Primary Care Psychology - Public Health and Psychology - Lecture Slides, Slides of Public Health

Download Primary Care Psychology - Public Health and Psychology - Lecture Slides and more Slides Public Health in PDF only on Docsity! Primary Care Psychology Docsity.com Presentation Outline  Why primary care psychology?  Barriers to primary care psychology  Models of psychological practice in primary care  Pediatric psychology in primary care  Training issues in primary care psychology Docsity.com Primary Care Psychology  “the provision of health and mental health services that includes the prevention of disease and the promotion of healthy behaviors in individuals, families, and communities” (Bray, et al., 2004, p. 8)  Changing role of psychology as a mental health profession to a health profession Docsity.com Why is psychology important in primary care? 1. Behavioral health factors  7 of the top 10 health risk factors are lifestyle or behavior factors (VandenBos, et al., 1991)  60% of visits to primary care involve behavioral health issues (Cummings, Cummings, & Johnson, 1997)  100% of medical visits involve a psychological or behavioral component (Belar, 1996) Docsity.com Why is psychology important in primary care? 2. Mental health factors  28% of Americans have a mental disorder – Only ½ of those receive treatment – ½ of those treated receive treatment only through primary care providers – ADHD is one example!!  20-25% of patients in primary care have a mental disorder (Spitzer, et al., 1995) Docsity.com Psychosocial Issues in Pediatric PC  The “hidden morbidity”  CBCL given to pediatric PC patients; 25% had elevated scores  Gave DISC to patients with elevated scores and a random sample of non-elevated patients  PCP diagnosed emotional/behavioral problems in 6% of patients, while 12% of patients were diagnosed based on the DISC  83% of patients with an emotional/behavioral problem were NOT diagnosed by PCP (Costello, 1988) Docsity.com Identification of Psychosocial Issues in PC  Identification of Ψ problems in PC has increased  In 1979: 6.8% identified with Ψ problems  In 1996: 18.7% with Ψ problems  Largest increases in: – Attention problems (1.4% to 9.2%) – Emotional problems (.2% to 3.6%)  Medication, counseling, and referrals for Ψ problems also increased  Paralleled increases in single-parent families and Medicaid enrollment  Why? (K ll h t l 2000) Docsity.com Referral of Pediatric PC Patients  Child Behavior Study 1994-1997 – Sampled 400 PCP and 21,000 patients (aged 4-15 yrs)  Of patients with a new Ψ problem presenting in PC (approx 4,000 patients), 76% were not referred – 46% could be managed by PCP – 35% were already receiving additional services – 15% self-limiting problem (Rushton, Bruckman, & Kelleher, 2002) Docsity.com Role of Primary Care Psychologists  Assessment of psychosocial or behavioral symptoms  Mood-related symptoms  Child behavior problems  Psychosocial management of acute and chronic health conditions  Adherence to physician recommendations  Pain management  Coping with stressful medical procedures Docsity.com Role of Primary Care Psychologists  Collaboration with other primary care providers  Consulting with physicians, nurses, and other health care providers  Identification of appropriate experts for referrals  Referring patients for additional psychological services (Bray, et al., 2004; McDaniel, et al., 2002) Docsity.com Barriers to Psychological Services in Primary Care  Practical issues  Time and space  Ethical issues  Informed consent  Confidentiality  Insurance payment  New CPT codes = reimbursement??  Research is needed  Education and training of graduate students (Black & Nabors, 2004; Perrin, 1999; Schroeder, 1999) Docsity.com Models of Collaboration 3. Psychologist as interdisciplinary team member – Physicians and psychologists share responsibility for patient care – Billing is done as a team – Managed care has made this model more obsolete – Example: special populations (e.g., diabetes, failure to thrive, developmental disabilities) Docsity.com Models of Collaboration 4. Psychologist as community collaborator – focused on community rather than individuals – leads to programs implemented on a community level – prevention programs – Example: NRBHC (Black & Nabors, 2004; Drotar, 1995) Docsity.com Diagnostic & Statistical Manual for Primary Care (DSM-PC): Child & Adolescent Version  Coding system for the recognition and treatment of common behavioral and developmental symptoms in primary care  Developed by American Academy of Pediatrics, Society of Pediatric Psychology, and others  2 Core Areas: Situations & Child Manifestations (Drotar, 1999) Docsity.com Diagnostic & Statistical Manual for Primary Care (DSM-PC): Child & Adolescent Version 2. Child Manifestations (10) – Symptoms organized into behavioral clusters – Allow physicians to consider:  Severity of presenting problem  Common developmental presentations  Differential diagnosis Docsity.com Diagnostic & Statistical Manual for Primary Care (DSM-PC): Child & Adolescent Version 2. Child Manifestations Developmental Competency Impulsive/Hyperactive or Inattentive Behavior Negative/Antisocial Behavior Emotions and Mood Illness-Related Behavior Docsity.com Diagnostic & Statistical Manual for Primary Care (DSM-PC): Child & Adolescent Version Problem Severity: 1. Developmental Variations • Behaviors may raise concern but are within range of typical for the child’s age 2. Problems • Disrupt child’s functioning but do not warrant a DSM-IV diagnosis 3. Disorders Docsity.com Practicing Primary Care Psychology  Use of relationship-building strategies – Frequent empathetic statements are not necessary – Implied relationship due to the physician-patient relationship that already exists – Norm within primary care is “get to the problem” quickly – Summary statement implies understanding of the patient’s problem Docsity.com Practicing Primary Care Psychology  Selection of appropriate intervention – Use of interventions designed to facilitate small changes – Use of psychoeducational material – Avoid using the same strategy for every patient (e.g., a depressed patient may benefit from increased enjoyable activities or reduction in negative thinking) Docsity.com Practicing Primary Care Psychology  Inappropriate level of care – Primary care interventions should be tried before referring for outside mental health services (in most cases)  Overdocumentation – No need for lengthy background information – Notes should be < 1 page Docsity.com