Comparison of Teleintegrated Care and Telereferral Care for Treating Complex Psychiatric Disorders in Primary Care: A Pragmatic Randomized Comparative Effectiveness Trial.

Importance: Only one-third of patients with complex psychiatric disorders engage in specialty mental health care, and only one-tenth receive adequate treatment in primary care. Scalable approaches are critically needed to improve access to effective mental health treatments in underserved primary care settings. Objective: To compare 2 clinic-to-clinic interactive video approaches to delivering evidence-based mental health treatments to patients in primary care clinics. Design, Setting, and Participants: This pragmatic comparative effectiveness trial used a sequential, multiple-assignment, randomized trial (SMART) design with patient-level randomization. Adult patients treated at 24 primary care clinics without on-site psychiatrists or psychologists from 12 federally qualified health centers in 3 states who screened positive for posttraumatic stress disorder and/or bipolar disorder and who were not already receiving pharmacotherapy from a mental health specialist were recruited from November 16, 2016, to June 30, 2019, and observed for 12 months. Interventions: Two approaches were compared: (1) telepsychiatry/telepsychology-enhanced referral (TER), where telepsychiatrists and telepsychologists assumed responsibility for treatment, and (2) telepsychiatry collaborative care (TCC), where telepsychiatrists provided consultation to the primary care team. TER included an adaptive intervention (phone-enhanced referral [PER]) for patients not engaging in treatment, which involved telephone outreach and motivational interviewing. Main Outcomes and Measures: Survey questions assessed patient-reported outcomes. The Veterans RAND 12-item Health Survey Mental Component Summary (MCS) score was the primary outcome (range, 0-100). Secondary outcomes included posttraumatic stress disorder symptoms, manic symptoms, depressive symptoms, anxiety symptoms, recovery, and adverse effects. Results: Of 1004 included participants, 701 of 1000 (70.1%) were female, 660 of 994 (66.4%) were White, and the mean (SD) age was 39.4 (12.9) years. Baseline MCS scores were 2 SDs below the US mean; the mean (SD) MCS scores were 39.7 (14.1) and 41.2 (14.2) in the TCC and TER groups, respectively. There was no significant difference in 12-month MCS score between those receiving TCC and TER (ß = 1.0; 95% CI, -0.8 to 2.8; P = .28). Patients in both groups experienced large and clinically meaningful improvements from baseline to 12 months (TCC: Cohen d = 0.81; 95% CI, 0.67 to 0.95; TER: Cohen d = 0.90; 95% CI, 0.76 to 1.04). For patients not engaging in TER at 6 months, there was no significant difference in 12-month MCS score between those receiving PER and TER (ß = 2.0; 95% CI, -1.7 to 5.7; P = .29). Conclusions and Relevance: In this comparative effectiveness trial of patients with complex psychiatric disorders randomized to receive TCC or TER, significantly and substantially improved outcomes were observed in both groups. From a health care system perspective, clinical leadership should implement whichever approach is most sustainable. Trial Registration: ClinicalTrials.gov Identifier: NCT02738944.

Psicología Y Profesión En España. Los Primeros Años Del Colegio Oficial De Psicólogos / Psychology And Profession In Spain. The Early Years Of The Spanish Psychological Association

La creación del COP tuvo enorme trascendencia para el establecimiento de la Psicología y para dotarla de identidad. Desde la Ley de creación en 1980, esta organización de carácter semipúblico destinada a ordenar y representar la profesión no ha dejado de crecer, a pesar de graves problemáticas internas y externas. El COP ha pasado por diversas etapas, que reflejan y al tiempo ayudan a caracterizar la corta historia disciplinar de la psicología, sobre todo su definición, frente a otras profesiones. El artículo ofrece una amplia revisión legislativa y documental, sobre todo desde su revista portavoz, Papeles del Psicólogo. Analiza sus complicados primeros años, hasta 1993, bajo la dirección de Carlos Camarero y de Adolfo Hernández, marcados por la configuración interna de la Organización, una grave problemática profesional, y la lucha por conseguir la Licenciatura. (AU)

The creation of the Spanish Psychological Association (Spanish acronym, COP) was of enormous significance in the establishing of psychology in Spain, and in the creation of its identity. Since the publication of the 1980 Law of Creation [of the COP], this organization-aimed at regulating and representing the psychology profession-has not stopped growing, despite the serious internal and external issues it has had. The Spanish Psychological Association has gone through different stages over the past 40 years, which reflect and help us to characterize the short history of Spanish psychology, in particular the history of its delimitation with respect to other professions. This article presents an extensive legislative and documentary review, particularly based on its representative publication, Papeles del Psicólogo/Psychologist Papers. We analyze the complicated early years, up to 1993, under the direction of Carlos Camarero and Adolfo Hernández, a phase marked by the internal configuration of the organization, a serious challenge for the profession, and the fight to approve the master’s degree. (AU)

Waiting list eradication in secondary care psychology: Addressing a National Health Service blind spot.

