ECP / Integrated Care / Health Psych forum

[bmedclinic]

Hey All,
I've decided to start a part time gig doing health psych /primary care. However, there are a TON of small details I need to sort out that quite frankly dont get discussed on this board. Most of the topics on this board revolve around getting into doc programs and internship/postdoc. However, I'm wondering if a forum exists for early career psychologists. If not, is there any interest in such a forum here?

Topics that would be helpful to me:
-billing
-private practice
-use of tech. in practice /EHR
-credentialing
-integrated care
-establishing/ guiding your career where you want it to go, etc.

There's also a chance that APA's info on early career psychologists would be most helpful, but unfortunately they do not (that I know of) have a forum for what I've listed above. Rather, there are listservs, but they just dont function the same way, which results in minimized usefulness. Ideally the national register would have something like this given their commitment to both early career psychologists and integrated care/advocacy. However, I dont think they're set up for that, either and I've not talked to anyone there about it.

Anyways, I think starting something like this would be awesome. However, if it already exists and I'm unaware, please post and let me know about such resources.

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[erg923]

There is a MH billing list on google groups-John Courtney, Ph.D is the admin.

There is a internal VA list serve for integrated care that is very active, and although you cant access that, resources are posted on the MIRREC/integrated care website here from VISN2. I have recently been assisting with some of this.

http://www.mirecc.va.gov/cih-visn2/clinical_resources.asp

I'm not on any commercial insurance panels as a provider, so not sure about that.

I think reading this book cover to cover is essential.
http://www.valorebooks.com/textbook...medium=cpc&utm_campaign=BingFTP&date=01/25/16

 

[deleted343839]

+1 for the book erg mentioned. Behavioral Consultation and Primary Care by Robinson and Reiter is also a nice resource.

If you belong to APA Division 38 there is a peer consultation program that's free of charge. Might be worth the membership fee, which isn't much. I think APAHC has a similar program too.

 

[bmedclinic]

+1 for the book erg mentioned. Behavioral Consultation and Primary Care by Robinson and Reiter is also a nice resource.

If you belong to APA Division 38 there is a peer consultation program that's free of charge. Might be worth the membership fee, which isn't much. I think APAHC has a similar program too.

nice erg, thanks.
I considered re-joining APA... very much considered it. Just havent plopped down the $250 yet to do it. I'll prob get that book erg mentioned.

 

[deleted343839]

(Pssst... you don't have to be a member of APA to join Division 38, or APAHC.)

 

[bmedclinic]

(Pssst... you don't have to be a member of APA to join Division 38, or APAHC.)

Oh, I thought that was NOT than case. Thanks MamaPhD!

 

[bmedclinic]

also erg I was very impressed with those mirecc resources. Thanks again.

 

[smalltownpsych]

I think it would be beneficial to discuss many of these topics on this site. Many of the students and prospective psychologists could benefit from hearing about the professional issues. These types of topics come up pretty regularly on the psychiatrist site which is one reason I frequent their board. Besides yesterday's students are today's ECPs.

 

[futureapppsy2]

I think it would be beneficial to discuss many of these topics on this site. Many of the students and prospective psychologists could benefit from hearing about the professional issues. These types of topics come up pretty regularly on the psychiatrist site which is one reason I frequent their board. Besides yesterday's students are today's ECPs.

We have a good chunk of ECP members here. By all means, I think @AcronymAllergy and I would very much welcome ECP discussions. So, feel free to start them!

 

[erg923]

Most of the regular psychologists on here are probably, technically, ECP sans Jon Snow, PsyDr, Fanofmeehl,

 

[cara susanna]

I'm definitely interested in ECP issues.

 

[erg923]

An ECP issue, at least for me, has been how to "move up" within the service line and really assume roles that I feel psychologists are, or at least should be, trained for. That's broadly defined, and different for each person I suppose. For me, it it more/higher pay, leadership/coordinating roles, and less direct clinical service. I am currently 80/20 (20% assistant training director). Prior to that, I managed a 90/10, with 10% being interim EBT coordinator at this VA (which I did not find as enthralling as I hoped). I have managed to develop side work that is also not direct clinical service that adds a good 25-30k onto my yearly earnings without taking much time away from my family most weeks.

 

[bmedclinic]

I have managed to develop side work that is also not direct clinical service that adds a good 25-30k onto my yearly earnings without taking much time away from my family most weeks.

I think everyone is interested in that.

 

[erg923]

I think everyone is interested in that.

Probably, however, at this VA, very few of the staff psychs do anything outside VA. I think part of the appeal of VA is relatively generous salary and benefits (compared to general market) and a strict 40 hour work week.

 

[deleted343839]

An ECP issue, at least for me, has been how to "move up" within the service line and really assume roles that I feel psychologists are, or at least should be, trained for.

I have an ECP friend who has moved up the ranks at a surprising (bordering on ridiculous) pace by working at a VAMC in a less desirable location. To some extent I think it's a matter of being in the right place at the right time.

 

[erg923]

I have an ECP friend who has moved up the ranks at a surprising (bordering on ridiculous) pace by working at a VAMC in a less desirable location. To some extent I think it's a matter of being in the right place at the right time.

