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Dear community,

This is going to read like a desperation.
I am a pre-doctoral intern at an APA-accredited site. My current rotation is PCMHI.

I have some confusion around scheduling and triage. My supervisor told me to do some reach on my own to gain a better understanding of the PCMHI model.
I schedule patients by the hour and try to keep 5 appointments a day to have room for unscheduled appointments, consultation, and supervision. What is the typical expectation of an intern that is a couple of months away from completing an internship? (Caseload, appointments/day, and level of supervision required).

Occasionally, I receive urgent requests from primary care providers to speak to unscheduled patients. Due to Covid-19, I don't see these patients at the clinic since we have transitioned service delivery to telecare. I call these patients minutes after receiving the request and briefly taking a look at their medical chat. Sometimes, I ended giving information about local resources if the patient's basic needs for food and shelter were more pressing than anything else. Sometimes, it would be a full session if the patient was highly distressed and had a lot to process. I was told by my supervisor that if I ended spending an hour with a patient on the first call, then I should have done an intake (there is an intake template with structured specific questions for an intake session).
What is the protocol for triaging a hand-off from a primary care provider?

Any insight or information will be gratefully appreciated.
Thank you!
 
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psych.meout

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Dear community,

This is going to read like a desperation.
I am a pre-doctoral intern at an APA-accredited site. My current rotation is PCMHI.
I feel that I am held to undefined expectations with inconsistent support. I do the best I can and really want to make it to the finish line.

I have some confusion around scheudling and triage. My supervisor told me to do some reach on my own to gain a better understanding of the PCMHI model.
I scheudle patients by the hour and try to keep 5 appoinments day to have room for unscheuled appoinments, consultation, and supervision. What is the typical expectation of an intern that is a couple months away from completing internship? (Case load, appoinments/day, and level of supervision required).

Occationally, I receive urgent requests from primary care provider to speak to unscheduled patients. Due to Covid-19, I don't see these patients at the clinic since we have transitioned service delivery to telecare. I call these patients minutes after receiving the request and briefly taking a look at their medical chat. Sometimes, I ended give information about local resources if the patient's basis needs for food and shelter were more pressing than anything else. Sometimes, it would a full session if the patient was highly distressed and had a lot to process. I was told by my supervisor that if I ended spending an hour with a patient on the first call, then I should have done an intake (there is an intake template with structured specific questions for an intake session).
What is the potocal for triaging a hand-off from a primary care provider?

Any insight or information will be gratefully appreciated.
Thank you!
Yes, if you're explicitly doing PCMHI (especially at the VA, where they're probably strictest about the model), you should complete a triage if you take a full hour with the patient, regardless of how you get the patient (e.g., warm hand-off, view alert, scheduled). And a "full session" with PCMHI should be 30 minutes, not 60.
 
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erg923

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Dear community,

This is going to read like a desperation.
I am a pre-doctoral intern at an APA-accredited site. My current rotation is PCMHI.

I have some confusion around scheudling and triage. My supervisor told me to do some reach on my own to gain a better understanding of the PCMHI model.
I scheudle patients by the hour and try to keep 5 appoinments day to have room for unscheuled appoinments, consultation, and supervision. What is the typical expectation of an intern that is a couple months away from completing internship? (Case load, appoinments/day, and level of supervision required).

Occationally, I receive urgent requests from primary care provider to speak to unscheduled patients. Due to Covid-19, I don't see these patients at the clinic since we have transitioned service delivery to telecare. I call these patients minutes after receiving the request and briefly taking a look at their medical chat. Sometimes, I ended give information about local resources if the patient's basis needs for food and shelter were more pressing than anything else. Sometimes, it would a full session if the patient was highly distressed and had a lot to process. I was told by my supervisor that if I ended spending an hour with a patient on the first call, then I should have done an intake (there is an intake template with structured specific questions for an intake session).
What is the potocal for triaging a hand-off from a primary care provider?

Any insight or information will be gratefully appreciated.
Thank you!
Why does your supervisor suck at their job...would be my primary question here.

And yes, the "intake" is PCMHI should be able to be done in 30, (maybe 40) minutes. If it takes an hour, either the template is too involved (its not a 90791), or you are doing something wrong,
 
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psych.meout

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Why does your supervisor suck at their job...would be my primary question here.