OBJECTIVES: Waiting times for secondary care psychological therapy remain a 'blind spot' in serious mental illness (SMI) provision, and their reduction is a priority within the National Health Service (NHS) Five Year Forward View. The paper describes the eradication of waiting times within a community-based NHS service and the effectiveness of strategies whilst examining help-seeking behaviour, compliance and therapeutic need. METHODS: Analyses are reported for treatment compliance and therapeutic outcomes for 208 waiting-list cohort individuals seen by the SMI psychology service over an 18-month period between October 2014 and March 2016. RESULTS: No significant clinical or demographic differentiation between individuals who successfully completed therapy compared to those who disengaged was observed. Despite an average 2.20-year waiting time, this alone did not significantly impact engagement with psychological treatment and all psychological therapies provided led to a significant clinical improvement and no individuals who completed therapy required re-referral at 12-month follow-up. CONCLUSIONS: If imposed appropriately over a suitable time frame evidence-based practice coupled with effective operationalization can result in efficient needs-led psychological provision within SMI and secondary care. Potentially debilitating waiting times for service users and other referring professionals can be avoided, whilst psychology provision retains a flexible, formulation-based and person-centred approach.

The Question-prompt list (QPL): Why it is needed in the Indian oncology setting?

BACKGROUND: In India, caregivers are an integral part of the illness experience, especially in cancer, to the extent that they can become proxy decision-makers for the patient. Further, owing to acute resource constraints in the Indian healthcare system, it may be difficult for oncologists to assess and elicit questions from each patient/caregiver. Consequently, there is a need to address these unique aspects of oncology care in India to improve patient outcomes and understanding of their illness and treatment. This can be achieved through a Question Prompt List (QPL), a checklist used by care recipients during medical consultations. RECENT FINDINGS: This narrative review will first introduce research on the development and effectiveness of the QPL, and then it will highlight current gaps in oncology care in India and explore how the QPL may aid in closing these gaps. A literature search of the empirical research focused on the development, feasibility and acceptability of the QPL in oncology settings was conducted. The final review included 40 articles pertaining to QPL research. Additionally, psycho-oncology research in India centered on information needs and experiences was reviewed. Current Indian psycho-oncology research reports patients' want to be actively involved in their cancer care and a need for more illness information. However, a high demand on physicians' resources and the family caregivers' interference can be barriers to meeting patients' information/communication needs. International research demonstrates that a QPL helps structure and decrease consultation time, improves patient satisfaction with care, and improves the quality of communication during medical encounters. CONCLUSION: QPLs for Indian patients and caregivers may focus on the scope of medical consultations to address patient needs while influencing the course and content of the patient-caregiver-physician interactions. Further, it can address the resource constraints in Indian oncology care settings, thus reducing the physician's burden.

You Are the Future: Embodied History in China's Psy-boom.

Ms. Zhou, Ms. Liu, and Ms. Wen represent three generations of psychological counselors in China. They all work in Chengdu, the provincial capital of Sichuan province. China is in the midst of what scholars call the "psy-boom." This is generally defined as the rapid rise in psychological services in the country. Rather than understanding this rise as a linear phenomenon or one in which the understanding of psychology and its uses are universally shared by all practitioners, these three therapists show how haphazard and staggered the uptake in psychological services has been. They also show how the different historical contexts and shifting qualification standards that defined their generation of the psy-boom in turn shaped their therapeutic practice. The study uses Bourdieu's concept of the habitus to show how the embodied history of China's psy-boom impacts the practice of counselling and understanding of psychology.

Unburdening the Shoulders of Giants: A Quest for Disconnected Academic Psychology.

