RESUMO
It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.
Assuntos
Treinamento por Simulação , Humanos , Treinamento por Simulação/métodos , Inquéritos e Questionários , Internato e Residência/métodos , Psicologia/educação , Docentes de Medicina , Prestação Integrada de Cuidados de Saúde , Medicina do Comportamento/educaçãoRESUMO
Community-based primary care settings play an important role in the provision of health care to vulnerable populations, as well as in primary care education. Much attention has been given to medical education in community-based primary care and as the need for workforce development grows for behavioral health in primary care, clinical supervision of prelicensure psychology learners in primary care will also need greater attention. Clinical supervision not only impacts learner professional development but also impacts the patient care learners provide. The purpose of this article is to give attention to clinical supervision within the primary care behavioral health (PCBH) model in the context of community-based primary care. The intersection of supervision approaches in specialty mental health care and medical education will be presented, as well as how these approaches can be combined when working with learners within PCBH. Additionally, challenges to clinical supervision in primary care will be discussed as well as solutions to improve not only workforce development in PCBH but also professional development for clinical supervisors in primary care. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Assuntos
Medicina do Comportamento , Atenção Primária à Saúde , Humanos , Preceptoria , Medicina do Comportamento/educação , Atenção à Saúde , Desenvolvimento de PessoalRESUMO
BACKGROUND: Knowledge regarding the impact of curricula with behavioral medicine content and competencies (BMCC) on physical therapy (PT) students' clinical reasoning skills is lacking. OBJECTIVES: The primary objective was to compare the clinical reasoning skills, focusing on clients' behavioral change, of entry-level PT students with or without BMCC in their curricula. The secondary objective was to compare students' attitudes and beliefs in a biomedical and biopsychosocial practice orientation. METHODS: Swedish final-semester PT students (n = 151) completed the Reasoning 4 Change (R4C) instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. A blueprint was used for curricular categorization. The independent t-test was used. RESULTS: Students attending programs with BMCC curricula (n = 61) had superior scores compared with students without BMCC curricula (n = 90) in the following R4C variables, all of which were related to clinical reasoning focused on behavioral change: Knowledge, Cognition, Self-efficacy, Input from the client, Functional behavioral analysis, and Strategies for behavioral change. Students who did not receive BMCC curricula scored higher in the R4C contextual factors and reported a greater biomedical practice orientation than students receiving BMCC curricula. There was no difference in the biopsychosocial practice orientation between groups. CONCLUSIONS: Our findings support the benefit of structured entry-level PT curricula with BMCC on final-semester students' clinical reasoning skills focused on behavioral change and their level of biomedical practice orientation. Further, our findings elucidated educational opportunities to augment students' self-efficacy and strengthen their behavioral competencies in clinical reasoning. For the generalizability of the results further research in other contexts is needed.
Assuntos
Medicina do Comportamento , Raciocínio Clínico , Humanos , Medicina do Comportamento/educação , Currículo , Estudantes , Competência Clínica , Modalidades de Fisioterapia/educaçãoRESUMO
There is inconsistency in the training of military medical providers on the regulations and procedures outlining US Army-specific psychiatric readiness related competencies. These competencies are necessary to ensure the appropriate categorization of a soldier's psychiatric readiness. There exists a need for a formal, comprehensive training curriculum accessible to all providers that is time- and cost-effective. Due to the COVID-19 pandemic, there is are additional barriers of social distancing, remote virtual healthcare delivery, and geographic dispersion of healthcare personnel. To address these concerns, we developed a curriculum to target these competencies and deliver them virtually. The curriculum was developed and executed based on Kern's six-step approach to curriculum development, and the objective was to train military behavioral health providers on temporary duty limitations, administrative separations, and medical board referrals based on current US Army policies and procedures. The training was implemented virtually and conducted over the course of 3-hour training sessions to two separate groups. Evaluation of training objectives was conducted via a survey of paired before and after questions, analyzing the change in perceived confidence among learners. Among the 58 respondents, training resulted in statistically significant improvement in confidence in recognizing when a US Army soldier needs a temporary profile, writing a temporary e-profile, deciding when it is critical to contact a US Army soldier's commander, executing administrative separation, deciding when a US Army soldier is at medical retention determination point (MRDP), and in referring a US Army soldier to medical board. Results show the feasibility of virtual training to enhance medical readiness-related competencies of healthcare providers at the enterprise-level to help improve medical readiness. Limitations included immediate and subjective aspects of our results. It is unclear whether our training or similar training sessions resulted in changes in behaviors such as increased profiling or medical board referrals.
