Clinical Community Psychology: Reflections on the Decades Following Swampscott.

The Swampscott report was foundational, but in some ways reflected divisions within community psychology that have continued into the present. Community psychologists trained in the 1970s and, especially, the 1980s confronted a period where the original focus of community mental health began to have less influence in the mental health field due to a variety of public policies, and the growth of third party payments as a significant source of health care funding. Programs that engaged communities and provided a base for prevention interventions were greatly curtailed because of changes in federal legislation and limited opportunities for state and local funding, although prevention interventions found growing interest from research funders. Clinical and community psychologists who trained in this period increasingly looked to a variety of areas outside of mental health. Consequently, the field of community psychology has become more applied and less academic, with increased attention to advocacy, theory, and global perspectives. The sweep of these changes and their implications for the future of the field are discussed here.

Implications of Healthcare Payment Reform for Clinical Psychologists in Medical Settings.

Health reform, post the passing of the Patient Protection and Affordable Care Act, has highlighted the need to better address critical issues such as primary care, behavioral health, and payment reform. Much of this need is subsequent to robust data showing the seemingly uncontrollable growth of healthcare costs, and the exacerbation of these costs for patients with comorbid behavioral health and medical conditions. There is increasing recognition that incorporating behavioral health in primary care leads to improved outcomes and better care. To address these problems, primary care will play critical roles across the healthcare system, especially in the delivery of behavioral health services. Psychologists are uniquely positioned to take advantage of this propitious moment and can help facilitate the integration of behavioral and primary care by developing competencies in integrated care, training a capable workforce, and advocating for integrated care as the status quo.

[Feasibility of consultation - liaison psychiatry in a large general hospital: quantitative description of services and personnel expenditure]. / Möglichkeiten der psychosozialen Konsiliarversorgung im Schwerpunktkrankenhaus. Quantitative Leistungsdarstellung und Personalaufwand.

BACKGROUND: The integration of psychiatric departments in general hospitals lead to an increasing demand of psychiatric consultation, which often overstrains personnel resources of short staffed psychiatric services. To provide consulting service, as it is demanded by guidelines, a multidisciplinary consulting team could be a possible solution. METHODS: A retrospective descriptive analysis of all consultations made by the psychosocial consultation and liaison service at the general hospital Wels-Grieskirchen in the years 2012 and 2013. RESULTS: There was an increase in referrals overall of 22 % from 2012 to 2013. The largest increase was observed in the group of psychiatrists, who carried out 33.1 % of all consultations. Most consultations, 39.5 %, were done by the group of clinical psychologists, partly substituting medical attendance. Taking together both occupational groups, the expected number of consultations of at least 3 % of all admissions could be achieved. CONCLUSION: A multidisciplinary consulting team consisting of psychiatrists, psychologists, psychosomatic physicians and social workers staffed with 5.11-6.79 full-time personnel is able to provide psychosocial consultation service at a quantitative level required by international guidelines.

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.

Integrating mental health services into a general hospital in Puerto Rico.

The prevalence of mental health problems in the general population should be carefully considered. The literature has reported a high co-morbidity of medical and mental illnesses; therefore, collaborative efforts incorporating psychological services into medical settings are imperative. In Puerto Rico, this is not a regular practice in general hospitals. Improving access to mental health services is a challenge and requires the creation of new venues within the healthcare system. This paper describes the theoretical framework, mission, and objectives of the Clinical Psychology Services Program (CPSP) implemented at Damas Hospital in Puerto Rico. From December 2002 to December 2010, a total of 13,580 visits were made to inpatients in diverse clinical units of the hospital; 61% of all inpatients evaluated met the criteria for at least one mental health disorder based on the DSM-IV-TR. The CPSP's outcomes highlight the acceptance and relevance of incorporating mental health services and clinical psychologists into general hospitals.