And yes, the "intake" is PCMHI should be able to be done in 30, (maybe 40) minutes. If it takes an hour, either the template is too involved (its not a 90791), or you are doing something wrong,
Yeah, I'm not sure how "go figure it out on your own" is an acceptable supervision style to OP's supervisor, especially when there are specific materials developed by the VA for PCMHI and even a codified, multi-day PCMHI competency training.
 

erg923

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Yeah, I'm not sure how "go figure it out on your own" is an acceptable supervision style to OP's supervisor, especially when there are specific materials developed by the VA for PCMHI and even a codified, multi-day PCMHI competency training.
Orientation to the rotation/service is a standard and basic part of supervisory duties and responsibility, Not sure what is going on there, but it should be reported to the TD certainly.
 
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Why does your supervisor suck at their job...would be my primary question here.

And yes, the "intake" is PCMHI should be able to be done in 30, (maybe 40) minutes. If it takes an hour, either the template is too involved (its not a 90791), or you are doing something wrong,
Yes. It is a mutual understanding that I am doing something seriously wrong, and I am here to find out what am I doing wrong and how wrong am I.
 

erg923

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Yes. It is a mutual understanding that I am doing something seriously wrong, and I am here to find out what am I doing wrong and how wrong am I.
No. Its not clear to me what you are doing wrong. What's clear to me is that your PCMHI supervisor doesn't seem to want to supervise or teach you about/orient you to PCMHI. Which obviously seems odd, and is concerning.
 
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Yes, if you're explicitly doing PCMHI (especially at the VA, where they're probably strictest about the model), you should complete a triage if you take a full hour with the patient, regardless of how you get the patient (e.g., warm hand-off, view alert, scheduled). And a "full session" with PCMHI should be 30 minutes, not 60.
Sorry this might be really silly to ask, and I am feeling embarrassed.
What does it mean to complete a triage?

Would that be:
talk to/see the patient on the same day,
find out what the needs are,
provide information and/or psychoeducation,
encourage self-referral in the future if mental health services are declined and clearly no mental health needs and no previous mental health diagnosis,
brief assessments, PHQ-9, GAD-&, AUDIT-C...
review scores with the client,
schedule for a follow-up session if follow-up needed,
make recommendations for treatment options and make referrals for proper care,
consult with other providers (s) to address different needs, such as diet, chronic pain, smoking cessation....
brieflly assess SDV and HI; full risk assessment when needed,
give information about crisis resources.
 
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Orientation to the rotation/service is a standard and basic part of supervisory duties and responsibility, Not sure what is going on there, but it should be reported to the TD certainly.
The last intern at this rotation had very similar struggles. I have had multiple conversations with the TD. Some of our verbalized concerns were addressed superficially and unfavorably due to our intern status. The TD got verbally aggressive with me once when I tried to explain my side of the story.

There is no middle ground to meet sometimes. The system is very protective of itself. We the interns have learned to be VERY careful.
 
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erg923

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The last intern at this rotation had very similar struggles. I have had multiple conversations with the TD. Some of our verbalized concerns were addressed superficially and unfavorably due to our intern status. The TD got verbally aggressive with me once when I tried to explain my side of the story.

There is no middle ground to meet sometimes. The system is very protective of itself. We the interns have learned to be VERY careful.
If you are screwing up because your PCMHI supervisor has, for whatever reason, abrogated their duty, then the screwing up is their fault, not yours.
If said screw ups lead to poor performance reviews, I would advise taking it up the chain of command (beyond the TD). If not, I would leave it alone, as the TD sounds like he/she is being lazy and unreceptive to feedback. You can reflect this on his/her performance review.

I dont think anybody here can teach you PCMHI model fidelity over the internet, so I would advise looking over the following document:

.
 

psych.meout

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If you are screwing up because your PCMHI supervisor has, for whatever reason, abrogated their duty, then the screwing up is their fault, not yours.
If said screw ups lead to poor performance reviews, I would advise taking it up the chain of command (beyond the TD). If not, I would leave it alone, as the TD sounds like he/she is being lazy and unreceptive to feedback. You can reflect this on his/her performance review.

I dont think anybody here can teach you PCMHI model fidelity over the internet, so I would advise looking over the following document:

.
100% this.

The TD sucks and is unwilling to do their job or make other supervisors do theirs. This sounds like some weird ego trip and just being bad at their job with no motivation to change.

