Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Clinical Psychology in Medical Settings Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Abouljoud, M., Klintmalm, G., & Whitehouse, S. (2012). Transplant organizational structures: Viewpoints from established centers. American Journal of Transplantation, 12, 2623–2629. https://doi.org/10.1111/j.1600-6143.2012.04189.x.

    Article  PubMed  CAS  Google Scholar 

  • Abouljoud, M., & Whitehouse, S. (2013). Transplant programs, centers, and institutes: What does it all mean? Current Opinion in Organ Transplantation, 18, 229–234.

    Article  PubMed  Google Scholar 

  • Aiello, A., Simanek, A., & Galea, S. (2010). Population levels of psychological stress, herpesvirus reactivation and HIV. AIDS and Behavior, 14, 308–317.

    Article  PubMed  Google Scholar 

  • American College of Surgeons, Commission on Cancer. (2012). Cancer program standards 2012: Ensuring patient-centered care. Chicago: American College of Surgeons

    Google Scholar 

  • Auxier, A., Runyan, C., Mullin, D., Mendenhall, T., Young, J., & Kessler, R. (2012). Behavioral health referrals and treatment initiation rates in integrated primary care: A Collaborative Care Research Network study. Translational Behavioral Medicine, 2, 337–344.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ayalon, L., Areán, P. A., Linkins, K., Lynch, M., & Estes, C. L. (2007). Integration of mental health services into primary care overcomes ethnic disparities in access to mental health services between black and white elderly. The American Journal of Geriatric Psychiatry, 15, 906–912.

    Article  PubMed  Google Scholar 

  • Beacham, A. O., Van Sickle, K. S., Khatri, P., Ali, M. K., Reimer, D., Farber, E. W., & Kaslow, N. J. (2017). Meeting evolving workforce needs: Preparing psychologists for leadership in the Patient-Centered Medical Home. American Psychologist, 72, 42–54.

    Article  PubMed  Google Scholar 

  • Bertges Yost, W., Eshelman, A., Raoufi, M., & Abouljoud, M. S. (2005). A national study of burnout among American transplant surgeons. Transplantation Proceedings, 37, 1399–1401.

    Article  PubMed  CAS  Google Scholar 

  • Blount, A. (2003). Integrated primary care: Organizing the evidence. Families, Systems, & Health, 21, 121–134.

    Article  Google Scholar 

  • Burwell, S. M. (2015). Setting value-based payment goals—HHS efforts to improve US health care. New England Journal of Medicine, 372, 897–899.

    Article  PubMed  CAS  Google Scholar 

  • Butler, J. A., Roderick, P., Mullee, M., Mason, J. C., & Peveler, R. C. (2004). Frequency and impact of nonadherence to immunosuppressants after renal transplantation: A systematic review. Transplantation, 77, 769–776.

    Article  PubMed  Google Scholar 

  • Centers for Disease Control and Prevention. (2017). Chronic diseases: The leading causes of death and disability in the United States. Retrieved from https://www.cdc.gov/chronicdisease/overview/.

  • Charns, M. P., & Young, G. (2011). Organization design and coordination. In L. R. Burns, E. H. Bradley, & B. J. Weiner (Eds.), Shortell and Kaluzny’s healthcare management: Organizational design & behavior (6th ed, pp. 64–90). Clifton Park, NY: Thomson Delmar Learning.

    Google Scholar 

  • Chomienne, M. H., Grenier, J., Gaboury, I., Hogg, W., Ritchie, P., & Farmanova-Haynes, E. (2011). Family doctors and psychologists working together: Doctors’ and patients’ perspectives. Journal of Evaluation in Clinical Practice, 17, 282–287.

    Article  PubMed  Google Scholar 

  • Chwastiak, L. A., Davydow, D. S., McKibbin, C. L., Schur, E., Burley, M., McDonell, M. G.,. … Daratha, K. B. (2014). The effect of serious mental illness on the risk of rehospitalization among patients with diabetes. Psychosomatics, 55, 134–143.

    Article  PubMed  Google Scholar 

  • Davydow, D. S., Russo, J. E., Ludman, E., Ciechanowski, P., Lin, E. H., Von Korff, M., … Katon, W. J. (2011). The association of comorbid depression with intensive care unit admission in patients with diabetes: A prospective cohort study. Psychosomatics, 52, 117–126.

    Article  PubMed  PubMed Central  Google Scholar 

  • Denhaerynck, K., Dobbels, F., Cleemput, I., Desmyttere, A., Schafer-Keller, P., Schaub, S., & De Geest, S. (2005). Prevalence, consequences, and determinants of nonadherence in adult renal transplant patients: A literature review. Transplantation International, 18, 1121–1133. https://doi.org/10.1111/j.1432-2277.2005.00176.x.