La Psicología del Deporte y la Psicología de la Salud: dos campos profesionales y un objetivo común / The Psychology of the Sport and the Psychology of the Health: two professional fields and a common aim

La expansión de la psicología del deporte como disciplina cient´fica y aplicada en los últimos años tiene como consecuencia la apertura de nuevos campos de intervención, pero también la interrelación con algunos ya existentes. El objetivo de este trabajo es definir cuáles son los ámbitos de trabajo que la psicología del deporte comparte con la psicología de la salud y cuáles son aquellos en los que aunque compartan el objetivo, los medios son diferentes(AU)

The expansion of the psychology of the sport like discipline cient'fica and applied in the last years it takes as a consequence the opening of new fields of intervention, but also the interrelationship with already existing some. The aim of this work is define which are the areas of work that the psychology of the sport shares with the psychology of the health and which are those in which though they share the aim, the means are different (AU)

The diagnosis of mental disorders: the problem of reification.

A pressing need for interrater reliability in the diagnosis of mental disorders emerged during the mid-twentieth century, prompted in part by the development of diverse new treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM), third edition answered this need by introducing operationalized diagnostic criteria that were field-tested for interrater reliability. Unfortunately, the focus on reliability came at a time when the scientific understanding of mental disorders was embryonic and could not yield valid disease definitions. Based on accreting problems with the current DSM-fourth edition (DSM-IV) classification, it is apparent that validity will not be achieved simply by refining criteria for existing disorders or by the addition of new disorders. Yet DSM-IV diagnostic criteria dominate thinking about mental disorders in clinical practice, research, treatment development, and law. As a result, the modern DSM system, intended to create a shared language, also creates epistemic blinders that impede progress toward valid diagnoses. Insights that are beginning to emerge from psychology, neuroscience, and genetics suggest possible strategies for moving forward.

Psychotherapy in Australia: clinical psychology and its approach to depression.

In Australia, clinical psychology training is dominated by cognitive and behavioral treatments (CBTs), although there is exposure to other theoretical orientations. Since 2001, over 20% of general medical practitioners (GPs) have received training in CBT, and psychiatry training increasingly incorporates CBT elements. Psychotherapy by medical practitioners is financially supported by universal health care funding with supplementation by patients and their private health insurance. Federally funded health benefits for up to 12 psychology consultations per year are provided on referral from GPs and psychiatrists, and initial takeup has been very strong. Mrs. A would be a typical patient for such a referral. However, she would not fulfill criteria for priority access from state-funded mental health services. Mrs. A would probably consult a GP and receive antidepressants, although she may also access a range of other community support programs. Access to and acceptance of psychotherapy would be greater in urban areas, and if she were of Anglo-Saxon and non-indigenous origin.

Billing effectively with the new health and behavior current procedural terminology codes in primary care and specialty clinics.

The health and behavior current procedural terminology (CPT) codes introduced in 2003 have gained nationwide acceptance through Medicare and limited acceptance through third party payers. The codes facilitate accurate description and quantification of behavioral medicine services within a primary care or specialty clinic setting. The author reviews their appropriate utilization to enhance reimbursement and facilitate development of self-sustaining behavioral medicine programs. Information is provided on increased use and reimbursement of codes within psychology. Future directions for continued advocacy, increased acceptance, training, and research are discussed.

Integrating clinical psychology into primary care settings.

The primary care setting offers a mostly new and exciting opportunity for clinical psychology. Historically, psychology has been relegated to the "back forty," distant and far removed from mainstream medicine in most major hospitals. The primary care integration possibilities for clinical psychology are many. The present article will highlight these opportunities as well as provide the reader with an understanding as to why this conceptual paradigm and practical shift is needed as well as how to integrate clinical psychology services into the primary care setting.

A funding model for a psychological service to plastic and reconstructive surgery in UK practice.

Appearance related distress in both clinical and general populations is associated with the increasing identification of surgery as a solution, leading to referrals for cosmetic surgery and pressure on NHS resources. Cosmetic surgery guidelines are designed to control this growing demand, but lack a sound evidence base. Where exceptions are provided on the basis of psychological need, this may recruit patients inappropriately into a surgical pathway, and creates a demand for psychological assessment which transfers the resource problem from one service to another. The model described below evaluates the impact of a designated psychology service to a plastic surgery unit. Developing an operational framework for delivering cosmetic guidelines, which assesses patients using clearly defined and measurable outcomes, has significantly reduced numbers of patients proceeding to the NHS waiting list and provided a systematic audit process. The associated cost savings have provided a way of funding a psychologist within the plastic surgery service so that psychological assessment becomes routine, alternative methods of treatment are easily available and all patients have access to psychological input as part of the routine standard of care.

