogue behavioral observation from research to clinical practice: useful or cost-defective?

The special section on analogue behavioral observation (ABO) provided an in-depth review of various ABO assessment procedures. Despite their availability, however, these procedures are rarely used in clinical practice. This may result in part from the traditions on which most ABO assessments are based, from distinctions between clinical and research assessment environments, and from the need for more information about the cost-effectiveness of ABO strategies for meeting specific needs of clinicians in applied settings. Suggestions for bridging the research-clinical gap involve investigating more thoroughly when ABO does and does not provide useful information for various purposes in applied settings and increasing accessibility and cost-effectiveness of ABO procedures for practitioners.     

Organizational school psychology: Issues and considerations

School psychologists have been encouraged to become actively involved in facilitating organizational change in public schools. Activities such as organization development, administrative-centered consultation, training of multidisciplinary teams, program planning, and program evaluation have been considered as important aspects of school psychology. However, when the practice of school psychology at the organizational level of public schools is considered as a distinct area, a range of conceptual and practical issues become apparent: (a) What is the nature and scope of organizational-level practice of school psychology? (b) Under what conditions may this kind of professional effort be useful, to whom, in what ways? (c) What are the knowledge and skills necessary for effective organizational-level practice? These issues are addressed in this article through delineation of the emerging area of “organizational school psychology (OSP),” an approach to school psychology practice which complements more established approaches that focus directly on the individual child or on groups of children.     

Sport psychology service delivery: staying ethical while keeping loose

Although the parent discipline of sport psychology is psychology, the delivery of sport psychology services has its main roots in physical education and sports science (motor learning and control, skill acquisition). Thus, sport psychologists may look more like coaches than they look like clinicians or counselors. In this article, the authors trace the evolution of sport psychology services and contrast the temporal, spatial, and delivery issues of applied sport psychology with more mainstream counseling and clinical psychology. The looser boundaries of sport psychologist practice have both benefits and dangers, and the authors offer some examples to professional psychologists who are thinking of expanding their delivery of service to athletes and coaches.     

Telepsychology outcome research with children and adolescents: A review of the literature

Using technology as a service medium has been touted as a potentially feasible and effective alternative and/or adjunct to in-person services. The telepsychology literature has given less attention to children and adolescents in comparison to adults. This review provides a summary and critique of the empirical research focused on psychological services provided to children and adolescents using three technology media (i.e., videoconferencing, Internet, and telephone). The evidentiary support for providing services with each of these media for a range of concerns is encouraging. The quantity and quality of research, however, both need to be enhanced to better understand how technology mediates the provision of youth services, as well as to elevate telepsychology within professional psychology. Future research and its subsequent impact on policy and practice are considered. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Virtual reality in psychotherapy: review.

Virtual reality (VR) has recently emerged as a potentially effective way to provide general and specialty health care services, and appears poised to enter mainstream psychotherapy delivery. Because VR could be part of the future of clinical psychology, it is critical to all psychotherapists that it be defined broadly. To ensure appropriate development of VR applications, clinicians must have a clear understanding of the opportunities and challenges it will provide in professional practice. This review outlines the current state of clinical research relevant to the development of virtual environments for use in psychotherapy. In particular, the paper focuses its analysis on both actual applications of VR in clinical psychology and how different clinical perspectives can use this approach to improve the process of therapeutic change.     

Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice.     

Essential tension: specialization with broad and general training in psychology

The practice fields of psychology develop through specialization in training and education. The recognized specialties play a major role in developing new opportunities for professional psychology and providing quality services for the public. The essential tension comes from the balance of innovation and tradition and, in professional psychology, from the balance of fragmentation and unification. As an example, specialization in clinical child psychology is integrated within the broad and general traditions. The greater degree of focused science and practice in a specialty is the logical consequence of advances of the discipline and profession of psychology. ((c) 2006 APA, all rights reserved).     