Assuntos
Medicina do Comportamento/educação , Competência Clínica , Currículo , Educação a Distância , Medicina Militar/educação , Psiquiatria/educação , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Humanos , Distanciamento Físico , Autoimagem , Inquéritos e QuestionáriosRESUMO
The objective was to study physical therapists' (PTs') experiences of learning and delivering a complex intervention, a tailored behavioral medicine treatment (BMT) targeting adolescents with pain in primary care.Method: An explorative study with qualitative approach, using content analysis. Three primary care PTs delivering the treatments in a randomized controlled study were interviewed regarding their views on the BMT.Results: The participating PTs considered learning about and delivering the BMT as challenging but rewarding. The biopsychosocial approach, tailoring of the treatment and dialogues with parents were identified as key aspects of the BMT program. The process of formulating a functional behavioral analysis was perceived as strenuous. The supervision of the PTs throughout the study was regarded as crucial and necessary for learning about and providing tailored BMT.Conclusion: Learning about and delivering BMT targeting adolescents with persistent pain is fruitful but laborious and demanding according to three PTs experienced with treatment of pediatric pain in primary care. Extensive education and long periods of supervision seem to be crucial for success and safe delivery according to protocol.
Assuntos
Atitude do Pessoal de Saúde , Medicina do Comportamento/educação , Medicina do Comportamento/métodos , Manejo da Dor/métodos , Fisioterapeutas/educação , Adolescente , Criança , Humanos , Pesquisa QualitativaRESUMO
The COVID-19 pandemic has posed unprecedented challenges to health service psychology (HSP) education and training but also presents tremendous opportunities for growth that will persist well past the resolution of this public health crisis. The present article addresses three aims in understanding the challenges and opportunities faced by the HSP education and training community. First, it describes challenges to HSP education and training created by the COVID-19 pandemic, including the need to maintain the integrity of training; facilitate trainee progress; continue clinical service delivery; manage the safety and wellbeing of trainees, faculty, staff, and clients/patients; and adhere to national and local emergency orders. Second, the article summarizes guidance from training organization leadership regarding training program and clinical site responses to these challenges. Several principle-based recommendations called upon training programs to prioritize trainees and their training needs, while urging balance and flexibility in meeting the multiple demands of training programs, institutions, and the public. Third, the article discusses key opportunities for improvement in HSP education and training, including more effective use of competency evaluations; distance technologies in therapy, supervision, and admissions; and reconsideration of internship and degree timing and HSP's identity as a health care profession; and the potential for comprehensive review and redesign of HSP education and training. Embracing these opportunities may help ensure that HSP education and training is preparing its graduates to meet the psychological health care needs of the future. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Assuntos
Medicina do Comportamento/educação , Infecções por Coronavirus , Currículo , Educação de Pós-Graduação , Serviços de Saúde Mental , Pandemias , Pneumonia Viral , Telemedicina , Adulto , COVID-19 , Educação de Pós-Graduação/organização & administração , Humanos , Serviços de Saúde Mental/organização & administração , Telemedicina/organização & administraçãoRESUMO
BACKGROUND AND OBJECTIVES: Primary care behavioral health (PCBH) is a service delivery model of integrated care linked to a wide variety of positive patient and system outcomes. However, considerable challenges with provider training and attrition exist. While training for nonphysician behavioral scientists is well established, little is known about how to train physicians to work efficiently within integrated teams. METHODS: We conducted a case study analysis of family medicine residencies in the military health system using a series of 30 to 45-minute semistructured interviews. We conducted qualitative template analysis of these cases to chart programs' current educational processes related to PCBH. Thirteen individuals consisting of program directors, behavioral and nonbehavioral faculty, and residents across five programs participated in the study. RESULTS: Current educational processes included a variety of content on PCBH (eg, treatment for depression, clinical referral pathways, patient-centered communication), primarily using a mix of didactic and practice-based placements. Resource allocation was seen as a critical contributor to quality. There was variability in the degree to which integrated behavioral health providers were incorporated as residency faculty, such that programs where these specialists were more incorporated reported more intentional curriculum development and health care systems-level content. CONCLUSIONS: While behavioral health content was well represented in family medicine residency curriculum, the depth and integration of content was inconsistent. More intentional and integrated curriculum accompanied faculty development and integration of behavioral health faculty. Future research should evaluate if faculty development programs and faculty status of behavioral scientists results in different educational or health care outcomes.