It's also not possible to teach it to you in this forum or without direct, in-person supervision. The competency training is three full days long and even that is somewhat abridged compared to what you need to be competent to do PCMHI. I did it for a year and had a brilliant supervisor, which is necessary for something that keeps you on your toes, requires it's own specific techniques, skills, etc., and forces you to use everything else you learned in clinical training in a very short period of time.
 
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Thank you, everyone, for addressing my questions and concerns. It is very validating and helps me to understand why do I always feel that I cannot please my supervisor no matter how hard I try. The interactions have an almost disturbing sadistic taste that often left me feeling awful at the core. I know what I am dealing with now. Thanks!
 

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I was a PCMHI provider at the VA for a while, and we are expected to have appts in 20-30 min. We also kept a good portion of our schedule free so we could be available for warm handoffs. When we saw a warm handoff we would do a brief functional assessment. I agree that your supervisor needs to provide far more guidance to you. If you're VA, there are a ton of training resources available.
 
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Were you given any sort of template for your initial intake and common resources that are provided during the first session from your supervisor? I agree with everyone else in that I'm confused why your supervisor is not orienting you to the service and providing a framework. It appears as though you were set loose on your own to serve as a psuedo-social worker.
 

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The PCMHI model is so different from the way most psychologists are trained, and it's not your fault that you haven't been properly oriented or supervised. I agree with others - your supervisor is not doing their job.

Here are a few other resources that may help you better understand key concepts, though of course these are not substitutes for appropriate training on site:

 

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Yes, I want to add that it sounds like I received far more training for my actual job (the competency training, reading materials, shadowing/being observed, etc) than you have received on internship! And I completed a PCMHI rotation on internship as well.
 

psych.meout

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Yes, I want to add that it sounds like I received far more training for my actual job (the competency training, reading materials, shadowing/being observed, etc) than you have received on internship! And I completed a PCMHI rotation on internship as well.
I received all that and more as a practicum student doing PCMHI. I couldn't imagine just being told to figure it out on my own. As MamaPhD said, the PCMHI model is just so different from most of your other training that it's not really feasible to adapt to it without serious formal training. That said, I think it would be really helpful for most prac students or interns to do a rotation in PCMHI, because it really hones many different important skills.
 

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What is the protocol for triaging a hand-off from a primary care provider?

Agreed with the others. If you are asking this question after your first two weeks on the rotation, your supervisor has not oriented you properly or you didn't read the orientation materials. There is plenty of VA literature on the basics of what PC-MHI is and what falls within that scope of practice. It sounds like you are partially serving the role of a social worker or approaching patients from a traditional mental health model. Either way, it seems you are not learning or being taught the proper way to manage in that particular role.
 

psych.meout

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Agreed with the others. If you are asking this question after your first two weeks on the rotation, your supervisor has not oriented you properly or you didn't read the orientation materials. There is plenty of VA literature on the basics of what PC-MHI is and what falls within that scope of practice. It sounds like you are partially serving the role of a social worker or approaching patients from a traditional mental health model. Either way, it seems you are not learning or being taught the proper way to manage in that particular role.
Once in a while PCMHI can feel a bit like social work, e.g., hooking patients up with various services to address their psychosocial needs, especially at the VA.
 
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Once in a while PCMHI can feel a bit like social work, e.g., hooking patients up with various services to address their psychosocial needs, especially at the VA.
While that's true, it sounds like that's predominately what this person is doing, since there's little to no mention of an abbreviated intake.
 
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Once in a while PCMHI can feel a bit like social work, e.g., hooking patients up with various services to address their psychosocial needs, especially at the VA.

While in reality, this may be for a number of VA clinical jobs (mine included), it is more incidental to good customer service than it is a true part of the job description. If this is all an intern is learning, that is a problem.
 
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psych.meout

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While in reality, this may be for a number of VA clinical jobs (mine included), it is more incidental to good customer service than it is a true part of the job description. If this is all an intern is learning, that is a problem.
Yeah, that's a much better way to put it than I did, though those (albeit relatively rare) occasions feels like it's not just customer service to the veteran themselves, but also to the medical providers, who seem to be at a loss for what to do when there are structural barriers to care (e.g., food insecurity for veterans who are having trouble managing diabetes).
 

erg923

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Yeah, that's a much better way to put it than I did, though those (albeit relatively rare) occasions feels like it's not just customer service to the veteran themselves, but also to the medical providers, who seem to be at a loss for what to do when there are structural barriers to care (e.g., food insecurity for veterans who are having trouble managing diabetes).
Why would that go to PCMHI? What are you going to do about that? All primary care clinics in the VA have a medical social worker, right?
 