    Article  Google Scholar 

  • Dew, M. A., DiMartini, A. F., De Vito Dabbs, A., Myaskovsky, L., Steel, J., Unruh, M., … Greenhouse, J. B. (2007). Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation, 83, 858–873. https://doi.org/10.1097/01.tp.0000258599.65257.a6.

    Article  PubMed  Google Scholar 

  • DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107.

    Article  PubMed  CAS  Google Scholar 

  • Freeman, E., McGuire, C. A., Thomas, J. W., & Thayer, D. A. (2014). Factors affecting costs in Medicaid populations with behavioral health disorders. Medical Care, 52, S60-S66.

    Article  Google Scholar 

  • Gallo, J. J., Zubritsky, C., Maxwell, J., Nazar, M., Bogner, H. R., Quijano, L. M., … Levkoff, S. E. (2004). Primary care clinicians evaluate integrated and referral models of behavioral health care for older adults: Results from a multisite effectiveness trial (PRISM-e). Annals of Family Medicine, 2, 305–309.

    Article  PubMed  PubMed Central  Google Scholar 

  • Golden, S. H., Lazo, M., Carnethon, M., Bertoni, A. G., Schreiner, P. J., Roux, A. V. D., … Lyketsos, C. (2008). Examining a bidirectional association between depressive symptoms and diabetes. Journal of the American Medical Association, 299, 2751–2759.

    Article  PubMed  Google Scholar 

  • Guck, T. P., Guck, A. J., Brack, A. B., & Frey, D. R. (2007). No-show rates in partially integrated models of behavioral health care in a primary care setting. Families, Systems, & Health, 25, 137.

    Article  Google Scholar 

  • Health Resources & Services Administration. (2006). Credentialing & privileging health center practitioners. Policy Information Notice 2001–16. (2001, 2006). Retrieved from https://bphc.hrsa.gov/programrequirements/policies/pin200116.html.

  • Health Service Psychology Education Collaborative. (2013). Professional psychology in health care services: A blueprint for education and training. American Psychologist, 68, 411–426. https://doi.org/10.1037/a0033265.

    Article  Google Scholar 

  • Hunter, C. L., & Goodie, J. L. (2010). Operational and clinical components for integrated-collaborative behavioral healthcare in the patient-centered medical home. Families, Systems, & Health, 28, 308.

    Article  Google Scholar 

  • Hunter, C. L., Goodie, J. L., Oordt, M. S., & Dobmeyer, A. C. (2017). Integrated behavioral health in primary care: Step-by-step guidance for assessment and intervention (2nd ed.). Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Jesse, M. T., Abouljoud, M., & Eshelman, A. (2015). Determinants of burnout among transplant surgeons: A national survey in the United States. American Journal of Transplantation, 15, 772–778. https://doi.org/10.1111/ajt.13056.

    Article  PubMed  CAS  Google Scholar 

  • Jesse, M. T., Abouljoud, M. S., Hogan, K., & Eshelman, A. (2015). Burnout in transplant nurses. Progress in Transplantation, 25, 196–202. https://doi.org/10.7182/pit2015213.

    Article  PubMed  Google Scholar 

  • Jesse, M. T., Rubinstein, E., Eshelman, A., Wee, C., Tankasala, M., Li, J., & Abouljoud, M. (2016). Lifestyle and self-management by those who live it: Patients engaging patients in a chronic disease model. The Permanente Journal, 20, 45–50.

    PubMed  PubMed Central  Google Scholar 

  • Jesse, M. T., Ryan, M. E., Eshelman, A., Ghanem, T., Williams, A. M., Miller-Matero, L. R., & Yaremchuk, K. (2015). Integrated psychological care in head and neck cancer: Views from health care providers, patients, and supports. The Laryngoscope, 125, 1345–1351.

    Article  PubMed  Google Scholar 

  • Kathol, R. G., McAlpine, D., Kishi, Y., Spies, R., Meller, W., Bernhardt, T., … Gold, W. (2005). General medical and pharmacy claims expenditures in users of behavioral health services. Journal of General Internal Medicine, 20, 160–167.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kazak, A. E., Nash, J. M., Hiroto, K., & Kaslow, N. J. (2017). Psychologists in patient-centered medical homes (PCMHs): Roles, evidence, opportunities, and challenges. American Psychologist, 72, 1–12.

    Article  PubMed  Google Scholar 

  • Kessler, R. (2012). Mental health care treatment initiation when mental health services are incorporated into primary care practice. Journal of the American Board of Family Medicine, 25, 255–259.

    Article  PubMed  Google Scholar 

  • Kheirkhah, P., Feng, Q., Travis, L. M., Tavakoli-Tabasi, S., & Sharafkhaneh, A. (2016). Prevalence, predictors and economic consequences of no-shows. BMC Health Services Research, 16, 13. https://doi.org/10.1186/s12913-015-1243-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kirch, D. G., & Ast, C. E. (2017). Health care transformation: The role of academic health centers and their psychologists. Journal of Clinical Psychology in Medical Settings, 24, 86–91.

