The Future of Psychology in Medicaid's Health Delivery System for People with Disabilities

State Medicaid programs are rapidly converting fee-for-service health delivery systems to managed care for people with disabilities. In theory, managed care models of health delivery will substantially improve the quality of care for people with disabilities, but in reality, few successful models exist. This period of transition holds both opportunities and challenges for psychologists in medical settings. Because Medicaid reforms for people with disabilities may herald similar reforms for both the public and the private sectors, psychology's response will determine its role in the future of health care delivery for this population. Changes in training and increased attention to outcomes research, innovations in practice, and advocacy will be the keys to success.     

CBT with Youth: Immodest Proposals for Training the Next Generation

January 2014 brings the inauguration of the Affordable Care Act (ACA) in the United States. The ACA introduces affordable healthcare to all citizens and proposes a system to hold all healthcare providers accountable for quality treatment. This article discusses differences in the new healthcare climate and highlights specific areas of focus for training child clinicians in CBT in the midst of this evolution. Child clinicians, more than ever, will need a sound foundation of CBT theory and training so that they may fluidly practice and apply core principles in any setting, with any intervention. Transformations to the health care arena brought about by the ACA will see doctoral level clinicians practicing in a wider variety of roles, in highly integrated settings, and with an increasingly diverse population. Ability to ground intervention in solid theoretical framework will enable clinicians to practice in these numerous conditions effectively and meet accountability standards set by the ACA. Arming child clinicians with these skills will create a generation of practitioners well-prepared to care for youth in the developing atmosphere of mental health care in the United States.     

Investing in our future: unrealized opportunities for funding graduate psychology training

PURPOSE: Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION: Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.     

Intelligence artificielle et médecine : quelles règles éthiques et juridiques pour une IA responsable ?

Combining AI and medicine means talking about the medicine of the future, but even more about improving the quality of care. Its fields of application: predictive medicine, precision medicine, decision support, prevention, computer-assisted surgery, robotic support for the elderly, etc. are all related concerns: the possibility of maintaining human contact with the patient, the explicability of the algorithm - the collection of health data - and the improvement of the health care system. AI applications are already improving the quality of care. Its deployment at the heart of the medicine of the future is in constant evolution. To be acceptable and legitimate, the decisions of any algorithm must be understood and therefore explained. Only a good understanding of the diagnoses and therapies proposed by the AI application will allow doctors to discuss with their patients and to explain the possible alternatives. In the opposite case, the doctor risks to dismiss the use of algorithms because he will not be able to justify the decisions which will pose problems in terms of liability research in particular.     

The next wave of change for psychology and mental health services in the health care revolution

Recent national changes in the de facto system of health and mental health care are described. Although the percentage of people without health insurance (always or sometimes) has not decreased, the organization of insured care has changed dramatically. Of the insured population, 75% are under some form of managed care. For 88% of the managed care population, mental health care has not been integrated with health care: the so-called carve-out. The author argues that system integration (carve-ins), for a variety of reasons, will begin soon and will occur very rapidly. A tilt toward carve-ins will have substantial impact on psychologists' training, service delivery, and research.     

Striving for a culturally responsive process in training health professionals on Asian American and Pacific Islander youth violence prevention

The quality of youth violence prevention practice is dependent on the quality of education and training of professionals who will care for disadvantaged and/or underserved youth. The authors propose that culturally responsive youth violence prevention curricula, focused on Asian Americans and Pacific Islanders, should: 1) target institutions that train health professionals likely to serve Asian Americans and Pacific Islanders; 2) promote the professional development of Asian American and Pacific Islander students and enhance all students' comfort in addressing behavioral, social, and cultural concerns; 3) cover specific issues relevant to Asian Americans and Pacific Islanders, including the role of acculturative stress, socioeconomic hardship, and other risk factors that may account for mental health disparities; and 4) continuously engage researchers, educators, and community stakeholders in cooperatively and creatively applying new knowledge to clinical challenges. The authors summarize resources for youth violence prevention education that have been used for training healthcare professionals in a multicultural context.     

高校青年教师心理健康及团体心理训练设计研究

随着高校青年教师的比例日益上升。高校青年教师的心理健康问题必须予以足够的重视。本研究采用临床症状自评量表(SCL-90)和艾森克个性问卷(EPQ)对高校青年教师心理健康状况进行调查．结果显示高校青年教师主要存在的问题表现在生理与心理问题、人际关系问题、心理压力问题、情绪稳定性问题等四方面。依据高校青年教师的心理特点及其现状。其团体心理训练的主要内容有改善心智模式训练、情绪管理训练、意志力训练、人格魅力训练、人际沟通训练、缓解压力训练、适应与发展训练、身心保健训练等．主要的训练方法是团体讨论和角色扮演。     

Challenges to professional psychology education in the 21st century: response to Peterson

Professional psychology education faces many critical challenges brought about by the major changes occurring in the health care arena. This article shows that professional schools and programs have a good record of responding to these challenges and of taking proactive steps sponding to prepare their graduates for new health care roles and delivery systems. Data on admissions to psychology doctoral training programs demonstrate little support for the toral concerns raised by Donald R. Peterson (2003, this issue) about the preparation of students for graduate training in professional programs. Although quality concerns are important to investigate, such examination best resides with portant the American Psychological Association's Committee on Accreditation, which has the promotion of quality and excellence in professional psychology education and training as its major goal and responsibility.     