In current academic psychology, scholars typically develop their research and ideas by drawing on the work of other contemporary and preceding psychological scientists and by following certain conventions of the field. I refer to this variant of psychology as connected because the emphasis is on connecting various research findings and ideas generated by different scholars (e.g., by showing how they are related to each other via referencing). In this article, I argue that, although connected psychology advances psychological knowledge, it restricts the total amount of knowledge that could eventually be produced and therefore limits the potential of the discipline to improve the understanding of psychological phenomena. As a solution, I propose that, alongside the currently existing connected psychology, disconnected psychology should be established. In disconnected psychology, researchers develop their ideas by following the main principles of psychological method, but they are disconnected from a "field" consisting of other psychologists and therefore do not follow the discipline's norms and conventions. By drawing on one of the core constructs from information theory-information entropy-I argue that combining the two streams of psychology would result in the most significant advancement of psychological knowledge.

A licenciatura em Psicologia no Brasil: a institucionalização na regulamentação da formação / Teaching degree in Psychology in Brazil: the institutionalization in the regulation of education

Este estudo objetivou analisar a institucionalização da modalidade licenciatura na legislação que regulamentou a formação e a profissão de psicólogo no Brasil em 1962. O trabalho, de cunho historiográfico, teve como procedimento metodológico a análise documental de fontes primárias localizadas no site da Câmara Federal dos Deputados, a saber, o dossiê do PL 3825/58. Outras fontes utilizadas foram as revistas Boletim de Psicologia, Arquivos Brasileiros de Psicotécnica e Revista Psicologia Normal e Patológica. A partir da análise dos dados, identificamos que nos primeiros anteprojetos que tratavam da formação e regulamentação da profissão em 1953 não havia a proposta da licenciatura para a formação de professores de psicologia para atuação no ensino secundário. A licenciatura como modalidade de formação para os psicólogos, com uma proposta curricular coerente com a legislação então vigente para a formação de professores, apareceu apenas em 1961, e foi mantida na lei 4119, aprovada em 1962.

This study had the objective to analyze the institutionalization of the undergraduate degree in the legislation that regulated the education and the profession of the psychologist in Brazil in 1962. This research, of historiographic nature, had as a methodological procedure the documentary analysis of unpublished primary sources located on the website of the Federal Chamber of Deputies, the dossier of the PL3825/58. Other sources were the journals Boletim de Psicologia, Arquivos Brasileiros de Psicotécnica and Revista Psicologia Normal e Patológica. From the analysis of the data, we identified that, in the first projects that dealt with the education and regulation of the profession of psychologists in 1953, there was no proposal for the degree for the education of psychology teachers for high school. The degree as an education modality for psychologists, with a curricular proposal consistent with the legislation already existent for the education of teachers, appeared only in 1961, and was maintained in the project that became the law #4119, approved in 1962.

El papel de la organización colegial-COP en el posicionamiento internacional de la Psicología Española (1979-2018) / The role of the Association of Psychologists-COP in the international ranking of Spanish Psychology (1979-2018)

La presencia de revistas españolas de psicología en diferentes bases de datos internacionales (JCR y SJR) es un indicador que determina el crecimiento y la madurez de esta disciplina y aporta una visión de la actividad científica en psicología y su situación en el contexto internacional. El objetivo del presente trabajo es determinar el papel del Colegio de Psicólogos como editor de revistas de psicología de impacto. Se seleccionaron 17 revistas indexadas simultáneamente en las bases JCR y SJR de 2018. Los resultados muestran como el 53% de éstas son editadas o coeditadas por un Colegio de Psicólogos, con especial relevancia del Colegio de Psicólogos de Madrid, teniendo una mayor presencia en otras bases de datos y un mayor número de revistas en los primeros cuartiles del JCR (SSCI), si bien no existen diferencias en el número de registros en los tres primeros cuartiles desde 1997 hasta la actualidad. Se puede concluir que las políticas de estado y las campañas de posicionamiento de universidades, asociaciones y colegios juegan un papel clave en la internacionalización y posicionamiento, y que en el caso español el Colegio de Psicólogos es el principal editor y promotor de una auténtica política orientada a estos fines

The presence and spread of Spanish psychology journals in different international databases (JCR and SJR) is an indicator that determines the maturity and growth of this field, apart from providing an interesting view of the scientific activity for what concerns psychology and its situation within the international context. The objective of the present work is to determine the role of the College of Psychologists as editor of psychology high-impact journals. 17 indexed journals were simultaneously selected in the JCR and SJR databases. The results show how 53% of them are edited or coedited by a College of Psychologists, with the particular relevance of the College of Psychologists from Madrid, having this a higher presence in other databases and a higher number of 1st quartile journals in JCR (SSCI); however, there are no differences in the number of first quartile registers in the time span that goes from 1997 until now. We could conclude that the state policies and the ranking campaigns of universities, associations and colleges play a key role in internationalization and ranking, since, in the case of Spain, the College of Psychologists is the main editor and promotor of a true policy focused on these objectives

A systematic review of the psychology literature addressing hospital practice.