    Article  PubMed  Google Scholar 

  • Kubzansky, L. D., Koenen, K. C., Spiro, A., Vokonas, P. S., & Sparrow, D. (2007). Prospective study of posttraumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study. Archives of General Psychiatry, 64, 109–116.

    Article  PubMed  Google Scholar 

  • LaPaglia, D., Thompson, B., Hafler, J., & Chauvin, S. (2017). Training for leadership roles in academic medicine: Opportunities for psychologists in the AAMC LEAD Program. Journal of Clinical Psychology in Medical Settings, 24, 118–123.

    Article  PubMed  Google Scholar 

  • Leto, L., & Feola, M. (2014). Cognitive impairment in heart failure patients. Journal of Geriatric Cardiology, 11, 316–328.

    PubMed  CAS  Google Scholar 

  • Levant, R. F., House, A. T., May, S., & Smith, R. (2006). Cost offset: Past, present, and future. Psychological Services, 3, 195.

    Article  Google Scholar 

  • McDaniel, S. H., Grus, C. L., Cubic, B. A., Hunter, C. L., Kearney, L. K., Schuman, C. C., … McCutcheon, S. (2014). Competencies for psychology practice in primary care. American Psychologist, 69, 409.

    Article  PubMed  Google Scholar 

  • Medicare.gov. (2017). Hospital compare. Retrieved from https://www.medicare.gov/hospitalcompare/search.html.

  • Meyer, T., Eshelman, A., & Abouljoud, M. (2006). Neuropsychological changes in a large sample of liver transplant candidates. Transplantation Proceedings, 38, 3559–3560.

    Article  PubMed  CAS  Google Scholar 

  • Miller-Matero, L. R., Dykuis, K. E., Albujoq, K., Martens, K., Fuller, B. S., Robinson, V., & Willens, D. E. (2016). Benefits of integrated behavioral health services: The physician perspective. Families, Systems, & Health, 34, 51–55.

    Article  Google Scholar 

  • Miller-Matero, L. R., Hyde-Nolan, M. E., Eshelman, A., & Abouljoud, M. (2015). Health literacy in patients referred for transplant: Do patients have the capacity to understand? Clinical Transplantation, 29, 336–342. https://doi.org/10.1111/ctr.12519.

    Article  PubMed  Google Scholar 

  • Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: A meta-analysis of 94 interview-based studies. Lancet Oncology, 12, 160–174. https://doi.org/10.1016/s1470-2045(11)70002-x.

    Article  PubMed  Google Scholar 

  • Nash, J. M., McKay, K. M., Vogel, M. E., & Masters, K. S. (2012). Functional roles and foundational characteristics of psychologists in integrated primary care. Journal of Clinical Psychology in Medical Settings, 19, 93–104.

    Article  PubMed  Google Scholar 

  • National Comprehensive Cancer Network. (2017). NCCN Clinical Practice Guidelines in Oncology. Distress Management, Version 1.2017. Retrieved from https://www.nccn.org/professionals/physician_gls/pdf/distress.pdf.

  • Park, M., Katon, W. J., & Wolf, F. M. (2013). Depression and risk of mortality in individuals with diabetes: A meta-analysis and systematic review. General Hospital Psychiatry, 35, 217–225.

    Article  PubMed  PubMed Central  Google Scholar 

  • Pinsky, B. W., Takemoto, S. K., Lentine, K. L., Burroughs, T. E., Schnitzler, M. A., & Salvalaggio, P. R. (2009). Transplant outcomes and economic costs associated with patient noncompliance to immunosuppression. American Journal of Transplantation, 9, 2597–2606. https://doi.org/10.1111/j.1600-6143.2009.02798.x.

    Article  PubMed  CAS  Google Scholar 

  • Porter, M. E. (2008). Value-based health care delivery. Annals of Surgery, 248, 503–509.

    PubMed  Google Scholar 

  • Reiss-Brennan, B. (2014). Mental health integration: Normalizing team care. Journal of Primary Care & Community Health, 5, 55–60.

    Article  Google Scholar 

  • Robinson, P. J., & Reiter, J. T. (2016). Behavioral consultation and primary care: A guide to integrating services (2nd ed.). Cham: Springer.

    Book  Google Scholar 

  • Rodrigue, J. R., Nelson, D. R., Hanto, D. W., Reed, A. I., & Curry, M. P. (2013). Patient-reported immunosuppression nonadherence 6 to 24 months after liver transplant: Association with pretransplant psychosocial factors and perceptions of health status change. Progress in Transplantation, 23, 319–328. https://doi.org/10.7182/pit2013501.