Psychologists' role in family-centered approach to practice, training, and research with young children

Family-centered, community-based, coordinated care for children with special needs is presented as the best practice model for providing services to children and families. Psychologists must learn to play an active role in this frame-work that both integrates psychology with other health and education disciplines and uses the broad spectrum of psychological knowledge about families, development, community organization, and intervention strategies. Key principles of family-centered child psychology affect practice research and training. The psychologist becomes part of a team created to support families as the primary care-givers of their children. Training programs must reorganize the types of experiences both in the classroom and the field to train new psychologists within this model. As mandates for family-centered care affect policies at the state and federal levels, research will remain a critical factor in understanding the effects of these policy shifts on child and family functioning and the delivery of services.     

Implementation and Dissemination of Military Informed and Evidence-Based Interventions for Community Dwelling Military Families

Community dwelling military families from the National Guard and Reserve contend with deployment-related stressors in relative isolation, living in communities where mental health providers may have little knowledge of military culture. When they are community residents, active duty service members and families tend to live in close proximity to their military installations. This article will focus primarily on the challenges to quality mental health care for reserve component (RC) families. Where studies of RC families are absent, those of active component (AC) families will be highlighted as relevant. Upon completion of a deployment, reintegration for RC families is complicated by high rates of symptomatology, low service utilization, and greater barriers to care relative to AC families. A paucity of providers skilled in evidence-based treatments (EBTs) limits community mental health capacity to serve RC military families. Several emergent programs illustrate the potential for better serving community dwelling military families. Approaches include behavioral health homes, EBTs and treatment components, structured resiliency and parent training, military informed schools, outreach methods, and technology-based coping, and psychoeducation. Methods from implementation science to improve clinical skill acquisition and spread and sustainability of EBTs may advance access to and quality of mental health treatment and are reviewed herein. Recommendations related to research methods, military knowledge and treatment competencies, and transition to a public health model of service delivery are discussed.     

Towards effective treatment of eating disorders: nothing is as practical as a good theory

There is much room for improvement in the treatment of eating disorders, anorexia nervosa in particular. It is argued that for more effective treatment a radical change in thinking and doing is needed. First, the wide-spread multicausal model of eating disorders must be abandoned and replaced by (a) fundamental strategic research into the most parsimonious explanation of eating disorders and (b) interventions solely directed on the specific maintaining mechanisms. Second, evidence-based working is needed in mental health care. In daily practice, two of three psychotherapists do not treat their eating disordered patients with the best treatment available, i.e. cognitive behaviour therapy. The Dutch Ministry of Health, Welfare and Sport tried to improve the care for eating disorder patients by the nomination of several specialist hospital units. These units are, however, not selected for their treatment quality or the use of evidence-based treatment protocols. It is argued that this ministerial operation will not increase the supply of effective treatment. The Minister obviously should have done two other things to improve the amount and quality of treatment supply for eating disorders: First, she better could invest in a broad array of workshops, training and supervision programs in cognitive behaviour therapy for all psychotherapists working with eating disorders. Second, since nothing is so practical as a good theory, the facilitation of research into parsimonious models of the relevant mechanisms as well as the experimental tests of interventions on these mechanisms would have been a promising move to effective treatment.     

Suicide Prevention in a Treatment Setting

Reducing the suicide rate through treatment depends on the development of new knowledge and new technology with emphasis on early intervention and continuing lowintensity contact for many troubled suicidal people, rather than the current preoccupation with detecting and hospitalizing the “highest risk.” I anticipate that sophisticated interactive computer programs will be effective in improving screening and case finding, thus bringing many more suicidal persons into contact with primary care physicians and outpatient mental health services for the purpose of relieving psychological pain. Computer programs will be invaluable in improving training for both primary care providers and outpatient mental health workers. Improved communication networks will prove to be useful resources for maintaining continuity of care and consultation, which is important in long-term treatment. Other technical developments include simplifying and making explicit various treatment approaches, in both psychotherapy and drug therapy, so that research can proceed to clarify what type of treatment helps which type of suicidal patient.     

Living the vision: health care, social justice and institutional identity.

This paper will examine the topic of identity in Roman Catholicism from the perspective of topics contained in or absent from mission statements of 25 Catholic health care institutions. In particular, I will look at these from the perspective of social justice as well as how this and other topics such as human dignity, sanctity of life, stewardship, pastoral care and the likelihood of mergers with other institutions will affect the healing ministry of Catholic health care providers. The article will conclude that there are three key dimensions to Catholic health care: leadership in advocating reform of the current health care system, care for the marginalized and under-insured, and the provision of pastoral care in all institutions.     

Improving Fairness in Coverage Decisions: Performance Expectations for Quality Improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.     