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Why would that go to PCMHI? What are you going to do about that? All primary care clinics in the VA have a medical social worker, right?
It wasn't supposed to go to PCMHI per se and the situation wasn't handled like a PCMHI case (e.g., no triage), but rather some medical providers, especially newer ones or those who still didn't grasp what PCMHI does (despite previous attempts at education), requested help for these kinds of things. It provided an opportunity to get the veteran help (e.g., by hooking them up with SW) and educate the providers on PCMHI in general and how they could refer the veteran to SW or other services without treating PCMHI like SW.
 
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erg923

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It wasn't supposed to go to PCMHI per se and the situation wasn't handled like a PCMHI case (e.g., no triage), but rather some medical providers, especially newer ones or those who still didn't grasp what PCMHI does (despite previous attempts at education), requested help for these kinds of things. It provided an opportunity to get the veteran help (e.g., by hooking them up with SW) and educate the providers on PCMHI in general and how they could refer the veteran to SW or other services without treating PCMHI like SW.
When I did PCMHI in the VA it was like talking to walls with some docs and NPs. After 3 years, some were still like: "Whoa...you can see my patients in need same day?!"
Me (in my head): That right, Einstein. We have been over this a dozen times in the past 3 years.
MD/NP: Never thought I'd see the day...
Me: Yep. They can put a man on the moon too there, Copernicus.
 
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erg923

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And just to clarify for the OP, PCMHI has changed significantly over the years, and even more so over the past 3 years. In 2012, they were still calling it "Behavioral Health Lab." Which I thought was ridiculous since it made it sound like their was some crazed psychologist with a bunch of beakers and dry ice seeing patients in a random, hidden office.

My facility was doing an abbreviated psychiatric evaluation/intake (essentially) that still met threshold for the 90791 code back in early 2017. It was only right before I left that they started to get real strict about the "functional assessment" thing. We also saw some patients that clearly needed longer term services until they had their MHC (or PCT) intake since MHC was so backed up, so that someone would have "eyes on" them and their condition/symptoms. Sometimes this was as long as 8-9 weeks. I think this is probably much less common now since "model fidelity" has taken over. Or so I have heard.
 
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The most recent development that I'm aware of in the VA is the move to prioritize same-day access. Sounds great, in theory, unfortunately it has some flaws. I think it's called the PCMHI5, but it's essentially the percent of new patients who are seen same day. The target is 75%, but I don't believe it takes into account patient preference, so if a patient doesn't have time to stick around for a same-day appointment the PCMHI providers get dinged on the metric.
 

erg923

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The most recent development that I'm aware of in the VA is the move to prioritize same-day access. Sounds great, in theory, unfortunately it has some flaws. I think it's called the PCMHI5, but it's essentially the percent of new patients who are seen same day. The target is 75%, but I don't believe it takes into account patient preference, so if a patient doesn't have time to stick around for a same-day appointment the PCMHI providers get dinged on the metric.
That was around my whole time in the VA too, but leadership couldn't really figure out how to run the stats so that it reflected anything meaningful in their "dashboard."

PCMHI was still just trying to stay within accepted weighted RVUs when I was there. I think that's why we held on to the initial sessions as being able to be coded as a 90791( instead of 90832), since it was like 3 weighted RVUs or something.
 

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When I did PCMHI in the VA it was like talking to walls with some docs and NPs. After 3 years, some were still like: "Whoa...you can see my patients in need same day?!"
Me (in my head): That right, Einstein. We have been over this a dozen times in the past 3 years.
MD/NP: Never thought I'd see the day...
Me: Yep. They can put a man on the moon too there, Copernicus.
I've had these encounters as well as:

Me: Oh, I see you have a patient coming in at 11:00 who has [X issue]. PCMHI can help with that by [Y].
MD/NP: You can do that?
Me: Yes, just let me know when you're finished with the patient and I can come over to offer them the service or you can just walk them over to my office.
MD/NP: Wait, you can do that....and see them today?
Me: Yes [FML]

I don't know which is worse, the providers not including PCMHI when it was something obviously germane PCMHI and about which we've previously discussed or those who would try to rope us into something clearly inappropriate for PCMHI.
 