Board Certification in Psychology: Insights from Medicine and Hospital Psychology

For physicians board certification is an accepted tradition that research suggests improves services and outcomes. In contrast, relatively few psychologists pursue board certification suggesting ambivalence or limited contingencies reinforcing it. The authors report on medical school and hospital-based psychologists’ attitudes toward board certification and current certification status. About one-fifth (21.7%) of the sample were certified by the American Board of Professional Psychology, a greater proportion than psychologists generally: Highest rates were seen in neuropsychology (7.5%), clinical psychology (6.4%), clinical child and adolescent psychology (3.2%) and clinical health psychology (2.8%). Few (<2%) reported their hospitals required board certification. Half recognized benefits to the profession for psychologists pursuing board certification, yet 70% opposed requiring it for their hospital-based practice. Forces seeking to promote healthcare quality ultimately may increase expectations for board certification. If consumers, employers, hospitals and managed care organizations demand board certification for health professionals, greater numbers of psychologists would likely seek it.     

TOWARDS AN INTERNATIONAL PROFESSION OF CLINICAL PSYCHOLOGY: AN ANGLO-SWEDISH PERSPECTIVE

Previous reviews of the international trends in the development of clinical psychology as a profession have identified the United Kingdom and the Nordic States as countries where the role of the psychologist is approximating that in North America. The article presents a review of the historical and current influences on the development of clinical psychology in the United Kingdom and in Sweden. In Europe, where clinical psychology is mainly a Health Service profession rather than a private practice, independence of the management and medical responsibility of the psychiatrist has become more of a key issue. Of the two major ‘schools’ of clinical psychology, identified in Britain with the behavioral approach of the Maudsley Institute of Psychiatry and the psychodynamic approach of the Tavistock Clinic, the behavioral school tended to dominate in Britain until the 1970s. In Sweden, the psychodynamic approach importing many of the aspects of British Object Relations Theory, gained ascendence. This resulted in a split between the more academic form of clinical psychology in Sweden, which had produced research of international importance (e.g. the role of psychological factors in stress-related illness), and professional education in psychology with its emphasis on psychotherapeutic training. Whereas in Britain, during the 1970s, clinical psychology broke away from psychiatry, became more eclectic, and entered the general medical and health areas, these changes failed to take place in Sweden. On the other hand, private practice amongst psychologists in Sweden has shown a dramatic increase during recent years and there are now some clear trends towards eclecticism in the education of psychologists. The issue of medical responsibility remains unresolved in Sweden. That British clinical psychology has reached more progressive and cordial professional relationships in this respect may be, in part, due to the status of the scientist-practitioner role that the initial behavioral emphasis achieved. The major contributions of and trends in British and Swedish clinical psychology are discussed with a view to identifying international trends.     

Does psychopathology predict counseling duration?

Many university counseling centers have adopted case management policies in an effort to conserve limited resources. Fearing that students with more severe problems will consume too many clinical resources, many counseling centers have decided to refer such students to external agencies or providers for mental health services. However, this fear might be unwarranted because empirical research has not shown a substantial relationship between psychopathology and counseling duration. This investigation examined whether a new treatment-planning inventory, the Butcher Treatment Planning Inventory, might be useful for better understanding the relationships between various problem areas and counseling duration. Participants were new clients (students and staff members) at a university counseling center in the southeastern USA. Professional staff members and graduate students in counselor education, clinical psychology, and clinical social work provided counseling services to the participants. Lower scores on several scales predicted counseling duration. In other words, clients with lower scores on these scales (representing less psychopathology) attended more counseling sessions than clients with greater psychopathology. Therapists' background also predicted counseling duration; clients who worked with either a professional staff member or graduate student in counselor education attended more sessions than clients who worked with a graduate student in clinical psychology. The results of this study, combined with previous research, suggest that measures of psychopathology are not very useful for identifying which clients will complete long-term counseling. Until better information becomes available, actuarial tables remain the most efficient means for predicting counseling duration.