Assuntos
Medicina do Comportamento/educação , Prestação Integrada de Cuidados de Saúde , Medicina de Família e Comunidade/educação , Internato e Residência , Atenção Primária à Saúde , Currículo , Humanos , Serviços de Saúde Militar , Pesquisa QualitativaRESUMO
Paediatric medical psychology is a specialised field within clinical health psychology focussed on the behavioural, developmental, and psychological needs of children, adolescents, and families in healthcare contexts. Paediatric medical psychologists address a myriad of problems by employing evidence-based evaluations and interventions in order to support the well-being of paediatric patients and their families. In this paper, we provide an overview of paediatric medical psychology including the education and training required to be a paediatric psychologist followed by common problems addressed by paediatric psychology, the settings paediatric psychologists work in, and the services they provide. Discussion concludes with future application of integrating paediatric psychology throughout the continuum of care to optimise adjustment and health of paediatric patients.
Assuntos
Medicina do Comportamento , Transtornos Mentais , Psicologia da Criança , Psicologia Médica , Adolescente , Medicina do Comportamento/educação , Criança , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Psicologia da Criança/educação , Psicologia Médica/educaçãoRESUMO
OBJECTIVE: Behavioral health providers are often employed in inpatient settings. However, it is unclear if there is mental health diagnosis agreement between referring physicians and behavioral health providers. The purpose of this study is to assess for referring physician and behavioral health provider mental health diagnostic agreement in a general hospital setting. METHOD: An analysis of 60 consecutive inpatient referrals to a behavioral health provider in a general hospital setting was conducted. The initial referral diagnosis from referring internal medicine physicians was compared with the diagnosis made by the behavioral health provider. RESULTS: Kappa statistics indicated good diagnostic agreement for substance abuse (.79), anxiety disorders (.82), adjustment disorders (.88), relational conflict (.88), and "other" (.74). There was less agreement for depressive disorders (.55). CONCLUSIONS: Diagnostic agreement was good overall, suggesting that referrals to inpatient behavioral health providers are often appropriate. Results indicated that depression was underdiagnosed by physicians in the study sample. This is problematic given that depression can be successfully treated through the use of medication and psychotherapy.
Assuntos
Medicina do Comportamento/educação , Hospitais Gerais , Internato e Residência , Equipe de Assistência ao Paciente , Diagnóstico Diferencial , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Psiquiatria/educação , Encaminhamento e Consulta , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Inquéritos e QuestionáriosRESUMO
In 2004, Mälardalen University, Sweden, introduced a new undergraduate entry-level physiotherapy program. Program developers constructed the curriculum with behavioral medicine content that reflected the contemporary definition and values of the physiotherapy profession aligning it with current best practices, evidence, and the International Classification of Functioning, Disability, and Health (ICF). The new curriculum conceptualized movement and function as modifiable behaviors in that they reflect behavioral contingencies, perceptions, beliefs, and lifestyle factors as well as pathophysiology and environmental factors. The purpose of this article is to describe how one university accordingly structured its new curriculum and its review. We describe the rationale for the curriculum's behavioral medicine content and competencies, its development and implementation, challenges, long-term outcomes, and its related research enterprise. We conclude that physiotherapy practiced by our graduates augments that taught in other programs based on accreditation reviews. With their expanded practice scope, graduates are systematically practicing within the constructs of health and function conceptualized within the ICF. Our intent in sharing our experience is to exemplify one university's initiative to best prepare students with respect to maximizing physiotherapy outcomes as well as establish a dialogue regarding minimum standards of behavioral medicine competencies in physiotherapy education and practice.