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As much as I do think there are flaws in current PCMHI implementation in VA as a system, I was also extremely impressed by the service at my site. The medical providers seemed to genuinely appreciate, respect, and value PCMH. There are certainly areas for improvement (warm hand-offs not a good fit, or not occurring despite being a good fit, etc), however, my impression was that the PCMH folks provide a service that significantly improves quality of care for veterans, and is invaluable not only to the primary care clinic but also specialty MH. Having moved over to specialty mental health clinics now I'm constantly referring back to triage notes from the same handful of really excellent PCMH psychologists/psychiatrists.

For a mental health provider I think it's one of the most encouraging and appealing parts of being part of the VA system. Just my two cents.
 

erg923

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I've had these encounters as well as:

Me: Oh, I see you have a patient coming in at 11:00 who has [X issue]. PCMHI can help with that by [Y].
MD/NP: You can do that?
Me: Yes, just let me know when you're finished with the patient and I can come over to offer them the service or you can just walk them over to my office.
MD/NP: Wait, you can do that....and see them today?
Me: Yes [FML]

I don't know which is worse, the providers not including PCMHI when it was something obviously germane PCMHI and about which we've previously discussed or those who would try to rope us into something clearly inappropriate for PCMHI.
As much as I do think there are flaws in current PCMHI implementation in VA as a system, I was also extremely impressed by the service at my site. The medical providers seemed to genuinely appreciate, respect, and value PCMH. There are certainly areas for improvement (warm hand-offs not a good fit, or not occurring despite being a good fit, etc), however, my impression was that the PCMH folks provide a service that significantly improves quality of care for veterans, and is invaluable not only to the primary care clinic but also specialty MH. Having moved over to specialty mental health clinics now I'm constantly referring back to triage notes from the same handful of really excellent PCMH psychologists/psychiatrists.

For a mental health provider I think it's one of the most encouraging and appealing parts of being part of the VA system. Just my two cents.
There is an evidence base for the effectiveness (and cost effectiveness) of PCMHI (or its equivalent). I'm am not saying there isn't, and I think it can be beneficial to patients and health systems. I want to be very clear about that.

That said, I have written on this board before about various problems with this model for psychologists and the role of clinical psychological science in the current health system, citing some quite influential names and papers. Namely, if a masters level provider can do it, maybe this isn't something the doctoral level profession needs to own and shout from the rooftops as "the future of psychology." Also, generally speaking, if the VA thinks its the "bees knees,"chances are there is something wrong with it, or at least another side to be argued.
 
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beginner2011

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There is an evidence base for the effectiveness (and cost effectiveness) of PCMHI (or its equivalent). I'm am not saying there isn't, and I think it can be beneficial to patients and health systems. I want to be very clear about that.

That said, I have written on this board before about various problems with this model for psychologists and the role of clinical psychological science in the current health system, citing some quite influential names and papers. Namely, if a masters level provider can do it, maybe this isn't something the doctoral level profession needs to own and shout from the rooftops as "the future of psychology." Also, generally speaking, if the VA thinks its the "bees knees,"chances are there is something wrong with it, or at least another side to be argued.
Mind sharing them again? I must have missed that convo (I miss a lot of stuff here, unfortunately).
 
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erg923

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Mind sharing them again? I must have missed that convo (I miss a lot of stuff here, unfortunately).
Not tonight, no. They exist and are somewhere. I can look tomorrow.

Point is: Clinical Psychologists seriously needs to get out of this notion that "anything you can do I can do better."

"Doc, I'm pretty much cool but I can't sleep" and "Doc I'm pretty much cool but I feel feel anxious since I got back from (insert Middle eastern country here) is not a skill that Clinical Psychology should be hanging its hat on and celebrating as one of our biggest roles and biggest victories in the clinical service sphere. And lets not delude ourselves here, please. The "health psychology" component of PCMHI (in the VA at least) is the minority, and most often could be managed by a master-level clinical SW and a nutritionist working with the primary care doc. I don't really know why a Psychologist would be needed there, or if there would any further benefit to adding that service...whatever their specialty training?