Hospitals, with their unique practice constraints and opportunities, are one of the most important arenas wherein the field of clinical psychology has developed throughout its history. However, there have been few efforts to comprehensively examine the literature on this topic. This is a literature worth examining, not only out of historical interest but also in the effort to provide direction for the field. Accordingly, systematic, scoping review methods were used to address the question: What does the psychology literature tell us about the nature and evolution of psychology practice in hospitals? The review identified 115 papers on this topic dating from 1916-2017, primarily in the form of practice commentaries and case studies. Analysis of the papers revealed 2 broad themes. One involved the nature of hospital practice, which concentrated on the major domains of assessment, psychotherapy and research activities along with issues related to training. The second involved structural and policy-related considerations such as cost-effectiveness and reimbursement models, leadership, the structure of practice, relationship to physicians, and hospital privileges. Implications of the review include the need for better data on the hospital practices of psychologists and continued work on role definition and the unique value of psychology. Other implications include direction for training models, practice models such as stepped care and a compromise between program and department-based management, privileges, and mental health reform. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Promoting measurement-based care and quality measure development: The APA mental and behavioral health registry initiative.

Measurement-based care has important implications across multiple avenues in mental and behavioral health care, including clinical care, quality improvement, and accountability. Using measurement-based care to demonstrate that quality care is being provided within the context of cost-efficient care could strengthen the position of mental and behavioral health providers as critical members of the health care system. Yet when measurement-based care is used to assess performance of providers, and then that performance influences reimbursement, it must be done with great care and deliberation so as not to result in unintended consequences such as punishing providers. Given psychology's expertise in measurement, the American Psychological Association (APA) and its members are uniquely suited to be leaders in promoting measurement-based care to assess quality and value. In this policy analysis paper, we examine the importance of measurement-based behavioral and mental health care across a variety of public service populations. We describe the increased federal regulatory focus on promoting quality and cost efficient care, the importance of defining and measuring quality care, and introduce an important resource being developed by APA to promote provider engagement in measurement-based care and effective participation in payment reform efforts in health care. We conclude with specific recommendations for how the field can move forward with using measurement-based care to assess accountability. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Individual and organizational psychosocial predictors of hospital doctors' work-related well-being: A multilevel and moderation perspective.

BACKGROUND: The high prevalence of burnout and depression among doctors highlights the need to understand the psychosocial antecedents to their work-related well-being. However, much of the existing research has been atheoretical, operationalized a narrow measurement of well-being, and predominantly examined such relationships at the individual level. PURPOSE: This study uses a multilevel perspective to examine individual (i.e., job demands and resources) and organizational-level psychosocial predictors of three measures of work-related well-being: perceived stress, presenteeism, and work engagement. The job demands-resources theory underpins the postulated relationships. METHODOLOGY: The 2014 National Health Service Staff Survey was analyzed using multilevel modeling in MPlus. The data set involved 14,066 hospital-based doctors grouped into 157 English hospital organizations (i.e., Trusts). RESULTS: Congruent with job demands-resources theory, job demands (workplace aggression and insufficient work resources) were stronger predictors of perceived stress and presenteeism than job resources. Equally, job resources (job control and manager support) were generally stronger predictors of work engagement than job demands. At the organizational level, bed occupancy rates and number of emergency admissions predicted work engagement. No hypothesized individual or multilevel interactions were observed between any of the job demands and resources. PRACTICAL IMPLICATIONS: The findings emphasize that a broader perspective of work-related well-being among hospital doctors should be employed and the empirical value of examining such relationships from a multilevel perspective. Successful health intervention should target the appropriate antecedent pathway and recognize the role of organizational-level factors when trying to manage hospital doctors' work-related well-being.

