The need for psychologists trained to work in primary care settings has been well documented. In addition, efforts to increase access to primary health care for underserved and uninsured populations via community health centers and an increasing emphasis on patient-centered medical homes have heightened the demand for behavioral healthcare providers in these settings. However, psychologists trained according to a traditional specialty healthcare model may be ill-equipped for working in this fast-paced environment due to differences in practice routines, poor skills fit, or assumptions about needed services. Add to this the fact that psychology has been slow to offer didactic and practical training opportunities for psychologists to meet primary care workforce needs.
Thus, Florida Institute of Technology’s School of Psychology worked closely with the Brevard Health Alliance, the county’s only Federally Qualified Health Center (FQHC), to develop an integrated care behavioral health practicum placement. The purpose of the practicum was threefold: 1) to train Psy.D. students as members of primary care treatment teams and expand opportunities for psychologists within primary care; 2) to improve access to behavioral health services for our county’s economically disadvantaged residents; and 3) to improve primary care providers’ job satisfaction and effectiveness in treating behaviorally-based health problems.
In January 2011, four students began providing behavioral health consultation services in one clinic location under my supervision, each covering one day/week. Since that time, we have expanded into two other clinic sites and onto the FQHC’s mobile unit, with seven students providing behavioral health consultation, totaling 10.5 days/week, and two students providing peer supervision. From January 2011 through September 2013, students met with approximately 1,000 unduplicated patients who would have been unlikely to receive behavioral services otherwise.
To measure provider satisfaction and behavioral health competence, we surveyed providers at the initial training site prior to offering services, and then again a year and a half later. All surveyed reported that the addition of behavioral health consultants had improved the clinic’s behavioral health treatment “quite a bit” or “a lot,” and they unanimously reported that they would recommend such services to medical colleagues for use with their patients. Providers indicated high satisfaction in areas assessed, including access to behavioral health services, types of services provided, helpfulness to both providers and patients, timeliness of feedback, and quality of service. Medical providers also endorsed improved ability to manage patients with low motivation and non-adherence to medical treatment.
Even with these positive outcomes, the pièce de résistance has been the recent hiring of three Florida Tech Psy.D. graduates to work full-time in our clinics. Seeing our training efforts come full circle and knowing that these psychologists will help develop even more future integrated behavioral health psychologists is especially rewarding.
I greatly appreciate National Register’s support of this work. With the funding provided by the Judy E. Hall, Ph.D. Early Career Psychologist Award, I purchased supplemental training materials for students and therapeutic aids for patients, with an emphasis on pediatrics. My behavioral health service expansion efforts have also been enhanced by the additional credibility and prestige afforded to me by this award’s recognition.
Kristi Van Sickle, PsyD, a licensed psychologist, is an Assistant Professor of Community Health at the Florida Institute of Technology and the Executive Director of the Brevard Healthcare Forum, her county’s health planning body. She is also the Director of Behavioral Health for Brevard Health Alliance, Inc. She has been credentialed by the National Register since 2006.