I think we (Ph.D.s) should be doing and penetrating much more as doctoral-level scientist and clinicians. If we aren't....I think a 2 year degree in clinical social work is just fine. This is exactly why I left clinical service positions and redirected my effort to serving the healthcare system in a different way.
 
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Not tonight, no. They exist and are somewhere. I can look tomorrow.

Point is: Clinical Psychologists seriously needs to get out of this notion that "anything you can do I can do better."

"Doc, I'm pretty much cool but I can't sleep" and "Doc I'm pretty much cool but I feel feel anxious since I got back from (insert Middle eastern country here) is not a skill that Clinical Psychology should be hanging its hat on and celebrating as one of our biggest roles and biggest victories in the clinical service sphere. And lets not delude ourselves here, please. The "health psychology" component of PCMHI (in the VA at least) is the minority, and most often could be managed by a master-level clinical SW and a nutritionist working with the primary care doc. I don't really know why a Psychologist would be needed there, or if there would any further benefit to adding that service...whatever their specialty training?

I think we (Ph.D.s) should be doing and penetrating much more as doctoral-level scientist and clinicians. If we aren't....I think a 2 year degree in clinical social work is just fine. This is exactly why I left clinical service positions and redirected my effort to serving the healthcare system in a different way.
Out of curiosity, what sort of job do you have now?
 

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Not tonight, no. They exist and are somewhere. I can look tomorrow.

Point is: Clinical Psychologists seriously needs to get out of this notion that "anything you can do I can do better."

"Doc, I'm pretty much cool but I can't sleep" and "Doc I'm pretty much cool but I feel feel anxious since I got back from (insert Middle eastern country here) is not a skill that Clinical Psychology should be hanging its hat on and celebrating as one of our biggest roles and biggest victories in the clinical service sphere. And lets not delude ourselves here, please. The "health psychology" component of PCMHI (in the VA at least) is the minority, and most often could be managed by a master-level clinical SW and a nutritionist working with the primary care doc. I don't really know why a Psychologist would be needed there, or if there would any further benefit to adding that service...whatever their specialty training?

I think we (Ph.D.s) should be doing and penetrating much more as doctoral-level scientist and clinicians. If we aren't....I think a 2 year degree in clinical social work is just fine. This is exactly why I left clinical service positions and redirected my effort to serving the healthcare system in a different way.

This topic seems to have run its course, so I will stray off topic and just say that I agree with this sentiment so much. Psychology needs to better define scope of practice and protect its turf instead of relying on the notion that we to the same thing better (and for more money). While I think those of us who are a bit older are safe, I am curious to see how budgetary restrictions may impact this in the future. Many non-VA health systems already use mid level providers for this purpose.
 

WisNeuro

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This topic seems to have run its course, so I will stray off topic and just say that I agree with this sentiment so much. Psychology needs to better define scope of practice and protect its turf instead of relying on the notion that we to the same thing better (and for more money). While I think those of us who are a bit older are safe, I am curious to see how budgetary restrictions may impact this in the future. Many non-VA health systems already use mid level providers for this purpose.
One of the reasons I am expanding my forensic work, that'll be a safe, and lucrative position for a while. Sorry kids, you're on your own. :)
 

erg923

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This topic seems to have run its course, so I will stray off topic and just say that I agree with this sentiment so much. Psychology needs to better define scope of practice and protect its turf instead of relying on the notion that we to the same thing better (and for more money). While I think those of us who are a bit older are safe, I am curious to see how budgetary restrictions may impact this in the future. Many non-VA health systems already use mid level providers for this purpose.
Right. There is really nothing about PCMHI that is unique to a psychologist. Thus, I have been somewhat bewildered to see how in love psychology seems to have become with it. "The future of psychology, etc." Um no, its not. Social workers do this almost exclusively outside the VA.
 
