Integrated care

[PsychBoxe]

My current practicum placement is in a primary care setting where both psychologists and medical residents work together to treat a wide patient base. I am impressed and encouraged by the level of integration and collaboration at this site and am wondering if this is a typical experience for others.

What are other members' experiences in integrated care settings? By "integrated" I mean mental health services that are both co-located and imbedded within a medical setting.

What are the obstacles, if any that you have faced working in these settings?

Integrated care (e.g. behavioral medicine) is a strengthening area of psychology and would like to know what others think of its future and implications for practice.

Psychboxe

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[AcronymAllergy]

It's definitely an area in which I've seen a lot of growth just in my own grad school+ career. The biggest obstacle I've run into thus far is just educating other providers as to what it is we do, what services we provide, what types of referrals are most appropriate, etc. Additionally, it can sometimes be a tough/awkward "feeling out" process for psychologists in a team of medical providers to find their voice, so to speak. Some can be afraid to speak up and voice opinions, which can lead to psych as a whole potentially being marginalized. At the same time, others can be a bit too vocal in trying to assert themselves, and thus risk alienating the rest of the team.

All in all, though, I've found the medical professionals with whom I've worked to express overwhelmingly positive reactions to having us psych/neuropsych folks around. This can be particularly true when they have a research idea in mind, as you could end up being the first person they come to with it, depending on how you position yourself.

 

[JeyRo]

My current practicum placement is in a primary care setting where both psychologists and medical residents work together to treat a wide patient base. I am impressed and encouraged by the level of integration and collaboration at this site and am wondering if this is a typical experience for others.

What are other members' experiences in integrated care settings? By "integrated" I mean mental health services that are both co-located and imbedded within a medical setting.

What are the obstacles, if any that you have faced working in these settings?

Integrated care (e.g. behavioral medicine) is a strengthening area of psychology and would like to know what others think of its future and implications for practice.

Obstacles were pretty minor. The docs seemed all very appreciative of our presence. I would say I had less opportunity to do psych. testing than I wanted to, though (although I think that was more a feature of the training infrastructure within the Psychology program more than anything).

Psychboxe

University of Rochester Medical Center has a great integrated family medicine rotation for their psych. postdocs if you're interested in that kind of thing. In terms of obstacles, very few. Generally physicians seem to universally appreciate our presence.

 

[Therapist4Chnge]

Michigan State has a solid (2yr) fellowship program that involves integrated health services.

 

[Pragma]

It is a very popular model and a lot of health systems are shifting some of their existing psychologists to work, at least for part of their time, within primary care settings. There are also a lot of specialty positions that open up for niches like bariatric surgery or other clinics where they do one specific thing. I had some friends get hired into roles like that.

 

[MBellows]

It is a very popular model and a lot of health systems are shifting some of their existing psychologists to work, at least for part of their time, within primary care settings. There are also a lot of specialty positions that open up for niches like bariatric surgery or other clinics where they do one specific thing. I had some friends get hired into roles like that.

It doesn't hurt that PPACA pushes really hard towards integrated care settings.

 

[PHD12]

My current practicum placement is in a primary care setting where both psychologists and medical residents work together to treat a wide patient base. I am impressed and encouraged by the level of integration and collaboration at this site and am wondering if this is a typical experience for others.

What are other members' experiences in integrated care settings? By "integrated" I mean mental health services that are both co-located and imbedded within a medical setting.

What are the obstacles, if any that you have faced working in these settings?

Integrated care (e.g. behavioral medicine) is a strengthening area of psychology and would like to know what others think of its future and implications for practice.

Psychboxe

I've had overall very positive experiences with integrated care.

In terms of obstacles, you will find many providers that label patients or come up with their own "psychological" theories/explanations. We tend to view psychological problems in a pretty complex manner and take so many factors into account. Many providers are not trained to think this way. Many don't know about approaches, like motivational interviewing, that can increase compliance with medical recommendations and think that a "tough" approach works. We can provide a ton of education in this manner and help them manage burnout and frustration with patients.

 

[bmedclinic]

Good Thread, OP.
IPC is one of my areas that I've been fortunate enough to work in and want to be at least part of my careeer moving forward.
First off, I've had about 3 years experience in primary care while in grad school, and I think going through the internship application phase this has paid off tons, as every VA seems very interested in my primary care experience and research. Second, as you know, VA's are shifting to this type of practice- slowly- though.

Finally, I can talk about this all day, but note- there are certainly barriers. For those that say there arent, you either dont have enough experience to likely see the barriers or where you are working is integrated so well that the barriers are invisible now-- but they're there. Many physicians are AWESOME to work with.. but those who do not have a favorable opinion of psychology or an "old school" way of thinking will clearly become apparent. Your job is to navigate that and sell, sell, sell, with a good psychoeducation angle to the docs about why you are so helpful.