To clarify, I am pretty select about "moving up." I am less gunning for chief and supervisory positions and more gunning for some of the non-traditional and central office opportunities. I would have really no desire to be the service chief here, or likely anywhere else.

 

[Harry3990]

I have managed to develop side work that is also not direct clinical service that adds a good 25-30k onto my yearly earnings without taking much time away from my family most weeks.

Are you comfortable with discussing/outlining the side work that you do? I'm always interested in hearing more about these types of nontraditional roles because profs tend to talk about them 0% of the time in grad school (at least my experience). Any details regarding what you actually do (as opposed to the oft-cited title of "consultant") would be greatly appreciated.

Great idea for a thread by the way! Would love to see more topics like this on this forum.

 

[erg923]

Are you comfortable with discussing/outlining the side work that you do? I'm always interested in hearing more about these types of nontraditional roles because profs tend to talk about them 0% of the time in grad school (at least my experience). Any details regarding what you actually do (as opposed to the oft-cited title of "consultant") would be greatly appreciated.

Great idea for a thread by the way! Would love to see more topics like this on this forum.

I'll message you.

 

[Harry3990]

I thought I'd post this question here rather than starting a new thread since it's related to integrated/primary care.

I've read more recently about 30-min sessions more often being the norm in integrated care settings. For those of you who have used this session length for therapy, I'm interested in hearing your thoughts. Some questions are below, but feel free to share whatever you think is relevant or helpful to newbies like me interested in learning more. I'm going to read the Hunter book as soon as I save up some money to buy it, as I believe they discuss this in some detail based on my reading of the intro (sample) chapter. They mention a common knee-jerk reaction being "I can't do that in 30 minutes!". I admit, I find it difficult to imagine condensing (or reprioritizing) my intake and therapy sessions that much as well.

1) Was it a difficult adjustment for you to shorten sessions this much? (assuming most people train with 45-50 min sessions)
2) Since most studies evaluating evidenced-based interventions use longer sessions (this may be an incorrect assumption), do you think the shorter length is a detriment to the intervention's efficacy?
3) Do you find it harder to establish good rapport/trust within 30 min sessions?
4) What do you like about the shorter sessions?
5) What do you not like about them?

 

[deleted343839]

I've read more recently about 30-min sessions more often being the norm in integrated care settings. For those of you who have used this session length for therapy, I'm interested in hearing your thoughts. Some questions are below, but feel free to share whatever you think is relevant or helpful to newbies like me interested in learning more. I'm going to read the Hunter book as soon as I save up some money to buy it, as I believe they discuss this in some detail based on my reading of the intro (sample) chapter. They mention a common knee-jerk reaction being "I can't do that in 30 minutes!". I admit, I find it difficult to imagine condensing (or reprioritizing) my intake and therapy sessions that much as well.

I don't think 30 minutes is an unreasonable amount of time for follow-up visits in integrated settings. For intakes, I'd still prefer a full hour (if not a bit more). It's interesting that you bring up the point about research because I learned to do 30-minute therapy sessions as an interventionist for a clinical trial in an integrated setting.

Obviously, to do a session in 30 minutes you need to set realistic goals, and you need to orient the patient to the model (especially if they've had previous psychotherapy). The format is better suited to fairly structured, agenda-driven approaches such as CBT and behavioral health interventions. Homework is essential, though it can feel more like coaching on home-based work at times. I think it's possible to streamline sessions without sacrificing rapport, though for many patients I would still opt for more conventional session lengths.

 

[erg923]

The intake in primary care is not really an intake as you may typically think of one, and if you cant let that go, it's likely to be a problem.

My "intakes" are also half hour and really capture a present, and functionally oriented, presenting concern. I do psych history, screen for psychotic symptoms/hx, the relevant psychosocial concerns to the case, mental status, and treatment plan discussion. Usually easily done in 30 minutes if you can reign in an tangents that patient may start to go on. This should not really be thought of as diagnostic eval, although one should of course be able to narrow down what they are likley looking at, as well as rule-outs.

 

[bmedclinic]

The intake in primary care is not really an intake as you may typically think of one, and if you cant let that go, it's likely to be a problem.

My "intakes" are also half hour and really capture a present, and functionally oriented, presenting concern. I do psych history, screen for psychotic symptoms/hx, the relevant psychosocial concerns to the case, mental status, and treatment plan discussion. Usually easily done in 30 minutes if you can reign in an tangents that patient may start to go on. This should not really be thought of as diagnostic eval, although one should of course be able to narrow down what they are likley looking at, as well as rule-outs.

I agree, the intake in primary care needs to be brief. If your first contact with a patient is a warm handoff though, that encounter (imo) needs to be 10-15 min ideally. That's with the goal of giving them something behaviorally based they can try, and if it doesnt work out, then they're coming back to see you, not the PCP for the next visit. In my experience (as a student, pre-licensure) this was the case, and they would come back after that visit for a 30 minute session. Note that I'm yet to do this as a stand alone, licensed psychologist integrated into primary care.

 

[bmedclinic]

also, btw, joined div 38 and its my new favorite.