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beginner2011

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I did it for a year and had a brilliant supervisor, which is necessary for something that keeps you on your toes, requires it's own specific techniques, skills, etc., and forces you to use everything else you learned in clinical training in a very short period of time.
Right. There is really nothing about PCMHI that is unique to a psychologist.
I think different people sometimes have very different views of what happens in PCMHI, which is odd to me. As an intern, my experience was more consistent with the former. I can imagine how if I were in that role for multiple years my view may be more like the latter. However, I wonder how accurate it is to say that a typical master's level provider can complete a solid functional analysis, triage, and deliver a brief intervention in a 30 minute appointment with limited/no information beyond "they're depressed" or "I think they have PTSD?"
 

erg923

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I think different people sometimes have very different views of what happens in PCMHI, which is odd to me. As an intern, my experience was more consistent with the former. I can imagine how if I were in that role for multiple years my view may be more like the latter. However, I wonder how accurate it is to say that a typical master's level provider can complete a solid functional analysis, triage, and deliver a brief intervention in a 30 minute appointment with limited/no information beyond "they're depressed" or "I think they have PTSD?"
Half the PMHI team at my former VA were LCSWs. They did this all day everyday. And they seemed just a good as me. Typical masters level? Probably not. Good ones with some brief training. Sure.
 
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Sanman

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I think different people sometimes have very different views of what happens in PCMHI, which is odd to me. As an intern, my experience was more consistent with the former. I can imagine how if I were in that role for multiple years my view may be more like the latter. However, I wonder how accurate it is to say that a typical master's level provider can complete a solid functional analysis, triage, and deliver a brief intervention in a 30 minute appointment with limited/no information beyond "they're depressed" or "I think they have PTSD?"

I think that the question here is how much specialized training does the average psychologist get in PC-MHI skills over a mid-level provider? My experience was not that much. You are retraining everyone for that job from a traditional mental health model, so why pay a psychologist more money to do it?
 

beginner2011

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I think that the question here is how much specialized training does the average psychologist get in PC-MHI skills over a mid-level provider? My experience was not that much. You are retraining everyone for that job from a traditional mental health model, so why pay a psychologist more money to do it?
Psychologists get quite a bit more training in psychodiagnostic assessment, have more experience with high-risk pts, are more capable of consuming/applying research, and are often more familiar with a variety of evidence based treatments, all of which are important elements of PCMHI.
 

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Right. There is really nothing about PCMHI that is unique to a psychologist. Thus, I have been somewhat bewildered to see how in love psychology seems to have become with it. "The future of psychology, etc." Um no, its not. Social workers do this almost exclusively outside the VA.
From my experience, there are two things psychologists brought to PCMHI that the LCSWs did not: cognitive screens and decision-making capacity. Although we had LCSWs who technically could administer MoCAs, physicians tended to prefer ours because we gave a thorough interpretation instead of just saying the score and cutoff. And decision-making they needed a doctoral level provider to sign off. Our current PCMHI psychologist, who took over for me, actually has a clinic where she does capacity assessments over in Primary Care regularly.
 

erg923

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From my experience, there are two things psychologists brought to PCMHI that the LCSWs did not: cognitive screens and decision-making capacity. Although we had LCSWs who technically could administer MoCAs, physicians tended to prefer ours because we gave a thorough interpretation instead of just saying the score and cutoff. And decision-making they needed a doctoral level provider to sign off. Our current PCMHI psychologist, who took over for me, actually has a clinic where she does capacity assessments over in Primary Care regularly.
Thats a fair point.
 

Sanman

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Psychologists get quite a bit more training in psychodiagnostic assessment, have more experience with high-risk pts, are more capable of consuming/applying research, and are often more familiar with a variety of evidence based treatments, all of which are important elements of PCMHI.
So, in my view, these are elements of general training that we bring to the table for any job, not just PCMHI. However, we don't all explicitly train in triage, abbreviated intake, and focused, time limited, health related interventions. Back to ERG's point, what you listed above is what we do better not exclusively.
 
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Sanman

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From my experience, there are two things psychologists brought to PCMHI that the LCSWs did not: cognitive screens and decision-making capacity. Although we had LCSWs who technically could administer MoCAs, physicians tended to prefer ours because we gave a thorough interpretation instead of just saying the score and cutoff. And decision-making they needed a doctoral level provider to sign off. Our current PCMHI psychologist, who took over for me, actually has a clinic where she does capacity assessments over in Primary Care regularly.
Agreed, this is why I have spent a good deal of my time developing knowledge and completing decisional capacity evaluations as part of my previous job (specifically geriatric decisional capacity in my case). Not something that can be easily taken away from us by mid-levels and it may be where I focus my PP efforts in the future.
 
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