Practicing psychology in the era of managed care. Implications for practice and training

Beginning with the HMO Act of 1973, managed care, a system for controlling health care costs, rapidly expanded and gained influence as the main vehicle for health care delivery in the United States. Implementation of managed care principles in the mental health arena has generated much debate, particularly with respect to issues of quality of care. The authors briefly trace the development of managed care and evaluate its impact on the practice of psychology. The extant literature is reviewed with specific attention to issues of quality of care, confidentiality of patient information, and shifting practice patterns of clinicians. Finally, the future of professional psychology within the context of managed care is examined, and the implications of newly created mental health roles for practitioners, training programs, and organized psychology are discussed.     

医学院校教学医院临床实践教学的现状与对策

国家赋予医学院校教学医院救死扶伤和教书育人的两个职能,它在现行医疗体制改革的情况下与病人的维权发生了激烈的碰撞,临床实践教学出现了滑坡现象.在分析了医学院校教学医院临床实践教学现状的基础上,作者试从制定相应法规,保障临床实践教学;践行行医准则,尊重病人权利等几个方面进行了阐述,以期保证医学院校教学医院临床实践教学的质量.     

Improving fairness in coverage decisions: performance expectations for quality improvement

Patients and physicians often perceive the current health care system to be unfair, in part because of the ways in which coverage decisions appear to be made. To address this problem the Ethical Force Program, a collaborative effort to create quality improvement tools for ethics in health care, has developed five content areas specifying ethical criteria for fair health care benefits design and administration. Each content area includes concrete recommendations and measurable expectations for performance improvement, which can be used by those organizations involved in the design and administration of health benefits packages, such as purchasers, health plans, benefits consultants, and practitioner groups.     

Postdisaster psychological intervention since 9/11

A wealth of research and experience after 9/11 has led to the development of evidence-based and evidence-informed guidelines and strategies to support the design and implementation of public mental health programs after terrorism and disaster. This article reviews advances that have been made in a variety of areas, including development of improved metrics and methodologies for conducting needs assessment, screening, surveillance, and program evaluation; clarification of risk and resilience factors as these relate to varying outcome trajectories for survivors and inform interventions; development and implementation of evidence-based and evidence-informed early, midterm, and late interventions for children, adults, and families; adaptation of interventions for cultural, ethnic, and minority groups; improvement in strategies to expand access to postdisaster mental health services; and enhancement of training methods and platforms for workforce development among psychologists, paraprofessionals, and other disaster responders. Continuing improvement of psychologists' national capacity to respond to catastrophic events will require more systematic research to strengthen the evidence base for postdisaster screening and interventions and effective methods and platforms for training. Policy decisions are clearly needed that enhance federal funding to increase availability and access to services, especially for longer term care. Traumatic bereavement represents a critical area for future research, as much needs to be done to clarify issues related to reactions and adaptation to a traumatic death.     

Considerations on medical training for gender-affirming care: Motivations and perspectives

Abstract

Background: Many transgender individuals lack access to needed medical care, partially due to a lack of providers with experience in gender-affirming healthcare.

Aims: The purpose of this study was to identify professional motivators for medical providers seeking out training in gender-affirming care and to define which training experiences were most beneficial to their career development. By identifying experienced providers’ recommendations on which training modalities are most relevant to their practice, we aim to suggest future directions for medical education initiatives to effectively expand the transgender care workforce.

Methods: A voluntary cross-sectional electronic survey was distributed through professional listservs and publicly-available referral lists to interdisciplinary providers who self-identified as having experience in providing care to transgender individuals.

Results: One hundred and fifty-three (n?=?153) physicians, physician assistants, or advance-practice nurses responded to the survey. The majority (96.7%) were located in the United States, representing 37 states. The two most common motivators for seeking out training in gender-affirming care were filling a need in the community (73.0%) and/or having met a transgender-identified person in a clinical setting who requested care (63.8%). While many providers gained skills independently (57.3%), the two most commonly-available training opportunities were professional conferences (57.3%) and mentorship (41.3%). Respondents were most likely to recommend that others in their field be trained via structured clinical experience (e.g., a rotation or longitudinal exposure during training), rather than additional didactic training.

Discussion: This study identifies key high-yield training methodologies which could improve access to quality gender-affirming healthcare. Through integration of structured clinical experiences during training, direct clinical mentorship, and professional development at conferences on gender-affirming care, the workforce of welcoming and prepared healthcare providers for transgender patients will increase. This will lead to a tremendous improvement on access to gender-affirming care in our communities.     

The impact of diabetes on psychological well being and quality of life. The role of patient education

People with diabetes live in a society that does not understand their condition. The overall perception that people with serious diabetes inject insulin and that Type 2 diabetes is relatively mild remains rife within the general population and even with some health care professionals. To make the situation worse, only few people understand that diabetes is a condition that cannot be simply controlled by medications and that the presence of diabetes markedly alters the lives of individuals and their families. Consequently, in this article we will be reviewing the scientific evidence of the effects of impaired psychological well being and poor perception of life quality on patients with diabetes. We will be enlightening the importance of patient education and self-empowerment on this aspect of management, which is crucial for the improvement in the physical, psychological and social well being of every patient suffering from this disease.