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Sandy Talks Health Psychology

Question 1: How do you differentiate Health Service Psychology from Health Psychology?

For me, Health Service Psychology (HSP) is the broader of the two concepts. HSP encompasses the foundation for psychology as a primary care profession as well as psychology as a specialty care profession. In the Blue Print for Health Service Psychology Education and Training, APA has promulgated a list of broad and general competencies for the wide range of psychologists who work across the entire health care system, including mental health, behavioral health and physical health settings. The focus of HSP is thus this broad definition of psychological practice across service settings, including all specialties that provide health care services. Individuals in such practice should be engaged in evidence-based practice that is patient-centered, culturally responsive, accessible and effective, and informed by population-based data. HSP was developed to help psychologists participate in the larger healthcare system, whether working in teams or alone, to ensure the role of psychologist was defined more broadly in terms of “health” rather than restricted to “mental health.”

Health Psychology, as recognized by the Society for Health Psychology, has specific scientific roots and includes the recognized specialty of Clinical Health Psychology. Health Psychology has a core of specialized knowledge and competencies applied to a range of patient-centered problems. These problems are usually encountered in primary and tertiary healthcare settings, often referred to as “medical” settings, and include primary and secondary prevention and health promotion as well as improvement of the health care system.

It is understandable and quite probable that there may be some confusion between the two terms. Health Service Psychology (HSP) is the broad class of specialties and providers across all settings, while Health Psychology is the recognized specialty within psychology, based on psychological science, that works with patient populations with diagnosed medical issues and related psychological conditions. I think that the HSP terminology, in particular, will likely get clearer over time as the HSP definition grows and is included in APA accreditation processes. We should also consider whether proactive work can be done to clarify these concepts sooner and more directly for both psychology and the healthcare system.

Question 2. What do you see as the biggest challenge facing health psychology in the changing healthcare environment?

I must highlight two challenges in addressing this question. The first challenge relates to funding and reimbursement. Health psychology has built a strong foundation, through the promulgation of a sound set of clinical guidelines and educational guidelines, which will prepare the next generation of scientists and clinicians. Health psychology as an applied specialty is currently well respected, and it appears that board certification is increasing. The big challenge here appears to be securing continuing funding for science and education to build upon those prior successes. Another part of the funding issue focuses on reimbursement for services. We need our science to generate data that shows funders and funding sources that dollars invested in psychological science has brought about a stronger understanding of the human condition. Further, we need to show that funding spent on advanced health psychology training indeed prepares a cadre of highly competent health care providers and scientists. Also, we must demonstrate that funding for our evidence-based health care services provide outcomes that are as strong as, or, in some cases, even stronger than other health care professions. We then must be prepared to function in a value-based payment system, functioning on flexibly meeting patient needs.

The second major challenge I would highlight in the changing, chaotic healthcare environment is the long-term effort to weaken the Affordable Care Act, which emphasized integrated care and patient-centered, family-centered, collaborative care. The ACA was empowering to health psychologists and laid important groundwork for health psychologists to play a more integral role in healthcare, including greater leadership roles and opportunities. With continuing efforts to repeal and replace the ACA, I have serious concern that much positive movement in integrated and collaborative care could be reduced, leaving health psychologists with lesser roles in the healthcare delivery system. In particular, the repeal of the ACA could have a serious detrimental impact on integrated and specialty care efforts with low-income, marginalized individuals, given changes to Medicaid under consideration.

Question 3. Given the current emphasis on specialization and certification, how do you express the value of psychology as a unified professional identity?

Psychologists, quite similarly to other medical professionals and professions, are unified by our core knowledge, skills, attitudes and competencies. Our foundation in psychology is based on broad and general, accredited education and training—we have core competencies of scientific mindfulness, ethical standards for scientists and healthcare providers, and concerns for the welfare of all people. This provides us with a unified professional identity, while still recognizing that board certification, specialization and specialties can allow for more in-depth competence and experience. Current data suggests that in today’s healthcare system, both consumers and healthcare settings alike expect providers to be board certified, and they also appear to understand that all health disciplines have a core foundation from which ranges of specialization emerge and evolve. All psychologists have a foundation in psychological science and related behavioral science, ethics and human welfare. I think the rest of the world may understand our commonalities better than we do. Perhaps, the Great Seal of the United States, as printed, says it best: E pluribus unum -- “Out of many, one.”

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