    Article  PubMed  Google Scholar 

  • Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H., & Mills, P. J. (2006). Depression in heart failure: A meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. Journal of the American college of Cardiology, 48, 1527–1537.

    Article  PubMed  Google Scholar 

  • Schmaling, K. B., & Linton, J. C. (2017). Psychologists in academic administration: A call to action and service. Journal of Clinical Psychology in Medical Settings, 24, 110–117.

    Article  PubMed  Google Scholar 

  • Scott, K. M., Lim, C., Al-Hamzawi, A., Alonso, J., Bruffaerts, R., Caldas-de-Almeida, J. M., … Kessler, R. C. (2016). Association of mental disorders with subsequent chronic physical conditions: World mental health surveys from 17 countries. JAMA Psychiatry, 73, 150–158. https://doi.org/10.1001/jamapsychiatry.2015.2688.

    Article  PubMed  PubMed Central  Google Scholar 

  • Söllner, W., DeVries, A., Steixner, E., Lukas, P., Sprinzl, G., Rumpold, G., & Maislinger, S. (2001). How successful are oncologists in identifying patient distress, perceived social support, and need for psychosocial counselling? British Journal of Cancer, 84, 179.

    Article  PubMed  PubMed Central  Google Scholar 

  • U.S. News & World Report. (2017). Best Hospitals. Retrieved from http://health.usnews.com/best-hospitals.

  • United Network of Organ Sharing. (2017). Policy. Retrieved from https://unos.org.

  • Walsh, T. L., Hanscom, B., Homa, K., & Abdu, W. A. (2005). The rate and variation of referrals to behavioral medicine services for patients reporting poor mental health in the national spine network. Spine, 30, E154–E160.

    Article  PubMed  Google Scholar 

  • Weng, F. L., Chandwani, S., Kutyka, K. M., Zacker, C., Chisholm-Burns, M. A., & Demissie, K. (2013). Prevalence and correlates of medication non-adherence among kidney transplant recipients more than 6 months post-transplant: A cross-sectional survey. BMC Nephrology, 14, 261.

    Article  PubMed  PubMed Central  Google Scholar 

  • Westphal, J. A. (2005). Resilient organizations: Matrix model and service line management. Journal of Nursing Administration, 35, 414–419.

    Article  PubMed  Google Scholar 

  • World Health Organization, World Organization of National Colleges, Academies, & Academic Associations of General Practitioners/Family Physicians. (2008). Integrating mental health into primary care: A global perspective. Geneva: World Health Organization.

    Google Scholar 

  • Wright, K. M., Simpson, G. K., Koh, E.-S., Whiting, D. L., Gillett, L., Simpson, T., & Firth, R. (2015). Development and evaluation of information resources for patients, families, and healthcare providers addressing behavioral and cognitive sequelae among adults with a primary brain tumor. Journal of Neuroscience Nursing, 47, 135–145.

    Article  PubMed  Google Scholar 

  • Young, J. Q., Kline-Simon, A. H., Mordecai, D. J., & Weisner, C. (2015). Prevalence of behavioral health disorders and associated chronic disease burden in a commercially insured health system: Findings of a case-control study. General Hospital Psychiatry, 37, 101–108. https://doi.org/10.1016/j.genhosppsych.2014.12.005.

    Article  PubMed  Google Scholar 

  • Zabora, J., BrintzenhofeSzoc, K., Curbow, B., Hooker, C., & Piantadosi, S. (2001). The prevalence of psychological distress by cancer site. Psycho-Oncology, 10, 19–28.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Transplant Institute, Henry Ford Health System, Detroit, MI, 48202, USA

    Marwan Abouljoud, Anne Eshelman, Kelly Bryce & Michelle T. Jesse

  2. Division of Transplant and Hepatobiliary Surgery, Department of Surgery, Henry Ford Health System, Detroit, MI, 48202, USA

    Marwan Abouljoud

  3. Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, 48202, USA

    Michael Ryan

  4. Psychosomatic Medicine, Behavioral Health, Henry Ford Health System, Detroit, MI, 48202, USA

    Michael Ryan, Anne Eshelman, Kelly Bryce & Michelle T. Jesse

  5. Center for Health Policy & Health Services Research, Henry Ford Health System, Detroit, MI, 48202, USA

    Michelle T. Jesse

Authors
  1. Marwan Abouljoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Ryan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anne Eshelman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kelly Bryce
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michelle T. Jesse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michelle T. Jesse.

Ethics declarations

Conflict of interest

The authors Marwan Abouljoud, Michael Ryan, Anne Eshelman, Kelly Bryce, and Michelle T. Jesse declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abouljoud, M., Ryan, M., Eshelman, A. et al. Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm. J Clin Psychol Med Settings 25, 267–277 (2018). https://doi.org/10.1007/s10880-017-9532-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-017-9532-9

Keywords

Search

Navigation