The primary care toolkit http://www.springer.com/psychology/health+and+behavior/book/978-0-387-78970-5 is a fantastic resource in my opinion.

 

[PsychBoxe]

It's very encouraging to know that others in the field have had similar experiences and that there are strong programs that offer fellowships.

Most of the physicians I work with respect and value psychological conceptualizations and interventions. On the other hand, I do agree that a large part of this is learning how to sell your craft in a convincing and confident manner. I believe that if our practice is offered and delivered in a collaborative fashion it opens up new avenues for treatment. I have found that a few family medicine docs, and even psychiatrists, quickly jump to DSM criteria and diagnoses before thinking about relevant information that can better inform treatment.

I have found that a crucial role in my integrated care experience is helping the medical residents explore their own interpersonal patterns with patients. For example, helping a resident identify when they get hooked into a patient who is drug-seeking, argumentative, aggressive, and resistant. I have the opportunity to witness these interactions and offer an outside perspective, which helps all parties involved. In this same experience I am able to learn about how medical residents interact with patients and attend to many issues in a very restricted, rigid time frame. Learning all around.

 

[Therapist4Chnge]

I have found that a crucial role in my integrated care experience is helping the medical residents explore their own interpersonal patterns with patients. For example, helping a resident identify when they get hooked into a patient who is drug-seeking, argumentative, aggressive, and resistant. I have the opportunity to witness these interactions and offer an outside perspective, which helps all parties involved. In this same experience I am able to learn about how medical residents interact with patients and attend to many issues in a very restricted, rigid time frame. Learning all around.

I think these two points are worth repeating, as they provide two very tangible opportunities to make a meaningful contribution within a multi-disc environment. Part of my week is spent doing in-patient consult work, though I find at least 20% of that time is spent providing a mix of didactic training and curbside consults about the consults that were done. Residents are still very much still in training, and most want to learn anything/everything that can help them get through their training. I usually bring structured feedback and a journal article (if they want to learn more). In certain instances I'll offer to go along with the resident (or colleague) to see the patient if there is something specific I think could be helpful.

One of the best lessons I learned from my stint in the corp world....develop a reputation for being a resource provider, not taker. The first question you should ask yourself when you meet someone is, "what can I do for them?" and if done correctly you'll start to hear, "what can I do for you?" It seems counter-intuitive, but you will find many more positive opportunities if people are seeking you for assistance/expertise. In the Primary Care / Integrated Care setting you will see this on an hourly/daily basis. One of my first psych mentors gave me a great follow-up tidbit for this: "Two ears, one mouth." I still need to remind myself of that every now and again.

 

[PsychBoxe]

I think these two points are worth repeating, as they provide two very tangible opportunities to make a meaningful contribution within a multi-disc environment. Part of my week is spent doing in-patient consult work, though I find at least 20% of that time is spent providing a mix of didactic training and curbside consults about the consults that were done. Residents are still very much still in training, and most want to learn anything/everything that can help them get through their training. I usually bring structured feedback and a journal article (if they want to learn more). In certain instances I'll offer to go along with the resident (or colleague) to see the patient if there is something specific I think could be helpful.

One of the best lessons I learned from my stint in the corp world....develop a reputation for being a resource provider, not taker. The first question you should ask yourself when you meet someone is, "what can I do for them?" and if done correctly you'll start to hear, "what can I do for you?" It seems counter-intuitive, but you will find many more positive opportunities if people are seeking you for assistance/expertise. In the Primary Care / Integrated Care setting you will see this on an hourly/daily basis. One of my first psych mentors gave me a great follow-up tidbit for this: "Two ears, one mouth." I still need to remind myself of that every now and again.

I am finding this to be so true. I think that it has many parallels to how we interact with clients. Approaching each situation with intentional curiosity reflects a desire to offer support. I find that keeping this in the forefront of my interactions is contagious to others. I am learning how to ask "what can I do for you" because the climate of the site encourages it. I hope that this practice can be implemented in other settings where care and communication is still fragmented and rigidly hierarchical.

 

[Therapist4Chnge]

It can be hard as a student (for all of the obvious and not so obvious reasons), so figuring out when you can best contribute is an important step, as you won't be given the same latitude as you would as a more experienced clinician. More experience isn't necessarily better, but you still want to pick your battles. I found working with peer and people in closer proximity in rank is more easily received. I also found that observation and clarification were really helpful approaches for me to adopt, because I learned a ton once I learned to shut up and listen every once in awhile.