A psicologia organizacional em uma perspectiva fenomenológica-hermenêutica: a produtividade em questão / La psicología organizacional en una perspectiva fenomenológicahermenéutica: la productividad en questión / The organizational psychology in a phenomenological-hermeneutic perspective: the productivity in question

RESUMO. Neste estudo procura-se explicitar como a exigência de produtividade se encontra presente no processo de treinamento e desenvolvimento que se articula nas organizações pela psicologia. Por meio de um pensar calcado na tecnocracia, a relação que o trabalhador detém com seu trabalho e, por tabela, sua qualificação, passou a ser medida pela sua produção, requisito fundamental para a manutenção do indivíduo na organização. Com base no pensamento fenomenológico-hermenêutico, tal como elaborado por Martin Heidegger, o objetivo deste artigo é apresentar outra proposta em psicologia e suas práticas no contexto corporativo. Nesta proposta, procura-se deslocar a ênfase depositada na produtividade excessiva para o processo singular, de forma a valorizar o modo como cada um se articula com sua tarefa laboral. Com isso, importa pensar como cada um se apropria de sua relação com o trabalho, considerando que a exigência de produção excessiva se edifica no contexto epocal no qual o trabalho e o trabalhador vêm se articulando e que Heidegger denomina de era da técnica.

RESUMEN. En este estudio se busca explicar cómo el requisito de productividad está presente en el proceso de formación y desarrollo que se articula en las organizaciones por la Psicología. Por intermedio de un pensamiento basado en la tecnocracia, la capacidad del trabajador comenzó a medirse por su producción, un requisito fundamental para el mantenimiento del individuo en la organización. Basado en el pensamiento fenomenológico-hermenéutico, como elaborado por Martin Heidegger, el objetivo de este artículo es presentar otra propuesta en psicología y sus prácticas en la organización. En esta propuesta, el énfasis pasa de la productividad excesiva al proceso singular para valorar la forma en que cada uno se articula con su tarea de trabajo. Con esto se trata de respectar el hombre singular según su ritmo, ya que cada uno se apropia de su manera de la relación con el trabajo, teniendo en cuenta que la demanda de producción excesiva se construye en el contexto actual en el que el trabajo y el trabajador se han estado articulando y lo que Heidegger llama de era de la técnica.

ABSTRACT This study sought to explain how the demand for productivity is present in the training and development process that is articulated in organizations by Psychology. Through thinking based on technocracy, the relationship that the worker has with his work and, according to his qualification, started to be measured by his production, a fundamental requirement for the maintenance of the individual in the organization. Based on phenomenological-hermeneutic thinking, as elaborated by Martin Heidegger, the objective of this study was to present another proposal in psychology and its practices in the organization. In this proposal, we sought to shift the emphasis placed on excessive productivity to the singular process, in order to value the way in which each one articulates with his work task. With this, it is important to think about how each one appropriates his relationship with work, considering that the demand for excessive production is built in the epochal context, in which work and the worker has been articulating and what Heidegger calls the era of technique.

Acolhimento psicológico e afeto em tempos de pandemia: práticas políticas de afirmação da vida / Recepción psicológica y afecto en tiempos de pandemia: prácticas políticas de afirmación de vida / Psychological caring and affection in times of pandemic: life-affirming political practices

Resumo Este artigo tem como proposição discorrer acerca do acolhimento psicológico enquanto uma prática política de afirmação da vida e da saúde no panorama nacional, onde as políticas públicas para tratar a pandemia de Covid-19 tomam rumos distanciados de uma noção mais ampla de cuidado. Inspiradas na vivência de atuar em um dispositivo de acolhimento de uma universidade pública nesse momento de pandemia, nosso objetivo neste texto consiste em discutir os desafios para ultrapassar um modelo clássico de "acolhimento" em psicologia. Fundamentadas na cartografia, percorremos 05 pistas: "a-pandemia-em-nós", "o acolhimento e seus rastros", "contato, contágio e a potência dos encontros", "o cuidado como revolução numa experiência viva de afirmação da vida" e "amparo e afeto numa prática engajada". Tais pistas problematizam a prática do acolhimento psicológico partindo da reconfiguração das fronteiras relacionais em situações extremas, no caso, a pandemia, bem como das afetações que esse intervir produz nesse campo de atuação.