Twenty-first century education: toward greater emphasis on context-social, economic, and educational.

In calling for a greater emphasis on the social, economic, and educational contexts, the discussion presented in this article is generally supportive of C.R. Snyder and T.R. Elliott's (this issue, pp. 1033-1054) vision of 21st century graduate education in clinical psychology. Attention is directed toward the asocial nature of professional psychology, a brief analysis of the influence of economics on the development of clinical psychology education, and the American Psychological Association's accreditation process as it shapes professional psychology education.

Following the money: economic inhibitors of change affecting graduate education in clinical psychology.

C.R. Snyder and T.R. Elliott (this issue, pp. 1033-1054) offer a thoughtful and elaborate model for future training in graduate clinical psychology, couched in visionary optimism. However, they interpret history and present trends in a manner that seems to ignore the realistic demands of economic forces. They propose thoughtful, constructive, pro-social directions, but seem at least partially oblivious to underlying economic forces destined to impede meaningful implementation of their model.

Assessing the costs, benefits, cost-effectiveness, and cost-benefit of psychological assessment: we should, we can, and here's how.

To the extent that assessment improves the effectiveness of treatment, prevention, or other services, it can be said to be effective. If an assessment is as effective as alternatives for improving treatment and less costly, it can be said to be cost-effective. If that improvement in the effectiveness of the service is monetary or monetizable, the assessment can be judged beneficial. And, if the sum of monetary and monetizable benefits of assessment exceeds the sum of the costs of treatment, the assessment can be said to be cost-beneficial. An overview of cost-related issues is followed by practical strategies that researchers and administrators can use to measure incremental costs, incremental effectiveness, and incremental benefits of adding psychological assessments to other psychological interventions.

Drug companies and clinical psychology.

This article argues that the pharmaceutical industry uses psychological techniques focusing on social conditioning, shame, and guilt to sell its concepts and products to an ever-widening group of health care professionals. Clinical psychology shows signs of both joining and resisting this process.

The high cost of prescription privileges.

This article presents some data regarding the costs in the augmentation of programs aimed at equipping psychologist to prescribe medications. Data are presented relative to the financial burden it will place on students, universities, internship sites, and the consumers of psychological services.

Prescription privileges for psychologists: constituencies and conflicts.

The pros and cons of the proposal to link prescription privileges specifically to psychological training vary from the point of view of the constituencies involved. The present article analyzes those differences. Two surprising facts are noted. First, it is scientist-practitioners who are resisting the move toward prescription privileges, not so much the basic science organizations. Second, while the practice-based organizations have been avid in their support of prescription privileges, the same cannot be said for rank and file private practitioners. On closer examination, the costs, benefits, and views of the different constituencies make sense of these anomalies. The resistance to prescription privileges is not arbitrary or unreasonable and it is not likely to go away any time soon.

Concluding remarks on the debate about prescription privileges for psychologists.

This article summarizes the six primary arguments for and against prescription privileges for psychologists (PPP or RxP) that were presented in this special issue. Four articles addressed points made in the testimony in favor of PPP by the American Psychological Association. Six articles addressed points in the testimony against PPP by the American Association of Applied and Preventive Psychology. It is concluded that the PPP debate reflects a deep schism in clinical psychology that represents a serious disunity in the field. The disunity is seen as a divide between those trained to be psychotherapists and those trained to be scientist-practitioners. It is argued that the former support PPP and are interested in the survival of professional schools, while the latter oppose PPP and are interested in the survival of university departments of psychology. For the discipline to survive there must be a rapprochement between these factions and alternatives to PPP for the retraining of psychotherapy practitioners.