Assuntos
Medicina do Comportamento/educação , Competência Clínica , Currículo , Especialidade de Fisioterapia/educação , Desenvolvimento de Programas/métodos , Humanos , Suécia , UniversidadesRESUMO
Comorbidity with behavioral health conditions is highly prevalent among those experiencing serious medical illnesses and is associated with poor outcomes. Siloed provision of behavioral and physical healthcare has contributed to a workforce ill-equipped to address the often complex needs of these clinical populations. Trained specialist behavioral health providers are scarce and there are gaps in core behavioral health competencies among serious illness care providers. Core competency frameworks to close behavioral health training gaps in primary care exist, but these have not extended to some of the distinct skills and roles required in serious illness care settings. This paper seeks to address this issue by describing a common framework of training competencies across the full spectrum of clinical responsibility and behavioral health expertise for those working at the interface of behavioral health and serious illness care. The authors used a mixed-method approach to develop a model of behavioral health and serious illness care and to delineate seven core skill domains necessary for practitioners working at this interface. Existing opportunities for scaling-up the workforce as well as priority policy recommendation to address barriers to implementation are discussed.
Assuntos
Medicina do Comportamento/educação , Prestação Integrada de Cuidados de Saúde/métodos , Serviços de Saúde Mental/organização & administração , Recursos Humanos/organização & administração , Competência Clínica , Cuidados Críticos , HumanosAssuntos
Transtornos do Comportamento Infantil/terapia , Orientação Infantil/educação , Internato e Residência , Transtornos Mentais/terapia , Pediatria/educação , Adolescente , Medicina do Comportamento/educação , Criança , Transtornos do Comportamento Infantil/diagnóstico , Competência Clínica , Currículo , Humanos , Comunicação Interdisciplinar , Transtornos Mentais/diagnóstico , Saúde Mental , Estados UnidosRESUMO
The Workforce Education and Training component of California's Mental Health Services Act, which passed in 2004, has infused funding into the public mental health system. However, funding has not kept pace with an existing behavioral health workforce shortage crisis, the rapid growth of an aging population, and the historical lack of geriatric training in higher education for the helping professions. This policy brief draws on recent study findings, state planning documents, and a review of the literature to describe gaps and deficiencies in the behavioral health workforce that serves older adults in California. The brief offers recommendations to the following specific audiences for improving workforce preparation and distribution: state policymakers and administrators; educational institutions, accrediting bodies, and licensing boards; and county mental health/behavioral health departments and their contracted providers.
Assuntos
Medicina do Comportamento , Serviços de Saúde para Idosos , Mão de Obra em Saúde/estatística & dados numéricos , Serviços de Saúde Mental , Idoso , Idoso de 80 Anos ou mais , Medicina do Comportamento/educação , Credenciamento , Geriatria/educação , Humanos , Serviços de Saúde Mental/provisão & distribuição , Transtornos Relacionados ao Uso de Substâncias , Prevenção do SuicídioRESUMO
Primary care behavioral health (PCBH) is a model of integrated healthcare service delivery that has been well established in the field of psychology and continues to grow. PCBH has been associated with positive patient satisfaction and health outcomes, reduced healthcare expenditures, and improved population health. However, much of the education and training on PCBH has focused on developing behavioral health providers to practice in this medical setting. Less attention has been paid to physician team members to support and practice within an integrated environment. This is problematic as underdeveloped physician team members may contribute to low utilization and attrition of behavioral health consultants. A scoping review was conducted to examine the training of physicians in this domain since 2006. Twenty-one studies were identified, predominantly in Family Medicine training programs. Although PCBH training was generally well received, more program evaluation, formalized curriculum, and faculty development are needed to establish best practices.