Resumen Este artículo propone hablar de la recepción psicológica como práctica política de afirmación de la vida y la salud en el panorama nacional, donde las políticas públicas para hacer frente a la pandemia Covid-19 se alejan de una noción más amplia de cuidado. Inspirándonos en la experiencia de trabajar en un centro de acogida psicológica de una universidad pública en este momento pandémico, nuestro objetivo en este texto es discutir los desafíos para superar un modelo clásico de "recepción " en psicología. A partir de la cartografía, cubrimos 5 pistas: "la-pandemia-em-nosotros", "la acogida y sus huellas", "contacto, contagio y el poder de los encuentros ", "el cuidado como revolución en una experiencia viva de afirmación de vida" y "apoyo y afecto en una práctica comprometida". Tales pistas problematizan la práctica de la recepción psicológica a partir de la reconfiguración de los límites relacionales en situaciones extremas, en este caso la pandemia, así como de los afectos que esta intervención produce en este campo de acción.

Abstract This article proposes to discuss psychological care as a political practice of affirming life and health in the national scenery, in which public policies to address the Covid-19 pandemic have taken a step away from a broader notion of care. Inspired by the experience of working in a public university psychological care facility during this pandemic, our aim with this text is to discuss the challenges to overcome a classic model of "caring" in psychology. Based on cartography, we follow 5 clues: "the-pandemic-in-us", "the psychological care and its tracks", "contact, contagion and the power of encounters", "caring as a revolution in a living experience of affirmation of life" and "support and affection in a committed practice". Such clues problematize the practice of psychological care starting from the reconfiguration of relational boundaries in extreme situations, in this case, the pandemic, as well as from the affections that this intervention produces in psychology.

Psychophysiological Intervention to Improve Preparedness in Military Special Operations Forces.

BACKGROUND: Actual studies in military training support the use of new methodological approaches such as high intensity interval training and inverse periodization training rather than conventional approaches. However, the application and analysis of success of these new methodologies are as yet unknown.METHODS: The military adapted the civil reverse periodization training system, composed of 6 wk and five sessions per week. For the first 3 wk soldiers performed two sessions with the objective of increasing the maximal strength of the upper and lower body muscles, and three sessions of short high-intensity interval training (HIIT). In the following 3 wk they combined two endurance HIIT and two resistance HIIT sessions with military equipment while conducting a military task.RESULTS: After the training a significant body mass index decrease was found, along with an increase in lower limb muscular strength, aerobic and anaerobic performance, resilience, stress tolerance, and psychological flexibility. Regarding the ratio of acceptance there was an increased ratio compared to previous years of 7%. In addition, married soldiers with children presented greater resilience, stress tolerance, psychological flexibility, and a higher ratio of success.DISCUSSION: Accepted soldiers presented greater psychological status and stress tolerance, highlighting the importance of the work of the unit psychologists to reinforce and monitor the psychometric profile of the soldiers as well as their intrinsic characteristics of personality and emotionality. The greater baseline physical condition and higher performance in all physical tests proves how reverse periodization training models are a great stimuli and training approach in soldiers.Tornero-Aguilera JF, Gregório Pelarigo J, Clemente-Suarez VJ. Psychophysiological intervention to improve preparedness in military Special Operations forces. Aerosp Med Hum Perform. 2019; 90(11):953-958.

Evaluation of Weigh Forward: A group intervention delivered by dietitians and psychologists within a National Health Service specialist weight management service.

There is limited evidence of the effectiveness of non-surgical interventions for severe obesity. Our aim was to evaluate a group intervention delivered by a National Health Service (NHS) specialist weight management service to contribute to the evidence base and inform the development of future services. Participants in this prospective cohort study were patients attending NHS Grampian Specialist Weight Management Services. The intervention was an interactive 12-session group programme based on evidence-based psychological model, with combined dietetic and psychological knowledge and support provided. The primary outcome was mean weight change at the end of the intervention and for 12-mo follow-up (including programme completers, baseline observation carried forward [BOCF], last observation carried forward). Secondary outcome measures included mood, anxiety, binge eating and quality of life. A total of 166 patients accepted a place on the group programme, mean body mass index was 48.9 kg/m2 . Mean weight loss at 6 mo was 5.6 kg and 35.2% of those who completed the group (n = 88) lost ≥5%. Using BOCF, 18.7% lost ≥5% at 6 mo. Those who remained in the programme maintained their weight loss 12 and 18 mo after the start of the intervention. Significant improvements were also found in psychological variables, including reduced depression, anxiety, binge eating and improved emotion regulation. This real-world evaluation of an NHS intervention for patients with severe obesity suggests that individuals who engage achieve a moderate weight loss, which most maintain a year later, although further research is needed to strengthen this conclusion.

Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm.

Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient's presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.