Assuntos
Medicina do Comportamento/educação , Educação Médica/métodos , Atenção Primária à Saúde/métodos , Currículo , Prestação Integrada de Cuidados de Saúde , Humanos , Relações InterprofissionaisRESUMO
Psycho-oncology has come of age as its own unique subspecialty under the umbrella of oncology, vastly refining our knowledge regarding the psychosocial impact of cancer and fostering acceptance of the psychological underpinnings of the cancer experience, in turn improving the overall quality of cancer care. The importance of integrating psychological practice into the comprehensive treatment of cancer has become readily apparent, and psychosocial support services are increasing in quantity and breadth. It is the aim of this article to present a cogent argument for the proliferation of Integrated Behavioral Medicine (IBM) programs in both inpatient and outpatient clinical cancer treatment centers via an in-depth discussion of a successful IBM program including analysis of program structure, service delivery model and description of clinical services provided, and a longitudinal review of referral trends.
Assuntos
Medicina do Comportamento/educação , Atenção à Saúde , Medicina Integrativa/educação , Modelos Educacionais , Neoplasias/psicologia , Neoplasias/terapia , Hospitais Urbanos , HumanosRESUMO
A "standard" historiographical overview of the development of health psychology in the United States, alongside behavioral medicine, first summarizes previous disciplinary and professional histories. A "historicist" approach follows, focussing on a collective biographical summary of accumulated contributions of one cohort (1967-1971) at State University of New York at Stony Brook. Foundational developments of the two areas are highlighted, contextualized within their socio-political context, as are innovative cross-boundary collaboration on "precursor" studies from the 1960s and 1970s, before the official disciplines emerged. Research pathways are traced from social psychology to health psychology and from clinical psychology to behavioral medicine.
Assuntos
Medicina do Comportamento/história , Autobiografias como Assunto , Medicina do Comportamento/educação , Medicina do Comportamento/métodos , Historiografia , História do Século XX , Humanos , Psicologia Social/história , Psicologia Social/métodos , Estados UnidosRESUMO
This article traces the historical evolution of ongoing theoretical debates in psychology in France from the 1940s until today. Its aim is to show how the conjunction of certain conditions led to a rapid expansion of American-derived mainstream health psychology during the 1980s. The authors describe the French context in the post-World War II period and outline the implementation of 'clinical psychology in health settings' in the 1950s, under the influence of Daniel Lagache. The strong critiques of the new psychology profession in the 1950s, 1960s and 1970s are examined. Our conclusion reflects upon future implications of ongoing rivalries between different approaches to psychology.
Assuntos
Medicina do Comportamento/história , Medicina do Comportamento/educação , Medicina do Comportamento/métodos , França , História do Século XX , História do Século XXI , Humanos , Política , Teoria PsicológicaRESUMO
The objective of this study was to assess feasibility, utilization, perceived value, and targeted behavioral health (BH) treatment self-efficacy associated with a collaborative child and adolescent psychiatry (CAP) consultation and BH education program for pediatric primary care practitioners (PCPs). Eighty-one PCPs from 41 member practices of a statewide pediatric practice association affiliated with an academic medical center participated in a program comprising on-demand telephonic CAP consultation supported by an extensive BH learning community. Findings after 2 years of implementation suggest that the program was feasible for large-scale implementation, was highly utilized and valued by PCPs, and was attributed by PCPs with enhancing their BH treatment self-efficacy and the quality of their BH care. After participation in the program, nearly all PCPs believed that mild to moderate presentations of common BH problems can be effectively managed in the primary care setting, and PCP consultation utilization was congruent with that belief.